Prophylactic Effects of a Fixed Dorsolamide/Timolol Combination on IOP Elevation before Intravitreal Anti-VEGF Injection

Young Jin Lim; Jong Myong Kim; Yong Seop Han; In Young Chung; Jong Moon Park

doi:10.3341/jkos.2011.52.6.702

Journal List > J Korean Ophthalmol Soc > v.52(6) > 1009060

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Lim, Kim, Han, Chung, and Park: Prophylactic Effects of a Fixed Dorsolamide/Timolol Combination on IOP Elevation before Intravitreal Anti-VEGF Injection

Original Article

J Korean Ophthalmol Soc 2011;52(6):702-708.

Published online: 31 August 2011

DOI: https://doi.org/10.3341/jkos.2011.52.6.702

Prophylactic Effects of a Fixed Dorsolamide/Timolol Combination on IOP Elevation before Intravitreal Anti-VEGF Injection

Young Jin Lim, MD¹, Jong Myong Kim, MD¹, Yong Seop Han, MD¹, In Young Chung, MD, PhD^1,², Jong Moon Park, MD, PhD^1,²

¹Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea

²Institute of Health Science, Gyeongsang National University, Jinju, Korea

Address reprint requests to Yong Seop Han, MD, Department of Ophthalmology, Gyeongsang National University Hospital #79 Gangnam-ro, Jinju 660-702, Korea Tel: 82-55-750-8171, Fax: 82-55-758-4258, E-mail: medcabin@hanmail.net

Received 19 November 2010 Revised 30 January 2011 Accepted 29 April 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 purpose of the present study was to investigate the prophylactic effects of a fixed combination of dorsolamide/timolol on intraocular pressure (IOP) elevation before intravitreal anti-VEGF injection.

Methods

A prospective, randomized clinical trial was conducted on 91 eyes of 91 patients undergoing intravitreal an-ti-VEGF injection. The eyes were randomly divided into 2 groups, the eyes which had used the fixed prophylactic dorsolamide/timolol combination (group 1, 58 eyes) and the eyes which had not used the combination (group 2, 15 eyes). The IOP was measured one hour and 5 minutes prior to the procedure, 5 minutes interval up to 30 minutes after the procedure and one hour, 1 day, 7 days, and one month after the procedure. The IOP changes were analyzed.

Results

The mean 5 minutes and 30 minutes postoperative IOPs were 14.12 ± 4.18 mm Hg and 10.87 ± 1.58 mm Hg in group 1 and 28.21 ± 3.16 mm Hg and 17.48 ± 2.34 mm Hg in group 2, respectively. After IVBI, the mean 5 min post-operative IOP was 12.17 ± 1.13 mm Hg in group 1 and 27.12 ± 3.35 mm Hg in group 2. After IVRI, the mean 5 minutes postoperative IOP was 15.98 ± 4.14 mm Hg in group 1 and 25.19 ± 1.04 mm Hg in group 2.

Conclusions

Prophylactic use of a fixed dorsolamide/timolol combination before intravitreal anti-VEGF injection is an easy and safe method of preventing IOP elevation immediately after intravitreal injection of bevacizumab or ranibizumab.

Keywords: Bevacizumab, Dorsolamide, IOP, Ranibizumab, Timolol

References

1. Lew YJ, Park HJ, Lee TG, et al. Primary combined photodynamic therapy and intravitreal bevacizumab injection for neovascular age-related macular degeneration. J Korean Ophthalmol Soc. 2010; 51:35–41.

2. Smit DP, Meyer D. Intravitreal bevacizumab: an analysis of the evidence. Clin Ophthalmol. 2007; 1:273–84.

3. el Matri L, Chebil A, Kort F, et al. Intravitreal injection of triamcinolone combined with bevacizumab for choroidal neovascularization associated with large retinal pigment epithelial detachment in age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol. 2010; 248:779–84.

4. Sampat KM, Garg SJ. Complications of intravitreal injections. Curr Opin Ophthalmol. 2010; 21:178–83.

5. Nunes RP, Nóbrega MJ, De Novelli FJ, et al. Causes of interruption of bevacizumab therapy in age-related macular degeneration. Arq Bras Oftalmol. 2010; 73:146–9.

