Secondary glaucoma after intravitreal dexamethasone implant (Ozurdex) injection in patients with retinal disorder: A retrospective study

• Published in: Indian journal of ophthalmology Vol. 70; no. 2; pp. 585 - 589
• Main Authors: Sweta, V, Shibi Dev, B, Sandhya, R
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01.02.2022; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer - Medknow
• Subjects: Complications and side effects; Dexamethasone; Diabetes mellitus; Diabetic Retinopathy - complications; Dosage and administration; Drug Implants; Drug therapy; Drugs; Edema; Eye; Glaucoma; Glaucoma - complications; Glucocorticoids; Humans; Injection; Intraocular Pressure; Intravitreal Injections; Macular Edema - diagnosis; Macular Edema - drug therapy; Macular Edema - etiology; Occlusion; Optic nerve; Patients; Retina; Retinal Vein Occlusion - complications; Retinal Vein Occlusion - diagnosis; Retinal Vein Occlusion - drug therapy; Retrospective Studies; Risk factors; Special Focus, Glaucoma, Original; Statistical analysis; Steroids; Visual Acuity; Visual field; United States; CRVO- Central retinal vein occlusion; T/t- treatment; DME- Diabetic macular edema; CME- Cystoid macular edema; BRVO- Branch retinal vein occlusion; IOP- Intraocular pressure; AGM- Antiglaucoma medication; CNVM- Choroidal neovascular membrane; IV- Intravitreal
• ISSN: 0301-4738; 1998-3689
• DOI: 10.4103/ijo.IJO_684_21

Purpose: To investigate the rate of secondary glaucoma after intravitreal (IV) dexamethasone implant (ozurdex) 0.7 mg injection in a retinal disorder over a clinical treatment period of 2 years in a tertiary eye care center. Methods: Retrospective study based on the records of patients receiving IV ozurdex 0.7 mg implant for T/t of cystoid macular edema (CME), diabetic macular edema (DME), macular edema due to central retinal vein occlusion/branch retinal vein occlusion (CRVO/BRVO), and choroidal neovascular membrane (CNVM) at a tertiary eye care hospital for 2 years with 6 months of follow-up. The post-T/t intraocular pressure (IOP) and antiglaucoma medication (AGM) required was recorded at day 1, 1 week, 1, 2, 3, 4, and 6 months and analyzed for secondary IOP spike or ocular hypertension defined as IOP >21 mmHg at any point in time. The patients with pre-existing glaucoma and lost to follow-up were excluded. Results: A total of 102 eyes of 80 patients were included in the study. The mean baseline IOP was 14.40 + 2.97 mmHg, post-injection was 15.01 + 3.22 mmHg at day 1, 15.15 + 3.28 mmHg at 1 week, 15.96 + 3.62 mmHg at 1 month, 16.26 + 3.95 mmHg at 2 months, 15.41 + 3.33 mmHg at 3 months, 15.38 + 3.28 mmHg at 4 months, and 14.27 + 2.69 mmHg at 6 months. No significant difference was seen from baseline IOP at day 1 (P = 0.163), 1 week (P = 0.086), and 6 months (P = 0.748). Statistically significant difference was seen at 1 month (P = 0.0009), 2 months (P = 0.0001), 3 months (P = 0.023), and 4 months (P = 0.026). The mean IOP peak at 2 months recovered to baseline by 6 months subgroup IOP trend shows a similar variation and the results are consistent with the studies in the literature. About 19/102 (18.62%) eyes showed an IOP spike post-T/t. The maximum was seen at 2 months; 16 eyes showed a rise in the range 22-25 mmHg; 8 in the range 26-30 mmHg; and 1 eye had 34 mmHg and required multiple AGM-no surgical intervention was needed. Conclusion: A secondary IOP spike post-IV ozurdex 0.7 mg seen in 18.62% of the cases require AGM. The IOP monitoring should be meticulously performed for the variations and secondary IOP spike management to prevent irreversible damage to the optic nerve and visual field.