Abstract
Purpose :
Medical prophylaxis with pressure-lowering agents prior to anti-vascular endothelial factor (VEGF) injections has emerged as a strategy for controlling intraocular pressure (IOP) spikes in patients who are at risk for glaucomatous change. We performed a retrospective, observational study to investigate whether pretreatment had an effect on glaucoma progression in eyes with preexisting glaucoma or ocular hypertension (OHT).
Methods :
A total of 66 eyes from 54 patients with a preexisting diagnosis of glaucoma or OHT, treated with six or more injections of ranibizumab, bevacizumab, or aflibercept were selected for chart review. Primary outcome measures were rate of visual field loss in dB/year, rate of change in retinal nerve fiber layer (RNFL) thickness in microns/year, and need for additional glaucoma medications, surgery, or laser.
Results :
The number of eyes requiring additional glaucoma medication over the follow up period was 5 (25.0%) of 20 and 14 (30.4%) of 46 for the pretreated and non-pretreated groups, respectively. The number of eyes requiring glaucoma surgery or laser was 4 (20.0%) of 20 and 13 (28.3%) of 46 for the pretreated and non-pretreated groups, respectively. Estimated mean rate of pattern standard deviation (PSD) decline was not significant in either group (p > 0.073), with no difference between groups (p = 0.332). Estimated mean rate of global RNFL thinning was -4.22 µm/year in pretreated eyes and -5.29 µm/year in non-pretreated eyes. Although both groups showed significant RNFL change from baseline (p < 0.011), no difference was detected between groups (p = 0.467).
Conclusions :
Prophylactic pressure-lowering medication is a method for controlling IOP fluctuations secondary to intravitreal anti-VEGF injections, but pretreatment had no detectable effect on structural or functional glaucoma progression. Larger prospective studies are needed to further understand the nature and extent of the association between anti-VEGF therapy and glaucoma progression. Patients receiving repeated injections may be at risk for glaucomatous complications requiring invasive intervention. It is advisable for ophthalmologists to exercise caution when administering treatment in this population of patients.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.