The aim of this study was to assess the effect of vitreous reflux and its amount on short-term intraocular pressure after intravitreal injection of ranibizumab.
Methods:
The study included 316 eyes of 276 patients. Intraocular pressures were measured before intravitreal injection (preIOP), immediately after intravitreal injection (postIOP0), and 30 min after intravitreal injection (postIOP30). The amount of vitreous reflux was evaluated by measuring conjunctival bleb diameter, and patients were grouped as; group 1: no vitreous reflux, group 2: less vitreous reflux, and group 3: more vitreous reflux. The data were analyzed using variance analysis, chi-square test, and regression analysis.
Results:
PostIOP0 values were highest in group 1, followed by group 2 and group 3 (all p values < 0.001). PostIOP30 values were similar in group 1 and group 2 (p = 0.261), but were lower in group 3 than other two groups (p < 0.001, p = 0.001, respectively). Vitreous reflux was identified as the only factor affecting postinjection intraocular pressure changes (p < 0.001), and a negative correlation was found between the total number of intravitreal injection and vitreous reflux (p = 0.032).
Conclusion:
The major factor affecting short-term postinjection intraocular pressure elevation was vitreous reflux, and intraocular pressure levels increased as the amount of vitreous reflux decreased. Vitreous reflux and its amount decreased as the total number of intravitreal injection increased.
PangCEMrejenSHoangQVet al. Association between needle size, postinjection reflux, and intraocular pressure spikes after intravitreal injections. Retina2015; 35(7): 1401–1406.
2.
RosenfeldPJBrownDMHeierJSet al. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med2006; 355: 1419–1431.
KnechtPBMichelsSSturmVet al. Tunnelled versus straight intravitreal injection: intraocular pressure changes, vitreous reflux, and patient discomfort. Retina2009; 29(8): 1175–1181.
5.
HoangQVTsuangAJGelmanRet al. Clinical predictors of sustained intraocular pressure elevation due to intravitreal anti-vascular endothelial growth factor therapy. Retina2013; 33(1): 179–187.
6.
KimJEMantravadiAVHurEYet al. Short-term intraocular pressure changes immediately after intravitreal injections of anti-vascular endothelial growth factor agents. Am J Ophthalmol2008; 146(6): 930.e1–934.e1.
7.
ArikanGOsman SaatciAHakan OnerF.Immediate intraocular pressure rise after intravitreal injection of ranibizumab and two doses of triamcinolone acetonide. Int J Ophthalmol2011; 4(4): 402–405.
8.
GismondiMSalatiCSalvetatMLet al. Short-term effect of intravitreal injection of Ranibizumab (Lucentis) on intraocular pressure. J Glaucoma2009; 18(9): 658–661.
9.
BakriSJPulidoJSMcCannelCAet al. Immediate intraocular pressure changes following intravitreal injections of triamcinolone, pegaptanib, and bevacizumab. Eye (Lond)2009; 23(1): 181–185.
10.
HoangQVJungJJMrejenSet al. Influence of axial length and postinjection reflux on sustained intraocular pressure elevation as a result of intravitreal anti-vascular endothelial growth factor therapy. Retina2014; 34(3): 519–524.
11.
OzkayaAAlkinZCelikUet al. Comparing the effects of three different intravitreal injection techniques on vitreous reflux and intraocular pressure. J Ocul Pharmacol Ther2013; 29(3): 325–329.
12.
RodriguesEBMeyerCHGrumannAJret al. Tunneled scleral incision to prevent vitreal reflux after intravitreal injection. Am J Ophthalmol2007; 143(6): 1035–1037.
13.
SaeedMUBatraRQureshiFet al. Reflux of drug during intra-vitreal anti-VEGF therapies. Semin Ophthalmol2011; 26(6): 357–360.
14.
KampougerisGSpyropoulosDMitropoulouA.Intraocular pressure rise after anti-VEGF treatment: prevalence, possible mechanisms and correlations. J Curr Glaucoma Pract2013; 7(1): 19–24.
15.
