Effect of Dorzolamide/Timolol or Brinzolamide/Timolol Prophylaxis on Intravitreal Anti-VEGF Injection-Induced Intraocular Hypertension

Abstract

Purpose: To evaluate prospectively whether anti-glaucomatic drugs administered prior to intravitreal anti-vascular endothelial growth factor (VEGF) injection bevacizumab (Avastin,(R) Roche) or ranibizumab (Lucentis,(R) Novartis) prevents intraocular hypertension after the injection. Subjects and methods: In total, 166 patients (175 eyes) scheduled for intravitreal anti-VEGF injection treatment were prophylactically treated 1 hour before the procedure with Dorzolamide/Timolol (Cosopt,(R) MSD) (Group 1, 53 eyes) or Brinzolamide/Timolol (Elazop,(R) Alcon) (Group 2, 84 eyes) or left untreated (Group 3, 29 eyes). Intraocular pressure was analyzed 5 minutes prior to the injection, every 5 minutes for 30 minutes after the procedure, and 1 hour, 1 day, 7 days, and 1 month after the procedure. Results: The intraocular pressures 5 minutes before the procedure (baseline) for Groups 1, 2, and 3 were 12.06 +/- 1.85, 13.98 +/- 2.68, and 13.81 +/- 2.24 mmHg, respectively. Five and 30 minutes after the procedure, the intraocular pressures of the three groups were 14.12 +/- 4.18, 14.87 +/- 3.35, and 28.21 +/- 3.16 mmHg, respectively, and 10.87 +/- 1.58, 14.25 +/- 2.43, and 17.48 +/- 2.34 mmHg, respectively. For all three groups, the changes relative to baseline 5 and 30 minutes after injection were significant. When the three groups were divided according to whether they received bevacizumab or ranibizumab and the changes in intraocular pressure relative to baseline were analyzed, all six subgroups exhibited significant changes in intraocular pressure 5 and 30 minutes after the procedure. Conclusion: The prophylactic administration of anti-glaucomatic drugs prior to intravitreal anti-VEGF injection effectively reduced the early intraocular pressure elevation. This approach was also safe and could be performed accurately.