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B.W. Roberts, R.M. Feist, J.O. Mason, III, M.F. White, Jr., M.L. Thomley, M.A. Albert, Jr., R.S. V; Effects Of Surgical Intravitreal Triamcinolone Injections On Intraocular Pressure . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1452.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the effects of triamcinolone during vitrectomy on intraocular pressure.
A retrospective analysis was performed of 37 injections of 24 (9 male, 15 female) consecutive patients who underwent pars plana vitrectomy with intravitreal triamcinolone (IVTA) by two of four surgeons at Retina Consultants of Alabama between October 2002 and August 2005. Data was collected from examinations at the following time points: pre–operative, at one day post operatively, up to twelve months three months post operatively, and at last follow–up. Intraocular pressures (IOP) and treatment of high pressures were assembled for comparison.
Mean age was 58 years. Duration of follow–up ranged from 1 day post operative to 12 months with a mean follow–up of 12 months. Of the 37 injections given to 24 patients, IOP increase was 25mm or greater in 17 (45.9%) injections of 13 patients (52.4%). In 20 injections (54.1%) of 11 patients (45.8%) IOP remained below 25mm. Of the 17 with elevated IOP, 12 were successfully controlled on one IOP lowering drop, 9 injections required two drops, three required three drops, and one was referred to a glaucoma specialist, but required no surgical intervention. The average time for increase was 36.5 days, ranging from 1 to 100 days post operative. One patient had a history of open angle glaucoma, being treated with two drops before and after surgery, and maintained normal IOP. Four patients had a history of steroid response glaucoma. Of those patients, one was placed on one drop temporarily, two remain on two drops, and one remains on three drops. Two of those patients eventually developed diabetic iris neovascularization resulting in neovascular glaucoma, and were referred to a glaucoma specialist. One of those two was treated with shunt tube placement, and the other was stabilized using drop therapy.
Surgical use of IVTA presents a risk of elevated IOP. Close to half of the injections resulted in a steroid response IOP elevation. These IOP elevations responded well to treatment, usually with drop therapy alone. While the risk of elevated IOP should be considered in any decision to attempt IVTA, this is by no means an absolute contraindication.
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