Intraocular pressure changes related to intravitreal injections of ranibizumab: analysis of pseudophakia and glaucoma subgroup

Abstract

The purpose of this study was to determine intraocular pressure (IOP) changes following intravitreal ranibizumab injections and to investigate the effect of pre-existing glaucoma and pseudophakia. Two hundred and two eyes of 175 patients who received repeated intravitreal ranibizumab injections were included in this study. IOP measurements were obtained at both 30 min and 24 h after each injection. IOP changes after the first, third, sixth, ninth, and twelfth injections were analyzed. Data gotten from subgroups with pre-existing glaucoma and pseudophakia were also analyzed. The mean number of injections was 4.81 ± 2.7 (range: 3-18), while the mean IOP prior to the first intravitreal ranibizumab injection was 15.11 ± 2.8 (9-25) mmHg. At the last visit, IOP was 14.66 ± 2.8 (9-22) mmHg. There was no cumulative increase in IOP at either 30 min or 24 h values throughout repeated injections. Pseudophakic patients had significantly lower mean IOP values at 30 min after all injections except for twelfth. The number of eyes with an IOP higher than 21 mm Hg and the mean IOP values were significantly higher in patients with pre-existing glaucoma at 30 min after the first and third injections. Pseudophakic eyes are less prone to immediate IOP spikes than phakic eyes. Pre-existing glaucoma may be a potential risk factor for uncontrolled IOP spikes immediately after intravitreal injection; nonetheless, this effect is usually transient and does not cause long-term problems. Also, ranibizumab injections can be administered safely under close monitoring.

Ranibizumab versus Bevacizumab for the Treatment of Idiopathic Choroidal Neovascularization: 2-Year Results

“…In patients with younger age, IOP was mildly increased after injection, but lower than 30 mm Hg. It has been reported that there was no cumulative increase in IOP at either 30 minutes or 24 hours after intravitreal injection of ranibizumab in patients older than 60 years (19). In the present study, our patients were much younger (32.10 ± 5.84 years in the bevacizumab group and 29.43 ± 4.95 years in the ranibizumab group).…”

A minimally invasive adjustable‐depth blunt injector for delivery of pharmaceuticals into the posterior pole

“…reported in a study of 202 eyes that 23.3% had IOP of >21 mmHg, 30 min after a first injection of ranibizumab (Demirel et al. ). Moreover, recent studies suggest that repeated intravitreous injections of antivascular endothelial growth factor for diabetic macular oedema and AMD cause sustained elevation of IOP and may potentially increase the risk of glaucoma (Brown et al.…”

“…For example, Brown et al reported that 8% of 423 AMD patients receiving intravitreal injections of ranibizumab demonstrated a postinjection intraocular pressure of 30 mmHg or more (Brown et al 2006). In a study by Kim et al with (Demirel et al 2015). Moreover, recent studies suggest that repeated intravitreous injections of antivascular endothelial growth factor for diabetic macular oedema and AMD cause sustained elevation of IOP and may potentially increase the risk of glaucoma (Brown et al 2006;Bakri et al 2009;Adelman et al 2010;Pang et al 2015).…”

Patient Safety in Ophthalmology

“…• Intraocular pressure (IOP) acute and transitory elevation, lasting maximum some hours and with individual variations, is caused by the injection of fluid in the eye [99]. However, cases of sustained IOP elevation following anti-VEGF have been described, although they are rare [100]. On the contrary, intravitreal injections of corticosteroids, and in particular of Dexamethasone, showed to cause chronic ocular hypertension in almost one out of three patients [101].…”