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Qin M, Yu-Wai-Man C. Glaucoma: Novel antifibrotic therapeutics for the trabecular meshwork. Eur J Pharmacol 2023; 954:175882. [PMID: 37391006 PMCID: PMC10804937 DOI: 10.1016/j.ejphar.2023.175882] [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: 04/03/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/02/2023]
Abstract
Glaucoma is a chronic and progressive neurodegenerative disease characterized by the loss of retinal ganglion cells and visual field defects, and currently affects around 1% of the world's population. Elevated intraocular pressure (IOP) is the best-known modifiable risk factor and a key therapeutic target in hypertensive glaucoma. The trabecular meshwork (TM) is the main site of aqueous humor outflow resistance and therefore a critical regulator of IOP. Fibrosis, a reparative process characterized by the excessive deposition of extracellular matrix components and contractile myofibroblasts, can impair TM function and contribute to the pathogenesis of primary open-angle glaucoma (POAG) as well as the failure of minimally invasive glaucoma surgery (MIGS) devices. This paper provides a detailed overview of the current anti-fibrotic therapeutics targeting the TM in glaucoma, along with their anti-fibrotic mechanisms, efficacy as well as the current research progress from pre-clinical to clinical studies.
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Affiliation(s)
- Mengqi Qin
- King's College London, London, SE1 7EH, UK
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2
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Shughoury A, Bhatwadekar A, Jusufbegovic D, Hajrasouliha A, Ciulla TA. The evolving therapeutic landscape of diabetic retinopathy. Expert Opin Biol Ther 2023; 23:969-985. [PMID: 37578843 PMCID: PMC10592121 DOI: 10.1080/14712598.2023.2247987] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/30/2023] [Accepted: 08/11/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Diabetic retinopathy (DR) is a leading cause of blindness worldwide. Recent decades have seen rapid progress in the management of diabetic eye disease, evolving from pituitary ablation to photocoagulation and intravitreal pharmacotherapy. The advent of effective intravitreal drugs inhibiting vascular endothelial growth factor (VEGF) marked a new era in DR therapy. Sustained innovation has since produced several promising biologics targeting angiogenesis, inflammation, oxidative stress, and neurodegeneration. AREAS COVERED This review surveys traditional, contemporary, and emerging therapeutics for DR, with an emphasis on anti-VEGF therapies, receptor tyrosine kinase inhibitors, angiopoietin-Tie2 pathway inhibitors, integrin pathway inhibitors, gene therapy 'biofactory' approaches, and novel systemic therapies. Some of these investigational therapies are being delivered intravitreally via sustained release technologies for extended durability. Other investigational agents are being delivered non-invasively via topical and systemic routes. These strategies hold promise for early and long-lasting treatment of DR. EXPERT OPINION The evolving therapeutic landscape of DR is rapidly expanding our toolkit for the effective and durable treatment of blinding eye disease. However, further research is required to validate the efficacy of novel therapeutics and characterize real world outcomes.
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Affiliation(s)
- Aumer Shughoury
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA 46202
| | - Ashay Bhatwadekar
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA 46202
| | - Denis Jusufbegovic
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA 46202
| | - Amir Hajrasouliha
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA 46202
| | - Thomas A Ciulla
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA 46202
- Midwest Eye Institute, Indianapolis, IN, USA 46290
- Clearside Biomedical, Inc., Alpharetta, GA, USA 30005
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Kalogeropoulos D, Shaw L, Skondra D, Christodoulou A, Kalogeropoulos C. Central Serous Chorioretinopathy: An Update on the Current State of Management. Klin Monbl Augenheilkd 2023. [PMID: 37336237 DOI: 10.1055/a-2062-3751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Central serous chorioretinopathy (CSCR) is a relatively common retinal disorder that leads to central vision impairment, often with a high recurrence rate. The exact etiology and pathogenetic mechanisms have not been fully elucidated but are likely to be associated with hyperpermeability of the choroidal capillaries and failure of the retinal pigment epithelium (RPE), leading to serous detachment of the neurosensory retina. Multimodal imaging plays a critical role in the diagnostic approach and monitoring of CSCR. Fortunately, the natural course of the disease is usually self-limiting, with spontaneous resolution and total fluid reabsorption. However, some patients may exhibit recurrences or persistent subretinal fluid (chronic CSCR), leading to progressive and irreversible RPE atrophy or photoreceptor damage. Thus, to prevent permanent visual loss, individualized treatment should be considered. Recent developments in the diagnostic and therapeutic approach have contributed to better outcomes in patients with CSCR. More studies are required to improve our understanding of epidemiology, pathogenesis, diagnosis, and treatment, with a significant impact on the management of this challenging clinical entity. The purpose of this review is to summarize the current knowledge about the clinical features, diagnostic workup, and therapeutic approach of CSCR.
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Affiliation(s)
| | - Lincoln Shaw
- Ophthalmology, University of Chicago, Pritzker School of Medicine, Chicago, Illinois, United States
| | - Dimitra Skondra
- Ophthalmology, University of Chicago, Pritzker School of Medicine, Chicago, Illinois, United States
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Li J, Li C, Zhang Q, Qiu C. Leukoencephalopathy with calcifications and cysts: A case report with literature review. Neurol Sci 2023:10.1007/s10072-023-06776-y. [PMID: 37004603 DOI: 10.1007/s10072-023-06776-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 03/20/2023] [Indexed: 04/04/2023]
Abstract
Leukoencephalopathy with calcifications and cysts (LCC; OMIM #614561) is a rare disease and at present there are less than 100 cases reported worldwide. Mutations in the SNORD118 gene is now known to be the cause of LCC. We present a case who was heterozygous for the n.70G>A and n.6C>T sequence variants of the SNORD118 gene, variants which to date have not been described. Compared with the cases that we reviewed, our patient had the second longest time to diagnosis (age 56) from onset of symptoms 40 years prior. Moreover, his cousin's family has a high prevalence of epilepsy. This paper reviewed all published reports to date that had descriptive cases involving LCC as well as testing for the SNORD118 gene. Since 1996 only 85 patients have been described in 59 case reports. In this review, we summarize their clinical features, especially central nervous system symptoms, treatment, pathology, and gene testing results.
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Affiliation(s)
- Jingya Li
- Department of Neurology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Youdian Road, Hangzhou, Zhejiang Province, P. R. China
| | - Chun Li
- Department of Neurology, Anji Traditional Chinese Medical Hospital, 299 Shengli West Road,, Anji Huzhou, Zhejiang Province, P. R. China
| | - Qing Zhang
- Department of Neurology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Youdian Road, Hangzhou, Zhejiang Province, P. R. China
| | - Chao Qiu
- Department of Neurology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Youdian Road, Hangzhou, Zhejiang Province, P. R. China.
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Kinaci-Tas B, Alderliesten T, Verbraak FD, Rasch CRN. Radiation-Induced Retinopathy and Optic Neuropathy after Radiation Therapy for Brain, Head, and Neck Tumors: A Systematic Review. Cancers (Basel) 2023; 15:cancers15071999. [PMID: 37046660 PMCID: PMC10093581 DOI: 10.3390/cancers15071999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023] Open
Abstract
Background: Patients with brain, head, and neck tumors experience a decline in their quality of life due to radiation retinopathy and optic neuropathy. Little is known about the dose–response relationship and patient characteristics. We aimed to systematically review the prevalence of radiation retinopathy and optic neuropathy. Method: The primary outcome was the pooled prevalence of radiation retinopathy and optic neuropathy. The secondary outcome included the effect of the total radiation dose prescribed for the tumor according to the patient’s characteristics. Furthermore, we aimed to evaluate the radiation dose parameters for organs at risk of radiation retinopathy and optic neuropathy. Results: The pooled prevalence was 3.8%. No retinopathy was reported for the tumor’s prescribed dose of <50 Gy. Optic neuropathy was more prevalent for a prescribed dose of >50 Gy than <50 Gy. We observed a higher prevalence rate for retinopathy (6.0%) than optic neuropathy (2.0%). Insufficient data on the dose for organs at risk were reported. Conclusion: The prevalence of radiation retinopathy was higher compared to optic neuropathy. This review emphasizes the need for future studies considering retinopathy and optic neuropathy as primary objective parameters.
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Affiliation(s)
- Buket Kinaci-Tas
- Department of Radiation Oncology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
- Correspondence:
| | - Tanja Alderliesten
- Department of Radiation Oncology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - Frank D. Verbraak
- Department of Ophthalmology, Amsterdam University Medical Centers, Location VU Medical Center, 1081 HV Amsterdam, The Netherlands
| | - Coen R. N. Rasch
- Department of Radiation Oncology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
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Noma H, Yasuda K, Narimatsu A, Asakage M, Shimura M. New individualized aflibercept treatment protocol for branch retinal vein occlusion with macular edema. Sci Rep 2023; 13:1536. [PMID: 36707696 PMCID: PMC9883511 DOI: 10.1038/s41598-023-28533-z] [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: 08/09/2022] [Accepted: 01/19/2023] [Indexed: 01/29/2023] Open
Abstract
We evaluated the long-term (24-month) efficacy of a novel individualized treatment protocol with 2 mg aflibercept for treatment-naive BRVO with macular edema. Each patient received an initial aflibercept injection and was then examined every 2 weeks until recurrence of edema. At recurrence, each patient received a second injection of aflibercept. The period of efficacy was defined as the time between the first and second injections. Subsequently, each patient was examined and re-injected with aflibercept at their personalized treatment interval, which was defined as 1 week shorter than the period of efficacy. Thirty-seven eyes of 48 patients showed recurrence after the initial injection. The mean period of efficacy was 92.5 ± 40.8 days, and the mean number of visits before recurrence, 7.6 ± 2.9. The mean 24-month best corrected visual acuity (BCVA) was significantly better than the mean baseline BCVA but significantly worse than the best BCVA during the period of efficacy. The mean gain of BCVA at 24 months was 0.07 ± 0.18 logMAR. The mean 24-month central macular thickness (CMT) was significantly lower than the mean baseline CMT but showed no difference from the mean best CMT (p = 0.060). The mean total number of visits during the 24 months was 15.8 ± 3.4. We conclude that the individualized treatment protocol that was based on the period of efficacy in treatment-naïve BRVO eyes with macular edema achieved satisfactory long-term visual outcome.
