Abstract
Purpose:
To study the long-term effects of intravitreal injections of bevacizumab on intraocular pressure (IOP) in patients with diabetic macular edema (DME).
Methods:
This is a retrospective chart review of patients with diabetic macular edema, who were treated with intravitreal bevacizumab (1.25 mg/0.05cc) from June of 2011 through June of 2012. The IOP of the injected eye as well as the fellow non-injected eye (control) were recorded at baseline and subsequent follow up visits. Patients with glaucoma, on glaucoma medications, or with baseline IOP >21mmHg were excluded. Fisher Exact, Mann-Whitney U, and regression tests were used for statistical analysis.
Results:
A total of 100 patients (100 injected and 48 non-injected eyes) were included in the study. Age ranged from 33 to 86 with a mean of 57±10 years. The study population was mostly Hispanic (83%). Patients were followed for an average of 295±165 days. The mean number of injections was 2±1 with a range of 1-8. In our study, 26% of injected eyes and 18.8% of control eyes had a post injection increase in IOP greater than or equal to 5mmHg (p=.411). Secondly, 4% of injected eyes and 6.3% of control eyes had an increase greater than or equal to 10mmHg (p=.682). None of the injected or fellow eyes had an IOP increase greater than 15mmHg. During follow-up visits, IOP greater than 21mmHg was recorded in 8% of injected eyes and 8.3% of control eyes. In that subgroup of eyes (IOPs > 21mmHg), the average maximum IOP change from baseline was 7.1±2.9mmHg in injected eyes and 8.5±3.7mmHg in control eyes (p=.424). The number of injections did not significantly predict change in post-injection IOP from baseline (p=.229). Only one patient in the study required a topical anti-glaucoma medication due to persistently high IOP.
Conclusions:
In our study, injected eyes did not show a statistically significant increase in IOP when compared to non-injected eyes. Although persistent elevations have been observed in previous studies of intravitreal injections for AMD in patients with a history of glaucoma, our study demonstrated that if a patient has no history of glaucoma, the risk of developing ocular hypertension or glaucoma due to intravitreal bevacizumab for diabetic macular edema is minimal. There was also no correlation observed between the number of injections and elevated IOP.
Keywords: 561 injection •
499 diabetic retinopathy •
568 intraocular pressure