Comparison of Intraocular Pressure Response Between Intravitreal Dexamethasone Implant and Triamcinolone Acetonide Suspension in Patients with Retinal Diseases

Purpose: To compare the incidence and severity of intraocular pressure (IOP) elevation following intravitreal dexamethasone implant versus preservative-free triamcinolone acetonide suspension in patients with retinal diseases. Methods:A retrospective observational cohort study was conducted at a large retina practice.Patients who received at least two injections of either dexamethasone implant or triamcinolone acetonide between 2011 and 2023 were included.IOP was measured at baseline and follow-up using Goldmann or Tonopen tonometry.The primary outcome was a change in IOP from baseline.Secondary outcomes included IOP increases 5 or 10 mmHg, IOP >21mmHg, and need for IOP-lowering therapy.Results: A total of 165 patients received dexamethasone implants, and 146 patients received triamcinolone acetonide injections for analysis.In the dexamethasone group, the mean IOP rose from 14.8 to 19.4 mmHg (p = 0.0001), with 31.2% of eyes showing 5 mmHg increase, 7.9% of eyes showing 10 mmHg increases and 23.6% exceeding 21mmHg.IOP-lowering medications averaged 0.48 in treated eyes and 0.26 in fellow eyes (p = 0.001).In the triamcinolone group, mean IOP changed from 15.3 to 14.5mmHg (p = 0.71), with 19.1% of eyes showing 5 mmHg increase, 2.8% of eyes showing 10mmHg increases and 11.8% exceeding 21mmHg.IOP-lowering medications averaged 0.21 in treated eyes and 0.12 in fellow eyes (p = 0.03). Conclusion:Intravitreal dexamethasone implants demonstrated a significantly higher risk of intraocular pressure elevation compared to those receiving preservative-free triamcinolone acetonide.These findings highlight the need for individualized treatment selection and careful postinjection monitoring