Behavior of Intraocular Pressure After Intravitreal Injection of Triamcinolone Acetonide Among Egyptians

PURPOSE To evaluate the changes in intraocular pressure (IOP) after intravitreal injection of triamcinolone acetonide for the management of diabetic macular edema (DME). METHODS The study design is a prospective, interventional, two-arm, dose-response study. Nineteen patients with bilateral DME were included, one eye for every patient underwent intravitreal injection of 4 mg triamcinolone acetonide (group A, 19 eyes), and the other eye of the same patient underwent intravitreal injection of 8 mg triamcinolone acetonide (group B, 19 eyes); the selection as to which eye was to receive either dose was random. The patients were followed up for 6 months after injection; complete ophthalmological examination and optical coherent topography were done. RESULTS Intravitreal triamcinolone acetonide was effective in reduction of DME in group A in the first 3 months only, while in group B with high dose (8 mg) the improvement continued for 6 months after injection. Significant IOP rise was observed in both groups with an incidence of 68.1% and 73.7% in groups A and B, respectively. IOP-lowering drugs were used to control IOP; however, one patient in each group needed glaucoma filtration surgery in both eyes after intractable glaucoma with failure of medical treatment. CONCLUSION Although intravitreal injection of triamcinolone acetonide is very effective in managing DME and with lower cost than other modalities, the rise in IOP and the burden of glaucoma are major concerns. High corticosteroid responder is an individualized reaction irrespective of the intravitreal triamcinolone acetonide dose used.