Risk of Ocular Hypertension With Intravitreal Triamcinolone Compared to the Dexamethasone Implant

Purpose: To determine whether there is a difference in the risk of ocular hypertension between patients in a large United States healthcare database who received an intravitreal dexamethasone implant and those who received intravitreal (IVT) triamcinolone acetonide injections. Methods: A retrospective cohort study was conducted from 2011 to 2022. Cohorts were created by identifying patients who were treated for the first time with either dexamethasone implants or IVT triamcinolone. The primary outcome was the number of patients requiring treatment for ocular hypertension. Cox proportional hazards regression modeling was performed for risk analyses, and inverse proportional treatment weighting was included. A sensitivity analysis used a new diagnosis of glaucoma or suspected glaucoma as the outcome. Results: In total, 147 (8.8%) of 1665 patients treated with dexamethasone implants and 282 (7.3%) of 3866 patients treated with IVT triamcinolone received medical or surgical therapy for ocular hypertension. In hazards models with inverse proportional treatment weighting of propensity scores, cohorts were found to be balanced in all covariates (standardized mean difference <0.1 for each variable). Cox proportional hazards regression analysis showed no difference in risk of requiring ocular hypertension treatment in the group treated with dexamethasone implants compared with the IVT triamcinolone group in the postinjection period of 1 to 40 days (hazard ratio HR, 0.77, 95% CI, 0.53–1.12; P = .17). However, analysis after 40 days showed that treatment with dexamethasone implants, as compared with IVT triamcinolone, conferred an increased risk of requiring ocular hypertension treatment (HR, 1.41, 95% CI, 1.08–1.86; P = .01). Sensitivity analyses showed a similar, but nonsignificant risk of progressing to a diagnosis of glaucoma or suspected glaucoma in the dexamethasone implant group compared with the IVT triamcinolone group at 40 days after injection (HR, 1.24, 95% CI, 0.91–1.70; P = .18). Conclusions: Treatment with dexamethasone implants was associated with an increased risk of requiring ocular hypertension treatment when compared with IVT triamcinolone treatment. Clinicians should be aware of this increased risk when counseling patients regarding their treatment options.