Der Einfluss multipler Anti-VEGF-Injektionen auf den intraokularen Druck

Zusammenfassung

Hintergrund Multiple Anti-VEGF-Injektionen sollen als möglicher Risikofaktor für postoperative Augendruckerhöhungen untersucht werden.

Methode Es wurden 50 Augen von 50 Patienten in die retrospektive Studie aufgenommen, die mindestens 10 intravitreale Injektionen mit VEGF-Inhibitoren (Indikationen: altersbedingte Makuladegeneration, diabetische Makulopathie, Makulaödem nach retinalem Venenverschluss) an einem Auge erhalten hatten und deren Augendruck am 1. postoperativen Tag gemessen wurde. Ein Intraokulardruck (IOD) > 21 mmHg wurde als erhöht eingestuft und auf einen Zusammenhang zur Zahl der Injektionen hin untersucht.

Ergebnisse Es wurden 669 IOD-Messungen analysiert (nach im Mittel 13,4 Injektionen pro Auge). Bei 43 Augen (86%) kam es nach keiner Injektion zu einer IOD-Erhöhung am 1. postoperativen Tag. Eine transiente IOD-Erhöhung (> 21 mmHg) war nach 19 Injektionen (2,8%) zu verzeichnen (1 Patient davon mit 8 IOD-Erhöhungen). Es konnte keine persistierende IOD-Erhöhung oder Tendenz zur Zunahme von transienten IOD-Erhöhungen mit zunehmender Zahl der Injektionen nachgewiesen werden. Augen mit bekanntem Glaukom waren signifikant häufiger von einer IOD-Erhöhung betroffen als Augen ohne Glaukom (5,5 vs. 2,2%).

Schlussfolgerungen Multiple intravitreale Injektionen von Anti-VEGF-Inhibitoren sind kein eigenständiger Risikofaktor für persistierende Augendruckerhöhungen. Individuelle Risikofaktoren (z. B. präexistentes Glaukom) prädisponieren jedoch zu transienten IOD-Erhöhungen.

Abstract

Background To evaluate the possible effects of multiple intravitreal anti-vascular endothelial growth factor (VEGF) injections on intraocular pressure (IOP).

Methods This study included 50 eyes of 50 patients who underwent multiple (≥ 10 injections) intravitreal anti-VEGF injections in one eye with age-related macular degeneration, diabetic macular edema or retinal vein occlusion. IOP was recorded after every injection on the first postoperative day. IOP > 21 mmHg was regarded as abnormal. For statistical analysis, the IOP was correlated with the number of injections.

Results A total of 669 IOP-measurements (mean 13.4 treatment/eye) were analyzed. No IOP-elevation was recorded in 43 eyes (86%). Transient elevated IOP > 21 mmHg was measured after 19 intravitreal injections (2.8%, one patients with 8 IOP elevations). In general, there was no increasing risk of IOP elevation with time, no case of sustained IOP elevation and no additional long term glaucoma treatment necessary. Eyes with pre-existing glaucoma were significantly more affected from transient IOP-elevation than non-glaucoma eyes (5.5 vs. 2.2%).

Conclusions Multiple anti-VEGF injections are not associated with an increased risk of sustained IOP-elevation. On the other hand, individual risk factors exist and predispose to IOP-elevation (e.g., pre-existing glaucoma).

Schlüsselwörter

altersbedingte Makuladegeneration - Glaukom - retinaler Venenverschluss - intraokularer Druck - intravitreale Injektionen

Key words

age-related macular degeneration - glaucoma - retinal vein occlusion - intraocular pressure - intravitreal injections - VEGF inhibitors

