Triamcinolone acetonide is a synthetic corticosteroid primarily used for its marked anti-inflammatory action.
In Canada, the 40-mg/mL suspension has been authorized for intramuscular and intra-articular administration or for injection into tendon sheaths or ganglia. It is indicated for systemic corticosteroid therapy in conditions such as dermatoses, or rheumatoid arthritis and other connective tissue disorders.

Intravitreal or intraocular injection of this product is not an authorized route of administration in Canada. Diabetic macular edema, cystoid macular edema and choroidal neovascularization secondary to age-related macular degeneration are among the conditions for which the use of intravitreal injection of Triamcinolone has been reported.

Topical ophthalmic, oral and intravenous corticosteroids have long been associated with ocular ARs. Local injections of steroids, even at sites far from the eye, have been associated with eye complications such as the development of cataract, glaucoma, and even retinal and choroidal emboli.

Intravitreal injection of Triamcinolone has several reported complications. Immediate complications include retinal detachment and vitreous hemorrhage. Complications developing later include cataract progression, steroid-induced glaucoma and endophthalmitis.
Triamcinolone persists for long periods. Low concentrations were found in samples of aqueous humor up to 1.5 years after intravitreal injection.
Cases of increased intraocular pressure requiring medical intervention following intravitreal injection have also been reported.
Patients with a history of primary open-angle glaucoma are at a higher risk of increased intraocular pressure.

A number of ocular adverse reactions following intravitreal injection of Triamcinolone in Canada have been reported in scientific literature. They included increased intraocular pressure requiring glaucoma medication ( 60 cases ), cataract progression requiring extraction ( 12 ), endophthalmitis ( 1 ) and temporary occlusion of the central retinal artery ( 1 ).

From 1973 to 2009, Health Canada received 1 report of serious ocular adverse reactions suspected of being associated with combined photodynamic therapy and intravitreal injection of Triamcinolone. The case involved a 13-year-old girl in whom increased intraocular pressure, retinal hemorrhage and reduced visual acuity developed following two injections of Triamcinolone given about 3 months apart.

Source: Health Canada, 2009

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