Khalil, H., Gouda, A., Abd Allah, I. (2022). Comparison between the Effect of Aflibercept (Eylea) and Ranibizumab (Lucentis) on Intraocular Pressure after 3rd Injection in Treatment of Diabetic Macular Edema. test, 3(3), 130-145. doi: 10.21608/ejmr.2022.255022
Hossam El Deen Mohamed Khalil; Ahmed Taha Gouda; Ibrahim Osama Ibrahim Abd Allah. "Comparison between the Effect of Aflibercept (Eylea) and Ranibizumab (Lucentis) on Intraocular Pressure after 3rd Injection in Treatment of Diabetic Macular Edema". test, 3, 3, 2022, 130-145. doi: 10.21608/ejmr.2022.255022
Khalil, H., Gouda, A., Abd Allah, I. (2022). 'Comparison between the Effect of Aflibercept (Eylea) and Ranibizumab (Lucentis) on Intraocular Pressure after 3rd Injection in Treatment of Diabetic Macular Edema', test, 3(3), pp. 130-145. doi: 10.21608/ejmr.2022.255022
Khalil, H., Gouda, A., Abd Allah, I. Comparison between the Effect of Aflibercept (Eylea) and Ranibizumab (Lucentis) on Intraocular Pressure after 3rd Injection in Treatment of Diabetic Macular Edema. test, 2022; 3(3): 130-145. doi: 10.21608/ejmr.2022.255022

Comparison between the Effect of Aflibercept (Eylea) and Ranibizumab (Lucentis) on Intraocular Pressure after 3rd Injection in Treatment of Diabetic Macular Edema

Egyptian Journal of Medical Research
Volume 3, Issue 3, July 2022, Pages 130-145    PDF (352.19 K)
Document Type: Original Article
DOI: 10.21608/ejmr.2022.255022
Authors
Hossam El Deen Mohamed Khalil; Ahmed Taha Gouda; Ibrahim Osama Ibrahim Abd Allah
Ophthalmology Department, Faculty of Medicine, Beni Suef University
Abstract
Background: Currently, intravitreal injection of anti-VEGF is typically applied in the treatment of choroidal neovascularization (CNV), which occurs in patients with wet age-related macular degeneration (wAMD) and high myopia. It is also used to treat patients with macular edema secondary to diabetic retinopathy (DME) and retinal vein occlusions (RVO-ME). Objectives: This is a prospective, comparative clinical study between aflibercept (Eylea) and Ranibizumab (Lucentis) done to evaluate changes in intraocular pressure following 3rd intravitreal injection of different types of anti-VEGF agents used in patients presenting with proliferative diabetic retinopathy and diabetic macular edema and determine the need to monitor IOP after intravitreal injections of anti-VEGF agents. Patients and Methods: This is a prospective, comparative clinical study, that was conducted on 60 eyes of 60 patients. Patients scheduled for intravitreal injection of anti-VEGF 3 times were randomly divided into 2 groups: Group A: 30 eyes will be scheduled for intravitreal injection of ranibizumab (0.5 mg/0.05 ml) 3 times for the treatment of diabetic macular edema or proliferative diabetic retinopathy. Their mean age was (59.80±7.27 years), Group B: 30 eyes will be scheduled for intravitreal injection of aflibercept (2 mg/0.05 ml) 3 times for the treatment of diabetic macular edema or proliferative diabetic retinopathy. Their mean age was (59.83±6.29 years). Results: There is no significant difference between IOP after 1 week,1 month and 2 months regarding ranibizumab and aflipercept, however, the range of decrease of IOP after one month regarding aflipercept was less than that of ranibizumab, accordingly, we can correlate this difference to the longer half life of aflipercept than that of ranibizumab. Conclusion: The current study confirms the results of previous studies which showed the safety of multiple IV injection of anti-VEGF agents for IOP elevation in post-injection first month in non glaucomatous patients. However, there might be a tendency to  increased IOP in glaucoma cases and repeated injections, so further studies about safety of repeated injections, in glaucomatous patients and for different retinal disorders should be carried out. Our study for intravitreal injections recommend “monitoring of IOP after injection and providing therapy when elevated IOP warrants intervention”.
Keywords
Aflibercept (Eylea); Ranibizumab (Lucentis); Diabetic Macular Edema
References
  1. Catt Research Group. Ranibizumab and bevacizumab for neovascular age-related macular degeneration. N Engl J Med. 2011; 364: 1897–908.
  2. Heier JS, David MB, Victor C, Jean-Francois K, Peter KK, Quan DN, Bernd K, Allen H, Yuichiro O, George DY et al. Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration. Ophthalmology. 2012; 119: 2537–48.
  3. Heier JS, Antoszyk AN, Pavan PR, et al. (2006): Ranibizumab for treatment of neovascular age-related macular degeneration: a phase I/II multicenter, controlled, multidosestudy.Ophth-almology; 113(4):633, e1-4.
  4. Van der Reis MI, La Heij EC et al. (2011): A systematic review of the adverse events of intravitreal anti-vascular endothelial growth factor injections. Retina; 31:1449–1469.
