Long-term effects of intravitreal bevacizumab and aflibercept on intraocular pressure in wet age-related macular degeneration

Abstract

Background To evaluate the incidence of sustained elevation of intraocular pressure (SE-IOP) associated with intravitreal injections of anti-vascular endothelial growth factors (anti-VEGF) bevacizumab and aflibercept in patients with wet age-related macular degeneration (wAMD). Methods A retrospective cohort study consisting of 120 eyes from 120 patients with anti-VEGF treatment for wAMD. Three different anti-VEGF groups were considered: i) 71 cases receiving bevacizumab only, ii) 49 cases receiving bevacizumab before switch to aflibercept, iii) 49 cases after switch to aflibercept. 120 uninjected fellow eyes served as controls. SE-IOP was defined as an increase from baseline ≥5 mmHg on 2 consecutive follow-up visits. The incidence of SE-IOP was analysed using exact Poisson tests and survival analysis. The time course of IOP was evaluated with linear mixed effect modelling. Results In total, 6 treated eyes (2.38% incidence per eye-year) and 9 fellow eyes (3.58% incidence per eye-year) developed SE-IOP, and survival analysis showed no statistically significant difference (p = 0.43). Furthermore, the incidence of SE-IOP did not differ between the three anti-VEGF groups. Comparing the injected eyes of patients under 70 years to those of patients over 70 years, there was a statistically significant difference in survival without SE-IOP (incidence of 16.7% vs 0.7%, respectively, p < 0.0001). Conclusion Intravitreal anti-VEGF injections were not associated with sustained elevation of IOP. These results do not support the claim that repeated anti-VEGF injections could elevate IOP.

Effect of Prefilled vs Vial-Drawn Syringes on Sustained Increases in Intraocular Pressure in Patients Treated With Aflibercept

“…Sustained IOP increase was noted in 6 of 257 eyes (2.3%), which is lower than what has been reported in previous literature. 8,9,14 –17 These current findings align with those of Wehrli et al 18 and a recent study by Kähkönen et al 11 that showed low frequency of sustained IOP increases after initiation of VEGF.…”

“…Freund et al 24 reported a lower incidence of sustained IOP increase in patients treated with aflibercept compared with ranibizumab. However, Kähkönen et al 11 did not find such associations when comparing aflibercept with ranibizumab, possibly due to a small cohort size. It is hypothesized these associations may also be due to the molecular structure of anti-VEGF agents in addition to the increased volumetric expansion in the eye.…”

“…Further post hoc analysis of randomized controlled trials showed treatment with anti-VEGF to significantly increase the risk for sustained IOP increases compared with those treated with panretinal photocoagulation or laser. 10 Contra dicting this notion, Kähkönen et al 11 recently investigated patients treated with bevacizumab and aflibercept and found no significant increase in sustained IOP changes compared with untreated fellow eyes. More studies are needed to draw further conclusions.…”

Pyruvate-conjugation of PEGylated liposomes effectively enhances their uptake in retinal photoreceptors

“…This would make it easier to find a suitable dosing regimen and would allow for prolonged drug exposure in the target cell, minimizing administration frequency [42]. This in turn is especially relevant for IVT injections that carry a range of potential complications [40,[43][44][45].…”

Immediate Effect of Intravitreal Bevacizumab Injection on Intraocular Pressure

“…3 However, FDA has approved Ranibizumab and Aflibercept for ocular use and Bevacizumab is used off label because of its cost effectiveness. 4,5 Rise in the intraocular pressure can block the juxtapupillary retinal and optic nerve head blood flow proportional to its quantitative rise. It can also cause damage to retinal ganglion cell layer.…”