July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
The incidence of increased intraocular pressure and glaucoma incisional surgery following treatment with dexamethasone intravitreal implant in a private practice setting
Author Affiliations & Notes
  • Rim Makhlouf
    Optometry, Nova Southeastern University , Ft Lauderdale, Florida, United States
  • Jay Levy
    Retina Macula Specialists of Miami, North Miami Beach, Florida, United States
  • Rashid Taher
    Retina Macula Specialists of Miami, North Miami Beach, Florida, United States
  • Diana Shechtman
    Retina Macula Specialists of Miami, North Miami Beach, Florida, United States
  • Ava K Bittner
    Optometry, Nova Southeastern University , Ft Lauderdale, Florida, United States
  • Footnotes
    Commercial Relationships   Rim Makhlouf, None; Jay Levy, None; Rashid Taher, None; Diana Shechtman, Alcon (R), Allergan (S), B&L (R), B&L (S), Essilor (R), Optos (R), SBH (R), Zeavision (R), Zeiss (R), Zeiss (S); Ava Bittner, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 396. doi:
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      Rim Makhlouf, Jay Levy, Rashid Taher, Diana Shechtman, Ava K Bittner; The incidence of increased intraocular pressure and glaucoma incisional surgery following treatment with dexamethasone intravitreal implant in a private practice setting. Invest. Ophthalmol. Vis. Sci. 2018;59(9):396.

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

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Abstract

Purpose : Dexamethasone intravitreal implant (Ozurdex, DEX) is FDA-approved for the treatment of macular edema associated with retinal vein occlusion (RVO) and diabetic retinopathy (DR), and for the treatment of non-infectious uveitis affecting the posterior segment. Its potential effect on intraocular pressure (IOP) is well documented yet variable. One recent study at an academic hospital setting found that nearly a third of patients had a significant increase in IOP > 10 mmHg and 5% required glaucoma incisional surgery. The purpose of our study is to further assess the incidence and risk factors of increased IOP and glaucoma surgery following DEX treatment in a private retina practice setting.

Methods : A retrospective review of records from retinal specialists in private practice during the period of June 1st, 2015 to January 31st, 2017 included data for 174 eyes of 145 patients who received DEX injections for macular edema related to RVO (36%), DR (56%) or uveitis/other (8%). Their mean age was 66.6 years (SD 10.6; range 38-92), 42% were female, 76% were white, and mean baseline IOP was 15mmHg. Multilevel modeling accounted for correlations between eyes during logistic regression analyses.

Results : The mean number of DEX injections was 2.23 (0.12 SD; range 1-7). Most patients (80%) received no more than three injections. IOP increases >10mmHg from baseline only occurred in 6% of eyes and any post-intravitreal DEX injection IOP >25mm was only found in 8.6%; these IOP rises were not significantly related to increased number of injections with DEX (OR=2.0, p=0.13; OR=0.34, p=0.06) or other ocular injections (anti-VEGF or steroid) before (p=0.97; p=0.63) or during the period in between DEX injections (p=0.46; p=0.08). Only 16% had pre-existing glaucoma, ocular hypertension or glaucoma suspect status at baseline, which was not significantly related to IOP increase >10mmHg (OR=1.4, p=0.90), but was associated with any post-treatment IOP >25mmHg (OR=17.4, 95% CI: 1.12, 282; p=0.04). No eyes required glaucoma surgery and IOP increase was managed in most cases with topical medication(s).

Conclusions : In a private practice setting, the rate of significant IOP increase following dexamethasone intravitreal injections was relatively low and manageable with topical glaucoma medications. No patients required glaucoma incisional surgery.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

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