Ocular Hypertension and Glaucoma after Intravitreal Injection of Triamcinolone Acetonide

Year 2018, Volume: 4 Issue: 1, 24 - 30, 20.04.2018

Refika Hande Karakahya , Defne Kalaycı Ahmet Karakurt

https://doi.org/10.19127/mbsjohs.413426

Cited By: 1

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.

Keywords

intravitreal triamcinolone acetonide, streoid induced glaucoma, macular edema

References

• Agrawal S, Agrawal J, Agrawal T. Management of intractable glaucoma following intravitreal triamcinolone acetonide. Am J Ophthalmol 2004; 138: 286–287.
• Becker B, Bresnick G, Chevrette L, et al. Intraocular pressure and its response to topical corticosteroids in diabetes. Arch Ophthalmol 1966; 76: 477–483.
• Breusegem C, Vandewalle E, Van Calster J, et al. Predictive value of a topical dexamethasone provocative test before intravitreal triamcinolone acetonide injection. Invest Ophthalmol Vis Sci 2009;50: 573–576.
• Ciardiella AP, Klancnik J,Schiff W,et al. Intravitreal triamcinolone for the treatment of refractory diabetic macular oedema with hard exudates: an optical coherence tomography study. Br J Ophthalmol 2004;88:1131-6
• Clark AF, Wordinger RJ: The role of steroids in outflow resistance. Exp Eye Res 2009; 88: 752–759.
• Çekiç O, Chang S, Tseng JJ, et al. Intravitreal triamcinolone treatment for macular edema associated with central retinal vein occlusion and hemiretinal vein occlusion. Retina 2005; 25: 846-850.
• Gillies MC, Simpson JM, Billson FA, et al. Safety of an intravitreal injection of triamcinolone: results from a randomized clinical trial. Arch Ophthalmol 2004; 122:336–340.
• Holekamp NM, Thomas MA, Pearson A. The safety profile of long-term, high-dose intraocular corticosteroid delivery. Am J Ophthalmol. 2005 Mar;139(3):421-8.
• Jonas JB, Kreissig I, Degenring R. Intraocular pressure after intravitreal injection of triamcinolone acetonide. Br J Ophthalmol 2003;87:24-27
• Jonas JB, Harder B, Kamppeter BA. Inter-eye difference in diabetic macular edema after unilateral injection of triamcinolone acetonide. Am J Ophthalmol 2004a;138:970-77.
• Jonas JB, Degenrig RF, Kamppeter BA,et al.Duration of the effect of Intravitreal triamcinolone acetonide.as treatment for diffuse diabetic macular edema. Am J Ophthalmol 2004b;138:158-160.
• Jonas JB. Intravitreal triamcinolone acetonide for treatment of intraocular oedematous and neovascular diseases. Acta Ophthalmol Scand 2005;83(6): 645-63.
• Jonas JB, Akkoyun I,Kreissig I, Degenring RF. Diffuse diabetic macular edema treated by intravitreal triamcinolone acetonide: a comparative nonrandomized study. Br JOphthalmol 2005a:89:321-326.
• Jonas JB, Akkoyun I, Kamppeter B, et al. Branch retinal vein occlusion treated by intravitreal triamcinolone acetonide. Eye 2005b;19:65-71.
• Jonas JB, Degenring RF, Kreissig I, Akkoyun I, Kamppeter BA. Intraocular pressure elevation after intravitreal triamcinolone acetonide injection. Ophthalmology 2005c; 112:593–598.
• Jones R 3rd, Rhee DJ. Corticosteroid-induced ocular hypertension and glaucoma: a brief review and update of the literature. Curr Opin Ophthalmol 2006; 17(2): 163-7.
• Kocabora MS, Yilmazli C, Taskapili M, et al. Development of ocular hypertension and persistent glaucoma after intravitreal injection of triamcinolone. Clin Ophthalmol 2008; 2: 167-71.
• Mason JO 3rd, Somaiya MD, Singh RJ. Intravitreal concentration and clearance of triamcinolone acetonide in nonvitrectomized human eyes. Retina 2004; 24: 900–4.
• Massin P, Audren F, Haouchine B, Erginay A, et al. Intravitreal triamcinolone acetonide for diabetic diffuse macular edema. Ophthalmology 2004;111:218-225.
• Özkıriş A, Erkılıç K. Complications of intravitreal injection of triamcinolone acetonide. Can J Ophthalmol 2005;40:63-8.
• Razeghinejad MR, Katz LJ. Steroid-induced iatrogenic glaucoma. Ophthalmic Res 2012;47:66-80.
• Roth DB, Verma V, Realini T, et al. Long-term incidence and timing of intraocular hypertension after intravitreal triamcinolone injection. Ophthalmology 2009;116:455-60.
• Rubin B, Taglienti A, Rothman RF. The effect of selective laser trabeculoplasty on intraocular pressure in patients with intravitreal steroid-induced elevated intraocular pressure. J Glaucoma 2008;17:287–292.
• Singh IP, Ahmad SI, Yeh D, et al. Early rapid rise in intraocular pressure after intravitreal triamcinolone acetonide injection. Am J Ophthalmol 2004;138: 286–287.
• Smithen LM, Ober MD, Maranan L, et al. Intravitreal triamcinolone acetonide and intraocular pressure. Am J Ophthalmol 2004;138:740–743.
• Spandau UHM, Derse M, Schmitz-Valckenberg P, et al. Dosage dependency of intravitreal triamcinolone acetonide as treatment for diabetic macular edema. Br J Ophthalmol 2005;89:999-1003.
• Viola F, Morescalchi F, Staurenghi G. Argon laser trabeculoplastyfor intractable glaucoma following triamcinolone. Arch Ophthalmol 2006,124:133–4.