Topical Steroid Challenge Prior to Intravitreal Kenalog Injection: Does it Prevent IOP Spikes

Abstract

Abstract: : Purpose: Intravitreal injection of Kenalog (IVK) is now accepted clinical practice for treatment of a variety of retinal disorders, in particular macular edema. There is now increasing evidence to show that a significant intraocular pressure (IOP) rise occurs in approximately 30–50% of eyes injected. The purpose of our study was to investigate if treating potential IVK candidates with intensive topical 1% prednisone acetate (Predforte^®) for three weeks could help prevent the post–injection IOP spike by weeding out the steroid responders. Methods: Retrospective chart review of all patients who received an IVK from June 2003 to Aug 2004. In patients who had both eyes injected the second eye was excluded from the study. All patients received a pars plana injection of 0.1ml (4mg) of Kenalog. Vigorous ocular massage or a 30G anterior chamber paracentesis was used to reduce the IOP immediately post–injection. Data collected from the charts included diagnosis of glaucoma; IOP at baseline, immediate post–injection and at all clinic visits post–injection, time of IOP spike, pre and post–injection glaucoma medications. A greater than 5mmHg IOP increase from pre–injection baseline IOP was considered significant. Results: 53 eyes of 53 patients received IVK injection. 24 patients were pretreated with Predforte^® (Group A) and 29 had no pre–treatment (Group B), 2 patients that were pretreated had an IOP spike, did not receive IVK injection and were excluded from the analysis. Baseline IOP (Mean +SD) in Groups A and B were 14.5 + 3.2 mmHg and 14.28 + 3.86 mmHg, respectively. In the pretreatment group (Group A) 25 % of patients had a significant IOP spike at an average of 30 days post–injection, ranging from 6–36 mmHg above baseline. In Group B, 34 % of patients had a significant IOP spike at an average of 25 days post–injection, ranging from 6–16 mm Hg above baseline. Mean+SD post–injection IOP was 16.8 + 4.7 mmHg at a mean follow–up of 4.46 months in Group A. In comparison, patients in Group B had a mean +SD IOP of 15.24 + 5.2 mmHg at a mean follow–up of 4.7 months. All IOP spikes were well controlled medically and none needed a surgical glaucoma intervention. There were no other complications from the injection. Conclusions: Intensive topical steroid challenge prior to IVK does not weed out steroid responders sufficient enough to prevent significant IOP spikes. The increase in IOP in most cases is moderate and is controlled with anti–glaucoma medications.

Keywords: retina • diabetic retinopathy • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled