title: Subconjunctival hemorrhage after intravitreal injection of anti-vascular endothelial growth factor.
abstract: OBJECTIVE
  To investigate the risk factors for subconjunctival hemorrhage (SCH) after intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) and evaluate the relationship between hemodynamic status at the time of injection and SCH.
  
  
  METHODS
  We retrospectively reviewed the medical records of 598 cases of 173 patients who underwent intravitreal injection of ranibizumab whose hemodynamic status was monitored at the time of the injection. Cases with SCH after the injection were included in the SCH group. We compared systemic factors, including the hemodynamic status between the SCH group and the control group.
  
  
  RESULTS
  The SCH group included 67 cases and the control group included 531 cases without SCH. Baseline hemodynamic status was not significantly related to development of SCH. However, systolic blood pressure (BP) at injection was a significant risk factors for SCH (P = 0.034). Elevated systolic BP, mean arterial pressure (MAP), and pulse rate from baseline to time of injection were significantly related to the development of SCH (P = 0.011, P = 0.014, P = 0.036, respectively). In multivariate analysis, hypertension, a large change in MAP, and a fewer previous injections were significant risk factors for SCH after intravitreal injection (P = 0.030, P = 0.032, P = 0.028, respectively).
  
  
  CONCLUSIONS
  Hemodynamic risk factors exist for SCH after intravitreal injection of anti-VEGF. To reduce the risk of SCH, strategies should seek to decrease patient anxiety, especially in those with hypertension.
authors.affiliation: Department of Ophthalmology, Korea University College of Medicine, 126-1 Anam-dong 5-ga, Sungbuk-gu, Seoul, 136-705, South Korea.
authors.forename: Cheolmin
authors.initials: C
authors.lastname: Yun
authors.forename: Jaeryung
authors.initials: J
authors.lastname: Oh
authors.forename: Soon-Young
authors.initials: SY
authors.lastname: Hwang
authors.forename: Seong-Woo
authors.initials: SW
authors.lastname: Kim
authors.forename: Kuhl
authors.initials: K
authors.lastname: Huh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D062186:Arterial Pressure / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D016022:Case-Control Studies; D003229:Conjunctival Diseases / Q000453:epidemiology / Q000209:etiology*; D005130:Eye Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000150:complications; D015994:Incidence; D058449:Intravitreal Injections / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D000069579:Ranibizumab / Q000008:administration & dosage*; D012189:Retrospective Studies; D012307:Risk Factors; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab