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S. Bhatia, M.P. Rubin, K. Rezaei; Intraocular Pressure Elevation Associated With Low Dose Intravitreal Triamcinolone Injection . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3848.
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Intravitreal triamcinolone (Kenalog) has rapidly become a preferred treatment for diabetic macular edema. While there is increasing evidence to support the efficacy of Kenalog, there is great concern as to the side effects of injecting steroids intravireally, particularly with regards to intraocular pressure (IOP.) Many diabetic patients also have glaucoma, and may not tolerate the elevation in IOP associated with higher dose treatments. We are interested in studying the efficacy and safety of low dose Kenalog (2mg) in the treatment of diabetic macular edema.
A retrospective study of 38 consecutive patients with diabetic macular edema were studied. All patients received intravitreal injections of 2mg of Kenalog. IOP was measured prior to injection, as well as the day after injection. Visual acuity and ocular coherence tomography (OCT) imaging was performed prior to injection and one month following injection.
The average IOP of patients prior to injection was 15.54 +/– 3.57 with a post operative IOP of 17.41 +/– 3.96., with an average elevation of 1.87. By OCT, the average central macular thickness prior to injection was 477.58 +/– 111.31. Post injection it was 332.45 +/– 90.52.
See OCT table for data on other quadrants.
Intravitreal triamcinolone injected intravitreally at a dose of 2mg incurs only a minimal increase in IOP while providing a significant reduction in macular edema. Only one patient had an increase in IOP greater than 10 points above baseline, and the IOP never exceed 30 after the first day of injection. We believe that low dose tramcinolone is a safer alternative to higher dose injections, especially for those patients who are less likely to tolerate elevated IOP.
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