title: Persistent ocular hypertension following intravitreal bevacizumab and ranibizumab injections.
abstract: OBJECTIVE
  To study ocular hypertension (OHT) following intravitreal injections of bevacizumab and/or ranibizumab in patients with age-related macular degeneration (AMD).
  
  
  METHODS
  Retrospective case series. Patients with AMD who were treated at a tertiary referral center with intravitreal bevacizumab and/or ranibizumab injections from January 1, 2006 to December 31, 2008 were studied. The development of OHT following these injections was investigated.
  
  
  RESULTS
  Four out of 116 patients with AMD (3.45%) developed sustained elevated intraocular pressure (IOP) after multiple intravitreal injections of bevacizumab 1.5 mg/0.06 mL and/or ranibizumab 0.5 mg/0.05 mL. An analysis of 4 cases revealed: None of the patients had a previous diagnosis or family history of glaucoma/OHT. Two patients had both bevacizumab and ranibizumab injections. Two patients developed OHT after recent intravitreal ranibizumab and 2 patients after recent intravitreal bevacizumab injection. Two patients were pseudophakic with a history of YAG capsulotomy. The range of preinjection IOP was 8-15 mmHg (mean, 13 mmHg). The range of postinjection IOP was 28-36 mmHg (mean, 31.75 mmHg). The range of IOP increase was 17-21 mmHg (mean, 18.75 mmHg). Mean number of pan-anti-VEGF injections prior to OHT was 13.3 (range, 3-19). A disrupted posterior capsule might predispose patients to the development of OHT.
  
  
  CONCLUSIONS
  Persistent OHT may occur after intravitreal anti-VEGF injection in patients with no previous diagnosis of glaucoma or OHT. OHT may persist across several visits and patients may require IOP-lowering therapy. Sustained elevation in IOP usually occurs after multiple injections.
authors.affiliation: Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut 06510, USA. ron.adelman@yale.edu
authors.forename: Ron A
authors.initials: RA
authors.lastname: Adelman
authors.forename: Qi
authors.initials: Q
authors.lastname: Zheng
authors.forename: Hylton R
authors.initials: HR
authors.lastname: Mayer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D056965:Injections, Intraocular; D007429:Intraocular Pressure / Q000187:drug effects; D008268:Macular Degeneration / Q000188:drug therapy*; D008297:Male; D009798:Ocular Hypertension / Q000139:chemically induced* / Q000503:physiopathology; D000069579:Ranibizumab; D012189:Retrospective Studies; D013997:Time Factors; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014822:Vitreous Body
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab