Predictors of elevated intraocular pressure after intravitreal injection of anti-vascular endothelial growth factor: a prospective observational study

Abstract

Purpose: To investigate the patterns and predictors of intraocular pressure (IOP) changes after intravitreal injection (IVI) of anti-vascular endothelial growth factors (anti-VEGFs).Methods: This study enrolled 32 men and 16 women (mean age, 65.3±12.3 years) who underwent IVI of anti-VEGFs between January and March 2020 in our department. IOPs were measured using Goldmann applanation tonometry. Potential predictors included age, sex, lens status, axial length, history of glaucoma, number of previous IVIs, diagnosis, and post-injection vitreous reflux.Results: The respective mean IOP was 16.2 mmHg, 32.7 mmHg, 21.7 mmHg, and 18.3 mmHg at baseline and at 5, 15, and 30 minutes after IVI. IOP elevation of ≥15 mmHg was observed in 48% of eyes at 5 minutes after IVI; all spikes resolved and the IOP reduced to <21 mmHg within 60 minutes. Previous IVI number (r=0.346, p=0.016) and baseline IOP (r=0.304, p=0.04) were associated with IOP at 5 minutes after IVI. Baseline IOP was associated with IOPs at 15 and 30 minutes after IVI (r=0.488-0.573, p<0.001). In multivariate regression analysis, the previous IVI number (b=0.55, p=0.04) was an independent predictor of IOP at 5 minutes after IVI.Conclusion: Transient but substantial IOP elevation shortly after IVI of anti-VEGFs was positively correlated with the number of previous IVIs; this could be used to stratify patients for IOP spike prophylaxis, especially those with advanced glaucoma at risk of further optic nerve damage secondary to acute ocular hypertension. Ophthalmologists should assess patient susceptibility to glaucomatous damage, along with the risks andcomplications of prophylaxis