IOP-Related Events After IVIs for Macular Edema in SCORE2
By Jean Shaw
Selected and Reviewed by Neil M. Bressler, MD, and Deputy Editors
Journal Highlights
JAMA Ophthalmology, December 2021
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In a secondary analysis of the SCORE2 study, Aref et al. investigated IOP-related events in patients who received intravitreal injections (IVIs) of anti-VEGF medications for macular edema secondary to central retinal vein occlusion (CRVO) or hemiretinal vein occlusion (HRVO). They found that the risk of an IOP-related event in these patients warrants ongoing monitoring of IOP for up to 60 months.
For this study, the researchers assessed 312 patients with macular edema secondary to CRVO or HRVO who were not taking an IOP-lowering medication at baseline in SCORE2. Main outcomes were a rise in IOP more than 10 mm Hg from baseline, a rise in IOP to a level higher than 35 mm Hg, and the need for IOP-lowering incisional or laser surgery.
During SCORE2, patients were randomized to IVIs of aflibercept or bevacizumab. At the six-month mark, good responders were re-randomized to either continued monthly injections or a treat-and-extend protocol with their original drug. Poor responders were switched to the alternative anti-VEGF medication. After month 12, participants were treated at investigator discretion using any commercially available anti-VEGF drug, and follow-up visits were conducted through month 60.
For this analysis, the mean age of the 312 participants was 67.8 years (standard deviation [SD], 12.1 years), and 138 (44.2%) were female. Through 60 months of follow-up, 25 eyes (8%) experienced a rise in IOP more than 10 mm Hg over baseline, and five (1.6%) had an IOP higher than 35 mm Hg. The 60-month Kaplan-Meier cumulative incidences of IOP elevation greater than 10 mm Hg over baseline and IOP higher than 35 mm Hg were .13 and .02, respectively. No definitive differences were noted in the number of IOP-related events between recipients according to initial randomization to aflibercept or bevacizumab injections.
Finally, three participants (1%) underwent IOP-lowering incisional surgery, and an additional three (1%) had IOP-lowering laser surgery.
In summary, the authors said, the proportion of eyes with IOP-related events in SCORE2 participants supports monitoring IOP in eyes treated with IVIs of anti-VEGF drugs for macular edema associated with CRVO or HRVO.
The original article can be found here.