Intravitreal Corticosteroid Implantation in Diabetic Macular Edema: Updated European Consensus Guidance on Monitoring and Managing Intraocular Pressure

Abstract

Intravitreal therapy for diabetic macular edema can, in susceptible patients, increase intraocular pressure (IOP). As uncontrolled IOP can potentially be sight threatening, monitoring is an essential component of patient management. It can be challenging for retina specialists to ensure that monitoring is rigorous enough to detect and resolve any potential problems at the earliest opportunity without it also being overburdensome for patients who have the lowest risk of developing an IOP rise. We have developed dynamic algorithms that: (1) tailor the frequency and extent of monitoring according to individual susceptibility and current IOP and (2) assist retina specialists in deciding when they should consider a referral to a glaucoma specialist. One algorithm is for patients with a relatively low susceptibility to developing an IOP rise (those whose baseline IOP is < 22 mmHg and who do not have a history of IOP events). Depending on their first post-implantation IOP check, the algorithm classifies them as: low risk if IOP remains < 22 mmHg; medium risk if IOP is 22–25 mmHg and any rise from baseline is < 10 mmHg; or high risk if IOP is > 25 mmHg or any rise from baseline is ≥ 10 mmHg. Thereafter, the algorithm guides on the frequency and extent of monitoring required in each of these groups and, if IOP rises or falls during treatment, patients may move up or down the risk groups accordingly. A different algorithm is provided for patients who are more susceptible to developing an IOP rise (those with a baseline IOP of ≥ 22 mmHg or a prior history of an IOP event). These patients need monitoring more closely so this algorithm has only medium- or high-risk classifications. These algorithms update the previous monitoring guidance by Goñi et al. (Goñi et al. in Ophthalmol Ther 5:47–61, 2016). Graphical Abstract

ILUVIEN® in diabetic macular edema that persists or recurs despite treatment: Results from the Retina.pt® RIVER audit

“…13,31 The safety profile of FAc implant should considerer the changes in IOP and the mean time to IOP lowering surgery. 35 No significant changes in IOP were found during follow-up which is in line with other studies. 31,34,36,37 However, SLT was performed in 20.9% of eyes at 36 months post-FAc implant, a higher percentage when compared to other real-word studies.…”

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

“…The efficacy of controlling chronic DMO after FAc intravitreal implantation has been widely studied across Europe [ 18 , 29 – 33 ]. Moreover, international treatment guidelines and consensus on the management of IOP in patients with DMO after FAc intravitreal implantation have been recently published [ 34 , 35 ]. However, few studies other than pivotal reports have focused on its impact on IOP [ 20 , 22 ].…”

Aflibercept versus ranibizumab for diabetic macular edema: A meta-analysis

“…10 Corticosteroid sustained-release agents are also a hot topic in the treatment of DME due to their long duration of maintaining effective drug concentration, simple operation, and reliable efficacy. 11 Boyer et al found that intravitreal injection of dexamethasone, which is a sustained-release agent, can reduce macular oedema and improve patients’ vision. 12 Malcles et al 13 found that implantation of Ozurdex (dexamethasone implant) can improve macular oedema, reduce macular fovea thickness and have good safety in DME patients.…”