Yamamoto Yumiko, Komatsu Tsutomu, Koura Yuji, Nishino Koji, Fukushima Atsuki, Ueno Hisayuki
Department of Ophthalmology and Visual Science, Kochi Medical School, Kohasu, Nankoku City, Japan.
Can J Ophthalmol. 2008 Feb;43(1):42-7. doi: 10.3129/i07-186.
Despite the benefits of intraocular steroids for the treatment of inflammatory, neovascular, proliferative, and edematous diseases, one of the side effects is raised intraocular pressure (IOP). In this study, we attempted to identify when IOP elevates, peaks, and returns to the preinjection baseline IOP after intravitreal or posterior sub-Tenon administration of triamcinolone acetonide, as well as the factors that might affect IOP.
Retrospective case review was undertaken of 69 patients (82 eyes), who received either a 4 mg intravitreal (16 eyes) or a 20 mg posterior sub-Tenon (66 eyes) triamcinolone acetonide injection. IOP assessment for each eye was completed at the preinjection baseline and at the first, third, and sixth month of follow-up.
The mean IOP of all eyes increased significantly at each follow-up. The mean maximum elevation ratio from the baseline was 4.0 (SD 5.2) mm Hg. An elevation of 5 mm Hg or greater occurred in 28 eyes (34.1%). The maximum elevation correlated significantly with age (p < 0.01). The incidence of an elevation of 5 mm Hg or greater was significantly higher among patients younger than 60 years (p < 0.01) and relatively higher among female patients (p = 0.051). The mean IOP increased significantly at the first month after intravitreal injection but at all follow-up periods after posterior sub-Tenon injection. There was no significant difference in IOP elevation according to disease type, although eyes with diabetic retinopathy tended to be at higher risk of IOP elevation. Two eyes of two female patients, who had received posterior sub-Tenon injections for the treatment of diabetic retinopathy, required glaucoma surgery.
The IOP elevation of 5 mm Hg or greater observed in 34.1% of the eyes was consistent with past reports. IOP elevation was associated with patients of less than 60 years of age and with female sex, and it lasted longer after posterior sub-Tenon injection than after intravitreal injection. Careful assessment of IOP during a follow-up period of at least 6 months is paramount, especially in younger female patients after posterior sub-Tenon injection.
尽管眼内注射类固醇对治疗炎症性、新生血管性、增殖性和水肿性疾病有益，但副作用之一是眼压升高。在本研究中，我们试图确定玻璃体内或Tenon囊下注射曲安奈德后眼压何时升高、达到峰值以及恢复到注射前的基线眼压，以及可能影响眼压的因素。
对69例患者（82只眼）进行回顾性病例分析，这些患者接受了4 mg玻璃体内（16只眼）或20 mg Tenon囊下（66只眼）曲安奈德注射。在注射前基线以及随访的第1、3和6个月对每只眼进行眼压评估。
所有眼的平均眼压在每次随访时均显著升高。相对于基线的平均最大升高幅度为4.0（标准差5.2）mmHg。28只眼（34.1%）眼压升高5 mmHg或更高。最大升高幅度与年龄显著相关（p<0.01）。60岁以下患者眼压升高5 mmHg或更高的发生率显著更高（p<0.01），女性患者相对更高（p = 0.051）。玻璃体内注射后第1个月平均眼压显著升高，但Tenon囊下注射后所有随访期均升高。根据疾病类型，眼压升高无显著差异，尽管糖尿病视网膜病变患者的眼眼压升高风险往往更高。两名接受Tenon囊下注射治疗糖尿病视网膜病变的女性患者的两只眼需要进行青光眼手术。
34.1%的眼中观察到眼压升高5 mmHg或更高，这与既往报道一致。眼压升高与60岁以下患者以及女性相关，Tenon囊下注射后眼压升高持续时间比玻璃体内注射后更长。在至少6个月的随访期内仔细评估眼压至关重要，尤其是Tenon囊下注射后的年轻女性患者。
