Rapidly Progressive Visual Field Deterioration in a Glaucomatous Patient Treated with Several Anti-VEGF Injections for Neovascular AMD: A Case Report

Introduction

Intravitreal anti-vascular endothelial growth factor (VEGF) agents have revolutionized, and are now the mainstay of treatment for neovascular age-related macular degeneration (AMD) [1], [2], [3].

Although widely used, due to their efficacy, they are not entirely without risks.

One of the recognized side effects of intravitreal anti-VEGF injections (IVIs) is the elevation of intraocular pressure (IOP) [4], [5], [6]. Although transient and related mainly to an increase in intraocular volume, the increase of IOP has a negative effect on changes in the thickness of the peripapillary nerve fiber layer [7], [8] and seems to be more deleterious in glaucoma patients who already show optic nerve damage and in which IOP spikes take longer to return to basal levels (where normal IOP values are considered between 10 and 21 mmHg) [9]. Moreover, an increase in IOP following IVI is associated with a significant reduction in optic nerve perfusion [10], [11].

Up to the present, there have been no reports of visual field (VF) degradation related to an increase in IOP following repeated intravitreal injections. The purpose of this report is to show the correlation between acute increases in IOP after IVIs and VF loss, especially in glaucomatous patients.

Publication History

Received: 17 October 2022

Accepted: 13 December 2022

Article published online:
25 April 2023

• References

• 1 Heier JS, Brown DM, Chong V. et al. Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration. Ophthalmology 2012; 119: 2537-2548
• 2 Rosenfeld PJ, Brown DM, Heier JS. et al. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med 2006; 355: 1419-1431
• 3 Brown DM, Kaiser PK, Michels M. et al. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med 2006; 355: 1432-1444
• 4 Kim JE, Mantravadi AV, Hur EY. et al. Short-term Intraocular pressure changes immediately after intravitreal injections of anti-vascular endothelial growth factor agents. Am J Ophthalmol 2008; 146: 930-934.e1
• 5 Hollands H, Wong J, Bruen R. et al. Short-term intraocular pressure changes after intravitreal injection of bevacizumab. Can J Ophthalmol 2007; 42: 807-811
• 6 Mojica G, Hariprasad SM, Jager RD. et al. Short-term intraocular pressure trends following intravitreal injections of ranibizumab (Lucentis) for the treatment of wet age-related macular degeneration. Br J Ophthalmol 2008; 92: 584-584
• 7 Horsley MB, Mandava N, Maycotte MA. et al. Retinal nerve fiber layer thickness in patients receiving chronic anti–vascular endothelial growth factor therapy. Am J Ophthalmol 2010; 150: 558-561.e1
• 8 Beck M, Munk MR, Ebneter A. et al. Retinal Ganglion Cell Layer Change in Patients Treated With Anti–Vascular Endothelial Growth Factor for Neovascular Age-related Macular Degeneration. Am J Ophthalmol 2016; 167: 10-17
• 9 Khaw PT. Glaucoma–1: diagnosis. BMJ 2004; 328: 97-99
• 10 Wen JC, Chen CL, Rezaei KA. et al. Optic Nerve Head Perfusion Before and After Intravitreal Antivascular Growth Factor Injections Using Optical Coherence Tomography-based Microangiography. J Glaucoma 2019; 28: 188-193
• 11 Riva CE, Hero M, Titze P. et al. Autoregulation of human optic nerve head blood flow in response to acute changes in ocular perfusion pressure. Graefes Arch Clin Exp Ophthalmol 1997; 235: 618-626
• 12 Tsui JL, Lau IH, Li SL. et al. Predictors of elevated intraocular pressure after intravitreal injection of anti-vascular endothelial growth factor: a prospective observational study. Hong Kong J Ophthalmol 2021; 25: 6-11
• 13 Hoguet A, Chen PP, Junk AK. et al. The Effect of Anti-Vascular Endothelial Growth Factor Agents on Intraocular Pressure and Glaucoma. Ophthalmology 2019; 126: 611-622
• 14 Agard E, Elchehab H, Ract-Madoux G. et al. Repeated intravitreal anti–vascular endothelial growth factor injections can induce iatrogenic ocular hypertension, especially in patients with open-angle glaucoma. Can J Ophthalmol 2015; 50: 127-131
• 15 Poli M, Denis P, Dot C. et al. Conduite à tenir face au risque dʼhypertonie oculaire après injection intra-vitréenne. J Fr Ophtalmol 2017; 40: e77-e82