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We thank Dr. Gallenga and Dr. Lobefalo for their interest in our article (Kocabora et al 2008) and for their comments.  We agree with them on the importance of pharmacovigilance and of warning the ophthalmology community about the potential risks of intravitreal triamcinolone (IVTA). We should always follow the principle of primum, non nocere in our medical practices. On the other hand, if we consider that the therapeutic effect of IVTA is almost ‘miraculous’ in select cases, then we also feel obligated to offer our patients the benefit of this treatment until a safer and effective alternative becomes available. This dilemma originates from the nature of our profession. Our main responsibilities are to inform our patients and obtain their consent for treatment by off-label use of trimancinoloneD and also to evaluate the risk-benefit ratio for each individual patient and eye, which is a prerequisite in selecting candidates for IVTA.  We do not think that off-label use of triamcinolone should be considered illicit; many well known drugs are used off-label in routine ophthalmological practice, including mitomycin-C (adjunct to trabeculectomy), cefuroxime (intracameral), and vancomycin (intravitreal), etc. Moreover, many approved drugs carry the risk of serious side effects with on-label use.  Steroid use in general comes with serious side effects regardless of the disease and administration route. Secondary intraocular pressure (IOP) elevation is observed even with approved uses of steroids such as ocular topical and systemic (oral and parenteral) uses. For that reason we do not consider IOP elevation to be a specific side effect of triamcinolone, although there is no doubt that the administration site exacerbates it. On the other hand, the retinal toxicity of preserved triamcinolone has been demonstrated in animal studies; hence, this toxicity can be avoided by use of a preservative-free triamcinolone formulation.  In conclusion, based on scientific rationale and guided by the results of medical studies, we believe that triamcinolone has become the de facto standard for treatment of certain edematous, inflammatory, and neovascular eye diseases as an off-label drug, but we also agree that its use should be limited according to precisely determined criteria

clinical ophthalmology

Patients treated with intravitreal triamcinolone acetonide [from Gallenga and Lobefalo] and Response to correspondence [from Kocabora]&amp;nbsp; ||FREE PAPER||