Incidence of glaucoma surgeries related to intravitreal Anti-VEGF injections
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First Author: N.Maes UK
Co Author(s): S. Schendel J. Liu G. Docherty
To highlight the elevated number of Glaucoma surgeries related to the use of intravitreal antivascular endothelial growth factor (anti-VEGF) over a period of 18 months (from January/2016 to July/2017), under the care of one glaucoma surgeon in Vancouver, British Columbia.
University of British Columbia, Vancouver, Canada
Glaucoma surgeries performed during this period were retrospectively reviewed. The patients who were undergoing intravitreal Anti-VEGF treatment were included. The subjects who developed Neovascular Glaucoma and those who required steroid injections, were excluded. Patient’s epidemiology was collected, as well as glaucoma surgery performed, subtype of anti-VEGF medication used and retinal cause for treatment. The mean number of drops, visual acuity and intraocular pressure (IOP) before, 6 and 12 months after surgery were also assessed. More recently, the deterioration of the mean deviation (MD) in the Visual Field (HVF) from baseline up to 2 years after surgery was also collected.
A total of 430 Glaucoma surgeries were performed. From this total, 121 (28.14%) surgeries were carried out in the context of ongoing treatment with anti-VEGF intravitreal injections, corresponding to 107 patients (12 patients required 2 surgeries during this time and 1 patient required 3 surgeries). Six (5.6%) of these patients required bilateral glaucoma surgery. Of the cases, 41 (33.88%) were previously known to have glaucoma or were glaucoma suspects and 80 (66.11%) did not have glaucoma or ocular hypertension before starting the Anti-VEGF treatment. The mean visual acuity before surgery was 20/70 and it was 20/80 12 months after. The most prevalent retinal pathology was age related Macular Degeneration (AMD), seen in 87 patients (71.9%), followed by Diabetic Retinopathy in 21 cases (17.35%) and retinal vein occlusion in 12 subjects (10%). The most commonly used Anti-VEGF medication was the Bevacizumab, being administrated exclusively in 103 cases (84.42%), or in combination with Aflibercept or Ranibizumab in 9 patients (7.43%). The Aflibercept was used alone in 9 of our patients (7.43%). The average MD of the visual field performed before the Glaucoma surgery was -14.88dB. After a 2-year interval, the new average MD was -17.78dB. Thirty-one of 64 patients had a deterioration of -5dB or less. Twelve patients (19%) had a deterioration in between -5 and -15dB and 3 patients declined more than -15dB on the HVF.
A surprisingly elevated rate of Glaucoma surgeries has been observed among patients that require intravitreal anti-VEGF treatment in Vancouver. To the best of our knowledge, according to the most recent literature review, this inflated number of glaucoma surgeries related to Anti-VEGF treatment has not been reported worldwide. The incidence of surgical glaucoma among this rising population of patients seems to be a local health problem that requires active discussion for further understanding. At the moment, the Canadian Ophthalmological Society is engaged in assessing national data on the subject