6. Park HY, Yi K, Kim HK. Intraocular pressure elevation after intra-vitreal triamcinolone acetonide injection. Korean J Ophthalmol. 2005; 19:122–7.

7. Bashshur ZF, Terro AM, Haibi CP, et al. Intravitreal triamcinolone acetonide: Pattern of secondary intraocular pressure rise and possible risk factors. Clin Ophthalmol. 2008; 2:269–74.

8. Pong JC. Anterior chamber paracentesis in patients with acute elevation of intraocular pressure. Graefes Arch Clin Exp Ophthalmol. 2008; 246:463–4.

9. Arnavielle S, Creuzot-Garcher C, Bron AM. Anterior chamber paracentesis in patients with acute elevation of intraocular pressure. Graefes Arch Clin Exp Ophthalmol. 2007; 245:345–50.

10. Cheung CM, Durrani OM, Murray PI. The safety of anterior chamber paracentesis in patients with uveitis. Br J Ophthalmol. 2004; 88:582–3.

11. Lee SJ, Lee JJ, Kim SD. Multiple retinal hemorrhage following anterior chamber paracentesis in uveitic glaucoma. Korean J Ophthalmol. 2006; 20:128–30.

12. Astam N, Batioğ lu F, Ozmert E. Short-term efficacy of intravitreal bevacizumab for the treatment of macular edema due to diabetic retinopathy and retinal vein occlusion. Int Ophthalmol. 2009; 29:543–8.

13. Avery RL, Pearlman J, Pieramici DJ, et al. Intravitreal bevacizumab (Avastin) in the treatment of proliferative diabetic retinopathy. Ophthalmology. 2006; 113:1695.

14. Atchaneeyasakul LO, Trinavarat A. Choroidal ruptures after adjuvant intravitreal injection of bevacizumab for aggressive posterior retinopathy of prematurity. J Perinatol. 2010; 30:497–9.

15. Brouzas D, Koutsandrea C, Moschos M, et al. Massive choroidal hemorrhage after intravitreal administration of bevacizumab (Avastin) for AMD followed by controlateral sympathetic ophthalmia. Clin Ophthalmol. 2009; 3:457–9.

16. Artunay O, Yuzbasioglu E, Rasier R, et al. Incidence and management of acute endophthalmitis after intravitreal bevacizumab (Avastin) injection. Eye. 2009; 23:2187–93.

17. 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; 20:174–9.

18. Adelman RA, Zheng Q, Mayer HR. Persistent ocular hypertension following intravitreal bevacizumab and ranibizumab injections. J Ocul Pharmacol Ther. 2010; 26:105–10.

19. Chang W, Chung M. Efficacy of anterior chamber paracentesis after intravitreal triamcinolone injection. Eur J Ophthalmol. 2007; 17:776–9.

20. Seong HK, Lee JM, Park YS, Lee BR. Immediate natural course of IOP after IVTA and the effect of preoperative ocular massage. J Korean Ophthalmol Soc. 2007; 48:808–14.

21. Theoulakis PE, Lepidas J, Petropoulos IK, et al. Effect of brimoni-dine/timolol fixed combination on preventing the short-term intra-ocular pressure increase after intravitreal injection of ranibizumab. Klin Monbl Augenheilkd. 2010; 227:280–4.

22. Gismondi M, Salati C, Salvetat ML, et al. Short-term effect of intravitreal injection of Ranibizumab (Lucentis) on intraocular pressure. J Glaucoma. 2009; 18:658–61.

23. Shonat RD, Wilson DF, Riva CE, Cranstoun SD. Effect of acute increases in intraocular pressure on intravascular optic nerve head oxygen tension in cats. Invest Ophthalmol Vis Sci. 1992; 33:3174–80.

