Sustained Intraocular Pressure Rise after the Treat and Extend Regimen at 3 Years: Aflibercept versus Ranibizumab.

Area of Science:

• Ophthalmology
• Retinal Diseases
• Pharmacology

Background:

• Anti-VEGF therapies like aflibercept and ranibizumab are standard treatments for neovascular eye conditions.
• The treat and extend (T&E) protocol optimizes treatment intervals for these therapies.
• Sustained intraocular pressure (IOP) rise is a potential complication that requires monitoring.

Purpose of the Study:

• To identify risk factors associated with sustained IOP elevation in patients undergoing T&E with aflibercept/ranibizumab.
• To determine the incidence of IOP rise and its impact on visual function and retinal nerve fiber layer (RNFL) thickness.

Main Methods:

• Retrospective, multicentric observational chart review of 789 patients (1021 eyes) treated for diabetic macular edema, wet age-related macular degeneration, or macular edema due to retinal vein occlusion.
• Sustained IOP rise defined as ≥6 mmHg increase or >24 mmHg on two consecutive visits.
• Statistical analyses included Mantel-Haenszel tests, generalized estimating equations, and univariate/multivariate analysis (P < 0.05).

Main Results:

• Mean follow-up was 42.4 months; overall incidence of sustained IOP rise was 8.91%.
• Risk factors identified: male gender, South Asian ethnicity, older age, presence of AMD/RVO, ranibizumab use, higher injection frequency, narrow angles, switching to bevacizumab/ranibizumab, and pre-existing glaucoma.
• No significant visual field or RNFL changes were observed; no patients required filtering surgery or returned to baseline IOP.

Conclusions:

• Sustained IOP rise is a notable concern in patients on chronic anti-VEGF therapy, particularly those with compromised vision.
• Identifying risk factors allows for tailored monitoring and management strategies.
• While IOP rise occurred, significant visual or structural damage was not observed in this cohort, underscoring the importance of continued follow-up.