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Zografos LJ, Andrews E, Wolin DL, Calingaert B, Davenport EK, Michel A, Latocha M, Schmidt-Ott UM, Lovic N, Brunck LR, Johnson KT, Suzart-Woischnik K. Evaluation of Physician Knowledge of Safety and Safe Use Information for Intravitreal Aflibercept Injection in Europe: A Second Survey of Physicians Following Dissemination of Updated Risk-Minimization Materials. Pharmaceut Med 2024; 38:63-73. [PMID: 38049618 PMCID: PMC10824811 DOI: 10.1007/s40290-023-00506-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Materials have been distributed in the European Union to inform physicians on the safe use of intravitreal aflibercept (IVT-AFL) as part of the risk-minimization plan for IVT-AFL. OBJECTIVE We aimed to measure physician knowledge and understanding of key safety information for IVT-AFL. METHODS The current study was a follow-up cross-sectional survey ('wave 2') to an earlier survey ('wave 1') examining the effectiveness of the IVT-AFL educational materials by assessing physician knowledge of the key safety information. Based on wave 1 results, the educational materials were revised to focus more on items of key concern (e.g., use in women of childbearing potential, procedural information); physicians in France, Germany, Italy, Spain, and the UK completed a questionnaire to evaluate their knowledge of key safety information in the revised educational materials. RESULTS Among 454 physician respondents (of 4715 invited; response rate 9.6%), most reported having received the IVT-AFL Summary of Product Characteristics (SmPC; 89%) and Prescriber Guide (82%). More than half reported receiving the Injection Procedure Video (54%) and Patient Booklet (65%). The highest percentage of correct answers was observed for questions concerning procedural steps, the most important risks, and safe use as emphasized by the educational materials and the SmPC. CONCLUSION Physician knowledge and understanding of safe use of IVT-AFL, including for questions that prompted revisions to the educational materials, suggests the need to reconsider methods for developing educational materials to follow best practices (e.g., focusing on only key messages and pretesting with end users).
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Affiliation(s)
- Laurie J Zografos
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA.
| | - Elizabeth Andrews
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Dan L Wolin
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Brian Calingaert
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Eric K Davenport
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
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Sayin N, Kocak I, Pehlivanoğlu S, Pekel G, Er A, Bayramoğlu SE, Aydin A. A quantitative sonoelastography evaluation of ocular and periocular elasticity after intravitreal ranibizumab injection. J Fr Ophtalmol 2023; 46:1030-1038. [PMID: 37598105 DOI: 10.1016/j.jfo.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/28/2023] [Accepted: 03/05/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE We evaluated changes in ocular and periocular elasticity by ultrasound (US) elastography in intravitreal ranibizumab-treated eyes and the healthy fellow eyes of patients with neovascular AMD. METHODS The study was performed on 52 eyes of 26 volunteers who ranged in age from 59 to 89 (mean 72±7.78) years old. The study group consisted of the patients with neovascular AMD treated with intravitreal ranibizumab. The fellow eyes (without choroidal neovascularization) of the study group were selected as the control group. All patients were examined with sonoelastography before intravitreal injection and at 1day, 1week, and 1month after intravitreal injection. All images were acquired with a Toshiba Aplio 500 ultrasound system (Tokyo, Japan) including software with a combined autocorrelation method and a multifrequency linear probe. The elastography values of the anterior vitreous (AV), posterior vitreous (PV), retina-choroid-sclera complex (RCS), retrobulbar fat tissue (RF), optic nerve head (ONH) and retrobulbar optic nerve (RON) were measured in each eye. RESULTS There were 13 male (50%) and 13 female (50%) participants in our study. Anterior vitreous, posterior vitreous, RCS, retrobulbar fat tissue, ONH, and RON US elastography values were similar in both groups (P˃0.05 for all). On the other hand, there was a positive correlation between the difference between baseline and 1-month PV sonoelastography values and age (r=0.47, P=0.035). CONCLUSION A single dose intravitreal Ranibizumab (Lucentis®, Genentech, USA) injection does not alter the elasticity of ocular and periocular structures.
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Affiliation(s)
- N Sayin
- University of Health Sciences, School of Medicine, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey.
| | - I Kocak
- University of Health Sciences, School of Medicine, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey.
| | - S Pehlivanoğlu
- University of Health Sciences, School of Medicine, Beyoglu Eye Training and Research Hospital, İstanbul, Turkey
| | - G Pekel
- Pamukkale University School of Medicine, Department of Ophthalmology, Denizli, Turkey
| | - A Er
- İzmir Tepecik, Training and Research Hospital, Izmir, Turkey
| | - S E Bayramoğlu
- University of Health Sciences, School of Medicine, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - A Aydin
- Near East University, School of Medicine, Lefkosa, Cyprus
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Aşikgarip N, Temel E, Örnek K. Macular ganglion cell complex changes in eyes treated with aflibercept for neovascular age-related macular degeneration. Photodiagnosis Photodyn Ther 2021; 35:102383. [PMID: 34102332 DOI: 10.1016/j.pdpdt.2021.102383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/23/2021] [Accepted: 06/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND To evaluate the effect of intravitreal aflibercept injection on macular ganglion cell complex (GCC) in patients with neovascular age-related macular degeneration (nAMD). METHODS In total, 36 eyes of 36 treatment-naïve patients with nAMD (18 female and 18 male) and 36 eyes of 36 healthy subjects (20 female and 16 male) as controls were included in this retrospective study. Spectral-domain optical coherence tomography images were evaluated after each injection for 3 months and at 12 months. Mean GCC thickness of the center, inner ring, and outer ring of the ETDRS grid was automatically quantified. RESULTS Mean foveal thickness was statistically significantly decreased at 3 months and at 12 months compared with baseline in the patient group. Ganglion cell layer thickness in the center was statistically significantly decreased in eyes with nAMD at baseline. There was a statistically significant decrease for mean retinal nerve fiber layer, ganglion cell layer, and inner plexiform layer thickness at 12 months compared with baseline. CONCLUSIONS Macular GCC thickness was decreased after intravitreal aflibercept injection in patients with nAMD, in particular at 12 months.
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Affiliation(s)
- Nazife Aşikgarip
- Department of Opthalmology, Kırşehir Ahi Evran Training and Research Hospital, Kırşehir, Turkey
| | - Emine Temel
- Department of Opthalmology, Kırşehir Ahi Evran Training and Research Hospital, Kırşehir, Turkey.
| | - Kemal Örnek
- Department of Opthalmology, Kırşehir Ahi Evran University School of Medicine, Kırşehir, Turkey
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Bae HW, Choi W, Hwang AR, Lee SY, Seong GJ, Kim CY. Effects of Hypoxic Preconditioning and Vascular Endothelial Growth Factor on the Survival of Isolated Primary Retinal Ganglion Cells. Biomolecules 2021; 11:biom11030391. [PMID: 33800918 PMCID: PMC8002095 DOI: 10.3390/biom11030391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 11/16/2022] Open
Abstract
This study aimed to investigate the effect of hypoxic preconditioning (HPC) on primary retinal ganglion cell (RGC) survival and the associated mechanism, including the role of vascular endothelial growth factor (VEGF). Retinas were separated from the enucleated eyeballs of Sprague-Dawley rats on postnatal days 1-4. RGCs were harvested using an immunopanning-magnetic separation system and maintained for 24 h in a defined medium. Hypoxic damage (0.3% O2) was inflicted on the cells using a CO₂ chamber. Anti-VEGF antibody (bevacizumab) was administered to RGCs exposed to hypoxic conditions, and RGC survival rate was compared to that of non-anti-VEGF antibody-treated RGCs. HPC lasting 4 h significantly increased RGC survival rate. In the RGCs exposed to hypoxic conditions for 4 h, VEGF mRNA and protein levels were significantly increased. Treatment with high dose bevacizumab (>1 mg/mL) countered HPC-mediated RGC survival. Protein kinase B and focal adhesion kinase levels were significantly increased in 4-h hypoxia-treated RGCs. HPC showed beneficial effects on primary RGC survival. However, only specifically controlled exposure to hypoxic conditions rendered neuroprotective effects. Strong inhibition of VEGF inhibited HPC-mediated RGC survival. These results indicate that VEGF may play an essential role in promoting cell survival under hypoxic conditions.
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Affiliation(s)
| | | | | | | | | | - Chan Yun Kim
- Correspondence: ; Tel.: +82-2-2228-3570; Fax: +82-2-312-0541
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Zografos LJ, Andrews E, Wolin DL, Calingaert B, Davenport EK, Hollis KA, Schmidt-Ott UM, Petraro P, Vassilev ZP. Physician and Patient Knowledge of Safety and Safe Use Information for Aflibercept in Europe: Evaluation of Risk-Minimization Measures. Pharmaceut Med 2020; 33:219-233. [PMID: 31933286 DOI: 10.1007/s40290-019-00279-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND As part of the risk-management plan for aflibercept in the European Union, materials have been developed to educate physicians and patients in Europe on the safe use of aflibercept. OBJECTIVES The objectives of this study were to measure receipt of the educational materials and to evaluate understanding of key safety information for aflibercept. METHODS An observational cross-sectional study among physicians and patients with recent aflibercept experience in France, Germany, Italy, Spain, and the UK was conducted. Eligible physicians and patients completed a brief questionnaire regarding their knowledge of key safety information. RESULTS Among the 8424 physicians invited to participate in the survey, 428 physicians were eligible, completed the questionnaire, and were included in this analysis. Most physicians reported having received the aflibercept summary of product characteristics (87%) and prescriber guide (77%); approximately half reported receiving the injection procedure video (50%) and patient booklet (54%). Physician knowledge of the most important topics (i.e., side effects; preparing patients for aflibercept injection) was high. Physician knowledge of dosing was high for neovascular (wet) age-related macular degeneration and lower for less commonly prescribed indications. Most physicians knew the contraindications for aflibercept and recognized possible side effects. Among the 874 patients approached about participation in the study, 773 patients were eligible, completed the questionnaire, and were included in the analysis. Patients' reported receipt was relatively low for the aflibercept patient booklet (38%) and the audio CD (23%). Patient knowledge of the health conditions to discuss with a doctor prior to injection was generally high; knowledge about possible side effects varied. Most patients knew that they should speak to a physician immediately if they experienced a possible side effect of aflibercept. CONCLUSION Most physicians reported receiving the summary of product characteristics, prescriber guide, and patient booklet; half reported receiving the intravitreal injection procedure video. Patient receipt of the educational material was variable. Observed patterns of knowledge indicated the greatest knowledge of the most important risks emphasized in the educational material and lower knowledge of more complex or less salient aspects of safe use.
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Affiliation(s)
- Laurie J Zografos
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA.
| | - Elizabeth Andrews
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Daniel L Wolin
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Brian Calingaert
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Eric K Davenport
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Kelly A Hollis
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | | | - Paul Petraro
- Bayer US, Whippany, NJ, USA.,Novo Nordisk Inc., 800 Scudders Mill Road, Plainsboro, NJ, 08536, USA
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Zografos LJ, Andrews E, Wolin DL, Calingaert B, Davenport EK, Hollis KA, Djokanovic N, Racanelli VS, Petraro P, Vassilev ZP. Evaluation of Physician Knowledge of the Key Safety Information for Aflibercept in Canada: Evaluation of Risk-Minimization Measures. Pharmaceut Med 2020; 33:235-246. [PMID: 31933288 DOI: 10.1007/s40290-019-00278-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND As part of the risk-management plan (RMP) for aflibercept, materials have been developed to educate physicians in Canada on the key safety information and safe use for aflibercept. OBJECTIVE The objectives of this study were to assess whether physicians in Canada received and reviewed the aflibercept educational materials (i.e. vial preparation instruction card, intravitreal injection procedure video, and product monograph) and to evaluate their knowledge of key safety information. METHODS Retinal specialists and ophthalmologists who prescribe and/or administer aflibercept were recruited to complete a survey. Physicians could complete and return a paper questionnaire by mail or complete the questionnaire online via a study website. RESULTS Of the 308 physicians invited to participate in the survey, 95 (31%) completed the questionnaire. Nearly all physicians (98%) reported receiving at least one of the educational materials. The proportion of correct responses to individual questions on storage and preparation of aflibercept ranged from 54 to 98%. Physician knowledge was high on the recommended dose of aflibercept (91%), dose preparation (91-96% on individual items), and dosing guidelines (75-95% on individual items). Most physicians knew the contraindications for aflibercept (89%) and that aflibercept should not be used in pregnancy unless clearly indicated by medical need in which benefits outweigh risks (60%); 21% responded more conservatively that aflibercept should never be used in pregnancy. Knowledge was high for most questions about injection procedures (91-99% on individual items); however, fewer physicians (24%) correctly reported that the eye should be covered with a sterile drape. Knowledge was high for possible side effects (89-100% on individual items) and actions to take in relation to the potential for increased intraocular pressure (86-93% on individual items). CONCLUSION Nearly all physicians (98%) reported having received the product monograph, and most (82%) reported having received the vial preparation instruction card; nearly half (46%) reported having received the intravitreal injection procedure video. Physicians' knowledge of the most important topics was high. Knowledge varied for topics that are less frequently encountered (e.g. use in women of childbearing potential) and for recommendations that are not standard medical practice in Canada (e.g. use of sterile drape).
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Affiliation(s)
- Laurie J Zografos
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA.
| | - Elizabeth Andrews
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Dan L Wolin
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Brian Calingaert
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Eric K Davenport
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Kelly A Hollis
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | | | | | - Paul Petraro
- Bayer U.S., Whippany, NJ, USA.,Novo Nordisk Inc., 800 Scudders Mill Road, Plainsboro, NJ, 08536, USA
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Thackaberry EA, Lorget F, Farman C, Bantseev V. The safety evaluation of long-acting ocular delivery systems. Drug Discov Today 2019; 24:1539-1550. [DOI: 10.1016/j.drudis.2019.05.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/09/2019] [Accepted: 05/31/2019] [Indexed: 01/14/2023]
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8
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Raza S, Ergun SB, Toklu Y, Cakmak HB, Ipek A, Cagil N. Evaluating the Effect of Intravitreal Ranibizumab on Retrobulbar Hemodynamics by Color Doppler Ultrasonography in Neovascular AMD. Ophthalmic Surg Lasers Imaging Retina 2019; 50:437-443. [DOI: 10.3928/23258160-20190703-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 01/17/2019] [Indexed: 11/20/2022]
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Calvo P, Ferreras A, Al Adel F, Dangboon W, Brent MH. EFFECT OF AN INTRAVITREAL DEXAMETHASONE IMPLANT ON DIABETIC MACULAR EDEMA AFTER CATARACT SURGERY. Retina 2018; 38:490-496. [PMID: 28196056 PMCID: PMC5841849 DOI: 10.1097/iae.0000000000001552] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To analyze the effects of a dexamethasone intravitreal implant (DEX; Ozurdex 700 μg; Allergan) administered immediately after cataract surgery in diabetic patients. METHODS This prospective, single-arm, open label study (NCT01748487 at ClinicalTrials.gov) involved Type 2 diabetic patients with at least mild diabetic retinopathy (DR) who underwent cataract surgery and DEX insertion after phacoemulsification, and intraocular lens implantation were enrolled. Best-corrected visual acuity and central retinal thickness (CRT) measured by spectral-domain optical coherence tomography were recorded at 1 week preoperatively, and 1 week, 1 month, and 3 months after surgery. Adverse events were also recorded. RESULTS Twenty-four eyes of 24 patients (17 [70.8%] men; mean age 63.7 ± 8.7 years) with mild nonproliferative DR (41.7%), moderate nonproliferative DR (33.3%), severe nonproliferative DR (16.7%), or treated proliferative DR (8.3%) were selected. After DEX treatment, mean CRT changed from 241.1 μm (95% confidence interval, 227.5-254.6 μm) at baseline to 236.9 μm (95% confidence interval, 223.9-249.9 μm) at 1 week (P = 0.09), 238.9 μm (95% confidence interval, 225.5-252.3 μm) at 1 month (P = 0.44), and 248 μm (95% confidence interval, 232.4-260.8 μm) at 3 months (P = 0.15). No eyes showed a postoperative increase >50 μm in the CRT at any visit. A 10% increase in CRT was found in 8.3% of eyes. Mean best-corrected visual acuity significantly improved from 0.37 (20/50) at baseline to 0.19 (20/30) at 1 week, 0.12 (20/25) at 1 month, and 0.12 (20/25) at 3 months (P < 0.001 for each comparison). Mean intraocular pressure before surgery was 13.8 mmHg, and none of the patients developed an intraocular pressure ≥22 mmHg at any visit. None of the patients developed any serious adverse events during the follow-up. CONCLUSION These short-term results suggest that a single DEX injection intraoperatively after phacoemulsification could avoid an increase in CRT after cataract surgery in diabetic patients.
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Affiliation(s)
- Pilar Calvo
- IIS-Aragon, Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
- University of Zaragoza, Zaragoza, Spain
| | - Antonio Ferreras
- IIS-Aragon, Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
- University of Zaragoza, Zaragoza, Spain
| | - Fadwa Al Adel
- Department of Ophthalmology, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Wantanee Dangboon
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand; and
| | - Michael H. Brent
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
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Comparative cyto-histological study of needle tip aspirates and entry sites after intravitreal injection using different needle types. PLoS One 2017; 12:e0174467. [PMID: 28692684 PMCID: PMC5503168 DOI: 10.1371/journal.pone.0174467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 03/09/2017] [Indexed: 12/12/2022] Open
Abstract
A comparison of the cellular content of needle tip aspirates and entry sites after transconjunctival intravitreal injection (IVI) using different needle types was performed. White outbred rats and human cadaver eyes were used for IVI by hypodermic 27 gauge (G) and 30G needles, and spinal anesthesia Pencan 27G needles. Aspiration of vitreous for quantitative morphological and cell cultivation analysis, as well as cyto-histological analysis of aspirates and entry sites were carried out. The most common cells in the aspirates from all needle types were conjunctival epithelial-, ciliary body non-pigmented epithelial- and sclerocyte-like cells and granular proteins. Crystallized vitreous specimens were present in each aspirate. The entry sites of hypodermic needles showed marked trauma in all wall layers of rat and human eyes accompanied by cellular destruction and hemorrhages. Pencan 27G needle caused less tissue trauma with partial reposition of sclerocytes. Transconjunctival IVIs with hypodermic 27G and 30G, and Pencan 27G needles result in trauma of all layers of the eyeball. The possible consequences of cellular content being cut and injected into the eye, as well as the entry site wound shape deserve future consideration and improvements.
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Jia YP, Sun L, Yu HS, Liang LP, Li W, Ding H, Song XB, Zhang LJ. The Pharmacological Effects of Lutein and Zeaxanthin on Visual Disorders and Cognition Diseases. Molecules 2017; 22:E610. [PMID: 28425969 PMCID: PMC6154331 DOI: 10.3390/molecules22040610] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/05/2017] [Accepted: 04/06/2017] [Indexed: 12/19/2022] Open
Abstract
Lutein (L) and zeaxanthin (Z) are dietary carotenoids derived from dark green leafy vegetables, orange and yellow fruits that form the macular pigment of the human eyes. It was hypothesized that they protect against visual disorders and cognition diseases, such as age-related macular degeneration (AMD), age-related cataract (ARC), cognition diseases, ischemic/hypoxia induced retinopathy, light damage of the retina, retinitis pigmentosa, retinal detachment, uveitis and diabetic retinopathy. The mechanism by which they are involved in the prevention of eye diseases may be due their physical blue light filtration properties and local antioxidant activity. In addition to their protective roles against light-induced oxidative damage, there are increasing evidences that L and Z may also improve normal ocular function by enhancing contrast sensitivity and by reducing glare disability. Surveys about L and Z supplementation have indicated that moderate intakes of L and Z are associated with decreased AMD risk and less visual impairment. Furthermore, this review discusses the appropriate consumption quantities, the consumption safety of L, side effects and future research directions.
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Affiliation(s)
- Yu-Ping Jia
- College of Pharmaceutical Engineering of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China.
| | - Lei Sun
- College of Pharmaceutical Engineering of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China.
| | - He-Shui Yu
- College of Pharmaceutical Engineering of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China.
| | - Li-Peng Liang
- College of Pharmaceutical Engineering of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China.
| | - Wei Li
- College of Pharmaceutical Engineering of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China.
| | - Hui Ding
- Tianjin Zhongyi Pharmaceutical Co., Ltd., Tianjin 300193, China.
| | - Xin-Bo Song
- College of Pharmaceutical Engineering of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China.
- Tianjin Zhongyi Pharmaceutical Co., Ltd., Tianjin 300193, China.
| | - Li-Juan Zhang
- College of Pharmaceutical Engineering of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China.
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Roy R, Saurabh K, Das D, Panigrahi PK, Das S, Pal SS, Jain A. Variation in Visual Outcome to Anti-Vascular Endothelial Growth Factors in Choroidal Neovascular Membrane Developing in Eyes with Previously Untreated Versus Focal Laser-Treated Central Serous Chorioretinopathy. Semin Ophthalmol 2016; 32:781-786. [PMID: 27533737 DOI: 10.1080/08820538.2016.1182556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Rupak Roy
- Department of Vitreoretina, Sankara Nethralaya, Kolkata, West Bengal, India
| | - Kumar Saurabh
- Department of Vitreoretina, Sankara Nethralaya, Kolkata, West Bengal, India
| | - Debmalya Das
- Department of Vitreoretina, Sankara Nethralaya, Kolkata, West Bengal, India
| | | | - Sudipta Das
- Department of Vitreoretina, Sankara Nethralaya, Kolkata, West Bengal, India
| | | | - Amit Jain
- Shri Bhagwan Mahavir Vitreoretina Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Ganglion Cell Complex Evaluation in Exudative Age-Related Macular Degeneration after Repeated Intravitreal Injections of Ranibizumab. BIOMED RESEARCH INTERNATIONAL 2015; 2015:268796. [PMID: 26167478 PMCID: PMC4475747 DOI: 10.1155/2015/268796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 10/17/2014] [Accepted: 10/26/2014] [Indexed: 12/01/2022]
Abstract
Purpose. To detect the effects of intravitreal ranibizumab injections on GCC in patients with wet AMD. Methods. 32 wet AMD eyes were selected and submitted at three ranibizumab injections. RTVue-OCT GCC and MM5 protocol were performed before treatment and twenty days after each injection. Results. At baseline mean GCC thickness was 93.9 ± 18.5 μm. Twenty days after each intravitreal injection it was, respectively, 85.8 ± 10.1, 86.5 ± 9.3, and 91.1 ± 11.5 μm, without statistical significance. A significant improvement in visual acuity (P = 0.031) and a reduction of mean foveal (P = 0.001) and macular thickness (P = 0.001) were observed. Conclusion. The clinical results confirm therapeutic efficacy of intravitreal injections of ranibizumab in wet AMD. A contemporary not statistically significant reduction of GCC thickness suggests that the loading phase of ranibizumab does not have any toxic effects on ganglion cell complex.
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Effect of supplemental lutein and zeaxanthin on serum, macular pigmentation, and visual performance in patients with early age-related macular degeneration. BIOMED RESEARCH INTERNATIONAL 2015; 2015:564738. [PMID: 25815324 PMCID: PMC4359817 DOI: 10.1155/2015/564738] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 09/21/2014] [Accepted: 09/21/2014] [Indexed: 12/15/2022]
Abstract
Purpose. To compare the 2-year effect of multiple doses of lutein/zeaxanthin on serum, macular pigmentation, and visual performance on patients with early age-related macular degeneration (AMD). Methods. In this randomized, double-blinded, and placebo-controlled trial, 112 early AMD patients randomly received either 10 mg lutein, 20 mg lutein, a combination of lutein (10 mg) and zeaxanthin (10 mg), or placebo daily for 2 years. Serum concentration of lutein/zeaxanthin, macular pigment optical density (MPOD), visual functions including best-spectacle corrected visual acuity (BCVA), contrast sensitivity (CS), flash recovery time (FRT), and vision-related quality of life (VFQ25) was quantified. Results. Serum lutein concentration and MPOD significantly increased in all the active treatment groups. Supplementation with 20 mg lutein was the most effective in increasing MPOD and CS at 3 cycles/degree for the first 48 weeks. However, they both significantly increased to the same peak value following supplementation with either 10 mg or 20 mg lutein during the intervention. No statistical changes of BCVA or FRT were observed during the trial. Conclusions. Long-term lutein supplementation could increase serum lutein concentration, MPOD, and visual sensitivities of early AMD patients. 10 mg lutein daily might be an advisable long-term dosage for early AMD treatment.
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Cho YW, Han YS, Chung IY, Kim SJ, Seo SW, Yoo JM, Park JM. Suppression of laser-induced choroidal neovascularization by intravitreal injection of tristetraprolin. Int J Ophthalmol 2014; 7:952-8. [PMID: 25540745 DOI: 10.3980/j.issn.2222-3959.2014.06.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 08/25/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To examine the effect of intravitreal adenoviral vector-mediated tristetraprolin (Ad-TTP) on VEGF mRNA expression in a rat model of laser-induced choroidal neovascularization. METHODS Ad-TTP was prepared using a commercial kit. Retinal laser-induced photocoagulation (10 spots per eye) was performed on rats in this experimental choroidal neovascularization (CNV) model. Rats were divided into four groups: control (single intravitreal injection of balanced salt solution, n=10), laser-induced CNV (photocoagulation only, n=20), laser-induced CNV plus Ad-TTP injection (photocoagulation plus a single intravitreal Ad-TTP injection, n=20) and Ad-TTP injection only (n=10). Changes in choroidal morphology were evaluated in ten rats in the laser only and the laser plus Ad-TTP groups. Two weeks after laser injury, the size of CNV was calculated by perfusion with high-molecular-weight fluorescein isothiocyanate (FITC)-dextran. VEGF mRNA expression in retina-choroid tissue from ten rats in each group was measured by reverse transcription polymerase chain reaction (RT-PCR). RESULTS Two weeks after treatment, the area of laser-induced CNV was reduced by approximately 60% in the rats given the Ad-TTP injection compared with that in the laser-only group. There was a tendency toward decreased VEGF mRNA expression in the Ad-TTP injection groups. CONCLUSION A single intravitreal injection of Ad-TTP significantly suppressed CNV size in this experimental laser-induced CNV model. Ad-TTP injection also decreased VEGF mRNA expression compared with that in the laser-induced CNV group. The present study is meaningful as the first study to investigate the effect of tristetraprolin delivered via intravitreal injection.
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Affiliation(s)
- Yong Wun Cho
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju 660-702, Korea
| | - Yong Seop Han
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju 660-702, Korea ; Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju 660-702, Korea
| | - In Young Chung
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju 660-702, Korea ; Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju 660-702, Korea
| | - Seong Jae Kim
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju 660-702, Korea
| | - Seong Wook Seo
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju 660-702, Korea ; Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju 660-702, Korea
| | - Ji Myong Yoo
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju 660-702, Korea ; Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju 660-702, Korea
| | - Jong Moon Park
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju 660-702, Korea ; Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju 660-702, Korea
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Gutiérrez-Hernández JC, Caffey S, Abdallah W, Calvillo P, González R, Shih J, Brennan J, Zimmerman J, Martínez-Camarillo JC, Rodriguez AR, Varma R, Santos A, Sánchez G, Humayun M. One-Year Feasibility Study of Replenish MicroPump for Intravitreal Drug Delivery: A Pilot Study. Transl Vis Sci Technol 2014; 3:8. [PMID: 25774328 DOI: 10.1167/tvst.3.3.8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 03/21/2014] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To determine the feasibility of the surgical procedure and to collect some safety data regarding the bioelectronics of a novel micro drug pump for intravitreal drug delivery in a Beagle dog model for up to 1 year. METHODS Thirteen Beagle dogs were assigned to two groups. The experimental group (n = 11) underwent pars plana implantation of MicroPump; the body of which was sutured episclerally, while its catheter was secured at a pars plana sclerotomy. The control group (n = 2) underwent sham surgeries in the form of a temporary suturing of the MicroPump, including placement of the pars plana tube. Baseline and follow-up exams included ophthalmic examination and imaging. The experimental animals were euthanized and explanted at predetermined time points after surgery (1, 3, and 12 months), while the control animals were euthanized at 3 months. All operated eyes were submitted for histopathology. RESULTS Eyes were scored according to a modified McDonald-Shadduck system and ophthalmic imaging. Neither the implanted eyes nor the control eyes showed clinically significant pathological changes beyond the expected surgical changes. The operated eyes showed neither significant inflammatory reaction nor tissue ingrowth through the sclerotomy site compared with the fellow eyes. CONCLUSION This study shows that the Replenish Posterior MicroPump could be successfully implanted with good safety profile in this animal model. TRANSLATIONAL RELEVANCE The results of this study in a Beagle dog model are supportive of the biocompatibility of Replenish MicroPump and pave the way to the use of these devices for ocular automated drug delivery after further testing in larger animal models.
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Affiliation(s)
| | | | - Walid Abdallah
- Replenish Inc., Pasadena, CA ; Department of Ophthalmology, Zagazig University, Faculty of Medicine, Zagazig, Egypt ; Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | | | | | | | | | | | | | - Rohit Varma
- Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Arturo Santos
- Centro de Retina Médica y Quirurgica, SC and Tecnológico de Monterrey, Campus Guadalajara, Mexico
| | - Gisela Sánchez
- Centro de Retina Médica y Quirurgica, SC and Tecnológico de Monterrey, Campus Guadalajara, Mexico
| | - Mark Humayun
- Replenish Inc., Pasadena, CA ; Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Gutiérrez-Hernández JC, Caffey S, Abdallah W, Calvillo P, González R, Shih J, Brennan J, Zimmerman J, Martínez-Camarillo JC, Rodriguez AR, Varma R, Santos A, Sánchez G, Humayun M. One-Year Feasibility Study of Replenish MicroPump for Intravitreal Drug Delivery: A Pilot Study. Transl Vis Sci Technol 2014. [DOI: 10.1167/tvst.3.4.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Oliva A, Llabrés M, Fariña JB. Capability measurement of size-exclusion chromatography with a light-scattering detection method in a stability study of bevacizumab using the process capability indices. J Chromatogr A 2014; 1353:89-98. [PMID: 24786652 DOI: 10.1016/j.chroma.2014.04.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 04/09/2014] [Accepted: 04/10/2014] [Indexed: 10/25/2022]
Abstract
In this study, we investigated if the size-exclusion chromatography coupled with light-scattering and refractive index detection (SEC/LS/RI) method is fitted for its intended purpose and checked if the analytical method is able to provide enough conforming results. For this, the process capability indices Cp, Cpk, and Cpm were computed. The traditional X-chart and moving range (MR) chart were used by the same analyst to monitor the equipment in the laboratory over a 1-year period. For this, a bovine serum albumin (BSA) sample (0.3 mg mL(-1)) with a nominal Mw of 66.4 kDa was analyzed each working day. The results confirmed that the analytical method is in-control and stable. To determine whether the given process meets the present capability requirement and runs under the desired quality conditions, the Pearn and Shu (2003) method based on the lower confidence bound C on Cpm was used. The estimator Cpm was 1.81, and the lower confidence bound C was 1.40. We therefore conclude that the true value of the method capability Cpm is no less than 1.40 with a 95% level of confidence. This result indicates that the method is satisfactory and no stringent precision control is required. The usefulness of this method was applied in the characterization of bevacizumab commercial pharmaceutical preparations stored under different conditions that lead to aggregation. In this case, the computed Cpm index was 0.98 (0.70, 1.26), which indicates that the method does not comply with the specification limits and needs to be revised. The quality improvement effort should: (1) reduce the uncertainty in the absolute Mw determination; (2) either move the process mean closer to the target value or reduce the process variation, i.e. improve the method accuracy (μ-T) and precision (σ(2)). On this point, the Bayesian posterior distribution of the mean and standard deviation pointed out the need to control the precision but specially accuracy in order to reduce the overall uncertainty of analytical method and thus, the method is capable.
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Affiliation(s)
- Alexis Oliva
- Departamento de Ingeniería Química y Tecnología Farmacéutica, Facultad de Farmacia, Universidad de La Laguna, 38200 Tenerife, Spain.
| | - Matías Llabrés
- Departamento de Ingeniería Química y Tecnología Farmacéutica, Facultad de Farmacia, Universidad de La Laguna, 38200 Tenerife, Spain
| | - José B Fariña
- Departamento de Ingeniería Química y Tecnología Farmacéutica, Facultad de Farmacia, Universidad de La Laguna, 38200 Tenerife, Spain
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Wolf A, Kampik A. Efficacy of treatment with ranibizumab in patients with wet age-related macular degeneration in routine clinical care: data from the COMPASS health services research. Graefes Arch Clin Exp Ophthalmol 2014; 252:647-55. [PMID: 24424409 PMCID: PMC3968520 DOI: 10.1007/s00417-013-2562-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 12/17/2013] [Accepted: 12/31/2013] [Indexed: 12/25/2022] Open
Abstract
Background To assess healthcare processes during treatment of neovascular age-related macular degeneration (AMD) in patients under real-life conditions and evaluate efficacy of monthly visual acuity (VA) assessment in a pro re nata treatment regime. Methods A multicentre, prospective, non-interventional study based in Germany included neovascular AMD patients treated with intravitreal ranibizumab. Patients completed a 3-month loading phase with monthly intravitreal injections of 0.5 mg ranibizumab, followed by a 12-month maintenance phase during which investigators documented VA, additional injections, metamorphopsias, routine ophthalmological examinations and adverse events at monthly follow-up visits. Efficacy analysis included change from baseline in best-corrected VA (BCVA) based on descriptive statistics. Results A total of 2,232 patients were enrolled throughout Germany and 1,729 patients (mean age 77.8 years, 63.2 % women) comprised the efficacy population with a complete set of data. In the clinical setting recorded in our study, only a minority of patients underwent optical coherence tomography during the maintenance phase (71 of 1,729 patients). Patients received a mean total of 4.5 injections; three injections during upload phase and 1.5 additional injections during maintenance phase. Over half of the patients (51.4 %) did not receive additional injections. Mean decimal BCVA increased during the upload phase, (from LogMAR mean of 0.201 at baseline to 0.219 at Month 4) but displayed a decline over time (0.192 at Month 15). Conclusion Ranibizumab treatment in a real-life setting demonstrated efficacy in neovascular AMD patients, as shown by initial gains in BCVA. However, maintenance and improvement of these gains during the maintenance phase in a clinical routine setting remained below those expected compared with MARINA, ANCHOR and CATT trials, most likely due to a low number of retreatments, and the high number of patients with a poor response in regard to improvements of VA who were not investigated in these studies. Trial registration number This phase IV non-interventional health services research study was conducted under the Novartis internal registration code, CRFB002ADE10.
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Affiliation(s)
- Armin Wolf
- Augenklinik der LMU, Klinikum der Universität München, Campus Innenstadt, Mathildenstrasse 8, 80336, München, Germany,
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Ganglion Cell Complex Evaluation in Exudative Age-Related Macular Degeneration after Repeated Intravitreal Injections of Ranibizumab. BIOMED RESEARCH INTERNATIONAL 2014. [DOI: 10.1155/2014/268796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To detect the effects of intravitreal ranibizumab injections on GCC in patients with wet AMD.Methods. 32 wet AMD eyes were selected and submitted at three ranibizumab injections. RTVue-OCT GCC and MM5 protocol were performed before treatment and twenty days after each injection.Results. At baseline mean GCC thickness was 93.9 ± 18.5 μm. Twenty days after each intravitreal injection it was, respectively, 85.8 ± 10.1, 86.5 ± 9.3, and 91.1 ± 11.5 μm, without statistical significance. A significant improvement in visual acuity (P= 0.031) and a reduction of mean foveal (P= 0.001) and macular thickness (P= 0.001) were observed.Conclusion. The clinical results confirm therapeutic efficacy of intravitreal injections of ranibizumab in wet AMD. A contemporary not statistically significant reduction of GCC thickness suggests that the loading phase of ranibizumab does not have any toxic effects on ganglion cell complex.
