Ozurdex injection

[Koalajane]

I am at some time in the not too distant future having Ozurdex implant in my eyes. Ozurdex is a steroid.

Will this have any effect on the steroids I normally take. Probably a strange question I know but my brain works in strange ways

[PMRpro Ambassador]

Not a strange question at all!

Apparently it can lead to significant systemic levels of steroid so I would imagine that you will find it has an effect on the PMR symptoms and possibly you will be able to reduce the oral dose a bit for a while but I can't find real details of the way it is released. It will be similar to the intramuscular steroid injections - a peak at the start and then the amount released will fall off over the following weeks/months.

Does the specialist know you are on oral pred? Are they expecting to repeat the injection in the future? They must have come up against similar things before.

[Koalajane in reply to PMRpro]

I did tell her I was on oral steroids and that it had had an effect on my cararacts

[PMRpro Ambassador in reply to Koalajane]

According to the stuff I read, it has a fair effect on both raised eye pressures and cataracts itself. But I suppose it is a rock and a hard place.

[Koalajane in reply to PMRpro]

They are operating on my cataracts as well, my eye pressure tends to be high due to thick cornea but this is monitored regularly before any of my injections

[PMRpro Ambassador in reply to Koalajane]

Can they not do anything about that? I know there is a procedure for pressure they can do when they do a cataract.

[Koalajane in reply to PMRpro]

I think it is a case of the pressure is not really high but it looks it because of the thickness of the cornea. Once it was realised my cornea was thick by a consultant I was taken off drops for glaucoma and seems to hover in the high range of normal.

[PMRpro Ambassador in reply to Koalajane]

My corneal problem is astigmatism. I saw the eye specialist here the other week and she blithely informed me I should never have a cataract op as they were rarely successful with astigmatism and there was nothing they could do. Totally confused now as I was under the impression there was laser surgery! Luckily the cataract is tiny and has only just appeared last year.

[Grammy80 in reply to PMRpro]

I don't understand her position at all. Part of my vision issue, since age 12, was that I had astigmatism which was corrected by the lenses in my glasses. When I had my cataract surgery, I never thought of it; I had the surgery with lens implants and all was well. Here is a little bonus for you:

For most cases of astigmatism, the preferred method of treatment is the placement of a toric lens implant. A toric lens replaces your cataract and neutralizes astigmatism thereby giving you sharper vision. I have been using these types of toric lens implants since they were FDA approved many years ago. Jul 23, 2022 (and I checked Mayo Clinic site too)💞

[PMRpro Ambassador in reply to Grammy80]

Quite - what I thought. But it has rather shaken my faith in her!

[Grammy80 in reply to PMRpro]

That, I totally understand!!! Thank goodness we can gain knowledge and have a mouth to sometimes save ourselves!💞

[PastelsinArt in reply to PMRpro]

I had cataract surgery on the eye with most astigmatism in 2014 which was successful but of course didn't alter the astigmatism. If it's done privately you can have a more sophisticated lens replacement that corrects this but I wasn't informed about this 😠. About 18 months later I had laser treatment of the cornea and now I can see better than before the cataract developed. Result!

[PMRpro Ambassador in reply to PastelsinArt]

That's more like what I thought - must investigate further.

[PMRpro Ambassador in reply to PastelsinArt]

I wonder if that was the problem - she said sometimes the cataract op doesn't come out well. Everyone expects perfect sight with their lens implant don't they? It seemed strange since she told me I would see better with contact lenses - where they use torics. So logic says ...

So the laser treatment is good?

[PastelsinArt in reply to PMRpro]

It was for me. After cataract surgery I was fine physically but felt cheated that I'd not been told that if I'd gone private I could have had a more sophisticated intraocular lens to the astigmatism (turned out I'd been given an information leaflet that was out of date at my initial assessment). I eventually saw a consultant privately whose advised the laser treatment and also said that having it older means it's more stable as the cornea is less likely to change shape. Seven years on I'm still delighted with the resulting vision. I only need reading glasses.

[PMRpro Ambassador in reply to PastelsinArt]

I'm not sure how it works here - but I bet if I wanted an expensive lens I could pay and have it done at the hospital - the system allows for patients to pay for stuff!

[Orpheus82 in reply to PMRpro]

you need to ask your ophthalmologist about toric lenses which when implanted will correct astigmatism. They’ve been around for a while in the private sector and we have been using them in the NHS in the past few months with promising results. Laser treatment can also remodel the cornea to reduce astigmatism.

[PMRpro Ambassador in reply to Orpheus82]

I was under the impression that was the case - so was rather taken aback by her statement. She mentioned the cataract a year ago and said I needed to be seen in a year. I actually went for something else and suddenly she sent me for a scan of the cornea and then said I should avoid a cataract op as long as possible as they didn't go well with astigmatism and there was nothing they could do to cure it. Hence my confusion!

[Karenjaninaz in reply to PMRpro]

I think your ophthalmologist needs “curing”.

[Orpheus82 in reply to PMRpro]

Well you are right to be confused! As long as you haven’t any other pathology or keratoconus there’s no reason you couldn’t have a toric lens implant. An ordinary implant will replace a lens but you would still have to have glasses to correct the remaining astigmatism. It may be that your ophthalmologist has not had much experience with toric lenses.

[PMRpro Ambassador in reply to Orpheus82]

Ah - she didn't mention ketatoconus but I think the astigmatism may be irregular. Unusually I didn't get a discharge letter so I can't check. Probably be in Italian though she does speak German well

[LWNE]

Hello there, I also have "thick corneas" and before my lens replacement surgeries for cataracts (exacerbated by Pred, but would have developed anyway), my pressures were always "high normal"...they are now much lower. Alongside PMR I have uveitis, and one of the possible treatments is steroid implants, but currently im reponding well to increased Pred and eyedrops. Plan is to get me back down to 5mg fairly quickly, and stay there for a while to stabilise. Before the uveitis flare (after none for 2 years!), I had tapered very slowly after 4 years from.PMR diagnosis to 2mg. Eye doctor is hopeful I will get below 5mg again, so im still positive!

[Koalajane in reply to LWNE]

yes I am to have the implants a few weeks before the cataract ops. I have macular oedema

[LWNE]

I wish you all the best! I have had the oedema with the uveitis flare, but eye hosp in Bristol were on the ball, and we caught it early enough for oral and topical Pred to treat it...

[Daisyroo]

please put this question to the Macular Society on Healthunlocked. They know about Ozurdex and will be able to help you.

[Koalajane in reply to Daisyroo]

thank you I will, do they know much about steroids?

[PMRpro Ambassador in reply to Koalajane]

Exactly what I was thinking! That is half the trouble - most people seem to know half the story with so much when it comes to oral steroids.

[Koalajane in reply to PMRpro]

they don’t seem to know about oral steroids. I will see how it affects my sugars by testing and if I can reduce my prednisolone all well and good. The Ozurdex implant is supposed to release slowly over 6 months.