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S. Bowditch, R.L. McIntosh, Q. Mohamed, S.M. Saw, T.Y. Wong; Efficacy of Intravitreal Triamcinolone for Treatment of Retinal Diseases: An Evidence–Based Systematic Review . Invest. Ophthalmol. Vis. Sci. 2006;47(13):924.
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© ARVO (1962-2015); The Authors (2016-present)
Although intravitreal triamcinolone (IVTA) has been advocated as a treatment for a wide range of retinal conditions, including neovascular age related macular degeneration (AMD), diabetic macular edema, and venous occlusive disease, the evidence supporting its use in these conditions is unclear. We evaluated the evidence for interventions with IVTA in retinal diseases.
We conducted a systemic review of all English and non–English language articles, retrieved using a keyword search of MEDLINE (1966 – onwards), EMBASE (1966 onwards), Cochrane Collaborations, NIH Clinical Trials Database, and ARVO (2003–2005). This was supplemented by hand searching the reference lists of selected major review articles.
Out of 695 citations retrieved, 14 randomized clinical studies were analyzed. Of these 14, 5 studies reported IVTA use for neovascular AMD, 6 for diffuse diabetic macular edema, 2 for macular edema secondary to retinal vein occlusion and 1 for cystoid macular edema secondary to retinitis pigmentosa. There was short–term improvement in macular edema and visual acuity in both neovascular AMD and diffuse diabetic macular edema. In neovascular AMD, no significant benefit was seen at 1 year. In diffuse diabetic macular edema, repeated injection of IVTA at 6 monthly intervals resulted in improved visual acuity and macular thickness on OCT. Adverse effects of IVTA included increased incidence of raised intraocular pressure, progression of cataract and endophthalmitis. Many studies were methodologically poor, lacked adequate power, and failed to report on long–term visual outcomes, with only 2 having follow up of 1 year or longer.
There is limited evidence for the use of IVTA alone in the treatment of neovascular AMD. IVTA appears to improve vision and macular edema in diffuse diabetic macular edema and the benefits are maintained over 1 year. More robust randomized, double–masked, placebo controlled clinical trials are needed to determine the safety and efficacy of IVTA for treatment of various retinal diseases
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