The Use of Intravitreal Triamcinolone Acetonide – An Overview

Triamcinolone acetonide is an intermediate-acting, relatively powerful steroid (see Table 1). Like all steroids, it dampens both the cell-mediated and the humoral component of inflammatory reactions. Clinically, this translates to reduced vessel permeability, justifying the use of this drug in most cases of macular oedema. It has also been shown to block the breakdown of the blood–ocular barrier by modulating effector proteins downstream of the vessel growth factor (VEGF) receptor.1 Triamcinolone acetonide has been shown to be present in the vitreous up to three months after delivery.2 It should be kept in mind that this is true only for non-vitrectomised eyes; in eyes that have been vitrectomised the drug is present for much shorter periods of time after delivery and is, to some extent, related to the amount of vitreous still present. The use of intravitreal triamcinolone acetonide (IVT) has given ophthalmologists new treatment options in a variety of ocular ailments, as demonstrated by the large number of papers and reports on this topic that are now available. This is not surprising, as IVT is the solution to many retinal conditions in which potent and localised suppression of the inflammatory cascade is needed. However, there are indications, limitations and side effects to the use of the drug that must be considered in clinical practice.