Incidence of Intraocular Pressure Elevation following Intravitreal Ranibizumab (Lucentis) for Age-related Macular Degeneration

Reis, Gustavo Msm; Grigg, John; Chua, Beng Huat; Lee, Anne; Lim, Ridia; Higgins, Ralph; Martins, Alessandra; Goldberg, Ivan; Clement, Colin I

doi:10.5005/jp-journals-10008-1213

Cited by 14 publications

(5 citation statements)

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“…Previous studies have had conflicting results on the long-term effects of anti-VEGFs on IOP. Reis et al identified a statistically significant rise in the incidence of SE-IOP when comparing injected eyes to control eyes (7.47% versus 0.93%) [ 13 ]. Another controlled study by Wehrli et al reported a 0.51% eye-year incidence in the treated eye and 1.00% in the fellow eye, a statistically non-significant difference [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Reis et al and Bilgic et al showed that the incidence of SE-IOP is associated with older age and pre-existing glaucoma among other clinical predictors [ 12 , 13 ]. Various potential predictors were analysed in our study, including glaucoma status, baseline IOP, sex and injection interval, but only younger age was determined to be a risk factor for SE-IOP associated with anti-VEGF therapy.…”

Section: Discussionmentioning

confidence: 99%

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Long-term effects of intravitreal bevacizumab and aflibercept on intraocular pressure in wet age-related macular degeneration

2021

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Background To evaluate the incidence of sustained elevation of intraocular pressure (SE-IOP) associated with intravitreal injections of anti-vascular endothelial growth factors (anti-VEGF) bevacizumab and aflibercept in patients with wet age-related macular degeneration (wAMD). Methods A retrospective cohort study consisting of 120 eyes from 120 patients with anti-VEGF treatment for wAMD. Three different anti-VEGF groups were considered: i) 71 cases receiving bevacizumab only, ii) 49 cases receiving bevacizumab before switch to aflibercept, iii) 49 cases after switch to aflibercept. 120 uninjected fellow eyes served as controls. SE-IOP was defined as an increase from baseline ≥5 mmHg on 2 consecutive follow-up visits. The incidence of SE-IOP was analysed using exact Poisson tests and survival analysis. The time course of IOP was evaluated with linear mixed effect modelling. Results In total, 6 treated eyes (2.38% incidence per eye-year) and 9 fellow eyes (3.58% incidence per eye-year) developed SE-IOP, and survival analysis showed no statistically significant difference (p = 0.43). Furthermore, the incidence of SE-IOP did not differ between the three anti-VEGF groups. Comparing the injected eyes of patients under 70 years to those of patients over 70 years, there was a statistically significant difference in survival without SE-IOP (incidence of 16.7% vs 0.7%, respectively, p < 0.0001). Conclusion Intravitreal anti-VEGF injections were not associated with sustained elevation of IOP. These results do not support the claim that repeated anti-VEGF injections could elevate IOP.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Long-term effects of intravitreal bevacizumab and aflibercept on intraocular pressure in wet age-related macular degeneration

2021

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“…During this study, no new or unexpected ocular or non-ocular safety events were identified. Elevation in IOP can be expected during the treatment with ranibizumab, and our study had 2% of patients developing glaucoma which was well controlled with medication [ 19 ]. However, in case of patients with preexisting glaucoma or ocular hypertension, this may be of concern.…”

Section: Discussionmentioning

confidence: 99%

Sub-optimal gain in vision in retinal vein occlusion due to under-treatment in the real world: results from an open-label prospective study of Intravitreal Ranibizumab

