Long-term probability of intraocular pressure elevation with the intravitreal dexamethasone implant in the real-world

Abstract

Purpose To evaluate the long-term cumulative probability of intraocular pressure (IOP) elevation with the intravitreal dexamethasone implant (IDI) when used to treat different indications: diabetic macular edema, uveitis, retinal vein occlusion. Methods 705 IDI injections (429 eyes) were assessed and Kaplan-Meier graphs were generated to assess: the probability of different levels of IOP elevation (IOP21, 25 or 35 mmHg), IOP change 10 mmHg, initiation of IOP-lowering treatment, glaucoma surgery, IOP change with repeat injections and IOP elevation in eyes with glaucoma and ocular hypertension (OHT). Results The cumulative probability of IOP 21, 25 and 35 mmHg was 50%-60%, 25%-30% and 6%-7% at 12–24 months, respectively. The probability of initiating IOP-lowering medication was 31%-54% at 12–24 months. Glaucoma and OHT eyes had a higher probability of mild IOP elevation (21 mmHg, 65.1%, 75% and 57.8%, p = 0.01), yet a similar moderate (25 mmHg, 22.3%, 28% and 30.2%, p = 0.91) and severe elevation of IOP (35 mmHg, 3.7%, 7.1% and 4%, p = 0.71) as normal eyes. Glaucoma surgery was required in only 0.9% cases (4/429). At baseline, 8.8% of the treated eyes had glaucoma, 6.7% OHT and 16.9% were already on IOP-lowering medication. Conclusions In the long-term (24 months), IOP elevation is common, generally mild (30% IOP, 25 mmHg) and well-tolerated, resolving with topical treatment (54%) and rarely requiring surgery (0.9%).