Short-term change of intraocular pressure following inravitreal dexamethasone implantation_Chinese Journal of Ocular Fundus Diseases

Authors：

Zhao Jing ,  Dai Hong , Zhang Peng , Zheng Bodi

Department of Ophthalmology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China;

Corresponding?author：

Dai Hong, Email: dai-hong@x263.net

Keywords：

Dexamethasone/therapeutic use; Macular edema/drug therapy; Intraocular pressure

DOI：

10.3760/cma.j.cn511434-20200522-00234

Video：

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Objective To observe the short-term intraocular pressure changes of the affected eye after the implantation of dexamethasone vitreous implant (Ozurdex), and indirectly understand the tightness of the scleral perforation of the 22G implant device.Methods This is a prospective cohort design clinical observational study. From January 2018 to January 2020, 90 eyes (90 patients) who underwent vitreous Ozurdex implantation in the Department of Ophthalmology of Beijing Hospital were included in the study. There were 52 males (52 eyes), and 38 females (38 eyes); they were 14-79 years old. Forty-three eyes (43 patients) had retinal vein occlusion with macular edema, 29 eyes (29 patients) had uveitis with or without macular edema, 18 eyes (18 patients) had diabetic macular edema. All eyes underwent standard scleral tunnel vitreous cavity implantation Ozurdex treatment. The intraocular pressure was measured with a non-contact pneumatic tonometer 10 min before implantation (baseline) and 10, 30 min and 2, 24 h after implantation. The difference were compared between the intraocular pressure at different time points after implantation and the baseline. Wilcoxon signed rank test was used to compare intraocular pressure between baseline and different time points after implantation.Results The average baseline intraocular pressure of the affected eye was 14.85 [interquartile range (IQR): 11.60, 17.63] mmHg (1 mmHg=0.133 kPa). The average intraocular pressure at 10, 30 and 2, 24 hours after implantation were 11.90 (IQR: 8.95, 16.30), 13.75 (IQR: 9.95, 16.80), 13.60 (IQR: 10.95, 17.20), and 14.65 (IQR: 12.20, 17.50) mmHg. Compared with the baseline intraocular pressure, the intraocular pressure decreased at 10 and 30 minutes after implantation, the difference was statistically significant (P＜0.001, P=0.002); the intraocular pressure difference was not statistically significant at 2, 24 h after implantation (P=0.140, 0.280).Conclusions There is a statistically significant difference in intraocular pressure reduction compared with the baseline in 10 and 30 minutes after vitreous implantation of Ozurdex, and there is no statistically significant difference between 2, 24 hours. This suggests that the 22G scleral puncture port of the preinstalled implant device cannot be completely closed immediately, and short-term intraocular pressure monitoring after implantation should be appropriately strengthened.

Citation： Zhao Jing, Dai Hong, Zhang Peng, Zheng Bodi. Short-term change of intraocular pressure following inravitreal dexamethasone implantation. Chinese Journal of Ocular Fundus Diseases, 2020, 36(10): 772-776. doi: 10.3760/cma.j.cn511434-20200522-00234 Copy

