Intraocular pressure elevation after subtenon triamcinolone acetonide injection; Multicentre retrospective cohort study in Japan

Autoři: Yuki Maeda aff001;  Hiroto Ishikawa aff001;  Hiroki Nishikawa aff003;  Miho Shimizu aff001;  Takamasa Kinoshita aff001;  Rie Ogihara aff001;  Shigehiko Kitano aff001;  Chihiro Yamanaka aff001;  Yoshinori Mitamura aff001;  Masahiko Sugimoto aff001;  Mineo Kondo aff001;  Yoshihiro Takamura aff001;  Nahoko Ogata aff001;  Tomohiro Ikeda aff001;  Fumi Gomi aff001
Působiště autorů: J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan aff001;  Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan aff002;  Center for Clinical Research and Education, Hyogo College of Medicine, Nishinomiya, Japan aff003;  Department of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan aff004;  Department of Ophthalmology, Diabetes Center, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Japan aff005;  Department of Ophthalmology, Tokushima University, Tokushima, Japan aff006;  Department of Ophthalmology, Mie University, Tsu, Japan aff007;  Department of Ophthalmology, Fukui University, Yoshida, Japan aff008;  Department of Ophthalmology, Nara Medical University School of Medicine, Kashihara, Japan aff009
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226118



To evaluate real-world evidence for intraocular pressure (IOP) elevation after subtenon triamcinolone acetonide injection (STTA) in 1252 Japanese patients (1406 eyes) in the Japan Clinical REtina STudy group (J-CREST).


This was a multicentre retrospective study of the medical records of 1252 patients (676 men (758 eyes); mean age: 63.8 ± 12.9 years) who received STTA in participating centres between April 2013 and July 2017.


IOP elevation was observed in 206 eyes (14.7%) and IOP increase ≥ 6 mmHg was found in 328 eyes (23.3%). In total, 106 eyes (7.5%) needed medication and two eyes (0.14%) needed surgical procedures. Younger age, higher baseline IOP, and steroid dose were risk factors associated with IOP elevation. Risk factors associated with IOP increase ≥ 6 mmHg were younger age, lower baseline IOP, steroid dose, and higher incidences of diabetic macular oedema (DME) and uveitis. In contrast, with steroid dose fixed at 20 mg, a lower incidence of DME was a risk factor for increased IOP, suggesting that STTA had dose-dependent effects on IOP increase, especially in patients with DME.


Our real-world evidence from a large sample of Japanese patients who received STTA showed that the incidence of IOP elevation after STTA was 14.7%, and was associated with younger age, higher baseline IOP, and steroid dose. Thus, IOP should be monitored, especially in patients with younger age, higher baseline IOP, and higher incidences of DME and uveitis.

Klíčová slova:

Eye diseases – Eyes – Glaucoma – Medical risk factors – Ophthalmic procedures – Steroids – Surgical and invasive medical procedures – Uveitis


1. Smith JL, McCrary JA, Bird AC, Kurstin J, Kulvin SM, Skilling FD Jr, et al. Sub-tenon steroid injection for optic neuritis. Trans Am Acad Ophthalmol Otolaryngol. 1970; 74: 1249–1253. 5493410

2. Bakri SJ, Kaiser PK. Posterior subtenon triamcinolone acetonide for refractory diabetic macular edema. Am J Ophthalmol.2005; 139: 290–294. doi: 10.1016/j.ajo.2004.09.038 15733990

3. Cardillo JA, Melo LA Jr, Costa RA, Skaf M, Belfort R Jr, Souza-Filho AA, et al. Comparison of intravitreal versus posterior sub-Tenon's capsule injection of triamcinolone acetonide for diffuse diabetic macular edema. Ophthalmology. 2005; 112: 1557–1563. doi: 10.1016/j.ophtha.2005.03.023 16019075

4. Cellini M, Pazzaglia A, Zamparini E, Leonetti P, Campos EC. Intravitreal vs. subtenon triamcinolone acetonide for the treatment of diabetic cystoid macular edema. BMC Ophthalmol. 2008; 8: 5.

