triamcinolone suprachoroidal (Rx)

>10%

Increased intraocular pressure (IOP), nonacute (14%)

Eye pain, nonacute (12%)

1-10%

Cataract (7%)

Increased IOP, acute (6%)

Vitreous detachment (5%)

Headache (5%)

Injection site pain (4%)

Conjunctival hemorrhage (4%)

Reduced visual acuity (4%)

Dry eye (3%)

Eye pain, acute (3%)

Photophobia (3%)

Vitreous floaters (3%)

Uveitis (2%)

Conjunctival hyperemia (2%)

Punctate keratitis (2%)

Conjunctival edema (2%)

Meibomianitis (2%)

Anterior capsule contraction (2%)

Chalazion (2%)

Eye irritation (2%)

Eye pruritus (2%)

Eyelid ptosis (2%)

Photopsia (2%)

Vision blurred (2%)

Contraindications

Hypersensitivity to triamcinolone and other product components

Cautions

Corticosteroid-related effects

• May produce cataracts, increased IOP, and glaucoma
• May enhance establishment of secondary ocular infections due to bacteria, fungi, or viruses
• Caution with history of ocular herpes simplex
• Do not use with active ocular herpes simplex

Altered endocrine function

• Hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing syndrome, and hyperglycemia can occur, particularly with long-term use
• Corticosteroids can produce reversible HPA axis suppression with potential for glucocorticosteroid insufficiency following withdrawal; minimize by gradual dose reduction
• This type of relative insufficiency may persist for months after discontinuation of therapy; therefore, in any situation of stress occurring during that period, reinstitute hormone therapy
• Corticosteroid clearance decreased with hypothyroid and increased with hyperthyroid; changes in thyroid status may necessitate dose adjustment

Pregnancy

There are no adequate and well-controlled studies in pregnant women to inform drug-associated risks

Systemic exposure is negligible following suprachoroidal injection

Animal studies

• Topical ocular administration of corticosteroids has been shown to produce teratogenicity at clinically relevant doses

Lactation

Unknown if ocular administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in human milk

Systemically administered corticosteroids appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects

Pregnancy Categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

Mechanism of Action

Corticosteroid; suppresses inflammation by inhibiting multiple inflammatory cytokines, resulting in decreased edema, fibrin deposition, capillary leakage, and migration of inflammatory cells

Absorption

Among 19 patients, 18 of 19 had serum concentrations below the lower limit of quantitation

Suprachoroidal Injection Preparation

Suprachoroidal injection procedure is performed under controlled aseptic conditions, including use of sterile gloves, sterile drape, sterile eyelid speculum (or equivalent), and sterile cotton swab

Apply adequate anesthesia and broad-spectrum microbicide to periocular skin, eyelid, and ocular surface before the injection

See prescribing information for complete preparation instructions and diagrams

Suprachoroidal Injection

See prescribing information for complete preparation instructions and diagrams

Monitor intraocular pressure immediately after injection

Storage

Store at 15-25ºC (59-77ºF)

Store in original carton to protect from light

Do not freeze

Discard unused portion