Pierre-Henry Gabrielle1, Vuong Nguyen2, Benjamin Wolff3, Rohan Essex4, Stephanie Young5, Adrian Hunt2, Chui Ming Gemmy Cheung6, Jennifer J Arnold7, Daniel Barthelmes8, Catherine Creuzot-Garcher9, Mark Gillies2. 1. Department of Ophthalmology, Dijon University Hospital, Dijon, France; Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney, Australia. Electronic address: phgabrielle@gmail.com. 2. Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney, Australia. 3. Centre Ophtalmologique Maison Rouge, Strasbourg, France. 4. Academic Unit of Ophthalmology, Australian National University, Acton, Australia. 5. Gladesville Eye Specialists, Gladesville, Australia. 6. Singapore National Eye Centre, Singapore, Republic of Singapore. 7. Marsden Eye Research, Sydney, Australia. 8. Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. 9. Department of Ophthalmology, Dijon University Hospital, Dijon, France.
Abstract
PURPOSE: To report long-term changes in intraocular pressure (IOP) in eyes receiving vascular endothelial growth factor (VEGF) inhibitors for various retinal conditions over 12 and 24 months in routine clinical practice. DESIGN: Retrospective analysis of data from a prospectively designed observational outcomes registry, the Fight Retinal Blindness! PARTICIPANTS: Treatment-naïve eyes receiving monotherapy with VEGF inhibitors (ranibizumab [0.5 mg], aflibercept [2 mg], or bevacizumab [1 mg]) with at least 3 injections from December 2013 through December 31, 2018, and at least 12 months of follow-up. METHODS: Intraocular pressure was measured at each clinical visit for all eyes as part of routine practice. MAIN OUTCOME MEASURES: The primary outcome was the mean change in IOP (in millimeters of mercury) at 12 months. The following secondary IOP outcome measures were investigated at 12 and 24 months: (1) mean change in IOP from baseline and (2) proportion of clinically significant IOP increase defined as an elevation of at least 6 mmHg to an IOP of more than 21 mmHg at any point during the follow-up. RESULTS: We identified 3429 treatment-naïve eyes (395 receiving bevacizumab, 1138 receiving aflibercept, and 1896 receiving ranibizumab) with complete IOP data from 3032 patients with 12 months of follow-up data, of which 2125 (62%) had 24 months of follow-up data. The overall mean IOP change was -0.5 mmHg (95% confidence interval CI, -0.6 to -0.3 mmHg) at 12 months and -0.4 mmHg (95% CI, -0.6 to -0.3 mmHg) at 24 months, whereas the proportions of clinically significant IOP increases were 5.6% and 8.8%, respectively. A lower mean IOP change and fewer IOP elevations at 12 and 24 months was observed in eyes receiving aflibercept than in those receiving bevacizumab and ranibizumab (P ≤ 0.01 for both comparisons at each time point and outcome). Eyes with pre-existing glaucoma demonstrated more IOP increases over 12 and 24 months (odds ratio [OR], 2.2 [95% CI, 1.2-3.8; P = 0.012] and 2.1 [95% CI, 1.1-3.8; P = 0.025], respectively). CONCLUSIONS: Mean IOP did not change significantly from baseline to 12 and 24 months in eyes receiving VEGF inhibitors, whereas clinically significant IOP elevations occurred in a small proportion of eyes. Aflibercept was associated with fewer clinically significant IOP elevations, whereas eyes with pre-existing glaucoma were at a higher risk.
PURPOSE: To report long-term changes in intraocular pressure (IOP) in eyes receiving vascular endothelial growth factor (VEGF) inhibitors for various retinal conditions over 12 and 24 months in routine clinical practice. DESIGN: Retrospective analysis of data from a prospectively designed observational outcomes registry, the Fight Retinal Blindness! PARTICIPANTS: Treatment-naïve eyes receiving monotherapy with VEGF inhibitors (ranibizumab [0.5 mg], aflibercept [2 mg], or bevacizumab [1 mg]) with at least 3 injections from December 2013 through December 31, 2018, and at least 12 months of follow-up. METHODS: Intraocular pressure was measured at each clinical visit for all eyes as part of routine practice. MAIN OUTCOME MEASURES: The primary outcome was the mean change in IOP (in millimeters of mercury) at 12 months. The following secondary IOP outcome measures were investigated at 12 and 24 months: (1) mean change in IOP from baseline and (2) proportion of clinically significant IOP increase defined as an elevation of at least 6 mmHg to an IOP of more than 21 mmHg at any point during the follow-up. RESULTS: We identified 3429 treatment-naïve eyes (395 receiving bevacizumab, 1138 receiving aflibercept, and 1896 receiving ranibizumab) with complete IOP data from 3032 patients with 12 months of follow-up data, of which 2125 (62%) had 24 months of follow-up data. The overall mean IOP change was -0.5 mmHg (95% confidence interval CI, -0.6 to -0.3 mmHg) at 12 months and -0.4 mmHg (95% CI, -0.6 to -0.3 mmHg) at 24 months, whereas the proportions of clinically significant IOP increases were 5.6% and 8.8%, respectively. A lower mean IOP change and fewer IOP elevations at 12 and 24 months was observed in eyes receiving aflibercept than in those receiving bevacizumab and ranibizumab (P ≤ 0.01 for both comparisons at each time point and outcome). Eyes with pre-existing glaucoma demonstrated more IOP increases over 12 and 24 months (odds ratio [OR], 2.2 [95% CI, 1.2-3.8; P = 0.012] and 2.1 [95% CI, 1.1-3.8; P = 0.025], respectively). CONCLUSIONS: Mean IOP did not change significantly from baseline to 12 and 24 months in eyes receiving VEGF inhibitors, whereas clinically significant IOP elevations occurred in a small proportion of eyes. Aflibercept was associated with fewer clinically significant IOP elevations, whereas eyes with pre-existing glaucoma were at a higher risk.
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: Swarup S Swaminathan; Anne L Kunkler; Ann V Quan; Charles M Medert; Elizabeth A Vanner; William Feuer; Ta Chen Chang Journal: Am J Ophthalmol Date: 2020-12-24 Impact factor: 5.488