Wung Jae Kim; Young-Hoon Park

doi:10.3341/jkos.2008.49.1.91

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Kim and Park: The Intraocular Pressure Rise Secondary to Subtenon’s Injection of Triamcinolone After Intravitreal Injection

Original Article

J Korean Ophthalmol Soc 2008;49(1):91-97.

Published online: 3 August 2008

DOI: https://doi.org/10.3341/jkos.2008.49.1.91

The Intraocular Pressure Rise Secondary to Subtenon’s Injection of Triamcinolone After Intravitreal Injection

Wung Jae Kim, M.D., Young-Hoon Park, M.D.

Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea

Address reprint requests to Young-Hoon Park, M.D. Department of Ophthalmology, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea #65-1 Keumo-dong, Uijeongbu-si, Gyeonggi-do 480-130, Korea Tel: 82-31-820-3110, Fax: 82-31-847-3418, E-mail: parkyh@catholic.ac.kr

Received 22 May 2007 Accepted 10 October 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the safety of posterior subtenon’s injection of triamcinolone acetonide (PSTA) after intravitreal triamcinolone acetonide injection (IVTA).

Methods

We reviewed the charts of 34 patients who had previously treated with IVTA. Patients were categorized as steroid responder or non-responder. Responders were defined as having a relative intraocular pressure increase of 5 mmHg and absolute intraocular pressure greater than 24 mmHg. Relative risk of intraocular pressure was prospectively evaluated after PSTA.

Result

Eighteen eyes were categorized as steroid responders after IVTA injection and sixteen eyes were categorized as non-responders. For the actual amount of increase in the intraocular pressures, the steroid responder group (39%) was shown to be statistically higher than the non-responder group (6%) (P=0.044). However, the mean pressure values did not show a significant difference (P>0.05). Only one eye required the use of glaucoma medications and the intraocular pressure remained normal after treatment.

Conclusions

PSTA is a relatively safe treatment method after IVTA injection regardless of steroid responsiveness.

Keywords: Intraocular pressure, Subtenon injection, Triamcinolone acetonide

References

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Figure 1.

Comparison of mean intraocular pressure after intravitreal triamcinolone acetonide injection between responders and non-responders.

Figure 2.

Comparison of mean intraocular pressure after posterior subtenon’s injection of triamcinolone acetonide between responders and non-responders.

Figure 3.

Kaplan-Meier survival curves comparing probability of intraocular pressure elevation between steroid responders and non-responders after posterior subtenon’s injection of triamcinolone acetonide (P=0.034 Kaplan-Meier analysis).

Table 1.

Comparison between responder and non-responder groups

	Non-responder	Responder	P-value^*
Mean age (years)	60.87±10.74	61.11±8.87	0.945
Baseline intraocular pressure	15.56±1.93 mmHg	15.44±1.42 mmHg	0.839
Male : Female	8:8	11:7
RVO : CSME	4:12	6:12

RVO = retinal vein occlusion;

CSME = clinically significant macular edema with diabetes mellitus;

P value^*= estimated by Wilcoxon rank-sum test.

Table 2.

Mean intraocular pressure after IVTA (mmHg)

	2 weeks	1 month	2 months	3 months	4 months	5 months	6 months
Non-responder	15.75±1.93	16.12±2.33	16.37±2.33	16.37±1.92	16.25±2.11	15.46±1.50	14.84±2.23
Responder	16.66±2.58	18.94±4.43	20.94±6.26	22.44±3.20	21.66±7.15	18.11±3.75	15.05±2.22
P-value*	0.120	0.043	0.005	0.006	0.002	0.020	0.717

P-value*=estimated by Wilcoxon rank-sum test.

Table 3.

Mean intraocular pressure after PSTA (mmHg)

	2 weeks	1 month	2 months	3 months	4 months	5 months	6 months
Non-responder	14.68±3.62	15.81±2.66	15.37±2.41	15.18±2.19	14.37±2.36	14.37±1.06	14.42±1.51
Responder	16.33±3.48	18.55±4.59	16.72±2.73	16.38±3.22	15.94±2.92	15.70±2.16	14.85±1.46
P-value*	0.544	0.212	0.154	0.443	0.223	0.164	0.893

P-value*= estimated by Wilcoxon rank-sum test.

Table 4.

Characteristics of patients with intraocular pressure increase after posterior subtenon injection of triamcinolone acetonide

Case	Age /Gender	Diagnosis	DM/HBP	Treatment before PSTA	Time to intraocular peak pressure (weeks)	Intraocular peak pressure (mmHg)	Final intraocular pressure (mmHg)	Final Treatment
1	84/M	BRVO	-/+	None	2	20	13	None
2	75/M	CSME	+/-	Cosopt,	12	24	15	Cosopt,
				Alphagan				Alphagan
3	60/F	CSME	+/-	None	2	19	13	None
4	64/F	CRVO	+/-	None	4	21	14	None
5	58/F	BRVO	-/+	Xalatan	4	24	21	Xalatan
6	45/F	CSME	+/-	Cosopt,	12	23	21	Cosopt,
				Alphagan				Alphagan
			‐	Xalatan				Xalatan
7	67/M	CSME	+/+	None	4	28	11	Cosopt,
								Alphagan
8	38/M	BRVO	-/+	Cosopt,	4	28	15	Cosopt,
				Alphagan				Alphagan
				Xalatan				Xalatan

Case 1=non-responder after IVTA;

Case 2-8=Responder after IVTA;

Case 7=the eye that needed additional glaucoma medication;

BRVO=branched retinal vein occlusion;

CRVO=central retinal vein occlusion;

CSME=clinically significant macular edema with diabetes mellitus;

PSTA=posterior subtenon’s injection of triamcinolone acetonide.

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