Intraocular Pressure rise after Anti-VEGF Treatment: Prevalence, Possible Mechanisms and Correlations

Kampougeris, George; Spyropoulos, Dimitrios; Mitropoulou, Adrianna

doi:10.5005/jp-journals-10008-1132

Cited by 36 publications

(29 citation statements)

References 30 publications

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“…However, information regarding long-term increase in IOP is varied in the literature [ 34 ]. Kampougeris and colleagues define a raise in IOP as an increase up to 5 mmHg from baseline [ 35 ]. In our study, the values of IOP were within the normal limits at all timepoints, and ± 1 mmHg changes in mean IOP scores were seen from baseline to most timepoints; these changes were not significant, consistent with the aforementioned statement.…”

Section: Discussionmentioning

confidence: 99%

A Multicenter, Retrospective Study (RE-ENACT 2) on Razumab™ (World's First Biosimilar Ranibizumab) in Retinal Vein Occlusion

2020

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Purpose The REal life assessmENt of safety And effeCTiveness of Razumab 2 (RE-ENACT 2) study evaluated the long-term effectiveness of biosimilar ranibizumab. We present the subgroup analysis of patients with retinal vein occlusion (RVO). Methods Data of patients who received pro re nata (PRN) biosimilar ranibizumab (November 2015 to December 2018, 17 centers) were analyzed. Endpoints were change from baseline in best corrected visual acuity (BCVA, Snellen’s/logMAR), central subfield thickness (CSFT), intraocular pressure (IOP), and proportions of patients having intraretinal fluid (IRF) and subretinal fluid (SRF) at weeks 4, 8, 12, 16, 20, 24, 30, 36, and 48. Results Of 101 patients, 48.51% were men, and the majority (79.21%) were treatment naïve and had received 3 (range 1–5) injections (53.5%). Significant improvements ( P < 0.05) were observed from baseline to all timepoints for BCVA [baseline, 0.89 ± 0.06 ( n = 94); week 48, 0.41 ± 0.08 ( n = 14)] and CSFT [baseline, 527.58 ± 19.9 ( n = 85); week 48, 307.47 ± 16.4 ( n = 15)]. Changes in IOP (mmHg) were non-significant [baseline, 15.38 ± 0.4 ( n = 94); week 48, 13.94 ± 0.6 ( n = 16); P = 0.5575). Proportions of patients having IRF [baseline, 71.3% ( n = 84) vs week 48, 0% ( n = 15)] and SRF [baseline, 52.5% ( n = 83) vs week 48, 0% ( n = 15)] were decreased. Similar results for BCVA, CSFT, IOP, IRF, and SRF were observed for BRVO and CRVO subgroups. There were no new safety concerns. Conclusions Biosimilar ranibizumab demonstrated improvements in visual acuity and disease outcomes up to 48 weeks in patients with RVO without any new safety concerns. Electronic supplementary material The online version of this article (10.1007/s40123-020-00277-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

A Multicenter, Retrospective Study (RE-ENACT 2) on Razumab™ (World's First Biosimilar Ranibizumab) in Retinal Vein Occlusion

2020

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“…Sustained intraocular pressure rise following intravitreal anti-VEGF injections is a known phenomenon, with several publications addressing this issue in part or whole [1][2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…ere is a certain measure of discrepancy in reporting insofar as the potential risk factors as well as definitions of intraocular pressure (IOP) rise are concerned [6][7][8]. With numerous publications on the subject, it is only natural that contrasting outcomes are noted in studies conducted across the globe [1][2][3][4][5][6][7][8], the most disputed amongst risk factors for IOP rise being the number of injections administered and the treatment interval [2] between consecutive injections. When one factor in the indication, the anti-VEGF agent used, the phakic status, the anterior chamber angle status, family history of glaucoma, and other characteristics [1,2], it is evident that the condition (IOP rise) and analysis thereof is a complex phenomenon.…”

Section: Introductionmentioning

confidence: 99%

Sustained Intraocular Pressure Rise after the Treat and Extend Regimen at 3 Years: Aflibercept versus Ranibizumab

