Ocular hypertension and severe intraocular pressure elevation after posterior subtenon injection of triamcinolone acetonide for various diseases

Switching to subtenon triamcinolone acetonide does not jeopardize the functional and anatomic outcomes of dexamethasone implant treated eyes with diabetic macular edema

BACKGROUND

Intraocular dexamethasone implant (DEXi) is an efficient treatment for diabetic macular edema (DME). However, it may be unavailable or contraindicated. Triamcinolone acetonide is another corticosteroid that has proved to be safe and effective in treating macular edema complicating various diseases including diabetes. The purpose of this study is to evaluate the outcomes of a switch from DEXi to subtenon triamcinolone acetonide (STTA) and back, in eyes with DME.

METHODS

Retrospective study. DME eyes that had been treated with DEXi and switched to STTA between October 2018 and February 2019 (stock shortage of DEXi) were included. The functional and anatomical outcomes of the switch and switch-back were studied.

RESULTS

26 eyes of 17 patients (mean age 67.1 ± 8.2 years) were considered. The mean baseline visual acuity (VA) was 0.35 ± 0.17 decimals remaining stable after DEXi, STTA and switch-back to DEXi. The mean central macular thickness (CMT) was 492.7 ± 32.8 µm initially, decreasing to 294.3 ± 133.4 µm after DEXi, 369.9 ± 182.3 µm after STTA and 297.6 ± 72.0 µm after switching back to DEXi (all p < 0.05 versus baseline). Compared to baseline, the CMT reduction was numerically better after DEXi and switching back to DEXi than after STTA (mean reduction: -200.4 µm, -167.7 µm, and -95.08 µm respectively, p = 0.13). Intraocular pressure was comparable after DEXi and STTA.

CONCLUSION

DEXi is the steroid of choice in DME. However, STTA can be a cost-effective alternative when DEXi is unavailable or contraindicated. This study suggests that STTA may be used in the context of a step therapy in DME.

Acute systemic complications of intravitreal bevacizumab and triamcinolone injections – a comparative study

Introduction: Macular edema is a common visual threatening complication in patients with diabetic retinopathy and retinal vein occlusion. The injection of intravitreal drugs, such as anti-vascular endothelial growth factor (anti-VEGF) and corticosteroids, revolutionized the treatment of these diseases.

Aim: To compare and assess the acute systemic complications of intravitreal bevacizumab and triamcinolone injections in patients with diabetic retinopathy and retinal vein occlusion.

Materials and methods: The study population included 211 patients with diabetic retinopathy and retinal vein occlusion who required intravitreal injections of bevacizumab and triamcinolone. In this study, 118 patients had generally received intravitreal injections with bevacizumab and the rest (93 patients) injections with triamcinolone. Experimental data, including demographic information, number of injections, the history of comorbidities, intraocular pressure, and systemic hypertension before and after injections, were recorded on specific forms following groups’ classification. In addition, the incidence of various complications was investigated during one month after the intravitreal injections.

Results: In the present study, we included 211 patients (mean age 62.41±11.34 years, median - 63 years). The results showed that there was no significant correlation between the injectable drug and changes in increased intraocular pressure (IOP) (p=0.66). No significant difference was detected for systemic hypertension in any of the studied groups. On the other hand, the incidence of complications of blood sugar, facial skin redness, neurological problems of TIA and CVA, myocardial infarction, vascular problems after injection, and ocular complications were estimated to be zero, 1.4, 0, 0.8, 0, and 6.1%, respectively.

Conclusions: Overall, the results indicated a prevalence of 1.4% for systemic complications and a prevalence of 6.1% for ocular complications. Accordingly, it seems that intravitreal injections of both drugs studied in the present study are placed in the group of low complication medications.