Centrifuged-Concentrated Intravitreal Slurry Triamcinolone Acetonide: An Inexpensive, Easy, and Viable Alternative to Long-Term Steroid Delivery

摘要

Purpose: This work reports the duration, safety, and viability of intravitreal slurry triamcinolone acetonide (TA; 1.0 mL of 40-mg/mL TA centrifuge concentrated into a 0.1-mL pellet) to treat cystoid macular edema (CME). Methods: A retrospective, consecutive review was conducted of patients undergoing intravitreal slurry TA injections, July 2009 to December 2018. Results: In 143 eyes of 120 patients, slurry TA resolved CME for a mean of 327.15 (SD?=?213.11) days, or 10.76 (SD?=?7.00) months, per intravitreal injection (n?=?466). In 100 eyes requiring multiple injections (n?=?423), mean duration was 270.95 (SD?=?177.14) days, or 8.91 (SD?=?5.82) months, between injections. In 43 single-injection eyes, duration was 749.30 (SD?=?483.17) days, or 24.63 (SD?=?15.88) months. Mean duration decreased from 337.89 (SD?=?210.46) days, or 11.11 (SD?=?6.92) months, in nonvitrectomized eyes to 279.74 (SD 179.63) days, or 9.20 (SD?=?5.91) months, in vitrectomized eyes (n?=?74 injections, t ?=?2.24, P ?=?.014, 1-tailed). Central foveal thickness as shown on optical coherence tomography decreased by 173.89μ (SD?=?147.56μ), from 459.16μ (SD?=?47.14μ) to 285.27μ (SD?=?77.27μ; t ?=?–25.31, P ? ?10 mm Hg increase from baseline) 94.79 days (SD?=?85.52 days), or 3.11 (SD?=?2.81) months, following injection. Conclusions: A single injection of slurry TA lasted on average 10.76 months with significant improvement of CME and visual acuity. Adverse ocular effects were comparable to currently available, long-term, implantable steroids. Slurry TA appears to be an easily reproducible, safe, and cost-effective alternative to long-term intraocular steroid delivery.