High-Dose Intrapolyp Triamcinolone Acetonide Can Decrease Polyp Size While Maintaining IOP

High-dose intrapolyp triamcinolone acetonide (TA) injections decrease polyp size without raising intraocular pressure (IOP), according to findings published in Eye. The treatment is a safe and effective option for patients who have had endoscopic sinus surgery or dacryocystorhinostomy.

Intrapolyp steroid injections deliver high concentrations of steroids directly and locally to nasal polyps and surrounding nasal mucosa. Used as an alternative to oral steroids, injections last for 6 to 8 weeks without causing systemic side effects, according to researchers. However, due to the nasal cavity’s proximity to the eye, intrapolyp steroid injections can increase IOP and are linked with the development of glaucoma and cataracts.

To learn more about the effects of intrapolyp TA injections on IOPs and nasal polyps in patients after endoscopic sinus surgery, researchers conducted a randomized, double-blind, placebo-controlled study. A total of 43 patients were divided into either the TA injection group (Group I, 20 mg/ml, 2 mL; 22 patients) or the placebo normal saline injection group (group II, 2 mL; 21 patients). During the study, patients were seen 5 times: at baseline and then at 2, 4, 8, and 12 weeks postinjection.

Investigators found that the mean IOP elevation in both eyes was not significantly different between the groups (P >.05) and was not higher than 2 mm Hg during the week 4 visit. There also was no significant difference in the proportion of patients with IOPs higher than 21 mm Hg at 4 weeks and 8 weeks between the groups (P >.05). However, researchers noted a significant difference in polyp size between both groups (P <.01) until week 8.

During the study, patients did not encounter any complications, such as visual loss, visual field defects, bleeding, or infection.

“Our ophthalmology assessment findings demonstrate that high doses of TA injection can be safely used for polyps or ostium granulomas after endoscopic dacryocystorhinostomy in healthy patients,” the researchers concluded.

Limitations of the study include its small size and the exclusion of patients at high risk for developing glaucoma, such as those with diabetes, high baseline IOP, high myopia, cardiovascular diseases, and connective tissue diseases.

Reference

Lee TH, Nam JG, Lee CK. Effects of intrapolyp steroid injection on intraocular pressure and recurrent polyp treatment. Eye. Published online September 16, 2021. doi:10.1038/s41433-021-01719-3.