Impact on intraocular pressure after 20-MG decanted triamcinolone acetonide (kenalog) injection when using prophylactic antiglaucoma therapy

Giulio Barteselli, Payam Amini, Isaac C. Ezon, Joseph T. Nezgoda, Lingyun Cheng, William R. Freeman

Research output: Contribution to journalArticle

Abstract

Purpose: To analyze intraocular pressure (IOP) response after 20-mg decanted intravitreal triamcinolone acetonide followed by early prophylactic IOP-lowering therapy.

Method: Overall, IOP results of 120 high-dose decanted intravitreal triamcinolone acetonide injections from 58 nonglaucomatous patients with macular edema, with antiglaucoma therapy prescribed from Week 1 regardless of baseline IOP were retrospectively reviewed.

Results: In cases of consistent compliance with IOP-lowering drugs (79.2%), IOP increased by 2 mmHg at 4 months (P = 0.300) and returned to baseline at 6 months. In cases of noncompliance (20.8%), IOP increased by 7 mmHg at 1 month (P <0.001) and returned to baseline after starting treatment. Multivariate regression analysis showed that nonvitrectomized eyes and noncompliance with IOP-lowering drugs were independent predictors of increase in IOP greater than 21 mmHg (P = 0.0098 and P = 0.0019, respectively). Nonvitrectomized eyes had a 46% greater chance to experience increase in IOP compared with vitrectomized ones. Poor compliance with IOP-lowering drugs lead to a 45% greater likelihood of experiencing increase in IOP compared with compliant patients. Multiple injections were not associated with the increased risk for increase in IOP greater than 21 mmHg (P = 0.273). Of 120 cases, 2 eyes (1.7%) developed uncontrolled IOP and required glaucoma surgery by 4 months, with good final IOP outcome.

Conclusion: Twenty milligram decanted intravitreal triamcinolone acetonide can be safely used to treat macular edema in nonglaucomatous patients; IOP elevation can be adequately controlled with prophylactic antiglaucoma drugs. Noncompliance with prophylactic therapy creates an early spike in IOP, and vitreous status can significantly impact increase in IOP. Compliance with IOP-lowering drugs should be stressed to patients receiving high-dose intravitreal triamcinolone acetonide especially in cases of nonvitrectomized eyes.

Original languageEnglish
Pages (from-to)75-81
Number of pages7
JournalRetina
Volume35
Issue number1
DOIs
Publication statusPublished - Jan 3 2015

Fingerprint

Triamcinolone Acetonide
Intraocular Pressure
Injections
Therapeutics
Pharmaceutical Preparations
Macular Edema

Keywords

  • glaucoma
  • intraocular pressure
  • Kenalog, macular edema
  • triamcinolone acetonide

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Impact on intraocular pressure after 20-MG decanted triamcinolone acetonide (kenalog) injection when using prophylactic antiglaucoma therapy. / Barteselli, Giulio; Amini, Payam; Ezon, Isaac C.; Nezgoda, Joseph T.; Cheng, Lingyun; Freeman, William R.

In: Retina, Vol. 35, No. 1, 03.01.2015, p. 75-81.

Research output: Contribution to journalArticle

Barteselli, Giulio ; Amini, Payam ; Ezon, Isaac C. ; Nezgoda, Joseph T. ; Cheng, Lingyun ; Freeman, William R. / Impact on intraocular pressure after 20-MG decanted triamcinolone acetonide (kenalog) injection when using prophylactic antiglaucoma therapy. In: Retina. 2015 ; Vol. 35, No. 1. pp. 75-81.
@article{19701912504c4ab4a76900d5a0afbe43,
title = "Impact on intraocular pressure after 20-MG decanted triamcinolone acetonide (kenalog) injection when using prophylactic antiglaucoma therapy",
abstract = "Purpose: To analyze intraocular pressure (IOP) response after 20-mg decanted intravitreal triamcinolone acetonide followed by early prophylactic IOP-lowering therapy.Method: Overall, IOP results of 120 high-dose decanted intravitreal triamcinolone acetonide injections from 58 nonglaucomatous patients with macular edema, with antiglaucoma therapy prescribed from Week 1 regardless of baseline IOP were retrospectively reviewed.Results: In cases of consistent compliance with IOP-lowering drugs (79.2{\%}), IOP increased by 2 mmHg at 4 months (P = 0.300) and returned to baseline at 6 months. In cases of noncompliance (20.8{\%}), IOP increased by 7 mmHg at 1 month (P <0.001) and returned to baseline after starting treatment. Multivariate regression analysis showed that nonvitrectomized eyes and noncompliance with IOP-lowering drugs were independent predictors of increase in IOP greater than 21 mmHg (P = 0.0098 and P = 0.0019, respectively). Nonvitrectomized eyes had a 46{\%} greater chance to experience increase in IOP compared with vitrectomized ones. Poor compliance with IOP-lowering drugs lead to a 45{\%} greater likelihood of experiencing increase in IOP compared with compliant patients. Multiple injections were not associated with the increased risk for increase in IOP greater than 21 mmHg (P = 0.273). Of 120 cases, 2 eyes (1.7{\%}) developed uncontrolled IOP and required glaucoma surgery by 4 months, with good final IOP outcome.Conclusion: Twenty milligram decanted intravitreal triamcinolone acetonide can be safely used to treat macular edema in nonglaucomatous patients; IOP elevation can be adequately controlled with prophylactic antiglaucoma drugs. Noncompliance with prophylactic therapy creates an early spike in IOP, and vitreous status can significantly impact increase in IOP. Compliance with IOP-lowering drugs should be stressed to patients receiving high-dose intravitreal triamcinolone acetonide especially in cases of nonvitrectomized eyes.",
keywords = "glaucoma, intraocular pressure, Kenalog, macular edema, triamcinolone acetonide",
author = "Giulio Barteselli and Payam Amini and Ezon, {Isaac C.} and Nezgoda, {Joseph T.} and Lingyun Cheng and Freeman, {William R.}",
year = "2015",
month = "1",
day = "3",
doi = "10.1097/IAE.0000000000000268",
language = "English",
volume = "35",
pages = "75--81",
journal = "Retina",
issn = "0275-004X",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Impact on intraocular pressure after 20-MG decanted triamcinolone acetonide (kenalog) injection when using prophylactic antiglaucoma therapy

