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R.A. Equi, E. de Juan; Subretinal Triamcinolone for the Treatment of Neovascular AMD: A Pilot Study . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1812.
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Purpose: To determine the safety and feasibility of delivering subretinal triamcinolone acetonide (TA) using a minimally invasive, transvitreal technique and to demonstrate its efficacy in the treatment of occult choroidal neovascularization (CNV) due to age-related macular degeneration (AMD). Methods: Safety and feasibility of subretinal injection of TA was first tested in 18 rabbit and 7 cynomolgus monkey eyes using a novel 25-gauge transscleral cannula with a soft-tipped 41-gauge extendable subretinal cannula. After IRB approval, TA was delivered into the subretinal space of six eyes of six patients with subfoveal occult CNV due to AMD. Results: Data from the rabbit and cynomolgus monkey eyes demonstrated overall toleration of subretinal injection of TA. Persistent neurosensory retinal detachment overlying the site of injection was present in rabbit eyes injected with TA but was not present in any of the monkey eyes. None of the six patients who underwent subretinal injection of TA experienced any intraoperative complications. Standard snellen visual acuity measurements demonstrated no significant decline in visual acuity. During the study, no significant adverse events were observed following injection in the postoperative period (ranging from 2 to 12 weeks) in any of the patients. Subretinal triamcinolone precipitate could be observed for up to one week after injection but no patient demonstrated persistent neurosensory retinal detachment as a result of the injection. One patient demonstrated complete absorption of subretinal fluid that was present preoperatively 12 weeks after injection. Visual acuity improved from 20/400 to 20/200. Conclusions: Subretinal triamcinolone acetonide can be delivered safely using a 25-gauge transscleral cannula with an extendable 41-gauge subretinal cannula. Data from rabbit and monkey eyes demonstrate no significant toxicity. Preliminary data from a small pilot study in patients with subfoveal occult CNV demonstrate resolution of subretinal fluid and/or associated visual improvement in several patients and no significant intraoperative or postoperative complications.
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