triamcinolone intravitreal

Action and Spectrum

Actions and Spectrum: 

triamcinolone acetonide is a corticosteroid medication that can be administered intravitreally, meaning it is injected into the eye’s vitreous humor. The intravitreal route allows targeted medication delivery to the retina and surrounding tissues.  

Action: 

• Anti-inflammatory: triamcinolone acetonide has potent anti-inflammatory properties. It suppresses the release of inflammatory mediators and inhibits the migration of inflammatory cells, thereby reducing inflammation in the eye. 
• Immunosuppressive: triamcinolone inhibits the activity of immune cells, such as macrophages and lymphocytes, which play a role in immune-mediated eye conditions. By suppressing the immune response, it helps to alleviate certain ocular diseases. 
• Anti-angiogenic: triamcinolone can inhibit the growth of abnormal blood vessels in the eye, a process known as angiogenesis. This property is beneficial in treating certain retinal conditions characterized by excessive blood vessel growth, such as macular edema. 

The Spectrum of Use: 

• Macular Edema: triamcinolone intravitreal injections are commonly used to treat macular edema, which is the swelling of the central part of the retina (macula). It can occur due to various conditions, including diabetic retinopathy, retinal vein occlusion, and uveitis. triamcinolone helps reduce macular edema by reducing inflammation and suppressing vascular leakage. 
• Retinal Vein Occlusion: triamcinolone may be used in cases of retinal vein occlusion, where a blockage occurs in veins that drain blood from the retina. It helps to reduce macular edema and improve visual outcomes in these cases. 
• Uveitis: It refers to inflammation of the uvea, the eye’s middle layer. triamcinolone can be effective in controlling inflammation associated with uveitis. 
• Other Conditions: triamcinolone intravitreal injections may also be considered for certain other retinal disorders, such as proliferative diabetic retinopathy, choroidal neovascularization, and certain types of macular degeneration. However, the use of triamcinolone for these conditions is typically less common compared to other treatment options. 

Drug Interaction

Adverse Reaction

Frequency not defined 

Glaucoma 

Hypopion 

Abnormal sensation in the eye 

Anterior chamber cells 

Vitreous detachment 

Eye pruritus 

Cataract cortical 

Injection site hemorrhage 

Cataract subcapsular 

Conjunctival hemorrhage 

Increased intraocular pressure 

Cataract nuclear 

Anterior chamber flare 

Exophthalmos 

Optic disc vascular disorder 

Lacrimation increased 

Vitreous floaters 

Foreign body sensation in the eyes 

Cataract 

Black Box Warning

Black Box Warning: 

None 

Contraindication / Caution

Contraindication/Caution: 

Contraindication 

• Ocular Infections: triamcinolone should not be used when there is an active ocular infection, such as bacterial, viral, or fungal infection in or around the eye. The presence of an infection may be worsened or masked by the immunosuppressive effects of the corticosteroid, potentially leading to complications. 
• Hypersensitivity: Individuals who have known hypersensitivity or allergic reactions to triamcinolone acetonide or any of its components should not receive intravitreal injections of triamcinolone. 
• Glaucoma: triamcinolone can increase intraocular pressure (IOP), which can be problematic for individuals with pre-existing glaucoma. Intravitreal triamcinolone injections may exacerbate glaucoma symptoms and elevate IOP, potentially leading to optic nerve damage. 
• Cataracts: triamcinolone can accelerate the formation or progression of cataracts, clouding the eye’s lens. Individuals with significant pre-existing cataracts may be at higher risk of vision impairment or complications following intravitreal injections of triamcinolone. 
• Retinal Detachment: triamcinolone intravitreal injections may not be recommended if there is a pre-existing retinal detachment or a high risk of retinal detachment. The injection procedure can potentially worsen the detachment or increase the risk of developing a detachment. 
• Ocular Herpes Simplex: Individuals with a history of ocular herpes simplex virus (HSV) infection should avoid triamcinolone intravitreal injections due to the risk of reactivation and exacerbation of the herpes infection. 
• Uncontrolled Systemic Infections: In the presence of uncontrolled systemic infections, such as tuberculosis or systemic fungal infections, triamcinolone intravitreal injections should be avoided due to the risk of disseminating the infection. 

Caution 

• Glaucoma Susceptibility: Individuals with a family history of glaucoma or those at high risk for developing glaucoma should be closely monitored for changes in intraocular pressure (IOP) following triamcinolone injections. Elevated IOP can lead to glaucoma or worsen pre-existing glaucoma. 
• Diabetes: triamcinolone can affect blood sugar levels and may cause hyperglycemia (high blood sugar) in individuals with diabetes. Close monitoring of blood glucose levels is generally recommended during and after triamcinolone intravitreal injections. 
• Cataracts: As mentioned earlier, triamcinolone can accelerate the formation or progression of cataracts. Individuals with mild to moderate cataracts should be closely monitored for changes in visual acuity and lens opacity following the injection. 
• Ocular Herpes Simplex: While it is listed as a contraindication, in cases where the benefits outweigh the risks, triamcinolone intravitreal injections may still be considered in individuals with a history of ocular herpes simplex virus (HSV) infection. However, caution should be exercised, and antiviral prophylaxis may be necessary to minimize the risk of viral reactivation. 
• Pregnancy and Breastfeeding: The safety of triamcinolone intravitreal injections during pregnancy and breastfeeding has not been established. It should be used cautiously and only if the potential benefits outweigh the risks. The decision should be made in consultation with a healthcare provider. 
• Ocular Surgery: triamcinolone injections should be used with caution in individuals who have undergone recent ocular surgery or have plans for ocular surgery. triamcinolone in the eye may affect the surgeon’s ability to visualize structures during surgery. 
• Systemic Side Effects: Although the systemic absorption of triamcinolone from intravitreal injections is generally low, it can still cause systemic side effects. Individuals with a history of systemic corticosteroid use should be monitored for potential systemic effects such as adrenal suppression, osteoporosis, and immune system suppression. 

Pregnancy / Lactation

Pregnancy consideration:  

US FDA pregnancy category: D 

Lactation:   

Excreted into human milk: Yes 

Pregnancy category: 

• Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 
• Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 
• Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    
• Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.    
• Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    
• Category N: There is no data available for the drug under this category 

Pharmacology

Pharmacology: 

triamcinolone acetonide, when administered intravitreally, exhibits potent anti-inflammatory and immunosuppressive effects. As a synthetic corticosteroid, it inhibits the production and release of inflammatory mediators, reducing tissue swelling, vasodilation, and immune cell infiltration in the eye.

It suppresses the activity of immune cells, such as macrophages and lymphocytes, which play a role in immune-mediated eye conditions. Additionally, triamcinolone has anti-angiogenic properties, inhibiting the growth of abnormal blood vessels in the eye.

These pharmacological actions of triamcinolone intravitreal injections make it effective in reducing macular edema and managing retinal vein occlusion, uveitis, and some instances of choroidal neovascularization. 

Pharmacodynamics: 

Mechanism of action: when administered intravitreally, triamcinolone acetonide exerts its therapeutic effects through several mechanisms of action.  

• Anti-inflammatory Action: triamcinolone is a synthetic corticosteroid that is a potent anti-inflammatory agent. It functions by binding to intracellular glucocorticoid receptors, leading to the modulation of gene transcription and subsequent suppression of inflammatory mediators. By inhibiting the production and release of the pro-inflammatory cytokines, chemokines, and other inflammatory molecules, triamcinolone helps to reduce inflammation within the eye, including the suppression of edema and the infiltration of immune cells. 
• Vascular Permeability Reduction: triamcinolone can decrease vascular permeability in the retina. It helps to stabilize the blood-retinal barrier by inhibiting the leakage of fluid and proteins from the blood vessels into surrounding retinal tissue. This action is particularly beneficial in macular edema, where excess fluid accumulates in the macula, leading to vision impairment. 
• Anti-Angiogenic Effects: triamcinolone exhibits anti-angiogenic properties, which means it can inhibit the formation of abnormal blood vessels. In conditions like choroidal neovascularization (CNV) associated with age-related macular degeneration, triamcinolone helps to suppress the growth of new blood vessels below the retina, reducing the risk of vision loss. 
• Immunomodulatory Effects: triamcinolone exerts immunomodulatory effects by suppressing the activity of immune cells, including macrophages and lymphocytes. triamcinolone can help manage inflammatory eye conditions, such as uveitis, by reducing immune cell infiltration and subsequent tissue damage by inhibiting the immune response. 

Pharmacokinetics: 

Absorption 

triamcinolone is slowly absorbed into the systemic circulation after intravitreal injection. The absorption rate can vary, but generally, the drug remains localized within the vitreous cavity, resulting in minimal systemic exposure. 

