Reichle Michelle L
VA Connecticut Healthcare System, Newington Campus, Newington, Connecticut, USA.
Optometry. 2005 Aug;76(8):450-60. doi: 10.1016/j.optm.2005.06.013.
Intravitreal corticosteroid injections are a new therapeutic procedure used to treat various retinal edematous and neovascular conditions. They have been used in the treatment of diabetic macular edema, exudative macular degeneration, pseudophakic cystoid macular edema, macular edema associated with retinal vein occlusion, and chronic uveitis as well as other conditions. Because the use of this therapeutic technique is becoming increasingly more common, adverse effects are now being seen. The most common adverse effects associated with intravitreal steroid injection are elevation of intraocular pressure and progression of cataract. Endophthalmitis, pseudoendophthalmitis, and retinal detachment have also been reported.
This report describes 2 patients who were followed up at the VA Connecticut Healthcare System Newington Campus Optometry Clinic for steroid-induced elevation of intraocular pressure after intravitreal corticosteroid injection. One patient exhibited elevation of intraocular pressure after his first intravitreal steroid injection for treatment of clinically significant macular edema secondary to diabetes. The second patient did not exhibit a steroid response to the first intravitreal steroid injection utilized as treatment for choroidal neovascularization from age-related macular degeneration. However, he did show a rise in intraocular pressure after a second intravitreal corticosteroid injection. Intraocular pressures, treatment, and frequency of follow-up in both patients pre- and postinjection are discussed.
Elevation of intraocular pressure after intravitreal steroid injection can commonly be controlled with topical glaucoma medications. Cataract progression is common in patients after intravitreal injection of corticosteroid; however, findings show these patients are at no additional risk for cataract surgery complications. Therefore, these do not appear to be major contraindications. However, because 30% to 50% of patients experience intraocular pressure rise up to a few months postinjection, and patients are at higher risk for complications such as endophthalmitis, optometrists should be aware of appropriate management after this increasingly utilized therapeutic procedure.
玻璃体内注射皮质类固醇是一种用于治疗各种视网膜水肿和新生血管疾病的新治疗方法。它们已被用于治疗糖尿病性黄斑水肿、渗出性黄斑变性、人工晶状体性黄斑囊样水肿、与视网膜静脉阻塞相关的黄斑水肿、慢性葡萄膜炎以及其他病症。由于这种治疗技术的使用越来越普遍，现在出现了不良反应。与玻璃体内注射类固醇相关的最常见不良反应是眼压升高和白内障进展。也有眼内炎、假眼内炎和视网膜脱离的报道。
本报告描述了 2 例在康涅狄格州退伍军人医疗系统纽因顿校区验光诊所接受随访的患者，他们在玻璃体内注射皮质类固醇后出现类固醇诱导的眼压升高。一名患者在首次玻璃体内注射类固醇以治疗继发于糖尿病的具有临床意义的黄斑水肿后出现眼压升高。第二名患者在首次玻璃体内注射类固醇以治疗年龄相关性黄斑变性引起的脉络膜新生血管时未出现类固醇反应。然而，他在第二次玻璃体内注射皮质类固醇后确实出现了眼压升高。讨论了两名患者注射前后的眼压、治疗和随访频率。
玻璃体内注射类固醇后眼压升高通常可用局部青光眼药物控制。玻璃体内注射皮质类固醇后患者白内障进展很常见；然而，研究结果表明这些患者白内障手术并发症的风险没有增加。因此，这些似乎不是主要禁忌症。然而，由于 30%至 50%的患者在注射后几个月内会出现眼压升高，并且患者发生眼内炎等并发症的风险更高，验光师应该了解这种越来越常用的治疗方法后的适当管理。
