Consider IOP monitoring and prophylactic treatment in patients undergoing repeat intravitreal anti-VEGF injections

Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections are now in widespread use for a plethora of retinal diseases. It is recognised that there is a transient intraocular pressure (IOP) rise after intravitreal anti-VEGF therapy although the exact mechanism of this is unclear.

In most patients the IOP normalises but in approximately 10% patients there is a sustained pressure elevation (2,4). Patients with ocular hypertension or glaucoma and patients having repeated intravitreal anti-VEGF injections appear to be more susceptible to the IOP rise and delayed recovery (1-4). Repeated anti-VEGF injections may also increase the future risk of developing glaucoma or ocular hypertension (3).

IOP monitoring, prophylactic measures or an adjustment in injection interval should be considered when administering repeated intravitreal anti-VEGF injections, particularly in glaucoma patients.

Contributor: Humma Shahid, Cambridge, UK

References

1. Bressler SB, Almukhtar T, Bhorade A. Repeated intravitreous ranimizumab injections for diabetic macular edema and the risk of sustained elevation of intraocular pressure or the need for ocular hypotensive treatment. JAMA Ophthalmol 2015; 133(5): 589-97
2. Zhou Y, Zhou M, Xia S. Sustained elevation of intraocular oressure associated with intravitreal administration of anti-vascular endothelial growth factor: A systemic review and meta-analysis. Sci Rep 2016; 6:39301
3. Wingard JB, Delzell DAP, Houlihan NV. Incidence of glaucoma or ocular hypertension after repeated anti-vascular endothelial growth factor injections for macular degeneration. Clin Ophthalmol 2019; 13: 2563-2572
4. Hoguet A, Chen PP, Junk AK. The effect of anti-vascular endothelial growth factor agents on intraocular pressure and glaucoma. A report by the American Academy of Ophthalmology. Ophthalmology 2019; 126: 611-622

Tip Reviewer: Roger Hitchings
Tip Editors: Frances Meier-Gibbons, Humma Shahid, Karl Mercieca, Francisco Goni