Multiple Ozurdex (dexamethasone intravitreal implant, Allergan) injections can cause mild and moderate spikes in intraocular pressure (IOP), but not severe spikes beyond 30mm HG, according to research published in Clinical Ophthalmology.

Researchers sought to investigate the frequency and degree of ocular hypertension associated with sequential injections of Ozurdex and to determine whether topical medications were sufficient for controlling IOP in these patients.

In this retrospective review study, researchers studied the IOP fluctuations for a total of 183 injections over a period of at least 12 months. The main indications for treatment were uveitis, diabetic macular edema (DME) and retinal vein occlusion (RVO). A total of 139 eyes received a single injection, 25 eyes were administered two injections and 19 eyes were given three injections. The frequency of ocular hypertension was mild (31%, 26%, 53%), moderate (26%, 24%, 42%) and severe (12%, 12%, 11%) for single, two and three injections, respectively.

Following a single injection, patients with primary open-angle glaucoma (POAG) had a significantly higher IOP (25.1 ± 1.7) compared with patients with no medical or family history of glaucoma (20.8 ± 0.65). Among the treatment groups, patients with uveitis had the highest IOP after a single injection, followed by central RVO, branch RVO and DME groups.

On average, patients with an IOP of ≥28.6mm Hg received pressure-lowering medications, after which their IOP reached a stable level (16.7mm Hg) without the need for additional interventions.

“Among treatment groups, patients with POAG had a significantly higher IOP spike compared to the control group. Therefore, given their increased susceptibility for IOP elevations, dexamethasone implants should be used with caution in patients with POAG,” researchers said. “Finally, patients with uveitis had the highest IOP spike, presumably due to the uveitis-mediated IOP spike, as well as previous treatments with steroids.”

Bahadorani S, Krambeer C, Wannamaker K. The effects of repeated Ozurdex injections on ocular hypertension. Clin Ophthalmol. 2018 April 3;12:639-642.