Original article
Short-term Intraocular Pressure Changes Immediately After Intravitreal Injections of Anti–Vascular Endothelial Growth Factor Agents

https://doi.org/10.1016/j.ajo.2008.07.007Get rights and content

Purpose

To assess short-term trends and the need to monitor intraocular pressure (IOP) changes immediately after intravitreal injections of ranibizumab, bevacizumab, pegaptanib, and triamcinolone acetonide.

Design

Retrospective, interventional case series.

Methods

Charts of 213 consecutive injections to 120 eyes of 112 patients were reviewed. Pressures were measured before injection, immediately after injection (T0), and at five-minute intervals until IOP was less than 30 mm Hg. Optic nerve perfusion was assessed by testing for hand movement vision and by indirect ophthalmoscopic examination. Kaplan-Meier and Chi-square analyses of IOP after injections and correlation of IOP spikes to drug, needle bore size, injection volume, and history of glaucoma were performed.

Results

Mean preinjection IOP was 14 mm Hg (range, 7 to 22 mm Hg). Mean IOP at T0 was 44 mm Hg (range, 4 to 87 mm Hg). All but one eye had at least hand movement vision and a perfused optic nerve at T0. IOP was reduced to less than 30 mm Hg in 96% of injections by 15 minutes and in 100% by 30 minutes. Eyes with a history of glaucoma took longer to normalize the IOP (P = .002). Statistically significant IOP spikes were observed with a smaller needle bore size (P < .0001) and in eyes with a history of glaucoma (P = .001).

Conclusions

Elevations in IOP immediately after intravitreal injections are common, but are transient. Prolonged monitoring of IOP may not be necessary on the day of injection in most cases if hand movement vision, optic nerve perfusion, and lack of intraocular complications have been verified. However, cautious monitoring should be considered in select cases.

Section snippets

Methods

A retrospective chart review of consecutive injections given by a single retina specialist (J.E.K.) in an outpatient office setting between May 1, 2006 and November 30, 2006 was performed. Using either a 30- or 32-gauge needle (TSK3213; Air-Tite, Virginia Beach, Virginia, USA), 0.05 ml bevacizumab (Avastin; Genentech, San Francisco, California, USA) or ranibizumab (Lucentis; Genentech) were administered. Because of larger particle size, 0.1 ml triamcinolone acetonide (Bristol-Myers Squibb Co,

Results

Data from 213 consecutive intravitreal injections to 120 eyes of 112 patients were analyzed. The mean age of patients was 76 years (range, 29 to 92 years), with 48 men and 64 women. Fifty-three eyes were phakic and 67 eyes were pseudophakic. Patients received intravitreal injections for a range of vitreoretinal diseases. The most common reason for injection of ranibizumab, bevacizumab, and pegaptanib was exudative macular degeneration with choroidal neovascular membrane (84%). Other

Discussion

As intravitreal injections become an increasingly common method of treatment, investigating the need for monitoring IOP after injection is important for patient safety, increased patient satisfaction despite need for repeated injections, and enhancement of office flow. In addition, this study aimed to determine factors that affect IOP immediately after injection. We found that elevations in IOP after intravitreal injections were common, can be quite high, and can occur with all currently used

Judy E. Kim, MD, is a graduate of Johns Hopkins University School of Medicine, Baltimore, Maryland and Howard Hughes Medical Institute-National Institutes of Health Research Scholars Program. She completed her ophthalmology residency training at Bascom Palmer Eye Institute and vitreoretinal fellowship at the Medical College of Wisconsin, Milwaukee, Wisconsin. Dr Kim is currently an Associate Professor of Ophthalmology at the Medical College of Wisconsin.

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Judy E. Kim, MD, is a graduate of Johns Hopkins University School of Medicine, Baltimore, Maryland and Howard Hughes Medical Institute-National Institutes of Health Research Scholars Program. She completed her ophthalmology residency training at Bascom Palmer Eye Institute and vitreoretinal fellowship at the Medical College of Wisconsin, Milwaukee, Wisconsin. Dr Kim is currently an Associate Professor of Ophthalmology at the Medical College of Wisconsin.

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