Steroids may increase risks for retinal complications

DANA POINT, Calif. — Steroids may not be the “ultimate solution” for treating patients with retinal diseases because of the risks associated with their use, said Anurag Gupta, MD, here at the Ocular Drug & Surgical Therapy Update meeting.

“Steroids are used for everything from diabetic macular edema to central retinal vein occlusions, branch retinal vein occlusions, and just about everything else out there,” Dr. Gupta said. “Why do we use them? Primarily, we just were not happy with what we had. Treatments weren’t giving us the bigger results we wanted, and intraocular steroids have a rapid effect and are fairly easy to administer.”

But despite their current popularity, complications have been associated with intraocular steroid injections, he said.

“Intravitreal triamcinolone may have a higher incidence of endophthalmitis than other intravitreal antibiotics,” Dr. Gupta said. The use of intravitreal steroids may also cause elevated IOP, cataract, retinal detachment and vitreous hemorrhage, he noted.

“Even a single injection of triamcinolone may lead to an increased IOP and increased cataract,” he said.

These are all known complications of intravitreal steroids, Dr. Gupta said, but there is evidence that other damage may be taking place as well.

“We are starting to find a little more information about what is happening at the cellular level,” he said. “Early evidence right now in the laboratory suggests possible photoreceptor disorganization as well as other retinal cell deaths, and this is at currently used dosages and smaller dosages as well.”