Intraocular Pressure Elevation after Intravitreal Triamcinolone Acetonide Injection

Hye Young Park; Kayoung Yi; Ha Kyoung Kim

doi:10.3341/kjo.2005.19.2.122

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Park, Yi, and Kim: Intraocular Pressure Elevation after Intravitreal Triamcinolone Acetonide Injection

Original Article

Korean J Ophthalmol 2005;19(2):122-127.

Published online: 21 December 2005

DOI: https://doi.org/10.3341/kjo.2005.19.2.122

Intraocular Pressure Elevation after Intravitreal Triamcinolone Acetonide Injection

Hye Young Park, MD, Kayoung Yi, MD, Ha Kyoung Kim, MD

Department of Ophthalmology, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea

Reprint requests to Ha Kyoung Kim, MD. Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University, 948-1, Darim-1 dong, Yeongdeungpo-gu, Seoul 150-950, Korea. Tel: 82-2-829-5193, Fax : 82-2-848-4638, E-mail: ophkim@ hallym.or.kr

^∗ This study was presented as a poster at the 92nd Annual Meeting of Korean Ophthalmological Society, October, 2004.

Received 10 January 2005 Accepted 18 April 2005

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

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.

Keywords: Intravitreal triamcinolone acetonide (IVTA) injection, Intraocular pressure (IOP), Younger age

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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

Table 1.

Intraocular pressure (IOP) before and after 4-mg intravitreal triamcinolone acetonide injection

Follow up time	Number of eyes	IOP (mmHg)		p-Value
Follow up time	Number of eyes	Mean	Range	p-Value
Pre-injection	59	14.6	8~24
1 day	51	15.3	8~26	0.366
7 days	42	16.6	10~39	0.055
14 days	40	18.4	11~44	0.001
28 days	48	19.0	10~56	0.002
2 months	46	20.5	9~50	0.000
3 months	50	19.1	10~42	0.000
4 months	30	17.0	9~42	0.078
5 months	23	18.5	9~46	0.074
6 months	27	15.5	9~32	0.319
7 months	19	15.4	8~25	0.426
8 months	12	17.2	10~32	0.194
9 months	9	15.3	11~19	0.539
10 months	5	12.2	8~18	0.129
11 months	3	16.3	15~19	0.379

p-value: difference between postoperative and preoperative values

Table 2.

Factors affecting intraocular pressure (IOP) elevation

Factors	Group A vs. B
Factors	p-value
Mean Age	0.009^∗
Sex	0.602
Past Medical History
Diabetes Mellitus	0.651
Hypertension	0.171
Ophthalmologic operation History
Phaco. ＋ PCL	0.020^†
Vitrectomy	0.208
Mean Refractive Error	0.117

Group A: group of normal IOP during follow-up period (N=34). Group B: group of increased IOP during the follow-up period (N =26).

^∗ Younger age showed a statistically significant relation with

^† In cases with previous cataract IOP elevation (p=0.009). operation history, there was a statistically significant relation with normal IOP (p=0.020).

Table 3.

Time at elevation of intraocular pressure (IOP) in the patients who underwent intravitreal triamcinolone acetonide injection twice

Patients	Time (POD) at elevation of IOP		Interval between the 1st & 2nd IVTA injection
Patients	1st injection	2nd injection	Interval between the 1st & 2nd IVTA injection
1	2 mon	1 mon	6
2	14 days	－	7
3	7 days	7 days	6
4	－	－	6
5	3 mon	2 mon	4
6	2 mon	－	6
7	2 mon	1 mon	2
8	1 day	2 mon	2

There was no IOP elevation in one patient (patient 4). In two cases (patients 2 and 6) IOP elevation occurred after the first injection but not after the second injection. In the other cases, significant IOP elevation occurred after both injections. POD: post-operation days, IOP: intraocular pressure, IVTA: intravitreal triamcinolone acetonide.

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