Long-Term Incidence And Timing Of Intraocular Hypertension After Intravitreal Triamcinolone Acetonide Injection

Purpose: To describe the long-term incidence and timing of steroid-induced ocular hypertension after intravitreal triamcinolone acetonide (IVTA) therapy. Design: Retrospective case series of 929 eyes of 841 patients. Participants: Patients with a variety of posterior segment disorders in a single group practice. Intervention: Pars plana injection of IVTA. Main Outcome Measures: Intraocular pressure (IOP) and requirement for glaucoma surgery. Results: Overall, 929 eyes received ≥1 injections (mean, 1.6) of 4 mg of IVTA. During a mean follow-up period of 14±6.9 months, the Kaplan-Meier cumulative incidences of IOP elevations \u3e21 mmHg at 6, 12, 18, and 24 months post-injection were 28.2%, 34.6%, 41.2%, and 44.6%, respectively; similarly, the incidences of eyes with IOP measurements \u3e25 mmHg were 14.6%, 19.1%, 24.1%, and 28.2%, respectively. At the same time points, lOP-lowering medications were required byl3.0%, 16.9%, 20.7%, and 24.2% of eyes, respectively. Only 3 eyes (0.3%) required lOP-lowering surgery. Preexisting glaucoma, younger age, and a history of an IOP elevation after a previous IVTA injection were risk factors for IOP elevations after IVTA injection. The minimum and maximum follow-up were 3 weeks and 37 months. The mean rate of attrition in this study was 3% per month. Conclusions: Elevations in IOP after IVTA injection are common. Younger patients and eyes with preexisting glaucoma or a history of a steroid response should be monitored more closely for IOP elevations after IVTA therapy

Selective laser trabeculoplasty: Does energy dosage predict response?

Background: Selective laser trabeculoplasty (SLT) is a widely used treatment for open angle glaucoma, producing sustained reductions of intraocular pressure (IOP). The aim of this study was to evaluate the long-term relationship between SLT energy dosage and IOP reduction. Materials and Methods: A retrospective review was performed for patients receiving primary SLT therapy, with inclusion of subjects treated with 360° of SLT. Energy settings were collected upon treatment and IOP was collected at baseline up to 36 months. Pearson′s correlation coefficient was used to determine whether there was a significant correlation between SLT energy and IOP reduction at all time points. Kaplan-Meier analysis with log-rank test was performed to determine the differences in IOP reduction ≥20% from baseline among those treated with low (105 mJ) energy SLT. Results: A total of 104 eyes (75 patients) were included. The mean total SLT energy was 93.73 mJ (standard deviation (SD) = 21.83 mJ, range: 34.4-122 mJ). A significant positive correlation (P ≤ 0.05) between the amount of energy delivered and IOP reduction was found at all time points. Log-rank test showed a significant difference in IOP reduction ≥20% from baseline between the three energy groups, with low energy patients experiencing failure at an earlier time (P = 0.05). Conclusions: Within the range of total energy examined, there is a positive correlation between total energy used and amount of pressure reduction achieved at up to 3 years of follow-up. This may be useful in determining the optimal energy dosage for maximum effect for patients receiving SLT

Short-term complications of intravitreal injection of triamcinolone acetonide

To describe the short-term complications associated with intravitreal triamcinolone acetonide (IVTA) injection in the treatment of posterior segment disorders. The medical records of 784 patients (929 consecutive eyes) were retrospectively reviewed at a single institution. One or more IVTA injections for treatment of a variety of steroid-responsive posterior segment disorders (predominantly diabetic macular edema, choroidal neovascularization, and retinal venous occlusions) were administered. Adverse events occurring within 3 months of the initial injection were identified. The most common adverse event occurring within 3 months after the initial injection was steroid-related ocular hypertension, with intraocular pressure spikes of >21 mm Hg in 21% of eyes and >25 mm Hg in 11% of eyes. Ocular inflammation occurred in six eyes (0.6%): four eyes with sterile hypopyon and two eyes without hypopyon. Three eyes (0.3%) had corneal epithelial defects thought to be related to pretreatment with povidone-iodine solution. No eyes had culture-positive infectious endophthalmitis. Cataract progression was not assessed in this analysis. IVTA injection for the treatment of steroid-responsive disorders of the posterior segment, when administered under sterile conditions, is associated with a low incidence of serious vision-threatening adverse events within the first 3 months after injection

Optic nerve head and retinal nerve fiber layer analysis: a report by the American Academy of Ophthalmology

OBJECTIVETo evaluate the current published literature on the use of optic nerve head (ONH) and retinal nerve fiber layer (RNFL) measurement devices in diagnosing open-angle glaucoma and detecting progression. METHODSA search of peer-reviewed literature was conducted on February 15, 2006 in PubMed and the Cochrane Library for the period January 2003 to February 2006. The search was limited to studies of adults in English-language journals and yielded 442 citations. The panel reviewed the abstracts of these articles and selected 159 articles of possible clinical relevance for review. Of these 159 full-text articles, 82 were determined to be relevant for the first author and methodologist to review and rate according to the quality of evidence. RESULTSThere were no studies classified as having the highest level of evidence (level I). The ONH and RNFL imaging instruments reviewed in this assessment were determined to be highly effective in distinguishing eyes with glaucomatous visual field (VF) loss from normal eyes without VF loss, based on level II evidence. In addition, some studies demonstrated that parameters from ONH or RNFL imaging predicted the development of VF defects among glaucoma suspects. Studies on detecting glaucoma progression showed that although there was often agreement on progression between the structural and functional (VF) tests, a significant proportion of glaucoma patients progressed by either the structural or the functional test alone. CONCLUSIONSThe ONH and RNFL imaging devices provide quantitative information for the clinician. Based on studies that have compared the various available technologies directly, there is no single imaging device that outperforms the others in distinguishing patients with glaucoma from controls. Ongoing advances in imaging and related software, as well as the impracticalities associated with obtaining and assessing optic nerve stereophotographs, have made imaging increasingly important in many practice settings. The information obtained from imaging devices is useful in clinical practice when analyzed in conjunction with other relevant parameters that define glaucoma diagnosis and progression