1.	London NJ, Chiang A, Haller JA. The dexamethasone drug delivery system: indications and evidence[J]. Adv Ther, 2011, 28(5): 351-366. DOI: 10.1007/s12325-011-0019-z.
2.	Adán A, Pelegrín L, Rey A, et al. Dexamethasone intravitreal implant for treatment of uveitic persistent cystoid macular edema in vitrectomized patients[J]. Retina, 2013, 33(7): 1435-1440. DOI: 10.1097/IAE.0b013e31827e247b.
3.	Furino C, Boscia F, Recchimurzo N, et al. Intravitreal dexamethasone implant for refractory macular edema secondary to vitrectomy for macular pucker[J]. 2014, 34(8): 1612-1616. DOI: 10.1097/IAE.0000000000000105.
4.	Mayer WJ, Wolf A, Kernt M, et al. Twelve-month experience with Ozurdex for the treatment of macular edema associated with retinal vein occlusion[J]. Eye (Lond), 2013, 27(7): 816-822. DOI: 10.1038/eye.2013.79.
5.	Lee, SS, Hughes P, Ross AD, et al. Biodegradable implants for sustained drug release in the eye[J]. Pharm Res, 2010, 27(10): 2043-2053. DOI: 10.1007/s11095-010-0159-x.
6.	Alag?z N, Alag?z C, Y?lmaz I, et al. Immediate intraocular pressure changes following intravitreal dexamethasone implant[J]. J Ocul Pharmacol Ther, 2016, 32(1): 44-49. DOI: 10.1089/jop.2015.0087.
7.	Garay-Aramburu G, Gomez-Moreno A. Response #2 to immediate intraocular pressure tendency following intravitreal delivery of dexamethasone implant; Alag?z et al. J. Ocul. Pharmacol. Ther. 32: 44-49, 2016[J]. J Ocul Pharmacol Ther, 2016, 32(6): 344-345. DOI: 10.1089/jop.2016.0029.
8.	谷瀟雅, 喻曉兵, 戴虹. 地塞米松玻璃體腔植入劑治療視網膜靜脈阻塞繼發黃斑水腫一年臨床觀察[J]. 中華眼底病雜志, 2018, 34(3): 221-227. DOI: 10.3760/cma.j.issn.1005-1015.2018.03.004.Gu XY, Yu XB, Dai H. One year clinical observation of dexamethasone intravitreal implant (Ozurdex) in the treatment of macular edema secondary to retinal vein occlusion[J]. Chin J Ocul Fundus Dis, 2018, 34(3): 221-227. DOI: 10.3760/cma.j.issn.1005-1015.2018.03.004.
9.	盧穎毅, 谷瀟雅, 喻曉兵, 等. 不同年齡視網膜中央靜脈阻塞繼發黃斑水腫患者玻璃體腔注射地塞米松玻璃體內植入劑療效比較[J]. 中華實驗眼科雜志, 2019, 37(5): 363-368. DOI: 10.3760/cma.j.issn.2095-0160.2019.05.009.Lu YY, Gu XY, Yu XB, et al. Comparative study of intravitreal dexamethasone implant in the treatment of macular edema secondary to central retinal vein occlusion with different ages[J]. Chin J Exp Ophthalmol, 2019, 37(5): 363-368. DOI: 10.3760/cma.j.issn.2095-0160.2019.05.009.
10.	Violaine C, Fran?oise V, Eric HS, et al. Intraocular pressure after intravitreal injection of dexamethasone implant for macular edema resulting from retinal vein occlusion[J]. Eur J Ophthalmol, 2015, 25(5): 454-458. DOI: 10.5301/ejo.5000585.
11.	Sofia T, Abdallah AE, Robert LJ, et al. Short-term safety of dexamethasone implant for treatment of macular edema due to retinal vein occlusion, in eyes with glaucoma or treated ocular hypertension[J]. Graefe’s Arch Clin Exp Ophthalmol, 2017, 255(4): 725-732. DOI: 10.1007/s00417-016-3553-1.
12.	Choi W, Park SE, Kang HG, et al. Intraocular pressure change after injection of intravitreal dexamethasone(Ozurdex) implant in Korean patients[J]. Br J Ophthalmol, 2019, 103(10): 1380-1387. DOI: 10.1136/bjophthalmol-2018-312958.
13.	de Vries VA, Bassil FL, Ramdas WD.The effects of intravitreal injections on intraocular pressure and retinal nerve fiber layer: a systematic review and meta-analysis[J/OL]. Sci Rep, 2020, 10: 13248[2020-08-06]. https://www.nature.com/articles/s41598-020-70269-7. DOI: 10.1038/s41598-020-70269-7.
14.	Garay-Aramburu G, Gómez-Moreno á, Urcola JA, et al. 22-gauge sclerotomy architecture evaluated by anterior segment optical coherence tomography[J]. Br J Ophthalmol, 2014, 98(2): 280-281. DOI: 10.1136/bjophthalmol-2013-303801.
15.	Lorenz K, Zwiener I, Mirshahi, A. Subconjunctival reflux and need for paracentesis after intravitreal injection of 0.1 ml bevacizumab: comparison between 27-gauge and 30-gauge needle[J]. Graefe’s Arch Clin Exp Ophthalmol, 2010, 248(11): 1573-1577. DOI: 10.1007/s00417-010-1490-y.
16.	Ozkaya A, Alkin Z, Celik U, et al. Comparing the effects of three different intravitreal injection techniques on vitreous reflux and intraocular pressure[J]. J Ocul Pharmacol Ther, 2013, 29(3): 325-329. DOI: 10.1089/jop.2012.0144.
17.	Rodrigues EB, Meyer CH, Grumann Jr A, et al. Tunneled scleral incision to prevent vitreal reflux after intravitreal injection[J]. Am J Ophthalmol, 2007, 143(6): 1035-1037. DOI: 10.1016/j.ajo.2007.01.035.
18.	Knecht PB, Michels S, Sturm V, et al. Tunneled versus straight intravitreal injection: intraocular pressure changes, vitreous reflux, and patient discomfort[J]. Retina, 2009, 29(8): 1175-1181. DOI: 10.1097/IAE.0b013e3181aade74.
19.	Meyer CH, Liu Z, Brinkmann CK, et al. Penetration force, geometry, and cutting profile of the novel and old Ozurdex needle: the MONO study[J]. J Ocul Pharmacol Ther, 2014, 30(5): 387-391. DOI: 10.1089/jop.2013.0231.
20.	Woo SJ, Park KH, Hwang JM, et al. Risk factors associated with sclerotomy leakage and postoperative hypotony after 23-gauge transconjunctival sutureless vitrectomy[J]. Retina, 2009, 29(4): 456-463. DOI: 10.1097/IAE.0b013e318195cb28.
21.	Duval R, Hui JM, Rezaei KA. Rate of sclerotomy suturing in 23-gauge primary vitrectomy[J]. Retina, 2014, 34(4): 679-683. DOI: 10.1097/IAE.0b013e3182a48972.
22.	Bamonte G, Mura M, Stevie Tan H. Hypotony after 25-gauge vitrectomy[J]. Am J Ophthalmol, 2011, 151(1): 156-160. DOI: 10.1016/j.ajo.2010.06.042.
23.	Gismondi M, Salati C, Salvetat ML, et al. Short-term effect of intravitreal injection of ranibizumab (Lucentis) on intraocular pressure[J]. J Glaucoma, 2009, 18(9): 658-661. DOI: 10.1097/IJG.0b013e31819c4893.
24.	Hollands H, Wong J, Bruen R, et al. Short-term intraocular pressure changes after intravitreal injection of bevacizumab[J]. Can J Ophthalmol, 2007, 42(6): 807-811. DOI: 10.3129/i07-172.
25.	Kim JE, Mantravadi AV, Hur EY, et al. Short-term intraocular pressure changes immediately after intravitreal injections of anti-vascular endothelial growth factor agents[J]. Am J Ophthalmol, 2008, 146(6): 930-934. DOI: 10.1016/j.ajo.2008.07.007.
26.	Hoang QV, Tsuang AJ, Gelman R, et al. Clinical predictors of sustained intraocular pressure elevation due to intravitreal anti-vascular endothelial growth factor therapy[J]. Retina, 2013, 33(1): 179-187. DOI: 10.1097/IAE.0b013e318261a6f7.
27.	Sharei V, H?hn F, K?hler T, et al. Course of intraocular pressure after intravitreal injection of 0.05ml ranibizumab(Lucentis)[J]. Eur J Ophthalmol, 2010, 20(1): 174-179. DOI: 10.1177/112067211002000124.
28.	Kato Y, Nakakura S, Matsuo N, et al. Agreement among Goldmann applanation tonometer, iCare, and Icare PRO rebound tonometers; non-contact tonometer; and tonopen XL in healthy elderly subjects[J]. Int Ophthalmol, 2018, 38(2): 687-696. DOI: 10.1007/s10792-017-0518-2.
29.	Yildiz A, Yasar T. Comparison of goldmann applanation, non-contact, dynamic contour and tonopen tonometry measurements in healthy and glaucomatous eyes, and effect of central corneal thickness on the measurement results[J]. Med Glas (Zenica), 2018, 15(2): 152-157. DOI: 10.17392/960-18.
30.	Bang SP, Lee CE, Kim YC. Comparison of intraocular pressure as measured by three different non-contacttonometers and goldmann applanation tonometer for non-glaucomatous subjects[J]. BMC Ophthalmol, 2017, 17(1): 199. DOI: 10.1186/s12886-017-0593-1.

1. London NJ, Chiang A, Haller JA. The dexamethasone drug delivery system: indications and evidence[J]. Adv Ther, 2011, 28(5): 351-366. DOI: 10.1007/s12325-011-0019-z.
2. Adán A, Pelegrín L, Rey A, et al. Dexamethasone intravitreal implant for treatment of uveitic persistent cystoid macular edema in vitrectomized patients[J]. Retina, 2013, 33(7): 1435-1440. DOI: 10.1097/IAE.0b013e31827e247b.
3. Furino C, Boscia F, Recchimurzo N, et al. Intravitreal dexamethasone implant for refractory macular edema secondary to vitrectomy for macular pucker[J]. 2014, 34(8): 1612-1616. DOI: 10.1097/IAE.0000000000000105.
4. Mayer WJ, Wolf A, Kernt M, et al. Twelve-month experience with Ozurdex for the treatment of macular edema associated with retinal vein occlusion[J]. Eye (Lond), 2013, 27(7): 816-822. DOI: 10.1038/eye.2013.79.
5. Lee, SS, Hughes P, Ross AD, et al. Biodegradable implants for sustained drug release in the eye[J]. Pharm Res, 2010, 27(10): 2043-2053. DOI: 10.1007/s11095-010-0159-x.
6. Alag?z N, Alag?z C, Y?lmaz I, et al. Immediate intraocular pressure changes following intravitreal dexamethasone implant[J]. J Ocul Pharmacol Ther, 2016, 32(1): 44-49. DOI: 10.1089/jop.2015.0087.
7. Garay-Aramburu G, Gomez-Moreno A. Response #2 to immediate intraocular pressure tendency following intravitreal delivery of dexamethasone implant; Alag?z et al. J. Ocul. Pharmacol. Ther. 32: 44-49, 2016[J]. J Ocul Pharmacol Ther, 2016, 32(6): 344-345. DOI: 10.1089/jop.2016.0029.
8. 谷瀟雅, 喻曉兵, 戴虹. 地塞米松玻璃體腔植入劑治療視網膜靜脈阻塞繼發黃斑水腫一年臨床觀察[J]. 中華眼底病雜志, 2018, 34(3): 221-227. DOI: 10.3760/cma.j.issn.1005-1015.2018.03.004.Gu XY, Yu XB, Dai H. One year clinical observation of dexamethasone intravitreal implant (Ozurdex) in the treatment of macular edema secondary to retinal vein occlusion[J]. Chin J Ocul Fundus Dis, 2018, 34(3): 221-227. DOI: 10.3760/cma.j.issn.1005-1015.2018.03.004.
9. 盧穎毅, 谷瀟雅, 喻曉兵, 等. 不同年齡視網膜中央靜脈阻塞繼發黃斑水腫患者玻璃體腔注射地塞米松玻璃體內植入劑療效比較[J]. 中華實驗眼科雜志, 2019, 37(5): 363-368. DOI: 10.3760/cma.j.issn.2095-0160.2019.05.009.Lu YY, Gu XY, Yu XB, et al. Comparative study of intravitreal dexamethasone implant in the treatment of macular edema secondary to central retinal vein occlusion with different ages[J]. Chin J Exp Ophthalmol, 2019, 37(5): 363-368. DOI: 10.3760/cma.j.issn.2095-0160.2019.05.009.
10. Violaine C, Fran?oise V, Eric HS, et al. Intraocular pressure after intravitreal injection of dexamethasone implant for macular edema resulting from retinal vein occlusion[J]. Eur J Ophthalmol, 2015, 25(5): 454-458. DOI: 10.5301/ejo.5000585.
11. Sofia T, Abdallah AE, Robert LJ, et al. Short-term safety of dexamethasone implant for treatment of macular edema due to retinal vein occlusion, in eyes with glaucoma or treated ocular hypertension[J]. Graefe’s Arch Clin Exp Ophthalmol, 2017, 255(4): 725-732. DOI: 10.1007/s00417-016-3553-1.
12. Choi W, Park SE, Kang HG, et al. Intraocular pressure change after injection of intravitreal dexamethasone(Ozurdex) implant in Korean patients[J]. Br J Ophthalmol, 2019, 103(10): 1380-1387. DOI: 10.1136/bjophthalmol-2018-312958.
13. de Vries VA, Bassil FL, Ramdas WD.The effects of intravitreal injections on intraocular pressure and retinal nerve fiber layer: a systematic review and meta-analysis[J/OL]. Sci Rep, 2020, 10: 13248[2020-08-06]. https://www.nature.com/articles/s41598-020-70269-7. DOI: 10.1038/s41598-020-70269-7.
14. Garay-Aramburu G, Gómez-Moreno á, Urcola JA, et al. 22-gauge sclerotomy architecture evaluated by anterior segment optical coherence tomography[J]. Br J Ophthalmol, 2014, 98(2): 280-281. DOI: 10.1136/bjophthalmol-2013-303801.
