Intravitreal bevacizumab (Avastin) causing acute glaucoma: an unreported complication

Jalil, Assad; Fenerty, Cecilia; Charles, Stephen

doi:10.1038/sj.eye.6703018

Cited by 55 publications

(42 citation statements)

References 5 publications

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“…From pharmacokinetic studies it is known that bevacizumab, a 149-kDa full-length antibody, diffuses into the anterior chamber and clears slowly from the vitreous cavity [24]. Jalil et al [25 ]hypothesized that bevacizumab may accumulate in the trabecular meshwork, thereby blocking the aqueous outflow and leading to increased IOP.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Intraocular Pressure Changes in Patients with Neovascular Age-Related Macular Degeneration Treated with Ranibizumab

et al. 2013

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Background/Aims: To investigate the long-term effects of multiple intravitreal injections (IVTs) of ranibizumab (Lucentis) on intraocular pressure (IOP) in patients with neovascular age-related macular degeneration. Methods: In 320 eyes, IOP measurements were performed at baseline prior to injection and compared with IOP measurements of the last visit. Correlations between mean IOP change and total number of IVTs, visual acuity or patient age were tested. Results: The mean IOP increase was 0.8 ± 3.1 mm Hg (p < 0.0001). Seven eyes showed final IOP values between 22 and 25 mm Hg. The mean follow-up was 22.7 ± 14.1 months. No further correlations between IOP change and number of IVTs, visual acuity or patient age have been found. Conclusions: This study demonstrated a statistically significant IOP increase in patients treated with repeated injections of ranibizumab. However, IOP increase required no glaucoma treatment during the study. Therefore, repeated injections with ranibizumab can be considered safe with regard to long-term IOP changes in patients without ocular hypertension or glaucoma.

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Section: Discussionmentioning

confidence: 99%

Long-Term Intraocular Pressure Changes in Patients with Neovascular Age-Related Macular Degeneration Treated with Ranibizumab

et al. 2013

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“…43,44 Other presumed mechanisms include the extreme fluctuations in intraocular pressure (IOP) and deformation of the globe during intravitreal injection, resulting in vitreoretinal traction. 43,45,46 Another possible mechanism is the angio-fibrotic switch of VEGF and connective tissue growth factor (CTGF) in PDR. The anti-VEGF intravitreal injection reduces intravitreal unbound, active VEGF levels.…”

Section: Adverse Effectsmentioning

confidence: 99%

“…Studies with pegaptanib have shown such a spike normalizes within 1 h. 54 One of the other possible reasons for the raised IOP after IVB includes blockage of the trabecular meshwork by bevacizumab, which is a large 148-kDa protein. 46 The frequency of transient IOP rise after bevacizumab was reported as 0.16%. 55 Temporary increase in IOP following IVB injection: level of evidence IV.…”

Section: Adverse Effectsmentioning

confidence: 99%

A review of anti-VEGF agents for proliferative diabetic retinopathy

Osaadon

Fagan

Lifshitz

et al. 2014

Eye

224

148

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“…Being a full-length antibody, bevacizumab diffuses slowly into the anterior chamber and clears slowly from the vitreous cavity [18]. Therefore, Jalil et al [19] hypothesized that bevacizumab accumulation in the trabeculum leads to aqueous outflow resistance and acute rise in IOP. Another possible mechanism for the development of sustained IOP elevations may be associated with the repackaging of bevacizumab in plastic syringes and extended storage times of the drug [12,13,14], which may lead to aggregation of proteins and/or nonproteinaceous materials such as silicone oil from the syringes.…”

Section: Discussionmentioning

confidence: 99%

Anterior Chamber Paracentesis Might Prevent Sustained Intraocular Pressure Elevation after Intravitreal Injections of Ranibizumab for Age-Related Macular Degeneration

Ichiyama¹,

Sawada²,

Kakinoki³

et al. 2014

Ophthalmic Res

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Background/Aims: To evaluate the efficacy of anterior chamber paracentesis for preventing sustained intraocular pressure (IOP) elevation after intravitreal ranibizumab (IVR) injections for age-related macular degeneration (AMD). Methods: The medical records for all cases of exudative AMD treated with IVR injections and followed monthly for 12 months or longer were reviewed retrospectively. Anterior chamber paracentesis was performed just before IVR injections. A sustained IOP elevation was defined as 22 mm Hg or higher during 2 consecutive visits with an increase exceeding 6 mm Hg from baseline. Results: One hundred and eleven eyes met the inclusion criteria, and none of these eyes had a sustained IOP elevation. Conclusions: Anterior chamber paracentesis before IVR injections may prevent sustained IOP elevations.

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Intravitreal bevacizumab (Avastin) causing acute glaucoma: an unreported complication

Cited by 55 publications

References 5 publications

Long-Term Intraocular Pressure Changes in Patients with Neovascular Age-Related Macular Degeneration Treated with Ranibizumab

Long-Term Intraocular Pressure Changes in Patients with Neovascular Age-Related Macular Degeneration Treated with Ranibizumab

A review of anti-VEGF agents for proliferative diabetic retinopathy

Anterior Chamber Paracentesis Might Prevent Sustained Intraocular Pressure Elevation after Intravitreal Injections of Ranibizumab for Age-Related Macular Degeneration

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