Intraocular pressure change after injection of intravitreal dexamethasone (Ozurdex) implant in Korean patients

Abstract

Background/AimsTo analyse intraocular pressure (IOP) changes over a period of 1 year after intravitreal dexamethasone (DEX, Ozurdex) implant injection and to compare the results with those of previously published studies that involved non-Asian populations.MethodsA retrospective observational study was conducted. A total of 540 eyes of 503 patients who received DEX implant injection and were diagnosed with macular oedema (ME) due to various retinal diseases were examined. IOP was measured prior to injection and at 1 week, 1 month, 2 months, 3 months, 6 months and 12 months after DEX implant injection. IOP elevation was divided into four categories: postinjection IOP of >35 mm Hg, >30 mm Hg and >25 mm Hg, and an IOP elevation of >10 mm Hg, relative to the baseline measurement.ResultsThe mean baseline IOP was 13.45±2.95. The mean IOP gradually increased until 2 months postinjection (IOP=16.85±5.96 mm Hg, p<0.001) and then gradually decreased until 12 months postinjection (IOP=13.80±4.04mm Hg, p=0.16). IOP was >25 mm Hg in 57 eyes (10.6%), >30mm Hg in 29 eyes (5.4%) and >35mm Hg in 9 eyes (1.7%); IOP exhibited >10 mm Hg elevation from the baseline IOP in 61 eyes (11.3%). Overall, the incidence rate of IOP elevation after DEX treatment was 12.6% (68 eyes). Among the 68 eyes (12.6%) with elevated IOP, 60 (11.1%) required treatment: 59 (10.9%) required IOP-lowering medication and 1 (0.2%) ultimately required surgical interventions.ConclusionsThe incidence of adverse IOP elevation requiring the prolonged use of IOP-lowering medication and surgical intervention after DEX implantation was significantly lower than the incidence reported in previous Western population-based studies. Intravitreal DEX injection may therefore be an effective and relatively safe treatment modality for ME in Asian patients.

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

“…In our study, although the average IOP value was obtained after excluding patients with OHTN at previous visits, IOP levels were higher than reported in other studies, as was OHTN prevalence. A recent study reported an average IOP at baseline of 13.45 mmHg, which increased to 16.85 mmHg at 2 months after IVD implantation; in addition, the prevalence of OHTN was 10.6% 20 . The SAFODEX study reported a prevalence of IOP ≥ 25 mmHg after the first IVD implantation of 11.4% 21 .…”

“…To date, most studies have focused on IOP changes or OHTN prevalence after IVD implantation; however, the relationship between IOP trends and subsequent OHTN occurrence has not been evaluated 13,20,21 . Our study showed that IOP level or a change in IOP from the previous visit may be a significant factor for predicting subsequent OHTN.…”

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%.…”

<p>Initial Ten Years of Experience with the Intravitreal Dexamethasone Implant: A Retrospective Chart Review</p>

“…In our study population, 21.6% of eyes experienced a maximum IOP >25 mmHg and/or reached a maximum IOP ≥10 mmHg above baseline, which was a similar rate as reported in other studies. 17,19,[31][32][33] However, 42.2% of eyes required the addition of at least one anti-glaucoma medication, either initiating or escalating therapy. This is slightly higher than the 29.1% in SHASTA, 5 31% reported by SAFODEX, 31 and 35.8% reported by Haller et al 3 Many of the eyes initiating such therapy in our study were doing so as adjuvant treatment for macular edema rather than elevated IOP.…”