Repeated intravitreal anti-vascular endothelial growth factor injections can induce iatrogenic ocular hypertension, especially in patients with open-angle glaucoma.

Abstract

OBJECTIVE:

To report the rate of intraocular pressure (IOP) elevation after repeated intravitreal injections (IVIs) of anti-vascular endothelial growth factor (anti-VEGF) agents and to determine the risk factors.

METHODS:

A total of 193 patients (217 eyes) undergoing ranibizumab (n = 196) or bevacizumab (n = 21) IVIs were prospectively examined. The incidence of ocular hypertension (OHT) after these injections was investigated with respect to the number of injections, pre-existing open-angle glaucoma, diabetes, YAG capsulotomy, age, and sex.

RESULTS:

A total of 1461 IVIs was performed. After a mean of 6.7 ± 7.1 IVIs (range, 1-49), 4.6% (n = 10) had IOP elevation more than 25 mm Hg and required medical treatment (1.4% of them spiked above 30 mm Hg). Patients with pre-existing glaucoma experienced higher prevalence of OHT (12.9%) and greater rates than the control group (19.6 ± 5.7 mm Hg vs 16.4 ± 3.9 mm Hg, p < 0.001). No significant difference was found in the diabetes subgroup (n = 66, p = 0.62) or in the YAG capsulotomy subgroup (n = 24, p = 0.51) compared with the control group. The IOP peak was significantly correlated with the total number of IVIs (p = 0.0002, r = 0.25).

CONCLUSIONS:

Serial IVIs may lead to persistent IOP elevation that requires IOP-lowering therapy. The risk is correlated with the number of injections and increases in the glaucoma population, and must be checked during follow-up.

• Authors: Emilie Agard, Hussam Elchehab, Guillaume Ract-Madoux, Aurélie Russo, Constance Lagenaite, Corinne Dot
• Journal: Canadian journal of ophthalmology. Journal canadien d'ophtalmologie (Can J Ophthalmol) Vol. 50 Issue 2 Pg. 127-31 (Apr 2015) ISSN: 1715-3360 [Electronic] England
• PMID: 25863852 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Chemical References

• Angiogenesis Inhibitors
• Antibodies, Monoclonal, Humanized
• Antihypertensive Agents
• VEGFA protein, human
• Vascular Endothelial Growth Factor A
• Bevacizumab
• Ranibizumab

Topics

• Adult
• Aged
• Aged, 80 and over
• Angiogenesis Inhibitors (adverse effects)
• Antibodies, Monoclonal, Humanized (adverse effects)
• Antihypertensive Agents (therapeutic use)
• Bevacizumab
• Female
• Glaucoma, Open-Angle (complications)
• Humans
• Iatrogenic Disease
• Incidence
• Intraocular Pressure (drug effects)
• Intravitreal Injections
• Male
• Middle Aged
• Ocular Hypertension (chemically induced, drug therapy)
• Prospective Studies
• Ranibizumab
• Retreatment
• Risk Factors
• Vascular Endothelial Growth Factor A (antagonists & inhibitors)