Biochemical quantification of triamcinolone in subconjunctival depots
P. H. Kalina, J. C. Erie and L. Rosenbaum
Department of Ophthalmology, Mayo Clinic Scottsdale, Ariz, USA.
OBJECTIVE: To biochemically quantify the amount of active triamcinolone
acetonide remaining after subconjunctival administration and to assess the
effectiveness of surgical management for glaucoma induced by triamcinolone.
DESIGN: Case series. PARTICIPANTS: Seven eyes of seven patients whose ages
ranged from 47 to 84 years underwent excision of depot triamcinolone. Six
of seven eyes required surgical intervention for medically unresponsive
intraocular pressure (IOP) elevation. RESULTS: Pharmacologically active
triamcinolone was identified up to 13 months following injection (range, 3
to 13 months). The mean amount in the excised sample was 5.4 mg (range, 2.0
to 8.8 mg), and the mean percentage of the original sample remaining was
20% (range, 4.2% to 44%). Glaucoma was diagnosed a mean of 3 months after
injection (range, 1 to 6 months). Mean IOP was 37 mm Hg before excision and
16 mm Hg after removal. Surgical excision of visible triamcinolone
normalized IOP in six of seven patients without need for glaucoma
medications. CONCLUSIONS: Periocular injection of triamcinolone
necessitates careful monitoring of IOP. Medically unresponsive IOP
elevation may occur as late as 6 months following periocular triamcinolone
injection. Surgical excision of remaining triamcinolone depot is an
effective therapy for IOP elevation. Guidelines for safely using
triamcinolone are discussed.
