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Safety of high-dose intravitreal triamcinolone acetonide as low-cost alternative to anti-vascular endothelial growth factor agents in lower-middle-income countries

Authors Ghoraba HH, Leila M, Elgouhary SM, Elgemai EEM, Abdelfattah HM, Ghoraba HH, Heikal MA

Received 25 August 2018

Accepted for publication 17 October 2018

Published 26 November 2018 Volume 2018:12 Pages 2383—2391


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Hammouda Hamdy Ghoraba,1,2 Mahmoud Leila,3 Sameh Mohamed Elgouhary,4 Emad Eldin Mohamed Elgemai,2,5 Haithem Mamon Abdelfattah,2,6 Hashem Hammouda Ghoraba,2 Mohamed Amin Heikal7

1Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt; 2Department of Retina, Magrabi Eye Hospital, Tanta, Egypt; 3Retina Department, Research Institute of Ophthalmology, Giza, Egypt; 4Department of Ophthalmology, Faculty of Medicine, Menoufia University, Menoufia, Egypt; 5Department of Ophthalmology, Damanhour Teaching Hospital, Damanhour, Egypt; 6Department of Ophthalmology, Banha Teaching Hospital, Banha, Egypt; 7Department of Ophthalmology, Faculty of Medicine, Benha University, Benha, Egypt

Purpose: The purpose of this study was to evaluate the safety of high-dose intravitreal triamcinolone acetonide (IVTA) as affordable low-cost alternative to anti-vascular endothelial growth factor (anti-vascular endothelial growth factor [anti-VEGF] agents) in lower-middle-income countries.
Patients and methods: This was a retrospective interventional non-comparative case series. The study recruited patients who received 20 mg IVTA for treating various retinal and optic nerve diseases over the past 5 years. Main outcome measure was assessment of complications secondary to high-dose IVTA. The crosstabs procedure was used to display the interaction between the variables tested. The ANOVA test was used to analyze the differences among group means.
Results: The study included 207 eyes of 168 patients. The main indication for high-dose IVTA were diabetic macular edema 64%, and macular edema secondary to retinal vein occlusion 19%. The mean follow-up period post-injection was 22 months. Mean number of injections was 1.3. Cataract developed in 54% of eyes. Glaucoma developed in 18.5% of eyes. Glaucoma surgery for intractable glaucoma attributed to high-dose IVTA was needed in 1% of eyes. Endophthalmitis and retinal detachment developed in one patient each.
Conclusion: High-dose IVTA is a safe and cost-effective alternative to anti-VEGF agents. Cataract formation and intraocular pressure rise do not pose major adverse effects when weighed against the risk of vision loss due to inability to afford anti-VEGF treatment.

Keywords: high-dose IVTA, cost-effectiveness of anti-VEGF, ICER of anti-VEGF per QALY

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