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Campos A, Mota C, Caramelo F, Oliveira N, Silva S, Sousa J. Inflammation and Vasculitis Related to Brolucizumab. J Clin Med 2024; 13:5208. [PMID: 39274421 PMCID: PMC11396242 DOI: 10.3390/jcm13175208] [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: 07/15/2024] [Revised: 08/24/2024] [Accepted: 08/31/2024] [Indexed: 09/16/2024] Open
Abstract
Background/objectives: To compare the prevalence of intra-ocular inflammation (IOI) between brolucizumab and aflibercept in neovascular age-related macular degeneration (nAMD) after intra-vitreal injections (IVI) and to compare the IOI odds ratios (ORs) of both therapies with the prevalence of septic endophthalmitis after IVI that was previously reported in the literature. Methods: A total of 468 IVI of brolucizumab (117 eyes) were compared with 2884 IVI of aflibercept (305 eyes) regarding IOI and occlusive retinal vasculitis (RV) from December 2021 to June 2023 in this retrospective study. The OR was calculated for both anti-VEGF agents and was compared with the relative risk of septic endophthalmitis after IVI. Results: There were four eyes with unilateral IOI related to brolucizumab (3.42%), one presenting uveitis (0.85%), two vitritis (1.71%) and the last one presenting occlusive RV (0.85%), compared with two eyes presenting unilateral IOI (anterior uveitis, 0.66%) and none with RV from the aflibercept cohort. The incidence of IOI per injection with brolucizumab (0.855%) was significantly higher compared with aflibercept (0.069%, p = 0.004). The OR of IOI related to brolucizumab IVI compared with septic endophthalmitis was 20 times greater (1.49 for aflibercept, p = 0.646, versus 20.15 for brolucizumab, p < 0.001). The OR of RV with brolucizumab compared with septic endophthalmitis was 4.6. Conclusion: Data from our department suggest a much higher risk of IOI and occlusive retinal vasculitis after brolucizumab when compared with aflibercept. The risk of IOI and severe sight-threatening complications related to brolucizumab is greater than the risk of septic endophthalmitis after any IVI.
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Affiliation(s)
- António Campos
- Ophtalmology Department, Centro Hospitalar de Leiria, 2410-197 Leiria, Portugal
- ciTechCare, Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2414-016 Leiria, Portugal
| | - Carolina Mota
- Ophtalmology Department, Centro Hospitalar de Leiria, 2410-197 Leiria, Portugal
| | - Francisco Caramelo
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-504 Coimbra, Portugal
| | - Nuno Oliveira
- Ophtalmology Department, Centro Hospitalar de Leiria, 2410-197 Leiria, Portugal
| | - Sara Silva
- Ophtalmology Department, Centro Hospitalar de Leiria, 2410-197 Leiria, Portugal
| | - João Sousa
- Ophtalmology Department, Centro Hospitalar de Leiria, 2410-197 Leiria, Portugal
- ciTechCare, Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2414-016 Leiria, Portugal
- Sciences Department, Faculty of Health Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal
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Durrani AF, Momenaei B, Soni V, Tennant M, Hsu J, Vander J, Spirn M, Kang EYC, Hwang YS, Kaushal G, Garg SJ. Long-Term Stability, Sterility, And Cost-Effectiveness of 0.05% Chlorhexidine Gluconate as Antisepsis for Intravitreal Injection. J Ocul Pharmacol Ther 2024. [PMID: 39169875 DOI: 10.1089/jop.2024.0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024] Open
Abstract
Purpose: Commercially available chlorhexidine gluconate (CHG) has a beyond-use date of 24 h. This study evaluated the stability and sterility of 0.05% CHG for 30 days after opening and compared its cost to povidone iodine (PI) for intravitreal injection antisepsis. Methods: 0.05% CHG was aliquoted into 1-mL syringes and stored at room temperature or refrigerated. Turbidity, pH, high-performance liquid chromatography (HPLC), and sterility testing were performed. A cost analysis was conducted. Results: 0.05% CHG remained stable for at least 30 days. All samples had measured turbidity <0.5 nephelometric turbidity units. The pH of all samples remained between 5.0 and 7.0. HPLC demonstrated CHG concentration at day 30 relative to day 0 of 98.52% ± 4.16% at room temperature and 99.99% ± 3.38% at 2°C -6°C. The cost per week to perform 150 injections using 0.05% CHG was $463.25 when opening a new bottle daily compared with $16.73 for 5% PI. This cost decreased to $23.16 when utilizing a bottle of CHG for 30 days. Conclusion: 0.05% CHG remains stable and sterile for at least 30 days after opening. The ability to use CHG for at least 30 days after its opening significantly decreases its utilization expense.
