A trial of topical prednisolone acetate before intravitreal triamcinolone acetonide decreases intraocular pressure spikes

• Published in: Canadian journal of ophthalmology Vol. 45; no. 5; pp. 484 - 488
• Main Authors: Hollands, Hussein, MD, MSc (Epid), BSc, Seif, Gamal, MD, MSc, BSc, Hollands, Simon, MSc, Gale, Jeffrey, MD, FRCSC, BSc
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.10.2010
• Subjects: Administration, Topical; Aged; Choroidal Neovascularization - drug therapy; Follow-Up Studies; Glucocorticoids - administration & dosage; Humans; Immunosuppressive Agents - adverse effects; Injections; Internal Medicine; Intraocular Pressure - drug effects; intraocular pressure spikes; intravitreal triamcinolone acetonide; IOP; Macular Edema - drug therapy; Ocular Hypertension - chemically induced; Ocular Hypertension - diagnosis; Ocular Hypertension - prevention & control; Ophthalmic Solutions - administration & dosage; Ophthalmology; Prednisolone - administration & dosage; Prednisolone - analogs & derivatives; prednisolone acetate; Retrospective Studies; Tonometry, Ocular; Triamcinolone Acetonide - adverse effects; Vitreous Body; intraocular pressure spikes; IOP; intravitreal triamcinolone acetonide; prednisolone acetate
• ISSN: 0008-4182; 1715-3360
• DOI: 10.3129/i10-050

Abstract Objective: To compare adverse intraocular pressure (IOP) spikes in patients receiving intravitreal triamcinolone acetonide (IVTA) in 2 cohorts: ( i ) patients who underwent a topical prednisolone acetate trial (PAT) without incurring a short-term IOP rise, and ( ii ) control patients who did not undergo a PAT. Design: Retrospective cohort study. Participants: Charts of all patients who underwent any intravitreal injection during the study period were reviewed ( n = 1150). Methods: Patients in the PAT group received a 6-week course of prednisolone acetate 1% 4 times per day and had an IOP that did not rise above 25 mm Hg or above 8 mm Hg over the IOP in the contralateral eye. Patients undergoing a PAT and having a short-term IOP rise were not studied. Control patients did not receive a PAT. All patients received 12-20 mg of IVTA. Patients were followed for a minimum of 6 weeks and follow-up lasted for I year or until intraocular surgery or another IVTA injection was performed. Results: There were 97 patients in the PAT cohort and 75 control patients. Patients in the PAT cohort had a lower proportional rise between maximum IOP and baseline (43%) compared with controls (64%) ( p = 0.035). Patients in the PAT group also had a lower risk of incurring a 40% ( p = 0.05), 60% ( p = 0.0I8), and 100% ( p = 0.045) increase in maximum IOP (vs baseline) compared with controls and were less likely to require glaucoma filtration surgery ( p = 0.035). Conclusions: Patients undergoing a PAT who did not have a subsequent short-term IOP rise had a lower risk of severe IOP spikes after IVTA compared with those patients receiving IVTA but not having undergone a PAT.