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Predicting the safety zone for steroid-induced ocular hypertension induced by intravitreal dexamethasone implantation
  1. Wungrak Choi1,
  2. Hyoung Won Bae1,
  3. Hye Jung Shin2,
  4. Eun Woo Kim1,
  5. Chan Yun Kim1,
  6. Min Kim1,
  7. Gong Je Seong1
  1. 1Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
  2. 2Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
  1. Correspondence to Dr Min Kim, Ophthalmology, Yonsei University College of Medicine, Seodaemun-gu 03722, Korea (the Republic of); minkim76{at}


Background/aims This study aimed to predict the possibility of steroid-induced ocular hypertension (OHT) after intravitreal dexamethasone (DEX) implantation and to identify a proper safety zone for such injections.

Methods A cross-sectional observational study was conducted and included 908 patient eyes that underwent DEX implant injection due to various retinal diseases. Intraocular pressure (IOP) was measured before injection, at 1 week, and at 1, 2, 3, 6 and 12 months thereafter. Eyes of enrolled patients were divided into the OHT and normal IOP groups. Univariable logistic regression analysis was used to assess significant associations between steroid-induced OHT and covariates; significant and previously reported significant variables were analysed with a multivariable model, and predictive nomograms were developed.

Results Age, sex, axial length, glaucomatous eye, neovascular glaucoma, secondary glaucoma, uveitis history, hypertension, depression, diabetes mellitus and a history of previous laser-assisted in-situ keratomileusis or laser-assisted subepithelial keratectomy were significantly related to steroid-induced OHT (p<0.05). The calibration plot revealed good prediction under a predicted value of 0.4. Cut-off values for 80%, 86%, 91%, 95% and 98% sensitivity and specificity were offered for the safety zone after intravitreal DEX implantation.

Conclusion We developed two nomograms to predict a safety zone for intravitreal DEX implantation. These can be used to identify individuals who may be safely prescribed steroid treatments and for whom extra caution should be exercised.

  • intraocular pressure
  • drugs
  • glaucoma
  • retina

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  • MK and GJS contributed equally.

  • Contributors WC, HWB, MK and GJS conceived the design of the study. WC, EWK, CYK, MK and GJS collected the data. WC, HJS, GJS and CYK analysed and interpreted the data. WC, MK, HJS, GJS and HWB drafted the article. WC, EWK, GJS, CYK and MK critically revised the article.

  • Funding This work was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF-2019 R1I1A1A01061721 and NRF-2019 R1G1A1008122) and by a faculty research grant of Yonsei University College of Medicine (6-2020-0139).

  • Disclaimer The funding organization had no role in the design or conduct of this research.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Gangnam Severance Hospital Institutional Review Board (IRB)/Ethics Committee approval was obtained. The requirement for informed consent was waived, as this was a retrospective review of existing patient records (IRB number: 3-2020-0255). The study protocol adhered to the tenets of the Declaration of Helsinki and was compliant with the Health Insurance Portability and Accountability Act.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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