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Affiliation(s)
- Asad F Durrani
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Bita Momenaei
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Viren Soni
- Department of Pharmaceutical Sciences, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Matthew Tennant
- Alberta Retina Consultants and the University of Alberta, Edmonton, Canada
| | - Jason Hsu
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - James Vander
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Marc Spirn
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Eugene Yu-Chuan Kang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Gagan Kaushal
- Department of Pharmaceutical Sciences, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sunir J Garg
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Angelia M, Amelia YS, Alberta IB, Tanto S, Pratama KG. Evaluating the efficacy of pars plana vitrectomy in the management of endophthalmitis after following the endophthalmitis vitrectomy study: A systematic review and meta-analysis. Tzu Chi Med J 2024; 36:284-290. [PMID: 38993830 PMCID: PMC11236082 DOI: 10.4103/tcmj.tcmj_14_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/17/2024] [Accepted: 04/02/2024] [Indexed: 07/13/2024] Open
Abstract
Endophthalmitis is a devastating eye complication that requires prompt and effective treatment. A pivotal study in the field of endophthalmitis treatment is the endophthalmitis vitrectomy study (EVS), conducted over a decade ago. The primary objective of this study was to assess the effectiveness of pars plana vitrectomy (PPV) as a treatment option for endophthalmitis following the EVS study. We conducted a comprehensive search across three databases: PubMed, EBSCO host, and ProQuest. Reference lists of published articles were searched. Our study encompassed research conducted between January 2013 and January 2023 to ensure the most up-to-date findings. The best-corrected visual acuity (BCVA) in logMar, causative agents, and predicting factors for visual outcome were evaluated. Nine studies involving 351 eyes were included in the study; however, only eight were included in the meta-analysis. We observed a significant BCVA improvement compared to baseline at 1 month, >1-3 months, >3-6 months, and ≥12-month follow-up, with mean differences of 1.06 (P < 0.001), 1.25 (P < 0.001), 1.41 (P < 0.001), and 1.01 (P < 0.001), respectively. A causative organism was cultured in 61.4% of cases, and the majority of them were Coagulase-negative Streptococcus, Staphylococcus aureus, and Streptococcus sp. Factor associated with better visual acuity includes a younger age, lower intraocular pressure, and culture-negative endophthalmitis. Meanwhile, culture-positive endophthalmitis particularly Streptococcus sp., lower baseline vision, and presence of retinal detachment at initial presentation were identified as a prognostic for poorer visual outcome. PPV demonstrated a significant visual gain in patients with endophthalmitis in the 1st, 3rd, and 6th months. However, caution is warranted in drawing a definitive conclusion.
