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Editors Selection IGR 16-4
Surgery: Triamcinolone and aqueous flow in ADD
Comment by Theodore Krupin on:
19407 Use of triamcinolone acetonide particles to visualize aqueous outflow, Devgan U, Ophthalmic Surgery Lasers and Imaging, 2007; 38: 258-260
In this technique paper, Devgan (1103) describes the intraoperative instillation of reconstituted dilute non-preserved triamcinolone acetonide (Kenalog7, Bristol-Meyers Squibb, New York, NY) particles into the anterior chamber to visualize aqueous humor flow through a valved aqueous drainage device (ADD). The paper presents detailed preparation of the steroid suspension to remove the liquid carrier and preservatives. While this technique is helpful in detecting the presence of vitreous in the anterior chamber following complicated cataract removal, its use with implantation of an ADD is less apparent. The time to assure proper functioning of a valved or nonvalved ADD is before implantation
The time to assure proper functioning of a valved or non-valved ADD is before implantation. Moreover, flow through the device can be confirmed at the completion of surgery by excess instillation of balanced salt solution into the anterior chamber with digital monitoring of intraocular pressure. This avoids possible clogging of the anterior chamber tube slits with a non-valved ADD or clogging of the mechanism of a valved ADD with triamcinolone acetonide particles. Devgan states particles accumulate in the iridocorneal angle for a few days. Finally, Bristol-Meyers Squibb issued a Kenalog safety notice on November 22, 2006 with the recommendation not to perform intraocular administration of the drug.
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