Abstract
Objective
To understand intraocular pressure (IOP) response after switching from intravitreal bevacizumab (IVB) and/or ranibizumab (IVR) to intravitreal aflibercept (IVA) for treatment-resistant neovascular age-related macular degeneration (nAMD) in patients with and without coexisting glaucoma-related diagnoses.
Methods
Retrospective, cross-sectional comparative case series of 62 eyes of 58 patients treated with intravitreal injection for nAMD from March 2010 to April 2018. Patients with glaucoma-related diagnoses, defined here as open-angle glaucoma or suspicion of open-angle glaucoma, ocular hypertension, and/or narrow-angle glaucoma, were compared to those without glaucoma. IOP data were collected at baseline, at the three visits where patients received loading doses of IVB/IVR, and at all of the visits following the switch to IVA through the end of follow-up.
Results
19 eyes with pre-existing glaucoma-related diagnoses were compared to 43 eyes without such diagnoses. Baseline IOP was similar for glaucoma and non-glaucoma patients. The loading doses of IVB/IVR did not impact IOP; however, a small, sustained rise in IOP was noted among patients with glaucoma-related diagnoses by the final IVB/IVR injections before the switch to IVA (∆IOP 1.61 ± 0.52 mmHg, P < 0.002). After conversion to IVA, pre-injection IOP declined in eyes both with (−1.59 ± 0.54 mmHg, P < 0.001) and without (−0.99 ± 0.28 mmHg, P < 0.001) glaucoma-related diagnoses.
Conclusions
IOP in patients with glaucoma-related diagnoses appears to be more sensitive to intravitreal injections than it is in patients without glaucoma-related diagnoses. It rises with IVB/IVR and declines after the switch to IVA. Switching patients with nAMD to IVA may present an opportunity to lower IOP in patients with glaucoma.
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Acknowledgements
The authors thank Dr. Jeffrey L. Marx, Dr. Megan Nichols, Christine Gould, Jamie Ramos, and Miranda D. Prosniewski, as well as Carol Spencer, Lahey Hospital Librarian, for research support. DJR is the Harry N. Lee Family Chair in Innovation at the Lahey Hospital & Medical Center, Beth Israel Lahey Health.
Funding
DJR: Supported by the Harry N. Lee Family Chair in Innovation at the Lahey Hospital & Medical Center, Beth Israel Lahey Health. JCM: Supported by a grant from Office of Medical Education, Lahey Hospital & Medical Center, Beth Israel Lahey Health.
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DJR was responsible for the study hypothesis and design, the development of electronic medical record reporting tools, reviewing and analyzing the data, interpreting the results, and writing of the manuscript. JCM was responsible for the chart review, extracting and analyzing the data, figure development, and writing of the manuscript. EES was responsible for the chart review, extracting and analyzing the data, and writing of the manuscript. YZ was responsible for the chart review, extracting and analyzing the data, figure development, and writing of the manuscript. AMA was responsible for analyzing the data and writing of the manuscript. MLC was responsible for interpreting the data, figure development, and writing of the manuscript. SR was responsible for interpreting the data and writing of the manuscript. PRC was responsible for interpreting the data and writing of the manuscript.
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Meeting Presentation: Annual meeting of the American Glaucoma Society, San Diego, California, March 17, 2019.
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Ramsey, D.J., McCullum, J.C., Steinberger, E.E. et al. Intraocular pressure decreases in eyes with glaucoma-related diagnoses after conversion to aflibercept for treatment-resistant age-related macular degeneration. Eye 36, 1813–1819 (2022). https://doi.org/10.1038/s41433-021-01729-1
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DOI: https://doi.org/10.1038/s41433-021-01729-1
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