24. Că lugă ru D, Că lugă ru M. Fixed combinations of glaucoma medications. Oftalmologia. 2008; 52:23–31.

25. Yeh J, Kravitz D, Francis B. Rational use of the fixed combination of dorzolamide – timolol in the management of raised intraocular pressure and glaucoma. Clin Ophthalmol. 2008; 2:389–99.

26. Shim JC, Choe CM, Seong GJ. A comparision of short term use ef-fects and satety of timoptic(R) with those of cosopt(R) in normal Korean. J Korean Ophthalmol Soc. 2002; 43:1206–11.

27. Miglior S, Grunden JW, Kwok K; Xalacom/Cosopt European Study Group. Efficacy and safety of fixed combinations of latano-prost/timolol and dorzolamide/timolol in open-angle glaucoma or ocular hypertension. Eye. 2010; 24:1234–42.

28. Teus MA, Miglior S, Laganovska G, et al. Efficacy and safety of travoprost/timolol vs dorzolamide/timolol in patients with open-angle glaucoma or ocular hypertension. Clin Ophthalmol. 2009; 3:629–36.

29. Eakins KE, Whitelocke RA, Bennett A, Martenet AC. Prostaglandin- like activity in ocular inflammation. Br Med J. 1972; 3:452–3.

30. Jampol LM. Aphakic cystoid macular edema. A hypothesis. Arch Ophthalmol. 1985; 103:1134–5.

Figure 1.

Serial change of mean IOP in both groups. ^* IOP = intraocular pressure.

Table 1.

Patient demographics

	Group 1	Group 2	p-value
Number of eyes	53	29
Age (mean ± SD, yr)	61.92 ± 13.76	61.00 ± 12.58	0.426^*
Sexuality (M/F)	29/24	20/9	0.263^†
Laterality (OD/OS)	29/24	14/15	0.385^†
IVBI/IVRI	38/15	19/10	0.094^†

SD = standard deviation; IVBI = intravitreal bevacizumab injection; IVRI = intravitreal ranibizumab injection.

^* Student t-test

^† Chi-square test.

Table 2.

Indications for intravitreal anti VEGF injections in both groups

	Group 1 (n = 53)	Group 2 (n = 33)
AMD with CNV	17	11
Idiopathic CNV	12	5
RVO	10	7
DM retinopathy	9	5
Myopic CNV	5	1

AMD = age related macular degeneration; CNV = choroidal neo- vascularization; RVO = retinal vein occlusion; DM = diabetes mellitus.

Table 3.

Serial changes of mean IOP between group 1 and group 2

	Group 1 (n = 53)		Group 2 (n = 29)		p-value^‡
	IOP (mean ± SD, mm Hg)	p-value	IOP (mean ± SD, mm Hg)	p-value	p-value^‡
Preop 1 hr	13.38 ± 2.20		13.45 ± 1.96		0.172
Preop 5 min	12.06 ± 1.85	0.000^*	13.81 ± 2.24	0.217^*	0.741
Postop 5 min	14.12 ± 4.18	0.021^†	28.21 ± 3.16	0.004^†	0.031
Postop 10 min	12.12 ± 3.34	0.153^†	24.33 ± 2.65	0.071^†	0.089
Postop 15 min	12.05 ± 1.48	0.214^†	20.53 ± 4.35	0.108^†	0.319
Postop 20 min	11.28 ± 2.31	0.370^†	17.48 ± 2.75	0.213^†	0.122
Postop 25 min	10.98 ± 2.32	0.077^†	18.45 ± 1.85	0.064^†	0.100
Postop 30 min	10.87 ± 1.58	0.142^†	17.48 ± 2.34	0.144^†	0.048
Postop 1 hr	10.65 ± 2.38	0.007^†	18.72 ± 1.65	0.020^†	0.135
Postop 1 day	11.40 ± 1.93	0.142^†	14.40 ± 2.32	0.174^†	0.326
Postop 1 wk	12.86 ± 2.13	0.200^†	14.72 ± 2.85	0.087^†	0.494
Postop 1 mon	12.78 ± 2.37	0.250^†	14.59 ± 2.63	0.156^†	0.264

IOP = intraocular pressure; SD = standard deviation.

