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Robert W. Besinger, Ching J. Chen, Omolola Idowu, Tyler Q. Kirk; Analysis of Ocular Hypertension in Patients Receiving Intravitreal Anti-VEGF Therapy. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3615.
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To study the effects of anti-VEGF injections on intraocular pressure.
This retrospective case series consisted of patients receiving intravitreal injections of bevacizumab, ranibizumab, or both. Patients were excluded for the following: previous glaucoma diagnosis or treatment, history of recent ocular surgery or steroid therapy, or incomplete medical record. The bevacizumab group was further subdivided based upon three compounding pharmacies. Pre and post injection intraocular pressure data was obtained and analyzed.
We analyzed clinical data on 300 patients who received injections of bevacizumab, ranibizumab, or both by one surgeon (CJC) from January 1, 2006 to August 1, 2010. The patient population was 80% white, 52% female, with a mean age of 73.8(range 24-98). 71% received anti-VEGF therapy for age-related macular degeneration, 24% for diabetic retinopathy, and 5% for retinal venous occlusion. 66% of eyes were injected with bevacizumab, 22% with ranibizumab, and 12% of eyes received a combination. Our criteria proposed significant IOP rise at 15mmHG from baseline, a threshhold of 25mmHg, or 10mmHg of asymmetry between the eyes. This revealed a significant IOP rise in 4.3% of anti-VEGF treated eyes with 53% receiving bevacizumab, 40% receiving ranibizumab, and 7% both. These eyes received a mean of 6(min=2, max=13) injections before an IOP rise was observed. The mean IOP in anti-VEGF treated eyes was 15.2, compared to 14.7 in untreated eyes (p=0.003). There was no difference in the mean IOP between the three treatment groups, nor between groups based on number of treatments. There was no significant difference between bevacizumab compounding pharmacies.
Patients receiving intravitreal anti-VEGF injections may develop sustained ocular hypertension without a history of predisposing factors. There was no significant difference in IOP effects when comparing bevacizumab, ranibizumab, and combination treatments. There was a small but significant elevation in mean IOP when comparing anti-VEGF injected eyes to those that did not receive injections.
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