1
|
Shoeibi N, Ghosi Z, Jafari H, Omidtabrizi A. Effect of antiglaucoma agents on short-term intraocular pressure fluctuations after intravitreal bevacizumab injections. Int Ophthalmol 2021; 41:1081-1090. [PMID: 33389369 DOI: 10.1007/s10792-020-01667-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 11/27/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the effect of prophylactic pressure-lowering medications on intraocular pressure (IOP) spikes after intravitreal injections (IVIs) METHODS: In this randomized double-blind clinical trial, 74 eyes that were candidates for intravitreal anti-vascular endothelial growth factor (VEGF) injection (IVI) (0.05 mL, 1.25 mg of bevacizumab) were enrolled and sorted randomly into five groups, group 1: topical timolol 0.5% (n = 16); group 2: topical brimonidin (n = 15); group 3: oral acetazolamide 250 mg (n = 14); group 4: intravenous mannitol (1.5 gr/kg) (n = 16); group 5: no intraocular pressure-lowering medication (n = 13). Medications were administered 30-60 min prior to injection. None of the patients had history of glaucoma. Intraocular pressure was measured before (baseline), 5 min after (T5), 10 min after (T10), 15 min after (T15) and 30 min after (T30) IVI using Goldmann Tonometer. RESULTS There was a statistically significant, but relatively weak negative correlation between the amount of vitreous reflux post-IVI intraocular pressure elevation (Spearman's rho = -0.315, p = 0.006). There was no difference of the amount of vitreous reflux (P = 0.196) between study groups. The baseline mean IOP for Groups 1, 2, 3,4 and 5 were 11.19 ± 3.7, 10.07 ± 2.19, 11 ± 2.98, 10.13 ± 3.48 and12.54 ± 2.60 mmHg, respectively. (P = 0.214) There was no difference of peak IOP spike between groups at T5: 37 ± 19.7, 34.80 ± 15.76, 33.43 ± 18.29, 33.56 ± 16.88, 34.92 ± 9.99 mmHg (P = 0.977). There was also no difference of IOP at T10, T15 and T30 between study groups: P = 0.979, P = 0.994 and P = 0.692, respectively. CONCLUSION Although it is advisable to prevent IOP spikes, our study showed that use of prophylactic pressure-lowering medications with every mechanism of action has no effect in IOP spikes following intravitreal bevacizumab injections in non-glaucomatous eyes. Trial registrationThe study was registered with clinicaltrails.gov (ID# NCT02140450). Trial registration date: 05.09.2014.
Collapse
Affiliation(s)
- Nasser Shoeibi
- Associate Professor of Ophthalmology, Khatam Eye Hospital, Mashhad University of Medical Sciences, eye research center, Mashhad, Iran
| | - Zina Ghosi
- Resident of Ophthalmology, Khatam Eye Hospital, Mashhad University of Medical Sciences, eye research center, Mashhad, Iran
| | - Habib Jafari
- Anterior Segment Fellow in Ophthalmology, Khatam Eye Hospital, Mashhad University of Medical Sciences, eye research center, Mashhad, Iran
| | - Arash Omidtabrizi
- Vitreoretina Fellowship Student, Khatam Al Anbia Eye Hospital, Mashhad University of Medical Sciences, eye research centerAbutalib crossroad, Ghareni Blvd, Mashhad, Iran.
| |
Collapse
|
2
|
Nuzzi R, Scalabrin S, Becco A. Reduction of Intraocular Pressure Spikes Due to Intravitreal Bevacizumab Injections by Scleral Indentation with Cotton Swab or Digital Ocular Massage: Innovative Techniques Compared. Clin Ophthalmol 2020; 14:2533-2541. [PMID: 32921980 PMCID: PMC7458273 DOI: 10.2147/opth.s263474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 07/07/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study aims to evaluate the effectiveness of different decompressive injection techniques in reducing intraocular pressure (IOP) spikes, if compared to the injection without pressure applied on the eye, following the intravitreal injection of bevacizumab. PATIENTS AND METHODS Two hundred patients with indication to intravitreal therapy were randomized into five arms: 40 received intravitreal injection without ocular decompression (arm A), 40 with pre-injection scleral indentation with cotton swab (arm B), 40 with pre-injection digital ocular massage (arm C), 40 with post-injection scleral indentation with cotton swab (arm D) and 40 with post-injection digital ocular massage (arm E). All patients underwent measurement of the IOP with Goldamm applanation tonometer 10 minutes before and 10 minutes after the injection. The primary endpoint of the study was variation of the post- injection IOP with the different techniques. RESULTS An increase in post-injection IOP was observed in all the arms, if compared to pre-injection values. The greatest increase was observed in arm A with a mean IOP rise of 17.60 mmHg. All other techniques showed lower mean IOP increases: arm B 10.76 mmHg, arm C 9.35 mmHg, arm D 8.8 mmHg, arm E 3.4 mmHg. The post-injection IOP differences of innovative techniques compared to the technique without ocular decompression were all statistically significant (p-value <0.01). If compared to arm A (35%), a reduction in IOP spike ≥40 mmHg frequency was also observed. The status of phakia/pseudophakia, a previous diagnosis of glaucoma and the underlying pathology for which indication was given to inject bevacizumab did not significantly alter the post-injection IOP in any of the protocols. CONCLUSION The introduction of new injection protocols, such as injections performed before or after decompressive treatments, could be a safe and effective approach to control post-injection IOP increase.
