J Korean Ophthalmol Soc.  2011 Jul;52(7):876-880. 10.3341/jkos.2011.52.7.876.

The Effectiveness of Selective Laser Trabeculoplasty in Steroid-Induced Ocular Hypertension

• Lee JH
• Seong MC
• Cho HY
• Lee YJ

• KMID: 2214715
• DOI: http://doi.org/10.3341/jkos.2011.52.7.876

Abstract

PURPOSE
To report the effectiveness of selective laser trabeculoplasty (SLT) in patients with intraocular hypertension refractory to maximum tolerated medical therapy after intravitreal triamcinolone acetonide (IVTA).
CASE SUMMARY
The records of 3 patients with steroid-induced intraocular hypertension that did not respond to maximum tolerated medical therapy were retrospectively reviewed. The patients received SLT instead of filtering surgery or Argon laser trabeculoplasty. The mean intraocular pressure (IOP) of 13.7 mm Hg increased to 30.7 mm Hg within 13 days of IVTA. IOP was uncontrolled despite maximum tolerated medical therapy. Patients underwent SLT 15.3 weeks after IVTA. Mean IOP decreased to 16 +/- 3.0 mm Hg after 1 day, 19.7 +/- 8.0 mm Hg after 1 week, 17 +/- 8.0 mm Hg after 1 month, 12.3 +/- 2.9 mm Hg after 3 months and 12.3 +/- 0.6 mm Hg after 4 to 6 months. The number of IOP lowering drugs were decreased to 1 from 4.3 after 6 months of SLT.
CONCLUSIONS
SLT may be effective and safe for the treatment of steroid-induced intraocular hypertension refractory to maximum tolerated medical therapy.

Keyword

Intravitreal triamcinolone acetonide injection; Selective laser trabeculoplasty; Steroid-induced ocular hypertension

MeSH Terms

Argon
Filtering Surgery
Humans
Hypertension
Intraocular Pressure
Ocular Hypertension
Retrospective Studies
Trabeculectomy
Triamcinolone Acetonide
Argon
Triamcinolone Acetonide

Figure

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  Figure 1. Effects of selective laser trabeculoplasty in 3 patients with elevated IOP after intravitreal triamcinolone acetonide.

Reference

References

1. Jonas JB, Kreissig I, Degenring R. Secondary chronic open-angle glaucoma after intravitreal triamcinolone acetonide. Arch Ophthalmol. 2003; 121:729–30.

2. Jonas JB, Kreissig I, Degenring R. Intraocular pressure after intravitreal injection of triamcinolone acetonide. Br J Ophthalmol. 2003; 87:24–7.

3. Becker B, Mills DW. Corticosteroids and intraocular pressure. Arch Ophthalmol. 1963; 70:500–7.

4. Gaston H, Absolon MJ, Thurtle OA, Sattar MA. Steroid responsiveness in connective tissue diseases. Br J Ophthalmol. 1983; 67:487–90.

5. Podos SM, Becker B, Morton WR. High myopia and primary open-angle glaucoma. Am J Ophthalmol. 1966; 62:1038–43.

6. Jones R 3rd, Rhee DJ. Corticosteroid-induced ocular hypertension and glaucoma: a brief review and update of the literature. Curr Opin Ophthalmol. 2006; 17:163–7.

7. Singh IP, Ahmad SI, Yeh D, et al. Early rapid rise in intraocular pressure after intravitreal triamcinolone acetonide injection. Am J Ophthalmol. 2004; 138:286–7.

8. Ricci F, Missiroli F, Parravano M. Argon laser trabeculoplasty in triamcinolone acetonide induced ocular hypertension refractory to maximal medical treatment. Eur J Ophthalmol. 2006; 16:756–7.

9. Viola F, Morescalchi F, Staurenghi G. Argon laser trabeculoplasty for intractable glaucoma following intravitreal triamcinolone. Arch Ophthalmol. 2006; 124:133–4.

10. Russo V, Barone A, Cosma A, et al. Selective laser trabeculoplasty versus argon laser trabeculoplasty in patients with uncontrolled open-angle glaucoma. Eur J Ophthalmol. 2009; 19:429–34.

11. Latina MA, de Leon JM. Selective laser trabeculoplasty. Ophthalmol Clin North Am. 2005; 18:409–19.

12. McLean JM. Use of ACTH and cortisone. Trans Am Ophthalmol Soc. 1950; 48:293–6.

13. Jonas JB, Degenring RF, Kreissig I, et al. Intraocular pressure elevation after intravitreal triamcinolone acetonide injection. Ophthalmology. 2005; 112:593–8.

14. Becker B. Intraocular pressure response to topical corticosteroids. Invest Ophthalmol. 1965; 4:198–205.

15. Rohen JW, Linnér E, Witmer R. Electron microscopic studies on the trabecular meshwork in two cases of corticosteroid-glaucoma. Exp Eye Res. 1973; 17:19–31.

16. Johnson D, Gottanka J, Flügel C, et al. Ultrastructural changes in the trabecular meshwork of human eyes treated with corticosteroids. Arch Ophthalmol. 1997; 115:375–83.

17. Knepper PA, Breen M, Weinstein HG, Blacik JL. Intraocular pressure and glycosaminoglycan distribution in the rabbit eye: effect of age and dexamethasone. Exp Eye Res. 1978; 27:567–75.

18. Wordinger RJ, Clark AF. Effects of glucocorticoids on the trabecular meshwork: towards a better understanding of glaucoma. Prog Retin Eye Res. 1999; 18:629–67.

19. Baser E, Seymenoglu R. Selective laser trabeculoplasty for the treatment of intraocular pressure elevation after intravitreal triamcinolone injection. Can J Ophthalmol. 2009; 44:e21.

20. Rubin B, Taglienti A, Rothman RF, et al. The effect of selective laser trabeculoplasty on intraocular pressure in patients with intravitreal steroid-induced elevated intraocular pressure. J Glaucoma. 2008; 17:287–92.

21. Pizzimenti JJ, Nickerson MM, Pizzimenti CE, Kasten-Aker AG. Selective laser trabeculoplasty for intraocular pressure elevation after intravitreal triamcinolone acetonide injection. Optom Vis Sci. 2006; 83:421–5.

22. Mermoud A, Pittet N, Herbort CP. Inflammation patterns after laser trabeculoplasty measured with the laser flare meter. Arch Ophthalmol. 1992; 110:368–70.

23. Traverso CE, Greenidge KC, Spaeth GL. Formation of peripheral anterior synechiae following argon laser trabeculoplasty. A prospective study to determine relationship to position of laser burns. Arch Ophthalmol. 1984; 102:861–3.

24. Weinreb RN, Ruderman J, Juster R, Zweig K. Immediate intraocular pressure response to argon laser trabeculoplasty. Am J Ophthalmol. 1983; 95:279–86.

25. Weinreb RN, Ruderman J, Juster R, Wilensky JT. Influence of the number of laser burns administered on the early results of argon laser trabeculoplasty. Am J Ophthalmol. 1983; 95:287–92.