Short-term intraocular pressure changes after intravitreal injection of bevacizumab in diabetic retinopathy patients

Abstract

BackgroundThis study examined the changes in short-term intraocular pressure (IOP) in a prospective series of patients undergoing intravitreal bevacizumab injection. The aim was to evaluate the frequency and predictive factors related to intraocular pressure (IOP) elevation in patients receiving intravitreal bevacizumab.Patients and methodsThis study included 52 patients with diabetic retinopathy between 28 to 75 years of age with a mean age of 51 years; 30 (58%) were females, and 22 (42%) were males. All patients received bevacizumab (1.25 mg/0.05 mL) injected intravitreally in a standard fashion between May 2012 to February 2013 in the AL-Jumhoury teaching hospital. IOP was measured at baseline, 5, 10, and 30 minutes after injection using Goldman applanation tonometry.StatisticsData were analyzed using the SPSS v.12.0 for windows. Basic, demographic, and clinical data were analyzed using means, proportions, and appropriate 95% confidence intervals (CIs).ResultsMost patients (85%) were diagnosed with proliferative diabetic retinopathy, while 15% presented with diabetic macular edema. The mean IOP values at baseline, 5, 10, and 30 minutes after injection were 14.0 mmHg (95% CI 13.4–14.7), 36.1 mmHg (95% CI 33.5–38.6), 25.7 mmHg (95% CI 23.8–27.5), and 15.5 mmHg (95% CI 12.4–16.51), respectively. Regression analysis showed a trend toward phakic patients having higher IOP at 30 minutes.ConclusionIntravitreal injection of bevacizumab is safe with respect to short-term IOP changes, as almost all IOP returned to a safe range (<25 mmHg) within 30 minutes. Elevated IOP 30 minutes after injection only occurs rarely, so routine prophylactic use of anti-glaucoma medication is not indicated.

Intravitreal infusion: A novel approach for intraocular drug delivery

“…The IOP decreased rapidly over the next 30 min (Fig. 1) and the mean IOP at 30 min before removal of the needle was 14.67 ± 2.46 mmHg, which was similar to the reported IOP observed 30 minutes after intravitreal injection789101115.…”

“…In recent years, numerous studies have reported an acute volume-related intraocular pressure (IOP) elevation after intraocular injections56789101112131415. Lemos-Reis et al .…”

“…More than 95% of IOP values are under 30 mmHg in 30 minutes after intravitreal injection789101115. Robust IOP homeostatic mechanisms keeps ocular pressures within relatively narrow acceptable bounds throughout most peoples’ lives27.…”

Intraocular Pressure Spikes after Aflibercept Intravitreal Injections

“…The implication of crystalline lens status continues to be discussed in the literature: some studies found a different IOP profile between phakic and pseudophakic patients, whereas others did not [3,7,12,13]. Contrary to our study, Kerimoglu et al [3] found a greater IOP increase in phakic patients than in pseudophakic patients 10 min after a 0.1-ml IVI of triamcinolone, which could raise the hypothesis of transient iridocorneal angle closure for this injected volume.…”

2018 Update on Intravitreal Injections: Euretina Expert Consensus Recommendations

“…Studies have shown that in most patients IOP returns to safe levels within 30 min after IVI [19-27]. It has been reported, that 89% of patients receiving intravitreal ranibizumab experienced an IOP rise of more than 30 mm Hg at 5 s after injection [23], approximately one third after the first 5 min [16].…”