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Jain R, Daigavane S. Intravitreal OZURDEX vs. Intravitreal Bevacizumab for Diabetic Macular Edema: A Comprehensive Review. Cureus 2024; 16:e56796. [PMID: 38654796 PMCID: PMC11036026 DOI: 10.7759/cureus.56796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/23/2024] [Indexed: 04/26/2024] Open
Abstract
This comprehensive review examines the efficacy, safety, and implications of intravitreal OZURDEX and intravitreal bevacizumab in treating diabetic macular edema (DME). DME is a common complication of diabetes mellitus and a leading cause of vision loss. OZURDEX, through sustained release of dexamethasone, targets inflammation and vascular permeability, while bevacizumab inhibits vascular endothelial growth factor (VEGF), reducing angiogenesis. However, differences in safety profiles exist, with OZURDEX associated with an increased risk of intraocular pressure elevation and cataract formation and bevacizumab potentially carrying systemic risks. The choice between these treatments should be individualized, considering patient preferences, ocular and systemic comorbidities, and cost-effectiveness. Collaboration among healthcare providers is essential for the comprehensive management of DME. Future research should focus on long-term comparative studies, predictors of treatment response, and exploration of novel therapeutic targets to optimize treatment outcomes for patients with DME.
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Affiliation(s)
- Raina Jain
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sachin Daigavane
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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2
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Increased mortality after intravitreal injections of anti-VEGF for neovascular AMD among patients with prior stroke or acute myocardial infarction. Eye (Lond) 2022; 36:153-159. [PMID: 33654317 PMCID: PMC8727623 DOI: 10.1038/s41433-021-01416-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 12/09/2020] [Accepted: 01/15/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To evaluate whether intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF) in neovascular age-related macular degeneration (nAMD) patients with prior stroke or acute myocardial infarction (AMI) are associated with increased mortality. METHODS From 2005 to 2013, nAMD patients in the Taiwan National Health Insurance Research Database who received IVI of anti-VEGF and had a diagnosis of stroke/AMI prior to their first injections were defined as the IVI group. The mortality of the IVI group during the study period was compared to that of the non-IVI group, which consisted of nAMD patients who had prior stroke/AMI but were never exposed to anti-VEGF. The IVI group and the non-IVI group were 1-4 matched according to propensity score (PS), which was derived from age, sex, date of stroke/AMI and comorbidities. PS-adjusted Cox regression analyses were used to estimate the hazard ratio (HR) for mortality associated with IVI of anti-VEGF. Subgroup analyses were also performed according to the interval between stroke/AMI and IVI (≤6 months, 6 months to 1 year, 1-2 years, >2 years). RESULTS There were 3384 individuals in the IVI group and 13,536 individuals in the non-IVI group. The IVI group had a significantly higher mortality risk (adjusted HR = 2.37; 95% confidence interval (CI), 2.14-2.62) than the non-IVI group. Subgroup analyses revealed that elevated mortality was significant when anti-VEGF was injected within 1 year after stroke/AMI. CONCLUSIONS We found an increased mortality risk associated with IVI of anti-VEGF in nAMD patients with prior stroke/AMI compared to the mortality risk of nAMD patients with prior stroke/AMD but without exposure to anti-VEGF.
