Acute, Sustained, Intraocular Pressure increases following Anti-Vascular Endothelial Growth Factor Treatment for Retinal Conditions: A Review of Clinical Evidence and Guidelines

Key Message

Five relevant publications comprising one meta-analysis, two prospective randomized controlled trials, one retrospective non-randomized comparative study, and one retrospective non-comparative study were identified. The evidence on the risk factors that lead to acute sustained intraocular pressure (IOP) increases (or sustained elevated IOP) requiring surgery following anti-vascular epithelial growth factor (VEGF) intravitreal injection treatment for retinal disease was inconclusive, primarily due to heterogeneity in the studies. Across the relevant studies, there was variation in the patient populations, the types of anti-VEGF agents used for treatment, compounding and administration of the agents, the comparators, and the length of follow-up. Importantly, studies reported on the incidence of elevated IOP that required any form of treatment as multiple management pathways are available for the condition. In addition to surgery, patients may be treated with medication, a combination of surgery and medication, or be put under observation.Of the five relevant studies, one non-comparative study reported that surgical intervention (trabeculectomy) and medication were used together to control IOP in one patient with neovascular age-related macular degeneration, following treatment with single or combined doses of anti-VEGF agents. Given the low rate of elevated IOP that required surgery, the attendant risk factors could not be assessed. No relevant evidence-based guidelines were identified.