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Abstract #6773 Published in IGR 4-1
Subtenon's depot corticosteroid injections in patients with a history of corticosteroid-induced intraocular pressure elevation
Levin DS; Han DP; Dev S; Wirostko WJ; Mieler WF; Connor TB; George V; Eastwood DAmerican Journal of Ophthalmology 2002; 133: 196-202
PURPOSE: To determine whether a history of intraocular pressure (IOP) elevation from local corticosteroid administration could predict subsequent IOP elevation after posterior subtenon's corticosteroid injection. METHODS: A retrospective review was performed of 64 consecutive patients (64 eyes) receiving posterior subtenon's corticosteroid injection. Patients were categorized as either historical corticosteroid responders or nonresponders based on IOP response to topical corticosteroid drops in the same eye or to previous posterior subtenon's corticosteroid injection of the fellow eye. Historical responders were defined as having a relative IOP increase of 5 mmHg and absolute IOP greater than 24 mmHg with an anatomically open angle. Relative risk of IOP elevation was evaluated based on historical response and presenting diagnosis. RESULTS: Nine eyes were historical responders, and 55 eyes were historical nonresponders. A higher rate of recurrent IOP elevation developed in historical responder eyes (four of nine, 44%) compared with nonresponders (seven of 55, 13%) after posterior subtenon's injection (p = 0.04, Fisher's test; p = 0.07, Kaplan-Meier analysis). Historical responders with uveitis were at significantly higher risk of IOP elevation than nonresponders without uveitis (hazard ratio = 10.8, p = 0.04, Cox proportional hazards). All but one eye that developed IOP elevation from posterior subtenon's injection was adequately controlled with topical antiglaucoma therapy. CONCLUSIONS: In nonglaucomatous eyes, a previous history of corticosteroid-induced IOP elevation is a relative, not absolute, contraindication to posterior subtenon's corticosteroid injection, because the risk of IOP elevation is not absolute, and because it can usually be well controlled with topical antiglaucoma therapy.
Dr. D.S. Levin, Department of Ophthalmology and the Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI 53226-4812, USA
Classification:
9.4.1 Steroid-induced glaucoma (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders)