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G. E. Fish, the Diabetic Retinopathy Clinical Research Network; Two-Year Side Effects Associated With Peribulbar Injections of Triamcinolone Acetonide. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1348.
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To evaluate the long term adverse effects of anterior and posterior peribulbar injections of triamcinolone acetonide (TA) on intraocular pressure (IOP) elevation and cataract development.
This study reports on IOP and lens progression data through 2 years on eyes with diabetic macular edema (DME) randomized to either focal/grid photocoagulation, anterior injection of 20 mg TA, anterior injection followed by focal/grid laser, posterior injection of 40 mg TA, or posterior injection followed by focal/grid laser. Eyes receiving pharmacotherapy for DME other than the randomized treatment or ocular or systemic corticosteroids (N=31) were excluded from the safety analyses. As a result, the cohort for analysis included 36 eyes that received anterior peribulbar injections, 38 that received posterior peribulbar injections, and 29 that received laser photocoagulation alone.
IOP increased from baseline by >10 mm Hg during at least one visit through 2 years in 7% eyes in the laser group, 31% eyes in the anterior injection groups, and 16% eyes in the posterior injection groups. IOP reached >30 mm Hg in 0%, 19%, and 8% in the three groups, respectively. One (3%), 9 (25%), and 5 (13%) eyes in the three groups, respectively, were treated with IOP-lowering medications at some point. At 2 years there were no eyes that had IOP >30 mm Hg, however, 0, 6 (21%), and 3 (11%) eyes were being treated with IOP-lowering medication at 2 years in the laser, anterior, and posterior groups, respectively. Among phakic eyes at baseline, 4% in the laser group, 16% in the anterior injection group, and 3% in the posterior injection group underwent cataract surgery prior to the two-year visit.
Based on this small randomized trial, it appears that over 2 years anterior peribulbar injections are linked to an increased incidence of IOP elevation compared with laser or posterior peribulbar injections. There also may be an increased risk of cataract development with anterior injections.
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