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Affiliation(s)
- Maria Angelia
- Department of Emergency, Mitra Keluarga Kalideres Hospital, Jakarta, Indonesia
| | - Yufilia Suci Amelia
- Department of Emergency, Marianum Catholic Hospital, Halilulik, East Nusa Tenggara, Indonesia
| | - Ivana Beatrice Alberta
- Department of Ophthalmology, Primasatya Husada Citra Hospital, Surabaya, Jawa Timur, Indonesia
| | - Stefany Tanto
- Department of Emergency, University of Pelita Harapan, Jakarta, Indonesia
| | - Kevin Gracia Pratama
- Department of Emergency, Fatima General Hospital, Ketapang Regency, West Kalimantan, Indonesia
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4
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Israilevich RN, Mansour H, Patel SN, Garg SJ, Klufas MA, Yonekawa Y, Regillo CD, Hsu J. Risk of Endophthalmitis Based on Cumulative Number of Anti-VEGF Intravitreal Injections. Ophthalmology 2024; 131:667-673. [PMID: 38182029 DOI: 10.1016/j.ophtha.2023.12.033] [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: 08/02/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 01/07/2024] Open
Abstract
PURPOSE To determine the risk of endophthalmitis in eyes undergoing intravitreal injections (IVIs) of anti-VEGF based on cumulative number of injections per eye. DESIGN Retrospective cohort study. PARTICIPANTS Patients from a single center undergoing IVIs of ranibizumab, aflibercept, or bevacizumab. METHODS Eyes were divided into quartiles based on injection number causative of endophthalmitis between January 1, 2011, and June 1, 2022. MAIN OUTCOME MEASURES Interquartile clinical outcomes and cumulative risk of endophthalmitis per injection and per eye. RESULTS A total of 43 393 eyes received 652 421 anti-VEGF injections resulting in 231 endophthalmitis cases (0.035% per injection, 1 in 2857), of which 215 were included. The cumulative endophthalmitis risk increased from 0.0018% (1 in 55 556) after 1 injection to 0.013% (1 in 7692) after 11 injections (0.0012 percentage point change), versus 0.014% (1 in 7143) after 12 injections to 0.025% (1 in 4000) after 35 injections (0.00049 percentage point change), versus 0.025% (1 in 4000) after 36 injections to 0.031% (1 in 3226) after 66 injections (0.00017 percentage point change), versus 0.031% (1 in 3226) after 63 injections to 0.033% (1 in 3030) after 126 injections (0.000042 percentage point change) (P < 0.001). Likewise, the cumulative endophthalmitis risk per eye increased from 0.028% (1 in 3571) to 0.20% (1 in 500) between injections 1 and 11 (0.018 percentage point change), versus 0.21% (1 in 476) to 0.38% (1 in 263) between injections 12 and 35 (0.0075 percentage point change), versus 0.38% (1 in 263) to 0.46% (1 in 217) between injections 36 and 66 (0.0026 percentage point change), versus 0.46% (1 in 217) to 0.50% (1 in 200) between injections 67 and 126 (0.00063 percentage point change) (P < 0.001). CONCLUSIONS The cumulative endophthalmitis risk per injection and per eye increased with greater number of injections received but appeared to do so at a higher rate during earlier injections and at a lower rate further into the treatment course. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
| | - Hana Mansour
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Samir N Patel
- Retina Vitreous Consultants, Pittsburgh, Pennsylvania
| | - Sunir J Garg
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Michael A Klufas
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Yoshihiro Yonekawa
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Carl D Regillo
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Jason Hsu
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania.
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5
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Soleimani M, Haydar AA, Cheraqpour K, Zeidabadinejad H, Esfandiari A, Eshaghhosseiny N, Shahmohammadi A, Banz S, Djalilian AR. In praise of povidone-iodine application in ophthalmology. Surv Ophthalmol 2023:S0039-6257(23)00143-1. [PMID: 37944600 DOI: 10.1016/j.survophthal.2023.11.002] [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: 07/28/2023] [Revised: 10/26/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023]
Abstract
Polyvinyl pyrrolidone or povidone-iodine (PVP-I) is a water-soluble complex formed by the combination of iodine and a water-soluble polymer, polyvinyl pyrrolidone. This complex exerts bactericidal, fungicidal, and virucidal action by gradually releasing free iodine at the site of application to react with pathogens. In ophthalmology, PVP-I is used as a disinfectant and antiseptic agent for preoperative preparation of the skin and mucous membranes and for treating contaminated wounds. PVP-I has been shown to reduce effectively the risk of endophthalmitis in various ocular procedures, including cataract surgery and intravitreal injections; however, it has also been used in the treatment of conjunctivitis, keratitis, and endophthalmitis, with promising results especially in low-resource situations. PVP-I has been associated with complications such as postoperative eye pain, persistent corneal epithelial defects, ocular inflammation, and an attendant risk of keratitis. In cases of poor PVP-I tolerance, applying PVP-I at lower concentrations or using alternative antiseptics such as chlorhexidine should be considered. We provide an update on the efficacy of PVP-I in the prophylaxis and treatment of conjunctivitis, keratitis, and endophthalmitis and a comprehensive analysis of the current literature regarding the use of PVP-I in the management of these ocular conditions. Also, PVP-I-related adverse effects and toxicities and its alternatives are discussed. The goal is to present a thorough evaluation of the available evidence and to offer practical recommendations for clinicians regarding the therapeutic usage of PVP-I in ophthalmology.
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Affiliation(s)
- Mohammad Soleimani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA.
| | - Ali A Haydar
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Kasra Cheraqpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Haniyeh Zeidabadinejad
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Amirreza Esfandiari
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | | | | | - Soraya Banz
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA; University of Edinburgh, UK.
| | - Ali R Djalilian
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA.
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6
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Xu LT, Price KW, Ramos MS, Nowacki AS, Yuan A, Yan J. Outcomes of a Multicenter 10-Year Review of Postinjection Endophthalmitis and Associated Systemic Medical Comorbidities. JOURNAL OF VITREORETINAL DISEASES 2023; 7:504-509. [PMID: 37974918 PMCID: PMC10649454 DOI: 10.1177/24741264231200738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Purpose: To investigate whether any systemic medical conditions may be associated with a higher risk for developing postinjection endophthalmitis. Methods: This case-control study is a retrospective review within the Emory Eye Center from 2009 to 2019 and The Cleveland Clinic Foundation from 2012 to 2019. Each case was matched in a 1:4 case-to-control ratio. The associations between medical comorbidities and endophthalmitis were explored using multivariable logistic regression models on the combined sample. Results: Sixty-six individuals were diagnosed with injection-associated endophthalmitis. Systemic immunocompromised status was found to be a risk factor associated with developing endophthalmitis with an adjusted odds ratio (aOR) of 3.17 (P = .009). Other conditions with increased risk approaching statistical significance included a history of pulmonary disease (aOR, 1.74; P = .08) and a history of smoking (aOR, 1.72; P = .06). Conclusions: This is the first report to our knowledge demonstrating that immunocompromised status is associated with an increased risk for developing postinjection endophthalmitis. While this study may be limited due to its retrospective nature, the result may nevertheless serve as a guidance for risk counseling. Future analysis using a large-scale database will be needed.
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Affiliation(s)
- Lucy T. Xu
- Emory Eye Center, Emory University School of Medicine, Atlanta, GA, USA
- Retina Group of Washington, Annapolis, MD, USA
| | - Kenneth W. Price
- Emory Eye Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael S. Ramos
- Cole Eye Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Amy S. Nowacki
- Department of Quantitative Health Sciences, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Alex Yuan
- Cole Eye Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jiong Yan
- Emory Eye Center, Emory University School of Medicine, Atlanta, GA, USA
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7
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Seyer LD, Wills R, Scott EM, Betbeze C. Description of non‐brachycephalic canine conjunctival microbiome before and after application of an antiseptic preparation. Vet Ophthalmol 2022; 25:297-306. [DOI: 10.1111/vop.12992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/25/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Lindsay D. Seyer
- Department of Clinical Sciences, College of Veterinary Medicine Mississippi State University Starkville Mississippi USA
| | - Robert Wills
- Department of Comparative Biomedical Sciences, College of Veterinary Medicine Mississippi State University Starkville Mississippi USA
| | - Erin M. Scott
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences Texas A&M University Texas USA
| | - Caroline Betbeze
- Department of Clinical Sciences, College of Veterinary Medicine Mississippi State University Starkville Mississippi USA
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8
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Marín-Nieto J, Reino-Perez C, Santillana-Cernuda G, Díaz-Bernal JM, Luque-Aranda R, García-Basterra I. FACE MASK CONTAMINATION DURING COVID-19 PANDEMIA. A STUDY ON PATIENTS RECEIVING INTRAVITREAL INJECTIONS. Retina 2021; 41:2215-2220. [PMID: 33965993 DOI: 10.1097/iae.0000000000003202] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the bacterial growth in the surgical face masks used by patients who received intravitreal injections and study the effect of povidone-iodine on the periocular area (PA) of masks. METHODS Forty patients who attended for intravitreal injections were divided in those with less (<4 hours) and more (>4 hours) than 4 hours of mask use. Each group was divided depending on the application or not of povidone-iodine in the PA of the mask. Bacterial load was studied on PA and mouth area samples. RESULTS The bacterial load in the PA was higher in the >4 hours group compared with the <4 hours group (13.2 vs. 48.75 colony-forming units/μL; P = 0.03). The contamination in the PA significantly decreased after applying povidone-iodine in the >4 hours group (P = 0.01). The use or not of povidone-iodine was strongly correlated to a positive culture (OR = 9.0, P = 0.00. CI 1.63-49.44). CONCLUSION Surgical face masks worn for more than 4 hours present higher contamination in the PA than those with less use. Bacterial load in the PA is reduced with povidone-iodine on masks used for more than 4 hours. This contamination should be considered in the asepsis protocol of intravitreal injections.
