The effect of intraocular pressure lowering medications on the pressure spike associated with intravitreal injection


  • Olya Pokrosvkaya Mater Miscericordiae University Hospital, Dublin, Ireland
  • Ian Dooley
  • Salma Babiker
  • Catherine Croghan
  • Claire Hartnett
  • Anthony Cullinane



intraocular pressure, intravitreal injection, anti-VEGF, ranibizumab, exudative macular degeneration, wet macular degeneration, apraclonidine, dorzolamide


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.

Author Biography

Olya Pokrosvkaya, Mater Miscericordiae University Hospital, Dublin, Ireland

Ophthalmology registrar, Department of Ophthalmology, Mater Miscericordiae University Hospital, Dublin, Ireland


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