David J Ramsey1,2, James C McCullum3,4, Elise E Steinberger4, Yubo Zhang5, Amer Mosa Alwreikat3,4, Michael L Cooper4, Shiyoung Roh3,4, Paul R Cotran3,4. 1. Department of Ophthalmology, Lahey Hospital & Medical Center, Peabody, MA, USA. David.J.Ramsey@lahey.org. 2. Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, USA. David.J.Ramsey@lahey.org. 3. Department of Ophthalmology, Lahey Hospital & Medical Center, Peabody, MA, USA. 4. Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, USA. 5. Brandeis University, Waltham, MA, USA.
Abstract
OBJECTIVE: To understand intraocular pressure (IOP) response after switching from intravitreal bevacizumab (IVB) and/or ranibizumab (IVR) to intravitreal aflibercept (IVA) for treatment-resistant neovascular age-related macular degeneration (nAMD) in patients with and without coexisting glaucoma-related diagnoses. METHODS: Retrospective, cross-sectional comparative case series of 62 eyes of 58 patients treated with intravitreal injection for nAMD from March 2010 to April 2018. Patients with glaucoma-related diagnoses, defined here as open-angle glaucoma or suspicion of open-angle glaucoma, ocular hypertension, and/or narrow-angle glaucoma, were compared to those without glaucoma. IOP data were collected at baseline, at the three visits where patients received loading doses of IVB/IVR, and at all of the visits following the switch to IVA through the end of follow-up. RESULTS: 19 eyes with pre-existing glaucoma-related diagnoses were compared to 43 eyes without such diagnoses. Baseline IOP was similar for glaucoma and non-glaucoma patients. The loading doses of IVB/IVR did not impact IOP; however, a small, sustained rise in IOP was noted among patients with glaucoma-related diagnoses by the final IVB/IVR injections before the switch to IVA (∆IOP 1.61 ± 0.52 mmHg, P < 0.002). After conversion to IVA, pre-injection IOP declined in eyes both with (-1.59 ± 0.54 mmHg, P < 0.001) and without (-0.99 ± 0.28 mmHg, P < 0.001) glaucoma-related diagnoses. CONCLUSIONS: IOP in patients with glaucoma-related diagnoses appears to be more sensitive to intravitreal injections than it is in patients without glaucoma-related diagnoses. It rises with IVB/IVR and declines after the switch to IVA. Switching patients with nAMD to IVA may present an opportunity to lower IOP in patients with glaucoma.
OBJECTIVE: To understand intraocular pressure (IOP) response after switching from intravitreal bevacizumab (IVB) and/or ranibizumab (IVR) to intravitreal aflibercept (IVA) for treatment-resistant neovascular age-related macular degeneration (nAMD) in patients with and without coexisting glaucoma-related diagnoses. METHODS: Retrospective, cross-sectional comparative case series of 62 eyes of 58 patients treated with intravitreal injection for nAMD from March 2010 to April 2018. Patients with glaucoma-related diagnoses, defined here as open-angle glaucoma or suspicion of open-angle glaucoma, ocular hypertension, and/or narrow-angle glaucoma, were compared to those without glaucoma. IOP data were collected at baseline, at the three visits where patients received loading doses of IVB/IVR, and at all of the visits following the switch to IVA through the end of follow-up. RESULTS: 19 eyes with pre-existing glaucoma-related diagnoses were compared to 43 eyes without such diagnoses. Baseline IOP was similar for glaucoma and non-glaucoma patients. The loading doses of IVB/IVR did not impact IOP; however, a small, sustained rise in IOP was noted among patients with glaucoma-related diagnoses by the final IVB/IVR injections before the switch to IVA (∆IOP 1.61 ± 0.52 mmHg, P < 0.002). After conversion to IVA, pre-injection IOP declined in eyes both with (-1.59 ± 0.54 mmHg, P < 0.001) and without (-0.99 ± 0.28 mmHg, P < 0.001) glaucoma-related diagnoses. CONCLUSIONS: IOP in patients with glaucoma-related diagnoses appears to be more sensitive to intravitreal injections than it is in patients without glaucoma-related diagnoses. It rises with IVB/IVR and declines after the switch to IVA. Switching patients with nAMD to IVA may present an opportunity to lower IOP in patients with glaucoma.
Authors: Joseph J Tseng; Sushma K Vance; Kara E Della Torre; Luis S Mendonca; Michael J Cooney; James M Klancnik; John A Sorenson; K Bailey Freund Journal: J Glaucoma Date: 2012 Apr-May Impact factor: 2.503
Authors: Philip J Rosenfeld; David M Brown; Jeffrey S Heier; David S Boyer; Peter K Kaiser; Carol Y Chung; Robert Y Kim Journal: N Engl J Med Date: 2006-10-05 Impact factor: 91.245
Authors: Steven L Mansberger; Mae O Gordon; Henry Jampel; Anjali Bhorade; James D Brandt; Brad Wilson; Michael A Kass Journal: Ophthalmology Date: 2012-05-16 Impact factor: 12.079
Authors: Brennan D Eadie; Mahyar Etminan; Bruce C Carleton; David A Maberley; Frederick S Mikelberg Journal: JAMA Ophthalmol Date: 2017-04-01 Impact factor: 7.389
Authors: Sophie J Bakri; Colin A McCannel; Albert O Edwards; Darius M Moshfeghi Journal: Graefes Arch Clin Exp Ophthalmol Date: 2008-04-19 Impact factor: 3.117