Effect of antiglaucoma agents on short-term intraocular pressure fluctuations after intravitreal bevacizumab injections.

Abstract

To evaluate the effect of prophylactic pressure-lowering medications on intraocular pressure (IOP) spikes after intravitreal injections (IVIs) METHODS: In this randomized double-blind clinical trial, 74 eyes that were candidates for intravitreal anti-vascular endothelial growth factor (VEGF) injection (IVI) (0.05mL, 1.25mg of bevacizumab) were enrolled and sorted randomly into five groups, group 1: topical timolol 0.5% (n = 16); group 2: topical brimonidin (n = 15); group 3: oral acetazolamide 250mg (n = 14); group 4: intravenous mannitol (1.5 gr/kg) (n = 16); group 5: no intraocular pressure-lowering medication (n = 13). Medications were administered 30-60min prior to injection. None of the patients had history of glaucoma. Intraocular pressure was measured before (baseline), 5min after (T5), 10min after (T10), 15min after (T15) and 30min after (T30) IVI using Goldmann Tonometer. There was a statistically significant, but relatively weak negative correlation between the amount of vitreous reflux post-IVI intraocular pressure elevation (Spearman's rho = -0.315, p = 0.006). There was no difference of the amount of vitreous reflux (P = 0.196) between study groups. The baseline mean IOP for Groups 1, 2, 3,4 and 5 were 11.19 ± 3.7, 10.07 ± 2.19, 11 ± 2.98, 10.13 ± 3.48 and12.54 ± 2.60mmHg, respectively. (P = 0.214) There was no difference of peak IOP spike between groups at T5: 37 ± 19.7, 34.80 ± 15.76, 33.43 ± 18.29, 33.56 ± 16.88, 34.92 ± 9.99mmHg (P = 0.977). There was also no difference of IOP at T10, T15 and T30 between study groups: P = 0.979, P = 0.994 and P = 0.692, respectively. Although it is advisable to prevent IOP spikes, our study showed that use of prophylactic pressure-lowering medications with every mechanism of action has no effect in IOP spikes following intravitreal bevacizumab injections in non-glaucomatous eyes. Trial registrationThe study was registered with clinicaltrails.gov (ID# NCT02140450). Trial registration date: 05.09.2014.