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Ghulam Dastgir, Sara Ferri, John Danias, Eric Shrier; Impact of Intravitreal Bevacizumab on Intraocular Pressure. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2970.
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Bevacizumab is an anti-vascular endothelial growth factor agent used in the management of various neovascular ocular conditions. Case studies in the literature have reported significant increases in intraocular pressure (IOP) following intravitreal injection of bevacizumab. This study explores the long-term effect of intravitreal bevacizumab on IOP in glaucomatous eyes, nonglaucomatous eyes, and eyes at high risk for glaucoma.
A retrospective chart review of 87 eyes of 87 patients who received intravitreal bevacizumab injections by one surgeon (ES) for various ophthalmic indications was performed. The study population consisted of patients with and without a history of glaucoma in the injected eye. Patients with active neovascular glaucoma, history of glaucoma filtration surgery, and cataract surgery following bevacizumab administration were excluded. Data included two-year average intraocular pressures prior to administration of bevacizumab and regular follow-up of IOP beginning 4-6 weeks after first bevacizumab injection. Endpoint was the addition of at least one IOP-lowering medication over the course of the treatment period. Chi-square analyses were performed to compare IOP changes over various time points.
Of the 87 eyes receiving intravitreal bevacizumab, 60 eyes were nonglaucomatous, 22 eyes were glaucomatous, and 5 eyes were at high risk for glaucoma. The median follow-up time was 14 months with a range of 2 months to 57 months. There was no difference between pre-avastin average IOP and 4-6 week follow-up IOP (Χ²=0.317) or the average of the final three IOP’s at follow-up (Χ²=0.892). There was a significant difference between the pre-injection IOP and the maximum measured IOP at follow up (Χ²=0.049). A total of 5 eyes (5.7%) in the study population required the addition of an IOP-lowering medication; two were glaucomatous, two were nonglaucomatous, and one was at high risk for glaucoma.
Intravitreal bevacizumab may cause a significant elevation of IOP over the course of follow-up in both glaucomatous and nonglaucomatous eyes. However, this increase may be transient and clinically may not require initiation of IOP-lowering medication. We recommend regular close monitoring of IOP in patients receiving intravitreal bevacizumab irrespective of a history of glaucoma.
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