Tolerance of Dexamethasone intravitreal implant in GAO patients according to their initial treatment and repeated intravitreal injections

Purpose To evaluate the tolerance of dexamethasone intravitreal implant (DEX implant) in patients with history of open-angle glaucoma (OAG) or ocular hypertension (OHT) according to their initial treatment and the repetition of intravitreal injections (IVI). Methods We performed a retrospective two-center clinical study which included 100 patients treated by DEX implants, divided into one group with OAG or OHT patients (n = 50 patients), and one control group (n = 50 patients) including patients with no history of OHT or GAO, matched by age and pathology. IOP was measured and hypotensive treatments were gathered in all patients respectively at baseline, one week, and each month during six months. Results Mean age was 71.77 (SD +/- 10.5) years old in GAO/OHT group and 70.4 (SD +/- 10.7) years old in control group and mean number IVI was respectively 2.2 (1–7) and 2.8 (1–11). After the first injection, 50% of OAG/OHT patients and 42% of the control group increased their IOP more than 6 mmHg (p = 0.42). There was no difference between the IOP responses of patients initially treated with monotherapy and the control group but there was significantly more high responders (+>15 mmHg) in patients initially treated with bi and triple therapy. The proportion of responders increased when patient had more than one injection (64 and 56% respectively in OAG and control group, p = 0.22) and the number of high responders doubled (16% at the first IVI, 32% of multi-IVI). An increased of hypotensive therapy was required in 54% of OAG/OHT patients versus 38% in control group (p = 0.1). Conclusions DEX implant is well tolerated for the patients under monotherapy. In contrast Patient under bi or triple therapy were at risk of ocular hypertension and filtering surgery. Repeated IVI increased the risk of ocular hypertension.