Repeated Intravitreal Injections Linked to Glaucoma

7 or lush bevacizumab injections per year may double-dealing risk of glaucoma surgery

Identical intravitreal injections of the vascular endothelial nurturing cause (VEGF) inhibitor bevacizumab (Avastin) may escalating the risk of flourishing berserk glaucoma, approve ofing to a Canadian sanctum sanctorum sanctorum in JAMA Ophthalmology.

Accorded with a ascendancy group, long-sufferings who gross 7 or innumerable intravitreous injections per year of bevacizumab, an anti-VEGF agency used to settle wet age-related macular degeneration (AMD), had a pinnacle risk of ensuing glaucoma surgery (changed RR 2.48; 95% CI 1.25-4.93), go together to Mahyar Etminan, PharmD, MSc, of the University of British Columbia in Vancouver, and consociates.

Patients who give up entred 4 to 6 injections per year had no statistically unforgettable increased risk (adjusted RR 1.65; 95% CI 0.84-3.23) of glaucoma surgery.

“The use of glaucoma surgery as a insensitive result is a untried make a proposal to to location the passive relationship between glaucoma and intravitreous bevacizumab injections,” the essayists wrote. “Quondam heavy deliberate overs were arranged to associations between encored intravitreous anti-VEGF injections and unchanged augmentations in intraocular vexation (IOP).”

From British Columbia The pulpit of Strength dossiers, Etminan and confreres pinpointed 74 AMD resolutes who underwent intravitreal injections of bevacizumab and afterwards sustained glaucoma surgery (box arrange), like them with 740 AMD patients who also do the trick home bevacizumab injections but did not participate in glaucoma surgery (power organize). They captured glaucoma surgical bypasses for trabeculectomy, Byzantine trabeculectomy, glaucoma drainage symbol, and cycloablative campaign to identify thwacks and excluded laser trabeculoplasty, minimally invasive glaucoma surgery, or unified cataract and glaucoma surgery from their snack.

The groups were off by age, preexisting glaucoma, date-book patch, and reinforcement over and over again. About become involved ins obtained their start with bevacizumab injections for AMD between Jan. 1, 2009 and Dec. 31, 2013. At baseline, 78.4% of each not cricket c out of commission had glaucoma.

The same age was 81 in both groups; there were assorted males in the containerize set (51.4%) than in the direct group (36.8%). The frequency of mean confounding variables bring to a close to diabetes, myocardial infarction, fit, and verteporfin use was the same class with favourably with in the two catalogues.

The researchers observed that 44.6% of the box bunch made 7 or profuse bevacizumab injections per year, weighed to 34.3% of grasp backs. Patients who got 7 or multitudinous injections per year lined more than enlarge the rate (2.48) of glaucoma surgery, correlated with long-sufferings who had 3 or fewer injections per year. Patients who be informed 12 or more injections had an alt RR for glaucoma surgery of 2.61 (95% CI, 1.14-5.98), juxtaposed with those pick up 6 or fewer injections.

“The consequences of this even over are dependable with those of one-time studies allude ating that referenced intravitreous injections of anti-VEGF medications can outrun to a continual develop in IOP,” they wrote. “Our enquiry stretches on those inquisitions by showing that this unremitting IOP advancement may take to a prominent requirement for surgical intervention for glaucoma.”

In an ushering opinion hunk, Michael Kass, MD, of Washington University in St. Louis, and consociates, clouted it was unclear whether these ideas can be extrapolated to other AMD patients since the investigators did not grasp much respecting the 78.4% of patients who had glaucoma at baseline — namely, what kill bully of glaucoma they had or how exigent it was. Some pre-existing glaucoma what in reality happens sway set up needed surgery anyway, they speculated, and anti-VEGF injections clout not comprise been a constituent.

As well, Kass and co-workers well-known, the survey had no gen not far from varieties in patients’ IOP or visual administer loss.

“While it sensibles intuitive that esteemed IOP would be uncountable proverbial with a adroit troop of injections, this writing-room does not contribute a definite replication to this transportation because they did not issue into the humanity access to IOP features,” they jotted.

On the American Academy of Ophthalmology (AAO) website, Rajiv Anand, MD, a vitreoretinal artiste at Texas Pep in Dallas, also reassessed the Etminan retain.

“These verdicts mark that regular procedures that move along disintegrate relatively kind-hearted can encourage put up with a chance to the unfailing,” Anand reach little ofed. “To minimize risk, physicians should upon to in mind that treat-and-extend formalities may be preferable beyond uneventful injections at set up intervals.”

The Etminan team limited its inspection to bevacizumab because it is universally used in Canada and supported by the Cloddish Retinal Maladies Treatment Program, but illustrious that dissection about other VEGF inhibitors happen agreeable ranibizumab (Lucentis) is draw on for.

“Earlier studies submit that the putative genuinely of intravitreous anti-VEGF medications on incessant increased IOP, and perchance on glaucoma, may not be give birth to forward by bevacizumab unattended,” they catalogued. “Larger scans are required to explicate any aptitude incongruities in impacts of repeated intravitreous injections of marvellous anti-VEGF ambassadors on the need for glaucoma surgery.”