The use of intravitreal corticosteroids, evidence-based and otherwise.
OBJECTIVE
To provide a current update on the use of intravitreal corticosteroids as a treatment for a variety of retinal diseases.


RESULTS
Pharmacokinetic studies demonstrate that a single 4 mg injection of intravitreal triamcinolone acetonide is present in the vitreous for up to 3 months. Many recent studies demonstrate a significant reduction in macular edema often with a significant improvement in vision for up to several months followed by a waning of treatment effect and recurrence of macular edema. Retreatments have been shown to be efficacious. Intravitreal triamcinolone acetonide may help lead to a reduction in subfoveal hard exudates in diffuse diabetic macular edema. It has been shown to be a more potent treatment than sub-Tenon's and retrobulbar triamcinolone acetonide for persistent macular edema. It may also be a significant adjunctive treatment for choroidal neovascularization treated with photodynamic therapy. Intravitreal corticosteroid implants have also been shown to be beneficial in early trials for persistent macular edema.


CONCLUSIONS
Intravitreal triamcinolone acetonide provides a potent short-term treatment for persistent macular edema and may be a useful adjunctive treatment for choroidal neovascularization. It remains to be determined whether intravitreal corticosteroids can provide long-term visual gain or stabilization. The side-effect profile of intravitreal corticosteroids is significant with corticosteroid-induced intraocular pressure rises. With longer-term studies, the rate of posterior subcapsular cataract formation is higher than previously reported, and there is a small but potential risk of endophthalmitis.
Conti
Stephen M
SM
Department of Ophthalmology, University of Toronto, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
Kertes
Peter J
PJ
D019317:Evidence-Based Medicine; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D012164:Retinal Diseases / Q000188:drug therapy*; D014222:Triamcinolone Acetonide / Q000009:adverse effects / Q000627:therapeutic use*; D014822:Vitreous Body
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide