title: Intraocular pressure in eyes receiving monthly ranibizumab in 2 pivotal age-related macular degeneration clinical trials.
abstract: OBJECTIVE
  To characterize preinjection intraocular pressure (IOP) in eyes receiving monthly ranibizumab versus sham or verteporfin photodynamic therapy (PDT) for age-related macular degeneration (AMD).
  
  
  METHODS
  Post hoc analysis of IOP data from 2 phase 3 clinical trials, the Minimally Classic/Occult Trial of the Anti-VEGF Antibody Ranibizumab in the Treatment of Neovascular AMD (MARINA) and the Anti-VEGF Antibody for the Treatment of Predominantly Classic Choroidal Neovascularization in AMD (ANCHOR) trial.
  
  
  METHODS
  All safety-evaluable patients who received 1 or more injections of sham or PDT or of ranibizumab and had 1 or more postbaseline IOP measurements recorded for the study eye.
  
  
  METHODS
  Preinjection IOP measurements for study eyes (n = 1125) and fellow eyes in MARINA and ANCHOR at baseline and at each monthly visit through month 24 were analyzed.
  
  
  METHODS
  End points evaluated were maximum preinjection IOP during the 24-month treatment period; any occurrence of absolute preinjection IOP of 21 mmHg or more, 25 mmHg or more, or 30 mmHg or more; any occurrence of IOP increase of 6 mmHg or more, 8 mmHg or more, or 10 mmHg or more from baseline; any combination of IOP increase of 6 mmHg or more or 8 mmHg or more from baseline with concurrent absolute preinjection IOP of 21 mmHg or more or 25 mmHg or more; glaucoma-related adverse events; new glaucoma medications used for 45 days or more; and glaucoma filtration or laser surgeries.
  
  
  RESULTS
  Across treatment groups, 60.1% to 70.9% of study eyes had a maximum preinjection IOP of less than 21 mmHg. Comparing ranibizumab 0.5 mg versus sham or PTD treatment, respectively: 39.9% versus 29.1% and 10.9% versus 5.1% had maximum preinjection IOPs of 21 mmHg or more or 25 mmHg or more, respectively; 44.1% versus 29.9% and 24.2% versus 13.6% had IOP increases from baseline of 6 mmHg or more or 8 mmHg or more, respectively; 26.1% versus 13.6% and 16.8% versus 9.0% had 1 or more IOP increase from baseline of 6 mmHg or more or 8 mmHg or more, respectively, with a concurrent IOP of 21 mmHg or more; 9.6% versus 3.7% and 7.5% versus 2.4% had 1 or more IOP increase from baseline of 6 mmHg or more or 8 mmHg or more, respectively, with a concurrent IOP of 25 mmHg or more. No differences were observed in fellow eyes.
  
  
  CONCLUSIONS
  Most ranibizumab-treated eyes did not experience sustained preinjection IOP of 21 mmHg or more (>2 consecutive visits) over 24 months. When evaluating the combined IOP end point, more ranibizumab-treated eyes had 1 or more IOP increase from baseline of 6 mmHg or more or 8 mmHg or more, with concurrent highest IOPs of 21 mmHg or more and 25 mmHg or more versus sham or PDT. Intraocular pressure should be monitored in eyes receiving ranibizumab.
authors.affiliation: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota. Electronic address: bakri.sophie@mayo.edu.
authors.forename: Sophie J
authors.initials: SJ
authors.lastname: Bakri
authors.affiliation: Horngren Family Vitreoretinal Center, Department of Ophthalmology, Byers Eye Institute at Stanford University, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Darius M
authors.initials: DM
authors.lastname: Moshfeghi
authors.affiliation: Genentech, Inc., South San Francisco, California.
authors.forename: Steve
authors.initials: S
authors.lastname: Francom
authors.affiliation: Genentech, Inc., South San Francisco, California.
authors.forename: Amy Chen
authors.initials: AC
authors.lastname: Rundle
authors.affiliation: Genentech, Inc., South San Francisco, California.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Reshef
authors.affiliation: Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan.
authors.forename: Paul P
authors.initials: PP
authors.lastname: Lee
authors.affiliation: Genentech, Inc., South San Francisco, California.
authors.forename: Carol
authors.initials: C
authors.lastname: Schaeffer
authors.affiliation: Genentech, Inc., South San Francisco, California.
authors.forename: Roman G
authors.initials: RG
authors.lastname: Rubio
authors.affiliation: Genentech, Inc., South San Francisco, California.
authors.forename: Phillip
authors.initials: P
authors.lastname: Lai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D005260:Female; D005901:Glaucoma / Q000139:chemically induced / Q000188:drug therapy; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy; D000069579:Ranibizumab; D012307:Risk Factors; D014065:Tonometry, Ocular; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity; D057135:Wet Macular Degeneration / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000959:Antihypertensive Agents; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab