Intraocular Pressure Changes after Triamcinolone Acetonide Intravitreal Injection

Aim: To investigate the intraocular pressure (IOP) response after intravitreal triamcinolone acetonide (IVTA) injections astreatment of intraocular neovascular or oedematous diseases and the ability to predict secondary steroid-induced glaucoma.Methods: The prospective consecutive comparative interventional case series study included 80 eyes of 76 patients,group (A), 40 eyes; group (B), 40 eyes, who received an intravitreal injectionof 4mg triamcinolone acetonide and had a follow-up time of 1 weeks interval for 6 weeks. In group (B), topical prednisolone acetate (0.1%) was administrated 3 times daily for 2 weeks before injection, and the follow-up started 1 day before injection.Results: In group (A) IOP increased significantly (p=0.001) from 13.8 (1.9) mmHg preoperatively to a mean maximum of 15.6 (2.7) mmHg postoperatively. An IOP rise to values higher than 20mmHg was observed in 6 (15%) eyes. Elevation of IOP occurred 1 week after the injection. In group (B) IOP increased non significantly (p 0.001) from 14.8 (2.1) mmHg preoperatively to a mean maximum of 16.35 (2.7) mmHg (range 13-24mmHg) postoperatively. 5 (12.5%) of patients in group B showed significant elevation of IOP ( 25mmHg) after topical administration of prednisolone acetate and were excluded from injection. 4 of them were managed by topical B-blockers, and 1 eye required trabeculoplasty. Preoperative predictive factor for the rise in IOP was younger age (p=0.0002). It was statistically independent of refractive error, presence of diabetes mellitus, and indication for the injection. In all but two eye, IOP could be lowered to the normal range with topical medication during the follow-up period, without development of glaucoma tousoptic nerve head changes. Conclusions: After intravitreal injections of 4mg of triam-cinolone acetonide, an IOP elevation can develop in about 25% of eyes starting 1 week after injection, but the onset is inconstant in all cases. In the vast majority, IOP can be normalized by topical medication. Topical steroid administration pre-injection helped knowing the steroid responders and non-responders, so avoiding the occurrence of 2 ry refractory glaucoma steroid-injection.