Abstract
Purpose
To report on the follow-up of patients who received an intravitreal triamcinolone acetonide injection (IVTA) as treatment of exudative age-related macular degeneration.
Methods
The clinical interventional case-series study included 205 patients (222 eyes) with progressive exudative age-related macular degeneration with subfoveal neovascularization who consecutively received an IVTA of about 20 mg as only therapeutic procedure and for whom follow-up was at least 3 months. Mean follow-up was 10.4±7.1 months (range, 3–35.7 months).
Results
Visual acuity improved significantly (P<0.001) from baseline (0.90±0.45 logarithm of the minimum angle of resolution (LogMar)) to a mean minimum of 0.79±0.42 LogMar during follow-up. In 86 (38.7%) eyes and in 55 (24.8%) eyes, best visual acuity increased by at least two and three Snellen lines, respectively. Comparing the measurements at specific postinjection examination dates showed that visual acuity measurements taken at 1, 2, and 3 months after injection were not significantly different from the baseline value. Measurements taken at 6, 9, and 12 months after the injection were significantly (P<0.001) lower than the measurements at baseline. Mean loss at 6 months was 1.4±3.8 Snellen lines, at 9 months, 2.5±4.6 lines, and at 12 months after the injection, 2.6±4.0 lines. Intraocular pressure increased significantly (P<0.001) during the first 6 months, and returned to baseline at 9 months after injection.
Conclusions
Single injection high-dosage IVTA did not show an apparent benefit at 12 months after injection in patients with neovascular age-related macular degeneration.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Machemer R, Sugita G, Tano Y . Treatment of intraocular proliferations with intravitreal steroids. Trans Am Ophthalmol Soc 1979; 77: 171–180.
Tano Y, Chandler D, Machemer R . Treatment of intraocular proliferation with intravitreal injection of tramcinolone acetonide. Am J Ophthalmol 1980; 90: 810–816.
Tano Y, Sugita G, Abrams G, Machemer R . Inhibition of intraocular proliferation with intravitreal corticosteroid. Am J Ophthalmol 1980; 89: 131–136.
Ishibashi T, Miki K, Sorgente N, Patterson R, Ryan SJ . Effects of intravitreal administration of steroids on experimental subretinal neovascularization in the subhuman primate. Arch Ophthalmol 1985; 103: 708–711.
Antoszyk AN, Gottlieb JL, Machemer R, Hatchell DL . The effects of intravitreal triamcinolone acetonide on experimental pre-retinal neovascularization. Graefes Arch Clin Exp Ophthalmol 1993; 231: 34–40.
Machemer R . Five cases in which a depot steroid (hydrocortisone acetate and methylprednisolone acetate) was injected into the eye. Retina 1996; 16: 166–167.
Danis RP, Bingaman DP, Yang Y, Ladd B . Inhibition of preretinal and optic nerve head neovascularization in pigs by intravitreal triamcinolone acetonide. Ophthalmology 1996; 103: 2099–2104.
Penfold PL, Gyory JF, Hunyor AB, Billson FA . Exudative macular degeneration and intravitreal triamcinolone. A pilot study. Aust NZ J Ophthalmol 1995; 23: 293–298.
Challa JK, Gillies MC, Penfold PL, Gyory JF, Hunyor AB, Billson FA . Exudative macular degeneration and intravitreal triamcinolone: 18 month follow up. Aust NZ J Ophthalmol 1998; 26: 277–281.
Danis RP, Ciulla TA, Pratt LM, Anliker W . Intravitreal triamcinolone acetonide in exudative age-related macular degeneration. Retina 2000; 20: 244–250.
Jonas JB, Kreissig I, Degenring RF . Repeated intravitreal injections of triamcinolone acetonide as treatment of progressive exudative age-related macular degeneration. Graef Arch Clin Exp Ophthalmol 2002; 240: 873–874.
Ranson NT, Danis RP, Ciulla TA, Pratt L . Intravitreal triamcinolone in subfoveal recurrence of choroidal neovascularisation after laser treatment in macular degeneration. Br J Ophthalmol 2002; 86: 527–529.
Penfold PL . Intravitreal triamcinolone in recurrence of choroidal neovascularisation. Br J Ophthalmol 2002; 86: 600–601.
