1
|
Kivrak U, Arsan AK, Akçay G, Bulut MN, Kanar HS, Hacısalihoğlu AO, Şimşek Ş. Clinical features, management, and outcomes of patients with sterile endophthalmitis associated with intravitreal bevacizumab injection: retrospective case series. Int Ophthalmol 2024; 44:216. [PMID: 38705908 DOI: 10.1007/s10792-024-03134-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 04/11/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE To evaluate clinical features, treatment protocol, outcomes, and complications that developed in this case series of 24 patients who had consecutive sterile endophthalmitis after intravitreal bevacizumab (IVB) injection. METHODS In this retrospective case series, IVB was repackaged in individual aliquots from the three batches that were used on the same day. IVB was injected into 26 eyes of 26 patients due to diabetic macular edema, age-related macular degeneration, and branch retinal vein occlusion. All patients had intraocular inflammation. Patients were divided into two groups severe and moderate inflammation according to the intraocular inflammation. The medical records of all patients were reviewed. At each follow-up visit, the complete ophthalmologic examination was performed, including best corrected visual acuity (BCVA), intraocular pressure, biomicroscopy, and posterior fundus examination. RESULTS Twenty-four of 26 patients were included in the study. Two patients were excluded from this study since they didn't come to follow-up visits. The mean BCVA was 1.00 ± 0.52 Log MAR units before IVB. At the final visit, the BCVA was 1.04 ± 0.47 Log MAR units. These differences were not significant (p = 0.58). Of the 24 eyes, 16 eyes had severe, and 8 eyes had moderate intraocular inflammation. Eleven eyes in the severe inflammation group underwent pars plana vitrectomy due to intense vitreous opacity. Smear, culture results, and polymerase chain reaction results were negative. CONCLUSION Sterile endophthalmitis may occur after IVB injection. Differential diagnosis of sterile endophthalmitis from infective endophthalmitis is crucial to adjust the appropriate treatment and prevent long-term complications due to unnecessary treatment.
Collapse
Affiliation(s)
- Ulviye Kivrak
- Department of Ophthalmology, University of Health Sciences, Kartal Lütfi Kirdar City Hospital, Kartal Dr. Lütfi Kirdar Egitim ve Arastirma Hastanesi Göz Klinigi, Cevizli, D-100 Güney Yanyol, Cevizli Mevkii No:47, 34865, Istanbul, Turkey.
- Advanced Neurological Sciences, Istanbul University Institute of Graduate Studies in Health Sciences, Istanbul, Turkey.
| | - Aysu Karatay Arsan
- Department of Ophthalmology, University of Health Sciences, Kartal Lütfi Kirdar City Hospital, Kartal Dr. Lütfi Kirdar Egitim ve Arastirma Hastanesi Göz Klinigi, Cevizli, D-100 Güney Yanyol, Cevizli Mevkii No:47, 34865, Istanbul, Turkey
| | - Güzide Akçay
- Department of Ophthalmology, University of Health Sciences, Kartal Lütfi Kirdar City Hospital, Kartal Dr. Lütfi Kirdar Egitim ve Arastirma Hastanesi Göz Klinigi, Cevizli, D-100 Güney Yanyol, Cevizli Mevkii No:47, 34865, Istanbul, Turkey
| | - Muhammed Nurullah Bulut
- Department of Ophthalmology, University of Health Sciences, Kartal Lütfi Kirdar City Hospital, Kartal Dr. Lütfi Kirdar Egitim ve Arastirma Hastanesi Göz Klinigi, Cevizli, D-100 Güney Yanyol, Cevizli Mevkii No:47, 34865, Istanbul, Turkey
| | - Hatice Selen Kanar
- Department of Ophthalmology, University of Health Sciences, Kartal Lütfi Kirdar City Hospital, Kartal Dr. Lütfi Kirdar Egitim ve Arastirma Hastanesi Göz Klinigi, Cevizli, D-100 Güney Yanyol, Cevizli Mevkii No:47, 34865, Istanbul, Turkey
| | - Aynur Oflaz Hacısalihoğlu
- Department of Ophthalmology, University of Health Sciences, Kartal Lütfi Kirdar City Hospital, Kartal Dr. Lütfi Kirdar Egitim ve Arastirma Hastanesi Göz Klinigi, Cevizli, D-100 Güney Yanyol, Cevizli Mevkii No:47, 34865, Istanbul, Turkey
| | - Şaban Şimşek
- Department of Ophthalmology, University of Health Sciences, Kartal Lütfi Kirdar City Hospital, Kartal Dr. Lütfi Kirdar Egitim ve Arastirma Hastanesi Göz Klinigi, Cevizli, D-100 Güney Yanyol, Cevizli Mevkii No:47, 34865, Istanbul, Turkey
| |
Collapse
|
2
|
Pesce NA, Plastino F, Reyes-Goya C, Bernd J, Pavone V, Dal Monte M, Kvanta A, Locri F, André H. Mitigation of human iris angiogenesis through uPAR/LRP-1 interaction antagonism in an organotypic ex vivo model. FASEB J 2024; 38:e23533. [PMID: 38451430 DOI: 10.1096/fj.202301892rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/05/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
Rubeosis Iridis (RI) is characterized by an increase in neovascularization and inflammation factors in the iris. During angiogenesis, the urokinase plasminogen activator (uPA) and its receptor (uPAR) play a pivotal role in extracellular matrix remodeling, where uPAR regulates endothelial cell migration and proliferation through assembly with transmembrane receptors. Here, in the context of hypoxia-induced angiogenesis, the uPA/uPAR system blockage was investigated by using UPARANT in a novel ex vivo human iris organotypic angiogenesis assay. The effects of uPA/uPAR system antagonism in the humanized model of ocular pathologic angiogenesis were analyzed by sprouting angiogenesis and protein assays (western, dot blots, and co-immunoprecipitation) and correlated to vascular endothelial growth factor (VEGF) inhibition. Phosphoprotein and co-immunoprecipitation assay illustrated an unidentified antagonism of UPARANT in the interaction of uPAR with the low-density lipoprotein receptor-related protein-1 (LRP-1), resulting in inhibition of β-catenin-mediated angiogenesis in this model. The effects of uPA/uPAR system inhibition were focal to endothelial cells ex vivo. Comparison between human iris endothelial cells and human retinal endothelial revealed an endothelial-specific mechanism of β-catenin-mediated angiogenesis inhibited by uPA/uPAR system blockage and not by VEGF inhibition. Collectively, these findings broaden the understanding of the effects of the uPA/uPAR system antagonism in the context of angiogenesis, revealing non-canonical β-catenin downstream effects mediated by LRP-1/uPAR interaction.
