The effect of intravitreal injections for diabetic macular edema on intraocular pressure: Comparative study

Abstract Objective: The study's goal is to determine how IOP gets affected following intravitreal injection of various anti-VEGF for diabetic macular edema (DME) over 2 months duration using applanation tonometery. Methods: Nominated patients coming through the ophthalmology department of Kafrelsheikh and Tanta university hospitals who meet the presence inclusion criteria. 36 eyes were examined, including their IOP. By using a 30 gauge needle, intravitreal injection of ranibizumab (0.5 mg/0.05 ml), intravitreal injection of aflibercept (2 mg/0.05 ml) and intravitreal injection of Dexamethazone implant (Ozurdex) were administered through 3.5 to 4 mm after limbus. Then next IOP interpretation was measured 1 week, 1 month and 2 months of intravitreal injections for each drug. IOPs were measured also earlier pre injection "baseline IOP". All pressures were measured using the applantation tonometry. Results: 36 Patients received intravitreal injection once and followed up for 2 months. 18 males and 18 females, their ages ranged from 45-76 years (mean 59.59 years (. Diabetic retinopathy observed clinically to be clinically significant macular edema and was proved by OCT and central foveal thickness was assessed. After 1 week and 2 months of intravitreal injections of the three materials no significant difference was noted in the IOP values (P value with 0.868 and 0.246 respectively). IOP measurement after 1 month was significantly higher in eyes injected with Ozurdex compared with eyes injected with ranibizumab or aflibercept (P value with 0.032). IOP returned to the normal range in three groups over the next month without any medical treatment. According to our study, the result of stratification with respect to age, and gender is not significant as p-value for age (0.893), gender (0.083). Conclusion: In our study, frequency of raised IOP after anti VEGF were found more with Ozurdex than ranibizumab and aflibercept and that was more statistically significant after 1 month post injection. Though even without treatment IOP returns to normal within 2 months indicating Ozurdex safety as trustworthy antivegf theraby for resistant DME. Intravitreal injection of anti-VEGF drugs may have significant side effects so appropriate post-injection observation is crucial to reduce risk.