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Ophthalmology and Therapy
Published in: Ophthalmology and Therapy 1/2016

Open Access 01-06-2016 | Original Research

Elevated Intraocular Pressure After Intravitreal Steroid Injection in Diabetic Macular Edema: Monitoring and Management

Authors: Francisco J. Goñi, Ingeborg Stalmans, Philippe Denis, Jean-Philippe Nordmann, Simon Taylor, Michael Diestelhorst, Antonio R. Figueiredo, David F. Garway-Heath

Published in: Ophthalmology and Therapy | Issue 1/2016

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Abstract

Introduction

With the increasing use of intravitreal administration of corticosteroids in macular edema, steroid-induced intraocular pressure (IOP) rise is becoming an emergent issue. However, for patients in whom intravitreal steroids are indicated, there are no specific recommendations for IOP monitoring and management after intravitreal administration of corticosteroids.

Method

An expert panel of European ophthalmologists reviewed evidence on corticosteroid-induced IOP elevation. The objective of the panel was to propose an algorithm based on available literature and their own experience for the monitoring and management of corticosteroid-induced IOP elevation, with a focus on diabetic patients.

Results

Data from trials including diabetic patients with a rise of IOP after intravitreal steroid administration indicate that IOP-lowering medical treatment is sufficient for a large majority of patients; only a small percentage underwent laser trabeculoplasty or filtering filtration surgery. A 2-step algorithm is proposed that is based on the basal value of IOP and evidence for glaucoma. The first step is a risk stratification before treatment. Patients normotensive at baseline (IOP ≤ 21 mmHg), do not require additional baseline diagnostic tests. However, patients with baseline ocular hypertension (OHT) (IOP > 21 mmHg) should undergo baseline imaging and visual field testing. The second step describes monitoring and treatment after steroid administration. During follow-up, patients developing OHT should have baseline and periodical imaging and visual field testing; IOP-lowering treatment is proposed only if IOP is >25 mmHg or if diagnostic tests suggest developing glaucoma.

Conclusion

The management and follow-up of OHT following intravitreal corticosteroid injection is similar to that of primary OHT. If OHT develops, IOP is controlled in a large proportion of patients with standard IOP treatments. The present algorithm was developed to assist ophthalmologists with guiding principles in the management of corticosteroid-induced IOP elevation.

Funding

Alimera Sciences Limited.
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Metadata
Title
Elevated Intraocular Pressure After Intravitreal Steroid Injection in Diabetic Macular Edema: Monitoring and Management
Authors
Francisco J. Goñi
Ingeborg Stalmans
Philippe Denis
Jean-Philippe Nordmann
Simon Taylor
Michael Diestelhorst
Antonio R. Figueiredo
David F. Garway-Heath
Publication date
01-06-2016
Publisher
Springer Healthcare
Published in
Ophthalmology and Therapy / Issue 1/2016
Print ISSN: 2193-8245
Electronic ISSN: 2193-6528
DOI
https://doi.org/10.1007/s40123-016-0052-8

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