IOP after Triamcinolone Acetonide

Abstract

We read with great interest the recent report by Jonas et al.1Jonas J.B. Degenring R.F. Kreissig I. et al.Intraocular pressure elevation after intravitreal triamcinolone acetonide injection.Ophthalmology. 2005; 112: 593-598Abstract Full Text Full Text PDF PubMed Scopus (287) Google Scholar In their study, the authors have reported a rise in intraocular pressure (IOP) starting a week after the intravitreal injection of 20-mg triamcinolone acetonide. We present the results of a study carried out at our department using 4-mg triamcinolone acetonide injected intravitreally for macular edema arising due to a variety of causes (cystoid macular edema including postcataract extraction, retinal vein occlusions and uveitis, diabetic macular edema, and edema associated with age-related macular degeneration). In our series of 26 eyes, a rise in IOP was noted in 0.0% of eyes at 1 week, 15.8% of eyes at 6 weeks, 38.5% of eyes at 3 months, and 22.2% of eyes at 6-month follow up. The Friedman test was used on the data. There was a significant rise in mean IOP over the 6-month follow up (P = 0.039). Maximum and mean IOPs remained within the normal range at week 1 and were observed to increase after week 6. All cases of raised IOP were controlled by available antiglaucoma medication, and none required surgical intervention. The timing of raised IOP in our series was therefore later than that reported by Jonas et al. In their series, Chan et al2Chan C.K. Fan D.S. Chan W.M. et al.Ocular-hypertensive response and corneal endothelial changes after intravitreal triamcinolone injections in Chinese subjects a 6-month follow-up study.Eye. 2004; : 1-6PubMed Google Scholar reported an IOP elevation at a mean of 5.2 weeks. A rise in IOP was noted by Young et al3Young S. Larkin G. Branley M. Lightman S. Safety and efficacy of intravitreal triamcinolone for cystoid macular oedema in uveitis.Clin Experiment Ophthalmol. 2001; 29: 2-6Crossref PubMed Scopus (310) Google Scholar 1 month or later after intravitreal triamcinolone injection. We believe the later rise of IOP may be a result of the lower dose of intravitreal triamcinolone acetonide used in our case series. It is important to highlight this difference in outcomes, as 4 mg is the more commonly used intravitreal triamcinolone dose. Author ReplyOphthalmologyVol. 113Issue 2PreviewWe thank Drs Dhir and Prasad for their interest in our article. They say that in their study population receiving a dose of 4-mg intravitreal triamcinolone acetonide for treatment of macular diseases similar to those in our study, intraocular pressure (IOP) increased significantly at 6 weeks after the injection, whereas at 1 week after the injection IOP did not differ significantly from baseline. They conclude that the later timing of the rise in IOP in their study with 4-mg triamcinolone compared with our study with about 20 mg of triamcinolone was due to the difference in the dose. Full-Text PDF