Elizabeth A Atchison1, Kevin M Wood2, Cynthia G Mattox3, Catherine N Barry2, Flora Lum2, Mathew W MacCumber4. 1. Department of Ophthalmology, Rush University Medical Center, Chicago, Illinois. 2. American Academy of Ophthalmology, San Francisco, California. 3. New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts. 4. Department of Ophthalmology, Rush University Medical Center, Chicago, Illinois. Electronic address: mmaccumber@illinoisretina.com.
Abstract
PURPOSE: To identify sustained differences in intraocular pressure (IOP) after intravitreous injections of anti-vascular endothelial growth factor (VEGF) drugs. DESIGN: Database study. PARTICIPANTS: Patients seeing an ophthalmic provider who contributes to the database. METHODS: We identified a total of 23 776 unique patients who received only a single type of anti-VEGF medication (bevacizumab, aflibercept, or ranibizumab) by injection in the right eye in the American Academy of Ophthalmology Intelligent Research in Sight Registry. Subgroups included patients with age-related macular degeneration only and patients who had not received an anti-VEGF injection for at least 1 year before the study. We examined those with at least 12, 18, and 25 injections for each of these 3 medications. For all groups, we used fellow, untreated eyes for comparison. MAIN OUTCOME MEASURES: The mean change in IOP from baseline at a minimum of 1 year of follow-up and the proportion of eyes with a clinically significant IOP increase (defined as sustained rise of at least 6 mmHg to an IOP of more than 21 mmHg). RESULTS: All patients in all groups receiving all drugs showed a decrease in IOP from baseline, with a mean of 0.9 mmHg in treated eyes compared with an average decrease of 0.2 mmHg in fellow untreated eyes, a statistically significant difference. A generalized linear model accounting for confounders associated bevacizumab with slightly less lowering of IOP than aflibercept and ranibizumab in most subgroups. A clinically significant IOP increase was seen in 2.6% of eyes receiving injections compared with 1.5% in the associated untreated fellow eyes. Clinically significant IOP increases occurred at a rate of 1.9%, 2.8%, and 2.8% for aflibercept, ranibizumab, and bevacizumab, respectively, which was significantly higher than untreated fellow eyes for bevacizumab and ranibizumab, but not for aflibercept. CONCLUSIONS: These analyses from real-world data indicate that anti-VEGF intravitreous injections are associated with a small but statistically significant decrease in IOP over time. A proportion of patients, on average 2.6%, experienced a sustained clinically significant IOP rise with these drugs overall compared with 1.5% in the fellow untreated eyes. However, such an increase was not seen with aflibercept.
PURPOSE: To identify sustained differences in intraocular pressure (IOP) after intravitreous injections of anti-vascular endothelial growth factor (VEGF) drugs. DESIGN: Database study. PARTICIPANTS: Patients seeing an ophthalmic provider who contributes to the database. METHODS: We identified a total of 23 776 unique patients who received only a single type of anti-VEGF medication (bevacizumab, aflibercept, or ranibizumab) by injection in the right eye in the American Academy of Ophthalmology Intelligent Research in Sight Registry. Subgroups included patients with age-related macular degeneration only and patients who had not received an anti-VEGF injection for at least 1 year before the study. We examined those with at least 12, 18, and 25 injections for each of these 3 medications. For all groups, we used fellow, untreated eyes for comparison. MAIN OUTCOME MEASURES: The mean change in IOP from baseline at a minimum of 1 year of follow-up and the proportion of eyes with a clinically significant IOP increase (defined as sustained rise of at least 6 mmHg to an IOP of more than 21 mmHg). RESULTS: All patients in all groups receiving all drugs showed a decrease in IOP from baseline, with a mean of 0.9 mmHg in treated eyes compared with an average decrease of 0.2 mmHg in fellow untreated eyes, a statistically significant difference. A generalized linear model accounting for confounders associated bevacizumab with slightly less lowering of IOP than aflibercept and ranibizumab in most subgroups. A clinically significant IOP increase was seen in 2.6% of eyes receiving injections compared with 1.5% in the associated untreated fellow eyes. Clinically significant IOP increases occurred at a rate of 1.9%, 2.8%, and 2.8% for aflibercept, ranibizumab, and bevacizumab, respectively, which was significantly higher than untreated fellow eyes for bevacizumab and ranibizumab, but not for aflibercept. CONCLUSIONS: These analyses from real-world data indicate that anti-VEGF intravitreous injections are associated with a small but statistically significant decrease in IOP over time. A proportion of patients, on average 2.6%, experienced a sustained clinically significant IOP rise with these drugs overall compared with 1.5% in the fellow untreated eyes. However, such an increase was not seen with aflibercept.
Authors: M Gómez-Mariscal; B Puerto; F J Muñoz-Negrete; V de Juan; G Rebolleda Journal: Graefes Arch Clin Exp Ophthalmol Date: 2019-06-28 Impact factor: 3.117
Authors: David J Ramsey; James C McCullum; Elise E Steinberger; Yubo Zhang; Amer Mosa Alwreikat; Michael L Cooper; Shiyoung Roh; Paul R Cotran Journal: Eye (Lond) Date: 2021-08-12 Impact factor: 4.456
Authors: Ta C Chang; Richard K Parrish; Danielle Fujino; Scott P Kelly; Elizabeth A Vanner Journal: Am J Ophthalmol Date: 2020-10-10 Impact factor: 5.258
Authors: Yangjiani Li; Nathan E Hall; Suzann Pershing; Leslie Hyman; Julia A Haller; Aaron Y Lee; Cecilia S Lee; Michael Chiang; Flora Lum; Joan W Miller; Alice Lorch; Tobias Elze Journal: Ophthalmol Retina Date: 2021-05-12
Authors: Vincent Daien; Bora M Eldem; James S Talks; Jean-Francois Korobelnik; Paul Mitchell; Robert P Finger; Taiji Sakamoto; Tien Yin Wong; Obaro Evuarherhe; Gemma Carter; Joao Carrasco Journal: BMC Ophthalmol Date: 2019-10-16 Impact factor: 2.209
Authors: Cecilia S Lee; Julia P Owen; Ryan T Yanagihara; Alice Lorch; Suzann Pershing; Leslie Hyman; Joan W Miller; Julia A Haller; Michael F Chiang; Flora Lum; Aaron Y Lee Journal: Ophthalmol Glaucoma Date: 2020-03-31