The Preservative-Free Intravitreal Injection

DESCRIPTION
Triamcinolone acetonide is a long acting depot preparation of triamcinolone, a potent synthetic corticosteroid with marked anti-inflammatory action. It is a 9 – derivative of Prednisolone designated as (C₂₄ H₃₁ FO₆ = 434.5)

COMPOSITION
Each milliliter contains 40mg of Triamcinolone acetonide as a sterile aqueous suspension.

PHARMACOLOGICAL ACTIONS
Triamcinolone has highly selective glucocorticoid activity without significant mineralocorticoid action. As a part of glucocorticoid activity it also possesses a pronounced anti-inflammatory property that forms the basis for most of its therapeutic uses. It is a long acting agent with duration of action of several hours. In contrast, the acetonide ester of triamcinolone has actions lasting for several days to weeks.

INDICATIONS
Intravitreal Triamcinolone acetonide has been used for various ocular diseases. It is useful in severe chronic allergic and inflammatory processes involving the eye, such as herpes zoster ophthalmicus, iritis, iridocyclitis, diffuse posterior uveitis and choroiditis, optic neuritis, chorioretinitis, sympathetic ophthalmia, diffuse diabetic macular edema, chronic cystoid macular edema, prevention of PVR, identification of vitreous during vitrectomy in patients with rhegmatogenous retinal detachment, macular edema secondary to CRVO and BRVO, chronic uveitis, pars planitis, diabetic papillopathy, uveitic cystoid macular edema, serous retinal detachment in Vogt-Koyanagi-Harada syndrome, exudative age related macular degeneration, chronic prephthisical ocular hypotomy, persistent pseudophakic cystoid macular edema, ocular Ischemic syndrome, etc.

CONTRAINDICATIONS
Contraindicated in those persons who have intraocular infections like corneal ulcer, and in patients having glaucoma.

WARNINGS

• Being a suspension, this preparation should not be injected intravenously
• It should be injected only under strict aseptic and antiseptic precautions
• It is not recommended for children under 6 years of age
• Risk of hypoadrenalism in infants if given to nursing mothers or infants
• Immunization procedures should not be undertaken during steroid therapy
• Intraoperative triamcinolone injection may obscure visualization intraoperatively & postoperatively in eyes with hydrophilic acrylic lenses

ADVERSE EFFECTS
Mild iritis, mild vitritis, retinal & choroid vascular occlusion, pain on injection, corneal ulceration, due to improper site of injection, swelling, cataract, elevation of IOP, pseudoptosis, vitreous hemorrhage, corticosteroid induced ocular hypertension, post injection infectious endophthalmitis, sterile endophthalmitis, retinal lesions by the injection needle, etc.

DOSAGE
The normal dose of 4mg/0.1 ml may be sufficient for intravitreal injection in any case related to uveitis or retinal problem. For uvea related inflammation the normal dose of PST (Posterior Subtenon) injection 20mg/0.5 ml is recommended. However, the maximum dose that can be administered is 40mg/1 ml per dose.

ADMINISTRATION
Before use shake the vial well to ensure a uniform suspension. Rule out clumping or granular appearance of the suspension before withdrawing into syringe. After withdrawal, inject without delay to avoid setting in the syringe. Use fresh sterile hypodermic 27 gauge needle. I inch or more in length to inject Aurocort.

PRESENTATION
Vial containing 40mg/ml as a sterile aqueous suspension in pack of five.

STORAGE
Store in a cool, dark place, avoid freezing.

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