Predictive value of short-term steroid intraocular pressure elevation testing for long-term steroid intraocular pressure elevation in diabetic macular edema treatment.

PURPOSE: This study aims to investigate whether there is a correlation between intraocular pressure (IOP) elevation after intravitreal triamcinolone acetonide (TA) testing and IOP response following fluocinolone acetonide (FAc) implant injection in the treatment of diabetic macular edema.

METHODS: This study employed a real-world observational cohort retrospective design, enrolling patients who had received at least one intravitreal TA injection prior to a FAc implant injection between December 2018 and July 2022. Demographic data, medical and ophthalmic history were collected at baseline. Mean IOP was assessed before and after both treatments and steroid-response was defined as an IOP greater than 21 mmHg. Statistical analysis was performed to determine correlated IOP changes.

RESULTS: A total of 28 eyes were included in the study. Six eyes exhibited a steroid response following the initial TA injection, and none of these eyes demonstrated a steroid response following the FAc implant. The FAc implant resulted in steroid response in six additional eyes. The analysis revealed no statistically significant correlation between the occurrence of a steroid response following a TA injection and the subsequent mean IOP progression following an FAc implant injection at any time point. No correlation was observed between the variation in IOP following the two treatments.

CONCLUSION: It is crucial to evaluate the necessity of a prior short-acting steroid challenge, which carries the risk of multiple disease relapses, given the potential for a prolonged and stable steroid to provide superior control. The predictive value of the test with TA was not evident in our sample, suggesting some usefulness in delaying treatment with the FAc implant.