Managing IOP After Intravitreal Injections, With Katherine Talcott, MD

As the demand for intravitreal injections rises with increasing cases of retinal diseases, including age-related macular degeneration (AMD), diabetic retinopathy, and retinal vein occlusions (RVO), so does concern over their impact on intraocular pressure (IOP). At the 2025 American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting, Katherine Talcott, MD, a retina specialist at the Cole Eye Institute, Cleveland Clinic, addressed a key question: Do these injections raise IOP—and if so, what does that mean for long-term patient care?

Short-term IOP spikes post-injection are well-documented, while many patients tolerate this well, others report transient blurred vision or discomfort.

“IOP increases in the short term,” Talcott told HCPLive. “The eye has a fixed volume, and we're injecting an additional volume, so it's common for pressure to go up. It’s not uncommon for my patients to say their vision is a little blurry or irritated for a period afterwards. I make sure that patients can see my hands moving after the injection, and if they can’t, I recheck the pressure.”

Talcott emphasizes tailored follow-up: after checking vision clarity immediately post-injection, she monitors for pressure spikes in select patients, sometimes using pressure-lowering drops or considering a glaucoma workup. More nuanced risks arise with steroid-based injections, which can cause delayed IOP increases.

However, Talcott pointed to available data—ranging from clinical trials to large registry studies using the IRIS registry—indicating that long-term pressure increases affect only a small minority of patients, often fewer than 5%.

With newer therapies entering the market, including high-volume anti-vascular endothelial growth factor (VEGF) agents and complement inhibitors for geographic atrophy, the interplay between injection volume and IOP remains an area of active observation. Talcott stressed the importance of ongoing vigilance as treatment intervals extend and drug types evolve.

She also welcomed growing cross-specialty collaboration in ophthalmology, noting the value of retina specialists participating in broader meetings like ASCRS. Looking ahead, Talcott expressed optimism for continued innovation in the field, citing upcoming trial data and evolving treatment strategies for AMD and geographic atrophy.

“It'll be interesting to see how this plays out, and then some of our patients, like our AMD patients, might be getting anti-VEGF injections, but also might be getting complement inhibitor injections,” Talcott told HCPLive. “It’ll be interesting to see how that sort of shakes out, but good to remain vigilant about checking.”

Relevant disclosures for Talcott include AbbVie, Apellis, Bausch & Lomb, and Zeiss.

References

Talcott KE. Does IOP Really Increase with Intravitreal Injections?. Presented at: 2025 American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting. April 25-28, 2025. Los Angeles, CA.