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Affiliation(s)
- Juan Marín-Nieto
- Department of Ophthalmology, University Hospital Virgen de la Victoria, Málaga, Spain
- University of Málaga, Málaga, Spain
| | - Carmen Reino-Perez
- Department of Ophthalmology, University Hospital Virgen de la Victoria, Málaga, Spain
| | | | | | - Rafael Luque-Aranda
- Department of Ophthalmology, University Hospital Virgen de la Victoria, Málaga, Spain
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9
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Finkelstein M, Katz G, Zur D, Rubowitz A, Moisseiev E. The Effect of Syringe Filling Technique on the Risk for Endophthalmitis after Intravitreal Injection of Anti-VEGF Agents. Ophthalmologica 2021; 245:34-40. [PMID: 34348344 DOI: 10.1159/000518236] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 07/02/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Maya Finkelstein
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
| | - Gabriel Katz
- Department of Ophthalmology, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dinah Zur
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Alexander Rubowitz
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Moisseiev
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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Bisorca-Gassendorf L, Boden KT, Szurman P, Al-Nawaiseh S, Rickmann A, Januschowski K. [Postoperative endophthalmitis-a review of literature]. Ophthalmologe 2021; 118:210-218. [PMID: 33270146 DOI: 10.1007/s00347-020-01271-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Postoperative endophthalmitis is one of the most feared complications for ophthalmologists, and the number of infections after intraocular procedures have been increasing. Nonetheless, a prompt intervention can result in the recovery of vision. In the past, endophthalmitis after cataract surgery was accountable for the majority of cases but is becoming less frequent due to the progress of surgical techniques and demographic developments with a steadily increasing number of intravitreal injections. In this article, the different forms of postoperative endophthalmitis are assessed in terms of pathophysiology and their specific characteristics depending on their etiology.
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Affiliation(s)
- L Bisorca-Gassendorf
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland.
| | - K T Boden
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland
| | - P Szurman
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland
| | - S Al-Nawaiseh
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland
| | - A Rickmann
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland
| | - K Januschowski
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland
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11
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Pancholy M, Storey PP, Levin HJ, Obeid A, Patel SN, Kuley B, Hsu J, Spirn MJ, Fineman M, Klufas MA, Gupta O, Ho AC, Garg SJ. Endophthalmitis following Intravitreal Anti-Vascular Endothelial Growth Factor Therapy: Changes in Incidence and Outcomes over a 9-Year Period. Curr Eye Res 2021; 46:1370-1377. [PMID: 33522314 DOI: 10.1080/02713683.2021.1874023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Aims: To evaluate whether the incidence, microbial spectrum, and visual outcomes of endophthalmitis following intravitreal injections have changed over time.Methods: Retrospective cohort study of endophthalmitis in eyes receiving intravitreal injection of anti-vascular endothelial growth factor between 2009-2012 and 2016-2017 at a single, large retina practice.Results: A total of 283,315 injections resulted in 96 suspected infectious endophthalmitis cases. Comparing 2009-2012 and 2016-2017, the rate of suspected endophthalmitis changed from 1 in 2,663 injections to 1 in 3,195 injections (p = .37). Visual outcomes 6 months after endophthalmitis were significantly better during the latter period (p = .04), with an average loss of 6.3 lines of VA in 2009-2012 compared to a loss of 3.6 lines in 2016-2017. In multivariate analysis, a "no-talking" policy during injections resulted in a trend towards a decrease in endophthalmitis incidence (p = .08). Cessation of post-injection topical antibiotic use did not independently decrease endophthalmitis incidence (p = .24) when the effect of a "no-talking" policy was taken into account. A lower rate of endophthalmitis was seen after prefilled vs. conventionally prepared ranibizumab syringe use for injection (0.014% vs. 0.035%, respectively), though this difference did not meet statistical significance (p = .16).Conclusion: The incidence of endophthalmitis after intravitreal injection decreased and visual outcomes improved between the periods of 2009-2012 and 2016-2017. A "no-talking" policy during injections was associated with a trend toward a decrease in endophthalmitis rate.
