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