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B.R. Kosobucki, W.R. Freeman, L. Cheng; Photographic Estimation of the Duration of High Dose Intravitreal Triamcinolone in the Vitrectomized Eye . Invest. Ophthalmol. Vis. Sci. 2004;45(13):1918.
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Purpose: Many eyes with macular edema and other disorders requiring high dose steroid treatment are vitrectomized. We wished to determine the duration of residence of triamcinolone in the vitrectomized eye. Methods: Observational consecutive case series. Twenty–three eyes of 23 patients underwent intravitreal injection of high dose (20 mg) decanted triamcinolone acetonide (Kenalog) at the conclusion of vitrectomy surgery or in previously vitrectomized eyes with macular edema from diabetes, uveitis, cataract surgery, or persisting after prior retinal detachment repair, plus proliferative vitreoretinopathy. Main outcome measure was disappearance of triamcinolone crystals after intravitreal Injection. Secondary outcomes included complications of injections. Results: The median time to disappearance of triamcinolone after high dose decanted triamcinolone in the vitrectomized eye with saline fill was 113 days (95% confidence interval (CI) 85–191 days). In the phakic eyes the median time to disappearance was 191 days (95% CI 148–191 days). In the pseudophakic eyes the median time to disappearance was 102 days (95% CI 85–113 days). This difference was not significant (p=0.12). In one aphakic eye the triamcinolone crystals disappeared between 29 and 85 days. There were no cases of endophthalmitis or severe inflammatory reaction in the 23 eyes in the series. Nine eyes (39%) developed elevated intraocular pressure above 21 mm Hg, excluding postoperative day one. Eight of these patients were successfully treated with topical medications. Sixteen eyes (70%) experienced IOP rise >5 mm Hg. Five eyes (22%) experienced IOP rise >10 mm Hg. Conclusions:High dose decanted intravitreal triamcinolone has a median residence time of 113 days in the vitrectomized eye. Although this appears to be shorter than in the non–vitrectomized eye, this study suggests that a sufficient duration of action will be present to be clinically useful.
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