Intraocular pressure change after injection of intravitreal dexamethasone (Ozurdex) implant in Korean patients

Course of uveitis in children with juvenile idiopathic arthritis (JIA): Five years follow-up data from a prospective multicenter Inception Cohort of Newly diagnosed patients with JIA (ICON-JIA) study

BACKGROUND

Juvenile idiopathic arthritis-associated uveitis (JIAU) typically takes a chronic course, frequently leading to ocular complications and often requiring long-term treatment. The present study assesses the 5-years outcome of JIAU by analyzing data from a prospective study initiated in 2010.

METHODS

Data from 75 patients with onset of uveitis after study enrollment, and with a documentation at 5-years follow-up (5yFU) were available for analysis of uveitis characteristics, frequency and predictors of "inactivity on medication " (defined as inactive uveitis for ≥ 6 months) and "inactivity off medication " (defined as inactive uveitis for ≥ 6 months off medication).

RESULTS

At the 5yFU, visual acuity remained good in the majority of eyes (LogMAR < 0.1 in 65.5%; mean LogMAR 0.11 ± 0.31), ocular surgery was required in only 5% of patients, although complications occurred in 46.7% of patients until the 5yFU. Uveitis was inactive in 85.3% of patients, with 77.3% still receiving disease-modifying antirheumatic drugs (DMARDs). Until 5yFU, 82.7% of patients experienced ≥ one episode of "inactivity on medication " (30.7% once, 37.3% twice, 14.7% three or more times), and 17.3% ≥ one episode of "inactivity off medication ", respectively. Both "inactivity on medication " as well as "inactivity off medication " were associated with lower JIA disease activity (cJADAS10; ESR), and with an increased quality of life.

CONCLUSIONS

Despite intensified DMARD treatment, almost half of the children experience JIAU-related ocular complications after 5 years of disease; however, visual acuity mostly remains good. Uveitis inactivity can be achieved frequently, but is often limited in duration. Lower JIA activity appears to correlate with uveitis inactivity on and off medication.

Safety of intravitreal injections with the mobile laminar airflow device Operio after more than 10.000 injections

PURPOSE

To evaluate the occurrence of complications following intravitreal injections (IVIs) performed in an outpatient clean room (OCR) equipped with the mobile laminar airflow device (LAF) Operio.

METHODS

This retrospective study analyzed the data of 10,016 IVIs performed in an OCR from April 2023 to November 2024. All information of each patient was registered, such as diagnosis, drug injected and any occurring complication or adverse events such as endophthalmitis, intraocular inflammation, rhegmatogenous retinal detachment (RRD), vitreous hemorrhages and elevated intraocular pressure.

RESULTS

From April 2023 to November 2024, 10,016 IVIs were performed in 1700 eyes of 1460 patients with the average age of 76.10 ± 12.37 years. The most representative diagnosis were Age-related Macular Degeneration (AMD) (47.60%), Retinal Vein Occlusion (RVO) (18.90%) and Diabetic Macular Edema (DME) (8.42%). Ten (4.24%) cases of ocular hypertensions were reported after dexamethasone implant whereas no cases of endophthalmitis or RRD were registered.

CONCLUSIONS

The OCR equipped with Operio was easy to set up, safe regarding all IVI-related complications, first and foremost endophthalmitis, helpful in improving the management of IVIS, and allowed us to decongest the operating room for more complex surgeries.

Assessment the real-world safety of intravitreal dexamethasone implant (Ozurdex): novel insights from a comprehensive pharmacovigilance analysis utilizing the FAERS database

OBJECTIVE

The intravitreal dexamethasone implant (Dex) is widely used for various ocular conditions, including diabetic macular edema (DME), retinal vein occlusion (RVO), and non-infectious uveitis. Despite its efficacy, concerns remain regarding its safety profile. This study aims to analyze the adverse events (AEs) associated with Dex reported in the FDA Adverse Event Reporting System (FAERS) database from 2010 to 2024.

METHODS

Data were extracted from FAERS, focusing on cases where Dex was the primary suspect drug. The dataset was processed to eliminate duplicates and incomplete entries. Disproportionality analysis, including Reporting Odds Ratio (ROR) and Proportional Reporting Ratio (PRR), was used to detect safety signals. AEs were categorized by system organ class (SOC) and preferred term (PT).

RESULTS

A total of 1,588 adverse event reports (AERs) were analyzed, revealing a significant upward trend. The Eye disorders was the most commonly reported SOC, with strong disproportionality signals (ROR: 45.11; PRR: 23.71). Key AEs identified at the PT level included Corneal decompensation, Choroidal hematoma, and Posterior capsule rupture, which were not listed on the drug label. Considering the reported numbers, the Endophthalmitis was the most common AE. Additionally, a significant proportion of AEs were observed within the first seven days post-administration, emphasizing the need for monitoring.

CONCLUSION

While Dex remains an effective treatment option for ocular conditions, its use is associated with significant risks, particularly regarding unexpected and severe complications such as corneal decompensation. Continuous pharmacovigilance and detailed patient monitoring are essential to mitigate these risks. Future studies should focus on prospective designs and comprehensive clinical data to better understand the safety profile of Dex.

Clinical prediction nomogram for steroid-induced ocular hypertension risk in patients with intravitreal dexamethasone implant

Background

Recognizing the risk factors and understanding the mechanisms underlying steroid-induced ocular hypertension (SIOH) are vital to prevent potent vision loss and ensure the safety and effectiveness of dexamethasone (DEX) injections. The study aimed to develop a novel nomogram for predicting the risk of SIOH and determining safety zones for steroid injections.

Methods

This single-center, retrospective, case-control study included a total of 154 eyes with available measured axial length that had undergone AS-OCT and DEX implantation at the Yonsei University Health System. The eyes were categorized into the SIOH (n = 39) and post-steroid normal IOP (n = 115) groups. We measured intraocular pressure (IOP) for all eyes prior to DEX implantation, at 1 week post-implantation, and at 1, 2, 3, 6, and 12 months thereafter. We used AS-OCT to analyze the trabecular meshwork (TM) height and ocular parameters.

Results

The predictive nomogram, including TM height, yielded an AUC of 0.807 (95 % confidence interval [CI], 0.737-0.877) and demonstrated significantly higher predictive accuracy than that of previous nomograms, which did not consider TM height and had an AUC of 0.644 (95 % CI, 0.543-0.745) (p = 0.031). The calibration plot demonstrated a strong predictive accuracy for a predicted value of approximately 0.4. We established cutoff values to ensure different levels of sensitivity and specificity within the safety zone following DEX implantation.

Conclusion

Our improved nomogram incorporating TM height as a newly identified risk factor, established a safety threshold for intravitreal DEX implantation, helping identify safe individuals from those who require caution.

Baseline intraocular pressure: an independent risk factor in severe steroid-induced ocular hypertension after intravitreal dexamethasone implant

PURPOSE

To evaluate the baseline intraocular pressure (IOP)-related risk of severe steroid-induced ocular hypertension (SIOH). We hypothesized that the incidence and severity of SIOH may differ according to baseline IOP in patients who received intravitreal dexamethasone implants.

METHODS

A total of 889 eyes treated with intravitreal dexamethasone implants and a baseline IOP of ≤ 23 mmHg were enrolled. Enrolled patients were divided into two groups: the steroid-responders (127 eyes) and the non-steroid-responders (762 eyes). The steroid-responders group was subdivided into post-injection IOP of ≥ 25, > 30, or > 35 mmHg or IOP elevation of ≥ 10 mmHg over the baseline value. The odds ratio of SIOH was calculated using univariable logistic regression analysis, and significant variables were analyzed with a multivariable model. IOP was measured before (baseline IOP) and after dexamethasone implant injection at 1 week and 1, 2, 3, 6, and 12 months.

RESULTS

Although baseline IOP was significantly associated with the development of SIOH in logistic regression analysis, the results from the subgroup analysis differed. In the group with IOP elevation of ≥ 10 mmHg over the baseline, SIOH was not significantly associated with baseline IOP, but it was significantly related to higher baseline IOP in the severe SIOH group (IOP > 30 and > 35 mmHg).

CONCLUSIONS

Higher baseline IOP is a risk factor for severe SIOH. Clinicians should be aware of the risk of SIOH when administering steroids intravitreally to patients with high baseline IOP (IOP > 19 mmHg).

Real-world effectiveness of intravitreal dexamethasone implants - Comparison between eyes eligible and ineligible for clinical trials and their associated outcomes

BACKGROUND

Concerns about the generalizability of pivotal randomized controlled trials (pRCTs) findings have been raised. We aimed to compare intravitreal dexamethasone implants' (IDIs) effectiveness for diabetic macular edema (DME) and central retinal vein occlusion (CRVO), between eyes eligible and ineligible for pRCTs.

METHODS

This retrospective cohort study analyzed Taiwan's Chang Gung Research Database, including DME or CRVO eyes initiating IDIs during 2015-2020. We classified all treated eyes as eligible or ineligible for pRCTs following major selection criteria of the MEAD and GENEVA trials, and evaluated three-, six-, and twelve-month changes in central retinal thickness (CRT) and visual acuity (VA) after initiating IDIs.

RESULTS

We included 177 IDI-treated eyes (DME: 72.3%; CRVO: 27.7%), of which 39.8% and 55.1% were ineligible for DME and CRVO pRCTs, respectively. LogMAR-VA and CRT changes at different times were comparable in DME eyes eligible (LogMAR-VA difference: 0.11 to 0.16; CRT difference: -32.7 to -96.9 μm) and ineligible (LogMAR-VA difference: -0.01 to 0.15; CRT difference: -54.5 to -109.3 μm) for the MEAD trial. By contrast, CRVO eyes ineligible for the GENEVA trial had greater LogMAR-VA changes (0.37 ~ 0.50) than those eligible (0.05 ~ 0.13), with comparable CRT reductions (eligible eyes: -72.3 to -106.4 μm; ineligible eyes: -61.8 to -110.7 μm) (all p-values <0.05 of the mean differences between eligible and ineligible CRVO eyes for all follow-ups).

CONCLUSIONS

IDIs had similar VA and CRT outcomes among DME eyes, regardless of pRCT-eligibility. However, among CRVO eyes, those ineligible for pRCTs showed greater deterioration in VA than those eligible.

Diagnosis and Management of Non-Infectious Uveitis in Pediatric Patients

Uveitis in children accounts for 5-10% of all cases. The causes vary considerably. Classically, uveitis is distinguished according to its infectious or inflammatory origin and whether it is part of a systemic disease or represents an isolated ocular disease. It is important to highlight the specificity of certain etiologies among children such as juvenile idiopathic arthritis. The development of visual function can potentially be hindered by amblyopia (children aged < 7 years), in addition to the usual complications (synechiae, macular edema) seen in adult patients. Moreover, the presentation of uveitis in children is often "silent" with few warning signs and few functional complaints from young children, which frequently leads to a substantial diagnostic delay. The diagnostic approach is guided by the presentation of the uveitis, which can be characterized by its location, and corresponds to the initial and main site of intraocular inflammation; its presentation, whether acute or chronic, granulomatous or not; and the response to treatment. Pediatricians have an important role to play and must be aware of the various presentations and etiologies of uveitis in children. Juvenile idiopathic arthritis is the most common etiology of pediatric non-infectious uveitis, but other causes must be recognized. Promptly initiated treatment before complications arise requires early diagnosis, recognition, and treatment. Any dependence on prolonged local corticosteroid therapy justifies discussing the introduction of a corticosteroid-sparing treatment considering the risk to develop corticoid-induced glaucoma and cataracts. Systemic corticosteroid therapy can be required for urgent control of inflammation in the case of severe uveitis. Long-lasting immunosuppressive treatment and biotherapies are most often prescribed at the same time to reinforce treatment efficacy and to prevent relapse and corticosteroid dependency. We review the different causes of uveitis, excluding infection, and the diagnostic and therapeutic management aimed at limiting the risk of irreversible sequelae.

Analysis of Corticosteroid-Induced Glaucoma Using the Japanese Adverse Drug Event Reporting Database

Glaucoma is the most common cause of blindness, which significantly reduces quality of life. Most glaucoma cases are primary glaucoma; nevertheless, many patients suffer from glaucoma caused by drugs, such as corticosteroids. A comprehensive review of the risks associated with corticosteroid-induced glaucoma is limited. Therefore, we used the Japanese Adverse Drug Event Reporting Database (JADER) published by the Pharmaceuticals and Medical Devices Agency (PMDA) to analyze the risk factors associated with glaucoma and the trends and characteristics of corticosteroid-induced glaucoma. We did not find sex or age differences associated with the onset of glaucoma. Hierarchical clustering and principal component analysis revealed that triamcinolone acetonide and betamethasone sodium phosphate, which are used around the eyes in Japan, are more likely to induce intraocular pressure (IOP) elevation compared with other corticosteroids. Increased IOP is a direct cause of glaucoma. Based on these findings, it may be necessary to limit or avoid the use of these corticosteroids.

Axial Length as a Risk Factor for Steroid-Induced Ocular Hypertension

PURPOSE

In this study, we aimed to assess whether axial length (AXL) is a true risk factor for steroid-induced ocular hypertension (OHT). We hypothesized that the proportion of patients with steroid-induced OHT among individuals who have received intravitreal dexamethasone (DEX) injections would differ according to the AXL of their eyes.

MATERIALS AND METHODS

A single-center, cross-sectional, case-control study was conducted on 467 eyes that underwent DEX implant injection owing to various retinal diseases. Intraocular pressure (IOP) was measured before the injection and 1 week and 1, 2, 3, 6, and 12 months after the injection. Enrolled patients were divided into OHT and normal IOP groups. Univariable logistic regression analysis was used to calculate odds ratios of steroid-induced OHT with significant variables being analyzed using a multivariable model.

RESULTS

A longer AXL was identified as a risk factor for steroid-induced OHT via both univariable and multivariable analyses, with an odds ratio of 1.216 [95% confidence interval (CI): 1.004-1.472, p=0.0452]. The optimal cut-off value for AXL in terms of steroid-induced OHT was 23.585 mm, with an odds ratio of 2.355 (95% CI: 1.429-3.882, p=0.0008).

CONCLUSION

Our findings indicate that a long AXL is a risk factor for steroid-induced OHT. Further, clinicians should be aware of steroid-induced OHT when treating patients with high myopia with steroids.

CLINICAL FEATURES OF INTRAVITREAL DEXAMETHASONE IMPLANTATION IN VITRECTOMIZED EYES OF PATIENTS WITH DIABETIC MACULAR EDEMA

PURPOSE

To identify the clinical outcomes of intravitreal dexamethasone implantation (IVD) in previously vitrectomized eyes of patients with diabetic macular edema.

METHOD

We performed a retrospective observational study. We recorded central subfield thickness, best-corrected visual acuity, and intraocular pressure up to 12 months after IVD implant placement. We compared the duration of IVD action, intraocular pressure trends, and the prevalence of ocular hypertension after the first IVD treatment of nonvitrectomized and vitrectomized eyes. We also compared the central subfield thickness, best-corrected visual acuity, number of IVD treatments, and prevalence of ocular hypertension between the 2 groups after 12 months.

RESULTS

We found no significant between-group differences in the central subfield thickness, best-corrected visual acuity, or the prevalence of ocular hypertension during treatment. However, the duration of action of the first IVD treatment was significantly shorter in vitrectomized eyes, and these eyes required more IVD treatments during the 12-month follow-up period. The maximal average intraocular pressure was observed at 2 months after the first IVD treatment in the nonvitrectomized group, but 1 month after the first IVD treatment in the vitrectomized group.

CONCLUSION

These findings suggest that the IVD pharmacokinetics and pharmacodynamics differ between vitrectomized and nonvitrectomized eyes. Nevertheless, given the relatively long-lasting effectiveness of the treatment and the good clinical results, consecutive IVD treatments may be beneficial for patients with diabetic macular edema with previously vitrectomized eyes.

Intravitreal Dexamethasone Implants for Refractory Macular Edema in Eyes with Noninfectious Uveitis

Macular edema (ME) is a common cause of visual loss among eyes with uveitis, and its management can be challenging. Steroids are an effective treatment for ME, and intravitreal dexamethasone (DEX) implants provide sustained steroid release. The purpose of this study is to evaluate intravitreal DEX implant on refractory ME in eyes with noninfectious uveitis. A retrospective study including 52 eyes of 37 patients with refractory uveitic ME was conducted from January 2011 through August 2017 at Linkou Chang Gung Memorial Hospital in Taiwan. Patients’ demographic characteristics were collected. In addition, clinical information, including corrected visual acuity (VA), intraocular pressure (IOP), and central retinal thickness (CRT) on optical coherence tomography, was recorded and analyzed. During the study period, affected eyes received a total of 110 intravitreal DEX implants (range, one to six in each eye). After the first DEX implant injection in all eyes, VA significantly improved at one and two months. CRT significantly decreased one month after a single DEX implant, and the effect lasted for six months and waned over time. Patients receiving multiple DEX implants still showed significant decreases in CRT one month after the first implant. Increases in IOP were noted one month after the DEX implant, but the IOP could be medically controlled. Intravitreal DEX implants can effectively treat refractory uveitic ME, improving both VA and CRT with an acceptable safety profile. Further studies are necessary to evaluate the effect of multiple implants and long-term outcomes.

Clinical Spectrum of Uveal Metastasis in Korean Patients Based on Primary Tumor Origin

PURPOSE

To describe the clinical features and prognosis of patients with uveal metastasis in Korea.

DESIGN

Retrospective, observational case series.

PARTICIPANTS

Patients diagnosed at 2 tertiary high-volume centers between November 2005 and November 2019.

METHODS

Evaluation of multimodal imaging and electronic medical records.

MAIN OUTCOME MEASURES

The clinical features and outcomes were assessed based on the primary cancer site.

RESULTS

A total of 134 uveal metastases (128 choroidal, 3 iris, and 3 ciliary body tumors) were diagnosed in 95 eyes of 80 patients. Mean age at diagnosis was 56 years (median, 55 years; range, 24-86 years), with a minor preponderance of women (61%). Tumors were bilateral in 15 patients (19%) and the primary origin was established in 49 patients (61%) before ocular detection. The primary tumor originated in the lung (48%), breast (24%), gastrointestinal tract (10%), liver (3%), pancreas (3%), kidney (1%), cervix (1%), and nasopharynx (1%), with some remaining unknown (10%). The overall 5-year survival rate was 21%. Kaplan-Meier analysis revealed that the worst survival was found in pancreatic cancers (mean survival, 5.9 months; P = 0.045), and the best survival was found in gastrointestinal tract cancers (mean survival, 44.5 months).

CONCLUSIONS

The primary tumor origins in Korean patients with uveal metastases differed from those reported in primarily population-based studies of White patients, with a higher prevalence of lung and gastrointestinal tract cancers.

Predicting the safety zone for steroid-induced ocular hypertension induced by intravitreal dexamethasone implantation

BACKGROUND/AIMS

This study aimed to predict the possibility of steroid-induced ocular hypertension (OHT) after intravitreal dexamethasone (DEX) implantation and to identify a proper safety zone for such injections.

METHODS

A cross-sectional observational study was conducted and included 908 patient eyes that underwent DEX implant injection due to various retinal diseases. Intraocular pressure (IOP) was measured before injection, at 1 week, and at 1, 2, 3, 6 and 12 months thereafter. Eyes of enrolled patients were divided into the OHT and normal IOP groups. Univariable logistic regression analysis was used to assess significant associations between steroid-induced OHT and covariates; significant and previously reported significant variables were analysed with a multivariable model, and predictive nomograms were developed.

RESULTS

Age, sex, axial length, glaucomatous eye, neovascular glaucoma, secondary glaucoma, uveitis history, hypertension, depression, diabetes mellitus and a history of previous laser-assisted in-situ keratomileusis or laser-assisted subepithelial keratectomy were significantly related to steroid-induced OHT (p<0.05). The calibration plot revealed good prediction under a predicted value of 0.4. Cut-off values for 80%, 86%, 91%, 95% and 98% sensitivity and specificity were offered for the safety zone after intravitreal DEX implantation.

CONCLUSION

We developed two nomograms to predict a safety zone for intravitreal DEX implantation. These can be used to identify individuals who may be safely prescribed steroid treatments and for whom extra caution should be exercised.

Clinical features and prognostic factors in 71 eyes over 20 years from patients with Coats' disease in Korea

This retrospective study assesses the clinical features, treatment strategies, and long-term outcomes of patients with Coats’ disease in Korea. Multimodal imaging and medical records of consecutive patients treated between July 2000 and April 2020 at two tertiary centers were evaluated based on onset age (adult vs. childhood [< 18 years]). Factors associated with final visual acuity (VA) and risk of treatment failure were assessed. A total of 71 eyes of 67 patients were included, with subgrouping by onset age showing 45% childhood and 55% adult cases. Overall, Stage 2 disease was most common at presentation (76%), though childhood cases had more Stage 3b (22% vs. 3%, P = 0.02) and greater clock hours of retinal telangiectasia (7 vs. 5, P = 0.005). First-line treatment included laser (25%), combined laser/anti-VEGF (23%), cryotherapy (20%), surgery (16%), and anti-VEGF only (9%). Cryotherapy was associated with a higher risk for secondary interventions (OR 11.8, P < 0.001), required in 56% overall. Despite a 3-line VA decrease in 34% overall, adult cases had superior final VA (P = 0.037). Multivariable regression showed that the number of anti-VEGF injections performed during the initial treatment period was associated with a 9.4 letter improvement in vision (P = 0.041). We observed a higher proportion of adult-onset Coats’ disease than previously reported in other non-Asian populations. An aggressive treatment with the addition of anti-VEGF may yield the most favorable long-term visual outcomes.

Investigating the Relationship between Glaucoma Prevalence and Trabecular Meshwork Length

Glaucoma is one of the most common causes of blindness worldwide, but the risk factors of glaucoma are yet to be fully understood. We investigated the relationship between the prevalence of glaucoma and trabecular meshwork (TM) length by comparing the mean TM length of a South Korean population with that of another ethnic population. We included 250 eyes of 125 patients who underwent anterior segment optical coherence tomography at Yonsei University Gangnam Severance Hospital between January 2015 and December 2017. We measured the distance from the scleral spur to Schwalbe’s line in patients with open and closed angles and calculated the TM length using the open- and closed-angle ratios in the general population. The mean TM length of the patients in our study was 752 ± 116 μm. Considering the compensated data, the estimated true mean TM length in the Korean population was 793 ± 76 μm, which was similar to the mean TM length of a previously evaluated Hispanic population, but differed significantly from those of previously evaluated Asian (Chinese), Caucasian, and African-American populations (p < 0.05). Our results support the hypothesis that the development of glaucoma would be affected by TM length.

Anti-Tumor Necrosis Factor Treatment in the Management of Pediatric Noninfectious Uveitis: Infliximab Versus Adalimumab

Purpose: Management of uveitis displays a particular challenge in childhood. This study aims to compare the efficacy and safety of infliximab (IFX) and adalimumab (ADA) in pediatric noninfectious uveitis that were refractory to conventional immunosuppresives. Methods: This retrospective single-center study included 33 patients who were treated with anti-tumor necrosis factor (TNF) agents (16 with IFX and 17 with ADA). Patients had diverse etiologies, including juvenile idiopathic arthritis, idiopathic uveitis, and Behçet's disease. Demographic characteristics, systemic diagnosis, findings of the ophthalmological examination, control of ocular inflammation, response to treatment, and the rate of clinical remission were studied. Results: Fourteen (87.5%) patients receiving IFX and 10 (58.8%) patients receiving ADA achieved response to treatment during the follow-up (P = 0.118). The agents were discontinued with complete clinical remission in 6 (37.5%) patients receiving IFX and in 2 (11.8%) patients receiving ADA (P = 0.118). Baseline visual acuities and parameters of inflammation improved significantly in both groups after anti-TNF therapy. Conclusion: Both IFX and ADA are safe and effective for pediatric noninfectious uveitis.

Initial Ten Years of Experience with the Intravitreal Dexamethasone Implant: A Retrospective Chart Review

Purpose

To evaluate the initial ten years of results from the intravitreal dexamethasone implant (DEX) in patients treated for retinal vein occlusion (RVO), diabetic macular edema (DME) or uveitis.

Methods

Retrospective chart review of patients receiving DEX since its FDA approval. Best-corrected visual acuity (BCVA), central macular thickness (CMT) on optical coherence tomography, intraocular pressure and cataract status were collected. Baseline data were collected from the initial DEX and post-treatment data at the visit at least four weeks after the last DEX.

Results

In total, 315 eyes received 1216 DEX over 63.9±4.6 weeks. In the branch RVO (n=90), central RVO (n=59) and DME (n=62) cohorts, BCVA improved significantly (p<0.05). The uveitis (n=154) cohort did not have a significant change in BCVA, 0.62±0.04 to 0.61±0.04 logMAR (p=0.34). Younger patients, vitrectomized eyes, and eyes without a history of glaucoma were associated with significantly better BCVA outcomes in the uveitis cohort (p<0.05). Overall, CMT decreased significantly from 376.6±6.8 to 322.7±5.0 µm (p<0.05). Intraocular pressure increased significantly (p<0.001) and the percentage of patients requiring anti-glaucoma medications increased from 33.0% to 67.6%. Of phakic eyes, 58.8% (n=63) had cataract progression or underwent surgery with those who underwent surgery experiencing a significant improvement in BCVA (p<0.05).

Conclusion

Repeated DEX over extended follow-up offers significant anatomic benefits to all cohorts. Visual benefits are only seen in RVO, DME and select uveitis demographics.

Effects of Repeated Intravitreal Injections of Dexamethasone Implants on Intraocular Pressure: A 4-Year Study

Purpose

Dexamethasone and other corticosteroids are administered intravitreally to treat a variety of retinal diseases. As a side effect, they can alter intraocular pressure (IOP). The purpose of this study is to describe the incidence, severity, and management of ocular hypertension following the administration of multiple intravitreal injections of dexamethasone implants.

Materials and Methods

A total of 78 eyes of 78 subjects (males 62%; females 38%; mean age 67 ± 13 years SD) received a total of 152 intravitreal injections of 0.7 mg dexamethasone implants over 4 years. Indications included retinal vein occlusion (87%), diabetic macular edema (9%), wet-type age-related macular degeneration (4%). Ocular hypertension was defined as intraocular pressure above 23 mmHg or any pressure increase of 10 mmHg or more from baseline values. IOP was measured by applanation tonometry before the injection (T0), as well as one week (T1), one month (T2), and three months (T3) afterwards.

Results

Five percent (4/78) of subjects developed ocular hypertension after the 1st injection. On the second and third rounds, additional 7.2% (3/42) and 4.2% (1/24) of subjects developed the same side effect. Among the 8 subjects who received a fourth injection, none was found with OHT. Pressure elevations were detected at T2 and T3. In all patients, topical medical therapy was sufficient to lower the IOP below threshold. Mean pressure variations following the first injection as compared to previous recorded values were +0.97 mmHg (T1), +0.92 mmHg (T2), and -0.41 mmHg (T3) (p < 0.05). Mean pressure variations following the second injection were +0.54 mmHg (T1), +0.23 mmHg (T2) and -0.66 mmHg (T3) (p < 0.05).

Conclusion

Ocular hypertension is a recognized side effect of intravitreal dexamethasone. Some patients develop it right after the first injection, while others develop it subsequently, on the 2nd or 3rd round. This side effect becomes most apparent 30-90 days following the implantation procedure and responds well to topical pressure-lowering medications.

Repeatability of binarization thresholding methods for optical coherence tomography angiography image quantification

Binarization is a critical step in analysis of retinal optical coherence tomography angiography (OCTA) images, but the repeatability of metrics produced from various binarization methods has not been fully assessed. This study set out to examine the repeatability of OCTA quantification metrics produced using different binarization thresholding methods, all of which have been applied in previous studies, across multiple devices and plexuses. Successive 3 × 3 mm foveal OCTA images of 13 healthy eyes were obtained on three different devices. For each image, contrast adjustments, 3 image processing techniques (linear registration, histogram normalization, and contrast-limited adaptive histogram equalization), and 11 binarization thresholding methods were independently applied. Vessel area density (VAD) and vessel length were calculated for retinal vascular images. Choriocapillaris (CC) images were quantified for VAD and flow deficit metrics. Repeatability, measured using the intra-class correlation coefficient, was inconsistent and generally not high (ICC < 0.8) across binarization thresholds, devices, and plexuses. In retinal vascular images, local thresholds tended to incorrectly binarize the foveal avascular zone as white (i.e., wrongly indicating flow). No image processing technique analyzed consistently resulted in highly repeatable metrics. Across contrast changes, retinal vascular images showed the lowest repeatability and CC images showed the highest.

Assessment of single nucleotide polymorphisms associated with steroid-induced ocular hypertension

AIM

To access the association of forty-eight single nucleotide polymorphisms (SNPs) identified from Caucasian population with steroid-induced ocular hypertension (OHT) in India population.

METHODS

Fifty-four triamcinolone-acetonide (TA) and forty-seven dexamethasone (Dex) administered subjects were enrolled in the study after a written consent. Intraocular pressure (IOP) values were recorded for a period of 6-month post steroid injections and patients were grouped as steroid-responders (SR: IOP≥21 mm Hg) and non-responders (NR: IOP≤20 mm Hg). Genomic DNA was isolated from peripheral venous blood. Forty-eight SNPs identified in TA treated Caucasian patients by genome wide association study (GWAS) were genotyped using iPLEX™ MassARRAY among TA as well as Dex administered Indian patients. Genotyping data of 48 general subjects from a previous study were considered as reference controls for statistical analysis. Genotypic frequencies were calculated and P-value, Chi-square and odds ratio at 95% confidence-interval of group A (steroid treated vs controls), group B (SR vs NR), group C (phenotype correlation: influence of time, severity and gender on IOP rise), were calculated. P<0.05 was considered to be statistically significant.

RESULTS

OHT was observed in 50% of TA and 26% of Dex administered patients, respectively. IOP rise was mostly severe (>30 mm Hg) and immediate (<1wk) among TA-SR patients while it was noticed to be mild (<30 mm Hg) and between 1-2mo among Dex-SR patients. Logistic regression for risk factor correlation with OHT remained non-significant, hence these factors were not considered as confounding parameters for further analysis. rs133, rs34016742, rs274554, rs10936746, rs274547, rs804854, rs7751500, rs359498, and rs7547448 SNPs significantly varied even after Bonferroni corrections (P<0.0025; group A). rs1879370 (TA) and rs6559662 (Dex) were significantly (P<0.05) associated with OHT (group B). rs133 (severe IOP rise), rs11047639 and rs1879370 (male gender), and rs11171569 (immediate IOP rise) significantly (P<0.05) influenced the phenotype correlation only among TA-OHT patients. However, the significance of these SNPs in group B and phenotype analysis (group C) was lost upon Bonferroni corrections (P<0.0025).

