Intraocular Pressure Rises More With Ranibizumab, Bevacizumab Than Aflibercept

Bevacizumab and ranibizumab treatments carry a higher risk of increased intraocular pressure (IOP) compared with aflibercept, according to research published in the American Journal of Ophthalmology. 

Researchers conducted a retrospective cohort study of 6585 participants (mean age, 73.6 years; 60% women) undergoing anti-vascular endothelial growth factor (VEGF) treatment with aflibercept (n=1749), bevacizumab (n=1112) or ranibizumab (n=3724) who received their first injection between 2011 and 2020. Patient IOP increase was defined by a recorded ICD-9 code 365 or the dispensation of 2 glaucoma medications within 180 days of each other. 

A total of 544 cases of increased IOP were noted in the intention-to-treat analysis. Patients treated with bevacizumab (hazard ratio [HR], 2.20; 95% CI, 1.64-2.95) and ranibizumab (HR, 1.88; 95% CI, 1.46-2.42) had a higher risk for IOP increase compared with individuals treated with aflibercept. The as-treated analysis confirms these elevated risks for bevacizumab (HR, 3.76; 95% CI, 2.30-6.17) and ranibizumab (HR, 2.49; 95% CI, 1.62-3.82), the report shows. 

“Repeated intravitreal injections of ranibizumab and bevacizumab may promote an inflammatory response due to increased [placental growth factor] levels in the eye: this could lead treated eyes to a higher risk of inflammatory-related increases in IOP than aflibercept,” the researchers suggest. 

A lack of data on glaucoma location (right vs left eye) and the indicated use for anti-VEGF treatments are acknowledged limitations to the study.