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Frank Tsai, William R Freeman; Decanted Triamcinolone for Macular Edema in Non-Vitrectomized and Vitrectomized Eyes. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):376.
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© ARVO (1962-2015); The Authors (2016-present)
Intravitreal triamcinolone acetonide (IVTA) doses varying from 1-4mg have traditionally been used. Higher doses of IVTA may provide better treatment response or longer duration of effect. We report the largest retrospective case series evaluating the safety and efficacy of high-dose decanted IVTA for macular edema in vitrectomized and non-vitrectomized eyes.
A retrospective chart review of 78 injections in 40 consecutive eyes treated with intravitreal injection of decanted 20mg triamcinolone acetonide injected for macular edema was performed. The non-vitrectomized group comprised of 15 eyes, while 25 eyes had prior vitrectomy. Change in best-corrected visual acuity (BCVA), intraocular pressure, central macular thickness (CMT), and complications were reviewed. Macular edema was associated with diabetes, vein occlusion, uveitis, or post-operative surgery. All patients had at least 3 months of follow-up with a mean of 9 months. Reinjection of IVTA was performed on a PRN basis. Injection cost was compared to dexamethasone intravitreal implant. Data analyses was performed using JMP version 5 (SAS,Cary,NC).
Improvement in BCVA was found in 12 of 15 eyes(80%) at 2 months, 8 of 14 eyes(57%) at 6 months, and 8/12 eyes(67%) at 12 months for non-vitrectomized eyes, compared with 13 of 25 eyes(52%), 14 of 25 eyes(56%), and 9 of 17 eyes(53%) of vitrectomized eyes, respectively. The mean change in BCVA letter score from baseline at 1, 2, and 3 months was 7.5, 9.8, and 5.86 in the non-vitrectomized eyes, and 1.3, 6.8, and 0.9 in the vitrectomized eyes, respectively. CMT improved in both groups and was statistically significant at all time points. 40% of eyes developed IOP >21mm of Hg. The rate of cataract requiring surgery was 50% after 1 year. Retinal detachment and glaucoma surgery occurred in 1 eye each.
Decanted IVTA is safe and effective for treating macular edema due to various etiologies. Although it appears more effective in non-vitrectomized patients, decanted IVTA provides statistically significant visual gains peaking at 2 months after injection, but up to 12 months in some patients after a single injection. The dose of IVTA can be reliably titrated by the decantation method. The duration of decanted IVTA appears similar to Ozurdex, which peaks at 2 months and generally lasts 3-6 months. The acquisition cost of Kenalog was $75 per dose, compared to $1295 per dose of Ozurdex.
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