Intravitreal triamcinolone and its effect on intraocular pressure

Vidhya, N (2007) Intravitreal triamcinolone and its effect on intraocular pressure. Masters thesis, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai.


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INTRODUCTION: Periocular and Orbital injections of long-acting corticosteroids are being used to treat inflammatory conditions of the eye for many years. However it has been suggested that peribulbar injection may not be adequate to treat chronic ocular disease because their action is partly due to systemic absorption of the drug and their effectiveness lasts only for a few days to weeks. Intraocular administration has the potential to deliver steroids at high local concentrations. AIMS AND OBJECTIVES: To study the effect of intravitreal triamcinolone on intraocular pressure in eyes with no preexisting evidence of glaucoma. INCLUSION CRITERIA: Patients with progressive decrease in visual acuity due to 1. Exudative age related macular degeneration with subfoveal neovascularisation 2. Diffuse diabetic macular edema 3. Macular edema due to central retinal vein occlusion, branch retinal vein occlusion. 4. Cystoid macular edema following cataract surgery. 5. Macular edema following laser treatment. EXCLUSION CRITERIA: Patients with pre existing glaucoma and others like irregular cornea. MATERIALS AND METHODS: It was a prospective consecutive non comparative interventional case series study conducted in Aravind eye hospital and includes all patients with diffuse diabetic macular edema, cystoid macular edema following cataract surgery, macular edema due to central retinal vein occlusion ,branch retinal vein occlusion, macular edema following laser treatment, exudative age related macular degeneration with sub foveal neovascularisation. Treatment was with intravitreal triamcinolone acetonide after obtaining informed consent from all the patients. Intraocular pressure measured before the procedure and after the procedure and at one month, three months and six months by Goldman applanation tonometer. RESULTS: In the study group mean intraocular pressure increased significantly (p=0.000) after the intravitreal triamcinolone injection from 15.03 ± 2.989 mm Hg to 23.65 ± 11.226 mm Hg, during follow up. The mean rise in intraocular pressure was 8.62 ± 10.647 mm Hg, with the proportion increase being 59.03% Rise in intraocular pressure is defined as measurements outside the normal range at least one IOP measurement higher than 21 mm Hg. Increased IOP was observed in 31 patients in this series. Increase in IOP is defined as the difference between maximal postoperative IOP and baseline IOP. Mean increase in IOP for the entire study group was 8.62 ± 10.647 mm Hg. DISCUSSION: The aim of this study was to analyze the effects of intravitreal triamcinolone on IOP and to find out the baseline characteristics that can cause increase in IOP. Variables that were analyzed in this study included age gender systemic disease, ocular condition for which the drug was administered, baseline IOP. Age proved to be an important determinant in the development of increased intraocular pressure (p=0.005) increased IOP tend to occur in younger age group than the older age group and persists for a longer time. At the end of one month follow up 40% of the patients aged less than or equal to 45 years showed an increase in IOP. At the end of 3 months 50% had increase in IOP, and at 6 months 30% had increase in IOP. The mean age of triamcinolone responders in other studies were relatively high compared to this study group. Though Jonas et al., found a tendency of increased IOP in younger age group their mean age of triamcinolone responders was 71.3 ± 9.9 years which was very high compared to this study. Smithen et al., did not find any correlation with age. LIMITATIONS OF THE STUDY: 1. Small sample size. Though there was significant variation with age and occurrence of increased IOP, since the no. of patients were very less the results could not be generalized and further studies are required to determine the age limit for intravitreal triamcinolone acetonide. 2. Baseline IOP Since baseline IOP was determined on a single measurement taken by different persons at different time of time of the day which might not reflect the true baseline IOP. 3. Follow up period Follow up period was 6 months while intravitreal triamcinolone might persist in the eye for more than 9 months. CONCLUSION: A prospective study on 94 eyes after the administration of a single dose of intravitreal triamcinolone acetonide showed that 1. Incidence of IOP elevation was 33% 2. Mean time of increase of IOP was 2.9 months. 3. Incidence of ocular hypertension in 1st month was 24% 4. Age and baseline IOP could be the positive predictive factors. 5. 90% of the cases were controlled with medical therapy. IOP elevation was transient and 90% of cases did not have optic nerve head changes and elevated IOP was controlled with medications.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Intravitreal triamcinolone; intraocular pressure
Subjects: MEDICAL > Ophthalmology
Depositing User: Devi S
Date Deposited: 16 Feb 2018 11:12
Last Modified: 16 Feb 2018 11:12

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