Narayanan

Kelkar²,

Abbas

et al. 2021

BMC Ophthalmol

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Background Macular edema secondary to retinal vein occlusion (RVO) is an important cause of loss of vision. Intravitreal injections (IVI) of anti-vascular endothelial growth factor (VEGF) are the standard of care in this disease, as shown in numerous randomized controlled trials. The purpose of this study was to study the efficacy and safety of ranibizumab, an anti-VEGF agent, in the real-world setting. Methods This was 48 weeks, open-label, prospective, multicentre, observational study. Patients diagnosed with ME secondary to RVO were treated with IVI of Ranibizumab 0.5 mg in real-world conditions. Efficacy was measured by improvement seen in best-corrected visual acuity (BCVA) in terms of Early Treatment of Diabetic Retinopathy Study (ETDRS) Letter Scores and change in central retinal thickness (CRT) measured by optical coherence tomography. Results One hundred eyes of 100 patients (79 with branch retinal vein occlusion and 21 with central retinal vein occlusion) were recruited in the study. The mean (standard deviation, SD) BCVA was 52.8 (21.99) letters at baseline and 62.3 (24.40) letters at week 48. From baseline, there was a significant improvement in BCVA by 7.7 letters (p = 0.001) at 48 weeks. The mean (SD) of CRT was 479.9 (216.25) μm at baseline and it decreased significantly to 284.9 (171.35) μm at week 48 (p < 0.001). During the study period, the average number of intravitreal injections was 3.5 per patient. There was no report of endophthalmitis in any eye. Conclusions Ranibizumab is well tolerated and effective in treating macular edema secondary to RVO in real-world clinical settings. However, there is under-treatment compared to controlled clinical trials, and the gain in vision is sub-optimal with under-treatment. Trial registration Clinical Trials Registry - India: CTRI/2015/07/005985.

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“…Reis GM et al, 2017 attributed the sustained elevation of IOP to the passage of high molecular weight molecules through the anterior hyaloid or zonule, and consequent obstruction or damage of the trabecular mesh with repeated applications 26 .…”

Section: Safety Of Intravitreal Anti-vegf Injections In Diabetic Macularmentioning

confidence: 99%

Safety of intravitreal anti VEGF injections in diabetic macular edema

Abouelkheir,

Elshafey,

Othman

et al. 2023

Egyptian Journal of Ophthalmology, (Mansoura Ophthalmic Center)

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Propose: Diabetic macular edema (DME) is the most common cause of visual impairment in patients with diabetes mellitus.The pathogenesis of DME is complex and multifactorial. DME can be diagnosed using noncontact stereoscopic biomicroscopy, contact lens biomicroscopy, Fundus fluorescein angiography (FFA), and Optical Coherence Tomography (OCT). Intravitreal anti-vascular endothelial growth factor (VEGF) agents have been investigated in the treatment of DME.This study aims to investigate the safety of intravitreal anti-VEGF during a six-month follow-up.Methods: Sixty patients with type I or II diabetes mellitus complaining from central involved DME were recruited for this longitudinal study. All patients were subjected to full history taking, complete ophthalmological examination, systemic evaluation, FFA, and OCT imaging. Patients were subdivided into three groups, 20 patients each: Ranibizumab group, Bevacizumab group, and Aflibercept group.Results: After 6-month follow-up, the ranibizumab group showed slightly higher systemic cardiovascular and cerebrovascular accidents rates, while the Bevacizumab group showed insignificant higher risk of ocular inflammation and endophthalmitis, aflibercept has the least incidence of ocular adverse effects. Conclusion:Anti-VEGF intravitreal injections are relatively safe for the treatment of DME. Aflibercept showed the least incidence of ocular side effects. The current study suggested that intravitreal anti-VEGF could be administered safely to diabetic patients with decreased glomerular filtration rate (GFR).

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Incidence of Intraocular Pressure Elevation following Intravitreal Ranibizumab (Lucentis) for Age-related Macular Degeneration

Cited by 14 publications

References 14 publications

Long-term effects of intravitreal bevacizumab and aflibercept on intraocular pressure in wet age-related macular degeneration

Long-term effects of intravitreal bevacizumab and aflibercept on intraocular pressure in wet age-related macular degeneration

Sub-optimal gain in vision in retinal vein occlusion due to under-treatment in the real world: results from an open-label prospective study of Intravitreal Ranibizumab

Safety of intravitreal anti VEGF injections in diabetic macular edema

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