5. Diabetic Retinopathy Clinical Research Network, Chew E, Strauber S, Beck R, Aiello LP, Antoszyk A, et al. Randomized trial of peribulbar triamcinolone acetonide with and without focal photocoagulation for mild diabetic macular edema: a pilot study. Ophthalmology. 2007; 114: 1190–1196. doi: 10.1016/j.ophtha.2007.02.010 17544778

6. Entezari M, Ahmadieh H, Dehghan MH, Ramezani A, Bassirnia N, Anissian A. Posterior sub-tenon triamcinolone for refractory diabetic macular edema: a randomized clinical trial. Eur J Ophthalmol. 2005; 15: 746–750. doi: 10.1177/112067210501500614 16329060

7. Ozdek S, Bahceci UA, Gurelik G, Hasanreisoglu B. Posterior subtenon and intravitreal triamcinolone acetonide for diabetic macular edema. J Diabetes Complications. 2006; 20: 246–251. doi: 10.1016/j.jdiacomp.2005.06.015 16798476

8. Ozkurt YB, Akkaya S, Aksoy S, Evciman T, Haboglu M. Posterior sub-Tenon's capsule triamcinolone acetonide injection for the treatment of diabetic macular edema. J Ocul Pharmacol Ther. 2015; 31: 455–460. doi: 10.1089/jop.2014.0130 26154736

9. Shimura M, Yasuda K, Nakazawa T, Shiono T, Sakamoto T, Nishida K. Drug reflux during posterior subtenon infusion of triamcinolone acetonide in diffuse diabetic macular edema not only brings insufficient reduction but also causes elevation of intraocular pressure. Graefes Arch Clin Exp Ophthalmol. 2009; 247: 907–912. doi: 10.1007/s00417-009-1074-x 19343359

10. Toda J, Fukushima H, Kato S. Injection of triamcinolone acetonide into the posterior sub-tenon capsule for treatment of diabetic macular edema. Retina. 2007; 27: 764–769. doi: 10.1097/IAE.0b013e318030bfcd 17621188

11. Kawaji T, Takano A, Inomata Y, Sagara N, Iwao K, Inatani M, et al. Trans-Tenon's retrobulbar triamcinolone acetonide injection for macular oedema related to branch retinal vein occlusion. Br J Ophthalmol. 2008; 92: 81–83. doi: 10.1136/bjo.2007.124578 17965103

12. Lin JM, Chiu YT, Hung PT, Tsai YY. Early treatment of severe cystoid macular edema in central retinal vein occlusion with posterior sub-tenon triamcinolone acetonide. Retina. 2007; 27: 180–189. doi: 10.1097/01.iae.0000237584.56552.1c 17290200

13. Wakabayashi T, Okada AA, Morimura Y, Kojima E, Asano Y, Hirakata A, et al. Trans-tenon retrobulbar triamcinolone infusion for chronic macular edema in central and branch retinal vein occlusion. Retina. 2004; 24: 964–967. doi: 10.1097/00006982-200412000-00020 15579998

14. Dong Z, Namba K, Kitaichi N, Goda C, Kitamura M, Ohno S. Efficacy and complications of intravitreal injection of triamcinolone acetonide for refractory cystoid macular edema associated with intraocular inflammation. Jpn J Ophthalmol. 2008; 52: 374–379. doi: 10.1007/s10384-008-0574-2 18991038

15. Ferrante P, Ramsey A, Bunce C, Lightman S. Clinical trial to compare efficacy and side-effects of injection of posterior sub-Tenon triamcinolone versus orbital floor methylprednisolone in the management of posterior uveitis. Clin Exp Ophthalmol. 2004; 32: 563–568. doi: 10.1111/j.1442-9071.2004.00902.x 15575824

16. Helm CJ, Holland GN. The effects of posterior subtenon injection of triamcinolone acetonide in patients with intermediate uveitis. Am J Ophthalmol. 1995; 120: 55–64. doi: 10.1016/s0002-9394(14)73759-6 7611330

17. Takeuchi M, Kanda T, Kaburaki T, Tanaka R, Namba K, Kamoi K, et al. Real-world evidence of treatment for relapse of noninfectious uveitis in tertiary centers in Japan: A multicenter study. Medicine. 2019; 98: e14668. doi: 10.1097/MD.0000000000014668 30817592

18. Johnson KS, Chu DS. Evaluation of sub-Tenon triamcinolone acetonide injections in the treatment of scleritis. Am J Ophthalmol. 2010; 149: 77–81. doi: 10.1016/j.ajo.2009.07.035 19875093

19. Park YH. Sub-tenon triamcinolone acetonide injection in the treatment of scleritis. Am J Ophthalmol. 2010; 150: 128; author reply 128–129. doi: 10.1016/j.ajo.2010.03.013 20609711