Collapse
Affiliation(s)
- Noemi Anna Pesce
- Division of Eye and Vision, Department of Clinical Neuroscience, St Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Biology, University of Pisa, Pisa, Italy
| | - Flavia Plastino
- Division of Eye and Vision, Department of Clinical Neuroscience, St Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | - Jonathan Bernd
- Division of Eye and Vision, Department of Clinical Neuroscience, St Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Vincenzo Pavone
- Department of Chemical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Anders Kvanta
- Division of Eye and Vision, Department of Clinical Neuroscience, St Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Filippo Locri
- Division of Eye and Vision, Department of Clinical Neuroscience, St Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Helder André
- Division of Eye and Vision, Department of Clinical Neuroscience, St Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Acharya NR, Vitale AT, Sugar EA, Holbrook JT, Burke AE, Thorne JE, Altaweel MM, Kempen JH, Jabs DA. Intravitreal Therapy for Uveitic Macular Edema-Ranibizumab versus Methotrexate versus the Dexamethasone Implant: The MERIT Trial Results. Ophthalmology 2023; 130:914-923. [PMID: 37318415 PMCID: PMC10524707 DOI: 10.1016/j.ophtha.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/31/2023] [Accepted: 04/12/2023] [Indexed: 06/16/2023] Open
Abstract
PURPOSE To evaluate the effectiveness of 3 different intravitreal treatments for persistent or recurrent uveitic macular edema (ME): dexamethasone implant, methotrexate, and ranibizumab. DESIGN Single-masked, randomized controlled clinical trial. PARTICIPANTS Patients with minimally active or inactive uveitis and persistent or recurrent uveitic ME in one or both eyes. METHODS Patients at 33 centers were randomized 1:1:1 to receive 1 of the 3 therapies. Patients with bilateral ME received the same treatment in both eyes. MAIN OUTCOME MEASURES The primary outcome, measured at 12 weeks, was reduction in central subfield thickness (CST) expressed as a proportion of baseline (CST per CST at baseline) assessed with spectral-domain OCT by readers masked to treatment assignment. Secondary outcomes included improvement and resolution of ME, change in best-corrected visual acuity (BCVA), and elevations in intraocular pressure (IOP). RESULTS One hundred ninety-four participants (225 eligible eyes) were randomized to dexamethasone (n = 65 participants and 77 eyes), methotrexate (n = 65 participants and 79 eyes), or ranibizumab (n = 64 participants and 69 eyes). All received at least 1 injection of the assigned treatment. At the 12-week primary outcome point, each group showed significant reductions in CST relative to baseline: 35%, 11%, and 22% for dexamethasone, methotrexate, and ranibizumab, respectively. Reduction of ME was significantly greater in the dexamethasone group than for either methotrexate (P < 0.01) or ranibizumab (P = 0.018). Only the dexamethasone group showed a statistically significant improvement in BCVA during follow-up (4.86 letters; P < 0.001). Elevations of IOP by 10 mmHg, to 24 mmHg or more, or both were more common in the dexamethasone group; IOP spikes to 30 mmHg or more were uncommon overall and were not significantly different among groups. Reductions in BCVA of 15 letters or more were more common in the methotrexate group and typically were attributable to persistent ME. CONCLUSIONS At 12 weeks, in eyes with minimally active or inactive uveitis, dexamethasone was significantly better at treating persistent or recurrent ME than methotrexate or ranibizumab. Risk of IOP elevation was greater with dexamethasone, but elevations to levels of 30 mmHg or more were infrequent. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
- Nisha R Acharya
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Department of Epidemiology, University of California, San Francisco, San Francisco, California
| | - Albert T Vitale
- Department of Ophthalmology, University of Utah, Salt Lake City, Utah
| | - Elizabeth A Sugar
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Janet T Holbrook
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alyce E Burke
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer E Thorne
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael M Altaweel
- The Wisconsin Reading Center, Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - John H Kempen
- Schepens Eye Research Institute, Department of Ophthalmology, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts; MCM Eye Unit, Department of Ophthalmology, MCM Comprehensive Specialized Hospital and MyungSung Medical College, Addis Ababa, Ethiopia; Department of Ophthalmology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia; Sight for Souls, Bellevue, Washington
| | - Douglas A Jabs
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
| |
Collapse
|
5
|
Sato M, Kubono H, Yamashita K, Nagamoto T, Ofuji Y, Sakakura S, Fukumoto R, Hata S, Kawamura M, Suzuki K. Annular choroidal detachment following intravitreal aflibercept injection in a patient with nivolumab treatment: a case report. BMC Ophthalmol 2022; 22:476. [PMID: 36482328 PMCID: PMC9733300 DOI: 10.1186/s12886-022-02714-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 11/26/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND To present a novel case that developed annular choroidal detachment after intravitreal anti-vascular endothelial growth factor antibody injection in a patient after immune checkpoint inhibitor treatment. CASE PRESENTATION A 58-year-old Japanese man presented visual impairment in the right eye. Ophthalmological examination revealed macular edema in the right eye, which suggested the possibility of age-related macular degeneration. Following the intravitreal aflibercept injection, the annular choroidal detachment was observed in the injected eye. As hypotony or thick sclera was not observed, choroidal detachment seemed to have appeared due to enhanced inflammation by intravitreal injection. The patient had a history of stage IV paranasal cavity cancer and was treated with nivolumab, an immune checkpoint inhibitor. The immune response might have been enhanced due to the use of nivolumab so that intravitreal injection triggered inflammation. Three weeks after sub-tenon injection of triamcinolone acetonide, macular edema and choroidal detachment improved. CONCLUSIONS Intravitreal aflibercept injection caused annular choroidal detachment in our patient, presumably because the immune system was activated after nivolumab treatment. To the best of our knowledge, this is the first case report of annular choroidal detachment that developed after intravitreal injection in a patient with a history of nivolumab therapy. With the increasing use of immune checkpoint inhibitors in patients with various cancers, clinicians should be aware of these potentially associated immune-related adverse events.
Collapse
Affiliation(s)
- Maho Sato
- grid.415133.10000 0004 0569 2325Department of Ophthalmology, Keiyu Hospital, 3-7-3 Minatomirai, Nishiku, Yokohama, Kanagawa Japan ,grid.26091.3c0000 0004 1936 9959Department of Ophthalmology, Keio University, Tokyo, Japan
| | - Hirohisa Kubono
- grid.415133.10000 0004 0569 2325Department of Ophthalmology, Keiyu Hospital, 3-7-3 Minatomirai, Nishiku, Yokohama, Kanagawa Japan
| | - Kazuya Yamashita
- grid.415133.10000 0004 0569 2325Department of Ophthalmology, Keiyu Hospital, 3-7-3 Minatomirai, Nishiku, Yokohama, Kanagawa Japan
| | - Takashi Nagamoto
- grid.415133.10000 0004 0569 2325Department of Ophthalmology, Keiyu Hospital, 3-7-3 Minatomirai, Nishiku, Yokohama, Kanagawa Japan
| | - Yoshiko Ofuji
- grid.415133.10000 0004 0569 2325Department of Ophthalmology, Keiyu Hospital, 3-7-3 Minatomirai, Nishiku, Yokohama, Kanagawa Japan
| | - Saki Sakakura
- grid.415133.10000 0004 0569 2325Department of Ophthalmology, Keiyu Hospital, 3-7-3 Minatomirai, Nishiku, Yokohama, Kanagawa Japan
| | - Ryuki Fukumoto
- grid.415133.10000 0004 0569 2325Department of Ophthalmology, Keiyu Hospital, 3-7-3 Minatomirai, Nishiku, Yokohama, Kanagawa Japan
| | | | - Mari Kawamura
- grid.415133.10000 0004 0569 2325Department of Ophthalmology, Keiyu Hospital, 3-7-3 Minatomirai, Nishiku, Yokohama, Kanagawa Japan
| | - Kotaro Suzuki
- grid.415133.10000 0004 0569 2325Department of Ophthalmology, Keiyu Hospital, 3-7-3 Minatomirai, Nishiku, Yokohama, Kanagawa Japan
| |
Collapse
|
6
|
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.
Collapse
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.
