35 EyeWorld Asia Pacific | June 2024 GLAUCOMA The Effect of Intravitreal Injections on Glaucoma Procedures by Ellen Stodola, Editorial Co-Director Anti-VEGF intravitreal injections (IVI) may have some effect on the success of glaucoma procedures, and both retina specialist, Christina Weng, MD, MBA, and glaucoma specialist, Emily Schehlein, MD, agree that this is situation dependent on the patient, with various scenarios and pathologies to consider in addition. Dr. Weng highlighted three specific situations where there could be a relation between injections and glaucoma procedures. First, she brought up the ongoing debate regarding whether or not intravitreal injections impact IOP for the long term. “We know that in the short term, all intravitreal injections transiently elevate the IOP to the 30–40 mmHg range, but for most patients, this will self-resolve within 30–60 minutes,” she said. “That being said, there is some literature suggesting that recurrent induced spikes could lead to persistent IOP elevation, especially in patients with glaucoma.1 So theoretically, this could counteract the effect of a procedure like MIGS, but additional research is needed.” Additionally, approximately one-third of patients injected with intravitreal steroids will experience a significant rise in IOP approximately 6–8 weeks later, so this should always be monitored closely. She said it is important to remember that, in general, there is no definitive evidence to support that intravitreal injections cause glaucoma or negatively impact the success of glaucoma procedures.2,3 Dr. Schehlein echoed some of Dr. Weng’s observations regarding transient increase in IOP with IVIs, conflicts in the literature, and the active research in this area. Patients with glaucoma are more likely to develop an IOP spike than are patients without glaucoma, she said, adding that a study by Good et al. found that 33% of glaucoma patients compared to 3.1% of non-glaucoma patients (p<0.001) had an IOP spike following injection.4 While the increase in IOP with a spike from IVI is usually transient, Dr. Schehlein noted that some studies have shown long-term sustained IOP elevation can occur and lead to the patient requiring glaucoma surgery.5,6 Dr. Weng performs an intravitreal injection in a patient with wet macular degeneration. Source: Christina Y. Weng, MD, MBA/ Credit: Agapito Sanchez, Jr.
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