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Based on experimental and clinical studies performed by Machemer and coworkers and other researchers,1 intravitreal injection of triamcinolone acetonide (IVTA) has been used as an alternative for the treatment of several diseases of the retina and uvea, such as chronic cystoid macular edema, age-related macular degeneration, and retinal vascular occlusion.2 However, it is an invasive procedure, with the risks of complications such as raised intraocular pressure (IOP), vitreous hemorrhage, and endophthalmitis. We describe the clinical course of 3 patients who developed secondary open-angle glaucoma following IVTA, uncontrollable by topical antiglaucomatous medication, treated with argon laser trabeculoplasty.
Patient 1 was a 44-year-old man with subfoveal choroidal neovascularization in angioid streaks, despite 3 sessions of photodynamic therapy with verteporfin. Patient 2 and patient 3, respectively 65 and 67 years old, had diffuse diabetic macular edema. In an attempt to reduce subfoveal exudation and suppress subretinal angiogenesis (in patient 1), and to reduce diffuse diabetic macular edema (in patients 2 and 3), a transconjunctival intravitreal injection of 20 mg/0.1 mL of crystalline triamcinolone acetonide was administered to the affected eye. The procedure was carried out under topical anesthesia after paracentesis was performed to decrease the volume of the globe. All patients were phakic with normal baseline IOP and no evidence of glaucoma.
Viola F, Morescalchi F, Staurenghi G. Argon Laser Trabeculoplasty for Intractable Glaucoma Following Intravitreal Triamcinolone. Arch Ophthalmol. 2006;124(1):133–134. doi:10.1001/archopht.124.1.133
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