July 2018
Volume 59, Issue 9
Free
ARVO Annual Meeting Abstract  |   July 2018
The Effects of Temporary Intraocular Pressure Spikes after Intravitreal Dexamethasone Implantation (DEX) on the Retinal Nerve Fiber Layer
Author Affiliations & Notes
  • Kendall Wannamaker
    Ophthalmology, University of Texas Health Science Center San Antonio, San Antonio, Texas, United States
  • Jordan Comstock
    Ophthalmology, University of Texas Health Science Center San Antonio, San Antonio, Texas, United States
  • Sepehr Bahadorani
    Ophthalmology, University of Texas Health Science Center San Antonio, San Antonio, Texas, United States
  • Nathan Gresores
    Medical Center Ophthalmology Associates, San Antonio, Texas, United States
  • Kyle Maclean
    Ophthalmology, University of Texas Health Science Center San Antonio, San Antonio, Texas, United States
  • Edward R Chu
    Ophthalmology, University of Texas Health Science Center San Antonio, San Antonio, Texas, United States
  • Kinley Beck
    Ophthalmology, University of Texas Health Science Center San Antonio, San Antonio, Texas, United States
  • Chelsey Krambeer
    Medical Center Ophthalmology Associates, San Antonio, Texas, United States
  • Joshua Michael Iltis
    Ophthalmology, University of Texas Health Science Center San Antonio, San Antonio, Texas, United States
  • Daniel Kermany
    Medical Center Ophthalmology Associates, San Antonio, Texas, United States
  • Roberto Diaz-Rohena
    Ophthalmology, University of Texas Health Science Center San Antonio, San Antonio, Texas, United States
  • Daniel Nolan
    Medical Center Ophthalmology Associates, San Antonio, Texas, United States
  • Jeong-Hyeon Sohn
    Ophthalmology, University of Texas Health Science Center San Antonio, San Antonio, Texas, United States
  • Michael Singer
    Medical Center Ophthalmology Associates, San Antonio, Texas, United States
  • Footnotes
    Commercial Relationships   Kendall Wannamaker, None; Jordan Comstock, None; Sepehr Bahadorani, None; Nathan Gresores, None; Kyle Maclean, None; Edward Chu, None; Kinley Beck, None; Chelsey Krambeer, None; Joshua Iltis, None; Daniel Kermany, None; Roberto Diaz-Rohena, Allergan (C), Allergan (F); Daniel Nolan, None; Jeong-Hyeon Sohn, None; Michael Singer, Aerpio (C), Aerpio (R), Alcon (F), Alimera (F), Allegro (F), Allergan (C), Ampio (C), Clearside (C), Genentech (C), Genentech (R), Guidepoint (C), Notal Vision (C), Ophthotech (F), Optos (F), Regeneron (R), Regeneron (F), Santen (C), Santen (R)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 2705. doi:https://doi.org/
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      Kendall Wannamaker, Jordan Comstock, Sepehr Bahadorani, Nathan Gresores, Kyle Maclean, Edward R Chu, Kinley Beck, Chelsey Krambeer, Joshua Michael Iltis, Daniel Kermany, Roberto Diaz-Rohena, Daniel Nolan, Jeong-Hyeon Sohn, Michael Singer; The Effects of Temporary Intraocular Pressure Spikes after Intravitreal Dexamethasone Implantation (DEX) on the Retinal Nerve Fiber Layer. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2705. doi: https://doi.org/.

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

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Abstract

Purpose : To examine the effect of IOP spikes on the retinal nerve fiber layer (RNFL) after treatment with DEX implant.

Methods : This retrospective chart review included 193 patients who received the DEX implant with 34 patients meeting inclusion criteria. Inclusion criteria included IOP spikes ≥22mmHg after DEX implant with subsequent Optical Coherence Tomography (OCT) imaging of both eyes at least 6 months after the initial IOP spike. Use of IOP lowering drops was not an exclusion criterion. Patients were stratified based on the magnitude of IOP elevation and degree of elevation from baseline. Data were analyzed based on age, sex, race, diagnosis, glaucoma history, and central corneal thickness. The untreated, contralateral eye was used as the control. The unpaired two-tailed Student's t-test was used for statistical analysis.

Results : The mean time between initial IOP spikes and OCT imaging was 24.5 months ranging from 6 to 69 months. Mean RNFL thicknesses for eyes with IOP spikes ≥22mmHg were not statistically significant compared to untreated eyes (p=0.50) regardless of treatment diagnosis. There was no significant difference in mean RNFL thickness between treated eyes with IOP spikes ≥22mmHg and ≥30mmHg with both groups >10mmHg from the baseline IOP compared to control eyes (p=0.31 and p=0.11, respectively). However, there was a significant difference in the mean RNFL thickness between the treatment (77.0 ± 14.9μm) and control arm (85.2 ± 16.2μm, p < 0.05) for those eyes with IOP spikes ≥25 and >10mmHg from baseline. For these patients, nevertheless, there was no significant difference in RNFL thickness (p=0.27) after controlling for a past history of glaucoma.

Conclusions : Temporary elevation of IOP after DEX implantation does not lead to a meaningful change in RNFL thickness in most cases. Heightened vigilance of IOP spikes with alterations in RNFL thickness may be warranted in those patients with a past ocular history of glaucoma.

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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