EXTENDED REPORT

Intraocular pressure alterations following intravitreal triamcinolone acetonide

D J Rhee^1,2,3, R E Peck², J Belmont⁴, A Martidis⁴, M Liu⁴, J Chang², J Fontanarosa³ and M R Moster³

¹ Glaucoma Service, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
² Laboratory for Molecular Ophthalmology, Wills Eye Hospital, Philadelphia, PA 19107, USA
³ William and Anna Glaucoma Service, Wills Eye Hospital, Philadelphia, PA 19107, USA
⁴ Retina Service, Wills Eye Hospital, Philadelphia, PA 19107, USA

Correspondence to:
Correspondence to:
Douglas J Rhee
MD, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, USA; dougrhee{at}aol.com

Aims: To determine the prevalence of intraocular pressure (IOP) alterations following intravitreal injection of triamcinolone acetonide (IVTA) and to assess possible risk factors of IOP elevation in eyes receiving single and/or repeat injections.

Methods: Retrospective, consecutive case series. 570 consecutive eyes of 536 patients who received a single IVTA injection (4 mg/0.1 ml) and a second set of 43 eyes of 40 patients who received a second injection. Retrospective review of all IVTA cases performed by three vitreoretinal surgeons over a 42 month period beginning in 2000. The main outcome measure was change in IOP defined as absolute value of IOP elevation (5 mm Hg or higher, 10 mm Hg or higher), and percentage of baseline (30% or higher increase from baseline IOP).

Results: Of the 528 eyes receiving single injections, 281 (53.2%) had an IOP elevation; 267 eyes (50.6%) experienced an elevation of IOP of at least 30%, and 245 (45.8%) and 75 (14.2%) eyes had an increase of 5 mm Hg or 10 mm Hg or more, respectively. Baseline IOP greater than 16 mm Hg is a risk factor for post-injection IOP elevation. Of the 43 eyes which received a second injection, 28 (65.1%) experienced an increase in IOP of at least 30% of baseline. Filtering surgery was required in five (0.094%) of the single and one (2.3%) of repeat injection eyes.

Conclusions: Elevated IOP after IVTA is common and patients should be monitored beyond 6 months post-injection. Patients with a baseline IOP more than 16 mm Hg or receiving a second injection should be carefully monitored for an elevated IOP.

Abbreviations: BRVO, branch retinal vein occlusion; CMO, cystoid macular oedema; CRVO, central retinal vein occlusion; IOP, intraocular pressure; IVTA, intravitreal triamcinolone acetonide; NPDR, non-proliferative diabetic retinopathy; PDR, proliferative diabetic retinopathy

Keywords: intravitreal triamcinolone; steroid induced glaucoma

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