Course of Intraocular Pressure after Intravitreal Injection of 0.05 mL Ranibizumab (Lucentis®)

Purpose This prospective study examines the changes in short-term intraocular pressure (IOP) in patients with wet age-related macular degeneration (AMD) receiving intravitreal injections of 0.05 mL ranibizumab (Lucentis®) in a supine position. Methods A total of 45 eyes (45 patients, 16 M, 29 F, mean age: 78 y) received intravitreal ranibizumab injections for treatment of wet AMD (0.05 mL = 0.5 mg). The IOP was measured by Schiötz tonometry immediately preoperatively and postoperatively, and also after 3 and 10 minutes in a supine position. No history of glaucoma was present. Results The mean preoperative IOP was 22.4±5.5 mmHg in supine position. Immediately after the injection, IOP increased to 47.9±15.1 (range 23–82, p<0.001), with 32 eyes (71.1%) >40 and 19 eyes (42.2%) >50 mmHg. The mean difference between preoperative IOP and immediately after the injection was +25.5±13.6 mmHg. IOP decreased spontaneously by the first 3 minutes after operation by 12.6±6.0 mmHg and after 10 minutes by 21±9.4 mmHg. The mean difference between preoperative IOP and 10 minutes postoperatively was +4.6±7.0 mmHg (range: −9.3 to +25.9 mmHg, p<0.001). Eyes without a subconjunctival reflux had a higher increase in IOP than eyes with any reflux (p<0.001). Conclusions IOP increased significantly in a considerable number of patients after intravitreal ranibizumab injections. A rapid and spontaneous decline was observed in the majority of cases. If there is no subconjunctival reflux after the injection, the increase in IOP is higher than in eyes with any back-flow under the conjunctiva.