Safety of 6000 intravitreal dexamethasone implants

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Publicated to:British Journal Of Ophthalmology. 104 (1): 39-46 - 2020-01-01 104(1), DOI: 10.1136/bjophthalmol-2019-313991

Authors: Rajesh, Bindu; Zarranz-Ventura, Javier; Fung, Adrian T; Busch, Catharina; Sahoo, Niroj Kumar; Rodriguez-Valdes, Patricio J; Sarao, Valentina; Mishra, Sanjay Kumar; Saatci, A Osman; Udaondo Mirete, Patricia; Querques, Giuseppe; Farah, Michel Eid; Lanzetta, Paolo; Arevalo, J Fernando; Kodjikian, Laurent; Chhablani, Jay; Gupta, A; Singh, A; Goud, Abhilash; Mansour, Ahmad; Banker, Alay; Sen, Alok C; Marashi, Ameen; Maia, Andre; Maiti, Aniruddha; Sala-Puigdollers, Anna; Sharma, Ashish; Cagini, Carlo; Bernal-Morales, Carolina; Sarvaiya, Chintan; Veritti, Daniele; Zur, Dinah; Masarwa, Dua; Novais, Eduardo; Giancipoli, Ermete; Bandello, Francesco; Al-Khersan, Hasenin; Wong, J S; Raji, K; Wu, Lihteh; Okada, Mali; Nagpal, Manish; Casella, Marcelo; Lupidi, Marco; Avila, Marcos; Berrocal, Maria; Iglicki, Matias; Maia, Mauricio; Cavalleri, Michele; Rasheed, Mohammed Abdul; Asencio-Duran, Monica; Rassu, Nicolo; D'Anna-Mardero, Oriana; Gabrielle, Pierre-Henry; Shenoy, Prateek; Gallego-Pinazo, Roberto; Dolz Marco, Rosa; Kumar, S; Patyal, S; Fraser-Bell, Samantha; Cohen, Shai; Singh, Sumit Randhir; Sharma, V; Chaikitmongkol, Voraporn; Cebeci, Zafer; Ayhan, Ziya

Affiliations

Amer Univ Beirut, Dept Ophthalmol, Beirut, Lebanon - Author

Apdo 144-1225 Plaza Mayor, San Jose 1225, Costa Rica - Author

Bankers Retina Clin & Laser Ctr, Ahmadabad, Gujarat, India - Author

Chiang Mai Univ, Dept Ophthalmol, Fac Med, Retina Div, Chiang Mai, Thailand - Author

Chiang Mai Univ, Retina Div, Dept Ophthalmol, Fac Med, Chiang Mai, Thailand - Author

Clin Oftalmol Ctr Caracas, Retina & Vitreous, Caracas, Venezuela - Author

Command Hosp, Dept Ophthalmol 11, Lucknow, Uttar Pradesh, India - Author

Command Hosp, Dept Ophthalmol, Lucknow Cantt 226002, India - Author

Dijon Univ Hosp, Dept Ophthalmol, Dijon, France - Author

Dokuz Eylul Univ, Izmir, Turkey - Author

Hosp Civils Lyon, Croix Rousse Univ Hosp, Ophthalmol, Lyon, France - Author

Hosp Clin Barcelona, Vitreoretinal Unit, Inst Clin Oftalmol ICOF, Barcelona, Spain - Author

Hosp La Paz, Vitreoretinal Dept, Madrid, Spain - Author

Hosp Univ La Fe, Ophthalmol Dept 13, Valencia, Spain - Author

IEMO, Udine, Italy - Author

INRA, Ctr Taste & Feeding Behav, UMR1324, Dijon, France - Author

Inst Clin Barcelona, Inst Clin Oftalmol ICOF, Hosp Clin Barcelona Insi, Barcelona, Spain - Author

Int Specialist Eye Ctr, Kuala Lumpur, Malaysia - Author

Istanbul Univ, Dept Ophthalmol, Istanbul Fac Med, Istanbul, Turkey - Author

Khoo Teck Puat Hosp, Singapore, Singapore - Author

Lotus Eye Hosp, Coimbatore, Tamil Nadu, India - Author

LV Prasad Eye Inst, Kallam Anji Reddy Campus,Banjara Hills, Hyderabad 500034, Telangana, India - Author

LV Prasad Eye Inst, Vitreoretina, Hyderabad 500034, Andhra Pradesh, India - Author

Marashi Eye Clin, Aleppo, Syria - Author

Oftalvist Clin, Valencia, Spain - Author

Osped San Raffaele, Ophthalmol, Milan, Italy - Author

Rafic Hariri Univ Hosp, Dept Ophthalmol, Beirut, Lebanon - Author

Retina Fdn & Eye Res Ctr, Ahmadabad, Gujarat, India - Author

Royal Victorian Eye & Ear Hosp, Melbourne, Vic, Australia - Author

Sadguru Netra Chikitsalya, Dept Retina & Uvea, Chitrakoot, India - Author

Sushrut Eye Fdn, Kolkata, India - Author

Tecnol Monterrey, Escuela Med, Inst Oftalmol & Ciencias Visuales, Ophthalmol, San Pedro Garza Garcia, Mexico - Author

