title: Sustained Elevation of Intraocular Pressure Associated with Intravitreal Administration of Anti-vascular Endothelial Growth Factor: A Systematic Review and Meta-Analysis.
abstract: This study aimed to assess whether repetitive intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF) cause sustained elevation of intraocular pressure (SE-IOP). We conducted a systematic review and meta-analysis based on five randomized controlled trials (RCTs) assessing 1428 subjects and 17 non-RCTs evaluating 8358 cases. In the RCTs, an increased risk of SE-IOP was found in the anti-VEGF group (summary risk ratio [RR] = 3.00, 95% confidence interval [CI]: 1.63-5.53) compared with the sham injection or laser group. The increased risk of SE-IOP was correlated with follow-up duration (RR = 2.14, 95% CI 0.69-6.57 at 6 months; RR = 3.15, 95% CI 0.99-10.09 at 12 months; RR = 3.48, 95% CI 1.38-8.78 at 23 months). The risk of SE-IOP after non-exclusion of pre-existing glaucoma patients (RR = 3.48, 95% CI 1.38-8.78) was higher than that obtained after excluding pre-existing glaucoma patients (RR = 2.6, 95% CI 1.16-5.81). In non-RCTs, the pooled prevalence of SE-IOP was 4.7% (95% CI 3.7-5.8) regardless of diagnosis criteria. In conclusion, repeated intravitreal injections of anti-VEGF agents cause a 2-fold elevation in SE-IOP risk.
authors.affiliation: Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
authors.forename: Yandan
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Ophthalmology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Minwen
authors.initials: M
authors.lastname: Zhou
authors.affiliation: Department of Ophthalmology, the second hospital affiliated to the University of South China, Hengyang, Hunan, China.
authors.forename: Shigang
authors.initials: S
authors.lastname: Xia
authors.affiliation: Department of Otorhinolaryngology, Xiangya Hospital,Central South University, Changsha, Hunan, China.
authors.forename: Qiancheng
authors.initials: Q
authors.lastname: Jing
authors.affiliation: Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
authors.forename: Ling
authors.initials: L
authors.lastname: Gao
mesh_terms: D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*
chemical_list: D042461:Vascular Endothelial Growth Factor A