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R. Reddy, M.S. Alomram, M. Diaz, S. Huang; Meta–Analysis of Intravitreal Triamcinolone Acetonide for the Treatment of Macular Edema . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4270.
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A meta–analysis was performed to establish quantitative estimates of ocular complications associated with intravitreal triamcinolone acetonide (IVTA).
A systematic review of MEDLINE, EMBASE, and Cochrane Register of Controlled Trials, Database of Systematic Reviews (1966–12/31/2004) and abstracts from the AAO/ASRS/ARVO was performed. One–hundred initial studies were identified using the key words: IVTA, treatment, macular edema. Limiting criteria to IVTA for macular edema due to DM, RVO, and pseudophakia revealed 71 citations. Studies were excluded if less than five patients, follow–up of less than one month, IVTA combined with another procedure or medication, could not be translated, or were not case series. Forty–eight studies met ultimate search criteria. A generalized mixed model logistic regression was used to estimate the overall incidence of complications and analyzed using SAS v9.1 for Windows.
Analysis of the 48 studies revealed a total of 1,024 eyes among 890 patients. Among these there were 232 eyes that developed ocular hypertension (OH), 41 cataracts, and 7 other type of ocular complications were identified. Fifteen studies were retrospective and 33 prospective. The mean age of patients was 66 with a range of 58 to 78. Fify–four percent of patients were male. Analysis of OH and cataracts in those studies with an IVK dose of 4 mg revealed a pre–adjusted occurrence of probability of 18 and 2% respectively. OH in Europe and the US was 26/11%; for cataracts, 5/1%. Prospective v retrospective studies had a likelihood of OH of 19/15%; for cataracts, 0.9/5%. Likelihood ratios for OH in patients with IVTA any dose, DME, RVO, multiple causes, IOL, effect of laser and the ratios for cataracts in patients with DME and RVO, IVTA with at least 1 reported cataract, and retro v prospective studies will be reported.
Analysis helps to establish complication rates resulting from IVTA treatment of macular edema and may alter treatment paradigms. The rate was found to be higher and significant if DME was the underlying cause, for treatment outside the U.S. or if photocoagulation had been performed. OH was significantly higher in Europe (p =0.0130). A lower dose of IVTA resulted in a lower likelihood of hypertension, although did not reach statistical significance(p=0.055).
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