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Graefe's Archive for Clinical and Experimental Ophthalmology

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Open Access 11-07-2023 | Edema | Glaucoma

Incidence and treatment approach of intraocular pressure elevation after various types of local steroids for retinal diseases

Authors: Agata Anna Wykrota, Alaa Din Abdin, Cristian Munteanu, Ursula Löw, Berthold Seitz

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 12/2023

Abstract

Purpose

For the treatment of macular edema, in addition to the use of antivascular endothelial growth factors, steroids are also used intravitreally and sub-Tenon. Side effects include among others cataract formation and elevation of intraocular pressure (IOP). The aim of this retrospective study was to elicit the IOP elevation after administration of various steroidal medication, the time of onset, and the efficacy of the administered IOP-lowering therapies.

Methods

We included 428 eyes with a postoperative (n = 136), diabetic (n = 148), uveitic macular edema (n = 61), and macular edema after retinal vein occlusion (n = 83). These patients were treated with one or more diverse steroidal agents once or multiple times. These drugs included: triamcinolone acetonide (TMC) as intravitreal injection (TMC IVI) or sub-Tenon (TMC ST), as well as dexamethasone (DXM) and fluocinolone acetonide (FA) intravitreally. An increase of IOP of ≥ 25 mmHg was designated as pathological. A steroid response in anamnesis, the time of onset of IOP rise from the first administration, and the therapy administered were documented.

Results

Of 428 eyes, 168 eyes (39.3%) had IOP elevation up to a mean of 29.7 (SD ± 5.6) mmHg, which occurred at a median of 5.5 months. Steroids most frequently leading to rise of IOP included DXM (39.1% of all eyes receiving that drug), TMC IVI (47.6%), TMC ST combined with DXM (51.5%), DXM with FA (56.8%), and TMC IVI with DXM (57.4%). A Kaplan–Meier analysis and the Log Rank test showed a significant difference (p < 0.001). IOP rise was treated as follows: 119 conservatively (70.8%), and 21 surgically (12.5%, cyclophotocoagulation 8.3%, filtering surgery 1.8%, in 4 the steroidal drug implant was removed 2.4%), and 28 eyes received no therapy (16.7%). Sufficient IOP regulation was achieved in 82 eyes (68.9%) with topical therapy. In 37 eyes (31.1%) with persistently elevated intraocular pressure, topical therapy had to be continued over the follow-up of 20 ± 7 months.

Conclusions

IOP increases after any type of steroid application are not rare. Results of our study let us suspect that especially therapy with intravitreal dexamethasone, either as a monotherapy or in combination with another steroid, tends to increase IOP more than other steroids. Regular IOP checks are necessary after each steroid administration, with possible initiation of long-term conservative and/or surgical therapy if necessary.

Quigley HA, Broman AT (2006) The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol 90:262–267. https://doi.org/10.1136/bjo.2005.081224CrossRefPubMedPubMedCentral

Kwon YH, Fingert JH, Kuehn MH, Alward WL (2009) Primary open-angle glaucoma. N Engl J Med 360:1113–1124. https://doi.org/10.1056/NEJMra0804630CrossRefPubMedPubMedCentral

Anderson DR (2011) Normal-tension glaucoma (Low-tension glaucoma). Indian J Ophthalmol 59:97–101. https://doi.org/10.4103/0301-4738.73695CrossRef

Kass MA, Heuer DK, Higginbotham EJ, Johnson CA, Keltner JL, Miller JP, Parrish RK 2nd, Wilson MR, Gordon MO (2002) The ocular hypertension treatment study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol 120:701–713. https://doi.org/10.1001/archopht.120.6.701. (discussion 829-830)CrossRefPubMed

Fini ME, Schwartz SG, Gao X, Jeong S, Patel N, Itakura T, Price MO, Price FW Jr, Varma R, Stamer WD (2017) Steroid-induced ocular hypertension/glaucoma: Focus on pharmacogenomics and implications for precision medicine. Prog Retin Eye Res 56:58–83. https://doi.org/10.1016/j.preteyeres.2016.09.003CrossRefPubMed

McLean JM (1950) Use of ACTH and cortisone. Trans Am Ophthalmol Soc 48:293–296

Francois J (1964) Cortisone and eye strain. Ann Ocul (Paris) 187:805–816

Sacconi R, Giuffrè C, Corbelli E, Borrelli E, Querques G, Bandello F (2019) Emerging therapies in the management of macular edema: a review. F1000Res 8:1413. https://doi.org/10.12688/f1000research.19198.1CrossRef

Hoffmann EM, Lamparter J (2016) Differentiation of ocular hypertension. Ophthalmologe 113:715–728. https://doi.org/10.1007/s00347-016-0304-yCrossRefPubMed

10.

Jones R 3rd, Rhee DJ (2006) Corticosteroid-induced ocular hypertension and glaucoma: a brief review and update of the literature. Curr Opin Ophthalmol 17:163–167. https://doi.org/10.1097/01.icu.0000193079.55240.18CrossRefPubMed

11.

Spira-Eppig C, Eppig T, Bischof M, Schießl G, Milioti G, Käsmann-Kellner B, Carstensen H, Schick B, Seitz B (2018) Per aspera ad astra : implementation of electronic patient records in a university eye hospital : Experience with FIDUS in the Clinic for Ophthalmology at the Saarland University Center UKS. Ophthalmologe 115:868–877. https://doi.org/10.1007/s00347-017-0588-6CrossRefPubMed

12.

Malclès A, Dot C, Voirin N, Vié AL, Agard É, Bellocq D, Denis P, Kodjikian L (2017) Safety of intravitreal dexamethasone implant (Ozurdex): The SAFODEX study. Incidence and Risk Factors of Ocular Hypertension. Retina 37:1352–1359. https://doi.org/10.1097/IAE.0000000000001369CrossRefPubMed

13.

Abdin AD, Suffo S, Bischoff-Jung M, Daas L, Pattmöller M, Seitz B (2020) Advantages of a designated IVI center for a German university eye hospital. Ophthalmologe 117:50–57. https://doi.org/10.1007/s00347-019-0911-5CrossRefPubMed

14.

Aljundi W, Daas L, Abu Dail Y, Käsmann-Kellner B, Seitz B, Abdin AD (2022) Topical NSAIDs and oral acetazolamide for macular edema after uncomplicated phacoemulsification: outcome and predictors of non-response. J Clin Med 11:5537. https://doi.org/10.3390/jcm11195537CrossRefPubMedPubMedCentral

15.

Sobrin L, D’Amico DJ (2005) Controversies in intravitreal triamcinolone acetonide use. Int Ophthalmol Clin 45:133–141. https://doi.org/10.1097/01.iio.0000176353.56990.3bCrossRefPubMed

16.

Beer PM, Bakri SJ, Singh RJ, Liu W, Peters GB 3rd, Miller M (2003) Intraocular concentration and pharmacokinetics of triamcinolone acetonide after a single intravitreal injection. Ophthalmology 110:681–686. https://doi.org/10.1016/S0161-6420(02)01969-3CrossRefPubMed

17.

Shen L, You Y, Sun S, Chen Y, Qu J, Cheng L (2010) Intraocular and systemic pharmacokinetics of triamcinlone acetonide after a single 40-mg posterior subtenon application. Ophthalmology 117:2365–2371. https://doi.org/10.1016/j.ophtha.2010.03.033CrossRefPubMed

18.

Thomas ER, Wang J, Ege E, Madsen R, Hainsworth DP (2006) Intravitreal triamcinolone acetonide concentration after subtenon injection. Am J Ophthalmol 142:860–861. https://doi.org/10.1016/j.ajo.2006.05.023CrossRefPubMed

19.

Inoue M, Takeda K, Morita K, Yamada M, Tanigawara Y, Oguchi Y (2004) Vitreous concentrations of triamcinolone acetonide in human eyes after intravitreal or subtenon injection. Am J Ophthalmol 138:1046–1048. https://doi.org/10.1016/j.ajo.2004.05.028CrossRefPubMed

20.

Haller JA, Dugel P, Weinberg DV, Chou C, Whitcup SM (2009) Evaluation of the safety and performance of an applicator for a novel intravitreal dexamethasone drug delivery system for the treatment of macular edema. Retina 29:46–51. https://doi.org/10.1097/IAE.0b013e318188c814CrossRefPubMed

21.

Schmitz K, Maier M, Clemens CR, Höhn F, Wachtlin J, Lehmann F, Bertelmann T, Rüdiger K, Horn M, Bezatis A, Spital G, Meyer CH, German Retinal Vein Occlusion Group (2014) Reliability and safety of intravitreal Ozurdex injections. The ZERO study. Ophthalmologe 111:44–52. https://doi.org/10.1007/s00347-012-2737-2CrossRefPubMed

22.

ILUVIEN Summary of Product Characteristics. https://www.medicines.org.uk/emc/medicine/27636. Accessed 22 Jan 2023

23.

Massa H, Nagar AM, Vergados A, Dadoukis P, Patra S, Panos GD (2019) Intravitreal fluocinolone acetonide implant (ILUVIEN®) for diabetic macular oedema: a literature review. J Int Med Res 47:31–43. https://doi.org/10.1177/0300060518816884CrossRefPubMed

24.

Schmitt-Eilenberger VK, Augustin AJ (2013) Early experience with Iluvien for the treatment of chronic DME. Retina Today July/August:34–37. http://retinatoday.com/2013/08/early-experience-with-iluvien-for-the-treatment-of-chronic-dme/

25.

Doucette LP, Walter MA (2017) Prostaglandins in the eye: Function, expression, and roles in glaucoma. Ophthalmic Genet 38:108–116. https://doi.org/10.3109/13816810.2016.1164193CrossRefPubMed

26.

Armstrong RA (2013) Statistical guidelines for the analysis of data obtained from one or both eyes. Ophthalmic Physiol Opt 33:7–14. https://doi.org/10.1111/opo.12009CrossRefPubMed

27.

Scott IU, Ip MS, VanVeldhuisen PC, Oden NL, Blodi BA, Fisher M, Chan CK, Gonzalez VH, Singerman LJ, Tolentino M, SCORE StudyResearch Group (2009) A randomized trial comparing the efficacy and safety of intravitreal triamcinolone with standard care to treat vision loss associated with macular edema secondary to branch retinal vein occlusion: the Standard Care versus Corticosteroid for Retinal Vein Occlusion (SCORE) study report 6. Arch Ophthalmol 127:1115–1128. https://doi.org/10.1001/archophthalmol.2009.233CrossRefPubMedPubMedCentral

28.

Tao Y, Jonas JB (2011) Intravitreal Triamcinolone. Ophthalmologica 225:1–20. https://doi.org/10.1159/000317909CrossRefPubMed

29.

Ip MS, Scott IU, VanVeldhuisen PC, Oden NL, Blodi BA, Fisher M, Singerman LJ, Tolentino M, Chan CK, Gonzalez VH, SCORE Study Research Group (2009) A randomized trial comparing the efficacy and safety of intravitreal triamcinolone with observation to treat vision loss associated with macular edema secondary to central retinal vein occlusion: the Standard Care versus Corticosteroid for Retinal Vein Occlusion (SCORE) study repost 5. Arch Ophthalmol 127:1101–1114. https://doi.org/10.1001/archophthalmol.2009.234CrossRefPubMedPubMedCentral

30.

Jonas JB, Degenring RF, Kreissig I, Akkoyun I, Kamppeter BA (2005) Intraocular pressure elevation after intravitreal triamcinolone acetonide injection. Ophthalmology 112:593–598. https://doi.org/10.1016/j.ophtha.2004.10.042CrossRefPubMed

31.

Cardillo JA, Melo LAS Jr, Costa RA, Skaf M, Belfort R Jr, Souza-Filho AAS, Farah ME, Kuppermann BD (2005) Comparison of intravitreal versus posterior sub-Tenon´s capsule injection of triamcinolone acetonide for diffuse diabetic macular edema. Ophthalmology 112:1557–1563. https://doi.org/10.1016/j.ophtha.2005.03.023CrossRefPubMed

32.

Mora P, Eperon S, Felt-Baeyens O, Gurny R, Sagodira S, Breton P, Guex-Crosier Y (2005) Trans-scleral diffusion of triamcinolone acetonide. Curr Eye Res 30:355–361. https://doi.org/10.1080/02713680590934094CrossRefPubMed

33.

Razeghinejad MR, Katz LJ (2012) Steroid-induced iatrogenic glaucoma. Ophthalmic Res 47:66–80. https://doi.org/10.1159/000328630CrossRefPubMed

34.

Rezkallah A, Mathis T, Abukhashbah A, Voirin N, Malclès A, Agard É, Lereuil T, Denis P, Dot C, Kodjikian L (2021) Long-term incidence and risk factors of ocular hypertension following dexamethasone-implant injections. The SAFODEX-2 study. Retina 41:1438–1445. https://doi.org/10.1097/IAE.0000000000003080CrossRefPubMed

35.

Alfaqawi F, Lip PL, Elsherbiny S, Chavan R, Mitra A, Mushataq B (2017) Report of 12-months efficacy and safety of intravitreal fluocinolone acetonide implant for the treatment of chronic diabetic macular oedema: a real-world result in the United Kingdom. Eye (Lond) 31:650–656. https://doi.org/10.1038/eye.2016.301CrossRefPubMed

36.

Fallico M, Maugeri A, Lotery A, Longo A, Bonfiglio V, Russo A, Avitabile T, Furino C, Cennamo G, Barchitta M, Agodi A, Marolo P, Ventre L, Caselgrandi P, Reibaldi M (2021) Fluocinolone acetonide vitreous insert for chronic diabetic macular oedema: a systematic review with meta-analysis of real-world experience. Sci Rep 11:4800. https://doi.org/10.1038/s41598-021-84362-yCrossRefPubMedPubMedCentral

37.

Handzel DM, Briesen S, Romanou-Papadopoulou V, Dardenne CM, Remmel RM (2009) Behandlung des Irvine-Gass-Syndroms durch Sub-Tenon-Injektion von Triamcinolon. Retina and Uveitis 25–34

38.

Ozurdex Summary of Product Characteristics. https://www.medicines.org.uk/emc/medicine/23422. Accessed 22 Jan 2023

39.

Maturi RK, Pollack A, Uy HS, Varano M, Gomes AMV, Li XY, Cui H, Lou J, Hashad Y, Whitcup SM, Ozurdex MEAD Study Group (2016) Intraocular pressure in patients with diabetic macular edema treated with dexamethasone intravitreal implant in the 3-year MEAD study. Retina 36:1143–1152. https://doi.org/10.1097/IAE.0000000000001004CrossRefPubMed

40.

Pearson PA, Comstock TL, Ip M, Callanan D, Morse LS, Ashton P, Levy B, Mann ES, Eliott D (2011) Fluocinolone acetonide intravitreal implant for diabetic macular edema: a 3-year multicenter, randomized, controlled clinical trial. Ophthalmology 118:1580–1587. https://doi.org/10.1016/j.ophtha.2011.02.048CrossRefPubMed

41.

Bailey C, Chakravarthy U, Lotery A, Menon G, Talks J, Medisoft Audit Group (2017) Real-world experience with 0.2 µg/day fluocinolone acetonide intravitreal implant (ILUVIEN) in the United Kingdom. Eye (Lond) 31:1707–1715. https://doi.org/10.1038/eye.2017.125CrossRefPubMed

42.

Li X, Wang N, Liang X, Xu G, Li XY, Jiao J, Lou J, Hashad Y, China Ozurdex in RVO Study Group (2018) Safety and efficacy of dexamethasone intravitreal implant for treatment of macular edema secondary to retinal vein occlusion in Chinese patients: randomized, sham-controlled, multicenter study. Graefes Arch Clin Exp Ophthalmol 256:59–69. https://doi.org/10.1007/s00417-017-3831-6CrossRefPubMed

43.

Chakravarthy U, Taylor SR, Koch FHJ, de Sousa JPC, Bailey C, ILUVIEN Registry Safety Study (IRISS) Investigators Group (2019) Changes in intraocular pressure after intravitreal fluocinolone acetonide (ILUVIEN): real-world experience in three European countries. Br J Ophthalmol 103:1072–1077. https://doi.org/10.1136/bjophthalmol-2018-312284CrossRefPubMed

44.

Chin EK, Almeida DRP, Velez G, Xu K, Peraire M, Corbella M, Elshatory YM, Kwon YH, Gehrs KM, Boldt HC, Sohn EH, Russell SR, Folk JC, Mahajan VB (2017) Ocular Hypertension after Intravitreal Dexamethasone (Ozurdex) Sustained-Release Implant. Retina 37:1345–1351. https://doi.org/10.1097/IAE.0000000000001364CrossRefPubMedPubMedCentral

45.

Levin DS, Han DP, Dev S, Wirostko WJ, Mieler WF, Connor TB, George V, Eastwood D (2002) Subtenon´s depot corticosteroid injections in patients with a history of corticosteroid-induced intraocular pressure elevation. Am J Ophthalmol 133:196–202. https://doi.org/10.1016/s0002-9394(01)01372-1CrossRefPubMed

Title: Incidence and treatment approach of intraocular pressure elevation after various types of local steroids for retinal diseases
Authors: Agata Anna Wykrota
Alaa Din Abdin
Cristian Munteanu
Ursula Löw
Berthold Seitz
Publication date: 11-07-2023
Publisher: Springer Berlin Heidelberg
Keywords: Edema
Glaucoma
Hypertension
Cyclophotocoagulation
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 12/2023
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-023-06163-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Incidence and treatment approach of intraocular pressure elevation after various types of local steroids for retinal diseases

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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