Slurry Kenalog: A Lower Cost, Quick and Easy Alternative for Long-term Intraocular Steroid Delivery


ABSTRACT

Objective:

Slurry Kenalog (centrifuge concentrated triamcinolone acetonide 40mg/0.1ml) is an easily reproducible, safe and cost effective alternative to long term intraocular steroid delivery. PURPOSE: To demonstrate the safety, efficacy and viability of centrifuged intravitreal Slurry Kenalog (triamcinolone acetonide) to treat macular edema at a low cost, with an acceptable side effect profile, and with reduced treatment burden.

Methods:

Slurry Kenalog was prepared by centrifuging 1.0 cc of Kenalog (40mg/ml) into a 0.1 cc pellet (effectively 40mg/0.1ml). Retrospective review of all consecutive patients who received Slurry Kenalog 0.1 cc intravitreally for cystoid macular edema (CME), with a minimum follow up of 9 mos from the last injection. Indications for treatment included CME due to diabetes (62%), CRVO (16%), uveitis (11%), radiation retinopathy (5%), infectious endophthalmitis (3%), and BRVO (2%). Sixty-three eyes of 52 patients received 257 injections between June, 2009 and December, 2016, 7.5 years. The average follow up was 3.25 years/eye. Duration of effect was based upon recurrence of edema by OCT from the last injection.

Results:

Slurry Kenalog lasted an average of 8.4 months from a single intravitreal injection (range 2-24 months), as measured by recurrence of macular edema on OCT. In eyes with prior vitrectomy, the duration was 5.4 months, and without prior vitrectomy 9.1 months. Eight of 11 phakic eyes (73%) underwent cataract extraction. Thirteen eyes (21%) developed a steroid response (defined as a change of 10 mm Hg from baseline). Ten (16%) were controlled on 2 or fewer drops, 2 (3%) were monitored, and one eye (1.6%) required a trabeculectomy. There were no cases of infectious endophthalmitis and one case of nonsterile inflammation, which resolved without sequelae.

Conclusions:

Slurry Kenalog has a long average duration of effect of 8.4 months. The typical steroid associated side effects were average or lower than comparative, long term, implantable steroid preparations. There were no serious adverse events. Assuming an average of 2.9 injections over 2 years, the medication cost would be approximately $29. which is up to 500 times less costly than currently available long term steroid preparations. Slurry Kenalog is an important and novel treatment which reduces cost and treatment burden for both the physician and the patient.


CONTACT DETAILS

 

Susan M. Malinowski
Southfield, United States
Email : smmalinowski@aol.com
Cell Phone: +12487524615
Work Phone: +12483568610