Gillies MC, Simpson JM, Luo W, Penfold P, Hunyor HB, Chua W et al. A randomized clinical trial of a single dose of intravitreal triamcinolone acetonide for neovascular age-related macular degeneration: one-year results. Arch Ophthalmol 2003; 121: 667–873.
Jonas JB, Kreissig I, Hugger P, Sauder G, Panda-Jonas S, Degenring R . Intravitreal triamcinolone acetonide for exudative age-related macular degeneration. Br J Ophthalmol 2003; 87: 462–468.
Spaide RF, Sorenson J, Maranan L . Combined photodynamic therapy with verteporfin and intravitreal triamcinolone acetonide for choroidal neovascularization. Ophthalmology 2003; 110: 1517–1525.
Jonas JB, Akkoyun I, Budde WM, Kreissig I, Degenring RF . Intravitreal re-injection of triamcinolone for exudative age-related macular degeneration. Arch Ophthalmol 2004; 122: 218–222.
Jonas JB, Degenring RF, Kreissig I, Friedemann T, Akkoyun I . Exudative age-related macular degeneration treated by intravitreal triamcinolone acetonide. A prospective comparative non-randomized study. Eye 2005; 19: 163–170.
Jonas JB, Kreissig I, Degenring RF . Factors influencing visual acuity after intravitreal triamcinolone acetonide as treatment of exudative age-related macular degeneration. Br J Ophthalmol 2004; 88: 1557–1562.
Jonas JB, Spandau UH, Harder B, Vossmerbaeumer U, Kamppeter BA . Inter-eye difference in exudative age-related macular degeneration with minimally classic or occult subfoveal neovascularisation after unilateral intravitreal injection of triamcinolone acetonide. Am J Ophthalmol 2005; 139: 1073–1079.
Jonas JB, Kreissig I, Degenring RF . Intravitreal triamcinolone acetonide for treatment of intraocular proliferative, exudative and angiogenic diseases. Prog Ret Eye Res 2005; 5: 587–611.
Jonas JB, Hayler JK, Söfker A, Panda-Jonas S . Intravitreal injection of crystalline cortisone as adjunctive treatment of proliferative diabetic retinopathy. Am J Ophthalmol 2001; 131: 468–471.
Jonas JB, Söfker A . Intraocular injection of crystalline cortisone as adjunctive treatment of diabetic macular oedema. Am J Ophthalmol 2001; 132: 425–427.
Martidis A, Duker JS, Greenberg PB, Rogers AH, Puliafito CA, Reichel E et al. Intravitreal triamcinolone for refractory diabetic macular oedema. Ophthalmology 2002; 109: 920–927.
Jonas JB, Hayler JK, Söfker A, Panda-Jonas S . Regression of neovascular iris vessels by intravitreal injection of crystalline cortisone. J Glaucoma 2001; 10: 284–287.
Greenberg PB, Martidis A, Rogers AH, Duker JS, Reichel E . Intravitreal triamcinolone acetonide for macular oedema due to central retinal vein occlusion. Br J Ophthalmol 2002; 86: 247–248.
Jonas JB, Kreissig I, Degenring RF . Endophthalmitis after intravitreal injection of triamcinolone acetonide. Arch Ophthalmol 2003; 121: 1663–1664.
Spandau UHM, Derse M, Schmitz-Valckenberg P, Papoulis C, Sagstetter BU, Stiefvater KH et al. Measurement of triamcinolone acetonide concentration after filtering of solvent agent. Am J Ophthalmol 2005; 139: 712–713.
Spandau U, Sauder G, Schubert U, Hammes HP, Jonas JB . Effect of triamcinolone acetonide on proliferation of retinal endothelial cells in vitro and in vivo. Br J Ophthalmol 2005; 89: 745–747.
Spaide RF, Sorenson J, Maranan L . Photodynamic therapy with verteporfin combined with intravitreal injection of triamcinolone acetonide for choroidal neovascularization. Ophthalmology 2005; 112: 301–304.
Smithen LM, Spaide RF . Photodynamic therapy and intravitreal triamcinolone for a subretinal neovascularization in bilateral idiopathic juxtafoveal telangiectasis. Am J Ophthalmol 2004; 138: 884–885.
