title: Changes in intraocular pressure in study and fellow eyes in the IVAN trial.
abstract: OBJECTIVE
  To describe changes in intraocular pressure (IOP) in the 'alternative treatments to Inhibit VEGF in Age-related choroidal Neovascularisation (IVAN)' trial (registered as ISRCTN92166560).
  
  
  METHODS
  Randomised controlled clinical trial with factorial design.
  
  
  METHODS
  Patients (n=610) with treatment naïve neovascular age-related macular degeneration were enrolled and randomly assigned to receive either ranibizumab or bevacizumab and to two regimens, namely monthly (continuous) or as needed (discontinuous) treatment.
  
  
  METHODS
  At monthly visits, IOP was measured preinjection in both eyes, and postinjection in the study eye.
  
  
  METHODS
  The effects of 10 prespecified covariates on preinjection IOP, change in IOP (postinjection minus preinjection) and the difference in preinjection IOP between the two eyes were examined.
  
  
  RESULTS
  For every month in trial, there was a statistically significant rise in both the preinjection IOP and the change in IOP postinjection during the time in the trial (estimate 0.02 mm Hg, 95% CI 0.01 to 0.03, p<0.001 and 0.03 mm Hg, 95% CI 0.01 to 0.04, p=0.002, respectively). There was also a small but significant increase during the time in trial in the difference in IOP between the two eyes (estimate 0.01 mm Hg, 95% CI 0.005 to 0.02, p<0.001). There were no differences between bevacizumab and ranibizumab for any of the three outcomes (p=0.93, p=0.22 and p=0.87, respectively).
  
  
  CONCLUSIONS
  Anti-vascular endothelial growth factor agents induce increases in IOP of small and uncertain clinical significance.
  
  
  BACKGROUND
  ISRCTN92166560.
authors.affiliation: Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK.
authors.forename: Alexander J E
authors.initials: AJ
authors.lastname: Foss
authors.affiliation: School of Clinical Sciences, Clinical Trials Evaluation Unit, University of Bristol, Bristol, UK.
authors.forename: Lauren J
authors.initials: LJ
authors.lastname: Scott
authors.affiliation: School of Clinical Sciences, Clinical Trials Evaluation Unit, University of Bristol, Bristol, UK.
authors.forename: Chris A
authors.initials: CA
authors.lastname: Rogers
authors.affiliation: School of Clinical Sciences, Clinical Trials Evaluation Unit, University of Bristol, Bristol, UK.
authors.forename: Barney C
authors.initials: BC
authors.lastname: Reeves
authors.affiliation: Department of Ophthalmology, Bradford Royal Infirmary, Bradford, West Yorkshire, UK.
authors.forename: Faruque
authors.initials: F
authors.lastname: Ghanchi
authors.affiliation: School of Life and Health Sciences, Aston University, Birmingham, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Gibson
authors.affiliation: Centre for Experimental Medicine, Queens University Belfast, Belfast, UK.
authors.forename: Usha
authors.initials: U
authors.lastname: Chakravarthy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors; D000068258:Bevacizumab / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects / Q000502:physiology*; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D008875:Middle Aged; D000069579:Ranibizumab / Q000008:administration & dosage*; D015861:Retinal Neovascularization / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D013997:Time Factors; D014065:Tonometry, Ocular; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D000068258:Bevacizumab; D000069579:Ranibizumab
keywords: Glaucoma; Macula; Pharmacology