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V. Gualino, F. Audren, A. Erginay, B. Haouchine, J. Bergmann, A. Gaudric, P.G. Massin; Intraocular Pressure After Intravitreal Triamcinolone Acetonide for Diabetic Diffuse Macular Edema . Invest. Ophthalmol. Vis. Sci. 2005;46(13):1433.
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Purpose: To evaluate prospectively the effect on intraocular pressure (IOP) of intravitreal injection of 4mg triamcinolone acetonide (TA) for refractory diffuse diabetic macular edema. Methods: Diabetic patients included in 2 prospective randomized trials received an intravitreal injection of 4 mg TA. All eyes had diabetic macular edema unresponsive to laser photocoagulation. To detect corticosteroid–induced ocular hypertension, one month of treatment with topical 0.1% dexamethasone three times daily in both eyes of all patients was administered before inclusion. TA injection was performed only if IOP rise under dexamethasone treatment did not exceed 15mmHg. IOP, measured before and after dexamethasone treatment, before and at various times after injection, the need of an antiglaucomatous treatment, the time of occurrence of ocular hypertension if ever, were studied. Results:Thirty–five eyes of 35 patients were injected. Follow–up after injection was at least 24 weeks for all patients. A IOP superior to 24 mmHg was observed in 17 eyes (48,6%) at a mean time after injection of 38.3 ± 34.8 days (2 to 113). In all cases, ocular hypertension was controlled by topical treatment. Before and after dexamethasone treatment, mean ± SD PIO was 15.7 ± 2.4 mmHg (10 to 20) and 18.2 ± 2.5 µm (15 to 22) respectively (p=0.0015, Wilcoxon test for paired samples) in the group of eyes which experienced IOP superior to 24 mmHg. Before and after dexamethasone treatment, mean ± SD PIO was 15.7 ± 3.0 mmHg (12 to 22) and 16.7 ± 3.0 mmHg (10 to 23) respectively (p=0.0015, Wilcoxon test for paired samples) in the group of eyes which did not experienced IOP superior to 24 mmHg (p> 0.08). Conclusions: Intravitreal injection of triamcinolone induces a IOP rise in almost half cases in our series of eyes with diabetic macular edema. Our results allows to discuss the value of a predictive test with topical dexamethasone for glucocorticoid–induced hypertension. The rise of IOP with the test is significant, but its magnitude is low, which can limit its use. Further studies are warranted..
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