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Sepehr Bahadorani, Michael Jansen, Wayne Tie, Chelsey Krambeer, Daniel Kermany, Michael Singer; Repeated Ozurdex injections do not increase the frequency of ocular hypertension beyond 30 mmHg. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1068.
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© ARVO (1962-2015); The Authors (2016-present)
Elevated intraocular pressure (IOP) is a major downside to Ozurdex and yet, it is not clear how repeated injections affect the incidence of ocular hypertension (OHT). The purpose of this study was to correlate the frequency and degree of OHT with the number of dexamethasone intravitreal implant injections. We hypothesize that sequential applications of dexamethasone implants increases the incidence of mild, moderate, and severe ocular hypertension.
An IRB-approved retrospective review was conducted on patients that received one or more dexamethasone implants. The primary outcome included highest mean IOP and frequency/degree of OHT that developed following treatments. The degree of OHT was defined as IOP measurements of ≥23 (mild), ≥25 (moderate), or ≥30 (severe) mmHg. The main indications for treatment were uveitis, diabetic macular edema (DME), and branch (BRVO) or central (CRVO) retinal vein occlusion. Statistical significance was determined using one analysis of variance [ANOVA].
A total of 183 injections were studied for 171 patients (183 eyes), where 139 eyes received a single injection, 25 eyes received two injections, and 19 eyes received three injections. The frequency of OHT was: mild [31%, 26%, 53%], moderate [26%, 24%, 42%], and severe [12%, 12%, 11%] for single, two, or three injections., The mean IOP did not significantly differ for one injection [21.7 + 0.64], two [21.8 + 1.13], or three injections [23.4 + 1.28] (p-value > 0.05). Following a single injection, patients with primary open angle glaucoma (POAG) had a significantly higher IOP [25.1 + 1.7] compared to patients with no medical or family history of glaucoma [20.8 + 0.65] (p-value = 0.004). Patients with uveitis [24.3 + 1.7] had the highest IOP after single injection followed by CRVO [21.8 + 1.4], BRVO [21.1 + 1.1], and DME [20.7 + 1.1] groups (uveitis versus DME p-value = 0.054).
Results of this study show that sequential dexamethasone implant injections increase the incidence of mild and moderate ocular hypertension, but not severe hypertension. Therefore, the IOP elevating effects of dexamethasone are not cumulative. Patients with uveitis had the highest IOP presumably due to previous treatments with steroids. Finally, given their increased susceptibility for IOP elevations, dexamethasone implants should be used with caution in patients with POAG.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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