Predictors of Sustained Intraocular Pressure Elevation in Patients Receiving Anti-Vascular Endothelial Growth Factor Therapy for Neovascular Age-Related Macular Degeneration

Abstract

 

Purpose

 

To determine predictors of sustained intraocular pressure (IOP) elevation in patients treated with intravitreal anti-vascular endothelial growth factor (VEGF) therapy for neovascular age-related macular degeneration (NV AMD) using a cross sectional physician survey.

 

Methods

 

530 retina specialists were surveyed regarding current anti-VEGF intravitreal injection protocols including the anti-VEGF drug of choice, needle size, injection volume, injection technique, and self-reported prevalence of sustained IOP elevation. Multivariate logistic regressions were performed to assess the influence of these factors on long-term IOP.

 

Results

 

There was no relationship between the frequency of sustained IOP elevation and anti-VEGF drug of choice. Participants using 31 gauge needles were 2.8 times more likely to observe a high frequency of sustained IOP elevation than those who used 27, 30, or 32 gauge needles (p=0.028). Physicians who injected greater than 0.05cc in less than one second were over 5 times more likely to observe a high frequency of sustained IOP elevation (p<0.01).

 

Conclusions

 

Serial anti-VEGF injections using either 31 gauge needles, higher injection volumes, and a rapid injection technique may lead to sustained IOP elevations. The underlying mechanism may relate to rapid elevations in IOP inducing injury to the trabecular meshwork. Further investigation of the relationship between injection technique and sustained IOP elevation is warranted.

 

 

 

Keywords: 568 intraocular pressure • 412 age-related macular degeneration • 561 injection