MAY 14, 2009
The use of anecortave acetate to treat steroid-induced glaucoma is an area of intense interest among ophthalmologists and glaucoma researchers for several reasons: its unique mechanism of action, which is not well understood; unique delivery mechanism of depot anterior sub-Tenon injection; and apparent effectiveness at preventing surgical intervention, according to anecdotal case reports. In this small uncontrolled case series of eight eyes (seven patients) with severe steroid-induced glaucoma from either sub-Tenon or intravitreal triamcinolone acetonide injections on maximum medical therapy, anecortave acetate injections significantly lowered IOP and prevented surgical intervention to treat glaucoma in four eyes.
Mean IOP at baseline when undergoing anecortave acetate treatment was very high in this series at 39.9 mm Hg. The mean drop in IOP from baseline after one month was significant, at 34.5 percent (14.1 mm Hg). IOP reduction persisted for up to six months or more in some subjects. This early small case series is important since it has quantified the effectiveness of this experimental treatment and demonstrated a lack of unanticipated complications. Three cases in this series had at least 30 months of follow-up.
It is especially important to find effective nonsurgical treatments for steroid-related ocular hypertension, as often it is apparently self-limited over time. However, the IOPs it generates can be so high and resistant to standard medical treatment that risky glaucoma surgery is sometimes contemplated to prevent significant acute vision loss. A relatively low-risk interventional treatment that effectively lowers IOP for at least several months would be a welcome alternative to immediate standard surgical treatment in these cases.
Anecortave acetate injection is currently undergoing clinical trials for the treatment of primary open-angle glaucoma (POAG). It is believed that it might be particularly effective among patients who experience significant IOP elevation with corticosteroid exposure. If eventually approved for the treatment of POAG, anecortave acetate could become an effective alternative treatment for acute steroid-induced glaucoma as well.
Dr.Reynolds has no financial interests to disclose.