Evaluation of Subretinal Triamcinolone Acetonide in Patients with Exudative Age-Related Macular Degeneration

[Retinal drug targets]

Retinal effects of systemically administered drugs are rare due to the hematoretinal barriers that protect the retina from circulating active principles. However, some compounds may have direct or indirect toxic effects on the retina through direct interaction with a specific receptor or due to their accumulation within pigment of uveal cells. In the latter case, toxicity is dose-dependent and may be observed years after cessation of medication, as observed with antimalarial drugs. Anti-infective and anti-inflammatory agents, particularly glucocorticoids, are currently injected peri- or intraocularly. The mechanisms and the exact toxicity of glucocorticoids on the retina remain poorly understood. More recently, anti-VEGF has been specifically developed for the treatment of retinal diseases. However, the long-term blockade of VEGF on normal retinal physiology should be determined taking into account VEGF and VEGF receptors expression in the normal and pathologic retina. Whilst enormous advances are made in the treatment of retinal diseases, basic research is still required to define more accurately the molecular targets of drugs to improve their benefits and reduce their potential side effects.

Natural history of sub-retinal triamcinolone acetonide deposition after triamcinolone-assisted vitrectomy

PURPOSE

To describe the natural course of subretinal triamcinolone acetonide (TA) deposition after a TA-assisted vitrectomy for retinal detachment.

METHODS

Observational case series.

RESULTS

TA deposition was observed between the neurosensory retina and retinal pigment epithelium in the macular area at the conclusion of vitreoretinal surgery in three patients with retinal detachment. On follow up, TA granules gradually decreased over the next 2 weeks and resolved completely by 3 weeks. Two months after the operation, the retina was observed to be successfully attached and no ophthalmoscopic or functional damage was observed.

CONCLUSION

As no apparent clinically detectable adverse effect was found in the three cases that demonstrated subretinal deposition of TA we opine that active surgical maneuvers to remove the same are not warranted during surgery.