Central retinal artery perfusion following 0.1 ml intravitreal injection of bevacizumab

Purpose: To study the pattern of perfusion of central retinal artery (CRA) after 0.1 ml intravitreal injection of bevacizumab to verify the need for any maneuver to decrease the intraocular pressure (IOP) including anterior chamber paracentesis (ACP). Methods: This is a prospective, interventional, noncomparative case series. Patients receiving intravitreal injection of bevacizumab for choroidal neovascularization (CNV) secondary to age-related macular degeneration, diabetic macular edema and retinal veno-occlusive diseases were included in the study. Each eye received 0.1 ml intravitreal injection of bevacizumab and the status of perfusion of CRA and its pulsation was monitored by indirect ophthalmoscopy until cessation of visible pulsation. Main outcome measures were patency of CRA, its pulsation and time from injection to cessation of pulsation. Results: Seventy seven eyes of 70 patients were studied. At first ophthalmoscopy 30 seconds after injection, CRA was open in all cases with or without pulsation. CRA occlusion was not observed in any case. In 20 eyes (26%) CRA was patent without pulsation. In 57 eyes (74%) CRA pulsation was detected and this visible pulsation of CRA stopped within an average time of 167±99 seconds (range: 30-480 seconds). From 17 eyes which had significant vitreous reflux, only 6 eyes had CRA pulsation which stopped in a mean time of 80±36 seconds. There was a significant difference between pulsation duration in patients with and without vitreous reflux (Mann-Whitney U test, P=0.005). Absence of postinjection vitreous reflux was a risk factor for CRA pulsation after intravitreal injection of 0.1 ml of bevacizumab (relative risk: 2.41, 95% CI: 1.25-4.62). Conclusion: Considering the absence of CRA closure and the short time needed for the cessation of pulsation after intravitreal injection of 0.1 ml bevacizumab, no treatment including ACP is warranted before or after such injections in nonglaucomatous eyes. Indirect ophthalmoscopy is a noninvasive useful maneuver to ascertain patency of CRA after intravitreal injections.