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Invited Commentary
April 2017

Anti-VEGF Injections and Glaucoma Surgery

Author Affiliations
  • 1Department of Ophthalmology and Visual Sciences, Washington University, St Louis, Missouri
JAMA Ophthalmol. 2017;135(4):368-369. doi:10.1001/jamaophthalmol.2017.0148

Intravitreous injections of anti–vascular endothelial growth factor (VEGF) drugs are used commonly to treat retinal diseases, including age-related macular degeneration (AMD), diabetic retinopathy, and retinal vein occlusion. Injections of any agent into the vitreous increase the volume of the eye and cause a temporary rise in intraocular pressure (IOP). This is usually self-limited and abates in 30 to 60 minutes.

The original studies of the safety and efficacy of intravitreous injections of anti-VEGF drugs found little or no overall effect on IOP. However, a number of case reports subsequently linked intravitreous injections to persistent IOP elevations, some of which required ocular hypotensive medication, laser trabeculoplasty, and even glaucoma surgery.1-3 A post hoc analysis of the ANCHOR (Anti-VEGF Antibody for the Treatment of Predominantly Classic Choroidal Neovascularization of Age-Related Macular Degeneration) and MARINA (Minimally Classic/Occult Trial of the Anti-VEGF Antibody Ranibizumab in the Treatment of Neovascular Age-Related Macular Degeneration) trials found that 11% of eyes treated with ranibizumab had an IOP of 25 mm Hg or greater compared with 5% of control eyes.4 Similarly, a post hoc analysis of patients treated for center-involved diabetic macular edema found sustained IOP elevations or initiation or augmentation of ocular hypotensive medication in 9.5% of participants treated with ranibizumab and prompt or delayed laser treatment but in only 3.4% of participants who received sham injection and laser treatment.5

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