Effects of intravitreally administered prolonged corticosteroids on intraocular pressure

PURPOSE. To analyze the effects of intravitreal injections of prolonged corticosteroids (Ozurdex®) on intraocular pressure (IOP).

METHODS. The study involved 330 patients (142 men, 188 women aged 54.5 (40 to 63) years who received 399 intravitreal injections (IVI) of Ozurdex®. Patients were divided into two main groups: 1st group consisted of 184 (55.7%) patients who did not use antihypertensive therapy before or after IVI of Ozurdex®; 2nd group consisted of 146 (44.3%) patients who used hypotensive drugs before IVI, or immediately after IVI of Ozurdex®. Two subgroups were formed according to main concomitant disease: 1st subgroup — 167 (50.6%) patients with retinal vein occlusion (RVO); 2nd subgroup — 163 (49.4%) patients with diabetic retinopathy (DR). The IOP level was measured before IVI, the next day, and one month after drug administration. In cases of ophthalmic hypertension, local carbonic anhydrase inhibitors were used as monotherapy, or in combination with beta-blockers.

RESULTS. An increase in IOP observed in 44% of cases after the first injection was stabilized by medications: in 80.7% with the help of monotherapy, in 19.3% — with combined antihypertensive therapy. In 100% of cases, patients with hypertension and history of laser coagulation did not require IOP correction by a drug combination. The mean IOP values tended to decrease in all patients (p<0.01). Cataract was diagnosed in 69% of cases, phacoemulsification after the first IVI was performed in 9%, and after the second injection — in 19% of cases. There is a more frequent occurrence of ophthalmic hypertension in patients with RVO. The correlation coefficient between the IOP level before and after treatment was r=0.148 in patients with RVO and r=−0.0221 in patients with DR, respectively. There was no statistical relationship between the development of ophthalmic hypertension and the number of Ozurdex® injections received.

CONCLUSION. The rise in intraocular pressure after intravitreal introduction of the Ozurdex® implant is diagnosed 17% more often in patients with RVO. IOP increased more often after the first injection, while there was no correlation between hypertension and the number of Ozurdex® injections. In 8.5% of cases, combination therapy was required. In half of patients with ophthalmic hypertension, the IOP has compensated independently within 3–15 months after IVI.

1. Audren F, Lecleire-Collet A, Erginay A, et al. Intravitreal triamcinolone acetonide for diffuse diabetic macular edema: phase 2 trial comparing 4 mg vs 2 mg. Am J Ophthalmol. 2006; 142(5):794-799. doi: 10.1016/j.ajo.2006.06.011

2. Lambiase A, Abdolrahimzadeh S and Recupero SM. An update on intravitreal implants in use for eye disorders. Drugs Today. 2014; 50(3):239-249. doi: 10.1358/dot.2014.50.3.2103755

3. Malclès A, Dot C, Voirin N, et al. Real-life study in diabetic macular edema treated with dexamethasone implant: the Reldex study. Retina. 2017; 37(4):753-760. doi: 10.1097/IAE.0000000000001234

4. Güler E, Totan Y and Betül Güragaç F. Intravitreal bevacizumab and dexamethasone implant for treatment of chronic diabetic macular edema. Cutan Ocul Toxicol. 2017; 36(2):180-184. doi: 10.3109/15569527.2015.1127254

5. Pareja-Rios A, Ruiz-de la Fuente-Rodriguez P, Bonaque- Gonzalez S, et al. Intravitreal dexamethasone implants for diabetic macular edema. Int J Ophthalmol. 2018; 11(1):77-82. doi: 10.18240/ijo.2018.01.14

6. Bellocq D, Akesbi J, Matonti F, et al. The pattern of recurrence in diabetic macular edema treated by dexamethasone implant: the PREDIAMEX study. Ophthalmol Retina. 2018; 2:567-573. doi: 10.1016/j.oret.2017.10.016

7. Malclès A, Dot C, Voirin N, et al. Safety of intravitreal dexamethasone implant (OZURDEX): the SAFODEX study. Incidence and risk factors of ocular hypertension. Retina. 2017;37:1352-1359 doi: 10.1097/IAE.0000000000001369

8. Recommandations-SFG-SFO-2017.pdf, http://www.leglaucome.fr/ wp-content/uploads/2017/03/Recommandations-SFG-SFO-2017.pdf (accessed 8 October 2018.

9. Callanan DG, Gupta S, Boyer DS, Ciulla TA, Singer MA, Kuppermann BD, Liu CC, Li XY, Hollander DA, Schiffman RM, Whitcup SM: Dexamethasone intravitreal implant in combination with laser photocoagulation for the treatment of diffuse diabetic macular edema. Ophthalmology. 2013;120:1843-1851. doi:10.1016/j.ophtha.2013.02.018

10. Boyer DS, Yoon YH, Belfort R Jr, Bandello F, Maturi RK, Augustin AJ, Li XY, Cui H, Hashad Y, Whitcup SM: Three-year, randomized, shamcontrolled trial of dexamethasone intravitreal implant in patients with diabetic macular edema. Ophthalmology. 2014;121:1904-1914. doi: 10.1016/j.ophtha.2014.04.024

11. Malcl s A, Dot C, Voirin N, et al. Safety of intravitreal dexamethasone implant (OZURDEX): the SAFODEX study. Incidence and risk factors of ocular hypertension. Retina. 2017;37:1352-1359. doi: 10.1097/IAE.0000000000001369