Perspectives on Glaucoma

Repeated anti-VEGF injections reduces outflow in AMD patients

Repeated anti-VEGF injections in patients with age-related macular degeneration reduces aqueous outflow facility, particularly in patients with higher-than-normal intraocular pressure at baseline, according to a study.

Patients receiving unilateral anti-VEGF treatment were recruited, so that the fellow eye could be used as control. According to injection frequency, they were divided in a low injection group (10 injections) and a high injection group (20 injections), made up of 20 and 22 patients, respectively. A further division was made between patients with baseline ocular hypertension and normotensive patients. IOP and tonographic outflow facility were measured and compared between eyes and between groups.

A small but statistically significant decrease in outflow facility in the injected eye as compared with the fellow eye was found in the patients who received 20 or more injections. No difference between eyes was found in patients receiving 10 or less injections. Patients with ocular hypertension at baseline had a highly significant outflow facility decrease, up to 46%, in the injected eye.

Although the mechanism of outflow reduction remains unknown, this study suggests that long-term anti-VEGF therapy may expose patients, particularly those with ocular hypertension, to the risk of glaucomatous field loss.

“Ophthalmologists who administer anti-VEGF injections should be aware of these findings and monitor patients closely for changes in IOP or evidence of glaucoma, especially in those with pre-existing ocular hypertension,” the authors concluded. – by Michela Cimberle

Disclosure: None of the authors have financial interests to disclose.

Repeated anti-VEGF injections in patients with age-related macular degeneration reduces aqueous outflow facility, particularly in patients with higher-than-normal intraocular pressure at baseline, according to a study.

Patients receiving unilateral anti-VEGF treatment were recruited, so that the fellow eye could be used as control. According to injection frequency, they were divided in a low injection group (10 injections) and a high injection group (20 injections), made up of 20 and 22 patients, respectively. A further division was made between patients with baseline ocular hypertension and normotensive patients. IOP and tonographic outflow facility were measured and compared between eyes and between groups.

A small but statistically significant decrease in outflow facility in the injected eye as compared with the fellow eye was found in the patients who received 20 or more injections. No difference between eyes was found in patients receiving 10 or less injections. Patients with ocular hypertension at baseline had a highly significant outflow facility decrease, up to 46%, in the injected eye.

Although the mechanism of outflow reduction remains unknown, this study suggests that long-term anti-VEGF therapy may expose patients, particularly those with ocular hypertension, to the risk of glaucomatous field loss.

“Ophthalmologists who administer anti-VEGF injections should be aware of these findings and monitor patients closely for changes in IOP or evidence of glaucoma, especially in those with pre-existing ocular hypertension,” the authors concluded. – by Michela Cimberle

Disclosure: None of the authors have financial interests to disclose.

    Perspective
    Scott Anthony

    Scott Anthony

    The treatment of exudative macular degeneration with intravitreal anti-VEGF drugs has overwhelmingly benefited countless patients. This study brought to light that a consequence of these treatments may be sustained elevated intraocular pressure in patients with a high number of injections.

    In practice, such patients typically have significant retinal disease that tends to overshadow any future glaucoma risk associated with ocular hypertension. Keeping in mind that this study defined ocular hypertension as IOP greater than 21 mm Hg, compared to the Ocular Hypertension Treatment Study’s cut-off of 24 mm Hg or higher, and the small sample size of five patients in this group, it is difficult to draw any strong clinical conclusions.

    However, untreated ocular hypertension patients who undergo anti-VEGF treatments should certainly be monitored carefully, while their risk factors for conversion to glaucoma and your decision to treat must account for the severity of their retinal condition.  

    • Scott Anthony, OD, FAAO
    • Cleveland VAMC Adjunct assistant professor of clinical optometry, staff optometrist

    Disclosures: Anthony reports no relevant financial disclosures.