1. Intraocular pressure monitoring post intravitreal steroids: a systematic review.
- Author
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Kiddee W, Trope GE, Sheng L, Beltran-Agullo L, Smith M, Strungaru MH, Baath J, and Buys YM
- Subjects
- Dexamethasone adverse effects, Drug Implants, Fluocinolone Acetonide adverse effects, Fluocinolone Acetonide analogs & derivatives, Humans, Intraocular Pressure drug effects, Intravitreal Injections, Ocular Hypertension chemically induced, Ocular Hypertension therapy, Risk Factors, Tonometry, Ocular, Triamcinolone Acetonide adverse effects, Glucocorticoids adverse effects, Intraocular Pressure physiology, Monitoring, Physiologic, Ocular Hypertension diagnosis
- Abstract
The use of intravitreal (IVT) corticosteroids for treatment of posterior segment diseases has increased significantly over the last decade. A commonly recognized complication of IVT steroids is secondary ocular hypertension (OHT) that can occur immediately secondary to direct intraocular volume increase or weeks to months later as a result of increased outflow resistance. We performed a meta-analysis and found 32% (95% confidence interval, 28.2-36.3) of individuals developed OHT following 4 mg IVT triamcinolone, 66% (50.2-78.8) and 79% (72.2-84.5) following 0.59 and 2.1 mg fluocinolone implant, respectively, and 11% (6.4-17.9) and 15% (9.2-24.3) following 0.35 and 0.7 mg dexamethasone implant, respectively. Risk factors included pre-existing glaucoma, higher baseline intraocular pressure (IOP), younger age, OHT following previous injection, uveitis, higher steroid dosage, and fluocinolone implant. Most cases of OHT can be controlled medically; up to 45% following fluocinolone implant require surgery, however. We suggest a protocol to monitor IOP after IVT steroid injection/implantation that includes checking IOP within 30 minutes after injection, followed by 1 week after IVT triamcinolone and 2 weeks after implant insertion, then every 2 weeks for the first month and monthly for up to 6 months after IVT triamcinolone and dexamethasone implantation and 9 months after fluocinolone implantation., (Copyright © 2013 Elsevier Inc. All rights reserved.)
- Published
- 2013
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