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Affiliation(s)
- Maitri Pancholy
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
| | - Philip P Storey
- Austin Retina Associates, University of Texas Dell Medical School, Austin, Texas, USA
| | - Hannah J Levin
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Anthony Obeid
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Samir N Patel
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Brandon Kuley
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Jason Hsu
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Marc J Spirn
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Mitchell Fineman
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Michael A Klufas
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Omesh Gupta
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Allen C Ho
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Sunir J Garg
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA
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Effectiveness of immediate vitrectomy and intravitreal antibiotics for post-injection endophthalmitis. Graefes Arch Clin Exp Ophthalmol 2021; 259:1609-1615. [PMID: 33502628 DOI: 10.1007/s00417-021-05071-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/29/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To show that an immediate vitrectomy with an intravitreal injection of antibiotics can be an effective approach for the treatment of acute endophthalmitis following intravitreal injections. METHODS We reviewed all cases of clinical endophthalmitis caused by an intravitreal injection that were treated in our department between March 2012 and November 2019. Only patients that underwent a vitrectomy within 6 h after presentation to the clinic and with a documented visual acuity shortly before the causative event were included. Baseline best-corrected visual acuity (BCVA) before the causative event was compared to BCVA measured within a follow-up period of 8 months (up to 14 months). RESULTS In total, 30 eyes of 30 patients were included. The BCVA before the intraocular infection was a mean value of 0.55 logMAR, and the BCVA on the day of the endophthalmitis decreased significantly to 1.66 logMAR. Within 2 months following the pars plana vitrectomy (PPV), the mean BCVA improved to 0.83 logMAR. Eight months following PPV (mean value, 8.20 months; SD, 3.59 months), the mean BCVA was 0.63 logMAR. In the last follow-up interval most of the eyes recovered, and the BCVA did not differ significantly from baseline. Two eyes underwent further pars plana surgery during the follow-up period. No enucleation was required. CONCLUSION In this study, we have shown that an immediate vitrectomy with subsequent intravitreal injection of antibiotics is an effective option for treating post-injection endophthalmitis and frequently results in recovery of vision; thus, it should be performed as early as possible, where available.
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Nuzbrokh Y, Kassotis AS, Ragi SD, Jauregui R, Tsang SH. Treatment-Emergent Adverse Events in Gene Therapy Trials for Inherited Retinal Diseases: A Narrative Review. Ophthalmol Ther 2020; 9:709-724. [PMID: 32740739 PMCID: PMC7708583 DOI: 10.1007/s40123-020-00287-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Indexed: 12/24/2022] Open
Abstract
Patient safety is a primary priority in the conduction of retinal gene therapy trials. An understanding of risk factors and mitigation strategies for post-procedure complications is crucial for the optimization of gene therapy clinical trial protocols. In this review, we synthesize the literature on ocular delivery methods, vector platforms, and treatment-emergent adverse effects in recent gene therapy clinical trials for inherited retinal diseases.
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Affiliation(s)
- Yan Nuzbrokh
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
- Jonas Children's Vision Care, New York, NY, USA
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Alexis S Kassotis
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Sara D Ragi
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
- Jonas Children's Vision Care, New York, NY, USA
| | - Ruben Jauregui
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
- Jonas Children's Vision Care, New York, NY, USA
| | - Stephen H Tsang
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA.
