Changes of intraocular pressure after intravitrealinjection of 4mg triamcinolone acetonide in treatmentof macular edema

AIM: To investigate the changes of intraocular pressure(IOP) and associated factors of IOP elevation after 4mgintravitreal injection of triamcinolone acetonide (IVTA) intreatment of macular edema.·METHODS: The study is prospective, consecutive, andnon-comparative interventional case series including 93 eyeswith macular edema associated with retinal vein occlusion( =54 eyes) or diabetic retinopathy ( =39 eyes), whichreceived 4mg IVTA injection. The change in IOP was followedfor all cases at pre-operation and 14 days, 1, 2, 3, 4, 5, and 6months post-operation. Associated factors of IOP elevationwere examined regarding baseline IOP, causal disease, ageand gender.·RESULTS: IOP increased significantly ( <0.001) at 14 days16.02 ± 2.45mmHg after injection and peaked at 18.80 ±6.20mmHg at 2 months post-injection ( <0.001) from14.85± 2.55 mmHg preoperatively. An IOP rise to the valuehigher than 21mmHg was observed in 2 (2.2%) eyes 14 daysafter injection and which was observed in 14 (15.1%), 18(19.5%), 9(9.6%), 4(4.3%), 0, and 0 eyes respectively at 1,2, 3, 4, 5, and 6 months after injection. One eye (1.07%)showed pressure elevation of over 5mmHg than baseline 14days after injection and IOP peaked to 22mmHg (23.7%) at 2months after injection. Five (5.3%) eyes had an increase of10mmHg at 1 month and IOP peaked to 12mmHg (12.9%) at2 months after injection. The rise in IOP was statisticallyassociated with younger age (correlation coefficient -0.18--0.29, <0.05), high baseline IOP (correlation coefficient0.52-0.79, all <0.001), and the presence of diabetesmellitus (correlation coefficient 0.23, <0.001) butindependent of gender (correlation coefficient -0.002-0.04, all>0.05). In all eyes, IOP could be lowered to the normalrange with topical medication, without development ofglaucomatous optic nerve head changes.·CONCLUSION: Elevated IOP after 4mg IVTA injection iscommon and patients should be monitored beyond 6 monthspost-injection. In all the cases, IOP can be normalized bytopical medication. Patients with high baseline IOP, diabeticretinopathy, and younger age should be carefully monitoredfor an elevated IOP.