Effect of pegaptanib sodium 0.3 mg intravitreal injections (Macugen) in intraocular pressure: posthoc analysis from V.I.S.I.O.N. study

摘要

Vascular endothelial growth factor (VEGF) blockade has become the gold standard in the treatment of neovascular age-related macular degeneration (AMD). Intravitreal administration of these drugs usually causes transitory elevations in intraocular pressure (IOP) caused by the additional volume. Initial safety data analyses of VEGF blockers from pivotal phase 3 randomised clinical trials suggested sustained IOP changes after 2-3 years of follow up. There are reports of sustained high IOP after non-selective VEGF inhibition. In one study, four patients had IOP measurements as high as 50 mm Hg that developed within hours after intravitreal injection of ranibizumab 0.5 mg and that lasted up to 1 month after first or second injection.5 This effect on IOP was sustained across several visits, and required topical and systemic glaucoma therapy. None of the patients had a previous history of glaucoma, ocular hypertension or IOP asymmetry. A retrospective chart review of 215 eyes suggested a higher incidence of sustained elevated IOP with bevacizumab therapy compared with ranibizumab, a response more common in patients with pre-existing glaucoma.6 A second retrospective chart review on 155 eyes reported sustained elevated IOP after ranibizumab, bevacizumab or pegaptanib with no association with injection frequency, number of injections, or anti-VEGF agent used.7 Expected IOP elevations 60 min after injection were reported in aflibercept studies, but sustained IOP elevation has not been reported.