Clinical Science

Glaucoma Filtration Surgery Following Sustained Elevation of Intraocular Pressure Secondary to Intravitreal Anti-VEGF Injections

Simon E. Skalicky, MBBS, MMed (Ophthal Sci); Ivan Ho, FRANZCO; Ashish Agar, FRANZCO; Allan Bank, FRANZCO

  • Ophthalmic Surgery, Lasers and Imaging
  • July/August 2012 - Volume 43 · Issue 4: 328-334
  • DOI: 10.3928/15428877-20120618-01
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Abstract

BACKGROUND AND OBJECTIVE:

To document cases of sustained elevation of intraocular pressure (IOP) while receiving intravitreal anti-vascular endothelial growth factor (VEGF) agents and subsequent management.

PATIENTS AND METHODS:

A retrospective series of all cases managed by the authors and colleagues was performed.

RESULTS:

Six patients developed sustained elevated IOP; five received ranibizumab and one bevacizumab. Four received unilateral and two received bilateral injections. Two had preexisting primary open-angle glaucoma and one had pseudoexfoliative glaucoma, all with stable IOP prior to anti-VEGF treatment. Angles were open in all cases. Peak IOP averaged 43 mm Hg (range: 34 to 60 mm Hg). The mean number of injections preceding the IOP increase was 10 (range: 1 to 20). Four patients required trabeculectomy, one selective laser trabeculoplasty, and one multiple topical medications.

CONCLUSION:

A sustained increase in IOP requiring glaucoma filtering surgery is a rare but important treatment complication for patients receiving intravitreal anti-VEGF therapy, especially those with preexisting glaucoma or glaucoma risk factors.

AUTHORS

From Sydney Eye Hospital (SES, IH); the Faculty of Medicine (SES, IH), University of Sydney; Retina Associates (IH); Australian School of Advanced Medicine (IH), Macquarie University; Prince of Wales Hospital (AA, AB), Glaucoma Unit; and the Faculty of Medicine (AA), University of New South Wales, Sydney, Australia.

Presented at the Asia-Pacific Academy of Ophthalmology meeting, March 24, 2011, Sydney, Australia.

The authors have no financial or proprietary interest in the materials presented herein.

Address correspondence to Simon E. Skalicky, MBBS, MMed (Ophthal Sci), 21 Kenilworth Street, Bondi Junction, NSW 2022 Australia. E-mail: ykcilaks@yahoo.com

Received: September 27, 2011
Accepted: March 01, 2012

doi: 10.3928/15428877-20120618-01

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