Risk of Intraocular Pressure Increase With Intravitreal Injections of Vascular Endothelial Growth Factor Inhibitors: A Cohort Study

• Published in: American journal of ophthalmology Vol. 248; pp. 45 - 50
• Main Authors: Spini, Andrea, Giometto, Sabrina, Donnini, Sandra, Posarelli, Matteo, Dotta, Francesco, Ziche, Marina, Tosi, Gian Marco, Girardi, Anna, Lucenteforte, Ersilia, Gini, Rosa, Etminan, Mahyar, Virgili, Gianni
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2023
• Subjects: Aflibercept; Aged; Angiogenesis Inhibitors - adverse effects; Anti-VEGF; Bevacizumab; Bevacizumab - adverse effects; Cohort Studies; Cohort study; Female; Glaucoma; Glaucoma - drug therapy; Humans; Intraocular Pressure; Intraocular pressure increase; Intravitreal injection; Intravitreal Injections; Intravitreous injection; IOP; Male; Observational study; Ranibizumab; Ranibizumab - therapeutic use; Real-word evidence; Receptors, Vascular Endothelial Growth Factor - therapeutic use; Recombinant Fusion Proteins - adverse effects; Retrospective Studies; Retrospective study; Vascular Endothelial Growth Factor A; VEGF inhibitors; Glaucoma; Observational study; Intravitreal injection; Retrospective study; IOP; Aflibercept; Bevacizumab; Intravitreous injection; Cohort study; Ranibizumab; Real-word evidence; Anti-VEGF; VEGF inhibitors; Intraocular pressure increase; Intraocular pressure
• ISSN: 0002-9394; 1879-1891; 1879-1891
• DOI: 10.1016/j.ajo.2022.11.015

Intraocular pressure increase (IOPi) after intravitreal injections of vascular endothelial growth factor inhibitors (VEGFis) might be different among different VEGFis (bevacizumab, aflibercept, ranibizumab). The purpose of this study was to evaluate the risk of IOPi among new users of bevacizumab, ranibizumab, and aflibercept in nondiabetic patients in Tuscany, Italy. Retrospective cohort study. Tuscan regional administrative database was used to identify subjects with a first VEGFi intravitreal injection between 2011 and 2020, followed to first incidence of IOPi. Diabetic subjects, those with pre-existing IOPi, or previous use of dexamethasone implants were excluded. Multivariable Cox regression analyses (intention-to-treat and as treated) were conducted to evaluate risk of IOPi among aflibercept, bevacizumab, and ranibizumab, adjusting for potential confounding variables. IOPi was defined as the first record of International Classification of Diseases, Ninth Revision (ICD-9-CM) code 365 or use of 2 glaucoma drugs dispensations within 180 days of each other. We identified 6585 new users of VEGFis: 1749 aflibercept, 1112 bevacizumab, and 3724 ranibizumab. Women made up 60% of the cohort, with a mean age of 73.6 years. In the intention-to-treat analysis, the adjusted hazard ratio (HR) for incident IOPi, compared with aflibercept, was higher for bevacizumab (HR = 2.20, 95% CI = 1.64-2.95) and ranibizumab users (HR = 1.88, 95% CI = 1.46-2.42), respectively. The HRs remained robust after exclusion of patients with proxy of retinal vascular occlusion. As treated analysis confirmed such results (bevacizumab: HR = 3.76, 95% CI = 2.30-6.17; ranibizumab: HR = 2.49, 95% CI = 1.62-3.82). This study found an increased risk of IOPi among nondiabetic patients with ranibizumab and bevacizumab compared with aflibercept. Future studies are needed to validate these findings.