Purpose

To identify sustained differences in intraocular pressure (IOP) after intravitreous injections of anti–vascular endothelial growth factor (VEGF) drugs.

Design

Database study.

Participants

Patients seeing an ophthalmic provider who contributes to the database.

Methods

We identified a total of 23 776 unique patients who received only a single type of anti-VEGF medication (bevacizumab, aflibercept, or ranibizumab) by injection in the right eye in the American Academy of Ophthalmology Intelligent Research in Sight Registry. Subgroups included patients with age-related macular degeneration only and patients who had not received an anti-VEGF injection for at least 1 year before the study. We examined those with at least 12, 18, and 25 injections for each of these 3 medications. For all groups, we used fellow, untreated eyes for comparison.

Main Outcome Measures

The mean change in IOP from baseline at a minimum of 1 year of follow-up and the proportion of eyes with a clinically significant IOP increase (defined as sustained rise of at least 6 mmHg to an IOP of more than 21 mmHg).

Results

All patients in all groups receiving all drugs showed a decrease in IOP from baseline, with a mean of 0.9 mmHg in treated eyes compared with an average decrease of 0.2 mmHg in fellow untreated eyes, a statistically significant difference. A generalized linear model accounting for confounders associated bevacizumab with slightly less lowering of IOP than aflibercept and ranibizumab in most subgroups. A clinically significant IOP increase was seen in 2.6% of eyes receiving injections compared with 1.5% in the associated untreated fellow eyes. Clinically significant IOP increases occurred at a rate of 1.9%, 2.8%, and 2.8% for aflibercept, ranibizumab, and bevacizumab, respectively, which was significantly higher than untreated fellow eyes for bevacizumab and ranibizumab, but not for aflibercept.

Conclusions

These analyses from real-world data indicate that anti-VEGF intravitreous injections are associated with a small but statistically significant decrease in IOP over time. A proportion of patients, on average 2.6%, experienced a sustained clinically significant IOP rise with these drugs overall compared with 1.5% in the fellow untreated eyes. However, such an increase was not seen with aflibercept.

中文翻译：

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玻璃体内抗血管内皮生长因子药物对眼压的真实影响

目的

确定玻璃体内注射抗血管内皮生长因子（VEGF）药物后眼压（IOP）的持续差异。

设计

数据库研究。

参加者

看到眼科提供者为数据库做出贡献的患者。

方法

在美国眼科病院智能眼科研究中心的右眼中，我们确定了总共23776名独特的患者，他们仅通过右眼注射接受了单一类型的抗VEGF药物（贝伐单抗，阿柏西普或兰尼单抗）。亚组包括仅患有年龄相关性黄斑变性的患者，以及在研究前至少一年未接受抗VEGF注射的患者。我们对这3种药物中的每一种分别进行了至少12、18和25次注射的患者进行了检查。对于所有组，我们使用未经处理的同伴眼睛进行比较。

主要观察指标

在至少一年的随访中，眼压从基线的平均变化以及眼压在临床上具有显着眼压升高（定义为持续升高至少6 mmHg到大于21 mmHg的眼压）的比例。

结果

接受所有药物治疗的所有组中的所有患者的眼压均较基线水平降低，治疗眼的平均眼压为0.9 mmHg，而未治疗眼的平均眼压为0.2 mmHg，具有统计学意义。在大多数亚组中，与贝伐单抗相关的混杂因素的广义线性模型的眼压降低幅度低于阿非西普和兰尼单抗。在接受注射的眼睛中，有2.6％的人眼内IOP升高，与之相比，未经治疗的同伴眼睛中的眼压升高了1.5％。临床上显着的IOP增高率分别为aflibercept，ranibizumab和bevacizumab，分别为1.9％，2.8％和2.8％，这明显高于未经治疗的贝伐单抗和ranibizumab，但非aflibercept。

结论

这些来自现实世界数据的分析表明，抗VEGF玻璃体内注射与随时间推移IOP的微小但统计学上显着降低有关。这些药物总体上平均有2.6％的患者经历了持续的临床显着眼压升高，而未治疗的另一只眼则为1.5％。但是，使用阿柏西普却没有看到这样的增加。