The Effect of Intraocular Pressure Lowering Medications on the Pressure Spike Associated with Intravitreal Injection
Author(s)
Olya Pokrovskaya1*,
Ian Dooley2,
Salma Babiker2,
Catherine Croghan2,
Claire Hartnett2,
Anthony Cullinane2
Affiliation(s)
1 Department of Ophthalmology, Mater Miscericordiae University Hospital, Dublin, Ireland. 2 Department of Ophthalmology, Cork University Hospital, Cork, Ireland.
1 Department of Ophthalmology, Mater Miscericordiae University Hospital, Dublin, Ireland. 2 Department of Ophthalmology, Cork University Hospital, Cork, Ireland.
ABSTRACT
Aim: This study investigates whether the post intravitreal injection intraocular pressure (IOP) spike is modifiable with the use of prophylactic apraclonidine and dorzolomide. Methods: The study design was a prospective, randomised controlled trial. 80 eyes undergoing intravitreal injection of anti-VEGF agent were studied. A control group (n = 42) received no IOP lowering drops, and a study group (n = 38) received guttae apraclonidine and dorzolamide 30 to 40 minutes before the intravitreal injection. IOP measurements were taken in both groups using the Perkins tonometer at baseline, immediately before and after the injection, 5 minutes post-injection, and 15 minutes post-injection. Results: Mean IOP immediately post injection in the study group was 26.71 mmHg, and in the control group was 32.73. The main outcome measure was the area under the curve (AUC)—reflecting the trend of IOP post injection. The AUC was lower in the study group compared to the control group (Mann-Whitney U test, p = 0.046). Conclusions: The use of prophylactic apraclonidine and dorzolamide is effective in modifying the post-injection IOP spike. IOP lowering prophylaxis may be considered in patients with a high baseline IOP.
Aim: This study investigates whether the post intravitreal injection intraocular pressure (IOP) spike is modifiable with the use of prophylactic apraclonidine and dorzolomide. Methods: The study design was a prospective, randomised controlled trial. 80 eyes undergoing intravitreal injection of anti-VEGF agent were studied. A control group (n = 42) received no IOP lowering drops, and a study group (n = 38) received guttae apraclonidine and dorzolamide 30 to 40 minutes before the intravitreal injection. IOP measurements were taken in both groups using the Perkins tonometer at baseline, immediately before and after the injection, 5 minutes post-injection, and 15 minutes post-injection. Results: Mean IOP immediately post injection in the study group was 26.71 mmHg, and in the control group was 32.73. The main outcome measure was the area under the curve (AUC)—reflecting the trend of IOP post injection. The AUC was lower in the study group compared to the control group (Mann-Whitney U test, p = 0.046). Conclusions: The use of prophylactic apraclonidine and dorzolamide is effective in modifying the post-injection IOP spike. IOP lowering prophylaxis may be considered in patients with a high baseline IOP.
Cite this paper
Pokrovskaya, O. , Dooley, I. , Babiker, S. , Croghan, C. , Hartnett, C. and Cullinane, A. (2015) The Effect of Intraocular Pressure Lowering Medications on the Pressure Spike Associated with Intravitreal Injection. Open Journal of Ophthalmology, 5, 149-154. doi: 10.4236/ojoph.2015.54023.
Pokrovskaya, O. , Dooley, I. , Babiker, S. , Croghan, C. , Hartnett, C. and Cullinane, A. (2015) The Effect of Intraocular Pressure Lowering Medications on the Pressure Spike Associated with Intravitreal Injection. Open Journal of Ophthalmology, 5, 149-154. doi: 10.4236/ojoph.2015.54023.
