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We read with interest the article by Dierks et al1 comparing the short-term effects of intravitreal injection of Kenalog-40 (Bristol-Myers Squibb, Princeton, NJ) with intravitreal injection of the vehicle and of triamcinolone acetonide in rabbit eyes. A 10% to 25% increase in a- and b-wave electroretinographic amplitudes of eyes with intravitreal injection of Kenalog-40 or triamcinolone compared with noninjected eyes was reported, although the probability of this being a chance finding (P value) was not stated.
Furthermore, the ratio of a- and b-wave amplitudes in the injected eyes to control eyes was compared across groups; there were no statistical differences except for an increase in the dark-adapted b-wave amplitude ratio only between the Kenalog-40 and vehicle groups at only 1 of 7 stimulating intensities (there was no statistical difference comparing intravitreal injection of the vehicle with intravitreal injection of triamcinolone). Details concerning the Bonferroni correction, which adjusts for multiple corrections (more than 80 in this article, increasing the likelihood of obtaining a P value of .02 by chance alone), were not provided. Consequently, it remains unclear whether the perceived elevation in amplitudes was real.
Dierks and colleagues concluded that triamcinolone may enhance rod pathway function and may be used in “inherited retinal degeneration . . . such as retinitis pigmentosa.”1 Unfortunately, increased b-wave amplitude has been described as a consequence of possible photoreceptor toxicity and as a drug-induced change.2 - 4
We commend Dierks and colleagues for urging further definition of the safety profile and mode of action of intravitreal triamcinolone. It is our view that despite widespread use of the latter, there is need for further clarification of the former.
Correspondence: Dr Holz, Cullen Eye Institute, Baylor College of Medicine, 6565 Fannin St, NC 205, Houston, TX 77030 (eholz@bcm.tmc.edu).
Financial Disclosure: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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