title: Intravitreal Anti-VEGF Injections Reduce Aqueous Outflow Facility in Patients With Neovascular Age-Related Macular Degeneration.
abstract: We assess the effect of intravitreal anti-VEGF injections on tonographic outflow facility.
  
  
  
  Patients with age-related macular degeneration who had received unilateral intravitreal anti-VEGF injections were recruited into two groups, those with ≤10 and those with ≥20 total anti-VEGF injections. Intraocular pressure and tonographic outflow facility of injected and uninjected fellow eyes were measured and compared between groups. Risk factors for development of reduced outflow facility also were assessed.
  
  
  
  Outflow facility was 12% lower in the injected eyes of patients who received ≥20 anti-VEGF injections, compared to contralateral uninjected eyes (P = 0.02). In contrast, there was no facility reduction for patients with ≤10 anti-VEGF injections (P = 0.4). In patients with ocular hypertension in the uninjected eye (IOP > 21 mm Hg, n = 5), the outflow facility of injected eyes was on average 46% lower (P = 0.01) than in the uninjected fellow eyes. This was significantly greater than the difference observed in patients with IOP ≤ 21 mm Hg in the uninjected eye (P = 2 × 10-4). In patients with ocular hypertension in the injected eye (n = 6) the differences in facility and IOP between contralateral eyes were significantly greater than in patients with IOP ≤ 21 mm Hg in the injected eye (P = 2 × 10-4 and P = 7 × 10-4, respectively).
  
  
  
  Chronic anti-VEGF injections significantly reduce outflow facility in patients with AMD. The greatest facility reduction is observed in patients with baseline ocular hypertension. Ophthalmologists who administer anti-VEGF injections should be aware of these findings and monitor patients closely for changes in IOP or evidence of glaucoma, especially in those with pre-existing ocular hypertension.
authors.affiliation: Department of Ophthalmology, University of Washington, Seattle, Washington, United States 2Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina, United States.
authors.forename: Joanne C
authors.initials: JC
authors.lastname: Wen
authors.affiliation: Department of Bioengineering, Imperial College London, London, United Kingdom.
authors.forename: Ester
authors.initials: E
authors.lastname: Reina-Torres
authors.affiliation: Department of Bioengineering, Imperial College London, London, United Kingdom.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Sherwood
authors.affiliation: Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina, United States.
authors.forename: Pratap
authors.initials: P
authors.lastname: Challa
authors.affiliation: Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina, United States.
authors.forename: Katy C
authors.initials: KC
authors.lastname: Liu
authors.affiliation: Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina, United States.
authors.forename: Guorong
authors.initials: G
authors.lastname: Li
authors.affiliation: Department of Bioengineering, Imperial College London, London, United Kingdom.
authors.forename: Jason Y H
authors.initials: JY
authors.lastname: Chang
authors.affiliation: Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina, United States.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Cousins
authors.affiliation: Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina, United States.
authors.forename: Stefanie G
authors.initials: SG
authors.lastname: Schuman
authors.affiliation: Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina, United States.
authors.forename: Priyatham S
authors.initials: PS
authors.lastname: Mettu
authors.affiliation: Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina, United States.
authors.forename: W Daniel
authors.initials: WD
authors.lastname: Stamer
authors.affiliation: Department of Bioengineering, Imperial College London, London, United Kingdom.
authors.forename: Darryl R
authors.initials: DR
authors.lastname: Overby
authors.affiliation: Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina, United States.
authors.forename: R Rand
authors.initials: RR
authors.lastname: Allingham
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D001082:Aqueous Humor / Q000187:drug effects / Q000378:metabolism*; D000068258:Bevacizumab / Q000008:administration & dosage*; D020256:Choroidal Neovascularization / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D000069579:Ranibizumab / Q000008:administration & dosage*; D013997:Time Factors; D014065:Tonometry, Ocular; D016896:Treatment Outcome; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D020533:Angiogenesis Inhibitors; D000068258:Bevacizumab; D000069579:Ranibizumab