Skip to main content

Advertisement

SpringerLink
Log in

Subconjunctival reflux and need for paracentesis after intravitreal injection of 0.1 ml bevacizumab: comparison between 27-gauge and 30-gauge needle

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

Intravitreal injections may lead to a significant elevation of the intraocular pressure (IOP). A paracentesis may become necessary for acute reduction of the IOP in certain cases. The purpose of this study was to determine the frequency of paracentesis performed and the grade of reflux under the conjunctiva after injection of 0.1 ml bevacizumab (1.25 mg), depending on the thickness of the needles used.

Methods

A retrospective review was undertaken of the surgery reports of 234 consecutive intravitreal bevacizumab injections in 145 eyes of 144 patients within 14 months. In particular, the frequency of paracentesis, the thickness of the needles used (27-gauge versus 30-gauge), the lens status, and a semi-quantitative reflux grade were analysed.

Results

A paracentesis was performed in 78 cases (33%) for acute reduction of the IOP. In the 27-gauge group the frequency was 26% (25 of 96), and in the 30-gauge group 38% (53 of 138) (p = 0.05, independent estimating equation (IEE)). The medians of the semi-quantitative assessment of the reflux grade under the conjunctiva were 2.0 in the 27-gauge group (corresponding to a mild reflux) and 1.0 in the 30-gauge group (corresponding to a minimal reflux, p < 0.001, IEE).

Conclusions

When using a 30-gauge needle for intravitreal injections, the reflux under the conjunctiva was less than with a 27-gauge needle. However, the use of a 30-gauge needle appeared to be associated with a higher frequency of paracentesis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Rodrigues EB, Meyer CH, Schmidt JC, Hoerle S, Kroll P (2004) Unsealed sclerotomy after intravitreal injection with a 30-gauge needle. Retina 24:810–812

    Article  PubMed  Google Scholar 

  2. Jager RD, Aiello LP, Patel SC, Cunningham ET Jr (2004) Risks of intravitreous injection: a comprehensive review. Retina 24:676–698

    Article  PubMed  Google Scholar 

  3. Bakri SJ, Pulido JS, McCannel CA, Hodge DO, Diehl N, Hillemeier J (2009) Immediate intraocular pressure changes following intravitreal injections of triamcinolone, pegaptanib, and bevacizumab. Eye 23:181–185

    Article  CAS  PubMed  Google Scholar 

  4. Benz MS, Albini TA, Holz ER, Lakhanpal RR, Westfall AC, Iyer MN, Carvounis PE (2006) Short-term course of intraocular pressure after intravitreal injection of triamcinolone acetonide. Ophthalmology 113:1174–1178

    Article  PubMed  Google Scholar 

  5. Morlet N, Young SH (1993) Prevention of intraocular pressure rise following intravitreal injection. Br J Ophthalmol 77:572–573

    Article  CAS  PubMed  Google Scholar 

  6. Rodrigues EB, Meyer CH, Grumann A Jr, Shiroma H, Aguni JS, Farah ME (2007) Tunneled scleral incision to prevent vitreal reflux after intravitreal injection. Am J Ophthalmol 143:1035–1037

    Article  PubMed  Google Scholar 

  7. Ziemssen F, Heiduschka P, Peters S, Grisanti S, Schraermeyer U (2008) Chances and risks of anti-VEGF therapy. Klin Monatsbl Augenheilkd 225:770–778

    Article  CAS  PubMed  Google Scholar 

  8. Modarres M, Nazari H, Falavarjani KG, Naseripour M, Hashemi M, Parvaresh MM (2009) Intravitreal injection of bevacizumab before vitrectomy for proliferative diabetic retinopathy. Eur J Ophthalmol 19:848–852

    PubMed  Google Scholar 

  9. Kotliar K, Maier M, Bauer S, Feucht N, Lohmann C, Lanzl I (2007) Effect of intravitreal injections and volume changes on intraocular pressure: clinical results and biomechanical model. Acta Ophthalmol Scand 85:777–781

    Article  PubMed  Google Scholar 

  10. Boon CJ, Crama N, Klevering BJ, van Kuijk FJ, Hoyng CB (2008) Reflux after intravitreal injection of bevacizumab. Ophthalmology 115:1270, author reply 1271

    Article  PubMed  Google Scholar 

  11. Huang WC, Lin JM, Chiang CC, Tsai YY (2008) Necessity of paracentesis before or after intravitreal injection of bevacizumab. Arch Ophthalmol 126:1314–1315, author reply 1315

    Article  PubMed  Google Scholar 

  12. He Z, Bui BV, Vingrys AJ (2008) Effect of repeated IOP challenge on rat retinal function. Invest Ophthalmol Vis Sci 49:3026–3034

    Article  PubMed  Google Scholar 

  13. He Z, Bui BV, Vingrys AJ (2006) The rate of functional recovery from acute IOP elevation. Invest Ophthalmol Vis Sci 47:4872–4880

    Article  PubMed  Google Scholar 

  14. Sharei V, Höhn F, Köhler T, Hattenbach LO, Mirshahi A (2010) Course of intraocular pressure after intravitreal injection of 0.05 mL ranibizumab (Lucentis®). Eur J Ophthalmol 20:174–179

    PubMed  Google Scholar 

  15. Raju JR, Weinberg DV (2002) Accuracy and precision of intraocular injection volume. Am J Ophthalmol 133:564–566

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany

    Katrin Lorenz & Alireza Mirshahi

  2. Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany

    Isabella Zwiener

  3. Department of Ophthalmology, Ludwigshafen Hospital, Ludwigshafen, Germany

    Alireza Mirshahi

Authors
  1. Katrin Lorenz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Isabella Zwiener
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alireza Mirshahi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katrin Lorenz.

Additional information

Authors have no financial or proprietary interest in any of the instrumentation or devices used in this study. No funds or grants have been received in support of this study. Authors have full control of all primary data, and agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review their data if requested.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lorenz, K., Zwiener, I. & Mirshahi, A. Subconjunctival reflux and need for paracentesis after intravitreal injection of 0.1 ml bevacizumab: comparison between 27-gauge and 30-gauge needle. Graefes Arch Clin Exp Ophthalmol 248, 1573–1577 (2010). https://doi.org/10.1007/s00417-010-1490-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-010-1490-y

Keywords

Search

Navigation