Incidence of Sustained Ocular Hypertension Using Prepackaged Versus Freshly-Prepared Intravitreal Bevacizumab for the Treatment of Neovascular AMD

Abstract

Purpose: To compare the incidence of sustained ocular hypertension (OHT) following injection of pre-packaged IVB versus freshly-prepared IVB monotherapy for neovascular AMD

Methods: Retrospective review of patients with neovascular AMD treated with intravitreal bevacizumab (IVB) monotherapy at two retina practices using different preparations of IVB between 1/1/2009 and 12/31/2011. Number of IVB injections and IOP were recorded. Patients with less than 3-month follow-up, other intravitreal anti-VEGF injections, or neovascularization of the iris/angle were excluded . Subgroup analysis of patients with preexisting glaucoma was performed. Sustained OHT was defined as IOP>25 mm Hg on >=2 separate visits with an increase of >=6 mm Hg from baseline or any IOP measurement >25 mm Hg with an increase from baseline of >=6 mmHg requiring treatment. The eye-year (EY) incidence of sustained OHT was compared between eyes treated with both IVB preparations.

Results: 740 eyes in 634 patients were included. 14 eyes (0.81% incidence per EY) developed sustained OHT. In eyes without preexisting glaucoma, 7/298 eyes (1.11% incidence per EY) injected with pre-packaged IVB developed sustained OHT compared to 3/361 eyes (0.32% incidence per EY) injected with freshly-prepared IVB, not statistically significant (95% CI: 0.68-17.30). Regardless of IVB preparation, increasing injections was significantly associated with higher incidence of sustained OHT for eyes without glaucoma: 3/457 eyes receiving 1-10, 7/159 eyes receiving 11-20, and 0/46 eyes receiving 21-30 injections (p=0.003). For eyes with preexisting glaucoma, 3/41 eyes (3.52% incidence per EY) injected with pre-packaged IVB developed sustained OHT compared to 1/40 eyes (1.12% incidence per EY) injected with freshly-prepared IVB, not statistically significant (95% CI: 0.33-29.88). Regardless of IVB preparation, incidence of sustained OHT was significantly higher for eyes with preexisting glaucoma (4/81 eyes; 2.29% incidence per EY) compared to eyes without preexisting glaucoma (10/659 eyes; 0.64% incidence per EY) (95% CI: 1.09-11.81)

Conclusions: Incidence of sustained OHT following IVB is low with no statistically significant difference between pre-packaged and freshly-prepared injections. Regardless of preparation, eyes with increasing number of injections or preexisting glaucoma had a higher incidence of sustained OHT

Keywords: 688 retina • 748 vascular endothelial growth factor • 561 injection