EFFECT OF PROPHYLACTIC TOPICAL BRIMONIDINE (0.15%) ADMINISTRATION ON THE DEVELOPMENT OF SUBCONJUNCTIVAL HEMORRHAGE AFTER INTRAVITREAL INJECTION CHANG SIK KIM, MD,*† KI YUP NAM, MD,* JUNG YEUL KIM, MD*† Purpose: Brimonidine (0.15%), which is used to lower intraocular pressure, is an a-2- adrenergic agonist that has vasoconstrictive effects. This study examined whether the administration of brimonidine (0.15%) before intravitreal injection prevents subconjunctival hemorrhage. Methods: A prospective, randomized, double-masked single-center study. Two hundred and forty-four patients (244 eyes) who underwent intravitreal injection were prospectively examined. The control group (118 eyes) was given normal saline, while the experimental group received 0.15% brimonidine (126 eyes) 30 minutes before the intravitreal injection. On Days 1 and 7, the treatment outcome was assessed using slit-lamp microscopy. The severity of subconjunctival hemorrhage was scored on a scale of 1 (mild) to 3 (severe). To determine the size of the affected area, the lengths of the short and long axes of the subconjunctival hemorrhage were measured in millimeters and then multiplied. To consider both the severity and the size of subconjunctival hemorrhage, the severity score was multiplied by the size of the subconjunctival hemorrhage. Results: Subconjunctival hemorrhage occurred as a result of intravitreal injection in 13.5% (17 eyes) of the brimonidine group and in 29.7% (35 eyes) of the control group (P = 0.003). On Days 1 and 7, the severity and size of the subconjunctival hemorrhage and the product of these 2 parameters were significantly lower in the brimonidine group. Conclusion: The administration of 0.15% brimonidine before an intravitreal injection decreased the incidence, severity, and size of subconjunctival hemorrhage. RETINA 31:389–392, 2011 V arious drugs are injected intravitreally, including anti–vascular endothelial growth factor, steroids, and antibiotics. Adverse effects that may follow an intravitreal injection include ocular pain, foreign body sensation, epiphora, subconjunctival hemorrhage, in- traocular pressure elevation, retinal detachment, cat- aracts, vitreous hemorrhage, and endophthalmitis. 1 Of these, subconjunctival hemorrhage is one of the most common complications. Although subconjunctival hemorrhage does not cause ophthalmological prob- lems over the long term, it may cause aesthetic problem and anxiety. Brimonidine is a selective a-2-adrenergic agonist that lowers intraocular pressure. It is used to treat patients with glaucoma and has a vasoconstrictive effect because of its characteristics as a sympathetic agonist. 2,3 These vasoconstrictive effects have been exploited to reduce bleeding in laser in situ keratomileusis, 4 cataract surgery, 5 and strabismus surgery. 6 Given this back- ground, we examined whether the administration of brimonidine before an intravitreal injection decreases the amount of subconjunctival hemorrhage. Patients and Methods This is a prospective, randomized, double-masked single-center study. After informed consent from the patients was obtained, we prospectively examined the incidence and severity of subconjunctival hemorrhage after intravitreal Avastin (bevacizumab; Genentech Inc., South San Fransisco, CA) injection in 244 patients (244 eyes) between May and November of 2008. Patients who initially underwent an intravitreal 389