title: Bevacizumab and Panretinal photocoagulation protect against ocular hypertension after posterior subtenon injection of triamcinolone acetonide for diabetic macular edema.
abstract: OBJECTIVE
  To analyze the prognostic factors for ocular hypertension after posterior subtenon injection of triamcinolone acetonide (PSTA) for the treatment of diabetic macular edema (DME).
  
  
  METHODS
  Patients who received PSTA for DME from January 2006 to December 2011 were enrolled retrospectively and were followed until December 2012 in one hospital. Modified Cox regression models were used to analyze the factors associated with ocular hypertension, which was defined as an intraocular pressure>21 mmHg after PSTA.
  
  
  RESULTS
  A total of 180 PSTA injections were given to 114 eyes from 73 adults with DME. During a mean follow-up of 50.4 weeks after each injection, ocular hypertension occurred in 20.6% of injections (28.1% of eyes). Treatment-naïve patients with proliferative diabetic retinopathy (PDR) had a higher risk of ocular hypertension after PSTA than those with nonproliferative diabetic retinopathy (NPDR) [hazard ratio (HR)=3.255, p=0.030]. Intravitreal injection of bevacizumab (IVB) before PSTA had a significant effect in lowering the risk of ocular hypertension after PSTA in patients with PDR who had received panretinal photocoagulation (PRP) (HR=0.107, p=0.035). Both prompt PRP and IVB following PSTA had a protective effect against ocular hypertension in treatment-naïve patients with PDR (HR=0.086, p=0.0002 and HR=0.155, p=0.049, respectively).
  
  
  CONCLUSIONS
  Treatment-naïve patients with PDR had a higher risk of ocular hypertension after PSTA than those with NPDR. Bevacizumab and prompt PRP both had a protective effect against ocular hypertension after PSTA in patients with PDR.
authors.affiliation: Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; Division of Biostatistics, Graduate Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Ophthalmology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Hsieh
authors.affiliation: Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chung-May
authors.initials: CM
authors.lastname: Yang
authors.affiliation: Division of Biostatistics, Graduate Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. Electronic address: shuhui@ntu.edu.tw.
authors.forename: Shu-Hui
authors.initials: SH
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000068258:Bevacizumab / Q000627:therapeutic use*; D003930:Diabetic Retinopathy / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D008028:Light Coagulation; D008269:Macular Edema / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000517:prevention & control*; D012189:Retrospective Studies; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000068258:Bevacizumab; D014222:Triamcinolone Acetonide
keywords: anti-vascular endothelial growth factor; diabetic macular edema; ocular hypertension; panretinal photocoagulation; steroids