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The effects of temporary intraocular pressure spikes after intravitreal dexamethasone implantation on the retinal nerve fiber layer

Authors Wannamaker KW, Kenny S, Das R, Mendlovitz A, Comstock JM, Chu ER, Bahadorani S, Gresores NJ, Beck KD, Krambeer CJ, Kermany DS, Diaz-Rohena R, Nolan DP, Sohn JH, Singer MA

Received 13 January 2019

Accepted for publication 3 May 2019

Published 27 June 2019 Volume 2019:13 Pages 1079—1086


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Dr Scott Fraser

Kendall W Wannamaker,1 Sarah Kenny,1 Rishi Das,1 Aaron Mendlovitz,2 Jordan M Comstock,1 Edward R Chu,1 Sepehr Bahadorani,1 Nathan J Gresores,2 Kinley D Beck,1 Chelsey J Krambeer,2 Daniel S Kermany,2 Roberto Diaz-Rohena,1 Daniel P Nolan,2 Jeong-Hyeon Sohn,1 Michael A Singer2

1Ophthalmology, University of Texas Health Science Center San Antonio, San Antonio, TX, USA; 2Medical Center Ophthalmology Associates, San Antonio, TX, USA

Background and objective: The dexamethasone (DEX) implant is known to cause temporary intraocular pressure (IOP) spikes after implantation. The purpose of this study is to determine if IOP spikes after DEX implant cause significant thinning in the retinal nerve fiber layer (RNFL).
Study design, patients, and methods: A total of 306 charts were reviewed with 48 and 21 patients meeting inclusion criteria for the cross-sectional and prospective groups, respectively. Cross-sectional inclusion criteria: IOP spike ≥22 mmHg up to 16 weeks after DEX implant, DEX implant in only 1 eye per patient, and spectral-domain optical coherence tomography (OCT) RNFL imaging of both eyes ≥3 months after IOP spike. Prospective inclusion criteria: OCT RNFL performed within 1 year prior to DEX implantation, IOP spike ≥22 mmHg up to 16 weeks after DEX implant, and OCT RNFL performed ≥3 months after IOP spike. The average RNFL thickness in the contralateral eye was used as the control in the cross-sectional group. Institutional review board approval was obtained.
Results: In the cross-sectional group, there was no statistically significant difference in the mean RNFL thicknesses in the treated vs untreated eyes (80.4±15.5 μm and 82.6±15.8 μm, respectively; P=0.33) regardless of treatment diagnosis, magnitude of IOP spike, or history of glaucoma. In the prospective group, mean RNFL thicknesses before and after IOP spikes ≥22 mmHg were similar (78.0±14.8 μm and 75.6±13.6 μm, respectively; P=0.13).
Conclusion and relevance: Temporary elevation of IOP after DEX implantation when treated with topical IOP lowering drops does not appear to lead to a meaningful change in RNFL thickness.

Keywords: Ozurdex®, dexamethasone, glaucoma, intraocular pressure, retinal nerve fiber layer, ocular hypertension

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