Is IOP a Concern Post-Injection of Macugen, Avastin, or Lucentis?

Abstract

Purpose:: To determine the extent of IOP elevation following intravitreal injections of Macugen, Avastin, and Lucentis.

Methods:: 169 eyes with wet AMD received intravitreal injections of one of three anti-VEGF medications: 75 eyes received Macugen (.09 ml), 69 received Avastin (.05ml), and 25 received Lucentis (.05ml). IOP was taken within one minute of injection and every 5-10 minutes until the pressure was reduced to a safe level. Vision was evaluated immediately following injection.

Results:: Mean pre-injection lOP for Macugen, Avastin, and Lucentis respectively were as follows: 13.1 +/- 3 mmHg, 14.1 +/- 3 mmHg, and 12.6 +/- 3 respectively; at 1" post-injection IOP increased to 41.6 +/- 13 mmHg from Macugen, 36.8 +/- 10 mmHg from Avastin, and 37.2 +/- 9 from Lucentis, with a clinically significant difference between Lucentis and Macugen (p=0.03). IOP reduction occurred more quickly with Lucentis than with Macugen or Avastin, reducing to 16.6 +/- 4 by 21-30 minutes, while IOP was still remained elevated at 22.9 +/- 8 from Macugen (p=0.003) and 21.9 +/- 7 from Avastin (p=0.02). There was a 5.3% (4/75) incidence of transient NLP following Macugen injections, while no patients went NLP following Avastin or Lucentis.

Conclusions:: Macugen, Avastin, and Lucentis injections all result in a very significant transient rise in IOP that may be damaging to the optic nerve, particularly in patients with advanced glaucoma. Of the three drugs, Lucentis appears to be the safest in terms of IOP.

Keywords: age-related macular degeneration • intraocular pressure • drug toxicity/drug effects