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Hypotensive efficacy of topical brimonidine for intraocular pressure spikes following intravitreal injections of antivascular endothelial growth factor agents: a randomised crossover trial
  1. Tina Felfeli,
  2. Avner Hostovsky,
  3. Rachel Trussart,
  4. Peng Yan,
  5. Michael H Brent,
  6. Efrem D Mandelcorn
  1. Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Efrem D Mandelcorn, Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto Western Hospital, University Health Network, Toronto, ON M5T 2S8, Canada; efrem.mandelcorn{at}


Purpose To determine the effect of topical brimonidine tartrate prophylaxis on intraocular pressure (IOP) spikes following intravitreal injection of antivascular endothelial growth factor (anti-VEGF) agents.

Methods This is a randomised crossover trial of consecutive non-glaucomatous eyes receiving intravitreal anti-VEGF injections between December 2016 and July 2017. All eyes were randomly assigned to no prophylaxis or topical brimonidine tartrate 0.15 % administered 20 min prior to injection in one of two consecutive visits. Measurements of IOP were obtained immediately (T0), 10 min (T10) and 20 min (T20) after injection during the visits with and without prophylaxis.

Results Among the 58 eyes of 55 patients (116 visits), the mean (SD) age was 74.3 (11.6), and 62% were female. The mean baseline IOP was 15.3 (2.3) mm Hg (range: 11–20). On average, the immediate postinjection IOP during the visit without prophylaxis was 41.6 (12) mm Hg (range: 17–81). Compared with no prophylaxis, the visit with preadministered topical brimonidine tartrate had a lower IOP at T0 (p<0.001), T10 (p=0.001) and T20 (p=0.043), and a smaller proportion of eyes with IOP elevation of greater than 20 mm Hg from preinjection (p=0.002) and IOP greater than 50 mm Hg at T0 (p=0.036). Without prophylaxis, two eyes (two patients) had an IOP of greater than 70 mm Hg at T0 and thus underwent anterior chamber paracentesis.

Conclusion Topical brimonidine tartrate prophylaxis for intravitreal injection of anti-VEGF agents effectively reduces IOP spikes in non-glaucomatous eyes and may be easily incorporated into ophthalmologists’ current practice.

Trial registration number NCT03513172

  • alpha2-adrenergic agonists
  • intraocular pressure
  • intraocular pressure spikes
  • intravitreal injections

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  • Presented at This material was presented as a 7-minute oral presentation as part of the Innovations in Retina Section at the American Academy of Ophthalmology Annual Meeting 2017, November 11–14, New Orleans.

  • Correction notice The paper has been corrected since it was published Online First. The drug name Avastin has been changed to Eylea.

  • Contributors Conception and design of the study: EDM, TF, PY, MHB, AH, RT. Data collection: TF, AH, RT. Analysis and interpretation: TF, EDM, AH, RT. Initial drafting of the manuscript: TF, EDM. Critical revision of the article: EDM, MHB, TF, PY, AH, RT. Final approval of the article and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: EDM, TF, MHB, AH, RT, PY. Obtained funding: EDM. Literature search: TF, PY, AH. Administrative, technical or logistic support: EDM, MHB, TF, AH, RT, PY.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer EDM has received honoraria from Novartis Canada and Bayer Canada. MHB has membership on an advisory panel for Alcon Canada, Novartis Canada and Bayer Canada. The remaining authors (TF, AH, RT and PY) have no disclosures to declare. None of the authors have proprietary or financial interest in any of the work discussed in this manuscript.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval This study was approved by the institutional ethics review board (University Health Network Research Ethics Board, University of Toronto), and the research protocol adhered to the tenets of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional unpublished data available from the study.

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