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Rosenfeld and colleagues reported that ranibizumab (Lucentis) had no long-term effect on intraocular pressure (IOP) as determined by monthly measurements during the 2-year MARINA study.1 We are unaware of previous studies examining the short-term effect on IOP by intravitreal ranibizumab in patients with wet age-related macular degeneration.
We conducted a retrospective chart review of 50 ranibizumab injections from 23 patients. IOP was recorded using Goldmann applanation tonometry. All patients included in this series received ranibizumab injection as directed by the instructions provided in the package insert (volume 0.05 mL). Prior to injection, the mean baseline IOP was 14.04 (SD 3.16) mm Hg with a range of 9–22 mm Hg (n = 50). Thirty minutes after injection, the mean IOP was 21.10 (4.74) mm Hg with a range of 10–31 mm Hg (n = 50). At 1-week follow-up, the average IOP was 13.94 mm Hg (n = 19). The 2-week follow-up IOP averaged 12.5 mm Hg (n = 6). At the 4-week follow-up visit, the average IOP was 13.75 mm Hg (n = 37). The difference between the preinjection IOP and the IOP measured at all follow-up visits was not statistically significant (p = 0.297).
None of the 50 eyes experienced an IOP rise to greater than 31 mm Hg as measured 30 min after ranibizumab injection. Following the injection, none of the 50 eyes required IOP-lowering drops or anterior chamber paracentesis to lower IOP.
After intravitreal injections of ranibizumab, patients typically wait in the clinic another 30 min to have the IOP checked. Our series reveals that intravitreal injection of ranibizumab results in an expected mild transient elevation of IOP immediately after injection. However, the IOP normalises to baseline soon after without employing therapy for IOP control. We therefore challenge the need for patients to have IOP checked after ranibizumab injection and leave this decision to physician discretion. Shorter clinic visits translate into improved allocation of resources for both patients and physicians. It is reassuring that IOP returns to baseline at the 1-week, 2-week and 4-week follow-up visits. In such cases where a patient is unable to return to their follow-up visit, our data reassure that IOP theoretically should not remain elevated.
In summary, our limited series reveals that ranibizumab injection is safe in terms of elevation of IOP in a short-term setting. Anterior chamber paracentesis immediately after injection is not recommended, as this procedure has a risk of lens damage and a theoretical risk of increasing the chance of infection. The MARINA study also shows that monthly ranibizumab injections are safe in terms of its effect on long-term IOP.1
Funding: Research supported by an unrestricted grant from the Research to Prevent Blindness Organization, New York, NY.
Competing interests: None.
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