Effects of Drug and Eye Speculum on the Intraocular Pressure in Bilateral Simultaneous Intravitreal Injections

Abstract

Purpose: Investigation of the effects of intraocular pressure (IOP) changes on the eye speculum (blepharosta) in bilateral injections of intravitreal ranibizumab (IVR) and aflibercept (IVA)

Material-Methods: Because of diabetic retinopathy and macular edema, 72 eyes of 36 patients with IVR and IVA for the first time were included in the evaluation.Patients with ocular surgery or drug use history were not included in the study. Patients in both groups had blepharosta, open blepharosta (A), and closed eye blepharosta (K). The intraocular pressure was measured by contact intraocular pressure (AEGIB, KEGIB), intraocular pressure (ABGİB, KBGİB) and post injection intraocular pressure (AEGİB, KEGİB) contact hand tonometry before insertion of the blepharosta

Results: In the IVR group, 17 males and 19 females, mean age was 67.0 ± 8.5 years, 18 males and 18 females in the IVA group had a mean age of 64.90 ± 6.32 years. There were no statistically significant differences between the groups in the IVR group (p = 0.6, p = 0.12, respectively) In the IVR group, the AOGiB was 18.07 ± 4.60 mmHg, the ABGİB was 19.90 ± 5.59 mmHg, the AEGİB was 47.53 ± 7.25 mmHg, the KÖGİB was 18.93 ± 4.60 mmHg, the KBGİB was 22.33 ± 6.32 mmHg, the KEGİB was 52.07 ± 2.62 mmHg while in the IVA group was AOGİB 17.17 ± 3.24 mmHg and ABGİB 19.70 ± 3.31 mmHg mmHg, AEGİB 48.20 ± 6.46 mmHg, KÖGİB 16.97 ± 2.94 mmHg, KBGİB 19.57 ± 3.21 mmHg and KEGİB 39.70 ± 4.21 mmHg . There was no statistically significant difference between the groups in terms of values ​​of AÖGİB, ABGİB, AEGİB, KÖGİB (p values ​​0.38, 0.86, 0.86, 0.054 respectively). The values ​​of KBGİB and KEGİB were statistically significantly lower in the IVA group (pvalues ​​0.037, 0.001 respectively) In the IVR group, the difference between the AÖGİB-ABGİB difference was -1.83 ± 1.85, the difference between the AÖGİB-AEGİB difference -29.46 ± 12.47, ABGİB-AEGİB difference -27.63 ± 12.60, KÖGİB-KBGİB difference -3.40 ± 3.57, KÖGİB-KEGİB -34.13 ± 9.06, -30.73 ± 9.56 while in the IVA group the difference between AÖGİB-ABGİB -2.53 ± 2.40, AÖGİB-AEGİB difference 31.03 ± 16.96, ABGİB-AEGİB difference -28.50 ± 16.89, KÖGİB-KBGİB difference -2.60 ± 2.52, KÖGİB-KEGİB difference -22.73 ± 19.05 , And the difference between the rates of KBGİB-KEGİB was -20.13 ± 18.94. There were no statistically significant differences between the groups in terms of AÖGİB-ABGİB, AÖGİB-AEGİB, ABGİB-AEGİB and KÖGİB-KÖGİB difference values ​​(p values ​​0.21,0.68,0.82,0.32 respectively). The values ​​of KÖGİB-KEGİB and KBGİB-KEGİB difference were statistically significant (respectively p values ​​of 0.004, 0.008)

Conclusion: According to the IVR group in the IVA group, the use of closed blepharosta allows less IOP exchange.

Keywords

• Intravitreal injection,intraocular pressure

Bilateral Eşzamanlı İntravitreal Enjeksiyonlarda İlaç ve Göz Spekulumunun Göziçi Basıncına Etkisi

Abstract

Amaç:Bilateral aynı seansta intravitreal ranibizumab(IVR) ve aflibercept(IVA) enjeksiyon hastalarında göz spekulumunun(blefarosta)  göziçi basıncı(GİB) değişimine etkisinin incelenmesi

Gereç-Yöntem: Diabetik retinopati ve makula ödemi nedeniyle ilk defa IVR  ve IVA yapılan 36 şar hastanın 72 şer  gözü  değerlendirilmeye alındı.Önceden oküler cerrahi veya ilaç kullanım hikayesi olan hastalar çalışmaya alınmadı.Her iki gruptaki hastaların bir gözüne açık blefarosta(A),diğer gözüne kapalı blefarosta(K) uygulandı. Blefarosta takılmadan önce göziçi basıncı(AÖGİB,KÖGİB), takıldıktan sonra göziçi basıncı(ABGİB,KBGİB) ve enjeksiyon sonrası göziçi basıncı(AEGİB,KEGİB) kontakt el tonometresi ile ölçüldü.

Bulgular:IVR grubunda 17 erkek,19 kadın,yaş ortalaması 67.0 ±8.5 yıl, IVA grubunda 18 erkek,18 kadın yaş ortalaması 64.90 ±6.32 yıldı,gruplar arasında istatistiksel farklılık yoktu.(sırasıyla p=0.6,p=0.12) IVR grubunda AÖGİB 18.07±4.60 mmHg, ABGİB 19.90 ± 5.59 mmHg, AEGİB  47.53 ±7.25 mmHg, KÖGİB 18.93 ±4.60 mmHg, KBGİB 22.33± 6.32 mmHg, KEGİB 52.07 ±2.62 mmHg iken IVA grubunda AÖGİB  17.17 ±3.24 mmHg, ABGİB 19.70 ±3.31mmHg, AEGİB 48.20 ±6.46 mmHg, KÖGİB 16.97±2.94 mmHg, KBGİB 19.57± 3.21 mmHg, KEGİB 39.70± 4.21 mmHg bulundu. AÖGİB,ABGİB,AEGİB,KÖGİB değerleri açısından gruplar arasında istatistiksel farklılık yoktu.(sırasıyla p değerleri 0.38, 0.86, 0.86, 0.054)  KBGİB  ve KEGİB  değerleri  IVA grubunda  istatistiksel anlamlı derecede düşük bulundu.(sırasıyla p değerleri 0.037, 0.001)  IVR grubunda  AÖGİB-ABGİB farkı -1.83± 1.85, AÖGİB-AEGİB farkı -29.46 ±12.47, ABGİB-AEGİB farkı -27.63 ±12.60, KÖGİB-KBGİB farkı -3.40 ±3.57, KÖGİB-KEGİB  -34.13 ±9.06, KBGİB-KEGİB farkı -30.73 ±9.56 iken IVA grubunda AÖGİB-ABGİB farkı -2.53± 2.40, AÖGİB-AEGİB farkı 31.03 ±16.96, ABGİB-AEGİB farkı -28.50 ±16.89, KÖGİB-KBGİB farkı -2.60 ±2.52, KÖGİB-KEGİB farkı -22.73 ±19.05, KBGİB-KEGİB farkı -20.13 ±18.94 bulundu. Gruplar arasında AÖGİB-ABGİB, AÖGİB-AEGİB, ABGİB-AEGİB, KÖGİB-KBGİB fark değerleri açısından istatistiksel farklılık yoktu.(sırasıyla p değerleri 0.21,0.68,0.82,0.32)  IVA grubunda KÖGİB-KEGİB, KBGİB-KEGİB fark değerleri istatistiksel olarak anlamlı derecede düşüktü.(sırasıyla p değerleri 0.004, 0.008)

Sonuç:IVA grubunda IVR grubuna göre kapalı blefarosta kullanılması ile daha az GİB değişimi sağlanabilmektedir.

