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Elizabeth Anne Atchison, Catherine N Barry, Flora Lum, Cynthia Mattox, Mathew W MacCumber; The Real World Effect of Anti-VEGF Injections on IOP Using the IRIS Registry. Invest. Ophthalmol. Vis. Sci. 2017;58(8):871. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Several previous studies have suggested a link between intravitreal anti-vascular endothelial growth factor (VEGF) injections and a sustained increase in intraocular pressure (IOP). We analyzed the effect of the most commonly used of these drugs on sustained IOP using a large, real world registry-based sample.
A total of 23,282 patients in the IRIS® Registry were examined who had neovascular age related macular degeneration (AMD), diabetic macular edema (DME) or branch or central retinal vein occlusion (BRVO/CRVO) with retinal edema and received at least one injection in the right eye with bevacizumab, aflibercept, or ranibizumab during the study period (1/1/13 to 12/31/15). Three subgroups were primarily analyzed: all patients, AMD-only, and patients who were treatment naive for at least one year before the start of the study. Patients who had more than one type of injection were excluded. Change from pre-injection IOP to IOP at last injection at least 1 year later was calculated. Significance was evaluated using generalized linear model repeated measures analysis of longitudinal, observational data controlled for potential confounding factors including gender, race, age, number of anti-VEGF injections, glaucoma before or during study period, history of vitrectomy, post-injection vitrectomy, post-injection cataract surgery, post-injection pseudophakia and baseline pre-injection IOP reading. To evaluate the possible confounding effect of the diagnosis of glaucoma or undergoing cataract surgery during the study period a fourth group excluding these patients was also analyzed.
Table 1 outlines the findings of the study. All subgroups of patients for all drugs had a small decrease in IOP over the course of the study. Comparing the three drugs, IOP was higher in bevacizumab treated eyes compared to aflibercept and ranibizumab treated eyes in most cases, though differences were small. These patterns held in the group excluding glaucoma patients and those undergoing cataract surgery during the study period.
In this large study anti-VEGF therapy was associated with a small decrease in IOP over time. Although statistically significant, differences in IOP between the three drugs aflibercept, ranibizumab, and bevacizumab were overall small, suggesting no clinically relevant difference between these drugs and changes in IOP over time.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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