1
|
Calci C, Castro DG, Schuetz YP, Mermoud A, Ambresin A. Rapidly Progressive Visual Field Deterioration in a Glaucomatous Patient Treated with Several Anti-VEGF Injections for Neovascular AMD: A Case Report. Klin Monbl Augenheilkd 2023; 240:478-480. [PMID: 37164425 DOI: 10.1055/a-2004-5664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Coraline Calci
- Ophthalmology, Swiss Visio Montchoisi - Centre B Lausanne, CH, Lausanne, Switzerland
| | | | | | - André Mermoud
- Ophthalmology, Swiss Visio Montchoisi - Centre B Lausanne, CH, Lausanne, Switzerland
- Ophthalmology, Swiss Glaucoma Research Fondation, Lausanne, Switzerland
| | - Aude Ambresin
- Ophthalmology, Swiss Visio Montchoisi - Centre B Lausanne, CH, Lausanne, Switzerland
- Ophthalmology, Swiss Visio Retina Research, Center, Lausanne, Switzerland
| |
Collapse
|
2
|
Incidence of elevated intraocular pressure after intravitreal injection in Japanese patients with age-related macular degeneration. Sci Rep 2021; 11:12246. [PMID: 34112856 PMCID: PMC8192945 DOI: 10.1038/s41598-021-91832-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/31/2021] [Indexed: 12/05/2022] Open
Abstract
The purpose of this study was to report the incidence of elevated intraocular pressure (IOP) after intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF) in Japanese patients with age-related macular degeneration (AMD). A retrospective study of chart review of patients who underwent ≥ 10 intravitreal anti-VEGF injections between April 2009 and December 2019 was conducted. Elevated IOP was defined as IOP ≥ 25 mmHg at one visit. Cases with elevated IOP resulting from IVI were identified. Furthermore, the association between elevated IOP and some parameters, as the risk factors that influence elevated IOP, was investigated. A total of 402 eyes of 370 patients were included in this study. Twenty-eight eyes of 26 patients (7.0%) were identified as cases with elevated IOP after IVI. The mean time of elevation after baseline was 50.6 ± 26.5 months. History of glaucoma (p = 0.021; odds ratio, 5.85), treatment modality (p = 0.019; odds ratio, 6.32), and total number of injections (p = 0.003; odds ratio, 1.03) were significantly associated with elevated IOP. A late complication of elevated IOP is associated with IVI in patients with AMD. Particularly, history of glaucoma and treat and extend regimen with frequent injections were found to be risk factors of elevated IOP.
Collapse
|
3
|
Allmendinger A, Butt YL, Mueller C. Intraocular pressure and injection forces during intravitreal injection into enucleated porcine eyes. Eur J Pharm Biopharm 2021; 166:87-93. [PMID: 34102300 DOI: 10.1016/j.ejpb.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/06/2021] [Accepted: 06/01/2021] [Indexed: 11/24/2022]
Abstract
Injection of biological molecules into the intravitreous humor is of increasing interest for the treatment of posterior segment eye diseases such as age-related degenerative macular degeneration. The injection volume is limited by an increase in intraocular pressure (IOP) and 50-100 µL are typically used for most intravitreally (IVT) applied commercial products. Direct measurement of IOP is difficult and has not been studied dependent on solution properties and injection rates. We used an instrumental set-up to study IOP ex vivo using healthy enucleated porcine eyes. IOP was determined as a function of injection volume for viscosities between 1 and 100 mPas, injection rates of 0.1, 1, and 1.5 mL/min, and needle length and diameter (27/30G and 0.5/0.75″) using Dextran solutions. IOP increased exponentially for injection volumes larger than 100 µL. We did not observe differences in IOP dependent on viscosity, injection rate, and needle diameter. However, variability increased significantly for injection volumes larger than 100 µL and, unexpectedly, declined with higher viscosities. We demonstrate that the exponential increase in IOP is not reflected by injection force measurements for typical configurations that are used for IVT application. The present findings may guide injection volumes for intravitreal injection and inform injection force considerations during technical drug product development.
Collapse
Affiliation(s)
- Andrea Allmendinger
- Pharmaceutical Development & Supplies Biologics, F. Hoffmann-La Roche, Grenzacherstr. 124, 4070 Basel, Switzerland.
| | - Yuen Li Butt
- Pharmaceutical Development & Supplies Biologics, F. Hoffmann-La Roche, Grenzacherstr. 124, 4070 Basel, Switzerland
| | - Claudia Mueller
- Pharmaceutical Development & Supplies Biologics, F. Hoffmann-La Roche, Grenzacherstr. 124, 4070 Basel, Switzerland
| |
Collapse
|
4
|
Cui QN, Gray IN, Yu Y, VanderBeek BL. Repeated intravitreal injections of antivascular endothelial growth factors and risk of intraocular pressure medication use. Graefes Arch Clin Exp Ophthalmol 2019; 257:1931-1939. [PMID: 31152311 PMCID: PMC6698200 DOI: 10.1007/s00417-019-04362-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/12/2019] [Accepted: 05/14/2019] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To determine the risk of initiating ocular hypertension and glaucoma treatment with repeated injections of antivascular endothelial growth factors (anti-VEGF). METHODS A unique, retrospective cohort study was performed using a large national US medical claim database. The study population included patients who had 1 or more injections of an anti-VEGF agent. Exclusion occurred for any previous glaucoma, glaucoma suspect, glaucoma-related procedure, an ocular steroid injection, or not seeing an eye care provider at least once in each year of follow-up. Cohorts were divided into quartiles based on the number of injections performed over the follow-up period. Patients were observed for 2 and 3 years. The main outcome measure was defined as any new prescription for an ocular antihypertensive medication with a concurrent diagnosis of glaucoma, glaucoma suspect, or ocular hypertension. Multivariate logistic regression determined the odds of initiating glaucoma treatment in each injection quartile while controlling for numerous covariates. Sensitivity analysis assessed outcomes that included new medication only as well as a new medication plus diagnosis of glaucoma. RESULTS In total, 17,113 and 9992 patients met 2- and 3-year observation end points, respectively. The multivariate odds ratio for initiating glaucoma treatment at 2 years was higher in the highest quartile (OR 1.96, 95% CI 1.39-2.76, p < 0.001) compared with the lowest. The 3-year comparison had similar results with increased odds in the highest quartile (OR 1.51, 95% CI 1.07-2.13, p = 0.006) compared with the lowest. Sensitivity analyses also showed similar results with more injections being associated with initiating treatment (p < 0.053 for all comparisons). CONCLUSIONS Repeated anti-VEGF injections are associated with an increased odds of initiating treatment for ocular hypertension and glaucoma.
Collapse
Affiliation(s)
- Qi N Cui
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, 51 North 39th St., Philadelphia, PA, 19104, USA
| | - Iga N Gray
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, 51 North 39th St., Philadelphia, PA, 19104, USA
| | - Yinxi Yu
- Center for Preventative Ophthalmology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Brian L VanderBeek
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, 51 North 39th St., Philadelphia, PA, 19104, USA.
- Department of Biostatistics & Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
- Leonard Davis Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| |
Collapse
|
5
|
Kodjikian L, Bellocq D, Bandello F, Loewenstein A, Chakravarthy U, Koh A, Augustin A, de Smet MD, Chhablani J, Tufail A, García-Layana A, Sudhalkar A, Mathis T. First-line treatment algorithm and guidelines in center-involving diabetic macular edema. Eur J Ophthalmol 2019; 29:573-584. [DOI: 10.1177/1120672119857511] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Management of center-involving diabetic macular edema represents a real therapeutic challenge. Diabetic macular edema is the leading cause of visual acuity impairment in diabetic patients. Since the advent of intravitreal drugs, management of diabetic macular edema has significantly evolved. The historical grid laser photocoagulation is no longer recommended as first-line treatment of diabetic macular edema owing to the findings of the pivotal randomized controlled trials, and anti-vascular endothelial growth factor therapy has emerged as first-line therapy. Steroids also represent a valid treatment option in the management of naïve diabetic macular edema and their efficacy has also been confirmed in several studies. The optimal treatment for diabetic macular edema should consider both general and ophthalmological comorbidities. Patient compliance and motivation should also be carefully evaluated as some treatments require monthly follow-up. Based on recent literature evidence, the present review provides clinicians with a first-line treatment algorithm for center-involving diabetic macular edema tailored to the patient’s individual characteristics.
