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Ocular hypertension following 40 mg sub-Tenon triamcinolone versus 0.7 mg dexamethasone implant versus 2 mg intravitreal triamcinolone

Published:August 24, 2020DOI:https://doi.org/10.1016/j.jcjo.2020.06.021

      Abstract

      Objective

      To compare rates of ocular hypertension (OHT) in eyes receiving 40 mg sub-Tenon triamcinolone (STT), 0.7 mg dexamethasone implant (DEX), and 2 mg intravitreal triamcinolone (IVT).

      Methods

      This study is a single-centre, retrospective case series. All patients receiving STT and DEX between 4/1/2014 and 3/1/2017 and IVT between 3/1/2012 and 3/1/2017 with a minimum of 3 months’ follow-up were included. OHT was defined as an intraocular pressure (IOP) >24 mm Hg. Patients receiving any other form of topical, oral, or intravitreal steroid were excluded.

      Results

      113 eyes from 104 patients in the STT group, 122 eyes from 109 patients in the DEX group, and 109 eyes from 103 patients in the IVT group were included. The mean number of injections for each eye was 1.7 in the STT group, 2.6 for the DEX group, and 2.8 for the IVT group (p < 0.001). Twenty eyes (17.7%) developed OHT in the STT group, 19 eyes (15.6%) developed OHT in the DEX group, and 14 eyes (12.8%) developed OHT in the IVT group (p = 0.60). IOP was controlled in all eyes with observation, topical IOP-lowering medication, or surgical intervention. The rate of incisional glaucoma surgery was 1.7% in the STT group, 1.6% in the DEX group, and 0% in the IVT group (p = 0.55).

      Conclusions

      The rate of OHT was similar across treatment groups. The proportion of OHT in patients with a history of glaucoma was no different from that in patients without a history of glaucoma. All cases were successfully managed with observation, medical treatment, or incisional surgery.

      Résumé

      Objectif

      Comparer le taux d'hypertension oculaire (HTO) dans des yeux soumis à l'un des traitements suivants : 40 mg de triamcinolone administrés sous la capsule de Tenon (TSCT); implant de dexaméthasone dosé à 0,7 mg (DEX) ou injection intravitréenne de 2 mg de triamcinolone (IIVT).

      Méthodes

      Cette étude rétrospective d'une série de cas a été réalisée dans un seul centre. Ont été inclus tous les patients qui ont reçu la TSCT ou un DEX du 4/1/2014 au 3/1/2017 et une IIVT du 3/1/2012 au 3/1/2017 et qui ont fait l'objet d'un suivi minimum de 3 mois. L'HTO se définissait comme une pression intraoculaire (PIO) > 24 mm Hg. Les patients qui recevaient toute autre forme de stéroïdes (topiques, oraux ou intravitréens) ont été exclus.

      Résultats

      Ainsi, 113 yeux de 104 patients dans le groupe TSCT, 122 yeux de 109 patients dans le groupe DEX et 109 yeux de 103 patients dans le groupe IIVT ont été inclus. Le nombre moyen d'injections dans chaque œil était de 1,7 dans le groupe TSCT, de 2,6 dans le groupe DEX et de 2,8 dans le groupe IIVT (p < 0,001). Il est apparu une HTO dans 20 yeux (17,7 %) du groupe TSCT, 19 yeux (15,6 %) du groupe DEX et 14 yeux (12,8 %) du groupe IIVT (p = 0,60). Dans tous les yeux, la PIO a été prise en charge de l'une des 3 façons suivantes : observation, médicament topique pour abaisser la PIO ou intervention chirurgicale. Le taux de chirurgie incisionnelle du glaucome se chiffrait à 1,7 % dans le groupe TSCT, à 1,6 % dans le groupe DEX et à 0 % dans le groupe IIVT (p = 0,55).

      Conclusions

      Le taux d'HTO était semblable dans tous les groupes de traitement. La proportion d'HTO ne différait pas, que les patients aient ou non des antécédents de glaucome. L'observation, le traitement médicamenteux ou la chirurgie incisionnelle ont permis la prise en charge réussie de tous les cas d'HTO.
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