To investigate the association between elevated intraocular pressure (IOP) and accelerated cataract formation in patients treated with intravitreal triamcinol one. Analysis of longitudinal data from a randomized, doub...To investigate the association between elevated intraocular pressure (IOP) and accelerated cataract formation in patients treated with intravitreal triamcinol one. Analysis of longitudinal data from a randomized, double-masked, placebo-c ontrolled trial of intravitreal triamcinolone for age-related macular degenerat ion (the Intravitreal Triamcinolone Study). Patients with phakic eyes who partic ipated in a randomized clinical trial of intravitreal triamcinolone for age-rel ated macular degeneration were studied. There were 57 phakic eyes in the treatme nt group and 54 phakic eyes in the control group. One eye per patient was studie d. Four milligrams of intravitreal triamcinolone or 1 ml subconjunctival saline. Intraocular pressure rise of at least 5 mmHg (IOP responders) and progression o f posterior subcapsular cataract by 2 or more grades using photographic standard s from the Age Related Eye Disease Study. Progression of posterior subcapsular c ataract (PSC) by 2 or more grades in the treatment group was significantly highe r among 16 IOP responders (51%after 2 years) than among 37 nonresponders (3%; P < 0.0001, log-rank test). There was no significant progression of PSC in the placebo group or the opposite eye of the treatment group. Progression of cortica l cataracts also was significantly higher among responders than nonresponders (1 5%vs. 3%; P=0.015, log-rank test). The progression of nuclear cataracts (13% vs. 3%) was not significantly different between IOP responders and nonresponders (P=0.3, log-rank test). Although steroid-relate d cataracts are unlikely to develop in eyes that do not experience elevated IOP after intravitreal triamcinolone, those eyes that do also have a very high risk of rapidly experiencing posterior subcapsular lens opacification. This strong as sociation suggests that the mechanism responsible for the development of steroid -induced PSC cataract and raised IOP may be similar.展开更多
PURPOSE: To evaluate complications and results of intravitreal triamcinolone acetonide for treatment of macular edema. DESIGN: Interventional, consecutive, retrospective case series. METHODS: Ninety-three eyes with ma...PURPOSE: To evaluate complications and results of intravitreal triamcinolone acetonide for treatment of macular edema. DESIGN: Interventional, consecutive, retrospective case series. METHODS: Ninety-three eyes with macular edema arising from retinovascular etiologies were treated with 4 mg intravitreal triamcinolone. Eyes were monitored after injection for visual acuity changes and complications, including cataract formation and increase in intraocular pressure (IOP). Cataract progression was analyzed by linear regression analysis of lens scores from lens opacity standards. RESULTS: The mean visual acuity improved from 20/125 to- 1 to 20/100+ 2 by one to two months after injection (P < .001) and was 20/100 at the final examination (P=.006) at a mean of 1.2 years after injection. Complications included a severe, culture-negative inflammatory reaction in one eye (1.1% ). IOP increased to 30 mm Hg or more in nine (9.7% ) of 93 eyes between 1 and 140 days after injection and wasmore frequent in eyes receiving one or more preinjection glaucoma drops (two of 13 eyes, 15.4% , vs seven of 80 eyes, 8.75% , without preinjection glaucoma drops). Nuclear sclerosis increased at a rate of 0.175 U per year, posterior subcapsular cataracts at 0.423 U per year, and cortical cataracts at 0.045U per year. Posterior subcapsular cataract increased by ≥ 1 U or required cataract surgery in 45.2% of eyes followed at least one year. CONCLUSIONS: Intravitreal triamcinolone improves visual acuity in most eyes but eyes must be monitored carefully for increase in IOP. Posterior subcapsular cataract formation becomes visually significant in almost half of eyes by one year after injection.展开更多
文摘To investigate the association between elevated intraocular pressure (IOP) and accelerated cataract formation in patients treated with intravitreal triamcinol one. Analysis of longitudinal data from a randomized, double-masked, placebo-c ontrolled trial of intravitreal triamcinolone for age-related macular degenerat ion (the Intravitreal Triamcinolone Study). Patients with phakic eyes who partic ipated in a randomized clinical trial of intravitreal triamcinolone for age-rel ated macular degeneration were studied. There were 57 phakic eyes in the treatme nt group and 54 phakic eyes in the control group. One eye per patient was studie d. Four milligrams of intravitreal triamcinolone or 1 ml subconjunctival saline. Intraocular pressure rise of at least 5 mmHg (IOP responders) and progression o f posterior subcapsular cataract by 2 or more grades using photographic standard s from the Age Related Eye Disease Study. Progression of posterior subcapsular c ataract (PSC) by 2 or more grades in the treatment group was significantly highe r among 16 IOP responders (51%after 2 years) than among 37 nonresponders (3%; P < 0.0001, log-rank test). There was no significant progression of PSC in the placebo group or the opposite eye of the treatment group. Progression of cortica l cataracts also was significantly higher among responders than nonresponders (1 5%vs. 3%; P=0.015, log-rank test). The progression of nuclear cataracts (13% vs. 3%) was not significantly different between IOP responders and nonresponders (P=0.3, log-rank test). Although steroid-relate d cataracts are unlikely to develop in eyes that do not experience elevated IOP after intravitreal triamcinolone, those eyes that do also have a very high risk of rapidly experiencing posterior subcapsular lens opacification. This strong as sociation suggests that the mechanism responsible for the development of steroid -induced PSC cataract and raised IOP may be similar.
文摘PURPOSE: To evaluate complications and results of intravitreal triamcinolone acetonide for treatment of macular edema. DESIGN: Interventional, consecutive, retrospective case series. METHODS: Ninety-three eyes with macular edema arising from retinovascular etiologies were treated with 4 mg intravitreal triamcinolone. Eyes were monitored after injection for visual acuity changes and complications, including cataract formation and increase in intraocular pressure (IOP). Cataract progression was analyzed by linear regression analysis of lens scores from lens opacity standards. RESULTS: The mean visual acuity improved from 20/125 to- 1 to 20/100+ 2 by one to two months after injection (P < .001) and was 20/100 at the final examination (P=.006) at a mean of 1.2 years after injection. Complications included a severe, culture-negative inflammatory reaction in one eye (1.1% ). IOP increased to 30 mm Hg or more in nine (9.7% ) of 93 eyes between 1 and 140 days after injection and wasmore frequent in eyes receiving one or more preinjection glaucoma drops (two of 13 eyes, 15.4% , vs seven of 80 eyes, 8.75% , without preinjection glaucoma drops). Nuclear sclerosis increased at a rate of 0.175 U per year, posterior subcapsular cataracts at 0.423 U per year, and cortical cataracts at 0.045U per year. Posterior subcapsular cataract increased by ≥ 1 U or required cataract surgery in 45.2% of eyes followed at least one year. CONCLUSIONS: Intravitreal triamcinolone improves visual acuity in most eyes but eyes must be monitored carefully for increase in IOP. Posterior subcapsular cataract formation becomes visually significant in almost half of eyes by one year after injection.
