Risk factors for elevated intraocular pressure after trans-tenon retrobulbar injections of triamcinolone

Purpose: To determine the risk factors that induce an elevation of intraocular pressure (IOP) after trans-Tenon retrobulbar injections of triamcinolone acetonide. Methods: We retrospectively reviewed the medical records of 49 consecutive patients (49 eyes) with choroidal neovascularization or diffuse diabetic macular edema who had received one trans-Tenon retrobulbar injection of triamcinolone acetonide (20mg) between June 2003 and September 2004, while being treated at Kagawa University Hospital or Okayama Saiseikai General Hospital. Diabetes mellitus had been diagnosed in ten of the patients. Steroid responders were defined as having a relative increase in intraocular pressure (IOP) of > 6 mmHg and an absolute IOP > 20 mmHg with an anatomically open anterior chamber angle. The mean follow-up time was 4.2 +/- 0.2 months (range, 3-6 months). Results: Nine patients were responders and 40 patients were nonresponders. The elevation of the IOP occurred 1 to 4 weeks after the injection. The only preoperative predictive factor for the steroid responders was the presence of diabetes mellitus (multiple logistic regression analysis, odds ratio = 32.783 P = 0.006). After topical glaucoma medication, the IOP returned to acceptable levels in all responders. Conclusions: Our results suggest an association between diabetes mellitus and elevated IOP after a trans-Tenon retrobulbar triamcinolone acetonide injection.