Biochemical quantification of triamcinolone in subconjunctival depots

Area of Science:

• Ophthalmology
• Pharmacology

Background:

• Corticosteroid injections, such as triamcinolone acetonide, are used to treat various ocular conditions.
• Subconjunctival or periocular administration can lead to elevated intraocular pressure (IOP), a form of secondary glaucoma.
• The duration and amount of active triamcinolone remaining after injection are not well-characterized.

Purpose of the Study:

• To biochemically quantify residual active triamcinolone acetonide after subconjunctival injection.
• To evaluate the efficacy of surgical intervention for managing triamcinolone-induced glaucoma.

Main Methods:

• A case series involving seven patients who underwent surgical excision of triamcinolone depots.
• Biochemical analysis to quantify remaining triamcinolone.
• Monitoring of intraocular pressure (IOP) before and after surgical intervention.

Main Results:

• Active triamcinolone was detected up to 13 months post-injection, with an average of 20% of the original amount remaining.
• Glaucoma developed a mean of 3 months after injection.
• Surgical excision significantly reduced mean IOP from 37 mm Hg to 16 mm Hg.
• Six of seven patients achieved normalized IOP post-surgery without glaucoma medications.

Conclusions:

• Subconjunctival triamcinolone can cause persistent IOP elevation, potentially as late as six months post-injection.
• Surgical removal of triamcinolone depots is an effective treatment for medically unresponsive glaucoma.
• Close IOP monitoring is crucial after periocular triamcinolone administration.