Ocular side effects associated with peribulbar injections of triamcinolone acetonide for diabetic macular edema.
OBJECTIVE
To evaluate long-term effects of anterior and posterior peribulbar injections of triamcinolone acetonide on intraocular pressure (IOP) elevation and cataract development.


METHODS
This study reports on IOP and cataract progression through 2 years in 96 eyes with diabetic macular edema randomized to focal/grid photocoagulation, 20 mg triamcinolone acetonide anterior injection, anterior injection followed by laser, 40 mg triamcinolone acetonide posterior injection, or posterior injection followed by laser.


RESULTS
Intraocular pressure increased from baseline by ≥ 10 mmHg at ≥ 1 visit through 2 years in 2 eyes (8%) in the laser group, 11 eyes (31%) in the anterior groups, and 6 eyes (17%) in the posterior groups. Among phakic eyes at baseline, 0, 5 (17%), and 1 (3%) in the 3 groups, respectively, underwent cataract surgery before the 2-year visit.


CONCLUSIONS
Based on this small randomized trial, it appears that over 2 years, anterior peribulbar triamcinolone acetonide injections are associated with an increased incidence of IOP elevation and an increased risk of cataract development compared with laser or posterior peribulbar injections. The association of posterior injections with IOP elevation is less certain. Although the study involved eyes with diabetic macular edema, the results should be relevant to other conditions treated with peribulbar corticosteroids.
Chew
Emily Y
EY
National Eye Institute/National Institutes of Health, Bethesda, Maryland, USA.
Glassman
Adam R
AR
Beck
Roy W
RW
Bressler
Neil M
NM
Fish
Gary E
GE
Ferris
Fredrick L
FL
Kinyoun
James L
JL
D000368:Aged; D002386:Cataract / Q000139:chemically induced* / Q000503:physiopathology; D002387:Cataract Extraction; D003131:Combined Modality Therapy; D003930:Diabetic Retinopathy / Q000188:drug therapy*; D018450:Disease Progression; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007267:Injections; D007429:Intraocular Pressure / Q000187:drug effects*; D017075:Laser Coagulation; D007908:Lens, Crystalline / Q000187:drug effects; D008269:Macular Edema / Q000188:drug therapy*; D008875:Middle Aged; D009798:Ocular Hypertension / Q000139:chemically induced* / Q000503:physiopathology; D009915:Orbit; D012307:Risk Factors; D058475:Tenon Capsule; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000009:adverse effects*
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide