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| |  Increases in Intraocular Pressure Follow Intravitreal Injections of Antiangiogenic Drugs: Presented at RC2009 By Cameron Johnston NEW YORK -- October 5, 2009 -- It is well known that intravitreal injections of steroids such as triamcinolone are associated with dramatic increases in intraocular pressure (IOP), and that these increases can represent a serious threat to vision in patients who already have glaucoma or ocular hypertension, or are at risk of developing these conditions. However, according to a study presented here at the Retina Congress (RC) 2009, IOP also increases following injections of antiangiogenic drugs such as ranibizumab or bevacizumab. However, these increases in IOP are different from the increases experienced when the patient is treated with intravitreal steroids. Ron Adelman, MD, Department of Ophthalmology and Visual Sciences, Yale School of Medicine, New Haven, Connecticut presented the findings in a poster session on October 2, As Dr. Adelman explained to DocGuide in an interview, the risk of elevated IOP is present with all drugs that are injected intravitreally. For example, in glaucoma patients who are treated with injections of triamcinolone, one-third will develop increases in IOP. These increases, he said, are seen immediately after the injection is given, but appear to resolve within 30 to 45 minutes. However, by the time of the patient’s next visit to the clinic, the IOP may have doubled or tripled, and such increases may last for 6 months and more. The patient may then be at serious risk of damage to the optic nerve. In Dr. Adelman’s chart review, 4 out of 116 (3.45%) patients, 2 treated with ranibizumab, and 2 with bevacizumab developed elevated IOP. Among patients injected with steroids, IOP increases were usually seen after just 1 injection. In Dr. Adelman’s review, patients developed elevated IOP after a mean of 7.2 injections (range, 1-19 injections). In the 4 patients who were evaluated, IOP increased from a mean of 15.2 mm Hg at baseline to 35.8 mm Hg post operatively, representing a mean increase of 20.6 mm Hg. Dr. Adelman said these findings suggest that increases in IOP are much less likely to occur following injections of antiangiogenic drugs compared with injections of intravitreal steroids, and they usually occur only after several injections. Still, these increases in IOP are clinically important. They may last for several months’ duration, during which time the patient is at risk for damage to the optic nerve head, especially if the patient already has glaucoma, or ocular hypertension. Dr. Adelman added that measuring IOP should be a routine procedure for all patients undergoing intravitreal injections, whether it is with a steroid or an antiangiogenic drug. However, many healthcare insurers will not pay for this added test in the United States. Such increases in IOP are known to occur among patients who are not felt to be at risk for glaucoma, and who do not have a history of glaucoma. Therefore, it is important that the clinician take this into account when prescribing anti-vascular endothelial growth factor therapies for patients with a wide range of eye diseases. The 2009 Retina Congress is a combined meeting of the American Society of Retina Specialists, the Macula Society, and the Retina Society. [Presentation title: Persistent Ocular Hypertension Following Multiple Intravitreal Bevacizumab and Ranibizumab Injections. Poster 701]
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