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Editors Selection IGR 13-4

Miscellaneous: Anti-VEGF injections and IOP

Comment by Malik Kahook on:

56090 Intraocular pressure in eyes receiving monthly ranibizumab in 2 pivotal age-related macular degeneration clinical trials, Bakri SJ; Moshfeghi DM; Francom S et al., Ophthalmology, 2014; 121: 1102-1108

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Jalil and colleagues first reported sustained elevation in intraocular pressure (IOP) after injection of the anti-vascular endothelial growth factor (VEGF) agent bevacizumab in 2007.¹ Since this first report, there have been several publications that support or reject the connection between injections of anti-VEGF agents (pegaptanib, bevacizumab and/or ranibizumab) and sustained elevation of IOP in patients with age related macular degeneration (ARMD). The report by Bakri and colleagues leverages phase-III data from the ANCHOR and MARINA studies to complete a post-hoc analysis of IOP trends post repeated injections with ranibizumab. They concluded that more ranibizumab-treated eyes had one or more episodes of IOP elevation from baseline of six mmHg or more or eight mmHg or more, with concurrent highest IOPs of 21 mmHg or more and 25 mmHg or more versus sham or photodynamic therapy (PDT). Based on their findings, they recommend that IOP should be monitored in eyes receiving ranibizumab.

They recommend that IOP should be monitored in eyes receiving ranibizumab

There are several limitations to this study, including a lack of uniformity for IOP-measuring methods and lack of standardization for when IOP was measured. Since this was an ARMD centric study, we are not provided with data on nerve status, visual field status or gonioscopy. There is little information on subgroup analyses of patients with pre-existing glaucoma who were enrolled into both studies and whether they had an increased risk for IOP spikes during the trial. Overall, the novelty of this study is centered on the prospective nature of data collection and the presence of a control group (sham injections and PDT) that allows for more objective analyses compared to previous retrospective studies that lacked a concurrent control group. The mechanisms leading to IOP elevation remain unclear and are not addressed by this study.

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