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Affiliation(s)
- Hidetaka Noma
- Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, 1163, Tatemachi, Hachioji, Tokyo, 193-0998, Japan.
| | - Kanako Yasuda
- Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, 1163, Tatemachi, Hachioji, Tokyo, 193-0998, Japan
| | - Akitomo Narimatsu
- Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, 1163, Tatemachi, Hachioji, Tokyo, 193-0998, Japan
| | - Masaki Asakage
- Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, 1163, Tatemachi, Hachioji, Tokyo, 193-0998, Japan
| | - Masahiko Shimura
- Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, 1163, Tatemachi, Hachioji, Tokyo, 193-0998, Japan
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Bai L, Wang Y, Liu X, Zheng Y, Wang W, He N, Tariq F, Wang F, Zhang S. The Optimization of an Anti-VEGF Therapeutic Regimen for Neovascular Glaucoma. Front Med (Lausanne) 2022; 8:766032. [PMID: 35083234 PMCID: PMC8784790 DOI: 10.3389/fmed.2021.766032] [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: 08/28/2021] [Accepted: 12/09/2021] [Indexed: 11/23/2022] Open
Abstract
This study investigates the safety and efficacy of conbercept injection through different routes for neovascular glaucoma (NVG) treatment, in which seventy-four patients (81 eyes) with NVG caused by ischemia retinopathy had participated. Patients were divided into three stages according to the progression of NVG and were randomly assigned to receive intracameral or intravitreal conbercept injection. After conbercept injection, patients experienced improved best-corrected visual acuity (BCVA), good intraocular pressure (IOP) control, and neovascularization of Iris (NVI) regression. In stage III, patients required trabeculectomy with mitomycin C plus pan-retinal photocoagulation (PRP) to achieve complete NVI regression. Compared to the intravitreal group, the intracameral group had significantly lower IOP in 2 days in stage III and 1 day in stages I and II after injection, complete NVI regression before PRP in stages I and II, and better NVI regression in stage III. The rates of hyphema after trabeculectomy and malfunction filtering bleb suffering needle bleb revision were lower in the intracameral group, but only the hyphema rate was significantly different. Injections through different routes are all safe. We recommend intravitreal injections for patients in stages I and II, but for stage III, intracameral injection is better, and trabeculectomy with mitomycin C should be conducted within 2 days after injection to maximally reduce the risk of perioperative hyphema. Trial Registration:ClinicalTrials.gov, identifier NCT03154892.
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Affiliation(s)
- Ling Bai
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yanfen Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xindi Liu
- Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuping Zheng
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wenjing Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Na He
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Farheen Tariq
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Feng Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shu Zhang
- Experimental Teaching Center for Clinical Skills, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Geriatric Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Comparison of before versus after intravitreal bevacizumab injection, growth factor levels and fibrotic markers in vitreous samples from patients with proliferative diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 2022; 260:1899-1906. [PMID: 35028761 DOI: 10.1007/s00417-021-05515-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/07/2021] [Accepted: 11/24/2021] [Indexed: 11/04/2022] Open
Abstract
PURPOSE In diabetic retinopathy patients, intravitreal bevacizumab (IVB) injections are widely used to facilitate dissection of retinal fibrovascular membranes during surgery, reduce the rate of perioperative hemorrhage, and prevent recurrent neovascularization. Previous studies have shown that IVB may worsen fibrosis and thereby impair vision. The aim of this study was to determine which markers are associated with fibrosis. METHODS Twenty-three patients with proliferative diabetic retinopathy (PDR) underwent pars plana vitrectomy (PPV) with IVB pretreatment for intraocular hemorrhage (IOH) and/or tractional retinal detachment (TRD). Vitreous samples were obtained at the time of IVB injection and again at the beginning of PPV, about a week later. Using Western blot analysis, the concentrations of vascular endothelial growth factor (VEGF), placental growth factor (PIGF), insulin like growth factor-1 (IGF-1), angiogenin-1 (Ang-1), and vascular endothelial cadherin (VE-cadherin) were measured in vitreous samples. RESULTS After treatment with IVB, VEGF, PIGF, and VE-cadherin concentrations in the vitreous significantly decreased (p < 0.001, p < 0.001, and p = 0.001, respectively), whereas the concentrations of IGF-1 increased (p = 0.001). There were no significant changes in Ang-1 concentrations in the vitreous after IVB injection (p = 0.732). There were no statistically significant differences in VEGF-A, PIGF, VE-cadherin, IGF, and Ang-1 levels before and after IVB injection when the IOH and TRD groups underwent subgroup analysis (p = 0.696, p = 0.516, p = 0.498, p = 0.188, and p = 0.243, respectively). CONCLUSION The levels of VEGF and other cytokines changed in the vitreous after IVB. The adverse effects associated with IVB, such as fibrosis, may result from modulation of vitreous cytokine concentrations. In the treatment of PDR, drugs that optimize the effects of PIGF, IGF-1, and VE-cadherin to reduce these side effects may be useful.
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Takayama K, Someya H, Yokoyama H, Kimura T, Takamura Y, Morioka M, Terasaki H, Ueda T, Ogata N, Kitano S, Tashiro M, Sakamoto T, Takeuchi M. Potential bias of preoperative intravitreal anti-VEGF injection for complications of proliferative diabetic retinopathy. PLoS One 2021; 16:e0258415. [PMID: 34624063 PMCID: PMC8500446 DOI: 10.1371/journal.pone.0258415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 09/27/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose Intravitreal anti-VEGF injection (IVI) is administered before vitrectomy to assist management of proliferative diabetic retinopathy (PDR)-related complications. In the clinical setting, retinal surgeons determine the use of preoperative IVI based on individual criteria. In this study, we investigated factors related to the potential bias of retinal surgeons in using IVI prior to vitrectomy for PDR-related complications, and evaluated the real-world outcomes of surgeon-determined preoperative IVI. Methods Medical records of 409 eyes of 409 patients who underwent 25-gauge vitrectomy for PDR complications at seven Japanese centers (22 surgeons) were retrospectively reviewed. Ocular factors, demographic and general clinical factors, surgical procedures, and postoperative complications were compared between IVI group (patients who received preoperative IVI; 87 eyes, 21.3%) and non-IVI group (patients who did not receive preoperative IVI; 322 eyes, 78.7%). In addition, baseline HbA1c in IVI group and non-IVI group was compared between eyes with and without postoperative complications. Results At baseline, IVI group was younger (P<0.001), had shorter duration of diabetes treatment (P = 0.045), and higher frequencies of neovascular glaucoma [NVG] (P<0.001) and tractional retinal detachment [TRD] (P<0.001) compared to non-IVI group. Although IVI group had higher frequencies of intraoperative retinal break and tamponade procedure, there were no significant differences in postoperative complications and additional treatments between two groups. Baseline HbA1c levels were also not correlated with postoperative complications of VH, NVG, and RD both in IVI group and non-IVI group. Logistic regression analysis identified age (P<0.001, odds ratio [OR] 0.95), presence of NVG (P<0.001, OR 20.2), and presence of TRD (P = 0.0014, OR 2.44) as preoperative factors in favor of IVI. Conclusions In this multicenter real-world clinical study, younger age and presence of NVG and TRD were identified as potential biases in using IVI before vitrectomy for PDR complications. Eyes that received preoperative IVI had more intraoperative retinal breaks requiring tamponade than eyes not receiving IVI, but postoperative outcome was not different between the two groups.
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Affiliation(s)
- Kei Takayama
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Hideaki Someya
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Hiroshi Yokoyama
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takeshi Kimura
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshihiro Takamura
- Department of Ophthalmology, University of Fukui Faculty of Medical Sciences, Yoshida, Japan
| | - Masakazu Morioka
- Department of Ophthalmology, University of Fukui Faculty of Medical Sciences, Yoshida, Japan
| | - Hiroto Terasaki
- Department of Ophthalmology, Kagoshima University, Kagoshima, Japan
| | - Tetsuo Ueda
- Department of Ophthalmology, Nara Medical University, Kashihara, Japan
| | - Nahoko Ogata
- Department of Ophthalmology, Nara Medical University, Kashihara, Japan
| | - Shigehiko Kitano
- Diabetes Center, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan
| | - Maki Tashiro
- Diabetes Center, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University, Kagoshima, Japan
| | - Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
- * E-mail:
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Alves ADCS, Bruinsmann FA, Guterres SS, Pohlmann AR. Organic Nanocarriers for Bevacizumab Delivery: An Overview of Development, Characterization and Applications. Molecules 2021; 26:4127. [PMID: 34299401 PMCID: PMC8305806 DOI: 10.3390/molecules26144127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 01/08/2023] Open
Abstract
Bevacizumab (BCZ) is a recombinant humanized monoclonal antibody against the vascular endothelial growth factor, which is involved in the angiogenesis process. Pathologic angiogenesis is observed in several diseases including ophthalmic disorders and cancer. The multiple administrations of BCZ can cause adverse effects. In this way, the development of controlled release systems for BCZ delivery can promote the modification of drug pharmacokinetics and, consequently, decrease the dose, toxicity, and cost due to improved efficacy. This review highlights BCZ formulated in organic nanoparticles providing an overview of the physicochemical characterization and in vitro and in vivo biological evaluations. Moreover, the main advantages and limitations of the different approaches are discussed. Despite difficulties in working with antibodies, those nanocarriers provided advantages in BCZ protection against degradation guaranteeing bioactivity maintenance.
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Affiliation(s)
- Aline de Cristo Soares Alves
- Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Rio Grande do Sul, Porto Alegre 90610-000, Brazil; (F.A.B.); (S.S.G.)
| | | | | | - Adriana Raffin Pohlmann
- Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Rio Grande do Sul, Porto Alegre 90610-000, Brazil; (F.A.B.); (S.S.G.)
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Bai L, Tariq F, He YD, Zhang S, Wang F. Intracameral anti-VEGF injection for advanced neovascular glaucoma after vitrectomy with silicone oil tamponade. Int J Ophthalmol 2021; 14:456-460. [PMID: 33747825 PMCID: PMC7930538 DOI: 10.18240/ijo.2021.03.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/21/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the effect of intracameral injection of conbercept for the treatment of advanced neovascular glaucoma (NVG) after vitrectomy with silicone oil tamponade. METHODS Conbercept 0.5 mg/0.05 mL was injected into the anterior chamber of 5 eyes, which had developed advanced NVG after vitrectomy with silicone oil tamponade. Then, trabeculectomy with mitomycin C and pan-retinal photocoagulation (PRP) or extra-PRP were conducted within 2d. The follow-up time was 6mo. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), neovascularization of iris (NVI) were recorded before and after treatment. RESULTS Within 2d after injection, IOP control, and NVI regression were optimal for trabeculectomy. Hyphema occurred in one eye in the process of injection. But none of them present hyphema after trabeculectomy. At the end of follow-up time, all eyes had improved BCVA, well-controlled IOP, and completely regressed NVI. CONCLUSION Intracameral injection of conbercept is safe and effective in the treatment of patients with advanced NVG after vitrectomy with silicone oil tamponade. Within 2d after injection is the optimal time window for trabeculectomy, which can maximally reduce the risk of perioperative hyphema.
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Affiliation(s)
- Ling Bai
- Department of Ophthalmology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710003, Shaanxi Province, China
| | - Farheen Tariq
- Department of Ophthalmology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710003, Shaanxi Province, China
| | - Yi-Dan He
- Department of Ophthalmology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710003, Shaanxi Province, China
| | - Shu Zhang
- Experimental Teaching Center for Clinical Skills, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710003, Shaanxi Province, China
- Department of Geriatric Medicine, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710003, Shaanxi Province, China
| | - Feng Wang
- Department of Ophthalmology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710003, Shaanxi Province, China
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Dourado LFN, Silva CN, Dos Anjos LC, Mortari MR, Silva-Cunha A, Fialho SL. Ischemia-induced retinal injury is attenuated by Neurovespina, a peptide from the venom of the social wasp Polybia occidentalis. Neuropeptides 2021; 85:102113. [PMID: 33370615 DOI: 10.1016/j.npep.2020.102113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 01/28/2023]
Abstract
Neurovespina is a synthetic peptide modified from Occidentalin-1202, a nine amino acid residue peptide isolated from the venom of the social wasp Polybia occidentalis. Previous studies showed that this peptide has a neuroprotective effect on the central nervous system, but its action on the eye has not been explored. So, the objective of this work was to investigate the neuroprotective effect of Neurovespina on the retina and its angiogenic potential in the chicken chorioallantoic membrane (CAM). Retinal ischemia was induced in rats by acute elevation of intraocular pressure (IOP). Electroretinography (ERG) measurements, histopathological and immunohistochemical analysis, and transmission electronic microscopy (TEM) records were performed to check the neuroprotection effect of Neurovespina in the retina of the animals. The angiogenic activity of the peptide was investigated by CAM assay. The results showed that Neurovespina was able to reduce the effects induced by ischemic injury, preventing the reduction of a- and b-waves in the scotopic ERG. Histopathological and immunohistochemistry assays showed that Neurovespina, mainly at 60 μg/ml, protected all layers of the retina. The CAM assay revealed that the peptide promoted the reduction of CAM vessels. So, Neurovespina was able to protect retinal cells from ischemic insult and has an antiangiogenic effect, which can be considered as a promising neuroprotective agent for intravitreal application.
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Affiliation(s)
- Lays Fernanda Nunes Dourado
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Campus Pampulha, Av. Antônio Carlos, 6627, Belo Horizonte, MG CEP 31270-901, Brazil
| | - Carolina Nunes Silva
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Campus Pampulha, Av. Antônio Carlos, 6627, Belo Horizonte, MG CEP 31270-901, Brazil
| | - Lilian Carneiro Dos Anjos
- Laboratório de Neurofarmacologia, Departamento de Ciências Fisiológicas, Instituto de Ciências Biológicas, Universidade de Brasília, DF, Brazil
| | - Márcia Renata Mortari
- Laboratório de Neurofarmacologia, Departamento de Ciências Fisiológicas, Instituto de Ciências Biológicas, Universidade de Brasília, DF, Brazil
| | - Armando Silva-Cunha
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Campus Pampulha, Av. Antônio Carlos, 6627, Belo Horizonte, MG CEP 31270-901, Brazil
| | - Silvia Ligório Fialho
- Diretoria de Pesquisa e Desenvolvimento, Fundação Ezequiel Dias, Rua Conde Pereira Carneiro, 80, Belo Horizonte, MG CEP 30510-010, Brazil.
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13
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Özcan G, Gündüz AK, Mirzayev İ, Oysul K, Uysal H. Early Results of Stereotactic Radiosurgery in Uveal Melanoma and Risk Factors for Radiation Retinopathy. Turk J Ophthalmol 2020; 50:156-162. [PMID: 32631003 PMCID: PMC7338750 DOI: 10.4274/tjo.galenos.2019.78370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: To report treatment results and complications of stereotactic radiosurgery in uveal malignant melanoma and to identify risk factors for development of radiation retinopathy. Materials and Methods: This was a retrospective study of 36 patients diagnosed with uveal melanoma between 2014 and 2019. Best corrected visual acuity, funduscopic findings, basal tumor diameter and tumor thickness were recorded at baseline and at follow-up visits at 3-month intervals. The response of tumors to stereotactic radiosurgery and complications were determined. Results: The mean basal diameter of tumor was 10.2 (range: 4.0-19.4, standard deviation [SD]: ±3.3) mm x 9.7 (range: 4.5-18.0, SD: ±3.3), tumor thickness was 5.1 (range: 2.0-11.0, ±2.4) mm at baseline. The mean follow-up period was 17.2 (range: 6-48, SD: ±10.43) months. The mean visual acuity was 0.5 (SD: ±0.3) logMAR before treatment and 0.6 (SD: ±0.3) logMAR after the mean follow-up period. The most common complications after stereotactic radiosurgery were cataract (38.9%) and radiation retinopathy (27.7%). There was a statistically significant relation between radiation retinopathy development and tumor distance from the optic disc (p=0.04). The rate of eye salvage was 83.3% in this study. Conclusion: Our short-term results show stereotactic radiosurgery was an effective and sustained treatment modality among the other eye conservation therapies.
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Affiliation(s)
- Gökçen Özcan
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Ahmet Kaan Gündüz
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - İbadulla Mirzayev
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Kaan Oysul
- Medicana International Hospital, Clinic of Radiation Oncology, Ankara, Turkey
| | - Hasan Uysal
- Medicana International Hospital, Clinic of Radiation Oncology, Ankara, Turkey
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14
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Lee SW, Sim HE, Park JY, Kim JS, Chang IB, Park YS, Hwang JH. Changes in inner retinal layer thickness in patients with exudative age-related macular degeneration during treatment with anti-vascular endothelial growth factor. Medicine (Baltimore) 2020; 99:e19955. [PMID: 32332680 PMCID: PMC7220743 DOI: 10.1097/md.0000000000019955] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to identify any changes that occur in the retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GC-IPL) in patients with exudative age-related macular degeneration (AMD) during treatment with anti-vascular endothelial growth factor (VEGF) injections.Patients were enrolled in this retrospective study if they had exudative AMD, had received at least 3 injections of ranibizumab or aflibercept, and had a minimum of 12 months of follow-up. We analyzed the changes in the RNFL and GC-IPL using spectral-domain optical coherence tomography in rescan mode.Fifty-two eyes of 52 patients who had been treated with repeated anti-VEGF injections for exudative AMD were included. At the final visit, there was no significant between-group difference in best-corrected visual acuity or intraocular pressure. There was a significant decrease in central macular thickness in all groups (P < .05). There was a decrease in RNFL thickness that was only statistically significant in the ranibizumab group and when the ranibizumab or aflibercept groups were combined (P = .036 and .044, respectively). The thickness of the GC-IPL layer was significantly decreased in the aflibercept and total group (P = .035 and P = .048, respectively).The thicknesses of the RNFL and GC-IPL decreased in patients with exudative AMD who underwent repeated anti-VEGF injections.
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Affiliation(s)
- Seong Woo Lee
- Department of Ophthalmology, Sanggye Paik Hospital, Inje University, Seoul
| | - Ha Eun Sim
- Department of Ophthalmology, Sanggye Paik Hospital, Inje University, Seoul
| | - Jae Yong Park
- Department of Ophthalmology, Sanggye Paik Hospital, Inje University, Seoul
| | - Jae Suk Kim
- Department of Ophthalmology, Sanggye Paik Hospital, Inje University, Seoul
| | - In Beom Chang
- Department of Ophthalmology, Busan Paik Hospital, Inje University, Busan
| | | | - Je Hyung Hwang
- Department of Ophthalmology, Sanggye Paik Hospital, Inje University, Seoul
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15
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Abu-Yaghi NE, Abed AM, Khlaifat DF, Nawaiseh MB, Emoush LO, AlHajjaj HZ, Abojaradeh AM, Hattar MN, Abusaleem SK, Sabbagh HM, Abu Gharbieh YA, Quaqazeh SA. Factors Affecting Compliance to Anti-Vascular Endothelial Growth Factor Treatment of Diabetic Macular Edema in a Cohort of Jordanian Patients. Clin Ophthalmol 2020; 14:921-929. [PMID: 32273676 PMCID: PMC7102883 DOI: 10.2147/opth.s248661] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/04/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose To determine compliance rates and characteristics and to investigate factors affecting patients’ adherence to treatment with anti-vascular endothelial growth factors (anti-VEGFs) for diabetic macular edema (DME) in a cohort of Jordanian patients. Methods A retrospective case series wherein the files of DME patients treated with anti-VEGFs were reviewed and analyzed for factors affecting treatment compliance was undertaken. Demographic, clinical and ocular characteristics were recorded. All patients were also interviewed by phone using a structured questionnaire. Univariate and multivariate analyses were performed to determine factors associated with compliance. Results A total of 117 patients (65 males 52 females) were included in this study with a mean age of 62.93 years (±9.75). Approximately, 85% of patients were compliant to their treatment and follow-up plan during the first year of management. Subjective perception of visual improvement after receiving three loading doses was the only independent variable with a unique statistically significant contribution to compliance. All other studied factors in this group of patients were not significantly associated with patient compliance. Conclusion VEGF suppression via the intravitreal route to treat DME is a long-term process that requires caregiver dedication but also proper patient compliance. Addressing real-life barriers in those patients may help guide future strategies to improve the treatment experience, lower the financial burden and contribute to better outcomes. Patients' perceptions of possible treatment outcomes at the short term may influence their long-term commitment to therapy.
