ABSTRACT
PURPOSE: To evaluate the safety and efficacy of intravitreal triamcinolone after 18 months of follow up in patients with age-related macular degeneration and subfoveal or juxtafoveal choroidal neovascularization considered unsuitable for laser photocoagulation. METHODS: Thirty eyes of 28 patients, referred from general eye clinics as well as the private clinic of one of the authors to a hospital-based retinal out-patient clinic, were treated with an intravitreal injection of triamcinolone (4 mg). The primary outcome measure was the proportion of eyes with loss of six or more lines on a Bailey-Lovie Chart. The incidence of adverse events associated with treatment was also observed. RESULTS: Of the 20 eyes with initial visual acuity (VA) of 6/60 or better, the vision was maintained (+/-1 Bailey-Lovie lines) in 11 eyes (55%), while six eyes (30%) suffered severe visual loss (six or more lines). The VA improved by five to six lines in three of 10 eyes with initial vision of 3/60 or worse. Three of four eyes receiving a second injection suffered either progressive cataract or elevated intra-ocular pressure (IOP) requiring cataract surgery and/or filtering surgery. One of 26 eyes (3%) receiving a single injection showed progression of cataract and elevation of IOP within 6 weeks of treatment and required anti-glaucoma medication for 6 weeks. Progression of nuclear sclerosis 8-12 months after treatment was observed in six of 26 eyes (23%) receiving a single injection. CONCLUSIONS: The results of the present study suggest that a single intravitreal injection of 4 mg triamcinolone is reasonably well tolerated by the human eye. The rate of development of severe visual loss was less than reported for historical controls. Because the results are preliminary and uncontrolled, the treatment should not be used routinely until its benefit to patients is established by a prospective, randomized controlled study.
Subject(s)
Choroidal Neovascularization/drug therapy , Glucocorticoids/therapeutic use , Macular Degeneration/complications , Triamcinolone Acetonide/therapeutic use , Aged , Aged, 80 and over , Choroidal Neovascularization/etiology , Exudates and Transudates , Female , Follow-Up Studies , Glucocorticoids/administration & dosage , Glucocorticoids/adverse effects , Humans , Injections , Intraocular Pressure/drug effects , Male , Safety , Treatment Outcome , Triamcinolone Acetonide/administration & dosage , Triamcinolone Acetonide/adverse effects , Visual Acuity , Vitreous BodyABSTRACT
PURPOSE: To study the efficacy of the anti-inflammatory agent triamcinolone (Kenacort A-40) in patients with exudative age-related macular degeneration and subfoveal and juxtafoveal choroidal new vessels, considered unsuitable for laser photocoagulation. METHOD: Thirty eyes of 28 patients were treated with intravitreal injection of triamcinolone. The subsequent visual acuity (VA) of treated eyes was compared with published VA outcomes of untreated eyes. Patients were classified into three types according to their responses to treatment. RESULTS: Within two weeks of receiving treatment, exudation decreased and vision improved in the majority of Types I and II patients (87%), the trend continuing in longer term follow-up. The overall VA outcome for treated eyes was significantly better than published VA data for untreated exudative macular lesions. CONCLUSIONS: The preliminary results are encouraging and no serious side effects of a single injection of triamcinolone have been detected in patients followed for up to 18 months. The treatment should, however, continue to be regarded as unproven and only administered in the context of a prospective, case-controlled clinical trial.
