The Long-Term Observation of Intraocular Pressure after Intravitreal Injections of Bevacizumab, Triamcinolone, and Combination of Both

Yong Woon Shin; Hee Yoon Cho; Yoon Jung Lee; Min Chul Seong

doi:10.3341/jkos.2011.52.5.574

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Shin, Cho, Lee, and Seong: The Long-Term Observation of Intraocular Pressure after Intravitreal Injections of Bevacizumab, Triamcinolone, and Combination of Both

Original Article

J Korean Ophthalmol Soc 2011;52(5):574-581.

Published online: 3 August 2011

DOI: https://doi.org/10.3341/jkos.2011.52.5.574

The Long-Term Observation of Intraocular Pressure after Intravitreal Injections of Bevacizumab, Triamcinolone, and Combination of Both

Yong Woon Shin, MD, Hee Yoon Cho, MD, Yoon Jung Lee, MD, Min Chul Seong, MD

Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea

Address reprint requests to Min Chul Seong, MD Department of Ophthalmology, Hanyang University Guri Hospital #249-1 Gyomun-dong, Guri 471-710, Korea Tel: 82-31-560-2350, Fax: 82-31-564-9479, E-mail: goddns76@hanmail.net

Received 3 August 201028 October 2010 Accepted 10 March 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The present study investigates the onset and frequency of increased intraocular pressure (IOP) after injections of intravitreal Bevacizumab, Triamcinolone, and a combination of both drugs.

Methods

Patients were classified into three groups: Bevacizumab group (group A), Triamcinolone group (group B), and combined drug group (group C), irrespective of the underlying causes. The IOP was measured 30 minutes prior to followed by one day, one week, one month, two months, three months, six months, and one year after injection. The measured IOP at each time point was compared with the pre-injection IOP and the differences in IOP among the three groups were statistically analyzed. The relationships between various factors possible of increasing IOP were also analyzed.

Results

A total of 259 subjects were enrolled in the present study. An IOP increase of more than 5 mm Hg was observed in 25 eyes (15%) in group A, 34 eyes (40%) in group B, and 40 eyes (50%) in group C. There was no statistically significant mean IOP change after injection in group A, but in groups B and C there was an increase in mean IOP up until two and three months after injection, respectively. However, eyes in group A with a history of glaucoma showed statistically significant increases in IOP.

Conclusions

The onsets and frequencies of increased IOP were different with the different drugs. Proper follow-up for increased IOP after injection is necessary based on the type of drug used.

Keywords: Bevacizumab, Combined drugs, Intraocular pressure, Intravitreal injection, Triamcinolone

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Figure 1.

The change of mean intraocular pressure (IOP) during follow up period. Note that the mean IOP of group B increased during post injection 7 to 60 days. The mean IOP of group C increased during post injection 30 to 90 days. The mean IOP of Group A showed no statistically significant change. Group A: Bevacizumab, Group B: Triamcinolone, Group C: Bevacizumab + Triamcinolone. ^* Post injection days.

Figure 2.

The percentage of eyes showing increased IOP of more than 5 mmHg at each follow up time. Group B and C showed higher percentages of increased IOP than Group A during post injection 7 to 90 days. There were no statistically significant differences between Group B and C (p > 0.05) during the entire follow up period. Group A: Bevacizumab, Group B: Triamcinolone, Group C: Bevacizumab + Triamcinolone. ^* Post injection days.

Table 1.

Clinical characteristics of the eyes enrolled in the current study

	Bevacizumab (A)	Triamcinolone (B) B	Bevacizumab + Triamcinolone	(C) p-value
Number of eyes	166	85	80
Age (mean ± SD, yr)	59.46 ± 12.36	61.2 ± 11.29	58.90 ± 10.60	0.405^†
Mean follow up (day)	197.80	221.41	210.38	0.071^†
1 year follow up^* (n)	75	38	30	0.496^‡
Lens (phakic : pseudophakic)	96:70	52:33	59:21	0.098^‡
Past injection history (n)	28 (16.8%)	30 (35.3%)	26 (32.5%)	0.002^‡
History of glaucoma (n)	10 (6%)	2 (2.4%)	7 (8.8%)	0.205^‡
Diagnosis
PDR	86 (51.5%)	16 (18.8%)	36 (45%)	0.003^‡
NPDR with ME	26 (15.6%)	39 (45.9%)	21 (26.3%)	0.001^‡
RVO with ME	13 (7.8%)	25 (29.4%)	22 (27.5%)	0.000^‡
ARMD	32 (19.23%)	4 (4.71%)	1 (1.3%)	0.000^‡
Others	9 (5.42%)	1 (1.18%)	0 (0%)	0.041^‡

DR = proliferative diabetic retinopathy; NPDR = non-proliferative diabetic retinopathy; ME = macular edema; RVO = retinal vein occlusion; ARMD = age-related macular degeneration.

^* The number of eyes followed up for one year;

^† ANOVA test;

^‡ Chi-square test.

Table 2.

