Evaluation of the effects of recurrent intravitreal aflibercept and ranibizumab on intraocular pressure change in patients with diabetic retinopathy and wet type age related macular degeneration

Güvenç TOPRAK, Evaluation of the Effects of Recurrent Intravitreal Aflibercept and Ranibizumab on Intraocular Pressure Change in Patients with Diabetic Retinopathy and Wet Type Age Related Macular Degeneration. Master Thesis, Bolu, 2019 Age-related macula degeneration (AMD) is the most causative factor of untreatable vision loss in developed countries. It was described mainly two type such as neovascular and non-neovascular. Wet AMD progresses more agressively than dry AMD, despite its rarely occasion. Choroidal neovascular membrane (CNVM) is the characteristic lesion in wet-AMD. Vascular endothelial growth factor (VEGF) is the main responsible for CNVM. Diabetic Retinopathy (DR) is the most frequent disease of treatable blindness. Vision loss in DR secondary to macular edema most often. DME related with increase of vascular leakage associated with higher VEGF levels. VEGF plays key role in AMD and DRP pathogenesis. Anti-VEGF agents such as Ranibizumab or Aflibercept are usually used in the treatment of these disease. Anti-VEGF agents were mostly injected intravitreally and IOP elevation and vitreous reflux are the most complications after intravitreal injection. We aimed to compare of the effect of repeated injections and type of anti-VEGF agents and disease on IOP change and vıtreus reflux in the patient injected with more than 10 injections. Additionaly, we also evaluated RNFL thickness at baseline and 6th months of follow-up. Total number of injections and IOP measurements at abovementioned times were similar in AMD and DRP groups. The IOP measured at postoperative early period was lower in AMD group than those in DRP group. The difference of the patients' age and diameter of bleb were found statically significant. These parameters in AMD was higher than in DRP. All parameter were similar among the groups of ranibizumab and aflibercept. In both groups (AMD-DRP), RNFL values of the patients who were followed before and after the injection were diagnosed with open angle glaucoma. This dilution was significantly higher in the DRP patient group. The negative correlation was observed between IOP measurement shortly after injection and pseudophakic status and diameter of bleb secondary to vitreus reflux. There was no correlation between number of injections and IOP measurements. In conclusion, we thought that vitreus liquefaction in the patients with AMD may be causing factor for vitreus reflux, which contributes to lower IOP measurement. Early IOP elevation after intravitreal injection in pseudophakic patients were observed less often than phakic patients. We thought that enhanced vitreus volume after cataract surgery might cause less IOP elevation after intravitreal injection. In addition, RNFL thinning in the group of patients with glaucoma DRP was thought to be due to IOP elevation after intravitreal injection. It was thought that this damage might be more in young individuals with glaucoma and premedication before intravitreal injection was suggested. Keyword: DRP, Wet-AMD, Aflibercept, Ranibizumab, Vitreous Reflux, IOP, RNFL