Long-Term Trends in Intraocular Pressure After Combined Vitrectomy With Sub-Tenon Injection of Triamcinolone Acetonide

Kim, So-Yoon; Shin, Juyoun; Yum, Hae-Ri; Han, Jae Hyung; Yang, Ji-Wook; Park, Young-Hoon

doi:10.1097/iae.0000000000000333

Cited by 4 publications

(5 citation statements)

References 25 publications

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“…The DII also offers several significant safety advantages over other available sustained-release corticosteroid platforms. Options for sustained-delivery steroid after vitrectomy include sub-Tenon’s 11 or intravitreal 12 injection of triamcinolone acetonide on-label (Triesence: Alcon, Dallas, TX) or off-label (Kenalog-40: Bristol-Myers Squibb, Princeton, NJ), and dexamethasone intravitreal implant 13 (Ozurdex: Allergan, Irvine, CA). While sub-Tenon’s injection of steroids is an attractive approach in that it is not intraocular, there are potential issues with the predictability of dosing via this route, risk of IOP rise, local tissue toxicity, risk of intravascular injection, and unpredictable duration of effect.…”

Section: Discussionmentioning

confidence: 99%

Dexamethasone Sustained-Release Intracanalicular Insert for Control of Postoperative Inflammation After Pars Plana Vitrectomy

Suñer¹,

Peden²

2021

OPTH

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Purpose To evaluate the safety and efficacy of a dexamethasone sustained-release intracanalicular insert (DII) (Dextenza ® Ocular Therapeutix, Inc., Bedford, MA) for control of inflammation and pain after pars plana vitrectomy (PPV) compared to standard topical steroid therapy. Methods Retrospective, case-matched comparison of consecutive patients undergoing PPV. Control patients were matched by diagnosis and procedure performed. The primary outcome was the proportion of patients with complete anterior chamber cell clearance (ACCC) at postoperative day 7. Secondary outcomes included proportion developing intraocular pressure (IOP) >25 mmHg, change in mean optical coherence tomography central foveal thickness (OCT CFT), and proportion developing cystoid macular edema (CME) on qualitative analysis of OCT. Results The DII group had a statistically significant higher rate of complete ACCC compared to the topical steroid group (65% versus 35%, respectively, with p=0.01). No eyes had IOP >25 mmHg in the DII, compared to 2 eyes in the topical steroid group (not statistically significant). Overall, mean OCT CFT decreased in both groups; one patient had CME in the DII group, as compared to three in the topical steroid group (not statistically significant). Conclusion The dexamethasone intracanalicular insert provided excellent safety and efficacy in control of postoperative inflammation following PPV in this retrospective case-matched study.

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Section: Discussionmentioning

confidence: 99%

Dexamethasone Sustained-Release Intracanalicular Insert for Control of Postoperative Inflammation After Pars Plana Vitrectomy

Suñer¹,

Peden²

2021

OPTH

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“…3,[6][7][8] Combined with the findings that vitrectomy alone can raise IOP, this may suggest that the rate of IOP-related problems should be higher if such an injection is given at the end of surgery. 9 However, a study by Kim et al (2015), which evaluated the use of a sub-Tenon's depot of 40 mg triamcinolone acetonide at the end of vitrectomy surgery, found no difference in IOP over a 24-month period when comparing patients who received sub-Tenon's steroid injection with those who did not. Their results were consistent with our finding of no significant difference in IOP-related outcomes in eyes receiving subconjunctival 4 mg triamcinolone acetonide compared with eyes receiving only topical steroid drops.…”

Section: Discussionmentioning

confidence: 99%

“…Their results were consistent with our finding of no significant difference in IOP-related outcomes in eyes receiving subconjunctival 4 mg triamcinolone acetonide compared with eyes receiving only topical steroid drops. 10 Another potential concern is that there may be insufficient control of inflammation with a steroid injection alone. This is supported by a study by Dieleman et al (2011), who showed a statistically significant increase in flare measured by laser after cataract surgery in patients treated solely with subconjunctival betamethasone acetate 5.7 mg/mL compared with those receiving traditional topical steroid drop taper.…”

Section: Discussionmentioning

confidence: 99%

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Elimination of Steroid Drops After Vitreoretinal Surgery

Atchison

Gilca

Civantos

et al. 2019

Journal of VitreoRetinal Diseases

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Purpose: The objective of this study was to compare intraocular pressure (IOP) and inflammatory outcomes between patients receiving a single subconjunctival triamcinolone acetonide injection at the end of surgery and those receiving subconjunctival dexamethasone at the end of surgery plus a traditional topical steroid drop taper. Methods: A retrospective consecutive case series compared patients operated on by 2 surgeons, both utilizing 500 mL BSS-PLUS (balanced salt solution with bicarbonate, dextrose, and glutathione; Alcon Laboratories, Inc) infusion solution containing 10 mg dexamethasone, which is added to the solution in the operating room or at the pharmacy. However, one surgeon utilized a single 4 mg triamcinolone acetonide subconjunctival injection at the end of surgery, without additional steroid drops (intervention group), and the other utilized subconjunctival dexamethasone plus a traditional topical steroid taper over a period of 4 to 6 weeks (control group). Results: There were 161 surgeries in the intervention group and 163 in the control group. No statistically significant differences were found in the usage rate of additional IOP-lowering drops, IOP > 29 mmHg, or IOP increase ≥ 10 mmHg over baseline during the follow-up period. Inflammatory complications were rare in both groups. Five percent of those in the intervention group received supplemental topical steroid drops postoperatively. Conclusions: A single subconjunctival triamcinolone acetonide injection at the end of surgery may represent a reasonable alternative to requiring patients to use a steroid drop taper following vitreoretinal surgery.

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“…Mi and Thompson [ 23 ] also reported that vitrectomy was not correlated with increased risk of IOP elevation compared with fellow control eyes. Kim et al [ 24 ] demonstrated that vitrectomy by itself or combined vitrectomy with sub-Tenon injection of triamcinolone acetonide did not increase IOP in the long term. Lalezary et al [ 25 ] reported that vitrectomy did not increase IOP even after removal of the crystalline lens.…”

Section: Discussionmentioning

confidence: 99%

Positional Intraocular Pressure of Vitrectomized and Normal Fellow Eyes

Lee

Bae

Kim

2018

Korean J Ophthalmol

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PurposeTo compare posture-induced intraocular pressure (IOP) changes in vitrectomized eyes and normal eyes of patients who had vitrectomy in one eye.MethodsA total of 31 patients older than 20 years of age who underwent vitrectomy were enrolled in the study. At least six months after vitrectomy, we measured IOP in both eyes using a rebound tonometer 10 minutes after the patient assumed sitting, supine, right lateral decubitus, and left lateral decubitus positions. Patients with a history of ocular surgery (not including vitrectomy) or recent medication use associated with IOP were excluded. IOP and ocular parameters of vitrectomized and normal fellow eyes were compared. For the decubitus position, IOP values of dependent and nondependent eyes were compared.ResultsNo significant difference was observed in IOP between vitrectomized and normal eyes in the sitting and supine positions. The IOP for dependent eyes (on the lower side in the lateral decubitus position) was significantly higher than the IOP for nondependent eyes in both right lateral decubitus (right vitrectomized eye 19.31 ± 4.20 vs. 16.71 ± 4.02 mmHg, p < 0.001; left vitrectomized eye 18.35 ± 1.75 vs. 16.04 ± 3.02 mmHg, p = 0.003) and left lateral decubitus (right vitrectomized eye 17.32 ± 4.63 vs. 19.15 ± 3.83 mmHg, p = 0.004; left vitrectomized eye 16.19 ± 1.81 vs. 18.12 ± 2.29 mmHg, p < 0.001) positions.ConclusionsIOP was higher in the dependent than the nondependent eye in the lateral decubitus position, for both vitrectomized and nonoperated eyes.

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Long-Term Trends in Intraocular Pressure After Combined Vitrectomy With Sub-Tenon Injection of Triamcinolone Acetonide

Abstract: Vitrectomy by itself or combined vitrectomy with sub-Tenon injection of TA does not seem to increase IOP in the long term.

Cited by 4 publications

References 25 publications

Dexamethasone Sustained-Release Intracanalicular Insert for Control of Postoperative Inflammation After Pars Plana Vitrectomy

Dexamethasone Sustained-Release Intracanalicular Insert for Control of Postoperative Inflammation After Pars Plana Vitrectomy

Elimination of Steroid Drops After Vitreoretinal Surgery

Positional Intraocular Pressure of Vitrectomized and Normal Fellow Eyes

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