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A Novel Approach to Prevent Intraocular Pressure Spikes and Reflux during Intravitreal Injections

Omer Othman Abdullah

Objective: The main objective of this study is to prevent IOP spikes and to retain the desired amount of the intravitreal injections. Introduction: The anti vasoproliferative endothelial growth factor (VEGF) is widely used, which can cause spikes in intraocular pressure and refluxes during the injection. Subject and method: A retrospective data recording performed on patients who received anti-VEGF intravitreal injections (IVI). A total of 200 patients, (88 women and 112 men), each of them injected with one eye (200 eyes). The patients had been divided into four groups: Group A: No treatment given. Group B: Only acetazolamide tabs 500 mg. Group C: Timolol maleate eye drop, Brimonidine tartrate eye drop and Dorzolamide hydrochloride eye drop. Group D: Received both topical and oral hypotensive prophylactic therapy. Result: The mean IOP pre-injection in all groups was 14.44, while post-injection was 28.73 with a p-value of <0.001. In the Group D, which received both topical and systemic IOP-lowering therapy showed lowest IOP mean for both pre-injection (12 mmHg) and post-injection (17 mmHg) while the highest post-injection IOP mean had been recorded in the group A (38 mmHg) and the p-value was highly significant. Totally 32% developed reflux, and the mean IOP among them were 38.16 mmHg with a very highly significant p-value <0.001. The reflux in Group A was 80%, the non-refluxing were myopic, and their spike reached 25 mmHg. In Group D, 4% had reflux and were hyperopic with a mean IOP of 17 mmHg. Conclusion: This study concludes that combined topical and systemic ocular hypotensive therapy medications are gold standard pre-injection guidelines to prevent both post-injection IOP spikes and reflux.