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Topical apraclonidine as a prevention method of subconjunctival hemorrhage (SCH) and pain after intravitreal injections (IVI)

Session Details

Session Title: New Drug Treatment and Technology I

Session Date/Time: Friday 18/09/2015 | 11:00-12:30

Paper Time: 11:40

Venue: Thalie.

First Author: : O.Lagstein ISRAEL

Co Author(s): :    N. Ben Artzi   E. Bartov   Z. BurganskiEliash   A. Achiron   A. Nemet  

Abstract Details

PURPOSE:Apraclonidine is an adrenergic agonist which is slightly more selective to α-2-adrenergic receptors (IOP lowering effect) than to α-1-adrenergic receptors (vasoconstrictive effect). Our purpose was, to evaluate the efficiency of topical Apraclonidine in reducing the frequency and severity of SCH and pain after IVI, thus increasing patients' satisfaction from the procedure and compliance to treatment.


IVI clinic - the vitreoretinal unit at the E. Wolfson Medical Center. Affiliated to Sacklers School of Medicine, Tel-Aviv University, Israel. All patients received a recommendation for an IVI of Bevacizumab by a retina specialist.


A prospective, double blinded, random, single center research. Thirty-five patients (70 eyes) receiving two consecutive monthly IVI of 1.25mg/0.05cc Bevacizumab, delivered by a 30-gauge needle, were examined. All patients were examined twice, once at each monthly IVI .Patients were randomly assigned to receive 0.05cc (which equals 1 drop) of topical Apraclonidine 0.5% or placebo (NaCl 0.9%) to the treated eye, 30 minutes before the IVI. At their next IVI appointment, patients recieved the other type of intervention. 30 minutes after the IVI, patients were examined. SCH was assessed by a slit-lamp microscopy. SCH size was calculated by multiplying the width and length (in millimeters) of the affected area. Pain was assessed by the Visual Analog Scale (scale of 1-10).


SCH occurred following IVI in 48.5% (17 eyes) of the Apraclonidine group and in 57.1% (20 eyes) of the control group (p =0.648). 30 minutes following the IVI, mean size of the SCH was 1.76 mm^2 in the Apraclonidine group and 2.98 mm^2 in the control group (p=0.1). Mean Visual Analog Scale pain score was 1.8 in the Apraclonidine group and 3.43 in the control group (p= smaller than 0.001).


Topically applying 1 drop of Apraclonidine 0.5%, 30 minutes before an IVI, did not decrease the incidence of SCH, but showed a none-significant trend of decreasing its severity (size). Post-IVI pain was significantly reduced after applying topical Apraclonidine. We believe that by its α-2-adrenegic receptor agonist effect, Apraclonidine prevents the temporary volume-related IOP-spike and pain following an IVI. As to our experience, topically applying Apraclonidine before an IVI could increase patients' satisfaction and compliance to treatment.

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