Acta Diabetologica | 2019
Long-term outcomes after intravitreal dexamethasone treatment in steroid responders
Abstract
AimsIntravitreal steroid implants have emerged as an adjunctive therapy in diabetic macular edema (DME) in patients refractory to anti-vascular endothelial growth factor agents. However, the use of these agents in patients with a prior history of steroid-induced ocular hypertension is limited. The present study aimed to analyze long-term intraocular pressure (IOP) response to the dexamethasone implant in patients with DME and a history of steroid-induced increase in IOP.MethodsIn a multicenter retrospective review, 17 eyes with DME and a history of steroid-induced increase in IOP to > 21\xa0mmHg were treated with the dexamethasone implant and followed for 18\xa0months. Patients with a history of vitrectomy of vitreoretinal interface pathology were excluded. The primary outcomes were the change in IOP and use of IOP-lowering agents.ResultsAmong the study population (17 eyes), there was no significant change in mean IOP from baseline through 18\xa0months (15.9 ± 2.0–14.6 ± 2.8\xa0mmHg; p = 0.18). The number of patients requiring IOP-lowering agents rose from 5 at baseline to 14 at 18\xa0months (p = 0.0049). None of the study eyes required surgical treatment.ConclusionsThough dexamethasone does predictably lead to an increase in IOP, this adverse effect was effectively managed with topical treatment. The present study suggests that the intravitreal dexamethasone implant may be considered in patients with DME and a history of steroid-induced ocular hypertension who have exhausted first-line treatments.