Intravitreal triamcinolone: Efficacy and complications of different methods of drug delivery

Abstract

 

Purpose

 

It is well established that intravitreal triamcinolone (IVTA) is an effective treatment of macular edema, however issues exist with complications of treatment. The aim of this study was to assess the efficacy and complication rates of different methods of IVTA delivery, specifically, preservative-free Triesence (Alcon Laboratories) and preservative-containing Kenacort A-40 (Aspen Pharma).

 

Methods

 

Members of The Royal Australian and New Zealand College of Ophthalmologists were invited to enter data regarding patients receiving IVTA into a secure online platform. Main outcomes assessed included logMAR visual acuity (VA), central macular thickness (CMT) and incidence of complications at one month post-injection.

 

Results

 

208 Triesence and 80 Kenacort injections from 135 patients (mean age 64) were recorded. The most common indications for treatment were diabetic macular edema (46.8%), uveitis (32.4%), pseudophakic macular edema (7.9%) and retinal vein occlusion (6.5%).<br /> <br /> At one month post-injection, the median VA in the Triesence and Kenacort groups improved by 0.1 (interquartile range IQR 0.0-0.2) and 0.1 (IQR 0.0-0.3) logMAR units respectively (p=0.14). Median CMT in the Triesence and Kenacort groups improved by 121.5µm (IQR 58.8-214.5) and 190.0µm (IQR 70.8-315.0) respectively (p=0.86). There were no statistically significant differences in complication rates, with ocular hypertension the most common complication seen in 13.9% of patients. One case of sterile endophthalmitis was observed in both groups.<br /> <br /> By dose, 4mg of IVTA improved median VA by 0.2 (IQR 0.0-0.3) logMAR units compared with 0.0 (IQR 0.0-0.2) in the <4mg IVTA group (p<0.0001). 4mg of IVTA improved CMT by 153µm (IQR 64-252) compared to 118µm (IQR 57-232) in the <4mg IVTA group (p=0.54).

 

Conclusions

 

Both Triesence and Kenacort improved VA and CMT at one month post-injection with no significant differences in efficacy between the two treatments. Additionally, both treatments had a similar time to re-injection and complications profile. Sterile endophthalmitis was still found to occur despite administration of preservative-free Triesence. Interestingly, 4mg of IVTA may be more effective in improving VA compared to <4mg, without an increased rate of complications.  

 

VA and CMT improvement in Triesence and Kenacort groups.

 

 

VA and CMT improvement in 4mg and <4mg IVTA groups.