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The Effect of Anti-Vascular Endothelial Growth Factor Agents on Intraocular Pressure and Glaucoma: A Report by the American Academy of Ophthalmology.

Publication ,  Journal Article
Hoguet, A; Chen, PP; Junk, AK; Mruthyunjaya, P; Nouri-Mahdavi, K; Radhakrishnan, S; Takusagawa, HL; Chen, TC
Published in: Ophthalmology
April 2019

PURPOSE: To assess the effect of intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents on immediate and long-term intraocular pressure (IOP) elevation and glaucoma. METHODS: Literature searches of the PubMed and Cochrane databases, last conducted in April 2018, yielded 253 unique citations. Of these, 41 met the inclusion criteria and were rated according to the strength of evidence. Two articles were rated level I, 17 were rated level II, and 15 were rated level III; an additional 7 were excluded because of poor study design and lack of relevance to the topic under evaluation. RESULTS: The studies that reported on short-term IOP elevation (i.e., between 0 and 60 minutes) showed that an immediate increase in IOP is seen in all patients when measured between 0 and 30 minutes of intravitreal injection and that the IOP elevation decreases over time. The data on long-term IOP elevation were mixed; 7 studies reported that between 4% and 15% of patients developed sustained elevation of IOP at 9 to 24 months after injection, whereas 6 studies found no long-term change in IOP from 1 to 36 months after injection. Pretreatment with glaucoma medications, anterior chamber tap, vitreous reflux, longer intervals between injections, and longer axial lengths were associated with lower IOP elevations after injection. Data were mixed on the relationship between IOP increase and the type of intravitreal injection, number of intravitreal injections, preexisting glaucoma, and globe decompression before injection. There were no data on the onset or progression of glaucoma in the studies reviewed in this assessment. CONCLUSIONS: Intravitreal injection of anti-VEGF agents results in an immediate and transient increase in IOP. A long-term increase in IOP also may be seen, and further studies are needed to determine at-risk populations. Although there is some suggestion in the literature, there is currently insufficient data to determine the impact of intravitreal anti-VEGF injections on glaucoma progression. Although pretreatment with glaucoma medications, performing anterior chamber paracentesis, or increasing the interval between injections may reduce the impact of transient IOP elevation, the clinical significance and associated risks of these interventions are unknown.

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Published In

Ophthalmology

DOI

EISSN

1549-4713

Publication Date

April 2019

Volume

126

Issue

4

Start / End Page

611 / 622

Location

United States

Related Subject Headings

  • Vascular Endothelial Growth Factor A
  • United States
  • Technology Assessment, Biomedical
  • Ophthalmology & Optometry
  • Intravitreal Injections
  • Intraocular Pressure
  • Humans
  • Glaucoma
  • Databases, Factual
  • Angiogenesis Inhibitors
 

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Hoguet, A., Chen, P. P., Junk, A. K., Mruthyunjaya, P., Nouri-Mahdavi, K., Radhakrishnan, S., … Chen, T. C. (2019). The Effect of Anti-Vascular Endothelial Growth Factor Agents on Intraocular Pressure and Glaucoma: A Report by the American Academy of Ophthalmology. Ophthalmology, 126(4), 611–622. https://doi.org/10.1016/j.ophtha.2018.11.019
Hoguet, Ambika, Philip P. Chen, Anna K. Junk, Prithvi Mruthyunjaya, Kouros Nouri-Mahdavi, Sunita Radhakrishnan, Hana L. Takusagawa, and Teresa C. Chen. “The Effect of Anti-Vascular Endothelial Growth Factor Agents on Intraocular Pressure and Glaucoma: A Report by the American Academy of Ophthalmology.Ophthalmology 126, no. 4 (April 2019): 611–22. https://doi.org/10.1016/j.ophtha.2018.11.019.
Hoguet A, Chen PP, Junk AK, Mruthyunjaya P, Nouri-Mahdavi K, Radhakrishnan S, et al. The Effect of Anti-Vascular Endothelial Growth Factor Agents on Intraocular Pressure and Glaucoma: A Report by the American Academy of Ophthalmology. Ophthalmology. 2019 Apr;126(4):611–22.
Hoguet, Ambika, et al. “The Effect of Anti-Vascular Endothelial Growth Factor Agents on Intraocular Pressure and Glaucoma: A Report by the American Academy of Ophthalmology.Ophthalmology, vol. 126, no. 4, Apr. 2019, pp. 611–22. Pubmed, doi:10.1016/j.ophtha.2018.11.019.
Hoguet A, Chen PP, Junk AK, Mruthyunjaya P, Nouri-Mahdavi K, Radhakrishnan S, Takusagawa HL, Chen TC. The Effect of Anti-Vascular Endothelial Growth Factor Agents on Intraocular Pressure and Glaucoma: A Report by the American Academy of Ophthalmology. Ophthalmology. 2019 Apr;126(4):611–622.
Journal cover image

Published In

Ophthalmology

DOI

EISSN

1549-4713

Publication Date

April 2019

Volume

126

Issue

4

Start / End Page

611 / 622

Location

United States

Related Subject Headings

  • Vascular Endothelial Growth Factor A
  • United States
  • Technology Assessment, Biomedical
  • Ophthalmology & Optometry
  • Intravitreal Injections
  • Intraocular Pressure
  • Humans
  • Glaucoma
  • Databases, Factual
  • Angiogenesis Inhibitors