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Di Staso F, Gaudio PA. Aqueous Outflow Facility after Periocular Triamcinolone Injection: A Preliminary Evaluation of the Falck Medical Applanation Tonometer. J Curr Glaucoma Pract 2023; 17:197-204. [PMID: 38269263 PMCID: PMC10803273 DOI: 10.5005/jp-journals-10078-1421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 09/15/2023] [Indexed: 01/26/2024] Open
Abstract
Aim To evaluate the Falck Medical Applanation Tonometer 1 (FMAT-1) as a device for measuring intraocular pressure (IOP) and outflow facility (OF) in patients with uveitis after periocular triamcinolone injection in one eye. Materials and methods Retrospective observational comparison. IOP and OF measurements were recorded and analyzed, comparing Goldmann tonometry and FMAT-1 readings. Records were reviewed for adult patients with uveitis who had undergone recent periocular triamcinolone injection in one eye. Results A total of 19 patients' records were evaluated. In treated eyes, median IOPs (in mm Hg) by Goldmann and FMAT-1 were 21 and 21.0, respectively, and mean IOPs were 22.21 and 21.15, respectively. In untreated eyes, median IOPs by Goldmann and FMAT-1 were 15 and 15.7, respectively, and mean IOPs were 15.52 and 15.31, respectively. Median OF (in µL/mm Hg) in treated and untreated eyes was 0.17 and 0.22, respectively, and mean values were 0.17 and 0.23, respectively. Pearson correlation showed an inverse relationship between IOP and OF in treated eyes, and linear regression analysis showed that IOP strongly predicted outflow in this group. Conclusion The FMAT-1 generates IOP results substantially similar to Goldmann and OF readings with greater ease than prior tonography devices. Clinical significance The mechanism of corticosteroid-induced IOP elevation appears to be a reduction in aqueous OF, and its measurement is tonography. This technique has traditionally been cumbersome. FMAT-1 is a newly launched instrument that measures IOP and OF at the slit lamp simultaneously in a few seconds. How to cite this article Staso FD, Gaudio PA. Aqueous Outflow Facility after Periocular Triamcinolone Injection: A Preliminary Evaluation of the Falck Medical Applanation Tonometer. J Curr Glaucoma Pract 2023;17(4):197-204.
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Affiliation(s)
- Federico Di Staso
- Connecticut Uveitis Foundation, Ocular Immunology, West Hartford, United States
| | - Paul A Gaudio
- Connecticut Uveitis Foundation, Ocular Immunology, West Hartford, United States
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de Smet MD, Goncerut M, Asmus F, Yamamoto R. Refractory post-surgical cystoid macular edema managed following suprachoroidal microcatheterization and delivery of triamcinolone. BMC Ophthalmol 2023; 23:367. [PMID: 37670276 PMCID: PMC10478372 DOI: 10.1186/s12886-023-03110-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Post-surgical macular edema (ME) is a common cause of prolonged visual impairment. Here we report on the feasibility and clinical outcomes from the use of a novel suprachoroidal microcatheter to treat post-surgical chronic ME by the posterior suprachoroidal placement of a triamcinolone acetonide (TA) suspension. METHODS Two patients were catheterized with the Oxulumis suprachoroidal delivery system on two separate occasions starting 5 and 10 mm posterior to the limbus. The catheter only remains in the suprachoroidal space for the time of the drug administration. Visual acuity and spectral domain optical coherence tomography (SD-OCT) changes were followed over several weeks to months to determine the duration of ME resolution. RESULTS Suprachoroidal microcatheterization for posterior delivery of triamcinolone was possible in all attempts using the illuminated Oxulumis catheter. No reflux, scleral or choroidal trauma was observed. There was no intraocular pressure rise during the follow-up period. The triamcinolone deposit was visible on infrared imaging and on SD-OCT a choroidal elevation was visible. Both progressively disappeared over time. A rapid resolution of ME associated with improved vision was observed following each injection for 3 to 7 months with a TA dose of 2.4 mg or 4 mg. CONCLUSIONS In these patients with poorly responsive ME, posterior suprachoroidal TA led to a visible suprachoroidal drug deposit and prolonged visual improvement. The Oxulumis microcatheterization device performed as expected and was not associated with any complications.
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Affiliation(s)
- Marc D de Smet
- Helvetia Retina Associates, Lausanne, Switzerland.
- New York Eye and Ear Infirmary of Mt Sinai, Icahn School of Medicine, New York City, NY, USA.
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Driban M, Kedia N, Arora S, Chhablani J. Novel pharmaceuticals for the management of retinal vein occlusion and linked disorders. Expert Rev Clin Pharmacol 2023; 16:1125-1139. [PMID: 37933706 DOI: 10.1080/17512433.2023.2277882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/27/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Retinal vein occlusion (RVO) is the second leading cause of blindness from retinal vascular disease behind diabetic retinopathy. Anti-vascular endothelial growth factor (VEGF) and glucocorticoid therapy are the cornerstones of pharmaceutical treatment for RVO. There is considerable interest in developing new pharmaceuticals in and out of these two classes to reduce costs, lower injection burden, and treat the occlusion itself, rather than the complications. AREAS COVERED In this review, we discuss novel pharmaceuticals for the treatment of RVO outside of current standard of care. We performed a comprehensive literature search encompassing pharmaceuticals that have recently been approved or have shown promising results in early clinical trials or animal models. EXPERT OPINION Anti-VEGF therapy remains the most efficacious treatment for RVO with a very favorable side effect profile. New biosimilars reduce costs while maintaining efficacy. Novel glucocorticoids may be a useful therapy in patients for whom anti-VEGF therapy has failed, or as an adjunct. Pharmaceuticals in other drug classes, particularly those with neuroprotective or regenerative properties, as well as those geared toward treating the occlusion itself, represent exciting options for early RVO therapy, but are likely years away from clinical relevance.
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Affiliation(s)
- Matthew Driban
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nikita Kedia
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Supriya Arora
- Bahamas Vision Center and Princess Margaret Hospital, Nassau, New Providence, Bahamas
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Efficacy of subtenon 20-mg triamcinolone injection versus 0.1% dexamethasone eye drops for controlling inflammation after phacoemulsification: a randomized controlled trial. Sci Rep 2022; 12:16471. [PMID: 36183042 PMCID: PMC9526735 DOI: 10.1038/s41598-022-20522-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
A prospective randomized control trial of 140 eyes from 140 patients, who underwent phacoemulsification, was conducted to compare the efficacy of subtenon corticosteroids injection with corticosteroids eye drops for controlling postoperative intraocular inflammation. Seventy patients received subtenon 20-mg triamcinolone injection (TA group), whereas the other 70 patients received 0.1% dexamethasone eye drops (Dexa group) after the uneventful surgeries. We examined and measured anterior chamber inflammation (ACI) score, laser flare-cell metering, conjunctival redness, pain, discomfort, visual acuity, intraocular pressure, and central foveal thickness on 1, 7, 14, 28 and 90 days postoperatively. At one month after the surgery, full recovery (zero ACI score) was found in 43 patients (63.20%) in the Dexa group versus 47 patients (68.10%) in the TA group (p = 0.55). There were no statistically significant differences in aqueous cells (p = 0.37) and flare (p = 0.86) between the two groups at one month. All participants experienced no serious adverse events. In conclusion, we found no statistically significant difference between subtenon 20-mg triamcinolone injection and 0.1% dexamethasone eye drop to control inflammation postoperatively. A single subtenon 20-mg triamcinolone injection could be an alternative anti-inflammatory treatment for an uneventful phacoemulsification.
