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

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Abstract

Purpose

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) (0.05 mL, 1.25 mg 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 250 mg (n = 14); group 4: intravenous mannitol (1.5 gr/kg) (n = 16); group 5: no intraocular pressure-lowering medication (n = 13). Medications were administered 30–60 min prior to injection. None of the patients had history of glaucoma. Intraocular pressure was measured before (baseline), 5 min after (T5), 10 min after (T10), 15 min after (T15) and 30 min after (T30) IVI using Goldmann Tonometer.

Results

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 ± 2.60 mmHg, 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 ± 9.99 mmHg (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.

Conclusion

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

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Data availability

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

The study was funded and supported by the eye research center of Khatam Eye Hospital, Mashhad University of Medical Sciences, with the grant number: 910292.

Author information

Authors and Affiliations

  1. Associate Professor of Ophthalmology, Khatam Eye Hospital, Mashhad University of Medical Sciences, eye research center, Mashhad, Iran

    Nasser shoeibi

  2. Resident of Ophthalmology, Khatam Eye Hospital, Mashhad University of Medical Sciences, eye research center, Mashhad, Iran

    Zina Ghosi

  3. Anterior Segment Fellow in Ophthalmology, Khatam Eye Hospital, Mashhad University of Medical Sciences, eye research center, Mashhad, Iran

    Habib Jafari

  4. Vitreoretina Fellowship Student, Khatam Al Anbia Eye Hospital, Mashhad University of Medical Sciences, eye research centerAbutalib crossroad, Ghareni Blvd, Mashhad, Iran

    Arash Omidtabrizi

Authors
  1. Nasser shoeibi
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  2. Zina Ghosi
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  4. Arash Omidtabrizi
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by [Nasser shoeibi], [Zina Ghosi], [Habib Jafari] and [Arash Omidtabrizi]. The first draft of the manuscript was written by [Arash Omidtabrizi] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Arash Omidtabrizi.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This study was carried out in accordance with ethical standards set forth by the 1989 Declaration of Helsinki with the approval of the Institutional Review Board and Ethics Committee of the Mashhad University of Medical Sciences.

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All the patients provided a written informed consent to participate in the study.

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Patients signed informed consent regarding publishing their data.

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shoeibi, N., Ghosi, Z., Jafari, H. et al. Effect of antiglaucoma agents on short-term intraocular pressure fluctuations after intravitreal bevacizumab injections. Int Ophthalmol 41, 1081–1090 (2021). https://doi.org/10.1007/s10792-020-01667-z

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