Evaluation of Intravitreal Kenalog Toxicity in Humans
Presented in part at: American Academy of Ophthalmology meeting, October 2005, Chicago, Illinois.
Received 3 March 2006; accepted 11 August 2006. published online 15 January 2007.
Objective
To evaluate possible functional toxicity of intravitreal Kenalog (commercial triamcinolone acetonide) in patients’ retinas.
Design
Observational case series.
Participants
Thirty-two phakic eyes of 16 patients who had nonproliferative diabetic retinopathy and bilateral macular edema refractory to laser therapy, which had no other eye disorder and no previous ophthalmic operation.
Intervention
Kenalog (4 mg/0.1 ml) was injected intravitreally to one eye, whereas the second eye served as the control. The experimental eye was chosen as the eye with worse visual acuity (VA).
Main Outcome Measures
Deterioration of electroretinogram parameters of the study eye measured at 3 months of follow-up when compared with the electroretinogram responses of the fellow, control eye and when compared with electroretinogram responses obtained before injection. Visual acuity, intraocular pressure (IOP), and eventual complications were assessed. No improvement or deterioration of VA or any increase in IOP was regarded as a secondary outcome.
Results
Average maximal response amplitude ratios of the dark-adapted b-wave (treated/control eyes) of the electroretinogram were 0.93 before (P = 0.221) and 0.94 (P = 0.387) 3 months after Kenalog injection. Average ratios of the light-adapted b-wave amplitude (treated/control eyes) of the electroretinogram were 1.04 (P = 0.702) before and 0.86 (P = 0.138) 3 months after Kenalog injection. No significant differences (P>0.05) were found between the electroretinogram parameters obtained from all eyes before and 3 months after Kenalog injection. Average VAs in the treated eyes were 1.08, 0.8, and 1.0 logarithm of the minimum angle of resolution units before and 2 and 4 months after injection, respectively. Temporary elevation of IOP was found in 4 treated eyes of 4 patients (25%).
Conclusions
No electroretinographic evidence of a retinotoxic effect of intravitreal Kenalog was found in our patients.
1Department of Ophthalmology, Ha’Emek Medical Center, Afula, Israel.
2Department of Ophthalmology, Rambam Medical Center, Haifa, Israel.
3Department of Physiology, Ruth and Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology and Rappaport Institute, Haifa, Israel.
Correspondence to Yaron Lang, MD, Department of Ophthalmology, Ha’Emek Medical Center, Afula 18000, Israel.
Manuscript no. 2006-267.
The authors have no financial or proprietary interest in any of the products mentioned in the article.
ABSTRACT