Abstract
Purpose :
It has been suggested that intravitreal anti-VEGF injections (IVIs) can accelerate progression of glaucoma but the risk of any IVI exposure on needing glaucoma surgery is not clear. This case-control study determines the increased risk associated with IVIs and the need for glaucoma surgery.
Methods :
Participants were collected from a glaucoma specialist practice in British Columbia, Canada with a diagnosis of glaucoma, glaucoma suspect, or ocular hypertension and seen between January 1, 2017 – December 31, 2019. Cases were defined as having at least one glaucoma procedural intervention (not combined with cataract surgery) within this timeframe. Controls had no surgical interventions for their glaucoma and were recruited in a 2:1 ratio to cases with age and sex matching. Clinical data was collected for each participant’s most recent follow up visit within the timeframe including whether the participant had any previous exposure to IVIs. Rates of previous IVI exposure amongst surgical glaucoma cases were compared to non-surgical controls to calculate an odds ratio. Ethics approval was obtained from the University of British Columbia ethics board.
Results :
A total of 133 surgical glaucoma cases and 266 non-surgical glaucoma controls were recruited with no significant difference in demographic information. The average age in years being 71.9 in cases and 73.8 in controls. The cohort was 57% male in cases and 53% in controls. The distribution of glaucoma diagnoses and retinal indications for IVIs were similar amongst both cases and controls. Cases used a significantly (P<0.001) larger number of topical medications (3.54) compared to controls (2.27). There was also a significant (P<0.001) difference in average IOP between cases (25.69 mm Hg) and controls (15.03 mm Hg). The crude odds ratio for glaucoma surgery amongst those with any IVI exposure was 6.69 (95% CI 3.52-12.73). The adjusted odds ratio using multivariate logistic regression for this association was 8.49 (95% CI 4.20-17.18) when adjusting for age, sex, and medical comorbidities such as hypertension and diabetes.
Conclusions :
This study demonstrates that any previous exposure to IVIs is associated with a significantly higher risk of glaucoma surgery amongst patients with glaucoma. As the use of IVIs continues to increase, it is important for providers to be aware of this risk particularly in those with pre-existing glaucoma.
This is a 2021 ARVO Annual Meeting abstract.