Intravitreal steroids glaucoma risks

Can you discuss the risks of intravitreal steroids as it relates to both the risks of glaucoma and optic nerve damage. I would appreciate as many specifics as possible. I have a terrible case of chronic CME. It began in 2007 post -operatively and was treated with Kenalog injection. The CME resolved quickly and completely. I had transient IOP elevation that resolved in a few months after treatment with Cosopt. After another surgery in 2008, the CME returned. All non-steroid treatments(Avastin, etc)  failed to help over a years time. I was then given Durezol drops(steroid), saw CME improve, but had to stop due to IOP spike. But no permanent problems. I'm now in my third year of treatment for CME with only topical Nevanac, and oral Neptazane.
The CME persists. My vision is declining.( 20/20 to 20/40 now 20/50 ) I have no signs of permanent optic nerve damage and all my bouts of elevated IOP have been temporary. I want to have another Kenalog. Can the risks of the Kenalog be worse than continued CME damaging my macula? My doctor says yes, but I have a hard time understanding. If you agree with my doctor, at least help me understand why. If CME gets worse, one doctor will do ILM peel if I agree, but makes no promise it will help. Would this not be more risky than the Kenalog? Please help.

[Houman Vosoghi, MD]

Given your history of previous steroid response (eye pressure going up), I would be worried about the long term effect of the kenalog on your eye pressure.  Sometimes, the pressure goes up and does not respond adequately to drops and may require glaucoma surgery.  Although if you are weighing the risks of the kenalog vs. the membrane peel, it's a tough decision.  Some would argue that the Kenalog would eventually wear off and better long term results have been obtained with membrane peeling.  I would consult with a couple of very high profile retina specialists for second and third opinions before making the decision.  If you do end up getting the Kenalog injection, I would consider getting your eye pressure checked every couple of weeks for the first three months (especially if there is any evidence of damage from the previous pressure episodes).  Good luck.

HV