Elsevier

Ophthalmology

Volume 119, Issue 2, February 2012, Pages 321-326
Ophthalmology

Original article
Effect on Intraocular Pressure in Patients Receiving Unilateral Intravitreal Anti-Vascular Endothelial Growth Factor Injections

https://doi.org/10.1016/j.ophtha.2011.08.011Get rights and content

Purpose

We assessed the frequency and predictive factors related to intraocular pressure (IOP) elevation in neovascular age-related macular degeneration (AMD) patients undergoing unilateral intravitreal ranibizumab and/or bevacizumab injections.

Participants

Charts of 207 patients with neovascular AMD who presented to a single physician at a retinal referral practice over a 6-month period were retrospectively reviewed.

Methods

Data recorded included demographic information, clinical findings, total number of bevacizumab and ranibizumab injections received and IOP at each visit. Increases above baseline IOP of >5, >10, or >15 mmHg on ≥2 consecutive visits while under treatment were noted.

Main Outcome Measures

The frequency of IOP elevation was compared between treated and untreated eyes. In addition, among treated eyes, frequency and odds ratio of experiencing IOP elevation >5 mmHg above baseline on ≥2 consecutive visits was stratified by number of injections. For the main regression analysis, the outcome variable was IOP elevation >5 mmHg on ≥2 consecutive visits and the main independent variable was total number of injections.

Results

On ≥2 consecutive visits, 11.6% of treated versus 5.3% of untreated/control eyes experienced IOP elevation of >5 mmHg. The mean number of injections was higher in those with (24.4; 95% confidence interval [CI], 20.9–28.0; range, 9–39) than without IOP elevation of >5 mmHg (20.4; 95% CI, 18.9–21.8; range, 3–48) on ≥2 consecutive visits. There was an increased odds ratio (5.75; 95% CI, 1.19–27.8; P = 0.03) of experiencing IOP elevation >5 mmHg on ≥2 consecutive visits in patients receiving ≥29 injections compared with ≤12 injections. Of the factors considered, only the total number of injections showed a statistically significant association with IOP elevation >5 mmHg above baseline on ≥2 consecutive visits in treated eyes (P = 0.05).

Conclusions

A greater number of intravitreal anti-vasular endothelial growth factor injections is associated with an increased risk for IOP elevation >5 mmHg on ≥2 consecutive visits in eyes with neovascular AMD receiving intravitreal ranbizumab and/or bevacizumab.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

Section snippets

Methods

Institutional review board approval was obtained for this Health Insurance Portability and Accountability Act-compliant, retrospective cohort study, and all research adhered to the tenets of the Declaration of Helsinki. We retrospectively reviewed the charts of a consecutive series of 207 neovascular AMD patients who were seen between February 1, 2010 and July 31, 2010, by a single physician (K.B.F.) at 2 offices of the Vitreous Retina Macula Consultants of New York, who were followed for ≥9

Results

A total of 207 patients were included in this study. The mean patient age at the initiation of treatment was 79 years; 35% were male, and 56% of eyes were phakic at the time of initial ranibizumab or bevacizumab injection (see Table 1 for other baseline demographic information). Mean number of total injections was 20.8 (range, 3–48). Mean follow-up time was 148.6 weeks (range, 9.7–274). On ≥2 consecutive visits, 11.6% of treated versus 5.3% of untreated/control eyes experienced IOP elevation of

Discussion

Elevations of IOP were not noted to be a complication of ranibizumab injections in the ANCHOR and MARINA trials as determined by mean monthly preinjection measurements during the 2-year follow-up.1, 2 In the VISION trial,7, 8 there was no evidence of increased mean preinjection IOP over 2 years after the injection of intravitreal pegaptanib every 6 weeks. Mean values for IOP returned to preinjection levels by 1 week after injections. In contrast, post hoc analysis of data from the ANCHOR and

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Cited by (0)

Manuscript no. 2011-261.

Financial Disclosure(s): The authors have made the following disclosures:

K. Bailey Freund – Consultant, Research Support – Genentech; Consultant– Alcon; Consultant – Regeneron; Consultant – Alimera.

Supported by the LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Institute, and The Macula Foundation Inc. The funding organizations had no role in the design or conduct of this research.

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