Ocular side effects associated with peribulbar injections of triamcinolone acetonide for diabetic macular edema

Abstract

Purpose: 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.

Conclusion: 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.

Figures

Figure 1

Kaplan-Meier analysis of cumulative probability of intraocular pressure (IOP) change ≥ 10 mm Hg or IOP- lowering medication prescribed at any visit. The “# eyes at risk” indicates the number of eyes still in follow up at the beginning of the interval that have not previously met the IOP outcome. The “# outcome” indicates the number of eyes with IOP change ≥ 10 mm Hg or IOP- lowering medication prescribed for the first time during the subsequent time interval. Data from eyes with incomplete follow up were censored at the last completed visit.