Transient vision and intraocular pressure changes following anti-vascular endothelial growth factor injection

To assess transient intraocular pressure (IOP) and visual acuity (VA) changes following anti-vascular endothelial growth factor (anti-VEGF) injections and explore factors influencing recovery.

A prospective observational study.

Eighty-six patients (100 eyes) receiving anti-VEGF injections with either aflibercept, bevacizumab, or ranibizumab at a retina clinic were included.

Age, biological sex, diagnosis (neovascular age-related macular degeneration, retinal vein occlusion, diabetic macular edema), antiseptic used, anti-VEGF agent, glaucoma status, and IOP-lowering pretreatment were collected. IOP and VA using Snellen charts were measured at baseline, 1, 10, 20, and 30 minutes after injection. Spearman's correlation coefficients were used to assess the relationships between IOP and VA. Ordinal logistic regression was used to evaluate predictors of delayed VA recovery.

At 1 minute after intravitreal injection (IVI), VA worsened significantly from a baseline of 0.29 ± 0.21 to 0.76 ± 0.65 logMAR (p < 0.001), while IOP rose from 14.34 ± 4.39 mm Hg to 54.53 ± 20.21 mm Hg (p < 0.001). VA progressively improved over time, with 43% of eyes returning to baseline at 1 minute, 67% at 10 minutes, 83% at 20 minutes, and 89% at 30 minutes. The Spearman correlation coefficient for VA and IOP was statistically significant at 1-minute follow-up after IVI at 0.244 (p = 0.014) but not at later follow-ups. Eyes returning to baseline VA at 1 minute exhibited lower IOP than those not at baseline (p = 0.0004). Logistic regression revealed no significant predictors of delayed VA recovery.

Worsened VA and elevated IOP are common in the immediate postinjection period with later improvement. Patients' awareness of VA fluctuations within the first 30 minutes postinjection may aid in the early detection and management of complications associated with IOP elevation.