Eficácia profilática da brimonidina no pico tensional após injeção intra-vítrea de bevacizumab: ensaio clínico randomizado em cross-over

Purpose: ­­­­­To determine the efficacy of topical brimonidine in reducing the intraocular pressure (IOP) spikes following intravitreal injections. Materials and Methods: In a randomised crossover clinical trial, patients who were treated with two monthly consecutive intravitreal injections of bevacizumab were enrolled. Each patient was then randomised to the control group (no prophylaxis) or to the intervention group (prophylactic treatment with brimonidine, 20 minutes before the injection), with crossover of the subjects at the second visit. IOP measurements were performed before the injection, immediately (T0), 10 (T10) and 20 (T20) minutes after the injection. Results: We included 40 eyes of 40 patients (80 injections), with a median age of 71,5 years old (range 32-83), of whom 40% were female (n=16). Mean IOP before the injection was 13,4mmHg (standard deviation [SD] ±3,2; range: 8-26). In the control group, mean IOP at T0 was 35,6mmHg (SD:±11,6; range:15-68,7), in contrast to an IOP of 30,7mmHg (SD:±10,2; range:13,3-53,7), in the intervention group. Comparing both groups, patients treated with brimonidine had a lower IOP at T0 (IOP 14% lower; p=0,0012), T10 (p=0,0016) and T20 (p<0,001). There were no adverse drug reactions reported. Conclusion: This study shows that prophylactic treatment with brimonidine before intravitreal injections can be useful in reducing IOP spikes after the injection.