Early Intravitreal Triamcinolone Acetonide Injection Improves Visual Outcomes in Open Globe Injury: Study

Researchers have found that early intravitreal injection of triamcinolone acetonide (TA) significantly reduces the severity of traumatic proliferative vitreoretinopathy (TPVR) and improves functional outcomes of patients with open globe injury (OGI). A recent study was published in The British Journal Of Ophthalmology by Guo H. and colleagues. This approach is novel and provides a hint toward better outcomes in patients with severe ocular trauma.

A prospective single-center randomized controlled trial was conducted on patients presenting with globe rupture injuries in zone III. Patients were then randomly assigned into one of two groups: 34 patients received a 0.1 mL intravitreal injection of TA at the end of the emergency surgery, while 34 patients in the control group received 0.1 mL of balanced salt solution. The allocation ratio was 1:1 to balance the two arms in this study. The primary outcome measure was the severity of TPVR during the performance of vitrectomy, 10±3 days after the initial surgery. The secondary outcomes measured included the improvement in VA; the anatomical retinal and macular attachment rates; the recurrence of PVR; and the side effects noted six months following vitrectomy.

There were a number of key differences in outcomes between the TA-treated versus the control groups:

  • There was significantly less serious TPVR in the TA group when compared to controls during vitrectomy (p=0.028).

  • During TPVR scoring, the mean in the TA group was 9.30 ± 0.82 and that of the control group was 6.44 ± 1.06. This increase in the TA group was statistically significant upon comparison (p=0.036).

  • The improvement in visual acuity was statistically significant after six months, showing 92% in the TA group versus 63.64% in the control group, with p=0.008, which may be indicative of early visual recovery from severe injury to the eye following injection of TA.

  • Overall attachment rate in the TA group was 88% while in the control group it was 63.64% with a p value of 0.049. This shows that the most vital factor in maintaining the vision, namely the retinal attachment is very much dependent on the treatment with TA.

  • There was no significant difference between the two groups regarding macular repositioning and PVR recurrence, with p-values of 0.215 and 0.191, respectively.

  • Temporary elevation of intraocular pressure occurred in one eye in the TA group after the initial surgery, but there were no major side effects reported. This therefore suggests that intravitreal TA is generally safe to use in patients with OGI.

Early intravitreal injection of triamcinolone acetonide has been documented to reduce traumatic proliferative vitreoretinopathy, improve the attachment of the retina, and consequently improve the visual outcome in patients suffering from open globe injury. The current study emphasizes the role of TA as a treatment modality in complication suppression post-OGI and states that long-term studies regarding its benefit in reducing the recurrence of PVR and ensuring better visual recovery are required. These findings may form newer aspects of treatment protocols in the management of severe ocular trauma and ensure better patient outcomes.

Reference:

Guo, H., Yu, J., He, T., Chen, S., Sun, Z., Zhang, J., Sun, Z., Yang, W., Yao, B., Yang, X., Liu, Y., Zhang, M., Meng, Y., Yang, L., & Yan, H. (2024). Early use of intravitreal triamcinolone to inhibit traumatic proliferative vitreoretinopathy: a randomised clinical trial. The British Journal of Ophthalmology, 108(8), 1161–1167. https://doi.org/10.1136/bjo-2023-32431

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