Distribution 

triamcinolone is distributed within the vitreous humor of the eye after intravitreal administration. Its distribution beyond the eye is limited, with minimal penetration into the systemic circulation. The drug does not readily cross the blood-retinal barrier or blood-aqueous barrier. 

Metabolism 

triamcinolone undergoes hepatic metabolism, primarily by enzymatic processes, including oxidation and conjugation. The significant triamcinolone metabolites are inactive or have significantly reduced glucocorticoid activity. Metabolism primarily occurs in the liver, but systemic exposure to metabolites is generally low after intravitreal injection due to limited systemic absorption. 

Elimination and Excretion 

triamcinolone and its metabolites are eliminated primarily via the kidneys. However, following intravitreal injection, the elimination of triamcinolone from the vitreous cavity occurs slowly, with a gradual decrease in concentration over time. Systemic excretion of triamcinolone and its metabolites is limited due to the low systemic exposure associated with intravitreal administration. 

Adminstartion

Administration: 

Intravitreal administration 

triamcinolone acetonide is administered intravitreally and injected into the eye’s vitreous cavity. A qualified ophthalmologist should perform the procedure in a sterile environment.  

• Pre-Injection Evaluation: Before the procedure, the ophthalmologist will evaluate the patient’s ocular condition and medical history and perform a thorough eye examination, including intraocular pressure (IOP) measurement. This evaluation helps determine the suitability of triamcinolone intravitreal injections and assess potential risks. 
• Informed Consent: The ophthalmologist will explain the procedure, its benefits, risks, and potential complications to the patient. Informed consent will be obtained, and any questions or concerns can be addressed. 
• Preparation: The eye and surrounding area will be cleansed with an antiseptic solution, and a sterile drape will be placed over the patient’s face to maintain a sterile field. 
• Anesthesia: Local anesthesia is typically administered to numb the eye and make the procedure more comfortable. This can be done using topical anesthetic eye drops and subconjunctival injection of a local anesthetic agent. 
• Injection Procedure: The ophthalmologist will use a specialized injection technique to deliver the triamcinolone acetonide into the vitreous cavity. The injection is usually performed through the pars plana, which is the area of the eye located behind the iris and the ciliary body. 
• Post-Injection Care: After the injection, the eye may be monitored for a short period to ensure the stability of intraocular pressure. Antibiotic eye drops/ointment may be prescribed to prevent infection, and a patch or shield may be placed over the eye for protection. The patient will receive post-injection instructions regarding activities, medication use, and follow-up visits. 
• Follow-up Visits: Regular follow-up visits will be scheduled to monitor the response to the injection, assess visual acuity, check for complications, and determine the need for subsequent injections or alternative treatments. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: triamcinolone intravitreal 

Pronounced: [ trye-am-SIN-oh-lone-IN-tra-VIT-ree-al ] 

Why do we use triamcinolone intravitreal 

When administered intravitreally, triamcinolone acetonide has several uses in treating various ocular conditions. Here are some typical indications for triamcinolone intravitreal injections: 

• Macular Edema: triamcinolone intravitreal injections are commonly used to manage macular edema. This condition involves the swelling of the central part of the retina (macula) and can occur due to several underlying causes, such as diabetic retinopathy, retinal vein occlusion, and uveitis. triamcinolone helps reduce macular edema by suppressing inflammation and decreasing vascular leakage. 
• Retinal Vein Occlusion: triamcinolone injections may be employed in cases of retinal vein occlusion, a condition characterized by the blockage of the retinal veins. This blockage can lead to macular edema and vision loss. triamcinolone can help alleviate macular edema associated with retinal vein occlusion by reducing inflammation and improving fluid dynamics in the retina. 
• Uveitis: It refers to the inflammation of the uvea, which is the eye’s middle layer. triamcinolone intravitreal injections can be used as an adjunctive treatment in cases of uveitis to help suppress intraocular inflammation and reduce associated complications. 
• Diabetic Retinopathy: triamcinolone may be considered in some instances of diabetic retinopathy, mainly when macular edema is present. It helps reduce edema and improve visual outcomes in some individuals with diabetic retinopathy, though other treatment options are also available. 
• Choroidal Neovascularization: triamcinolone can be used as a temporary treatment option for some choroidal neovascularization (CNV) instances. CNV involves the abnormal growth of blood vessels beneath the retina and can occur in conditions such as age-related macular degeneration. triamcinolone injections help reduce inflammation and suppress abnormal blood vessel growth.