First Author: A.Ergin TURKEY
Co Author(s): U. Limon I. Kutluturk Karagoz P. Ergin
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To study the intraocular pressure changes associated with intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents (bevacizumab, ranibizumab, Aflibercept).
The study was conducted in departmet of ophthalmology Health Sciences University Umraniye Training and Research hospital in İstanbul
In this retrospective study medical records of the patients were reviewed between May 2014 and December 2016 in our department. Exclusion criteria were open-angle or angle-closure glaucoma, suspected glaucoma (IOP > 21 mmHg and/or cup to disc ratio > 0.5), currently receiving a systemic beta blocker, previously receiving intravitreal injection of any medication (steroid, gancyclovir, and anti-VEGF agent), current use of steroid eye drops, and any ocular surface disease precluding a reliable IOP measurement. The protocols on the frequency of anti-VEGF injections for patients were: 1 injection per month for 3 consecutive months (with a minimum 4-week interval between 2 injections), followed by a pro re nata (PRN) protocol with monthly follow-up. The IOP was measured by Goldmann applanation tonometer before and on the first day, in the first month, third month, sixth month and twelveth month after injection. Ninety three of the eyes were injected bevacizumab, 57 of the eyes injected ranibizumab and 44 of the eyes injected Aflibercept. Sustained IOP elevation was defined as either an IOP > 21 mmHg or an increase from baseline ≥ 5 mmHg on two consecutive visits. The IOP was compared by using compare means paired sample t test (SPSS 17).
One hundred and ninety four eyes of 141 patients met the inclusion criteria. The mean age was 64 years (ranging from 37–90 years of age). The most common diagnosis was diabetic macular edema (137 eyes, 70.61%). Fifty eyes was age-related macular degeneration (25.77 %) and 7 eyes was central retinal vein oclusion (3.60 %). The mean IOP ± standard deviation (SD) before treatment was 16.96 ± 2.56 mmHg. The means ± SDs after treatment on the first day, in the first month, third month, sixt month and twelveth month were 16.55 ± 2.95, 16.53 ± 2.90, 16.63 ± 3.03, 16.69 ± 3.12, and 17.41 ± 2.76 mmHg, respectively. Two of 194 treated eyes (1.03%) developed sustained IOP elevation (IOP ≥ 5 mmHg from baseline on two consecutive visits). The IOP returned to baseline levels after 2 months and there was no need of anti-glaucoma medication. On the first day post injection there was a significant reduction of the mean IOP compared with the baseline level. There was also statistically significant between mean baseline IOP and post injection first month (p<0.005).
Intraocular pressure changes may occur after intravitreal anti-VEGF injections. In our study IOP according to basal level, has been found low statistically significant on the first day and first month after injection. After receiving intravitreal injection of anti-VEGF agent, a small proportion of non-glaucomatous eyes developed a sustained IOP elevation without requiring IOP-lowering treatment.