FalkensteinIAChengLFreemanWR.Changes of intraocular pressure after intravitreal injection of bevacizumab (avastin). Retina2007; 27: 1044–1047.
16.
MojicaGHariprasadSMJagerRDet al. Short-term intraocular pressure trends following intravitreal injections of ranibizumab (Lucentis) for the treatment of wet age-related macular degeneration. Br J Ophthalmol2008; 92(4): 584.
17.
HohnFMirshahiA.Impact of injection techniques on intraocular pressure (IOP) increase after intravitreal ranibizumab application. Graefes Arch Clin Exp Ophthalmol2010; 248(10): 1371–1375.
18.
HollandsHWongJBruenRet al. Short-term intraocular pressure changes after intravitreal injection of bevacizumab. Can J Ophthalmol2007; 42: 807–811.
TurgutBDemirTCelikerU.The effects of injection site on the reflux following intravitreal injections. J Clin Med Res2009; 1(5): 280–284.
21.
RodriguesEBGrumannAJrPenhaFMet al. Effect of needle type and injection technique on pain level and vitreal reflux in intravitreal injection. J Ocul Pharmacol Ther2011; 27(2): 197–203.
22.
LorenzKZwienerIMirshahiA.Subconjunctival reflux and need for paracentesis after intravitreal injection of 0.1 ml bevacizumab: comparison between 27-gauge and 30-gauge needle. Graefes Arch Clin Exp Ophthalmol2010; 248(11): 1573–1577.
23.
KotliarKMaierMBauerSet al. Effect of intravitreal injections and volume changes on intraocular pressure: clinical results and biomechanical model. Acta Ophthalmol Scand2007; 85(7): 777–781.
24.
FuestMKotliarKWalterPet al. Monitoring intraocular pressure changes after intravitreal Ranibizumab injection using rebound tonometry. Ophthalmic Physiol Opt2014; 34(4): 438–444.
25.
BoonCJCramaNKleveringBJet al. Reflux after intravitreal injection of bevacizumab. Ophthalmology2008; 115: 1270; author reply 1271.
26.
TranosPBharGLittleB.Postoperative intraocular pressure spikes: the need to treat. Eye (Lond)2004; 18(7): 673–679.
27.
HayrehSS.Anterior ischemic optic neuropathy. IV. Occurrence after cataract extraction. Arch Ophthalmol1980; 98: 1410–1416.
28.
HeZBui VingrysAJ.The rate of functional recovery from acute IOP elevation. Invest Ophthalmol Vis Sci2006; 47(11): 4872–4880.
29.
HeZBuiBVVingrysAJ.Effect of repeated IOP challenge on rat retinal function. Invest Ophthalmol Vis Sci2008; 49(7): 3026–3034.
30.
KolkerAE.Visual prognosis in advanced glaucoma: a comparison of medical and surgical therapy for retention of vision in 101 eyes with advanced glaucoma. Trans Am Ophthalmol Soc1977; 75: 539–555.
31.
SavageJAThomasJVBelcherCDIIIet al. Extracapsular cataract extraction and posterior chamber intraocular lens implantation in glaucomatous eyes. Ophthalmology1985; 92(11): 1506–1516.
32.
DedaniaVSBakriSJ.Sustained elevation of intraocular pressure after intravitreal anti-VEGF agents: what is the evidence. Retina2015; 35(5): 841–858.
Lopez-GuajardoLDel ValleFGMorenoJPet al. Reduction of pegaptanib loss during intravitreal delivery using an oblique injection technique. Eye (Lond)2008; 22(3): 430–433.
35.
BrodieFLRuggieroJGhodasraDHet al. A novel method for the measurement of reflux from intravitreal injections: data from 20 porcine eyes. Curr Eye Res2014; 39(7): 752–757.
36.
BrodieFLRuggieroJGhodasraDHet al. Volume and composition of reflux after intravitreal injection. Retina2014; 34(7): 1473–1476.
37.
SaeedMUQureshiFBatraRet al. Effect of reflux of drug during intravitreal anti-VEGF therapies on foveal thickness. Semin Ophthalmol2011; 26(2): 61–63.
