Regression of neovascular iris vessels by intravitreal injection of crystalline cortisone.
OBJECTIVE
To report the clinical outcome of patients who received an intravitreal injection of crystalline triamcinolone acetonide as treatment of neovascular glaucoma.


METHODS
The study included 14 eyes of 14 patients with secondary neovascular glaucoma attributable to proliferative diabetic retinopathy (n = 9) or ischemic central retinal vein occlusion (n = 5). All patients received an intravitreal injection of 20 mg of crystalline triamcinolone acetonide as the only procedure (n = 4) or in combination with additional procedures, such as goniosynechiolysis (n = 1), phacoemulsification and intraocular lens implantation (n = 2), or transscleral peripheral retinal cryocoagulation (n = 7). Mean follow-up time was 3.10 +/- 2.40 months (median, 3.5 months; range, 0.50-5.7 months). A goniosynechiolysis was carried out in those patients in whom the anterior chamber was circumferentially closed.


RESULTS
After surgery, including the first days after surgery, the patients were nearly pain-free. Intraocular pressure was significantly (P < 0.01) reduced from 33.4 +/- 14.5 mm Hg before surgery to 20.7 +/- 8.2 mm Hg at the end of the follow-up period. Postoperative visual acuity (mean, 0.09 +/- 0.07; median, 0.10; range, finger counting to 0.25) was slightly but not significantly (P = 0.31) better than the preoperative values. Degree of rubeosis iridis decreased significantly (P = 0.02) from 2.6 +/- 1.3 relative units to 1.3 +/- 1.2 relative units. When considering only the four patients for whom the intraocular cortisone injection was the only procedure performed, mean intraocular pressure decreased from 26.5 +/- 12.1 mm Hg to 21.75 +/- 11.3 mm Hg.


CONCLUSIONS
Intravitreal injection of crystalline cortisone with most of the vehicle removed may be a potentially useful additional tool in the treatment of neovascular glaucoma.
Jonas
J B
JB
Department of Ophthalmology and Eye Hospital, Faculty for Clinical Medicine Mannheim, Ruprecht-Karls-University, Heidelberg, Germany. Jost.Jonas@ma.augen.uniheidelberg.de
Hayler
J K
JK
Söfker
A
A
Panda-Jonas
S
S
D000368:Aged; D000369:Aged, 80 and over; D003460:Crystallization; D003930:Diabetic Retinopathy / Q000150:complications; D005260:Female; D015355:Glaucoma, Neovascular / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D007429:Intraocular Pressure; D007498:Iris / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D012170:Retinal Vein Occlusion / Q000150:complications; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*; D014792:Visual Acuity; D014822:Vitreous Body
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide