Skip to main content

Advertisement

SpringerLink
Log in

Subconjunctival hemorrhage after intravitreal injection of anti-vascular endothelial growth factor

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

Abstract

Purpose

To investigate the risk factors for subconjunctival hemorrhage (SCH) after intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) and evaluate the relationship between hemodynamic status at the time of injection and SCH.

Methods

We retrospectively reviewed the medical records of 598 cases of 173 patients who underwent intravitreal injection of ranibizumab whose hemodynamic status was monitored at the time of the injection. Cases with SCH after the injection were included in the SCH group. We compared systemic factors, including the hemodynamic status between the SCH group and the control group.

Results

The SCH group included 67 cases and the control group included 531 cases without SCH. Baseline hemodynamic status was not significantly related to development of SCH. However, systolic blood pressure (BP) at injection was a significant risk factors for SCH (P = 0.034). Elevated systolic BP, mean arterial pressure (MAP), and pulse rate from baseline to time of injection were significantly related to the development of SCH (P = 0.011, P = 0.014, P = 0.036, respectively). In multivariate analysis, hypertension, a large change in MAP, and a fewer previous injections were significant risk factors for SCH after intravitreal injection (P = 0.030, P = 0.032, P = 0.028, respectively).

Conclusions

Hemodynamic risk factors exist for SCH after intravitreal injection of anti-VEGF. To reduce the risk of SCH, strategies should seek to decrease patient anxiety, especially in those with hypertension.

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

Fig. 1

Similar content being viewed by others

References

  1. Doshi RR, Bakri SJ, Fung AE (2011) Intravitreal injection technique. Semin Ophthalmol 26:104–113

    Article  PubMed  Google Scholar 

  2. van der Reis MI, La Heij EC, De Jong-Hesse Y, Ringens PJ, Hendrikse F, Schouten JS (2011) A systematic review of the adverse events of intravitreal anti-vascular endothelial growth factor injections. Retina 31:1449–1469

    Article  PubMed  Google Scholar 

  3. 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 

  4. Fukuyama J, Hayasaka S, Yamada K, Setogawa T (1990) Causes of subconjunctival hemorrhage. Ophthalmologica 200:63–67

    Article  CAS  PubMed  Google Scholar 

  5. Pitts JF, Jardine AG, Murray SB, Barker NH (1992) Spontaneous subconjunctival haemorrhage—a sign of hypertension? Br J Ophthalmol 76:297–299

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Wilson RJ (1986) Subconjunctival hemorrhage: overview and management. J Am Optom Assoc 57:376–380

    CAS  PubMed  Google Scholar 

  7. Mimura T, Usui T, Yamagami S, Funatsu H, Noma H, Honda N, Amano S (2010) Recent causes of subconjunctival hemorrhage. Ophthalmologica 224:133–137

    Article  PubMed  Google Scholar 

  8. Pan W (2001) Akaike’s information criterion in generalized estimating equations. Biometrics 57:120–125

    Article  CAS  PubMed  Google Scholar 

  9. Bhargava M, Ikram MK, Wong TY (2012) How does hypertension affect your eyes? J Hum Hypertens 26:71–83

    Article  CAS  PubMed  Google Scholar 

  10. Wong TY, Mitchell P (2007) The eye in hypertension. Lancet 369:425–435

    Article  PubMed  Google Scholar 

  11. Dayani PN, Siddiqi OK, Holekamp NM (2007) Safety of intravitreal injections in patients receiving warfarin anticoagulation. Am J Ophthalmol 144:451–453

    Article  CAS  PubMed  Google Scholar 

  12. Mason JO 3rd, Frederick PA, Neimkin MG, White MF Jr, Feist RM, Thomley ML, Albert MA Jr (2010) Incidence of hemorrhagic complications after intravitreal bevacizumab (Avastin) or ranibizumab (Lucentis) injections on systemically anticoagulated patients. Retina 30:1386–1389

    Article  PubMed  Google Scholar 

  13. Horn W, Hoerauf H (2008) Intravitreal injections during anticoagulant treatment. Klin Monatsbl Augenheilkd 225:217–219

    Article  CAS  PubMed  Google Scholar 

  14. Manzoni GM, Pagnini F, Castelnuovo G, Molinari E (2008) Relaxation training for anxiety: a ten-year systematic review with meta-analysis. BMC Psychiatry 8(2):41

    Article  PubMed Central  PubMed  Google Scholar 

  15. Jacob RG, Kraemer HC, Agras WS (1977) Relaxation therapy in the treatment of hypertension. a review. Arch Gen Psychiatry 34:1417–1427

    Article  CAS  PubMed  Google Scholar 

Download references

Financial support

This study was supported by a grant from the Korea University (K1400675).

Conflict of Interest

The authors do not have any conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Korea University College of Medicine, 126-1 Anam-dong 5-ga, Sungbuk-gu, Seoul, 136-705, South Korea

    Cheolmin Yun, Jaeryung Oh, Seong-Woo Kim & Kuhl Huh

  2. Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea

    Soon-Young Hwang

Authors
  1. Cheolmin Yun
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jaeryung Oh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Soon-Young Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Seong-Woo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kuhl Huh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jaeryung Oh.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yun, C., Oh, J., Hwang, SY. et al. Subconjunctival hemorrhage after intravitreal injection of anti-vascular endothelial growth factor. Graefes Arch Clin Exp Ophthalmol 253, 1465–1470 (2015). https://doi.org/10.1007/s00417-014-2837-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-014-2837-6

Keywords

Search

Navigation