title: Comparison of acetazolamide, brimonidine, and anterior chamber paracentesis for ocular hypertension control after initial intravitreal bevacizumab injection: a randomized clinical trial.
abstract: OBJECTIVE
  To evaluate the effects of oral acetazolamide (ACZ), anterior chamber paracentesis (ACP), or topical brimonidine tartrate (BT) to reduce intraocular pressure (IOP) elevation after intravitreal bevacizumab injection (IVBI).
  
  
  METHODS
  A total of 56 patients scheduled for IVBI (1.5 mg/0.06 mL) were randomly assigned to a pretreatment with ACZ (14 eyes), BT (14 eyes), as well as an immediately after ACP (14 eyes), or no treatment (control group-CG) (14 eyes). IOP was measured 90 minutes before injection (baseline), just before injection, and at 3, 10, 20, and 30 minutes after the procedure.
  
  
  RESULTS
  IOP was increased at 3 minutes after injection in CG, 20.9±2.1 (mean±SE intraindividual change in mm Hg); BT, 15.5±2.3; ACZ, 13.7±1.7; but not in ACP, 0.3±1.2 (P<0.0001). At 30 minutes after injections, IOP difference to baseline was not significantly different in groups BT, 0.0±0.7; ACZ, -3.2±0.8; and ACP, -2.5±3.9, but was kept higher in the CG, 4.0±4.3 (P<0.0001).
  
  
  CONCLUSIONS
  ACP prevents IOP elevation after IVBI, whereas ACZ and BT caused a faster return to baseline than untreated nonglaucomatous eyes. Further studies with larger number of subjects, including glaucomatous patients, and the use of other topical glaucoma medications are warranted to establish a standard recommendation.
authors: *Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto USP, Ribeirão Preto-SP, Brazil †Macular Imaging and Treatment Division, Hospital de Olhos Araraquara, Araraquara-SP, Brazil.
authors: Bianka Y N Y
authors: BY
authors: Katayama
authors: Marco A
authors: MA
authors: Bonini-Filho
authors: André M V
authors: AM
authors: Messias
authors: Jayter S
authors: JS
authors: Paula
authors: Luiz F T
authors: LF
authors: Martin
authors: Rogério
authors: R
authors: Costa
authors: Rodrigo
authors: R
authors: Jorge
mesh_terms: D000086:Acetazolamide / Q000627:therapeutic use*; D000284:Administration, Oral; D000287:Administration, Topical; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D000867:Anterior Chamber / Q000601:surgery*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D000068258:Bevacizumab; D000068438:Brimonidine Tartrate; D005260:Female; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D019152:Paracentesis; D011810:Quinoxalines / Q000627:therapeutic use*; D014065:Tonometry, Ocular
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000959:Antihypertensive Agents; D011810:Quinoxalines; D000068258:Bevacizumab; D000068438:Brimonidine Tartrate; D000086:Acetazolamide