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Lyndon Tyler, Michael Singer, Darren Bell, Faisal Ansari, Udit Jain, Paul Woods; Intraocular Pressure Control for Patients Undergoing Combination Intravitreal Anti-VEGF and Dexamethasone Therapy for Macular Edema from Retinal Vein Occlusion. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5801.
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To evaluate whether the addition of an IOP-lowering medication reliably controlled intraocular pressure for patients undergoing combination intravitreal anti-VEGF and dexamethasone injections for the treatment of macular edema associated with retinal vein occlusion.
62 patients underwent multiple injections of combination anti-VEGF and sustained-release dexamethasone intravitreal implant for macular edema secondary to retinal vein occlusion (RVO), from September 2009 to June 2014. Intraocular pressure (IOP) was followed for all patients during the course of the study, extending up to 51 months (4.25 years) of follow-up. 10 of these patients were found to have elevated IOP ≥ 23 mmHg and were treated with brimonidine 0.2% - timolol 0.5% (Combigan). Baseline elevated IOP was measured and then compared to post-treatment IOP for all time points as well as month-by-month comparisons, extending up to 12 months of post-IOP elevation treatment. The primary endpoint was IOP following treatment with recurrence of elevated IOP.
Average elevated intraocular pressure requiring initiation of treatment was 28.6 mmHg. Average intraocular pressure after addition of brimonidine 0.2% - timolol 0.5% was 16.7 mmHg (p = <0.001). Percentage of treatment cycles that had an intraocular pressure < 23 mmHg after starting treatment: 73.7%. Percentage of treatment cycles that had an intraocular pressure < 25 mmHg after starting treatment: 89.5%. Percentage of treatment cycles that had an intraocular pressure < 30 mmHg after starting treatment: 100%. Of the eyes that had a secondary IOP ≥ 23 mmHg while on treatment, 80% of the secondary IOP elevation occurred within 4 months of starting treatment (60% within the first month).
Although intraocular pressure elevation occurs in patients undergoing multiple cycles of combination intravitreal anti-VEGF and dexamethasone therapy for macular edema in retinal vein occlusion, the pressure can generally be reliably controlled by using one combination glaucoma drop.
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