Consider and address steroid response when indicating intravitreal corticosteroid therapy - especially in patients with high baseline IOP and in those with glaucoma.
January 18, 2026

Consider and address steroid response when indicating intravitreal corticosteroid therapy - especially in patients with high baseline IOP and in those with glaucoma.

A substantial proportion of patients who require intravitreal corticosteroid injections or implants have comorbid glaucoma or an increased risk of glaucoma. Before proceeding, ensure glaucoma is controlled and anticipate a possible steroid response in advance. Approximately one-third of patients receiving a dexamethasone intravitreal implant will require IOP-lowering (antihypertensive) therapy, and more than half of patients with pre-existing glaucoma will need an escalation of IOP-lowering treatment. Therefore, consider consulting a glaucoma specialist before injection/implantation, especially if the IOP is not at target or the patient has shown steroid response earlier. (1,2,3) It has been shown that also type 1 diabetes, myopia, long axial length and age can increase the risk of a relevant steroid response. (4)


References

  1. Roberti G, Oddone F, Agnifili L, Katsanos A, Michelessi M, Mastropasqua L, et al. Steroid-induced glaucoma: Epidemiology, pathophysiology, and clinical management. Surv Ophthalmol. 2020;65(4):458-472. doi:10.1016/j.survophthal.2020.01.002. PMID:32057761.
  2. Ertan E, Çelen İ, Gül C. Incidence and risk factors of ocular hypertension following intravitreal dexamethasone implantation: the role of baseline intraocular pressure. Int Ophthalmol. 2025;45(1):233. doi:10.1007/s10792-025-03605-3. PMID:40478293.
  3. Querques G, Figus M, De Bernardo M, Toro MD, Gharbiya M, Gallinaro V, et al. Safety profile of intravitreal dexamethasone implant to manage diabetic macular edema: A systematic review of real-world studies. Ophthalmologica. 2025;248(4):308-325. doi:10.1159/000545987. PMID:40505647.
  4. Goñi FJ, Barton K, Dias JA, Diestelhorst M, García-Feijoo J, Hommer A, et al. Intravitreal corticosteroid implantation in diabetic macular edema: Updated European consensus guidance on monitoring and managing intraocular pressure. Ophthalmol Ther. 2022;11(1):15-34. doi:10.1007/s40123-021-00427-1. PMID:34993882.


Contributor: Dr. med. Fabian Gielen, Head of Glaucoma, Kantonsspital Winterthur, Switzerland

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