1. Assessment of Intraocular Pressure in patients treated with aflibercept Cristina Vendrell Gómez, Anna Puntí Badosa, Natalia Procházka Enrich, Antonia Sierra Carpio Ophthalmology, Hospital de Viladecans, Barcelona, Spain
PURPOSE: Aflibercept, under the brand name Eylea, the most recently developed anti-VEGF agent, is a recombinant fusion protein consisting of vascular endothelial growth factor (VEGF)-binding portions from the extracellular domains of human VEGF receptors 1 and 2, that are fused to the FC portion of the human IgG1 immunoglobulin.
The current study was designed to evaluate long-term effects of Aflibercept injections on intraocular pressure (IOP) in eyes with neovascular age-related macular degeneration (AMD), diabetic macular edema (DME) or retinal vein occlusion (RVO).
METHODS: This retrospective study (January 2014 to January 2017) was conducted by the department of Ophthalmology in Viladecans Hospital. The study enrolled 236 patients who underwent multiple intravitreal Aflibercept injections (2mg/0.05ml) at the retina department in our hospital. The treatment consisted of at least a loading dose of three injections. The interval between each injection varied from 3 to 5 weeks during the first 3 months. Followed by intravitreal injections every 6 weeks, 8 weeks or more, based on the treat and extend criteria. This protocol was characterized by the adjustment of individual injection intervals according to therapeutic response, made on the basis of the ophthalmologist's interpretations of OCT, FA when needed, and clinical examination, including slit-lamp biomicroscopy, and indirect ophthalmoscopy observation.
Intraocular pressure (IOP) was measured in each visit, considering the IOP baseline the measure of IOP before the loading dose. Follow-up measurements were taken, first one after the loading dose and every two to four months the subsequent ones.
The study included only naïve eyes (n=138) which had not had any anti-VEGF previous injections or corticosteroid intravitreous injections of any kind.
The primary outcome was the change in IOP from the baseline. IOP rise was defined as an increase of 5 mmHg over the baseline.
Secondary outcomes included: sex, age, indication for Aflibercept, previous cataract surgery, history of glaucoma or ocular hypertension with its treatment.
The mean difference in IOP between last and baseline measurement was compared using two-sample paired t-test and with one-way ANOVA for indication. A p-value <0.05 was considered statistically significant.
RESULTS: 138 naïve eyes (114 patients) were included in the current retrospective analysis. Reasons for exclusion were: not having finished the loading dose, missing IOP data after loading dose or previous anti-VEGF treatments other than Aflibercept,
The study group consisted of 66 female (57.9%) and 48 (42.1%) male patients. Their Mean age being: 76.0 ± (SD) (range 39 to 93 years).
The main indication for Aflibercept in the macula department of our hospital was AMD (n=72, 52.2%) followed by DME (n=54, 39.1%) and RVO (n=12, 8.7%).
The mean baseline IOP was 17.2 (SD: 3.2) and last mean IOP was 16.8 (3.0). The mean IOP difference from baseline versus last was not statistically significant (p=0.15). The mean IOP difference from baseline was not statistically significant compared to previous treatment of glaucoma (p=0.65), or pseudophakia (p=0.27), or by previous AMD/DME/RVO (p=0.63).
The increase of IOP in the glaucomatous eyes was not higher than in the non-glacomatous eyes, p=0.51 (two sample t-test for independent data).
9 eyes increased IOP 5 mmHg over their baseline after the loading charge (6.5%) range mmHg; 3 of which had previous glaucoma treatment.
Only 2 eyes (1.4%) needed additional hypotensional treatment. One eye without previous glaucoma treatment needed a fixed combination drops (Timolol 0.5% + Brimonidine) and the other glaucomatous eye needed the fixed combination drops (Timolol 0.5% + Dorzolamide) and Brimonidine and cataract surgery. This treatment stabilized the IOP in both cases.
CONCLUSIONS:
The use of Aflibercept intravitreal injections did not cause significant changes in the patient’s IOP (p=0.51 paired t-test).
Previous history of glaucoma , pseudophakia or AMD / DME / RVO were no risks for the elevation of IOP.
Multiple Aflibercept injections were not a significant risk factor for IOP elevation in our study.
Choroidal neovascularization secondary to AMD
DME with cystoid macular edema with neurosensory retina detachment
References
1.-INTRAOCULAR PRESSURE IN PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION SWITCHED TO AFLIBERCEPT INJECTION AFTER PREVIOUS ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENTS. Rusu, Irene M. MD* ; Deobhakta, Avnish MD*,†,‡,§; Yoon, Dan BS*; Lee, Michele BS‡; Slakter, Jason S. MD†,¶; Klancnik, James M. MD†,¶; Thompson, Desmond PhD**; Freund, K. Bailey MD*,†,§,¶
2. AFLIBERCEPT IN BRANCH RETINAL VEIN OCCLUSION AS SECOND LINE THERAPY: CLINICAL OUTCOME 12 MONTHS AFTER CHANGING TREATMENT FROM BEVACIZUMAB/RANIBIZUMAB-A PILOT STUDY. Magdalena A.Wirth; Matthias D. Becker; Nocole Graf; Stephan Micheles. Int. J.Retina Vitreous 2016;2:20.
3. ASSOCIATION OF REPEATED INTRAVITREOUS BEVACIZUMAB INJECTIONS WITH RISK FOR GLAUCOMA SURGERY. Brennan D. Eadi; Mahyar Etminan,Bruce C. Carleton; David A. Maberley; Frederick S. Mikelberg. JAMA Ophthalmology I.