The effects of repeated Ozurdex injections on ocular hypertension

Bahadorani, Sepehr; Krambeer, Chelsey; Wannamaker, Kendall; Tie, Wayne; Jansen, Michael; Espitia, Jason; Sohn, Jong Hee; Singer, Michael

doi:10.2147/opth.s148990

Cited by 25 publications

(16 citation statements)

References 13 publications

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“…In patients receiving multiple injections, some studies showed no correlation between the number of injections and the risk of developing ocular hypertension, 19 , 31 while one study found an increased risk for IOP spikes below 30 mmHg. 32 Our study showed a higher mean IOP after the second injection. This increase was low, but statistically significant (P <0.05).…”

Section: Discussionsupporting

confidence: 48%

<p>Effects of Repeated Intravitreal Injections of Dexamethasone Implants on Intraocular Pressure: A 4-Year Study</p>

Pacella¹,

Loffredo²,

Malvasi³

et al. 2020

OPTH

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Purpose Dexamethasone and other corticosteroids are administered intravitreally to treat a variety of retinal diseases. As a side effect, they can alter intraocular pressure (IOP). The purpose of this study is to describe the incidence, severity, and management of ocular hypertension following the administration of multiple intravitreal injections of dexamethasone implants. Materials and Methods A total of 78 eyes of 78 subjects (males 62%; females 38%; mean age 67 ± 13 years SD) received a total of 152 intravitreal injections of 0.7 mg dexamethasone implants over 4 years. Indications included retinal vein occlusion (87%), diabetic macular edema (9%), wet-type age-related macular degeneration (4%). Ocular hypertension was defined as intraocular pressure above 23 mmHg or any pressure increase of 10 mmHg or more from baseline values. IOP was measured by applanation tonometry before the injection (T0), as well as one week (T1), one month (T2), and three months (T3) afterwards. Results Five percent (4/78) of subjects developed ocular hypertension after the 1st injection. On the second and third rounds, additional 7.2% (3/42) and 4.2% (1/24) of subjects developed the same side effect. Among the 8 subjects who received a fourth injection, none was found with OHT. Pressure elevations were detected at T2 and T3. In all patients, topical medical therapy was sufficient to lower the IOP below threshold. Mean pressure variations following the first injection as compared to previous recorded values were +0.97 mmHg (T1), +0.92 mmHg (T2), and −0.41 mmHg (T3) (p < 0.05). Mean pressure variations following the second injection were +0.54 mmHg (T1), +0.23 mmHg (T2) and −0.66 mmHg (T3) (p < 0.05). Conclusion Ocular hypertension is a recognized side effect of intravitreal dexamethasone. Some patients develop it right after the first injection, while others develop it subsequently, on the 2nd or 3rd round. This side effect becomes most apparent 30–90 days following the implantation procedure and responds well to topical pressure-lowering medications.

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Section: Discussionsupporting

confidence: 48%

<p>Effects of Repeated Intravitreal Injections of Dexamethasone Implants on Intraocular Pressure: A 4-Year Study</p>

Pacella¹,

Loffredo²,

Malvasi³

et al. 2020

OPTH

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“…Additionally, SAFODEX study revealed that repeated IVD resulted in more OHTN 21 . However, another study reported that multiple IVD did not increase the frequency of IOP spikes beyond 30 mmHg 31 . While a previous study reported high myopia to be a risk factor for OHTN after IVD implantation 21 , we found that a short axial length may represent an additional risk factor for OHTN.…”

Section: Discussionmentioning

confidence: 94%

Risk factors for ocular hypertension after intravitreal dexamethasone implantation in diabetic macular edema

