Subconjunctival hemorrhage after intravitreal injection of anti-vascular endothelial growth factor

Purpose: To investigate the risk factors for subconjunctival hemorrhage (SCH) after intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) and evaluate the relationship between hemodynamic status at the time of injection and SCH. Methods: We retrospectively reviewed the medical records of 598 cases of 173 patients who underwent intravitreal injection of ranibizumab whose hemodynamic status was monitored at the time of the injection. Cases with SCH after the injection were included in the SCH group. We compared systemic factors, including the hemodynamic status between the SCH group and the control group. Results: The SCH group included 67 cases and the control group included 531 cases without SCH. Baseline hemodynamic status was not significantly related to development of SCH. However, systolic blood pressure (BP) at injection was a significant risk factors for SCH (P = 0.034). Elevated systolic BP, mean arterial pressure (MAP), and pulse rate from baseline to time of injection were significantly related to the development of SCH (P = 0.011, P = 0.014, P = 0.036, respectively). In multivariate analysis, hypertension, a large change in MAP, and a fewer previous injections were significant risk factors for SCH after intravitreal injection (P = 0.030, P = 0.032, P = 0.028, respectively). Conclusions: Hemodynamic risk factors exist for SCH after intravitreal injection of anti-VEGF. To reduce the risk of SCH, strategies should seek to decrease patient anxiety, especially in those with hypertension.