Intraocular pressure spikes prevention after intravitreal injections

Session Details

Session Title: Free Paper Session 5: Anterior/Posterior Segment Surgery

Session Date/Time: Thursday 07/09/2017 | 11:00-12:30

Paper Time: 12:18

Venue: Room 117

First Author: : S.Carrillo Cristancho SPAIN

Co Author(s): :    S. Copete Piqueras   J. Rigo   R. Muniz Vidal   A. Calvo Alvarez   M. Zapata Victori   J. Garcia-Arumi              

Abstract Details

Purpose:

To assess the efficacy of prophylactic brimonidine 0.2 % instillation preventing intraocular pressure (IOP) spikes after intravitreal injections (IVI), compared with placebo.

Setting:

This study took place at the ophthalmology service of vall d'hebron hospital in Barcelona between November 2016 and February 2017.

Methods:

A prospective study was carried out. 210 consecutive intravitreal injections (IVI) of ranibizumab (n=70), aflibercept (n=120), and dexamethasone intravitreal implant (n=20) were randomized into prophylactic brimonidine 0.2 % drops (n=106), or placebo drops (artificial tears, n=104) given 30 minutes before the injection. IOP was measured using a Goldmann tonometer by a single observator before instillation of prophylactic drops and 10 minutes after all IVI. ) In those patients with IOP Spikes (IOP increase over 7 mmHg) posterior measurements every 15 minutes were taken until basal IOP (± 2mmHg was achieved. Those patients with IOP increase lower than 7 mmHg but with measurements above 25 mmHg, after 55 minutes of the procedure, were also treated with rescue pressure-lowering medication. Measurements to the fellow eye were made in order to determine the intra observer repeatability.

Results:

A total of 75 IOP spikes were reported, 30 with ranibizumab (40%), 45 with aflibercept (60%), and 0 with dexamethasone intravitreal implant. Incidence of IOP spikes in the placebo group (38 ranibizumab, 58 aflibercept, and 8 dexamethasone intravitreal implant) was 39/104 (37.5%), of which 30 achieved their basal IOP at minute 25, 3 until minute 40, 2 until minute 55, and 2 did not recover their basal IOP needing brimonidine as rescue pressure-lowering medication. The mean IOP before IVI was 13.4 (±2.8) mmHg and after the procedure 19.5 (±7.9) mmHg, mean change of 6 (±7.2) mmHg. In the brimonidine group (32 ranibizumab, 62 aflibercept, and 12 dexamethasone intravitreal implant) the incidence of IOP spikes was 36/106 (33.9%), of which 31 achieved their basal IOP at minute 25, 2 until minute 40, 1 until minute 55, 1 did not recover its normal IOP needing rescue dorzolamide prescription, and 1 required anterior chamber paracentesis since compromise of retinal artery perfusion was diagnosed at minute 10. The mean IOP before IVI was 13.61 (±3.8) mmHg and after the procedure 18.02 (±9.6) mmHg, mean change of 4.2 (±8.4) mmHg. There were no significant differences between the groups (Fisher test P>0.05).

Conclusions:

IOP spikes are frequent but transient in most of the eyes following IVI. Prophylactic brimonidine 0.2 % instilled 30 minutes before the injection did not show to be effective reducing the incidence of acute IOP spikes after intravitreal injections compared with placebo. Dexamethasone intravitreal implant proved to be safe avoiding IOP spikes; however, ophthalmologist should evaluated its risk of steroid induced glaucoma.

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