Long-term probability of intraocular pressure elevation with the intravitreal dexamethasone implant in the real-world.

To evaluate the long-term cumulative probability of intraocular pressure (IOP) elevation with the intravitreal dexamethasone implant (IDI) when used to treat different indications: diabetic macular edema, uveitis, retinal vein occlusion. 705 IDI injections (429 eyes) were assessed and Kaplan-Meier graphs were generated to assess: the probability of different levels of IOP elevation (IOP≥21, ≥25 or ≥35 mmHg), IOP change ≥10 mmHg, initiation of IOP-lowering treatment, glaucoma surgery, IOP change with repeat injections and IOP elevation in eyes with glaucoma and ocular hypertension (OHT). The cumulative probability of IOP ≥21, ≥25 and ≥35 mmHg was 50%-60%, 25%-30% and 6%-7% at 12-24 months, respectively. The probability of initiating IOP-lowering medication was 31%-54% at 12-24 months. Glaucoma and OHT eyes had a higher probability of mild IOP elevation (≥21 mmHg, 65.1%, 75% and 57.8%, p = 0.01), yet a similar moderate (≥25 mmHg, 22.3%, 28% and 30.2%, p = 0.91) and severe elevation of IOP (≥35 mmHg, 3.7%, 7.1% and 4%, p = 0.71) as normal eyes. Glaucoma surgery was required in only 0.9% cases (4/429). At baseline, 8.8% of the treated eyes had glaucoma, 6.7% OHT and 16.9% were already on IOP-lowering medication. In the long-term (24 months), IOP elevation is common, generally mild (30% IOP, ≥25 mmHg) and well-tolerated, resolving with topical treatment (54%) and rarely requiring surgery (0.9%).

Déclaration de conflit d'intérêts

Javier Zarranz-Ventura is a grant recipient of the Spanish Retina & Vitreous Society (Sociedad Española de Retina y Vítreo) and has been a consultant, lecturer and has received travel grants from Alcon, Alimera Sciences, Allergan, Bayer, Dorc and Novartis, and has been a lecturer for Topcon and Zeiss. Anna Sala-Puigdollers has given lectures for Allergan and Bayer and is a member of the Allergan International Retina Panel. Marc Figueras-Roca has given lectures for Allergan. Anna Boixadera has given lectures for Allergan, Bayer, and Novartis. Jose García-Arumí has been in advisory boards and has received grants from Alcon, Allergan, Bayer, Novartis. Alfredo Adan has been in advisory boards and is a consultant for Abbvie, Alcon, Alimera Sciences, Allergan, Bayer and Novartis, and has given lectures for Topcon and Zeiss. The other authors have no competing interests to declare. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.