Incidence of Glaucoma or Ocular Hypertension After Repeated Anti-Vascular Endothelial Growth Factor Injections for Macular Degeneration

Abstract

Purpose

To estimate the risk of glaucoma or sustained ocular hypertension (OHT) related to anti-vascular endothelial growth factor (VEGF) injections for age-related macular degeneration (AMD).

Design

Retrospective chart review.

Subjects

Patients who received unilateral anti-VEGF injections for AMD at the Wheaton Eye Clinic (IL).

Methods

Chart analysis was performed on 1095 patients, without prior glaucoma or OHT, who received unilateral anti-VEGF injections for AMD from 2005 to 2012, with data collected through 2013. Data collection included demographics, lens status, date and medication type of each injection, and the date of diagnosis of glaucoma or OHT by a treating glaucoma specialist, which was the main outcome measure. Rare events logistic regression was performed to determine the risk of disease development based on sex, lens status, and injection frequency.

Results

Unilateral glaucoma or sustained OHT developed in 42 patients over the course of follow-up, with 40 events in the injected eye only, 2 in the contralateral eye only. Statistical modeling predicted elevated risk for onset of glaucomatous disease with a higher maximum frequency of injections (p < 0.0001, odds ratio [OR] 2.18 for each additional injection over the most injection-intense 6 months for a given subject) and with phakic lens status (p = 0.0009, OR 0.33 for pseudophakia).

Conclusion

Our results show a significant risk for glaucoma or OHT development in patients undergoing repeated treatments with intravitreal anti-VEGF injections for AMD, establishing the first reliable connection between disease development and a period of high-frequency injections. In addition, we show a significantly increased risk of disease development in phakic patients, which we believe points to a mechanical explanation for this type of secondary glaucoma.

Keywords:

• exudative macular degeneration
• secondary glaucoma
• open-angle glaucoma
• anti-vascular endothelial growth factor

Acknowledgements

The authors wish to thank Dr. Ruth Williams for expert manuscript review. We are also grateful to the glaucoma and retina specialists of the Wheaton Eye Clinic for review and discussion of the research and its implications: Drs. Michael Andreoli, Susan Anderson-Nelson, Mark Daily, Greg Fenton, David Gieser, Richard Gieser, Stephen Gieser, Vikram Setlur, Edward Sung, and Ruth Williams.

Disclosure

The authors report no conflicts of interest in this work.