Intraocular Pressure Changes After Intravitreal Fluocinolone Acetonide Implant: Results from Four European Countries

Abstract

Introduction The 0.19 mg fluocinolone acetonide (FAc) intravitreal implant delivers a continuous intravitreal corticosteroid dose for the treatment of refractory diabetic macular oedema (DMO). The aim of this study was to assess the impact of an FAc intravitreal implant on intraocular pressure (IOP). Methods We retrospectively collected anonymised data on the patients’ characteristics, DMO treatment, and IOP and IOP-lowering treatments before and after the FAc intravitreal implant between September 2013 and March 2020 in several European centres. Results A total of 221 eyes from 179 patients were included. The mean follow-up duration was 13.4 (± 12.5, range 2.4–33.5) months. Overall, 194 eyes (88.2%) had received an intravitreal dexamethasone injection before the FAc intravitreal implant. For 25 eyes (11.3%) there was a history of glaucoma, and 52 eyes (23.5%) had previous IOP-lowering treatment. Mean IOP before injection was 14.7 (3.4) mmHg and increased to 16.9 (3.7) mmHg 12 months after injection ( P < 0.0001). During follow-up, 55 eyes (24.9%) required the addition or initiation of topical IOP-lowering medication, only one patient (0.5%) had laser trabeculoplasty and one patient (0.5%) a minimally invasive glaucoma surgery, and no patient required incisional IOP-lowering surgery. Conclusion The FAc intravitreal implant led to substantial IOP elevation. This elevation was monitored most of the time with addition or initiation of topical IOP-lowering medication. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-022-00504-z.

Preserflo Microshunt Surgery for Ocular Hypertension following Intravitreal Fluocinolone Acetonide Implant Removal: A Case Report

“…Our patient underwent 7 DEX-IVI before the first FAc-IVI. A recent study also confirmed that the mean IOP remained normal during the first year after FAc-IVI and that OHT was successfully managed with topical IOP-lowering therapy most of the time [13]. Patients with IOP-lowering therapy before the FAc-IVI seem to be more likely to have additional IOP-lowering treatments during the 12-month follow-up [13].…”

Glucocorticoid-Induced Ocular Hypertension and Glaucoma

“… 212 Similarly, in another study with patient data obtained from 4 European countries, it showed that in 1 year follow-up of patients who received fluocinolone acetonide implant, 24.4% of them developed significant IOP elevation. 153 …”

“…212 Similarly, in another study with patient data obtained from 4 European countries, it showed that in 1 year follow-up of patients who received fluocinolone acetonide implant, 24.4% of them developed significant IOP elevation. 153 Intracameral injection (delivery to the anterior chamber) and suprachoroidal injection (delivery to the suprachoroidal space) are also used for GC administration. 211 Mataftsi et al concluded that intracameral injection of preservative-free DEX did not increase the risk of GIOHT/GIG in pediatric patients after cataract surgery.…”