  5. Hollands H, Wong J, Bruemn R et al. (2007): Short-term intraocular pressure changes after intravitreal injection of bevacizumab. Can J Ophthalmol; 42:807– 811.
  6. Mojica G, Hariprasad SM, Jager RD et al. (2008): Short-term intraocu­lar pressure trends following intravitreal injections of ranibizumab (Lucentis) for the treatment of wet age-related macular degeneration. Br J Ophthalmol.; 92(4):584.
  7. Sharei V, Hohn F, Kohler T, et al. (2010): Course of Intraocular Pressure after Intravitreal Injection of 0.05 mL Ranibizumab (Lucentis). European Journal of Ophthalmology, 2010; 20, 174-179.
  8. Knip MM and Välimäki J. Effects of pegaptanib injections on intraocular pressure with and without anterior chamber paracentesis: a prospective study. Acta ophthalmologica. 2012; 90: 254–8.
  9. Kotliar K, Mathias M, Svetlana B, Nikolaus F, Chris L, Ines L et al. Effect of intravitreal injections and volume changes on intraocular pressure: clinical results and biomechanical model. Acta Ophthalmol Scand. 2007; 85: 777–81.
  10. Jack JK. Brad Bowling, Seventh Edition, 2012; pp: 312.
  11. Gismondi M, Salati C, Salvetat ML et al. (2009): Short-term effect of intravitreal injection of ranibizumab (Lucentis) on intraocular pressure. J Glaucoma; 18:658–661.
  12. Abedi G, Adelman RA and Salim S (2013): Incidence and management of elevated intraocular pressure with antivascular endothelial growth factor agents. Semin Ophthalmol; 28:126–130.
  13. Lemos-Reis R, Moreira-Gonc¸ et al. (2014): Immediate effect of intravitreal injection of bevacizumab on intraocular pressure. Clin Ophthalmol; 23:1383–1388.
  14. Sniegowski M, Mandava N and Kahook MY, (2010): Sustained intraocular pressure elevation after intravitreal injection of bevacizumab and ranibizumab associated with trabeculitis. Open Ophthalmol J; 4:28–29.
  15. Morshedi RG, Ricca AM and Wirostko BM (2014): Ocular hypertension following intravitreal antivascular endothelial growth factor therapy: review of the literature and possible role of nitric oxide. J Glaucoma (Epub ahead of print)
  16. SooHoo JR, Seibold LK and Kahook MY (2014): The link between intravitreal antivascular endothelial growth factor injections and glaucoma. Curr Opin Ophthalmol; 25:127–133.
  17. Good TJ, Kimura AE et al. (2011): Sustained elevation of intraocular pressure after intravitreal injections of anti-VEGF agents.Br J Ophthalmol; 95(8):1111-4.
  18. Adelman RA, Zheng Q, Mayer HR (2010): Persistent ocular hypertension following intravitreal bevacizumab and ranibizumab injections. J OculPharmacolTher; 26:105–110.
  19. Kernt M, Welge-Lüssen U, Yu A, et al. (2007):Bevacizumab is not toxic to human anterior- and posterior-segment cultured cells. Ophthalmologe; 104:965–971.
  20. Ladas JG, Yu F, Davis JL, et al. (2001): Relationship between aqueous humor protein leveland outflow facility in patients with uveitis. Invest Ophthalmol Vis Sci; 42:2584e8.
  21. Georgopoulos M, Polak K, Prager F et al. (2009): Characteristics of severe intraocular inflammation following intravitreal injection of bevacizumab (Avastin). British Journal of Ophthalmology; 93(4):457–462.
  22. Liu L, Ammar DA, Ross LA, et al. (2011): Silicone oil microdroplets and protein aggregates in repackaged bevacizumab and ranibizumab: effects of long-term storage and product mishandling. Invest Ophthalmol Vis Sci; 2:1023–1034.
  23. Meyer CH, Liu Z, Brinkmann C, et al. (2011): Accuracy, precision and repeatability in preparing the intravitreal dose with a 1.0-cc syringe. Acta Ophthalmol 2011. Epub ahead of print.
  24. Bakri SJ, McCannel CA, Edwards AO, et al. (2008): Persisent ocular hypertension following intravitreal ranibizumab. Graefesn Arch Clin Exp Ophthalmol; 246:955–958.
  25. Kahook MY, Kimura AE, Wong LJ et al. (2009): Sustained elevation in intraocular pressure associated with intravitreal bevacizumab injections. Ophthalmic Surg Lasers Imaging; 40: 293-5.
  26. Choi DY, Ortube MC, McCannel CA, et al. (2011):Sustained elevated intraocular pressures after intravitreal injection of bevacizumab, ranibizumab, and pegaptanib. Retina.; 31(6): 1028-35.
  27. Quigley HA and Broman AT (2006): The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol; 90: 262–267.
  28. Omay E, Elgin U, Sen E et al. (2016): The early effects of intravitreal anti vascular endothelial growth factor agents on intraocular pressure and central corneal thickness Int Ophthalmol; 36: 665.
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