Ocular Hypertension After Intravitreal Dexamethasone (Ozurdex) Sustained-Release Implant

Chin, Eric K.; Almeida, David R.P.; Vélez, Gabriel; Xu, Kui; Peraire, María; Corbella, Maria; Elshatory, Yasser; Kwon, Young H.; Gehrs, Karen M.; Boldt, H. Culver; Sohn, Elliott H.; Russell, Stephen R.; Folk, James C.; Mahajan, Vinit B.

doi:10.1097/iae.0000000000001364

Cited by 46 publications

(35 citation statements)

References 23 publications

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“…e percentage of transient increase in IOP (29.1%) was similar to that reported in the previous studies [6,17,20,21]. Similarly, the surgery for glaucoma has been previously described after single or multiple Ozurdex injections [21,22]. In our affected patient, the ocular hypertension completely and stably regressed after trabeculectomy, and considering the entire FU period of 43 months, intravitreal injections still resulted in a consistent improvement in visual acuity, suggesting that the treatment was beneficial despite the adverse event.…”

Section: Discussionsupporting

confidence: 87%

Intravitreal Injections for Macular Edema Secondary to Retinal Vein Occlusion: Long-Term Functional and Anatomic Outcomes

Maggio

Mete

Maraone

et al. 2020

Journal of Ophthalmology

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Purpose. To report the long-term visual and anatomic outcomes of intravitreal injections for macular edema (ME) secondary to retinal vein occlusion (RVO) in a real-life clinical setting. Design. Retrospective interventional case series. Methods. A total of 223 consecutive eyes with ME secondary to RVO, treated with the first three intravitreal Ranibizumab or dexamethasone injections between August 2008 and September 2018, were enrolled in the study. Subsequent retreatment was guided by best-corrected visual acuity (BCVA) and central macular thickness (CMT) measurements, aimed at achieving macular fluid regression and BCVA stability. BCVA and CMT were recorded at baseline and at subsequent annual time points. The mean number of injections administered each year and the incidence of adverse events were recorded. Results. The mean BCVA and CMT at baseline were 0.79 logMar (SD 0.71) and 615.7 μm (SD 257.5), respectively. The mean follow-up (FU) period was 47.8 months (min 12–max 120). At 12 months, the mean BCVA and CMT had significantly improved to 0.62 logMar (SD 0.68; p<0.0001) and 401.04 μm (SD 183.8; p<0.0001). Improvements remained significant at the final FU visit. Eyes with BRVO and nonischemic RVO showed significantly better visual outcomes when compared to eyes with CRVO and ischemic RVO, over the entire FU period. An average of 4.08 (SD 2.1) Ranibizumab and 1.5 (SD 0.6) Ozurdex injections were administered over the first 12 months. The number of injections decreased thereafter progressively. One eye with CRVO developed endophthalmitis and one with BRVO developed an intraocular pressure increase that was refractory to topical medications and ultimately treated with trabeculectomy. Conclusion. Intravitreal Ranibizumab and/or dexamethasone injections were found to be effective at inducing a long-lasting improvement of BCVA and CMT in a real-life clinical setting. A safety profile similar to that already well-established in Ranibizumab and dexamethasone treatment was observed, as well as a steady decrease in the number of intraocular injections required. The results support intravitreal treatments for BRVO and CRVO in patient populations with similar characteristics in similar settings.

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Section: Discussionsupporting

confidence: 87%

Intravitreal Injections for Macular Edema Secondary to Retinal Vein Occlusion: Long-Term Functional and Anatomic Outcomes

Maggio

Mete

Maraone

et al. 2020

Journal of Ophthalmology

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“…The Geneva study group’s (2011) results showed that a maximum rise of IOP was observed within 60 days of implantation in patients with ME due to BRVO [ 1 ]. Similarly, Chin et al [ 26 ] have reported that the greatest IOP elevation was seen at the 1.5-month to 2.5-month follow-up interval. A study into IOP elevation with intravitreal DEX implantation in the real world reported that the cumulative probability of having an IOP ≥ 21 mmHg was 20% at 1–2 weeks, and the probability of having an IOP ≥ 25 mmHg or ≥35 mmHg was 5% and 2% at 1–2 weeks, respectively [ 27 ].…”

Section: Discussionmentioning

confidence: 80%

Association between Early Anatomic Response and Intraocular Pressure Change after Intravitreal Dexamethasone Implant: An Optical Coherence Tomography Study

Kim

Lee

Kim

et al. 2020

JCM

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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.

