Comparison of 4 mg versus 20 mg intravitreal triamcinolone acetonide injections

• Published in: British journal of ophthalmology Vol. 92; no. 6; pp. 810 - 813
• Main Authors: Tammewar, A M, Cheng, L, Kayikcioglu, O R, Falkenstein, I A, Kozak, I, Goldbaum, M H, Freeman, W R
• Format: Journal Article
• Language: English
• Published: BMA House, Tavistock Square, London, WC1H 9JR BMJ Publishing Group Ltd 01.06.2008; BMJ; BMJ Publishing Group LTD
• Subjects: Age; Anti-Inflammatory Agents - administration & dosage; Biological and medical sciences; Drug Administration Schedule; Drug dosages; Follow-Up Studies; Glaucoma; Humans; Hypertension; Injections; Intraocular Pressure - drug effects; Medical sciences; Miscellaneous; Multivariate Analysis; Ocular Hypertension - drug therapy; Ocular Hypertension - surgery; Ophthalmology; Retrospective Studies; Studies; Triamcinolone Acetonide - administration & dosage; Vitrectomy; Corticosteroid; Acetonide; Adrenal hormone; Antiinflammatory agent; Vitreous body; Injection; Ophthalmology; Triamcinolone; Comparative study
• ISSN: 0007-1161; 1468-2079
• DOI: 10.1136/bjo.2007.126227

Aims:To compare the non-decanted (standard) 4 mg versus the decanted 20 mg intravitreal triamcinolone acetonide (IVTA) injections and to assess their effect on intraocular pressure (IOP).Methods:We retrospectively reviewed the records of 92 consecutive eyes, which received an intravitreal injection of either dose of triamcinolone acetonide, at a single retina centre. The change in IOP (elevation of at least 5 mm Hg from baseline or above 21 mm Hg) was analysed with a multivariate logistic analysis. The mean follow-up period in both groups was 27 weeks. A subgroup analysis comparing vitrectomised to non-vitrectomised eyes in both groups was also performed.Results:Of the 92 eyes, 46% (23 of 51) in the 4 mg group versus 30% (12 of 41) in the 20 mg group had an IOP >21 mm of Hg (p = 0.14) after a mean follow-up period of 27 weeks. The vitrectomised eyes (3 of 24) in the 20 mg group had a significantly lower rate of IVTA induced IOP elevation than the non-vitrectomised eyes (9 of 17) (p = 0.013). The IOP elevation occurred significantly earlier in the 4 mg group (vitrectomised eyes 27 (SD 43) days and non-vitrectomised eyes 61 (52) days) than in the 20 mg group (vitrectomised eyes 104 (56) days and non-vitrectomised eyes 119 (82) days), independent of the vitreous status (vitrectomised p = 0.05 and non-vitrectomised p = 0.04). The mean value of initial high IOP in the non-vitrectomised eyes was higher in the 4 mg group than in the corresponding 20 mg group (p = 0.048).Conclusion:Decanted 20 mg IVTA may not pose a significantly greater risk of IOP elevation than the 4 mg non-decanted IVTA.