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E. Y. Hur, J. E. Kim, A. Mantravadi; Intraocular Pressure Changes Following Intravitreal Injections in the Office. Invest. Ophthalmol. Vis. Sci. 2007;48(13):292.
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As the number of pharmacotherapy with intravitreal injections in the office increases for patients with retinal diseases, it is important to find ways to streamline patient care without sacrificing safety. We investigated whether patients should stay for monitoring of post-injection intraocular pressure (IOP) checks or can be allowed to leave after injections.
Patients who received intravitreal injections in the office during May 2006 to November 2006 were included. IOP was measured for each patient at baseline, immediately after injection, and every 5 minutes thereafter until IOP fell to <30mmHg. All patients were checked for vision of light perception or better and had indirect ophthalmoscopic examination for optic nerve perfusion status and intraocular complications immediately following injection.
Total of 112 patients received 213 injections to 120 eyes. Of the 213 injections, 138 (65%) were with bevacizumab, 32 (15%) were with pegaptanib, 27 (13%) were with ranibizumab, and 16 (8%) were with triamcinolone acetonide. Mean IOP prior to injection was 14mmHg (range: 7-22mmHg). Immediately after the injections, mean IOP was 46mmHg (range: 4-87mmHg). The number of injections with 30mmHg or higher at each 5 minutes after the injection was as follows: 168 (90%) injections at immediately after injection, 63 (30%) injections at 5 minutes, 25 (12%) injections at 10 minutes, 9 (4%) injections at 15 minutes, 5 (2%) injections at 20 minutes, 4 (2%) injections at 25 minutes and none at 30 minutes . For 9 injections (4%) of 9 eyes (7.5%), IOP remained higher than 30mmHg at 15 minutes after the injection. These included 3 injections (2%) of bevacizumab, 3 injections (11%) of ranibizumab, 2 injections (13%) of triamcinolone, and 1 injection (3%) of pegaptanib. In 76 injections (36%), IOP measured immediately after the injection was 50mmHg or higher. All eyes had at least light perception or better vision and perfused optic nerve immediately after the injection. No intraocular complications were observed with indirect ophthalmoscopic examination.
Elevations in IOP after intravitreal injections are common but transient and can occur with all of currently utilized intravitreal injections. In nearly all eyes, IOP returned to <30mmHg after 15 minutes and, by 30 minutes, all eyes had IOP <30mmHg. Therefore, it may not be necessary to keep patients after injections to monitor IOP, as long as light perception or better vision, perfusion of optic nerve, and lack of intraocular complications have been verified.
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