uso intravítreo de la triamcinolona en el edema macular diabético use of intravitreous triamcinolone in cases of diabetic macular edema
Clicks: 252
ID: 156298
2009
ANTECEDENTES: el edema macular diabético constituye la causa más frecuente de baja visión en personas con retinopatía diabética. En los diabéticos con edema macular diabético severo o difuso, la fotocoagulación con láser no ha brindado los resultados deseados. OBJETIVOS: revisar el estado actual del uso del acetato de triamcinolona por vía intravítrea en los pacientes con esa enfermedad. DESARROLLO: el acetato de triamcinolona es un corticoide con una potente acción antiinflamatoria y antiangiogénica, que consigue estabilizar la barrera hematorretiniana e inhibir la angiogénesis, de ahí que se ha empleado en el tratamiento del edema macular diabético, donde el daño de la barrera hematorretiniana y la liberación de factores angiogénicos en respuesta a la hipoxia están implicados fuertemente en la patogénesis de este tipo de edema. La administración intravítrea en diversas dosificaciones, y no en pocas ocasiones en forma repetida, han mostrado resultados un tanto controversiales al comparar el efecto beneficioso que produce el acetato de triamcinolona, con la corta duración de su efecto y las preocupaciones relacionadas con las complicaciones (hipertensión ocular, endoftalmitis, hemorragia vítrea, etc.) relacionadas con las reinyecciones. Actualmente se ensayan dispositivos que liberan el acetato de triamcinolona de forma lenta y prolongan su efecto, para encontrar una estrategia de tratamiento más razonable y que sus efectos terapéuticos sean siempre superiores a los efectos indeseados. CONCLUSIONES: el tratamiento con acetato de triamcinolona constituye una alternativa en la mejoría del edema macular diabético, aunque estudios prospectivos y con período de seguimiento largo son necesarios para llegar a resultados más consistentes.
BACKGROUNDS: diabetic macular edema is the more frequent cause of low grade vision in persons presenting with diabetic retinopathy. In diabetic patients with severe or diffuse diabetic macular edema, the laser-photocoagulation had not the desired effects. AIMS: to review the present state of intravitreous route of Triamcinolone use acetate by in patients presenting this entity. DEVELOPMENT: Triamcinolone acetate is a corticoid agent with a potent anti-inflammatory and antiangiogenic action stabilizing the hematoretinal barrier and to inhibit the angiogenesis, thus, its use in diabetic macular edema treatment where the damage to above mentioned barrier and the release of angiogenic factors in response to hypoxia are closely involved in pathogenesis of this type of edema. Intravitreous administration in many dosages and not in few occasions in a repetitive way, has showed some controversial results in comparing the beneficial effect achieved by Triamcinolone acetate, with a short term effect and the concerns related to complications (ocular hypertension, endophthalmitis, vitreous hemorrhage, etc) related to reinjections. Nowadays new devices are assayed releasing the Triamcinolone acetate in a slow way and lengthening its effect to find a more reasonable treatment strategy and with higher therapeutical effects than non-desirable ones. CONCLUSIONS: Triamcinolone acetate treatment is a alternative to improve the diabetic macular edema, although prospective studies and with a long-term follow-up period are needed to arrive to more consistent results.
BACKGROUNDS: diabetic macular edema is the more frequent cause of low grade vision in persons presenting with diabetic retinopathy. In diabetic patients with severe or diffuse diabetic macular edema, the laser-photocoagulation had not the desired effects. AIMS: to review the present state of intravitreous route of Triamcinolone use acetate by in patients presenting this entity. DEVELOPMENT: Triamcinolone acetate is a corticoid agent with a potent anti-inflammatory and antiangiogenic action stabilizing the hematoretinal barrier and to inhibit the angiogenesis, thus, its use in diabetic macular edema treatment where the damage to above mentioned barrier and the release of angiogenic factors in response to hypoxia are closely involved in pathogenesis of this type of edema. Intravitreous administration in many dosages and not in few occasions in a repetitive way, has showed some controversial results in comparing the beneficial effect achieved by Triamcinolone acetate, with a short term effect and the concerns related to complications (ocular hypertension, endophthalmitis, vitreous hemorrhage, etc) related to reinjections. Nowadays new devices are assayed releasing the Triamcinolone acetate in a slow way and lengthening its effect to find a more reasonable treatment strategy and with higher therapeutical effects than non-desirable ones. CONCLUSIONS: Triamcinolone acetate treatment is a alternative to improve the diabetic macular edema, although prospective studies and with a long-term follow-up period are needed to arrive to more consistent results.
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Authors | ;Juana Elvira Maciques Rodríguez;Laura Rosa Redondo Piñó;Manuel Licea Puig;Felipe Santana Pérez |
Journal | journal of international humanitarian action |
Year | 2009 |
DOI | DOI not found |
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