Intraocular Pressure Elevation after Injection of Triamcinolone Acetonide: A Multicenter Retrospective Case-Control Study

Inatani, Masaru; Iwao, Keiichiro; Kawaji, Takahiro; Hirano, Yoshio; Ogura, Yuichiro; Hirooka, Kazuyuki; Shiraga, Fumio; Nakanishi, Yasutaka; Yamamoto, Hiroyuki; Negi, Akira; Shimonagano, Yuka; Sakamoto, Taiji; Shima, Chieko; Matsumura, Miyo; Tanihara, Hidenobu

doi:10.1016/j.ajo.2007.12.010

Cited by 52 publications

(48 citation statements)

References 23 publications

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“…The increasing number of patients treated with TA by intravitreous and/or sub-Tenon injections, however, has attracted the attention of ophthalmologists because of the potential risk of steroid-induced ocular hypertension. 4,5 The mechanisms underlying steroid-induced ocular hypertension are associated with abnormal changes in the conventional outflow pathway caused by steroid administration. Some researchers attribute the decreased outflow to an accumulation of extracellular matrix (ECM) components, such as glycosaminoglycans, collagens, fibronectin, and elastin.…”

Section: Resultsmentioning

confidence: 99%

Involvement of RhoA/Rho-Associated Kinase Signal Transduction Pathway in Dexamethasone-Induced Alterations in Aqueous Outflow

Fujimoto

Inoue

Kameda

et al. 2012

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. We investigated the involvement of the RhoA/Rho kinase (ROCK) signal transduction pathway in dexamethasone (DEX)-induced changes in aqueous outflow.METHODS. Using trabecular meshwork (TM) and Schlemm's canal endothelial (SCE) cells, RhoA activation was evaluated with a pull-down assay and myosin light chain phosphorylation was evaluated by Western blot analysis. Outflow facility was measured in perfused porcine anterior segment organ cultures treated with DEX and/or Y-27632, a selective ROCK inhibitor. The barrier function of the cultured cells on a micropore filter was evaluated by measuring the transendothelial electrical resistance. Collagen, fibronectin, and integrin mRNA expression levels were evaluated by quantitative realtime RT-PCR. RESULTS.Relative RhoA activities increased following stimulation with 100 nM DEX in TM and SCE cells. Perfusion with DEX decreased outflow facility by 31.9 6 14.3% compared to controls at 24 hours, but not by 50 lM Y-27632 in addition to DEX. The transendothelial electrical resistance of the SCE cell monolayer was increased by 48.6 6 6.4% and 5.3 6 5.0% following DEX treatments without and with 10 lM Y-27632, respectively, compared to controls. In TM cells, the mRNA expressions of COL4A1 and fibronectin were increased significantly by DEX treatment, but combined treatment with Y-27632 and DEX significantly inhibited the increase in COL4A1and fibronectin expression.CONCLUSIONS. Activation of the Rho/ROCK pathway in SCE cells contributes to the mechanism of DEX-induced changes in aqueous outflow. (Invest Ophthalmol Vis Sci. 2012;53:7097-7108) DOI:10.1167/iovs.12-9989 S teroid-induced ocular hypertension is an important clinical problem related to the use of glucocorticoid therapy for many types of disorders. Already in 1963, Armaly reported that the widely used glucocorticoid dexamethasone (DEX) induces changes in intraocular pressure (IOP) and fluid dynamics in normal eyes, and that DEX-induced IOP elevation is observed more frequently in the patients with glaucoma. 1-3 IOP levels often are quite high in patients with steroid-induced ocular hypertension, and prolonged IOP elevation sometimes results in the loss of visual function. Topical administration of triamcinolone acetonide (TA), a synthetic corticosteroid, is considered a useful therapeutic modality for the management of intraocular inflammatory and/or proliferative diseases. The increasing number of patients treated with TA by intravitreous and/or sub-Tenon injections, however, has attracted the attention of ophthalmologists because of the potential risk of steroid-induced ocular hypertension. 4,5The mechanisms underlying steroid-induced ocular hypertension are associated with abnormal changes in the conventional outflow pathway caused by steroid administration. Some researchers attribute the decreased outflow to an accumulation of extracellular matrix (ECM) components, such as glycosaminoglycans, collagens, fibronectin, and elastin. [6][7][8][9] Others have proposed that the decreased outflow is due to decrea...

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Section: Resultsmentioning

confidence: 99%

Involvement of RhoA/Rho-Associated Kinase Signal Transduction Pathway in Dexamethasone-Induced Alterations in Aqueous Outflow

Fujimoto

Inoue

Kameda

et al. 2012

Invest. Ophthalmol. Vis. Sci.

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“…Çalışmalardan bazılarında yaş ile İVTA sonrası GİB artışı arasında ilişki saptanmazken 12,18,20,22,30 bazı çalışmalarda ise GİB artışı görülen hasta grubunun görülmeyenlere kıyasla daha genç oldukları savunulmuştur. 14,17,31 Lau ve ark.…”

Section: Discussionunclassified

“…Çalışmaların çoğunda GİB artışı açısından cinsiyetler arasında fark bulunmazken 12,14,18,20,22,25,30 Sönmez, 17 Lau, 21 Rhee, 22 Breusegem ve ark. 32 çalışmalarında erkekleri GİB artışı açısından daha riskli bulmuşlardır.…”

Section: Discussionunclassified

“…31 Çalışmaların çoğunda fakik ve psödofakik hastalar arasında GİB artışı açısından anlamlı fark bulunamamıştır. 17,18,21,30 Biz de çalışmamızda fakik hastalarda GİB artışı gelişimini daha yüksek oranda saptamakla birlikte aradaki farkı istatistiksel olarak anlamlı değildi.…”

Section: Discussionunclassified

“…Özellikle GİB'in 15 mmHg'nin üzerinde olmasının birçok çalışmada GİB artışı gelişimi ile ilişkisi gösterilmiştir. 12,17,18,20,22,30 Biz de çalışmamızda takiplerinde GİB'i 24 mmHg'nin üzerine çıkan grupta başlangıç GİB değerini artış saptanmayan gruba kıyasla anlamlı olarak yüksek saptadık ve başlangıç GİB'in 15 mmHg üzerinde olmasını artış için bir risk faktörü olarak tespit ettik.…”

Section: Discussionunclassified

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Evaulation of Incidence and Risk Factors for Intraocular Pressure Elevation After Intravitreal Triamcinolone Acetonide Injection

Uçar¹,

Dikkaya²,

Arvas³

et al. 2015

tjo

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Amaç: Makula ödemi tedavisinde kullanılan intravitreal triamsinolon asetonidin göz içi basıncı (GİB) üzerine etkisini ve GİB artışı açısından risk faktörlerini araştırmaktır. Ge reç ve Yön tem: Bu retrospektif çalışmada 56'sı (%65,8) diyabetik retinopati, 7'si (%8,2) santral retinal ven ve 22'si (%25,8) retinal ven dal tıkanıklığı ilişkili makula ödemi nedeniyle 4 mg intravitreal triamsinolon uygulanan 85 hastanın 93 gözü değerlendirildi. Hastalar enjeksiyon sonrası GİB değişimleri, GİB artışı ile yaş, cinsiyet, lens durumu, makula ödem etiyolojisi ve başlangıç GİB değeri arasındaki ilişki açısından incelendi. Bulgular: Otuz dokuzu kadın 46'sı erkek olan hastaların yaş ortalaması 61,58±9,5 yıl idi. İzlem boyunca 30 gözde (%32,2) ortalama 7,5 haftada 24 mmHg'nin üzerine çıkan GİB artışı görüldü. GİB artışı görülen hastaların tamamı topikal antiglokomatöz ilaç ile kontrol altına alınabildi. Ven tıkanıklığı olan 29 gözün 15'inde (%51,7), diyabetik makula ödemi olan 64 gözün 15'inde (%23,3) GİB artışı görüldü (p=0,01). Fakik 73 gözün 26'sında (%35,6), psödofakik 20 gözün 4'ünde (%20) GİB 24 mmHg'nin üzerinde ölçüldü (p=0,16). GİB artışı ile cinsiyet arasında anlamlı ilişki bulunmadı (p=0,33). GİB'de artış saptanan gözlerin enjeksiyon öncesi GİB ortalamaları 16,47±2,8 mmHg iken, artış saptanmayanlarınki 14,78±2,4 mmHg idi. GİB artışı gelişimi ile başlangıç GİB değeri arasında anlamlı ilişki vardı (p=0,01). Sonuç: GİB artışı intravitreal triamsinolon enjeksiyonu sonrasında sık görülen bir yan etkidir fakat çoğunlukla topikal tedavi ile kontrol altına alınabilmektedir. Özellikle başlangıç GİB>15 mmHg olan ve ven oklüzyonu nedeniyle enjeksiyon uygulanan hastalar GİB artışı açısından daha fazla risk taşımaktadır. (Turk J Ophthalmol 2015; 45: 86-91) Anah tar Ke li me ler: Glokom, intravitreal steroid enjeksiyonu, intraoküler basınç, risk faktörleri Objectives: To investigate the effect of intravitreal triamcinolone acetonide (IVTA) used for the macular edema on intraocular pressure (IOP) and to determine the risk factors for IOP elevation. Ma te ri als and Met hods: This retrospective study included 93 eyes of 85 patients who had 4 mg intravitreal triamcinolone injection. Of the 85 patients, 56 (65.8%) had diabetic macular edema, 22 (25.8%) had branch retinal, and 7 (8.2%) had central retinal vein occlusion. IOP changes after injection as well as the relation between IOP elevation and age, sex, lens status, etiology of macular edema, baseline IOP were evaluated. Re sults: Fourty-six male and 39 female patients with mean age 61.58±9.5 years were evaluated. IOP was recorded to be >24 mmHg in 30 eyes (32.2%) at follow-up visit after an average of 7.5 weeks. Normalization of IOP with medication was achieved in all IOP elevated eyes. Fifteen of 29 eyes (51.7%) with vein occlusion and 15 of 64 eyes (23.3%) with diabetic macula edema had IOP elevation (p=0.01). Twenty-six of 73 phakic (35.6%) and 4 of 20 pseudophakic eyes (20%) had IOP >24 mmHg (p=0.16). There was no association between IOP elevation and sex (p=0.33). Baseline...