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Affiliation(s)
- Nakhleh E Abu-Yaghi
- Department of Special Surgery, Ophthalmology Division, The University of Jordan, Amman, Jordan
| | - Alaa M Abed
- Department of Special Surgery, Ophthalmology Division, The University of Jordan, Amman, Jordan
| | | | | | - Laith O Emoush
- School of Medicine, The University of Jordan, Amman, Jordan
| | | | | | | | | | - Hashem M Sabbagh
- Department of Special Surgery, Ophthalmology Division, The University of Jordan, Amman, Jordan
| | - Yazan A Abu Gharbieh
- Department of Special Surgery, Ophthalmology Division, The University of Jordan, Amman, Jordan
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16
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Jose V, Radhakrishna S, Pipalava P, Singh I. Bevacizumab for eye diseases - Legal, regulatory, and ethical overview. Indian J Pharmacol 2020; 51:377-383. [PMID: 32029959 PMCID: PMC6984021 DOI: 10.4103/ijp.ijp_413_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 09/12/2019] [Accepted: 12/23/2019] [Indexed: 01/14/2023] Open
Abstract
Vascular endothelial growth factor (VEGF) inhibitors, ranibizumab, aflibercept, and pegaptanib are approved treatments for certain eye diseases that occurs especially in the elderly. These drugs are mostly inaccessible due to their high cost. Bevacizumab is a VEGF inhibitor, approved for cancer treatment. Being a cheaper alternative, it is extensively used off-label as an intravitreal injection for the treatment of eye diseases. In this article, we have analyzed similarities and differences between bevacizumab and ranibizumab, and potential long-term safety concerns with off-label use of bevacizumab. We also analyzed legal, regulatory, and ethical background of off-label use and provided recommendations to resolve this issue. Based on the extensive clinical data, actions taken, and recommendations provided by agencies such as the National Institute for Health and Care Excellence, International Council of Ophthalmology, United Kingdom and Thailand regulatory agency, intravitreal bevacizumab has adequate evidence for controlled licensing. Claiming better safety for ranibizumab at the expense of nonaffordability cannot be considered a positive risk-benefit scenario. Intravitreal bevacizumab is being used and will continue to be used off-label, if not regulatory controlled. Licensing will ensure the availability of intravitreal bevacizumab to the patients with eye diseases, without any legal or ethical concerns for the clinicians, and will also assist in generating long-term safety data. Safest delivery formulation and dosage form should be considered for approval. Both the regulatory agency and technical experts should join and take critical decision, which will be a big step forward to making a cost-effective drug available to the public.
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Affiliation(s)
- Vinu Jose
- Clinical Development and Medical Affairs, Intas Pharmaceuticals Ltd. (Biopharma), Ahmedabad, Gujarat, India
| | - Swetha Radhakrishna
- Clinical Development and Medical Affairs, Intas Pharmaceuticals Ltd. (Biopharma), Ahmedabad, Gujarat, India
| | - Parag Pipalava
- Clinical Development and Medical Affairs, Intas Pharmaceuticals Ltd. (Biopharma), Ahmedabad, Gujarat, India
| | - Inderjeet Singh
- Clinical Development and Medical Affairs, Intas Pharmaceuticals Ltd. (Biopharma), Ahmedabad, Gujarat, India
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17
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Intravitreal Injection of Anti-VEGF Antibody Induces Glomerular Endothelial Cells Injury. Case Rep Nephrol 2019; 2019:2919080. [PMID: 31934470 PMCID: PMC6942715 DOI: 10.1155/2019/2919080] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/28/2019] [Indexed: 01/20/2023] Open
Abstract
Introduction Antiangiogenic agents that inhibit vascular endothelial growth factor have emerged as important tools in cancer therapy and ocular diseases. Their systemic use can induce renal limited microangiopathy. Local use of anti-VEGF agent is supposed to be safe. We report here a unique case of early endothelial cells injury induced by intravitreal injection of bevacizumab. Case Presentation A 72-year-old man was addressed for acute kidney injury with proteinuria. He was under treatment with intravitreal injections of bevacizumab for glaucoma. Kidney biopsy was performed and electron microscopy showed signs of early stages of glomerular microangiopathy. Bevacizumab was discontinued resulting in the improvement of renal function and albuminuria. Discussion Bevacizumab, a humanized monoclonal antibody to VEGF is an approved therapy for metastatic cancer. Systemic adverse events including thrombotic microangiopathy have been mainly reported after its systemic injection. Podocytes produce VEGF that interacts with endothelial cells VEGF receptor-2 maintaining glomerular basement membrane integrity. Bevacizumab induce the detachment of endothelial cells from glomerular basement membrane leading to the proteinuria and renal function decline. Intravitreal bevacizumab is generally supposed to be safe. However, glomerular injury with microangiopathy features, even after intravitreal injection is possible. Conclusion We report the electron microscopy evidence that intravitreal injection of anti-VEGF induces glomerular endothelial cells injury. Nephrologists and ophthalmologists should be aware of this complication.
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18
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Awasthi U, Videkar C. Re: Staurenghi et al.: Efficacy and safety of ranibizumab 0.5 mg for the treatment of macular edema resulting from uncommon causes: twelve-month findings from PROMETHEUS (Ophthalmology. 2018;125:850-862). Ophthalmology 2019; 126:e43. [DOI: 10.1016/j.ophtha.2018.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 12/11/2018] [Indexed: 11/28/2022] Open
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19
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Staurenghi G, Lai TYY, Mitchell P, Wolf S, Wenzel A, Li J, Bhaumik A, Hykin PG. Reply. Ophthalmology 2019; 126:e45-e46. [PMID: 31122370 DOI: 10.1016/j.ophtha.2018.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 12/11/2018] [Indexed: 11/19/2022] Open
Affiliation(s)
- Giovanni Staurenghi
- Department of Biomedical and Clinical Science Luigi Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy.
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong
| | - Paul Mitchell
- Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Sebastian Wolf
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Wenzel
- Former employee of Novartis Pharma AG, Basel, Switzerland
| | - Jun Li
- Novartis Pharma AG, Basel, Switzerland
| | - Amitabha Bhaumik
- Former employee of Novartis Pharmaceutical Corporation, East Hanover, New Jersey
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20
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Feng J, Li B, Wen J, Jiang Y. Preoperative Timing of Intravitreal Bevacizumab Injection for Proliferative Diabetic Retinopathy Patients. Ophthalmic Res 2018; 60:250-257. [PMID: 30380554 DOI: 10.1159/000493640] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 09/03/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the changes in aqueous concentrations of inflammatory cytokines and fibrosis-related factors, and to detect the expression of vascular endothelial growth factor (VEGF) and proliferating cells in fibrovascular membranes (FVMs) of patients with proliferative diabetic retinopathy (PDR) after injection of intravitreal bevacizumab (IVB). METHODS Forty-two eyes of 42 patients with PDR, including 28 eyes that received IVB (1.25 mg) 2, 5, and 14 days before pars plana vitrectomy (PPV), and 14 eyes without IVB, were enrolled, in addition to 10 eyes of 10 patients with nondiabetic ocular diseases. Aqueous concentrations of inflammatory cytokines and fibrosis-related factors were analyzed by a multiplex bead assay. Fluorescence immunostaining was performed to examine the expression of VEGF and proliferating cells in the excised epiretinal membranes. RESULTS PDR eyes without IVB had the highest vitreous VEGF levels, and the level was statistically significant compared with that of PDR eyes that received IVB 2 days before surgery, PDR eyes that received IVB 5 days before surgery, and nondiabetic eyes (p = 0.011, p = 0.012, and p < 0.001, respectively). The expression of fibroblastic cells and connective tissue growth factor increased in epiretinal FVMs of the IVB group 21 days after treatment. CONCLUSIONS IVB injection may lead to a decrease in the intraocular concentrations of VEGF after 2-5 days and induce the formation of proliferation after 21 days, which suggests that PPV in PDR patients should take place within 1 week of the administration of preoperative IVB.
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Affiliation(s)
- Jing Feng
- Department of Ophthalmology, Peking University People's Hospital, and Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Bing Li
- Department of Ophthalmology, Peking University People's Hospital, and Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,Department of Ultrasonography, Peking University People's Hospital, Beijing, China
| | - Jing Wen
- Department of Ophthalmology, Peking University People's Hospital, and Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,Department of Pediatric Ophthalmology, Peking University First Hospital, Beijing, China
| | - Yanrong Jiang
- Department of Ophthalmology, Peking University People's Hospital, and Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing,
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21
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Which quadrant is less painful for intravitreal injection? A prospective study. Eye (Lond) 2018; 33:304-312. [PMID: 30202072 DOI: 10.1038/s41433-018-0208-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/03/2018] [Accepted: 07/17/2018] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To evaluate the relationship between injection site and pain severity following intravitreal injection of bevacizumab (IVB). DESIGN Prospective, randomized, four-armed, clinical trial. METHODS The present study was a prospective, randomized, four-armed clinical trial, which included 1004 eyes from 1004 patients. Patients receiving IVB were randomly assigned into four groups: superotemporal (ST); superonasal (SN); inferotemporal (IT); and inferonasal (IN) injections. The visual analog scale (VAS) was used to assess pain. Primary study variables were the relationship between pain severity and injection site, number of previous injections, age, sex, and indication for injection. Secondary variables included best-corrected visual acuity (BCVA) and central macular thickness (CMT) changes 1 month post IVB. RESULTS Overall mean pain score was 2.86 ± 2.2. Indications for injection were diabetic macular edema (84.1%), neovascular age-related macular degeneration (7.7%), and macular edema secondary to retinal vein occlusion (8.2%). The mean VAS scores in the SN, IN, ST, and IT groups were 1.5 ± 1.7, 3 ± 2.3, 4 ± 2, and 3 ± 2.1, respectively. Pain severity was significantly correlated with injection site (p < 0.001) and sex (p < 0.001); females showed higher pain scores. A negative correlation existed between pain score and number of previous injections (p = 0.03). Pain severity was not associated with age (p = 0.659), lens status (p = 0.478), vitreous reflux (p = 0.648), or indication for injection (p = 0.390). No significant complications were observed. CONCLUSIONS ST quadrant was the most painful and SN quadrant was the least painful sites for IVB. Pain severity score was significantly associated with injection site, number of injections, and sex.
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22
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Efficacy and Safety of Ranibizumab 0.5 mg for the Treatment of Macular Edema Resulting from Uncommon Causes. Ophthalmology 2018; 125:850-862. [DOI: 10.1016/j.ophtha.2017.12.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/26/2017] [Accepted: 12/01/2017] [Indexed: 11/20/2022] Open
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23
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Ferreira LM, Alonso JD, Kiill CP, Ferreira NN, Buzzá HH, Martins de Godoi DR, de Britto D, Assis OBG, Seraphim TV, Borges JC, Gremião MPD. Exploiting supramolecular interactions to produce bevacizumab-loaded nanoparticles for potential mucosal delivery. Eur Polym J 2018. [DOI: 10.1016/j.eurpolymj.2018.04.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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24
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Parikh R, Feng PW, Del Priore LV, Adelman RA, Chaudhry NA. Relationship Between Claims Data and the Preferences and Trends Survey: An Analysis of Anti-Vascular Endothelial Growth Factor Medication Choice for Age-Related Macular Degeneration. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/2474126417753433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To compare published self-reported practice patterns among retina specialists with published claims data representing actual practice patterns for the use of anti-vascular endothelial growth factor (anti-VEGF) medications in the treatment of age-related macular degeneration (AMD) in the United States. Methods: We compared physician self-reported preference for anti-VEGF medications to treat AMD in the American Society of Retina Specialists’ Preferences and Trends (PAT) survey with a previously published study using claims data from 2006 to 2015 from OptumLabs Data Warehouse as a data source. A Pearson χ2 test compared the relative proportions of drug use between the 2 groups, with <.05 indicating statistical significance. Results: From 2006 to 2015, the PAT surveys had approximately 3548 respondents to questions on which anti-VEGF medication was used for the treatment of AMD. Over the study period, 62.3% (2211/3548) of respondents preferred bevacizumab, 30.4% (1078/3548) ranibizumab, and 7.3% (259/3548) aflibercept in the treatment of AMD. Claims data on anti-VEGF use for AMD noted 59.7% (359 267/601 917) of injections were for bevacizumab, 23.8% (143 200/601 917) were for ranibizumab, and 16.5% (99 450/601 917) were for aflibercept. The difference in the relative use of bevacizumab, ranibizumab, and aflibercept use was not significant between the data sets ( P = .1991). Conclusions: The PAT survey responses appear to reflect actual physician practices based upon claims data and demonstrate the prevalence of bevacizumab as the prevailing treatment for AMD.
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Affiliation(s)
- Ravi Parikh
- Department of Ophthalmology and Visual Sciences, Yale University School of Medicine, New Haven, CT, USA
- Department of Ophthalmology, Weill Cornell Medical College, New York NY, USA
- Vitreous, Retina, and Macula Consultants of New York, New York, NY, USA
| | - Paula W. Feng
- Department of Ophthalmology and Visual Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Lucian V. Del Priore
- Department of Ophthalmology and Visual Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Ron A. Adelman
- Department of Ophthalmology and Visual Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Nauman A. Chaudhry
- Department of Ophthalmology and Visual Sciences, Yale University School of Medicine, New Haven, CT, USA
- Retina Group of New England, New London, CT, USA
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25
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Glass TJA, Chau V, Gardiner J, Foong J, Vinall J, Zwicker JG, Grunau RE, Synnes A, Poskitt KJ, Miller SP. Severe retinopathy of prematurity predicts delayed white matter maturation and poorer neurodevelopment. Arch Dis Child Fetal Neonatal Ed 2017; 102:F532-F537. [PMID: 28536205 DOI: 10.1136/archdischild-2016-312533] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 04/04/2017] [Accepted: 04/06/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine whether severe retinopathy of prematurity (ROP) is associated with (1) abnormal white matter maturation and (2) neurodevelopmental outcomes at 18 months' corrected age (CA) compared with neonates without severe ROP. DESIGN We conducted a prospective longitudinal cohort of extremely preterm neonates born 24-28 weeks' gestational age recruited between 2006 and 2013 with brain MRIs obtained both early in life and at term-equivalent age. Severe ROP was defined as ROP treated with retinal laser photocoagulation. Using diffusion tensor imaging and tract-based spatial statistics (TBSS), white matter maturation was assessed by mean fractional anisotropy (FA) in seven predefined regions of interest. Neurodevelopmental outcomes were assessed with Bayley Scales of Infant and Toddler Development-III (Bayley-III) composite scores at 18 months' CA. Subjects were compared using Fisher's exact, Kruskal-Wallis and generalised estimating equations. SETTING Families were recruited from the neonatal intensive care unit at BC Women's Hospital. PATIENTS Of 98 extremely preterm neonates (median: 26.0 weeks) assessed locally for ROP, 19 (19%) had severe ROP and 83 (85%) were assessed at 18 months' CA. RESULTS Severe ROP was associated with lower FA in the posterior white matter, and with decreased measures of brain maturation in the optic radiations, posterior limb of the internal capsule (PLIC) and external capsule on TBSS. Bayley-III cognitive and motor scores were lower in infants with severe ROP. CONCLUSIONS Severe ROP is associated with maturational delay in the optic radiations, PLIC, external capsule and posterior white matter, housing the primary visual and motor pathways, and is associated with poorer cognitive and motor outcomes at 18 months' CA.
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Affiliation(s)
- Torin J A Glass
- Department of Pediatrics (Neurology), University of Toronto and the Hospital for Sick Children, Toronto, Canada.,Neurosciences & Mental Health, SickKids Research Institute, Toronto, Canada
| | - Vann Chau
- Department of Pediatrics (Neurology), University of Toronto and the Hospital for Sick Children, Toronto, Canada.,Neurosciences & Mental Health, SickKids Research Institute, Toronto, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada
| | - Jane Gardiner
- BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Ophthalmology and Vision Science, University of British Columbia and BC Children's Hospital, Vancouver, Canada
| | - Justin Foong
- Neurosciences & Mental Health, SickKids Research Institute, Toronto, Canada
| | - Jillian Vinall
- Department of Anesthesiology, University of Calgary, Calgary, Canada
| | - Jill G Zwicker
- BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Pediatrics (Developmental Pediatrics), University of British Columbia and BC Children's and Women's Hospitals, Vancouver, Canada.,Department of Occupational Science and Occupational Therapy, Vancouver, Canada.,Sunny Hill Health Centre for Children, Vancouver, Canada
| | - Ruth E Grunau
- BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Pediatrics (Neonatology), University of British Columbia and BC Children's and Women's Hospitals, Vancouver, Canada
| | - Anne Synnes
- BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Pediatrics (Neonatology), University of British Columbia and BC Children's and Women's Hospitals, Vancouver, Canada
| | - Kenneth J Poskitt
- BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Radiology, University of British Columbia and BC Children's Hospital, Vancouver, Canada
| | - Steven P Miller
- Department of Pediatrics (Neurology), University of Toronto and the Hospital for Sick Children, Toronto, Canada.,Neurosciences & Mental Health, SickKids Research Institute, Toronto, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada
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26
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Sriboonnark T, Boonsopon S, Tesavibul N, Leeamornsiri S, Choopong P. Intravitreal bevacizumab in treatment of retinal neovascularization from tuberculous retinal vasculitis. Int J Ophthalmol 2017; 10:1627-1629. [PMID: 29062788 DOI: 10.18240/ijo.2017.10.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 07/27/2017] [Indexed: 11/23/2022] Open
Affiliation(s)
- Theeratach Sriboonnark
- Department of Ophthalmology, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Sutasinee Boonsopon
- Department of Ophthalmology, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Nattaporn Tesavibul
- Department of Ophthalmology, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Supinda Leeamornsiri
- Department of Ophthalmology, Thammasat University Hospital, Pathumthani 12120, Thailand
| | - Pitipol Choopong
- Department of Ophthalmology, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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Alginate hydrogel improves anti-angiogenic bevacizumab activity in cancer therapy. Eur J Pharm Biopharm 2017; 119:271-282. [DOI: 10.1016/j.ejpb.2017.06.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 04/09/2017] [Accepted: 06/28/2017] [Indexed: 01/30/2023]
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Abstract
Purpose: To evaluate the pain associated with intravitreal aflibercept injections. Methods: The study included 119 patients who received intravitreal aflibercept injection at a single institution. Pain was evaluated by visual analog scale (VAS) immediately after the injection of 2 mg/0.05 mL aflibercept into the vitreous cavity using a 27-G needle. Additional variables including age, sex, indication for the injection, injection site by quadrant (superotemporal or inferotemporal), position during injection (sitting or supine), number of previous intravitreal injections in the study eye, presence of diabetes mellitus or hypertension, and lens status (phakic or pseudophakic) were recorded and assessed with self-reported pain scores. Results: Pain scores on the VAS ranged from 9 to 70, with a median of 18. Indications for injection included diabetic macular edema (21.0%), macular edema secondary to central retinal vein occlusion (12.6%), and neovascular age-related macular degeneration (66.38%). Pain did not significantly correlate with any of the recorded variables. Conclusions: This is the first series evaluating the pain associated with intravitreal aflibercept injections. We demonstrated that pain associated with intravitreal aflibercept injection is generally mild with low pain scores.
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Fay AJ, King AA, Shimony JS, Crow YJ, Brunstrom-Hernandez JE. Treatment of Leukoencephalopathy With Calcifications and Cysts With Bevacizumab. Pediatr Neurol 2017; 71:56-59. [PMID: 28424147 PMCID: PMC5949049 DOI: 10.1016/j.pediatrneurol.2017.03.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/16/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Leukoencephalopathy with calcifications and cysts is a rare, autosomal recessive cerebral microangiopathy that causes progressive white matter disease, calcifications, and cysts within the brain. It is typically associated with slowly progressive psychomotor regression, seizures, and movement disorders. Although leukoencephalopathy with calcifications and cysts affects only the central nervous system, it demonstrates remarkable neuropathologic and radiologic overlap with Coats plus, a disorder of small vessels of the brain, eyes, gastrointestinal tract, and bone. Coats disease without extraocular involvement, a genetically distinct disorder from Coats plus, is characterized by retinal telangiectasias and exudative retinopathy, accompanied by neovascularization. Inhibition of vascular endothelial growth factor (VEGF) signaling with the monoclonal anti-VEGF antibody bevacizumab can improve retinal edema and exudates in Coats disease. Given these observations, we reasoned that VEGF inhibition might also be effective in treating leukoencephalopathy with calcifications and cysts and Coats plus, neither of which has any known therapy. METHODS We treated an 18-year-old man with leukoencephalopathy with calcifications and cysts using biweekly infusions of the VEGF inhibitor bevacizumab for more than one year and performed clinical examinations and brain imaging at three month intervals. RESULTS After treatment for more than one year, the patient showed improved bradykinesia and range of motion, and brain magnetic resonance imaging demonstrated a marked reduction in cyst volume and white matter lesions. CONCLUSIONS Further studies in a cohort of patients are warranted to investigate the efficacy of VEGF inhibition as a treatment for leukoencephalopathy with calcifications and cysts.
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Affiliation(s)
- Alex J. Fay
- Department of Neurology, University of California, San Francisco, San Francisco, California,Communications should be addressed to: Dr. Fay; Department of Neurology; University of California, San Francisco; 1550 4th Street; RH 546; MB 2922; San Francisco, CA 94107.
| | - Allison A. King
- Program in Occupational Therapy, Division of Hematology-Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Joshua S. Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Yanick J. Crow
- Faculty of Biology, Medicine and Health, Division of Evolution and Genomic Sciences, School of Biological Sciences, University of Manchester, UK,INSERM UMR 1163, Laboratory of Neurogenetics and Neuroinflammation, Institut Imagine, Hôpital Necker, Paris Descartes—Sorbonne Paris Cité University, Paris, France
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Matsuda M, Krempel PG, Marquezini MV, Sholl-Franco A, Lameu A, Monteiro MLR, Miguel NCDO. Cellular stress response in human Müller cells (MIO-M1) after bevacizumab treatment. Exp Eye Res 2017; 160:1-10. [PMID: 28419863 DOI: 10.1016/j.exer.2017.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 03/30/2017] [Accepted: 04/14/2017] [Indexed: 01/13/2023]
Abstract
Bevacizumab, an anti-vascular endothelial growth factor (VEGF) agent, is widely used in the treatment of retinal vascular diseases. However, due to the essential role Müller cell derived-VEGF plays in the maintenance of retinal neurons and glial cells, cell viability is likely to be affected by VEGF inhibition. We therefore evaluated the effect of bevacizumab-induced VEGF inhibition on Müller cells (MIO-M1) in vitro. MIO-M1 cells were cultured for 12 or 24 h in media containing bevacizumab at 0.25 or 0.5 mg/mL. Controls were cultured in medium only. Cell viability was determined with the trypan blue exclusion test and MTT assay. Caspase-3, beclin-1, glial fibrillary acidic protein (GFAP) and vimentin content were quantified by immunohistochemistry. Gene expression was evaluated by real-time quantitative PCR. Treatment with bevacizumab did not reduce MIO-M1 cell viability, but increased metabolic activity at 24 h (0.5 mg/mL) and induced apoptosis and autophagy, as shown by the increased caspase-3 levels at 12 h (0.25 and 0.5 mg/mL) and the increased beclin levels at 24 h (0.5 mg/mL). Caspase-3 mRNA was upregulated at 12 h and downregulated at 24 h in cells treated with bevacizumab at 0.25 mg/mL. Bevacizumab treatment was also associated with structural protein abnormalities, with decreased GFAP and vimentin content and upregulated GFAP and vimentin mRNA expression. Although bevacizumab did not significantly affect MIO-M1 cell viability, it led to metabolic and molecular changes (apoptosis, autophagy and structural abnormalities) suggestive of significant cellular toxicity.
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Affiliation(s)
- Monique Matsuda
- Laboratory of Investigation in Ophthalmology (LIM-33), Division of Ophthalmology, University of São Paulo Medical School, Brazil
| | - Paloma Gava Krempel
- Laboratory of Investigation in Ophthalmology (LIM-33), Division of Ophthalmology, University of São Paulo Medical School, Brazil
| | - Mônica Valeria Marquezini
- Laboratory of Experimental Air Pollution, University of São Paulo Medical School & Pro-Sangue Foundation, São Paulo, Brazil
| | - Alfred Sholl-Franco
- Laboratório de Neurogênese, Programa de Neurobiologia, Instituto de Biofísica Carlos Chagas Filho, UFRJ, Rio de Janeiro, Brazil
| | - Amanda Lameu
- Pharmacy College, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Mário Luiz R Monteiro
- Laboratory of Investigation in Ophthalmology (LIM-33), Division of Ophthalmology, University of São Paulo Medical School, Brazil.
| | - Nádia Campos de Oliveira Miguel
- Program of Cell and Developmental Biology, Institute of Biomedical Sciences, Federal University of Rio de Janeiro (UFRJ), Brazil
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New Developments in the Classification, Pathogenesis, Risk Factors, Natural History, and Treatment of Branch Retinal Vein Occlusion. J Ophthalmol 2017; 2017:4936924. [PMID: 28386476 PMCID: PMC5366235 DOI: 10.1155/2017/4936924] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/07/2017] [Indexed: 12/15/2022] Open
Abstract
For years, branch retinal vein occlusion is still a controversial disease in many aspects. An increasing amount of data is available regarding classification, pathogenesis, risk factors, natural history, and therapy of branch retinal vein occlusion. Some of the conclusions may even change our impression of branch retinal vein occlusion. It will be beneficial for our doctors to get a deeper understanding of this disease and improve the treatment skills. The aims of this review is to collect the information above and report new ideas especially from the past a few years.
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Parikh R, Ross JS, Sangaralingham LR, Adelman RA, Shah ND, Barkmeier AJ. Trends of Anti-Vascular Endothelial Growth Factor Use in Ophthalmology Among Privately Insured and Medicare Advantage Patients. Ophthalmology 2017; 124:352-358. [DOI: 10.1016/j.ophtha.2016.10.036] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/25/2016] [Accepted: 10/27/2016] [Indexed: 12/31/2022] Open
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Khneizer G, Al-Taee A, Bastani B. Self-limited membranous nephropathy after intravitreal bevacizumab therapy for age-related macular degeneration. J Nephropathol 2017; 6:134-137. [PMID: 28975092 PMCID: PMC5607973 DOI: 10.15171/jnp.2017.23] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 01/30/2017] [Indexed: 11/11/2022] Open
Abstract
Background:
Monoclonal antibodies targeting vascular endothelial growth factor (VEGF), such as bevacizumab, are administered intravitreally for the treatment of wet or exudative age-related macular degeneration (ARMD). Systemic use of bevacizumab has been linked to a wide range of renal adverse effects including proteinuria and hypertension.
Case Presentation:
We present the case of a 77-year-old Caucasian male with a past medical history of hypertension, vitamin D deficiency and paroxysmal atrial fibrillation who presented to primary care clinic with a 2-week history of bilateral lower extremity edema, 2 months after completing four monthly intravitreal injections of bevacizumab for ARMD. Examination was remarkable for blood pressure of 187/91 mm Hg and severe bilateral lower extremity edema. Work up revealed unremarkable complete blood count (CBC), comprehensive metabolic panel (CMP), lipid panel, and echocardiography, except for 491 mg/dL albuminuria. Metoprolol and furosemide were added to hydrochlorothiazide and lisinopril. Work up by nephrology consult team five months later was notable for a urinalysis revealing 3 red blood cells/high power field (RBC/HPF), 24-hour urine protein of 8.6 g, and serum creatinine of 1.2 mg/dL. Viral hepatitis panel, total complement activity (CH50), C3, C4, anti-nuclear antibody (ANA), anti-neutrophil cytoplasmic antibody (ANCA), serum and urine protein electrophoresis were all unremarkable. Renal biopsy was consistent with membranous nephropathy. Age-appropriate cancer screening was negative. Random urine protein-to-creatinine ratio declined to 2 g/g and then to 0.56 g/g at 7 and 10 months follow up, respectively. Serum blood urea nitrogen (BUN) and creatinine remained normal throughout the course of illness and patient did not require any immunosuppressive treatment.
Conclusions:
The wide range of nephrotoxicity after systemic bevacizumab has been well documented. Our case describes a self-limited biopsy-proven membranous nephropathy after intravitreal bevacizumab injections.
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Affiliation(s)
- Gebran Khneizer
- Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Ahmad Al-Taee
- Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Bahar Bastani
- Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
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Butler CT, Reynolds AL, Tosetto M, Dillon ET, Guiry PJ, Cagney G, O'Sullivan J, Kennedy BN. A Quininib Analogue and Cysteinyl Leukotriene Receptor Antagonist Inhibits Vascular Endothelial Growth Factor (VEGF)-independent Angiogenesis and Exerts an Additive Antiangiogenic Response with Bevacizumab. J Biol Chem 2016; 292:3552-3567. [PMID: 28035003 DOI: 10.1074/jbc.m116.747766] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 12/19/2016] [Indexed: 12/31/2022] Open
Abstract
Excess blood vessel growth contributes to the pathology of metastatic cancers and age-related retinopathies. Despite development of improved treatments, these conditions are associated with high economic costs and drug resistance. Bevacizumab (Avastin®), a monoclonal antibody against vascular endothelial growth factor (VEGF), is used clinically to treat certain types of metastatic cancers. Unfortunately, many patients do not respond or inevitably become resistant to bevacizumab, highlighting the need for more effective antiangiogenic drugs with novel mechanisms of action. Previous studies discovered quininib, an antiangiogenic small molecule antagonist of cysteinyl leukotriene receptors 1 and 2 (CysLT1 and CysLT2). Here, we screened a series of quininib analogues and identified a more potent antiangiogenic novel chemical entity (IUPAC name (E)-2-(2-quinolin-2-yl-vinyl)-benzene-1,4-diol HCl) hereafter designated Q8. Q8 inhibits developmental angiogenesis in Tg(fli1:EGFP) zebrafish and inhibits human microvascular endothelial cell (HMEC-1) proliferation, tubule formation, and migration. Q8 elicits antiangiogenic effects in a VEGF-independent in vitro model of angiogenesis and exerts an additive antiangiogenic response with the anti-VEGF biologic bevacizumab. Cell-based receptor binding assays confirm that Q8 is a CysLT1 antagonist and is sufficient to reduce cellular levels of NF-κB and calpain-2 and secreted levels of the proangiogenic proteins intercellular adhesion molecule-1, vascular cell adhesion protein-1, and VEGF. Distinct reductions of VEGF by bevacizumab explain the additive antiangiogenic effects observed in combination with Q8. In summary, Q8 is a more effective antiangiogenic drug compared with quininib. The VEGF-independent activity coupled with the additive antiangiogenic response observed in combination with bevacizumab demonstrates that Q8 offers an alternative therapeutic strategy to combat resistance associated with conventional anti-VEGF therapies.