| |
Collapse
|
7
|
Jang KH, Ahn JY, Sohn JH, Hwang DDJ. Safety Evaluation of Bilateral Same-day Intravitreal Injections of Bevacizumab. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.10.1164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
8
|
Jang K, Ahn J, Sohn J, Hwang DDJ. Evaluation of the Safety of Bilateral Same-Day Intravitreal Injections of Anti-Vascular Endothelial Growth Factor Agents: Experience of a Large Korean Retina Center. Clin Ophthalmol 2020; 14:3211-3218. [PMID: 33116371 PMCID: PMC7567572 DOI: 10.2147/opth.s276620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/21/2020] [Indexed: 01/21/2023] Open
Abstract
Purpose To evaluate the short-term ophthalmic side effects of bilateral same-day intravitreal anti-vascular endothelial growth factor (VEGF) injections. Patients and Methods We retrospectively analyzed patients who received intravitreal bevacizumab, ranibizumab, and aflibercept injections in both eyes on the same day between January 2014 and June 2019. The patients were followed up for 1 day, 1 week, and 1 month after the injections. Results A total of 323 patients (646 eyes) received 1418 bilateral same-day intravitreal anti-VEGF injections. The patients' mean age was 62.47 ± 13.97 years. The most common cause of bilateral injection was age-related macular degeneration (54.80%), followed by complications due to diabetic retinopathy (35.33%), retinal vein occlusion (2.40%), and central serious chorioretinopathy (1.27%). There were 22 cases of subconjunctival hemorrhage, 17 cases of temporary elevation of intraocular pressure, and no case of endophthalmitis. Twenty-one patients showed acute intraocular inflammation after the bilateral injection. All patients showed complete improvement within 2 weeks after the injection. Conclusion Bilateral same-day intravitreal anti-VEGF injection is a well-tolerated procedure on short-term follow-up. It is one of the more convenient approaches for both the patient and ophthalmologist.
Collapse
Affiliation(s)
- Kyuhwan Jang
- Department of Ophthalmology, HanGil Eye Hospital, Incheon, Korea
| | - Jayoung Ahn
- Department of Ophthalmology, HanGil Eye Hospital, Incheon, Korea
| | - Joonhong Sohn
- Department of Ophthalmology, HanGil Eye Hospital, Incheon, Korea
| | - Daniel Duck-Jin Hwang
- Department of Ophthalmology, HanGil Eye Hospital, Incheon, Korea.,Department of Ophthalmology, Catholic Kwandong University College of Medicine, Incheon, Korea
| |
Collapse
|
9
|
Gil-Martínez M, Rodríguez-Cid MJ, Fenández-Rodríguez MI, Blanco-Teijero MJ, Abraldes MJ, Bandín Vilar E, Zarra-Ferro I, González-Barcia M, Gómez-Ulla F, Fernández-Ferreiro A. Clinical features, management and outcomes of patients with sterile endophthalmitis associated with intravitreal injection of antivascular endothelial growth factor. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2020; 95:211-216. [PMID: 32156487 DOI: 10.1016/j.oftal.2020.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/22/2020] [Accepted: 01/25/2020] [Indexed: 06/10/2023]
Abstract
PURPOSE Analyze clinical features, management and outcomes of patients with sterile endophthalmitis associated with intravitreal antivascular endothelial growth factor. METHODS Observational retrospective case series of patients with sterile endophthalmitis following anti-VEGF intravitreal injections. Clinical data of patients treated with intravitreal anti-VEGFs during one year have been revised. Those who have presented an episode of sterile endophthalmitis are analyzed and their causality and management are studied. RESULTS Seven patients have had a sterile endophthalmitis onset within 4days after intravitreal injection (aflibercept n=5 and ranibizumab n=2). These patients have some active neovascular condition: age related macular degeneration (n=4), myopic choroidal neovascularization (n=1) or macular edema: diabetic macular edema (n=1), branch retinal vein occlusion (n=1). Shared signs and symptoms included painless vision loss, anterior chamber and vitreous cell and lack of hypopyon. In all patients, visual acuity returned to within one line of baseline acuity. CONCLUSION Differentiating cases of sterile from infectious endophthalmitis may be challenging. It is crucial to differentiate both entities as a good diagnosis determines the visual prognosis. We should be aware of minimal inflammation after repeated intravitreal injections in order to establish the adequate treatment.
