Acute rises in IOP that occur with anti-VEGF injections is a real phenomenon, but it is transient and may not necessarily warrant any intervention for many patients, according to Matthew Schlenker MD, MSc.
Tackling IOP spikes
Acute rises in IOP that occur with anti-VEGF injections is a real phenomenon, but it is transient and may not necessarily warrant any intervention for many patients, Dr. Schlenker noted.
“This rise (in IOP) does not last very long for the average patient,” Dr. Schlenker said. “For patients with healthy optic nerves, it may be reasonable to do nothing. However, they should be educated that it is happening.”
If a physician opts to treat this elevation in IOP, they can consider various modalities to manage the IOP rise.
One study has shown the most effective medical treatment to blunt fluctuations is apraclonidine, the same medication used to blunt IOP spikes post-glaucoma laser treatments.
A physician also can try to allow for subconjunctival reflux, said Dr. Schlenker.
“In the past, the main medication injected intravitreally was triamcinolone, and a 27-gauge needle was used which likely allowed for more reflux,” he said. “Studies show that if you allow for (subconjunctival) reflux when you do your anti VEGF-injection, there is a much lower risk of having a spike (in IOP).”
Still another intervention that can be in the armamentarium to manage acute rises in IOP resulting from injections of anti-VEGF agents is anterior chamber paracentesis, he noted, though the long-term effects of repeat paracenteses is unknown.
Matthew Schlenker, MD, MSc, FRCPC
p: +1 905-456-3937
This article was adapted from Dr. Schlenker’s presentation at the 51st Sally Letson Symposium in Ottawa, Ontario, Canada. Dr. Schlenker has no financial disclosures related to this content.