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Ben Ghezala I, Mariet A, Benzenine E, Bardou M, Bron AM, Gabrielle P, Baudin F, Quantin C, Creuzot-garcher C. Association between Obstetric Complications and Intravitreal Anti-Vascular Endothelial Growth Factor Agents or Intravitreal Corticosteroids. J Pers Med 2022; 12:1374. [PMID: 36143159 PMCID: PMC9501719 DOI: 10.3390/jpm12091374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
This nationwide population-based cohort study aimed to describe the use of intravitreal injections (IVTs) of anti-vascular endothelial growth factor (anti-VEGF) agents and corticosteroids in pregnant women in France and to report on the incidence of obstetric and neonatal complications. All pregnant women in France who received any anti-VEGF or corticosteroid IVT during pregnancy or in the month preceding pregnancy from 1 January 2009 to 31 December 2018 were identified in the national medico-administrative databases. Between 2009 and 2018, there were 5,672,921 IVTs performed in France. Among these IVTs, 228 anti-VEGF or corticosteroid IVTs were administered to 139 women during their pregnancy or in the month preceding their pregnancy. Spontaneous abortion or the medical termination of pregnancy occurred in 10 women (16.1%) who received anti-VEGF agents and in one (3.1%) of the women who received corticosteroids (p = 0.09). This is the first national cohort study of pregnant women treated with anti-VEGF or corticosteroid IVTs. We found a high incidence of obstetric complications in pregnant women treated with anti-VEGF or corticosteroid IVTs but could not demonstrate a statistically significant association between the intravitreal agents and these complications. These agents should continue to be used with great caution in pregnant women.
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Sugimoto M, Tsukitome H, Okamoto F, Oshika T, Ueda T, Niki M, Mitamura Y, Ishikawa H, Gomi F, Kitano S, Noma H, Shimura M, Sonoda S, Sawada O, Ohji M, Harimoto K, Takeuchi M, Takamura Y, Kondo M, Sakamoto T. Clinical preferences and trends of anti-vascular endothelial growth factor treatments for diabetic macular edema in Japan. J Diabetes Investig 2019; 10:475-483. [PMID: 30204303 PMCID: PMC6400162 DOI: 10.1111/jdi.12929] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/23/2018] [Accepted: 08/29/2018] [Indexed: 01/04/2023] Open
Abstract
AIMS/INTRODUCTION To determine the current clinical preferences of anti-vascular endothelial growth factor (VEGF) treatment protocols for diabetic macular edema (DME) in Japan. MATERIALS AND METHODS This was a descriptive cross-sectional study. Answers to a questionnaire consisting of 16 questions were obtained from 176 of 278 (63.3%) surveyed ophthalmologists. RESULTS The results showed that 81.2% preferred intravitreal injections of anti-VEGF antibodies as the first-line therapy. The most important indicators for beginning anti-VEGF therapy were: the best-corrected visual acuity in 44.3% and the retinal thickness in 30.7%. In the loading phase, 53.4% preferred a single injection, and in the maintenance phase, 75.0% preferred the pro re nata regimen. Financial limitation (85.8%) was reported as the most important difficulty in the treatment. For combination therapy with anti-VEGF treatment, panretinal photocoagulation, focal photocoagulations and a sub-Tenon steroid injection were preferred. The contraindications for anti-VEGF therapy were: prior cerebral infarction (72.7%). Regarding the use of both approved anti-VEGF agents in Japan, ranibizumab and aflibercept, 39.8% doctors used them appropriately. CONCLUSIONS Our results present the current clinical preferences of anti-VEGF treatment for DME in Japan. The best-corrected visual acuity and the retinal thickness are important indicators to institute this therapy. The majority of the ophthalmologists use anti-VEGF treatment as first-line therapy and prefer the 1 + pro re nata regimen.
