Intraocular Steroids for Treatment of Macular Edema

Macular edema (retinal swelling) results from leakage of damaged retinal vessels. Macular edema is common in diabetes, retinal vein occlusions and uveitis.   Macular edema damages retinal photoreceptors and leads to loss of vision. Injection of corticosteroid medications directly in the eye is an effective procedure for improving macular edema and vision.   Multiple preparations of intraocular steroids injections are available.   Intraocular steroids are injected in a brief well tolerated office procedure.  Intraocular steroids may (~25% risk) leads to an increase in eye pressure (secondary glaucoma).  Increased eye pressure can be treated in most cases with eye drops and rarely requires surgical treatment. Intraocular steroids may increase cataract formation.  

Kenalog (triamcinolone acetonide)-Kenalog is the most commonly used intraocular steroid and has been shown in many studies to be very effective for in the treatment of macular edema due to diabetes, retinal vein occlusion, and post-surgical macular edema.  Kenalog was initially FDA approved for use outside of the eye and is currently used off-label for intraocular injections. It has been safely used for intravitreal injections since 2004.  Insurance carriers will generally cover kenalog injections due to its widely proven effectiveness.

Triesence (triamcinolone acetonide)-Triesence is a preservative-free preparation of triamcinolone acetonide.  Triessence has shown a similar pattern of safety and effectiveness as Kenalog.  Triessence is FDA approved for use in uveitis and is used off-label for retinal vascular diseases.  Insurance carriers may not pay for Triesence.

Ozurdex (dexamethasone intravitreal implant)-Ozurdex is administered by inserting a microscopic implant in the eye with an injection procedure performed in the office.  The implant slow releases dexamethasone over approximately 6 months.  Ozurdex is the most recent steroid medication to be approved for use in the eye. In June, 2009 the FDA approved Ozurdex for retinal vein occlusions and posterior uveitis.  Insurance carriers may cover this medication for retinal vein occlusions and uveitis.  Ozurdex use has been limited due to its expense, variable insurance coverage and the benefits of kenalog.