Collapse
Affiliation(s)
- M Gil-Martínez
- Servicio de Oftalmología, Hospital de Conxo, Xerencia de Xestión Integrada de Santiago de Compostela, SERGAS, Santiago de Compostela, La Coruña, España; Instituto Oftalmológico Gómez-Ulla, Santiago de Compostela, La Coruña, España
| | - M J Rodríguez-Cid
- Servicio de Oftalmología, Hospital de Conxo, Xerencia de Xestión Integrada de Santiago de Compostela, SERGAS, Santiago de Compostela, La Coruña, España
| | - M I Fenández-Rodríguez
- Servicio de Oftalmología, Hospital de Conxo, Xerencia de Xestión Integrada de Santiago de Compostela, SERGAS, Santiago de Compostela, La Coruña, España; Instituto Oftalmológico Gómez-Ulla, Santiago de Compostela, La Coruña, España
| | - M J Blanco-Teijero
- Servicio de Oftalmología, Hospital de Conxo, Xerencia de Xestión Integrada de Santiago de Compostela, SERGAS, Santiago de Compostela, La Coruña, España
| | - M J Abraldes
- Servicio de Oftalmología, Hospital de Conxo, Xerencia de Xestión Integrada de Santiago de Compostela, SERGAS, Santiago de Compostela, La Coruña, España; Instituto Oftalmológico Gómez-Ulla, Santiago de Compostela, La Coruña, España
| | - E Bandín Vilar
- Servicio de Farmacia, Xerencia de Xestión Integrada de Santiago de Compostela, SERGAS, Santiago de Compostela, La Coruña, España; Grupo de Farmacología, Instituto de Investigación Sanitaria (IDIS), Santiago de Compostela, La Coruña, España
| | - I Zarra-Ferro
- Servicio de Farmacia, Xerencia de Xestión Integrada de Santiago de Compostela, SERGAS, Santiago de Compostela, La Coruña, España; Grupo de Farmacología, Instituto de Investigación Sanitaria (IDIS), Santiago de Compostela, La Coruña, España
| | - M González-Barcia
- Servicio de Farmacia, Xerencia de Xestión Integrada de Santiago de Compostela, SERGAS, Santiago de Compostela, La Coruña, España; Grupo de Farmacología, Instituto de Investigación Sanitaria (IDIS), Santiago de Compostela, La Coruña, España
| | - F Gómez-Ulla
- Instituto Oftalmológico Gómez-Ulla, Santiago de Compostela, La Coruña, España
| | - A Fernández-Ferreiro
- Servicio de Farmacia, Xerencia de Xestión Integrada de Santiago de Compostela, SERGAS, Santiago de Compostela, La Coruña, España; Grupo de Farmacología, Instituto de Investigación Sanitaria (IDIS), Santiago de Compostela, La Coruña, España.
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Dong L, Bai J, Jiang X, Yang MM, Zheng Y, Zhang H, Lin D. The gene polymorphisms of IL-8(-251T/A) and IP-10(-1596C/T) are associated with susceptibility and progression of type 2 diabetic retinopathy in northern Chinese population. Eye (Lond) 2016; 31:601-607. [PMID: 27935598 DOI: 10.1038/eye.2016.287] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022] Open
Abstract
PurposeThe aim of the present study is to investigate the association of the polymorphism of two genes in CXC chemokine family, interleukin-8 (IL-8) and interferon-inducible protein 10 (IP-10), with both susceptibility and progression of DR in T2D population of northern China.Patients and methodsA total of 1043 eligible type 2 diabetic patients from Heilongjiang of northern China were recruited for this study. They were grouped into: with diabetic retinopathy (DR, 528 cases) and without diabetic retinopathy (DNR, 515 cases). Single nucleotide polymorphism (SNP) genotyping of IL-8(-251T/A) and IP-10(-1596C/T) was performed by polymerase chain reaction. Multivariate analysis and stepwise multiple logistic progression analysis were conducted to evaluate the association between gene SNP and DR susceptibility and progression. Pooled odds ratio (OR) with 95% confidence interval (CI) was applied to assess the strength of the association among study groups.ResultsThe occurring of IL-8(-251) AA genotype was correlated with susceptibility (OR: 2.286, 95% CI: 1.382-3.782, P=0.001) and progression of high-risk proliferative diabetic retinopathy (PDR) (OR: 0.354, 95% CI: 0.162-0.770, P=0.009). Reversely, T allele of IP-10 (-1596) C/T was correlated with a reduced risk of DR (OR: 0.341, 95% CI: 0.249-0.466, P<0.001). However, gene polymorphisms of IL-8-251T/A and IP-10-1596C/T were not associated with diabetic macular edema (DME)(P>0.05).ConclusionsAA genotype of IL-8-251T/A was closely correlated to DR and high-risk proliferative diabetic retinopathy (PDR). -1596T allele of the IP-10 is a beneficial genotype for DR.
