Triamcinolone Acetonide (Intravitreal / Periocular)

How it works

As a depot corticosteroid it provides sustained local suppression of inflammation, reducing vascular permeability, leucocyte infiltration and the cytokine and prostaglandin response within the eye over an extended period.

Prescribing in practice

• This is a specialist intraocular/periocular injection that carries the risks of raised intraocular pressure (sometimes steroid glaucoma), cataract progression and, with intravitreal injection, endophthalmitis and retinal detachment, and must be given under sterile conditions by a trained ophthalmologist.
• It must not be used where there is active untreated ocular or periocular infection, since corticosteroid can worsen infection.
• Patients need counselling that a single injection has a prolonged effect and that intraocular pressure and the lens require ongoing surveillance.

Monitoring

Monitor intraocular pressure and lens status after injection and watch closely for signs of endophthalmitis in the days following an intravitreal procedure.

Counselling the patient

• Seek urgent ophthalmology review for increasing pain, redness, floaters or sudden loss of vision after the injection, as these can signal serious complications.
• You will need pressure checks because steroids can raise the pressure in the eye over time.
• Floaters from the steroid in the eye may be visible for a while after an intravitreal injection.

Evidence & guidelines

Intravitreal and periocular triamcinolone are established treatments for macular oedema and intraocular inflammation, with class risks of raised pressure, cataract and injection-related endophthalmitis well documented.