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Intravitreal Triamcinolone for Retinal Diseases |
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| Intravitreal Triamcinolone for Retinal Diseases |
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作者：Associat… 文章来源：Retinal Therapeutics Research Group, Save Sight Institute, University of Sydney and Sydney Eye Hospital 点击数：2608 更新时间：2004/7/11 
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| Triamcinolone acetonide administered by intravitreal injection has recently been proposed as a treatment for a variety of retinal conditions, especially those characterised by cystoid macular oedema. Experience with neovascular age-related macular degeneration, however, has shown that treatments that show promise when studied without controls often are no better, and sometimes worse, than placebo when randomised, placebo-controlled clinical trials are been performed. The only two randomised clinical trials of triamcinolone yet reported for retinal diseases have been performed at the Sydney Eye Hospital.
The IntraVitreal TriAmcinolone for exudative age related macular degeneration Study (IVTAS) studied the rate of severe visual loss over 12 months in 151 eyes with subfoveal neovascularisation, any part of which was classic, after a single injection of triamcinolone acetonide (4 mg). There was no difference between placebo-treated and triamcinolone-treated eyes with respect to loss of vision, although triamcinolone caused a small but significant reduction in the growth of neovascularisation when examined with fluorescein angiography 3 months after the injection. A single injection had a manageable adverse event profile. Elevated intraocular pressure was found in 42% of eyes and 25% developed cataract that required surgery when eyes were followed for up to 3 years.
The Triamcinolone for Diabetic Macular Oedema (TDMO) study compared intravitreal triamcinolone with standard treatment in 65 eyes. 18/33 (55%) eyes treated with triamcinolone gained five or more letters of best corrected visual acuity compared with 5/32 (16%) eyes treated with placebo (P=0.002). Optical coherence tomography showed a mean reduction of central retinal thickness of 152 µm in triamcinolone treated eyes compared with 36 µm for placebo. One triamcinolone-treated eye developed infectious endophthalmitis which was adequately treated without loss of visual acuity. The long-term (2 year) results of this study will be available in 2005.
Other studies using optical coherence tomography after intravitreal triamcinolone for radiation retinopathy, uveitis and minimally classic neovascularisation in age-related macular degeneration suggest that the major effect of triamcinolone is to reduce macular oedema. The mechanism by which this occurs is poorly understood.
Intravitreal triamcinolone has a significant adverse event profile and is not particularly helpful for subretinal neovascularisation. In the short-term, however, it appears very efficacious for diabetic macular oedema that persists despite conventional treatment. Only randomised clinical trials can establish how long this effect lasts, and whether it is helpful for other causes of macular oedema.
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