Randomized Clinical Trial of Intraocular Pressure-Lowering Medications on Preventing Spikes in Intraocular Pressure Following Intravitreal Anti-Vascular Endothelial Growth Factor Injections
Abstract Introduction Intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents are a primary management option for retinal diseases. Acute elevation of intraocular pressure (IOP) is a complication associated with these injections that should be considered. This study inv...
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Adis, Springer Healthcare
2024-12-01
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| Series: | Ophthalmology and Therapy |
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| Online Access: | https://doi.org/10.1007/s40123-024-01081-z |
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| author | Piriya Soomsawasdi Kulawan Rojananuangnit Eakkachai Arayangkoon Ratchada Chantiwas Sureeporn Pengrungreungwong Nontakorn Preawsampran Natnaree Tinpowong Rujira Samakhararaksakul Kanokwan Katkingkaew Natthapuch Seekhum Wanwisa Sathim |
| author_facet | Piriya Soomsawasdi Kulawan Rojananuangnit Eakkachai Arayangkoon Ratchada Chantiwas Sureeporn Pengrungreungwong Nontakorn Preawsampran Natnaree Tinpowong Rujira Samakhararaksakul Kanokwan Katkingkaew Natthapuch Seekhum Wanwisa Sathim |
| author_sort | Piriya Soomsawasdi |
| collection | DOAJ |
| description | Abstract Introduction Intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents are a primary management option for retinal diseases. Acute elevation of intraocular pressure (IOP) is a complication associated with these injections that should be considered. This study investigated and compared the prophylactic effects of fixed combination anti-glaucoma medication on IOP spikes following intravitreal anti-VEGF injections. Methods This randomized double-blind clinical trial included one eye of each participant indicated for treatment with intravitreal injection of anti-VEGF agents (bevacizumab, aflibercept, and ranibizumab) and randomly allocated to one of the three prophylactic anti-glaucoma medications, with each drug further divided into one- and two-drop regimens before intravitreal injection. Participants with allergies or contraindications to medications were excluded from the pretreatment groups and were invited to participate in the control group. Results The study involved 308 participants: 89 in the dorzolamide/timolol group, 86 in the brimonidine/timolol group, 101 in the brinzolamide/brimonidine group, and 32 in the control group. Baseline characteristics and IOP were comparable across all groups. In the prophylactic premedication groups, mean IOP at 30 min were within 21 mmHg and returned to their baseline at 1 h. Mean IOP measurements between baseline and 30 min in the brimonidine/timolol two-drop regimen were not significantly different: 13.72 ± 4.63 vs 15.11 ± 4.39 mmHg, p = 0.096. In the control group, IOP significantly increased from baseline at 30 min and 1 h post-injection: 14.31 ± 4.10, 22.15 ± 8.64, and 18.36 ± 7.52 mmHg, respectively, p < 0.001. Conclusion Topical fixed combination anti-glaucoma medication used as a prophylactic treatment before intravitreal anti-VEGF injections significantly prevented IOP spikes post-injection, with a comparable effect among three medications. Prophylactic treatment of IOP spikes should be considered as standard care to prevent further damage in patients with compromised retinal vascular and optic nerve perfusion. Trial Registration TCTR20241005001, retrospectively registered. |
| format | Article |
| id | doaj-art-cd33989887504eed856d0dc73e87c3b9 |
| institution | Kabale University |
| issn | 2193-8245 2193-6528 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Adis, Springer Healthcare |
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| series | Ophthalmology and Therapy |
| spelling | doaj-art-cd33989887504eed856d0dc73e87c3b92025-01-26T12:18:50ZengAdis, Springer HealthcareOphthalmology and Therapy2193-82452193-65282024-12-0114235136210.1007/s40123-024-01081-zRandomized Clinical Trial of Intraocular Pressure-Lowering Medications on Preventing Spikes in Intraocular Pressure Following Intravitreal Anti-Vascular Endothelial Growth Factor InjectionsPiriya Soomsawasdi0Kulawan Rojananuangnit1Eakkachai Arayangkoon2Ratchada Chantiwas3Sureeporn Pengrungreungwong4Nontakorn Preawsampran5Natnaree Tinpowong6Rujira Samakhararaksakul7Kanokwan Katkingkaew8Natthapuch Seekhum9Wanwisa Sathim10Department of Ophthalmology, Mettapracharak (Wat Rai Khing) HospitalDepartment of Ophthalmology, Mettapracharak (Wat Rai Khing) HospitalDepartment of Ophthalmology, Mettapracharak (Wat Rai Khing) HospitalDepartment of Ophthalmology, Mettapracharak (Wat Rai Khing) HospitalDepartment of Ophthalmology, Mettapracharak (Wat Rai Khing) HospitalDepartment of Ophthalmology, Mettapracharak (Wat Rai Khing) HospitalDepartment of