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G. E. Sanborn, G. Javey, C. T. Leffler; The Effect of Posterior Subtenon Injection of Triamcinolone Acetonide on Intra-Ocular Pressure. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5603.
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To investigate the effect of posterior subtenon injection of triamcinolone acetonide on intra-ocular pressure (IOP) in subjects with and without glaucoma.
A retrospective review of 152 consecutive eyes of 131 patients who received posterior subtenon injection of 40 mg triamcinolone acetonide was performed. Patients were categorized based on number of injections, history of glaucoma, and historical steroid response (defined as having an open angle, IOP increase of 5 mm Hg and an absolute IOP of greater than 24 mm Hg in response to previous topical or subtenon steroid treatments). Patients were reexamined according to the clinical circumstances, with first follow-up at 1 to 3 weeks post-injection, and mean follow-up of 25 weeks.
152 eyes were included; 142 eyes received single posterior subtenon injection. Indications for injection were clinically significant diabetic macular edema (77%), posterior uveitis (9%), pseudophakic cystoid macular edema (7%), or macular edema secondary to branch or central retinal vein occlusion (7%).38 eyes received pre-injection topical steroid challenge; 3 had steroid response as defined previously. 35 eyes had history of glaucoma or ocular hypertension with controlled pre-injection IOP on topical agents.In eyes with single subtenon injection, mean increase in IOP was 2.5 mm Hg. In eyes with multiple subtenon injections, mean increase in IOP was 2.2 mm Hg.In eyes with no previous history of glaucoma or ocular hypertension, mean increase in IOP was 2.5 mm Hg. In eyes with history of glaucoma or ocular hypertension, mean increase in IOP was 3.3 mm Hg. No statistically significant difference in post-injection increase in IOP was observed between normal and glaucoma subjects (p=0.392).
Our study showed that single posterior subtenon injection of triamcinolone acetonide may cause increase in IOP in both glaucoma and normal subjects with no statistically significant difference in the mean IOP increase between the two groups. Multiple posterior subtenon injections were not associated with statistically significant raise in IOP. However, this may be secondary to the small sample size of the eyes that underwent multiple injections. Pre-injection IOP, and history of steroid response of steroid response were significant in predicting post-injection IOP.
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