Brimonidine reduces subconjunctival hemorrhage after intravitreal injection

Retina. 2011;31(2):389-392.

Brimonidine 0.15% administered before intravitreal injection decreased the incidence, size and severity of post-injection subconjunctival hemorrhage, a study found.

Investigators set out to study vasoconstrictive effects produced by brimonidine. Brimonidine is most commonly used to reduce IOP, but it is also used to minimize bleeding in LASIK, cataract and strabismus surgery.

"These vasoconstrictive effects have been exploited to reduce bleeding in laser in situ keratomileusis, cataract surgery and strabismus surgery," the study authors said. "Given this background, we examined whether the administration of brimonidine before an intravitreal injection decreases the amount of subconjunctival hemorrhage."

The prospective, randomized, double-masked study included 244 eyes of 244 patients who underwent injections of Avastin (bevacizumab, Genentech). Mean patient age was 61 years. A study group of 126 patients received Alphagan (brimonidine 0.15%, Allergan) 30 minutes before intravitreal injection. A control group of 118 patients received normal saline.

Size and severity of subconjunctival hemorrhage were assessed at 1 day and 7 days after injection. Hemorrhage severity was graded on a scale of 1 (mild) to 3 (severe).

Study results showed that 13.5% of eyes in the brimonidine group and 29.7% of eyes in the saline group developed subconjunctival hemorrhage after intravitreal injection. The difference was statistically significant (P = .003).

Subconjunctival hemorrhage remained in 14 eyes in the brimonidine group (11.1%) and in 26 eyes in the saline group (22%) at 1 week. The difference was statistically significant (P = .025), the authors reported.