Choi

Kwon

2020

Sci Rep

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We designed a retrospective observational study to identify factors associated with ocular hypertension [OHTN, defined as intraocular pressure (IOP) > 25 mmHg] after intravitreal dexamethasone (IVD) implantation in diabetic macular edema (DME) patients. We measured IOP monthly after placement of an IVD implant, and identified the trend of IOP, incidence of OHTN, and its associated systemic or ocular factors. On average, IOP was highest at 2 months after IVD implantation. Of 84 DME patients who received an IVD implant, 3 (3.57%) presented with an IOP ≥ 25 mmHg at 1 month after implantation, 6 (7.14%) at 2 months, and 2 (2.38%) at 3 months. Compared with the non-OHTN group, the OHTN group had significantly shorter axial lengths and were younger. Logistic regression analysis revealed that axial length < 23.00 mm and age < 57 years were associated with OHTN occurrence. Patients whose IOP was elevated > 30% or ≥ 20 mmHg at 1 month post-implantation, subsequently developed OHTN with statistical significance. In conclusion, shorter axial length and younger age were associated with OHTN occurrence after IVD implantation. Additionally, identifying levels or trends in IOP at 1 month after the IVD procedure may be helpful in predicting subsequent OHTN occurrence. Diabetic macular edema (DME) is one of the main causes of visual impairment in diabetes patients 1,2. Although the exact mechanism has yet to be determined, one of the early signs of DME pathogenesis is damage to the blood-retina barrier, which occurs in association with metabolic changes, ischemia, and inflammation 3,4. Based on fundamental studies on vascular endothelial growth factor (VEGF) and randomized controlled trials of anti-VEGF agents, intravitreal injection of anti-VEGF agents has become the main treatment option for DME 5-8. Recently, micronized dexamethasone in a biodegradable copolymer has been introduced as another treatment option for refractory or chronic DME 9-11. Intravitreal dexamethasone (IVD) implantation makes it easier to control inflammation, which plays an important role in DME pathogenesis 12. Several studies have reported that IVD implantation is effective for restoring macular structure, thus contributing to improved visual function in DME patients 11,13,14. However, IVD implantation has potential complications, such as cataract formation and ocular hypertension (OHTN) 13,15. Diabetes patients are more susceptible to glaucoma as a result of elevated intraocular pressure (IOP) 16,17. Additionally, recent studies have reported that even eyes with no apparent diabetic retinopathy may develop glaucoma-related changes, including thinning of the retinal nerve fiber layer or macula ganglion cell-inner plexiform layer 18,19. Thus, appropriate management and interventions are needed to prevent irreversible visual impairment in OHTN cases. Although some studies have reported the prevalence of OHTN after IVD, few have examined the risk factors or precise time of occurrence of OHTN 20,21. Thus, we examined DME patients on a monthly basis after IVD...

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“…The above referenced studies showed an average of 29% of patients will have an IOP > 25 mmHg or 10 mmHg above baseline. Recent data showed that following multiple injections of intravitreal dexamethasone, 53% had an IOP greater than or equal to 23 mmHg; 42% with IOP great than or equal to 25 mmHg; and 11% greater than or equal to 30 mmHg [12]. The SAFODEX study evaluated ocular hypertension secondary to intravitreal dexamethasone when used for all etiologies.…”

Section: Discussionmentioning

confidence: 99%

Intraocular Pressure Control for Patients Undergoing Combination Intravitreal Anti-VEGF and Dexamethasone Therapy for Macular Edema from Retinal Vein Occlusion

Singer¹,

Bell²,

Singer³

et al. 2018

JPT

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Background and Objective: Sustained-release dexamethasone intravitreal implant is an effective treatment for macular edema secondary to retinal vein occlusion (RVO) but ocular hypertension is a side effect. This study evaluated whether the addition of a single combination IOP-lowering medication will reliably control intraocular pressure (IOP) for those patients. Study Design/Patients and Methods: Retrospective chart review of 62 patients that underwent multiple injections of combination anti-VEGF and sustained-release dexamethasone intravitreal implant for macular edema secondary to RVO. IOP spikes were treated with brimonidine 0.2% - timolol 0.5%. IRB approval was obtained. Results: The average elevated IOP requiring treatment was 28.6 mmHg. The average IOP after adding brimonidine 0.2% - timolol 0.5% was 16.7 mmHg. 100 percent of treatment cycles had an IOP< 30 mmHg after starting treatment. Conclusions: Using one combination IOP-lowering drop can reliably control the ocular hypertension that occurs secondary to combination therapy for macular edema in RVO.

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The effects of repeated Ozurdex injections on ocular hypertension

Cited by 25 publications

References 13 publications

<p>Effects of Repeated Intravitreal Injections of Dexamethasone Implants on Intraocular Pressure: A 4-Year Study</p>

<p>Effects of Repeated Intravitreal Injections of Dexamethasone Implants on Intraocular Pressure: A 4-Year Study</p>

Risk factors for ocular hypertension after intravitreal dexamethasone implantation in diabetic macular edema

Intraocular Pressure Control for Patients Undergoing Combination Intravitreal Anti-VEGF and Dexamethasone Therapy for Macular Edema from Retinal Vein Occlusion

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