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S. M. Walsman, J. Hade, M. Brimacombe, Retina Associates of New Jersey, P. Lama; Intravitreal Triamcinolone Injection and Frequency, Characteristics, and Risk Factors in the Development of Secondary Intraocular Pressure Elevation. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2096.
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To assess the frequency and characteristics of an intravitreal triamcinolone (IVT) related IOP elevation and to identify pre-treatment risk factors that may be associated with more severe and refractory IOP control.
Retrospective chart review of all patients receiving an IVT injection at tertiary care retinal practice between November 1997 and September 2004 was conducted.
IVT injections were associated with a clinically significant rise in IOP in 69.9%(n=366) of patients with a mean change in IOP of 8.67 mmHg and a mean IOPmax of 24.85mmHg. Elevation in IOP was observed to occur at any time post IVT injection but the average time to IOPmax was 1-2 months with the time to IOPmax curve following a Gaussian distribution. Younger age, concurrent treatment for glaucoma, and higher baseline IOP were associated with a significantly increase risk of a severe or medical refractory IOP elevation. Gender, race/ethnicity, pre-treatment retinal diagnosis, past medical history of diabetes, hypertension, or atherosclerotic vascular disease were not associated with an increased risk of an IVT-related IOP elevation.
Clinically significant IVT-related IOP elevation occurred at a greater frequency than all previously published studies. Most patients can be treated successfully with initiation of or escalation of glaucoma therapy. In the absence of well-designed randomized clinical studies demonstrating long-term clinical benefit from IVT injections as compared to conventional treatment we caution clinicians to carefully assess the risk/benefit ratio of IVT
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