Intraocular pressure decreases in eyes with glaucoma-related diagnoses after conversion to aflibercept for treatment-resistant age-related macular degeneration

Abstract

To understand intraocular pressure (IOP) response after switching from intravitreal bevacizumab (IVB) and/or ranibizumab (IVR) to intravitreal aflibercept (IVA) for treatment-resistant neovascular age-related macular degeneration (nAMD) in patients with and without coexisting glaucoma-related diagnoses. METHODS: Retrospective, cross-sectional comparative case series of 62 eyes of 58 patients treated with intravitreal injection for nAMD from March 2010 to April 2018. Patients with glaucoma-related diagnoses, defined here as open-angle glaucoma or suspicion of open-angle glaucoma, ocular hypertension, and/or narrow-angle glaucoma, were compared to those without glaucoma. IOP data were collected at baseline, at the three visits where patients received loading doses of IVB/IVR, and at all of the visits following the switch to IVA through the end of follow-up. RESULTS: 19 eyes with pre-existing glaucoma-related diagnoses were compared to 43 eyes without such diagnoses. Baseline IOP was similar for glaucoma and non-glaucoma patients. The loading doses of IVB/IVR did not impact IOP; however, a small, sustained rise in IOP was noted among patients with glaucoma-related diagnoses by the final IVB/IVR injections before the switch to IVA (ΔIOP 1.61 ± 0.52 mmHg, P < 0.002). After conversion to IVA, pre-injection IOP declined in eyes both with (−1.59 ± 0.54 mmHg, P < 0.001) and without (−0.99 ± 0.28 mmHg, P < 0.001) glaucoma-related diagnoses. CONCLUSIONS: IOP in patients with glaucoma-related diagnoses appears to be more sensitive to intravitreal injections than it is in patients without glaucoma-related diagnoses. It rises with IVB/IVR and declines after the switch to IVA. Switching patients with nAMD to IVA may present an opportunity to lower IOP in patients with glaucoma.

Comparison of risks of arterial thromboembolic events and glaucoma with ranibizumab and aflibercept intravitreous injection: A nationwide population‐based cohort study

“…The risk of glaucoma after intravitreal injections is concerned because patients with chronic retinal diseases may require multiple injections over time. The injection procedure itself does not significantly vary among anti-VEGF agents, so it was postulated that the agent itself may be a factor related to IOP elevations and glaucoma development [ 42 ]. Anti-VEGF agents, or their excipients, may trigger inflammation or immunological reactions, and this may affect aqueous humor production or outflow pathways, such as the trabecular meshwork [ 42 ].…”

“…The injection procedure itself does not significantly vary among anti-VEGF agents, so it was postulated that the agent itself may be a factor related to IOP elevations and glaucoma development [ 42 ]. Anti-VEGF agents, or their excipients, may trigger inflammation or immunological reactions, and this may affect aqueous humor production or outflow pathways, such as the trabecular meshwork [ 42 ]. Although inflammation more commonly occurs in patients treated with aflibercept, previous studies did not indicate the risk of glaucoma was higher in aflibercept groups than ranibizumab groups [ 43 , 44 ].…”