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

Figures & data

Figure 1 A 22-µm pore filter mounted on a 27-gauge 1 mL tuberculin syringe.

Notes: The micropores will prevent the passage of TA crystals during the preparation of high-dose IVTA from the commercial TA suspension. A close-up of the filter is shown in the inset.
Abbreviations: IVTA, intravitreal triamcinolone acetonide; TA, triamcinolone acetonide.

Table 1 Baseline patient characteristics

Baseline characteristics	N (%)
Male	116 (69)
Female	52 (31)
Age, years
<40	19 (11.3)
40–50	24 (14.3)
51–60	59 (35)
61–70	80 (48)
>70	25 (15)
Baseline IOP, mmHg
<10	1 (0.5)
10–14	130 (63)
15–18	68 (33)
>18–20	8 (4)
Baseline lens status
Phakic	159 (77)
Pseudophakic	47 (23)
Aphakic	1 (0.5)
Pathology
DME	132 (64)
RVO	39 (19)
OND	14 (7)
Uveitis	9 (4.3)
VMT-related ME	6 (3)
IGS	5 (2.4)
IRR	2 (1)
Number of injections
1	161 (78)
2–4	44 (21)
>4	2 (1)

Abbreviations: DME, diabetic macular edema; IGS, Irvine–Gass syndrome; IOP, intraocular pressure; IRR, Interferon-related retinopathy; ME, macular edema secondary to vitreomacular traction; OND, optic nerve disease; RVO, retinal vein occlusion; VMT, vitreomacular traction.

Table 2 Postoperative complications

Complications	N (%)
Cataract	86 (54)
Transient IOP rise	52 (25.3)
Glaucoma	38 (18.5)
Using 1 drop	16 (8)
Using 2 drops	8 (4)
Using 3 drops	9 (4.3)
Glaucoma surgery	5 (2.4)
Retinal detachment	1 (0.5)
Endophthalmitis	1 (0.5)

Abbreviation: IOP, intraocular pressure.

Table 3 Stratification of patients with increased IOP following high-dose IVTA injection

IOP status post-high-dose IVTA	N (%)
IOP rise	90 (44)
Glaucoma	38 (18.5)
Glaucoma surgery
Total	5 (2.4)
High-dose IVTA related	2 (1)
Post-NVG	1 (0.5)
Post-panuveitis (PAS and posterior synechiae)	2 (1)

Abbreviations: IOP, intraocular pressure; IVTA, intravitreal triamcinolone acetonide; NVG, neovascular glaucoma; PAS, peripheral anterior synechiae.

Table 4 Relative contribution (%) of number of high-dose IVTA injections to the development of complications

Number of injections	Glaucoma		Using 1 drop		Using 2 drops		Using 3 drops		Glaucoma surgery		Cataract
	Yes	No	Yes	No	Yes	No	Yes	No	Yes	No	Yes	No	IOL
1	78.3%	21.7%	91.9%	8.1%	95.0%	5.0%	95.7%	4.3%	96.9%	3.1%	32.3%	42.2%	25.5%
2	89.5%	10.5%	92.1%	7.9%	100.0%	0.0%	97.4%	2.6%	100.0%	0.0%	71.1%	15.8%	13.2%
3	80.0%	20.0%	100.0%	0.0%	100.0%	0.0%	80.0%	20.0%	100.0%	0.0%	60.0%	20.0%	20.0%
4	100.0%	0.0%	100.0%	0.0%	100.0%	0.0%	100.0%	0.0%	100.0%	0.0%	100.0%	0.0%	0.0%
5	100.0%	0.0%	100.0%	0.0%	100.0%	0.0%	100.0%	0.0%	100.0%	0.0%	0.0%	100.0%	0.0%
6	100.0%	0.0%	100.0%	0.0%	100.0%	0.0%	100.0%	0.0%	100.0%	0.0%	0.0%	0.0%	100.0%
Chi-square	13.209		16.890		18.161		17.364		19.580		26.828
P-value	0.046		0.0211		0.0177		0.0199		0.0159		0.003

Abbreviation: IVTA, intravitreal triamcinolone acetonide.

Table 5 Relative contribution (%) of the primary pathology to the development of complications

Pathology	Glaucoma		Using 1 drop		Using 2 drops		Using 3 drops		Glaucoma surgery
	Yes	No	Yes	No	Yes	No	Yes	No	Yes	No
DME	86.5%	13.5%	91.7%	8.3%	99.2%	0.8%	97.0%	3.0%	98.5%	1.5%
RVO	73.7%	26.3%	94.7%	5.3%	89.5%	10.5%	94.7%	5.3%	100.0%	0.0%
Uveitis	55.6%	44.4%	100.0%	0.0%	100.0%	0.0%	77.8%	22.2%	77.8%	22.2%
AION	75.0%	25.0%	100.0%	0.0%	75.0%	25.0%	100.0%	0.0%	100.0%	0.0%
Papillitis	66.7%	33.3%	100.0%	0.0%	100.0%	0.0%	66.7%	33.3%	100.0%	0.0%
IRR	0.0%	100.0%	50.0%	50.0%	100.0%	0.0%	100.0%	0.0%	50.0%	50.0%
DP	66.7%	33.3%	100.0%	0.0%	66.7%	33.3%	100.0%	0.0%	100.0%	0.0%
IGS	80.0%	20.0%	80.0%	20.0%	100.0%	0.0%	100.0%	0.0%	100.0%	0.0%
VMT-related ME	83.3%	16.7%	83.3%	16.7%	100.0%	0.0%	100.0%	0.0%	100.0%	0.0%
Chi-square	16.994	17.229	25.643	14.717	32.220
P-value	0.030	0.019	0.001	0.050	<0.001

Abbreviations: AION, anterior ischemic optic neuropathy; DME, diabetic macular edema; DP, diabetic papillopathy; IGS, Irvine-Gass syndrome; IOL, intraocular lens; IRR, Interferon-related retinopathy; ME, macular edema secondary to vitreomacular traction; RVO, retinal vein occlusion; VMT, vitreomacular traction.