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H. Wilson, R. Monshizadeh; Short–Term Anterior Segment Complications of Intravitreal Triamcinolone Acetonide Injection . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5027.
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Purpose: Intravitreal triamcinolone acetonide (TAC) injection is a relatively new treatment for macular edema. Given limited available safety data, this study investigated potential anterior segment complications and their relationship to presence of TAC in the anterior chamber immediately after injection and lens status. Methods: Retrospective chart review was conducted for a series of 50 eyes with macular edema (from BRVO, CRVO, wet ARMD, or diabetes) treated with intravitreal TAC (40 mg) at Inland Eye Institute. Anterior segment exam findings and IOP were studied at the following intervals: pre–injection, immediately post–injection, at one day, one week and up to 6 months later. Mean data was compared with the unpaired t test, and frequencies with odds ratios, confidence intervals, and Fisher’s exact test. Results: Anterior segment complications were observed in 60% of treated eyes (30/50) within 24 hours of injection: 4 IOP40 immediately post–injection requiring initiation of IOP–lowering therapy and one eventual trabeculectomy; 5 corneal abnormalities and 7 anterior chamber reactions. Intracameral TAC was detected in 34% (17/50) immediately post–injection. A trend for higher frequency of intracameral TAC was seen in pseudophakic eyes (9/17=0.53) vs. phakic eyes (8/33=0.24). Other anterior segment complications were more likely to occur in eyes with intracameral TAC (14/17=0.82) compared to those without (16/33=0.48) [OR = 4.96, 95% CI = 1.20–20.5, P=0.0323]. In contrast, frequency of anterior segment complications was similar in pseudophakic (10/17=0.59) and phakic eyes (17/33=0.52) [p>0.05]. Mean post–injection IOP immediately following treatment was modestly increased in eyes with intracameral TAC (mean IOP 34, n=17) vs. those without (31, n=33). However, neither intracameral TAC, pseudophakia, status of posterior capsule or pre–injection use of glaucoma medication was a statistically significant predicting factor for post–injection IOP. Conclusions: Intravitreal TAC–related anterior segment complications, though rarely severe, are common. Intracameral TAC observed immediately post–injection may be a predisposing factor for some of these complications.
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