Dose moderation key in limiting toxicity of intracameral triamcinolone

Chicago-Intracameral triamcinolone acetonide (Kenalog, Bristol–Myers Squibb) used judiciously offers simple and safe anti-inflammatory treatment in cataract surgery patients, said James P. Gills, MD, at "Spotlight on Cataract Surgery in 2005" during the annual meeting of the American Academy of Ophthalmology.

“The benefits of intracameral triamcinolone for the provider and patient are high, but it is very important to consider the dose. Intraocular medicines are safe only when used in a careful way,” Dr. Gills said.

Reports regarding intracameral triamcinolone during cataract surgery indicate that doses of up to 25 mg are being used. However, a dose as low as 0.5 mg can provide the desired anti-inflammatory effect, albeit with a shorter duration than higher doses, but also with a much better safety profile.

Dr. Gills advocated keeping the dose of intracameral triamcinolone below 2 mg, adding ascorbic acid to the irrigation solution as it appears to reduce potential side effects of the steroid, and using supplemental subconjunctival and topical corticosteroids for supplemental anti-inflammatory treatment.

He noted that in glaucoma patients, the 2 mg dose of intracameral triamcinolone can induce an IOP steroid response. However, that adverse event occurs less frequently with intracameral triamcinolone compared with the use of topical steroids. In addition, the IOP elevation is transient (3 to 6 weeks duration) and has not required surgery in any patients.