Triesence versus Kenalog

March 19, 2009

I don’t do it often, but I will inject patients with diabetic macular edema with Kenalog. There is a problem with that, though, in that Triesence is available and is preservative-free, and therefore on a medico-legal standpoint, one would have a very hard time defending the use of Kenalog. Kenalog has preservatives and is not cleared for intravitreal use. Now, it’s true that at worst, some have noted a sterile endophthalmitis from Kenalog use which resolves with no loss of vision, but who wants to take a chance. Of course, the problem is that Triesence is $125.00 vs. $5.00 for Kenalog, but I suppose that’s a headache for insurance plans, not me. Be sure to bill separately for the injection as well as for the product (J3300)




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One Response to “Triesence versus Kenalog”

  • This begs to bring up a very fine point in clinical medicine, that is, standard of care vs. FDA approval. I have always maintained that while the standard of care and FDA may be different; following the standard of care is most important or prudent. For example, intravitreal Avastin may NOT be FDA approved for use in the eye, whereas Lucentis is FDA approved for ophthalmic use. My attorney friends are comfortable upholding the standard of care. We use mainly Avastin in our area.

    Randall V. Wong, M.D.
    Diseases of the Retina