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Fluocinolone-acetonide Steroid-induced glaucoma: case report

An approximately 62-year-old woman developed steroid-induced glaucoma following treatment with fluocinolone-acetonide for diabetic macular oedema (DME). The woman with proliferative diabetic retinopathy received ranibizumab followed by two sessions of pan retinal laser photocoagulation in 2014. After 2 years, she presented with loss of vision due to bilateral vitreous haemorrhage and cataract. Subsequently, she underwent bilateral consecutive pars plana vitrectomy and phacoemulsification surgeries with posterior chamber intraocular lens (PCIOL) implantation. Following the procedure, her corrected distant visual acuity (CDVA) improved. However, her intraocular pressure (IOP) remained in the mid-teens with no evidence of rubeosis iridis in either eye. Subsequently, she was diagnosed with DME in the right eye with a central macular thickness of 544µm by optical coherence tomography (OCT). As a corrective measure, she received two injections of aflibercept [Eylea] without improvement in CDVA or central macular thickness. Thereafter, she received dexamethasone [Ozurdex] implant with a temporary improvement of CDVA to 20/150 for 4 months. Additionally, dexamethasone therapy did not respond to IOP. Hence, she received an intravitreal fluocinolone-acetonide [Iluvien] implant [dosage not stated] to treat the recalcitrant DME and to achieve a prolonged improvement of vision. The fluocinoloneacetonide showed good response to DME with the improvement of CDVA to 20\100 and reduction in central macular thickness to 174µm. However, after 6 month, she developed pain in the right eye due to elevated IOP to 40mm Hg. The gonioscopic picture showed dislodged fluocinolone-acetonide implant into the anterior chamber (AC) with an intact posterior capsule and stable PCIOL implant. The intravitreal fluocinolone-acetonide implant might have resulted in increased concentration of the medication at the trabecular meshwork leading to steroid-induced glaucoma. The woman received treatment with topical anti-glaucoma and acetazolamide. Despite these treatments, her IOP remained elevated above 30mm Hg. Then, the displaced fluocinolone-acetonide implant was removed by surgical procedure. After the procedure, IOP remained well controlled without anti-glaucoma medication and CDVA stabilized at 20/100 with no further deterioration of DME. Alzaabi M, et al. Anterior migration of intravitreal fluocinolone acetonide (Iluvien) implant in a pseudophakic eye with intact posterior capsule. American Journal of Ophthalmology Case Reports 20: Dec 2020. Available from: URL: http://doi.org/10.1016/j.ajoc.2020.100922

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Reactions 10 Oct 2020 No. 1825