Unexplained long-term increase in intraocular pressure during the treatment of macular disease with intravitreal anti-VEGF

Abstract

Purpose This study aimed to investigate the incidence and timing of unexplained intraocular pressure (IOP) increase over time following the administration of various intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents for macular diseases. Patients and methods This retrospective study included 2611 eyes treated multiple times with one or more different anti VEGF agents between 2016 and 2022. An IOP increase of ≥ 25 mmHg was classified as pathological. We analyzed the inci dence rates, the timing of the IOP increase during the administered therapy and the thickness of the retinal nerve fiber and ganglion cell layer over two years in eyes with IOP increase. Results A total of 50 eyes (1.9%) from 48 patients experienced an increase in IOP during anti-VEGF therapy. In 15 eyes, the increase was attributable to other ocular diseases (such as neovascular glaucoma, uveitis, or endophthalmitis), and these eyes were therefore excluded from further analysis. In contrast, 35 eyes (1.3%) from 33 patients with an average age of 68.4 ± 10,0 years, developed an unexplained increase in IOP up to an average of 27 [25–45] mmHg, typically after 12 [1–35] weeks. 97% of the affected eyes had no history of glaucoma. The baseline IOP was 16 [12–20] mmHg. In 24 eyes (68%), short-term topical therapy led to adequate IOP regulation. For 10 eyes (29%) with persistently elevated IOP, continued topical antiglau coma therapy was required, while 2 eyes required surgical intervention. The average thickness of the retinal nerve fiber layer and the ganglion cell layer did not change significantly over two years. Conclusion An increased IOP can occur during the course of anti-VEGF therapy in normotensive eyes. This phenomenon can be conservatively controlled in 94% of cases.