2020
DOI: 10.1038/s41598-020-70269-7
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The effects of intravitreal injections on intraocular pressure and retinal nerve fiber layer: a systematic review and meta-analysis

Abstract: The number of eye diseases treated with intravitreal injections is increasing. Obviously, an injection of fluid into the eye results in an increase of intraocular pressure (IOP), the main risk factor for glaucoma. However, the effect of these repeated IOP increases on the eye is unclear. Therefore, we performed a systematic review with meta-analyses. PubMed, Embase and Clinical Trials Registries were searched for articles investigating the relationship between intravitreal injections (anti-vascular endothelial… Show more

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Cited by 62 publications
(51 citation statements)
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“…IOP increases may occur immediately after anti-VEGF injections (due to an increase in vitreous volume) or after a series of injections (due to impaired aqueous outflow). A meta-analysis showed a statistically significant rise in IOP on the day of the injection followed by a significant decline the next day with no changes at the subsequent visits up to 12 months [ 27 ]. A recent report by the American Academy of Ophthalmology (AAO) on the effect of anti-VEGF therapy on IOP and glaucoma also noted a short-term elevation in IOP immediately after the injection followed by a gradual normalization over a week [ 28 ].…”
Section: Discussionmentioning
confidence: 99%
See 1 more Smart Citation
“…IOP increases may occur immediately after anti-VEGF injections (due to an increase in vitreous volume) or after a series of injections (due to impaired aqueous outflow). A meta-analysis showed a statistically significant rise in IOP on the day of the injection followed by a significant decline the next day with no changes at the subsequent visits up to 12 months [ 27 ]. A recent report by the American Academy of Ophthalmology (AAO) on the effect of anti-VEGF therapy on IOP and glaucoma also noted a short-term elevation in IOP immediately after the injection followed by a gradual normalization over a week [ 28 ].…”
Section: Discussionmentioning
confidence: 99%
“…The AAO report showed mixed results regarding long-term IOP changes—seven studies described a 4–15% incidence of sustained IOP elevation from 9 to 24 months after initiation of therapy, whereas six studies reporting no long-term changes in IOP at 1 to 36 months [ 28 ]. Prospective trials reported that 3.5–8.5% of nAMD eyes receiving ranibizumab or bevacizumab may develop a sustained rise in IOP [ 27 29 ] and the incidences of sustained IOP greater than 21 mmHg were 8.4%, 3.2%, 4.2%, and 2.7% in the q4wk ranibizumab (Rq4), 2 mg aflibercept every 4 weeks (2q4), 0.5 mg aflibercept every 4 weeks (0.5q4), and 2 mg aflibercept every 8 weeks (after 3 monthly doses; 2q8) groups, respectively in the VIEW 1 & 2 trials [ 30 ]. The incidence of IOP elevation in our study was small (0.48%) but since most of these eyes received only single Razumab injections, directly comparing our findings to those from 2-year trials should not be done.…”
Section: Discussionmentioning
confidence: 99%
“…Furthermore, there was an increased risk of developing retinal scarring and geographic atrophy in nAMD patients 2 to 5 years after initiating treatment [ 14 ]. Complications such as vitreous and subconjunctival hemorrhage, fluid accumulation under the fovea, increased intraocular pressure, endophthalmitis, and ocular inflammation have also been described [ 15 , 16 , 17 , 18 ].…”
Section: Introductionmentioning
confidence: 99%
“…The study also demonstrated a significant decrease in the incidence of elevated IOP when comparing aflibercept to ranibizumab [ 19 ]. In a recent meta-analysis of 46 studies investigating intravitreal bevacizumab, ranibizumab and aflibercept, IOP normalized 1 week after the injection and no significant change in IOP was found for longer time-intervals [ 20 ]. It remains inconclusive whether intravitreal anti-VEGF therapy leads to an elevated risk of sustained IOP rise.…”
Section: Introductionmentioning
confidence: 99%