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Choroidal Structural Changes of Posterior Subtenon Triamcinolone Acetonide Injection in Eyes with Refractory Diabetic Macular Edema. J Ophthalmol 2022; 2022:6882607. [PMID: 35237449 PMCID: PMC8885276 DOI: 10.1155/2022/6882607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 01/28/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To access the choroidal structural changes of posterior subtenon triamcinolone acetonide (PSTA) injection in eyes with refractory diabetic macular edema (DME). Methods Patients with refractory DME were enrolled and followed for 4 weeks after switching to PSTA injection. All patients underwent spectral-domain optical coherence tomography with enhanced depth imaging, and the choroidal images were binarized into the luminal area and total choroidal area. Subfoveal choroidal thickness (SFCT) and choroidal vascularity index (CVI) were evaluated before and after switching treatments. Results After switching to PSTA treatment, the final best-corrected visual acuity and central subfield thickness in eyes with refractory DME were significantly improved compared to the baseline values (P=0.002 and P < 0.001, respectively). Both the SFCT and CVI decreased during the follow-up period, and significant decreases were observed at 4-week follow-up (P < 0.001 and P=0.012, respectively). The linear regression analysis showed a significant correlation between the baseline SFCT and the final visual outcomes (P=0.047). Conclusions The alterations of SFCT and CVI in this study suggest that the choroidal vasculature is involved in the pathogenesis of refractory DME and could be affected by PSTA treatment. SFCT rather than CVI may be a prognostic biomarker for eyes with refractory DME.
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Shigemoto Y, Sakurada Y, Fukuda Y, Matsubara M, Parikh R, Kashiwagi K. The combination therapy of subtenon triamcinolone acetonide injection and intravitreal brolucizumab for brolucizumab-related intraocular inflammation. Medicine (Baltimore) 2021; 100:e27580. [PMID: 34678906 PMCID: PMC8542137 DOI: 10.1097/md.0000000000027580] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/07/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Brolucizumab is a novel anti-vascular endothelial growth factor agent with clinical trials demonstrating excellent efficacy for neovascular age-related macular degeneration (AMD) in both visual and anatomic outcomes. However, there is concern of intraocular inflammation (IOI), and we propose concurrent subtenon triamcinolone acetonide (STTA) to prevent IOI. PATIENT CONCERN A 73-year-old man was treated with aflibercept for neovascular AMD in his right eye. Despite 11 months of monthly intravitreal aflibercept injections, optical coherence tomography demonstrated persistent exudation. Ten days following his second brolucizumab injection, the patient presented with decreased vision due to vitritis in his right eye. DIAGNOSIS Brolucizumab-related IOI in neovascular AMD refractory to aflibercept. INTERVENTIONS A combination therapy involving of intravitreal brolucizumab and STTA. OUTCOMES The anti-vascular endothelial growth factor inhibitor was changed back to aflibercept; however, exudation persisted. Therefore, a combination therapy involving STTA (5 mg/0.5 mL) and intravitreal injection of brolucizumab (6.0 mg/0.05 mL) was performed to treat the exudation and as prophylaxis to recurrent IOI. Combination therapy achieved no recurrent IOI and resolution of exudation with 8-week treatment intervals. LESSONS This case might indicate that STTA is not only an optimal treatment option for brolucizumab-related IOI but also a preventive agent for this condition.
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Affiliation(s)
- Yumi Shigemoto
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Japan
| | - Yoichi Sakurada
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Japan
| | - Yoshiko Fukuda
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Japan
| | - Mio Matsubara
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Japan
| | - Ravi Parikh
- Manhattan Retina and Eye Consultants, New York, NY
- New York University Grossman School of Medicine, New York, NY
| | - Kenji Kashiwagi
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Japan
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Risk of Cataract in Intermediate Uveitis. Am J Ophthalmol 2021; 229:200-209. [PMID: 33713679 DOI: 10.1016/j.ajo.2021.02.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/17/2021] [Accepted: 02/24/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE To determine the incidence of and predictive factors for cataract in intermediate uveitis. DESIGN Retrospective cohort study. METHODS Patients were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study, in which medical records were reviewed to determine demographic and clinical data of every eye/patient at every visit at 5 participating US tertiary care uveitis centers. The primary outcome was development of vision-compromising cataract as defined by a decrease in visual acuity to 20/40 or less, or requiring cataract surgery. Survival analysis assessed visually defined cataract to avoid bias due to timing of surgery vis-à-vis inflammatory status. RESULTS Among 2,190 eyes of 1,302 patients with intermediate uveitis, the cumulative incidence of cataract formation was 7.6% by 1 year (95% confidence interval [CI] = 6.2%-9.1%), increasing to 36.6% by 10 years (95% CI = 31.2%-41.6%). Increased cataract risk was observed in eyes with concurrent anterior uveitis causing posterior synechiae (hazard ratio = 2.68, 95% CI = 2.00-3.59, P < .001), and in eyes with epiretinal membrane formation (hazard ratio = 1.54, 95% CI = 1.15-2.07, P = .004). Higher dose corticosteroid therapy was associated with significantly higher incidence of cataract, especially time-updated use of topical corticosteroids ≥2 times/d or ≥4 periocular corticosteroid injections. Low-dose corticosteroid medications (oral prednisone 7.5 mg daily or less, or topical corticosteroid drops <2 times/d) were not associated with increased cataract risk. CONCLUSIONS Our study found that the incidence of clinically important cataract in intermediate uveitis is moderate. The risk is higher with markers of severity and with higher doses of corticosteroid medications, the latter being potentially modifiable.
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Qu Y, Liu XS, Liang AY, Xiao JY, Zhao C, Gao F, Zhang MF. Subconjunctival injections of triamcinolone acetonide to treat uveitic macular edema. Int J Ophthalmol 2020; 13:1087-1091. [PMID: 32685396 DOI: 10.18240/ijo.2020.07.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/08/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the efficacy and safety of subconjunctival triamcinolone acetonide (TA) injections for treating uveitic macular edema (UME). METHODS This retrospective case series study included patients with UME who received subconjunctival TA injections with a minimum follow-up period of 6mo. The main outcome measure was central macular thickness (CMT). The secondary outcome measures included best-corrected visual acuity (BCVA), recurrence rate and intraocular pressure (IOP). RESULTS In total, 65 patients (80 eyes), mainly including idiopathic uveitis in 33 patients (50.77%) and Vogt-Koyanagi-Harada (VKH) syndrome in 19 patients (29.23%), were enrolled in this study. The mean CMT decreased from 457.6±173.0 µm at baseline to 325.9±176.8, 302.7±148.2, 332.2±177.3 and 270.6±121.6 µm at 1-, 2-, 3- and 6-months postinjection, respectively (all P<0.001). BCVA increased from logMAR 0.5±0.3 at baseline to logMAR 0.4±0.3, 0.4±0.3, 0.4±0.4 and 0.4±0.3 at the 1-, 2-, 3- and 6-months postinjection visits, respectively (all P<0.001). Twenty-one (21/80, 26.25%) eyes underwent relapse of UME within 6mo. A total of 20/80 (25%) eyes exhibited elevated IOPs, of which 13 eyes were controlled with topical IOP-lowering agents and 7 eyes underwent surgical removal of subconjunctival TA deposit. CONCLUSION Subconjunctival TA injections appear to be safe and effective for UME.
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Affiliation(s)
- Yi Qu
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xin-Shu Liu
- Department of Ophthalmology, the Fourth People's Hospital of Shenyang, Shenyang 110031, Liaoning Province, China
| | - An-Yi Liang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jun-Yan Xiao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Chan Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Fei Gao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Mei-Fen Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Kuley B, Storey PP, Pancholy M, Obeid A, Murphy J, Goodman J, Wibbelsman TD, Regillo C, Chiang A. Ocular Hypertension Following Intravitreal Injection of 0.7mg Dexamethasone Implant versus 2mg Triamcinolone. Semin Ophthalmol 2020; 35:141-146. [PMID: 32343619 DOI: 10.1080/08820538.2020.1758161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: To compare the incidence and outcomes of ocular hypertension (OHT) after intravitreal injection of 0.7 mg dexamethasone (DEX) and 2 mg triamcinolone acetonide (IVT).Methods: In a single-center, retrospective comparative case series, all patients with at least 3 months follow-up receiving 2 mg IVT 3/1/2012 - 3/1/2017 or 0.7 mg dexamethasone 10/1/2014 - 3/1/2017 were included. Ocular hypertension was defined as an intraocular pressure (IOP) ≥ 25 mmHg. Patients with a minimum of 3 months follow-up were included. Patients receiving any other form of topical, oral, or intravitreal steroid were excluded.Results: 106 eyes in 100 patients receiving IVT and 114 eyes in 102 patients receiving DEX were included. The mean number of injections was 2.9 for patients receiving IVT and 2.4 for patients receiving DEX (p = .11). Fourteen eyes (13.2%) in 14 patients receiving IVT developed OHT compared to 17 eyes (15.1%) in 15 patients receiving DEX (p = .85). All cases of OHT were managed with IOP lowering drops or observation alone.Conclusions: Rates of ocular hypertension following 2 mg IVT and DEX are similar. All patients developing OHT were successfully managed without surgical intervention.
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Affiliation(s)
- Brandon Kuley
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Philip P Storey
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Maitri Pancholy
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Anthony Obeid
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - James Murphy
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jake Goodman
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Turner D Wibbelsman
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Carl Regillo
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Allen Chiang
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
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Couret C, Poinas A, Volteau C, Riche VP, Le Lez ML, Errera MH, Creuzot-Garcher C, Baillif S, Kodjikian L, Ivan C, Le Jumeau de Kergaradec LM, Chiffoleau A, Jobert A, Jaulin J, Biron L, Hervouet E, Weber M. Comparison of two techniques used in routine care for the treatment of inflammatory macular oedema, subconjunctival triamcinolone injection and intravitreal dexamethasone implant: medical and economic importance of this randomized controlled trial. Trials 2020; 21:159. [PMID: 32041669 PMCID: PMC7011383 DOI: 10.1186/s13063-020-4066-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/11/2020] [Indexed: 01/17/2023] Open
Abstract
Background Whether they are injected peri- or intraocularly, corticosteroids are still essential tools in the therapeutic arsenal for treating inflammatory macular oedema. A few years ago, however, only triamcinolone acetonide was available to ophthalmologists. While this compound was initially developed for rheumatological or dermatological use, it has been increasingly deployed in ophthalmology, despite still being off-label. In 2011, the system for delivery of dexamethasone from a biodegradable, injectable implant into the vitreous cavity obtained approval for use in inflammatory macular oedema. While the efficacy and safety of triamcinolone in macular oedema, including inflammatory oedema, have already been studied, there are currently no publications on subconjunctival triamcinolone injections, which are simple, effective and well tolerated. To date, the dexamethasone 700 μg implant has been authorized for the treatment of noninfectious intermediate and posterior uveitis, but there have been no studies to evaluate the efficacy and safety of the different peri- and intraocular strategies, including the treatment of inflammatory macular oedema. Methods This protocol is therefore designed to compare the efficacy and safety of peri- and intraocular corticosteroid injections in the treatment of inflammatory macular oedema. In this ongoing study, 142 patients will be included, and the oedematous eye will be randomised to treatment with either subconjunctival triamcinolone injection or an intravitreal implant containing 700 μg dexamethasone. Follow-up is planned for 6 months with monthly visits. Each visit will include visual acuity measurement, a slit lamp examination, fundoscopy, intraocular pressure measurement, laser flare measurement (if available) and spectral domain optical coherence tomography. Discussion The results of this trial will have a real impact on public health if it is shown that a Kenacort retard® (i.e. triamcinolone) injection costing just €2.84 and performed in the physician’s office (with no additional overhead costs) is at least as effective as the dexamethasone 700 μg implant (Ozurdex®; costing approximately €960 with the injection performed in a dedicated room), with no increased side effects. Trial registration ClinicalTrials.gov, NCT02556424. Registered on 22 September 2015.
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Affiliation(s)
- Chloé Couret
- Department of Ophthalmology, CHU Nantes, Nantes, France
| | - Alexandra Poinas
- Clinical Investigation Centre CIC1413, INSERM and CHU Nantes, Nantes, France.
| | - Christelle Volteau
- Sponsor Department, Methodology and Biostatistics Platform, CHU Nantes, Nantes, France
| | | | | | - Marie-Hélène Errera
- Quinze-Vingts National Ophthalmology Hospital, DHU Sight Restore, CIC 1423, Sorbonne-Universités, UPMC Université, Paris, France
| | | | | | | | | | | | | | | | | | | | | | - Michel Weber
- Department of Ophthalmology, CHU Nantes, Nantes, France
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Maeda Y, Ishikawa H, Nishikawa H, Shimizu M, Kinoshita T, Ogihara R, Kitano S, Yamanaka C, Mitamura Y, Sugimoto M, Kondo M, Takamura Y, Ogata N, Ikeda T, Gomi F. Intraocular pressure elevation after subtenon triamcinolone acetonide injection; Multicentre retrospective cohort study in Japan. PLoS One 2019; 14:e0226118. [PMID: 31805140 PMCID: PMC6894825 DOI: 10.1371/journal.pone.0226118] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/18/2019] [Indexed: 11/21/2022] Open
Abstract
Purpose To evaluate real-world evidence for intraocular pressure (IOP) elevation after subtenon triamcinolone acetonide injection (STTA) in 1252 Japanese patients (1406 eyes) in the Japan Clinical REtina STudy group (J-CREST). Methods This was a multicentre retrospective study of the medical records of 1252 patients (676 men (758 eyes); mean age: 63.8 ± 12.9 years) who received STTA in participating centres between April 2013 and July 2017. Results IOP elevation was observed in 206 eyes (14.7%) and IOP increase ≥ 6 mmHg was found in 328 eyes (23.3%). In total, 106 eyes (7.5%) needed medication and two eyes (0.14%) needed surgical procedures. Younger age, higher baseline IOP, and steroid dose were risk factors associated with IOP elevation. Risk factors associated with IOP increase ≥ 6 mmHg were younger age, lower baseline IOP, steroid dose, and higher incidences of diabetic macular oedema (DME) and uveitis. In contrast, with steroid dose fixed at 20 mg, a lower incidence of DME was a risk factor for increased IOP, suggesting that STTA had dose-dependent effects on IOP increase, especially in patients with DME. Conclusion Our real-world evidence from a large sample of Japanese patients who received STTA showed that the incidence of IOP elevation after STTA was 14.7%, and was associated with younger age, higher baseline IOP, and steroid dose. Thus, IOP should be monitored, especially in patients with younger age, higher baseline IOP, and higher incidences of DME and uveitis.
