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Editors Selection IGR 9-3

IOP-Related: Dexamathasone provocative test

Comment by Keith Barton on:

22525 Predictive value of a topical dexamethasone provocative test before intravitreal triamcinolone acetonide injection, Breusegem C; Vandewalle E; Van Calster J et al., Investigative Ophthalmology and Visual Science, 2009; 50: 573-576

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The paper by Breusegem et al. (224) is interesting, as it reports the results of a study that is of practical value in estimating the likelihood of a significant corticosteroid-related intraocular pressure elevation after intravitreal triamcinolone injection. The study necessitated withholding IVTA injection for one month while the patient used dexamethasone 4 times daily for one month. The hypothesis tested was that the corticosteroid response to topical dexamethasone would be predictive of that to IVTA. Forty-three patients were enrolled, although 7 were subsequently excluded.

Some, but not all, high responders to IVTA can be identified in advance using topical dexamethasone 4 times daily for a month

Of the 36 included, 12 (33%) who developed no response to dexmethasone subsequently developed a response to IVTA (≥ 6 mmHg rise from baseline). No topical dexamethasone responders failed to mount a response to IVTA, i.e., all 4 (11%) developed a response. The conclusions from the study were, that it has a low sensitivity, high specificity, high positive predictive value and moderate negative predictive value. This study is useful in that it shows that some, but not all, high responders to IVTA can be identified simply in advance using topical dexamethasone 4 times daily for a month if it is clinically safe to withhold the treatment for that period of time.

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