Study raises concern about use of corticosteroid implant for macular edema in patients with glaucoma

PARIS — Corticosteroid implants to treat macular conditions should be used with extreme caution, and possibly avoided, in patients presenting with glaucoma or ocular hypertension, according to a study.

“The Ozurdex dexamethasone implant has proven highly effective in the treatment of macular edema secondary to RVO, diabetes and noninfectious posterior uveitis. However, there is no consensus on the safety of Ozurdex in patients with open-angle glaucoma. Our study was the first to investigate the effects of the implant in these patients,” Ann Laure Vié, MD, said at the meeting of the French Society of Ophthalmology.

Ann Laure Vié

The retrospective study, carried out in two university centers in France, included 100 patients treated with Ozurdex (Allergan) between 2010 and 2014; 47 patients had open-angle glaucoma and three had ocular hypertension. Indications for treatment were retinal vein occlusion in 57% of the cases, diabetic macular edema in 33% of the cases and Irvine-Gass syndrome in 10% of the cases.

At baseline, patients with glaucoma were on monotherapy in 46% of the cases, while two or three medications were used in 26% and 4% of the patients, respectively. Ocular hypertension was not treated by medications, and 10% of the patients had previously undergone filtration surgery.

“IOP increased in both the glaucoma/ocular hypertension group and control group by 5 mm Hg on average, but one-third of the glaucoma/ocular hypertension group had a transient increase of more than 10 mm Hg. Two-thirds of these patients necessitated additional or higher doses of medications,” Vié said.

She also reported that 6% of the patients on two or three medications had to undergo glaucoma surgery.

“Particularly in patients who are treated with two or more medications, Ozurdex should be prescribed with extreme caution,” Vié said. - by Michela Cimberle

Disclosure: Vié reports no relevant financial disclosures.