Intravitreal injections (IVI) of slow-release dexamethasone (DEX) are generally well tolerated. Ocular hypertension (OHT) and cataracts are the most common adverse effects of DEX-implant (DEX-I).
The cases reported concern 5 eyes in four DEX-I IVI high-responder patients whose intraocular pressure (IOP) returned to normal after administration of a XEN gel stent with mitomycin subconjunctival injection, thus allowing the continued use of DEX-I which was the only therapeutic option for these patients. All patients were pure steroid responders with normal optic nerves.
No hypertension was observed in any of the eyes after DEX-implant intravitreal reinjection following XEN-surgery.
All patients were successfully treated with XEN surgery and were retreated with DEX-implant with no further increase in IOP. The mean duration of follow-up after the MIGS procedure was 5 months (min-max, 2-12). None of the patients required needling.
XEN gel stent would seem to represent a safe and effective solution for treating steroid-induced hypertension. It allows for the medium and long-term use of DEX-I in high responders. It could be of clinical interest to study this combination in a prospective trial with a large number of patients and long-term follow-up.
*Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon
†UMR-CNRS 5510 Matéis, University of Medicine Lyon, Lyon, France
The XEN gel stent is not labeled for the use under discussion.
P.D. is a consultant for Alcon, Allergan, Novartis, and Théa. L.K. is a consultant for Abbvie, Allergan, Alimera, Bayer, Novartis, Roche, and Théa. The remaining authors declare that they have nothing to disclose.
Reprints: Laurent Kodjikian, MD, PhD, Department of Ophthalmology, Croix-Rousse University Hospital, 103, Grande Rue de la Croix-Rousse, 69317 Lyon Cedex 04, France (e-mail: email@example.com).
Received June 22, 2018
Accepted September 7, 2018