Intractable Intraocular Hypertension Induced by Repository Triamcinolone Acetonide

Herschler, Jonathan

doi:10.1016/0002-9394(72)90916-6

Cited by 55 publications

(17 citation statements)

References 3 publications

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“…[70][71][72] With the increasing popularity of intravitreal triamcinolone injections, 23,24 vitrectomy may prove useful in preventing glaucoma in selected cases.…”

Section: Filtration Surgerymentioning

confidence: 99%

Corticosteroid-induced glaucoma: a review of the literature

Kersey

Broadway

2005

Eye

382

228

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The intraocular pressure rise that can complicate the use of topical or systemic corticosteroid has been recognised for 50 years. More recently, following isolation of the myocilin gene (previously known as the trabecular meshwork inducible glucocorticoid response or TIGR gene), there has been renewed interest in this steroid-responsive phenomenon. Furthermore, the currently fashionable use of injectable intraocular steroids in the management of clinically significant subretinal fluid and macular oedema has resulted in an increased incidence. Animal studies, cell biology, molecular biology, and an improved knowledge of genetics have provided a better understanding of the mechanisms behind the response. The purpose of this review is to describe the risk factors for developing corticosteroid-induced glaucoma, to discuss the underlying mechanisms and genetics of the condition and to present management options.

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“…[70][71][72] With the increasing popularity of intravitreal triamcinolone injections, 23,24 vitrectomy may prove useful in preventing glaucoma in selected cases.…”

Section: Filtration Surgerymentioning

confidence: 99%

Corticosteroid-induced glaucoma: a review of the literature

Kersey

Broadway

2005

Eye

382

228

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“…There may be a delay in the onset of the increase in IOP of up to several months after corticosteroid injections [22,[34][35][36] . In Kalina's [36] study, 18 ocular hypertensions were seen after the subconjunctival injection of repository corticosteroid at a mean of 7.1 weeks (range: 1.5-16 weeks) and lasted for a mean duration of 3 months.…”

Section: Timing Of Responsementioning

confidence: 99%

“…In another randomized trial on 182 patients, 3 subjects (3.7%) in the difluprednate group had a clinically significant IOP rise ( 6 10 mm Hg from baseline and 6 21 mm Hg overall) compared to the placebo group [81] . Long-term steroid creams, lotions and ointments applied to the face, eyelids, or at distant sites may raise the IOP, as so may systemically administered corticosteroids [27, 34,46,[82][83][84] .…”

Section: Topical Steroidsmentioning

confidence: 99%

Steroid-Induced Iatrogenic Glaucoma

Lj²

2011

Ophthalmic Res

218

160

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Steroids in susceptible individuals can cause a clinical condition similar to primary open-angle glaucoma. Five percent of the population are high steroid responders and develop an intraocular pressure (IOP) elevation of more than 15 mm Hg above baseline. IOP elevation may occur as early as 1 day to as late as 12 weeks after intravitreal triamcinolone in 20–65% of patients. On average, 75% of eyes with steroid implants require IOP-lowering therapy at some point within 3 years of follow-up. The exact mechanism of steroid-induced glaucoma is not totally understood, but decreased trabecular meshwork outflow is regarded as the main cause of IOP elevation. High-risk patients who receive steroids should be monitored closely and if they develop elevated IOP, steroids with lower potency or steroid-sparing agents should be used. The IOP usually returns to normal within 2–4 weeks after stopping the steroid. About 1–5% of patients do not respond to medical therapy and need surgery. Trabeculectomy, trabeculotomy, shunt surgery, and cyclodestructive procedures are among the methods employed. Removal of residual sub-Tenon or intravitreal steroids may help hasten the resolution of the steroid response. Early results with anecortave acetate, an analog of cortisol acetate with antiangiogenic activity, in controlling IOP have been promising.

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“…40,41 • Periocular therapy: Periocular injections of repository corticosteroid is the most dangerous form of steroid because of their prolonged duration of action. 42 Intraocular pressure elevation may occur in response 45 Intravitreal injection of triamcinolone on the contrary can increase IOP by several mm Hg in about 50% of patients, within 2 to 4 weeks after the start of treatment and even may rise more rapidly in some eyes (e.g., in eyes that have pseudophakia or have undergone vitrectomy). 46,47 Smithen reported that among the nonglaucoma patients treated with intravitreal triamcinolone, 60% of patients with baseline IOP >15 mm Hg showed a rise in IOP following injection compared to 22% of those who had baseline IOP <15 mm Hg.…”

Section: Routes Of Administrationmentioning

confidence: 99%

Steroid-induced Glaucoma: An Avoidable Irreversible Blindness

Pandav¹,

Kaur²,

Kaushik³

et al. 2017

Journal of Current Glaucoma Practice

198

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Steroids are a group of anti-inflammatory drugs, commonly used to treat ocular and systemic conditions. Unmonitored use of steroids especially in eye drop formulations is common in situations when it is easily available over-the-counter, resulting in undesirable side effects.Among the ocular side effects, cataract and glaucoma are common. Steroid-induced ocular hypertension was reported in 1950, when long-term use of systemic steroid was shown to increase the intraocular pressure (IOP). Chronic administration of steroids in any form with raised IOP can cause optic neuropathy resulting in steroid-induced glaucoma.This review describes the pathophysiology and epidemiology of steroid-induced glaucoma, recognition of side effects, and principles of management. The purpose is to familiarize all clinicians with the potential dangers of administering steroids without monitoring the eye and the dangers of irreversible blindness in some instances of habitual self-prescription by patients.

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Intractable Intraocular Hypertension Induced by Repository Triamcinolone Acetonide

Cited by 55 publications

References 3 publications

Corticosteroid-induced glaucoma: a review of the literature

Corticosteroid-induced glaucoma: a review of the literature

Steroid-Induced Iatrogenic Glaucoma

Steroid-induced Glaucoma: An Avoidable Irreversible Blindness

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