Journal List > J Korean Ophthalmol Soc > v.59(6) > 1096562

Kim, Lee, and Wang: Intraocular Pressure Changes in Patients with Retinal Vein Occlusion Treated with Intravitreal Dexamethasone Implant Insertion

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).
jkos-59-519f1.tif
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).
jkos-59-519f2.tif
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.
jkos-59-519f3.tif
Table 1.
Demographic data
Demographic Value
Total number of eyes (patients) 32 (32)
Mean age (years) 63.7 ± 10.9
Gender (n, %)  
 Male 11 (34.4)
 Female 21 (65.6)
Eyes (n, %)  
 Right eye 14 (43.8)
 Left eye 18 (56.2)
Indication (n, %)  
 BRVO 24 (75.0)
 CRVO 8 (25.0)
Lens status (n, %)  
 Phakic eyes 22 (68.7)
 Pseudophakic eyes 10 (31.3)
Vitrectomy history (n, %)  
 Vitrectomized eyes 2 (6.3)
 Nonvitrectomized eyes 30 (93.7)
Past history  
 HTN 0
 Diabetes mellitus 1
 HTN and diabetes mellitus 7
 None 24
Disease onset (months)  
 ≤ 3 months 2
 3 to ≤ 6 months 8
 6 to ≤ 12 months 3
 12 to ≤ 24 months 19
 >24 months 0
 Unknown 0
Number of treatments  
 1 injection 1
 2 injections 2
 3 injections 6
 4 injections 7
 5 injections 4
 6 injections 2
 7 injections 2
 8 injections 1
 9 injections 4
 10 injections 3

Values are presented as mean ± SD or n (%) unless otherwise indicated.

BRVO = branched retinal vein occlusion; CRVO = central retinal vein occlusion; HTN = hypertension.

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*

Values are presented as mean ± SD or n (%) unless otherwise indicated.

DM = diabetes mellitus

* Mann-Whitney U-test

Fisher's exact test.

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