Prophylactic intraocular pressure lowering measures in anti-vascular endothelial growth factor therapy: A systematic review and meta-analysis

• Published in: Survey of ophthalmology Vol. 68; no. 3; pp. 425 - 445
• Main Authors: Arjmand, Parnian, Yu, Caberry W., Popovic, Marko M., Jhaveri, Aaditeya, Mandelcorn, Efrem D.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2023
• Subjects: Angiogenesis Inhibitors - therapeutic use; anti-VEGF; Bevacizumab - therapeutic use; Endothelial Growth Factors; glaucoma; Humans; Intraocular Pressure; Intravitreal Injections; Ocular Hypertension - drug therapy; Ocular Hypertension - prevention & control; prophylactic anterior chamber paracentesis; prophylactic IOP lowering medications; Ranibizumab - therapeutic use; RNFL thinning; Tonometry, Ocular; Vascular Endothelial Growth Factor A; RNFL thinning; RNFL; prophylactic anterior chamber paracentesis; glaucoma; VEGF; anti-VEGF; prophylactic IOP lowering medications; IOP
• ISSN: 0039-6257; 1879-3304
• DOI: 10.1016/j.survophthal.2022.12.002

•Anterior chamber paracentesis reduces immediate intraocular pressure (IOP) spikes following intravitreal anti-vascular endothelial growth factor (VEGF) injections.•Anterior chamber paracentesis preserves the retinal nerve fiber (RNFL) in the short- and long-terms.•IOP-lowering medications also reduce IOP spikes, with limited data on RNFL thickness. Acute intraocular pressure (IOP) elevation following repeat intravitreal anti-vascular endothelial growth factor (VEGF) injections (IVI) may pose a risk to the integrity of the retinal nerve fiber (RNFL). This meta-analysis investigates the role of IOP-lowering interventions such as an anterior chamber paracentesis (ACP) and IOP-lowering medications on the IOP in patients undergoing IVIs. MEDLINE, EMBASE, and the Cochrane Library were searched up to February, 2021. Studies investigating IOP-lowering interventions in patients undergoing IVI versus controls were included. The primary outcome was the IOP in the short- and long-term post-IVI. Secondary outcomes were changes in the RNFL thickness and best corrected visual acuity (BCVA). ACP at time of anti-VEGF injection significantly lowered IOP immediately post anti-VEGF (WMD: -27.98 mm Hg, P < 0.001). Patients in the ACP group also had significantly thicker RNFL compared to control (WMD: 2.07 um, P < 0.00001) at median follow-up of 16.5 months. IOP-lowering medications (on the day of injection or in the long-term) significantly reduced IOP up to 30 minutes after injection (WMD: -3.31 mm Hg, P = 0.003). This effect was statistically significant between the 2 arms up to 1 month follow-up. There was no difference in BCVA in intervention versus controls. ACP reduces immediate IOP spikes post-IVI and preserves the RNFL in the short- and longterms IOP-lowering medications also reduce IOP spike, with limited data on RNFL thickness.