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[Can Anti-VEGF Injections Cause Glaucoma or Ocular Hypertension?]

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Summary

Intravitreal anti-VEGF injections for macular disease can cause long-term intraocular pressure increases, potentially leading to glaucoma. Monitoring eye pressure after these treatments is crucial for patient eye health.

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Area of Science:

  • Ophthalmology
  • Retinal Diseases
  • Ocular Pharmacology

Background:

  • Intravitreal anti-VEGF injections are frequently used for neovascular macular disease.
  • Transient intraocular pressure (IOP) spikes are common post-injection due to increased vitreous volume.
  • Emerging evidence suggests multiple injections may cause sustained IOP elevation, even in non-glaucoma patients.

Purpose of the Study:

  • To investigate the link between frequent intravitreal anti-VEGF injections and long-term intraocular pressure elevation.
  • To identify potential risk factors and mechanisms associated with sustained IOP increase post-injection.
  • To highlight the need for long-term IOP monitoring in patients receiving these treatments.

Main Methods:

  • Review of clinical reports and literature concerning intravitreal injections and IOP changes.
  • Analysis of potential causative agents and mechanisms, including product-related factors.
  • Discussion of clinical implications and management strategies for elevated IOP.

Main Results:

  • Multiple intravitreal injections may lead to persistent IOP increase, sometimes requiring surgical intervention.
  • This phenomenon appears more prevalent with certain products (e.g., bevacizumab) or from broken bulk dispensing.
  • Potential contributors include high molecular weight molecules or silicone oil droplets causing trabecular meshwork inflammation or displacement.

Conclusions:

  • Sustained IOP elevation is a potential complication of frequent intravitreal anti-VEGF therapy.
  • Identifying and mitigating causative factors, such as silicone oil in syringes, is important.
  • Long-term ophthalmological monitoring of IOP is recommended after intravitreal injections.