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“…In addition, the safety of DEX was also guaranteed, without significant IOP elevation in the whole study group, a result which has been suggested as a possibility in previous studies. [ 12 , 17 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 10 ] DEX can be controlled-released from the device within 6 months, with gradual delivery of medication after the polymer device undergoes hydrolysis in the vitreous cavity. [ 11 , 12 ] Currently, DEX is used to manage the ME induced by branch retinal venous occlusion, central retinal venous occlusion, posterior uveitis and diabetic macular edema. [ 11 , 13 ] It shows similar effectiveness compared to anti-angiogenic agents but with less frequent injections.…”

Section: Introductionmentioning

confidence: 99%

“…[ 11 , 13 ] It shows similar effectiveness compared to anti-angiogenic agents but with less frequent injections. [ 14 ] Nevertheless, SIOH has been reported in patients who received DEX implantations, [ 12 – 16 ] and the degree and management of SIOH after DEX implantation is uncertain. After DEX implantation, the extent of SIOH ranges from transient elevations [ 17 ] to a severe form, for which medication and even surgical management could be warranted in some patients.…”

Section: Introductionmentioning

confidence: 99%

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Concurrent injection of dexamethasone intravitreal implant and anti-angiogenic agent in patients with macular edema

et al. 2017

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To evaluate the safety and efficiency in macular edema patients who concurrently received a single injection of a dexamethasone intravitreal implant (DEX, 0.7 mg) and ranibizumab (2.3 mg).A retrospective cohort study was conducted, and medical records from 2012 to 2016 were reviewed. Patients who received concurrent DEX and ranibizumab injections with a follow-up period of at least 3 months were enrolled in the study group. An age and gender-matched group received ranibizumab injections and was designated the control group. The best-corrected visual acuity (BCVA), central macular thickness (CMT) and intraocular pressure (IOP) were included in the analysis. Steroid-induced ocular hypertension (SIOH) is defined as either an elevation of more than 10 mmHg from baseline or a single IOP measurement of more than 30 mmHg.A total of 26 patients were enrolled in the current study with 13 patients in each group. Both the BCVA (P = .04) and CMT (P < .01) achieved significant improvement after the follow-up period in the study group. The IOP increased after the injection but no significant elevation was observed throughout the follow-up period in the study group (P = .15). For SIOH, 1 patient in the study group had an elevated IOP of 10 mmHg (7.7%) at 2 postoperative months, and no single IOP measurement of more than 30 mmHg was obtained. Five patients (38.5%) in the study group received medical treatment that successfully retarded their IOP elevation, and no individuals required surgical management. In the control group, there were no significant fluctuations concerning BCVA, CMT, and IOP, and no ocular hypertension was observed. According to the inter-group analysis, the CMT and BCVA recovered more significantly in the study group than in the control group.Concurrent injection of DEX and ranibizumab is a preliminary method that shows effectiveness in treating ME. Furthermore, safety is also guaranteed, with moderate levels of severity and transient IOP elevation being observed. A future large-scale study is necessary to evaluate the long-term effects and safety of this combined treatment.

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Ocular Hypertension After Intravitreal Dexamethasone (Ozurdex) Sustained-Release Implant

Cited by 46 publications

References 23 publications

Intravitreal Injections for Macular Edema Secondary to Retinal Vein Occlusion: Long-Term Functional and Anatomic Outcomes

Intravitreal Injections for Macular Edema Secondary to Retinal Vein Occlusion: Long-Term Functional and Anatomic Outcomes

Association between Early Anatomic Response and Intraocular Pressure Change after Intravitreal Dexamethasone Implant: An Optical Coherence Tomography Study

Concurrent injection of dexamethasone intravitreal implant and anti-angiogenic agent in patients with macular edema

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