Anti-VEGF Treatments Do Not Differ in Long-Term Intraocular Pressure

Keean Nanji, MD

Intravitreal anti-VEGF agents may not differ significantly in intraocular pressure increases between 12- and 24-month regimens, according to new data.

In a trial poster presented at the American Academy of Ophthalmology (AAO) 2022 Annual Meeting in Chicago this week, a team of investigators from McMaster University reported outcomes that they believe may help clarify and refine strategies for intraocular pressure prevention and monitoring among patients receiving retina disease therapy.

Led by Keean Nanji, MD, of the McMaster department of surgery in the division of ophthalmology, the team noted that the association between standard-care intravitreal anti-VEGF injection treatment for retina diseases including age-related macular degeneration and increased intraocular pressure “has not been fully elucidated.”

They sought to interpret the effect of such agents on pressure in patient eyes with neovascular AMD (nAMD) due to retinal vein occlusion (RVO) or diabetic macular edema (DME), after a 12-month or 24-month regimen.

Their key outcomes of investigation included the proportion of patients whose pre-injection intraocular pressure increased by ≥5 or ≥10 mmHg compared to baseline, or exceeded measures of ≥21 mmHg on consecutive or in single visits. They additionally sought the proportion of patients initiating on pressure-lowering agents during their anti-VEGF regimen.

Nanji and colleagues conducted meta-analyses for each outcome using data from 26 randomized controlled trials including 12,522 patient eyes. Their pooled cohort’s mean patient age was 68.3 years old, and 49.2% were male. Patients came from a variety of nAMD (n = 10), RVO (n = 4) and DME (n = 12) clinical trials.

Observed anti-VEGF agents included aflibercept, bevacizumab, ranibizumab 0.3 mg and ranibizumab 0.5 mg. Aflibercept and ranibizumab 0.5 mg were among the agents with a high-to-moderate certainty of evidence showing no more harm to patients’ intraocular pressure than control, based on consecutive patient increases of ≥5 mmHg pressure from baseline.

The same 2 agents were associated with high-to-moderate certainty of evidence supporting no increased risk of consecutive intraocular pressure measurements ≥21 mmHg per visit. Each of the 4 agents were additionally associated with no increased risk of initiated pressure-lowering drugs in patient eyes.

Though the trial was limited by a risk of imprecision dictating certainty of evidence—as well as lacking clinical trials primarily focused on intraocular pressure outcomes—the investigators concluded their findings could help educate patients and clinicians alike on the finer risks of anti-VEGF treatment prescription.

“(This may) help guide practice patterns to inform frequency of intraocular pressure monitoring in patients receiving anti-VEGF therapy,” they wrote.

The study, “The 12- and 24-Month Effects of Intravitreal Ranibizumab, Aflibercept, and Bevacizumab on Intraocular Pressure: A Network Meta-Analysis,” was presented at AAO 2022.