Incidence and risk factors of ocular hypertension following ıntravitreal dexamethasone implantation: the role of baseline intraocular pressure.

PURPOSE

This study aimed to evaluate the incidence of ocular hypertension (OHT) following intravitreal dexamethasone (Ozurdex) implantation and to investigate its association with baseline intraocular pressure (IOP).

METHODS

This retrospective cohort study included 698 patients (1085 eyes) who received Ozurdex implantation for diabetic macular edema, macular edema secondary to retinal vein occlusion, or other retinal disorders. Only patients with a minimum follow-up duration of six months were included. IOP measurements were recorded at baseline and at week 1, and months 1, 2, 3, and 6 post-injection. These values were compared using either the paired Student's t-test or the Wilcoxon signed-rank test, depending on data distribution. Logistic regression analysis was performed to identify independent risk factors for steroid-induced ocular hypertension (SIOHT).

RESULTS

The incidence of SIOHT was 38% (n = 412 eyes). The mean baseline IOP was 15.73 ± 3.4 mmHg, which peaked at month 1 (17.81 ± 4.0 mmHg, p < 0.001) and month 2 (17.30 ± 4.4 mmHg, p < 0.001), then declined and returned close to baseline by month 6 (15.38 ± 4.1 mmHg, p = 0.258). Multivariate analysis revealed that age (40-50 years, OR 2.95, p = 0.001), male gender (OR 1.82, p = 0.001), and higher baseline IOP (OR 1.09, p = 0.003) were significant independent risk factors. Among SIOHT cases, 72.6% exhibited IOP elevations between 25 and 30 mmHg, 22.6% had levels exceeding 30 mmHg, and 4.8% exceeded 35 mmHg. All patients were initially treated with topical IOP-lowering medications, and only 0.7% required trabeculectomy.

CONCLUSION

Intravitreal Ozurdex implantation is associated with a significant increase in IOP, necessitating close monitoring. Higher baseline IOP and male gender were identified as major risk factors. While the majority of cases were successfully managed with topical therapy, a small proportion required surgical intervention. Further research is warranted to improve risk stratification and optimize management strategies.