Tel Aviv Sourasky Med Ctr, Div Ophthalmol, Tel Aviv, Israel - Author

Tel Aviv Univ, Sackler Fac Med, Tel Aviv, Israel - Author

Univ Buenos Aires, Private Retina Serv, Buenos Aires, DF, Argentina - Author

Univ Chicago, Pritzker Sch Med, Chicago, IL 60637 USA - Author

Univ Estadual Londrina, Dept Ophthalmol, Londrina, Parana, Brazil - Author

Univ Fed Sao Paulo, Dept Ophthalmol & Visual Sci, Sao Paulo, SP, Brazil - Author

Univ Fed Sao Paulo, Ophthalmol, Sao Paulo, SP, Brazil - Author

Univ Klinikum Leipzig, Dept Ophthalmol, Leipzig, Germany - Author

Univ Lyon, CNRS, UMR 5510 Mateis, Lyon, France - Author

Univ Perugia, Dept Biomed & Surg Sci, Sect Ophthalmol, Perugia, Italy - Author

Univ Perugia, Sect Ophthalmol, Dept Biomed & Surg Sci, Perugia, Italy - Author

Univ Puerto Rico, Sch Med, San Juan, PR 00936 USA - Author

Univ Sassari, Dept Biomed Sci, Sassari, Italy - Author

Univ Sassari, Eye Clin, Dept Surg Microsurg & Med Sci, Sassari, Italy - Author

Univ Sydney, Dept Ophthalmol, Sydney, NSW, Australia - Author

Univ Sydney, Sydney Eye Hosp, Save Sight Inst, Sydney, NSW, Australia - Author

Univ Udine, Dept Med Ophthalmol, Udine, Italy - Author

Univ Udine, Udine, Italy - Author

Univ Vita Salute, Dept Ophthalmol, IRCCS Osped San Raffaele, Via Olgettina 60, I-20132 Milan, Italy - Author

Univ Vita Salute, IRCCS Osped San Raffaele, Dept Ophthalmol, Via Olgettina 60, I-20132 Milan, Italy - Author

Univ Vita Salute, Ophthalmol, IRCCS Osped San Raffaele, Via Olgettina 60, I-20132 Milan, Italy - Author

Westmead Hosp, Dept Ophthalmol, Sydney, NSW, Australia - Author

Abstract

Purpose To evaluate the real-life safety profile of intravitreal dexamethasone implant injection for various retinal conditions. Methods Retrospective multicenter analysis of intravitreal dexamethasone implant injections (700 mu g) due to various retinal conditions including central retinal venous occlusion (1861 injections), diabetic macular oedema (3104 injections), post-surgical cystoid macular oedema (305 injections) and uveitis (381 injections). The eyes were evaluated mainly for the occurrence of adverse events such as glaucoma, cataract, retinal detachment and endophthalmitis along during the follow-up period. Results A total of 6015 injections in 2736 eyes of 1441 patients (mean age of 65.7 +/- 12.9 years) were in total analysed over an average period of 18 months (range 6 months to 102 months). A total of 576 eyes (32.5% of the phakic eyes) developed cataract requiring surgical intervention. However, visually insignificant cataract progression was observed in another 259 phakic eyes (14.6%) which did not require surgical removal. A total of 727 eyes (26.5%) experienced an intraocular pressure (IOP) rise of >25 mm Hg, with 155 eyes (5.67%) having a prior history of glaucoma and 572 eyes (20.9%) having new onset IOP rise. Overall, more than 90% of eyes with IOP rise were managed medically, and 0.5% eyes required filtering surgery. Endophthalmitis (0.07%), retinal detachment (0.03%) and vitreous haemorrhage (0.03%) were rare. There was no significant change in visual acuity (p=0.87) and central macular thickness (p=0.12) at the last follow-up. Conclusion This is the largest real-life study assessing the safety of intravitreal dexamethasone implant injections in various retinal conditions. Cataract progression and intraocular pressure rise are the most common side effects, but are often rather easily manageable.

Keywords

12-month outcomesAgedCataractDexamethasoneDisease progressionDrug implantsDrugsEfficacyFemaleGlaucomaGlucocorticoidsHumansIntravitreal injectionsMacular edemaMacular edema secondaryMaleMiddle agedMulticenteMulticenterOzurdexRanibizumabRetinal diseasesRetinal vein occlusionRetinal-vein-occlusionRetrospective studiesSustained benefitsTreatment medicalTrialTriamcinoloneUveitis, posteriorVisioVisionVitreous

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The work has been published in the journal British Journal Of Ophthalmology due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2020, it was in position 9/62, thus managing to position itself as a Q1 (Primer Cuartil), in the category Ophthalmology.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 5.47. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

Weighted Average of Normalized Impact by the Scopus agency: 6.43 (source consulted: FECYT Feb 2024)
Field Citation Ratio (FCR) from Dimensions: 21.75 (source consulted: Dimensions Jun 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-06-21, the following number of citations:

WoS: 64
Scopus: 72
Europe PMC: 38
OpenCitations: 60

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This work has been carried out with international collaboration, specifically with researchers from: Argentina; Australia; Brazil; Costa Rica; France; Germany; India; Israel; Italy; Lebanon; Malaysia; Mexico; Puerto Rico; Singapore; Syria; Thailand; Turkey; United States of America; Venezuela.

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