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Palmieri F, Younis S, Bedan Hamoud A, Fabozzi L. Uveitis Following Intravitreal Injections of Faricimab: A Case Report. Ocul Immunol Inflamm 2023:1-5. [PMID: 38133943 DOI: 10.1080/09273948.2023.2293925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE Faricimab, a novel pharmaceutical agent targeting both angiopoietin-2 and vascular endothelial growth factor-A pathways, has gained approval for treating neovascular age-related macular degeneration and diabetic macular oedema. While clinical trials have demonstrated its favorable safety profile, this research presents two cases of hypertensive uveitis following intravitreal Faricimab injections. METHODS Medical history, clinical findings and multimodal images were retrospectively collected. RESULTS The patients experienced elevated intraocular pressure, mutton-fat keratic precipitates, anterior and posterior segment inflammation shortly after faricimab administration. CONCLUSIONS These cases prompt further investigation into the potential risk of uveitis associated with faricimab and underscore the importance of continued monitoring and research to elucidate its real-world safety profile.
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Affiliation(s)
- Filomena Palmieri
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Saad Younis
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| | | | - Lorenzo Fabozzi
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
- Medical Retina Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Puranen J, Koponen S, Nieminen T, Kanerva I, Kokki E, Toivanen P, Urtti A, Ylä-Herttuala S, Ruponen M. Antiangiogenic AAV2 gene therapy with a truncated form of soluble VEGFR-2 reduces the growth of choroidal neovascularization in mice after intravitreal injection. Exp Eye Res 2022; 224:109237. [PMID: 36096189 DOI: 10.1016/j.exer.2022.109237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/15/2022] [Accepted: 08/29/2022] [Indexed: 11/04/2022]
Abstract
Pathological angiogenesis related to neovascularization in the eye is mediated through vascular endothelial growth factors (VEGFs) and their receptors. Ocular neovascular-related diseases are mainly treated with anti-VEGF agents. In this study we evaluated the efficacy and safety of novel gene therapy using adeno associated virus 2 vector expressing a truncated form of soluble VEGF receptor-2 fused to the Fc-part of human IgG1 (AAV2-sVEGFR-2-Fc) to inhibit ocular neovascularization in laser induced choroidal neovascularization (CNV) in mice. The biological activity of sVEGFR-2-Fc was determined in vitro. It was shown that sVEGFR-2-Fc secreted from ARPE-19 cells was able to bind to VEGF-A165 and reduce VEGF-A165 induced cell growth and survival. A single intravitreal injection (IVT) of AAV2-sVEGFR-2-Fc (1 μl, 4.7 × 1012 vg/ml) one-month prior laser photocoagulation did not cause any changes in the retinal morphology and significantly suppressed fluorescein leakage at 7, 14, 21 and 28 days post-lasering compared to controls. Macrophage infiltration was observed after the injection of both AAV2-sVEGFR-2-Fc and PBS. Our findings indicate that AAV2 mediated gene delivery of the sVEGFR-2-Fc efficiently reduces formation of CNV and could be developed to a therapeutic tool for the treatment of retinal diseases associated with neovascularization.
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Affiliation(s)
- Jooseppi Puranen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Yliopistonranta 1, 70210, Kuopio, Finland.
