Intraocular Pressure–Related Events After Anti–Vascular Endothelial Growth Factor Therapy for Macular Edema Due to Central Retinal Vein Occlusion or Hemiretinal Vein Occlusion

Abstract

for the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) Investigator Group IMPORTANCE Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections are used to treat a variety of posterior segment conditions, including some associated with glaucoma, such as macular edema due to central retinal vein occlusion (CRVO). Therefore, information regarding intraocular pressure (IOP)-related events associated with anti-VEGF therapies is important to help balance the risks and benefits over the course of therapy.OBJECTIVE To investigate IOP-related events among participants in the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2).DESIGN, SETTING, AND PARTICIPANTS Secondary analysis of a randomized clinical trial that included 312 participants with macular edema secondary to CRVO or hemiretinal vein occlusion (HRVO) who were not taking IOP-lowering medications at baseline. First randomization occurred on September 14, 2014, and contained data through data freeze on April 1, 2020. Analysis took place from April 2020 through December 2020.INTERVENTIONS Study participants were initially randomized to 6 monthly intravitreal injections of aflibercept or bevacizumab. At month 6, protocol-defined good responders were rerandomized to continued monthly or treat-and-extend dosing of their originally assigned study drug, and protocol-defined poor or marginal responders were switched to alternative treatment. After month 12, participants were treated as per investigator discretion.MAIN OUTCOMES AND MEASURES Three different outcomes: (1) IOP elevation more than 10 mm Hg from baseline, (2) IOP to a level higher than 35 mm Hg, and (3) IOP-lowering incisional or laser surgery. RESULTSOf the 312 participants meeting inclusion criteria (138 [44.2%] were female; mean [SD] age, 67.8 [12.1] years), 25 (8.0%) had IOP elevation more than 10 mm Hg over baseline through month 60, and 5 (1.6%) had IOP higher than 35 mm Hg. The 60-month Kaplan-Meier cumulative incidence of IOP elevation more than 10 mm Hg over baseline was 0.13 (95% CI, 0.08-0.19), and the 60-month Kaplan-Meier cumulative incidence of IOP higher than 35 mm Hg was 0.02 (95% CI, 0.01-0.06), and did not differ among participants initially randomly assigned to receive aflibercept or bevacizumab. Three participants (1.0%) underwent IOP-lowering incisional surgery, and 3 participants (1.0%) underwent IOP-lowering glaucoma laser surgery.CONCLUSIONS AND RELEVANCE Intravitreal anti-VEGF injections are used to treat some conditions associated with glaucoma, such as macular edema due to CRVO, and the rates of IOP-related events in this trial support monitoring IOP in eyes treated with anti-VEGF therapy for macular edema associated with CRVO or HRVO for up to 60 months.

Prognostic Factor Study of Macular Edema Recurrence in Retinal Vein Occlusion after Conbercept Treatment: A Post Hoc Analysis of the FALCON Study

“…ME is visible on the fundus as increased macular thickness, fluid, or exudates. Fluorescein angiography (FA) can reveal vascular leakage and filling of cystic spaces [9,10]. However, the gold standard for diagnosing and evaluating ME due to RVO is optical coherence tomography (OCT), a noninvasive imaging tool for macular lesions [11,12].…”

Mid-Term Impact of Anti-Vascular Endothelial Growth Factor Agents on Intraocular Pressure

“…Although RVO is associated with IOP changes and glaucoma, our results were adjusted for retinal disease to address this potential confounding bias. However, a recent study by Ahmad et al found that a significant proportion of patients treated with anti-VEGF for RVO had an increase in IOP of more than 10 mmHg at 5 years after the initiation of anti-VEGF therapy [31]. It would, therefore, be interesting to study the evolution of IOP in these patients treated for RVO in a few years.…”

Intraocular Pressure in Eyes With Retinal Vein Occlusion Compared With Fellow Eyes

“…Participant follow-up occurred from November 2004 to February 2009 in SCORE and from September 2014 to March 2021 in SCORE2. Given the risk of IOP elevation associated with intravitreal therapies, we analyzed baseline IOP in SCORE and SCORE2 participants naive to intravitreal therapy, excluding those with preexisting glaucoma or prior IOP-lowering treatment. P values are 2-tailed and calculated in R, version 4.3.0 or SAS, version 9.4.…”