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Sobacı G, Güngör R, Ozge G. Effects of multiple intravitreal anti-VEGF injections on retinal nerve fiber layer and intraocular pressure: a comparative clinical study. Int J Ophthalmol 2013; 6:211-5. [PMID: 23638426 DOI: 10.3980/j.issn.2222-3959.2013.02.20] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 03/05/2013] [Indexed: 02/05/2023] Open
Abstract
AIM To determine the effect of multiple injections of ranibizumab or bevacizumab on retinal nerve fiber layer (RNFL) and intraocular pressure (IOP) in patients with age-related macular degeneration (AMD). METHODS This retrospective study includes 35 eyes of 35 patients treated with intravitreal bevacizumab (IVB, 1.25mg/0.05mL) and 30 eyes of 30 patients with intravitreal ranibizumab (IVR, 0.5mg/0.05mL) who had Fast RNFL analysis (Stratus™); IOP measurements were taken 30 minutes and 24 hours after each injection. RESULTS The mean ages were 68.0±7.5 and 69.1±7.7 years in the IVR and IVB groups, respectively (P=0.55). They underwent (6.3±1.9) and (5.1±1.3) injections (P=0.07) over (13.6±2.1) and (14.05±2.6) months (P=0.45) in the IVR and IVB groups, respectively. Changes in overall and temporal RNFL thickness in IVR-treated eyes (105.3±6.9µm and 74.4±11.2µm) were not different from those in untreated eyes in the IVR group (104.6± 8.4µm and 75.1±12.6µm) (P=0.57 and P=0.41, respectively). Similarly, overall and temporal RNFL thickness in IVB-treated eyes (105.8±8.1µm and 74.5±11.8µm) were not different from those in untreated eyes in the IVB group (104.6±8µm and 74.8±12.9µm) (P=0.42 and P=0.80, respectively). The frequencies of IOP rise (P=0.60) and changes in RNFL thickness from baseline (P=0.16) were comparable between groups. CONCLUSION Repeated intravitreal injection of ranibizumab or bevacizumab does not seem have adverse effects on RNFL thickness or IOP in wet AMD patients.
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Affiliation(s)
- Güngör Sobacı
- Department of Ophthalmology, GATA Medical School, Ankara, Turkey
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Effect of intravitreal bevacizumab on retrobulbar blood flow in injected and uninjected fellow eyes of patients with neovascular age-related macular degeneration. Retina 2012; 32:967-71. [PMID: 22146127 DOI: 10.1097/iae.0b013e31822c28d6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND To determine the effect of intravitreal administration of bevacizumab (1.25 mg/0.05 mL) on retrobulbar circulation of the injected and the fellow (uninjected) eyes in patients with neovascular age-related macular degeneration. METHODS In this prospective study, the retrobulbar hemodynamics of 43 patients with neovascular age-related macular degeneration was examined by color Doppler ultrasonography. Peak systolic velocity, end-diastolic velocity, and resistive index values in the central retinal artery and short posterior ciliary artery in both injected and uninjected fellow eyes were measured at baseline and 7 days after a single intravitreal injection of bevacizumab. RESULTS At baseline, the peak systolic velocity, end-diastolic velocity, and the resistive index in the central retinal artery and short posterior ciliary artery of the injected eye were not significantly different compared with the fellow uninjected eye (P > 0.05 for all). However, intravitreal bevacizumab induced a significant reduction in the peak systolic velocity and end-diastolic velocity and a significant rise in the resistive index of the central retinal artery and short posterior ciliary artery of the injected eye (P ≤ 0.006 for all). Peak systolic velocity and end-diastolic velocity decreased in the central retinal artery (P = 0.023 and P = 0.030) and the short posterior ciliary artery (P = 0.001 and P < 0.000) in the uninjected eye while the resistive index did not significantly change in central retinal artery (P = 0.114) and short posterior ciliary artery (P = 0.082) of the fellow eyes. CONCLUSION Intravitreal injection of bevacizumab significantly affects ocular hemodynamic parameters of both the injected and the uninjected fellow eyes with neovascular age-related macular degeneration.
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Orbital hemorrhage after intravitreal injection. Retin Cases Brief Rep 2012; 6:307-8. [PMID: 25389740 DOI: 10.1097/icb.0b013e3182378bc6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe a case of orbital hemorrhage after the administration of intravitreal ranibizumab. METHODS Retrospective chart review of one case. RESULTS A 73-year-old woman with a history of atrial fibrillation on coumadin anticoagulation (international normalized ratio = 3.4) presented with decreased vision and metamorphopsia in her right eye for 2 weeks duration. Examination was consistent with a diagnosis of neovascular age-related macular degeneration in the right eye. After one injection of intravitreal ranibizumab, she developed a bullous subconjunctival hemorrhage that extended into an orbital hemorrhage. CONCLUSION Intravitreal injection may result in orbital hemorrhage, particularly in the anticoagulated patient.
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Cruess AF, Berger A, Colleaux K, Greve M, Harvey P, Kertes PJ, Sheidow T, Tourville E, Williams G, Wong D. Canadian expert consensus: optimal treatment of neovascular age-related macular degeneration. Can J Ophthalmol 2012; 47:227-35. [PMID: 22687297 DOI: 10.1016/j.jcjo.2012.03.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 11/15/2011] [Accepted: 01/09/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND New therapeutic approaches, particularly anti-vascular endothelial growth factor (anti-VEGF) therapies, prevent, and in some cases reverse, vision damage caused by age-related macular degeneration (AMD). Unequal access to care across Canada remains a problem for many retina specialists and their patients. OBJECTIVE To develop a consensus concerning the management of patients with exudative age-related macular degeneration (AMD). DESIGN Consensus document. PARTICIPANTS Ten Canadian retina specialists. METHODS The development of a consensus among Canadian experts concerning optimal treatment of AMD began with a review of the clinical evidence, daily practices, existing guidelines, and current national and international approvals and policies. The experts met on June 29, 2010, in Quebec City to discuss their findings and to propose strategies for consensus. RESULTS The result of this expert panel is a consensus proposal for Canadian ophthalmologists and retina specialists who are treating patients with or at risk for developing neovascular AMD. CONCLUSIONS The consensus provides guidelines to aid retina specialists in managing exudative AMD. Currently, ranibizumab is the only agent with sufficient Level I evidence and a Health Canada-approved indication for the treatment of wet AMD. Bevacizumab has been shown to be noninferior in preserving and improving visual acuity when compared to ranibizumab. Potential safety differences between the 2 drugs remain to be elucidated. The positioning of ranibizumab in this therapeutic area will be further defined as additional data for existing and emerging therapies become available. Until then, this agent remains the therapy of choice for individuals with neovascular AMD.
