Abstract
Purpose :
Purpose: a commonly recognized complication of intravitreal steroids is secondary ocular hypertension (OHT). The aim of this retrospective study is to further characterize the effects of sustained-release intravitreal dexamethasone implants (SIDIs) on intraocular pressure (IOP). Specifically, we describe time course, incidence, and pharmacological management of OHT in eyes receiving repeated injections.
Methods :
Methods: this study included 78 eyes (78 patients) and 154 SIDIs injections over 3 years. Mean age: 67 ± 13.4 SD, 48 males (62%) and 30 females (38%). SIDIs contained 0.7mg of dexamethasone. Goldmann tonometry was performed at baseline (T0, before the injection) and at 1 week (T1w), 1 month (T1m), 3 months (T3m), and 6 months (T6m) after each intravitreal injection (INJ). Statistical analysis was performed using the Friedman test.
Inclusion criteria: macular edema secondary to retinal vein occlusion (84,6%), diabetic retinopathy (11,6%), wet-type AMD (3,8%); central macular thickness > 285 µm; BCVA < 45 letters on ETDRS; age > 18 years; treatment naïve.
Exclusion criteria: prior or present history of OHT; glaucoma; previous laser treatments or intravitreal procedures; cataract; presence of epiretinal membrane; ocular surgery in the preceding 6 months; pregnancy.
Results :
Results: following INJ-1, mean IOP was higher at T1w (+0.97 mmHg), T1m (+1.90 mmHg) and T3m (+1.57 mmHg) compared to baseline values measured at T0. Following INJ-2, mean IOP was higher at T1w (+2.03 mmHg), T1m (+2.26 mmHg) and T3m (+1.6 mmHg) compared to baseline values measured at T0. Statistical significance was lost (p > 0.05) following INJ-3 and INJ-4. Highest values were recorded at T1m (max 38 mmHg). Patients with IOP >= 21 mmHg or an IOP increase of >= 10 mmHg from baseline T0 (6 patients, 7.69%) were started on topical antihypertensive medications: timolol, carbonic anhydrase inhibitors alone or in combination with timolol, or alpha2-agonists, prostaglandins alone or in combination with timolol.
Conclusions :
Conclusion: SIDIs increase IOP. The magnitude of this effect varies substantially among patients, being negligible in some and severe in others. The latter were successfully treated with pharmacological therapy; intraocular pressure normalizes between 3-6 months after injection (T6m), without further therapy. No patient required laser treatment or glaucoma surgery.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.