Secondary ocular hypertension as an adverse effect of treatment with intravitreal dexamethasone implant: A retrospective Swedish cohort study.

Abstract

Purpose: To evaluate the incidence and risk factors for secondary ocular hypertension (SOHT) following intravitreal dexamethasone implants (Ozurdex®) in patients with diabetic macular oedema (DME) and macular oedema secondary to retinal vein occlusion (RVO) in a Swedish cohort.

Methods: This retrospective study included 309 eyes from 249 patients treated with Ozurdex® at Sahlgrenska University Hospital, Mölndal, Sweden, from 1 January 2016 to 31 December 2023. Electronic medical records were reviewed for data including patient demographics, number of injections, incidence of and treatment modalities for SOHT and rate of Ozurdex® discontinuation.

Results: Of the 309 eyes, 217 (70.2%) were in the DME group and 92 (29.8%) in the RVO group. Overall, 117 eyes (37.9%) developed SOHT (intraocular pressure (IOP) ≥25 mmHg or a rise of ≥10 mmHg from baseline); this included 77 of 217 DME eyes (35.5%) and 40 of 92 RVO eyes (43.5%). Men were more than twice as likely as women to develop SOHT (adjusted odds ratio [aOR]: 2.53, p < 0.001). Each unit increase in baseline IOP was associated with an 8% increase in the odds of SOHT (aOR: 1.08 p = 0.025). Of all eyes, 30.5% received IOP-lowering treatment, primarily prostaglandins. None required invasive surgery.

Conclusion: Our finding that 30.5% of eyes received IOP-lowering treatment confirms that SOHT is a prevalent complication following intravitreal dexamethasone implants. Male gender and higher baseline IOP were key indicators for developing SOHT after Ozurdex® treatment, emphasizing the need for vigilant monitoring. Most cases were managed with IOP-lowering eye drops, indicating that while common, SOHT is typically manageable without invasive interventions.