Long-Term Intraocular Pressure Changes in Patients with Neovascular Age-Related Macular Degeneration Treated with Ranibizumab

Abstract

Background/Aims: To investigate the long-term effects of multiple intravitreal injections (IVTs) of ranibizumab (Lucentis) on intraocular pressure (IOP) in patients with neovascular age-related macular degeneration. Methods: In 320 eyes, IOP measurements were performed at baseline prior to injection and compared with IOP measurements of the last visit. Correlations between mean IOP change and total number of IVTs, visual acuity or patient age were tested. Results: The mean IOP increase was 0.8 ± 3.1 mm Hg (p < 0.0001). Seven eyes showed final IOP values between 22 and 25 mm Hg. The mean follow-up was 22.7 ± 14.1 months. No further correlations between IOP change and number of IVTs, visual acuity or patient age have been found. Conclusions: This study demonstrated a statistically significant IOP increase in patients treated with repeated injections of ranibizumab. However, IOP increase required no glaucoma treatment during the study. Therefore, repeated injections with ranibizumab can be considered safe with regard to long-term IOP changes in patients without ocular hypertension or glaucoma.

Intraocular Pressure in Eyes Receiving Intravitreal Antivascular Endothelial Growth Factor Injections

“…The use of intravitreal antiangiogenic agents has assumed increasing importance and worldwide application in various vitreoretinal pathologies. Recent evidence suggests that both short-term and sustained IOP increases associated with anti-VEGF intravitreal injection therapy are of a real clinical concern [13] .…”

Anterior Chamber Paracentesis Might Prevent Sustained Intraocular Pressure Elevation after Intravitreal Injections of Ranibizumab for Age-Related Macular Degeneration

“…Wehrli et al [14] reported that a sustained IOP elevation or 1 IOP elevation exceeding 26 mm Hg occurred in 1 eye of 104 (1%) after IVR injections without paracentesis during 2 years of follow-up. Menke et al [15] reported that the mean IOP was elevated significantly by 0.8 ± 3.1 mm Hg after IVR injections without paracentesis (p < 0.0001). The prevalence of sustained IOP elevations was lower in the current than in previous studies [12,13,14] and the highest mean IOP during the follow-up period was not significantly elevated from baseline.…”

“…The percentages of sustained IOP elevations in patients with glaucoma have varied widely in previous studies [12,13,14,15]. Wehrli et al [14] also found no patients with AMD and glaucoma who developed a sustained IOP elevation or had an IOP elevation that exceeded 26 mm Hg.…”

“…Bevacizumab (Avastin, Genentech, South San Francisco, Calif., USA), which received initial US Food and Drug Administration approval for use in colorectal cancer [5], is also commonly used as an off-label treatment for AMD. With widespread use of anti-VEGF agents, some studies reported the occurrence of sustained intraocular pressure (IOP) elevation after intravitreal anti-VEGF injections [6,7,8,9,10,11,12,13,14,15]. Presently, sustained IOP elevation due to intravitreal injection of anti-VEGF agents is a real concern.…”

“…Presently, sustained IOP elevation due to intravitreal injection of anti-VEGF agents is a real concern. Some possible mechanisms underlying sustained IOP elevation after intravitreal injections of anti-VEGF agents have been previously proposed [6,7,8,9,10,11,12,13,14,15]. One of them is that the IOP spikes after injection cause damage to the outflow system and in turn prolong IOP elevation [7,8,9,10,11].…”