References
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http://dx.doi.org/10.1097/IAE.0b013e3180592ba6 [5] Wu, L. and Evans, T. (2010) [Immediate Changes in Intraocular Pressure after an Intravitreal Injection of 2.5 mg of Bevacizumab]. Archivos de la Sociedad Espanola de Oftalmologia, 85, 364-369.
http://dx.doi.org/10.1016/j.oftal.2010.09.010 [6] Sharei, V., Hohn, F., Kohler, T., et al. (2010) Course of Intraocular Pressure after Intravitreal Injection of 0.05 mL Ranibizumab (Lucentis). European Journal of Ophthalmology, 20, 174-179. [7] Hariprasad, S.M., Shah, G.K. and Blinder, K.J. (2006) Short-Term Intraocular Pressure Trends Following Intravitreal Pegaptanib (Macugen) Injection. American Journal of Ophthalmology, 141, 200-201.
http://dx.doi.org/10.1016/j.ajo.2005.07.053 [8] Rosenfeld, P.J., Brown, D.M., Heier, J.S., et al. (2006) Ranibizumab for Neovascular Age-Related Macular Degeneration. The New England Journal of Medicine, 355, 1419-1431.
http://dx.doi.org/10.1056/NEJMoa054481 [9] Aiello, L.P., Brucker, A.J., Chang, S., et al. (2004) Evolving Guidelines for Intravitreous Injections. Retina, 24, S3-S19.
http://dx.doi.org/10.1097/00006982-200410001-00002 [10] Frenkel, M.P., Haji, S.A. and Frenkel, R.E. (2010) Effect of Prophylactic Intraocular Pressure-Lowering Medication on Intraocular Pressure Spikes after Intravitreal Injections. Archives of Ophthalmology, 128, 1523-1527.
http://dx.doi.org/10.1001/archophthalmol.2010.297 [11] El Chehab, H., Le Corre, A., Agard, E., et al. (2012) Effect of Topical Pressure-Lowering Medication on Prevention of Intraocular Pressure Spikes after Intravitreal Injection. European Journal of Ophthalmology, 23. [12] Theoulakis, P.E., Lepidas, J., Petropoulos, I.K., et al. (2010) Effect of Brimonidine/Timolol Fixed Combination on Preventing the Short-Term Intraocular Pressure Increase after Intravitreal Injection of Ranibizumab. Klinische Monatsblatter fur Augenheilkunde, 227, 280-284.
http://dx.doi.org/10.1055/s-0029-1245201 [13] Pruessner, J.C., Kirschbaum, C., Meinlschmid, G., et al. (2003) Two Formulas for Computation of the Area under the Curve Represent Measures of Total Hormone Concentration versus Time-Dependent Change. Psychoneuroendocrinology, 28, 916-931.
http://dx.doi.org/10.1016/S0306-4530(02)00108-7 [14] Robin, A.L., Pollack, I.P., House, B., et al. (1987) Effects of ALO 2145 on Intraocular Pressure Following Argon Laser Trabeculoplasty. Archives of Ophthalmology, 105, 646-650.
http://dx.doi.org/10.1001/archopht.1987.01060050064039 [15] Barnes, S.D., Campagna, J.A., Dirks, M.S., et al. (1999) Control of Intraocular Pressure Elevations after Argon Laser Trabeculoplasty: Comparison of Brimonidine 0.2% to Apraclonidine 1.0%. Ophthalmology, 106, 2033-2037.
http://dx.doi.org/10.1016/S0161-6420(99)90420-7 [16] Ladas, I.D., Baltatzis, S., Panagiotidis, D., et al. (1997) Topical 2.0% Dorzolamide vs oral Acetazolamide for Prevention of Intraocular Pressure Rise after Neodymium:YAG Laser Posterior Capsulotomy. Archives of Ophthalmology, 115, 1241-1244.
http://dx.doi.org/10.1001/archopht.1997.01100160411003 [17] Wilensky, J.T., Gieser, D.K., Dietsche, M.L., et al. (1993) Individual Variability in the Diurnal Intraocular Pressure Curve. Ophthalmology, 100, 940-944.
http://dx.doi.org/10.1016/S0161-6420(93)31551-4 [18] Kim, J.E., Mantravadi, A.V., Hur, E.Y., et al. (2008) Short-Term Intraocular Pressure Changes Immediately after Intravitreal Injections of Anti-Vascular Endothelial Growth Factor Agents. American Journal of Ophthalmology, 146, 930-934, e931. [19] Hollands, H., Wong, J., Bruen, R., et al. (2007) Short-Term Intraocular Pressure Changes after Intravitreal Injection of Bevacizumab. Canadian Journal of Ophthalmology, 42, 807-811.
http://dx.doi.org/10.3129/i07-172 [20] Pallikaris, I.G., Kymionis, G.D., Ginis, H.S., et al. (2005) Ocular Rigidity in Living Human Eyes. Investigative Ophthalmology & Visual Science, 46, 409-414.
http://dx.doi.org/10.1167/iovs.04-0162 [21] Detry-Morel, M. (2008) Currents on Target Intraocular Pressure and Intraocular Pressure Fluctuations in Glaucoma Management. Bulletin de la Societe belge d’ophtalmologie, 35-43. [22] Realini, T., Barber, L. and Burton, D. (2002) Frequency of Asymmetric Intraocular Pressure Fluctuations among Patients with and without Glaucoma. Ophthalmology, 109, 1367-1371.
http://dx.doi.org/10.1016/S0161-6420(02)01073-4 [23] Zeimer, R.C., Wilensky, J.T., Gieser, D.K., et al. (1991) Association between Intraocular Pressure Peaks and Progression of Visual Field Loss. Ophthalmology, 98, 64-69.
http://dx.doi.org/10.1016/S0161-6420(91)32340-6
[1] Bloch, S.B., Larsen, M. and Munch, I.C. (2012) Incidence of Legal Blindness from Age-Related Macular Degeneration in Denmark: Year 2000 to 2010. American Journal of Ophthalmology, 153, 209-213, e202. [2] Bressler, N.M., Doan, Q.V., Varma, R., et al. (2011) Estimated Cases of Legal Blindness and Visual Impairment Avoided Using Ranibizumab for Choroidal Neovascularization: Non-Hispanic White Population in the United States with Age-Related Macular Degeneration. Archives of Ophthalmology, 129, 709-717.
http://dx.doi.org/10.1001/archophthalmol.2011.140 [3] Skaat, A., Chetrit, A., Belkin, M., et al. (2012) Time Trends in the Incidence and Causes of Blindness in Israel. American Journal of Ophthalmology, 153, 214-221, e211. [4] Falkenstein, I.A, Cheng, L. and Freeman, W.R. (2007) Changes of Intraocular Pressure after Intravitreal Injection of Bevacizumab (Avastin). Retina, 27, 1044-1047.
http://dx.doi.org/10.1097/IAE.0b013e3180592ba6 [5] Wu, L. and Evans, T. (2010) [Immediate Changes in Intraocular Pressure after an Intravitreal Injection of 2.5 mg of Bevacizumab]. Archivos de la Sociedad Espanola de Oftalmologia, 85, 364-369.
http://dx.doi.org/10.1016/j.oftal.2010.09.010 [6] Sharei, V., Hohn, F., Kohler, T., et al. (2010) Course of Intraocular Pressure after Intravitreal Injection of 0.05 mL Ranibizumab (Lucentis). European Journal of Ophthalmology, 20, 174-179. [7] Hariprasad, S.M., Shah, G.K. and Blinder, K.J. (2006) Short-Term Intraocular Pressure Trends Following Intravitreal Pegaptanib (Macugen) Injection. American Journal of Ophthalmology, 141, 200-201.
http://dx.doi.org/10.1016/j.ajo.2005.07.053 [8] Rosenfeld, P.J., Brown, D.M., Heier, J.S., et al. (2006) Ranibizumab for Neovascular Age-Related Macular Degeneration. The New England Journal of Medicine, 355, 1419-1431.
http://dx.doi.org/10.1056/NEJMoa054481 [9] Aiello, L.P., Brucker, A.J., Chang, S., et al. (2004) Evolving Guidelines for Intravitreous Injections. Retina, 24, S3-S19.
http://dx.doi.org/10.1097/00006982-200410001-00002 [10] Frenkel, M.P., Haji, S.A. and Frenkel, R.E. (2010) Effect of Prophylactic Intraocular Pressure-Lowering Medication on Intraocular Pressure Spikes after Intravitreal Injections. Archives of Ophthalmology, 128, 1523-1527.
