IOP after Triamcinolone Acetonide: Author Reply

Abstract

We thank Drs Lin, Tsai, and Hung for their letter and interest in our study. We agree with them that pars plana vitrectomy (PPV) is one option to treat triamcinolone acetonide–induced elevation of intraocular pressure (IOP).1Agrawal S. Agrawal J. Agrawal T.P. Vitrectomy as a treatment for elevated intraocular pressure following intravitreal injection of triamcinolone acetonide.Am J Ophthalmol. 2004; 138: 679-680Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar If, however, triamcinolone acetonide is associated with a positive therapeutic effect, such as an increase in visual acuity, the removal of triamcinolone acetonide will be combined with the disadvantage that the beneficial effect of intravitreal triamcinolone acetonide will soon be terminated after the PPV. A therapeutic advantage of a pars plana approach may be the relief of vitreoretinal traction on the macula, which may lead to a decrease in macular edema in patients with diabetic macular edema and epiretinal membranes.2Lewis H. Abrams G.W. Blumenkranz M.S. et al.Vitrectomy for diabetic macular traction and edema associated with posterior hyaloidal traction.Ophthalmology. 1992; 99: 753-759Abstract Full Text PDF PubMed Scopus (571) Google Scholar This advantage must be compared with the surgical risk of PPV.If one wants to maintain the positive therapeutic effect of triamcinolone acetonide and if, simultaneously, one has to treat IOP elevation, filtering surgery may be another option. According to previous small case series studies, filtering surgery in eyes with intravitreal triamcinolone acetonide may have a positive surgical and functional outcome and still leaves the triamcinolone acetonide in the eye.3Jonas J.B. Degenring R.F. Kamppeter B.A. Filtering surgery after intravitreal triamcinolone acetonide injection.J Glaucoma. 2004; 13: 261Crossref PubMed Scopus (4) Google Scholar One has to take into account, however, that after filtering surgery the duration of the intraocular availability of triamcinolone acetonide may be reduced due to a possibly higher turnover rate. An alternative to PPV and filtering surgery may be argon laser trabeculoplasty to reduce elevated IOP.4Viola F, Morescalchi F, Staurenghi G. Argon laser trabeculoplasty for intractable glaucoma following tntravitreal trimcinolone? Arch Ophthalmol. In press.Google Scholar In the future, anecortave acetate may play a role in the treatment of triamcinolone acetonide–induced ocular hypertension, because it has been said that anecortave acetate may be able to reverse steroid-induced ocular hypertension (Robin A, personal communication, 2005). We thank Drs Lin, Tsai, and Hung for their letter and interest in our study. We agree with them that pars plana vitrectomy (PPV) is one option to treat triamcinolone acetonide–induced elevation of intraocular pressure (IOP).1Agrawal S. Agrawal J. Agrawal T.P. Vitrectomy as a treatment for elevated intraocular pressure following intravitreal injection of triamcinolone acetonide.Am J Ophthalmol. 2004; 138: 679-680Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar If, however, triamcinolone acetonide is associated with a positive therapeutic effect, such as an increase in visual acuity, the removal of triamcinolone acetonide will be combined with the disadvantage that the beneficial effect of intravitreal triamcinolone acetonide will soon be terminated after the PPV. A therapeutic advantage of a pars plana approach may be the relief of vitreoretinal traction on the macula, which may lead to a decrease in macular edema in patients with diabetic macular edema and epiretinal membranes.2Lewis H. Abrams G.W. Blumenkranz M.S. et al.Vitrectomy for diabetic macular traction and edema associated with posterior hyaloidal traction.Ophthalmology. 1992; 99: 753-759Abstract Full Text PDF PubMed Scopus (571) Google Scholar This advantage must be compared with the surgical risk of PPV. If one wants to maintain the positive therapeutic effect of triamcinolone acetonide and if, simultaneously, one has to treat IOP elevation, filtering surgery may be another option. According to previous small case series studies, filtering surgery in eyes with intravitreal triamcinolone acetonide may have a positive surgical and functional outcome and still leaves the triamcinolone acetonide in the eye.3Jonas J.B. Degenring R.F. Kamppeter B.A. Filtering surgery after intravitreal triamcinolone acetonide injection.J Glaucoma. 2004; 13: 261Crossref PubMed Scopus (4) Google Scholar One has to take into account, however, that after filtering surgery the duration of the intraocular availability of triamcinolone acetonide may be reduced due to a possibly higher turnover rate. An alternative to PPV and filtering surgery may be argon laser trabeculoplasty to reduce elevated IOP.4Viola F, Morescalchi F, Staurenghi G. Argon laser trabeculoplasty for intractable glaucoma following tntravitreal trimcinolone? Arch Ophthalmol. In press.Google Scholar In the future, anecortave acetate may play a role in the treatment of triamcinolone acetonide–induced ocular hypertension, because it has been said that anecortave acetate may be able to reverse steroid-induced ocular hypertension (Robin A, personal communication, 2005).