Intraocular Pressure Changes Transient, Consistent Among Anti-VEGF Treatments

A recent observational, single-center, prospective, cross-sectional study evaluated the short-term postinjection intraocular pressure (IOP) changes after aflibercept 8 mg and faricimab, comparing them to aflibercept 2 mg.1

Intravitreal injection of anti-vascular endothelial growth factors (anti-VEGFs) has emerged as a primary first-line treatment for various retinal diseases, including neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), and cystoid macular edema secondary to retinal vein occlusion. These treatments have resulted in substantial visual gains in patients exhibiting these conditions.1

However, several studies have examined intravitreal injections of anti-VEGF treatments such as pegaptanib, ranibizumab, bevacizumab, and aflibercept. All four medications have been shown to increase IOP as a side effect after a short period without iridocorneal angle closure. However, these same studies have also indicated that IOP increases are often transient.2,3

In recent months, two new intravitreal compounds have been introduced into clinical practice: faricimab, which targets both angiopoietin-2 and VEGF-A, and aflibercept 8 mg, a higher-concentration version of aflibercept 2 mg with enhanced stability. Both medications are administered in volumes of .07 mL.1

“To date, the immediate effects of intravitreal faricimab and aflibercept 8 mg on IOP in real-world practice remain unclear,” wrote Arianna Paris, Institute of Clinical Neurosciences of Southern Switzerland, and colleagues. “This study aimed to investigate short-term IOP changes following IVT aflibercept 8 mg and IVT faricimab.”1

Paris and colleagues enrolled all patients diagnosed with nAMD and DME requiring intravitreal treatment who had attended the Institute of Clinical Neurosciences of Southern Switzerland’s medical retina clinic between February and May 2024. Patients were then divided into three cohorts according to the agent used: aflibercept 2 mg (group 1), aflibercept 8 mg (group 2), and faricimab (group 3). Patients were excluded if they had a diagnosis of glaucoma, ocular hypertension, or prior vitrectomy surgery in the study eye.1

A final total of 90 eyes from 90 patients were enrolled. Each cohort consisted of 30 patients. Investigators took IOP measurements before the injection (T0), as well as 30 seconds (T1), 5 minutes (T2), and 15 minutes (T3) after the injection. The primary outcome included absolute and relative changes at these four time points within each treatment group and between groups.1

Each of the three cohorts exhibited highly significant differences in mean IOP at each time point compared with mean IOP at baseline (P <.001). A significant difference occurred at T1 between groups 1 and 3 (P = .035) and between groups 2 and 3 (P = .002). No significant difference was observed at any time point between groups 1 and 2. At T1, mean IOP increased by 41.47 +/- 12.95 mm Hg, 43.46 +/- 8.97 mm Hg, and 32.19 +/- 11.06 mm Hg in groups 1, 2, and 3 respectively compared with baseline.1

Notably, the team indicated that the IOP elevation pattern mirrored earlier studies, both in its increase shortly after injection and the gradual return below 21 mm Hg within 15 minutes. Additionally, while significant difference was found at T1, the average pressures showed no significant difference by T2 and returned within normal limits at T3. Investigators concluded the study by indicating no significant association between the type of anti-VEGF used and short-term postinjection IOP fluctuations.1

“Further research involving larger sample sizes is necessary to validate the IOP fluctuations observed and to evaluate IOP changes following IVT aflibercept 8 g and faricimab in patients with glaucoma or ocular hypertension,” Paris and colleagues wrote. “Moreover, longitudinal studies are required to investigate potential long-term anatomical changes in retinal nerve fibre layer thickness after repeated IVT of these new formulations.”1

References

1. Paris A, Volpe G, Perruchoud-Ader K, Casanova A, Menghini M, Grimaldi G. Short-term intraocular pressure changes after intravitreal aflibercept 2 mg, aflibercept 8 mg and faricimab: A prospective, comparative study. British Journal of Ophthalmology. 2024;109(5):600-605. doi:10.1136/bjo-2024-326053

2. El Chehab H, Agard E, Russo A, Boujnah Y, Dot C. Intraocular Pressure Spikes after Aflibercept Intravitreal Injections. Ophthalmologica. 2016;236(1):43-47. doi:10.1159/000446878

3. Knip MM, Välimäki J. Effects of pegaptanib injections on intraocular pressure with and without anterior chamber paracentesis: a prospective study. Acta Ophthalmol. 2012;90(3):254-258. doi:10.1111/j.1755-3768.2010.01904.x