Incidence, Risk Factors, Treatment, and Outcome of Ocular Hypertension following Intravitreal Steroid Injections: A Comparative Study

Abstract

Purpose: To compare the incidence, risk factors, treatment, and outcomes associated with intravitreal triamcinolone-acetonide (TA) and dexamethasone-implant (Dex) induced ocular hypertension (OHT). Methods: This retrospective study reviewed 1549 TA and Dex administrations in 1075 eyes of 897 patients. Intraocular pressure (IOP) values were monitored for a period of 6-months following intravitreal injection(s) and patients were categorized as steroid-responders (SR): IOP ≥ 21mmHg, and non-responders (NR): IOP ≤ 20mmHg. Glaucoma patients, glaucoma suspects, uveitis, trauma, and less than one month IOP follow-up cases were excluded from the study. Incidence of IOP rise, time and magnitude of IOP rise, and its management procedures were studied. Ocular and systemic association with OHT incidence was investigated. Statistical analysis was performed using SPSS.23 and p < 0.05 was considered significant. Result: 28% of TA and 17% of Dex administered eyes developed OHT. Male subjects and elderly people (greater than 40 years) are at higher risk for OHT following steroid treatment. A high percentage of IOP rise was observed at day-1 (41%) for TA-SR, and after 1-month (50%) among Dex-SR. IOP rise was found to be more severe (>30mmHg) for TA-SR compared to Dex-SR (p=0.006). 6% TA-SR required trabeculectomy with medically uncontrollable IOP. Myopia is a risk factor for secondary OHT, whereas diabetes mellitus and hypercholesterolemia were protective of it. Conclusion: 28% of TA and 17% of Dex administrations developed OHT. Early and severe IOP rise was more common in TA than among Dex administrations. Myopia is a risk for Dex-OHT.

Role of Intravitreal Dexamethasone Implant in the Management of Treatment-Naive Diabetic Macular Edema: A Pre-Cataract Surgical Approach for Patients with Systemic Contraindications to Anti-VEGF Therapy

“…Comparing the safety profile of DEX with other corticosteroid treatments, such as intravitreal triamcinolone acetonide (IVTA), reveals that DEX is associated with a lower risk of elevated IOP. 15,16 IVTA has been linked to a higher risk of IOP elevation and glaucoma, which has limited its long-term use. 15,16 The findings of the current study, with only two eyes requiring topical AGM, support the notion that DEX may be a safer choice in terms of IOP management.…”

Pseudophakic macular edema in nondiabetic and diabetic patients without diabetic retinopathy treated with intravitreal dexamethasone implant

“…The implantation of a second DEX implant at month 6 in 3 patients did not produce an inadvertent bias aiding them to accomplish better therapeutic results. There was no significant increase in IOP after DEX implantation, this outcome being more severe (> 30 mmHg) and significant with the use of triamcinolone compared to dexamethasone [ 47 ]. Considering the relatively small sample size, caution is needed in drawing conclusions regarding the clinically important question being investigated.…”

Glucocorticoid-Induced Ocular Hypertension and Glaucoma

“… 145 Badrinarayanan et al found that 28% of non-glaucomatous eyes developed OHT ≥21 mmHg after triamcinolone-acetonide injection, and 17% of non-glaucomatous eyes that received a DEX implant were GC responders (IOP ≥21mmHg). 146 In a pediatric study, Krag et al found that 56% of children receiving systemic GCs had OHT (net increase in IOP ≥6 mmHg from baseline or a peak IOP ≥21 mmHg). 147 …”

“… 146 In a pediatric study, Krag et al found that 56% of children receiving systemic GCs had OHT (net increase in IOP ≥6 mmHg from baseline or a peak IOP ≥21 mmHg). 147 …”

“…Clinical Ophthalmology 2024:18 490 triamcinolone-acetonide injection, and 17% of non-glaucomatous eyes that received a DEX implant were GC responders (IOP ≥21mmHg). 146 In a pediatric study, Krag et al found that 56% of children receiving systemic GCs had OHT (net increase in IOP ≥6 mmHg from baseline or a peak IOP ≥21 mmHg). 147 In 1975, Cantrill et al found that highly potent GCs are associated with a higher risk of GIOHT.…”