title: Intraocular pressure monitoring post intravitreal steroids: a systematic review.
abstract: The use of intravitreal (IVT) corticosteroids for treatment of posterior segment diseases has increased significantly over the last decade. A commonly recognized complication of IVT steroids is secondary ocular hypertension (OHT) that can occur immediately secondary to direct intraocular volume increase or weeks to months later as a result of increased outflow resistance. We performed a meta-analysis and found 32% (95% confidence interval, 28.2-36.3) of individuals developed OHT following 4 mg IVT triamcinolone, 66% (50.2-78.8) and 79% (72.2-84.5) following 0.59 and 2.1 mg fluocinolone implant, respectively, and 11% (6.4-17.9) and 15% (9.2-24.3) following 0.35 and 0.7 mg dexamethasone implant, respectively. Risk factors included pre-existing glaucoma, higher baseline intraocular pressure (IOP), younger age, OHT following previous injection, uveitis, higher steroid dosage, and fluocinolone implant. Most cases of OHT can be controlled medically; up to 45% following fluocinolone implant require surgery, however. We suggest a protocol to monitor IOP after IVT steroid injection/implantation that includes checking IOP within 30 minutes after injection, followed by 1 week after IVT triamcinolone and 2 weeks after implant insertion, then every 2 weeks for the first month and monthly for up to 6 months after IVT triamcinolone and dexamethasone implantation and 9 months after fluocinolone implantation.
authors.affiliation: Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Weerawat
authors.initials: W
authors.lastname: Kiddee
authors.forename: Graham E
authors.initials: GE
authors.lastname: Trope
authors.forename: Lisa
authors.initials: L
authors.lastname: Sheng
authors.forename: Laura
authors.initials: L
authors.lastname: Beltran-Agullo
authors.forename: Michael
authors.initials: M
authors.lastname: Smith
authors.forename: M Hermina
authors.initials: MH
authors.lastname: Strungaru
authors.forename: Jasrajbir
authors.initials: J
authors.lastname: Baath
authors.forename: Yvonne M
authors.initials: YM
authors.lastname: Buys
mesh_terms: D003907:Dexamethasone / Q000009:adverse effects; D004343:Drug Implants; D005446:Fluocinolone Acetonide / Q000009:adverse effects / Q000031:analogs & derivatives; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects / Q000502:physiology*; D058449:Intravitreal Injections; D008991:Monitoring, Physiologic; D009798:Ocular Hypertension / Q000139:chemically induced / Q000175:diagnosis* / Q000628:therapy; D012307:Risk Factors; D014065:Tonometry, Ocular; D014222:Triamcinolone Acetonide / Q000009:adverse effects
chemical_list: D004343:Drug Implants; D005938:Glucocorticoids; D005446:Fluocinolone Acetonide; D003907:Dexamethasone; C035394:fluocinolone; D014222:Triamcinolone Acetonide