DME, Steroids and Glaucoma
Addressing concerns about steroid-induced intraocular pressure increases and the risk of glaucoma when managing diabetic macular edema
Charles C. Wykoff |
At a Glance
- Intravitreal corticosteroids are associated with risks, including IOP elevation which occurs in approximately 30–40 percent of treated patients
- Elevated IOP alone does not constitute glaucoma, and when secondary to an intravitreal steroid injection, is usually readily manageable with observation or topical ophthalmic drops in the large majority of cases
- For appropriate DME patients, intravitreal corticosteroids can represent a valuable alternative treatment option, with the possibility of a decreased treatment burden.
In my practice, I consider using intravitreal corticosteroids for managing diabetic macular edema (DME) in two categories of patients. First, among patients who respond adequately to anti-VEGF therapy, but the durability of current generation anti-VEGF monotherapies is insufficient for their lifestyle or preference. In this context, utilization of a steroid implant can often achieve a decreased treatment burden. Second, among patients who demonstrate an incomplete response to adequate anti-VEGF dosing.
There are legitimate reasons to pause before initiating corticosteroid therapy for DME. First, they are well recognized to increase the risk of cataract acceleration. In my view, even a single intravitreal steroid injection permanently changes the trajectory of cataract progression in that eye. Second, they have the potential to increase intraocular pressure (IOP); but there can be misconceptions about the correlation between IOP and glaucoma.
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