Predictive value of a dexamethasone provocative test prior to intravitreal triamcinolone acetonide injection

Abstract

Abstract Purpose To investigate the diagnostic value of a topical dexamethasone (DXM) provocative test for steroid‐induced ocular hypertension after intravitreal triamcinolone acetonide (IVTA) injection. Methods Patients scheduled for IVTA received DXM 4x over 4 weeks. IVTA was injected in those with no or moderate DXM steroid response (6 mmHg≤IOP rise≤15 mm Hg). High DXM steroid responders (IOP rise>15 mmHg) received no IVTA and were subsequently excluded. IOP was measured at baseline, 4 weeks after DXM drops, and at day 1, weeks 1, 2, and 4, and months 3 and 6 following IVTA. Results Thirty‐six patients (36 eyes) were included. After the DXM test, 4 patients (11%) and 2 patients (5%) were moderate and high steroid responders, respectively. After IVTA, 12 patients (33%) and 4 patients (11%) were moderate and high steroid responders, respectively. The DXM test had a sensitivity of 25% (95%CI[0.07,0.52]), a specificity of 100% (95%CI[0.83,1.00]), a positive predictive value of 100% (95%CI[0.40,1.00]), and a negative predictive value of 62% (95%CI[0.44,0.79]) for a moderate to high steroid response after IVTA. The IOP rise after IVTA was significantly higher in previous topical DXM responders vs. DXM nonresponders, 17.0±7.8 mmHg vs. 5.0±4.4 mmHg, respectively (P=.005, Mann Whitney U). Conclusion We found a low sensitivity, a high specificity, a high positive predictive value and a moderate negative predictive value for the topical DXM provocative test with regard to a steroid response after IVTA. These findings indicate that a topical DXM test is clinically useful in predicting steroid response after IVTA. However, a negative DXM provocative test does not rule out steroid response after IVTA.