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Hykin P, Prevost AT, Sivaprasad S, Vasconcelos JC, Murphy C, Kelly J, Ramu J, Alshreef A, Flight L, Pennington R, Hounsome B, Lever E, Metry A, Poku E, Yang Y, Harding SP, Lotery A, Chakravarthy U, Brazier J. Intravitreal ranibizumab versus aflibercept versus bevacizumab for macular oedema due to central retinal vein occlusion: the LEAVO non-inferiority three-arm RCT. Health Technol Assess 2021; 25:1-196. [PMID: 34132192 PMCID: PMC8287375 DOI: 10.3310/hta25380] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Licensed ranibizumab (0.5 mg/0.05 ml Lucentis®; Novartis International AG, Basel, Switzerland) and aflibercept (2 mg/0.05 ml Eylea®; Bayer AG, Leverkusen, Germany) and unlicensed bevacizumab (1.25 mg/0.05 ml Avastin®; F. Hoffmann-La Roche AG, Basel, Switzerland) are used to treat macula oedema due to central retinal vein occlusion, but their relative clinical effectiveness, cost-effectiveness and impact on the UK NHS and Personal Social Services have never been directly compared over the typical disease treatment period. OBJECTIVE The objective was to compare the clinical effectiveness and cost-effectiveness of three intravitreal antivascular endothelial growth factor agents for the management of macula oedema due to central retinal vein occlusion. DESIGN This was a three-arm, double-masked, randomised controlled non-inferiority trial. SETTING The trial was set in 44 UK NHS ophthalmology departments, between 2014 and 2018. PARTICIPANTS A total of 463 patients with visual impairment due to macula oedema secondary to central retinal vein occlusion were included in the trial. INTERVENTIONS The participants were treated with repeated intravitreal injections of ranibizumab (n = 155), aflibercept (n = 154) or bevacizumab (n = 154). MAIN OUTCOME MEASURES The primary outcome was an increase in the best corrected visual acuity letter score from baseline to 100 weeks in the trial eye. The null hypothesis that aflibercept and bevacizumab are each inferior to ranibizumab was tested with a non-inferiority margin of -5 visual acuity letters over 100 weeks. Secondary outcomes included additional visual acuity, and imaging outcomes, Visual Function Questionnaire-25, EuroQol-5 Dimensions with and without a vision bolt-on, and drug side effects. Cost-effectiveness was estimated using treatment costs and Visual Function Questionnaire-Utility Index to measure quality-adjusted life-years. RESULTS The adjusted mean changes at 100 weeks in the best corrected visual acuity letter scores were as follows - ranibizumab, 12.5 letters (standard deviation 21.1 letters); aflibercept, 15.1 letters (standard deviation 18.7 letters); and bevacizumab, 9.8 letters (standard deviation 21.4 letters). Aflibercept was non-inferior to ranibizumab in the intention-to-treat population (adjusted mean best corrected visual acuity difference 2.23 letters, 95% confidence interval -2.17 to 6.63 letters; p = 0.0006), but not superior. The study was unable to demonstrate that bevacizumab was non-inferior to ranibizumab in the intention-to-treat population (adjusted mean best corrected visual acuity difference -1.73 letters, 95% confidence interval -6.12 to 2.67 letters; p = 0.071). A post hoc analysis was unable to demonstrate that bevacizumab was non-inferior to aflibercept in the intention-to-treat population (adjusted mean best corrected visual acuity difference was -3.96 letters, 95% confidence interval -8.34 to 0.42 letters; p = 0.32). All per-protocol population results were the same. Fewer injections were required with aflibercept (10.0) than with ranibizumab (11.8) (difference in means -1.8, 95% confidence interval -2.9 to -0.8). A post hoc analysis showed that more bevacizumab than aflibercept injections were required (difference in means 1.6, 95% confidence interval 0.5 to 2.7). There were no new safety concerns. The model- and trial-based cost-effectiveness analyses estimated that bevacizumab was the most cost-effective treatment at a threshold of £20,000-30,000 per quality-adjusted life-year. LIMITATIONS The comparison of aflibercept and bevacizumab was a post hoc analysis. CONCLUSION The study showed aflibercept to be non-inferior to ranibizumab. However, the possibility that bevacizumab is worse than ranibizumab and aflibercept by 5 visual acuity letters cannot be ruled out. Bevacizumab is an economically attractive treatment alternative and would lead to substantial cost savings to the NHS and other health-care systems. However, uncertainty about its relative effectiveness should be discussed comprehensively with patients, their representatives and funders before treatment is considered. FUTURE WORK To obtain extensive patient feedback and discuss with all stakeholders future bevacizumab NHS use. TRIAL REGISTRATION Current Controlled Trials ISRCTN13623634. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 38. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Philip Hykin
- National Institute for Health Research Moorfields Biomedical Research Centre, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - A Toby Prevost
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Sobha Sivaprasad