Collapse
Affiliation(s)
- Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
- CNRS UMR Mateis, Villeurbanne, France
| | - David Bellocq
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sydney A. Fox chair of ophthalmology, Tel Aviv University, Tel Aviv, Israel
| | - Usha Chakravarthy
- Department of Ophthalmology, Queen’s University Belfast, Belfast, Northern Ireland
| | - Adrian Koh
- Eye and Retina Surgeons, Singapore, Singapore
- Singapore National Eye Centre, Singapore, Singapore
| | | | | | - Jay Chhablani
- Smt Kanuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Adnan Tufail
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | | | - Aditya Sudhalkar
- Raghudeep Eye Hospital, Iladevi Cataract Centre, Ahmedabad, India
| | - Thibaud Mathis
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| |
Collapse
|
6
|
Leleu I, Penaud B, Blumen-Ohana E, Rodallec T, Adam R, Laplace O, Akesbi J, Nordmann JP. [Late and sustained intraocular pressure elevation related to intravitreal anti-VEGF injections: Cases requiring filtering surgery (French translation of the article)]. J Fr Ophtalmol 2018; 41:789-801. [PMID: 30348599 DOI: 10.1016/j.jfo.2018.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 10/28/2022]
Abstract
We report cases of delayed, sustained elevated intraocular pressure (IOP) associated with repeated intravitreal anti-VEGF injections (IVI), which ultimately resulted in the need for filtering surgery. Two of the three cases demonstrated severe IOP elevation despite maximal medical treatment following unilateral IVI and required urgent filtering surgery. Optic nerve involvement was severe in all three cases. These intravitreal injections were performed for exudative age-related macular degeneration (AMD), and the patients did not show any sign of glaucoma or ocular hypertension prior to the initiation of treatment. Elevated IOP secondary to intravitreal steroids is a well-known side effect, as is immediate transient IOP elevation associated with anti-VEGF injection. Late, sustained IOP elevation after repeated injections of anti-VEGF, described approximately ten years ago, is often underestimated. Its incidence is estimated between 2.1% and 13% according to studies and increases with the number of IVI (cumulative effect). The pathophysiologic process is becoming increasingly understood, and several risk factors for this chronic IOP elevation have been identified. Most often, it is a moderate IOP elevation for which topical monotherapy is sufficient, or sometimes two, three or four medications or even selective laser trabeculoplasty (SLT). However, filtering surgery may rarely be required. Our findings illustrate a little-described phenomenon: a sudden, severe, late IOP elevation in response to anti-VEGF by an "overflow" effect, requiring urgent filtering surgery.
Collapse
Affiliation(s)
- I Leleu
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France.
| | - B Penaud
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
| | - E Blumen-Ohana
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
| | - T Rodallec
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
| | - R Adam
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
| | - O Laplace
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
| | - J Akesbi
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
| | - J-P Nordmann
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
| |
Collapse
|
7
|
Leleu I, Penaud B, Blumen-Ohana E, Rodallec T, Adam R, Laplace O, Akesbi J, Nordmann JP. Late and sustained intraocular pressure elevation related to intravitreal anti-VEGF injections: Cases requiring filtering surgery. J Fr Ophtalmol 2018; 41:e329-e340. [PMID: 30197188 DOI: 10.1016/j.jfo.2018.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 07/17/2018] [Accepted: 07/24/2018] [Indexed: 01/13/2023]
Abstract
We report cases of delayed, sustained elevated intraocular pressure (IOP) associated with repeated intravitreal anti-VEGF injections (IVI), which ultimately resulted in the need for filtering surgery. Two of the three cases demonstrated severe IOP elevation despite maximal medical treatment following unilateral IVI and required urgent filtering surgery. Optic nerve involvement was severe in all three cases. These intravitreal injections were performed for exudative age-related macular degeneration (AMD), and the patients did not show any sign of glaucoma or ocular hypertension prior to the initiation of treatment. Elevated IOP secondary to intravitreal steroids is a well-known side effect, as is immediate transient IOP elevation associated with anti-VEGF injection. Late, sustained IOP elevation after repeated injections of anti-VEGF, described approximately ten years ago, is often underestimated. Its incidence is estimated between 2.1 % and 13 % according to studies and increases with the number of IVI (cumulative effect). The pathophysiologic process is becoming increasingly understood, and several risk factors for this chronic IOP elevation have been identified. Most often, it is a moderate IOP elevation for which topical monotherapy is sufficient, or sometimes two, three or four medications or even selective laser trabeculoplasty (SLT). However, filtering surgery may rarely be required. Our findings illustrate a little-described phenomenon: a sudden, severe, late IOP elevation in response to anti-VEGF by an "overflow" effect, requiring urgent filtering surgery.
Collapse
Affiliation(s)
- I Leleu
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France.
| | - B Penaud
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
| | - E Blumen-Ohana
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
| | - T Rodallec
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
| | - R Adam
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
| | - O Laplace
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
| | - J Akesbi
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
| | - J-P Nordmann
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
| |
Collapse
|
8
|
The route of administration influences the therapeutic index of an anti-proNGF neutralizing mAb for experimental treatment of Diabetic Retinopathy. PLoS One 2018; 13:e0199079. [PMID: 29927948 PMCID: PMC6013198 DOI: 10.1371/journal.pone.0199079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 05/31/2018] [Indexed: 12/22/2022] Open
Abstract
Many neurodegenerative retinal diseases are treated with monoclonal antibodies (mAb) delivered by invasive intravitreal injection (IVT). In Diabetic Retinopathy there is a scarcity of effective agents that can be delivered using non-invasive methods, and there are significant challenges in the validation of novel therapeutic targets. ProNGF represents a potential novel target, and IVT administration of a function-blocking anti-proNGF mAb is therapeutic in a mouse model of DR. We therefore compared invasive IVT to less invasive systemic intravenous (IV) and local subconjunctival (SCJ) administration, for therapy of Diabetic Retinopathy. The IV and SCJ routes are safe, afford sustained pharmacokinetics and tissue penetration of anti-proNGF mAb, and result in long–term therapeutic efficacy that blocks retinal inflammation, edema, and neuronal death. SCJ may be a more convenient and less-invasive approach for ophthalmic use and may enable reduced frequency of intervention for the treatment of retinal pathologies.
