RESUMEN
PURPOSE: To determine whether a history of intraocular pressure elevation from local corticosteroid administration could predict subsequent intraocular pressure 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 intraocular pressure 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 intraocular pressure increase of 5 mm Hg and absolute intraocular pressure greater than 24 mm Hg with an anatomically open angle. Relative risk of intraocular pressure 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 intraocular pressure elevation developed in historical responder eyes (4 of 9, 44%) compared with nonresponders (7 of 55, 13%) after posterior subtenon's injection (P = .04, Fisher's test; P = .07, Kaplan-Meier analysis). Historical responders with uveitis were at significantly higher risk of intraocular pressure elevation than nonresponders without uveitis (hazard ratio = 10.8, P = .04, Cox proportional hazards). All but one eye that developed intraocular pressure elevation from posterior subtenon's injection was adequately controlled with topical antiglaucoma therapy. CONCLUSION: In nonglaucomatous eyes, a previous history of corticosteroid-induced intraocular pressure elevation is a relative, not absolute, contraindication to posterior subtenon's corticosteroid injection, because the risk of intraocular pressure elevation is not absolute, and because it can usually be well controlled with topical antiglaucoma therapy.
Asunto(s)
Dexametasona/análogos & derivados , Glucocorticoides/efectos adversos , Presión Intraocular/efectos de los fármacos , Hipertensión Ocular/inducido químicamente , Triamcinolona/análogos & derivados , Adulto , Anciano , Anciano de 80 o más Años , Tejido Conectivo/efectos de los fármacos , Contraindicaciones , Dexametasona/administración & dosificación , Quimioterapia Combinada , Femenino , Glucocorticoides/administración & dosificación , Humanos , Inyecciones , Masculino , Hemisuccinato de Metilprednisolona/administración & dosificación , Persona de Mediana Edad , Hipertensión Ocular/diagnóstico , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Triamcinolona/administración & dosificación , Triamcinolona Acetonida/administración & dosificaciónRESUMEN
As far as the treatment of chronic pseudophakic CME is concerned, it is important to understand that postoperative CME usually resolves with time. One must gauge the various treatment modalities outlined above with improvements in visual acuity and decreasing clinical macular thickening. Mild cases usually require no treatment, whereas those that entail clinically significant reductions in vision or macular thickening do require appropriate intervention.