Ocular Hypertension and Glaucoma after Intravitreal Injection of Triamcinolone Acetonide

Abstract

Objective: The use of intravitreal triamcinolone acetonide (IVTA) for intraocular neovascular, proliferative and edematous diseases has led to an increased incidence of corticosteroid-induced ocular hypertension. Even though largely replaced with anti-vascular endothelial growth factor (anti-VEGF) agents and slow-release dexamethasone implants, boosters are still required in nonresponsive or minimally responsive patients, in cases of tachyplaxis to these agents, or in combination therapies with anti-VEGFs.Metods: The records of 136 eyes of 124 patients who underwent 4 mg/ml IVTA treatment for macular edema of variable etiologies of diabetic macular edema, retinal vein occlusions, subretinal choroidal neovascularization, Irvine-Gass Syndrome, retinitis pigmentosa and idiopathic juxtafoveal telengiectasia in the period 2001–2006 were reviewed. Seventy-six eyes of 71 patients of which were followed for at least 3 months were included in the study. The patients were examined at the first day, second week, first month and every month after the injection. Mean intraocular pressure (IOP), IOP exceeding 21 mmHg and percentage of patients exhibiting IOP increase of 5 mmHg after IVTA injection, during the follow-up period were evaluated and compared statistically. Results: Mean age was 56.64±12.65 years and male to female ratio was 35/36. Mean follow-up time was 12.13±10.30 months. The mean IOP increased statistically (p= <0.001) during follow-up from 14.95±3.15 mmHg pre-injection level reaching to a maximum of 21.66±6.48 mmHg and decreased statistically (p= <0.001) to 15.58±4.16 mmHg at the end of the follow-up. There was no statistical difference between pre-injection and post-injection IOP levels (p=0.406). The IOP levels exceeded 21 mmHg in 46.05% of the eyes. There was an increase of 5 mmHg and more above the pre-injection level in the 53.94% of the eyes. Maximum IOP levels were reached at the 2.77±3.72 month. In 24 (31.58%) eyes, topical antiglaucomatous therapy was needed and later 1 eye (4.6%) required surgical intervention and 1 eye (4.6%) required argon laser trabeculoplasty to lower the IOP. Conclusion: The most common complication following İVTA injections is rise in IOP. Most of these ocular hypertension cases are controllable by medical therapy. However, the risk of glaucoma requiring surgery or long term antiglaucomatous use validate the necessity of a meticulous patient selection and close monitorization of IOP.