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Affiliation(s)
- Yuki Maeda
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroto Ishikawa
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
- * E-mail:
| | - Hiroki Nishikawa
- Center for Clinical Research and Education, Hyogo College of Medicine, Nishinomiya, Japan
| | - Miho Shimizu
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan
| | - Takamasa Kinoshita
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan
| | - Rie Ogihara
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Diabetes Center, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Japan
| | - Shigehiko Kitano
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Diabetes Center, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Japan
| | - Chihiro Yamanaka
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Tokushima University, Tokushima, Japan
| | - Yoshinori Mitamura
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Tokushima University, Tokushima, Japan
| | - Masahiko Sugimoto
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Mie University, Tsu, Japan
| | - Mineo Kondo
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Mie University, Tsu, Japan
| | - Yoshihiro Takamura
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Fukui University, Yoshida, Japan
| | - Nahoko Ogata
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Tomohiro Ikeda
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Fumi Gomi
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
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Karasu B. Short-term outcomes of subtenon triamcinolone acetonide injections in patients with retinitis pigmentosa-associated cystoid macular edema unresponsive to carbonic anhydrase inhibitors. Int Ophthalmol 2019; 40:677-687. [PMID: 31773389 DOI: 10.1007/s10792-019-01228-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/15/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the functional and anatomical results of subtenon triamcinolone acetonide injection (TA) in eyes with retinitis pigmentosa (RP) that had cystoid macular edema (CME) unresponsive to carbonic anhydrase inhibitors (CAIs). MATERIALS AND METHODS This is a prospective, interventional study. Forty-eight consecutive eyes that underwent subtenon TA for CME due to RP were recorded. Central macular thickness (CMT), best-corrected visual acuities (BCVAs) and intraocular pressures (IOPs) were evaluated before and after injection at 2nd week, 1st month, 2nd month and 3rd month, respectively. Spectral-domain optical coherence tomography (SD-OCT) was used to show anatomic findings. Complications such as cataract and glaucoma were recorded. RESULTS A total of 48 eyes of 42 patients with a mean age of 36.25 ± 15.59 years (range 13 to 63 years) and a mean follow-up of 4.45 ± 0.74 months (range 4 to 6 months) were recorded in the study. The mean initial BCVA increased from 1.09 ± 0.52 to 0.54 ± 0.29 logarithmic minimum angle of resolution (log MAR) (p < 0.001) at 3 months after injection and the mean central macular thickness decreased from 591.45 ± 209.55 µm to 270.83 ± 95.48 µm (p < 0.001). The mean iOP increased from 13.58 ± 2.87 mmHg to 15.91 ± 2.47 mmHg (p < 0.001). Multiple injections (3 injections) in 1 eye, 2 injections in 4 eyes and 1 injection in rest of the eyes were performed at 3-month intervals. Complications such as glaucoma and cataract were not observed in any patient during and after the treatment. CONCLUSION In the present study, a significant improvement in visual acuity and CMT were observed in eyes with subtenon TA for CME due to RP unresponsive to CAIS. Further studies with a long follow-up period of the population are required to investigate the role of subtenon TA of CME due to RP.
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Affiliation(s)
- Buğra Karasu
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Bereketzade Mah, Bereketzade Sok. No:2, Beyoğlu, 34421, Istanbul, Turkey.
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Erden B, Çakır A, Aslan AC, Bölükbaşı S, Elçioğlu MN. The Efficacy of Posterior Subtenon Triamcinolone Acetonide Injection in Treatment of Irvine-Gass Syndrome. Ocul Immunol Inflamm 2019; 27:1235-1241. [PMID: 31411519 DOI: 10.1080/09273948.2019.1620786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To evaluate the efficacy and safety of posterior 40 mg subtenon triamcinolone acetonide (PST) injection in treating Irvine-Gass syndrome.Methods: The retrospective study included 21 patients (mean age: 76 ± 8.2) with a treatment-naïve eye subjected to topical anesthesia and injection of 40 mg/ml triamcinolone via a blunt tip SubTenon cannula through a single inferonasal peritomy. Best corrected visual acuity (BCVA; logMAR), intraocular pressure (IOP), biomicroscopic and funduscopic findings, and optical coherence tomography (OCT) measurements were recorded.Results: Baseline central macular thickness decreased from 431 ± 136 µm to 300 ± 67 µm (1st month; p = .002), to 292 ± 56 µm (3rd month; p = .002), and to 299 ± 66 µm (6th month; p = .005). Mean BCVA increased from 0.71 ± 0.23 to 0.27 ± 0.11, 0.19 ± 0.06, and 0.24 ± 0.17, respectively (all visits; p < 0.001). Mean IOP values did not change significantly (p = .12).Conclusion: PST injection is an effective and safe treatment for Irvine-Gass syndrome.
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Affiliation(s)
- Burak Erden
- Retina Department, Okmeydanı Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Akın Çakır
- Retina Department, Okmeydanı Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | | | - Selim Bölükbaşı
- Retina Department, Okmeydanı Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mustafa Nuri Elçioğlu
- Retina Department, Okmeydanı Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Singh SR, Dogra M, Singh R, Dogra MR. Accidental Globe Perforation During Posterior Sub-Tenon's Injection of Triamcinolone Acetonide. Ophthalmic Surg Lasers Imaging Retina 2019; 50:466-467. [PMID: 31344249 DOI: 10.3928/23258160-20190703-11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/01/2019] [Indexed: 11/20/2022]
Abstract
Complications of posterior sub-Tenon's steroid injections like glaucoma, cataract, sub-conjunctival hemorrhage and ptosis are well known. The authors present this photo essay to highlight a rare but serious complication of globe perforation secondary to posterior sub-Tenon's triamcinolone injection and describe its management. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:466-467.].
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Dexamethasone intravitreal implant (OZURDEX®) for macular edema secondary to noninfectious uveitis: a review of the literature. Ther Deliv 2019; 10:343-351. [DOI: 10.4155/tde-2019-0024] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Macular edema (ME) is the leading cause of visual loss in uveitis and may persist long after ocular inflammation has been resolved. Local steroids are the first line treatment for uveitis and uveitic ME. Dexamethasone intravitreal implant (OZURDEX®; Allergan, Inc., CA, USA) has been used to treat diabetic ME and ME secondary to retinal vein occlusion. Recent studies have also demonstrated that Ozurdex may be effective treatment for patients with persistent uveitic ME. In this review, we present the results of the real word studies concerning the efficacy and safety of Ozurdex for the treatment of uveitic ME.
