Frequency of Intraocular Pressure Increase Within Days After Intravitreal Triamcinolone Injections in the Diabetic Retinopathy Clinical Research Network

Lauer, Andreas K.; Bressler, Neil M.; Edwards, Allison R.

doi:10.1001/archophthalmol.2011.214

Cited by 7 publications

(11 citation statements)

References 6 publications

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“…Preservative-free triamcinonolone acetonide has been used for a variety of retinal conditions and has been used intravitreally, subconjunctivally, and in the subtenon space. Several studies[ 50 51 52 53 54 55 56 57 58 59 60 61 ] have documented its cataractogenesis and IOP spikes. Intravitreal triamcinolone acetonide injections can cause both short-term IOP fluctuations and persistent ocular hypertension, the former being related in part to the volume of the injected drug and the latter a “pharmacopathological” response.…”

Section: Triamcinolone Acetonidementioning

confidence: 99%

Current intravitreal therapy and ocular hypertension

Sudhalkar

Bilgic²,

Vasavada

et al. 2021

Indian Journal of Ophthalmology

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To determine the effect of commonly used intravitreal agents on immediate and long-term IOP elevations and their association, if any, with glaucoma. Literature searches in PubMed and the Cochrane databased in January 2020 yielded 407 individual articles. Of these, 87 were selected for review based on our inclusion criteria. Based on the evidence provided, 20 were assigned level I, 27 level II, and 22 level III. Eight articles were rejected because of poor quality, insufficient clarity, or irrelevance based on standardized protocols set out by the American Academy of Ophthalmology. The studies that reported on short-term IOP elevation (i.e., between 0 and 60 min) showed that an immediate increase in IOP is seen in all patients who receive anti-VEGF agents or triamcinolone acetonide when measured between 0 and 30 min of intravitreal injection and that the IOP elevation decreases over time. The data on long-term IOP elevation were mixed; Pretreatment with glaucoma medications, anterior chamber tap, vitreous reflux, longer intervals between injections, and longer axial lengths were associated with lower IOP elevations after injection of anti-VEGF agents, while the position of the implant vis-à-vis, the anterior chamber was important for steroid therapy. Data were mixed on the relationship between IOP increase and the type of intravitreal injection, number of intravitreal injections, preexisting glaucoma, and globe decompression before injection. There were no data on the onset or progression of glaucoma in the studies reviewed in this assessment. However, some studies demonstrated RNFL thinning in patients receiving chronic anti-VEGF therapy. Most, if not all, intravitreal agents cause ocular hypertension, both in the short term and long term. The functional consequences of these observations are not very clear.

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Section: Triamcinolone Acetonidementioning

confidence: 99%

Current intravitreal therapy and ocular hypertension

Sudhalkar

Bilgic²,

Vasavada

et al. 2021

Indian Journal of Ophthalmology

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“…However, this approach is associated with central scotomas and decreased colour vision.While this treatment was proven clinically effective, a modified ETDRS approach24 where lighter burns are placed in the macula and especially close to the fovea, was adopted by many retinal physicians. The lighter burns are theoretically less likely to result in significant thermal injury to the neurosensory retina and cause less discomfort to the patients.Over the past seven years the Diabetic Retinopathy Clinical Research Network (DRCR.net) (a National Institutes of Health[NIH] sponsored clinical trial research network dedicated to the treatment of diabetic retinopathy) has conducted a series of studies25,26 comparing focal/grid laser treatment with macular grid (no advantage); focal/grid laser treatment with intravitreal injection of steroids[27][28][29] (focal/grid laser treatment showed superior results compared with intravitreal injection of triamcinolone alone); or in combination with focal/grid laser treatment. In addition, there was no long-term benefit of intravitreal injection of triamcinolone relative to focal/grid photocoagulation and outcomes slightly favoured the laser group compared with either of the two triamcinolone groups) and, more recently, focal/grid laser treatment compared with intravitreal injections of an Anti-VEGF agent (ranibizumab) 30.…”

mentioning

confidence: 99%

The Evolution of Retinal Laser Technology and Retinal Photocoagulation as Therapeutic Modality

Azoulay¹,

Pianka²,

Loewenstein³

2012

European Ophthalmic Review

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The effect of thermal insult to ocular tissue was first recorded in Western literature over two millennia ago. During the early scientific period and the ensuing eras, our understanding of this phenomenon, as well as our ability to accurately deliver dose-controlled therapeutic thermal energy to retinal tissue, have improved greatly. Since their commercial introduction in 1970, ophthalmic photocoagulation laser systems have been playing a cardinal role in the treatment and/or management of various ocular pathologies, predominantly though not limited to, retinal pathologies. Seminal studies, such as the Diabetic Retinopathy Study (DRS) and Early Treatment Diabetic Retinopathy Study (ETDRS), have solidified the role of such tools in the ophthalmologist’s therapeutic armamentarium; and to this day, as either stand-alone treatment or in combination with pharmacological agents, retinal laser therapy is recognised as the ‘gold standard’ for treating diabetic macular oedema (DME) and proliferative diabetic retinopathy (PDR). The continuous elucidation of the role that the retinal pigmented epithelium (RPE) plays in the emergence of retinal pathologies has prompted researchers and clinicians to further investigate selective RPE treatments – featuring significantly reduced or altogether devoid of collateral thermal damage to inner neural retinal structures with limited regenerative capacity. The convergence of electronic dosimetry, diagnostics imaging and new therapeutic laser modalities into a singular entity may serve as the technological platform for successfully employing such therapies in the near future.

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“…38 articles. 49 Given the paucity of studies on the prevention of CME after cataract surgery in diabetic patients, the ESCRS also decided to set up a European multicenter study investigating the efficacy of intravitreal anti-VEGF and subconjunctival corticosteroid injections to prevent the occurrence of CME after cataract surgery in diabetics.…”

Section: Discussionmentioning

confidence: 99%

“…Although visual acuity may decrease after cessation of treatment, visual acuity recovered in most patients after retreatment with NSAID eye drops. 49,50 Moreover, small studies suggest that a combination treatment with a topical corticosteroid and NSAID is more effective than a topical corticosteroid alone. The time to resolution of PCME was significantly shorter in patients treated with a combination of topical corticosteroids and NSAIDs.…”

Section: Treatmentmentioning

confidence: 99%

“…Increased IOP is a common complication of local corticosteroid administration, but prevalence may vary between various routes of administration. [48][49][50][51] Other routes of corticosteroid administration may also prevent the occurrence of CME, involving a lower incidence of IOP increase. Previous studies have investigated the use of high frequency prednisolone eye drops, oral prednisolone, intravitreal TA, and subtenon TA.…”

Section: Prevention Of Cystoid Macular Edema In Diabeticsmentioning

confidence: 99%

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Prevention and treatment of cystoid macular edema after cataract surgery

Wielders

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Frequency of Intraocular Pressure Increase Within Days After Intravitreal Triamcinolone Injections in the Diabetic Retinopathy Clinical Research Network

Cited by 7 publications

References 6 publications

Current intravitreal therapy and ocular hypertension

Current intravitreal therapy and ocular hypertension

The Evolution of Retinal Laser Technology and Retinal Photocoagulation as Therapeutic Modality

Prevention and treatment of cystoid macular edema after cataract surgery

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