Universität zu Köln

Goni, Francisco J., Stalmans, Ingeborg, Denis, Philippe, Nordmann, Jean-Philippe, Taylor, Simon ORCID: 0000-0002-1228-881X, Diestelhorst, Michael, Figueiredo, Antonio R. and Garway-Heath, David F. (2016). Elevated Intraocular Pressure After Intravitreal Steroid Injection in Diabetic Macular Edema: Monitoring and Management. OPHTHALMOL. THER., 5 (1). S. 47 - 62. CHAM: SPRINGER INTERNATIONAL PUBLISHING AG. ISSN 2193-6528

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Abstract

With the increasing use of intravitreal administration of corticosteroids in macular edema, steroid-induced intraocular pressure (IOP) rise is becoming an emergent issue. However, for patients in whom intravitreal steroids are indicated, there are no specific recommendations for IOP monitoring and management after intravitreal administration of corticosteroids. An expert panel of European ophthalmologists reviewed evidence on corticosteroid-induced IOP elevation. The objective of the panel was to propose an algorithm based on available literature and their own experience for the monitoring and management of corticosteroid-induced IOP elevation, with a focus on diabetic patients. Data from trials including diabetic patients with a rise of IOP after intravitreal steroid administration indicate that IOP-lowering medical treatment is sufficient for a large majority of patients; only a small percentage underwent laser trabeculoplasty or filtering filtration surgery. A 2-step algorithm is proposed that is based on the basal value of IOP and evidence for glaucoma. The first step is a risk stratification before treatment. Patients normotensive at baseline (IOP a parts per thousand currency sign 21 mmHg), do not require additional baseline diagnostic tests. However, patients with baseline ocular hypertension (OHT) (IOP > 21 mmHg) should undergo baseline imaging and visual field testing. The second step describes monitoring and treatment after steroid administration. During follow-up, patients developing OHT should have baseline and periodical imaging and visual field testing; IOP-lowering treatment is proposed only if IOP is > 25 mmHg or if diagnostic tests suggest developing glaucoma. The management and follow-up of OHT following intravitreal corticosteroid injection is similar to that of primary OHT. If OHT develops, IOP is controlled in a large proportion of patients with standard IOP treatments. The present algorithm was developed to assist ophthalmologists with guiding principles in the management of corticosteroid-induced IOP elevation. Alimera Sciences Limited.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Goni, Francisco J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Stalmans, Ingeborg UNSPECIFIED UNSPECIFIED UNSPECIFIED Denis, Philippe UNSPECIFIED UNSPECIFIED UNSPECIFIED Nordmann, Jean-Philippe UNSPECIFIED UNSPECIFIED UNSPECIFIED Taylor, Simon UNSPECIFIED orcid.org/0000-0002-1228-881X UNSPECIFIED Diestelhorst, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Figueiredo, Antonio R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Garway-Heath, David F. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-274797
DOI:	10.1007/s40123-016-0052-8
Journal or Publication Title:	OPHTHALMOL. THER.
Volume:	5
Number:	1
Page Range:	S. 47 - 62
Date:	2016
Publisher:	SPRINGER INTERNATIONAL PUBLISHING AG
Place of Publication:	CHAM
ISSN:	2193-6528
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language OPEN-ANGLE GLAUCOMA; TRIAMCINOLONE ACETONIDE INJECTION; RANDOMIZED CLINICAL-TRIAL; RETINAL VEIN OCCLUSION; DRUG-DELIVERY SYSTEMS; FLUOCINOLONE ACETONIDE; OCULAR HYPERTENSION; TRABECULAR MESHWORK; CORTICOSTEROIDS IMPLICATIONS; POSTERIOR SEGMENT Multiple languages Ophthalmology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/27479