Comparison between intraocular pressure spikes following intravitreal aflibercept injections between phakic and pseudophakic eyes

Ahmed Chafrash; Ahmed  Abdulgani; Ahmed  Kareem Joma; Eman  Hussein Alwan

doi:10.15218/zjms.2024.50

Authors

Ahmed Chafrash Ministry of Health, Directorate of Health, Hawler Teaching Hospital, Erbil, Iraq.
Ahmed Abdulgani Department of General Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq.
Ahmed Kareem Joma Department of General Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq.
Eman Hussein Alwan Department of General Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq.

DOI:

https://doi.org/10.15218/zjms.2024.50

Keywords:

Intravitreal injections, Age-related macular degeneration, Diabetic retinopathy, Intraocular pressure, Anti–vascular endothelial growth factor

Abstract

Background and objective: The quickest growth in the field of ophthalmology are intravitreal injections. Age-related macular degeneration, diabetic retinopathy and occlusive venous disease associated macular oedema include the most frequent indications of injections. Antiangiogenic agents are the most common injections. The aim of this study is to determine intraocular pressure changes following intravitreal injections between phakic and pseudophakic eyes.

Methods: A hospital based prospective cross-sectional study involved 50 patients divided into two groups; 27 phakic patients marked as group A, while 23 pseudophakic patients as group B. The study conducted in ophthalmology department of Erbil Teaching Hospital in Erbil city from July 2021 till April 2022. The participants were recruited from the outpatient clinic and planned for intravitreal anti-VEGF / aflibercept (EYLEA®) injection.

Results: The mean intraocular pressure difference pre-injection and six hours after single injection was -0.59 ± 1.21 and -0.65 ± 1.19 mmHg (higher in the post injection period) for group A and B respectively. This difference was statistically significant (P value was 0.018 and 0.015) for both group A and B respectively. The intraocular pressure levels reduced slightly after twenty-four hours following injection; the difference in intraocular pressure level between 6 hours and twenty-four hours was statistically significant for the phakic group (P value of 0.29) but insignificant for the pseudophakic group (P value of 0.056).

Conclusion: The status of the lens either being phakic or pseudophakic has no implication on intraocular pressure after intravitreal anti-VEGF injection. There was a statistically significant short-term increase in intraocular pressure in both groups after six hours of intravitreal injection.

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References

Petri AS, BoysenK, CehofskiLJ, van Dijk EHC, DysliC, Fuchs J, et al. Intravitreal injections with vascular endothelial growth factor inhibitors: A practical approach. Ophthalmol Ther 2020; 9(1): 191–203. DOI: 10.1007/s40123-020-00230-4

Das UN. Diabetic macular edema, retinopathy and age-related macular degeneration as inflammatory conditions. Arch Med Sci 2016; 12(5):1142–57. DOI: 10.5114/aoms.2016.61918

Hartman RR, Kompella UB. Intravitreal, subretinal, and suprachoroidal injections: Evolution of microneedles for drug delivery. J Ocul Pharm Ther 2018; 34(1 2):141–53. doi: 10.1089/jop.2017.0121

Han J, Rinella NT, Chao DL. Anesthesia for intravitreal injection: A systematic review. Clin Ophthalmol 2020; 14:543–50. DOI: 10.2147/OPTH.S223530

Lau PE, Jenkins KS, Layton CJ. Current evidence for the prevention of endophthalmitis in anti-VEGF intravitreal injections. J Ophthalmol 2018; 2018:1–12. DOI: 10.1155/2018/8567912

Trichonas G, Kaiser PK. Aflibercept for the treatment of age-related macular degeneration. Ophthalmol Ther 2013; 2(2):89–98. DOI: 10.1007/s40123-013-0015-2

Yang LPH, McKeage K. Intravitreal aflibercept: A review of its use in patients with macular oedema secondary to central retinal vein occlusion. Drugs Aging 2014; 31(5):395–404. Doi:10.1007/s40266-014-0176-2

Meyer CH, Holz FG. Preclinical aspects of anti-VEGF agents for the treatment of wet AMD: Ranibizumab and bevacizumab. Eye 2011; 25: 661–72. Doi:10.1038/eye.2011.66

Yazdi MH, Faramarzi MA, Nikfar S, Falavarjani KG, Abdollahi M. Ranibizumab and aflibercept for the treatment of wet age-related macular degeneration. Expert Opin Biol Ther 2015; 15(9):1349–58. doi: 10.1517/14712598.2015.1057565

Sivaprasad S, Hykin P, Saeed A, Beatty S, Grisanti S, Staurenghi G, et al. Intravitreal pegaptanib sodium for choroidal neovascularisation secondary to age-related macular degeneration: Pan-European experience. Eye 2010; 24(5):793–8. DOI: 10.1038/eye.2009.232

