Abstract
Purpose: :
Intravitreal Lucentis (IVL) injections are used widely in the treatment of retinal disease. An injection of 0.05ml has been observed to increase the intraocular pressure (IOP) post-IVL. The aim of the following study is to assess the effectiveness of topical Iopidine 1% pre-IVL in reducing the magnitude of IOP spike.
Methods: :
Pre-IVL & 1 minute post-IVL IOP measurements of 22 eyes were taken on two separate occasions. With no preparatory measures to lower IOP, a baseline set of IOP measurements were taken at the initial injection. A second set of IOP measurements were taken from the same eyes following topical administration of Iopidine 1% an hour pre-IVL at a separate treatment episode which occurred no sooner than 30 days. This approach was taken to match groups and control for other variables such as axial length, anterior chamber depth, phakic status and corneal thickness which can influence IOP measurements. IOP measurements were taken using a tonopen. Difference between the two group means was tested for statistical significance using student t-test.
Results: :
Without iopidine, post-IVL mean IOP was elevated by 31.14±14.69 mmHg. In the iopidine group post-IVL IOP spiked by a mean of 16.85±11.36 mmHg; with the difference between group means found to be statistically significant(p<0.05). In 3 patients, post-IVL IOP spike in the control group rose by 40mmHg to 58-61mmHg, an IOP high enough to potentially cause an adverse event. With iopidine, the post-IVL IOP change decreased to spikes of 15-26mmHg for all three patients.
Conclusions: :
All eyes will experience a rise in IOP following IVL. In some eyes this IOP spike can be of clinical significance, reaching pressures which may cause an adverse event, particularly in susceptible eyes with impaired optic nerve head perfusion or advanced glaucoma. Topical iopidine given an hour pre-IVL has been shown to significantly reduce the magnitude of the post-IVL IOP spike. In the context of more susceptible eyes that may well require repeated treatments with IVL, the use of IOP-lowering interventions appear to be of a great benefit; further enhancing the safety of this procedure of drug delivery.
Keywords: age-related macular degeneration • intraocular pressure • vascular endothelial growth factor