Analysis of factors associated with short-term elevation of intraocular pressure after ranibizumab intravitreal injection_Chinese Journal of Ocular Fundus Diseases

Authors：

Song Shuang , Zhang Peng , Gu Xiaoya , Lu Yingyi , Yu Xiaobing ,  Dai Hong

Department of Ophthalmology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China;

Corresponding author：

Dai Hong, Email: dai-hong@x263.net

Keywords：

Angiogenesis inhibitors/therapeutic use; Antibodies, monoclonal; Ocular Hypertension; Root cause analysis

DOI：

10.3760/cma.j.issn.1005-1015.2018.05.004

Video：

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Objective To investigate the factors associated with short-term elevation of intraocular pressure after ranibizumab intravitreal injection. Methods 292 eyes of 292 patients who were diagnosed retinopathy and suitable to receive ranibizumab intravitreal injection were enrolled in this prospective clinical study. There were 157 males and 135 females. 193 patients diagnosed with age-related macular degeneration and 99 other retinopathy patients. Mean age of patients was 62.75±13.74 years. All subjects underwent systemic and comprehensive ophthalmology examinations. The mean BCVA was 0.68±0.47 logMAR. Mean basal intraocular pressure was 18.1 mmHg (1 mmHg=0.133 kPa). All patients received intravitreal injection with 0.05 ml of ranibizumab (0.5 mg). The intraocular pressure were measured by non-contact tonometer at 10, 30, 120 minutes and 1 day after injection in a sitting position. The patients were grouped by the changes of intraocular pressure 10 minutes after injection. The elevation was more than 10 mmHg as elevation group and less than 10 mmHg as stable group. Analyze the possible related factors with elevation of intraocular pressure after ranibizumab intravitreal injection by comparing the different datum of two groups. Results The mean intraocular pressure were 23.8, 20.5, 19.9 and 17.4 mmHg at 10, 30, 120 minutes and 1 day after injection. The significant elevation level were 5.8, 2.4, 1.8, −0.7 mmHg compared with basal intraocular pressure. Among 292 eyes, intraocular pressure elevation in 68 eyes and stabled in 224 eyes. The age (Z=−0.732), gender (χ²=1.929), right or left eye (χ²=2.910), BCVA (Z=−0.039), diseases (χ²=2.088) were no significant difference between two groups (P＞0.05). The injection number (Z=−2.413, P=0.001), basal intraocular pressure (Z=−3.405, P=0.016) and elevations after injection (Z=−11.501, −8.366, −5.135, −3.568; P＜0.01) were significantly different comparing two groups (P＜0.05). By logistic regression analysis, basal intraocular pressure was positively correlated with the elevation of intraocular pressure 10 minutes after injection (B=−0.844, OR=0.43, 95%CI 0.24−0.76, P=0.004). Patients with higher basal intraocular pressure may occur intraocular pressure elevation after ranibizumab intravitreal injection much probably. Conclusions The factors associated with short-term elevation of intraocular pressure after ranibizumab intravitreal injection were basal intraocular pressure. The higher basal intraocular pressure, the higher risk to gain elevation of intraocular pressure after injection.

Citation： Song Shuang, Zhang Peng, Gu Xiaoya, Lu Yingyi, Yu Xiaobing, Dai Hong. Analysis of factors associated with short-term elevation of intraocular pressure after ranibizumab intravitreal injection. Chinese Journal of Ocular Fundus Diseases, 2018, 34(5): 432-435. doi: 10.3760/cma.j.issn.1005-1015.2018.05.004 Copy

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4.	宋爽, 戴虹, 喻晓兵. 玻璃体腔注药后眼压变化及其影响因素[J]. 中华眼底病杂志, 2016, 32(4): 453-457. DOI: 10.3760/cma.j.issn.1005-1015.2016.04.029.Song S, Dai H, Yu XB. Intraocular pressure after intravitreal injection of drugs[J]. Chin J Ocul Fundus Dis, 2016, 32(4): 453-457. DOI: 10.3760/cma.j.issn.1005-1015.2016.04.029.
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8.	Fujimoto T, Inoue T, Maki K, et al. Vascular endothelial growth factor-a increases the aqueous humor outflow facility[J/OL]. PLoS One, 2016, 11(9): 0161332[2016-09-01]. http://dx.plos.org/10.1371/journal.pone.0161332. DOI: 10.1371/journal.pone.0161332.
9.	Bakri SJ, Ekdawi NS. Intravitreal silicone oil droplets after intravitreal drug injections[J]. Retina, 2008, 28(7): 996-1001. DOI: 10.1097/IAE.0b013e31816c6868.
10.	Scott IU, Oden NL, VanVeldhuisen PC, et al. SCORE Study Report 7: incidence of intravitreal silicone oil droplets associated with staked-on vs luer cone syringe design[J]. Am J Ophthalmol, 2009, 148(5): 725-732. DOI: 10.1016/j.ajo.2009.06.004.
11.	Pallikaris IG, Kymionis GD, Ginis HS, et al. Ocular rigidity in patients with age-related macular degeneration [J]. Am J Ophthalmol, 2006, 141(4): 611-615.
12.	Kotliar K, Maier M, Bauer S, et al. Effect of intravitreal injections and volume changes on intraocular pressure: clinical results and biomechanical model[J]. Acta Ophthalmol Scand, 2007, 85(7): 777-781.
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14.	Hollands H, Wong J, Bruen R, et al. Short-term intraocular pressure changes after intravitreal injection of bevacizumab[J]. Can J Ophthalmol, 2007, 42(6): 807-811.
15.	Kim JE, Mantravadi AV, Hur EY, et al. Short-term intraocular pressure changes immediately after intravitreal injections of anti-vascular endothelial growth factor agents[J]. Am J Ophthalmol, 2008, 146(6): 930-934. DOI: 10.1016/j.ajo.2008.07.007.

