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Kanishka Randev Mendis, Hugo Lee, Jocelyne Rivero; Rebound tonometry intra ocular pressure screening of patients treated with anti vascular endothelial growth factor inhibitors. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4963.
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A temporary intraocular pressure (IOP) rise is associated with the anti VEGF injection. In most instances the IOP rise is reported to be transient and minimal. Rebound tonometry with i-care (Icare, Findland Oy) provides a rapid, sterile, objective method of IOP screening in patients treated with anti VEGF injections. The purpose of this study was to evaluate the IOP change in all anti- VEGF treated patients and investigate for at risk patients groups.
A prospective, consecutive, observational study of all patients treated with anti VEGF agents ( Ranibizumab, Bevacizumab- Genetech, USA; Aflibercept- Bayer, Australia) for wet age related macular degeneration, diabetic macular edema and retinal vascular obstruction and macular edema. Patients with a know history of glaucoma and on IOP therapy were excluded. All patients had a pre and post injection IOP measurements taken. The post injection readings were taken at 1 minute and 15 minutes time points. Patients with IOP above the normal range at 15minutes (12-22 mmHg) had further IOP measurements performed at 15 minutes intervals until the IOP normalized. All injections where carried out accordingly to established protocols for anti VEGF injections and the recommended dose and volume was administered in all cases.
Ninety eyes of seventy-nine patients were included. The mean age was 72 (SD-13.1), there were 45 males and 44 females, of these 45 had AMD, 22 DME and 16 patients had RVO. Of the patient treated 14% received Ranibizumab, 51% Bevacizumab and 32% Aflibercept. Average IOP, preinjection was 14.3mmHg (SD-3.62), at 1minute post injection was 34.3mmHg(SD-9.26) and at 15 minutes was 20 mmHg (SD-4.85). The data was also analyzed for other variables, which included phakic status, diabetes, and history of vitrectomy. Patients with a vitrectomy had the highest IOP rise (average IOP change 11mmHg vs 5.4mmHg- p-0.014)
Rebound tonometry provides an objective evaluation of IOP in the patients undergoing anti VEGF therapy. The pressure differentials will allow to identify patients that may require more careful evaluation if they were to continue on repeated anti VEGF therapy. Patients with vitrectomy continued on anti VEGF require more careful monitoring of IOP. More data is required on vitrectomised patients continued on anti VEGF therapy.
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