Collapse
|
9
|
Bracha P, Moore NA, Ciulla TA, WuDunn D, Cantor LB. The acute and chronic effects of intravitreal anti-vascular endothelial growth factor injections on intraocular pressure: A review. Surv Ophthalmol 2017; 63:281-295. [PMID: 28882597 DOI: 10.1016/j.survophthal.2017.08.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 08/27/2017] [Accepted: 08/28/2017] [Indexed: 01/18/2023]
Abstract
The acute and chronic effects of repeated intravitreal antivascular endothelial growth factor (VEGF) injections on intraocular pressure have not been fully characterized, and the development of sustained ocular hypertension could adversely affect patients who are at risk of glaucomatous optic neuropathy. As expected, volume-driven, acute ocular hypertension immediately follows intravitreal injection, but this pressure elevation is generally transient and well tolerated. Several medications have been investigated to limit acute ocular hypertension following anti-VEGF therapy, but the benefits of pretreatment are not conclusive. Chronic, sustained ocular hypertension, distinct from the short-term acute ocular hypertension after each injection, has also been associated with repeated intravitreal anti-VEGF injections. Risk factors for chronic ocular hypertension include the total number of injections, a greater frequency of injection, and preexisting glaucoma. Proposed mechanisms for chronic ocular hypertension include microparticle obstruction, toxic or inflammatory effects on trabecular meshwork, as well as alterations in outflow facility by anti-VEGF agents. Although limiting anti-VEGF therapy could minimize the risk of both acute and chronic ocular hypertension, foregoing anti-VEGF therapy risks progression of various macular diseases with resulting permanent central vision loss. While definitive evidence of damage to the retinal nerve fiber layer is lacking, patients receiving repeated injections should be monitored for ocular hypertension and patients in whom sustained ocular hypertension subsequently developed should be periodically monitored for glaucomatous changes with optic nerve optical coherence tomography and static visual fields.
Collapse
Affiliation(s)
- Peter Bracha
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA.
| | - Nicholas A Moore
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Thomas A Ciulla
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA; Retina Service, Midwest Eye Institute, Indianapolis, Indiana, USA
| | - Darrell WuDunn
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Louis B Cantor
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
10
|
Duan Y, Yang Y, Huang X, Lin D. Preliminary study of a controllable device for subtenon drug infusion in a rabbit model. Acta Ophthalmol 2017; 95:595-601. [PMID: 28391654 DOI: 10.1111/aos.13448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 02/26/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Conventional methods to treat intraocular diseases are invasive or associated with adverse effects. A minimally invasive means of sustained-release drug delivery to the vitreous is required. This study evaluated a novel device for subtenon drug delivery to the vitreous, relative to a single subconjunctival injection. METHODS Sixty adult New Zealand White rabbits were randomly assigned to receive demethylvancomycin (DMV) by continuous subtenon delivery with the flow rate of 0.1 ml/hr for 24 hr, or as a single 0.3 ml subconjunctival injection in the right eyes. Rabbits were killed in subgroups of six at 1, 3, 6, 12 and 24 hr. The DMV concentration of the vitreous humour of the right eye was analysed by high-performance liquid chromatography. RESULTS Overall, the vitreous DMV concentration of the subtenon group was significantly higher than that of the subconjunctival group (F = 25.928, p = 0.001). The DMV concentration of the subtenon group was also significantly higher than that of the subconjunctival group at 3, 6, 12 and 24 hr (t = 2.457, 5.064, 3.085, 4.207; p = 0.04, 0.01, 0.018, 0.004, respectively). In the subtenon group, the DMV concentration reached maximum (2.41 ± 0.67 μg/ml) at 6 hr, and at 24 hr was 2.37 ± 1.23 μg/ml. In the subconjunctival group, the DMV concentration reached maximum (0.48 ± 0.27 μg/ml) at 1 hr and declined to 0.09 ± 0.05 μg/ml at 24 hr. CONCLUSION Subtenon application with this novel minimally invasive design is an effective method for delivering an appropriate drug to the vitreous in a sustained and controllable amount.