Collapse
Affiliation(s)
- Raffaele Nuzzi
- Eye Clinic, Department of Surgical Sciences, University of Turin, AOU Città della Salute e della Scienza, Turin, Italy
| | - Simona Scalabrin
- Eye Clinic, Department of Surgical Sciences, University of Turin, AOU Città della Salute e della Scienza, Turin, Italy
| | - Alice Becco
- Eye Clinic, Department of Surgical Sciences, University of Turin, AOU Città della Salute e della Scienza, Turin, Italy
| |
Collapse
|
3
|
Lam J, Luttrell I, Ding L, Rezaei K, Chao JR, Chee Y, Olmos De Koo LC, Wen JC. Effect of prior glaucoma surgery on intraocular pressure immediately after anti-vascular endothelial growth factor injection. Graefes Arch Clin Exp Ophthalmol 2019; 257:2489-2494. [PMID: 31388743 DOI: 10.1007/s00417-019-04431-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/17/2019] [Accepted: 07/23/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND To characterize how prior incisional glaucoma surgery affects the intraocular pressure (IOP) elevation immediately following intravitreal anti-VEGF injections (IVI). METHODS Single institution, experimental study. Patients with a history of incisional glaucoma surgery who were receiving anti-VEGF injections were recruited as well as control eyes. Pre- and post-injection IOP measurements were compared as well as time to recovery to within 5 and 10 mmHg of baseline IOP. RESULTS Ten eyes with a history of glaucoma surgery and 29 control eyes receiving anti-VEGF injections were included. The most common indication for intravitreal anti-VEGF injection was proliferative diabetic retinopathy in both surgical and control eyes (50% vs 45%, p = 1.00). Post-injection IOP was significantly decreased compared to baseline IOP after anti-VEGF injection in surgical versus control eyes (26.5 ± 8.9 mmHg vs 44.2 ± 8.5 mmHg, respectively, p < 0.001). The mean change in IOP following intravitreal anti-VEGF injection was lower in surgical eyes (10.7 ± 6.6 mmHg vs 28.6 ± 8.3 mmHg, p < 0.001). The mean time for the IOP to return to within 10 mmHg of pre-injection IOP was less in surgical eyes (5.2 ± 4.1 min vs 13.3 ± 7.6 min, p = 0.002). CONCLUSIONS Eyes with prior incisional glaucoma surgery demonstrated a significantly lower post-injection IOP elevation and a faster recovery to within 10 mmHg of their pre-injection IOP. Incisional glaucoma surgery may be considered for patients where the attenuation of post-injection IOP elevation is needed and other less invasive measures have failed.
Collapse
Affiliation(s)
- Jocelyn Lam
- Department of Ophthalmology, University of Washington, 325 9th Ave, PO Box 359608, Seattle, WA, 98104-2499, USA
| | - Ian Luttrell
- Department of Ophthalmology, University of Washington, 325 9th Ave, PO Box 359608, Seattle, WA, 98104-2499, USA
| | - Leona Ding
- Department of Ophthalmology, University of Washington, 325 9th Ave, PO Box 359608, Seattle, WA, 98104-2499, USA
| | - Kasra Rezaei
- Department of Ophthalmology, University of Washington, 325 9th Ave, PO Box 359608, Seattle, WA, 98104-2499, USA
| | - Jennifer R Chao
- Department of Ophthalmology, University of Washington, 325 9th Ave, PO Box 359608, Seattle, WA, 98104-2499, USA
| | - Yewlin Chee
- Department of Ophthalmology, University of Washington, 325 9th Ave, PO Box 359608, Seattle, WA, 98104-2499, USA
| | - Lisa C Olmos De Koo
- Department of Ophthalmology, University of Washington, 325 9th Ave, PO Box 359608, Seattle, WA, 98104-2499, USA
| | - Joanne C Wen
- Department of Ophthalmology, University of Washington, 325 9th Ave, PO Box 359608, Seattle, WA, 98104-2499, USA.
| |
Collapse
|
4
|
Grzybowski A, Told R, Sacu S, Bandello F, Moisseiev E, Loewenstein A, Schmidt-Erfurth U. 2018 Update on Intravitreal Injections: Euretina Expert Consensus Recommendations. Ophthalmologica 2018; 239:181-193. [PMID: 29393226 DOI: 10.1159/000486145] [Citation(s) in RCA: 181] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 12/05/2017] [Indexed: 01/24/2023]
Abstract
Intravitreal injections (IVI) have become the most common intraocular procedure worldwide with increasing numbers every year. The article presents the most up-to-date review on IVI epidemiology and techniques. Unfortunately, important issues related to pre-, peri- and postinjection management lack randomized clinical trials for a final conclusion. Also, a great diversity of approaches exists worldwide. Therefore, expert consensus recommendations on IVI techniques are provided.
