Abstract
Objective:To determine the frequency of an increase in intraocular pressure (IOP) after intravitreal triamcinolone acetonide (IVTA) in diabetic versus non-diabetic patients with various chorio-retinal disorders.Methods:This prospective, interventional comparative case series was conducted at Isra Postgraduate Institute of Ophthalmology, Al-Ibrahim Eye Hospital, Karachi from May 2012 to April 2014. Two hundred thirty seven eyes of 180 patients were enrolled with 90 patients each in diabetic and non-diabetic group, requiring IVTA. IVTA 4mg/0.1ml was injected and IOP was measured at one week, one month, three months and six months in both groups of patients.Results:In diabetic group, 43 patients were male (47.8%) and 47 were female (52.2%), while in non-diabetic group, 56 (62.2%) patients were male and 34 (37.8%) were female. Mean age of patients in diabetic group was 52.21 ± 9.6 years and in non-diabetic group was 51.13 ± 10.75 years. The mean preoperative IOP was 13.6 ± 2.8 mmHg and 14.1 ± 2.4 mmHg in diabetic and non-diabetic group respectively. In diabetic group, mean (±SD) IOP was 16.4 ±4.9 mmHg, 14.6 ±3.6 mmHg, 17.6 ± 9.7 mmHg and 15.5 ± 7.09 mmHg at one week, one month, three months and 6 months post injection. While in non-diabetic cases, mean (±SD) IOP was 14.8 ± 3.33 mmHg, 15.9 ± 4.2 mmHg, 15.5 ± 4.2 mmHg and 14.1 ± 3.2 mmHg at one week, one month, three months and 6 months follow up. The raised IOP was observed in 117 eyes (49%) in both groups of patients, with 78 eyes (65%) in diabetic group and 39 eyes (33%) in non-diabetic group.Conclusions:After IVTA, an IOP rise was observed more in diabetics than non-diabetic patients.
Highlights
A number of studies[1,2,3,4,5] have reported that, individuals with diabetes mellitus (DM) experience a high prevalence of increased intraocular pressure (IOP) and primary open-angle glaucoma (POAG)
Is fibronectin synthesis in the trabecular meshwork a missing link for increase prevalence of glaucoma in DM has to be proven in further studies
Diabetic macular edema was the most frequent diagnosis in diabetic (n = 68 patients) while branch retinal vein occlusion (BRVO) was in nondiabetic cases (n = 31)
Summary
A number of studies[1,2,3,4,5] have reported that, individuals with diabetes mellitus (DM) experience a high prevalence of increased intraocular pressure (IOP) and primary open-angle glaucoma (POAG). The exact mechanism of elevated IOP in POAG is not known, but an increased resistance in the outflow channels is believed for diminished outflow of aqueous humor. The presence of fibronectin, an extracellular glycoprotein in the trabecular tissue, mainly, in the inner wall of schlemm’s canal and juxtacanalicular, or cribriform part of trabecular meshwork has been verified by other workers .[7] Glucose concentration is believed to be higher in aqueous humor of diabetic patients. Several studies have recognized that increased glucose level in aqueous induces increase in fibronectin synthesis and its accumulation in the trabecular meshwork with depletion of normal trabecular meshwork cells.[9,10] Is fibronectin synthesis in the trabecular meshwork a missing link for increase prevalence of glaucoma in DM has to be proven in further studies
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