Pressure-lowering drugs appear ineffective in preventing IOP spikes after intravitreal injection

There have been numerous published reports of IOP spikes after intravitreal injections. While these spikes are thought to be transient, it is unknown if repeated IOP spikes may cause damage in predisposed eyes. Topical IOP-lowering medications have been shown to be effective in preventing IOP spikes after argon laser trabeculoplasty. However, to the authors' knowledge, no topical or systemic medication has been studied to see if it can prevent IOP spikes after intravitreal injections.

This retrospective study included 71 patients with exudative AMD, with or without glaucoma, who underwent intravitreal anti-VEGF injections (pegaptanib, bevacizumab, or ranibizumab), most of whom received IOP-lowering medication one hour before injection. All three types of injections resulted in IOP spikes within two minutes of injection. In all patients, IOP was reduced to less than 30 mm Hg within 20 minutes. Patients with and without glaucoma showed a similar rate of IOP normalization over time in all three groups.

The authors conclude that this study's limitations, including its small size, its retrospective nature, and the variance between groups in the number of patients who received prophylactic treatment before intravitreal injection, are outweighed by the obvious results, which demonstrate that routine prophylactic use of IOP-lowering medications is essentially ineffective in preventing IOP spikes and therefore not necessary before intravitreal injection.