title: A trial of topical prednisolone acetate before intravitreal triamcinolone acetonide decreases intraocular pressure spikes.
abstract: OBJECTIVE
  To compare adverse intraocular pressure (IOP) spikes in patients receiving intravitreal triamcinolone acetonide (IVTA) in 2 cohorts: (i) patients who underwent a topical prednisolone acetate trial (PAT) without incurring a short-term IOP rise, and (ii) control patients who did not undergo a PAT.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Charts of all patients who underwent any intravitreal injection during the study period were reviewed (n = 1150).
  
  
  METHODS
  Patients in the PAT group received a 6-week course of prednisolone acetate 1% 4 times per day and had an IOP that did not rise above 25 mm Hg or above 8 mm Hg over the IOP in the contralateral eye. Patients undergoing a PAT and having a short-term IOP rise were not studied. Control patients did not receive a PAT. All patients received 12-20 mg of IVTA. Patients were followed for a minimum of 6 weeks and follow-up lasted for 1 year or until intraocular surgery or another IVTA injection was performed.
  
  
  RESULTS
  There were 97 patients in the PAT cohort and 75 control patients. Patients in the PAT cohort had a lower proportional rise between maximum IOP and baseline (43%) compared with controls (64%) (p = 0.035). Patients in the PAT group also had a lower risk of incurring a 40% (p = 0.05), 60% (p = 0.018), and 100% (p = 0.045) increase in maximum IOP (vs baseline) compared with controls and were less likely to require glaucoma filtration surgery (p = 0.035).
  
  
  CONCLUSIONS
  Patients undergoing a PAT who did not have a subsequent short-term IOP rise had a lower risk of severe IOP spikes after IVTA compared with those patients receiving IVTA but not having undergone a PAT.
authors.affiliation: Department of Ophthalmology, Queen's University, Kingston, Ont. hussein.hollands@yahoo.com
authors.forename: Hussein
authors.initials: H
authors.lastname: Hollands
authors.forename: Gamal
authors.initials: G
authors.lastname: Seif
authors.forename: Simon
authors.initials: S
authors.lastname: Hollands
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Gale
mesh_terms: D000287:Administration, Topical; D000368:Aged; D020256:Choroidal Neovascularization / Q000188:drug therapy; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007267:Injections; D007429:Intraocular Pressure / Q000187:drug effects*; D008269:Macular Edema / Q000188:drug therapy; D009798:Ocular Hypertension / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control*; D009883:Ophthalmic Solutions / Q000008:administration & dosage; D011239:Prednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D012189:Retrospective Studies; D014065:Tonometry, Ocular; D014222:Triamcinolone Acetonide / Q000009:adverse effects*; D014822:Vitreous Body
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D009883:Ophthalmic Solutions; C009935:prednisolone acetate; D011239:Prednisolone; D014222:Triamcinolone Acetonide