Abstract
Purpose: :
Intravitreal bevacizumab injections have become a widespread treatment for neovascular AMD. Several case reports and a recent study of 101 eyes have described intra-ocular pressure (IOP) elevation after repeated injections. We wanted to study a large group of patients treated in our retina clinic and evaluate the incidence and possible risk factors for IOP elevation after repeated intravitreal bevacizumab injections in neovascular age-related macular degeneration (AMD) patients.
Methods: :
We reviewed the charts of 203 consecutive patients (235 eyes) treated in our retina clinic with intravitreal bevacizumab for AMD. Data collected for each patient included: IOP before the initiation of treatment, before each subsequent injection and at the end of follow up; number of injections; length of follow up and the presence of glaucoma before treatment. Patients with preexisting uncontrolled glaucoma were excluded. Sustained IOP elevation was defined as ≥ 22 mmHg for more than 30 days.
Results: :
Sustained IOP elevation was observed in 29 of 235 (12%) treated eyes. Of these 22 required medications to control IOP. Mean IOP at the time of elevation diagnosis was 25 mmHg (range 22-36). There was no statistical difference in post-injection IOP elevation between patients with or without preexisting glaucoma. There was no correlation between IOP at the end of follow up or at the time of IOP elevation and: pre-injection IOP; length of follow up and number of injections. The only statistically significant difference was the mean interval between injections: 2.45 months in patients without and 1.9 months in patients with sustained IOP elevation (p=0.043).
Conclusions: :
AMD patients undergoing repeated intravitral bevacizumab injections, especially when frequent, are at an increased risk of sustained IOP elevation. Regular IOP measurements and IOP-lowering treatment in patients with persistent elevation are recommended.
Keywords: age-related macular degeneration • intraocular pressure • vascular endothelial growth factor