20. Cakir M, Cekic O, Bozkurt E, Pekel G, Yazici AT, Yilmaz OF. Combined intravitreal bevacizumab and triamcinolone acetonide injection for idiopathic neuroretinitis. Ocul Immunol Inflamm. 2009; 17: 221–223. doi: 10.1080/09273940902731023 19585368

21. Thach AB, Dugel PU, Flindall RJ, Sipperley JO, Sneed SR. A comparison of retrobulbar versus sub-Tenon's corticosteroid therapy for cystoid macular edema refractory to topical medications. Ophthalmology. 1997; 104: 2003–2008. doi: 10.1016/s0161-6420(97)30065-7 9400758

22. Jonas JB, Sofker A. Intraocular injection of crystalline cortisone as adjunctive treatment of diabetic macular edema. Am J Ophthalmol. 2001; 132: 425–427. doi: 10.1016/s0002-9394(01)01010-8 11530068

23. Greenberg PB, Martidis A, Rogers AH, Duker JS, Reichel E. Intravitreal triamcinolone acetonide for macular oedema due to central retinal vein occlusion. Br J Ophthalmol. 2002; 86: 247–248. doi: 10.1136/bjo.86.2.247 11815359

24. Chen SD, Lochhead J, Patel CK, Frith P. Intravitreal triamcinolone acetonide for ischaemic macular oedema caused by branch retinal vein occlusion. Br J Ophthalmol. 2004; 88: 154–155. doi: 10.1136/bjo.88.1.154 14693796

25. Moshfeghi DM, Kaiser PK, Scott IU, Sears JE, Benz M, Sinesterra JP, et al. Acute endophthalmitis following intravitreal triamcinolone acetonide injection. Am J Ophthalmol. 2003; 136: 791–796. doi: 10.1016/s0002-9394(03)00483-5 14597028

26. Diabetic Retinopathy Clinical Research Network (, Beck RW, Edwards AR, Aiello LP, Bressler NM, Ferris F, et al. Three-year follow-up of a randomized trial comparing focal/grid photocoagulation and intravitreal triamcinolone for diabetic macular edema. Arch Ophthalmol. 2009; 127: 245–251. doi: 10.1001/archophthalmol.2008.610 19273785

27. Diabetic Retinopathy Clinical Research Network, Elman MJ, Aiello LP, Beck RW, Bressler NM, Bressler SB, et al. Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. Ophthalmology. 2010; 117: 1064–1077 e1035. doi: 10.1016/j.ophtha.2010.02.031 20427088

28. Byun YS, Park YH. Complications and safety profile of posterior subtenon injection of triamcinolone acetonide. J Ocul Pharmacol Ther. 2009; 25: 159–162. doi: 10.1089/jop.2008.0087 19284323

29. Araki T, Ishikawa H, Iwahashi C, Niki M, Mitamura Y, Sugimoto M, et al. Central serous chorioretinopathy with and without steroids: A multicenter survey. PLOS One. 2019; 14: e0213110. doi: 10.1371/journal.pone.0213110 30818363

30. Covell LL. Glaucoma induced by systemic steroid therapy. Am J Ophthalmol. 1958; 45: 108–109. doi: 10.1016/0002-9394(58)91403-x 13487744

31. Woods AC. Clinical and experimental observation on the use of ACTH and cortisone in ocular inflammatory disease. Trans Am Ophthalmol Soc. 1950; 48: 259–296. 16693512

32. Schlaegel TF Jr, Weber JC. Treatment of pars planitis II. corticosteroids. Surv Ophthalmol. 1977; 22: 120,125–130.

33. Akduman L, Kolker AE, Black DL, Del Priore LV, Kaplan HJ. Treatment of persistent glaucoma secondary to periocular corticosteroids. Am J Ophthalmol. 1996; 122: 275–277. doi: 10.1016/s0002-9394(14)72027-6 8694104

34. Hirooka K, Shiraga F, Tanaka S, Baba T, Mandai H. Risk factors for elevated intraocular pressure after trans-tenon retrobulbar injections of triamcinolone. Jpn J Ophthalmol. 2006; 50: 235–238. doi: 10.1007/s10384-005-0306-9 16767378

35. Inatani M, Iwao K, Kawaji T, Hirano Y, Ogura Y, Hirooka K, et al. Intraocular pressure elevation after injection of triamcinolone acetonide: a multicenter retrospective case-control study. Am J Ophthalmol. 2008; 145: 676–681. doi: 10.1016/j.ajo.2007.12.010 18243153

