Ocular hypertension following intravitreal steroid injections: a comparative study between triamcinolone-acetonide and dexamethasone-implant
Reviewed by Sofia Rokerya

This was a retrospective observational study of steroid response following 1549 intravitreal steroid (TA and Dex) injections. One thousand and seventy-five eyes of 897 patients were reviewed. Glaucoma patients, glaucoma suspects, uveitis, trauma, and cases with less than one month of intraocular pressure (IOP) follow-up were excluded from the study. The eligible cohort for the study constituted 528 TA injections in 311 eyes of 248 patients and 510 Dex injections in 333 eyes of 271 patients. The mean age of patients receiving TA and Dex injection was 58.82 ±10.52 years and 59.35 ±10.36 years respectively. The corresponding male to female ratio was 2.8:1 and 3.3:1 for TA and Dex-administered groups, respectively. Bilateral injections were given in 23% and 25% of patients in the TA and Dex-treated groups, respectively. Diabetic macular edema (DME), retinal vein occlusion (RVO), and cystoid macular edema (CME) were the main indications among both steroid treatments. Multiple injections of TA were given in 123 (39.5%) eyes, and multiple Dex was administered in 101 (30.3%) eyes, respectively. The mean time interval between two consecutive steroid injections was five months, which did not vary significantly between TA and Dex treatments (p = 0.16). Patients were categorised as steroid-responders (SR): IOP≥21mmHg, and steroid non-responders (NR): IOP≤20mmHg. It was observed that the TA-treated group had a higher ocular hypertension (OHT) incidence than the Dex-treated group (p < 0.001). After six months of follow-up IOP observations, following intravitreal injection(s), steroid-induced OHT was observed in 87 (28%) eyes of TA and 56 (17%) eyes of Dex administrations. Males and subjects older than 40 years of age were at higher risk for OHT following steroid treatment. A high percentage of IOP rise was observed on day one (41%) for TA-SR, and after one month (50%) for Dex-SR. IOP rise was found to be more severe (>30mmHg) for TA-SR compared to Dex-SR (p = 0.006). Six percent TA-SR required trabeculectomy with medically uncontrollable IOP. Myopia is a risk factor for secondary OHT, whereas diabetes mellitus and hypercholesterolemia are protective; however, this potential correlation may require further large scale prospective and genetic association studies to confirm the findings. Strength: Large cohort. Weakness: Retrospective design.

Risk factors, treatment, and outcome of ocular hypertension following intravitreal steroid injections: a comparative study.
Badrinarayanana L, Rishi P, George R, et al.
OPHTHALMOLOGICA
2022;245(5):431-8.