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Errera MH, Westcott M, Benesty J, Falah S, Smadja J, Orès R, Pratas AC, Sedira N, Bensemlali A, Héron E, Goldschmidt P, Bodaghi B, Sahel JA. A Comparison of the Dexamethasone Implant (Ozurdex®) and Inferior Fornix-Based Sub-Tenon Triamcinolone Acetonide for Treatment of Inflammatory Ocular Diseases. Ocul Immunol Inflamm 2018; 27:319-329. [DOI: 10.1080/09273948.2018.1501492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Marie-Hélène Errera
- DHU Sight Restore, INSERM-DHOS CIC, Quinze-Vingts Hospital, Paris, France
- UPMC Univ Paris VI, Sorbonne Université, Paris, France
| | - Mark Westcott
- Department of Medical Retina, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Biomedical Research Centre, UCL Institute of Ophthalmology, London, UK
- Internal Medicine, DHU Sight Restore, Quinze-Vingts Hospital, Paris, France
| | - Jonathan Benesty
- DHU Sight Restore, INSERM-DHOS CIC, Quinze-Vingts Hospital, Paris, France
- UPMC Univ Paris VI, Sorbonne Université, Paris, France
| | - Sabrina Falah
- DHU Sight Restore, INSERM-DHOS CIC, Quinze-Vingts Hospital, Paris, France
| | - Jérôme Smadja
- DHU Sight Restore, INSERM-DHOS CIC, Quinze-Vingts Hospital, Paris, France
| | - Raphaëlle Orès
- DHU Sight Restore, INSERM-DHOS CIC, Quinze-Vingts Hospital, Paris, France
| | | | - Neila Sedira
- Internal Medicine, DHU Sight Restore, Quinze-Vingts Hospital, Paris, France
| | - Amine Bensemlali
- DHU Sight Restore, INSERM-DHOS CIC, Quinze-Vingts Hospital, Paris, France
| | - Emmanuel Héron
- Internal Medicine, DHU Sight Restore, Quinze-Vingts Hospital, Paris, France
| | | | - Bahram Bodaghi
- DHU Sight Restore, Pitié-Salpêtrière Hospital, UPMC Univ Paris VI, Sorbonne Universités, Paris, France
| | - José-Alain Sahel
- DHU Sight Restore, INSERM-DHOS CIC, Quinze-Vingts Hospital, Paris, France
- UPMC Univ Paris VI, Sorbonne Université, Paris, France
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Gómez-Gómez A, Loza E, Rosario MP, Espinosa G, de Morales JMGR, Herreras JM, Muñoz-Fernández S, Cordero-Coma M. Efficacy and safety of immunomodulatory drugs in patients with anterior uveitis: A systematic literature review. Medicine (Baltimore) 2017; 96:e8045. [PMID: 29049193 PMCID: PMC5662359 DOI: 10.1097/md.0000000000008045] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/15/2017] [Accepted: 08/18/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To assess the efficacy and safety of immunomodulatory drugs in patients with noninfectious anterior uveitis (AU). METHODS Systematic review of studies were retrieved from Medline (1961 to March 2016), Embase (1961 to March 2016), and Cochrane Library (up to March 2016), and a complementary hand search was also performed. The selection criteria were as follows: (population) noninfectious AU patients, adults; (intervention) immunomodulatory drugs (any dose, regimen, route of administration, duration of treatment); (outcome) control of inflammation, steroid-sparing effect, AU flares, adverse events, and so on; (study design) systematic literature reviews, randomized controlled trials, and observational studies. The study quality was assessed using the Jadad scale and according to The Oxford Centre for Evidence-based Medicine (update 2009). RESULTS We included 13 studies of moderate-poor quality, with a mean duration from 5 months to 20 years, and number of AU patients ranging from 9 to 274. Patient's demographic and clinical characteristics were very heterogeneous. In most cases, uveitis anatomic classification criteria and outcomes definitions were unclear. Some of the studies only included AU patients with a systemic disease associated, mostly spondyloarthritis, others, mixed populations (idiopathic and systemic disease associated patients), and in some articles this data is not described. We found that methotrexate, cyclosporine A, azathioprine, adalimumab, and golimumab might prevent AU flares, improve ocular inflammation and visual acuity, and decrease systemic steroids doses. CONCLUSIONS Although there is a lack of robust evidence, methotrexate, cyclosporine A, azathioprine, adalimumab, and golimumab might be effective in AU patients.
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Affiliation(s)
- Alejandro Gómez-Gómez
- Reumatología HM Hospitales-Hospital Universitario HM Sanchinarro, Madrid
- Reumatología, Hospital Universitario Infanta Sofía, Madrid
| | | | | | - Gerard Espinosa
- Department of Autoimmune Diseases, Institut Clinic de Medicina i Dermatologia, Hospital Clínic, Barcelona
| | - José M. García Ruiz de Morales
- Unidad de Inmunología, Complejo Asistencial Universitario e Instituto de Biomedicina Universidad de León (IBIOMED), León
| | - Jose M. Herreras
- Instituto Universitario de Oftalmobiología (IOBA), Universitdad de Valladolid, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Hospital Clínico Universitario de Valladolid
| | | | - Miguel Cordero-Coma
- Unidad de Uveitis, Complejo Asistencial Universitario e Instituto de Biomedicina Universidad de León (IBIOMED), León, Spain
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Kurt MM, Çekiç O, Akpolat Ç, Aslankurt M, Elçioğlu M. Vessel diameter study: intravitreal vs posterior subtenon triamcinolone acetonide injection for diabetic macular edema. Eye (Lond) 2017; 31:1155-1162. [PMID: 28338665 DOI: 10.1038/eye.2017.46] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 02/06/2017] [Indexed: 11/09/2022] Open
Abstract
PurposeTo detect and compare the vessel diameter effect of intravitreal vs subtenon injection of triamcinolone for diabetic macular edema (DME).MethodsSixty patients with DME who underwent triamcinolone injection either intravitreally (N=30) or under the tenon capsule (N=30) were included. Non-injected fellow eyes served as control. The main outcome measures were central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and artery-vein ratio (AVR).ResultsIn the intravitreal group, pre-injection mean CRAE (147.07 μ) decreased to 141.03 μ at 1 week and to 139.43 μ at 1 month (P<0.001) while baseline CRVE (209.61 μ) decreased initially to 198.85 μ at 1 week then to 198.49 μ at 1 month (P<0.001). In the subtenon group, pre-injection CRAE (152.18 μ) decreased to 149.49 μ at 1 week and to 147.47 μ at 1 month (P=0.017), while baseline CRVE (215.60 μ) decreased initially to 208.69 μ at 1 week then to 207.25 μ at 1 month (P=0.003). Pre-injection AVR values did not change at 1 week and at 1 month in both injection groups (P=0.66 and P=0.196, respectively). In the control group, none of the 3 parameters changed throughout the study period compared to the baseline (P>0.28).ConclusionIn eyes with DME, both intravitreal and subtenon triamcinolone injection led to a significant constriction of retinal arteries and veins.
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Affiliation(s)
- M M Kurt
- Department of Ophthalmology, Okmeydanı Training and Research Hospital, Şişli, Istanbul, Turkey
| | - O Çekiç
- Department of Ophthalmology, Okmeydanı Training and Research Hospital, Şişli, Istanbul, Turkey
| | - Ç Akpolat
- Department of Ophthalmology, Okmeydanı Training and Research Hospital, Şişli, Istanbul, Turkey
| | - M Aslankurt
- Department of Ophthalmology, Okmeydanı Training and Research Hospital, Şişli, Istanbul, Turkey
| | - M Elçioğlu
- Department of Ophthalmology, Okmeydanı Training and Research Hospital, Şişli, Istanbul, Turkey
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20
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Yazgan S, Celik U, Işık M, Yeşil NK, Baki AE, Şahin H, Gencer E, Doğan İ. Efficacy of golimumab on recurrent uveitis in HLA-B27-positive ankylosing spondylitis. Int Ophthalmol 2016; 37:139-145. [DOI: 10.1007/s10792-016-0239-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 04/19/2016] [Indexed: 12/19/2022]
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21
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Yüksel B, Uzunel UD, Kerci SG, Sağban L, Küsbeci T, Örsel T. Comparison of Subtenon Triamcinolone Acetonide Injection with Topical Nepafenac for the Treatment of Pseudophakic Cystoid Macular Edema. Ocul Immunol Inflamm 2016; 25:513-519. [PMID: 27015572 DOI: 10.3109/09273948.2016.1147587] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To compare the efficacy and safety of subtenon triamcinolone acetonide (TA) injection with topical nepafenac 0.1% for the treatment of pseudophakic cystoid macular edema (CME). METHODS In this prospective study, the TA group comprised 24 eyes and the nepafenac group 24 eyes. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), intraocular pressure measurements, and slit-lamp fundoscopy were performed in all subjects at baseline, 1, 2, 3, and 6 months. RESULTS Changes in BCVA and CRT over four follow-up visits were statistically significant (p<0.001). The mean CRT decreased from 513.3 to 318.9 μm in the TA group and from 483.7 to 278.0 μm in the nepafenac group. This reduction was statistically significant (p<0.001 for both groups). CONCLUSIONS Our visual and OCT results suggest that both treatment modalities are effective with few side-effects. However, nepafenac is more efficacious than subtenon TA in terms of visual gain and its correlation with the reduction in CRT.
