Intraocular pressure after intravitreal injection of triamcinolone acetonide

Abstract

Aim: To investigate the intraocular pressure (IOP) response after intravitreal injections of triamcinolone acetonide as treatment of intraocular neovascular or oedematous diseases. Methods: The prospective consecutive non-comparative interventional case series study included 71 patients (75 eyes) with progressive exudative age related macular degeneration (n = 64 eyes) or diffuse diabetic macular oedema (n = 11 eyes), who received an intravitreal injection of 25 mg triamcinolone acetonide. Mean follow up time was 6.86 (SD 2.52) months (range 3.1-14.47 months). Results: IOP increased significantly (p<0.001) from 15.43 (3.26) mm Hg preoperatively to a mean maximum of 23.38 (8.37) mm Hg (range 13-64 mm Hg) postoperatively. An IOP rise to values higher than 21 mm Hg was observed in 39 (52%) eyes. Elevation of IOP occurred about 2 months after the injection. Preoperative predictive factor for the rise in IOP was younger age (p=0.013). It was statistically independent of refractive error, presence of diabetes mellitus, and indication for the injection. In all but one eye, IOP could be lowered to the normal range with topical medication, without development of glaucomatous optic nerve head changes. In the eyes with an elevation of IOP, IOP normalised about 6 months after the injection, without further medication. Eyes undergoing repeatedly intravitreal injections of triamcinolone acetonide showed only an elevation of IOP, if after the first injection a rise of IOP had occurred. Conclusions: After intravitreal injections of 25 mg of triamcinolone acetonide, an IOP elevation can develop in about 50% of eyes, starting about 1-2 months after the injection. In the vast majority, IOP can be normalised by topical medication, and returns to normal values without further medication about 6 months after the injection. R ecent clinical and experimental studies have suggested that the intravitreal injection of triamcinolone acetonide may be a therapeutic option for the treatment of intraocular neovascular, oedematous, or inflammatory diseases.1-33 Taking into account that the eye comprises only 0.01% of the whole ocular volume, it makes sense to try treating intraocular diseases by intravitreal injections, instead of oral medication. The latter will need a higher dosage, with a higher number of systemic side effects, to reach the same intraocular concentration of the drug as if the medication was applied intraocularly. One of the ocular side effects of corticosteroids is the elevation of intraocular pressure (IOP) leading to a secondary chronic open angle glaucoma. [34][35][36] Since previous studies examined the rate and amount of elevation of IOP after topical application of cortisone leading to much lower intraocular concentrations of steroids than if the steroids were injected intravitreally, we aimed to evaluate the response of IOP after the intravitreal injection of corticosteroids. [34][35][36] Knowledge about the IOP response to the intravitreal injection of corticosteroids may be important for future discussions, under wh...

Intravitreal triamcinolone acetonide for macular oedema owing to retinal vein occlusion

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Intravitreal triamcinolone improves vision in eyes with chronic diabetic macular oedema refractory to laser photocoagulation

“…The intraocular pressure exceeded 22 mmHg in four, five, and two eyes at 1, 3, and 6 months rising by an average of 2.4, 2.8, and 2.7 mmHg of Hg at the same time points, however, only four eyes were considered to require treatment with topical antiglaucoma medications for IOPs above 28 mmHg. This is lower than the incidence of ocular hypertension reported by Jonas et al, 16 who reported IOP elevation of above 21 mmHg in 50% of their patients at about 1-2 months. It is important to note that Jonas et al used a much higher dose (25 mg) of triamcinolone.…”

Phacoemulsification with intravitreal triamcinolone in patients with cataract and coexisting diabetic macular oedema: a 6-month prospective pilot study

“…However, ivTA injection is not without potential risks including transient rise in intraocular pressure (IOP), cataract progression, vitreous haemorrhage, retinal detachment, as well as endophthalmitis. [18][19][20][21][22][23] This study aims to report the safety and efficacy of phacoemulsification with ivTA injection in diabetic patients with dual pathologies of cataract and CSMO. (4) proliferative diabetic retinopathy and other ocular conditions requiring immediate treatment.…”