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Frequent anti-VEGF injections may be associated with increased risk of glaucoma surgery
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A large pharmacoepidemiologic study carried out in British Columbia found that seven or more intravitreal injections of bevacizumab are associated with an increased risk of glaucoma surgery.
Using population-based Ministry of Health-supported databases, data analysis was performed on a cohort of patients who had received intravitreal Avastin (bevacizumab, Genentech) injections for age-related macular degeneration between January 2009 and December 2013, focusing on the cases that subsequently underwent glaucoma surgery. For each of these cases, 10 controls matched by age, pre-existing glaucoma, number of injections per year and duration of follow-up were selected among patients who did not undergo glaucoma surgery. A total of 74 cases and 740 controls were included.
An increased relative risk of 2.48 for glaucoma surgery was found in patients who had received seven or more injections per year, while no significantly higher risk was found in those with six or fewer injections.
Increased IOP is a well-known side effect of anti-VEGF therapy, although the mechanism is still unclear. However, no study so far had investigated in a large cohort of patients the correlation between anti-VEGF injections and IOP-lowering surgical procedures.
“Sustained IOP elevation may lead to a greater need for surgical intervention for glaucoma,” the study authors wrote. “Clinicians should be aware of the potential association of repeated, recent intravitreous anti-VEGF injections for diseases, such as exudative AMD, with subsequent need for glaucoma surgery.”
The authors clarified that restriction to bevacizumab was motivated by the adoption of this medication within the Provincial Retinal Diseases Treatment Program. However, increased IOP is a side effect other anti-VEGF agents share, and larger studies are needed to establish potential differences in the risk rate for glaucoma surgery. – by Michela Cimberle
Disclosure: Eadie reports no relevant disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Eadie BD, et al. JAMA Ophthalmol. 2017;doi:10.1001/jamaophthalmolo.2017.0059.
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