Development of ocular hypertension and persistent glaucoma after intravitreal injection of triamcinolone

M Selim Kocabora, Cemil Yilmazli, Muhittin Taskapili, Gokhan Gulkilik, Sahan DurmazVakif Gureba Education and Research Hospital, Istanbul, TurkeyPurpose: This study evaluates intraocular pressure (IOP) elevation secondary to intravitreal injection of triamcinolone acetonide (IVTA) and discusses its management.Methods: The records of 175 patients who underwent IVTA treatment and regular eye examinations in the period 2003–2006 were reviewed. One hundred and twenty-two of these patients were included in the study, of which 147 eyes that received IVTA (4 mg/0.1 ml) were followed for at least 9 months. Mean IOPs observed after IVTA injection as well as IOP elevations defined as moderate (≥5 mm Hg), important (≥10 mm Hg) and severe (>25 mm Hg) during the follow-up period were evaluated and compared statistically.Results: Overall, the mean IOPs following IVTA injection were statistically significantly higher than the preinjection IOP (15.8 ± 2.6), after the first hour (17.7 ± 2.9), the first week (18.7 ± 4.1), the first month (19.6 ± 6.2), the second month (19.1 ± 6.1), the third month (18.0 ± 4.1), the sixth month (17.3 ± 4.0), and the ninth month (17.0 ± 2.7), but not after the first day (16.3 ± 7.6). Important IOP elevations were observed mostly in the first (17.7%) and second months (10.2%). In 40 (27.7%) eyes, topical antiglaucomatous therapy was needed and 7 later required surgical intervention to lower the IOP. Of the remaining 33 eyes, topical treatment was continued in 14 (9.5%) because of IOPs ≥20 mm Hg.Conclusion: The persistence of IOP elevation beyond the IVTA clearance period and the development of intractable secondary glaucoma requiring surgical intervention substantiate the need for careful consideration of IVTA indication and follow-up.Keywords: intravitreal triamcinolone, intraocular pressure, steroid-induced glaucom

Surgical treatment of giant pyogenic granuloma of the upper eyelid

Pyogenic granuloma (PG), also known as lobular capillary hemangioma, is a benign acquired vascular lesion of the skin and mucous membranes. Diagnosis is aided by history of surgery, trauma or inflammation and characteristic clinical appearance, whereas, definitive diagnosis is made by histopathologic findings. PG is most often located on the head, neck, extremities, and upper trunk. From an ophthalmic perspective, a PG may be located on the eyelids, conjunctiva or rarely on the cornea. We present a case of surgically treated giant pyogenic granuloma of the upper eyelid, and we describe a technique of reconstruction of the upper eyelid skin by bilateral advancement flaps that allows the coverage of small- to medium-sized defects of this region with satisfactory esthetic and functional results

Tear osmolarity and tear film parameters in patients with unilateral pterygium

WOS: 000343672300009PubMed ID: 25255132Purpose: The aim of this study was to evaluate the differences in tear osmolarity and tear film parameters between pterygium-affected and healthy fellow eyes. Methods: The study enrolled 65 patients with unilateral pterygium. Tear osmolarity, tear film break-up time (TBUT), Schirmer I test measurements, fluorescein corneal staining, and conjunctival redness were evaluated. The results were compared between pterygium-affected eyes and healthy fellow eyes of the same patient (controls). The pterygium thickness was measured using optical coherence tomography. We also evaluated the relationship between pterygium thickness and tear osmolarity and between TBUT and Schirmer I test results in eyes with pterygium. Results: The mean tear osmolarity was 307 mOsm/L in pterygium-affected eyes and 294 mOsm/L in control eyes. The mean values of TBUT, Schirmer I test, corneal staining, and conjunctival redness scores were 10.3 +/- 3.4 seconds, 14.8 +/- 9.2 mm, 1.2 +/- 1.1, and 0.9 +/- 0.9 in the pterygium group, whereas the mean values were 12.3 +/- 4.4 seconds, 16.2 +/- 7.2 mm, 0.4 +/- 0.8, and 0.4 +/- 0.7 in the control group, respectively. Eyes with pterygium had significantly higher tear osmolarity levels, corneal staining, and conjunctival redness scores; and lower tear film TBUT and Schirmer I test values than eyes without pterygium (Wilcoxon signed rank test, P 0.05). Conclusions: This study showed that pterygium is associated with tear hyperosmolarity and abnormal tear film function