Collapse
Affiliation(s)
- Yiqin Duan
- Aier School of Ophthalmology; Central South University; ChangSha China
- Changsha Aier Eye Hospital; ChangSha China
| | - Yezhen Yang
- Aier School of Ophthalmology; Central South University; ChangSha China
- Changsha Aier Eye Hospital; ChangSha China
| | - Xuetao Huang
- Aier School of Ophthalmology; Central South University; ChangSha China
- Changsha Aier Eye Hospital; ChangSha China
| | - Ding Lin
- Aier School of Ophthalmology; Central South University; ChangSha China
- Changsha Aier Eye Hospital; ChangSha China
| |
Collapse
|
11
|
Vo Kim S, Fajnkuchen F, Sarda V, Qu-Knafo L, Bodaghi B, Giocanti-Aurégan A. Sustained intraocular pressure elevation in eyes treated with intravitreal injections of anti-vascular endothelial growth factor for diabetic macular edema in a real-life setting. Graefes Arch Clin Exp Ophthalmol 2017; 255:2165-2171. [PMID: 28831613 DOI: 10.1007/s00417-017-3782-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 08/04/2017] [Accepted: 08/14/2017] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The aim of this study was to investigate the sustained intraocular pressure (IOP) elevation after repeated anti-VEGF intravitreal injections (IVI) in patients with diabetic macular edema (DME). METHODS A retrospective study included 140 eyes without prior glaucoma, treated with at least three anti-VEGF injections for DME between 2012 and 2016. IOP elevation was defined by an increase above baseline IOP by ≥6 mmHg. Baseline IOP was defined as the mean of IOP values before treatment initiation. Three groups were differentiated: group 1 without IOP elevation, groups 2 and 3 with IOP elevation and IOP <21 mmHg (group 2) and ≥21 mmHg (group 3). Rate and several risk factors of IOP elevation were assessed and compared between the three groups. RESULTS IOP elevation occurred in ten eyes (7.1%). IOP was <21 mmHg in six eyes and ≥21 mmHg in four eyes. Statistically significant associations were found between IOP elevation and the number of injections, and HbA1c level. Two patients required local hypotonic treatment. CONCLUSIONS In a real-life setting, we confirmed in eyes with center-involved DME without prior glaucoma or IOP elevation that repeated anti-VEGF IVI may increase the risk of sustained IOP elevation in about 7% of eyes.
Collapse
Affiliation(s)
- S Vo Kim
- Ophthalmology Department, Avicenne Hospital, APHP, DHU Vision and Handicaps, Paris 13 University, 125 rue de Stalingrad, 93000, Bobigny, France
| | - F Fajnkuchen
- Ophthalmology Department, Avicenne Hospital, APHP, DHU Vision and Handicaps, Paris 13 University, 125 rue de Stalingrad, 93000, Bobigny, France.,Centre d'imagerie et de Laser, 11 rue Anoine Bourdelle, Paris, France
| | - V Sarda
- Ophthalmology Department, Avicenne Hospital, APHP, DHU Vision and Handicaps, Paris 13 University, 125 rue de Stalingrad, 93000, Bobigny, France
| | - L Qu-Knafo
- Ophthalmology Department, Avicenne Hospital, APHP, DHU Vision and Handicaps, Paris 13 University, 125 rue de Stalingrad, 93000, Bobigny, France
| | - B Bodaghi
- Ophthalmology Department, Avicenne Hospital, APHP, DHU Vision and Handicaps, Paris 13 University, 125 rue de Stalingrad, 93000, Bobigny, France.,Ophthalmology Department, Pitié-Salpétrière Hospital, APHP, DHU Vision and Handicaps, Paris 6 University, Paris, France
| | - A Giocanti-Aurégan
- Ophthalmology Department, Avicenne Hospital, APHP, DHU Vision and Handicaps, Paris 13 University, 125 rue de Stalingrad, 93000, Bobigny, France.
| |
Collapse
|
12
|
Poli M, Denis P, Dot C, Nordmann JP. Conduite à tenir face au risque d’hypertonie oculaire après injection intra-vitréenne. J Fr Ophtalmol 2017; 40:e77-e82. [DOI: 10.1016/j.jfo.2017.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 01/25/2017] [Accepted: 01/26/2017] [Indexed: 11/27/2022]
|
13
|
Duan YQ, Yang YZ, Huang XT, Lin D. Research on the comparison of the demethylvancomycin's diffusion-deposition characteristics in the ocular solid tissues of sustained subtenon drug delivery with subconjunctival injection. Drug Deliv 2017; 24:92-98. [PMID: 28155569 PMCID: PMC8241144 DOI: 10.1080/10717544.2016.1230904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
PURPOSE To compare the demethylvancomycin's diffusion-deposition characteristics in the ocular solid tissues of sustained subtenon drug delivery with subconjunctival injection. METHOD Sixty adult white rabbits were randomly assigned to the subtenon drug delivery group and the subconjunctival injection group. The subtenon drug delivery group was continuously infused demethylvancomycin to the subtenon of rabbits. The subconjunctival injection group was injected demethylvancomycin to the subconjunctival of rabbits. Cornea, iris and sclera were collected for high-performance liquid chromatography analyses to determine drug concentrations at one hour, three hours, six hours, 12 h and 24 h of drug administration. WinNonlin 6.3 was used to calculate the parameters of cumulative area under the curve (AUCcum) of demethylvancomycin. RESULTS The peak levels of demethylvancomycin concentration of the subtenon drug delivery group and the subconjunctival injection group were 92.406 ± 21.555 and 51.778 ± 14.001 μg/g in cornea, 28.451 ± 10.229 μg/g and 42.271 ± 27.291 μg/g in iris, 153.166 ± 51.738 μg/g and 57.423 ± 18.480 μg/g in sclera. The differences of concentrations between the two groups in cornea and sclera were statistically significant (F = 487.775, p < 0.001; F = 132.748, p < 0.001). The difference in iris was not statistically significant (F = 4.848, p = 0.064). The maximum of AUCcum of the subtenon drug delivery group and the subconjunctival injection group was 1808.23 h * μg/g and 273.73 h * μg/g in cornea, 489.12 h * μg/g and 216.16 h * μg/g in iris and 2166.34 h * μg/g and 392.57 h * μg/g in sclera at 24 h of drug administration. CONCLUSION The sustained subtenon drug delivery had a better drug permeability and accumulation in the intraocular solid tissue compared to subconjunctival injection, which demonstrated it was probably a promising and effective approach for treating posterior segment diseases and endophthalmitis.
Collapse
Affiliation(s)
- Yi-Qin Duan
- a Aier School of Ophthalmology, Central South University, ChangSha , P. R. China and.,b Changsha Aier Eye Hospital, ChangSha , P. R. China
| | - Ye-Zhen Yang
- a Aier School of Ophthalmology, Central South University, ChangSha , P. R. China and.,b Changsha Aier Eye Hospital, ChangSha , P. R. China
| | - Xue-Tao Huang
- a Aier School of Ophthalmology, Central South University, ChangSha , P. R. China and.,b Changsha Aier Eye Hospital, ChangSha , P. R. China
| | - Ding Lin
- a Aier School of Ophthalmology, Central South University, ChangSha , P. R. China and.,b Changsha Aier Eye Hospital, ChangSha , P. R. China
| |
Collapse
|
14
|
Reis GM, Grigg J, Chua B, Lee A, Lim R, Higgins R, Martins A, Goldberg I, Clement CI. Incidence of Intraocular Pressure Elevation following Intravitreal Ranibizumab (Lucentis) for Age-related Macular Degeneration. J Curr Glaucoma Pract 2017; 11:3-7. [PMID: 28138211 PMCID: PMC5263879 DOI: 10.5005/jp-journals-10008-1213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/24/2016] [Indexed: 11/16/2022] Open
Abstract
Aim The aim of this article is to evaluate the rate of patients developing sustained elevated intraocular pressure (IOP) after ranibizumab (Lucentis) intravitreal (IVT) injections. Design This is a retrospective study. Participants Charts of 192 consecutive patients receiving Lucentis for age-related macular degeneration (AMD) were retrospectively reviewed. Materials and methods We enrolled patients with at least two IOP measurements between injections. Elevated IOP was defined as >21 mm Hg with an increase of at least 20% from baseline. Noninjected contralateral eyes of the same patient cohort were used as control. Main outcome measures Primary outcome was defined as elevated IOP. Secondary outcomes were presence and type of glaucoma, number of injections, and time to IOP elevation. Results Elevated IOP occurred at a significantly higher rate in eyes receiving IVT ranibizumab (7.47%; n = 9) compared with control (0.93%; n = 1). Patients with preexisting glaucoma or ocular hypertension (OHT) were more likely to develop elevated IOP after IVT ranibizumab injection. Conclusion Intravitreal ranibizumab injections are associated with sustained IOP elevation in some eyes. How to cite this article Reis GMSM, Grigg J, Chua B, Lee A, Lim R, Higgins R, Martins A, Goldberg I, Clement CI. The Incidence of Intraocular Pressure Elevation following Intravitreal Ranibizumab (Lucentis) for Age-related Macular Degeneration. J Curr Glaucoma Pract 2017;11(1):3-7.
