title: A lack of delayed intraocular pressure elevation in patients treated with intravitreal injection of bevacizumab and ranibizumab.
abstract: OBJECTIVE
  The purpose of this study was to report the rate of intraocular pressure (IOP) elevation after intravitreal injections of anti-vascular endothelial growth factor agents for exudative age-related macular degeneration.
  
  
  METHODS
  Retrospective chart review of all patients receiving intravitreal ranibizumab and/or bevacizumab injections for exudative age-related macular degeneration from November 2005 to June 2010. Delayed ocular hypertension (OHT) was defined as either an IOP ≥22 mmHg on 2 consecutive visits (with an increase from baseline >6 mmHg) or an IOP >26 mmHg on a single visit with a concomitant initiation or augmentation of IOP-lowering treatment. Noninjected fellow eyes served as controls. Incidence of delayed OHT was analyzed using survival analyses, with risk assessed by Cox proportional hazards regression models. Eyes with glaucoma were evaluated separately.
  
  
  RESULTS
  Three hundred and two treated eyes and 226 control eyes met inclusion criteria. In eyes with exudative age-related macular degeneration without glaucoma, 3 of 270 injected eyes (0.51% incidence per eye-year) developed delayed OHT compared with 4 of 195 control eyes (1.00% incidence per eye-year), a difference that was not statistically significant (hazard ratio = 0.48; 95% confidence interval: 0.11-2.23). In eyes with exudative age-related macular degeneration and glaucoma, 2 of 32 injected eyes developed delayed OHT (3.1% incidence per eye-year) compared with 3 of 31 control eyes (5.7% incidence per eye-year), a difference that was not statistically significant (hazard ratio = 0.59; 95% confidence interval: 0.10-3.60).
  
  
  CONCLUSIONS
  The incidence of delayed OHT after intravitreal anti-vascular endothelial growth factor injections was low and did not differ between injected and control eyes, including eyes with glaucoma. These results argue against a significant risk of IOP elevation because of repeated anti-vascular endothelial growth factor therapy.
authors.affiliation: Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Wehrli
authors.forename: Kirstin
authors.initials: K
authors.lastname: Tawse
authors.forename: Marc H
authors.initials: MH
authors.lastname: Levin
authors.forename: Ali
authors.initials: A
authors.lastname: Zaidi
authors.forename: Maxwell
authors.initials: M
authors.lastname: Pistilli
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Brucker
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D000068258:Bevacizumab; D004359:Drug Therapy, Combination; D005122:Exudates and Transudates; D005260:Female; D005901:Glaucoma / Q000150:complications; D006801:Humans; D015994:Incidence; D007429:Intraocular Pressure / Q000187:drug effects*; D058449:Intravitreal Injections; D008297:Male; D009798:Ocular Hypertension / Q000139:chemically induced; D016016:Proportional Hazards Models; D000069579:Ranibizumab; D012189:Retrospective Studies; D013997:Time Factors; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D057135:Wet Macular Degeneration / Q000150:complications / Q000188:drug therapy*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab