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Gerassimos Lascaratos, Alex Baneke, Megan Jeffries, Adanna Obi, Saurabh Goyal, K Sheng Lim; Intravitreal triamcinolone at the time of cataract surgery may be beneficial for glaucoma patients with previous filtration surgery. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2670.
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© ARVO (1962-2015); The Authors (2016-present)
Scarring following small incision cataract surgery (phaco) remains an important cause of bleb failure. This study aims to explore the potential role of intravitreal triamcinolone (IVTA) during phaco in improving filtration surgery outcomes.
Case-control study of two groups of 8 open angle glaucoma patients each that underwent phaco with IVTA 4mg (IVTA group) or with no additional intervention (control group). The IVTA group comprised of 5 patients with previous tube surgery and 3 with previous trabeculectomy. The latter 3 patients also received subconjunctival 5FU 5mg at the time of phaco. The control group comprised of 4 tube and 4 trabeculectomy patients. Complete success [intraocular pressure (IOP) ≤21 without IOP lowering medications], qualified success (IOP≤21 on IOP lowering treatment) and failure (IOP>21 or additional glaucoma surgery or loss of light perception) were documented before and after phaco.
The mean (±SD) age in the control and IVTA groups was 73(±13) and 58(±21), respectively. The mean (±SD) follow-up (in months) in the control and IVTA groups was 18(±11) and 13(±7), respectively. The mean IOP slightly increased over time following phaco in the control group (12.3 at baseline, 14.6 at 3 months and 14.0 at last follow-up), while it showed a trend to improve in the IVTA group (16.8 at baseline, 14.0 at 3 months and 13.3 at last follow-up). The mean number of IOP-lowering medications also tended to increase with time in the control group (0.875 at baseline, 1.0 at 3 months and 1.375 at last follow-up), while it remained stable in the IVTA group (1.5 at baseline, 0.625 at 3 months and 1.25 at last follow-up). One step improvement in the final outcome (from qualified to complete success) was noted in 25% of IVTA patients, but none of the control patients. One step worsening in the final outcome was found in 50% of the control patients, but only in 25% of the IVTA patients. An acute IOP rise was not found in any of the IVTA patients. Serious complications following phaco were not encountered in either group, with the exception of one IVTA patient that developed fulminating CMV retinitis due to local immunosuppression.
These preliminary results suggest that IVTA injection during phaco may be a useful tool in enhancing the success of filtration surgery, although risks of local immunosuppression should be considered.
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