Journal
GRAEFES ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY
Volume 257, Issue 9, Pages 1931-1939Publisher
SPRINGER
DOI: 10.1007/s00417-019-04362-7
Keywords
Glaucoma; Anti-VEGF; Intravitreal injections; Epidemiology
Categories
Funding
- National Institutes of Health K23 Award [1K23EY025729-01]
- National Institute of Healthy-National Eye Institute K12 Award [2K12EY015398-11A1]
- University of Pennsylvania Core Grant for Vision Research [2P30EYEY001583]
- Research to Prevent Blindness
- Paul and Evanina Mackall Foundation
- NATIONAL EYE INSTITUTE [P30EY001583] Funding Source: NIH RePORTER
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Purpose To determine the risk of initiating ocular hypertension and glaucoma treatment with repeated injections of antivascular endothelial growth factors (anti-VEGF). Methods A unique, retrospective cohort study was performed using a large national US medical claim database. The study population included patients who had 1 or more injections of an anti-VEGF agent. Exclusion occurred for any previous glaucoma, glaucoma suspect, glaucoma-related procedure, an ocular steroid injection, or not seeing an eye care provider at least once in each year of follow-up. Cohorts were divided into quartiles based on the number of injections performed over the follow-up period. Patients were observed for 2 and 3 years. The main outcome measure was defined as any new prescription for an ocular antihypertensive medication with a concurrent diagnosis of glaucoma, glaucoma suspect, or ocular hypertension. Multivariate logistic regression determined the odds of initiating glaucoma treatment in each injection quartile while controlling for numerous covariates. Sensitivity analysis assessed outcomes that included new medication only as well as a new medication plus diagnosis of glaucoma. Results In total, 17,113 and 9992 patients met 2- and 3-year observation end points, respectively. The multivariate odds ratio for initiating glaucoma treatment at 2 years was higher in the highest quartile (OR 1.96, 95% CI 1.39-2.76, p < 0.001) compared with the lowest. The 3-year comparison had similar results with increased odds in the highest quartile (OR 1.51, 95% CI 1.07-2.13, p = 0.006) compared with the lowest. Sensitivity analyses also showed similar results with more injections being associated with initiating treatment (p < 0.053 for all comparisons). Conclusions Repeated anti-VEGF injections are associated with an increased odds of initiating treatment for ocular hypertension and glaucoma.
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