![]() Infectious endophthalmitis has been reported in three studies (See Table 2). 35 percent with an IOP of at least 21 mmHg throughout study. ![]() Prospective evaluation of IVTA (25 mg) for DME (26 eyes). Greater likelihood for IOP elevation if initial IOP is at least 15 mmHg.40 percent with an IOP of at least 24 mmHg after IVTA at mean of 100 days.28 percent with at least a10 mmHg rise in IOP compared to baseline.Mild to moderate IOP elevation in 32 IVTA eyes compared to three placebo eyes.Prospective, randomized IVTA (76 eyes) to placebo (75 eyes). In another study, one patient required glaucoma filtration surgery and vitrectomy to remove the residual corticosteroid on the eighth post-injection week for an IOP of 52 mmHg despite maximal medical therapy. 4 This type of presentation appears to be the exception, however. In one, three cases were reported that required surgical glaucoma intervention within one week of IVTA injection. 3Īlthough most reports of IVTA-induced ocular hypertension have demonstrated a good response to topical antiglaucoma therapy alone, two recent studies have reported "intractable" cases. One study found no association between multiple IVTA injections and significant IOP elevation.3 A known history of open-angle glaucoma does not appear to increase the risk of IVTA-induced ocular hypertension. No patient in these studies required trabeculectomy or tube-shunt procedures to control refractory IOP elevation. This was usually well-controlled with topical antiglaucoma agents. In all of these studies, mild to moderate intraocular pressure elevation was seen in a minority of patients, typically in the first three months following IVTA injection. Table 1 summarizes many of the papers on IVTA-induced ocular hypertension. In one study, a significantly higher proportion of patients receiving IVTA compared to controls, with at least 12 months follow-up, underwent cataract extraction (P>0.003). ![]() Ocular hypertension and corticosteroid-induced cataract are relatively frequent complications of IVTA injection. A layered pseudohypopyon or true hypopyon was not seen in this patient, nor were vitreous cells seen. Non-infectious endophthalmitis: White, crystalline-appearing clumped corneal endothelial precipitates one day following IVTA injection. Infectious endophthalmitis has been reported, but more commonly encountered are the findings of non-infectious endophthalmitis caused by migration of the triamcinolone into the anterior chamber (See Figures 1 and 2).įigure 2. Corticosteroid-induced ocular hypertension, glaucoma, and cataract have been described. Potential serious injection-related complications include acute traumatic cataract, retinal detachment due to increased vitreous traction or direct needle perforation of the retina, and vitreous hemorrhage. 1 Localized subconjunctival hemorrhage is a common finding following IVTA injection, especially in the setting of systemic anticoagulation or inadvertent penetration of a superficial blood vessel. Several injection-related and drug-related complications have been identified. Residual subconjunctival hemorrhage is seen as a result of the injection, but the eye is otherwise quiet. Non-infectious endophthalmitis: A white pseudohypopyon was seen two days after IVTA injection. Additionally, IVTA has been used as a surgical adjunct for perioperative control of ocular inflammation and intraoperative identification of vitreoretinal tissue planes (posterior hyaloid and epiretinal membranes).įigure 1. In the management of neovascular age-related macular degeneration, IVTA has been applied as monotherapy for occult lesions and as combined therapy with verteporfin photodynamic therapy for all types of choroidal neovascular membranes. IVTA has been used as monotherapy to treat macular edema of various etiologies including: pseudophakic cystoid macular edema (Irvine-Gass syndrome) macular edema from central retinal vein occlusion (CRVO) branch retinal vein occlusion (BRVO) diabetic macular edema (DME) retinitis pigmentosa uveitis and idiopathic cystoid macular edema. In this article, we'll review the various complications that have been reported, along with their treatment and outcomes. While data from randomized controlled clinical trials are lacking, IVTA has quickly found widespread application for a variety of posterior segment pathologies based on encouraging clinical case series. Intravitreous triamcinolone acetonide (IVTA) has become an increasingly popular method to treat macular disease amongst vitreoretinal surgeons.
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