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A.R. Toler, R.E. P. Frenkel; IOP Effects of Macugen in Glaucoma Patients . Invest. Ophthalmol. Vis. Sci. 2006;47(13):432.
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© ARVO (1962-2015); The Authors (2016-present)
To determine if Macugen injections cause adverse IOP effects in glaucoma patients.
31 intravitreal injections of Macugen (.09ml) were given to patients with wet AMD and glaucoma over a period of 7 months. Most of these patients were taking chronic anti–glaucoma medication, with a mean of .9 medications. In addition, patients were prophylactically treated with a mean of 1.3 IOP lowering medications prior to injection. IOP was taken within one minute of injection and every 5–10 minutes until the pressure was reduced to a safe level. Vision was evaluated immediately following injection.
Mean pre–injection IOP was 12.6 +/– 3 mmHg. The mean IOP immediately post–injection was 39.4 +/– 12.9 mmHg in patients who retained light perception vision immediately after injection. The incidence of transient NLP immediately following injection was 3.2% (1 out of 31). The initial IOP in this patient was >55 mmHg. Exact IOP measurement was not made above 55 mmHg since this patient underwent immediate anterior chamber paracentesis. Mean IOP in mmHg for all patients at 3–10" was 31.8 +/– 10.2, at 11–20" was 23.6 +/– 6.2, and at 21–30" was 20.9 +/– 9.8. Most patients' IOPs had significantly diminished by 30" post–injection; however, some patients took up to one hour. Mean IOP before Macugen showed no clinically significant difference when compared to mean IOP at the next follow up visit (p=0.33). Data will also be presented showing IOP effects of patients receiving Avastin (.05ml) rather than Macugen.
Macugen injections in glaucoma patients, who received prophylactic anti–glaucoma treatment, are associated with a very significant transient rise in IOP that generally persists for 30". These patients are scheduled to receive injections every 6 weeks, thus the problem may be recurrent. Recurring IOP spikes may be damaging to the optic nerve, particularly in patients with advanced glaucoma. The risk of these recurrent injections must be carefully weighed in patients with advanced glaucoma.
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