Ocular hypertension following intravitreal injection of 0.7mg dexamethasone implant versus 2mg triamcinolone

Abstract

Purpose : To compare the incidence and outcomes of ocular hypertension (OHT) after intravitreal injection of 0.7mg dexamethasone (DEX) and 2mg triamcinolone acetonide (IVT).

Methods : A single-center, retrospective review of all patients receiving 2mg IVT 3/1/2012 – 3/1/2017 and patients receiving 0.7mg dexamethasone 10/1/2014 – 3/1/2017 with a minimum of 3 months follow-up was performed. Ocular hypertension was defined as an intraocular pressure (IOP) > 24mmHg. Patients receiving any other form of topical, oral, or intravitreal steroid were excluded.

Results : 106 eyes in 100 patients receiving IVT and 114 eyes in 102 patients receiving DEX were included. The mean number of injections was 2.9 for patients receiving IVT and 2.4 for patients receiving DEX (p= 0.113). The mean follow-up time was 17.4 months for patients receiving IVT compared to 15.1 months for DEX (p= 0.102). 14 eyes (13.2%) in 14 patients receiving IVT developed OHT compared to 17 eyes (15.1%) in 15 patients receiving DEX (p= 0.846). The mean peak IOP in patients developing OHT was 32.2 mmHg (range 26 – 48 mmHg) for patients receiving DEX implant compared to 29.0 mmHg (range 25 – 38 mmHg) for patients receiving IVT (p = 0.086). Of the fourteen eyes of 14 patients receiving DEX implant with a history of glaucoma, 3 eyes of 3 patients (21.4%) developed OHT compared to 22 patients with a history of glaucoma receiving IVT in which 4 eyes of 4 patients (18.2%) developed OHT (p= 1.0). Overall, the mean duration of OHT before IOP returned ≤24 mmHg was 1.9 months. After OHT was first noted, twenty-four of 32 eyes (75.0%) achieved IOP control on the next follow-up visit. Mean duration of OHT until return to ≤24 mmHg was 1.3 months for patients receiving IVT compared to 2.4 months for patients receiving DEX implant (p= 0.052). A total of 17 eyes (14.9%) were started on IOP lowering medication at any point during the study in patients receiving DEX implant compared to 21 eyes (19.8%) in patients receiving IVT (p= 0.375). All cases of OHT were managed with IOP lowering drops or observation alone with no patients requiring surgical intervention.

Conclusions : In this study, eyes that received intravitreal injections of either 0.7mg DEX or 2mg IVT had similar rates of OHT with no statistically significant differences in the time to OHT or peak IOP. All cases of OHT were successfully managed with either IOP lowering drops or observation alone.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.