- National Institute for Health Research Moorfields Biomedical Research Centre, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Joana C Vasconcelos
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Caroline Murphy
- King's Clinical Trials Unit at King's Health Partners, King's College London, London, UK
| | - Joanna Kelly
- King's Clinical Trials Unit at King's Health Partners, King's College London, London, UK
| | - Jayashree Ramu
- National Institute for Health Research Moorfields Biomedical Research Centre, London, UK
| | - Abualbishr Alshreef
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Laura Flight
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rebekah Pennington
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Ellen Lever
- King's Clinical Trials Unit at King's Health Partners, King's College London, London, UK
| | - Andrew Metry
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Edith Poku
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Yit Yang
- The Eye Infirmary, New Cross Hospital, Wolverhampton, UK
| | - Simon P Harding
- Eye and Vision Science, University of Liverpool, and St Paul's Eye Unit, Royal Liverpool University Hospitals, Liverpool, UK
| | - Andrew Lotery
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Usha Chakravarthy
- Department of Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - John Brazier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Safety and Tolerability of Topical Ophthalmic Triamcinolone Acetonide-Loaded Liposomes Formulation and Evaluation of Its Biologic Activity in Patients with Diabetic Macular Edema. Pharmaceutics 2021; 13:pharmaceutics13030322. [PMID: 33801366 PMCID: PMC7998140 DOI: 10.3390/pharmaceutics13030322] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 01/01/2023] Open
Abstract
Intravitreal injections (IVTs) of corticosteroids as triamcinolone acetonide (TA) are frequently used for the treatment of many vitreous and retinal disorders. However, IVTs are related to severe ocular complications. Lately, a topical ophthalmic TA-loaded liposomes formulation (TALF) was designed to transport TA into the posterior segment of the eye when instilled on the ocular surface. To evaluate the safety, tolerability, and biological activity of TALF, an animal study and a phase I clinical assay were performed. Moreover, four patients with diabetic macular edema (DME) were treated with TALF in order to explore the biological activity of the formulation. No inflammation, lens opacity, swelling, or increase in intraocular pressure were recorded after the instillation of TALF in any of the animal or clinical studies. Mainly, mild and transient adverse events such as dry eye and burning were reported. TALF significantly improves visual acuity and diminishes central foveal thickness in patients with DME. The current data demonstrate the safety, tolerability, and biological activity of TALF. It seems that TALF can be used topically to treat vitreous and retinal diseases that respond to TA such as DME, avoiding the use of corticosteroid IVTs and their associated hazards.
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Benisek DA, Manzitti J, Scorsetti D, Rousselot Ascarza AM, Ascarza AA, Gomez Rancaño D, Quercia R, Ramirez Gismondi M, Carpio Total MA, Scorsetti ML, Spitzer E, Lombas C, Deprati M, Penna MI, Fernández F, Tinelli MA. Safety and clinical effectiveness of intravitreal administration of bevacizumab (Lumiere ®) in patients with neovascular age-related macular degeneration. Exp Ther Med 2020; 20:162. [PMID: 33093900 PMCID: PMC7571337 DOI: 10.3892/etm.2020.9291] [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] [Received: 01/30/2020] [Accepted: 06/24/2020] [Indexed: 11/05/2022] Open
Abstract
The present study was an open-label, prospective, uncontrolled and multicenter clinical trial to investigate the safety and effectiveness of bevacizumab (Lumiere®) administered by the intravitreal route for the treatment of neovascular age-related macular degeneration (nAMD). A total of 22 patients without previous treatment with anti-vascular endothelial growth factor were recruited. Monthly therapy with 1.25 mg intravitreal bevacizumab was applied. Adverse events (AE), visual acuity (VA) and central retinal thickness (CRT) were assessed at baseline, day 1 and day 28 after each injection. A total of 87 AEs were reported; most of them were not serious (96.6%), expected (65.5%) and occurred after the third injection (56.3%). The most frequent AE was 'conjunctival hemorrhage' (29.9% of AEs), attributed to the injection procedure. Treatment was not suspended due to safety reasons in any case. After six months, a statistically significant gain of +8.2 (SD±8.8) letters and a CRT reduction of -75.50 µm (SD±120.3) were achieved with unilateral therapy. VA improvement and CRT reduction were also achieved with bilateral therapy, although to a lesser extent. The results of the present study suggested that therapy with a minimum of 3 doses of bevacizumab over a 6-month period was well tolerated and resulted in a sustained response regarding VA improvement and CRT reduction from the beginning of therapy compared with the baseline value. The study protocol was registered at clinicaltrials.gov (ref. no. NCT03668054).
