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T. Hikichi, S. Kosaka, K. Takami, H. Ohtsuka, M. Higuchi, T. Matsushita, H. Ariga, R. Matsushita; Serum Concentration of Triamcinolone Acetonide Used for Visualization During Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4441.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the safety of triamcinolone acetonide (TA) for visualizing the vitreous gel and internal limiting membrane (ILM) during vitrectomy.
Blood samples were obtained from two patients preoperatively and 1, 3, 6, 12, 24, and 48 hours postoperatively to determine changes in the serum TA concentration postoperatively. Since the serum TA concentration peaked about 3 hours postoperatively, serum samples were obtained from another nine patients preoperatively and 3 hours postoperatively. The serum TA concentration was measured using high performance liquid chromatography. The mean (± standard deviation) age of the 11 patients (8 men, 3 women) was 66 ± 6 years. Vitrectomy was performed for a preretinal membrane in seven eyes, a macular hole in two eyes, and macular edema secondary to branch retinal vein occlusion in two eyes. In five eyes without posterior vitreous detachment, about 0.2 mL of the TA suspension was injected over the posterior pole and the posterior hyaloid membrane was detached at the optic disc by aspiration. In all 11 eyes, approximately 0.1 mL of the TA suspension was injected over the posterior pole, excess TA was aspirated with a vitrector, and a preretinal membrane and/or the ILM was incised. The excess TA was aspirated.
From 1 to 12 hours postoperatively, TA was detected in the serum, and the serum concentration peaked 3 hours postoperatively. Preoperatively and 24 and 48 hours postoperatively, TA was not detected in the serum (BLQ <0.02 ng/mL). The serum TA concentration 3 hours postoperatively was 0.173 ± 0.093 ng/mL.
Although TA injected into the vitreous cavity intraoperatively enters the serum, the concentration is much lower compared with the normal serum concentration of corticosteroids, e.g., 17-hydroxycorticosteroid within 9 mg/dl (90 ng/mL). The use of TA for visualizing the vitreous gel and ILM during vitrectomy should be safe regarding concerns about the disruption of the activity of corticosteroid hormones.
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