Ophthalmology, Mettapracharak (Wat Rai Khing) HospitalDepartment of Ophthalmology, Mettapracharak (Wat Rai Khing) HospitalDepartment of Ophthalmology, Mettapracharak (Wat Rai Khing) HospitalDepartment of Ophthalmology, Mettapracharak (Wat Rai Khing) HospitalDepartment of Ophthalmology, Mettapracharak (Wat Rai Khing) HospitalAbstract Introduction Intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents are a primary management option for retinal diseases. Acute elevation of intraocular pressure (IOP) is a complication associated with these injections that should be considered. This study investigated and compared the prophylactic effects of fixed combination anti-glaucoma medication on IOP spikes following intravitreal anti-VEGF injections. Methods This randomized double-blind clinical trial included one eye of each participant indicated for treatment with intravitreal injection of anti-VEGF agents (bevacizumab, aflibercept, and ranibizumab) and randomly allocated to one of the three prophylactic anti-glaucoma medications, with each drug further divided into one- and two-drop regimens before intravitreal injection. Participants with allergies or contraindications to medications were excluded from the pretreatment groups and were invited to participate in the control group. Results The study involved 308 participants: 89 in the dorzolamide/timolol group, 86 in the brimonidine/timolol group, 101 in the brinzolamide/brimonidine group, and 32 in the control group. Baseline characteristics and IOP were comparable across all groups. In the prophylactic premedication groups, mean IOP at 30 min were within 21 mmHg and returned to their baseline at 1 h. Mean IOP measurements between baseline and 30 min in the brimonidine/timolol two-drop regimen were not significantly different: 13.72 ± 4.63 vs 15.11 ± 4.39 mmHg, p = 0.096. In the control group, IOP significantly increased from baseline at 30 min and 1 h post-injection: 14.31 ± 4.10, 22.15 ± 8.64, and 18.36 ± 7.52 mmHg, respectively, p < 0.001. Conclusion Topical fixed combination anti-glaucoma medication used as a prophylactic treatment before intravitreal anti-VEGF injections significantly prevented IOP spikes post-injection, with a comparable effect among three medications. Prophylactic treatment of IOP spikes should be considered as standard care to prevent further damage in patients with compromised retinal vascular and optic nerve perfusion. Trial Registration TCTR20241005001, retrospectively registered.https://doi.org/10.1007/s40123-024-01081-zAnti-vascular endothelial growth factor (VEGF)Fixed combination anti-glaucoma medicationIntraocular pressure spikeIntravitreal injectionsProphylactic anti-glaucoma medication |
| spellingShingle | Piriya Soomsawasdi Kulawan Rojananuangnit Eakkachai Arayangkoon Ratchada Chantiwas Sureeporn Pengrungreungwong Nontakorn Preawsampran Natnaree Tinpowong Rujira Samakhararaksakul Kanokwan Katkingkaew Natthapuch Seekhum Wanwisa Sathim Randomized Clinical Trial of Intraocular Pressure-Lowering Medications on Preventing Spikes in Intraocular Pressure Following Intravitreal Anti-Vascular Endothelial Growth Factor Injections Ophthalmology and Therapy Anti-vascular endothelial growth factor (VEGF) Fixed combination anti-glaucoma medication Intraocular pressure spike Intravitreal injections Prophylactic anti-glaucoma medication |
| title | Randomized Clinical Trial of Intraocular Pressure-Lowering Medications on Preventing Spikes in Intraocular Pressure Following Intravitreal Anti-Vascular Endothelial Growth Factor Injections |
| title_full | Randomized Clinical Trial of Intraocular Pressure-Lowering Medications on Preventing Spikes in Intraocular Pressure Following Intravitreal Anti-Vascular Endothelial Growth Factor Injections |
| title_fullStr | Randomized Clinical Trial of Intraocular Pressure-Lowering Medications on Preventing Spikes in Intraocular Pressure Following Intravitreal Anti-Vascular Endothelial Growth Factor Injections |
| title_full_unstemmed | Randomized Clinical Trial of Intraocular Pressure-Lowering Medications on Preventing Spikes in Intraocular Pressure Following Intravitreal Anti-Vascular Endothelial Growth Factor Injections |
| title_short | Randomized Clinical Trial of Intraocular Pressure-Lowering Medications on Preventing Spikes in Intraocular Pressure Following Intravitreal Anti-Vascular Endothelial Growth Factor Injections |
| title_sort | randomized clinical trial of intraocular pressure lowering medications on preventing spikes in intraocular pressure following intravitreal anti vascular endothelial growth factor injections |
| topic | Anti-vascular endothelial growth factor (VEGF) Fixed combination anti-glaucoma medication Intraocular pressure spike Intravitreal injections Prophylactic anti-glaucoma medication |
| url | https://doi.org/10.1007/s40123-024-01081-z |
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