Hipertensão Ocular Secundária à Injeção Intravítrea de Triancinolona Acetonida: Incidência e Fatores de Risco

AUTOR(ES)
DATA DE PUBLICAÇÃO

2007

RESUMO

Introduction: Intravitreal triamcinolone acetonide injection has been widely used in the treatment of various oedematous, proliferative and neovascular retinal diseases. There is crescent concern about its adverse effects, notably ocular hypertension. Objective: To describe the effect of an intravitreal injection of 4 mg of triamcinolone acetonide on intraocular pressure, emphasizing ocular hypertension incidence and risk factor analysis. Methods:Two-hundred-and-thirty-one eyes of 219 patients that consecutively underwent a single intravitreal injection of triamcinolone acetonide in the Retina Department of Hospital São Geraldo / HC-UFMG and in Instituto da Visão, in Belo Horizonte MG, between January 2003 and October 2005, had their demographic and ophthalmological data (including Goldmann aplanation tonometry) gathered and analyzed, before and after corticosteroid administration. Statistical analysis considered a level of significance of five percent. One-hundred-and-fifty eyes of 150 patients that were followed for at least three months and met inclusion criteria were evaluated. Results: Intraocular pressure ³ 21 mmHg was detected in 48 eyes (32.0%) in a mean follow-up of 7.7 months. Increase in intraocular pressure ³ 5 mmHg, ³ 10 mmHg and ³ 30% was disclosed in respectively 63 (42.0%), 24 (16.0%) and 67 (44.7%) of treated eyes. All cases of ocular hypertension were controlled with topical medication, without the need for filtrering surgery. Statistical analysis revealed that ocular hypertension was independent of age, sex, systemic hypertension, diabetes mellitus, indication for triamcinolone injection, concurrent phododynamic therapy with verteporfin (PDT), previous surgical procedures such as cataract extraction and pars plana vitrectomy and length of follow-up. Preexistent chronic open-angle glaucoma was a significant risk factor for secondary ocular hypertension (relative risk = 2.17; p = 0.009), as well as baseline intraocular pressure ³ 16 mmHg (relative risk = 2.31; p = 0.002), in nonglaucomatous eyes. Baseline intraocular pressure <12, 12-14, 15- 17, 18-20 and >20 mmHg showed respective incidences of secondary ocular hypertension of 11.1%, 25.4%, 40.0%, 46.2% and 50.0% (p = 0.01). Conclusion: Intravitreal injection of 4 mg of triamcinolone acetonide induced ocular hypertension in one third of treated eyes. Eyes with previous chronic open-angle glaucoma and those with higher baseline intraocular pressure had an increased risk of significant intraocular pressure elevation. Eyes with secondary ocular hypertension showed a favourable response to topical medication.

ASSUNTO(S)

hipertensão ocular/induzido quimicamente decs dissertações acadêmicas decs glaucoma de ângulo aberto/complicações decs dissertação da faculdade de medicina ufmg triancinolona acetonida/uso terapêutico decs hipertensão ocular/epidemiologia decs injeções decs corpo vítreo decs hipertensão ocular/prevenção e controle decs triancinoloma acetonida/efeitos adversos decs idoso decs degeneração macular decs fatores de risco decs pressão intra-ocular/efeito de drogas decs doenças uterinas/quimioterapia decs triancinolona acetonida/administração e dosagem decs

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