dorzolamide-timolol-combination and apraclonidine

The purpose of this study was to evaluate intraocular pressure increase after intravitreal injections (IVIs) and the effect of prophylactic pressure-lowering medications.. A prospective study of 210 anti-vascular endothelial growth factor (VEGF) IVI (0.05 mL of bevacizumab or ranibizumab), that were divided into five groups, group 1: no intraocular pressure (IOP)-lowering medication (n=50); group 2: apraclonidine 1 % one drop 2 hours prior to IVI (n=50); group 3: acetazolamide 250 mg 2 hours prior (n=50); group 4: fixed combination brimonidine+timolol (n=30); group 5: fixed combination dorzolamide+timolol (n=30). IOP was measured before, immediately after (T1), 15 min after (T15) and 45 min after (T45) the IVI using a Perkins tonometer.. The mean IOP peak in group 1 was 46.4 ± 4.8 mmHg at T1, 21.7 ± 5.7 mmHg at T15 and 15.4 ± 4.3 mmHg at T45. Apraclonidine 1 % and the fixed combinations produced a significant reduction of IOP at every time point, of around 9 mmHg at T1. The reduction in IOP obtained with acetazolamide was not significant versus group 1 at T1 (-1.6 mmHg, P=0.12), but became significant at T15 and T45 (respectively, P=0.011 and P=0.015).. IOP spikes are high but transient following IVI. Acetazolamide proved to be ineffective in preventing this spike. Topical medications, however, produced a significant reduction in IOP spike as well as in the duration of the increased pressure, with no significant difference between fixed combinations and 1 % apraclonidine at T1. It would seem advisable to prevent this IOP spike in the case of repeated injections, particularly in patients with glaucoma.

Topics: Acetazolamide; Aged; Antibodies, Monoclonal, Humanized; Antihypertensive Agents; Bevacizumab; Brimonidine Tartrate; Chemoprevention; Clonidine; Drug Combinations; Female; Humans; Hypotonic Solutions; Intraocular Pressure; Intravitreal Injections; Macular Degeneration; Male; Ocular Hypertension; Quinoxalines; Sulfonamides; Thiophenes; Timolol; Tonometry, Ocular; Treatment Outcome

We document the recurrence of a CSMD in a patient subsequent to the instillation of topical ocular hypotensive medications and its resolution on discontinuation of therapy. An independent cause or causes contributing to the development of CSMD other than the use of topical ocular hypotensive medications cannot be ruled out in this case, neither can it be considered dissociated from the use of these drugs. We recommend that patients with VTS, those with a history of CSMD or having developed recurrent episodes of CSMD requiring management with topical ocular hypotensive medications, be cautiously monitored for the possible occurrence or exacerbation of CSMD.

Topics: Administration, Topical; Antihypertensive Agents; Clonidine; Drug Combinations; Drug Therapy, Combination; Humans; Intraocular Pressure; Male; Middle Aged; Ocular Hypertension; Recurrence; Retinal Detachment; Serum; Sulfonamides; Thiophenes; Timolol; Tomography, Optical Coherence; Visual Acuity