Sustained ocular hypertension following intravitreal injections of 0.5 mg/0.05 ml ranibizumab

Abstract

To report three cases with sustained ocular hypertension following intravitreal injections of 0.5 mg/0.05 ml ranibizumab and to underline the importance of monitoring intraocular pressure (IOP) following intravitreal injections of ranibizumab (Lucentis). Three patients were found to have high IOP after intravitreal injections of 0.5 mg/0.05 ml ranibizumab. IOP was elevated after the second ranibizumab injection in patients 1 and 2, and after the third injection in patient 3. The increase in IOP was sustained, requiring treatment with anti-glaucoma eye drops in all patients, the addition of systemic carbonic anhydrase inhibitor in one patient, and the application of selective laser trabeculoplasty (SLT) in another patient. None of the patients had a previous history of glaucoma or ocular hypertension. Sustained ocular hypertension may occur after intravitreal injections of 0.5 mg/0.05 ml ranibizumab. Although the precise mechanism of the pressure rise is unknown, three eyes in our series were controlled with topical or oral medication and one with SLT. The necessity of IOP monitoring is strongly emphasized after intravitreal injections of 0.5 mg/0.05 ml ranibizumab.

Ocular Hypertension Following Intravitreal Antivascular Endothelial Growth Factor Therapy

“…Of note, several articles were not listed in this table due to small sample size. 12,[50][51][52][53] The mechanism underlying sustained IOP elevation has not been clearly elucidated, although several potential etiologies have been proposed. Direct blockage of trabecular meshwork outflow has been proposed as an etiologic factor, either from the anti-VEGF molecules themselves, 8 or other high-molecular weight aggregates 13 such as silicone oil microdroplets that may leach into the injected solution from the syringe or plunger.…”

“…7 Drug-induced trabeculitis has also been proposed as a mechanism. 12 Several authors have proposed that anti-VEGF agents may directly physiologically decrease aqueous outflow, 8,50,51 and some have proposed that this may be due to direct anti-VEGF toxicity to anterior segment cells. However, in vitro toxicity studies have yielded conflicting results.…”

Incidence of Intraocular Pressure Elevation following Intravitreal Ranibizumab (Lucentis) for Age-related Macular Degeneration

“…4 Sustained OHT after anti-VEGF injections has been reported in both case series 25 and retrospective studies 67 ; the incidence ranges from 3 to 9%.…”

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

“…Bevacizumab (Avastin, Genentech, South San Francisco, Calif., USA), which received initial US Food and Drug Administration approval for use in colorectal cancer [5], is also commonly used as an off-label treatment for AMD. With widespread use of anti-VEGF agents, some studies reported the occurrence of sustained intraocular pressure (IOP) elevation after intravitreal anti-VEGF injections [6,7,8,9,10,11,12,13,14,15]. Presently, sustained IOP elevation due to intravitreal injection of anti-VEGF agents is a real concern.…”

“…Some possible mechanisms underlying sustained IOP elevation after intravitreal injections of anti-VEGF agents have been previously proposed [6,7,8,9,10,11,12,13,14,15]. One of them is that the IOP spikes after injection cause damage to the outflow system and in turn prolong IOP elevation [7,8,9,10,11]. To prevent this occurrence, we performed anterior chamber paracentesis just before intravitreal ranibizumab (IVR) injection.…”