title: Management of immediate and sustained intraocular pressure rise associated with intravitreal antivascular endothelial growth factor injection therapy.
abstract: OBJECTIVE
  To summarize the findings of recent reports of short-term and sustained intraocular pressure (IOP) rise associated with intravitreal antivascular endothelial growth factor (VEGF) injections and to guide the management of this infrequent complication.
  
  
  RESULTS
  Short-term increases in IOP are common immediately after intravitreal anti-VEGF injection. IOP takes longer to reach a safe level in patients with a history of glaucoma or ocular hypertension. Preinjection medicinal therapy and ocular decompression therapy may blunt this short-term IOP rise. Sustained increases in IOP are relatively infrequent, but are likely to necessitate intervention for IOP-lowering. A 'pro re nata' (PRN) injection protocol may obviate the need for intervention. The pathophysiology of sustained IOP rise is poorly understood, but may relate to repackaging processes undertaken by the pharmacies that compound these agents.
  
  
  CONCLUSIONS
  Treating physicians should be aware of the potential for short-term and sustained IOP rise associated with intravitreal anti-VEGF injection therapy. Considerations for management include prophylactic IOP-lowering with medicinal therapy and/or preinjection ocular decompression for patients with a history of glaucoma or ocular hypertension and switching to a 'PRN' injection protocol in patients suffering a sustained rise in IOP.
authors.affiliation: University of Illinois Eye & Ear Infirmary, Chicago, Illinois 60612, USA. ahmadaref@gmail.com
authors.forename: Ahmad A
authors.initials: AA
authors.lastname: Aref
mesh_terms: D020533:Angiogenesis Inhibitors / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D000959:Antihypertensive Agents / Q000627:therapeutic use; D000068258:Bevacizumab; D019299:Decompression, Surgical; D006801:Humans; D007429:Intraocular Pressure; D058449:Intravitreal Injections; D009798:Ocular Hypertension / Q000139:chemically induced / Q000628:therapy*; D014065:Tonometry, Ocular; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D057135:Wet Macular Degeneration / Q000188:drug therapy
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000959:Antihypertensive Agents; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab