June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Incidence and therapy of the elevation of intraocular pressure after intravitreal and/or subtenon administration of various steroidal agents
Author Affiliations & Notes
  • Agata Anna Wykrota
    Ophthalmology, Universitat des Saarlandes, Homburg, Saarland, Germany
  • Alaa Din Abdin
    Ophthalmology, Universitat des Saarlandes, Homburg, Saarland, Germany
  • Cristian Munteanu
    Ophthalmology, Universitat des Saarlandes, Homburg, Saarland, Germany
  • Ursula Löw
    Ophthalmology, Universitat des Saarlandes, Homburg, Saarland, Germany
  • Berthold Seitz
    Ophthalmology, Universitat des Saarlandes, Homburg, Saarland, Germany
  • Footnotes
    Commercial Relationships   Agata Wykrota None; Alaa Abdin None; Cristian Munteanu None; Ursula Löw None; Berthold Seitz None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 3684. doi:
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      Agata Anna Wykrota, Alaa Din Abdin, Cristian Munteanu, Ursula Löw, Berthold Seitz; Incidence and therapy of the elevation of intraocular pressure after intravitreal and/or subtenon administration of various steroidal agents. Invest. Ophthalmol. Vis. Sci. 2023;64(8):3684.

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

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Abstract

Purpose : For the treatment of macular edema, in addition to the use of antivascular endothelial growth factors, also steroids are used intravitreally and subtenon. Side effects include among others cataract formation and elevation of intraocular pressure (IOP). The aim of this retrospective study was to elicit the IOP elevation after administration of each steroidal agent, the time of onset, and the efficacy of the administered eye pressure-lowering therapies.

Methods : We included 428 eyes with a postoperative (n=136), diabetic (n=148), uveitic macular edema (n=61), and macular edema after retinal vein occlusion (n=83). These patients were treated with one or more diverse steroidal agents once or multiple times. These drugs included: triamcinolone acetonide (TMC) as intravitreal injection (TMC IVI) or subtenon (TMC ST), as well as dexamethasone (DXM) and fluocinolone acetonide (FA) intravitreally. An increase of IOP of ≥ 25 mmHg was designated as pathological. A steroid response in anamnesis, the time of onset of IOP rise from the first administration, and the therapy administered were documented.

Results : Of 428 eyes, 168 eyes (39.3%) had IOP elevation to a mean of 29.7 (SD ± 5.6) mmHg, which occurred at a median of 5.5 months. Steroids most often leading to rise of IOP included DXM (39.1%, % of all eyes getting this drug), TMC IVI (47.6%), TMC ST combined with DXM (51.5%), DXM with FA (56.8%), and TMC IVI with DXM (57.4%). These data are statistically significant with p < 0.001. IOP rise was treated as follows: 119 conservatively (70.8%), 21 surgically (12.5%, cyclophotocoagulation 8.3%, filtering surgery 1.8%, in 4 the drug carrier was removed 2.4%), and 28 eyes received no therapy (16.7%). Sufficient IOP regulation was achieved in 82 eyes (68.9%) with local therapy. In 37 eyes (31.1%) with persistently elevated intraocular pressure, topical therapy had to be continued over the follow-up of 20 ± 7 months.

Conclusions : IOP increases after any type of steroid application are not a rarity. Regular IOP checks are necessary after each steroid administration, with possible initiation of long-term conservative and/or surgical therapy if necessary. It is important to actively inform the patient about this side effect preoperatively.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

Median time of an IOP elevation after the first steroidal agent application in monotherapy and most often applied steroid combinations.

Median time of an IOP elevation after the first steroidal agent application in monotherapy and most often applied steroid combinations.

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