Preoperative ocular massage to lower the immediate intraocular pressure spike following intravitreal triamcinolone acetonide injection

초록

Purpose: The immediate intraocular pressure (IOP) spike induced by intravitreal volume loading may insult the eyes vulnerable to ischemic change. In present study, we evaluated the effect of preoperative ocular massage to lower the immediate IOP spike following intravitreal triamcinolone acetonide injection(IVTA). Methods: This prospective non-randomized comparative case-series study comprised thirty eyes of 27 patients with macular edema due to diabetic retinopathy and retinal vein occlusion. Seventeen eyes of 15 patients underwent IVTA(4mg/0.1ml) with ocular massage(preoperative, digital, intermittent for 5 minutes)(group A), and thirteen eyes of 12 patients underwent IVTA without ocular massage(group B). Paracentesis was not performed in any of the eyes. The IOPs before and after massage, and the IOPs after IVTA(immediately, 10minutes, 20minutes, 30minutes, and 2 hours after IVTA) were measured, respectively. In addition, the presence and duration of pulsation of central retinal artery was checked by indirect ophthalmoscopy. Exclusion criteria included preoperative ocular hypertension, glaucoma, pseudophakia and the presence of vitreous leakage during IVTA. Results: Mean preoperative decrease in IOP induced by ocular massage was 6.54±3.05 mmHg. Mean IOP immediately after IVTA was 29.0 ± 10.79 mmHg in group A and 38.12 ± 12.32 mmHg in group B, respectively. Mean IOP at 10 minutes after IVTA was 23.02 ± 7.82 mmHg in group A and 32.13 ± 9.24 mmHg in group B, respectively. Statistically, the IOP increment of group A is significantly lower than that of group B immediately and at 10 minutes after IVTA(p=0.03, p=0.04, Independent t-test). Mean IOPs at 20 minutes, 30 minutes and 2 hours after IVTA were not significantly different between group A and group B(p=0.31, p=0.19, p=0.24, Independent t-test). Immediately after IVTA, three eyes(25%) out of twelve eyes which were not obscured by triamcinolone particles in group A and five eyes(62.5%) out of nine eyes in group B demonstrated pulsation of the central retinal artery. 5 minutes after IVTA, none demonstrated pulsation of the central retinal artery any longer. Conclusions: Even a short span of the immediate IOP spike following IVTA may not be tolerable. Ocular massage is easy and simple to perform, inducing a significant decrease in IOP. This preoperative hypotension by ocular massage is effective in diminishing the immediate IOP spike following IVTA.