April 17, 2020
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OCT angiography shows acute IOP changes after intravitreal injections

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Repeated intravitreal injections may result in glaucomatous damage, according to research done at New York Eye and Ear Infirmary of Mount Sinai.

In a retrospective observational clinical study of 40 eyes of 39 patients, Richard B. Rosen, MD, and colleagues used OCT angiography to demonstrate the acute changes in IOP that result from reduced macular and peripapillary perfusion density after intravitreal injection.

“These injections cause eye pressure to temporarily go up three times normal levels, and while patients typically recover within minutes, we wanted to know the immediate impact on blood flow to the eye,” Rosen said in a press release from Mount Sinai.

Patients with diabetic retinopathy, macular degeneration, choroidal neovascular membrane, retinal vein occlusion or radiation retinopathy and vision better than 20/100 without media opacities or other ocular changes were given either intravitreal bevacizumab or aflibercept. IOP was checked before and immediately after injections, and macular and peripapillary OCT angiography using the RTVue XR 100 Avanti (Optovue) was performed before and within 3 minutes after injections.

Statistically signicant decreases in OCT angiographic perfusion density were seen in the macula (P < .001), parafovea (P = .0008), superior hemifield (P < .001) and inferior hemifield (P = .001).

Although both superficial and deep vessels were affected immediately after injection, perfusion was on average 7.5% decreased in supercial macular vessels vs. deep vessels.

“This study is important because we know that high eye pressure leads to tissue damage in glaucoma. If patients are receiving monthly injections that repeatedly stress the eye, we may have to start looking for signs of cumulative damage,” lead author Alexander Barash, MD, said in the release. – by Erin T. Welsh

Disclosures: Rosen reports he is a consultant for or has a financial interest in Optovue, Boehringer-Ingelheim, Astellas, Genentech/Roche, Nano Retina, OD-OS, Opticology, Guardion, GlaucoHealth and Regeneron/Bayer. The other authors report no relevant financial disclosures.