title: Repeated intravitreal anti-vascular endothelial growth factor injections can induce iatrogenic ocular hypertension, especially in patients with open-angle glaucoma.
abstract: OBJECTIVE
  To report the rate of intraocular pressure (IOP) elevation after repeated intravitreal injections (IVIs) of anti-vascular endothelial growth factor (anti-VEGF) agents and to determine the risk factors.
  
  
  METHODS
  A total of 193 patients (217 eyes) undergoing ranibizumab (n = 196) or bevacizumab (n = 21) IVIs were prospectively examined. The incidence of ocular hypertension (OHT) after these injections was investigated with respect to the number of injections, pre-existing open-angle glaucoma, diabetes, YAG capsulotomy, age, and sex.
  
  
  RESULTS
  A total of 1461 IVIs was performed. After a mean of 6.7 ± 7.1 IVIs (range, 1-49), 4.6% (n = 10) had IOP elevation more than 25 mm Hg and required medical treatment (1.4% of them spiked above 30 mm Hg). Patients with pre-existing glaucoma experienced higher prevalence of OHT (12.9%) and greater rates than the control group (19.6 ± 5.7 mm Hg vs 16.4 ± 3.9 mm Hg, p < 0.001). No significant difference was found in the diabetes subgroup (n = 66, p = 0.62) or in the YAG capsulotomy subgroup (n = 24, p = 0.51) compared with the control group. The IOP peak was significantly correlated with the total number of IVIs (p = 0.0002, r = 0.25).
  
  
  CONCLUSIONS
  Serial IVIs may lead to persistent IOP elevation that requires IOP-lowering therapy. The risk is correlated with the number of injections and increases in the glaucoma population, and must be checked during follow-up.
authors: Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France.
authors: Emilie
authors: E
authors: Agard
authors: Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France.
authors: Hussam
authors: H
authors: Elchehab
authors: Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France.
authors: Guillaume
authors: G
authors: Ract-Madoux
authors: Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France.
authors: Aurélie
authors: A
authors: Russo
authors: Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France.
authors: Constance
authors: C
authors: Lagenaite
authors: Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France. Electronic address: corinnedot.pro@hotmail.fr.
authors: Corinne
authors: C
authors: Dot
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects; D000959:Antihypertensive Agents / Q000627:therapeutic use; D000068258:Bevacizumab; D005260:Female; D005902:Glaucoma, Open-Angle / Q000150:complications*; D006801:Humans; D007049:Iatrogenic Disease; D015994:Incidence; D007429:Intraocular Pressure / Q000187:drug effects*; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000139:chemically induced* / Q000188:drug therapy; D011446:Prospective Studies; D000069579:Ranibizumab; D019233:Retreatment; D012307:Risk Factors; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000959:Antihypertensive Agents; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab