June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Impact on Intraocular Pressure (IOP) after 20mg Intravitreal Triamcinolone Acetonide (IVTA) Injections when utilizing prophylactic IOP-lowering therapy
Author Affiliations & Notes
  • Payam Amini
    Ophthalmology, UCSD, La Jolla, CA
  • Giulio Barteselli
    Ophthalmology, UCSD, La Jolla, CA
  • William Freeman
    Ophthalmology, UCSD, La Jolla, CA
  • Footnotes
    Commercial Relationships Payam Amini, None; Giulio Barteselli, None; William Freeman, OD-OS, Inc. (C)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 260. doi:
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      Payam Amini, Giulio Barteselli, William Freeman, ; Impact on Intraocular Pressure (IOP) after 20mg Intravitreal Triamcinolone Acetonide (IVTA) Injections when utilizing prophylactic IOP-lowering therapy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):260.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: To analyze long-term IOP response after 20mg decanted IVTA, and to determine if early prophylactic IOP-lowering therapy results in lower IOP-related complications.

Methods: Retrospective chart review of patients who underwent 20mg decanted IVTA between 2008 and 2012 for macular edema secondary to various retinal pathologies. Patients with history of glaucoma were excluded. IOP-lowering therapy was prescribed at week 1, independent of baseline IOP. Patients had baseline IOP checked before IVTA and at each follow-up visit. Vitreous status, lens status, compliance with IOP-lowering drugs, and IOP measurements were collected for all patients.

Results: Results of 120 injections of IVTA from 65 eyes of 58 patients were reviewed and included in the study. In cases of consistent compliance with IOP-lowering drugs (79.2% of the cases), mean IOP increased by 2 mmHg at 4 months (p=0.30) and returned to baseline at 12 months. In cases of non-compliance (20.8% of the cases), mean IOP increased by 7 mmHg at 1 month (p<0.05) and returned to baseline after starting treatment. In cases of non-vitrectomized eyes, significantly higher IOP recordings (p<0.001) were noted during the first 4 months after IVTA when compared to vitrectomized eyes. Out of 65 eyes, 2 eyes (3.1%) developed uncontrolled IOP despite maximal medical therapy and required glaucoma surgery by 4 months, with good final IOP outcome. Multivariate regression analysis showed that lens status was not a predictor for IOP rise, while non-vitrectomized eyes and non-compliance with IOP-lowering drugs resulted in significant IOP rise (p<0.05, and p=0.01, respectively). Univariate regression analysis showed that IOP rise was 130 times more likely in cases of non-vitrectomized, and 314 times more likely in cases of poor compliance with IOP-lowering drugs.

Conclusions: High-dose decanted IVTA can be safely used to treat macular edema in patients without a history of glaucoma. IOP elevation can be minimized and adequately controlled with prophylactic drugs. Non-compliance with IOP-lowering drugs creates an early spike in IOP, and vitreous status can significantly impact IOP rise. Compliance with IOP-lowering drugs should be stressed to patients receiving 20mg decanted IVTA especially if they have not been vitrectomized.

Keywords: 585 macula/fovea • 688 retina  
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