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Affiliation(s)
- Clare T Butler
- From the UCD School of Biomolecular and Biomedical Science, UCD Conway Institute and
| | - Alison L Reynolds
- From the UCD School of Biomolecular and Biomedical Science, UCD Conway Institute and
| | - Miriam Tosetto
- Centre for Colorectal Disease, St. Vincent's University Hospital, Dublin 4, Ireland, and
| | - Eugene T Dillon
- From the UCD School of Biomolecular and Biomedical Science, UCD Conway Institute and
| | - Patrick J Guiry
- UCD School of Chemistry, UCD Centre for Synthesis and Chemical Biology, University College Dublin, Belfield, Dublin 4, Ireland
| | - Gerard Cagney
- From the UCD School of Biomolecular and Biomedical Science, UCD Conway Institute and
| | - Jacintha O'Sullivan
- Trinity Translational Medicine Institute, Department of Surgery, Trinity College Dublin, St. James's Hospital, Dublin 8, Ireland
| | - Breandán N Kennedy
- From the UCD School of Biomolecular and Biomedical Science, UCD Conway Institute and
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Reduction in the frequency of intravitreal bevacizumab administrations achieved by posterior subtenon injection of triamcinolone acetonide in patients with diffuse diabetic macular edema. Jpn J Ophthalmol 2016; 60:401-7. [PMID: 27306783 DOI: 10.1007/s10384-016-0458-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 04/26/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate the effectiveness of posterior subtenon injections of triamcinolone acetonide (STTA) during treatment with intravitreal injections of bevacizumab (IVB) in eyes with diffuse diabetic macular edema (DDME). METHODS Forty eyes of 20 patients with bilateral DDME with foveal thickness (FT) greater than 400 μm were studied. Initially, both eyes of each patient received 1.25 mg/0.05 ml of IVB. One eye then received 20 mg/0.5 ml of STTA at the onset and at 16, 32, and 48 weeks. For the control, the other eye was not treated with STTA. Patients were treated with additional IVB when DDME recurred during the study to maintain the FT at <350 μm. The FT, logMAR visual acuity (VA), and intraocular pressure (IOP) were monitored monthly for 56 weeks. The total number of IVB injections during the 1-year follow-up was also calculated. RESULTS STTA-treated eyes had significantly more regression of FT and improvement of VA at several time points during the study than did the controls. The mean (SD) required number of IVB injections in the STTA-treated eyes during the study was 5.00 ± 1.75, which was significantly less than the 7.95 ± 1.57 in the control eyes. CONCLUSIONS Adjunctive STTA therapy to IVB for the treatment of DDME not only improved the morphological and functional regressions but also reduced the frequency of IVB treatments.
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Jo YJ, Kim WJ, Shin IH, Kim JY. Longitudinal Changes in Retinal Nerve Fiber Layer Thickness after Intravitreal Anti-vascular Endothelial Growth Factor Therapy. KOREAN JOURNAL OF OPHTHALMOLOGY 2016; 30:114-20. [PMID: 27051259 PMCID: PMC4820521 DOI: 10.3341/kjo.2016.30.2.114] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/13/2015] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the effects of intravitreal anti-vascular endothelial growth factor (VEGF) on thickness of the retinal nerve fiber layer (RNFL) in patients with age-related macular degeneration. Methods Twenty eyes of 20 patients diagnosed with age-related macular degeneration who underwent intravitreal anti-VEGF injection were studied. Postinjection RNFL thickness was measured using optical coherence tomography. Average thickness, four-quadrant RNFL thicknesses, and intraocular pressure (IOP) in affected eyes were measured before and 6 and 12 months after anti-VEGF injection for comparison. RNFL thickness and IOP in affected and normal fellow eyes were also compared. Given that macular lesions can affect RNFL thickness, the changes in thickness were evaluated by dividing the 12 clock-hour RNFL into the pathologic areas adjacent to the lesion and the non-pathologic area. Results The mean clock-hour segment in the pathologic area was 4.8 hours. A significantly thicker RNFL was exhibited in temporal quadrants and pathologic areas (p = 0.043 and 0.048, respectively) in affected eyes before injection compared to the baseline RNFL thickness in normal eyes. No significant differences were found in RNFL thickness or IOP between affected and normal eyes after injection. The changes over time in the temporal and pathologic areas were statistically significant at 6 and 12 months after injection compared to baseline data (p < 0.05). No significant differences were displayed in RNFL thickness in the other three quadrants or in non-pathologic areas in either affected or normal eyes. Sequential changes in RNFL thickness in affected eyes were not significant. Conclusions Repeat intravitreal anti-VEGF treatment did not have a significant effect on RNFL thickness. RNFL thickness significantly decreased with time in the pathologic areas and in the temporal segment adjacent to exudative macular lesions. The reduction in RNFL thickness was most likely associated with changes in the macular lesion rather than with anti-VEGF injection.
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Affiliation(s)
- Young-Joon Jo
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea.; Research Institute for Medical Science, Chungnam National University College of Medicine, Daejeon, Korea
| | - Woo-Jin Kim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Il-Hwan Shin
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jung-Yeul Kim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea.; Research Institute for Medical Science, Chungnam National University College of Medicine, Daejeon, Korea
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Abstract
Vascular endothelial growth factor (VEGF) is a signaling protein, that controls vasculogenesis, angiogenesis, vascular support and stimulates permeability of small blood vessels. The following isoforms are presently known: VEGF-A, VEGF-B, VEGF-C, VEGF-В and PGF. VEGF-A, that regulates neoangiogenesis and fibroblast formation, is thought to play the most important role in human organism. Increased expression of VEGF may lead to development and aggravation of pathological conditions including oncology. The article presents a review of preclinical and clinical studies of the main VEGF-inhibitors - bevacizumab and ranibizumab, as well as a brief account on other existing medications of this group. It describes ophthalmological indications for the use of antiangiogenetic agents, as well as the ways of their possible off-label use. The review presents investigations of intravitreal and intracameral injections of VEGF-inhibitors in patients with retinal, chorioidal, iris, and anterior chamber angle neovascularization. It gives examples of successful anti-VEGF use before Ahmed glaucoma valve drainage device implantation and in cases of neovascular glaucoma, induced by radiation therapy for intraocular tumors. Tenon’s capsule’s fibroblasts take part in the process of postoperative wound healing and scarring. According to the latest research, this process could be modulated by angiogenesis inhibitors. This review also recounts the use of anti-angiogenic agents to inhibit postoperative fibroblast proliferation, when used as monotherapy, or as an adjuvant to mitomycin С or 5-fluorouracil. It reviews the research on VEGF-inibitors use in combination with postoperative needling.
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Jeong KD, Kim JH, Kim JS, Hwang JH. Relationship between Pain and Injection Site during Intravitreal Injection. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.6.930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Kyeong Do Jeong
- Department of Ophthalmology, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Jung Hoon Kim
- Department of Ophthalmology, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Jae Suk Kim
- Department of Ophthalmology, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Je Hyung Hwang
- Department of Ophthalmology, Inje University Sanggye Paik Hospital, Seoul, Korea
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Tah V, Orlans HO, Hyer J, Casswell E, Din N, Sri Shanmuganathan V, Ramskold L, Pasu S. Anti-VEGF Therapy and the Retina: An Update. J Ophthalmol 2015; 2015:627674. [PMID: 26417453 PMCID: PMC4568374 DOI: 10.1155/2015/627674] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/28/2015] [Accepted: 07/05/2015] [Indexed: 01/31/2023] Open
Abstract
Ocular angiogenesis and macular oedema are major causes of sight loss across the world. Aberrant neovascularisation, which may arise secondary to numerous disease processes, can result in reduced vision as a result of oedema, haemorrhage, and scarring. The development of antivascular endothelial growth factor (anti-VEGF) agents has revolutionised the treatment of retinal vasogenic conditions. These drugs are now commonly employed for the treatment of a plethora of ocular pathologies including choroidal neovascularisation, diabetic macular oedema, and retinal vein occlusion to name a few. In this paper, we will explore the current use of anti-VEGF in a variety of retinal diseases and the impact that these medications have had on visual outcome for patients.
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Affiliation(s)
- Vikas Tah
- The Royal Berkshire NHS Foundation Trust, Craven Road, Reading RG1 5AN, UK
| | - Harry O. Orlans
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | - Jonathan Hyer
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | - Edward Casswell
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | - Nizar Din
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | | | - Louise Ramskold
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | - Saruban Pasu
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
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Abstract
Ocular angiogenesis is one of the underlying causes of blindness and vision impairment and may occur in a spectrum of disorders, including diabetic retinopathy, neovascular age-related macular degeneration, retinal artery or vein occlusion, and retinopathy of prematurity. As such, strategies to inhibit angiogenesis by suppressing vascular endothelial growth factor activity have proven to be effective in the clinic for the treatment of eye diseases. A complementary approach would be to increase the level of naturally occurring inhibitors of angiogenesis, such as thrombospondin (TSP)-1. This article summarizes the development of TSP-1-based inhibitors of angiogenesis.
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Affiliation(s)
- Jennifer N Sims
- Department of Pathology, Beth Israel Deaconess Medical Center , Harvard Medical School, Boston, Massachusetts
| | - Jack Lawler
- Department of Pathology, Beth Israel Deaconess Medical Center , Harvard Medical School, Boston, Massachusetts
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Khawaja MR, Minturn JT, Spittler AJ, Chiorean EG. Ocular metastasis of colorectal cancer: An uncommon presentation of a common malignancy. Hematol Oncol Stem Cell Ther 2015; 8:176-80. [PMID: 25784129 DOI: 10.1016/j.hemonc.2015.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 02/08/2015] [Accepted: 02/21/2015] [Indexed: 01/05/2023] Open
Abstract
Approximately 20% of patients with colorectal cancer have metastatic disease at time of diagnosis, and another 25-35% develop metastases during the course of their disease. Liver, peritoneum, and lungs are the most common sites of metastases. We report the case of a 60-year-old female who presented with ocular metastasis 4 years after her initial curative-intent treatment for T3N1M0 rectal adenocarcinoma. After local eye radiation therapy, she received palliative systemic chemotherapy and enjoyed a good quality of life for 32 months before succumbing to progressive disease. Ocular metastasis of colorectal cancer is rare. When present, it usually occurs in the setting of diffuse hematogenous spread. In addition to local therapy, systemic chemotherapy should also be considered.
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Affiliation(s)
- Muhammad Rizwan Khawaja
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - A John Spittler
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - E Gabriela Chiorean
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA; University of Washington, Seattle, WA, USA.
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Abu-Yaghi NE, Shokry AN, Abu-Sbeit RH. Bilateral same-session intravitreal injections of anti-vascular endothelial growth factors. Int J Ophthalmol 2014; 7:1017-21. [PMID: 25540758 DOI: 10.3980/j.issn.2222-3959.2014.06.20] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 06/22/2014] [Indexed: 01/02/2023] Open
Abstract
AIM To document the indications, safety and possible complications of bilateral same-session intravitreal anti-vascular endothelial growth factor (VEGF) injections performed in the ophthalmic operating room. METHODS A retrospective case series study. Consecutive records of seventy four patients receiving simultaneous bilateral intravitreal injections of either ranibizumab or bevacizumab, between September 2010 and September 2013, were reviewed and the outcomes were assessed. Data collected included number of injections, indications for injections, pre-injection and post-injection visual acuity (VA), pre-injection and post-injection intraocular pressure and ocular and systemic complications/complaints after each injection. RESULTS A total of 342 injections were administered to 74 patients, with a mean of 4.62 injections per patient. Seventy-three patients received bevacizumab (Avastin; Genentech Inc., South San Francisco, California, USA) alone, and only one patient received both bevacizumab and ranibizumab (Lucentis; Genentech Inc.) distributed between the injections. Pre- and post-injection VA follow-up measurements were available for 65 patients. Mean follow up period was 22mo. The indications for initiating therapy were choroidal neovascular membrane from age-related macular degeneration (3 patients) and diabetic macular edema (71 patients). The mean Snellen VA before each injection was 6/22. The next post-injection follow-up mean Snellen VA was 6/20. One patient had a painful, culture-positive endophthalmitis in one eye 3d after bilateral bevacizumab. Another patient had a painless subconjunctival hemorrhage in one eye. No other ocular or systemic adverse side effects/complaints have been registered in this study group. CONCLUSION Bilateral same-session intravitreal injections using a separate povidone-iodine preparation, speculum, needle, and syringe for each eye are well-tolerated. None of the subjects in this study requested to switch to alternating unilateral injections. Proper patient counseling as to the risk of complications with this procedure is necessary.
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Affiliation(s)
- Nakhleh E Abu-Yaghi
- Department of Ophthalmology, Faculty of Medicine, the University of Jordan, Amman 11118, Jordan
| | - Ahmed N Shokry
- Department of Ophthalmology, Faculty of Medicine, the University of Jordan, Amman 11118, Jordan
| | - Rami H Abu-Sbeit
- Department of Ophthalmology, Faculty of Medicine, the University of Jordan, Amman 11118, Jordan
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Johnson D, Jagan L, Kurji A, Jumaa K, Sharma S. Emergency department visits after intravitreal bevacizumab and ranibizumab injections in diabetic patients. Can J Ophthalmol 2014; 49:e146-8. [PMID: 25433751 DOI: 10.1016/j.jcjo.2014.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 08/22/2014] [Accepted: 08/31/2014] [Indexed: 10/24/2022]
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Nava-Castañeda A, Ulloa-Orozco I, Garnica-Hayashi L, Hernandez-Orgaz J, Jimenez-Martinez MC, Garfias Y. Triple subconjunctival bevacizumab injection for early corneal recurrent pterygium: one-year follow-up. J Ocul Pharmacol Ther 2014; 31:106-13. [PMID: 25369364 DOI: 10.1089/jop.2014.0060] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The aim of the study was to evaluate the effect of 3 subconjunctival bevacizumab injections in patients with an early corneal pterygium recurrence. METHODS This study was a nonrandomized single center trial. Patients with an early corneal pterygium recurrence were selected. All patients received 3 subconjunctival bevacizumab (2.5 mg/0.1 mL) injections (basal, 2 and 4 weeks) in the recurrence area of the pterygium. The corneal and corneal-conjunctival neovascularization areas and the corneal opacification area of each pterygium were determined using digital slit lamp pictures. RESULTS Thirty-eight patients were enrolled into the study; all patients were injected within 3 months of the diagnosed pterygium recurrence. Interestingly, the bevacizumab injections had a significant effect (P<0.05) on the reduction of corneal, corneal-conjunctival area of neovascularization determined as pixels and on the corneal opacification area determined as mm(2) when comparing the basal values, to the values obtained after 15 days, 1 month, 3 months, 6 months, and 12 months after injections. CONCLUSIONS The vascularized area in all recurrent pterygia and the corneal opacification area with this triple regimen of subconjunctival bevacizumab injections were reduced, which remained until the end of the study. These results suggest that bevacizumab subconjunctival injections could be useful to treat recurrent pterygium.
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Affiliation(s)
- Angel Nava-Castañeda
- 1 Research Unit, Institute of Ophthalmology Conde de Valenciana Foundation, Colonia Obrera, Mexico City, Mexico
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Sulaiman RS, Basavarajappa HD, Corson TW. Natural product inhibitors of ocular angiogenesis. Exp Eye Res 2014; 129:161-71. [PMID: 25304218 DOI: 10.1016/j.exer.2014.10.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/03/2014] [Accepted: 10/06/2014] [Indexed: 12/21/2022]
Abstract
Natural products are characterized by high chemical diversity and biochemical specificity; therefore, they are appealing as lead compounds for drug discovery. Given the importance of angiogenesis to many pathologies, numerous natural products have been explored as potential anti-angiogenic drugs. Ocular angiogenesis underlies blinding eye diseases such as retinopathy of prematurity (ROP) in children, proliferative diabetic retinopathy (DR) in adults of working age, and age-related macular degeneration (AMD) in the elderly. Despite the presence of effective therapy in many cases, these diseases are still a significant health burden. Anti-VEGF biologics are the standard of care, but may cause ocular or systemic side effects after intraocular administration and patients may be refractory. Many anti-angiogenic compounds inhibit tumor growth and metastasis alone or in combination therapy, but a more select subset of them has been tested in the context of ocular neovascular diseases. Here, we review the promise of natural products as anti-angiogenic agents, with a specific focus on retinal and choroidal neovascularization. The multifunctional curcumin and the chalcone isoliquiritigenin have demonstrated promising anti-angiogenic effects in mouse models of DR and choroidal neovascularization (CNV) respectively. The homoisoflavanone cremastranone and the flavonoid deguelin have been shown to inhibit ocular neovascularization in more than one disease model. The isoflavone genistein and the flavone apigenin on the other hand are showing potential in the prevention of retinal and choroidal angiogenesis with long-term administration. Many other products with anti-angiogenic potential in vitro such as the lactone withaferin A, the flavonol quercetin, and the stilbenoid combretastatin A4 are awaiting investigation in different ocular disease-relevant animal models. These natural products may serve as lead compounds for the design of more specific, efficacious, and affordable drugs with minimal side effects.
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Affiliation(s)
- Rania S Sulaiman
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, United States; Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, United States; Department of Biochemistry, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Halesha D Basavarajappa
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, United States; Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Timothy W Corson
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, United States; Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, United States; Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, United States; Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, United States.
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Hashemi S, Faramarzi MA, Ghasemi Falavarjani K, Abdollahi M. Bevacizumab for choroidal neovascularization secondary to age-related macular degeneration and pathological myopia. Expert Opin Biol Ther 2014; 14:1837-48. [DOI: 10.1517/14712598.2014.967210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Shimura M, Yasuda K. Topical bromfenac reduces the frequency of intravitreal bevacizumab in patients with branch retinal vein occlusion. Br J Ophthalmol 2014; 99:215-9. [DOI: 10.1136/bjophthalmol-2013-304720] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ferreira MA, Ferreira REA, Silva NS. Preoperative intravitreal bevacizumab and silicone oil tamponade for vitrectomy in diabetic retinopathy. World J Ophthalmol 2014; 4:75-81. [DOI: 10.5318/wjo.v4.i3.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/14/2014] [Accepted: 06/27/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the outcomes and complications of vitrectomy for diabetic retinopathy using preoperative bevacizumab and silicone oil (SO) tamponade.
METHODS: Eighty-four eyes (64 patients) that underwent vitrectomy to treat severe proliferative diabetic retinopathy were enrolled in this retrospective, interventional, serial case study. All patients provided signed informed consent preoperatively and the off-label use of bevacizumab was discussed with the patients and confirmed in the signed consent forms. Bevacizumab injections and SO tamponades were used in all cases and intraoperative complications, postoperative complications and postoperative outcomes were analyzed. The primary outcome was the occurrence of intraoperative and postoperative bleeding during and after vitrectomy and SO removal. The secondary outcomes were other complications that occurred during the two surgeries, the surgical time and the postoperative best-corrected visual acuity (BCVA) in logMAR scale compared with the preoperative BCVA in logMAR. The statistical analysis was performed with GraphPad Prism 5 (GraphPad Software, La Jolla, CA) using a column analysis (column statistics and frequency distribution) for the noncomparative analysis and a paired t-test for the comparative study; P < 0.05 indicated statistical significance.
RESULTS: Eighty-four eyes of 64 patients were included in the study. Of the 88 eyes initially recruited, 4 eyes (0.45%) developed phthisis bulbi and were excluded from the statistical analysis. Bevacizumab was injected between 1 and 10 d before surgery, with a mean of 3.7 ± 2.2 d. Forty-six eyes (54.8%) had no complications during the surgery; 6 eyes (7.1%) had vitreous hemorrhage; 21 (25%) had a single retinal tear; 7 (8.3%) had two or more retinal tears, one of which was in the posterior pole, temporal to the fovea; 2 (2.4%) had retinal tears associated with hemorrhage; 1 (1.2%) had choroidal detachment; and 1 eye (1.2%) had dialysis in the temporal entrance of the trocar. After the surgery and SO removal, 60 eyes (71.4%) had no complications, 8 (9.5%) had vitreous hemorrhage, 2 (2.4%) had a macular hole, 2 (2.4%) had an epiretinal membrane, 7 (8.3%) had rhegmatogenous retinal detachment, 2 (2.4%) had neovascular glaucoma, 2 (2.4%) had a corneal trophic ulcer, and 1 (1.2%) had central venous occlusion. The surgical time ranged from 40 to 120 min, with a mean of 77.8 ± 20.7 min. The final status of the lens was 34 phakic eyes (40.5%) and 24 pseudophakic eyes (28.5%); in 26 eyes (31%), the lens was extracted via phacoemulsification combined with vitrectomy or SO removal. The preoperative BCVA in logMAR ranged from 0.1 to 3.0, with a mean of 1.6 ± 0.9; the postoperative BCVA in logMAR ranged from 0.0 to 3.0, with a mean of 0.9 ± 0.7; the preoperative and postoperative BCVA values were significantly different (P < 0.0001).
CONCLUSION: Bevacizumab may diminish intraoperative and postoperative bleeding, thus possibly facilitating intraoperative maneuvers, diminishing the complications and playing a role in the final outcomes of these eyes.
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Tabatabaii A, Ahmadraji A, Khodabande A, Mansouri M. Acute bilateral endophthalmitis following bilateral intravitreal bevacizumab (avastin) injection. Middle East Afr J Ophthalmol 2014; 20:87-8. [PMID: 23580860 PMCID: PMC3617537 DOI: 10.4103/0974-9233.106402] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The clinical presentation and management of two patients who presented with acute bilateral endophthalmitis following bilateral intravitreal bevacizumab injection. Both cases were diagnosed clinically and subsequent to a vitreous sample, intravitreal ceftazidime (2.25 mg/0.1ml) and vancomycin (1 mg/0.1ml) were injected. One patient had a significant improvement in signs and symptoms after intravitreal antibiotics. However, there were was no improvement in the other patient and pars plana vitrectomy was performed bilaterally. Vitreous cultures were positive in both cases for Staphylococcus epidermidis.
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Affiliation(s)
- Ali Tabatabaii
- Farabi Eye Hospital, Tehran University of Medical Science, Tehran, Iran
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