May 2008
Volume 49, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2008
Predictive Value of a Dexamethasone Provocative Test Before Intravitreal Triamcinolone Acetonide Injection
Author Affiliations & Notes
  • C. M. Breusegem
    University Hospitals Leuven, Leuven, Belgium
    Ophthalmology,
  • E. Vandewalle
    University Hospitals Leuven, Leuven, Belgium
    Ophthalmology,
  • J. Van Calster
    University Hospitals Leuven, Leuven, Belgium
    Ophthalmology,
  • S. Fieuws
    University Hospitals Leuven, Leuven, Belgium
    Biostatistics,
  • I. Stalmans
    University Hospitals Leuven, Leuven, Belgium
    Ophthalmology,
  • T. Zeyen
    University Hospitals Leuven, Leuven, Belgium
    Ophthalmology,
  • Footnotes
    Commercial Relationships  C.M. Breusegem, None; E. Vandewalle, None; J. Van Calster, None; S. Fieuws, None; I. Stalmans, None; T. Zeyen, None.
  • Footnotes
    Support  None.
Investigative Ophthalmology & Visual Science May 2008, Vol.49, 1202. doi:
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      C. M. Breusegem, E. Vandewalle, J. Van Calster, S. Fieuws, I. Stalmans, T. Zeyen; Predictive Value of a Dexamethasone Provocative Test Before Intravitreal Triamcinolone Acetonide Injection. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1202.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: : To investigate the diagnostic value of a topical dexamethasone (DXM) provocative test prior to IVTA injection.

Methods: : In this prospective study, patients (pts.) scheduled for IVTA injection were consecutively included from March 2006 to July 2007 and received DXM drops 4 weeks prior to IVTA. If both eyes were eligible, only the left eye was included in the study. Patients were categorized into 2 classes of IOP rise following DXM test and IVTA compared to baseline: moderate (6 mmHg ≤ IOP rise ≤ 15 mm Hg) or high steroid responders (IOP rise > 15 mmHg). IVTA was injected after the DXM provocative test except in high steroid responders. IOP was measured at baseline, 4 weeks after DXM eye drops, and at day 1, week 1, 2, and 4, and month 3 and 6 following IVTA.

Results: : A total of 43 patients (43 eyes) were examined. Seven of them were excluded for final analysis [2 pts. did not receive IVTA because of a high steroid response following DXM test, one was lost of follow-up before IVTA, and 4 had either no 4-week lasting DXM test or insufficient IOP measurements]. Thirty-six patients (36 eyes) were included for analysis. The underlying eye disease for which IVTA was given was macular edema caused by diabetic retinopathy (n=17), central or branch retinal vein occlusion (n=18) or telangiectasias (n=1). Mean IOP at baseline was 15.0 ±2.7 mmHg. Following topical DXM test, 4 pts. (11%) were moderate responders (overall mean IOP of 16.9 ±4.4 mmHg) and 2 pts. were high responders (5%). In the 6 months after IVTA injection, 12 pts. (33%) and 4 pts. (11%) were moderate and high steroid responders respectively (mean maximal IOP of 21.3 ±6.4 mmHg). The topical DXM test had a sensitivity of 25% (95% CI [0.07, 0.52]), a specificity of 100% (95% CI [0.83, 1.00]), a positive predictive value of 100 % (95% CI [0.40, 1.00]), and a negative predictive value of 62% (95% CI [0.44, 0.79]) for a moderate or high IOP rise after IVTA. Moreover, in the group with a positive steroid response after IVTA (16 pts.), the mean IOP rise was higher in pts. with a positive DXM test compared to those with a negative DXM test, 17.0 ±7.8 mmHg vs. 9.3 ±3.6 mmHg respectively (P=0.14, Mann Whitney test).

Conclusions: : These findings pointed out a high positive predictive value of a topical DXM provocative test prior to IVTA injection.

Clinical Trial: : EC University Hospital Leuven

Keywords: intraocular pressure • corticosteroids • injection 
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