Intraocular Pressure Changes and VEGF Inhibitor Use in Various Retinal Diseases: Long-Term Outcomes in Routine Clinical Practice: Data from the Fight Retinal Blindness! Registry

Abstract Purpose To report long-term changes in intraocular pressure (IOP) in eyes receiving vascular endothelial growth factor (VEGF) inhibitors for various retinal conditions over 12- and 24-months in routine clinical practice. Design Retrospective analysis of data from a prospectively designed observational outcomes registry: the Fight Retinal Blindness! Project. Participants Treatment-naive eyes receiving monotherapy with VEGF inhibitors (ranibizumab [0.5mg], aflibercept [2mg] or bevacizumab [1 mg]) with at least 3 injections, from December 2013 to 31 December 2018 and at least 12 months of follow-up. Methods IOP was measured at each clinical visit for all eyes as part of routine practice. Main Outcome measures The primary outcome was the mean change in IOP (mmHg) at 12-months. The following secondary IOP outcome measures were investigated at 12 and 24 months: (1) mean change in IOP from baseline and (2) proportion of clinically significant IOP increase defined as an elevation of at least 6 mmHg to an IOP of more than 21 mmHg at any point during the follow-up. Results We identified 3429 treatment-naive eyes (395 bevacizumab, 1138 aflibercept and 1896 ranibizumab) with complete IOP data from 3032 patients with 12 months of follow-up data, of which 2125 (62%) had 24 months of follow-up data. The overall mean [95%CI] IOP change was -0.5 [-0.6, -0.3] mmHg at 12 months and -0.4 [-0.6, -0.3] mmHg at 24 months while the proportion of clinically significant IOP increases were 5.6% and 8.8%. A lower mean IOP change and fewer IOP elevations at 12- and 24-months was observed in eyes receiving aflibercept than in those receiving bevacizumab and ranibizumab (for both comparison P ≤ 0.01 at each time point and outcomes). Eyes with pre-existing glaucoma had more IOP increases over 12- and 24-months (OR = 2.2 [1.2, 3.8], P = 0.012 and OR = 2.1 [1.1, 3.8], P = 0.025, respectively). Conclusions Mean IOP did not change significantly from baseline to 12 and 24 months in eyes receiving VEGF inhibitors, while clinically significant IOP elevations occurred in a small proportion of eyes. Aflibercept was associated with fewer clinically significant IOP elevations, whereas eyes with pre-existing glaucoma were at a higher risk.