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Kirstin L. Tawse, Sarah J. Wehrli, Marc H. Levin, Ali Zaidi, Maxwell Pisitilli, Maureen G. Maguire, Alexander J. Brucker; Sustained Intraocular Pressure Elevations Due To Intravitreal Injection Of Bevacizumab And Ranibizumab. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4362.
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To report the frequency of delayed ocular hypertension in patients receiving intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents for the treatment of exudative age-related macular degeneration (AMD).
The charts of all patients receiving intravitreal ranibizumab and/or bevacizumab for exudative AMD from November 2005 to June 2010 at the Scheie Eye Institute were reviewed. In all patients with a baseline intraocular pressure (IOP) <21mmHg, delayed ocular hypertension was defined as an IOP >= 30mm Hg at a single visit, IOP >= 25mm Hg over 2 or more consecutive visits, or IOP >=25mm Hg with initiation of pressure lowering medication(s). IOP characteristics of injected versus non-injected eyes were then compared using survival analyses, with risk assessed by PHREG.
281 patients received intravitreal ranibizumab and/or bevacizumab injections for exudative AMD during the study period. Among those, 347 treated eyes (mean number of anti-VEGF injections +/- SD of 8.222 +/- 7.842) and 200 control eyes of unilaterally injected patients were followed for 2.127 +/- 1.471 and 2.098 +/- 1.397 years, respectively after the first treatment. Four of 347 (1.15%) treated eyes experienced delayed ocular hypertension compared to 3 of 200 (1.50%) control eyes. Three control eyes and four treatment eyes experienced IOP >=25 mmHg on a single visit and were not initiated on pressure lowering therapy and therefore did not meet the criteria for delayed ocular hypertension. Of the treated eyes experiencing delayed ocular hypertension, 2 eyes received lucentis only while 2 eyes received both lucentis and avastin prior to the development of ocular hypertension. No statistically significant risk for delayed ocular hypertension was found in eyes receiving intravitreal anti-VEGF injections (hazard ratio +/- 95% confidence interval = 0.426 +/- 0.100 - 1.821; p = 0.2495). When patients with any baseline IOP including glaucoma patients were included in the analysis, again no statistically significant risk for delayed ocular hypertension was found in eyes receiving intravitreal anti-VEGF injections.
In contrast to recent small case series, this study found no statistically significant increased risk of delayed ocular hypertension in this large sample of patients receiving intravitreal anti-VEGF agents for exudative AMD.
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