| | - Sanna Koponen
- A.I Virtanen Institute for Molecular Sciences, University of Eastern Finland, P.O Box 1627, 70211, Kuopio, Finland
| | - Tiina Nieminen
- A.I Virtanen Institute for Molecular Sciences, University of Eastern Finland, P.O Box 1627, 70211, Kuopio, Finland; Kuopio Center for Gene and Cell Therapy, Kuopio, Finland
| | - Iiris Kanerva
- A.I Virtanen Institute for Molecular Sciences, University of Eastern Finland, P.O Box 1627, 70211, Kuopio, Finland
| | - Emmi Kokki
- A.I Virtanen Institute for Molecular Sciences, University of Eastern Finland, P.O Box 1627, 70211, Kuopio, Finland
| | - Pyry Toivanen
- A.I Virtanen Institute for Molecular Sciences, University of Eastern Finland, P.O Box 1627, 70211, Kuopio, Finland
| | - Arto Urtti
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Yliopistonranta 1, 70210, Kuopio, Finland; Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5 E, FI-00790, University of Helsinki, Finland
| | - Seppo Ylä-Herttuala
- A.I Virtanen Institute for Molecular Sciences, University of Eastern Finland, P.O Box 1627, 70211, Kuopio, Finland; Gene Therapy Unit, Kuopio University Hospital, 70211, Kuopio, Finland
| | - Marika Ruponen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Yliopistonranta 1, 70210, Kuopio, Finland
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Fonollosa A, Gallego-Pinazo R, Sararols L, Adán A, López-Gálvez M, Figueroa MS. Guidance on brolucizumab management recommendations. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:S2173-5794(22)00084-6. [PMID: 35882576 DOI: 10.1016/j.oftale.2022.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/21/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Brolucizumab, a new generation anti-VEGF, has demonstrated efficacy and safety in AMD in the pivotal HAWK and HARRIER trials. Post-marketing, previously undetected adverse events related to intraocular inflammation have been reported. An independent post hoc review of the pivotal trials puts the rate of IOI at 4.6%. The aim of this paper is to propose a set of recommendations for implementing the management of brolucizumab in clinical practice. METHODS The recommendations made by the authors are based on their clinical experience, critical review of (i) the pivotal trials, the post-hoc analysis of the Safety Review Committee, (ii), and (iii) the published literature. RESULTS In the pivotal trials, brolucizumab showed sustained functional gains, superior anatomical outcomes with potentially longer intervals between injections and a well-tolerated overall safety profile. Adverse events reported post-marketing include retinal vasculitis and retinal vascular occlusion. Based on the available information, experts recommend (i) ruling out non-recommended patient profiles (prior history of ORI), (ii) screening the patient prior to each injection to rule out active ORI, (iii) monitoring the patient for early warning signs, and (iv) treating immediately should any adverse events develop. CONCLUSIONS The adverse events reported are rare, but may be associated with severe and irreversible loss of visual acuity. The recommendations made are intended to facilitate the management of brolucizumab in the routine practice of retinologists, to ensure patient safety and, should any adverse events occur, to minimise their impact on vision.
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Affiliation(s)
- A Fonollosa
- Servicio de Oftalmología, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain; Instituto Oftalmológico Bilbao, Bilbao, Spain
| | - R Gallego-Pinazo
- Unidad de Mácula y Ensayos Clínicos, Clínica Oftalvist, Valencia, Spain
| | - L Sararols
- Servicio de Oftalmología, Hospital General de Granollers, Granollers, Barcelona, Spain; Servicio de Oftalmología, Hospital Universitario General de Cataluña, Sant Cugat del Vallès, Barcelona, Spain
| | - A Adán
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M López-Gálvez
- Servicio de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain; Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - M S Figueroa
- Unidad de Retina, Clínica Baviera, Madrid, Spain; Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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4
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Iyer PG, Albini TA. Review of Intraocular Inflammation After Antivascular Endothelial Growth Factor Agents. Int Ophthalmol Clin 2022; 62:35-47. [PMID: 35752884 DOI: 10.1097/iio.0000000000000438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Manifestations of intraocular inflammation over time in patients on brolucizumab for neovascular AMD. Graefes Arch Clin Exp Ophthalmol 2021; 260:1843-1856. [PMID: 34932153 PMCID: PMC9061681 DOI: 10.1007/s00417-021-05518-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 11/01/2022] Open
Abstract
PURPOSE To describe the adverse events associated with brolucizumab, in particular the sequence of intraocular inflammation (IOI), retinal vasculitis (RV), and/or retinal vascular occlusion (RO). METHODS This was an unmasked post hoc analysis of the randomized HAWK/HARRIER clinical trials. Patients with neovascular AMD in the brolucizumab arms of the trials were included. IOI-related adverse events reported by study investigators were analyzed to determine early signs and the time course of IOI-related adverse events, using a subgroup of patients with definite/probable IOI cases identified in an independent unmasked post hoc review by an external safety review committee. A limited literature review on IOI following anti-VEGF therapy was also conducted. RESULTS Among 50 patients with definite/probable IOI cases identified by the safety review committee, 12 had RV or RO adverse events reported by the investigators. For 6 of 12, IOI (other than RV) was reported before RV or RO. The duration from the first IOI adverse event to the first RV or RO adverse event ranged from 16 to 171 days for 5 patients and was 553 days for 1 patient. Four of the 6 patients received ≥ 1 brolucizumab injection on or after the date of the first IOI adverse event and before the first RV or RO adverse event. CONCLUSIONS IOI may precede RV or RO in some patients treated with brolucizumab.
