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I.R. Kreissig, R.F. Degenring, I. Akkoyun, J.B. Jonas; Safety of Intravitreal High–Dose Re–Injections of Triamcinolone Acetonide . Invest. Ophthalmol. Vis. Sci. 2004;45(13):1185.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To evaluate side effects of high–dose re–injections of triamcinolone acetonide (TA) for various retinal diseases. Methods: The prospective clinical interventional case–series study included 46 patients (47 eyes) who received at least 2 intravitreal injections of 20 to 25 mg TA as treatment for exudative age–related macular degeneration (n=23), secondary angle–closure glaucoma due to iris neovascularization (n=7), diffuse diabetic macular edema (n=6), central retinal vein occlusion (n=5), branch retinal vein occlusion (n=2), other exudative retinal diseases (n=4). A 2nd injection (n=47) was done 6.7 ± 3.4 months after 1st injection, 3rd (n=9) 8.0 ± 4.6 months after 2nd injection, 4th injection (n=2) 9.5 and 10.8 months after 3rd injection; 1 eye received 6 injections. Mean follow–up after last injection 10.0 ± 6.6 months, mean total follow–up after 1st injection 20.7 ± 8.9 months. Preparation and injection of intravitreal TA (vehicle removed) were done under sterile conditions with patient draped as for intraocular surgery. Results: None of the 47 eyes had subluxation of lens or pseudophakos, infectious or sterile endophthalmitis, corneal endothelial decompensation, persistent vitreous clouding, proliferation or degeneration of retinal pigment epithelium. After 1st injection intraocular pressure (IOP) remained < 21 mmHg in 24 of 47 eyes (51%), after 2nd injection in 25 of 47 (53%), after 3rd in 5 of 9 (56%), after 4th injection in 1 of 2 eyes, after 6th injection in 1 eye. Increase of IOP > 21mmHg was controlled in 22 of 23 eyes by topical antiglaucomatous medication; in 1 eye rise of IOP after 2nd injection was up to 60mmHg, but controlled after a trabeculectomy. Eyes with no increase of IOP > 21 mmHg after 1st injection, usually did not experience an increase after re–injections. Mean maximal IOP after 1st, 2nd, 3rd , and 4th injection did not vary significantly (p >0.50), i.e.: 22.0 ± 6.4 mm Hg (n=47) versus 22.6 ± 7.3 mmHg (n=47) versus 22.9 ± 7.5 mmHg (n=9), versus 14 mmHg and 18 mmHg (n=2). Conclusions: Intravitreal re–injections of 20 to 25 mg TA might be tolerated by the eye during mean follow–up of 21 months after 1st injection and 10 months after last injection. Side effect, as increase of IOP > 21 mmHg, was not more pronounced after a 2nd injection than after the 1st. Subluxation of lens or pseudophakos and sterile or infectious endophthalmitis did not occur.
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