Abstract
Purpose: To investigate the associations between early anatomical responses and intraocular pressure (IOP) changes in macular edema (ME) due to retinal vascular diseases treated with an intravitreal dexamethasone (DEX) implant. Methods: A retrospective review was conducted involving ME patients who underwent intravitreal DEX implantation. The eyes were divided into increased IOP (IIOP) or non-IIOP (nIIOP) groups according to the presence or absence of significant IOP elevation. Significant IOP elevation was defined by both the absolute value of IOP elevation (5 mmHg or higher) and an elevation percentage of the baseline IOP (an increase equal to 30% of the pre-injection IOP or higher). We analyzed the difference in central subfield thickness (CST) change according to the IOP elevation after DEX implantation. Relationships between IOP change and CST reduction after intravitreal DEX implantation were analyzed by Pearson correlation coefficients. Results: A total of 49 eyes, 29 with diabetic ME and 20 with ME due to retinal vein occlusion (RVO), were included in this study. Of the 49 eyes, 18 eyes (36.7%) were classified as IIOP group and 31 (63.3%) as nIIOP group. Significant differences in mean CST reductions over baseline one week after DEX implantation were observed between the groups. The degree of CST reduction from baseline to 1 week was significantly correlated with the degree of IOP change from baseline at 1 week and 1 month after intravitreal DEX implantation. Conclusions: In patients with ME due to retinal vascular diseases, we noted an early anatomical response significantly correlated with IOP change after intravitreal DEX implantation. Therefore, patients with favorable early anatomical responses to DEX implantation should be carefully monitored for IOP elevation.
Highlights
The intravitreal dexamethasone (DEX) implant (Ozurdex, Allergan, Inc., Irvine, CA, USA) is a sustained-release device that is approved for the treatment of macular edema associated with diabetic retinopathy, retinal vein occlusions and noninfectious posterior uveitis [1,2,3,4,5,6].Despite its efficacy, elevations in intraocular pressure (IOP) and cataract formation are well-known side effects of the DEX implant [7,8]
Maturi et al [8] reported that IOP increases greater than 10 mmHg from baseline after the DEX implant occurred in 27.7% of patients with diabetic macular edema (DME), and their frequency did not increase with repeated injections
The main purpose of this study was to analyze the association between early central subfield thickness (CST) reduction and IOP change after intravitreal DEX implantation, and to investigate the possibility of predicting IOP elevation by analyzing early CST changes via spectral-domain optical coherence tomography (SD-OCT) after intravitreal DEX implantation
Summary
The intravitreal dexamethasone (DEX) implant (Ozurdex, Allergan, Inc., Irvine, CA, USA) is a sustained-release device that is approved for the treatment of macular edema associated with diabetic retinopathy, retinal vein occlusions and noninfectious posterior uveitis [1,2,3,4,5,6].Despite its efficacy, elevations in intraocular pressure (IOP) and cataract formation are well-known side effects of the DEX implant [7,8]. In the three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with Diabetic Macular Edema (MEAD trial), 32% of eyes had IOP above 25 mmHg and 6.6% of eyes had IOP above 35 mmHg after DEX implantation [6]. 41.5% of eyes required IOP-lowering medication, but only 0.6% of eyes underwent surgical procedures, such as trabeculectomy, within 3 years [6]. Maturi et al [8] reported that IOP increases greater than 10 mmHg from baseline after the DEX implant occurred in 27.7% of patients with diabetic macular edema (DME), and their frequency did not increase with repeated injections. Significant increases in IOP were reported in approximately one-third of patients treated with the DEX implant, and increases in IOP were typically controlled with medication and rarely required control via surgical procedure [6]
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