Collapse
Affiliation(s)
- Gustavo Msm Reis
- Consultant, Glaucoma Unit, Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - John Grigg
- Associate Professor, Glaucoma Unit, Sydney Eye Hospital, Sydney; Discipline of Ophthalmology, Central Clinical School, University of Sydney Sydney, New South Wales, Australia
| | - Brian Chua
- Clinical Lecturer and Staff Specialist, Glaucoma Unit, Sydney Eye Hospital, Sydney; Discipline of Ophthalmology, Central Clinical School, University of Sydney Sydney, New South Wales, Australia
| | - Anne Lee
- Clinical Lecturer and Staff Specialist, Glaucoma Unit, Sydney Eye Hospital, Sydney; Discipline of Ophthalmology, Central Clinical School, University of Sydney Sydney, New South Wales, Australia
| | - Ridia Lim
- Clinical Lecturer and Visiting Medical OfficerGlaucoma Unit, Sydney Eye Hospital, Sydney; Discipline of Ophthalmology, Central Clinical School, University of Sydney Sydney, New South Wales, Australia
| | - Ralph Higgins
- Visiting Medical Officer, Glaucoma Unit, Sydney Eye Hospital, Sydney; Discipline of Ophthalmology, Central Clinical School, University of Sydney Sydney, New South Wales, Australia
| | - Alessandra Martins
- Consultant, Department of Ophthalmology, Moorfields Eye Hospital London, United Kingdom
| | - Ivan Goldberg
- Clinical Associate Professor, Glaucoma Unit, Sydney Eye Hospital, Sydney; Discipline of Ophthalmology, Central Clinical School, University of Sydney Sydney, New South Wales, Australia
| | - Colin I Clement
- Clinical Lecturer and Staff Specialist, Glaucoma Unit, Sydney Eye Hospital, Sydney; Discipline of Ophthalmology, Central Clinical School, University of Sydney Sydney, New South Wales, Australia
| |
Collapse
|
15
|
Zhou Y, Zhou M, Xia S, Jing Q, Gao L. Sustained Elevation of Intraocular Pressure Associated with Intravitreal Administration of Anti-vascular Endothelial Growth Factor: A Systematic Review and Meta-Analysis. Sci Rep 2016; 6:39301. [PMID: 28000707 PMCID: PMC5175276 DOI: 10.1038/srep39301] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 11/21/2016] [Indexed: 02/08/2023] Open
Abstract
This study aimed to assess whether repetitive intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF) cause sustained elevation of intraocular pressure (SE-IOP). We conducted a systematic review and meta-analysis based on five randomized controlled trials (RCTs) assessing 1428 subjects and 17 non-RCTs evaluating 8358 cases. In the RCTs, an increased risk of SE-IOP was found in the anti-VEGF group (summary risk ratio [RR] = 3.00, 95% confidence interval [CI]: 1.63–5.53) compared with the sham injection or laser group. The increased risk of SE-IOP was correlated with follow-up duration (RR = 2.14, 95% CI 0.69–6.57 at 6 months; RR = 3.15, 95% CI 0.99–10.09 at 12 months; RR = 3.48, 95% CI 1.38–8.78 at 23 months). The risk of SE-IOP after non-exclusion of pre-existing glaucoma patients (RR = 3.48, 95% CI 1.38–8.78) was higher than that obtained after excluding pre-existing glaucoma patients (RR = 2.6, 95% CI 1.16–5.81). In non-RCTs, the pooled prevalence of SE-IOP was 4.7% (95% CI 3.7–5.8) regardless of diagnosis criteria. In conclusion, repeated intravitreal injections of anti-VEGF agents cause a 2-fold elevation in SE-IOP risk.
Collapse
Affiliation(s)
- Yandan Zhou
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Minwen Zhou
- Department of Ophthalmology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shigang Xia
- Department of Ophthalmology, the second hospital affiliated to the University of South China, Hengyang, Hunan, China
| | - Qiancheng Jing
- Department of Otorhinolaryngology, Xiangya Hospital,Central South University, Changsha, Hunan, China
| | - Ling Gao
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| |
Collapse
|
16
|
El Chehab H, Agard E, Russo A, Boujnah Y, Dot C. Intraocular Pressure Spikes after Aflibercept Intravitreal Injections. Ophthalmologica 2016; 236:43-7. [DOI: 10.1159/000446878] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 05/17/2016] [Indexed: 11/19/2022]
Abstract
The objective of this study was to assess the intraocular pressure (IOP) as well as the anatomical modifications of the anterior segment following an aflibercept injection. Patients underwent an aflibercept intravitreal injection (IVI) (0.05 ml) with a 30.5-gauge needle and an antireflux system. IOP was assessed before injection (T0), immediately after (T1), and 5 min (T5), 15 min (T15), and 45 min (T45) after the IVI. Before the IVI and immediately after the T1 measurement, a PENTACAM® acquisition was used to evaluate the anterior chamber parameters (anterior chamber volume, depth and measure of the iridocorneal angle). At T0, IOP was 12.9 ± 1.3 mm Hg. IOP significantly increased after IVI (42.7 ± 3 mm Hg, p < 0.001). IOP returned to baseline at T45 (13.0 ± 1.2 mm Hg, p = 0.877). Anterior chamber volume decreased after IVI (160.6 vs. 168.3 mm3, p = 0.002). No significant changes were found for iridocorneal angle and anterior chamber depth. Aflibercept IVI causes an acute increase in IOP over a short period without iridocorneal angle closure.
