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.
The clinical trials MARINA (Minimally Classic/Occult Trial of the Anti-VEGF Antibody Ranibizumab in the Treatment of Neovascular AMD) and ANCHOR (Anti-VEGF Antibody for the Treatment of Predominantly Classic Choroidal Neovascularization in AMD) showed the benefit of injections of VEGF inhibitors and also measured safety of IOP levels, said Dr. Schlenker.
These trials originally reported mean IOPs but did not look specifically at the number of patients with a clinically significant IOP rise over time. In post-hoc analysis, there was a statistically significant difference in patients who had a chronic IOP rise between those receiving injections and those receiving sham injections.
IOP rise can also be a concern in patients with diabetic macular edema receiving injections of VEGF inhibitors.
Dr. Schlenker noted data from a trial that compared ranibizumab and laser versus laser alone, where the investigators concluded repeated intravitreous injections of ranibizumab may increase the risk of sustained IOP elevation, suggesting a possible need for ocular hypotensive therapy. JAMA Ophthalmol. 2015 May;133(5):589-97.
The investigators concluded that the data indicate IOP be monitored periodically in eyes receiving repeated injections of anti-VEGF therapy, said Dr. Schlenker. “There was not a large number of patients with a problem in these studies; however, these studies mainly included patients who did not have a glaucoma, so may not be generalizable to other patient populations,” he said.
Matthew Schlenker, MD, MSc, FRCPC
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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.