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Vesna Jurisic Friberg, Thomas R. Friberg, Goran Bencic, Zoran Vatavuk; A Unique Perspective On The Incidence Of Intraocular Pressure Elevation And Glaucoma Following Intravitreal Triamcinolone Acetonide Injections. Invest. Ophthalmol. Vis. Sci. 2012;53(14):878.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the incidence of intraocular pressure elevation and possible glaucoma development following intravitreal triamcinolone acetonide injection (IVTA) in a large series of patients with Age Related Macular Degeneration (AMD).
A retrospective study was undertaken of the medical records of 80 patients with exudative AMD referred to an eye hospital in Sarajevo, Bosnia, from 2008-2010. At the time, no anti-VEGF drugs were available and patients were treated therefore with laser or with intravitreal steroids. We reviewed the records to evaluate the sequelae of intravitreal triamcinolone acetate injections (4 mg/0.1ml) used in treating exudative AMD. The study included 80 eyes of 75 patients (45 males and 30 females), age from 58 to 82 (average age 62) who received at least one steroid injection. Excluded from the study were glaucoma patients, glaucoma suspects, those having a family history of glaucoma, diabetics, and myopes > 6 Diopters. The main outcome measures were final intraocular pressure (IOP) and progression in cup:disc ratio.
The mean IOPs following IVTA injection were significantly higher than the preinjection IOPs (mean 16.1+/- 2.8mm Hg). After the first week, the increase in IOP was 5 +/-3 mmHg, after the third month 6 +/- 4 mm Hg, and after the sixth month 7 +/-3mgHg. The IOP elevations were observed mostly in the first (17,7%) and second months (10,2%) of follow-up. After 2 years the mean IOP had significantly decreased from 34 (+/- 10) to 18 (+/-8)mmHg. In 35 eyes (47%) topical glaucoma therapy was needed. 8 required surgical intervention to lower the IOP. On the remaining 40 eyes, topical treatment was continued in 21 because IOP was higher than 21 mm Hg. On the 42 eyes (53%), there was mild progression of the mean vertical cup disc ratio form 0.6 (SD 02) to 0.8 (SD 03).
IOP elevation secondary to intravitreal steroid injection is often multi-factorial. Such elevations are often confounded by the underlying retinal disease for which treatment was given, such as venous occlusion or diabetic retinopathy, which can each cause rubeosis iridis... In our unique series, subjects had AMD only, allowing for better insight into the complications of steroid injections themselves. In 47% of eyes treated with intra-vitreal steroids, the IOP elevation required glaucoma therapy. Despite apparently adequate IOP control, progressive cupping of the optic disc was common after such steroid injections.
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