For patients who receive long-term anti-VEGF therapy, their intraocular pressure (IOP) appears to remain steady, with only a small group experiencing clinically significant IOP spikes, a study in Ophthalmology Retina reports. The researchers also found patients who recevied aflibercept experienced fewer clinically significant IOP elevations, and eyes that had pre-existing glaucoma were at higher risk.

The study was a retrospective analysis of data from the Fight Retinal Blindness! Project and included treatment-naïve eyes that received monotherapy with anti-VEGF (ranibizumab, aflibercept or bevacizumab) with at least three injections from 2013 to 2018 and at least 12 months of follow-up. The primary outcome was the mean change in IOP at 12 months. Secondary IOP outcome measures at 12 and 24 months included the mean change in IOP from baseline and the proportion of clinically significant IOP increases, which was defined as an elevation of at least 6mm Hg to more than 21mm Hg at any point during the follow-up.

The investigators identified 3,429 treatment-naïve eyes (395 bevacizumab, 1,138 aflibercept and 1,896 ranibizumab) out of 3,032 patients who had complete IOP data over 12 months of follow-up, and 2,125 (62%) who had 24 months of follow-up data. 

The overall mean IOP change was minimal at -0.5mm Hg at 12 months and -0.4mm Hg at 24 months. The investigators reported only a small group (5.6% at 12 months and 8.8% at 24 months) had clinically significant IOP increases.          

Of note: the investigators observed a lower mean IOP change and fewer IOP elevations at 12 and 24 months in eyes that received aflibercept compared with those that were treated with bevacizumab and ranibizumab. Additionally, eyes with pre-existing glaucoma had more IOP increases over 12 and 24 months.

Gabrielle PH, Nguyen V, Wolff B, et al. Intraocular pressure changes and VEGF inhibitor use in various retinal diseases: long-term outcomes in routine clinical practices: data from the fight retinal blindness! registry. Ophthalmology Retina. June 20, 2020. [Epub ahead of print].