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Jung JJ, Della Torre KE, Fell MR, Teng CC, Freund KB. Presumed pyogenic granuloma associated with intravitreal anti-vascular endothelial growth factor therapy. Open Ophthalmol J 2011; 5:59-62. [PMID: 22216076 PMCID: PMC3249641 DOI: 10.2174/1874364101105010059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 07/30/2011] [Accepted: 09/16/2011] [Indexed: 11/22/2022] Open
Abstract
To report a case of a presumed pyogenic granuloma at the site of multiple intravitreal anti-Vascular Endothelial Growth Factor (VEGF) injections. Intravitreal anti-VEGF injections can be complicated by a localized reaction of the conjunctiva.
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Affiliation(s)
- Jesse J Jung
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
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Mitra A, Lip PL. Review of anti-vascular endothelial growth factor therapy in macular edema secondary to central retinal vein occlusions. EXPERT REVIEW OF OPHTHALMOLOGY 2011. [DOI: 10.1586/eop.11.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Engman SJ, Edwards AO, Bakri SJ. Administration of Repeat Intravitreal Anti-VEGF Drugs by Retina Specialists in an Injection-only Clinic for Patients with Exudative AMD: Patient Acceptance and Safety. Semin Ophthalmol 2011; 26:380-6. [DOI: 10.3109/08820538.2011.622337] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Matsuyama K, Ogata N, Matsuoka M, Wada M, Nishimura T, Takahashi K. Effects of Intravitreally Injected Bevacizumab on Vascular Endothelial Growth Factor in Fellow Eyes. J Ocul Pharmacol Ther 2011; 27:379-83. [DOI: 10.1089/jop.2010.0194] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kayako Matsuyama
- Department of Ophthalmology, Kansai Medical University, Takii Hospital, Osaka, Japan
| | - Nahoko Ogata
- Department of Ophthalmology, Nara Medical University, Nara, Japan
| | - Masato Matsuoka
- Department of Ophthalmology, Kansai Medical University, Takii Hospital, Osaka, Japan
| | - Mitsumasa Wada
- Department of Ophthalmology, Kansai Medical University, Takii Hospital, Osaka, Japan
| | - Tetsuya Nishimura
- Department of Ophthalmology, Kansai Medical University, Takii Hospital, Osaka, Japan
| | - Kanji Takahashi
- Department of Ophthalmology, Kansai Medical University, Hirakata Hospital, Osaka, Japan
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El-Mollayess GM, Noureddine BN, Bashshur ZF. Bevacizumab and Neovascular Age Related Macular Degeneration: Pathogenesis and Treatment. Semin Ophthalmol 2011; 26:69-76. [DOI: 10.3109/08820538.2010.545100] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Querques G, Avellis FO, Querques L, Bandello F, Souied EH. Age-related macular degeneration. Clin Ophthalmol 2011; 5:593-601. [PMID: 21654887 PMCID: PMC3102591 DOI: 10.2147/opth.s10161] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Indexed: 11/23/2022] Open
Abstract
Clinical question: Is there any new knowledge about the pathogenesis and treatment of age-related macular degeneration (AMD)? Results: We now understand better the biochemical and pathological pathways involved in the genesis of AMD. Treatment of exudative AMD is based on intravitreal injection of new antivascular endothelial growth factor drugs for which there does not yet exist a unique recognized strategy of administration. No therapies are actually available for atrophic AMD, despite some experimental new pharmacological approaches. Implementation: strategy of administration, safety of intravitreal injection
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Affiliation(s)
- Giuseppe Querques
- Service d'Ophtalmologie, Centre Hospitalier Intercommunal Créteil, Université Paris-Est Créteil, Créteil, France
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Abstract
The asthmatic athlete has a long history in competitive sport in terms of success in performance and issues related to doping. Well documented are detailed objective tests used to evaluate the athlete with symptoms of asthma or airway hyperresponsiveness and the medical management. Initiated at the 2002 Salt Lake City Games, the International Olympic Committee's Independent Asthma Panel required testing to justify the use of inhaled beta-2 agonists (IBAs) in Olympic athletes and has provided valuable guidelines to the practicing physician. This program was educational and documented the variability in prevalence of asthma and/or airway hyperresponsiveness and IBA use between different sports and different countries. It provided a standard of care for the athlete with respiratory symptoms and led to the discovery that asthmatic Olympic athletes outperformed their peers at both Summer and Winter Olympic Games from 2002 to 2010. Changes to the World Anti-Doping Agency's Prohibited List in 2010 permitted the use of 2 IBA produced by the same pharmaceutical company. All others remain prohibited. However, there is no pharmacological difference between the permitted and prohibited IBAs. As a result of these changes, asthmatic athletes are being managed differently based on a World Anti-Doping Agency directive that has no foundation in pharmacological science or in clinical practice.
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Current World Literature. Curr Opin Ophthalmol 2010; 21:239-46. [DOI: 10.1097/icu.0b013e32833983a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kim JY, Lee JH, Yoon IN. Electron Microscopy of Needle Tips Following Intravitreal Injections Using 30-Gauge Needles. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2010. [DOI: 10.3341/jkos.2010.51.7.949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ju-Young Kim
- Department of Ophthalmology, Wonju Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jong-Hyuck Lee
- Department of Ophthalmology, Wonju Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ie-Na Yoon
- Department of Ophthalmology, Wonju Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
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Abstract
A recent work by Ambati et al. represents a bold step towards a more effective diagnosis and treatment of age-related macular degeneration, with the new evidence showing that CCR3, a chemokine receptor, is an early marker of and potential therapeutic target for choroidal neovascularization development. In the wake of such a novel and significant finding, additional illumination to confirm and consolidate the promise shown by CCR3 will soon follow.
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Affiliation(s)
- A Brett Mason
- Yale University School of Medicine, New Haven, CT 06510, USA.
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