June 2020
Volume 61, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2020
The short- and long-term effect of intravitreal injections on intraocular pressure and retinal nerve fiber layer thickness - a systematic review and meta-analysis
Author Affiliations & Notes
  • Wishal Ramdas
    Ophthalmology, Erasmus Medical Center, Rotterdam, Netherlands
  • Victor A de Vries
    Ophthalmology, Erasmus Medical Center, Rotterdam, Netherlands
  • Fabiana L Bassil
    Ophthalmology, Erasmus Medical Center, Rotterdam, Netherlands
  • Footnotes
    Commercial Relationships   Wishal Ramdas, None; Victor de Vries, None; Fabiana Bassil, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 44. doi:
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      Wishal Ramdas, Victor A de Vries, Fabiana L Bassil; The short- and long-term effect of intravitreal injections on intraocular pressure and retinal nerve fiber layer thickness - a systematic review and meta-analysis. Invest. Ophthalmol. Vis. Sci. 2020;61(7):44.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : The number of eye diseases treated with intravitreal injections is increasing. Obviously, an injection of fluid into the eye results in an increase of intraocular pressure (IOP), the main risk factor for glaucoma. However, the effect of these repeated IOP increases on the eye is unclear.

Methods : A systematic review and meta-analysis was undertaken in an academic medical setting. PubMed, Embase and Clinical Trials Registries were searched for articles investigating the relationship between intravitreal injections (anti-vascular endothelial growth factor [anti-VEGF] or steroids) and either IOP, RNFL-thickness and glaucoma. Multiple meta-analyses were performed, combining data on intravitreal injection of anti-VEGF medication and dexamethasone implants.

Results : A total of 77 articles were included in the systematic review, of which 74 studies were eligible for meta-analyses. The short-term effect of an intravitreal injection of anti-VEGF showed a statistically significant increase in IOP. One day after injection of anti-VEGF, however, IOP was significantly lower than baseline. The long-term time-intervals showed no significant difference in IOP. After intravitreal injection of a dexamethasone implant, IOP was significantly higher than baseline 1 month post-injection. RNFL-thickness was significantly reduced 6 and 12 months post-injection of anti-VEGF, as well as at end of follow up.

Conclusions : The IOP increases shortly after the administration of an intravitreal injection of anti-VEGF and finally normalizes within the first week. IOP remains elevated for up to 6 months after injection of a dexamethasone implant. Currently, there are no well-designed studies that assessed the risk of glaucoma in patients treated with intravitreal injections. Future studies with visual field progression or glaucoma as an outcome itself are warranted. Caution is advised when using intravitreal medication, especially when treating patients with advanced glaucoma; in these cases, prophylactic IOP-lowering medication may be considered.

This is a 2020 ARVO Annual Meeting abstract.

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