Repeated intravitreal injections of antivascular endothelial growth factors and risk of intraocular pressure medication use
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To determine the risk of initiating ocular hypertension and glaucoma treatment with repeated injections of antivascular endothelial growth factors (anti-VEGF).
A unique, retrospective cohort study was performed using a large national US medical claim database. The study population included patients who had 1 or more injections of an anti-VEGF agent. Exclusion occurred for any previous glaucoma, glaucoma suspect, glaucoma-related procedure, an ocular steroid injection, or not seeing an eye care provider at least once in each year of follow-up. Cohorts were divided into quartiles based on the number of injections performed over the follow-up period. Patients were observed for 2 and 3 years. The main outcome measure was defined as any new prescription for an ocular antihypertensive medication with a concurrent diagnosis of glaucoma, glaucoma suspect, or ocular hypertension. Multivariate logistic regression determined the odds of initiating glaucoma treatment in each injection quartile while controlling for numerous covariates. Sensitivity analysis assessed outcomes that included new medication only as well as a new medication plus diagnosis of glaucoma.
In total, 17,113 and 9992 patients met 2- and 3-year observation end points, respectively. The multivariate odds ratio for initiating glaucoma treatment at 2 years was higher in the highest quartile (OR 1.96, 95% CI 1.39–2.76, p < 0.001) compared with the lowest. The 3-year comparison had similar results with increased odds in the highest quartile (OR 1.51, 95% CI 1.07–2.13, p = 0.006) compared with the lowest. Sensitivity analyses also showed similar results with more injections being associated with initiating treatment (p < 0.053 for all comparisons).
Repeated anti-VEGF injections are associated with an increased odds of initiating treatment for ocular hypertension and glaucoma.
KeywordsGlaucoma Anti-VEGF Intravitreal injections Epidemiology
This study was funded by the National Institutes of Health K23 Award (1K23EY025729-01), National Institute of Healthy-National Eye Institute K12 Award (2K12EY015398-11A1; PI: Maureen Maguire), and University of Pennsylvania Core Grant for Vision Research (2P30EYEY001583). Additional funding was provided by Research to Prevent Blindness and the Paul and Evanina Mackall Foundation. Funding from each of the above sources was received in the form of block research grants to the Scheie Eye Institute.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All analyses performed in this study involving data from humans were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was deemed exempted from IRB review by the University of Pennsylvania Institutional Review Board due to the deidentified nature of the data used within the study. The need for informed consent was also waived by the University of Pennsylvania IRB again due to the deidentified nature of the data used.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. None of the organizations had any role in the design or conduction of the study.
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