Anti-VEGF injections tied to accelerated glaucoma-like progression in susceptible eyes

This study investigated the structural and functional effects of repeated intravitreal anti-VEGF injections in eyes with preexisting glaucoma or ocular hypertension.

Study design

The authors of this retrospective, observational study included 28 patients with glaucoma or ocular hypertension who received at least 6 unilateral anti-VEGF injections; the fellow eye did not receive any injections and served as controls. Neovascular glaucoma patients were excluded. Primary outcome measures were change in retinal nerve fiber layer (RNFL) thickness, visual field loss and need for additional glaucoma medications, laser or surgery. Secondary outcome measures were BCVA changes and highest measured IOP at the start of clinic visits.

Outcomes

Compared with noninjected eyes, injected eyes demonstrated a significantly higher rate of decline in mean deviation (MD), pattern standard deviation and thinning of the RNFL in the superior quadrant (other quadrants were not statistically significant). There was no significant difference in the addition of glaucoma medications between groups. However, a greater number of injected eyes underwent glaucoma surgery or laser compared with controls. There were no significant disparities in baseline IOP between groups.

Limitations

The small sample size limits the power of this study. The presence of unilateral retinal neovascular disease is a confounding factor. Using the fellow noninjected eyes as a control does not address any RNFL or visual field changes that may occur due to retinal neovascular disease rather than glaucomatous change.

Clinical significance

Glaucoma patients who are receiving intravitreal anti-VEGF injections may warrant closer monitoring and more aggressive IOP lowering than those who do not receive injections. Prophylactic IOP lowering medication could be considered prior to the injection to help mitigate transient postinjection IOP spikes.