Persistent elevation of intraocular pressure following intravitreal injection of bevacizumab

Background: The number of patients treated with intravitreal injections has increased significantly over the past few years, mainly following the introduction of anti-vascular endothelial growth factor antibody intraocular drugs. Bevacizumab is mostly used in this group of medications. Objectives: To describe persistent elevation of intraocular pressure (IOP) following intravitreal injection of bevacizumab. Methods: We reviewed consecutive cases of persistent IOP elevation after intravitreal bevacizumab injection for exudative age-related macular degeneration (AMD). A total of 424 patients (528 eyes) met the inclusion criteria and received 1796 intravitreal injections of bevacizumab. Persistent IOP elevation was found in 19 eyes (3.6%, 19/528) of 18 patients (4.2%, 18/424) with IOP elevated 30-70 mmHg 3-30 days after injection. Results: Mean IOP was 42.6 mmHg (range 30-70); IOP elevations occurred after an average of 7.8 injections of bevacizumab (range 3-13). Injected eyes (19/528) had a significantly higher incidence of elevated IOP than uninjected eyes (fellow eyes), 1/328, P < 0.001. Conclusions: Like other anti-vascular endothelial growth factor (VEGF) substances reported in a few recent studies, intravitreal injection of bevacizumab for neovascular AMD may be associated with persistent IOP elevation. Providers should be aware that significant IOP elevation might occur after repeated treatments.