Collapse
|
17
|
Abstract
PURPOSE OF REVIEW This article summarizes recent findings pertaining to advancements in the treatment of glaucomas secondary to vascular occlusive disease to maximize visual outcomes. RECENT FINDINGS Retinal ischemia leads to a local increase in transcription of proteins responsible for aberrant angiogenesis and subsequent neovascular glaucoma. Antivascular endothelial growth factor (VEGF) therapy is helpful in the management of this condition. Although bevacizumab and ranibizumab offer relatively short-term effects, preliminary studies suggest that aflibercept may allow for longer term treatment. Preoperative anti-VEGF injection therapy improves outcomes after trabeculectomy and glaucoma drainage implant surgeries. The treatments for vascular occlusive disease may lead to intraocular pressure elevation and subsequent glaucoma. Aflibercept appears to be a safer agent in this regard. SUMMARY Prompt diagnosis and management of glaucomas associated with vascular occlusive disease are required to allow for the best possible outcome. Novel anti-VEGF agents, particularly aflibercept, should be strongly considered in the management of these conditions.
Collapse
|
18
|
Jiang F, Chen Q, Huang L, Wang Y, Zhang Z, Meng X, Liu Y, Mao C, Zheng F, Zhang J, Yan H. TNFSF15 Inhibits Blood Retinal Barrier Breakdown Induced by Diabetes. Int J Mol Sci 2016; 17:ijms17050615. [PMID: 27120595 PMCID: PMC4881442 DOI: 10.3390/ijms17050615] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 04/07/2016] [Accepted: 04/11/2016] [Indexed: 12/21/2022] Open
Abstract
Tumor necrosis factor superfamily 15 (TNFSF15) is an endogenous neovascularization inhibitor and an important negative regulator of vascular homeostasis. This study aimed to explore the potential role of TNFSF15 in diabetic retinopathy. Vitreous TNFSF15 and VEGF levels in proliferative diabetic retinopathy (PDR) patients were detected by ELISA. Retinal expression of TNFSF15 and the content of tight junction proteins (TJPs) in rats were detected by immunohistochemistry and Western blot, respectively. The blood retinal barrier (BRB) permeability was evaluated using Evans Blue (EB) dye. The TNFSF15/VEGF ratio was decreased in the vitreous fluid of patients with PDR relative to the controls, even though the expression levels of TNFSF15 were higher. TNFSF15 was dramatically decreased one month later after diabetes induction (p < 0.001), and then increased three months later and thereafter. TNFSF15 treatment significantly protected the BRB in the diabetic animals. Diabetes decreased TJPs levels in the retina, and these changes were inhibited by TNFSF15 treatment. Moreover, TNFSF15 decreased activation of VEGF both in mRNA and protein levels caused by diabetes. These results indicate that TNFSF15 is an important inhibitor in the progression of DR and suggest that the regulation of TNFSF15 shows promise for the development of diabetic retinopathy treatment strategies.
Collapse
Affiliation(s)
- Feng Jiang
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin 300052, China.
| | - Qingzhong Chen
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin 300052, China.
| | - Liming Huang
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin 300052, China.
| | - Ying Wang
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin 300052, China.
| | - Zhuhong Zhang
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin 300052, China.
| | - Xiangda Meng
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin 300052, China.
| | - Yuanyuan Liu
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin 300052, China.
| | - Chunjie Mao
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin 300052, China.
| | - Fang Zheng
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin 300052, China.
| | - Jingkai Zhang
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin 300052, China.
| | - Hua Yan
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin 300052, China.
| |
Collapse
|
19
|
Beato J, Pedrosa AC, Pinheiro-Costa J, Freitas-da-Costa P, Falcão MS, Melo A, Estrela-Silva S, Falcão-Reis F, Carneiro ÂM. Long-Term Effect of Anti-VEGF Agents on Intraocular Pressure in Age-Related Macular Degeneration. Ophthalmic Res 2016; 56:30-4. [DOI: 10.1159/000444395] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 02/02/2016] [Indexed: 11/19/2022]
|