ArticleCureus2025
Topical Prednisolone Acetate Challenge as a Predictor of Intraocular Pressure Elevation Following Ozurdex® in Diabetic Macular Edema: A Retrospective Study.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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3 authors.
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Abstract
Background Steroid-induced ocular hypertension remains a practical concern with intravitreal corticosteroid therapy. The dexamethasone implant (Ozurdex®) is widely used for diabetic macular edema (DME), yet increases in intraocular pressure (IOP) can still occur. Identifying patients at greater risk before treatment would allow more tailored counseling and follow-up. This study examined whether a short topical prednisolone acetate challenge can anticipate the IOP response to Ozurdex in routine care within a Middle Eastern cohort. Methods This retrospective, observational study included 27 eyes of 27 patients with DME treated at Salmaniya Medical Complex, Kingdom of Bahrain. All patients underwent a topical prednisolone acetate 1% challenge (QID for three to four weeks) before Ozurdex implantation. IOP was measured at baseline, after the topical challenge, and six to eight weeks post-Ozurdex using Topcon non-contact tonometry. The primary outcome was a clinically significant IOP rise after Ozurdex (≥10 mmHg). Friedman and Wilcoxon signed-rank tests were used for within-eye comparisons; correlation was assessed with Spearman's ρ. Results Mean baseline IOP was 18.4±2.2 mmHg, increasing to 19.6±2.5 mmHg after topical steroid challenge and 21.4±5.5 mmHg at six to eight weeks post-Ozurdex. Across the three timepoints, IOP differed significantly (χ²=14.47, p=0.0007). Pairwise comparisons confirmed significant rises from baseline to challenge (p=0.0034) and from baseline to Ozurdex (p=0.0033). The IOP change after topical challenge correlated moderately with post-Ozurdex IOP rise (Spearman's ρ=0.52, p=0.005). Clinically significant IOP elevation (≥10 mmHg) occurred in two eyes (7.4%), all managed medically without surgery. Conclusion A short-term topical prednisolone acetate challenge provides moderate predictive value for identifying eyes at risk of IOP elevation following Ozurdex implantation. While not a perfect predictor, this inexpensive and non-invasive test may assist clinicians in tailoring post-injection monitoring strategies, particularly in resource-limited or high-volume care settings.
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