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Affiliation(s)
- Daniel A Benisek
- Consultorios Oftalmológicos Benisek-Ascarza, Ciudad Autónoma de Buenos Aires, C1115ABB Buenos Aires, Argentina
| | - Julio Manzitti
- Consultorio Oftalmológico Julio Manzitti, Ciudad Autonóma de Buenos Aires, C1124AAG Buenos Aires, Argentina
| | - Daniel Scorsetti
- Instituto Scorsetti, Ciudad Autónoma de Buenos Aires, C1120AAC Buenos Aires, Argentina
| | - Andres M Rousselot Ascarza
- Consultorios Oftalmológicos Benisek-Ascarza, Ciudad Autónoma de Buenos Aires, C1115ABB Buenos Aires, Argentina
| | - Amalia A Ascarza
- Consultorios Oftalmológicos Benisek-Ascarza, Ciudad Autónoma de Buenos Aires, C1115ABB Buenos Aires, Argentina
| | - Diego Gomez Rancaño
- Consultorios Oftalmológicos Benisek-Ascarza, Ciudad Autónoma de Buenos Aires, C1115ABB Buenos Aires, Argentina
| | - Romina Quercia
- Consultorio Oftalmológico Julio Manzitti, Ciudad Autonóma de Buenos Aires, C1124AAG Buenos Aires, Argentina
| | - Matias Ramirez Gismondi
- Consultorio Oftalmológico Julio Manzitti, Ciudad Autonóma de Buenos Aires, C1124AAG Buenos Aires, Argentina
| | - Mateo A Carpio Total
- Instituto Scorsetti, Ciudad Autónoma de Buenos Aires, C1120AAC Buenos Aires, Argentina
| | - María L Scorsetti
- Instituto Scorsetti, Ciudad Autónoma de Buenos Aires, C1120AAC Buenos Aires, Argentina
| | - Eduardo Spitzer
- Clinical Research Department, Laboratorio Elea-Phoenix S.A., Los Polvorines, B1613AUE Buenos Aires, Argentina
| | - Carola Lombas
- Clinical Research Department, Laboratorio Elea-Phoenix S.A., Los Polvorines, B1613AUE Buenos Aires, Argentina
| | - Matías Deprati
- Health Department, Laboratorio Elea-Phoenix S.A., Los Polvorines, B1613AUE Buenos Aires, Argentina
| | - María Ines Penna
- Health Department, Laboratorio Elea-Phoenix S.A., Los Polvorines, B1613AUE Buenos Aires, Argentina
| | - Francisco Fernández
- Pharmacovigilance Department Laboratorio Elea-Phoenix S.A., Los Polvorines, B1613AUE Buenos Aires, Argentina
| | - Marcelo A Tinelli
- Clinical Research Department, Laboratorio Elea-Phoenix S.A., Los Polvorines, B1613AUE Buenos Aires, Argentina
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Balla S, Zold E, Potor L, Lukucz B, Vajas A, Ujhelyi B, Nagy V. Analysis of intravitreal bevacizumab treatment for macular oedema due to retinal vein occlusion. Eur J Ophthalmol 2020; 31:2528-2534. [PMID: 32993362 DOI: 10.1177/1120672120962051] [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] [Indexed: 01/08/2023]
Abstract
PURPOSE Our aim was to analyse the clinical effect of intravitreal bevacizumab treatment for macular oedema due to central/branch retinal vein occlusion (CRVO/BRVO). The end points were final best-corrected visual acuity (BCVA), BCVA improvement, final central 1-mm macular subfield thickness (CST) and change in CST. METHODS Our study included 34 CRVO and 25 BRVO patients. Patients received intravitreal bevacizumab (IVB) treatment at our department. Our control group consisted of 50 CRVO and 30 BRVO patients, who had not received this treatment because their disease developed before the anti-VEGF treatment became available. For statistical analysis, two-sample t-test, Pearson's correlation, and ANOVA were used. The level of significance was defined at p < 0.05. RESULTS With the two-sample t-test we found significant improvement of BCVA in the IVB-treated group (CRVO: 0.171 ± 0.270, p1 = 3.25×10-4; BRVO: 0.215 ± 0.282, p2 = 5.52×10-4). The difference in BCVA improvement was also significant compared to the control group (CRVO: p1 = 3.46×10-4; BRVO: p2 = 0.003). Significant decrease was observed in the CST in the treated group (CRVO: -345.114 ± 280.577, p1 = 6.94×10-9; BRVO: -151.875 ± 174.341, p2 = 1.67×10-4). In case of BRVO patients the final BCVA was significantly better in the treated group (0.617 ± 0.334) compared to the control group (0.406 ± 0.357), p = 0.016. CONCLUSION IVB treatment results in significantly better final visual acuity and leads to significantly increased BCVA improvement compared to patients with RVO-induced macular oedema receiving no treatment.
