June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Intravitreal triamcinolone: Efficacy and complications of different methods of drug delivery
Author Affiliations & Notes
  • Nicholas Mauwei Cheng
    The Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
    The Royal Melbourne Hospital, Melbourne, VIC, Australia
  • Ehud Zamir
    The Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
    Centre for Eye Research Australia, Melbourne, VIC, Australia
  • Anthony Dunlop
    Care Foresight, Newcastle, NSW, Australia
  • Richard Stawell
    The Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
    Eye Surgery Associates, Melbourne, VIC, Australia
  • Anthony John Hall
    Alfred Hospital, Melbourne, VIC, Australia
    Eye Surgery Associates, Melbourne, VIC, Australia
  • Robert Charles Andrew Symons
    The Royal Melbourne Hospital, Melbourne, VIC, Australia
  • Lauren Hodgson
    Centre for Eye Research Australia, Melbourne, VIC, Australia
  • Elizabeth Glatz
    Centre for Eye Research Australia, Melbourne, VIC, Australia
  • Sophie Rogers
    Centre for Eye Research Australia, Melbourne, VIC, Australia
  • Lyndell L Lim
    The Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
    Centre for Eye Research Australia, Melbourne, VIC, Australia
  • Footnotes
    Commercial Relationships Nicholas Cheng, None; Ehud Zamir, None; Anthony Dunlop, None; Richard Stawell, None; Anthony Hall, None; Robert Symons, Alcon (C), Novartis (R), Psivida (I); Lauren Hodgson, None; Elizabeth Glatz, None; Sophie Rogers, None; Lyndell Lim, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 1286. doi:
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    • Get Citation

      Nicholas Mauwei Cheng, Ehud Zamir, Anthony Dunlop, Richard Stawell, Anthony John Hall, Robert Charles Andrew Symons, Lauren Hodgson, Elizabeth Glatz, Sophie Rogers, Lyndell L Lim, ; Intravitreal triamcinolone: Efficacy and complications of different methods of drug delivery. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1286.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

It is well established that intravitreal triamcinolone (IVTA) is an effective treatment of macular edema, however issues exist with complications of treatment. The aim of this study was to assess the efficacy and complication rates of different methods of IVTA delivery, specifically, preservative-free Triesence (Alcon Laboratories) and preservative-containing Kenacort A-40 (Aspen Pharma).

 
Methods
 

Members of The Royal Australian and New Zealand College of Ophthalmologists were invited to enter data regarding patients receiving IVTA into a secure online platform. Main outcomes assessed included logMAR visual acuity (VA), central macular thickness (CMT) and incidence of complications at one month post-injection.

 
Results
 

208 Triesence and 80 Kenacort injections from 135 patients (mean age 64) were recorded. The most common indications for treatment were diabetic macular edema (46.8%), uveitis (32.4%), pseudophakic macular edema (7.9%) and retinal vein occlusion (6.5%).<br /> <br /> At one month post-injection, the median VA in the Triesence and Kenacort groups improved by 0.1 (interquartile range IQR 0.0-0.2) and 0.1 (IQR 0.0-0.3) logMAR units respectively (p=0.14). Median CMT in the Triesence and Kenacort groups improved by 121.5µm (IQR 58.8-214.5) and 190.0µm (IQR 70.8-315.0) respectively (p=0.86). There were no statistically significant differences in complication rates, with ocular hypertension the most common complication seen in 13.9% of patients. One case of sterile endophthalmitis was observed in both groups.<br /> <br /> By dose, 4mg of IVTA improved median VA by 0.2 (IQR 0.0-0.3) logMAR units compared with 0.0 (IQR 0.0-0.2) in the <4mg IVTA group (p<0.0001). 4mg of IVTA improved CMT by 153µm (IQR 64-252) compared to 118µm (IQR 57-232) in the <4mg IVTA group (p=0.54).

 
Conclusions
 

Both Triesence and Kenacort improved VA and CMT at one month post-injection with no significant differences in efficacy between the two treatments. Additionally, both treatments had a similar time to re-injection and complications profile. Sterile endophthalmitis was still found to occur despite administration of preservative-free Triesence. Interestingly, 4mg of IVTA may be more effective in improving VA compared to <4mg, without an increased rate of complications.  

 
VA and CMT improvement in Triesence and Kenacort groups.
 
VA and CMT improvement in Triesence and Kenacort groups.
 
 
VA and CMT improvement in 4mg and <4mg IVTA groups.
 
VA and CMT improvement in 4mg and <4mg IVTA groups.

 
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