EXUDATIVE MACULAR DEGENERATION AND INTRAVITREAL TRIAMCINOLONE - 18 MONTH FOLLOW-UP

Purpose: To evaluate the safety and efficacy of intravitreal triamcino lone after 18 months of follow up in patients with age-related macular degeneration and subfoveal or juxtafoveal choroidal neovascularizatio n considered unsuitable for laser photocoagulation. Methods: Thirty ey es of 28 patients, referred from general eye clinics as well as the pr ivate clinic of one of the authors to a hospital-based retinal out-pat ient clinic, were treated with an intravitreal injection of triamcinol one (4 mg). The primary outcome measure was the proportion of eyes wit h loss of six or more lines on a Bailey-Lovie Chart. The incidence of adverse events associated with treatment was also observed. Results: O f the 20 eyes with initial visual acuity (VA) of 6/60 or better the vi sion was maintained (+/- 1 Bailey-Lovie lines) in I I eyes (55%),while six eyes (30%) suffered severe visual loss (six or more lines). The V A improved by live to six lines in three of 10 eyes with initial visio n of 3/60 or worse. Three of four eyes receiving a second injection su ffered either progressive cataract or elevated intra-ocular pressure ( IOP) requiring cataract surgery and/or filtering surgery. One of 26 ey es (3%) receiving a single injection showed progression of cataract an d elevation of IOP within 6 weeks of treatment and required anti-glauc oma medication for 6 weeks. Progression of nuclear sclerosis 8- 12 mon ths after treatment was observed in six of 26 eyes (23%) receiving a s ingle injection. Conclusions: The results of the present study suggest that a single intravitreal injection of 4 mg triamcinolone is reasona bly well tolerated by the human eye. The rate of development of severe visual loss was less than reported for historical controls. Because t he results are preliminary and uncontrolled, the treatment should not be used routinely until its benefit to patients is established by a pr ospective, randomized controlled study.