15. Lorenz K, Zwiener I, Mirshahi, A. Subconjunctival reflux and need for paracentesis after intravitreal injection of 0.1 ml bevacizumab: comparison between 27-gauge and 30-gauge needle[J]. Graefe’s Arch Clin Exp Ophthalmol, 2010, 248(11): 1573-1577. DOI: 10.1007/s00417-010-1490-y.
16. Ozkaya A, Alkin Z, Celik U, et al. Comparing the effects of three different intravitreal injection techniques on vitreous reflux and intraocular pressure[J]. J Ocul Pharmacol Ther, 2013, 29(3): 325-329. DOI: 10.1089/jop.2012.0144.
17. Rodrigues EB, Meyer CH, Grumann Jr A, et al. Tunneled scleral incision to prevent vitreal reflux after intravitreal injection[J]. Am J Ophthalmol, 2007, 143(6): 1035-1037. DOI: 10.1016/j.ajo.2007.01.035.
18. Knecht PB, Michels S, Sturm V, et al. Tunneled versus straight intravitreal injection: intraocular pressure changes, vitreous reflux, and patient discomfort[J]. Retina, 2009, 29(8): 1175-1181. DOI: 10.1097/IAE.0b013e3181aade74.
19. Meyer CH, Liu Z, Brinkmann CK, et al. Penetration force, geometry, and cutting profile of the novel and old Ozurdex needle: the MONO study[J]. J Ocul Pharmacol Ther, 2014, 30(5): 387-391. DOI: 10.1089/jop.2013.0231.
20. Woo SJ, Park KH, Hwang JM, et al. Risk factors associated with sclerotomy leakage and postoperative hypotony after 23-gauge transconjunctival sutureless vitrectomy[J]. Retina, 2009, 29(4): 456-463. DOI: 10.1097/IAE.0b013e318195cb28.
21. Duval R, Hui JM, Rezaei KA. Rate of sclerotomy suturing in 23-gauge primary vitrectomy[J]. Retina, 2014, 34(4): 679-683. DOI: 10.1097/IAE.0b013e3182a48972.
22. Bamonte G, Mura M, Stevie Tan H. Hypotony after 25-gauge vitrectomy[J]. Am J Ophthalmol, 2011, 151(1): 156-160. DOI: 10.1016/j.ajo.2010.06.042.
23. Gismondi M, Salati C, Salvetat ML, et al. Short-term effect of intravitreal injection of ranibizumab (Lucentis) on intraocular pressure[J]. J Glaucoma, 2009, 18(9): 658-661. DOI: 10.1097/IJG.0b013e31819c4893.
24. Hollands H, Wong J, Bruen R, et al. Short-term intraocular pressure changes after intravitreal injection of bevacizumab[J]. Can J Ophthalmol, 2007, 42(6): 807-811. DOI: 10.3129/i07-172.
25. Kim JE, Mantravadi AV, Hur EY, et al. Short-term intraocular pressure changes immediately after intravitreal injections of anti-vascular endothelial growth factor agents[J]. Am J Ophthalmol, 2008, 146(6): 930-934. DOI: 10.1016/j.ajo.2008.07.007.
26. Hoang QV, Tsuang AJ, Gelman R, et al. Clinical predictors of sustained intraocular pressure elevation due to intravitreal anti-vascular endothelial growth factor therapy[J]. Retina, 2013, 33(1): 179-187. DOI: 10.1097/IAE.0b013e318261a6f7.
27. Sharei V, H?hn F, K?hler T, et al. Course of intraocular pressure after intravitreal injection of 0.05ml ranibizumab(Lucentis)[J]. Eur J Ophthalmol, 2010, 20(1): 174-179. DOI: 10.1177/112067211002000124.
28. Kato Y, Nakakura S, Matsuo N, et al. Agreement among Goldmann applanation tonometer, iCare, and Icare PRO rebound tonometers; non-contact tonometer; and tonopen XL in healthy elderly subjects[J]. Int Ophthalmol, 2018, 38(2): 687-696. DOI: 10.1007/s10792-017-0518-2.
29. Yildiz A, Yasar T. Comparison of goldmann applanation, non-contact, dynamic contour and tonopen tonometry measurements in healthy and glaucomatous eyes, and effect of central corneal thickness on the measurement results[J]. Med Glas (Zenica), 2018, 15(2): 152-157. DOI: 10.17392/960-18.
30. Bang SP, Lee CE, Kim YC. Comparison of intraocular pressure as measured by three different non-contacttonometers and goldmann applanation tonometer for non-glaucomatous subjects[J]. BMC Ophthalmol, 2017, 17(1): 199. DOI: 10.1186/s12886-017-0593-1.

Chinese Journal of Ocular Fundus Diseases

Short-term change of intraocular pressure following inravitreal dexamethasone implantation

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