Intravitreous anti-VEGF drugs slightly reduce intraocular pressure
Intravitreous injections of antivascular endothelial growth factor (anti-VEGF) drugs result in small but statistically significant decrease in intraocular pressure (IOP) over time, a recent database study has shown. Overall, 2.6 percent of eyes have a sustained clinically significant IOP rise compared with 1.5 percent in the fellow untreated eyes, but such an increase is not observed with aflibercept.
Participants were unique patients (n=23,776) who received only a single type of anti-VEGF medication (bevacizumab, aflibercept or ranibizumab) by injection in the right eye in the American Academy of Ophthalmology Intelligent Research in Sight Registry. Included in the subgroups were patients with age-related macular degeneration only and those who had not received anti-VEGF injection for at least 1 year prior to the study.
The authors examined patients with at least 12, 18 and 25 injections for each of the three medications. They used fellow untreated eyes for comparison for all groups. The primary endpoints were the mean change in IOP from baseline at a minimum of 1 year of follow-up and the proportion of eyes with a clinically significant IOP increase, defined as sustained rise of at least 6 mm Hg to an IOP of >21 mm Hg.
IOP decreased from baseline (mean, 0.9 mm Hg in treated eyes vs 0.2 mm Hg in fellow untreated eyes) in all patients in all groups receiving all drugs, showing a statistically significant difference. Bevacizumab was associated with slightly less lowering of IOP than aflibercept and ranibizumab in most subgroups, based on a generalized linear model accounting for confounders.
IOP significantly increased in 2.6 percent of eyes receiving injections compared with 1.5 percent in the associated untreated fellow eyes. The rate by which clinically significant IOP increases occurred was 1.9 percent for aflibercept, 2.8 percent for ranibizumab and 2.8 percent for bevacizumab, which was significantly higher for bevacizumab and ranibizumab, but not aflibercept, than fellow untreated eyes.