Incidence of ocular hypertension following intravitreal injection of 2mg triamcinolone

Abstract

Purpose : To report the incidence of ocular hypertension (OHT) following intravitreal injection of 2mg triamcinolone acetonide (IVT).

Methods : In a consecutive case series, all patients receiving 2mg IVT at Wills Eye Hospital between March 1, 2012 and March 1, 2017 were included. Ocular hypertension was defined as an intraocular pressure (IOP) measurement over 24mmHg at any follow-up visit after IVT. Exclusion criteria included less than 3 months follow-up after first IVT and receiving topical, periocular, or intravitreal steroid other than 2mg triamcinolone less than 3 months prior to first IVT or after IVT treatment was begun.

Results : A total of 106 eyes in 100 patients were included. Average patient age was 69.0 years and 22 patients had a prior history of glaucoma. Reasons for IVT included diabetic macular edema (40.6%), post-intraocular lens insertion macular edema (25.5%), retinal vein occlusion (18.9%), uveitis (10.4%), and other etiologies (11.3%). Eyes received an average of 2.85 IVT and average patient follow-up was 15.1 months (range 3.0 – 52.5). A total of 14 eyes (13.2%) in 14 patients developed ocular hypertension after a median of 1.5 injections (range 1-9) with an average peak IOP of 29.0 (range 25 – 38). A total of 4 eyes (3.8% overall) recorded an IOP of 30 or higher and 1 eye (0.94% overall) recorded an IOP of 35 or higher at any follow-up visit. Of the 22 patients with a history of glaucoma, 4 patients (18.2%) developed OHT after a median of 1.0 injection (range 1-2) with an average peak IOP of 27.3 (range 26-29). Of the 6 patients receiving bilateral injections, one patient developed unilateral OHT with a peak IOP of 26; no cases of bilateral OHT occurred. Overall, a total of 11 eyes (10.4%) had an IOP elevation ≥ 10mmHg above baseline at any point following first IVT. In all 14 cases of OHT, IOP was successfully controlled with topical IOP lowering medication alone; no patients required surgical intervention.

Conclusions : In a study of 106 eyes, ocular hypertension developed in 13.2% of eyes receiving intravitreal injection of 2mg triamcinolone. Previous studies of intravitreal injection of 4mg triamcinolone acetonide and 0.7mg dexamethasone implant have reported ocular hypertension rates of 40-50% and 16-32%, respectively. Incidence of ocular hypertension following intravitreal injection of 2mg triamcinolone compares favorably to injection of other select steroid agents or doses.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.