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Sustained elevation of intraocular pressure after intravitreal injections of anti-VEGF agents
  1. Travis J Good1,
  2. Alan E Kimura2,
  3. Naresh Mandava1,
  4. Malik Y Kahook1
  1. 1University of Colorado Denver School of Medicine, Denver, Colorado, USA
  2. 2Colorado Retina Associates, Denver, Colorado, USA
  1. Correspondence to Dr Malik Y Kahook, University of Colorado Denver, School of Medicine, Department of Ophthalmology, Rocky Mountain Lions Eye Institute, 1675 Aurora Court, PO Box 6510 Mail Stop F-731, Aurora, CO 80045, USA; malik.kahook{at}


Aims To report the rate of intraocular pressure (IOP) elevation associated with repeated intravitreal injections of antivascular endothelial growth factor (VEGF) agents and to determine if a pre-existing diagnosis of glaucoma is a risk factor for this phenomenon.

Methods The charts of 215 eyes undergoing intravitreal injection with anti-VEGF agents for wet age-related macular degeneration (AMD) were retrospectively examined with respect to frequency of injections, number of injections and changes in IOP. Data were analysed independently for two groups (1) pre-existing glaucoma and (2) no history of glaucoma.

Results Of the 215 eyes receiving injections with bevacizumab and/or ranibizumab, 6% (n=13) had sustained IOP elevation requiring medical or laser interventions. Of the eyes receiving only bevacizumab, 9.9% (10/101) had sustained elevated IOP, while 3.1% (3/96) of eyes receiving only ranibizumab experienced increases (p=0.049). Patients with pre-existing glaucoma experienced higher rates of elevated IOP when compared with patients without pre-existing glaucoma (33% vs 3.1% respectively; p<0.001). The glaucoma subgroup had a lower median number of injections (6; interquartile range 5–10) compared with the non-glaucoma group (9.5; interquartile range 6–13.7; p=0.031).

Conclusions The incidence of sustained elevated IOP in patients receiving intravitreal anti-VEGF injections is significant. Additionally, these data suggest the possibility of a heightened risk for further elevation of IOP in patients with pre-existing glaucoma who receive either bevacizumab or ranibizumab. Prospective studies are needed to verify these results and better understand the implications of these findings.

  • Age-related macular degeneration
  • glaucoma
  • bevacizumab
  • ranibizumab
  • intraocular pressure
  • neovascularisation
  • pharmacology
  • treatment medical

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  • Competing interests MYK, AEK and NM have received research support from Genentech in the past. Genentech had no involvement in this study nor with the preparation of this manuscript.

  • Ethics approval Ethics approval was provided by the Institutional Review Board in concordance with the applicable rules at the University of Colorado Denver Health Sciences Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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