Clinical Ophthalmology (Jun 2023)
Clinical Features Associated with Acute Elevated Intraocular Pressure After Intravitreal Anti-VEGF Injections
Abstract
Stephen A LoBue,1,2 Sofya Gindina,2 Nicholas J Saba,2 Tom Chang,2 Michael J Davis,2 Steven Fish2 1Department of Ophthalmology, Acuity Eye Group, Pasadena, CA, USA; 2Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, USACorrespondence: Tom Chang, Department of Ophthalmology, Acuity Eye Group, 100 E California Blvd, Pasadena, CA, 91105, USA, Email [email protected]: To study the effects of intravitreal injection (IVI) of anti-VEGF (vascular endothelial growth factor) agents on intraocular pressure (IOP) and find associations with acute pressure spikes.Methods: This was a three-month, prospective study of patients receiving outpatient IVI of anti-VEGF agents for diabetic retinopathy (DR), age-related macular degeneration (AMD), and retinal vein occlusion (RVO) at the Acuity Eye Group Medical Centers. IOP was measured pre- and post-injection at 10-minute intervals up to 50 minutes after injection with a handheld tonometer. Patients with an IOP greater than 35 mmHg at 30 minutes received an anterior chamber paracentesis (ACP), while patients below 35 mmHg were monitored without intervention.Results: A total of 617 patients (51% female, 49% male) received IVI for DR (n = 199), AMD (n = 355), and RVO (n = 63). ACP was performed in 17 patients. Average pre-injection IOP was 16 ± 4 compared to 24 ± 7 mmHg for the non-ACP vs ACP group, respectively (mean ± standard deviation), p 0.05. Patients with a pre-injection IOP > 25 mmHg and a history of glaucoma had a 58.3% rate of ACP. A 31-gauge needle had a higher mean increase in IOP from baseline compared to 30-gauge needle, p 25 mmHg may be associated with significant IOP spikes lasting longer than 30 minutes.Keywords: intravitreal injection, anti-VEGF, glaucoma, acute pressure spikes, anterior chamber paracentesis
