Repeat anti-VEGF injections may accelerate glaucomatous changes in eyes with pre-existing glaucoma or ocular hypertension (OHT), a study in the Journal of Glaucoma reports. As such, clinicians should review glaucoma medication needs or other interventions over the course of anti-VEGF therapy, a team of researchers from the University of Virginia suggests.

The study reviewed the records of 28 patients with preexisting glaucoma or OHT who received six or more unilateral anti-VEGF injections for concurrent neovascular retinal disease. The researchers considered the rate of visual field loss and change in retinal nerve fiber layer (RNFL) thickness and the need for additional glaucoma medications, surgery or laser treatments in both the injected and fellow non-injected eyes.

The investigation found 28.6% of the eyes in the injected group required additional glaucoma surgery or laser compared to 7.1% in the non-injected group. Of note: significantly more injected eyes required invasive glaucoma intervention.

The researchers also reported the injected eyes had a significantly greater average rate of decline in mean deviation and change in pattern standard deviation. Additionally, the study found the estimated RNFL change was significant in the injected group at approximately -4.27µm/year compared with -1.17µm/year in the non-injected group. Only the superior quadrant showed thinning that was significantly different between the groups, researchers noted.

“Intravitreal injections were associated with accelerated functional and structural glaucoma-like change in susceptible eyes. Clinicians should assess the need for glaucoma medications or other interventions over the course of anti-VEGF therapy,” the researchers wrote in their paper.

Du J, Patrie JT, Prum BE, et al. Effects of intravitreal anti-VEGF therapy on glaucoma-like progression in susceptible eyes. J Glaucoma. October 17, 2019. [Epub ahead of print].