Effect of Brimonidine/Timolol Fixed Combination on Preventing the Short-Term Intraocular Pressure Increase after Intravitreal Injection of Ranibizumab

Abstract

The aim of this study was to evaluate the safety and efficacy of brimonidine 0.2 % and timolol 0.5 % instillation as a fixed combination (Combigan, Allergan Inc.) to prevent acute intraocular pressure (IOP) increase occurring after intravitreal injection of ranibizumab (Lucentis, Novartis Pharma AG). A prospective double-blind placebo-controlled study was carried out. One eye of 88 consecutive normotensive age-related macular degeneration patients receiving Lucentis was randomized into placebo drops (artificial tears, 44 patients) or Combigan drops (44 patients) given twice a day the day before and the day of injection. IOP was measured before and 5, 10, 15 minutes and 1 hour after the intravitreal injection. The placebo group had the higher mean IOP at all time points after injection. Maximum IOP increase for both groups occurred at the 5-minutes time point. Mean post-injection IOP in the placebo group was 34.1 +/- 2.7 mmHg at 5 minutes post-injection versus 28.4 +/- 1.1 mmHg in the Combigan group (P < 0.001). IOP decreased to 24.9 +/- 1.8 mmHg (placebo group) and 19.9 +/- 1.1 mmHg (Combigan group) at 10 minutes post-injection. At 15 minutes post-injection, IOP was below 20 mmHg in all eyes of the Combigan group (100 %), whereas at the same time point these IOP levels were reached only by 34 % of the eyes of the placebo group (15 eyes). All eyes of both groups had a normal IOP 1 hour post-injection. No systemic or ocular side effect was recorded in either group. The use of Combigan drops twice a day the day before and the day of injection in eyes scheduled for intravitreal injection of Lucentis is a safe and effective prophylaxis to reduce the acute IOP spikes of the post-injection period.