May 31, 2019 Conference


Intraocular Pressure in Response to Conversion from Bevacizumab or Ranibizumab to Aflibercept in Patients with Neovascular Age-Related Macular Degeneration

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Elise Steinberger, Tufts University School of Medicine (Presenter)
Mr. Jim McCullum, Lahey Hospital & Medical Center
Yubo Zhang, Brandeis University
Dr. Amer Alwreikat, Lahey Hospital and Medical Center
Dr. David Ramsey, Lahey Hospital and Medical Center


To understand the safety profile of intravitreal injections of agents directed against vascular endothelial growth factor in patients with neovascular age-related macular degeneration (nAMD) with and without coexisting glaucoma.


Retrospective single center (teaching hospital) interventional case series of 62 eyes (58 patients) with nAMD that received ?3 IVB and/or IVR injections prior to ?3 IVA injections. Charts were reviewed to identify patients with any degree of primary open angle glaucoma (POAG), pseudoexfoliative glaucoma, and/or narrow angle glaucoma. Secondary types of glaucoma, e.g. steroid or trauma induced, were not included. Intraocular pressure (IOP) data was collected as the average of three visits for the following time points: baseline, following 3 loading doses of IVB/IVR, for the 3 visits before and after the switch to IVA, and for the 3 visits at the end of the follow-up period (EOF).


19 patients had glaucoma compared to 43 without glaucoma. Baseline IOP was similar for glaucoma and non-glaucoma patients. No change in IOP followed the loading doses of IVB/IVR for glaucoma or non-glaucoma patients; however, a significant rise in IOP was noted in patients with glaucoma by the final IVB/IVR injections (1.61±0.52 mmHg, p<0.002). A decline in IOP occurred following the switch to IVA and was greater for glaucoma (-1.59±0.54 mmHg, p<0.001) compared to non-glaucoma (-0.99±0.28 mmHg, p<0.001) patients. Injection interval or number of injections of IVA did not impact ?IOP.


IOP in subjects with glaucoma appears to be more sensitive to intravitreal injections, rising with IVB/IVR, and declining following the switch to IVA. IVA may be safer for patients with glaucoma compared to IVB/IVR.