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K.A. Tawansy, R.R. Lakhanpal, E. de Juan, Jr; Intra–Vitreal Triamcinolone for Severe ROP Refractory to Laser Ablation: One Year Results . Invest. Ophthalmol. Vis. Sci. 2005;46(13):3493.
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Purpose: To evaluate the safety and efficacy of intra–vitreal traimcinolone for treatment of persistent vasculopathy in severe ROP after complete ablative laser. Methods: Prospective non–randomized assessment of clinical response, complications, and one–year outcomes in a series of 21 neonates with bilateral ROP treated with 1 or 2 mgs of triamcinolone in the more severe eye. The first 7 patients (group I) had heavy neovascular activity despite thorough laser in at least 2 sessions and progressed to retinal detachment. The remaining 14 (group II) had persistent vascular activity 2 weeks after their second confluent ablation with 2 of the following high–risk features: increasing neovascularization, new hemorrhage, or heavy fluorescein leakage.Both triamcinolone–treated and non–treated fellow eyes received surgery per established protocols. Results: Of the 21 patients with refractory ROP, 16 (71%) were Hispanic and 10 (48%) had intra–ventricular hemorrhage. In group I, all 14 eyes had progressive retinal detachment treated with vitrectomy. Triamcinolone injection was associated with cicatrisation of new vessels and earlier surgery. Acuities at one year in eyes receiving triamcinolone ranged from light perception to 20/800, and four of seven (57%) had posterior pole attachment. None of the fellow eyes achieved acuity better than light perception or posterior pole attachment. In group II, 5 (36%) of the triamcinolone–treated eyes required no further intervention, while the remaining 9 required vitrectomy. All of the fellow eyes in group II required vitrectomy. At one year, 13 of 14 (93%) triamcinolone–treated eyes and 8 of 14 (57%) of fellow eyes had macular attachment with fixation. Complications in eyes receiving 2 mg of triamcinolone included two extra–macular folds associated with the steroid particles, not seen when dose was limited to 1 mg and the injection was directed into the anterior vitreous. One eye from group I and one from group II developed late cataract after vitrectomy, possibly accelerated by the steroid. No eyes developed a rise in intra–ocular pressure beyond 18 mm. Conclusions: Triamcinolone has the potential in eyes with severe ROP to reduce vascular activity that persists after ablative laser. While it permits earlier and safer vitreous surgery in eyes with evolving detachments, it may also accelerate detachment associated with a cicatricial response. The 1 mg dose appears to clinically effective with less potential to induce retinal fold than 2 mgs.
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