Subtenon's depot corticosteroid injections in patients with a history of corticosteroid-induced intraocular pressure elevation.
OBJECTIVE
To determine whether a history of intraocular pressure elevation from local corticosteroid administration could predict subsequent intraocular pressure elevation after posterior subtenon's corticosteroid injection.


METHODS
A retrospective review was performed of 64 consecutive patients (64 eyes) receiving posterior subtenon's corticosteroid injection. Patients were categorized as either historical corticosteroid responders or nonresponders based on intraocular pressure response to topical corticosteroid drops in the same eye or to previous posterior subtenon's corticosteroid injection of the fellow eye. Historical responders were defined as having a relative intraocular pressure increase of 5 mm Hg and absolute intraocular pressure greater than 24 mm Hg with an anatomically open angle. Relative risk of intraocular pressure elevation was evaluated based on historical response and presenting diagnosis.


RESULTS
Nine eyes were historical responders, and 55 eyes were historical nonresponders. A higher rate of recurrent intraocular pressure elevation developed in historical responder eyes (4 of 9, 44%) compared with nonresponders (7 of 55, 13%) after posterior subtenon's injection (P = .04, Fisher's test; P = .07, Kaplan-Meier analysis). Historical responders with uveitis were at significantly higher risk of intraocular pressure elevation than nonresponders without uveitis (hazard ratio = 10.8, P = .04, Cox proportional hazards). All but one eye that developed intraocular pressure elevation from posterior subtenon's injection was adequately controlled with topical antiglaucoma therapy.


CONCLUSIONS
In nonglaucomatous eyes, a previous history of corticosteroid-induced intraocular pressure elevation is a relative, not absolute, contraindication to posterior subtenon's corticosteroid injection, because the risk of intraocular pressure elevation is not absolute, and because it can usually be well controlled with topical antiglaucoma therapy.
Levin
Darrin S
DS
Department of Ophthalmology and the Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin 53226-4812, USA.
Han
Dennis P
DP
Dev
Sundeep
S
Wirostko
William J
WJ
Mieler
William F
WF
Connor
Thomas B
TB
George
Varghese
V
Eastwood
Dan
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003238:Connective Tissue / Q000187:drug effects; D000075202:Contraindications; D003907:Dexamethasone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007267:Injections; D007429:Intraocular Pressure / Q000187:drug effects*; D008297:Male; D008776:Methylprednisolone Hemisuccinate / Q000008:administration & dosage; D008875:Middle Aged; D009798:Ocular Hypertension / Q000139:chemically induced* / Q000175:diagnosis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D014221:Triamcinolone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D014222:Triamcinolone Acetonide / Q000008:administration & dosage
D005938:Glucocorticoids; D014221:Triamcinolone; C004180:dexamethasone 21-phosphate; D008776:Methylprednisolone Hemisuccinate; D003907:Dexamethasone; C030262:triamcinolone diacetate; D014222:Triamcinolone Acetonide