Triamcinolone
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Triamcinolone Increased intraocular pressure: case report A 45-year-old man developed increased intraocular pressure during treatment with triamcinolone for ocular sarcoidosis. The man, who had no ocular history, was referred for 2 weeks of painless vision loss in his right eye. On the basis of clinical findings, he was diagnosed with posterior uveitis with retinal granuloma secondary to presumed ocular sarcoidosis. He was initiated on prednisone. At 1 month follow-up, the lesion displayed mild regression with a decline in vision and persistent submacular fluid. He developed remarkable weight gain, and prednisone dose was tapered over 1 month and subsequently withdrawn. He was then initiated on local steroid therapy with 5 sub-Tenon’s triamcinolone [triamcinolone acetonide] (PSTA) periocular injections, 40 mg/mL with 1mL administered each treatment, delivered every 6 weeks. One month following the second triamcinolone injections and 6 months following the discontinuation of prednisone, clinical resolution of snowballs and vitritis was noticed. After 3 triamcinolone injections, his intraocular pressure (IOP) increased to 31mm Hg. The man’s IOP was controlled by using a combination of brimonidine/brinzolamide. Anterior uveitis was not noted at any point during his follow-up. At last follow-up, 19 months following the initial presentation and 11 months following the last dose of triamcinolone, his IOP was stable, vision improved with regression of the granuloma, improved vitreous traction, resolution of subretinal fluid with persistent macular striae. Author comment: "Risks of treatment with steroid therapy must be weighed against known side effects. A recent study evaluating effects and complications of periocular steroid injections found that after one or more periocular steroid injections. . .with an intraocular pressure of ≥24mm Hg and ≥30mm Hg was 34.0% and 15.0%, respectively". "Our patient was treated for ocular hypertension, with an IOP of 21 from baseline 12, after a second periocular injection." McMahon JF, et al. Optical Coherence Tomography and Management of a Retinal Granuloma in Presumed Ocular Sarcoidosis. Ocular Immunology and Inflammation 27: 1052-1056, No. 7, 3 Oct 2019. Available from: URL: http:// 803437192 doi.org/10.1080/09273948.2018.1497662 - USA
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Reactions 30 Nov 2019 No. 1781
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