Effect of Intravitreal Injection of Dexamethasone 0.7 mg (Ozurdex®) on Intraocular Pressure in Patients with Macular Edema

Abstract

Background: To evaluate the effect of Ozurdex® on intraocular pressure in patients with macular edema alone (group 1) or associated with glaucoma or ocular hypertension (group 2). Methods: A clinical, retrospective, observational, comparative study included 92 eyes with macular edema treated with a single injection of Ozurdex®; 27 eyes were previously diagnosed with glaucoma or ocular hypertension. Results: The mean intraocular pressure (group 1 vs. group 2) after injection was 12.1 versus 19.9 mm Hg, (p < 0.05; day 1); 17.5 versus 19.7 mm Hg (p < 0.05; month 1); 18.4 versus 20.9 mm Hg (p < 0.05; month 2); 15 versus 17.4 mm Hg (p < 0.05; month 3); 13.9 versus 16.7 mm Hg (p > 0.05; month 6); 13.8 versus 15.1 mm Hg (p > 0.05; month 9) and 13.1 versus 16.4 mm Hg (p > 0.05; month 12). Thirty eyes (32.6%) showed ocular hypertension (intraocular pressure >21 mm Hg) after the injection: 21.5% of group 1 and 59.3% of group 2. In group 2, 27 eyes (100%) needed medical treatment to reduce intraocular pressure in comparison to 8 patients (12.3%) in group 1 (p < 0.001). Conclusions: Intravitreal injection ofOzurdex® was associated with ocular hypertension in 32.6% of the eyes. Previous glaucoma or ocular hypertension are risk factors for this increase.

Dexamethasone implant in retinal vein occlusions

“…In our study, the level of cataract progression was higher than previously reported, which was important since dexamethasone implants are perceived to be less toxic to the lens than other steroids. Haller et al previously reported an ocular hypertension rate of 32.8% similar to that observed by Mazzarella et al2,3 The development of ocular hypertension in our study cohort was well below these previously reported levels, but this is still an important adverse reaction to be monitoring for. By initiating treatment with intravitreal dexamethasone implants patients must be aware of the risk of possible surgical or medical management of cataracts and glaucoma.…”

“…In patients with macular edema-associated RVOs not responsive to repetitive anti-VEGF therapies, the treatment effect after DEX implant treatment is encouraging. However, these results are achieved at the expense of adverse effects typically associated with steroids: Recent study demonstrated that intravitreal injection of DEX implant was associated with ocular hypertension in 32.6% of the eyes 2. Previous glaucoma and ocular hypertension are risk factors for this increase.…”

Intraocular Pressure Changes Following the Administration of Intravitreal Dexamethasone Implant: A Mini -Review

“…In addition, percentage of patients who required IOP-lowering medication following the injection has been reported between 10.9% and 54%. IOP elevation is usually well-controlled with IOP-lowering medication in most of studies and the rate of patients who underwent glaucoma surgery is not reported more than 2% in any study [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] .…”

“…IOP elevation is considered a common adverse event that may occur after the administration. IOP outcomes in clinical trials of IDI are summarized in Table 1 [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] . Different studies have reported the rates of IOP of > 25 mmHg in patients who developed IOP elevation following IDI administration are ranged from 7.1% to 58.7%.…”

Elevated Intraocular Pressure After Intravitreal Steroid Injection in Diabetic Macular Edema: Monitoring and Management

“…The recent 1-year retrospective study of Mazzarella et al evaluated the effect of intravitreal injection of dexamethasone (Ozurdex) on IOP in 92 patients with macular edema (including 36.5% with diabetic retinopathy) either without OHT (group 1; n = 65) or associated with glaucoma or OHT (group 2; n = 27) [ 49 ]. After injection, OHT (>21 mmHg) was observed in 21.5% of eyes of group 1 and 59.3% in group 2.…”