Chronic prephthisical ocular hypotony treated by intravitreal triamcinolone acetonide (2004)

Sir, Intraocular diseases associated with retinal or subfoveal neovascularization and intraretinal or subretinal oedema have recently been treated by intravitreal injections of triamcinolone acetonide. These disorders include diffuse diabetic macular oedema, proliferative diabetic retinopathy, central and branch retinal vein occlusion, exudative age-related macular degeneration, neovascular glaucoma, chronic uveitis, persistent pseudophakic cystoid macular oedema, retinal telangiectasias, radiation-induced maculopathy, sympathetic ophthalmia, and other clinical conditions (Machemer et al 1979; Danis et al. 2002; Greenberg et al. 2002). One of the most commonly occurring side-effects of intravitreal triamcinolone acetonide is secondary ocular hypertension (Jonas et al. 2003). It was the purpose of the present clinical interventional case series study to evaluate whether that side-effect can therapeutically be used in eyes with longstanding ocular hypotony. A 69-year-old patient presented with mature cataract, complete posterior synechiae and ocular hypotony, with intraocular pressure (IOP) readings of 2 − 4 mmHg. A scleral buckling procedure with subsequent pars plana vitrectomy to remove epiretinal membranes had resulted in the condition. There was no cyclodialysis or any reason detected as causing the ocular hypotony. The patient underwent phacoemulsification, synechiolysis, implantation of a posterior chamber lens and intravitreal injection of 20–25 mg triamcinolone acetonide. After surgery, visual acuity (VA) improved from 2/200 to values ranging between 0.20 and 0.40 during the follow-up of 19 months. Intraocular pressure increased to 12 − 16 mmHg without any further medication. A 90-year-old patient had suffered from an ocular contusion resulting in the rupture of a previous corneoscleral cataract wound with prolapse of the intraocular lens, suprachoroidal haemorrhage and retinal detachment due to giant retinal tear. Pars plana vitrectomy with retinal exocryocoagulation to fix the retinal break, inferior iridectomy and silicone oil endotamponade had been carried out. When the patient presented, IOP measured 4 mmHg. She underwent transpupillary silicone oil removal and secondary implantation of a scleral suture fixated posterior chamber lens combined with an intravitreal injection of 20–25 mg triamcinolone acetonide. After surgery, VA increased from 1/200 to values ranging between 0.05 and 0.10 during the follow-up of 4 months, and IOP was 7–8 mmHg. A 63-year-old patient showed longstanding ocular hypotony, with IOP decreasing to 5 mmHg or lower. He had experienced an ischaemic central retinal vein occlusion with subsequent multiple vitreoretinal procedures due to recurring vitreous haemorrhages and ischaemic proliferative retinopathy. Additionally, hyphemata had repeatedly occurred due to iris neovascularization. After an intravitreal injection of 20–25 mg triamcinolone acetonide, VA increased from 0.03 to 0.06, and IOP stabilized at 5 mmHg within 2 months of follow-up. In contrast to ocular hypertension, which can often be successfully cured by a whole array of antiglaucomatous medical and surgical methods, progressive ocular hypotony can be an untreatable condition, eventually leading to blindness and painful phthisis bulbi. In line with a previous report (Jonas et al. 2001), the clinical courses of the patients described here suggest that in some eyes with longstanding prephthisical ocular hypotony, intravitreal injection of crystalline cortisone can be beneficial in stabilizing the eye and in increasing IOP and VA. This may hold especially true when intraocular surgery is performed in eyes with ocular hypotony.