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Samantha Fraser-Bell, Sophia Zagora, Hemal Mehta, Anna Campain, Hon Seng Wong, Yeung Aaron, Mark C Gillies; A randomised clinical trial of slow versus fast intravitreal injection of ranibizumab (Lucentis®) and its impact on intraocular pressure (the Speed IOP Study). Invest. Ophthalmol. Vis. Sci. 2019;60(9):79. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the impact of fast versus slow intravitreal injection of Lucentis® (ranibizumab) on immediate post-injection intraocular pressure (IOP) elevation.
This was a prospective, randomised, crossover, single masked clinical trial.The study included 68 eyes of 68 patients being treated with ranibizumab (RBZ) for neovascular age-related macular degeneration (nAMD) randomly assigned to 2 groups (34 eyes in each). One group received intravitreal RBZ by a fast injection technique (in ≤ 1 second (s)) followed by a slower injection technique (over 3-4s) for their next visit's injection. The other group received RBZ by the slower injection technique first followed by the fast injection. Presence of post-injection reflux was documented.Goldmann applanation tonometry was used to measure IOP just prior to the injection and 2 and 15 minutes (mins) post-injection. The primary outcome was mean IOP elevation 2 mins after injection using the fast and the slow injection techniques. Secondary outcomes included: mean IOP elevation 15 mins post-injection between the groups, effect of lens status or reflux on post-injection IOP elevation, and any adverse events associated with the intravitreal injection techniques.
Of the 68 eyes enrolled, 64 completed the study. Injection speed had no significant impact on immediate post injection rise in IOP with the mean IOP elevation from baseline to 2 minutes being 18.0mmHg after slow injection and 17.9mmHg after fast injection of RBZ (P=0.93). At 15 minutes (mins), mean IOP elevation was 5.9mmHg vs 6.3mmHg after slow vs fast injection respectively (P=0.73). In the 41 eyes (64%) with reflux post injection, mean IOP elevation at 2mins was 9.7mmHg compared to 21.6mmHg in eyes without reflux (P<0.001). Lens status had no effect in degree if IOP elevation (P=0.12).
Intravitreal injection speed (fast versus slow) and lens status had no significant effect on immediate IOP elevation following intravitreal injections. Eyes with post-injection reflux had significantly less IOP elevation immediately post-injection.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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