title: Effect of brimonidine/timolol fixed combination on preventing the short-term intraocular pressure increase after intravitreal injection of ranibizumab.
abstract: BACKGROUND
  The aim of this study was to evaluate the safety and efficacy of brimonidine 0.2 % and timolol 0.5 % instillation as a fixed combination (Combigan, Allergan Inc.) to prevent acute intraocular pressure (IOP) increase occurring after intravitreal injection of ranibizumab (Lucentis, Novartis Pharma AG).
  
  
  METHODS
  A prospective double-blind placebo-controlled study was carried out. One eye of 88 consecutive normotensive age-related macular degeneration patients receiving Lucentis was randomized into placebo drops (artificial tears, 44 patients) or Combigan drops (44 patients) given twice a day the day before and the day of injection. IOP was measured before and 5, 10, 15 minutes and 1 hour after the intravitreal injection.
  
  
  RESULTS
  The placebo group had the higher mean IOP at all time points after injection. Maximum IOP increase for both groups occurred at the 5-minutes time point. Mean post-injection IOP in the placebo group was 34.1 +/- 2.7 mmHg at 5 minutes post-injection versus 28.4 +/- 1.1 mmHg in the Combigan group (P < 0.001). IOP decreased to 24.9 +/- 1.8 mmHg (placebo group) and 19.9 +/- 1.1 mmHg (Combigan group) at 10 minutes post-injection. At 15 minutes post-injection, IOP was below 20 mmHg in all eyes of the Combigan group (100 %), whereas at the same time point these IOP levels were reached only by 34 % of the eyes of the placebo group (15 eyes). All eyes of both groups had a normal IOP 1 hour post-injection. No systemic or ocular side effect was recorded in either group.
  
  
  CONCLUSIONS
  The use of Combigan drops twice a day the day before and the day of injection in eyes scheduled for intravitreal injection of Lucentis is a safe and effective prophylaxis to reduce the acute IOP spikes of the post-injection period.
authors.affiliation: Department of Ophthalmology, Royal Free Hospital NHS Trust, London, UK.
authors.forename: P E
authors.initials: PE
authors.lastname: Theoulakis
authors.forename: J
authors.initials: J
authors.lastname: Lepidas
authors.forename: I K
authors.initials: IK
authors.lastname: Petropoulos
authors.forename: A
authors.initials: A
authors.lastname: Livieratou
authors.forename: C K
authors.initials: CK
authors.lastname: Brinkmann
authors.forename: J M
authors.initials: JM
authors.lastname: Katsimpris
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D000959:Antihypertensive Agents / Q000008:administration & dosage; D000068438:Brimonidine Tartrate; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D006801:Humans; D015552:Injections, Intralesional / Q000009:adverse effects; D007429:Intraocular Pressure / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000139:chemically induced* / Q000517:prevention & control*; D015990:Placebo Effect; D011810:Quinoxalines / Q000008:administration & dosage*; D000069579:Ranibizumab; D013999:Timolol / Q000008:administration & dosage*; D016896:Treatment Outcome; D014822:Vitreous Body
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000959:Antihypertensive Agents; D004338:Drug Combinations; D011810:Quinoxalines; D000068438:Brimonidine Tartrate; D013999:Timolol; D000069579:Ranibizumab