title: Effect of prophylactic intraocular pressure-lowering medication on intraocular pressure spikes after intravitreal injections.
abstract: OBJECTIVE
  To determine if prophylactic use of intraocular pressure (IOP)-lowering medication is effective in reducing the IOP spikes after intravitreal injections of pegaptanib, bevacizumab, and ranibizumab.
  
  
  METHODS
  Seventy-one patients with exudative age-related macular degeneration received intravitreal injections of 1 of 3 anti-vascular endothelial growth factor medications: 30 patients received pegaptanib (0.09 mL), 47 patients received bevacizumab (0.05 mL), and 42 patients received ranibizumab (0.05 mL). Intraocular pressure-lowering medication, 1 hour prior to the injection, was used 63%, 74%, and 66% of the time in eyes that received pegaptanib, ranibizumab, and bevacizumab, respectively. Intraocular pressure was measured prior to injection, within 1 minute after injection, and every 5 to 10 minutes until the pressure was reduced to a safe level.
  
  
  RESULTS
  All 3 intravitreal injections caused significant initial IOP spikes (mean [SD] IOP of 38.5 [11.56] mm Hg in the pegaptanib group, 37.75 [8.36] mm Hg in the ranibizumab group, and 34.88 [10.45] mm Hg in the bevacizumab group). The IOP reduced to less than 30 mm Hg in all 3 groups within 20 minutes. Prophylactic medication did not prevent postinjection IOP spikes. Patients with and without glaucoma showed a similar rate of IOP normalization over time in all 3 groups.
  
  
  CONCLUSIONS
  Intraocular pressure spikes after intravitreal injection of pegaptanib, ranibizumab, and bevacizumab are common and in most cases transient. Routine prophylactic use of IOP-lowering medications is essentially ineffective in preventing IOP spikes after intravitreal injection of pegaptanib, ranibizumab, and bevacizumab and therefore not necessary before the injection.
authors.affiliation: Eye Research Foundation, Stuart, FL, USA.
authors.forename: Max P C
authors.initials: MP
authors.lastname: Frenkel
authors.forename: Shamim A
authors.initials: SA
authors.lastname: Haji
authors.forename: Ronald E P
authors.initials: RE
authors.lastname: Frenkel
mesh_terms: D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D052157:Aptamers, Nucleotide / Q000008:administration & dosage / Q000009:adverse effects; D000068258:Bevacizumab; D005260:Female; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000188:drug therapy; D008297:Male; D009798:Ocular Hypertension / Q000139:chemically induced / Q000188:drug therapy*; D000069579:Ranibizumab; D012189:Retrospective Studies; D014065:Tonometry, Ocular; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000959:Antihypertensive Agents; D052157:Aptamers, Nucleotide; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; C495058:pegaptanib; D000068258:Bevacizumab; D000069579:Ranibizumab