Bilgic¹,

Kodjikian²,

Chhablani

et al. 2020

Journal of Ophthalmology

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Purpose. To determine the risk factors associated with sustained intraocular pressure (IOP) rise in patients enrolled in the treat and extend (T&E) protocol receiving aflibercept/ranibizumab therapy for 3 years. Design. Retrospective, observational chart review. Setting. Multicentric. Patients. 789 patients (1021 eyes; 602 males) enrolled in T&E using aflibercept/ranibizumab for diabetic macular edema (DME), wet age-related macular degeneration (AMD), or macular edema in retinal vein occlusion (RVO). Intervention. The history, examination (clinical and special investigations), and treatment records were thoroughly scrutinized. Sustained IOP rise was defined as a rise in IOP above baseline by ≥6 mmHg and/or >24 mmHg on 2 or more consecutive visits. The Wilk–Shapiro test was used for confirming normality of data. The Mantel–Haenszel test and generalized estimating equations were used to analyse multicentric data as well as to analyse data from both eyes of the same patients in the event that both eyes were under therapy. The relative risk, chi-square test (with and without Yates’ correction), and univariate and multivariate analysis were used wherever appropriate. Statistical significance was set at P<0.05. The primary outcome measure was the determination of risk factors for sustained IOP rise with ranibizumab/aflibercept therapy. Secondary outcome measures included determining the incidence of IOP rise (short term and sustained), visual field, and retinal nerve fibre layer (RNFL) changes. Results. The mean follow-up was 42.4 months. Male gender, South Asian ethnicity, older age, presence of AMD and vein occlusion, use of ranibizumab, higher number of injections, narrow angles, switch to bevacizumab/ranibizumab, and preexisting glaucoma were associated with sustained IOP rise. No significant visual field and RNFL changes were seen. The overall incidence was 8.91%. No patient required filtering surgery. No patient with IOP rise returned to baseline. Conclusion. IOP rise is an important consideration as the chronicity of the condition can eventually lead to glaucomatous changes in eyes with already compromised vision. Follow-ups and use of appropriate therapy can be determined correspondingly.

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“…The intraocular pressure (IOP) rise occurring after this procedure revealed to be transient and usually normalizes spontaneously within 30 minutes; 6 - 8 however, repeated IOP spikes may be a contributing factor for sustained IOP elevation in susceptible eyes, related to the trabecular meshwork damage. 8 9 The presence of vitreous reflux has been associated with lower postinjection IOP 10 and Pang et al 11 reported that the incidence of vitreous reflux was higher with larger bore size needles. Hence, we hypothesize that larger 27-gauge needles are less associated with IOP spikes, as they may cause higher vitreous reflux.…”

Section: Introductionmentioning

confidence: 99%

Intravitreal Injections of Bevacizumab: The Impact of Needle Size in Intraocular Pressure and Pain

Loureiro¹,

Matos²,

Sepúlveda³

et al. 2017

Journal of Current Glaucoma Practice

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Aim To compare the effect of 30-gauge vs 27-gauge needle size on intraocular pressure (IOP) rise and patients’ pain experience after intravitreal injection (IVI) of bevacizumab.Materials and methods Cross-sectional, randomized, double-armed study. Patients were randomized to IVI with 30-gauge or 27-gauge needle. The IOP was measured pre and post IVI. Patients’ pain was graded using the visual analog scale (VAS).Results A total of 54 eyes were included. The IVI caused a significant IOP rise in both groups (p < 0.001). In the 30-gauge group, the mean pre- and postinjection IOP was 16.3 ± 3.6 mm Hg and 24.1 ± 9.0 mm Hg. The corresponding figures in the 27-gauge group were 18.0 ± 2.54 (p = 0.26) and 23.1 ± 7.5 mm Hg (p = 0.66). In the 30-gauge group, the mean VAS pain score was 3.2 ± 2.6 compared to 3.0 ± 2.5 in the 27-gauge group (p = 0.78).Conclusion The IVI caused a significant rise in IOP after the injection, independently of the needle size used. The 27-gauge needle coursed with lower postinjection IOP without prejudice of the patient comfort.Clinical significance The IVI with 27-gauge may be considered for glaucomatous eyes (higher risk eyes), for which IOP spikes are not recommended.How to cite this article Loureiro M, Matos R, Sepulveda P, Meira D. Intravitreal Injections of Bevacizumab: The Impact of Needle Size in Intraocular Pressure and Pain. J Curr Glaucoma Pract 2017;11(2):38-41.

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Intraocular Pressure rise after Anti-VEGF Treatment: Prevalence, Possible Mechanisms and Correlations

Cited by 36 publications

References 30 publications

A Multicenter, Retrospective Study (RE-ENACT 2) on Razumab™ (World's First Biosimilar Ranibizumab) in Retinal Vein Occlusion

A Multicenter, Retrospective Study (RE-ENACT 2) on Razumab™ (World's First Biosimilar Ranibizumab) in Retinal Vein Occlusion

Sustained Intraocular Pressure Rise after the Treat and Extend Regimen at 3 Years: Aflibercept versus Ranibizumab

Intravitreal Injections of Bevacizumab: The Impact of Needle Size in Intraocular Pressure and Pain

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