Purchase this article with an account.
Hussam El Chehab, Emilie Agard, Aurélie Russo, Ygal Boujnah, Corinne Dot; Intra-ocular pressure spike after Aflibercept intravitreal injections. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4612.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Since anti-VEGFs approval, intra vitreous injections (IVI) represent a booming therapeutic delivery mode. Immediate ocular hypertension (OHT) induced is known after ranibizumab or bevacizumab injection. The purpose of this study is to evaluate the OHT after Aflibercept injection.
We prospectively included 30 patients who received an Aflibercept IVI (40mg/ml, 0.05mL for wet AMD between October and November 2014 in our center. IVI was performed with a 30G needle pushed to the hilt, using an anti-reflux system after its removal. If a reflux was noted, the patient was excluded. We measured the intraocular pressure (IOP) using a portable aplanation tonometer PERKINS MK2 (Haag-Streit, Koeniz, Switzerland) before injection (T0), immediately after injection (T1), 5 minutes (T5), 15 minutes (T15) and 45 minutes (T45) after the IVI. The measures T0, T5, T15 and T45 were performed sitting and T1 was performed lying. Before IVI and immediately after T1 measurement, we performed an acquisition with PENTACAM (Oculus, Wetzlar, Germany), 3D-scan mode with 25 acquisitions per second, in order to assess changes in anterior segment parameters. We evaluated : anterior chamber volume, anterior chamber depth and estimation of iridocorneal angle. The IOP and morphological data were compared by a paired t-test.
Before IVI, IOP was 12.9mmHg+1.3. All patients had a significant increase in IOP after IVI (42.7mmHg+3, p <0.001). At T1, 20% of eyes (6 eyes) had an IOP greater than 50mmHg. All patients had light perceptions after IVI. At T5, IOP decreases but is still statistically higher than baseline IOP (23.6mmHg+3.1, p <0.001). At T15, IOP returns to normal values but is still higher than baseline (16.2mmHG+2.1, p = 0.009). There are 7 eyes with an OHT (IOP>21mmHg). At T45, IOP was 13mmHg+1.2, with no significant difference from baseline (p = 0.877).<br /> There is a statistically significant decrease in anterior chamber volume after IVI (168.3mm3 vs. 160.6mm3, p = 0.002). A subgroup analysis finds that this change after IVI occured only noted in phakic eyes (17yeux). Pseudophakic eyes did not differ before and after injection. There is no significant change after IVI in the other morphological variables.
Aflibercept IVI induces an IOP spike for a short time. The mechanism does not seem to be an angle closure. The repeated IVIs in same patient require to consider the potential risk especially in glaucoma patients.
This PDF is available to Subscribers Only