From the Guidelines
Kenalog (triamcinolone acetonide) is not recommended for treating Age-related Macular Degeneration (AMD). This steroid medication is sometimes used for other eye conditions like diabetic macular edema or retinal vein occlusions, but it is not an appropriate treatment for AMD. The most recent and highest quality study, 1, published in 2021, does not mention Kenalog as a treatment option for AMD. Instead, it highlights the importance of early treatment with anti-vascular endothelial growth factor (VEGF) injections for neovascular AMD and nutritional supplements (AREDS2 formula) for dry AMD.
Treatment Options for AMD
- For wet AMD, the standard treatments include anti-VEGF injections such as ranibizumab (Lucentis), aflibercept (Eylea), or bevacizumab (Avastin), which specifically target the abnormal blood vessel growth causing the condition.
- For dry AMD, there are currently limited treatment options, with focus on nutritional supplements (AREDS2 formula containing vitamins C, E, zinc, copper, lutein, and zeaxanthin), lifestyle modifications, and regular monitoring.
Risks of Using Kenalog for AMD
- Kenalog could potentially worsen macular degeneration by increasing intraocular pressure and accelerating cataract formation, which would be counterproductive for patients already experiencing vision loss.
- Studies have shown that corticosteroids, such as Kenalog, carry a higher risk of cataract and elevated intraocular pressure compared to anti-VEGF therapy 1.
Recommendation
If you have macular degeneration, consult with a retina specialist who can recommend appropriate evidence-based treatments for your specific type and stage of the disease. They can help you navigate the available treatment options and develop a personalized plan to manage your condition and prevent further vision loss.
From the Research
Treatment of Age-related Macular Degeneration (AMD) with Kenalog (Triamcinolone)
- Kenalog (Triamcinolone) has been used in the treatment of Age-related Macular Degeneration (AMD) as a monotherapy or in combination with other treatments such as photodynamic therapy (PDT) or anti-vascular endothelial growth factor (anti-VEGF) agents 2, 3, 4, 5, 6.
- Studies have shown that intravitreal injection of triamcinolone acetonide (IVTA) can improve visual acuity and reduce the number of PDT treatments required to stop choroidal neovascularization (CNV) activity 2, 3.
- The combination of IVTA and PDT has been shown to have a synergistic effect, leading to improved vision and reduced number of re-treatments with PDT 2, 3.
- However, the use of IVTA has also been associated with side effects such as cataract, intraocular pressure elevation, and macular atrophy 2, 3, 5, 6.
- The introduction of anti-VEGF-based drugs has revolutionized the treatment of AMD, but combination therapy with IVTA and anti-VEGF agents may still be a viable option for patients with exudative AMD 3, 5.
Efficacy of Kenalog (Triamcinolone) in AMD Treatment
- Studies have reported a positive outcome in transiently reducing the leakage from CNV and improving visual acuity in patients with exudative AMD treated with IVTA as monotherapy or in combination with PDT 2, 3, 4, 6.
- A mean visual acuity improvement of 0.18 logMAR was reported in patients treated with a combination of intravitreal bevacizumab and triamcinolone acetonide for CNV due to AMD unresponsive to anti-VEGF monotherapy 5.
- Repeated intravitreal injection of triamcinolone acetonide has been shown to lead to an increase in visual acuity in patients with exudative AMD, with the peak in visual acuity and intraocular pressure elevation occurring about 2 to 5 months after each injection 6.
Safety and Side Effects of Kenalog (Triamcinolone) in AMD Treatment
- The overall complication rate of IVTA has been reported to be high, with side effects including cataract, intraocular pressure elevation, and macular atrophy 2, 3, 5, 6.
- The use of IVTA has been associated with a rapid evolution of cataract, but cataract surgery may stimulate the development of CNV 3.
- Intraocular pressure elevation has been reported in patients treated with IVTA, but this can be successfully treated with medications 5, 6.