Regression of neovascular iris vessels by intravitreal injection of crystalline cortisone

Purpose: To report the clinical outcome of patients who received an intravi treal injection of crystalline triamcinolone acetonide as treatment of neov ascular glaucoma. Patients and Methods: The study included 14 eyes of 14 patients with second ary neovascular glaucoma attributable to proliferative diabetic retinopathy (n = 9) or ischemic central retinal vein occlusion (n = 5). All patients r eceived an intravitreal injection of 20 mg of crystalline triamcinolone ace tonide as the only procedure (n = 4) or in combination with additional proc edures, such as goniosynechiolysis (n = 1), phacoemulsification and intraoc ular lens implantation (n = 2), or transscleral peripheral retinal cryocoag ulation (n = 7). Mean follow-up time was 3.10 +/- 2.40 months (median. 3.5 months; range, 0.50-5.7 months). A goniosynechiolysis was carried out in th ose patients in whom the anterior chamber was circumferentially closed. Results: After surgery, including the first days after surgery, the patient s were nearly pain-free. Intraocular pressure was significantly (P < 0.01) reduced from 33.4 +/- 14.5 mm Hg before surgery to 20.7 +/- 8.2 mm Hg at th e end of the follow-up period. Postoperative visual acuity (mean, 0.09 +/- 0.07; median, 0.10; range, finger counting to 0.25) was slightly but not si gnificantly (P < 0.31) better than the preoperative values. Degree of rubeo sis iridis decreased significantly (P = 0.02) from 2.6 +/- 1.3 relative uni ts to 1.3 +/- 1.2 relative units. When considering only the four patients f or whom the intraocular cortisone injection was the only procedure performe d, mean intraocular pressure decreased from 26.5 +/- 12.1 mm Hg to 21.75 +/ - 11.3 mm Hg. Conclusions: Intravitreal injection of crystalline cortisone with most of t he vehicle removed may be a potentially useful additional tool in the treat ment of neovascular glaucoma.