title: [Efficacy of prophylactic treatment of intraocular pressure spikes due to intravitreal injections].
abstract: OBJECTIVE
  The purpose of this study was to evaluate intraocular pressure increase after intravitreal injections (IVIs) and the effect of prophylactic pressure-lowering medications.
  
  
  METHODS
  A prospective study of 210 anti-vascular endothelial growth factor (VEGF) IVI (0.05 mL of bevacizumab or ranibizumab), that were divided into five groups, group 1: no intraocular pressure (IOP)-lowering medication (n=50); group 2: apraclonidine 1 % one drop 2 hours prior to IVI (n=50); group 3: acetazolamide 250 mg 2 hours prior (n=50); group 4: fixed combination brimonidine+timolol (n=30); group 5: fixed combination dorzolamide+timolol (n=30). IOP was measured before, immediately after (T1), 15 min after (T15) and 45 min after (T45) the IVI using a Perkins tonometer.
  
  
  RESULTS
  The mean IOP peak in group 1 was 46.4 ± 4.8 mmHg at T1, 21.7 ± 5.7 mmHg at T15 and 15.4 ± 4.3 mmHg at T45. Apraclonidine 1 % and the fixed combinations produced a significant reduction of IOP at every time point, of around 9 mmHg at T1. The reduction in IOP obtained with acetazolamide was not significant versus group 1 at T1 (-1.6 mmHg, P=0.12), but became significant at T15 and T45 (respectively, P=0.011 and P=0.015).
  
  
  CONCLUSIONS
  IOP spikes are high but transient following IVI. Acetazolamide proved to be ineffective in preventing this spike. Topical medications, however, produced a significant reduction in IOP spike as well as in the duration of the increased pressure, with no significant difference between fixed combinations and 1 % apraclonidine at T1. It would seem advisable to prevent this IOP spike in the case of repeated injections, particularly in patients with glaucoma.
authors: Service d'ophtalmologie, HIA Desgenettes, 108, boulevard Pinel, 69003 Lyon, France.
authors: H
authors: H
authors: El Chehab
authors: A
authors: A
authors: Le Corre
authors: J-M
authors: JM
authors: Giraud
authors: G
authors: G
authors: Ract-Madoux
authors: B
authors: B
authors: Swalduz
authors: C
authors: C
authors: Dot
mesh_terms: D000086:Acetazolamide / Q000008:administration & dosage; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D000068258:Bevacizumab; D000068438:Brimonidine Tartrate; D018890:Chemoprevention / Q000379:methods*; D003000:Clonidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007038:Hypotonic Solutions / Q000008:administration & dosage; D007429:Intraocular Pressure / Q000187:drug effects / Q000502:physiology; D058449:Intravitreal Injections / Q000009:adverse effects*; D008268:Macular Degeneration / Q000188:drug therapy; D008297:Male; D009798:Ocular Hypertension / Q000209:etiology* / Q000517:prevention & control*; D011810:Quinoxalines / Q000008:administration & dosage; D013449:Sulfonamides / Q000008:administration & dosage; D013876:Thiophenes / Q000008:administration & dosage; D013999:Timolol / Q000008:administration & dosage; D014065:Tonometry, Ocular; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000959:Antihypertensive Agents; D004338:Drug Combinations; D007038:Hypotonic Solutions; D011810:Quinoxalines; D013449:Sulfonamides; D013876:Thiophenes; C479140:dorzolamide-timolol combination; D000068258:Bevacizumab; D000068438:Brimonidine Tartrate; D013999:Timolol; C016986:apraclonidine; D003000:Clonidine; D000086:Acetazolamide