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Abstract
Purpose
To report the incidence of intraocular pressure (IOP) elevation and identify the risk factors of IOP elevation after intravitreal dexamethasone 0.7 mg (Ozurdex®, Allergan, Irvine, CA, USA) implant.
Methods
A total of 86 eyes of 79 patients who underwent intravitreal dexamethasone implantation and who were followed for ≥3 months were included in the present study. IOP elevation was defined as a pressure > 21 mm Hg at some time during follow-up.
Results
Twenty-nine eyes (33.7%) had an IOP > 21 mm Hg after dexamethasone intravitreal implant. The incidence of IOP elevation increased rapidly at 2‒3 months after dexamethasone intravitreal implant. The Kaplan-Meier estimated incidence of IOP elevation was 25.6 ± 4.7% (mean ± standard error) at 81 days. Cox multivariate analysis showed the significant risk factors of IOP elevation to be age < 55 years (p = 0.045), baseline IOP ≥ 15 mm Hg (p < 0.001), and history of intraocular surgery (p = 0.039).
Conclusions
This study demonstrates the incidence of IOP elevation to be 33.7% and describes the risk factors associated with IOP elevation. Clinicians should be cautious regarding the possibility of IOP elevation after intravitreal dexamethasone implant, especially in the presence of identified risk factors.
References
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Figure 1.
The Kaplan-Meier cumulative incidence of elevated intraocular pressure (event) in 86 eyes that underwent intravitreal dexamethasone implant injection. Events occurred in 29 eyes and the last event was at 580 days after intravitreal dexamethasone implant injection.
Figure 2.
The Kaplan-Meier cumulative incidence of elevated intraocular pressure after intravitreal dexamethasone implant injection, for each group of eyes: Group 1, eyes with age ≥ 55 years (dotted line); and Group 2, eyes with age < 55 years (solid line).
Figure 3.
The Kaplan-Meier cumulative incidence of elevated intraocular pressure after intravitreal dexamethasone implant injection, for each group of eyes: Group 1, eyes with baseline intraocular pressure < 15 mm Hg (dotted line); and Group 2, eyes with baseline intraocular pressure ≥ 15 mm Hg (solid line).
Figure 4.
The Kaplan-Meier cumulative incidence of elevated intraocular pressure after intravitreal dexamethasone implant injection, for each group of eyes: Group 1, eyes without previous intraocular surgery (dotted line); and Group 2, eyes with previous intraocular surgery (solid line).
Table 1.
Results from survival analysis of eyes who underwent intravitreal dexamethasone implant injection
| Parameter | Total number of eyes | Number of IIOP (%) | Log-rank test | Generalized estimating equation |
|---|---|---|---|---|
| Demographic characteristics | ||||
| Sex | 0.081 | 0.087 | ||
| Male | 36 | 16 (44.4) | ||
| Female | 50 | 13 (26.0) | ||
| Age | 0.065 | 0.076 | ||
| ≥55 years | 65 | 19 (27.9) | ||
| ＜55 years | 21 | 10 (47.6) | ||
| Baseline IOP | <0.001 | <0.001 | ||
| ≥15 mm Hg | 38 | 21 (55.3) | ||
| ＜15 mm Hg | 48 | 8 (16.7) | ||
| Diagnosis | 0.027 | 0.041 | ||
| Uveitis | 13 | 3 (23.1) | ||
| Diabetic retinopathy | 23 | 12 (52.2) | ||
| Retinal vein occlusion | 50 | 14 (28.0) | ||
| Two or more injections | 0.111 | 0.096 | ||
| No | 66 | 18 (27.3) | ||
| Yes | 20 | 11 (55.0) | ||
| Systemic condition | ||||
| Hypertension | 0.451 | 0.440 | ||
| No | 61 | 19 (31.1) | ||
| Yes | 25 | 10 (40.0) | ||
| Diabetes mellitus | 0.057 | 0.068 | ||
| No | 60 | 17 (28.3) | ||
| Yes | 26 | 12 (46.2) | ||
| Previous intraocular surgery | 0.020 | 0.022 | ||
| No | 71 | 20 (28.2) | ||
| Cataract extraction alone | 9 | 3 (33.3) | ||
| Combined operation* | 6 | 6 (100.0) | ||
| History of glaucoma | 0.019 | 0.020 | ||
| No | 73 | 21 (28.8) | ||
| Yes | 13 | 8 (61.5) | ||
| Decrease in central macular thickness ≥20% | 0.178 | 0.190 | ||
| No | 9 | 1 (11.1) | ||
| Yes | 77 | 28 (36.4) | ||
Relative risks of elevated intraocular pressure were determined with a univariate Mantel-Cox log-rank test. Generalized estimating equation linear models, which are generally used to extract the appropriate amount of information from correlated data, were used to take into account the correlation between fellow eyes of the same patient.
Table 2.
Results from Cox multivariate regression of eyes that underwent intravitreal dexamethasone implant injection
| Parameter | Hazard ratio | 95% Confidence interval | p-value |
|---|---|---|---|
| Age＜55 years | 2.888 | 1.024–8.141 | 0.045 |
| Baseline IOP ≥ 15 mm Hg | 6.490 | 2.408–17.492 | <0.001 |
| Previous intraocular surgery | 3.731 | 1.068–13.032 | 0.039 |
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