36. Levin DS, Han DP, Dev S, Wirostko WJ, Mieler WF, Connor TB, et al. Subtenon's depot corticosteroid injections in patients with a history of corticosteroid-induced intraocular pressure elevation. Am J Ophthalmol. 2002; 133: 196–202. doi: 10.1016/s0002-9394(01)01372-1 11812422

37. Yamamoto Y, Komatsu T, Koura Y, Nishino K, Fukushima A, Ueno H. Intraocular pressure elevation after intravitreal or posterior sub-Tenon triamcinolone acetonide injection. Can J Ophthalmol. 2008; 43: 42–47. doi: 10.3129/i07-186 18204501

38. Makornwattana M, Suphachearaphan W. Incidence of steroid induced-ocular hypertension in postoperative pterygium excision. Journal of the Medical Association of Thailand. 2015; 98 Suppl 2: S151–157.

39. Park HY, Yi K, Kim HK. Intraocular pressure elevation after intravitreal triamcinolone acetonide injection. Korean J Ophthalmol. 2005; 19: 122–127. doi: 10.3341/kjo.2005.19.2.122 15988928

40. Vasconcelos-Santos DV, Nehemy PG, Schachat AP, Nehemy MB. Secondary ocular hypertension after intravitreal injection of 4 mg of triamcinolone acetonide: incidence and risk factors. Retina. 2008; 28: 573–580. doi: 10.1097/IAE.0b013e31816079e8 18398360

41. Liu X, Li Y, Zhang Y, Du W, Sun S, Lin B, et al. Comparison of intraocular pressure elevation after anterior versus posterior subtenon triamcinolone acetonide acetate injection: a retrospective study. Retina. 2012; 32: 1838–1843. doi: 10.1097/IAE.0b013e31824fd384 22487579

42. Iwao K, Inatani M, Kawaji T, Koga, Mawatari Y, Tanihara H. Frequency and risk factors for intraocular pressure elevation after posterior sub-Tenon capsule triamcinolone acetonide injection. J Glaucoma. 2007; 16: 251–256. doi: 10.1097/IJG.0b013e31802d696f 17473740

43. Roll P, Benedikt O. [Electronmicroscopic studies of the trabecular meshwork in corticosteroid glaucoma]. Klinische Monatsblatter fur Augenheilkunde. 1979; 174: 421–428. 480814

44. Wordinger RJ, Clark AF. Effects of glucocorticoids on the trabecular meshwork: towards a better understanding of glaucoma. Prog Retin Eye Res. 1999; 18: 629–667. doi: 10.1016/s1350-9462(98)00035-4 10438153

45. Polansky JR, Fauss DJ, Chen P, Chen H, Lütjen-Drecoll E, Johnson D, et al. Cellular pharmacology and molecular biology of the trabecular meshwork inducible glucocorticoid response gene product. Ophthalmologica. 1997; 211: 126–139. doi: 10.1159/000310780 9176893

46. Rozsa FW, Reed DM, Scott KM, Pawar H, Moroi SE, Kijek TG, et al. Gene expression profile of human trabecular meshwork cells in response to long-term dexamethasone exposure. Mol Vis. 2006; 12: 125–141. 16541013

47. Fingert JH, Clark AF, Craig JE, Alward WL, Snibson GR, McLaughlin M, et al. Evaluation of the myocilin (MYOC) glaucoma gene in monkey and human steroid-induced ocular hypertension. Invest Ophthalmol Vis Sci. 2001; 42: 145–152. 11133859

48. Kee C, Ahn BH. TIGR gene in primary open-angle glaucoma and steroid-induced glaucoma. Korean J Ophthalmol. 1997; 11: 75–78. doi: 10.3341/kjo.1997.11.2.75 9510647

49. Fini ME, Schwartz SG, Gao X, Jeong S, Patel N, Itakura T, et al. Steroid-induced ocular hypertension/glaucoma: Focus on pharmacogenomics and implications for precision medicine. Prog Retin Eye Res. 2017; 56: 58–83. doi: 10.1016/j.preteyeres.2016.09.003 27666015

50. Armaly MF. Statistical sttributes of the steroid hypertensive response in the clinically normal eye. I. The demonstration of three levels of response. Invest Ophthalmol. 1965; 4: 187–197. 14283012

51. Becker B. Intraocular pressure response to topical corticosteroids. Invest Ophthalmol. 1965; 4: 198–205. 14283013

52. Razeghinejad MR, Katz LJ. Steroid-induced iatrogenic glaucoma. Ophthalmic Res. 2012; 47: 66–80. doi: 10.1159/000328630 21757964

Článek vyšel v časopise


2019 Číslo 12