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Affiliation(s)
- Bora Yüksel
- a Izmir Bozyaka Training and Research Hospital , Department of Ophthalmology , Izmir , Turkey
| | - Umut Duygu Uzunel
- a Izmir Bozyaka Training and Research Hospital , Department of Ophthalmology , Izmir , Turkey
| | - Süleyman Gökhan Kerci
- a Izmir Bozyaka Training and Research Hospital , Department of Ophthalmology , Izmir , Turkey
| | - Levent Sağban
- a Izmir Bozyaka Training and Research Hospital , Department of Ophthalmology , Izmir , Turkey
| | - Tuncay Küsbeci
- a Izmir Bozyaka Training and Research Hospital , Department of Ophthalmology , Izmir , Turkey
| | - Tümay Örsel
- a Izmir Bozyaka Training and Research Hospital , Department of Ophthalmology , Izmir , Turkey
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Abstract
The aim of this review is to summarize recent developments in the treatment of uveitic macular edema (ME). ME represent a major cause of visual loss in uveitis and adequate management is crucial for the maintenance of useful vision in patients with chronic uveitis.
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Affiliation(s)
- Raquel Goldhardt
- Assistant Professor of Clinical Ophthalmology, University of Miami Miller School of Medicine, Bascom Palmer Eye Institute
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23
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Kola M, Hacioglu D, Turk A, Erdol H. The effectiveness and reliability of posterior sub-Tenon triamcinolone acetonide injection in branch retinal vein occlusion-related macular edema. Cutan Ocul Toxicol 2015; 35:185-9. [PMID: 26340259 DOI: 10.3109/15569527.2015.1074586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To investigate the effectiveness and reliability of posterior sub-Tenon triamcinolone acetonide (PSTA) application in branch retinal vein occlusion (BRVO)-related macular edema. METHODS Patients with confirmed BRVO-related macular edema were enrolled in the study. Patients were injected with a single, therapeutic dose of 40 mg PSTA. Detailed ophthalmic examination was performed at baseline and at 1, 3 and 6 months after the treatment. Best corrected visual acuity (BCVA), intraocular pressure (IOP), cataractogenic change (CC) and macular optical coherence tomography (OCT) analysis results were evaluated. The results were compared statistically. RESULTS Forty-one eyes of 41 patients with a mean age of 63.49 ± 10.99 (55-86) years, 15 (36.6%) females, were included in the study. BCVA in LogMAR values at 1 and 3 months were significantly better than at baseline, while no significant difference from baseline was observed in sixth month values (p < 0.001, p < 0.001 and p = 0.846, respectively). Central macular thickness values obtained using OCT were significantly lower at the first, third and sixth months compared to baseline (p < 0.001 for all). IOP elevation was determined in only two eyes (4.8%) at the end of the study period, and no CC was detected in any case. CONCLUSION PSTA application is an effective and safe option in BRVO-related macular edema.
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Affiliation(s)
- Mehmet Kola
- a Department of Ophthalmology, Faculty of Medicine , Karadeniz Technical University , Trabzon , Turkey
| | - Dilek Hacioglu
- a Department of Ophthalmology, Faculty of Medicine , Karadeniz Technical University , Trabzon , Turkey
| | - Adem Turk
- a Department of Ophthalmology, Faculty of Medicine , Karadeniz Technical University , Trabzon , Turkey
| | - Hidayet Erdol
- a Department of Ophthalmology, Faculty of Medicine , Karadeniz Technical University , Trabzon , Turkey
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Bilateral inferior oblique muscle paresis after posterior subtenon injection of triamcinolone acetonide. Taiwan J Ophthalmol 2015; 5:94-95. [PMID: 29018675 PMCID: PMC5602735 DOI: 10.1016/j.tjo.2014.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 05/07/2014] [Accepted: 05/09/2014] [Indexed: 11/24/2022] Open
Abstract
Posterior subtenon injections of steroidal drugs are commonly used to treat various chorioretinal inflammatory diseases. Subsequent strabismus is rare, but it is associated with severe visual disturbance when present. We report a case of simultaneous bilateral inferior oblique muscle paresis in a 60-year-old man who developed it after receiving intravitreal injections of bevacizumab and posterior subtenon injections of triamcinolone acetonide for the treatment of diabetic macular edema. The patient complained of excessive pain during the injections, which were performed at the 6 o’clock position in both eyes. According to the literature, inferior oblique muscle paresis after posterior subtenon injections is rare. This complication may be prevented by proper selection of the injection site and paying attention to any unusual patient complaints during the procedure.
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Bleriot A, Couret C, Le Meur G, Lebranchu P, Weber M. [Safety and efficacy of subconjunctival triamcinolone injections in the management of uveitic macular edema: retrospective study of thirty-one cases]. J Fr Ophtalmol 2014; 37:599-604. [PMID: 25199486 DOI: 10.1016/j.jfo.2014.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 04/23/2014] [Accepted: 04/25/2014] [Indexed: 12/01/2022]
Abstract
Triamcinolone acetonide (Kenacort) is a corticosteroid that can be administrated by subconjunctival injection, with an extended release for up to three months. Our retrospective study aims to analyze safety and efficacy of subconjunctival triamcinolone injections in the treatment of uveitic macular edema. We included 31 eyes of 30 patients, who had one or several injections. We studied the progression of visual acuity, central macular thickness by optical coherence tomography (OCT), intraocular pressure, and presence or absence of cataract, on the day of injection (T0), and at 1, 3, 6 and 12 months after injection. Twenty-one patients had only one injection; 10 patients had 2. The 12-month follow-up showed an improvement in visual acuity with an initial mean of 0.36 ± 0.27 logMAR to 0.23 ± 0.33 logMAR at 3 months of follow-up (P<0.0004), and to 0.24 ± 0.21 logMAR at 12 months (P=0.0371), for a two-line improvement. A decrease in mean central macular thickness was measured by OCT, from a mean of 444 ± 112 μm (0.24 ± 0.11 logSD-OCT) at T0 to 355 ± 103 μm (0.14 $ ± 0.10 logSD-OCT) at 3 months (P=0.0002). We did not find a significant increase in intraocular pressure, and we diagnosed one cataract during follow-up but this occurred in the uninjected eye as well. Subconjunctival injection of triamcinolone acetonide is a safe and effective treatment of macular edema related to uveitis. Initial clinical monitoring is necessary to detect iatrogenic events.
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Affiliation(s)
- A Bleriot
- Service d'ophtalmologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
| | - C Couret
- Service d'ophtalmologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - G Le Meur
- Service d'ophtalmologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - P Lebranchu
- Service d'ophtalmologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - M Weber
- Service d'ophtalmologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
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Turalba AV, Pasquale LR. Hypertensive phase and early complications after Ahmed glaucoma valve implantation with intraoperative subtenon triamcinolone acetonide. Clin Ophthalmol 2014; 8:1311-6. [PMID: 25050061 PMCID: PMC4103917 DOI: 10.2147/opth.s64257] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate intraoperative subtenon triamcinolone acetonide (TA) as an adjunct to Ahmed glaucoma valve (AGV) implantation. Design Retrospective comparative case series. Participants Forty-two consecutive cases of uncontrolled glaucoma undergoing AGV implantation: 19 eyes receiving intraoperative subtenon TA and 23 eyes that did not receive TA. Methods A retrospective chart review was performed on consecutive pseudophakic adult patients with uncontrolled glaucoma undergoing AGV with and without intraoperative subtenon TA injection by a single surgeon. Clinical data were collected from 42 eyes and analyzed for the first 6 months after surgery. Main outcome measures Primary outcomes included intraocular pressure (IOP) and number of glaucoma medications prior to and after AGV implantation. The hypertensive phase (HP) was defined as an IOP measurement of greater than 21 mmHg (with or without medications) during the 6-month postoperative period that was not a result of tube obstruction, retraction, or malfunction. Postoperative complications and visual acuity were analyzed as secondary outcome measures. Results Five out of 19 (26%) TA cases and 12 out of 23 (52%) non-TA cases developed the HP (P=0.027). Mean IOP (14.2±4.6 in TA cases versus [vs] 14.7±5.0 mmHg in non-TA cases; P=0.78), and number of glaucoma medications needed (1.8±1.3 in TA cases vs 1.6±1.1 in the comparison group; P=0.65) were similar between both groups at 6 months. Although rates of serious complications did not differ between the groups (13% in the TA group vs 16% in the non-TA group), early tube erosion (n=1) and bacterial endophthalmitis (n=1) were noted with TA but not in the non-TA group. Conclusions Subtenon TA injection during AGV implantation may decrease the occurrence of the HP but does not alter the ultimate IOP outcome and may pose increased risk of serious complications within the first 6 months of surgery.
