Risk of Glaucoma Following Intravitreal Injections in Exudative AMD Patients: A Retrospective Cohort Study

Document Type

Conference Proceeding

Publication Date

6-2025

Publication Title

Investigative Ophthalmology and Visual Science

Abstract

Purpose : This study aims to evaluate the association between the cumulative number of intravitreal injections and the subsequent risk of developing ocular hypertension, primary open-angle glaucoma (POAG), and the initiation of first-line glaucoma treatments in patients with exudative age-related macular degeneration (AMD).

Methods : This retrospective cohort study utilized the TriNetX United States Collaborative Network, providing access to electronic medical records from over 60 healthcare organizations. The study included patients with exudative AMD, excluding those with diabetic macular edema, retinal vein occlusion, retinal ischemia, or neovascular glaucoma. The control group consisted of patients with exudative AMD who never received intravitreal injections. Patients with a prior history of glaucoma and first-line glaucoma treatment were excluded. Patients were categorized into three groups based on cumulative intravitreal injections: 1–3, 4–6, and >7. Propensity score matching (1:1) was conducted to balance cohorts on demographic variables and comorbidities. Outcomes assessed included POAG, ocular hypertension, and initiation of glaucoma treatment at 1 year post-index. Time-to-event analysis was performed to estimate hazard ratios (HR) and 95% confidence intervals for each outcome.

Results : Post-matching cohort sizes were as follows: 1–3 injections (8,014 patients), 4–6 injections (4,183 patients), and >7 injections (15,225 patients). At 1 year, the hazard ratio for POAG was 0.74 (95% CI: 0.48–1.14) in the 1–3 injection group, 1.01 (95% CI: 0.60–1.70) in the 4–6 injection group, and 1.336 (95% CI: 1.02–1.75) in the >7 injection group, compared to controls. For ocular hypertension, the HR at 1 year was 1.64 (95% CI: 1.09–2.46) for 1–3 injections, 2.006 (95% CI: 1.09–3.69) for 4–6 injections, and 1.94 (95% CI: 1.48–2.54) for >7 injections. Regarding initiation of first-line glaucoma treatment, the HR at 1 year was 0.98 (95% CI: 0.78–1.22) for 1–3 injections, 0.993 (95% CI: 0.75–1.31) for 4–6 injections, and 1.21 (95% CI: 1.05–1.41) for >7 injections.

Conclusions : These findings suggest that cumulative injection burden is associated with increased risks of ocular hypertension and initiation of first-line treatment over time. Further research is warranted to explore the underlying mechanisms and the role of injection frequency in glaucoma risk.

Volume

66

Issue

8

First Page

294

Comments

Association for Research in Vision and Ophthalmology ARVO Annual Meeting, May 4-8, 2025, Salt Lake City, UT

Last Page

294

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