Development of ocular hypertension and persistent glaucoma after intravitreal injection of triamcinolone

Abstract

PurposeThis study evaluates intraocular pressure (IOP) elevation secondary to intravitreal injection of triamcinolone acetonide (IVTA) and discusses its management.MethodsThe records of 175 patients who underwent IVTA treatment and regular eye examinations in the period 2003–2006 were reviewed. One hundred and twenty-two of these patients were included in the study, of which 147 eyes that received IVTA (4 mg/0.1 ml) were followed for at least 9 months. Mean IOPs observed after IVTA injection as well as IOP elevations defined as moderate (≥5 mm Hg), important (≥10 mm Hg) and severe (>25 mm Hg) during the follow-up period were evaluated and compared statistically.ResultsOverall, the mean IOPs following IVTA injection were statistically significantly higher than the preinjection IOP (15.8 ± 2.6), after the first hour (17.7 ± 2.9), the first week (18.7 ± 4.1), the first month (19.6 ± 6.2), the second month (19.1 ± 6.1), the third month (18.0 ± 4.1), the sixth month (17.3 ± 4.0), and the ninth month (17.0 ± 2.7), but not after the first day (16.3 ± 7.6). Important IOP elevations were observed mostly in the first (17.7%) and second months (10.2%). In 40 (27.7%) eyes, topical antiglaucomatous therapy was needed and 7 later required surgical intervention to lower the IOP. Of the remaining 33 eyes, topical treatment was continued in 14 (9.5%) because of IOPs ≥20 mm Hg.ConclusionThe persistence of IOP elevation beyond the IVTA clearance period and the development of intractable secondary glaucoma requiring surgical intervention substantiate the need for careful consideration of IVTA indication and follow-up.

Safety and Efficacy of Intravitreal Preservative-Free Triamcinolone Acetonide (Triesence) for Macular Edema

“…IOP ‡ 25 mmHg or ‡ 10 mmHg above the baseline level at any follow-up visit was defined as a significant IOP elevation. 24,25 Up to a maximum of 3 antiglaucoma medications, including the patients' existing IOP-lowering medication, were allowed to be administrated if IOP ‡ 25 mmHg.…”

Glucocorticoids exert differential effects on the endothelium in an in vitro model of the blood–retinal barrier

“…However, GCs are associated with severe adverse side‐effects in the eye, such as increased intraocular pressure leading to glaucoma (Kocabora et al. ), and cataract formation (Chu et al. ).…”

Intravitreal Injections of 4 mg and 20 mg Triamcinolone Acetonide in the Treatment of Diabetic Macular Edema: Comparison of Efficacy and Side Effects

“…Yazarlar İVTA sonrası en sık karşılaşılan komplikasyonun steroide ikincil oküler hipertansiyon veya steroide bağlı açık açılı glokom olduğunu bildirmişlerdir. 1,2,3,4,5,6,7,8,9,10,11,12,13,14 Literatürde İVTA sonrası GİB'in değişmemesinden, olguların %60'dan fazlasında artışa neden olmasına kadar değiştiğini bildiren çalışmalar vardır. 21,22,28,29,30,31,32,33 Literatürde benzer çalışmalarda intravitreal uygulanan hastaların %1-17'sine trabekülektomi gerektiği bildirilmiştir.…”

“…Bu özellikleri ile antiinflamatuar, antiapopitotik, antiödematöz ve antianjiojenik etkiye sahiptirler. 4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19 İVTA tedavisi ile DMÖ'de en iyi düzeltilmiş görme keskinliği EİDGK ve santral maküler kalınlıkta (SMK) önemli derecede düzelmelerin olduğunu gösteren bir çok çalışma vardır. 20,21,22,23,24,25 Literatürde göz içi enjeksiyonunda yaygın kullanım dozu 4 mg/0,1 ml'dir.…”