Collapse
Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Reinhard Told
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Stefan Sacu
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Francesco Bandello
- Department of Ophthalmology, Vita-Salute University, San Raffaele Hospital, Milan, Italy
| | - Elad Moisseiev
- Department of Ophthalmology, Sackler Faculty of Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Loewenstein
- Department of Ophthalmology, Sackler Faculty of Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Sackler Faculty of Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | | |
Collapse
|
5
|
Bach A, Filipowicz A, Gold AS, Latiff A, Murray TG. Paracentesis following intravitreal drug injections in maintaining physiologic ocular perfusion pressure. Int J Ophthalmol 2017; 10:1925-1927. [PMID: 29259915 DOI: 10.18240/ijo.2017.12.22] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/14/2017] [Indexed: 01/05/2023] Open
Abstract
A retrospective analysis was performed of patients who received a paracentesis immediately following an intravitreal injection of bevacizumab or triamcinolone acetonide. These patients were previously diagnosed as having glaucoma, ocular hypertension, or had responded previously with sustained elevated intraocular pressure. Of 1661 procedures were performed. Totally 219 (13%) of the injections were on phakic patients. A median (SD) of 210 µL (40 µL) of aqueous was removed during each paracentesis. There were no reported incidences of any complications. We propose performing a paracentesis immediately following intravitreal injections for patients at risk for ocular hypertension, glaucoma, and retinal vein or artery occlusion.
Collapse
Affiliation(s)
- Austin Bach
- Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA
| | - Artur Filipowicz
- Des Moines University College of Osteopathic Medicine, Des Moines, IA 50312, USA
| | - Aaron S Gold
- Murray Ocular Oncology & Retina, Miami, FL 33143, USA
| | - Azeema Latiff
- Murray Ocular Oncology & Retina, Miami, FL 33143, USA
| | | |
Collapse
|
6
|
Pece A, Allegrini D, Montesano G, Dimastrogiovanni AF. Effect of prophylactic timolol 0.1% gel on intraocular pressure after an intravitreal injection of ranibizumab: a randomized study. Clin Ophthalmol 2016; 10:1131-8. [PMID: 27382246 PMCID: PMC4918739 DOI: 10.2147/opth.s106096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Purpose The purpose of this study is to make a prospective evaluation of the effect of timolol 0.1% eye gel on short-term intraocular pressure (IOP) after an intravitreal injection (IVI) of ranibizumab. Participants and methods One hundred and fifty eyes of 150 IVI-naïve patients with macular edema caused by various pathological conditions (age-related macular degeneration, central or branch retinal vein occlusion, and diabetic retinopathy) were scheduled to undergo an IVI of ranibizumab (0.5 mg/0.05 cc). The patients were randomly divided into three groups: 50 were not treated with timolol before the IVI (group 1); 50 received an instillation of timolol 0.1% eye gel the evening before the IVI (group 2); and 50 received an instillation of timolol 0.1% eye gel 2 hours before the IVI (group 3). The incidence of clinically significant intraocular hypertensive spikes (>25 mmHg and >40 mmHg) was then assessed. Results Our findings showed that mean IOP at baseline was significantly higher than at both 5 and 60 minutes after IVI (P<0.01). Spikes of >25 mmHg were recorded at either time in 27 patients (54%) in group 1, 23 patients (44%) in group 2, and 24 patients (48%) in group 3. None of the between-group differences were significant. Spikes of >40 mmHg (which were only detected 5 minutes after IVI) were recorded in nine (18%), eight (16%), and one patient (2%) in groups 1, 2, and 3, respectively. The only significant difference was between the control and group 3 (P=0.012). Conclusion An increase in IOP after antivascular endothelial growth factor IVI is a frequent complication. The prophylactic use of timolol 0.1% gel effectively reduced the mean IOP when administered 2 hours before IVI and was also effective in preventing dangerous IOP spikes of >40 mmHg. It is therefore recommended before IVIs as a means of preventing emergency procedures and preserving the health of the optic nerve.
Collapse
Affiliation(s)
- Alfredo Pece
- Eye Clinic, Melegnano Hospital, Vizzolo Predabissi, Italy
| | | | | | | |
Collapse
|