Dae Hyun Park; Seung Joo Ha; Sung Jin Lee

doi:10.3341/jkos.2015.56.6.891

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Park, Ha, and Lee: Intraocular Pressure Elevation after 0.7 mg Intravitreal Dexamethasone (Ozurdex®) Implantation: A One Year Follow-Up

Original Article

J Korean Ophthalmol Soc 2015;56(6):891-899.

Published online: 7 September 2015

DOI: https://doi.org/10.3341/jkos.2015.56.6.891

Intraocular Pressure Elevation after 0.7 mg Intravitreal Dexamethasone (Ozurdex^®) Implantation: A One Year Follow-Up

Dae Hyun Park, MD, Seung Joo Ha, MD, PhD, Sung Jin Lee, MD, PhD

Department of Ophthalmology, Soonchunhyang University College of Medicine, Seoul, Korea

Address reprint requests to Sung Jin Lee, MD, PhD Department of Ophthalmology, Soonchunhyang University Seoul Hospital, #59 Daesagwan-ro, Yongsan-gu, Seoul 140-743, Korea, Tel: 82-2-709-9354, Fax: 82-2-710-3196 E-mail: wismile@schmc.ac.kr

Received 23 August 201427 December 2014 Accepted 23 April 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the percentage and time of intraocular pressure (IOP) elevation and the factors influencing IOP elevation and treatment.

Methods

Thirty patients (33 eyes) who received intravitreal dexamethasone implantation from July 2012 to December 2013 and followed up more than 1 year were evaluated by measuring Goldmann IOP and confirming changes in IOP. The definition of IOP elevation was IOP above 20 mm Hg or IOP increase greater than 6 mm Hg.

Results

In 16 eyes (48.5%), IOP was elevated after intravitreal dexamethasone implantation. The first IOP elevation was mean 2.0 ± 0.7 months. In 21 eyes which received intravitreal dexamethasone implantation more than twice, the mean intervals of implantation were 4.5 months. In steroid responders, IOP after dexamethasone implantation was significantly increased at 1, 2, 3, 6, and 7 months. IOP increase in the treated eye was significant at 1, 2, 3, 5, and 7 months after dexamethasone implantation.

Conclusions

After intravitreal dexamethasone implantation, IOP was highest at 2 months. Additionally, IOP was elevated in approximately half of the patients (48.5%). Although the intravitreal dexamethasone implantation is effective against various diseases which occur due to macular edema, thorough identification of suitable patients and frequent IOP control is necessary for long-term treatment.

Keywords: Dexamethasone, Intraocular pressure, Steroid responder

References

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Figure 1.

Mean intraocular pressure (IOP) of responder (n＝16) and Non responder group (n＝17) treated with intravitreal dexamethasone 0.7 mg implantation measured with Goldmann applanation tonometer during 12 months follow up. Bar is 95% confidence interval for the mean. ^* Statistical significant difference of mean IOP compared to non responder (p ≤ 0.05, Mann-Whitney U-test). Pre＝ Preoperative time.

Figure 2.

Mean intraocular pressure (IOP) difference between treated with intravitreal dexamethasone 0.7 mg implantation and untreated eyes in responder group (n＝14) during 12 months follow up. Bar is 95% confidence interval for the mean of IOP difference. Pre ＝ Preoperative time. ^* Statistical significant difference (p ≤ 0.05, paired t-test).

Figure 3.

Mean intraocular pressure (IOP) difference between treated and untreated eyes in nonresponder group (n＝13). Observation period 12 months. Bar is 95% confidence interval for the mean of IOP difference. Pre ＝ Preoperative time.

Figure 4.

Mean increased intraocular pressure (IOP) from baseline IOP of responder (n＝16) and nonresponder group (n ＝17) treated with intravitreal dexamethasone 0.7 mg implantation measured with Goldmann applanation tonometer during 12 months follow up. Bar is 95% confidence interval for the mean. ^* Statistical significant difference of mean IOP compared to nonresponder (p ≤ 0.05, Mann-Whitney U-test).

Figure 5.

Classification of treatments. IOP＝ intraocular pressure; VEGF = vascular endothelial growth factor. ^*Ozurdex®, Allergan, Irvine, CA, USA; ^†Avastin®, Genentech Inc., San Francisco, CA, USA.

Table 1.

Patient demographics

Demographic	N
Total number of eyes (patients)	33 (30)
Mean age (years)	59.1 ± 12.4
Eyes
OD	14
OS	19
Gender
Male	18
Female	15
Diagnosis
ARMD	2
CRVO	7
BRVO	16
DME	7
CME	1
Lens status
Phakic	21
Pseudophakic	12
Vitrectomy history
Vitrectomized eye	7
Nonvitrectomized eye	26
Past history
Hypertension	8
Diabetes mellitus	8
Hypertension and diabetes mellitus	3
None	14
Disease onset (months)
＜3 months	8
3 to ≤ 6 months	5
6 to ≤ 12 months	3
12 to ≤ 24 months	5
＞24 months	5
Unknown	7
Injection method
Ozurdex injection at first	16
Ozurdex after IVB	3
Ozurdex after IVTA	1
Ozurdex after variable injections	13
Injection times
5 times	1
4 times	2
3 times	3
2 times	14
1 time	12

Values are presented as mean ± SD unless otherwise indicated. OD＝ left eye; OS＝ right eye; ARMD＝ age related macular degeneration; CRVO＝ central retinal vein occlusion; BRVO＝ branched retinal vein occlusion; DME＝ diabetic macular edema; CME＝ cystoid macular edema; IVB＝ intravitreal bevacizumab injection; IVTA＝ intravitreal triamcinolone injection.