Rechtman E, Danis RP, Pratt LM, Harris A . Intravitreal triamcinolone with photodynamic therapy for subfoveal choroidal neovascularization in age related macular degeneration. Br J Ophthalmol 2004; 88: 344–347.
Arevalo JF, Garcia RA, Mendoza AJ . Indocyanine green-mediated photothrombosis with intravitreal triamcinolone acetonide for subfoveal choroidal neovascularization in age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2005 May 20; [E-pub ahead of print].
Augustin AJ, Schmidt-Erfuhrt U . Verteporfin therapy combined with intravitreal triamcinolone in all types of choroidal neovascularisation due to age-related macular degeneration. Ophthlmology 2005, in press.
Augustin AJ, Schmidt-Erfuhrt U . Verteporfin and intravitreal triamcinolone acetonide combination therapy for occult choroidal neovascularisation in age-related macular degeneration. Am J Ophthalmol 2005, in press.
Schlotzer-Schrehardt U, Viestenz A, Naumann GO, Laqua H, Michels S, Schmidt-Erfuhrt U . Dose-related structural effects of photodynamic therapy on choroidal and retinal structures of human eyes. Graefes Arch Clin Exp Ophthalmol 2002; 240: 748–757.
Gragoudas ES, Adamis AP, Cunningham Jr ET, Feinsold M, Guyer DR, VEGF Inhibition Study in Ocular Neovascularization Clinical Trial Group. Pegaptanib for neovascular age-related macular degeneration. N Engl J Med 2004; 351: 2805–2816.
D'Amico DJ, Goldberg MF, Hudson H, Jerdan JA, Krueger DS, Luna SP et al. Anecortave acetate as monotherapy for treatment of subfoveal neovascularization in age-related macular degeneration: twelve-month clinical outcomes. Ophthalmology 2003; 110: 2372–2383.
Husain D, Kim I, Gauthier D, Luna AM, Tsilimbaris MK, Ezra E et al. Safety and efficacy of intravitreal injection of ranibizumab in combination with verteporfin PDT on experimental choroidal neovascularization in the monkey. Arch Ophthalmol 2005; 123: 509–516.
Verteporfin in Photodynamic Therapy (VIP) Study Group. Verteporfin therapy of subfoveal choroidal neovascularization in age-related macular degeneration: two year results of a randomized clinical trial including lesions with occultwith no classic choroidal neovascularization—Verteporfin in Photodynamic therapy report 2. Am J Ophthalmol 2001; 131: 541–560.
Wingate RJ, Beaumont PE . Intravitreal triamcinolone and elevated intraocular pressure. Aust NZ J Ophthalmol 1999; 27: 431–432.
Jonas JB, Degenring RF, Kreissig I, Akkoyun I, Kamppeter BA . Intraocular pressure elevation after intravitreal triamcinolone acetonide injection. Ophthalmology 2005; 112: 593–598.
Jonas JB, Degenring R, Kamppeter B, Kreissig I, Akkoyun I . Duration of the effect of intravitreal triamcinolone acetonide as treatment of diffuse diabetic macular oedema. Am J Ophthalmol 2004; 138: 158–160.
Sutter FK, Gillies MC . Pseudo-endophthalmitis after intravitreal injection of triamcinolone. Br J Ophthalmol 2003; 87: 972–974.
Roth DB, Chieh J, Spirn MJ, Green SN, Yarian DL, Chaudhry NA . Noninfectious endophthalmitis associated with intravitreal triamcinolone injection. Arch Ophthalmol 2003; 121: 1279–1282.
Gillies MC, Simpson JM, Billson FA, Luo W, Penfold P, Chua W et al. Safety of an intravitreal injection of triamcinolone: results from a randomized clinical trial. Arch Ophthalmol 2004; 122: 336–340.
Kaiser PK . Verteprofin therapy in combination with triamcinolone: published studies investigating a potential synergistic effect. Curr Med Res Opinion 2005; 5: 705–706.
Author information
Authors and Affiliations
Corresponding author
Additional information
Proprietary interest: none
Rights and permissions
About this article
Cite this article
Jonas, J., Spandau, U., Kamppeter, B. et al. Follow-up after intravitreal triamcinolone acetonide for exudative age-related macular degeneration. Eye 21, 387–394 (2007). https://doi.org/10.1038/sj.eye.6702222
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sj.eye.6702222
