Study examines anti-VEGF injections and sustained IOP increases

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There was no clear difference in increases of intraocular pressure (IOP) between anti-VEGF agents and controls at 12 and 24 months after the initiation of treatment, according to a study presented at AAO 2022.

In this network meta-analysis, data from 26 randomized control trials (12 522 eyes) comparing anti-VEGF agents (aflibercept, bevacizumab, ranibizumab, and injection controls) for the treatment of neovascular age-related macular degeneration, retinal vein occlusions, or diabetic macular edema were utilized in pairwise meta-analysis and Bayesian network meta-analysis to look at the proportion of patients whose IOP increased ≥5 mmHg from baseline on consecutive visits, increased ≥10 mmHg from baseline at any visit, was ≥21 mmHg on consecutive visits, was ≥25 mmHg at any visit, was ≥30 mmHg at any visit, prompted the initiation of IOP-lowering medications, or increased as per the clinicians’ discretion.

There was low to moderate certainty of evidence demonstrating no statistically significant difference between anti-VEGF agents and again between anti-VEGF agents and controls.

At 12 months, ranibizumab showed higher rates of IOP measurements ≥30 mmHg than bevacizumab but with a low certainty of evidence. At 24 months, Ranibizumab 0.5 mg showed higher rates of consecutive IOP increases of ≥5 mmHg with a low certainty of evidence. There were also higher rates of IOP increases as per the clinicians’ discretion at 12 months (a low certainty of evidence) and 24 months (very low certainty of evidence).

The 95% credible intervals in comparisons without statistically significant effects did not rule out important clinical effects.

The authors said the study was limited because IOP was not the main outcome in the trials included and suggested future trials should have a standardized threshold and measurement protocol.

Nanji K, et al. The 12- and 24-Month Effects of Intravitreal Ranibizumab, Aflibercept and Bevacizumab on IOP: A Network Meta-Analysis. Poster presented at: AAO 2022.