• Literatur

• 1 Bourne RR, Jonas JB, Flaxman SR. et al. Vision Loss Expert Group of the Global Burden of Disease Study. Prevalence and causes of vision loss in high-income countries and in Eastern and Central Europe 1990–2010. Br J Ophthalmol 2014; 98: 629-638
• 2 Jonas JB, Bourne RR, White RA. et al. Vision Loss Expert Group of the Global Burden of Disease Study. Visual impairment and blindness due to macular diseases globally: a systematic review and meta-analysis. Am J Ophthalmol 2014; 158: 808-815
• 3 Ding J, Wong TY. Current epidemiology of diabetic retinopathy and diabetic macular edema. Curr Diab Rep 2012; 12: 346-354
• 4 Jaulim A, Ahmed B, Khanam T. et al. Branch retinal vein occlusion: epidemiology, pathogenesis, risk factors, clinical features, diagnosis, and complications. An update of the literature. Retina 2013; 33: 901-910
• 5 Miller JW, Le Couter J, Strauss EC. et al. Vascular endothelial growth factor a in intraocular vascular disease. Ophthalmology 2013; 120: 106-114
• 6 Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group. Martin DF, Maguire MG, Fine SL. et al. Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results. Ophthalmology 2012; 119: 1388-1398
• 7 Do DV, Nguyen QD, Khwaja AA. et al. Ranibizumab for edema of the macula in diabetes study: 3-year outcomes and the need for prolonged frequent treatment. JAMA Ophthalmol 2013; 131: 139-145
• 8 Papadia M, Misteli M, Jeannin B. et al. The influence of anti-VEGF therapy on present day management of macular edema due to BRVO and CRVO: a longitudinal analysis on visual function, injection time interval and complications. Int Ophthalmol 2014; 34: 1193-1201
• 9 Solomon SD, Lindsley K, Vedula SS. et al. Anti-vascular endothelial growth factor for neovascular age-related macular degeneration. Cochrane Database Syst Rev 2014; (08)
• 10 Reibaldi M, Pulvirenti A, Avitabile T. et al. Pooled estimates of incidence of endophthalmitis after intravitreal injections of anti-vascular endothelial growth factor agents with and without topical antibiotic prophylaxis. Retina 2017;
• 11 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
• 12 Mathalone N, Arodi-Golan A, Sar S. et al. Sustained elevation of intraocular pressure after intravitreal injections of bevacizumab in eyes with neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2012; 250: 1435-1440
• 13 Tseng JJ, Vance SK, Della Torre KE. et al. Sustained increased intraocular pressure related to intravitreal antivascular endothelial growth factor therapy for neovascular age-related macular degeneration. J Glaucoma 2012; 21: 241-247
• 14 Kim YJ, Sung KR, Lee KS. et al. Long-term effects of multiple intravitreal antivascular endothelial growth factor injections on intraocular pressure. Am J Ophthalmol 2014; 157: 1266-1271.e1
• 15 Hoerauf H, Holz F, Kramer A. et al. Stellungnahme von DOG, RG und BVA zur Endophthalmitis-Prophylaxe bei IVOM, September 2013. Im Internet: http://www.dog.org/wp-content/uploads/2013/03/Stand-Sep-2013-IVOM-topische-Antibiose.pdf Stand: 01.09.2017
• 16 Jorge J, Díaz-Rey JA, González-Méijome JM. et al. Clinical performance of the Reichert AT 550: a new non-contact tonometer. Ophthalmic Physiol Opt 2002; 22: 560-564
• 17 Augustin AJ, Holz FG, Haritoglou C. et al. Retrospective, observational study in patients receiving a dexamethasone intravitreal implant 0.7 mg for macular oedema secondary to retinal vein occlusion. Ophthalmologica 2015; 233: 18-26
• 18 Clark AF, Wordinger RJ. The role of steroids in outflow resistance. Exp Eye Res 2009; 88: 752-759
• 19 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
• 20 Hoang QV, Tsuang AJ, Gelman R. et al. Clinical predictors of sustained intraocular pressure elevation due to intravitreal anti-vascular endothelial growth factor therapy. Retina 2012; 33: 179-187
• 21 Morshedi RG, Ricca AM, Wirostko BM. Ocular hypertension following intravitreal antivascular endothelial growth factor therapy: review of the literature and possible role of nitric oxide. J Glaucoma 2016; 25: 291-300
• 22 Yannuzzi NA, Patel SN, Bhavsar KV. et al. Predictors of sustained intraocular pressure elevation in eyes receiving intravitreal anti-vascular endothelial growth factor therapy. Am J Ophthalmol 2014; 158: 319-327
• 23 Lanzl I, Kotliar K. Können Anti-VEGF-Injektionen Glaukom und okuläre Hypertension verursachen?. Klin Monatsbl Augenheilkd 2017; 234: 191-193
• 24 Bressler SB, Almukhtar T, Bhorade A. et al. Repeated intravitreous ranibizumab injections for diabetic macular edema and the risk of sustained elevation of intraocular pressure or the need for ocular hypotensive treatment. JAMA Ophthalmol 2015; 133: 589-597