Persistent Ocular Hypertension following Multiple Intravitreal Anti-VEGF Injections for AMD

Abstract

Purpose: : To study ocular hypertension following multiple intravitreal injections of ranibizumab and/or bevacizumab in AMD patients.

Methods: : Retrospective study.

Results: : We studied three patients with sustained elevated intraocular pressures (IOP) after multiple intravitreal injections of ranibizumab 0.5 mg/0.05 cc and/or bevacizumab 1.5 mg/0.06 cc. Ocular hypertension (OHT) occurred 1 month after the 16^th ranibizumab injection in patient 1, and 4 months after the 3^rd ranibizumab injection in patient 2. Patient 3, maintained normal IOP after 4 ranibizumab injections, but developed OHT 1 month after the 2^nd bevacizumab injection. Bakri SJ et al 2008 (Graefes Arch Clin Exp Ophthalmol. 246(7):955-8.) reported four cases of persistent OHT following intravitreal ranibizumab and/or bevacizumab. In their series, persistent OHT occurred after: 1 ranibizumab injection in 1 patient; 2 ranibizumab injections in 1 patient; 4 injections (3 bevacizumab and 1 ranibizumab) in 1 patient; and 11 injections (9 bevacizumab and 2 ranibizumab) in 1 patient. A review of all 7 cases revealed: None of the patients had a previous diagnosis of glaucoma, OHT, or a family history of glaucoma. Six patients developed OHT after recent intravitreal ranibizumab and one patient after recent intravitreal bevacizumab. Four patients were pseudophakic with a history of a YAG capsulotomy. Mean pre-injection IOP was 16.4 mmHg (range, 13 to 22 mmHg). Mean post-injection IOP was 34.6 mmHg (range, 26.5 to 50 mmHg). Mean number of total anti-VEGF injections prior to OHT was 6.1 (range, 1-16). The mechanism of OHT is unknown, but it is hypothesized that high molecular weight proteins such as ranibizumab and bevacizumab may directly obstruct aqueous outflow or the anti-VEGF agents may decrease trabecular meshwork function.

Conclusions: : Significant and persistent ocular hypertension may occur after intravitreal anti-VEGF in patients with no previous diagnosis of glaucoma or OHT. OHT may be sustained across several visits and patients may require IOP lowering therapy. Sustained elevation in IOP may occur after only one anti-VEGF injection or after multiple injections (range, 1-16). A disrupted posterior capsule might predispose patients to the development of OHT. CR: None.

Keywords: age-related macular degeneration • vascular endothelial growth factor • choroid: neovascularization