title: Ocular decompression with cotton swabs lowers intraocular pressure elevation after intravitreal injection.
abstract: OBJECTIVE
  To determine the effect of preinjection ocular decompression by cotton swabs on the immediate rise in intraocular pressure (IOP) after intravitreal injections.
  
  
  METHODS
  Forty-eight patients receiving 0.05 mL ranibizumab injections in a retina clinic were randomized to 2 anesthetic methods in each eye on the same day (if bilateral disease) or on consecutive visits (if unilateral disease). One method utilized cotton swabs soaked in 4% lidocaine applied to the globe with moderate pressure and the other 3.5% lidocaine gel applied without pressure. IOPs were recorded at baseline (before injection) and at 0, 5, 10, and 15 minutes after the injection until the IOP was ≤30 mm Hg. The IOP elevations from baseline were compared after the 2 anesthetic methods.
  
  
  RESULTS
  The preinjection mean IOP (SD, mm Hg) was 15.5 (3.3) before the cotton swabs and 15.9 (3.0) before the gel (P=0.28). Mean IOP (SD, mm Hg) change immediately after injection was 25.7 (9.2) after the cotton swabs and 30.9 (9.9) after the gel (P=0.001). Thirty-five percent of gel eyes had IOP≥50 mm Hg compared with only 10% of cotton swab eyes immediately after the injection (P<0.001).
  
  
  CONCLUSIONS
  Decompressing the eye with cotton swabs during anesthetic preparation before an intravitreal injection produces a significantly lower IOP spike after the injection.
authors: *Miami Veterans Affairs Medical Center †Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL.
authors: Ninel Z
authors: NZ
authors: Gregori
authors: Matthew J
authors: MJ
authors: Weiss
authors: Raquel
authors: R
authors: Goldhardt
authors: Joyce C
authors: JC
authors: Schiffman
authors: Edgardo
authors: E
authors: Vega
authors: Cherrie-Ann
authors: CA
authors: Mattis
authors: Wei
authors: W
authors: Shi
authors: Linda
authors: L
authors: Kelley
authors: Vilma
authors: V
authors: Hernandez
authors: William J
authors: WJ
authors: Feuer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000295:instrumentation / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods*; D005128:Eye Diseases / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005782:Gels / Q000008:administration & dosage; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D058449:Intravitreal Injections; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000517:prevention & control; D011446:Prospective Studies; D000069579:Ranibizumab
chemical_list: D000779:Anesthetics, Local; D061067:Antibodies, Monoclonal, Humanized; D005782:Gels; D008012:Lidocaine; D000069579:Ranibizumab
references: Jpn J Ophthalmol. 2011 Nov;55(6):632-7
references: 21947489
references: Graefes Arch Clin Exp Ophthalmol. 1997 Oct;235(10):618-26
references: 9349945
references: J Glaucoma. 2009 Dec;18(9):658-61
references: 20010243
references: J Glaucoma. 2012 Apr-May;21(4):241-7
references: 21423038
references: J Ocul Pharmacol Ther. 2010 Feb;26(1):105-10
references: 20187807
references: Curr Opin Ophthalmol. 2012 Mar;23(2):105-10
references: 22249237
references: Br J Ophthalmol. 1994 Aug;78(8):643-8
references: 7918293
references: Retina. 2007 Oct;27(8):1044-7
references: 18040242
references: Ophthalmic Surg Lasers Imaging. 2009 May-Jun;40(3):293-5
references: 19485295
references: Graefes Arch Clin Exp Ophthalmol. 2012 Oct;250(10):1435-40
references: 22434210
references: Expert Opin Drug Deliv. 2012 Jul;9(7):735-41
references: 22554019
references: Ophthalmology. 2012 Feb;119(2):321-6
references: 22054994
references: Eur J Ophthalmol. 2010 Jan-Feb;20(1):174-9
references: 19927267
references: Am J Ophthalmol. 2008 Dec;146(6):930-4.e1
references: 18775528
references: Can J Ophthalmol. 2007 Dec;42(6):807-11
references: 18026202
references: Retina. 2012 Mar;32(3):434-57
references: 22374154
references: Br J Ophthalmol. 2011 Aug;95(8):1111-4
references: 20702430
references: Doc Ophthalmol. 1951;5-6:278-356
references: 14896880