March 2012
Volume 53, Issue 14
ARVO Annual Meeting Abstract  |   March 2012
Characterization of Elevation of Intraocular Pressure Following Intravitreal Injection
Author Affiliations & Notes
  • Loren S. Jack
    Ophthalmology, University of South Carolina, Columbia, South Carolina
  • Charles R. Blake
    Ophthalmology, Dorn Veteran’s Administration Medical Center, Columbia, South Carolina
  • Footnotes
    Commercial Relationships  Loren S. Jack, None; Charles R. Blake, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science March 2012, Vol.53, 879. doi:
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      Loren S. Jack, Charles R. Blake; Characterization of Elevation of Intraocular Pressure Following Intravitreal Injection. Invest. Ophthalmol. Vis. Sci. 2012;53(14):879.

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      © ARVO (1962-2015); The Authors (2016-present)

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Characterize the effect of elevated intraocular pressure following intravitreal injection when using lidocaine jelly with a cotton tipped applicator placed under the superior lid for anesthesia.


The computerized patient record system (CPRS) at William Jennings Bryan Dorn VAMC was used to identify CPT code 67028 for intravitreal (IVT) injections from 01/01/08 - 10/31/10. 115 patients (297 injections) were identified: 201 IVT ranibizumab, 85 IVT bevacizumab, and 11 IVT triamcinolone. The agent, pre-operative, post-operative and follow-up intraocular pressure (IOP) were identified.Sterile technique was used (sterile gloves and drape, periocular and conjunctival betadine, eyelid speculum) with pre- and post-treatment moxifloxacin and lidocaine jelly with cotton tipped applicator placed under upper lid in supratemporal quadrant for at least 10 minutes for local anesthesia. 0.05 mL was injected for ranibizumab and bevacizumab; 0.10 mL for triamcinolone.


Pre-operative (all agents 16 +/- 3.4, ranibizumab 16 +/- 3.7, bevacizumab 16 +/- 2.6, triamcinolone 16 +/- 4.1) and post-operative (all agents 27 +/- 7.7, ranibizumab 25 +/- 6.7, bevacizumab 29 +/- 6.7, triamcinolone 35 +/- 20) IOP were not statistically different. Time to follow-up visit (all agents 4.6 +/- 1.7, ranibizumab 4.4 +/- 1.5, bevacizumab 5.0 +/- 1.9, triamcinolone 3.9 +/- 2.0) as well as IOP at the follow-up visit (all agents 16.1 +/- 3.9, ranibizumab 16.0 +/- 4.6, bevacizumab 16.4 +/- 3.6, triamcinolone 20.1 +/- 4.5) were not statistically different.


These data show mean intraocular pressure rise from 16 mmHg to 27 mmHg, significantly lower than previously described post-operative IOP elevations when using topical anesthetic drops, topical lidocaine gel, or subconjunctival lidocaine. Among other factors, a modest compressive effect of a cotton tipped applicator placed under the lid for at least 10 minutes may blunt the post-injection pressure spike following intravitreal injection.  

Keywords: injection • intraocular pressure • drug toxicity/drug effects 

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