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Luis Mendonca, Quan Hoang, Jesse Jung, Sarah Mrejen, K Bailey Freund; Influence of Axial Length and Degree of Injection Reflux on Sustained Intraocular Pressure Elevation Due to Intravitreal Anti-Vascular Endothelial Growth Factor Therapy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4935.
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We previously reported 7.1% of our patient population experienced sustained intraocular pressure (IOP) elevation among 449 eyes from 328 neovascular age-related macular degeneration (NVAMD) patients injected with ranibizumab and/or bevacizumab. Here, we assess for an association of axial length with sustained IOP elevation in this population. Additionally, we determine whether axial length or the degree of immediate post-injection fluid reflux is associated with the severity of transient IOP elevation.
A prospective study was performed on a subset of 147 eyes from 74 consecutive NVAMD patients that presented to a single physician over a 2 month period. All patients had axial lengths measured by IOLMaster. 21 of these patients also had pre- and immediate post-injection IOP measured by Tonopen, as well as the degree of immediate post-injection reflux graded by an single experienced retinologist (KBF).
Among the 147 eyes studied, 9.5% had been identified with sustained IOP elevation in our prior studies. Axial length did not correlate with experiencing sustained IOP elevation. Specifically, eyes that had experienced sustained IOP elevation showed an axial length of 23.96 +/- 0.66 mm (mean +/- standard deviation, n = 14), which was not significantly different than that found in eyes that had not experienced sustained IOP elevation (23.44 +/- 1.24 mm, n = 133), with p = 0.12 (2-tailed t-test). Axial length also did not correlate with the degree of transient IOP elevation. Eyes with axial length ≤ 23.5 mm had an immediate post-injection IOP of 18.4 +/- 17.4 mmHg (n = 9), which was not significantly different than that found in eyes with axial length > 23.5 mm (17.8 +/- 16.7 mmHg, n = 12), with p = 0.94 (2-tailed t-test). Eyes without appreciable post-injection reflux had an immediate post-injection IOP of 30.2 +/- 9.3 mmHg (n = 12), which was significantly higher than those with reflux (1.1 +/- 7.2 mmHg, n = 9), with p < 0.001 (2-tailed t-test).
Axial length does not appear to be a predictor of experiencing transient or sustained IOP elevation. Repeated trabecular meshwork trauma related to the degree of post-injection reflux and immediate, post-injection IOP elevation may be a contributing factor.
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