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      Triancinolona intravítrea em vasculite retiniana: relato de caso Translated title: Intravitreal triamcinolone in retinal vasculitis: case report

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          Abstract

          Os autores relatam o caso de paciente com vasculite retiniana primária submetida à injeção intravítrea de triancinolona que apresentou melhora da inflamação e da acuidade visual logo após o procedimento. Observou-se também melhora da neovascularização de íris e de papila, porém houve surgimento de tração vítreo-retiniana na área macular com o passar do tempo, levando à discreta piora da visão. Os autores discutem também as ações da triancinolona sobre a inflamação e a angiogênese, assim como os efeitos colaterais encontrados nesta paciente.

          Translated abstract

          The authors present a case of a patient with the diagnosis of primary retinal vasculitis treated with intravitreal injection of triamcinolone, which determined improvement of inflammation and visual acuity. An improvement of iris and optic nerve head neovascularization was also observed, however, a macular traction developed after the injection, which determined a decrease in visual acuity. The authors also discuss the effects of triamcinolone on inflammation as well as the side effects observed in this patient.

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          Most cited references14

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          Intraocular concentration and pharmacokinetics of triamcinolone acetonide after a single intravitreal injection.

          To describe the pharmacokinetics occurring after the direct injection of triamcinolone acetonide into the vitreous humor of humans. Interventional case series. Five patients who received a single 4-mg intravitreal injection of triamcinolone acetonide. An aqueous humor sample was obtained from 5 eyes via an anterior chamber paracentesis at days 1, 3, 10, 17, and 31 after injection. At each visit, visual acuity and intraocular pressure were measured and indirect ophthalmoscopy was performed. A fluorescein angiogram was carried out at day 10. Concentrations were determined using high performance liquid chromatography; pharmacokinetic analysis was carried out using PK Analyst, an iterative, nonlinear, weighted, least-squares regression program. Intraocular concentrations of triamcinolone were measured and population pharmacokinetic parameters were calculated. Pharmacokinetic data followed a two-compartment model. Peak aqueous humor concentrations ranged from 2151 to 7202 ng/ml, half-lives from 76 to 635 hours, and the integral of the area under the concentration-time curve (AUC(0-t)) from 231 to 1911 ng/h per milliliter. After a single intravitreal injection of triamcinolone, the mean elimination half-life was 18.6 days in nonvitrectomized patients. The half-life in a patient who had undergone a vitrectomy was shorter at 3.2 days. There was considerable intrasubject variation among peak concentration, AUC(0-t) values, and elimination half-lives. After intravitreal injection, measurable concentrations of triamcinolone would be expected to last for approximately 3 months (93 +/- 28 days) in the absence of a vitrectomy. Because triamcinolone pharmacokinetics were characterized only in elderly patients with macular edema, the results cannot be extrapolated to other patient populations.
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            Corticosteroids inhibit the expression of the vascular endothelial growth factor gene in human vascular smooth muscle cells.

            The vascular endothelial growth factor (VEGF) is a specific mitogen for vascular endothelial cells and enhances vascular permeability and edemagenesis. VEGF is also a major regulator of angiogenesis and may be a key target for inhibiting angiogenesis in angiogenesis-associated diseases. Among the extensively studied angiostatic compounds are several corticosteroids when used alone or in combination with heparin. In this study we present evidence for an additional mechanism of action of hydrocortisone, cortisone and dexamethasone in inhibiting edemagenesis or angiogenesis. In cultures of aortic human vascular smooth muscle cells these corticosteroids (1 x 10(-8) to 1 x 10(-12) M) abolished the platelet-derived growth factor-induced (PDGF) expression of the VEGF gene in a dose-dependent manner. In contrast, two precursors of corticosteroids, desoxycorticosterone or pregnenolone, did not affect PDGF-induced VEGF expression. Our findings indicate that the capacity of corticosteroids to reduce edema or to prevent new blood vessel formation may be attributed, at least in part to the ability of these agents to abolish the expression of VEGF.
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              A randomized clinical trial of a single dose of intravitreal triamcinolone acetonide for neovascular age-related macular degeneration: one-year results.

              To determine if a single intravitreal injection of 4 mg of triamcinolone acetonide in patients with classic choroidal neovascularization associated with age-related macular degeneration can safely reduce the risk of severe visual loss. A double-masked, placebo-controlled, randomized clinical trial was performed in patients 60 years or older who had choroidal neovascularization with any classic component, a duration of symptoms of less than 1 year, and a visual acuity of 20/200 or better. Best-corrected visual acuity, intraocular pressure, and cataract grading were performed before the injection and then at 3, 6, and 12 months. The development of severe loss of vision (30 letters) by survival analysis on an intention-to-treat basis. One hundred fifty-one eyes were randomized into the study, and follow-up data were obtained for 73 (97%) of the 75 eyes in the treated group and for 70 (92%) of the 76 eyes in the control group. There was no difference between the 2 groups for the development of severe visual loss during the first year of the study (log-rank chi 2(1) = 0.03, P =.90). In both groups, the 12-month risk of severe visual loss was 35%, with a hazard ratio of 1.05 (95% confidence interval, 0.59-1.86). The change in size of the neovascular membranes, however, was significantly less in eyes receiving triamcinolone than in those receiving placebo 3 months after treatment (P =.01), although no difference was noted after 12 months. After 12 months, treated eyes had a significantly higher risk of an elevated intraocular pressure (31/75 [41%] vs 3/76 [4%]; P<.001), but not of cataract progression (P =.29). A single dose of intravitreal triamcinolone had no effect on the risk of loss of visual acuity during the first year of the study in eyes with age-related macular degeneration and classic choroidal neovascularization, despite a significant antiangiogenic effect found 3 months after treatment. This biological effect warrants further study.
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                Author and article information

                Journal
                abo
                Arquivos Brasileiros de Oftalmologia
                Arq. Bras. Oftalmol.
                Conselho Brasileiro de Oftalmologia (São Paulo, SP, Brazil )
                0004-2749
                1678-2925
                December 2004
                : 67
                : 6
                : 953-956
                Affiliations
                [02] orgnameUniversidade Federal de São Paulo
                [01] orgnameUniversidade Federal de São Paulo orgdiv1Setor de Uveítes e AIDS
                Article
                S0004-27492004000600021 S0004-2749(04)06700621
                88f08788-3cd4-4134-b90c-563f351e0be2

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 14, Pages: 4
                Product
                Product Information: website
                Categories
                Relatos de Casos

                Triamcinolone,Relato de caso,Uveíte,Injeções intralesionais,Vasculite retiniana,Triancinolona,Case report,Uveitis,Intralesional injections,Retinal vasculitis

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