Billant J, Douma I, Agard E, Levron A, Bouvarel H, Leroux P, Badri Y, Dot C
Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, Lyon, France.
Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, Lyon, France.
J Fr Ophtalmol. 2023 Nov;46(9):1039-1046. doi: 10.1016/j.jfo.2023.03.041. Epub 2023 Sep 26.
Steroid-induced ocular hypertension (OHT) occurs in approximately one third of cases after dexamethasone implant (DEXi) injection. Among these, more than one fifth occur after the third DEXi intravitreal injection (IVI). Our goal was to analyze the clinical profiles of these late responders.
A real-life, retrospective, observational study was conducted to assess demographic characteristics and intraocular pressure (IOP) responses in late responders (IOP ≥ 21mmHg, n DEXi ≥ 4). The following parameters were analyzed: IOP 2 months after IVI and number of glaucoma medications needed. The IOP response compared to baseline was defined as low (< +6mmHg), moderate (≤ +15mmHg) or high (> 15mmHg).
Late steroid-induced OHT occurred in 20.8% of cases. Twenty eyes (18 patients) were included. The mean duration of follow-up was 3.8±1.9 years. They received a mean number of 9.5±4.2 IVI. The first OHT peak, measured at 25.3±3.2mmHg (21-31), occurred after 6.8±2.3 IVI. Approximately 65% of OHT spikes occurred between the fourth and sixth IVI; 35% occurred later. At maximum, 1.7±1.0 glaucoma medications and 0.75±0.79 SLT procedures were required to control the OHT, with no filtering surgery required. The ratio of "low," "moderate," and "high" responders was 5%, 85% and 10% respectively.
Late steroid-induced OHT occurs after at least 3 DEXi in one fifth of multi-injected patients, requiring long-term IOP monitoring. This case series identifies mostly moderate responder profiles, whose IOP rise often remains well-controlled with medical management or laser treatment (SLT).
地塞米松植入剂（DEXi）注射后，约三分之一的患者会发生类固醇性高眼压（OHT）。其中，超过五分之一发生在第三次DEXi玻璃体内注射（IVI）之后。我们的目标是分析这些迟发性反应者的临床特征。
开展一项真实世界的回顾性观察研究，以评估迟发性反应者（眼压≥21mmHg，DEXi注射次数≥4次）的人口统计学特征和眼压（IOP）反应。分析了以下参数：IVI后2个月的眼压以及所需青光眼药物的数量。与基线相比的眼压反应被定义为低（<+6mmHg）、中度（≤+15mmHg）或高（>15mmHg）。
20.8%的病例发生迟发性类固醇性OHT。纳入了20只眼（18例患者）。平均随访时间为3.8±1.9年。他们平均接受了9.5±4.2次IVI。首次OHT峰值在6.8±2.3次IVI后出现，测量值为25.3±3.2mmHg（21 - 31）。约65%的OHT峰值出现在第四次至第六次IVI之间；35%出现在更晚的时候。控制OHT最多需要1.7±1.0种青光眼药物和0.75±0.79次选择性激光小梁成形术（SLT），无需进行滤过手术。“低”、“中”、“高”反应者的比例分别为5%、85%和10%。
在五分之一的多次注射患者中，至少3次DEXi注射后会发生迟发性类固醇性OHT，需要长期监测眼压。本病例系列主要确定了中度反应者的特征，其眼压升高通常通过药物治疗或激光治疗（SLT）能得到较好控制。
