Assessment of intraocular pressure changes following intravitreal injections of three anti-VEGF agents

Purpose

Intravitreal injection (IVI) of anti-vascular endothelial growth factor (anti-VEGF) agents has emerged as the primary treatment for prevalent retinal diseases. Despite its efficacy, IVI may induce intraocular pressure elevation due to vitreous fluid shifts. This study aims to compare the effects of three distinct anti-VEGF agents on intraocular pressure (IOP) elevation within a single clinic setting.

Design

A prospective study, conducted at a single retinal clinic in a tertiary medical center (Tel Aviv Sourasky Medical Centre, Tel-Aviv, Israel).

Methods

Patients receiving 3 different anti VEGF medications; bevacizumab, aflibercept, and ranibizumab, were examined. IOP was measured pre- and post-injection using an iCare Pro-tonometer. Demographic parameters and ocular characteristics were collected.

Results

The study included 195 patients (average age 76.13 years; 100 males, 95 females). The medications administered were aflibercept (N = 70, 35 %), bevacizumab (N = 73, 37.4 %), and ranibizumab (N = 52, 26.7 %). In patients with a normal baseline intraocular pressure, no significant variance was observed in the post-injection versus pre-injection pressure change (delta) across medications. Conversely, in patients with higher pressure (>20 mmHg), aflibercept incited a more substantial increase than bevacizumab or ranibizumab. No correlation emerged between the pressure rise and age or lens status.

Conclusions

No significant difference was found in the increase of intraocular pressure following injection among different medications in patients with low-normal intraocular pressure. However, for patients prone to higher baseline pressure, caution is recommended with aflibercept due to a more pronounced increase. Further research is essential to comprehend the factors influencing pressure increase and their associated clinical implications.