Iatrogenic intraocular pressure elevation after repeated intravitreal injection, a prospective cohort study

Abstract

PurposeTo report the rate of intraocular pressure (IOP) elevation after repeated intravitreal injections (IVIs) of anti–vascular endothelial growth factor (anti‐VEGF) agents and to assess its evolution over time.MethodsOur study was a prospective cohort including 221 patients (253 eyes) with exudative age‐related macular degeneration (AMD) or diabetic macular edema, undergoing ranibizumab (n =207) or aflibercept (n=44) or bevacizumab (n = 21) IVIs. Patients who received intravitreal or periocular corticosteroid injection were excluded. 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.Results1721 IVIs was performed. After a mean of 7.3‐4.1 IVIs (range 3‐62), 10 (4.6%) had IOP elevation more than 25 mmHg and required medical treatment, 1.4% of them spiked above 30 mmHg. 12 patients received medical treatment (10 monotherapies and 2 dual therapies), no surgical or laser treatment was required.Patients with pre‐existing glaucoma experienced higher prevalence of OHT (11.9%) and greater rates than the control group (19.3‐6.2 mmHg vs 15.6‐5.2 mmHg, p<0.001). No significant difference was found in the diabetes subgroup (81(??%, p=0.55) or in the YAG capsulotomy subgroup (32(??%, p= 0.44) compared with the control group. The IOP peak was significantly correlated with the total number of IVIs (p=0.0002). Results are consistent with previous work on the oldest cohort.ConclusionsSerial IVIs may lead to persistent IOP elevation that requires medical IOP‐lowering therapy. The risk is correlated with the number of injections and increases in the glaucoma population, therefore should be checked during follow‐up.