Liu Kexin, Yi Jinyang, Xu Juan, Zhong Li, Su Na
Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China.
Department of Pharmacy, Suining First People's Hospital, Suining, China.
BMC Ophthalmol. 2025 Mar 25;25(1):150. doi: 10.1186/s12886-025-03979-z.
The local application of triamcinolone acetonide (TA) in patients with macular edema (ME) is off-label and the data are limited. We designed a systematic review and network meta-analysis to compare risk of intraocular pressure (IOP) elevation among TA for different routes of administration used by patients diagnosed with macular edema.
We obtained data from the PubMed, Medline, Embase, and Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs). The outcome was IOP at 4, 12 or 24 weeks. We performed random-effects model and consistency model in the Bayesian framework with the multinma package in R. The GRADE was accorded for assess the evidence.
A total of 1138 citations were identified by our search, of which 16 RCTs enrolled 834 eyes (575 patients). The network showed that TA administration via different local routes and placebo were no significant differences in either pairwise or network estimates at the 4th week. IVTA (intravitreal triamcinolone acetonide) was associated with a statistically significant higher IOP at the 12th week compared to STiTA (sub-Tenon's infusion of triamcinolone acetonide) (MD: 1.67, 95% CI: 0.25 to 3.15, P < 0.05). IVTA, SCTA (suprachoroidal triamcinolone acetonide) and STiTA were both exhibited a statistically significant variance in IOP compared to placebo at the 24th week [(MD: 1.35, 95% CI: 0.23 to 2.30, P < 0.05), (MD: 2.42, 95% CI: 0.19 to 4.53, P < 0.05), (MD: 1.31, 95% CI: 0.02 to 2.49, P < 0.05)]. The probabilities of rankings and SUCRA showed that, at 4 and 12 weeks of follow-up, IVTA posed the highest risk of IOP elevation, while at the 24-week mark, SCTA exhibited the highest risk. In addition, RITA (retrobulbar injections triamcinolone acetonide) was shown to be safer.
For the increased risk of IOP, we recommend that treatment within 4 weeks is safe. Nevertheless, it is advisable to exercise caution when administering IVTA, STiTA, SCTA beyond a duration of 12 weeks, due to the potential risk of IOP elevation. RITA emerged as the safest injection route in the treatment of macular edema in terms of IOP risk. However, more high-quality randomized controlled trials will be necessary to further confirm this.
PROSPERO, CRD42022366513. https://www.crd.york.ac.uk/prospero/#recordDetails .
Not applicable.
曲安奈德（TA）在黄斑水肿（ME）患者中的局部应用属于超说明书用药，且相关数据有限。我们设计了一项系统评价和网状Meta分析，以比较诊断为黄斑水肿的患者使用不同给药途径的TA后眼压（IOP）升高的风险。
我们从PubMed、Medline、Embase和Cochrane对照试验中央注册库中获取随机对照试验（RCT）的数据。观察指标为4、12或24周时的眼压。我们在R语言中使用multinma软件包在贝叶斯框架下进行随机效应模型和一致性模型分析。采用GRADE方法评估证据质量。
我们的检索共识别出1138条引文，其中16项RCT纳入了834只眼（575例患者）。网状分析显示，在第4周时，不同局部给药途径的TA与安慰剂在两两比较或网状估计中均无显著差异。与Tenon囊下注射曲安奈德（STiTA）相比，玻璃体内注射曲安奈德（IVTA）在第12周时眼压升高具有统计学意义（MD：1.67，95%CI：0.25至3.15，P < 0.05）。在第24周时，与安慰剂相比，IVTA、脉络膜上腔注射曲安奈德（SCTA）和STiTA的眼压均有统计学意义的变化[（MD：1.35，95%CI：0.23至2.30，P < 0.05），（MD：2.42，95%CI：0.19至4.53，P < 0.05），（MD：1.31，95%CI：0.02至2.49，P < 0.05）]。排序概率和累积排序曲线下面积（SUCRA）显示，在随访4周和12周时，IVTA导致眼压升高的风险最高，而在24周时，SCTA风险最高。此外，球后注射曲安奈德（RITA）显示更安全。
鉴于眼压升高风险增加，我们建议4周内治疗是安全的。然而，由于存在眼压升高的潜在风险，在使用IVTA、STiTA、SCTA超过12周时建议谨慎。就眼压风险而言，RITA是治疗黄斑水肿最安全的注射途径。然而，需要更多高质量的随机对照试验来进一步证实这一点。
PROSPERO，CRD42022366513。https://www.crd.york.ac.uk/prospero/#recordDetails 。
不适用。
