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Abstract #27036 Published in IGR 12-4
Control of steroid-induced glaucoma with surgical excision of sub-Tenon triamcinolone acetonide deposits: a clinical and biochemical approach.
Okka M; Bozkurt B; Kerimoglu H; Ozturk BT; Gunduz K; Yılmaz M; Okudan SCanadian Journal of Ophthalmology 2010; 45: 1-6
Objective: To assess the efficacy of surgical excision of sub-Tenon triamcinolone acetonide (TA) deposits in the control of steroid-induced glaucoma.Design: Prospective, nonrandomized, interventional case series.Participants: Eighteen eyes of 14 subjects with increased IOP within 6 months of sub-Tenon TA injection who did not respond to medical antiglaucomatous treatment were included in the study.Methods: Under topical anaesthesia, steroid deposits were completely excised and placed in ethyl alcohol for the determination of the TA amount using high-performance liquid chromatography. The patients were followed up for 6 months and a paired-sample t test was used to compare mean IOP before and after excision of sub-Tenon TA deposits.Results: The mean IOP levels before and after the sub-Tenon steroid injections were 15.9 (SD 2.9) mm Hg and 36.4 (SD 8.4) mm Hg, respectively (p < 0.001). IOP levels decreased significantly after the removal of the deposits (mean 15.3 [SD 2.1] mm Hg) (p < 0.001). Within 6 months of follow-up, all glaucoma medications were stopped in 9 subjects without further IOP increase, whereas IOP control in 5 subjects necessitated using glaucoma medications. The median TA amount was found to be 7.35 mg (range 3.3-29.68 mg). IOP decrease after the excision showed no correlation with the amount of TA (p = 0.8).Conclusions: Surgical excision of the sub-Tenon steroid deposit should be considered as the primary treatment for steroid-induced glaucoma refractory to medical treatment.
Classification:
9.4.1 Steroid-induced glaucoma (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders)