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R.N. Sjaarda, A.L. Robin, E.P. Suan, A.A. Davis; Anterior Juxtascleral Depot of Anecortave Acetate: Novel Long–Duration Intraocular Pressure Reduction in Glaucoma Caused by Intravitreal Triamcinolone Acetonide . Invest. Ophthalmol. Vis. Sci. 2006;47(13):402.
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Triamcinolone acetonide is an effective inhibitor of neovascularization and among the most potent anti–angiogenic drugs known. Intravitreal triamcinolone acetonide (ITA), either alone or in combination with photodynamic therapy, has beneficial therapeutic effects for intraocular neovascular, inflammatory and edematous conditions. Treatment with glucocorticoids is often complicated with the elevation of intraocular pressure (IOP) with 22% of eyes having an elevation of 10 mm Hg or more and 6% having an elevation of 20 mm Hg or more. This elevation can occur within 4 days, reach IOPs over 60 mm Hg, and persist for 8 months or longer. This glaucoma may in part be due to morphologic and biochemical changes of trabecular meshwork cells including increased cell size, actin cytoskeletal reorganization, and significant induction of myocilin in the trabecular meshwork. Anecortave acetate (AA) is a cortisene, an analog of cortisol acetate, and lacks the typical anti–inflammatory and immunosuppressive properties of glucocorticoids. We evaluated the effect of an anterior juxtascleral depot (AJD) of AA in 4 eyes of 3 patients following ITA.
A single inferior AJD (into the sub–Tenon’s space) of 24 mg of AA was injected into 4 eyes of 3 patients with glaucoma due to ITA (1–9 injections), who were on 3.8+/–1.0 (range 3–5) glaucoma medications. Mean pre–treatment IOP was 41+/– 11 m
Follow–up ranged from 7 months to 1 year. IOP lowering appeared maximal by 1 month and ranged from 32 to 54%. The IOP lowering was additive to prior glaucoma medications. The mean IOP decrease was 48%+/–6%, lasted 6 months, and avoided glaucoma surgery in 75%, without adverse events.
The anterior juxtascleral depot administration of AA was safe and effective in lowering IOP in addition to other concomitant glaucoma medications in eyes with steroid induced glaucoma. This therapy did not require patient compliance to administer eye drops daily or more frequently. AA worked despite pre–treatment IOPs of 35–57 mm Hg and despite a minimum of three concomitant glaucoma medications. Further work is needed to evaluate the appropriate dose, time course, and per cent of eyes that can be helped by this novel therapy.
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