Collapse
Affiliation(s)
- L Dong
- Key Laboratory of Harbin Medical University Eye Center in Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - J Bai
- Key Laboratory of Harbin Medical University Eye Center in Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - X Jiang
- Key Laboratory of Harbin Medical University Eye Center in Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - M-M Yang
- Key Laboratory of Harbin Medical University Eye Center in Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Y Zheng
- Key Laboratory of Harbin Medical University Eye Center in Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - H Zhang
- Key Laboratory of Harbin Medical University Eye Center in Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - D Lin
- Department of Pharmacology, New York Medical College, Valhalla, NY, USA
| |
Collapse
|
12
|
Song J, Huang YF, Zhang WJ, Chen XF, Guo YM. Ocular diseases: immunological and molecular mechanisms. Int J Ophthalmol 2016; 9:780-8. [PMID: 27275439 DOI: 10.18240/ijo.2016.05.25] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 09/07/2015] [Indexed: 12/14/2022] Open
Abstract
Many factors, such as environmental, microbial and endogenous stress, antigen localization, can trigger the immunological events that affect the ending of the diverse spectrum of ocular disorders. Significant advances in understanding of immunological and molecular mechanisms have been researched to improve the diagnosis and therapy for patients with ocular inflammatory diseases. Some kinds of ocular diseases are inadequately responsive to current medications; therefore, immunotherapy may be a potential choice as an alternative or adjunctive treatment, even in the prophylactic setting. This article first provides an overview of the immunological and molecular mechanisms concerning several typical and common ocular diseases; second, the functions of immunological roles in some of systemic autoimmunity will be discussed; third, we will provide a summary of the mechanisms that dictate immune cell trafficking to ocular local microenvironment in response to inflammation.
Collapse
Affiliation(s)
- Jing Song
- Department of Ophthalmology, Affiliated Hospital of Logistics University of People's Armed Police Force, Tianjin 300161, China
| | - Yi-Fei Huang
- Department of Ophthalmology, Affiliated Hospital of Logistics University of People's Armed Police Force, Tianjin 300161, China; Department of Ophthalmology, General Hospital of PLA, Beijing 100853, China
| | - Wen-Jing Zhang
- Department of Ophthalmology, Affiliated Hospital of Logistics University of People's Armed Police Force, Tianjin 300161, China
| | - Xiao-Fei Chen
- Department of Ophthalmology, General Hospital of PLA, Beijing 100853, China
| | - Yu-Mian Guo
- Department of Ophthalmology, Affiliated Hospital of Logistics University of People's Armed Police Force, Tianjin 300161, China
| |
Collapse
|
13
|
Demirel S, Bilici S, Batıoğlu F, Özmert E. Is There Any Difference between Ranibizumab and Aflibercept Injections in Terms of Inflammation Measured with Anterior Chamber Flare Levels in Age-Related Macular Degeneration Patients: A Comparative Study. Ophthalmic Res 2016; 56:35-40. [DOI: 10.1159/000444497] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/07/2016] [Indexed: 11/19/2022]
|