Effect of prophylactic medication and influence of vitreous reflux in pressure rise after intravitreal injections of anti-VEGF drugs.
OBJECTIVE
To assess the efficacy of a hypotensive prophylactic medication in preventing intraocular pressure (IOP) changes after intravitreal injections, and the effect of occurrence of vitreous reflux on the variation of IOP.


METHODS
A total of 141 intravitreal injections of anti-vascular endothelial growth factor drugs (0.05 mL) were randomly distributed into 2 groups: in group 1 (n = 77), no prophylactic IOP-lowering medication was used; in group 2 (n = 64), a fixed combination of brimonidine and timolol was instilled 5 minutes before the injection. The IOP was measured before and 1, 15, and 30 minutes after the injection. The presence of vitreous reflux was recorded.


RESULTS
Despite significantly reducing the IOP by ~3 mm Hg, prophylactic medication did not prevent a transient IOP rise. A total of 22.7% of injections showed vitreous reflux, and those patients experienced much lower initial spikes. Indeed, only 6.5% out of 77 injections above 30 mm Hg within 1 minute after injection showed vitreous reflux. Only one case showed an IOP >30 mm Hg at 15 minutes, and none at 30 minutes postinjection. The IOP normalization rates over time were similar in all groups within 15 minutes.


CONCLUSIONS
Prophylactic medication instilled 5 minutes before the injection was not effective in preventing a pressure rise after intravitreal injections. Vitreous reflux decreased significantly the spike figures compared to injections with no reflux.
Department of Medical Retina and Vitreous Surgery, Centro de Ojos de La Coruña, La Coruña - Spain.
Pablo
P
Carnota-Méndez
Carlos
C
Méndez-Vázquez
Jaime
J
Otero-Villar
José Antonio
JA
Saavedra-Pazos
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D000068258:Bevacizumab; D000068438:Brimonidine Tartrate; D004338:Drug Combinations; D005128:Eye Diseases; D005260:Female; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000209:etiology / Q000517:prevention & control*; D011312:Pressure; D011446:Prospective Studies; D011810:Quinoxalines / Q000008:administration & dosage; D000069579:Ranibizumab; D012164:Retinal Diseases / Q000188:drug therapy*; D013999:Timolol / Q000008:administration & dosage; D014065:Tonometry, Ocular; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014822:Vitreous Body / Q000473:pathology*
D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000959:Antihypertensive Agents; D004338:Drug Combinations; D011810:Quinoxalines; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000068438:Brimonidine Tartrate; D013999:Timolol; D000069579:Ranibizumab