Purpose: To determine the immediate effect of intravitreal Bevacizumab on intraocular pressure (IOP) in eyes with retinal vascular disorders. Study Design: Interventional case series. Place and Duration of Study: Ophthalmology Department, Fauji Foundation Hospital, Rawalpindi, from January 2019to July 2019. Methods: One hundred and thirty one patients were included in this study using non probability consecutive sampling. IOP was measured before intravitreal injection (baseline) and at 5 and 30 minutes post-injection. Descriptive statistics were obtained using SPSS version 21.0. Results: One hundred and thirty one eyes of 131 patients were observed for IOP change after intra vitreal injection of Bevacizumab. Among them 23 (18%) were males and 108 (82.4%) were females. Mean age was 57.57 ± 13.09 years. Mean IOP at baseline was 16.16 ± 2.52 mmHg. At 5 minutes after injection, 108 eyes (82.4%) had raised IOP, maximum IOP recorded was 44 mmHg. There was a statistically significant correlation between IOP at baseline and 5 minutes with p = 0.005 (≤0.05). At 30 minutes, 94 eyes (71.7%) had IOP fallen back to normal. Statistically, an insignificant correlation was present between IOP at baseline and 30 minutes (p = 0.081) post-injection. IOP rise was not significantly correlated to gender, age, hypertension and asthma at any interval (p value > 0.05). However, IOP rise was significantly correlated in diabetic patients at 30 minutes. Conclusion: IOP elevation has been observed after intravitreal bevacizumab in immediate post-injection period which warrants the monitoring of IOP in this critical period to avoid serious blinding complications. Key Words: Bevacizumab, Vascular endothelial growth factor, Intraocular pressure, Goldmann applanation tonometer.
Purpose: To compare the anesthetic effect of topical proparacaine hydrochloride 0.5% with sub-conjunctival lidocaine 2% for intravitreal injection of Bevacizumab. Study Design: Quasi experimental study. Place and Duration of Study: Department of Ophthalmology Fauji Foundation Hospital, Rawalpindi, from July 2017 to January 2018. Methods: Sixty 60 patients who needed intravitreal Bevacizumab were included in the study after approval from the ethical review board. Exclusion criteria were patients with conditions that could affect pain sensation, acute ocular inflammation, history of intravitreal injection, using systemic analgesic/sedatives, uncooperative patients and unable to understand the pain scale. Written informed consent was taken. Name, age, gender, diagnosis, previous intravitreal injection, hospital registration number, address and contact numbers were noted. Patients were briefed about the visual analogue scale. Patients were divided into two groups. Group A received proparacaine drops and group B was given subconjunctival lidocaine injections before intravitreal bevacizumab. Results: The mean age of patients in this study was 60.38 ± 10.55 years. There were 03 (5.0%) males and 57 (95.0%) females. Majority of the patients (30%) presented with choroidal neovascularization followed by diabetic maculopathy, vitreous hemorrhage, central retinal vein occlusion and proliferative diabetic retinopathy. Mean pain score among both the groups was 3.67 ± 1.97 (topical group) and 1.70 ± 1.51 (sub-conjunctival group) respectively which was statistically significant (p-value 0.000). Among age, diabetes, duration of diabetes and hypertension, only hypertension had moderate correlation with the pain score (correlation coefficient = 0.316, p values = 0.017). Conclusion: Sub-conjunctival anaesthesia results in less pain during intravitreal drug administration as compared to the topical anaesthesia. Key Words: Intravitreal injections, Bevacizumab, Intravitreal Anti-VEGF, Anesthesia.
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