Intravitreal dexamethasone for macular edema may increase Intraocular Pressure: Study

A comprehensive retrospective study published in the Graefe's Archive for Clinical and Experimental Ophthalmology investigated the impact of steroidal medications on intraocular pressure (IOP) in patients who were treated for macular edema. The study spanned through various conditions such as postoperative, diabetic, uveitic macular edema, and macular edema after retinal vein occlusion by highlighting the potential risks associated with these treatments.

The study included patients treated with diverse steroidal agents with triamcinolone acetonide (TMC) as intravitreal injection or sub-Tenon, as well as dexamethasone (DXM) and fluocinolone acetonide (FA) intravitreally. The primary focus on IOP elevation with an increase of ≥ 25 mmHg was considered pathological. The research documented the steroid response, time of onset of IOP rise, and the efficacy of IOP-lowering therapies.

Out of the 428 eyes examined, 39.3% eyes experienced IOP elevation by reaching a mean of 29.7 mmHg after a median of 5.5 months. Also, certain steroids were more prone to causing IOP elevation, with DXM and TMC IVI combination showing the highest incidence at 57.4%. The study identified a significant difference in IOP elevation among various steroidal treatments (p < 0.001).

Out of the eyes with elevated IOP, 70.8% cases were treated conservatively, 12.5% cases underwent surgical interventions (including cyclophotocoagulation and filtering surgery), and 16.7% cases received no therapy. Sufficient IOP regulation was achieved in 68.9% of cases with the use of topical therapy, while 31.1% required ongoing topical therapy over a 20 ± 7 month follow-up.

The study found that IOP increase after steroidal applications are not uncommon. Intravitreal dexamethasone, either as a monotherapy or in combination with another steroid pose a higher risk of IOP elevation compared to other steroids. The findings emphasize the necessity for regular IOP monitoring following steroid administration with potential initiation of long-term conservative and/or surgical therapy when required.

Source:

Wykrota, A. A., Abdin, A. D., Munteanu, C., Löw, U., & Seitz, B. (2023). Incidence and treatment approach of intraocular pressure elevation after various types of local steroids for retinal diseases. Graefe's Archive for Clinical and Experimental Ophthalmology, 261(12), 3569–3579. https://doi.org/10.1007/s00417-023-06163-5