Korean J Ophthalmol.  2005 Jun;19(2):122-127. 10.3341/kjo.2005.19.2.122.

Intraocular Pressure Elevation after Intravitreal Triamcinolone Acetonide Injection

Affiliations
  • 1Department of Ophthalmology, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea. ophkim@hallym.or.kr

Abstract

PURPOSE
This study investigated firstly the change of intraocular pressure (IOP) after injection of intravitreal triamcinolone acetonide (IVTA) for the treatment of macular edema and secondly the factors that influence these changes. METHODS: A prospective, non-comparative study was performed in 60 patients at Kangnam Sacred Heart Hospital from October 2003 to September 2004. All the patients received 4-mg IVTA injection. RESULTS: Mean IOP was elevated from the day after injection and peaked at 20.5 mmHg after 2 months (p=0.000). Twenty-six eyes (43.3%) showed significant IOP elevation. IOP was not controlled despite full glaucoma medication in 7 (11.7%) eyes. Two eyes underwent filtering surgery. Younger age was a statistically significant predictive factor for IOP elevation (p=0.009). CONCLUSIONS: In this study, patients who needed filtering surgery developed an IOP spike within one week after the injection. Therefore, clinicians should consider checking IOP at the end of the first week. Furthermore, greater cautions is mandatory with relatively younger patients.

Keyword

Intravitreal triamcinolone acetonide (IVTA) injection; Intraocular pressure (IOP) ; Younger age

MeSH Terms

Adult
Aged
Aged, 80 and over
Female
Glucocorticoids/*administration & dosage/*adverse effects/therapeutic use
Humans
Injections
Intraocular Pressure/*drug effects
Macular Edema, Cystoid/*drug therapy/*physiopathology
Male
Middle Aged
Prospective Studies
Triamcinolone Acetonide/*administration & dosage/*adverse
Vitreous Body

Figure

  • Fig. 1. Distribution of mean intraocular pressure (IOP) after 4-mg intravitreal triamcinolone acetonide injection in 60 patients, 60 eyes. A: group of patients with normal IOP (N=34). B: group of patients with postoperative IOP elevation (N=26).

  • Fig. 2. Distribution of intraocular pressure (IOP) in patients with uncontrolled IOP (N=7). a,b: recovered to normal range of IOP during the long term follow-up period. c,d: were lost during the follow-up period and further observation was not available. e.f: showed persistent ocular hypertension despite full glaucoma medication and required filtering surgery to control IOP. After conventional penetrating glaucoma surgery, IOP was normalization. g: even though topical glaucoma medication was performed due to IOP elevation, IOP fluctuation continued for several months and the patient was still on follow-up at the time of writing. (number): patients age, ◇: date of trabeculectomy


Cited by  7 articles

Intraocular Pressure: Intravitreal Preservative-free Triamcinolone Injection in Diabetic Macular Edema and Branch Retinal Vein Occlusion
Chan Ho Lee, Young Seung Seo
J Korean Ophthalmol Soc. 2020;61(2):167-174.    doi: 10.3341/jkos.2020.61.2.167.

Intraocular Pressure Elevation After Intravitreal Triamcinolone Acetonide of Different Volumes: Comparing 0.1 ml vs 0.05 ml
Sung Yong Park, Kyung Seek Choi
J Korean Ophthalmol Soc. 2008;49(4):589-594.    doi: 10.3341/jkos.2008.49.4.589.

Prophylactic Effect of Brimonidine 0.15% on IOP Elevation After Intravitreal Triamcinolone Acetonide Injection
Myung-Won Lee, Sung Eun Kyung, Moo-Hwan Chang
J Korean Ophthalmol Soc. 2008;49(5):743-752.    doi: 10.3341/jkos.2008.49.5.743.

The Intraocular Pressure Rise Secondary to Subtenon's Injection of Triamcinolone After Intravitreal Injection
Wung Jae Kim, Young-Hoon Park
J Korean Ophthalmol Soc. 2008;49(1):91-97.    doi: 10.3341/jkos.2008.49.1.91.

The Long-Term Observation of Intraocular Pressure after Intravitreal Injections of Bevacizumab, Triamcinolone, and Combination of Both
Yong Woon Shin, Hee Yoon Cho, Yoon Jung Lee, Min Chul Seong
J Korean Ophthalmol Soc. 2011;52(5):574-581.    doi: 10.3341/jkos.2011.52.5.574.

Prophylactic Effects of a Fixed Dorsolamide/Timolol Combination on IOP Elevation before Intravitreal Anti-VEGF Injection
Young Jin Lim, Jong Myong Kim, Yong Seop Han, In Young Chung, Jong Moon Park
J Korean Ophthalmol Soc. 2011;52(6):702-708.    doi: 10.3341/jkos.2011.52.6.702.

The Change of Anterior Chamber Parameters with Pentacam® after Intravitreal Injection
Byoung Seon Kim, Che Ron Kim, Seong Jae Kim, Yong Seop Han, Seong Wook Seo, Ji Myung Yoo, In Young Chung, Jong Moon Park
J Korean Ophthalmol Soc. 2013;54(12):1824-1831.    doi: 10.3341/jkos.2013.54.12.1824.


Reference

1. Graham RO, Peyman GA. Intravitreal injection of dexamethasone. Treatment of experimentally induced endophthalmitis. Arch Ophthalmol. 1974; 92:149–54.
2. Beer PM, Bakri SJ, Singh RJ, et al. Intraocular concentration and pharmacokinetics of triamcinolone acetonide after a single injection. Ophthalmology. 2003; 110:681–6.
3. Jonas JB. Intraocular availability of triamcinolone acetonide after intravitreal injection. Am J Ophthalmol. 2004; 137:560–2.
Article
4. Danis RP, Ciulla TA, Pratt LM, et al. Intravitreal triamcinolone acetonide in exudative age-related macular degeneration. Retina. 2000; 20:244–50.
Article
5. Gillies MC, Simpson JM, Luo W, et al. A randomized clinical trial of a single dose of intravitreal triamcinolone acetonide for neovascular age-related macular degeneration: One-year results. Arch Ophthalmol. 2003; 121:667–73.
6. Jonas JB, Keissig I, Hugger P, et al. Intravitreal triamcinolone acetonide for exudative age related macular degeneration. Br J Ophthalmol. 2003; 87:462–8.
Article
7. Jonas JB, Sofker A. Intraocular injection of crystalline cortisone as adjunctive treatment of diabetic macular edema. Am J Ophthalmol. 2001; 132:425–7.
Article
8. Jonas JB, Kreissig I, Sofker A, et al. Intravitreal injection of triamcinolone for diffuse diabetic macular edema. Arch Ophthalmol. 2003; 121:57–61.
Article
9. Martidis A, Duker JS, Greenberg PB, et al. Intravitreal triamcinolone for refractory diabetic macular edema. Ophthalmology. 2002; 109:920–7.
Article
10. Greenberg PB, Martidis A, Rogers AH, et al. Intravitreal triamcinolone acetonide for macular edema due to central retinal vein occlusion. Br J Ophthalmol. 2002; 86:247–8.
Article
11. Ip MS, Kumar KS. Intravitreous triamcinolone acetonide as treatment for macular edema from central retinal vein occlusion. Arch Ophthalmol. 2002; 120:1217–9.
Article
12. Antcliff RJ, Spalton DJ, Stanford MR, et al. Intravitreal triamcinolone for uveitic cystoid macular edema: an optical coherence tomography study. Ophthalmology. 2001; 108:765–72.
Article
13. Martidis A. Duker JS, Puliafito CA. Intravitreal triamcinolone for refractory cystoid macular edema secondary to birdshot retinochoroidopathy. Arch Ophthalmol. 2001; 119:1380–3.
14. Young S, Larkin G. Branley M, et al. Safety and efficacy of intravitreal triamcinolone for cystoid macular edema in uveitis. Clin Experiment Ophthalmol. 2001; 29:2–6.
15. Conway MD, Canakis C, Livir-Rallatos C, et al. Intravitreal triamcinolone acetonide for refractory chronic pseudophakic cystoid macular edema. J Cataract Refract Surg. 2003; 29:27–33.
Article
16. Benhamou N, Massin P, Haouchine B, et al. Intravitreal triamcinolone for refractory pseudophakic macular edema. Am J Ophthalmol. 2003; 135:246–9.
Article
17. Shields MB. Textbook Of Glaucoma. 4th ed.Philadelphia: LIPPINCOTT WILLIAMS & WILKINS;1997. p. 323–8.
18. Lee J, Lee JH. The Effect of Intravitreal Triamcinolone Acetonide on cystoid Macular Edema. J Korean Ophthalmol Soc. 2004; 45:413–8.
19. Kreissig I, Degenring RF, Jonas JB. Diffuse diabetic macular edema intraocular pressure after intravitreal triamcinolone acetonide. Der Ophthalmologe. 2004. 13.
20. Wingate RJ, Beaumont PE. Intravitreal triamcinolone and elevated intraocular pressure. Aust N Z J Ophthalmol. 1999; 27:431–2.
21. Bakri SJ, Beer PM. The effect of intravitreal triamcinolone acetonide on intraocular pressure. Ophthalmic Surg Lasers Imaging. 2003; 34:386–90.
Article
22. Jonas JB, Kreissig I, Degenring R. Intraocular pressure after intravitreal injection of triamcinolone acetonide. Br J Ophthalmol. 2003; 87:24–7.
Article
23. Jonas JB, Kreissig I, Degenring R. Secondary chronic open-angle glaucoma after intravitreal triamcinolone acetonide. Arch Ophthalmol. 2003; 121:729–30.
Article
24. Singh IP, Ahmad SI, Yeh D, et al. Early rapid rise in intra ocular pressure after intravitreal triamcinolone acetonide injection. Am J Ophthalmol. 2004; 138:286–7.
25. Kaushik S, Gupta V, Gupta A, et al. Intractable glaucoma following intravitreal triamcinolone in central retinal vein occlusion. Am J Ophthalmol. 2004; 137:758–60.
Article
26. IN YS, Kim JH, Uhm KB. The effect of intravitreal triamcinolone acetonide on intraocular pressure. J Korean Ophthalmol Soc. 2004; 45:1075–80.
27. Savage H, Roh M. Safety and efficacy of intravitreal triamcinolone. Arch Ophthalmol. 2004; 122:1083.
Article
28. Gillies MC, Simpson JM, Billson FA, et al. Safety of an intravitreal injection of triamcinolone: results from randomized clinical trial. Arch Ophthalmol. 2004; 122:336–40.
29. Jaissle GB, Szurman P, Bartz-Schmidt KU. Ocular side effects and complication of intravitreal triamcinolone acetonide injection. Ophthalmologe. 2004; 101:121–8.
30. Jonas JB, Kreissig I, Degenring RF. Retinal complications of intravitreal injections of triamcinolone acetonide. Graefes Arch Clin Exp Ophthalmol. 2004; 242:184–5.
Article
31. Thall EH. Dosage of intravitreal triamcinolone. Am J Ophthalmol. 2003; 136:1192–3.
Article
32. Floman N, Zor U. Mechanism of steroid action in ocular inflammation: inhibition of prostaglandin production. Invest Ophthalmol Vis Sci. 1997; 16:69–73.
33. Peyman GA, Moshfeghi DM. Intravitreal triamcinolone acetonide. Retina. 2004; 24:488–90.
Article
Full Text Links
  • KJO
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr