Journal of Current Glaucoma Practice

Register      Login

VOLUME 17 , ISSUE 4 ( October-December, 2023 ) > List of Articles

Original Article

Aqueous Outflow Facility after Periocular Triamcinolone Injection: A Preliminary Evaluation of the Falck Medical Applanation Tonometer

Federico Di Staso, Paul A Gaudio

Keywords : Glaucoma, Goldmann, Outflow facility, Tonography, Triamcinolone, Uveitis

Citation Information : Di Staso F, Gaudio PA. Aqueous Outflow Facility after Periocular Triamcinolone Injection: A Preliminary Evaluation of the Falck Medical Applanation Tonometer. J Curr Glaucoma Pract 2023; 17 (4):197-204.

DOI: 10.5005/jp-journals-10078-1421

License: CC BY-NC 4.0

Published Online: 17-01-2024

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Aim: To evaluate the Falck Medical Applanation Tonometer 1 (FMAT-1) as a device for measuring intraocular pressure (IOP) and outflow facility (OF) in patients with uveitis after periocular triamcinolone injection in one eye. Materials and methods: Retrospective observational comparison. IOP and OF measurements were recorded and analyzed, comparing Goldmann tonometry and FMAT-1 readings. Records were reviewed for adult patients with uveitis who had undergone recent periocular triamcinolone injection in one eye. Results: A total of 19 patients’ records were evaluated. In treated eyes, median IOPs (in mm Hg) by Goldmann and FMAT-1 were 21 and 21.0, respectively, and mean IOPs were 22.21 and 21.15, respectively. In untreated eyes, median IOPs by Goldmann and FMAT-1 were 15 and 15.7, respectively, and mean IOPs were 15.52 and 15.31, respectively. Median OF (in µL/mm Hg) in treated and untreated eyes was 0.17 and 0.22, respectively, and mean values were 0.17 and 0.23, respectively. Pearson correlation showed an inverse relationship between IOP and OF in treated eyes, and linear regression analysis showed that IOP strongly predicted outflow in this group. Conclusion: The FMAT-1 generates IOP results substantially similar to Goldmann and OF readings with greater ease than prior tonography devices. Clinical significance: The mechanism of corticosteroid-induced IOP elevation appears to be a reduction in aqueous OF, and its measurement is tonography. This technique has traditionally been cumbersome. FMAT-1 is a newly launched instrument that measures IOP and OF at the slit lamp simultaneously in a few seconds.


HTML PDF Share
  1. Kwon YH, Fingert JH, Kuehn MH, et al. Primary open-angle glaucoma. N Engl J Med 2009;360(11):1113–1124. DOI: 10.1056/NEJMra0804630
  2. Schuster AK, Erb C, Hoffmann EM, et al. The diagnosis and treatment of glaucoma. Dtsch Arztebl Int 2020;117(13):225–234. DOI: 10.3238/arztebl.2020.0225
  3. Goldmann H. [A new applanation tonometer]. Bull Mem Soc Fr Ophtalmol 1954;67:474–477; discussion, 477–478.
  4. Doughty MJ, Zaman ML. Human corneal thickness and its impact on intraocular pressure measures: a review and meta-analysis approach. Surv Ophthalmol 2000;44(5):367–408. DOI: 10.1016/s0039-6257(00)00110-7
  5. Alward WL. Biomedicine. A new angle on ocular development. Science 2003;299(5612):1527–1528. DOI: 10.1126/science.1082933
  6. Johnson M, McLaren JW, Overby DR. Unconventional aqueous humor outflow: a review. Exp Eye Res 2017;158:94–111. DOI: 10.1016/j.exer.2016.01.017
  7. Friedenwald JS. Some problems in the calibration of tonometers. Am J Ophthalmol 1948;31(8):935–944. DOI: 10.1016/0002-9394(48)92522-7
  8. Friedenwald JS. Contribution to the theory and practice of tonometry. Am J Ophthalmol 1937;20(10):985–1024. DOI: 10.1016/S0002-9394(37)90425-2
  9. Langham ME, Leydhecker W, Krieglstein G, et al. Pneumatonographic studies on normal and glaucomatus eyes. Adv Ophthalmol 1976;32:108–133.
  10. Moses RA, Grodzki WJ. The Mackay-Marg tonometer. A note on calibration methods. Acta Ophthalmol (Copenh) 1971;49(5):800–804. DOI: 10.1111/j.1755-3768.1971.tb08680.x
  11. Jones R 3rd, Rhee DJ. Corticosteroid-induced ocular hypertension and glaucoma: a brief review and update of the literature. Curr Opin Ophthalmol 2006;17(2):163–167. DOI: 10.1097/01.icu.0000193079.55240.18
  12. Kersey JP, Broadway DC. Corticosteroid-induced glaucoma: a review of the literature. Eye (Lond) 2006;20(4):407–416. DOI: 10.1038/sj.eye.6701895
  13. Armaly MF. Statistical attributes of the steroid hypertensive response in the clinically normal eye. I. The demonstration of three levels of response. Invest Ophthalmol 1965;4:187–197.
  14. Armaly MF, Becker B. Intraocular pressure response to topical corticosteroids. Fed Proc 1965;24(6):1274–1278.
  15. Diabetic Retinopathy Clinical Research Network (DRCR.net), Beck RW, Edwards ARArch Ophthalmol, et al. Three-year follow-up of a randomized trial comparing focal/grid photocoagulation and intravitreal triamcinolone for diabetic macular edema. 2009;127(3):245–251. DOI: 10.1001/archophthalmol.2008.610
  16. Byun YS, Park YH. Complications and safety profile of posterior subtenon injection of triamcinolone acetonide. J Ocul Pharmacol Ther 2009;25(2):159–162. DOI: 10.1089/jop.2008.0087
  17. Maeda Y, Ishikawa H, Nishikawa H, et al. Intraocular pressure elevation after subtenon triamcinolone acetonide injection; multicentre retrospective cohort study in Japan. PLoS One 2019;14(12):e0226118. DOI: 10.1371/journal.pone.0226118
  18. Bernstein HN, Schwartz B. Effects of long-term systemic steroids on ocular pressure and tonographic values. Arch Ophthalmol 1962;68:742–753. DOI: 10.1001/archopht.1962.00960030746009
  19. Armaly MF. Effect of corticosteroids on intraocular pressure and fluid dynamics. I. The effect of dexamethasone in the normal eye. Arch Ophthalmol 1963;70:482–491. DOI: 10.1001/archopht.1963.00960050484010
  20. Kumar S, Shah S, Deutsch ER, et al. Triamcinolone acetonide decreases outflow facility in C57BL/6 mouse eyes. Invest Ophthalmol Vis Sci 2013;54(2):1280–1287. DOI: 10.1167/iovs.12-11223
  21. Fingert JH, Clark AF, Craig JE, et al. Evaluation of the myocilin (MYOC) glaucoma gene in monkey and human steroid-induced ocular hypertension. Invest Ophthalmol Vis Sci 2001;42(1):145–152.
  22. 510(k) Premarket Notification. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K151491.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.