Solomon SD, Lindsley K, Vedula SS, Krzystolik MG, Hawkins BS. Anti-vascular endothelial growth factor for neovascular agerelated macular degeneration. Cochrane Database Syst Rev 2019; 3(3): CD005139. Doi: 10.1002/14651858.CD005139.pub4

Pielen A, Feltgen N, Isserstedt C, Callizo J, Junker B, Schmucker C. Efficacy and safety of intravitreal therapy in macular edema due to branch and central retinal vein occlusion: A systematic review. PLoS One 2013; 8(10):e78538. DOI: 10.1371/journal.pone.0078538

Elman MJ, Qin H, Aiello LP, Beck RW, Bressler NM, Ferris FL, et al. Intravitreal ranibizumab for diabetic macular edema with prompt versus deferred laser treatment: Three-year randomized trial results. Ophthalmology 2012; 119(11):2312–8. DOI: 10.1016/j.ophtha.2012.08.022

Sternfeld A, Ehrlich R, Weinberger D, Dotan A. Effect of different lens status on intraocular pressure elevation in patients treated with anti-vascular endothelial growth factor injections. Int J Ophthalmol 2020; 13(1):79–84. DOI: 10.18240/ijo.2020.01.12

Gismondi M, Salati C, Salvetat ML, Zeppieri M, Brusini P. Short-term effect of intravitreal injection of ranibizumab (Lucentis) on intraocular pressure. J Glucoma 2009; 18(9):658–61. Doi: 10.1097/IJG.0b013e31819c4893

Hoang QV, Mendonca LS, della Torre KE, Jung JJ, Tsuang AJ, Freund KB. Effect on intraocular pressure in patients receiving unilateral intravitreal anti-vascular endothelial growth factor injections. Ophthalmology 2012; 119(2):321–6. DOI: 10.1016/j.ophtha.2011.08.011

Chehab HE, Corre AL, Agard E, Ract-Madoux G, Coste O, Dot C. Effect of topical pressure-lowering medication on prevention of intraocular pressure spikes after intravitreal injection. Eur J Ophthalmol 2013; 23(3):277–83. DOI: 10.5301/ejo.5000159

Lemos-Reis R, Moreira-Gonçalves N, Melo AB, Carneiro ÂM, Falcão-Reis FM. Immediate effect of intravitreal injection of bevacizumab on intraocular pressure. Clin Ophthalmol 2014; 8:1383–8. DOI: 10.2147/OPTH.S64721

Mayalı H, Tekin B, Kayıkçıoğlu ÖR, Kurt E, İlker SS. Evaluation of the effect of body position on intraocular pressure measured with rebound tonometer. Turk J Ophthalmol 2019; 49(1):6–9. DOI: 10.4274/tjo.galenos.2018.90359

Cui QN, Gray IN, Yu Y, VanderBeek BL. Repeated intravitreal injections of antivascular endothelial growth factors and risk of intraocular pressure medication use. Graefes Arch Clin Exp Ophthalmol 2019; 257(9):1931–9. DOI: 10.1007/s00417-019-04362-7

Foss AJE, Scott LJ, Rogers CA, Reeves BC, Ghanchi F, Gibson J, et al. Changes in intraocular pressure in study and fellow eyes in the IVAN trial. Br J Ophthalmol 2016; 100(12):1662–7. DOI: 10.1136/bjophthalmol-2015-307595

Demirel S, Yanik O, Batioglu F, Ozmert E. Intraocular pressure changes related to intravitreal injections of ranibizumab: Analysis of pseudophakia and glaucoma subgroup. Int Ophthalmol 2014; 35(4):541–7. DOI: 10.1007/s10792-014-9981-1

Dedania VS, Bakri SJ. Review sustained elevation of intraocular pressure after intravitreal anti-VEGF agents. Whatis the evidence? Retina 2015; 35(5):841–58. doi: 10.1097/IAE.0000000000000520. PMID: 25905784.

Bressler NM, Chang TS, Suñer IJ, Fine JT, Dolan CM, Ward J, et al. Vision-related function after ranibizumab treatment by better- or worse-seeing eye. Clinical trial results from MARINA and ANCHOR. Ophthalmology 2010; 117(4). DOI: 10.1016/j.ophtha.2009.09.002

Rofagha S, Bhisitkul RB, Boyer DS, Sadda SR, Zhang K. Seven-year outcomes in ranibizumab-treated patients in anchor, marina, and horizon: A multicenter cohort study (SEVEN-UP). Ophthalmology 2013; 120(11):2292–9. DOI: 10.1016/j.ophtha.2013.03.046

Zuo C, Long B, Guo X, Chen L, Liu X. Effect of phacoemulsification on anterior chamber angle in eyes with medically uncontrolled filtered primary angle-closure glaucoma. J Ophthalmol 2020; 2020. DOI: 10.1155/2020/8720450

Zamani M, Feghhi M, Azarkish A. Early changes in intraocular pressure following phacoemulsification. J Ophthalmic Vis Res 2013; 8(1):25–31. PMID: 23825709;