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I Leleu1, B Penaud1, E Blumen-Ohana1

  • 1Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France.

Journal Francais D'Ophtalmologie
|September 11, 2018
PubMed
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Repeated intravitreal anti-VEGF injections (IVI) can cause delayed, severe high intraocular pressure (IOP), sometimes requiring surgery. This serious side effect, though rare, necessitates careful monitoring in patients receiving IVI for conditions like age-related macular degeneration.

Area of Science:

  • Ophthalmology
  • Retinal Diseases
  • Glaucoma Research

Background:

  • Intravitreal anti-VEGF injections (IVI) are standard for exudative age-related macular degeneration (AMD).
  • While steroid-induced ocular hypertension is known, delayed, sustained IOP elevation post-IVI is less recognized.
  • Immediate transient IOP spikes after IVI are common, but chronic effects are often underestimated.

Observation:

  • This study details cases of delayed, severe intraocular pressure (IOP) elevation following repeated intravitreal anti-VEGF injections (IVI).
  • Patients presented with significant IOP spikes despite maximal medical management, necessitating urgent filtering surgery.
  • Optic nerve damage was severe in all reported cases, indicating a critical impact.

Findings:

  • Late-onset, sustained high IOP after repeated IVI, estimated between 2.1% and 13%, increases with injection frequency.
Keywords:
Anti-VEGFElevated intraocular pressureFiltering surgeryGlaucomaIntravitreal injectionNon-penetrating deep sclerectomy

Related Experiment Videos

  • A subset of patients experiences a sudden, severe IOP elevation due to an 'overflow' effect.
  • This phenomenon, though rare, can lead to the need for filtering surgery, even in patients without prior glaucoma or ocular hypertension.
  • Implications:

    • Highlights a potentially underestimated complication of anti-VEGF therapy.
    • Emphasizes the need for vigilant IOP monitoring in patients undergoing repeated IVI.
    • Suggests further research into the pathophysiology and risk factors for sustained IOP elevation post-IVI.