- Jonas Children's Vision Care, New York, NY, USA.
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA.
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Endophthalmitis following intravitreal injection of anti-vascular endothelial growth factor agents. Can J Ophthalmol 2020; 55:286-292. [DOI: 10.1016/j.jcjo.2020.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/27/2020] [Indexed: 11/17/2022]
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Liebmann JM, Barton K, Weinreb RN, Eichenbaum DA, Gupta PK, McCabe CM, Wolfe JD, Ahmed I, Sheybani A, Craven ER. Evolving Guidelines for Intracameral Injection. J Glaucoma 2020; 29 Suppl 1:S1-S7. [DOI: 10.1097/ijg.0000000000001451] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Patel SN, Gangaputra S, Sternberg P, Kim SJ. Prophylaxis measures for postinjection endophthalmitis. Surv Ophthalmol 2020; 65:408-420. [PMID: 31923477 DOI: 10.1016/j.survophthal.2019.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/24/2019] [Accepted: 12/30/2019] [Indexed: 12/23/2022]
Abstract
Intravitreal injections have become the most commonly performed ophthalmic procedure, transforming modern retina practice. Postinjection endophthalmitis, while rare, remains the most feared potential complication. Prophylaxis measures including topical antisepsis, hand hygiene, gloves, masks, and drapes have all been proposed to help prevent postinjection endophthalmitis; however, there remains significant variation in protocol, given the lack of agreement among retina specialists on which steps are crucial to prevent endophthalmitis. With millions of injections performed annually, collating data have helped us better understand risk factors for endophthalmitis after intravitreal injection. We summarize the consensus guidelines for intravitreal injection technique and comprehensively review the literature on prevention of postinjection endophthalmitis.
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Affiliation(s)
- Shriji N Patel
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
| | - Sapna Gangaputra
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Paul Sternberg
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Stephen J Kim
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Cohen SY, Kodjikian L, Devin F, Delyfer MN, Dot C, Oubraham H, Razavi S, Tadayoni R, Bodaghi B, Aho LS, Rogues AM, Soulias-Leveziel M, Korobelnik JF. Avis d’experts : actualisation des bonnes pratiques des injections intravitréennes. Recommandations de la Société française d’ophtalmologie et de la Société française d’hygiène hospitalière. J Fr Ophtalmol 2020; 43:59-62. [DOI: 10.1016/j.jfo.2019.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 11/13/2019] [Indexed: 11/28/2022]
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Chaturvedi R, Wannamaker KW, Riviere PJ, Khanani AM, Wykoff CC, Chao DL. Real-World Trends in Intravitreal Injection Practices among American Retina Specialists. Ophthalmol Retina 2019; 3:656-662. [PMID: 31133544 PMCID: PMC6684447 DOI: 10.1016/j.oret.2019.03.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/23/2019] [Accepted: 03/25/2019] [Indexed: 04/25/2023]
Abstract
PURPOSE To analyze practice patterns used for intravitreal injections (IVIs) by retinal specialists in the United States. DESIGN Cross-sectional online survey. PARTICIPANTS Retina specialists in the United States who responded to a web-based survey. METHODS Retinal specialists in the United States were contacted via e-mail to complete a web-based, anonymous, 24-question survey. Multivariate analysis was performed on a selected question of interest focused on choice of anesthetic used for IVI. MAIN OUTCOME MEASURES Differences in IVI practices, such as antibiotic preferences, and different odds of anesthetic use by demographic variables with 95% confidence intervals. RESULTS A total of 281 retinal specialists responded to the survey (17% response rate). Respondents' average age was 53 years, with an average of 20 years in practice. Respondents practiced in 42 states, with 90% practicing in an urban or suburban area. For anesthesia, 14% used a topical anesthetic with cotton swab compression, 27% used a subconjunctival anesthetic, and 31% used an anesthetic gel. Age, gender, geographic location, and practice setting did not seem to impact choice of anesthetic for IVI significantly. Sixty-six percent of respondents always use a lid speculum, 21% administer topical antibiotics before injection, 36% wear a mask, 73% wear gloves, and 45% always dilate the eyes before injection. Most respondents use a 30-gauge needle and inject in the inferior temporal quadrant (70%). Forty-five percent always perform bilateral injections the same day if indicated. After the injection, 14% administer post operative nonsteroidal anti-inflammatory drugs, 28% administer postoperative antibiotics, and 31% routinely check intraocular pressure after injection. CONCLUSIONS This study provided real-world trends in practices for IVI among retina specialists in the United States. In addition, age, gender, practice type, and geographic location did not influence anesthetic choice for IVI.
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Affiliation(s)
- Rahul Chaturvedi
- School of Medicine, University of California, San Diego, La Jolla, California
| | | | - Paul J Riviere
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | | | - Charles C Wykoff
- Retina Consultants of Houston, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - Daniel L Chao
- Andrew Viterbi Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, La Jolla, California.
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Ing MR, Shortell J, Golez J. Extraocular and Intraocular Infections Following Strabismus Surgery: A Review. J Pediatr Ophthalmol Strabismus 2019; 56:214-221. [PMID: 31322710 DOI: 10.3928/01913913-20190425-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/15/2019] [Indexed: 11/20/2022]
Abstract
An extensive literature review of various types of infections following strabismus surgery was facilitated by using the search engines PubMed and Google Scholar. In both search engines, the phrases "infection following strabismus surgery," "infection strabismus surgery," "complications of strabismus surgery," "endophthalmitis strabismus surgery," and "strabismus scleral perforation" were used for the review. The type of infection, surface involved, and site of the infection determined the type of therapy. Infections involving deeper tissues, such as periocular infection or orbital cellulitis, required systemic therapy. Sub-Tenon's abscesses required incision and drainage, as well as systemic antibiotics. The development of endophthalmitis following strabismus surgery was rare, but was usually devastating to the visual result. Symptoms of an adverse intraocular condition began by mean postoperative day 3, but the definitive diagnosis and treatment of endophthalmitis was not made until mean postoperative day 6. Despite early detection of this latter type of infection and early surgical intervention with vitreous paracentesis and intraocular injection of antibiotics, the visual result was extremely poor in more than two-thirds of the reported cases. Although there is no known way to truly prevent all infections following strabismus surgery, several techniques may be prudent for the strabismus surgeon to adopt to decrease the bacterial load and minimize the risk of infection. The surgeon should be encouraged to consider preoperative use of povidone-iodine on the operative field and avoid scleral perforation during surgery. [J Pediatr Ophthalmol Strabismus. 2019;56(4):214-221.].
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Campos A, Caramelo F, do Carmo A. RE: Hsu J: Minimizing the Risk of Endophthalmitis after Injection. What Have We Learned? (Ophthalmol Retina. 2019;3:1-2). Ophthalmol Retina 2019; 3:e3-e4. [PMID: 31174681 DOI: 10.1016/j.oret.2019.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 02/14/2019] [Accepted: 03/12/2019] [Indexed: 11/30/2022]
Affiliation(s)
- António Campos
- Department of Ophthalmology, Centro Hospitalar de Leiria, Leiria; Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal.
| | - Francisco Caramelo
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal; Laboratory of Biostatistics and Medical Informatics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Anália do Carmo
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal; Department of Clinical Pathology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
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Hsu J. Reply. Ophthalmol Retina 2019; 3:e4-e5. [PMID: 31174682 DOI: 10.1016/j.oret.2019.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 03/12/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Jason Hsu
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania.
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Hsu J. Minimizing the Risk of Endophthalmitis after Injection. ACTA ACUST UNITED AC 2019; 3:1-2. [DOI: 10.1016/j.oret.2018.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 10/28/2022]
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Schachat AP. Real-World Papers, Prophylaxis for Intravitreal Injections, Fluorescein Angiography and Neovascular Age-Related Macular Degeneration, and Anti-Vascular Endothelial Growth Factor Safety. Ophthalmol Retina 2018; 2:643-644. [PMID: 31047371 DOI: 10.1016/j.oret.2018.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 04/24/2018] [Accepted: 04/30/2018] [Indexed: 06/09/2023]
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