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Klin Monbl Augenheilkd 2010; 227(4): 280-284
DOI: 10.1055/s-0029-1245201
Originalarbeit

© Georg Thieme Verlag KG Stuttgart · New York

Effect of Brimonidine/Timolol Fixed Combination on Preventing the Short-Term Intraocular Pressure Increase after Intravitreal Injection of Ranibizumab

Wirksamkeit einer festen Brimonidin/Timolol-Kombination zur Vorbeugung einer kurzfristigen Intraokulardrucksteigerung nach intravitrealer Injektion von RanibizumabP. E. Theoulakis1 , J. Lepidas2 , I. K. Petropoulos3 , A. Livieratou2 , C. K. Brinkmann4 , J. M. Katsimpris2
  • 1Department of Ophthalmology, Royal Free Hospital NHS Trust, London, U. K. (Chairman: Mr. Hugo Henderson)
  • 2Department of Ophthalmology, General Hospital of Patras ”Agios Andreas”, Patras, Greece (Chairman: Dr. med. D. Feretis)
  • 3Ophthalmological Center of Terrassière, Geneva, Switzerland (Chairmen: Dr. med. P. M. Desmangles, Dr. med. M. A. Matter)
  • 4University Eye Clinic, Inselspital Bern, Bern, Switzerland (Chairman: Prof. S. Wolf)
Further Information

Publication History

received: 18.9.2009

accepted: 30.11.2009

Publication Date:
20 April 2010 (online)

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Zusammenfassung

Hintergrund: Die Studie dient der Beurteilung der Sicherheit und Wirksamkeit der Applikation von 0,2 % Brimonidin und 0,5 % Timolol in vorgefertigter Kombination (Combigan®, Allergan Inc.) zur Vorbeugung einer akuten Intraokulardrucksteigerung nach intravitrealer Injektion von Ranibizumab (Lucentis®, Novartis Pharma). Patienten und Methoden: Prospektive placebokontrollierte Doppelblindstudie. 88 normotensive AMD-Patienten wurden an einem Auge am Vortag und Tag der intravitrealen Injektion von Lucentis® entweder mit Placebotropfen (künstliche Tränentropfen, 44 Augen) oder Combigan® Tropfen (44 Augen) 2-mal tgl. behandelt. Der Intraokulardruck wurde 5, 10, 15 Minuten und eine Stunde nach der Injektion gemessen. Ergebnisse: Die Placebogruppe zeigte höhere Intraokulardruckwerte an allen Messzeitpunkten. Der höchste Intraokulardruckwert wurde fünf Minuten nach der Injektion gemessen. Der mittlere Druck war bei der Placebogruppe 34,1 ± 2,7 mmHg nach fünf Minuten gegenüber 28,4 ± 1,1 mmHg bei der Combigan®-Gruppe (p < 0,001). Nach zehn Minuten sank der Druck bei der Placebogruppe auf 24,9 ± 1,8 mmHg, bei der Combigan®-Gruppe auf 19,9 ± 1,1 mmHg. Nach 15 Minuten sank der Druck bei 100 % der Combigan®-Gruppe auf unter 20 mmHg. Dies war bei lediglich 34 % der Placebogruppe der Fall (15 Augen). Alle Studienaugen hatten normotensive Intraokulardruckwerte nach einer Stunde. Systemische oder okuläre Nebenwirkungen wurden nicht nachgewiesen. Schlussfolgerungen: Die Anwendung von Combigan®-Augentropfen 2-mal tgl. am Vortag und Tag der Lucentisinjektion ist eine sichere und wirksame Maßnahme um akute Drucksteigerungen nach der Injektion zu kupieren.

Abstract

Background: The aim of this study was to evaluate the safety and efficacy of brimonidine 0.2 % and timolol 0.5 % instillation as a fixed combination (CombiganTM, Allergan Inc.) to prevent acute intraocular pressure (IOP) increase occurring after intravitreal injection of ranibizumab (LucentisTM, Novartis Pharma AG). Patients and Methods: A prospective double-blind placebo-controlled study was carried out. One eye of 88 consecutive normotensive age-related macular degeneration patients receiving LucentisTM was randomized into placebo drops (artificial tears, 44 patients) or CombiganTM drops (44 patients) given twice a day the day before and the day of injection. IOP was measured before and 5, 10, 15 minutes and 1 hour after the intravitreal injection. Results: The placebo group had the higher mean IOP at all time points after injection. Maximum IOP increase for both groups occurred at the 5-minutes time point. Mean post-injection IOP in the placebo group was 34.1 ± 2.7 mmHg at 5 minutes post-injection versus 28.4 ± 1.1 mmHg in the CombiganTM group (P < 0.001). IOP decreased to 24.9 ± 1.8 mmHg (placebo group) and 19.9 ± 1.1 mmHg (CombiganTM group) at 10 minutes post-injection. At 15 minutes post-injection, IOP was below 20 mmHg in all eyes of the CombiganTM group (100 %), whereas at the same time point these IOP levels were reached only by 34 % of the eyes of the placebo group (15 eyes). All eyes of both groups had a normal IOP 1 hour post-injection. No systemic or ocular side effect was recorded in either group. Conclusions: The use of CombiganTM drops twice a day the day before and the day of injection in eyes scheduled for intravitreal injection of LucentisTM is a safe and effective prophylaxis to reduce the acute IOP spikes of the post-injection period.

Schlüsselwörter

Intraokulardrucksteigerung - intravitreale Injektion - Ranibizumab - Brimonidin - Timolol

Key words

intraocular pressure elevation - intravitreal injection - ranibizumab - brimonidine - timolol

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John M. Katsimpris, MD, PhD

Department of Ophthalmology, General Hospital of Patras ”Agios Andreas”

Ritsou & Empeirikou Street 73

GR-26335 Patras, Greece

Phone: ++ 30/26 10/6 43 49 7 ++ 30/6 93/6 95 09 50

Fax: ++ 30/26 10/64 34 97

Email: jkatsimpris@yahoo.com