Secondary ocular hypertension after dexamethasone intravitreal implant (Ozurdex) in the routine clinical practice

Abstract

Purpose : Secondary ocular hypertension (OHT) is one of the most concerning adverse events of sustained-release dexamethasone intravitreal implant (Ozurdex. Allergan, Irvine, CA). We conducted a multicenter retrospective study to evaluate the incidence of secondary OHT induced by Ozurdex requiring glaucoma surgery.

Methods : The charts of 262 eyes from patients with diabetic macular edema (DME), retinal vein occlusion (RVO), uveitis and macular edema (ME) secondary to various causes treated with one or more implants were retrospectively reviewed. Intraocular pressure (IOP), IOP-lowering medications and glaucoma interventions were collected before and after implantation. The main outcome measurements were the incidence of IOP greater than 25 mmHg and severe OHT requiring glaucoma surgery.

Results : Patients' mean age was 68.66 ± 15.27 years. 62 eyes had DME, 140 eyes had RVO, 50 eyes had uveitis and 10 eyes had ME secondary to miscellaneous causes. 114 eyes had pre-existing glaucoma or were glaucoma suspects. Mean baseline IOP was 14 ± 3 mmHg. The mean number of injections was 2.6 injections; the median was 1 injection (1-22). After implantation, 21.75% (57 eyes) had IOP greater than 25 mmHg. IOP greater than 25 mmHg occurred in 12.9% (8/62), 24.28% (34/140), 22% (11/50) and 40% (4/10) of DME, RVO, uveitis and other ME eyes, respectively. The onset of IOP increases range from the first week after the first implant to the 43^rd week. 25.95% (68 eyes) needed IOP-lowering medications. 4.58% (12 eyes) developed severe OHT requiring trabeculectomy or tube shunt surgery; 5 eyes were in the RVO group, 7 eyes were in the uveitis group; 10 eyes developed OHT within the first 3 implantation. The incidence of glaucoma surgery was 3.57% in RVO eyes, 14% in uveitis eyes, 0% in DME eyes, and 10.52% in pre-existing glaucoma/ glaucoma suspected eyes.

Conclusions : Secondary OHT induced by Ozurdex can usually be controlled by medication. The incidence of OHT requiring glaucoma surgery is 4.58% and is elevated with repeated injections. Uveitis patients have a tendency to develop more severe OHT. The onset of OHT ranges from a week to a year after implantation, so patients should be advised of the possibility prior to the treatment. IOP should be monitored following injection, even in patients who previously received Ozurdex treatment without IOP elevation.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.