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Abstract
Purpose
To investigate the occurrence and increase in intraocular pressure (IOP) over time in patients with retinal vein occlusion treated with dexamethasone intravitreal implants.
Methods
Thirty-two patients who met retreatment eligibility criteria received sequential intravitreal dexamethasone implant insertion for retinal vein occlusion in one eye, and were followed for 36 months (maximum of 10 injections) from February 2011 to March 2017. Patients without follow-up data at each investigation time point were excluded.
Results
An IOP increase ≥ 10 mmHg from baseline or an IOP ≥ 25 mmHg occurred in 18.8% of the patients. IOP-lowering medications were used in these patients. The first IOP elevation occurred with a mean of 5.9 months after the first intravitreal dexamethasone implant insertion in the IOP elevation group, and with a mean of 1.5 months after previous intravitreal dexamethasone implant insertion in each IOP elevation event. No patients required laser or incisional glaucoma surgery during the study period.
Conclusions
An increase in IOP occurred in the early period after intravitreal dexamethasone implant insertion, and did not occur in sequential insertion. Although an increase in IOP was a significant side effect of intravitreal dexamethasone implant insertion, the IOP could be controlled with careful observation and use of preliminary and therapeutic anti-ocular hypertensive agents.
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Figure 1.
Mean intraocular pressure (IOP) changes in eyes treated with dexamethasone intravitreal implant and in the fellow eyes during the 36-month follow up. Bar is 95% confidence interval for the mean. *Statistical significant difference of mean IOP compared to the fellow eye (p ≤ 0.05, Mann-Whitney U-test).
Figure 2.
Mean increased intraocular pressure (IOP) changes in eyes treated with dexamethasone intravitreal implant from baseline IOP of the responder (n = 6) and non-responder group (n = 26) during 36 months follow up. Bar is 95% confidence interval for mean. * Statistical significant difference of mean IOP compared to the fellow eye (p ≤ 0.05, Mann-Whitney U-test).
Figure 3.
Intraocular pressure (IOP) changes in the responder patients. (A) IOP change in the responder patient A. (B) IOP change in the responder patient B. (C) IOP change in the responder patient C. (D) IOP change in the responder patient D. (E) IOP change in the responder patient E. (F) IOP change in the responder patient F. Bar: span of time of anti-ocular hypertensive eyedrop use. * Intravitreal dexamethasone implant insertion; ￥ Mannitol intravenous injection.
Table 1.
Demographic data
Table 2.
Classification and demographics of responder and non-responder group
| Parameters | Steroid responder group (n = 6) | Steroid non-responder group (n = 26) | p-value |
|---|---|---|---|
| Female gender (n, %) | 2 (33.3) | 19 (73.1) | 0.148† |
| Age (years) | 64.5 ± 10.5 | 60.0 ± 12.6 | 0.439* |
| Right eye (n, %) | 4 (66.7) | 13 (50) | 0.196† |
| Pseudophakic eyes (n, %) | 5 (83.3) | 9 (34.6) | 0.637† |
| Vitrectomized eyes (n, %) | 0 (0) | 2 (7.7) | 0.661† |
| Diabetes (n, %) | 1 (16.7) | 0 (0) | 1.000† |
| Hypertension (n, %) | 0 (0) | 0 (0) | 1.000† |
| Hypertension and DM (n, %) | 1 (16.7) | 6 (23.1) | 0.625† |
| Duration of symptom (months) | 15.6 ± 9.0 | 12.2 ± 10.1 | 0.387* |
| Number of treatments | 5.2 ± 2.5 | 6.0 ± 2.9 | 0.608* |
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