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Baumal CR, Bodaghi B, Singer M, Tanzer DJ, Seres A, Joshi MR, Feltgen N, Gale R. Expert Opinion on Management of Intraocular Inflammation, Retinal Vasculitis, and Vascular Occlusion after Brolucizumab Treatment. Ophthalmol Retina 2021; 5:519-527. [PMID: 33007521 DOI: 10.1016/j.oret.2020.09.020] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Recent reports have described a spectrum of uncommon findings of intraocular inflammation (IOI), retinal vasculitis, or retinal vascular occlusion in patients with neovascular age-related macular degeneration (nAMD) treated with intravitreal injection (IVI) of brolucizumab. We present guidance on the clinical presentation of this spectrum and propose recommendations for management of these events. DESIGN PubMed literature review and expert opinion panel. PARTICIPANTS A working group of international medical experts and Novartis medical personnel. METHODS The working group deliberated on the clinical presentations and used a 3-pronged approach to develop management recommendations based on (1) critical appraisal of scientific literature; (2) clinical insights from the HAWK and HARRIER trials, postmarketing reports, and assessments from an independent Safety Review Committee (SRC); and (3) their clinical experience. MAIN OUTCOME MEASURES Management recommendations for a spectrum of ocular inflammatory events after treatment with brolucizumab or other anti-vascular endothelial growth factors (VEGFs). RESULTS Based on insights gained from the available information and the expertise of the contributors, recommendations were proposed for ocular examinations, imaging modalities, and treatment strategies for management of this spectrum of events. Patients should be educated to promptly report any relevant or persistent symptoms after IVI to facilitate timely intervention. Patients diagnosed with IOI should be evaluated for concomitant retinal vasculitis or retinal vascular occlusive events. Clinical examination can be augmented with multimodal imaging techniques, including widefield imaging, fluorescein angiography (with peripheral sweeps), and OCT. Once confirmed, the ongoing brolucizumab treatment should be suspended and intensive treatment with potent corticosteroids (topical, subtenon, intravitreal, or systemic) is recommended, which may be supplemented with other treatment strategies depending on the severity. Based on the clinical outcome of these events, individualized treatment with locally available standard of care should be considered for the underlying nAMD. CONCLUSIONS These recommendations emphasize the need for early diagnosis, prompt and timely intervention, intensive treatment, and frequent monitoring to minimize the risk of progression of these events. The proposed recommendations may facilitate a consistent management approach of this spectrum of ocular inflammatory events should they arise in nAMD after treatment with brolucizumab or other anti-VEGFs.
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Affiliation(s)
- Caroline R Baumal
- Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts.
| | - Bahram Bodaghi
- Ophthalmology, IHU FOReSIGHT, Sorbonne University, APHP, Paris, France
| | - Michael Singer
- Medical Center of Ophthalmology, University of Texas Health Science Center, San Antonio, Texas
| | - David J Tanzer
- Novartis Pharmaceutical Corporation, East Hanover, New Jersey
| | | | - Mayur R Joshi
- Novartis Pharmaceuticals UK Limited, London, United Kingdom
| | | | - Richard Gale
- York Teaching Hospital NHS Foundation Trust, University of York, York, United Kingdom
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7
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Anderson WJ, da Cruz NFS, Lima LH, Emerson GG, Rodrigues EB, Melo GB. Mechanisms of sterile inflammation after intravitreal injection of antiangiogenic drugs: a narrative review. Int J Retina Vitreous 2021; 7:37. [PMID: 33962696 PMCID: PMC8103589 DOI: 10.1186/s40942-021-00307-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/28/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Intraocular inflammation is an uncommon but potentially vision-threatening adverse event related to anti-VEGF therapy. This is of increasing importance given both the volume of injections performed, as well as the increased prevalence of inflammation seen with newer anti-VEGF agents. Brolucizumab, the newest anti-VEGF agent, has been associated