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Junglim Kim, Jeongmin Lee; Effect on intraocular pressure after intravitreal injection of anti-vascular endothelial growth factor agents in eyes with neovascular age related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5652.
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To report the rate of intraocular pressure (IOP) elevation associated with repeated intravitreal injections of antivascular endothelial growth factor (VEGF) agents and to determine if sustained elevation of IOP after injection was predicted using IOP one hour after injection.
The charts of 259 eyes undergoing intravitreal injection with anti-VEGF agents for neovascular age-related macular degeneration (AMD) were reviewed for history of glaucoma, total number of injections and changes in IOP. Sustained IOP elevation was defined as IOP≥ 22 mmHg and a change from baseline of ≥ 6 mmHg recorded on at least two consecutive visits and lasting ≥ 30 days. Data were analyzed independently for two groups according to difference between baseline IOP and IOP one hour after injection (1) more than 6 mmHg and (2) less than 6 mmHg.
Of the 259 eyes receiving injections with bevacizumab and/or ranibizumab, 4.25% (n=11 eyes) had sustained IOP elevation. The rate of sustained elevation IOP was 4.72 % (5/106) for the eyes receiving only bevacizumab, 2.68% (3/112) for the eyes receiving only ranibizumab and 7.32 % (3/41) for eyes undergoing bevacizumab and ranibizumab. The rates of glaucoma and sustained IOP elevation are high in the group which is more than 6 mmHg difference between baseline IOP and IOP one hour after injection (6.67% vs. 0.65% respectively, p=0.008, 9.52% vs. 0.63% respectively, p=0.001).
Sustained IOP elevations can occur undergoing intravitreal anti-VEGF treatment for neovascular AMD. It suggests the possibility of a heightened risk for further elevation of IOP in patients with pre-existing glaucoma who receive either bevacizumab or ranibizumab. AMD eyes that receive intravitreal anti VEGF injections need to be monitored for IOP changes, especially those in which is more than 6 mmHg difference between baseline IOP and IOP one hour after injection. Prospective studies are needed to verify these results and better understand the implications of these findings.
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