CONCLUSION

Prevalence of OHT in study population is observed to be similar to other studies both in TA and Dex treated patients. We can correlate rs34016742 involved in diabetes signaling pathway to the occurrence of ocular edematous and inflammatory conditions. Except rs133 that is involved in neuro-degeneration and myopia occurrence, none of the other SNPs identified in Caucasian population possess any correlation with OHT incidence in TA and Dex administered Indian subjects.

Risk factors for ocular hypertension after intravitreal dexamethasone implantation in diabetic macular edema

We designed a retrospective observational study to identify factors associated with ocular hypertension [OHTN, defined as intraocular pressure (IOP) > 25 mmHg] after intravitreal dexamethasone (IVD) implantation in diabetic macular edema (DME) patients. We measured IOP monthly after placement of an IVD implant, and identified the trend of IOP, incidence of OHTN, and its associated systemic or ocular factors. On average, IOP was highest at 2 months after IVD implantation. Of 84 DME patients who received an IVD implant, 3 (3.57%) presented with an IOP ≥ 25 mmHg at 1 month after implantation, 6 (7.14%) at 2 months, and 2 (2.38%) at 3 months. Compared with the non-OHTN group, the OHTN group had significantly shorter axial lengths and were younger. Logistic regression analysis revealed that axial length < 23.00 mm and age < 57 years were associated with OHTN occurrence. Patients whose IOP was elevated > 30% or ≥ 20 mmHg at 1 month post-implantation, subsequently developed OHTN with statistical significance. In conclusion, shorter axial length and younger age were associated with OHTN occurrence after IVD implantation. Additionally, identifying levels or trends in IOP at 1 month after the IVD procedure may be helpful in predicting subsequent OHTN occurrence.

Age as a risk factor for steroid-induced ocular hypertension in the non-paediatric population

BACKGROUND/AIMS

To evaluate the age-related risk of steroid-induced ocular hypertension by analysing intraocular pressure (IOP) changes after intravitreal dexamethasone (DEX, Ozurdex) implant injection.

METHODS

A retrospective observational study was conducted among patients (n=455; 570 eyes) who had received DEX injection. IOP was measured prior to injection and after 1 week and 1, 2, 3, 6 and 12 months. Results were divided into seven categories based on patient age: 16-30, 31-40, 41-50, 51-60, 61-70, 71-80 and 81-90 years. The IOP elevation rate was compared among the groups.

RESULTS

The IOP elevation rate was 42.9% in patients aged ≤30 years (35.3%, 28.3%, 14.9%, 12.2%, 8.4% and 9.1% in the 31-40, 41-50, 51-60, 61-70, 71-80 and 81-90 groups, respectively). Regardless of how IOP was measured, there was an increasing trend in the incidence of IOP elevation with decreasing age. Furthermore, there was a significant stepwise increase in the OR with decreasing age groups. After the 51-60 group was set as the reference point, the ORs (95% CIs) were 5.048 (1.436 to 17.747), 3.671 (1.101 to 12.238), 2.538 (1.043 to 6.178), 0.947 (0.431 to 2.078), 0.713 (0.312 to 1.626) and 0.646 (0.137 to 3.048) in the ≤30, 31-40, 41-50, 61-70, 71-80 and 81-90 groups, respectively.

CONCLUSION

The rate of adverse elevations in IOP after steroid use was significantly lower in older patients than in younger patients. Therefore, caution is required when prescribing steroids to younger patients (<51 years).

Steroid-induced glaucoma: Epidemiology, pathophysiology, and clinical management

Glucocorticoids are a class of anti-inflammatory drugs commonly used to treat various ocular and systemic conditions. Although the role of glucocorticoids in the treatment of numerous serious inflammatory diseases is pivotal, their prolonged use may increase intraocular pressure resulting in steroid-induced glaucoma. We provide a detailed update on steroid-induced glaucoma as a preventable cause of blindness in the adult and pediatric population and describe its epidemiology, social impact, and risk factors. Furthermore, we explore the propensity of different steroids to increase the intraocular pressure, the role of different routes of steroid administration, dosage and duration of treatment, as well as the clinical features, genetics, and management of steroid-induced glaucoma.