Reactions Weekly | 2021
Dexamethasone
Abstract
Ocular hypertension: case report A 79-year-old man developed ocular hypertension while receiving dexamethasone for macular oedema. The man with a history of anophthalmic socket and monocular vision presented with persistent macular oedema secondary to branch retinal vein occlusion in his only eye. His macular oedema exhibited a suboptimal anatomical and functional response even after three consecutive ranibizumab injections. Hence, an intravitreal dexamethasone implant (IDI) was inserted [dosage not stated]. On presentation, intraocular pressure (IOP) of 18mm Hg in his only eye was noted. Six weeks after IDI, he displayed a significant anatomical and functional response. BCVA improved to 20/40 and central macular thickness decreased. However, IOP had increased to 38mm Hg. Four months later, the man’s IOP remained at 28mm Hg even after the use of maximum medical therapy with a fixed combination of latanoprost/timolol, brimonidine and acetazolamide. A minimally invasive glaucoma surgery was recommended, and two trabecular microbypass stents [GTS400 iStent inject] were implanted to treat ocular hypertension. A grade I–II hyphema associated with the implants was noted during a one-day follow-up visit. IOP was 40mm Hg. And, despite medical treatment his IOP was 34mm Hg. Hence, anterior chamber washout was performed 48h later to avoid further complications. During the one-week followup, BCVA was 20/40 and IOP 16mm Hg without any topical IOP-lowering therapy. Istent implants were well in position. During a year follow-up, his IOP was found to be 18mm Hg without any medical treatment. Persistent macular oedema was managed with aflibercept not requiring the use of further IDI throughout the follow-up.