Incidence and treatment approach of intraocular pressure elevation after various types of local steroids for retinal diseases

Abstract

Purpose For the treatment of macular edema, in addition to the use of antivascular endothelial growth factors, steroids are also used intravitreally and sub-Tenon. Side effects include among others cataract formation and elevation of intraocular pressure (IOP). The aim of this retrospective study was to elicit the IOP elevation after administration of various steroidal medication, the time of onset, and the efficacy of the administered IOP-lowering therapies. Methods We included 428 eyes with a postoperative (n = 136), diabetic (n = 148), uveitic macular edema (n = 61), and macular edema after retinal vein occlusion (n = 83). These patients were treated with one or more diverse steroidal agents once or multiple times. These drugs included: triamcinolone acetonide (TMC) as intravitreal injection (TMC IVI) or sub-Tenon (TMC ST), as well as dexamethasone (DXM) and fluocinolone acetonide (FA) intravitreally. An increase of IOP of ≥ 25 mmHg was designated as pathological. A steroid response in anamnesis, the time of onset of IOP rise from the first administration, and the therapy administered were documented. Results Of 428 eyes, 168 eyes (39.3%) had IOP elevation up to a mean of 29.7 (SD ± 5.6) mmHg, which occurred at a median of 5.5 months. Steroids most frequently leading to rise of IOP included DXM (39.1% of all eyes receiving that drug), TMC IVI (47.6%), TMC ST combined with DXM (51.5%), DXM with FA (56.8%), and TMC IVI with DXM (57.4%). A Kaplan–Meier analysis and the Log Rank test showed a significant difference (p < 0.001). IOP rise was treated as follows: 119 conservatively (70.8%), and 21 surgically (12.5%, cyclophotocoagulation 8.3%, filtering surgery 1.8%, in 4 the steroidal drug implant was removed 2.4%), and 28 eyes received no therapy (16.7%). Sufficient IOP regulation was achieved in 82 eyes (68.9%) with topical therapy. In 37 eyes (31.1%) with persistently elevated intraocular pressure, topical therapy had to be continued over the follow-up of 20 ± 7 months. Conclusions IOP increases after any type of steroid application are not rare. Results of our study let us suspect that especially therapy with intravitreal dexamethasone, either as a monotherapy or in combination with another steroid, tends to increase IOP more than other steroids. Regular IOP checks are necessary after each steroid administration, with possible initiation of long-term conservative and/or surgical therapy if necessary.

Development of a biodegradable polymer-based implant to release dual drugs for post-operative management of cataract surgery

“…Ocular hypertension or evelation of IOP due to application of steroids have been reported to be dosage and time dependent [38,39]. Concerning the elevated IOP, glaucoma due to the long-term use of steroids is a known complication [40]. This can be managed by making adjustments to the steroid load during implant preparation.…”

Steroid-Induced Ocular Hypertension in Mice Is Differentially Reduced by Selective EP2, EP3, EP4, and IP Prostanoid Receptor Agonists

“…Glucocorticoids are powerful drugs that are used to treat a variety of inflammatory and immunological diseases of the body. In the eye, glucocorticoids such as dexamethasone (DEX), prednisolone, and triamcinolone are effective against a variety of inflammatory conditions [ 18 ]. Unfortunately, the use of these compounds can lead to side effects that adversely affect the eye, including cataract formation and, in steroid responders, the elevation of IOP [ 18 , 19 ] ( Figure 1 ).…”

“…In the eye, glucocorticoids such as dexamethasone (DEX), prednisolone, and triamcinolone are effective against a variety of inflammatory conditions [ 18 ]. Unfortunately, the use of these compounds can lead to side effects that adversely affect the eye, including cataract formation and, in steroid responders, the elevation of IOP [ 18 , 19 ] ( Figure 1 ). Indeed, in a retrospective clinical study comparing the effects of various steroids dosed intravitreally (ivt) and/or via sub-tenons (s.t.…”

“…), these drugs significantly increased IOP in human subjects. In 31% of patients with persistently raised IOP, topical ocular hypotensive drug therapy had to be continued over the almost 2-year follow-up period [ 18 ].…”

Recommendations for nutritional supplements for dry eye disease: current advances

“…Immunosuppressants and low-dose steroid drops have also been recommended as anti-inflammatory treatments ( Messmer, 2015 ; McCann et al, 2024 ). However, it is important to note that the extended use of topical anti-inflammatory agents and corticosteroids is limited due to their potential long-term adverse effects, such as cataracts and steroid-induced glaucoma ( Teo et al, 2023 ; Wykrota et al, 2023 ).…”