^* Statistical significance of between IOP before dropping dorsolamide/timolol and after 1 hour IOPs, Paired t-test

^† Statistical significance of between the preoperative IOP and the postoperative IOPs, Paired t-test

^‡ Statistical significance of between IOP of use dorsolamide/timolol and not use dorsolamide/timolol, Student t-test.

Table 4.

Effects of IVBI, IVRI on mean intraocular pressure between Group 1 and Group 2

IVBI (n = 57)	Group 1 (n = 38)		Group 2 (n = 19)		p-value^‡
IVBI (n = 57)	IOP (mean ± SD, mm Hg)	p-value	IOP (mean ± SD, mm Hg)	p-value	p-value^‡
Preop 1 hr	13.56 ± 2.08		13.73 ± 1.82		0.753
Preop 5 min	12.17 ± 1.77	0.000^*	13.67 ± 2.16	0.864^*	0.063
Postop 5 min	17.01 ± 1.13	0.021^†	27.12 ± 3.35	0.019^†	0.047
Postop 10 min	16.47 ± 2.87	0.120^†	24.34 ± 1.13	0.211^†	0.298
Postop 15 min	14.53 ± 1.10	0.231^†	18.48 ± 1.76	0.169^†	0.124
Postop 20 min	13.97 ± 2.01	0.103^†	16.17 ± 0.95	0.351^†	0.291
Postop 25 min	14.01 ± 1.25	0.082^†	17.01 ± 2.17	0.240^†	0.348
Postop 30 min	13.11 ± 2.31	0.147^†	15.89 ± 1.27	0.248^†	0.021
Postop 1 hr	12.96 ± 2.39	0.390^†	16.77 ± 2.09	0.042^†	0.053
Postop 1 day	12.57 ± 1.95	0.159^†	14.50 ± 2.28	0.154^†	0.320
Postop 1 wk	13.10 ± 2.08	0.074^†	15.36 ± 1.85	0.053^†	0.354
Postop 1 mon	12.78 ± 2.18	0.088^†	14.86 ± 2.73	0.129^†	0.396
IVRI (n = 25)	Group 1 (n = 15)		Group 2 (n = 10)
Preop 1 hr IOP	12.94 ± 2.50		12.91 ± 2.20		0.068
Preop 5 min IOP	11.78 ± 2.08	0.037^*	14.08 ± 2.48	0.010^*	0.018
Postop 5 min	15.98 ± 4.14	0.035^†	25.19 ± 1.04	0.037^†	0.021
Postop 10 min	12.77 ± 2.69	0.356^†	20.22 ± 2.73	0.669^†	0.521
Postop 15 min	12.87 ± 2.18	0.247^†	21.43 ± 2.24	0.539^†	0.326
Postop 20 min	13.01 ± 4.34	0.382^†	18.42 ± 1.94	0.739^†	0.264
Postop 25 min	12.81 ± 2.24	0.212^†	18.62 ± 1.82	0.339^†	0.162
Postop 30 min	10.27 ± 1.04	0.114^†	15.98 ± 2.71	0.241^†	0.023
Postop 1 hr	11.87 ± 2.24	0.040^†	16.02 ± 2.04	0.014^†	0.098
Postop 1 day	11.98 ± 1.86	0.545^†	14.21 ± 2.83	0.239^†	0.412
Postop 1 wk	12.26 ± 2.18	0.215^†	13.50 ± 2.54	0.459^†	0.484
Postop 1 mon	12.76 ± 2.89	0.158^†	14.08 ± 2.48	0.587^†	0.354

SD = standard deviation; IVBI = intravitreal bevacizumab injection; IVRI = intravitreal ranibizumab injection; IOP = intraocular pressure.

^* Statistical significance between IOP before and 1 hour after Dorsolamide/timolol, Paired t-test

^† Statistical significance between the preoperative IOP and the postoperative IOPs, Paired t-test

^‡ Statistical significance between IOP with dorsolamide/timolol and without dorsolamide/timolol, Student t-test.

TOOLS

Similar articles