Anti-VEGF Injections Increases the Risk of Open-Angle Glaucoma

Sahar Bedrood, MD, PhD

Treatment with anti–vascular endothelial growth factor therapy (anti-VEGF) for ophthalmological conditions could have an impact on a number of other outcomes.

A team, led by Sahar Bedrood, MD, PhD, Acuity Eye Group & Retina Institute - Pasadena, examined the impact of anti-VEGF injections on the prevalence of ocular hypertension (OHT) and primary open-angle glaucoma (POAG) with age-matched controls in data presented at the American Academy of Ophthalmology (AAO) 2020 Conference.​

In the 1 year, case control study, the investigators examined 927 eyes coming from 624 consecutive patients.

Each patient received an intravitreal injection (IVIs) of an anti-VEGF agents involving bevacizumab, ranibizumab or a combination for either neovascular age-related macular degeneration (AMD) or diabetic macular edema (DME).

The investigators found the treatment arm of the study had a significant increase in OHT, POAG, and glaucoma suspect (GS) when compared to the healthy control group (P < 0.00001, P < 0.0001 and P < 0.05, respectively).

Within the glaucoma suspect portion of the trial, the investigators found 18% of patients had cupping and retinal nerve fiber layer loss without ocular hypertension. POAG and OHT were also positively linked with the number of intravitreal injections (R² = .856, P = .008, and R² = .749, P < .05, respectively).

“Patients treated with anti-VEGF agents against age-matched controls had an increased rate of POAG, OHT and GS,” the authors wrote. “Interestingly, the rates of POAG and OHT were strongly correlated with the number of IVIs.”

Recently, researchers found high rates of nAMD patients cease anti-VEGF treatment over time.

A team, led by Robert P. Finger, MD, PhD, Department of Ophthalmology, University of Bonn, determined the visual acuity outcomes of anti-VEGF treatment for nAMD in both eyes for the remaining lifetime of patients.

In the study, the investigators used multistate modeling with real-world cohort data to examine the outcomes of 3192 patients with nAMD involving more than 67,000 visits for treatment at routine eye clinics in Australia, New Zealand, and Switzerland.

The investigators sought main outcomes of visual acuity in both eyes over the remaining lifetime of the patient.

For the mean remaining lifetime of 11 years, an estimated 12% (n = 371; 95% CI, 345-400) of the sample retained driving visual acuity. In addition, an estimated 15% (n = 463; 95% CI, 434-495) had reading visual acuity in at least 1 eye.

At that time, an estimated 82% of the sample (n = 2629; 95% CI, 2590-2660) had dropped.

The investigators also found a younger baseline age and more injections during the first year of treatment was linked to better long-term outcomes.

In a separate study, investigators found a number of outcomes for patients with nAMD are directly related to the retinal thickness variations following the initiating of anti-VEGF treatment.

When initiating anti-VEGF treatment for patients with nAMD, prognostic factors often guide specific treatments. It is believed that eyes with greater fluctuation in retinal thickness over time have worse outcomes than eyes with less variation.

After the investigators adjusted for baseline BCVA and trial allocations, BCVA worsened significantly across the quartiles of FCPT standard deviation.

The study, “The Association of POAG and OHT With Intravitreal Anti-VEGF,” was published online by AAO 2020.