We read with great interest the article by Dr Kalina et al1 on biochemical quantification of triamcinolone in subconjunctival depots. We agree with the authors that depot injections of triamcinolone acetonide may cause a late prolonged elevation of intraocular pressure (IOP).
Triamcinolone acetonide is minimally water soluble and very long lasting. Triamcinolone diacetate, however, is moderately water soluble and does not persist as long after depot injection. In a series of 12 patients reported by Herschler,2 only those patients treated with triamcinolone acetonide required surgical intervention for control of IOP. The three patients who received triamcinolone diacetate had spontaneous normalization of IOP within 3 months.
It has been our experience that if a rise in IOP is seen with triamcinolone diacetate, it tends not to be as prolonged as that seen with triamcinolone acetonide. Because it is much easier for a patient to have 3 months of steroid-induced
Goldstein DA, Fiscella RG, Tessler HH. Biochemical Quantification of Triamcinolone in Subconjunctival Depots. Arch Ophthalmol. 1996;114(3):363-364. doi:10.1001/archopht.1996.01100130359039