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Affiliation(s)
- Masahiko Sugimoto
- Department of OphthalmologyMie University Graduate School of MedicineTsuJapan
| | - Hideyuki Tsukitome
- Department of OphthalmologyMie University Graduate School of MedicineTsuJapan
| | - Fumiki Okamoto
- Department of OphthalmologyFaculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Tetsuro Oshika
- Department of OphthalmologyFaculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Tetsuo Ueda
- Department of OphthalmologyNara Medical UniversityKashiharaJapan
| | - Masanori Niki
- Department of OphthalmologyInstitute of Biomedical SciencesTokushima University Graduate SchoolTokushimaJapan
| | - Yoshinori Mitamura
- Department of OphthalmologyInstitute of Biomedical SciencesTokushima University Graduate SchoolTokushimaJapan
| | - Hiroto Ishikawa
- Department of OphthalmologyHyogo College of MedicineNishinomiyaJapan
| | - Fumi Gomi
- Department of OphthalmologyHyogo College of MedicineNishinomiyaJapan
| | - Shigehiko Kitano
- Department of OphthalmologyTokyo Women's Medical UniversityTokyoJapan
| | - Hidetaka Noma
- Department of OphthalmologyTokyo Medical University Hachioji Medical CenterHachiojiJapan
| | - Masahiko Shimura
- Department of OphthalmologyTokyo Medical University Hachioji Medical CenterHachiojiJapan
| | - Shozo Sonoda
- Department of OphthalmologyKagoshima University Graduate School of Medical and Dental SciencesSakuragaokaJapan
| | - Osamu Sawada
- Department of OphthalmologyShiga University of Medical ScienceOtsuJapan
| | - Masahito Ohji
- Department of OphthalmologyShiga University of Medical ScienceOtsuJapan
| | - Kozo Harimoto
- Department of OphthalmologyNational Defense Medical CollegeTokorozawaJapan
| | - Masaru Takeuchi
- Department of OphthalmologyNational Defense Medical CollegeTokorozawaJapan
| | - Yoshihiro Takamura
- Department of OphthalmologyFaculty of Medical SciencesUniversity of FukuiFukuiJapan
| | - Mineo Kondo
- Department of OphthalmologyMie University Graduate School of MedicineTsuJapan
| | - Taiji Sakamoto
- Department of OphthalmologyKagoshima University Graduate School of Medical and Dental SciencesSakuragaokaJapan
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Abreu-Gonzalez R, Gallego-Pinazo R, Abraldes M, Pinilla I, Lopez-Galvez MI. Management of diabetic macular edema patients in clinical practice in Spain. Eur J Ophthalmol 2018; 29:664-672. [DOI: 10.1177/1120672118804079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Purpose: Diabetic macular edema is the main cause of blindness in diabetic patients. Vascular endothelial growth factor is involved in diabetic macular edema pathogenesis. Vascular endothelial growth factor inhibitors are an important option in diabetic macular edema therapy. This survey investigates actual clinical practice in diabetic macular edema in Spain. Methods: An expert advisory panel of 17 Spanish ophthalmologists developed a 30-item anonymous questionnaire about diagnosis, treatment, and follow-up in diabetic macular edema. A total of 137 ophthalmologists from 10 Spanish regions completed the questionnaire online. Results: Almost all of the respondents (99.3%) record the measured visual acuity and perform biomicroscopic anterior (94.9%) and posterior (91.2%) segment examinations. Similarly, 100% of responding ophthalmologists always/almost always or frequently perform optical coherence tomography. Most respondents (65%) always/almost always or frequently perform a retinography. More than 50% rarely perform fluorescein angiography. Nearly, all (96.4%) of the specialists responded that, in center-involved diabetic macular edema, the first treatment is an anti–vascular endothelial growth factor drug. For corticosteroids, the first choice of most respondents (91.2%) was the dexamethasone implant. In the follow-up, almost all (96.4%) specialists record the measured visual acuity and most also perform biomicroscopic anterior (82.5%) and posterior (83.2%) segment examination. Conclusion: This survey shows the actual clinical practice in diabetic macular edema in Spain, finding that anti–vascular endothelial growth factor therapy is frequently used, and that diagnosis, treatments, and follow-up examinations used by specialists are homogeneous and according to diabetic macular edema guidelines.
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Affiliation(s)
| | | | - Maximino Abraldes
- Gómez-Ulla Ophthalmological Institute and University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Isabel Pinilla
- Aragon Health Sciences Institute, Lozano Blesa University Hospital, Zaragoza, Spain
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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.
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