Abstract
Purpose :
To study the effects of intravitreal injection (IVI) on intraocular pressure (IOP) and to predict the patient population which may be most susceptible to acute elevations in IOP.
Methods :
A three-month, prospective study of patients receiving IVI of anti-VEGF at the Acuity Eye Group. IOP was measured pre-injection as well as post-injection at 10-minute intervals up to 50 minutes. Patients with an IOP greater than 35mmHg at 30 minutes received an ACP. Patients with an IOP below 35mmHg were monitored without intervention.
Results :
617 patients were included, with a mean age of 73 years. Patients received IVI for diabetic retinopathy (n = 199), age-related macular degeneration (n= 355), and retinal vein occlusion (n = 63). Average pre-injection IOP was 16 +/-5 mmHg. Average post-injection IOP was 25, 27, 28, 27, and 29 mmHg at 10, 20, 30, 40, and 50 minutes respectively (P<.0001). The ACP group (n=17) had a pre-injection average IOP of 24 +/- 7 mmHg (p<.0001), and post-injection IOP of 47 +/- 10 and 44 +/- 9 mmHg at 10 and 20 minutes respectively (p<.0001). Overall, 33% of patients with a pre-injection IOP > 25 mmHg and 50% with a pre-injection IOP > 30 mmHg required ACP. A diagnosis of glaucoma was higher in the ACP group compared to the non-ACP, 82.3% vs 14.2% (p<0.0001), and a diagnosis of glaucoma suspect was also higher in the ACP group vs non-ACP, 17.6% vs 9.0 respectively ( p>0.05). Patients with a pre-injection IOP > 25 mmHg and a history of glaucoma had a 58.3% rate of ACP. The number of IVI were similar between the ACP and non-ACP group at 22 +/- 10 vs 19 +/- 11 injections, respectively. A 31-gauge needle had a higher incidence of ACP when pre-injection IOP > 25 versus 30-gauge, 42.9% vs 29.4% respectively (p>0.05).
Conclusions :
IVI of anti-VEGF medication is associated with a transient but significant increase in IOP. Patients with a pre-injection IOP of 25mmHg or greater, combined with a history of glaucoma, may be at a higher risk of prolonged IOP increases and may benefit from prophylactic ACP.
This is a 2021 ARVO Annual Meeting abstract.