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S. M. Gerzenstein, S. G. Schwartz, C. A. Puliafito, A. C. L. Cervino, N. F. Tsinoremas, M. E. Fini, Miami Ocular Pharmacogenomics Team; A Pharmacogenomic Pilot Study on Steroid-Induced Intraocular Pressure Elevation Following Intravitreal Triamcinolone Acetonide (IVTA) Injection. Invest. Ophthalmol. Vis. Sci. 2007;48(13):266.
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Off-label injection of intravitreal triamcinolone acetonide (IVTA) is a common treatment for various macular diseases. A major complication of IVTA is increased intraocular pressure (IOP) and steroid-induced glaucoma. Presently, it is not possible to predict which patients will develop complications, although some reports have suggested that genetic factors may be predisposing. In this study, we sought a pharmacogenomic relationship between IVTA-induced IOP elevation and polymorphisms in the glucocorticoid receptor gene.
Fifty-two patients treated with IVTA met all entry criteria for this study. The major clinical data points were baseline IOP and maximum IOP recorded during the 3 months following injection. DNA analysis was performed for 6 well known polymorphisms of the glucocorticoid receptor gene (GluArg22/23GluLys, Asn363Ser, IVS2+646C>G, IVS3-4G>C, IVS4-16G>T, and Asn766Asn).
The polymorphisms GluArg22/23GluLys, Asn363Ser, and IVS3-4G>C showed little variation within this sample and were excluded from more detailed analysis. The polymorphisms IVS2+646C>G, IVS4-16G>T, and Asn766Asn met Hardy-Weinberg equilibrium. No polymorphism was individually associated with IOP response via regression analysis. Six different haplotypes studied via regression analysis were not associated with IOP response.
In this small pilot study, we did not find a pharmacogenomic relationship between genetic polymorphisms in the glucocorticoid receptor and IVTA-induced IOP elevation. At this time, we are continuing to recruit patients in order to do a complete steroid pathway candidate gene analysis, and ultimately a whole genome screen.
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