Ocular steroid injections may increase glaucoma, OHT risk
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Key takeaways:
- One-fifth of patients who received ocular steroid injections were later diagnosed with glaucoma or ocular hypertension.
- The risk was higher for those receiving multiple injections.
Patients receiving ocular steroid injections may be at higher risk for developing glaucoma or ocular hypertension, even without prior diagnosis or treatment, according to research published in BMJ Open Ophthalmology.
“This study demonstrates that patients receiving periocular and/or intravitreal steroid injections are at considerable risk of developing new glaucoma/OHT, with a substantial proportion of patients requiring topical, laser or even surgical intervention to lower IOP,” Ashley Polski, MD, from the Moran Eye Center at the University of Utah, and colleagues wrote.
Polski and colleagues reviewed deidentified insurance claims data from the IBM MarketScan Database and included 19,156 adults with no prior history of glaucoma who received ocular steroid injections between 2011 and 2020.
Of those, 20.5% were diagnosed with glaucoma or ocular hypertension (OHT), 17.5% began using glaucoma drops and 2.27% needed a glaucoma procedure within 5 years of the initial injection.
Retrobulbar and intravitreal steroid injections were associated with higher risk for glaucoma compared with triamcinolone subconjunctival injections, researchers reported. A 0.59 mg fluocinolone acetonide intravitreal implant had the highest risk for glaucoma and OHT.
The risk for developing glaucoma or OHT was also higher for those receiving multiple steroid injections, with the largest increase in risk taking place after three injections.
“There are currently no well-defined, broadly accepted guidelines regarding the specific frequency and duration of glaucoma screening in patients receiving intravitreal or periocular steroid injections,” Polski and colleagues wrote. “Future work to better characterize and risk-stratify these patients would be useful both to provide practical, individualized patient counselling and to help guide clinicians as they treat and monitor their patients over time.”
Perspective
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Periocular and intraocular steroid injections are well-known to be associated with sharp rises in IOP and subsequent glaucoma development. In this study, Polski and colleagues found that intravitreal administration, whether through injection or from an implantable delivery system, posed the greatest risk for subsequent IOP elevation compared with subconjunctival and retrobulbar injections.
Among the intravitreal forms specifically, there also was variation; the sustained release 0.19 mg fluocinolone implant (Iluvien) demonstrated slightly less rates of IOP/glaucoma diagnoses when compared with intravitreal triamcinolone or the dexamethasone implant (Ozurdex). The surgically implanted device delivering 0.59 mg fluocinolone (Retisert) demonstrated the greatest risk for IOP elevation and subsequent need for treatment. Knowing the inherent risk associated with each of these methods of treatment may offer guidance to frequency of monitoring IOP in comanagement of these patients.
This study also serves to underscore the inherent risks for steroid treatment relating to glaucoma. There is an ever-expanding field of drug delivery options, and eye care professionals should be informed of the associated risks as they pertain to IOP.
Until there is a clear clinical picture as to which patients are likely to develop a steroid response, this study lends further evidence that all patients receiving steroid treatment via injection should be carefully monitored.
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