1. Song S, Yu XB, Dai H. Effect of prophylactic intraocular pressure-lowering medication (brinzolamide) on intraocular pressure after ranibizumab intravitreal injection: a case-control study[J]. Indian J Ophthalmol, 2016, 64(10): 762-766. DOI: 10.4103/0301-4738.195006.
2. Arikan G, Saatci AO, Oner FH. Immediate intraocular pressure rise after intravitreal injection of ranibizumab and two doses of triamcinolone acetonide[J]. Int J Ophthalmol, 2011, 4(4): 402-405. DOI: 10.3980/j.issn.2222-3959.2011.04.16.
3. Hoang QV, Tsuang AJ, Gelman R, et al. Clinical predictors of sustained intraocular pressure elevation due to intravitreal anti-vascular endothelial growth factor therapy[J]. Retina, 2013, 33(1): 178-187. DOI: 10.1097/IAE.0b013e318261a6f7.
4. 宋爽, 戴虹, 喻晓兵. 玻璃体腔注药后眼压变化及其影响因素[J]. 中华眼底病杂志, 2016, 32(4): 453-457. DOI: 10.3760/cma.j.issn.1005-1015.2016.04.029.Song S, Dai H, Yu XB. Intraocular pressure after intravitreal injection of drugs[J]. Chin J Ocul Fundus Dis, 2016, 32(4): 453-457. DOI: 10.3760/cma.j.issn.1005-1015.2016.04.029.
5. Wen JC, Reina-Torres E, Sherwood JM, et al. Intravitreal anti-VEGF injections reduce aqueous outflow facility in patients with neovascular age-related macular degeneration[J]. Invest Ophthalmol Vis Sci, 2017, 58(3): 1893-1898. DOI: 10.1167/iovs.16-20786.
6. Yannuzzi NA, Patel SN, Bhavsar KV, et al. Predictors of sustained intraocular pressure elevation in eyes receiving intravitreal anti-vascular endothelial growth factor therapy[J]. Am J Ophthalmol, 2014, 158(2): 319-327. DOI: 10.1016/j.ajo.2014.04.029.
7. Kim YJ, Sung KR, Lee KS, et al. Long-term effects of multiple intravitreal antivascular endothelial growth factor injections on intraocular pressure[J]. Am J Ophthalmol, 2014, 157(6): 1266-1271. DOI: 10.1016/j.ajo.2014.02.035.
8. Fujimoto T, Inoue T, Maki K, et al. Vascular endothelial growth factor-a increases the aqueous humor outflow facility[J/OL]. PLoS One, 2016, 11(9): 0161332[2016-09-01]. http://dx.plos.org/10.1371/journal.pone.0161332. DOI: 10.1371/journal.pone.0161332.
9. Bakri SJ, Ekdawi NS. Intravitreal silicone oil droplets after intravitreal drug injections[J]. Retina, 2008, 28(7): 996-1001. DOI: 10.1097/IAE.0b013e31816c6868.
10. Scott IU, Oden NL, VanVeldhuisen PC, et al. SCORE Study Report 7: incidence of intravitreal silicone oil droplets associated with staked-on vs luer cone syringe design[J]. Am J Ophthalmol, 2009, 148(5): 725-732. DOI: 10.1016/j.ajo.2009.06.004.
11. Pallikaris IG, Kymionis GD, Ginis HS, et al. Ocular rigidity in patients with age-related macular degeneration [J]. Am J Ophthalmol, 2006, 141(4): 611-615.
12. Kotliar K, Maier M, Bauer S, et al. Effect of intravitreal injections and volume changes on intraocular pressure: clinical results and biomechanical model[J]. Acta Ophthalmol Scand, 2007, 85(7): 777-781.
13. Frenkel RE, Mani L, Toler AR, et al. Intraocular pressure effects of pegaptanib (Macugen) injections in patients with and without glaucoma[J]. Am J Ophthalmol, 2007, 143(6): 1034-1035. DOI: 10.1001/archophthalmol.2010.297.
14. Hollands H, Wong J, Bruen R, et al. Short-term intraocular pressure changes after intravitreal injection of bevacizumab[J]. Can J Ophthalmol, 2007, 42(6): 807-811.
15. Kim JE, Mantravadi AV, Hur EY, et al. Short-term intraocular pressure changes immediately after intravitreal injections of anti-vascular endothelial growth factor agents[J]. Am J Ophthalmol, 2008, 146(6): 930-934. DOI: 10.1016/j.ajo.2008.07.007.

Chinese Journal of Ocular Fundus Diseases

Analysis of factors associated with short-term elevation of intraocular pressure after ranibizumab intravitreal injection

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