Management of immediate and sustained intraocular pressure rise associated with intravitreal anti-VEGF injection therapy

Purpose of review: To summarize the findings of recent reports of short-term and sustained intraocular pressure (IOP) rise associated with intravitreal anti-vascular endothelial growth factor (VEGF) injections and to guide the management of this infrequent complication. Recent findings: Short-term increases in IOP are common immediately after intravitreal anti- VEGF injection. IOP takes longer to reach a safe level in patients with a history of glaucoma or ocular hypertension. Pre-injection medicinal therapy and ocular decompression therapy may blunt this short-term IOP rise. Sustained increases in IOP are relatively infrequent, but are likely to necessitate intervention for IOP-lowering. A “pro re nata” (PRN) injection protocol may obviate the need for intervention. The pathophysiology of sustained IOP rise is poorly understood, but may relate to repackaging processes undertaken by the pharmacies that compound these agents. Summary: Treating physicians should be aware of the potential for short-term and sustained IOP rise associated with intravitreal anti-VEGF injection therapy. Considerations for management include prophylactic IOP-lowering with medicinal therapy and/or pre-injection ocular decompression for patients with a history of glaucoma or ocular hypertension and switching to a “PRN” injection protocol in patients suffering a sustained rise in IOP.