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Dexamethasone safe in glaucoma patients, with monitoring
The dexamethasone intravitreal implant can be performed in patients with glaucoma with close follow-up monitoring of IOP and use of topical antiglaucoma medications, according to researchers.
The retrospective review of case records followed 898 patients who received the intravitreal implant (Ozurdex, Allergan) for managing macular edema.
A total of 838 patients had no glaucoma referral or history of steroid response, and 60 had either a history of steroid response or had suspicious glaucomatous changes on clinical evaluation and were referred to the glaucoma department for further management. The mean age of study participants was 56.3 years, and the male to female ratio was 2:1.
IOP measurements were collected at day 1 after injection, week 1, week 2, month 3 and month 6.
In the nonglaucoma group, the overall mean IOP before injection was 13.96 mm Hg, and after injection the follow-up mean IOPs were 13.88 mm Hg for 1 week, 15.02 mm Hg for 2 weeks, 14.26 mm Hg for 3 months, and 13.99 mm Hg for 6 months.
In the glaucoma referral group, the overall mean before injection was 16.17 mm Hg, and after injection, the follow-up mean IOPs were 15.67 mm Hg for postoperative day 1, 19.07 mm Hg at 1 week, 22.59 mm Hg at 2 weeks, 21.61 mm Hg at 3 months and 18.10 mm Hg for 6 months.
The differences in IOP in each group were found to be significant.
The trend showed that IOP was higher in the second week follow-up compared with other follow-up times for both groups, but could be managed with antiglaucoma agents.
Patients with diabetic macular edema were found to have a greater percentage of rise in IOP compared with other indications for the dexamethasone implant, according to researchers.
“Hence, with a close early follow-up monitoring of IOP and timely medical intervention, Dex implant can be performed in patients with glaucoma,” the authors said.
Those who received two or more injections were more likely to have an IOP rise when compared to others who received a single injection, they noted. – by Abigail Sutton
Disclosures: The authors report no relevant financial disclosures.
Perspective
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They say that April showers bring May flowers. Even so, we never know exactly what to anticipate for the spring season.
Similarly, we know that glaucoma patients may experience a rise in IOP with the application of steroids, but you never quite know when or how much the IOP will rise, if at all. This potential side effect can complicate the management of comorbidities, as intraocular steroid injections are often utilized to manage macular edema and are becoming more mainstream with the transition to dropless cataract surgery.
Srinivasan and colleagues have found that the dexamethasone intravitreal implant for macular edema can be safely used in patients with mild glaucoma. It should be emphasized, however, that they excluded patients with poorly controlled or advanced glaucoma.
Thankfully, most glaucoma patients with macular edema can be managed without intravitreal steroid use. When additional measures are needed, this study has me feeling somewhat more comfortable with this treatment. While I won’t be the one performing the injection, it will certainly be up to me to follow the patient closely and manage any rise in pressure accordingly.
I happen to look forward to the vibrant colors of the spring …