J Korean Ophthalmol Soc.  2014 May;55(5):693-701. 10.3341/jkos.2014.55.5.693.

Changes in the Retinal Nerve Fiber Layer after Intravitreal Injections of Bevacizumab in Glaucoma Patients

• Park CH
• Lee KI
• Park HY
• Lee JH
• Kim IT
• Park CK

• KMID: 2218090
• DOI: http://doi.org/10.3341/jkos.2014.55.5.693

Abstract

PURPOSE
To examine retinal nerve fiber layer (RNFL) changes after intravitreal injection of bevacizumab in patients with or without underlying glaucoma.
METHODS
A total of 104 eyes of 104 patients with retinal disease undergoing intravitreal injection of bevacizumab were prospectively investigated. Bevacizumab injections (1.25/0.05 mg/mL) were performed using a standardized technique. In the patient who had pretreatment with intraocular pressure (IOP)-lowering medication, 1 drop of brimonidine was instilled 30 minutes before the injection. Before and after the intravitreal injections, the patients were monitored for IOP and evaluated with optical coherence tomography using Stratus at least 3 months after the injection.
RESULTS
Thirty minutes after injection, 6.4% of patients had an IOP over 30 mm Hg in the non-pretreatment group while no patient had an IOP over 30 mm Hg in the pretreatment group. In eyes with only retinal diseases, the RNFL thickness did not change significantly after the injection regardless of pretreatment, whereas in eyes with underlying glaucomatous damage and no pretreatment, significant decrease in RNFL thickness was observed at the superior (p = 0.036) and temporal (p = 0.048) sectors of the optic nerve head without pretreatment.
CONCLUSIONS
Intravitreal injection of bevacizumab did not typically cause significant changes in RNFL thickness; however, in eyes with underlying glaucoma without pretreatment, a significant decrease in RNFL thickness was observed in the superior and temporal sectors of the optic nerve head. Therefore, applying IOP-lowering pretreatment medication before intravitreal injection of bevacizumab is required for protection of RNFL in glaucoma patients.

Keyword

Bevacizumab; Intraocular pressure; Retinal nerve fiber layer thickness

MeSH Terms

Glaucoma*
Humans
Intraocular Pressure
Intravitreal Injections*
Nerve Fibers*
Optic Disk
Prospective Studies
Retinal Diseases
Retinaldehyde*
Tomography, Optical Coherence
Bevacizumab
Brimonidine Tartrate
Retinaldehyde

Figure

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  Figure 1. The changes of mean intraocular pressure after the intravitreal injection of bevacizumab. Significant differences of mean intraocular pressure were observed both in 2 minutes and 5 minutes after the injection (p < 0.05).

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  Figure 2. The changes of retinal nerve fiber layer (RNFL) thickness after the intravitreal injection of bevacizumab. Comparison between eyes without (A) or with (B) underlying glaucoma are shown.

• 

  Figure 3. The changes of retinal nerve fiber layer (RNFL) thickness after the intravitreal injection of bevacizumab. Comparison between eyes without (A) or with (B) underlying glaucoma without pretreatment are shown. The mean changes of RNFL thickness in eyes without (C) or with (D) underlying glaucoma are shown by the total average thickness and the sector average thickness.

• 

  Figure 4. The changes of retinal nerve fiber layer (RNFL) thickness after the intravitreal injection of bevacizumab. Comparison between eyes without (A) or with (B) underlying glaucoma with pretreatment are shown.

Reference

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