title: Elevated Intraocular Pressure After Intravitreal Steroid Injection in Diabetic Macular Edema: Monitoring and Management.
abstract: BACKGROUND
  With the increasing use of intravitreal administration of corticosteroids in macular edema, steroid-induced intraocular pressure (IOP) rise is becoming an emergent issue. However, for patients in whom intravitreal steroids are indicated, there are no specific recommendations for IOP monitoring and management after intravitreal administration of corticosteroids.
  
  
  METHODS
  An expert panel of European ophthalmologists reviewed evidence on corticosteroid-induced IOP elevation. The objective of the panel was to propose an algorithm based on available literature and their own experience for the monitoring and management of corticosteroid-induced IOP elevation, with a focus on diabetic patients.
  
  
  RESULTS
  Data from trials including diabetic patients with a rise of IOP after intravitreal steroid administration indicate that IOP-lowering medical treatment is sufficient for a large majority of patients; only a small percentage underwent laser trabeculoplasty or filtering filtration surgery. A 2-step algorithm is proposed that is based on the basal value of IOP and evidence for glaucoma. The first step is a risk stratification before treatment. Patients normotensive at baseline (IOP ≤ 21 mmHg), do not require additional baseline diagnostic tests. However, patients with baseline ocular hypertension (OHT) (IOP > 21 mmHg) should undergo baseline imaging and visual field testing. The second step describes monitoring and treatment after steroid administration. During follow-up, patients developing OHT should have baseline and periodical imaging and visual field testing; IOP-lowering treatment is proposed only if IOP is >25 mmHg or if diagnostic tests suggest developing glaucoma.
  
  
  CONCLUSIONS
  The management and follow-up of OHT following intravitreal corticosteroid injection is similar to that of primary OHT. If OHT develops, IOP is controlled in a large proportion of patients with standard IOP treatments. The present algorithm was developed to assist ophthalmologists with guiding principles in the management of corticosteroid-induced IOP elevation.
  
  
  BACKGROUND
  Alimera Sciences Limited.
authors.affiliation: Glaucoma Consultant, CTIG-Hospital Quirón Teknon, Barcelona, Spain. francisgoni@yahoo.com.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Goñi
authors.affiliation: Department of Ophthalmology, University Hospitals Leuven, Louvain, Belgium.
authors.forename: Ingeborg
authors.initials: I
authors.lastname: Stalmans
authors.affiliation: Department of Ophthalmology, Hôpital de la Croix-Rousse, Lyon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Denis
authors.affiliation: University Paris Descartes, Quinze-Vingts Hospital, Paris, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Nordmann
authors.affiliation: University of Surrey and Royal Surrey County Hospital, Surrey, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Taylor
authors.affiliation: Zentrum für Augenheilkunde, Universität zu Köln, Cologne, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Diestelhorst
authors.affiliation: University of Lisbon, Oftalmolaser Clinic, Lisbon, Portugal.
authors.forename: Antonio R
authors.initials: AR
authors.lastname: Figueiredo
authors.affiliation: NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.
authors.forename: David F
authors.initials: DF
authors.lastname: Garway-Heath
keywords: Diabetic macular edema; Intravitreal implants; Intravitreal steroid injection; Ocular hypertension; Steroid-induced glaucoma; Steroid-induced ocular hypertension