Nasser Shoeibi1, Zina Ghosi2, Habib Jafari3, Arash Omidtabrizi4. 1. Associate Professor of Ophthalmology, Khatam Eye Hospital, Mashhad University of Medical Sciences, eye research center, Mashhad, Iran. 2. Resident of Ophthalmology, Khatam Eye Hospital, Mashhad University of Medical Sciences, eye research center, Mashhad, Iran. 3. Anterior Segment Fellow in Ophthalmology, Khatam Eye Hospital, Mashhad University of Medical Sciences, eye research center, Mashhad, Iran. 4. Vitreoretina Fellowship Student, Khatam Al Anbia Eye Hospital, Mashhad University of Medical Sciences, eye research centerAbutalib crossroad, Ghareni Blvd, Mashhad, Iran. arash_omid2001@yahoo.com.
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 forintravitreal 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.
RCT Entities:
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.
Authors: Diane N Sayah; Andrei-Alexandru Szigiato; Javier Mazzaferri; Denise Descovich; Renaud Duval; Flavio A Rezende; Santiago Costantino; Mark R Lesk Journal: Br J Ophthalmol Date: 2020-04-28 Impact factor: 4.638
Authors: Sharon D Solomon; Kristina Lindsley; Satyanarayana S Vedula; Magdalena G Krzystolik; Barbara S Hawkins Journal: Cochrane Database Syst Rev Date: 2014-08-29