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Increased IOP occurs early in many patients with dexamethasone implants
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Half of patients with open-angle glaucoma and ocular hypertension treated with dexamethasone implants needed an add-on treatment early for elevated intraocular pressure, according to researchers in Retina.
The retrospective study included 100 patients treated with intravitreal injections of dexamethasone divided into two equal groups: group 1, OAG+/OHT+ for those with a history of OAG and OHT and group 2, OAG-/OHT- for those non-glaucomatous and nonhypertensive.
IOP and hypotensive treatment were evaluated initially, at 8 days and every 6 months after intravitreal treatment.
A total of 34% of glaucomatous patients experienced a transient IOP increase greater than 10 mm Hg vs. 16% in the OAG-/OHT- group, according to researchers.
A total of 54% of glaucoma patients increased their treatment, and hypotensive treatment was initiated in 38% of the OAG- patients.
At the end of the study, 28% of the OAG+/OHT+ group patients were switched to anti-VEGFs at the time of reinjections to prevent sustained high IOP and potential corticosteroid-induced glaucoma vs. 2% of the controls.
This study emphasizes the need for IOP monitoring during treatment, with half of the OAG+ and OHT+ patients needing an add-on treatment, the researchers said. The onset of increased IOP can occur early, they added.
Disclosure: Vié reported no financial disclosures. Please see the full study for all remaining authors’ relevant financial disclosures.
Perspective
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Scott Anthony, OD, FAAO
Glaucoma management in the setting of serious retinal disease can present many clinical challenges.
Monitoring for glaucoma progression is often confounded by the underlying retinal disease, which can significantly alter retinal nerve fiber layer optical coherence tomography and threshold visual field results. Likewise, steroid treatments for retinal disease can negatively alter the course of glaucoma in many patients with the known side effect of ocular hypertension.
This study demonstrates that glaucoma and ocular hypertension patients are more likely to encounter uncontrolled IOP following Ozurdex intravitreal treatment (dexamethasone, Allergan). Therefore, we must manage these patients with extra vigilance in the postoperative period, stressing glaucoma medication compliance and having a customized treatment plan in place in the event of an IOP spike.
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