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L. Im, S. Fekrat, S. Stinett, R. Allingham; A Prospective Study of Early Intraocular Pressure Change Post Intravitreal Triamcinolone Injection . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3416.
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To analyze the incidence of intraocular pressure (IOP) elevation within the first month following a single 4 mg intravitreal injections of triamcinolone acetonide (Kenalog) (IVK).
This prospective comparative interventional case series included twenty–eight eyes of 14 patients with no prior history of glaucoma or intravitreal injection. Following baseline elevation in both eyes, including IOP, gonioscopy, and optic nerve evaluation, 4 mg in 0.1 mL triamcinolone acetonide was injected into the vitreous cavity in a standard sterile fashion in one eye. Intraocular pressure and gonioscopy were repeated at 1, 2, and 4 week intervals post injection in both eyes.
Five women and 9 men had a mean age of 67.6 years. Mean baseline IOP of IVK treated and fellow control eye were similar at 15.9 mmHg vs. 16.6 mmHg, respectively. Non–IVK treated control eyes maintained a small IOP range (15.7–16.6 mmHg). In the IVK–treated eyes, mean maximum IOP was 54% above baseline compared to 11% of control eyes. Six of 14 patients (43%) had IOP elevation to 24 mmHg or higher with mean change of 8.6 mmHg and a mean maximum IOP of 32.1 mmHg. There was no correlation between IOP rise and diagnosis, gender, age or optic nerve appearance. However, 4 of 6 patients (67%) treated for IOP elevation had documented abnormal inferior angle changes during the course of the study, not present at baseline exam. Eyes that developed gonioscopic changes were 5 times more likely (calculated relative risk = 5) to be treated for elevated IOP than eyes that did have gonioscopic changes (CI 1.4–17.3). The most frequent time point for IOP treatment was at 2 weeks post–IVK injection, where 4 of 6 patients (67%) required pressure lowering agents. No eyes required surgical management of IOP during the course of this 4–week study.
Significant intraocular pressure rise after a single intravitreal injection of 4mg/0.1ml of triamcinolone acetonide can occur within one month of injection. In this study, the most frequent time point for IOP treatment was at 2 weeks post–IVK injection suggesting that early and frequent monitoring of IOP should be considered. Two thirds of patients requiring medical control of IOP developed gonioscopy changes not present at baseline. Gonioscopic changes in eyes receiving intravitreal triamcinolone may be a clinical indicator of determining eyes at risk for severe IOP elevation.
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