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Risk Factors Associated With Intraocular Pressure Increase in Patients With Uveitis Treated With the Fluocinolone Acetonide Implant

Parekh

Srivastava

Bena³

et al. 2015

JAMA Ophthalmol

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IMPORTANCE Elevated intraocular pressure (IOP) is a well-known adverse event associated with the fluocinolone acetonide implant (FAI), but no data are available regarding factors associated with increased risk of IOP elevation in patients treated with the FAI.OBJECTIVE To report risk factors that may predispose patients to elevated IOP after treatment with the FAI. DESIGN, SETTING, AND PARTICIPANTS Data from 3 multicenter, 3-year, prospective, randomized, phase 2b/3 clinical trials evaluating the safety and efficacy of the FAI were pooled and analyzed. Patients had no underlying glaucoma and at least one eye with a history of recurrent noninfectious uveitis affecting the posterior segment. Patients were treated with 1 or more of the following: systemic therapy (corticosteroids or other immunosuppressive drugs) for at least 3 months before enrollment, 2 or more sub-Tenon capsule corticosteroid injections for uveitis management during the 6 months before enrollment, or systemic corticosteroid or sub-Tenon capsule corticosteroid injection therapy required for at least 2 separate recurrences within 6 months before enrollment. MAIN OUTCOMES AND MEASURESFactors evaluated as risk factors for IOP elevation included age, sex, lens status, uveitis severity at enrollment, and location of uveitis.RESULTS Data analyses were based on 641 eyes. A total of 351 eyes did not receive the FAI, whereas 290 eyes had the 0.59-mg FAI placed. An increase in IOP of 10 mm Hg or elevation to 30 mm Hg was seen in 60 untreated eyes (17.1%) and 188 treated eyes (65.1%) (hazard ratio, 5.80; 95% CI, 4.28-7.70; P < .001). A total of 8 untreated eyes (2.3%) required surgical intervention for elevated IOP compared with 93 treated eyes (32.1%) (hazard ratio, 16.48; 95% CI, 8.24-32.96; P < .001). In patients with the FAI, younger age, male sex, and phakic lens status were associated with higher risk of IOP elevation and the need for glaucoma surgery (P = .003, P < .001, and P < .001, respectively). CONCLUSIONS AND RELEVANCEPatients receiving the FAI are at higher risk of developing an IOP increase of 10 mm Hg or an absolute IOP of 30 mm Hg when compared with patients without the FAI. Patients who are male, younger, and phakic are at an even higher risk for elevated IOP and possibly glaucoma surgery.

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Intraocular Pressure Elevation after Injection of Triamcinolone Acetonide: A Multicenter Retrospective Case-Control Study

Cited by 52 publications

References 23 publications

Involvement of RhoA/Rho-Associated Kinase Signal Transduction Pathway in Dexamethasone-Induced Alterations in Aqueous Outflow

Involvement of RhoA/Rho-Associated Kinase Signal Transduction Pathway in Dexamethasone-Induced Alterations in Aqueous Outflow

Evaulation of Incidence and Risk Factors for Intraocular Pressure Elevation After Intravitreal Triamcinolone Acetonide Injection

Risk Factors Associated With Intraocular Pressure Increase in Patients With Uveitis Treated With the Fluocinolone Acetonide Implant

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