30 EWAP DECEMBER 2022 GLAUCOMA I OP elevation following intravitreal injections can be divided into short-term and long-term elevations, said Christina Y. Weng, MD, MBA. Short-term elevations are common, and some studies have estimated that they affect greater than 90% of patients. “Research, as well as personal experience, has shown that IOP can often elevate to the 30s or even 40s mmHg for a transient period of time immediately following injection of anti-VEGF agents,” Dr. Weng said. “However, these elevations are short lasting and often resolve within 30–60 minutes, although there are some reports that IOP can remain elevated for more than a day.” She added that intravitreal injections of steroid agents may be the caveat to this because in addition to the initial IOP elevation, they can sometimes lead to elevations that occur 4–6 weeks after the injection. Dr. Weng said that the data becomes “a bit more ambiguous” with long-term elevations, and there have been a number of studies with varying conclusions. “However, if you look at the largest meta-analyses and database studies, the takeaway is that persistent IOP elevation or glaucoma after repeated by Ellen Stodola Editorial Co-Director Contact information Kahook: malik.kahook@gmail.com Mandava: naresh.mandava@cuanschutz.edu Weng: christina.weng@bcm.edu intravitreal injections can occur but is rare,” she said. Malik Y. Kahook, MD, noted the incidence of IOP elevations is about 1–3% of patients post-anti-VEGF use. “The number is not that high, and it is still unclear to me if we see it more with one anti-VEGF agent over another,” he said. “I think some of the information on IOP elevations post-injection of this class of medication has been conflated by observers,” he said. He added that there were many reports years ago, including from his group at the University of Colorado, that were focused on case clusters of IOP elevation related to compounding pharmacy practices. “We found silicone oil bubbles in repackaged bevacizumab syringes that were related to practices by specific pharmacies and related to shipping-induced mechanical stress on the syringes,” he said.1,2 “I think these events are very different from what is seen in regular practice and with use of FDA-approved versions of anti-VEGF agents. Furthermore, I think compounding pharmacy practices have evolved and are much better now compared to a few years ago.” This has resulted in a lower incidence of IOP elevation post-anti-VEGF agents, in Dr. Kahook’s experience. Naresh Mandava, MD, has looked at this issue with Dr. Kahook in several studies. Dr. Mandava first became interested in this topic after hearing a Dr. Weng administers an intravitreal injection in a patient with wet macular degeneration. Source: Christina Y. Weng, MD, MBA IOP elevation related to intravitreal injections This article originally appeared in the September 2022 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp.
RkJQdWJsaXNoZXIy Njk2NTg0