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Anne Laure Vie, Laurent Kodjikian, Ariane Malcles, Hussam El Chehab, Emilie Agard, Corinne Dot; Dexamethasone intravitreal implant tolerance in OHT and GAO patients : about 3O cases. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):200.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the tolerance of dexamethasone intravitreal implant (DEX implant, Ozurdex®) in patients with history of open-angle glaucoma (GAO) or ocular hypertension (OHT).
We performed a retrospective two-center clinical study including 60 patients treated by DEX implants. Patients were divided into : group 1 including 30 patients with history of GAO or HTO, and group 2 (control group) including 30 patients without HTO or GAO history. Intra ocular pressure (IOP) was measured and hypotensive regimen was evaluated at day zero, one week, 1, 2, 3, 4 and 6 months. The rate of progression of glaucoma was analyzed with SD-OCT (Cirrus 5000, Zeiss): peripapillary nerve fiber layer (RNFL), ganglion cell analysis, and vertical Cup/Disc, prior to intravitreal injection, then at 6 months, one, two and three years post therapy.
The mean age was 74 years old (+/-11) in group 1 and 73 years old (+/-10) in group 2. Indications for treatment were: retinal vein occlusion in 64%(CRVO 36% and BRVO 28%), Irvin-Gass syndrom (30%) and diabetic macular edema (6%). The mean DEX implant injection was 2.9(1-12). The mean follow-up was 21 months (4-42).<br /> In group 1, 74% patients had GAO and 26% had OHT. Fifty-six % of patients in Group 1 had IOP elevation more than 5mmHg during the follow-up, with a mean of +11.8 mmHg(+/-6,8). In group 1, 65% of patients required increased hypotensive therapy (17% received acetazolamide and 13% required a filtering surgery). Incremental treatment was correlated with the initial treatment : 37,5% of patients initially treated with monotherapy, 50% of patients treated with bitherapy and 75% of patient on tritherapy.<br /> In group 2, IOP superior to 25 mmHg was observed in 20% of patients. 23% of patients required hypotensive therapy to be maintained and then administered for each injection. No systemic or surgical treatment was required (p<0.05). No glaucoma structural progression was noticed in group 1.
IOP increases in almost all patients with GAO or OHT undergoing DEX implant treatment. However, two-third of these patients need a therapeutic escalation. This study also shows a significant increase in the use of filtering surgery in patient initially treated by bitherapy or more and therefore confirms the necessary caution from 2 hypotensive agents.
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