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Journal Français d'Ophtalmologie
Volume 41, n° 8
pages e329-e340 (octobre 2018)
Doi : 10.1016/j.jfo.2018.07.002
Received : 2 June 2018 ;  accepted : 24 July 2018
Editor's choice

Late and sustained intraocular pressure elevation related to intravitreal anti-VEGF injections: Cases requiring filtering surgery

I. Leleu , B. Penaud, E. Blumen-Ohana, T. Rodallec, R. Adam, O. Laplace, J. Akesbi, J.-P. Nordmann
 Centre hospitalier national d’ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France 

Corresponding author at: 10, rue de Roi-de-Sicile, 75004 Paris, France.10, rue de Roi-de-SicileParis75004France

We report cases of delayed, sustained elevated intraocular pressure (IOP) associated with repeated intravitreal anti-VEGF injections (IVI), which ultimately resulted in the need for filtering surgery. Two of the three cases demonstrated severe IOP elevation despite maximal medical treatment following unilateral IVI and required urgent filtering surgery. Optic nerve involvement was severe in all three cases. These intravitreal injections were performed for exudative age-related macular degeneration (AMD), and the patients did not show any sign of glaucoma or ocular hypertension prior to the initiation of treatment. Elevated IOP secondary to intravitreal steroids is a well-known side effect, as is immediate transient IOP elevation associated with anti-VEGF injection. Late, sustained IOP elevation after repeated injections of anti-VEGF, described approximately ten years ago, is often underestimated. Its incidence is estimated between 2.1 % and 13 % according to studies and increases with the number of IVI (cumulative effect). The pathophysiologic process is becoming increasingly understood, and several risk factors for this chronic IOP elevation have been identified. Most often, it is a moderate IOP elevation for which topical monotherapy is sufficient, or sometimes two, three or four medications or even selective laser trabeculoplasty (SLT). However, filtering surgery may rarely be required. Our findings illustrate a little-described phenomenon: a sudden, severe, late IOP elevation in response to anti-VEGF by an “overflow” effect, requiring urgent filtering surgery.

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Keywords : Anti-VEGF, Intravitreal injection, Elevated intraocular pressure, Glaucoma, Filtering surgery, Non-penetrating deep sclerectomy

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