Keywords

• İntravitreal enjeksiyon,göziçi basıncı

References

1. KAYNAKLAR 1. Brand CS. Management of retinal vascular diseases: a patient-centric approach. Eye (Lond) 2012;26:1-16. 2. Alakuş MF, Taş M, Öner V, et al. Diabetik Maküla Ödeminde İntravitreal Bevacizumab Etkinliğininin Değerlendirilmesi. Retina Vitreus 2012;1:35-40 3. Bakri SJ, Pulido JS, McCannel CA, Hodge DO, Diehl N, Hillemeier J. Immediate intraocular pressure changes following intravitreal injections of triamcinolone, pegaptanib, and bevacizumab. Eye 2009;23:181-185. 4. Sharei V, Höhn F, Köhler T, et al. Course of intraocular pressure after intravitreal injection of 0.05 mL ranibizumab (Lucentis). Eur J Ophthalmol 2010;20:174- 179. 5. Kotliar K, Maier M, Bauer S, et al. Effect of intravitreal injections and volume changes on intraocular pressure: clinical results and biomechanical model. Acta Ophthalmol Scand 2007;85:777-781. 6. Gismondi M, Salati C, Salvetat ML, et al. Short term effect of intravitreal injection of Ranibizumab (Lucentis) on intraocular pressure. J Glaucoma 2009;18:658- 661. 7. Höhn F, Mirshahi A. Impact of injection techniques on intraocular pressure (IOP) increase after intravitreal ranibizumab application. Graefes Arch Clin Exp Ophthalmol 2010;248:1371-1375. 8. Meyer CH, Holz FG. Preclinical aspects of anti-VEGF agents for the treatment of wet AMD: ranibizumab and bevacizumab. Eye (Lond) 2011;25:661-672 9. Satıcı A, Oğuz H, Gürler B.: Göz içi basınç ölçümünde Goldmann aplanasyon tonometresi ile Tono-Pen ve nonkontakt tonometre değerlerinin karşılaştırılması. T Oft Gaz. 1997;27:321-324. 10. Özdemir N, Tekin A, Ersöz TR. et al.: Tono-Pen tonometresi ile Goldmann applanasyon tonometresinin klinik larak karşılaştırılması. MN Ophthalmology. 1997;4:168-170. 11. Shingleton BJ, Pasternack JJ, Hung JW, O’Donoghue MW. Three- and five year changes in intraocular pressures after clear corneal phacoemulsification in open angle glaucoma patients, glaucoma suspects, and normal patients. J Glaucoma 2006;15:494-498. 12. Poley BJ, Lindstrom RL, Samuelson TW. Long term effects of phacoemulsification with intraocular lens implantation in normotensive and ocular hypertensive eyes. J Cataract Refract Surg 2008;34:735-742. 13. Kerimoglu H, Ozturk BT, Bozkurt B, et al. Does lens status affect the course of early intraocular pressure and anterior chamber changes after intravitreal injection? Acta Ophthalmol 2011;89:138-142. 14. Hollands H, Wong J, Bruen R, et al. Short-term intraocular pressure changes after intravitreal injection of bevacizumab. Can J Ophthalmol 2007;42:807-811. 15. Adelman RA, Zheng Q, Mayer HR. Anti-VEGF dials up the pressure: anti-VEGF therapy is an effective treatment option for a variety of retinal conditions. However, it also may increase IOP, J Ocul Pharmacol Ther. 2010 Feb;26(1):105-10. 16. Good TJ, Kimura AE, Mandava N, et al. Sustained elevation of intraocular pressure after intravitreal injections of anti-VEGF agents. Br J Ophthalmol. 2011 Aug;95(8):1111-4. 17. Epley KD, Tychsen L, Lueder GT. The effect of an eyelid speculum on intraocular pressure measurement in children. Am J Ophthalmol. 2002 Dec;134(6):926-7. 18. Shahid E, Shaikh A. Effect of different eye speculums on intra ocular pressure. J Pak Med Assoc. 2013 Oct;63(10):1278-80.