Abstract
Purpose :
To assess the impact of fast versus slow intravitreal injection of Lucentis® (ranibizumab) on immediate post-injection intraocular pressure (IOP) elevation.
Methods :
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.
Results :
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).
Conclusions :
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.