Intraocular Pressure Elevation After the Injection of Triamcinolone Acetonide: A Retrospective Multicenter Study

Abstract

Purpose:: To investigate frequency for the intraocular pressure (IOP) elevation after sub-Tenon capsule injection (STI) and intravitreal injection (IVI) of triamcinolone acetonide.

Methods:: The study included 406 eyes of 406 patients receiving either STI or IVI of triamcinolone acetonide at six clinical centers between May 2002 and September 2005. Patients with other corticosteroid administration, uveitis, ocular hypertension or glaucoma were excluded in this retrospective study. The IOP levels had been followed at least for 6 months after the administration of triamcinolone acetonide.

Results:: IOP levels of 24 mmHg or higher were observed in 14.3% of eyes treated with 40 mg STI while the IOP elevation was observed in only 3.7% of eyes with 20 mg STI, demonstrating significantly higher frequency for IOP elevation in 40 mg STI (p = 0.00074; chi-square test). Four mg and 8 mg IVIs induced the elevated IOP levels in the frequency of 5.6% and 38.5%, respectively, which also showed statistically significant difference (p = 0.010; chi-square test). The combination of STI and IVI induced the IOP elevation in 26.8%. Moreover, additional triamcinolone acetonide was administered in 135 of 406 eyes, of which 129 eyes had not encountered elevated IOP levels of 24 mmHg or higher in the first administration. But, among the 129 eyes, second administration induced elevated IOP levels of 24 mmHg or higher in 5.2% in 20 mg STI, 20.5% in 40 mg STI, 27.3% in 4 mg IVI, 36.4% in 8 mg IVI and 60.0% in STI plus IVI.

Conclusions:: The frequency for IOP elevation after the injection of triamcinolone acetonide shows dose-dependency. Second injection induces IOP elevation in eyes that had never shown IOP elevation in the first injection. IOP levels should be carefully monitored in eyes treated with the repeated or high dose administration.

Keywords: corticosteroids • intraocular pressure • injection