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In the study by Bashshur and colleagues,1 0.1 mL of bevacizumab was injected intravitreally; paracentesis was performed only if intraocular pressure (IOP) was greater than 25 mm Hg or the optic nerve head was not adequately perfused 20 minutes after injection. They did not mention how many patients needed paracentesis. I would like to add some comments on the subject.
There are 3 articles2 - 4 that discuss IOP changes following intravitreal bevacizumab and the necessity of paracentesis; however, the lack of consistency among their conclusions is controversial. Hollands et al3 suggest that clinicians should check IOP after injection or perform a preinjection paracentesis. In a study by Bakri et al,2 no patients required paracentesis, but a few patients required IOP-lowering drops. Falkenstein et al4 reported that paracentesis is unnecessary. These studies, however, used only 0.05 mL of bevacizumab; Bashshur et al used 0.1 mL. We also used 0.1 mL, and performed preinjectional paracentesis routinely on more than 300 patients, because the sudden rise in IOP (usually > 40 mm Hg) may damage delicate retinal structures, the optic nerve, and small vessels of the retina and choroids; this may aggravate the original ocular disease.
Another problem with not performing paracentesis was that drug reflux, when injected, resulted in elevated IOP, even though the injection site was covered with a sterile cotton-tipped applicator and pressure was applied for approximately 10 to 20 seconds. Preinjectional paracentesis can assess the amount of bevacizumab available in the vitreous cavity.
Finally, it would be stressful for patients to return to the operating room after 20 minutes.
Correspondence: Dr Tsai, Department of Ophthalmology, China Medical University Hospital, No. 2, Yue Der Road, Taichung, Taiwan (elsa10019@yahoo.com.tw).
Financial Disclosure: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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