Safety of high-dose intravitreal triamcinolone acetonide as low-cost alternative to anti-vascular endothelial growth factor agents in lower-middle-income countries

• Published in: Clinical ophthalmology (Auckland, N.Z.) N.Z.), 2018-01, Vol.12, p.2383-2391
• Main Authors: Ghoraba, Hammouda Hamdy, Leila, Mahmoud, Elgouhary, Sameh Mohamed, Elgemai, Emad Eldin Mohamed, Abdelfattah, Haithem Mamon, Ghoraba, Hashem Hammouda, Heikal, Mohamed Amin
• Format: Article
• Language: English
• Subjects: Aflibercept; Bevacizumab; Binding sites; Cataracts; Comparative analysis; Cost-effectiveness of anti-VEGF; Diabetes; Diabetic retinopathy; Displays (Marketing); Dosage and administration; Drug dosages; Economic aspects; Edema; Endophthalmitis; Endothelial growth factors; Eye surgery; Fluocinolone; Glaucoma; Glucocorticoids; High-dose IVTA; ICER of anti-VEGF per QALY; Iodine; Macular degeneration; Medical research; Ophthalmology; Optic nerve; Original Research; Patients; Povidone; Ranibizumab; Retinal detachment; Retinal diseases; Safety and security measures; Steroids (Organic compounds); Studies; Surgery; Systematic review; Teaching hospitals; Terminology; Triamcinolone; Vascular endothelial growth factor; Veins & arteries
• ISSN: 1177-5467; 1177-5483; 1177-5483
• DOI: 10.2147/OPTH.S185274

The purpose of this study was to evaluate the safety of high-dose intravitreal triamcinolone acetonide (IVTA) as affordable low-cost alternative to anti-vascular endothelial growth factor (anti-vascular endothelial growth factor [anti-VEGF] agents) in lower-middle-income countries. This was a retrospective interventional non-comparative case series. The study recruited patients who received 20 mg IVTA for treating various retinal and optic nerve diseases over the past 5 years. Main outcome measure was assessment of complications secondary to high-dose IVTA. The crosstabs procedure was used to display the interaction between the variables tested. The ANOVA test was used to analyze the differences among group means. The study included 207 eyes of 168 patients. The main indication for high-dose IVTA were diabetic macular edema 64%, and macular edema secondary to retinal vein occlusion 19%. The mean follow-up period post-injection was 22 months. Mean number of injections was 1.3. Cataract developed in 54% of eyes. Glaucoma developed in 18.5% of eyes. Glaucoma surgery for intractable glaucoma attributed to high-dose IVTA was needed in 1% of eyes. Endophthalmitis and retinal detachment developed in one patient each. High-dose IVTA is a safe and cost-effective alternative to anti-VEGF agents. Cataract formation and intraocular pressure rise do not pose major adverse effects when weighed against the risk of vision loss due to inability to afford anti-VEGF treatment.