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Intraocular pressure changes and vascular endothelial growth factor inhibitor use in various retinal diseases: long-term outcomes in routine clinical practice: data from the fight retinal blindness! Registry
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Referred to by Abstracts Ophthalmology, Volume 127, Issue 10, October 2020, Pages 1282-1286.. International audience. 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.
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