Safety profile of intravitreal triamcinolone acetonide.
BACKGROUND
There is currently a widespread use of intravitreal triamcinolone acetonide (IVTA) for age-related macular degeneration, diabetic macular edema, cystoid macular edema secondary to retinal vein occlusions, and uveitis. The aim of this investigation was to assess the rates of various complications associated with this treatment and to determine which factors are associated with the development of these complications.


METHODS
A retrospective interventional case series of all patients from one retina specialist undergoing IVTA was conducted in a clinical setting from 2002 to 2005. All disease entities were included. Patients were followed for a mean of 9.5 months after receiving 4 mg (0.1 mL) of nonfiltered triamcinolone acetonide (TA). All complications associated with the injection procedure or with the TA were noted.


RESULTS
Two hundred and twenty-three (223) eyes of 192 patients received a total of 336 IVTA injections between 2002 and 2005. The mean age was 73.3 years and mean follow-up was 9.5 months. A single injection was performed in 144 eyes (64.6%); 2 IVTAs in 55 eyes (24.7%); 3 IVTAs in 16 eyes (7.2%), and 3.6% of eyes had more than 3 injections at a minimal interval of 3 months. The only immediate complication was a single injection (0.3%) associated with a temporary occlusion of the central retinal artery, which opened immediately following anterior paracentesis. Late complications included endophthalmitis in 1 of 336 (0.3%) injections and a steroid response requiring glaucoma medication in 60 of 192 patients (31.3%). In patients with preexisting glaucoma, 58.8% required additional glaucoma medication. Glaucoma-filtering surgery was required in 2 of 192 patients (1.0%).


CONCLUSIONS
In the study center, the IVTA is extremely safe in patients without a history of glaucoma. However, patients with preexisting glaucoma with progressive optic neuropathy must be treated with great caution.
Baath
J
J
Undergraduate Medicine, University of Toronto, Toronto, Ontario, Canada.
Ells
A L
AL
Crichton
A
A
Kherani
A
A
Williams
R G
RG
D000368:Aged; D000369:Aged, 80 and over; D000867:Anterior Chamber / Q000601:surgery; D009877:Endophthalmitis / Q000139:chemically induced; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000150:complications; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007267:Injections; D007429:Intraocular Pressure / Q000187:drug effects; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000150:complications; D019152:Paracentesis; D015356:Retinal Artery Occlusion / Q000139:chemically induced; D012189:Retrospective Studies; D012307:Risk Factors; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000009:adverse effects*; D014822:Vitreous Body
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide