Impact on intraocular pressure after 20-mg decanted triamcinolone acetonide (kenalog) injection when using prophylactic antiglaucoma therapy.
Barteselli Giulio, Amini Payam, Ezon Isaac C, Nezgoda Joseph T, Cheng Lingyun, Freeman William R
AI Summary
Prophylactic glaucoma drops effectively control IOP after 20mg intravitreal triamcinolone; non-compliance causes significant IOP spikes, especially in non-vitrectomized eyes, emphasizing adherence.
Abstract
Purpose
To analyze intraocular pressure (IOP) response after 20-mg decanted intravitreal triamcinolone acetonide followed by early prophylactic IOP-lowering therapy.
Methods
Overall, IOP results of 120 high-dose decanted intravitreal triamcinolone acetonide injections from 58 nonglaucomatous patients with macular edema, with antiglaucoma therapy prescribed from Week 1 regardless of baseline IOP were retrospectively reviewed.
Results
In cases of consistent compliance with IOP-lowering drugs (79.2%), IOP increased by 2 mmHg at 4 months (P = 0.300) and returned to baseline at 6 months. In cases of noncompliance (20.8%), IOP increased by 7 mmHg at 1 month (P < 0.001) and returned to baseline after starting treatment. Multivariate regression analysis showed that nonvitrectomized eyes and noncompliance with IOP-lowering drugs were independent predictors of increase in IOP greater than 21 mmHg (P = 0.0098 and P = 0.0019, respectively). Nonvitrectomized eyes had a 46% greater chance to experience increase in IOP compared with vitrectomized ones. Poor compliance with IOP-lowering drugs lead to a 45% greater likelihood of experiencing increase in IOP compared with compliant patients. Multiple injections were not associated with the increased risk for increase in IOP greater than 21 mmHg (P = 0.273). Of 120 cases, 2 eyes (1.7%) developed uncontrolled IOP and required glaucoma surgery by 4 months, with good final IOP outcome.
Conclusion
Twenty milligram decanted intravitreal triamcinolone acetonide can be safely used to treat macular edema in nonglaucomatous patients; IOP elevation can be adequately controlled with prophylactic antiglaucoma drugs. Noncompliance with prophylactic therapy creates an early spike in IOP, and vitreous status can significantly impact increase in IOP. Compliance with IOP-lowering drugs should be stressed to patients receiving high-dose intravitreal triamcinolone acetonide especially in cases of nonvitrectomized eyes.
MeSH Terms
Shields Classification
Key Concepts6
In nonglaucomatous patients receiving 20-mg decanted intravitreal triamcinolone acetonide for macular edema, with consistent compliance (79.2%) with prophylactic IOP-lowering drugs, intraocular pressure (IOP) increased by 2 mmHg at 4 months (P = 0.300) and returned to baseline at 6 months.
In nonglaucomatous patients receiving 20-mg decanted intravitreal triamcinolone acetonide for macular edema, noncompliance (20.8%) with prophylactic IOP-lowering drugs resulted in an IOP increase of 7 mmHg at 1 month (P < 0.001), which returned to baseline after initiating treatment.
Multivariate regression analysis in nonglaucomatous patients receiving 20-mg decanted intravitreal triamcinolone acetonide for macular edema showed that nonvitrectomized eyes (P = 0.0098) and noncompliance with IOP-lowering drugs (P = 0.0019) were independent predictors of an increase in IOP greater than 21 mmHg.
Nonvitrectomized eyes had a 46% greater chance of experiencing an increase in IOP compared with vitrectomized ones after 20-mg decanted intravitreal triamcinolone acetonide injection in nonglaucomatous patients with macular edema.
Poor compliance with IOP-lowering drugs led to a 45% greater likelihood of experiencing an increase in IOP compared with compliant patients after 20-mg decanted intravitreal triamcinolone acetonide injection in nonglaucomatous patients with macular edema.
Of 120 cases of 20-mg decanted intravitreal triamcinolone acetonide injections in nonglaucomatous patients with macular edema, 2 eyes (1.7%) developed uncontrolled IOP and required glaucoma surgery by 4 months, with good final IOP outcome.
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