Abstract

SA.10.05

Triesence® versus purified Volon A® – What is the difference?

Martin S. Spitzer, Kathrin Rinker, Charlotte Frank, Efdal Yörük, Maximilian Schultheiss, Karl U. Bartz-Schmidt, Peter Szurman
Universitäts-Augenklinik Tübingen

Background
Intravitreal injections of triamcinolone are not only an important therapeutic tool for a variety of vitreo-retinal disorders, but can also be employed for visualization of the vitreous during pars plana vitrectomy. Triesence® is a preservative-free triamcinolone suspension that has been approved for visualization during vitrectomy via intravitreal administration and for intravitreal therapy of certain rare ocular diseases. However, the differences between Triesence® and purified (and thus also preservative-free) triamcinolones such as Volon A® or Kenalog® are not well specified, although the manufacturer of Triesence® advertises the product as „specifically formulated for the eye“.
Methods
Triesence®, Kenalog® or purified triamcinolone (Volon A®) (1 - 0.01 mg/ml) was added either directly on top or separated by a Boyden chamber filter to confluent cell cultures of retinal pigment epithelium (ARPE19) or retinal ganglion cells (RGC5). Cell viability was assessed using MTT-ELISA and Live/Dead®-Assay. The publicly available FDA application material for Triesence® was searched in respect to the differences between Triesence® and older triamcinolone preparations.
Results
Sedimentation of Triesence®, Kenalog® or purified Volon A® caused a pronounced decrease of cell viability. Cytotoxicity was most pronounced when Triesence® was used. Without direct sedimentation of triamcinolone crystals on top of cells one of the three formulations was cytotoxic. According to the publicly available FDA documents the approval of Triesence was due to studies that mainly have been conducted with Kenalog® or purified Volon-A®. Apart from intraoperative use during vitrectomy Triesence® has only been approved for sympathetic ophthalmia, temporal arteriitis, and ocular conditions unsresponsive to topical steroids. Consequently, the use of Triesence® like the older triamcinolone preparations (Kenalog® or Volon A®) for diabetic macular edema, for Irivine-Gass syndrome, for neovascular AMD or after retinal vein occlusion is off-label.
Conclusion
The main difference between Triesence® and purified triamcinolone formulations seems to be the significantly higher price of Triesence®. Direct contact between retinal cells and Triesence® particles should be avoided.

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