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G.A. Salam, A.A. Moshfeghi, D.M. Fastenberg, V.A. Deramo, P.J. Ferrone; Intravitreal Triamcinolone Acetonide Injection for Diabetic Macular Edema: Effect of Preparation Technique on Incidence of Anterior Chamber Reaction . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4013.
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Purpose: Intravitreal steroid injection has emerged as an effective modality for treating CME. Anterior chamber reaction following intravitreal triamcinolone injection is one of the reported complications of the procedure. We modified the preparation technique of triamcinolone in an attempt to reduce the incidence of anterior chamber reaction. Methods: This was a retrospective, consecutive, interventional series of patients who underwent intravitreal triamcinolone injection at a vitreoretinal practice. All patients had diagnosis of chronic diabetic cystoid macular edema. A first group of 20 patients (25 eyes) had intravitreal injection of 4 mg triamcinolone acetonide using a standard pars plana approach. A second group of 19 patients (19 eyes) had 4 mg of intravitreal triamcinolone acetonide injection with the following modifications to the standard technique: 1) drawing up the medication from a single-use vial and immediately pushing the plunger volume down to 0.1 cc, and 2) not allowing the readied syringe to sit for a prolonged period prior to injection, thereby avoiding separation of the vehicle from the drug. Patients were followed by a vitreoretinal surgeon on post-injection day one, and then periodically to monitor any occurrence of anterior chamber reaction and to document their visual status. Results: Five eyes out of 25 in the first group (20%) developed a mild to moderate anterior chamber reaction as noted by the presence of anterior chamber cells. One of these patients developed a painless, sterile endophthalmitis. Only one eye out of 19 eyes in the second group (5.2%) developed a mild anterior chamber reaction. Conclusions: This study provides valuable information regarding incidence of anterior chamber reaction following intravitreal triamcinolone injection using a modified preparation technique. By immediately going down to a volume of 0.1 cc in the TB syringe (after drawing up the drug), the preparation proportion of drug to vehicle remained reproducible and proper, thereby decreasing the chance of injecting more vehicle (and possible inflammatory nidus) than desired. Until an ophthalmic preparation of triamcinolone acetonide is commercially available for specific intravitreal use, these measures may prove helpful in reducing the incidence of anterior chamber reaction following intravitreal triamcinolone injection.
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