with an inflammatory retinal vasculitis and the underlying mechanism is unclear. Reviewing potential mechanisms and clinical differences of intraocular inflammation may assist clinicians and scientists in reducing the risk of these events in the future. OBSERVATIONS Two types of inflammation are seen with intravitreal injections, acute onset sterile inflammation and delayed onset inflammatory vasculitis. Acute onset inflammation can be subcategorized into subclinical anterior chamber inflammation and sterile uveitis/endophthalmitis. Subclinical anterior chamber inflammation can occur at rates as high as 19% after intravitreal anti-VEGF injection. Rates of sterile uveitis/endophthalmitis range from 0.05% to 4.4% depending on the anti-VEGF agent. Inflammatory vasculitis is only associated with brolucizumab and occurred in 3.3% of injections according to the post hoc review of the HAWK/HARRIER data. In addition, silicone oil from syringes can induce immunogenic protein aggregates. Agitation of the syringe, freeze thawing, shipping and improper storage prior to injection may increase the amount of silicone oil released from the syringe. CONCLUSION The main factors which play a role in intraocular inflammation after anti-VEGF injection can be divided into three causes: patient-specific, medication-specific and delivery-specific. The majority of clinically significant inflammation seen after intravitreal injection is an acute onset inflammatory response with most patients recovering baseline VA in 3-5 weeks. The presence of pain, hypopyon, severe anterior chamber reaction, hyperemia and significant vision loss may help distinguish infectious from non-infectious etiologies of post injection inflammation. Avoiding temperature fluctuation, mechanical shock, agitation during transport and handling of syringes/drugs, and the use of SO-free syringes may help minimize intraocular inflammation. While a definitive mechanism has not yet been established, current knowledge of the clinical presentation and vitreous histopathology of brolucizumab-retinal vasculitis favors an auto-immune type IV hypersensitivity reaction.
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Affiliation(s)
- William J Anderson
- Department of Ophthalmology, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | | | - Luiz Henrique Lima
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | | | - Eduardo Büchele Rodrigues
- Department of Ophthalmology, Saint Louis University School of Medicine, Saint Louis, MO, USA.,Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Gustavo Barreto Melo
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil. .,Hospital de Olhos de Sergipe, Rua Campo Do Brito, 995, Aracaju, SE, 49020-380, Brazil.
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Ebrahimiadib N, Lashay A, Riazi-Esfahani H, Jamali S, Khodabandeh A, Zarei M, Roohipoor R, Khojasteh H, Bazvand F, Ojani M, Shahabinejad M, Yaseri M, Modjtahedi BS, Davoudi S, Riazi-Esfahani M. Intravitreal Ziv-Aflibercept in Patients With Diabetic Macular Edema Refractory to Intravitreal Bevacizumab. Ophthalmic Surg Lasers Imaging Retina 2021; 51:145-151. [PMID: 32211904 DOI: 10.3928/23258160-20200228-03] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 10/25/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the efficacy of intravitreal ziv-aflibercept (IVZ) in patients with diabetic macular edema (DME) resistant to intravitreal bevacizumab (IVB). PATIENTS AND METHODS This prospective study was conducted in patients with persistent DME. Patients were switched to IVZ no longer than 6 weeks after the last three consecutive monthly IVB treatments and monitored over a course of 12 weeks. Changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and macular volume on optical coherence tomography were compared. RESULTS A total of 59 eyes (38 patients) were included. Mean BCVA improved from 0.84 to 0.71 logMAR (P = .001) after first IVZ treatment and remained significant. In a subgroup analysis, this significance was observed only in the group with baseline visual acuity of less than 20/50. Mean CMT decreased from 479 μm to 364 μm (P = .004) after the first IVZ injections and remained significant. CONCLUSION IVZ may be best reserved for patients with persistent DME after initial failure with bevacizumab, with less likelihood for anatomic or functional improvement in those with mild persistent DME. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:145-151.].
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Kaya M, Öner FH, Akbulut Yağcı B, Ataş F, Öztürk T. Non-infectious Intraocular Inflammation Following Intravitreal Anti-Vascular Endothelial Growth Factor Injection. Turk J Ophthalmol 2021; 51:32-37. [PMID: 33631912 PMCID: PMC7931657 DOI: 10.4274/tjo.galenos.2020.84042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives To evaluate the functional and anatomical results of patients with non-infectious intraocular inflammation (IOI) following intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection for the treatment of neovascular age-related macular degeneration (nAMD). Materials and Methods The medical records of patients receiving anti-VEGF treatment for nAMD between January 2015 and March 2019 were retrospectively analyzed. Preoperative and postoperative routine ophthalmological examinations, central macular thickness, duration of inflammation, and follow-up time of the patients with non-infectious IOI following anti-VEGF injection were recorded. Results Non-infectious IOI was determined in 13 eyes (11 eyes with aflibercept, 2 eyes with ranibizumab) of 1,966 patients who received a total of 12,652 anti-VEGF (4,796 aflibercept and 7,856 ranibizumab) injections. IOI was detected after a mean of 7 injections (2-12 injections). All eyes had both anterior chamber reaction (Tyndall +1/+3) and vitritis (grade 1-3). None of the patients had pain, hypopyon, or fibrin reaction. Visual acuity progressed to baseline levels within 28.3 days. Vitritis continued with a mean of 40 days. All patients recovered with topical steroid therapy. In 11 eyes, injection of the same anti-VEGF agent was continued. No recurrence of IOI was observed in any patients. Conclusion Non-infectious IOI following intravitreal anti-VEGF injection typically occurs without pain, conjunctival injection, hypopyon, or fibrin and responds well to topical steroid therapy. Visual acuity returns to baseline levels within weeks according to the severity of inflammation.
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Affiliation(s)
- Mahmut Kaya
- Dokuz Eylül University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Ferit Hakan Öner
- Dokuz Eylül University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Betül Akbulut Yağcı
- Dokuz Eylül University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Ferdane Ataş
- Dokuz Eylül University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Taylan Öztürk
- Dokuz Eylül University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
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Ucgul Atilgan C, Kosekahya P, Ozkoyuncu Kocabas D, Koc M, Sakir Goker Y. Densitometric analysis of cornea in patients with neovascular age-related macular degeneration after intravitreal aflibercept loading dose. Ther Adv Ophthalmol 2020; 12:2515841420950857. [PMID: 32923942 PMCID: PMC7457688 DOI: 10.1177/2515841420950857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 07/27/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose: To evaluate the anatomic changes in the cornea and anterior segment following
intravitreal aflibercept loading dose for neovascular age-related macular
degeneration. Methods: The study included 40 eyes of 40 patients with neovascular age-related
macular degeneration. Each patient underwent a loading dose of one injection
per month for three consecutive doses of aflibercept (0.05 ml/2 mg). Before
and after the loading dose, a record was made for each patient of corneal
topography, anterior segment, corneal densitometry, and lens densitometry
parameters with the Pentacam HR and specular microscopy parameters with a
non-contact specular microscope. The data before and after the aflibercept
loading dose were compared. Results: Corneal densitometry parameters in the 0- to 2-mm and 2- to 6-mm concentric
zones of the posterior layer were significantly higher after the loading
dose compared with baseline (p = 0.03,
p = 0.04, respectively). Corneal densitometry parameters of
the anterior, central, and total corneal layer in the 10- to 12-mm
concentric zone were also significantly higher after the loading dose
compared with baseline (p = 0.009,
p = 0.02, and p = 0.007, respectively). No
significant changes were determined in respect of corneal topography,
anterior segment, lens densitometry, and specular microscopy parameters
(p > 0.05 for all). Conclusion: The aflibercept loading dose caused slightly increased densitometric values
in some corneal regions while it did not affect the corneal topography,
anterior segment, lens densitometry, and specular microscopy parameters.
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Affiliation(s)
- Cemile Ucgul Atilgan
- Deparment of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Pinar Kosekahya
- Deparment of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ulucanlar Street Number 59, 06240 Ankara, Turkey
| | - Dilara Ozkoyuncu Kocabas
- Department of Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Koc
- Department of Ophthalmology, Special Kayseri Maya Eye Hospital, Kayseri, Turkey
| | - Yasin Sakir Goker
- Deparment of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
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Robbins CB, Feng HL, Fekrat S. Quiescent Neovascular Age-Related Macular Degeneration After Endophthalmitis. JOURNAL OF VITREORETINAL DISEASES 2020; 4:300-305. [PMID: 37009179 PMCID: PMC9976098 DOI: 10.1177/2474126420914282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose:This article describes eyes that achieved extended remission of neovascular age-related macular degeneration (NVAMD) following acute endophthalmitis.Methods:Adults who presented to the Duke Eye Center with acute endophthalmitis over a 9-year period and had at least 3 months of follow-up were identified. A retrospective review of medical records was performed to collect clinical data including demographic information, examination findings, etiology, treatment, and outcomes.Results:A total of 133 eyes of 130 patients with endophthalmitis were identified. Of these, 15 eyes of 14 patients (11.3%) were receiving intravitreal antivascular endothelial growth factor (anti-VEGF) injections for NVAMD. Six of these 15 eyes (40%) did not require an anti-VEGF injection after endophthalmitis for a mean of 36.2 months. Endophthalmitis was injection-related in 5 of 6 eyes (83%) and Baerveldt glaucoma drainage device–related in 1 of 6 eyes (17%). Two of the 6 (33%) had culture-proven infectious endophthalmitis, whereas 4 of 6 (67%) had culture-negative endophthalmitis. Five of 6 eyes have required no anti-VEGF therapy to date; the remaining eye restarted intravitreal aflibercept therapy 9.3 months after endophthalmitis.Conclusions:Acute endophthalmitis may be associated with reduced activity of choroidal neovascularization in a subset of eyes with NVAMD.
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Affiliation(s)
- Cason B. Robbins
- Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
| | - Henry L. Feng
- Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
| | - Sharon Fekrat
- Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
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Greenberg JP, Belin P, Butler J, Feiler D, Mueller C, Tye A, Friedlander SM, Emerson GG, Ferrone PJ. Aflibercept-Related Sterile Intraocular Inflammation Outcomes. ACTA ACUST UNITED AC 2019; 3:753-759. [DOI: 10.1016/j.oret.2019.04.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/24/2019] [Accepted: 04/03/2019] [Indexed: 10/27/2022]
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Muto T, Machida S. Effect of intravitreal aflibercept on corneal endothelial cells: a 6-month follow-up study. Clin Ophthalmol 2019; 13:373-381. [PMID: 30858687 PMCID: PMC6387600 DOI: 10.2147/opth.s177506] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Purpose To determine the effect of intravitreal aflibercept injection on the corneal endothelium in patients with diabetic or cystoid macular edema caused by retinal vein occlusion. Material and methods Forty-six eyes of 44 consecutive patients (27 men, 17 women; age range: 55-88 years) were evaluated. All participants initially received a single intravitreal injection of aflibercept (2 mg in 0.05 mL), followed by pro re nata use and underwent central corneal specular microscopy before the injection and at 1, 3 and 6 months after the first injection during a 6-month follow-up period. The endothelial cell density (ECD), average cell size (AVG), standard deviation of cell size (SD), coefficient of variation of cell size (CoV), maximum of cell size (MAX), minimum of cell size (MIN) and percentage of hexagonal cells (Hex%) were analyzed and the central corneal thickness (CCT) was measured. Results No significant differences in the ECD, AVG, SD, CoV, MIN, Hex% and CCT were observed between measurements obtained before and 1, 3 and 6 months after the first injection. However, the MAX measured before injection differed significantly from the values measured at 1, 3 and 6 months after the first injection (P=0.033). An average of 1.43±0.58 intravitreal aflibercept injections were administered per patient. Conclusion These study findings indicate that the intravitreal administration of aflibercept (2 mg) might very slightly alter the corneal endothelium within 6 months of the first injection.
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Affiliation(s)
- Tetsuya Muto
- Department of Ophthalmology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan,
| | - Shigeki Machida
- Department of Ophthalmology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan,
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Kiss S, Dugel PU, Khanani AM, Broder MS, Chang E, Sun GH, Turpcu A. Endophthalmitis rates among patients receiving intravitreal anti-VEGF injections: a USA claims analysis. Clin Ophthalmol 2018; 12:1625-1635. [PMID: 30214147 PMCID: PMC6124467 DOI: 10.2147/opth.s169143] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose Intravitreal (IVT) injections of the anti-vascular endothelial growth factor (VEGF) agents aflibercept, bevacizumab, and ranibizumab are commonly prescribed to treat neovascular age-related macular degeneration (nAMD). Studies comparing inflammation rates in large populations of patients receiving these agents and the treatment of ocular inflammation post-IVT anti-VEGF injections are scarce. In this study, we compared rates of endophthalmitis claims (sterile and infectious) following IVT anti-VEGF injections to determine the risk factors associated with developing endophthalmitis, and examined the claims for subsequent treatment. Patients and methods This retrospective cohort study of USA claims data examined the risk of developing endophthalmitis following IVT injection of aflibercept, bevacizumab, or ranibizumab in patients with nAMD between 11/18/2011 and 5/31/2013. The primary study outcome was occurrence of endophthalmitis within 30 days of a claim for an IVT anti-VEGF injection. Endophthalmitis rates were calculated separately for aflibercept, bevacizumab, and ranibizumab, followed by pairwise comparisons of endophthalmitis frequencies among the 3 treatments. Results This analysis included 818,558 injections from 156,594 patients with nAMD. The rates (% [n/N]) of endophthalmitis following aflibercept, bevacizumab, and ranibizumab IVT injections were 0.100% (136/135,973), 0.056% (268/481,572), and 0.047% (94/201,013), respectively. In a multivariate analysis, aflibercept was associated with a significantly higher risk of endophthalmitis vs ranibizumab (adjusted odds ratio, 2.19; 95% CI: 1.68–2.85; P<0.0001). The risk of endophthalmitis was similar for bevacizumab and ranibizumab. Within 14 days after endophthalmitis, 38.6% of cases received injectable antibiotics, 15.3% received injectable steroids, and 30.3% underwent vitrectomy. Conclusion The rate of endophthalmitis was very low, but higher following IVT injection with aflibercept compared with both bevacizumab and ranibizumab in patients with nAMD.
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Affiliation(s)
- Szilárd Kiss
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY, USA,
| | - Pravin U Dugel
- Retinal Consultants of Arizona, Phoenix, AZ, USA.,USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Michael S Broder
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
| | - Eunice Chang
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
| | - Gordon H Sun
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
| | - Adam Turpcu
- Genentech, Inc., South San Francisco, CA, USA
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Bilateral Severe Sterile Inflammation with Hypopyon after Simultaneous Intravitreal Triamcinolone Acetonide and Aflibercept Injection in a Patient with Bilateral Marked Rubeosis Associated with Ocular Ischemic Syndrome. Case Rep Ophthalmol Med 2017; 2017:5123963. [PMID: 28386497 PMCID: PMC5366781 DOI: 10.1155/2017/5123963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 03/06/2017] [Indexed: 11/17/2022] Open
Abstract
We report the clinical course of a diabetic patient with bilateral cataract and rubeosis in association with ocular ischemic syndrome and initially treated him with simultaneous intravitreal 2 mg aflibercept and 2 mg triamcinolone acetonide injection at the same setting prior to planned cataract surgery and further photocoagulation. However, sterile anterior segment inflammation characterized by hypopyon occurred four days apart in OU. Right eye developed the sterile inflammation at the third postinjection day and the left eye developed the sterile inflammation at the seventh postinjection day (two days after the uneventful cataract surgery with intraocular lens implantation) without any pain or significant redness. Vitreous biopsy taken during the right phacovitrectomy was negative for any microbial contamination. Both eyes were treated successfully with intensive topical prednisolone acetate with a relatively good visual outcome. It is likely that underlying ocular ischemic syndrome might have facilitated the formation of sterile inflammation as blood-aqueous barrier disruption and flare have already been present.