AU - Barteselli, Giulio

AU - Amini, Payam

AU - Ezon, Isaac C.

AU - Nezgoda, Joseph T.

AU - Cheng, Lingyun

AU - Freeman, William R.

PY - 2015/1/3

Y1 - 2015/1/3

N2 - Purpose: To analyze intraocular pressure (IOP) response after 20-mg decanted intravitreal triamcinolone acetonide followed by early prophylactic IOP-lowering therapy.Method: Overall, IOP results of 120 high-dose decanted intravitreal triamcinolone acetonide injections from 58 nonglaucomatous patients with macular edema, with antiglaucoma therapy prescribed from Week 1 regardless of baseline IOP were retrospectively reviewed.Results: In cases of consistent compliance with IOP-lowering drugs (79.2%), IOP increased by 2 mmHg at 4 months (P = 0.300) and returned to baseline at 6 months. In cases of noncompliance (20.8%), IOP increased by 7 mmHg at 1 month (P <0.001) and returned to baseline after starting treatment. Multivariate regression analysis showed that nonvitrectomized eyes and noncompliance with IOP-lowering drugs were independent predictors of increase in IOP greater than 21 mmHg (P = 0.0098 and P = 0.0019, respectively). Nonvitrectomized eyes had a 46% greater chance to experience increase in IOP compared with vitrectomized ones. Poor compliance with IOP-lowering drugs lead to a 45% greater likelihood of experiencing increase in IOP compared with compliant patients. Multiple injections were not associated with the increased risk for increase in IOP greater than 21 mmHg (P = 0.273). Of 120 cases, 2 eyes (1.7%) developed uncontrolled IOP and required glaucoma surgery by 4 months, with good final IOP outcome.Conclusion: Twenty milligram decanted intravitreal triamcinolone acetonide can be safely used to treat macular edema in nonglaucomatous patients; IOP elevation can be adequately controlled with prophylactic antiglaucoma drugs. Noncompliance with prophylactic therapy creates an early spike in IOP, and vitreous status can significantly impact increase in IOP. Compliance with IOP-lowering drugs should be stressed to patients receiving high-dose intravitreal triamcinolone acetonide especially in cases of nonvitrectomized eyes.

AB - Purpose: To analyze intraocular pressure (IOP) response after 20-mg decanted intravitreal triamcinolone acetonide followed by early prophylactic IOP-lowering therapy.Method: Overall, IOP results of 120 high-dose decanted intravitreal triamcinolone acetonide injections from 58 nonglaucomatous patients with macular edema, with antiglaucoma therapy prescribed from Week 1 regardless of baseline IOP were retrospectively reviewed.Results: In cases of consistent compliance with IOP-lowering drugs (79.2%), IOP increased by 2 mmHg at 4 months (P = 0.300) and returned to baseline at 6 months. In cases of noncompliance (20.8%), IOP increased by 7 mmHg at 1 month (P <0.001) and returned to baseline after starting treatment. Multivariate regression analysis showed that nonvitrectomized eyes and noncompliance with IOP-lowering drugs were independent predictors of increase in IOP greater than 21 mmHg (P = 0.0098 and P = 0.0019, respectively). Nonvitrectomized eyes had a 46% greater chance to experience increase in IOP compared with vitrectomized ones. Poor compliance with IOP-lowering drugs lead to a 45% greater likelihood of experiencing increase in IOP compared with compliant patients. Multiple injections were not associated with the increased risk for increase in IOP greater than 21 mmHg (P = 0.273). Of 120 cases, 2 eyes (1.7%) developed uncontrolled IOP and required glaucoma surgery by 4 months, with good final IOP outcome.Conclusion: Twenty milligram decanted intravitreal triamcinolone acetonide can be safely used to treat macular edema in nonglaucomatous patients; IOP elevation can be adequately controlled with prophylactic antiglaucoma drugs. Noncompliance with prophylactic therapy creates an early spike in IOP, and vitreous status can significantly impact increase in IOP. Compliance with IOP-lowering drugs should be stressed to patients receiving high-dose intravitreal triamcinolone acetonide especially in cases of nonvitrectomized eyes.

KW - glaucoma

KW - intraocular pressure

KW - Kenalog, macular edema

KW - triamcinolone acetonide

UR - http://www.scopus.com/inward/record.url?scp=84920282473&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84920282473&partnerID=8YFLogxK

U2 - 10.1097/IAE.0000000000000268

DO - 10.1097/IAE.0000000000000268

M3 - Article

C2 - 25077534

AN - SCOPUS:84920282473

VL - 35

SP - 75

EP - 81

JO - Retina

JF - Retina

SN - 0275-004X

IS - 1

ER -