http://dx.doi.org/10.1001/archophthalmol.2010.297 [11] El Chehab, H., Le Corre, A., Agard, E., et al. (2012) Effect of Topical Pressure-Lowering Medication on Prevention of Intraocular Pressure Spikes after Intravitreal Injection. European Journal of Ophthalmology, 23. [12] Theoulakis, P.E., Lepidas, J., Petropoulos, I.K., et al. (2010) Effect of Brimonidine/Timolol Fixed Combination on Preventing the Short-Term Intraocular Pressure Increase after Intravitreal Injection of Ranibizumab. Klinische Monatsblatter fur Augenheilkunde, 227, 280-284.
http://dx.doi.org/10.1055/s-0029-1245201 [13] Pruessner, J.C., Kirschbaum, C., Meinlschmid, G., et al. (2003) Two Formulas for Computation of the Area under the Curve Represent Measures of Total Hormone Concentration versus Time-Dependent Change. Psychoneuroendocrinology, 28, 916-931.
http://dx.doi.org/10.1016/S0306-4530(02)00108-7 [14] Robin, A.L., Pollack, I.P., House, B., et al. (1987) Effects of ALO 2145 on Intraocular Pressure Following Argon Laser Trabeculoplasty. Archives of Ophthalmology, 105, 646-650.
http://dx.doi.org/10.1001/archopht.1987.01060050064039 [15] Barnes, S.D., Campagna, J.A., Dirks, M.S., et al. (1999) Control of Intraocular Pressure Elevations after Argon Laser Trabeculoplasty: Comparison of Brimonidine 0.2% to Apraclonidine 1.0%. Ophthalmology, 106, 2033-2037.
http://dx.doi.org/10.1016/S0161-6420(99)90420-7 [16] Ladas, I.D., Baltatzis, S., Panagiotidis, D., et al. (1997) Topical 2.0% Dorzolamide vs oral Acetazolamide for Prevention of Intraocular Pressure Rise after Neodymium:YAG Laser Posterior Capsulotomy. Archives of Ophthalmology, 115, 1241-1244.
http://dx.doi.org/10.1001/archopht.1997.01100160411003 [17] Wilensky, J.T., Gieser, D.K., Dietsche, M.L., et al. (1993) Individual Variability in the Diurnal Intraocular Pressure Curve. Ophthalmology, 100, 940-944.
http://dx.doi.org/10.1016/S0161-6420(93)31551-4 [18] Kim, J.E., Mantravadi, A.V., Hur, E.Y., et al. (2008) Short-Term Intraocular Pressure Changes Immediately after Intravitreal Injections of Anti-Vascular Endothelial Growth Factor Agents. American Journal of Ophthalmology, 146, 930-934, e931. [19] Hollands, H., Wong, J., Bruen, R., et al. (2007) Short-Term Intraocular Pressure Changes after Intravitreal Injection of Bevacizumab. Canadian Journal of Ophthalmology, 42, 807-811.
http://dx.doi.org/10.3129/i07-172 [20] Pallikaris, I.G., Kymionis, G.D., Ginis, H.S., et al. (2005) Ocular Rigidity in Living Human Eyes. Investigative Ophthalmology & Visual Science, 46, 409-414.
http://dx.doi.org/10.1167/iovs.04-0162 [21] Detry-Morel, M. (2008) Currents on Target Intraocular Pressure and Intraocular Pressure Fluctuations in Glaucoma Management. Bulletin de la Societe belge d’ophtalmologie, 35-43. [22] Realini, T., Barber, L. and Burton, D. (2002) Frequency of Asymmetric Intraocular Pressure Fluctuations among Patients with and without Glaucoma. Ophthalmology, 109, 1367-1371.
http://dx.doi.org/10.1016/S0161-6420(02)01073-4 [23] Zeimer, R.C., Wilensky, J.T., Gieser, D.K., et al. (1991) Association between Intraocular Pressure Peaks and Progression of Visual Field Loss. Ophthalmology, 98, 64-69.
http://dx.doi.org/10.1016/S0161-6420(91)32340-6