The role of anterior segment optical coherence tomography in the detection of predictors of ophthalmic hypertension associated with anti-VEGF injections

Abstract

PURPOSE. To identify the predictors of increased intraocular pressure (IOP) after intravitreal injection (IVI) of an antiVEGF drug using anterior segment optical coherence tomography (AS-OCT), and to study changes in the iris-lens diaphragm produced by multiple injections in the treatment of neovascular form of age-related macular degeneration (nAMD).METHODS. IOP was measured with an ICare Pro tonometer before IVI, 1 minute after IVI, 30 minutes, 60 minutes and 180 minutes later. Anterior chamber depth (ACD), anterior chamber angle (ACA), and lens thickness were assessed using Revo NX tomograph (Optopol, Poland). The study was carried out before IVI, one month after the first IVI, one month after the third IVI, one year after the start of treatment. Axial length was measured once before IVI.RESULTS. An inverse correlation was found between axial length and an increase in IOP 1 min after IVI (r=0.65, p<0.001). According to AS-OCT data, one year after the start of treatment there was a significant decrease in ACD compared to the data before treatment (p><0.001), as well as a decrease in all parameters of ACA (p><0.05). Shorter axial length (R2 =0.45, p><0.05), shorter ACD (R2 =0.44, p><0.05), smaller ACA on the nasal (R2 =0.37, p><0.05) and temporal (R2 =0.39, p><0.05) sides in patients with their own lens led to a greater rise in IOP 1 min after IVI.CONCLUSION. Predictors of a sharp increase in IOP after IVI of an anti-VEGF drug in patients with nAMD that can be detected with AS-OCT are shorter ACD and smaller ACA. The following prognostic model was determined — with a 1-mm decrease in the axial length, an increase in IOP by 2.3 mm Hg should be expected, a decrease in ACA from the temporal side by 1° leads to an increase in IOP of 0.28 mm Hg>