Intraocular pressure of each group during follow-up period

Follow up (day)	A		B		C		p-value^*
Follow up (day)	Mean IOP ± SD (mmHg)	p-value^†	Mean IOP ± SD (mmHg)	p-value^†	Mean IOP ± SD (mmHg)	p-value^†	p-value^*
PreOP	15.28 ± 3.10		15.09 ± 3.18		15.01 ± 1.98		0.543
1	15.33 ± 3.43	0.393	16.41 ± 3.32	0.013	15.23 ± 3.15	0.422	0.265
7	15.15 ± 3.26	0.146	16.62 ± 4.11	0.008	15.82 ± 4.00	0.049	0.030
30	15.62 ± 3.96	0.189	16.97 ± 4.10	0.002	16.88 ± 5.98	0.005	0.091
60	15.53 ± 3.19	0.666	16.67 ± 4.82	0.020	16.39 ± 4.99	0.024	0.328
90	15.16 ± 3.56	0.240	16.09 ± 4.50	0.128	17.48 ± 7.32	0.006	0.026
180	15.36 ± 3.45	0.454	14.81 ± 4.16	0.287	16.30 ± 5.37	0.056	0.175
365	15.49 ± 3.14	0.659	14.45 ± 3.90	0.335	16.73 ± 5.81	0.097	0.053

A = Bevacizumab group; B = Triamcinolone group; C = Bevacizumab + Triamcinolone group; preOP = 30 minutes before injection; IOP = intraocular pressure; IIOP = increased intraocular pressure.

^* Statistical difference among three groups in each follow up day by ANOVA test;

^† Statistical difference of intraocular pressure between preinjection and each follow up day by independent t-test.

Table 3.

The mean IOP of eyes with increased IOP of more than 5 mmHg during follow up in each group

Follow up (day)	A (n = 25)		B (n = 34)		C (n = 40)		p-value^*
Follow up (day)	Mean IOP ± SD (mmHg)	N. of onset	Mean IOP ± SD (mmHg)	N. of onset	Mean IOP ± SD (mmHg)	N. of onset	p-value^*
PreOP	14.44 ± 3.07		14.18 ± 3.08		15.00 ± 1.90		0.406
1	16.36 ± 4.38	6	16.73 ± 3.76	4	16.27 ± 2.69	1	0.900
7	15.27 ± 3.71	3	18.38 ± 5.20	6	17.32 ± 4.45	9	0.053
30	17.66 ± 5.50	6	18.78 ± 5.20	11	19.41 ± 7.22	9	0.657
60	16.91 ± 4.00	3	18.57 ± 6.55	6	19.10 ± 4.99	11	0.324
90	17.13 ± 4.57	3	17.40 ± 5.56	7	20.56 ± 8.53	8	0.140
180	17.33 ± 4.69	2	15.31 ± 5.35	0	18.46 ± 5.95	1	0.111
365	16.77 ± 3.86	2	14.86 ± 4.57	0	18.69 ± 6.95	1	0.167
Average IIOP (mean ± SD, mmHg)	6.22 ± 1.50		8.76 ± 3.81		9.83 ± 7.31		0.022^†

A = bevacizumab group, B = triamcinolone group; C = bevacizumab + triamcinolone group; preOP = 30 minutes before injection; IOP = intraocular pressure; IIOP = increased intraocular pressure; N. of onset = the number of eyes which begin to increase intraocular pressure at follow-up day; Average IIOP = the average value of increased intraocular pressure from baseline study at the time of the beginning of IIOP.

^* Statistical significance was tested by one-way ANOVA among groups;

^† Statistical significance appeared only between group A and C by Turkey’s multiple comparison test (p = 0.017). The comparison of group A and B or B and C show non-significant difference (p = 0.142, 0.655).

Table 4.

The comparison of various factors that influence IOP between non-IIOP and IIOP groups

	Group	Non-IIOP	IIOP	p-value
Preop IOP (mmHg)^*	A	15.53	14.44	0.086
	B	15.61	14.18	0.040
	C	14.70	15.00	0.503
Psedophakic:Phakic^†	A	59:82	11:14	0.830
	B	23:28	10:24	0.177
	C	10:30	11:29	1.000
History of glaucoma^†	A	136:5	20:5	0.030
G(-):G(+)	B	50:1	33:1	1.00
	C	39:1	34:6	0.108
History of injection^†	A	119:15:7	19:3:3	0.474
(N:Beva:Tri)	B	34:5:12	21:3:10	0.807
	C	27:3:10	27:2:11	0.884

Preop IOP = intraocular pressure before injection; IOP = intraocular pressure; IIOP = increased intraocular pressure; A = Bevacizumab group; B = Triamcinolone group; C = Bevacizumab + Triamcinolone group; G(-) = no history of glaucoma; G(+) = history of glaucoma; N = no previous intravitreal injection history; Beva = history of intravitreal Bevacizumab injection; Tri = history of intravitreal Triamcinolone injection.

^* p-value by independent t-test;

^† p-value by Chi-square test.

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