The effect of intraocular pressure lowering medications on the pressure spike associated with intravitreal injection
Purpose. This study investigates whether the post intravitreal injection intraocular pressure (IOP) spike is modifiable with the use of prophylactic apraclonidine and dorzolomide.
Methods. The study design is a prospective, randomized controlled clinical trial. 80 eyes undergoing intravitreal injection of anti-VEGF agent were studied. A control group (n = 42) received no IOP lowering drops, and a study group (n = 38) received topical apraclonidine and dorzolamide 30 to 40 minutes before the intravitreal injection. IOP measurements were taken in both groups using the Perkins tonometer at baseline, immediately before and after the injection, 5 minutes post-injection, and 15 minutes post-injection.
Results. Mean IOP immediately post injection in the study group compared to the control group was lower: 26.71 mmHg versus 32.73 mmHg (p=0.026). The main outcome measure was the area under the curve (AUC), reflecting the trend of IOP post injection. The AUC was lower in the study group compared to the control group (Mann-Whitney U test, p=0.046).
Conclusions. The use of prophylactic apraclonidine and dorzolamide is effective in modifying the post-injection IOP spike. IOP lowering prophylaxis may be considered in patients with a high baseline IOP.
Full Text:PDF - EyeReports 2018 v4 p1-6
Bloch SB, Larsen M, Munch IC. Incidence of legal blindness from age-related macular degeneration in Denmark: year 2000 to 2010. Am J Ophthal. 2012; 153: 209-13.
Bressler NM, Doan QV, Varma R, et al. Estimated cases of legal blindness and visual impairment avoided using ranibizumab for choroidal neovascularization: non-Hispanic white population in the United States with age-related macular degeneration. Arch Ophthalmol. 2011; 129: 709-17.
Skaat A, Chetrit A, Belkin M, et al. Time trends in the incidence and causes of blindness in Israel. Am J Ophthalmol. 2012;153:214-21 e1.
Falkenstein IA, Cheng L, Freeman WR. Changes of intraocular pressure after intravitreal injection of bevacizumab (Avastin). Retina. 2007; 27: 1044-7.
Wu L, Evans T. [Immediate changes in intraocular pressure after an intravitreal injection of 2.5 mg of bevacizumab]. Arch Soc Esp Oftalmol. 2010; 85: 364-9.
Sharei V, Hohn F, Kohler T, et al. Course of intraocular pressure after intravitreal injection of 0.05 mL ranibizumab (Lucentis). Eur J Ophthalmol. 2010; 20: 174-9.
Hariprasad SM, Shah GK, Blinder KJ. Short-term intraocular pressure trends following intravitreal pegaptanib (Macugen) injection. American J Ophthalmol. 2006; 141: 200-1.
Rosenfeld PJ, Brown DM, Heier JS, et al. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med. 2006; 355: 1419-31.
Aiello LP, Brucker AJ, Chang S, et al. Evolving guidelines for intravitreous injections. Retina. 2004; 24: S3-19.
Frenkel MP, Haji SA, Frenkel RE. Effect of prophylactic intraocular pressure-lowering medication on intraocular pressure spikes after intravitreal injections. Arch Ophtalmol. 2010; 128: 1523-7.
El Chehab H, Le Corre A, Agard E, et al. Effect of topical pressure-lowering medication on prevention of intraocular pressure spikes after intravitreal injection. Eur J Ophthalmol. 2013; 23: 277-83.
Theoulakis PE, Lepidas J, Petropoulos IK, et al. Effect of brimonidine/timolol fixed combination on preventing the short-term intraocular pressure increase after intravitreal injection of ranibizumab. Klin Monbl Augenheilkd. 2010; 227: 280-4.
Pruessner JC, Kirschbaum C, Meinlschmid G, Hellhammer DH. Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time-dependent change. Psychoneuroendocrinology. 2003; 28: 916-31.
Robin AL, Pollack IP, House B, Enger C. Effects of ALO 2145 on intraocular pressure following argon laser trabeculoplasty. Arch Ophthalmol. 1987; 105: 646-50.
Barnes SD, Campagna JA, Dirks MS, Doe EA. Control of intraocular pressure elevations after argon laser trabeculoplasty: comparison of brimonidine 0.2% to apraclonidine 1.0%. Ophthalmol. 1999; 106: 2033-7.
Ladas ID, Baltatzis S, Panagiotidis D, et al. Topical 2.0% dorzolamide vs oral acetazolamide for prevention of intraocular pressure rise after neodymium:YAG laser posterior capsulotomy. Arch Ophthalmol. 1997; 115: 1241-4.
Wilensky JT, Gieser DK, Dietsche ML, et al. Individual variability in the diurnal intraocular pressure curve. Ophthalmol. 1993; 100: 940-4.
Kim JE, Mantravadi AV, Hur EY, Covert DJ. Short-term intraocular pressure changes immediately after intravitreal injections of anti-vascular endothelial growth factor agents. Am J Ophthalmol. 2008; 146: 930-4.
Hollands H, Wong J, Bruen R, et al. Short-term intraocular pressure changes after intravitreal injection of bevacizumab. Can J Ophthalmol. 2007; 42: 807-11.
Pallikaris IG, Kymionis GD, Ginis HS, et al. Ocular rigidity in living human eyes. Invest Ophthalmol Vis Sci. 2005; 46: 409-14.
Detry-Morel M. Currents on target intraocular pressure and intraocular pressure fluctuations in glaucoma management. Bull Soc Belge Ophthalmol. 2008; 308: 35-43.
Realini T, Barber L, Burton D. Frequency of asymmetric intraocular pressure fluctuations among patients with and without glaucoma. Ophthalmol. 2002; 109: 1367-71.
Zeimer RC, Wilensky JT, Gieser DK, Viana MA. Association between intraocular pressure peaks and progression of visual field loss. Ophthalmol. 1991; 98: 64-9.
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution 3.0 License.
Eye Reports [eISSN 2039-4756] is a new Open Access, online-only, peer-reviewed journal.