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Second triamcinolone injection can have additional therapeutic effect
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NUREMBERG, Germany — A second injection of triamcinolone acetonide may further improve visual acuity in patients with exudative age-related macular degeneration, according to a study presented here at the German Ophthalmic Surgeons meeting.
Ingrid Kreissig, MD, and colleagues conducted a nonrandomized, prospective, comparative study to determine whether a second injection of triamcinolone can have a therapeutic effect additional to that of an initial injection. The researchers compared 13 eyes of 13 patients with exudative AMD to 24 control eyes of 24 patients also with exudative AMD. All patients received an initial injection of 20 mg of triamcinolone. The study group received a second injection of triamcinolone an average of 7.2 months after the first injection.
Preoperatively, no significant differences were noted between the two groups in IOP, age or refraction, Dr. Kreissig said.
Visual acuity improved in 10 of the 13 eyes in the study group (77%), and three eyes showed no change. The improvements in VA were statistically significant after 2 months, Dr. Kreissig said.
Following the second injection, there was again a significant improvement in VA of 0.15 to a maximum of 0.23, she said.
“In six eyes, or 46%, there was a repeated improvement in visual acuity of more than two Snellen lines,” Dr. Kreissig said.
In the control group, VA did not significantly improve during the follow-up period.
None of the eyes required cataract surgery, she added.
Following the initial triamcinolone injection, a maximum increase in IOP of 20.2 mm Hg was seen at the 4-month follow-up. Increases were readily controlled with antiglaucoma medications, Dr. Kreissig said.
Following the second injection, mean IOP increased to a maximum of 19 mm Hg at 3 and 9 months. Three eyes (23%) had IOPs above 21 mm Hg, and one eye required trabeculectomy. Dr. Kreissig said the differences in pressure following the first and second injections were not statistically significant.
Dr. Kreissig added that patients who showed improvement in VA after the first injection can be expected to have a subsequent improvement following the second injection. Likewise, patients whose ocular hypertension did not increase after the first injection were not expected to show an increase after the second.