Analysis of Intraocular Pressure Elevation after Intravitreal Injection of Ranibizumab and Aflibercept

Abstract

Purpose: To evaluate long-term intraocular pressure (IOP) and risk of IOP elevation after intravitreal injection of ranibizumab or aflibercept in patients with age-related macular degeneration (AMD). Methods: From January 2013 to December 2016, we retrospectively reviewed patients who underwent intravitreal ranibizumab or aflibercept injections for AMD. IOP was measured before injection and 1 week, 1 month, 2 months, 3 months, 4 months, 5 months, 6 months, 9 months, and 1 year after injection. Sustained IOP elevation was defined when the final IOP increased by 6 mmHg more than the pre-injection IOP, and when there were two consecutively measured values > 21 mmHg. The risk factors were then analyzed. Results: Using Kaplan-Meier survival analysis, sustained IOP elevation occurred in 9 of 80 eyes (11.3%) in 1 year, and the mean survival time was 11.50 months after injection. Five eyes (12.8%) of the ranibizumab group and four eyes (9.8%) of the aflibercept group had mean survival times of 11.39 and 11.61 months, respectively. The log-rank test showed no significant difference between the two groups (p = 0.659). A significant risk factor for sustained IOP elevation was a history of primary open-angle glaucoma (p = 0.035). Conclusions:The incidence of sustained IOP elevation was not significantly different between the two groups. Clinicians should therefore carefully monitor the IOP before and after intravitreal ranibizumab or aflibercept injections, especially in AMD patients with primary open-angle glaucoma.