Table 2.

Classification and demographics of each classification

Demographic	High responder^* n＝8 (24.2%)	Moderate responder^† n＝8 (24.2%)	Non responder^‡ n＝17 (51.5%)	Among group p-value
Mean age (years)	54.9 ± 11.6 (43-72)	51.3 ± 11.0^# (41-72)	64.8 ± 11.0^# (39-81)	0.028^§
Eyes
OD	3	6	5	0.130^∏
OS	5	2	12
Gender
Male	6	8	4	＜0.001^∏
Female	2	0	13
Diagnosis
ARMD	1	0	1
CRVO	2	2	3
BRVO	3	4	9	0.873^∏
DME	1	2	4
CME	1	0	0
Lens status
Phakic	4	7	10	0.787^∏
Pseudophakic	4	1	7
Vitrectomy history
Vitrectomized eye	3	0	4	0.176^∏
Nonvitrectomized eye	5	8	13
Past history
Hypertension (HTN)	2	3	3
Diabetes mellitus (DM)	1	2	5	0.811^∏
HTN and DM	1	1	1	0.811
None	4	2	8
Disease onset (months)
＜3 months	1	2	5
3 to ≤ 6 months	0	3	2
6 to ≤ 12 months	1	0	2	0.173^∏
12 to ≤ 24 months	3	2	0	0.173
＞24 months	1	1	3
Unknown	2	0	5
Injection method
Ozurdex injection at first	2	3	11
Ozurdex after IVB	2	0	1	0.170^∏
Ozurdex after IVTA	0	0	1	0.170
Ozurdex after variable injections	4	5	4
Injection times
5 times	0	0	1
4 times	1	0	1
3 times	3	1	0	0.115^§
2 times	3	4	7
1 time	1	3	8
Baseline IOP (mm Hg)
≥ 19	3	1	2
15–18	1	4	9	0.318^∏
≤ 14	4	3	6

Values are presented as mean ± SD unless otherwise indicated.

OD＝ left eye; OS＝ right eye; ARMD＝ age related macular degeneration; CRVO＝ central retinal vein occlusion; BRVO＝ branched retinal vein occlusion; DME＝ diabetic macular edema; CME＝ cystoid macular edema; IVB＝ intravitreal bevacizumab injection; IVTA＝ intravitreal triamcinolone injection; IOP＝ intraocular pressure.

^* IOP＞31 mm Hg, or rise of more than 16 mm Hg

^† IOP 21-31 mm Hg, or pressure rise of 6-15 mm Hg

^‡ IOP＜21 mm Hg, or pressure increase less than 6 mm Hg

^§ Kruskal-Wallis test

^∏ Fisher’s exact test

^# Statistical significance based on Tukey’s multiple comparison.

Table 3.

Intraocular pressure increase

Classification ^*	Number (%) of eyes of increased IOP after intravitreal dexamethasone implantation (month)
Classification ^*	0.5	1	2	3	4	5	6	7	8	9	10	11	12
A^*	0	0	2 (6)	0	0	1 (3)	2 (6)	2 (6)	1 (3)	0	2 (6)	1 (3)	0
B^†	1 (3)	3 (9)	5 (15)	5 (15)	1 (3)	2 (6)	2 (6)	3 (9)	1 (3)	1 (3)	2 (6)	1 (3)	0
C^‡	32 (97)	30 (91)	30 (91)	28 (85)	32 (97)	30 (91)	29 (88)	28 (85)	31 (94)	32 (97)	29 (88)	31 (94)	33 (100)

IOP＝ intraocular pressure.

^* Increased IOP more than 16 mm Hg from baseline

^† IOP rise of 6-15 mm Hg

^‡ IOP increase less than 6 mm Hg.

Table 4.

Selective laser trabeculoplasty

Patient	Eye	Sex	Age	Diagnosis	Pre	IOP after intravitreal dexamethasone implantation (month)
Patient	Eye	Sex	Age	Diagnosis	Pre	0.5	1	2	3	4	5	6	7	8	9	10	11	12
1	OS	M	62	CRVO	16	17	16	15	21	11^‡	28.5^*	^*47^†	40^†§	22	13	11	13	14
2	OD	M	49	BRVO	21	27^*	18	21	34^†	18^‡	19	37^†	43^†	21^‡	31	39^§	15	16

IOP＝ intraocular pressure; OS＝ left eye, OD＝ right eye; CRVO＝ central retinal vein occlusion; BRVO＝ branched retinal vein occlusion; Pre ＝ Preoperative time.

^* Using eyedrop (Cosop®)

^† Intravenous mannitol injection

^‡ Intravitreal dexamethasone (Ozurdex®) implantation

^§ Selective laser trabeculoplasty.

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