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Affiliation(s)
- Angela V Turalba
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA ; Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Louis R Pasquale
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA ; Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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Bratton ML, He YG, Weakley DR. Dexamethasone intravitreal implant (Ozurdex) for the treatment of pediatric uveitis. J AAPOS 2014; 18:110-3. [PMID: 24698604 DOI: 10.1016/j.jaapos.2013.11.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 10/29/2013] [Accepted: 11/11/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE To report our experience using Ozurdex (Allergan, Irvine, CA), a biodegradable intravitreal implant containing of 0.7 mg of dexamethasone approved for use in adults with noninfectious uveitis in adults, in the treatment of pediatric uveitis. METHODS The medical records of consecutive patients with noninfectious posterior uveitis who were unresponsive to standard treatment and subsequently received the Ozurdex implant from March 2011 to March 2013 were retrospectively reviewed. RESULTS A total of 14 eyes of 11 patients (mean age, 10.1 years; range 4-12) received 22 Ozurdex implants during the study period. Of the 11 patients, 7 had idiopathic intermediate or posterior uveitis, 1 had sympathetic ophthalmia, 2 had juvenile idiopathic arthritis, and 1 had sarcoidosis. All patients were uncontrolled with standard treatment, including topical or sub-Tenon's or systemic corticosteriods and/or immune-modulation. Visual acuity improved after Ozurdex implant in 5 of 8 patients (63%). Intraocular inflammation was controlled or improved after 17 of 22 of implants (12 eyes [77%]). The frequency of topical corticosteroids was decreased and/or discontinued after 18 of 22 implants (12 eyes [82%]). Complications included implant migration into the anterior chamber (4 aphakic eyes), increased intraocular pressure (5 eyes), and progression of a preexisting cataract (1 eye). The uveitis reoccurred in 57% of eyes at 4.3 months (2-7 months) after injection. CONCLUSIONS The Ozurdex implant in combination with systemic immunomodulatory therapy resulted in improved visual acuity, control of intraocular inflammation, and a decrease in corticosteroid use. In the majority of eyes the uveitis reoccurred around 4 months after injection. The adverse events in our study are similar to those identified in adult studies.
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Affiliation(s)
- Monica L Bratton
- Department of Ophthalmology, University of Texas Southwestern, Dallas, Texas
| | - Yu-Guang He
- Department of Ophthalmology, University of Texas Southwestern, Dallas, Texas.
| | - David R Weakley
- Department of Ophthalmology, University of Texas Southwestern, Dallas, Texas
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Uveitis and gender: the course of uveitis in pregnancy. J Ophthalmol 2014; 2014:401915. [PMID: 24683491 PMCID: PMC3941965 DOI: 10.1155/2014/401915] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 12/09/2013] [Indexed: 12/26/2022] Open
Abstract
The hormonal and immunological changes in pregnancy have a key role in maintaining maternal tolerance of the semiallogeneic foetus. These pregnancy-associated changes may also influence the course of maternal autoimmune diseases. Noninfectious uveitis tends to improve during pregnancy. Specifically, uveitis activity tends to ameliorate from the second trimester onwards, with the third trimester being associated with the lowest disease activity. The mechanism behind this phenomenon is likely to be multifactorial and complex. Possible mechanisms include Th1/Th2 immunomodulation, regulatory T-cell phenotype plasticity, and immunosuppressive cytokines. This clearly has management implications for patients with chronic sight threatening disease requiring systemic treatment, as most medications are not recommended during pregnancy due to lack of safety data or proven teratogenicity. Given that uveitis activity is expected to decrease in pregnancy, systemic immunosuppressants could be tapered during pregnancy in these patients, with flare-ups being managed with local corticosteroids till delivery. In the postpartum period, as uveitis activity is expected to rebound, patients should be reviewed closely and systemic medications recommenced, depending on uveitis activity and the patient's breastfeeding status. This review highlights the current understanding of the course of uveitis in pregnancy and its management to help guide clinicians in managing their uveitis patients during this special time in life.
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Abstract
Birdshot chorioretinopathy is a relatively uncommon subtype of idiopathic posterior uveitis with distinct clinical characteristics and a strong genetic association with the Human Leukocyte Antigen (HLA)-A29 allele. The diagnosis remains clinical and is based on the presence of typical clinical features, including multiple, distinctive, hypopigmented choroidal lesions throughout the fundus. The long-term visual prognosis of this disorder, however, remains guarded – central visual acuity can be preserved until late in the disease and it is not uncommon for patients to receive inadequate immunosuppressive treatment, leading to a poor long-term outcome in which peripheral retinal damage eventually leads to visual deterioration. Birdshot chorioretinopathy has proven a particularly attractive area of study within the field of uveitis, as it is a relatively easily defined disease with an associated human leukocyte antigen haplotype. Despite this, however, the immune mechanisms involved in its pathogenesis remain unclear, and some patients continue to lose retinal function despite therapy with corticosteroids and conventional immunosuppressive agents. Laboratory research continues to investigate the underlying mechanisms of disease, and clinical research is now being driven to improve the phenotyping and monitoring of this condition as, in the era of so-called personalized medicine, it is becoming increasingly important to identify patients at risk of visual loss early so that they can be treated more aggressively with targeted therapies such as the newer biological agents. This approach requires the formation of collaborative groups, as the relative rarity of the condition makes it difficult for one center to accumulate enough patients for worthwhile studies. Nevertheless, results obtained with newer therapies, such as biological agents directed against particular cytokines or cell-surface receptors, demonstrate ever improving control of the inflammation in refractory cases, providing hope that the outlook for visual function in this condition can only improve.
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Affiliation(s)
- Victor Menezo
- Institut Catala de Retina, Barcelona, Spain ; Department of Ophthalmology, Provincial Hospital Consortium Castellon, Castello, Spain
| | - Simon Rj Taylor
- Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK ; Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
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Tempest-Roe S, Joshi L, Dick AD, Taylor SRJ. Local therapies for inflammatory eye disease in translation: past, present and future. BMC Ophthalmol 2013; 13:39. [PMID: 23914773 PMCID: PMC3750406 DOI: 10.1186/1471-2415-13-39] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 08/01/2013] [Indexed: 12/18/2022] Open
Abstract
Despite their side-effects and the advent of systemic immunosuppressives and biologics, the use of corticosteroids remains in the management of patients with uveitis, particularly when inflammation is associated with systemic disease or when bilateral ocular disease is present. The use of topical corticosteroids as local therapy for anterior uveitis is well-established, but periocular injections of corticosteroid can also be used to control mild or moderate intraocular inflammation. More recently, intraocular corticosteroids such as triamcinolone and steroid-loaded vitreal inserts and implants have been found to be effective, including in refractory cases. Additional benefits are noted when ocular inflammation is unilateral or asymmetric, when local therapy may preclude the need to increase the systemic medication. Implants in particular have gained prominence with evidence of efficacy including both dexamethasone and fluocinolone loaded devices. However, an appealing avenue of research lies in the development of non-corticosteroid drugs in order to avoid the side-effects that limit the appeal of injected corticosteroids. Several existing drugs are being assessed, including anti-VEGF compounds such as ranibizumab and bevacizumab, anti-tumour necrosis factor alpha antibodies such as infliximab, as well as older cytotoxic medications such as methotrexate and cyclosporine, with varying degrees of success. Intravitreal sirolimus is currently undergoing phase 3 trials in uveitis and other inflammatory pathways have also been proposed as suitable therapeutic targets. Furthermore, the advent of biotechnology is seeing advances in generation of new therapeutic molecules such as high affinity binding peptides or modified high affinity or bivalent single chain Fab fragments, offering higher specificity and possibility of topical delivery.
