Anti-VEGF Agents and IOP Spikes

Anti-VEGF injection is being investigated for treatment of the vascular or wet form of age-related macular degeneration (AMD). This is not an FDA-approved use for these medications, but it is becoming a popular off-label use. Wet AMD has no other good treatments and can quickly lead to serious vision loss, so any treatment that can reverse vision loss and preserve these gains can be expected to increase in popularity. However, researchers have discovered one major roadblock to this treatment avenue.

Following injections of anti-VEGF medications, patients have been experiencing spikes in intra-ocular pressure (IOP). Increased IOP can lead to optic nerve damage, and is the primary characteristic of most forms of glaucoma. Over time, elevated IOP can lead to vision loss. Short-term IOP spikes are a common side effect of all forms of eye injections, but the IOP spikes seen in anti-VEGF treatments seems to be long-term. Research suggests is may be related to a clogging of the open angle. One possible explanation is that the anit-VEGF drugs (primarily Avastin (bevacizumab) and Lucentis (ranibizumab)) may have been mishandled prior to injection and therefore contain a large number of silicone oil droplets. At least one study has shown that freezing the anti-VEGF drugs can cause silicone oil to leach the vials into the drug itself. When this occurs it causes a significant increase in the number of particles in the drug. Once inside the eye, the natural flow of fluids will draw them into the open angle, clogging it and causing secondary glaucoma.

If you are over the age of 45 and notice any changes in your vision, it is important to talk to an eye doctor to learn whether AMD may be responsible, and whether treatments are available for your form of the disease. Contact us today to find a local ophthalmologist.