Abstract
PurposeTo study the prevalence of sustained intraocular pressure (IOP) elevation associated with intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents.MethodsProspective comparative study. Non-glaucomatous patients scheduled to receive intravitreal injection of anti-VEGF therapy were recruited from an outpatient eye clinic, Songklanagarind Hospital between April 2013 and March 2014. The IOP was measured by Goldmann applanation tonometer before and at 1 hour, 1 week, 1 month, 3 months, and 6 months after injection. The IOP was compared using the repeated measures analysis. Sustained IOP elevation was defined as either an IOP > 21 mmHg or an increase from baseline ≥ 5 mmHg on two consecutive visits.ResultsSeventy eyes of 54 patients met the inclusion criteria. The most common diagnosis was diabetic macular edema (48%). The mean IOP ± standard deviation (SD) before treatment was 13.7 ± 2.8 mmHg. The means ± SDs after treatment at 1 hour, 1 week, 1 month, 3 months, and 6 months were 11.3 ± 2.6, 13.7 ± 3.6, 14.1 ± 3.3, 14.0 ± 2.3, and 13.7 ± 2.4 mmHg, respectively. A mean of IOP difference at 1 hour postinjection and at baseline was −2.36 ± 2.5 mmHg (P < 0.001). Four of 70 treated eyes (5.7%) developed sustained IOP elevation (IOP ≥ 5 mmHg from baseline on two consecutive visits). The IOP returned to baseline levels after 1 month, in three eyes. One eye had sustained IOP elevation at 3 and 6 months follow-up. Thereafter, IOP returned to baseline level. There was no need of anti-glaucoma medication.ConclusionsAfter receiving intravitreal injection of anti-VEGF agent, a small proportion of non-glaucomatous eyes developed a sustained IOP elevation without requiring IOP-lowering treatment. At 1 hour postinjection, there was a significant reduction of the mean IOP compared with the baseline level.
Highlights
Intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents are commonly used to treat a variety of retinal and choroidal neovascular diseases
The intraocular pressure (IOP) returned to baseline levels after 1 month, in three eyes
There was no need of anti-glaucoma medication
Summary
Intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents are commonly used to treat a variety of retinal and choroidal neovascular diseases. The well-established safety and efficacy of anti-VEGF intravitreal injection has resulted in its approval for the treatment of neovascular AMD and, more recently, retinal vein occlusion and diabetic retinopathy. The utilization of this treatment for these conditions has gained widespread acceptance worldwide [4, 5]. The introduction of additional fluid into the vitreous cavity by intravitreal therapy would be expected to cause an immediate rise in intraocular pressure (IOP) This transient, short-term IOP elevation (lasting up to 30 minutes) after intravitreal anti-VEGF therapy has been well described [6,7,8,9]. The present study determined the prevalence of sustained IOP elevation associated with intravitreal injection of anti-VEGF agents in non-glaucomatous eyes
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