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Abstract
Drug delivery into the posterior segment of the eye is complicated by the presence of the blood-ocular barrier. Strategies for delivering drugs to the posterior segment include systemic administration, modification of the blood-eye barrier, and local drug delivery. Recently, new topical treatments have emerged for the treatment of posterior eye disease. Iontophoretic, juxtascleral, and intravitreal routes can be used to achieve therapeutic levels in the posterior segment. Extended-release intravitreal drug delivery systems can achieve sustained therapeutic levels with the goal of providing a prolonged clinical benefit.
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Salek SS, Leder HA, Butler NJ, Gan TJ, Dunn JP, Thorne JE. Periocular triamcinolone acetonide injections for control of intraocular inflammation associated with uveitis. Ocul Immunol Inflamm 2013; 21:257-63. [PMID: 23617776 DOI: 10.3109/09273948.2013.767353] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To describe the effectiveness of periocular corticosteroid injections for the control of intraocular inflammation associated with noninfectious uveitis. METHODS A total of 81 patients (109 eyes) who received a periocular injection were evaluated for active inflammation, visual acuity, intraocular pressure, degree of intraocular inflammation, and the presence of ocular complications, including macular edema. RESULTS Of all eyes, 36% (95%CI: 25%, 45%) demonstrated clinical resolution of inflammation at the 1-month visit after first injection, and 48% (95%CI: 37%, 59%) at 3 months. For multiple injections, 50% (95%CI: 28%, 72%) demonstrated resolution of inflammation at 1 month after the last injection, and 41% (95%CI: 20%, 63%) resolution of inflammation at 3 months after the last injection. Of the 49 eyes that initially responded, the estimated median time to recurrence was 7.6 months. CONCLUSIONS Approximately half of the treated eyes had resolution of intraocular inflammation at 3 months after corticosteroid injection.
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Affiliation(s)
- Sherveen S Salek
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Noh DH, Sagong M, Chang WH. Three Cases of Vasoproliferative Tumor of the Retina. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.1.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Dong Hyoun Noh
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Min Sagong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Woo Hyok Chang
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
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Gharaee H, Khalife M, Poor SSH, Abrishami M. Infectious Scleritis after Subtenon Triamcinolone Acetonide Injection. Ocul Immunol Inflamm 2011; 19:284-5. [PMID: 21770808 DOI: 10.3109/09273948.2011.584010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Hamid Gharaee
- Eye Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Chew EY, Glassman AR, Beck RW, Bressler NM, Fish GE, Ferris FL, Kinyoun JL. Ocular side effects associated with peribulbar injections of triamcinolone acetonide for diabetic macular edema. Retina 2011; 31:284-9. [PMID: 20948459 PMCID: PMC3489034 DOI: 10.1097/iae.0b013e3181f049a8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate long-term effects of anterior and posterior peribulbar injections of triamcinolone acetonide on intraocular pressure (IOP) elevation and cataract development. METHODS This study reports on IOP and cataract progression through 2 years in 96 eyes with diabetic macular edema randomized to focal/grid photocoagulation, 20 mg triamcinolone acetonide anterior injection, anterior injection followed by laser, 40 mg triamcinolone acetonide posterior injection, or posterior injection followed by laser. RESULTS Intraocular pressure increased from baseline by ≥ 10 mmHg at ≥ 1 visit through 2 years in 2 eyes (8%) in the laser group, 11 eyes (31%) in the anterior groups, and 6 eyes (17%) in the posterior groups. Among phakic eyes at baseline, 0, 5 (17%), and 1 (3%) in the 3 groups, respectively, underwent cataract surgery before the 2-year visit. CONCLUSION Based on this small randomized trial, it appears that over 2 years, anterior peribulbar triamcinolone acetonide injections are associated with an increased incidence of IOP elevation and an increased risk of cataract development compared with laser or posterior peribulbar injections. The association of posterior injections with IOP elevation is less certain. Although the study involved eyes with diabetic macular edema, the results should be relevant to other conditions treated with peribulbar corticosteroids.
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Affiliation(s)
- Emily Y Chew
- National Eye Institute/National Institutes of Health, Bethesda, Maryland, USA
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Ossewaarde-van Norel A, Rothova A. Clinical Review: Update on Treatment of Inflammatory Macular Edema. Ocul Immunol Inflamm 2010; 19:75-83. [DOI: 10.3109/09273948.2010.509530] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Shen L, You Y, Sun S, Chen Y, Qu J, Cheng L. Intraocular and systemic pharmacokinetics of triamcinolone acetonide after a single 40-mg posterior subtenon application. Ophthalmology 2010; 117:2365-71. [PMID: 20678801 DOI: 10.1016/j.ophtha.2010.03.033] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2009] [Revised: 03/10/2010] [Accepted: 03/11/2010] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To characterize the pharmacokinetics of triamcinolone acetonide (TA) in aqueous, vitreous, and systemic circulation after a single subtenon injection. DESIGN Prospective interventional case series. PARTICIPANTS Thirty-six patients (36 eyes) who received a single posterior subtenon injection of TA (40 mg in 0.4 ml). METHODS Aqueous, vitreous, and blood samples were obtained at 1-hour, 1-day, 3-day, 5-day, 10-day, 14-day, 21-day, and 28-day time points after the posterior subtenon TA injection. At each time point, there were 3 to 6 eyes (patients). The concentrations of TA in the aqueous, vitreous, and plasma were analyzed using ultra-performance liquid chromatography coupled with tandem mass spectrometry. MAIN OUTCOME MEASURES Triamcinolone acetonide concentration in the samples was measured, and pharmacokinetic parameters were calculated. RESULTS The TA concentration-time profile in aqueous consisted of a fast distribution phase during the first 24 hours and a slow elimination phase thereafter. In contrast, the TA concentration-time profile in vitreous consisted of an absorption phase during the first 24 hours followed by a slow elimination phase. The TA in plasma followed a mono-exponential elimination during the study course. The TA concentration peak time for aqueous and plasma was at 1 hour and 24 hours, for vitreous after subtenon injection. The terminal elimination half-life in aqueous, vitreous, and plasma was 11.8, 17.1, and 25 days, respectively. The integral of the area under the concentration time curve (AUC(0-∞)) was 862 ng/day/ml for aqueous, 1262 ng/day/ml for vitreous, and 17.4 ng/day/ml for plasma. The total TA exposure to vitreous was 46% more than total TA exposure to the aqueous. The TA concentration in vitreous was 70- to 98-fold higher than that in plasma. CONCLUSIONS Posterior subtenon TA application can provide a sustained high local ocular TA level while also resulting in a very low systemic TA level, which may be well below the normal glucocorticoid level in humans.
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Affiliation(s)
- Lijun Shen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical College, Wenzhou, Zhejiang, China
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Reply. Am J Ophthalmol 2010. [DOI: 10.1016/j.ajo.2010.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Park YH. Sub-tenon triamcinolone acetonide injection in the treatment of scleritis. Am J Ophthalmol 2010; 150:128; author reply 128-9. [PMID: 20609711 DOI: 10.1016/j.ajo.2010.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 03/11/2010] [Indexed: 11/17/2022]
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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