New techniques for reducing intraocular pressure spike after intravitreal injection of bevacizumab

INTERVENTION: 200 patients were enrolled and underwent preoperative ophthalmologic evaluation, with anamnestic data collection. They were randomized to the different study arms (40 eyes injected for each study arm) using a simple randomisation method. Arm A was injected by standard intravitreal injection technique, that consists in these steps: 1. Periocular and palpebral skin disinfection with 5% povidone‐iodine solution; 2. Topical anesthetic and 5% povidone‐iodine instillation in the eye to be injected; 3. Intravitreal injection; 4. Application of gentle pressure using cotton swab for 5 seconds to avoid vitreous reflux 5. Instillation of povidone‐iodine 0.5%, Ofloxacin (Oftaquix®) and Netilmicin‐ Dexamethasone (Netildex®). Arm B was injected by pre‐injection scleral indentation technique (intravitreal injection performed according to the standard protocol, with the addition of pre‐injection scleral indentation, that consist in the application of a slight pressure using a cotton swab, such as to induce a minimum folding of the cotton swab rod, directly on the injection site for 60 seconds before performing the intravitreal injection); Arm C was injected by pre‐injection digital ocular massage technique (intravitreal injection performed according to the standard protocol, preceded by digital ocular massage for 5 minutes); Arm D was injected by post‐ injection scleral indentation technique (intravitreal injection performed according to the standard protocol, with addition of post‐ intravitreal injection scleral indentation); Arm E was injected by post‐ injection digital ocular massage technique (intravitreal injection performed according to the standard protocol, followed by digital ocular massage). All subjects underwent Goldmann applanation tonometry 10 min before and 10 min after the intravitreal injection of Bevacizumab. CONDITION: Intraocular pressure after bevacizumab intravitreal injection ; Eye Diseases PRIMARY OUTCOME: Variation of the post‐injection IOP with the different injection techniques measured using Goldmann applanation tonometry 10 min before and 10 min after injection. SECONDARY OUTCOME: ; 1. Percentage of post‐ intravitreal injection IOP spikes with IOP =40 mmHg in study arms measured using Goldmann applanation tonometry 10 min before and 10 min after injection; 2. Phakia/pseudophakia status; 3. Previous diagnosis of glaucoma; 4. Ophthalmic pathology for which indication was given to intravitreal injection; 5. The percentage of adverse events was also evaluated; INCLUSION CRITERIA: 1. Age between 18 to 99 years old 2. Indication for intravitreal injection of anti‐VEGF drug (bevacizumab) 3. Absence of contraindications to the execution of intravitreal injection (systemic or local conditions that make the injective treatment not indicated) 4. Possibility of expressing informed consent to participation in the study