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Payam Amini, Giulio Barteselli, William Freeman, Jacobs Retina Center; Impact on Intraocular Pressure (IOP) after 20mg Intravitreal Triamcinolone Acetonide (IVTA) Injections when utilizing prophylactic IOP-lowering therapy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):260.
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To analyze long-term IOP response after 20mg decanted IVTA, and to determine if early prophylactic IOP-lowering therapy results in lower IOP-related complications.
Retrospective chart review of patients who underwent 20mg decanted IVTA between 2008 and 2012 for macular edema secondary to various retinal pathologies. Patients with history of glaucoma were excluded. IOP-lowering therapy was prescribed at week 1, independent of baseline IOP. Patients had baseline IOP checked before IVTA and at each follow-up visit. Vitreous status, lens status, compliance with IOP-lowering drugs, and IOP measurements were collected for all patients.
Results of 120 injections of IVTA from 65 eyes of 58 patients were reviewed and included in the study. In cases of consistent compliance with IOP-lowering drugs (79.2% of the cases), mean IOP increased by 2 mmHg at 4 months (p=0.30) and returned to baseline at 12 months. In cases of non-compliance (20.8% of the cases), mean IOP increased by 7 mmHg at 1 month (p<0.05) and returned to baseline after starting treatment. In cases of non-vitrectomized eyes, significantly higher IOP recordings (p<0.001) were noted during the first 4 months after IVTA when compared to vitrectomized eyes. Out of 65 eyes, 2 eyes (3.1%) developed uncontrolled IOP despite maximal medical therapy and required glaucoma surgery by 4 months, with good final IOP outcome. Multivariate regression analysis showed that lens status was not a predictor for IOP rise, while non-vitrectomized eyes and non-compliance with IOP-lowering drugs resulted in significant IOP rise (p<0.05, and p=0.01, respectively). Univariate regression analysis showed that IOP rise was 130 times more likely in cases of non-vitrectomized, and 314 times more likely in cases of poor compliance with IOP-lowering drugs.
High-dose decanted IVTA can be safely used to treat macular edema in patients without a history of glaucoma. IOP elevation can be minimized and adequately controlled with prophylactic drugs. Non-compliance with IOP-lowering drugs creates an early spike in IOP, and vitreous status can significantly impact IOP rise. Compliance with IOP-lowering drugs should be stressed to patients receiving 20mg decanted IVTA especially if they have not been vitrectomized.
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