Predictive Value of Low–Dose Intravitreal Triamcinolone Acetonide for Steroid Responders

Abstract

Abstract: : Purpose: To determine the predictive value of a test 400–µg dose of intravitreal triamcinolone acetonide (TA) for the rise of intraocular pressure (IOP) after intravitreal injection of 4– or 8–mg TA. Methods: Eighty–three eyes were injected intravitreally with a test dose of 400 µg of TA. IOP was measured with Goldmann applanation at 1 or 2 days, 1 week, 1 month, and at varying intervals from 2–7 months postinjection. Eyes without an IOP elevation ≥ 5 mmHg after 1 week were given a second intravitreal injection of either 4 mg or 8 mg; eyes with elevated IOP > 5 mmHg did not receive another injection. Follow up ranged from < 1 month to ≥ 6 months. Results: Of the 83 eyes that received the 400–µg injection, 7 eyes (8%) showed an increase in IOP > 5 mmHg after 1 week. The average early IOP spike was 10 mmHg in these 7 eyes (range 5–25 mmHg); IOP in these eyes returned to preinjection levels with topical antiglaucoma therapy after 2 months. Of the 76 eyes given a second injection of TA (68 eyes, 4 mg; 8 eyes, 8 mg), 49 eyes were followed for ≥ 3 months postinjection; 12 eyes had an IOP elevation > 5 mmHg. Average IOP elevation was 10 mmHg (range 6–20 mmHg). Elevated IOP in this group was treated successfully within 2 months with topical medication. Four of 8 eyes (50%) given an 8–mg dose injection developed a late rise in IOP; only 8 of 68 eyes (12%) given a 4–mg dose developed a rise in IOP > 5 mmHg. Conclusions: An intravitreal microdose of 400 µg TA, followed for 1 week, may identify eyes at risk for steroid–induced IOP elevation after a full 4– or 8–mg dose of intravitreal TA. Eyes tolerating a 400–µg TA dose may be less likely to suffer a significant pressure elevation after a full–dose injection.

Keywords: corticosteroids • intraocular pressure