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Abstract：
Aim: To assess the incidence, risk factors, and treatment outcomes in intravitreal triamcinolone acetonide injection (IVTA) induced intraocular pressure rise and to compare IOP rise in 1-mg and 2-mg IVTA. Materials and methods: Prospective observational study conducted in all eyes receiving IVTA. Any pre-existing glaucoma and patients who received IVTA or dexamethasone implant in the last 6 months were excluded. Results: 9 between 61-70 years of age developed an IOP spike. The mean and standard deviation of age in years was 61.95 ± 8.70. Maximum eyes had ME due to Diabetic Retinopathy (53.3%). All cases of uveitic ME were reported to have an IOP spike. 2 out of 3 high myopic eyes and 1 eye with thyroid abnormality had an IOP spike. High IOP was found in 13 eyes, with more than 25 mm Hg rise in 4 eyes and more than 5 mm Hg rise from baseline IOP in 9 eyes. The mean and standard deviation of time taken for IOP raise (in days) was 46.39 ± 37.68. A total of 38 eyes received 1 mg of IVTA and the rest 22 received 2 mg of IVTA. 23.7% of 1 mg eyes experienced an IOP rise while it was 18.2% in eyes with 2 mg IVTA. The injection was repeated in 12 eyes and 41.7% developed an IOP spike among them. The independent \"t\" test results showed that there was a significant difference in the mean of IOP (Pre-injection) concerning the IOP rise (P=0.007*). 1 eye had IVTA crystals in the anterior chamber with raised IOP of 30 mm Hg. 1 out of 13 eyes with raised IOP needed 2 AGMs, the other 12 eyes responded well to 1 AGM. Discussion: IVTA is widely used in refractory cases of ME and steroid-induced glaucoma is the most common side effect of IVTA. To the best of our knowledge, there is a lack of literature on prospective studies on IVTA-associated risk factors, patterns of IOP elevation, and treatment outcomes. The pre-injection mean ± SD baseline IOP for uneventful eyes was 12.87±2.65 and the pre-injection mean IOP for eyes with IOP event was 15.23±2.89 (P=0.007*). Conclusion: We proposed that TA is an independent risk factor for post-intravitreal injection IOP spike. IVTA causes a maximum IOP spike at 1 to 2 months and has a protracted course that responds to anti-glaucoma medications. High baseline IOP, a repeated dose of IVTA, the presence of TA crystals in the anterior chamber, and high myopia were associated with significant IOP elevation. Abbreviations: ACD = Anterior chamber depth, AS = Anterior segment, AGM = Anti-glaucoma medications, ARMD = Age-related macular degeneration, BCVA = Best-corrected visual acuity, BRVO = Branch retinal vein occlusion, CCT = Central corneal thickness, CRVO = Central retinal vein occlusion, CME = Cystoid macular edema, CNVM = Choroidal neovascularization membrane, CSME = Clinically significant macular edema, DR = Diabetic retinopathy, ERM = Epiretinal membrane, IOP = Intraocular pressure, IGS = Irvine-Grass syndrome, GAGs = Glycosaminoglycans, IVTA = Intravitreal triamcinolone acetonide injection, ME = Macular edema, NVG = Neovascular glaucoma, OHT = Ocular hypertension, PDS = Pigment dispersion syndrome, PACG = Primary closed angle glaucoma, POAG = Primary open-angle glaucoma, PXF = Pseudoexfoliation, VA = Visual acuity, VEGF = Vascular endothelial growth factors, VH = Vonherick\'s grading, SD = Standard deviation, TA = Triamcinolone acetonide, TIGR = Trabecular meshwork inducible glucocorticoid response.
摘要：
目的：评估发病率，危险因素，玻璃体内注射曲安奈德（IVTA）引起的眼内压升高，并比较1mg和2mgIVTA引起的眼内压升高。材料和方法：在接受IVTA的所有眼睛中进行前瞻性观察研究。排除任何先前存在的青光眼和在过去6个月内接受IVTA或地塞米松植入的患者。结果：年龄在61-70岁之间的9人出现了IOP峰值。年龄的平均值和标准偏差为61.95±8.70。由于糖尿病性视网膜病变，最大的眼睛有ME（53.3％）。据报道，所有葡萄膜ME病例均有IOP峰值。3只高度近视眼和1只甲状腺异常眼出现IOP峰值。在13只眼睛中发现了高眼压，4只眼的IOP升高超过25mmHg，9只眼的IOP升高超过5mmHg。IOP升高所需时间的平均值和标准偏差(天)为46.39±37.68。总共38只眼睛接受了1毫克的IVTA，其余22只接受了2毫克的IVTA。1mg眼睛中有23.7％的IOP升高，而使用2mgIVTA的眼睛为18.2％。在12只眼中重复注射，其中41.7％出现IOP峰值。独立的“t”测试结果表明，与IOP升高有关的IOP（预注射）平均值存在显着差异（P=0.007*）。1只眼的前房有IVTA晶体，IOP升高为30mmHg。眼压升高的13只眼睛中有1只需要2只AGM，其他12只眼睛对1个AGM反应良好。讨论：IVTA广泛用于难治性ME，类固醇性青光眼是IVTA最常见的副作用。据我们所知,缺乏关于IVTA相关危险因素的前瞻性研究的文献，IOP升高的模式，和治疗结果。无事件眼的注射前平均±SD基线IOP为12.87±2.65，有IOP事件眼的注射前平均IOP为15.23±2.89（P=0.007*）。结论：我们认为TA是玻璃体腔注射后IOP峰值的独立危险因素。IVTA在1至2个月时引起最大IOP峰值，并且具有对抗青光眼药物反应的延长疗程。高基线IOP,重复剂量的IVTA，前房中存在TA晶体，高度近视与IOP显著升高相关。缩写：ACD=前房深度，AS=前段,AGM=抗青光眼药物，ARMD=年龄相关性黄斑变性，BCVA=最佳矫正视力，BRVO=视网膜分支静脉阻塞，CCT=中央角膜厚度，CRVO=视网膜中央静脉阻塞,CME=黄斑囊样水肿，CNVM=脉络膜新生血管，CSME=临床显著的黄斑水肿，DR=糖尿病视网膜病变，ERM=视网膜前膜，IOP=眼内压,IGS=Irvine-Grass综合征,GAG=糖胺聚糖，IVTA=玻璃体内注射曲安奈德，ME=黄斑水肿，NVG=新生血管性青光眼，OHT=眼部高血压，PDS=色素分散综合征，PACG=原发性闭角型青光眼，POAG=原发性开角型青光眼，PXF=假性剥脱，VA=视敏度，VEGF=血管内皮生长因子，VH=Vonherick\'s评分,SD=标准偏差，TA=曲安奈德，TIGR=小梁网可诱导的糖皮质激素反应。
