Effects of intravitreal injection of bevacizumab with or without anterior chamber paracentesis on intraocular pressure and peripapillary retinal nerve fiber layer thickness: a prospective study.

Abstract

To investigate the effects of intravitreal injection of bevacizumab (IVB) with or without anterior chamber paracentesis on intraocular pressure (IOP) and peripapillary retinal nerve fiber layer (PRNFL) thickness. In this prospective randomized clinical trial, 90 eyes with center involving diabetic macular edema or wet type age-related macular degeneration (AMD) were randomly assigned to receive IVB either without (group A) or with (group B) anterior chamber paracentesis. IOP was measured before and within 2 min, 30 min, 24 hours and 3 months after injections. Peripapillary spectral-domain optical coherence tomography (SD-OCT) was performed before and 3months after injections. Mean IOP changes 2 minutes, 30 minutes, 24 hours, and 3 months after injections were 26.4 ± 5.7 mmHg (P <0.001), 6.5 ± 6.3 mmHg (P <0.001), 0.2 ± 2.9 mmHg (P >0.99) and 0.5 ± 2.4 mmHg (P >0.99) in group A and -1.3 ± 2.4 mmHg (P <0.001), -3.2 ± 1.8 mmHg (P <0.001), -3.1 ± 1.8 mmHg (P <0.001) and -1.8 ± 2.2 mmHg (P <0.001) in group B, respectively Mean baseline average PRNFL thickness was 85.3±5.6 μm and 85.6 ± 5 μm in groups A and B respectively. Mean PRNFL thickness changes after 3 month was -2 ± 2 μm (P <0.001) in group A and 0 ± 2 μm (P =0.101) in group B. Mean PRNFL thickness in group A decreased more than group B (P <0.001). Conventional method of IVB injection was associated with acute IOP rise and significant PRNFL loss 3 months after injection. Anterior chamber paracentesis prevents acute IOP rise and PRNFL loss.