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17
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Twelve-month outcomes of treatment using ranibizumab or aflibercept for neovascular age-related macular degeneration: a comparative study. Graefes Arch Clin Exp Ophthalmol 2016; 254:2101-2109. [PMID: 27230919 DOI: 10.1007/s00417-016-3353-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/22/2016] [Accepted: 04/12/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To compare the 12-month treatment outcome of ranibizumab with that of aflibercept in cases of neovascular age-related macular degeneration (AMD). METHODS This retrospective single-institution study included patients who had been diagnosed with treatment-naïve neovascular AMD and treated using either ranibizumab (ranibizumab group, n = 30) or aflibercept (aflibercept group, n = 21) monotherapy over a 12-month follow-up period. Patients initially received three monthly injections, and were re-treated when neovascularization recurred. The best-corrected visual acuity (BCVA) at diagnosis and at 12 months, as well as the number of injections, were compared between the two groups. RESULTS In the ranibizumab group, the mean logarithm of the minimum angle of resolution BCVA values at diagnosis and at 12 months were 0.86 ± 0.45 and 0.72 ± 0.56, respectively. The equivalent values were 0.73 ± 0.37 and 0.58 ± 0.41 in the aflibercept group. The mean number of injections was 4.5 ± 1.3 in the ranibizumab group and 4.3 ± 0.9 in the aflibercept group. There was no difference in BCVA between the two groups at either diagnosis (P = 0.560) or 12 months (P = 0.702). There was also no difference between the two groups in the number of injections (P = 0.847). CONCLUSION The 12-month treatment outcome of intravitreal ranibizumab was similar to that of intravitreal aflibercept, with a comparable injection frequency. Further prospective studies with a more controlled design are needed to confirm our findings.
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Sella R, Gal-Or O, Livny E, Dachbash M, Nisgav Y, Weinberger D, Livnat T, Bahar I. Efficacy of topical aflibercept versus topical bevacizumab for the prevention of corneal neovascularization in a rat model. Exp Eye Res 2016; 146:224-232. [DOI: 10.1016/j.exer.2016.03.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 03/05/2016] [Accepted: 03/22/2016] [Indexed: 12/27/2022]
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Abstract
Aflibercept (Eylea(®)) is an anti-vascular endothelial growth factor agent indicated for intravitreal use in the treatment of diabetic macular oedema. In patients with diabetic macular oedema, significantly greater improvements from baseline to week 52 in visual acuity were seen with intravitreal aflibercept versus macular laser photocoagulation in the phase III VISTA-DME and VIVID-DME trials, and versus intravitreal bevacizumab or ranibizumab in those with worse visual acuity at baseline (i.e. Early Treatment Diabetic Retinopathy Study letter score of <69) in the phase III PROTOCOL-T trial. Intravitreal aflibercept was generally well tolerated in patients with diabetic macular oedema. In conclusion, intravitreal aflibercept is an important new treatment for diabetic macular oedema.
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Affiliation(s)
- Gillian M Keating
- Springer, Private Bag 65901, Mairangi Bay 0754, Auckland, New Zealand,
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Kim CH, Shin JS, Jeon CY, Chang YS, Lee YH. Noninfectious Endophthalmitis after Intravitreal Injection of Aflibercept. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.6.1018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Chung Hwan Kim
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea
| | - Ji Soo Shin
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea
| | - Chan Yang Jeon
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea
| | - Young Suk Chang
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea
| | - Young Hoon Lee
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea
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Kim JY, You YS, Kwon OW, Kim SH. Sterile Inflammation after Intravitreal Injection of Aflibercept in a Korean Population. KOREAN JOURNAL OF OPHTHALMOLOGY 2015; 29:325-30. [PMID: 26457038 PMCID: PMC4595258 DOI: 10.3341/kjo.2015.29.5.325] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 03/23/2015] [Indexed: 11/23/2022] Open
Abstract
Purpose To report the frequency and clinical features of sterile inflammation after intravitreal aflibercept injection in a Korean population. Methods A single-center, retrospective study was performed in patients who received intravitreal aflibercept from July 2013 through January 2015. Results A total of four cases of post-injection sterile inflammation were identified from 723 aflibercept injections in 233 patients. Patients presented 1 to 13 days after intravitreal aflibercept injection (mean, 5 days). The mean baseline visual acuity was 20 / 60, which decreased to 20 / 112 at diagnosis but ultimately recovered to 20 / 60. Three cases had inflammatory cells in the anterior chamber (mean, 2.25+; range, 0 to 4+), and all cases had vitritis (mean, 3+; range, 2+ to 4+). No patients had pain. Only one patient underwent anterior chamber sampling (culture negative) and injection of antibiotics. Three of four patients were treated with a topical steroid, and all experienced improvement in their symptoms and signs of inflammation. Conclusions The overall incidence of sterile inflammation after intravitreal aflibercept injection in a Korean population was 4 of 723 injections (0.55%), or 4 of 233 patients (1.79%). Sterile inflammation after intravitreal aflibercept injection typically presents without pain, and the visual outcomes are generally favorable.
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