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Affiliation(s)
- Szabolcs Balla
- Department of Ophthalmology, University of Debrecen, Debrecen, Hungary
| | - Eszter Zold
- Department of Ophthalmology, University of Debrecen, Debrecen, Hungary
| | - Laszlo Potor
- Research Groups, MTA-DE Vascular Biology, Thrombosis and Haemostasis Research Group, University of Debrecen, Debrecen, Hungary
| | - Balazs Lukucz
- Department of Technology and Economics, University of Budapest, Budapest, Hungary
| | - Attila Vajas
- Department of Ophthalmology, University of Debrecen, Debrecen, Hungary
| | - Bernadett Ujhelyi
- Department of Ophthalmology, University of Debrecen, Debrecen, Hungary
| | - Valeria Nagy
- Department of Ophthalmology, University of Debrecen, Debrecen, Hungary
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Intravitreal enzyme replacement inhibits progression of retinal degeneration in canine CLN2 neuronal ceroid lipofuscinosis. Exp Eye Res 2020; 198:108135. [PMID: 32634395 DOI: 10.1016/j.exer.2020.108135] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/23/2020] [Accepted: 06/29/2020] [Indexed: 01/13/2023]
Abstract
CLN2 neuronal ceroid lipofuscinosis is a rare recessive hereditary retinal and neurodegenerative disease resulting from deleterious sequence variants in TPP1 that encodes the soluble lysosomal enzyme tripeptidyl peptidase-1 (TPP1). Children with this disorder develop normally, but starting at 2-4 years of age begin to exhibit neurological signs and visual deficits. Vision loss that progresses to blindness is associated with progressive retinal degeneration and impairment of retinal function. Similar progressive loss of retinal function and retinal degeneration occur in a dog CLN2 disease model with a TPP1 null sequence variant. Studies using the dog model were conducted to determine whether intravitreal injection of recombinant human TPP1 (rhTPP1) administered starting after onset of retinal functional impairment could slow or halt the progression of retinal functional decline and degeneration. TPP1-null dogs received intravitreal injections of rhTPP1 in one eye and vehicle in the other eye beginning at 23.5-25 weeks of age followed by second injections at 34-40 weeks in 3 out of 4 dogs. Ophthalmic exams, in vivo ocular imaging, and electroretinography (ERG) were repeated regularly to monitor retinal structure and function. Retinal histology was evaluated in eyes collected from these dogs when they were euthanized at end-stage neurological disease (40-45 weeks of age). Intravitreal rhTPP1 injections were effective in preserving retinal function (as measured with the electroretinogram) and retinal morphology for as long as 4 months after a single treatment. These findings indicate that intravitreal injection of rhTPP1 administered after partial loss of retinal function is an effective treatment for preserving retinal structure and function in canine CLN2 disease.
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Skrzypecki J, Ciepiaszuk K, Gawryś-Kopczyńska M. Low-dose Bevacizumab Decreases Ocular Hypotensive Effect of Angiotensin II in Sprague Dawley Rats. Curr Eye Res 2020; 46:127-134. [PMID: 32571093 DOI: 10.1080/02713683.2020.1780264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Although the effectiveness of anti-VEGF agents in ophthalmology has been thoroughly documented, we do not fully comprehend the epidemiology and mechanistic background of their side effects, including intraocular and systemic hypertension. Here, we investigate the interference of a low-dose bevacizumab with key neuronal and humoral mechanisms maintaining blood and intraocular pressure homeostasis. MATERIALS AND METHODS Intraocular pressure (IOP), blood pressure (BP), and heart rate (HR) were measured in SPRD rats pretreated with bevacizumab or 0.9% NaCl at baseline and after infusion of angiotensin II, a humoral mediator involved in BP and IOP regulation. Superior cervical gangliectomy was performed to assess the effect of sympathetic nervous system on the analyzed parameters. Additionally, we studied the expression of a subset of genes related to renin-angiotensin system in the anterior segment of the eye. RESULTS At baseline, there was no significant difference in IOP, BP, and HR between rats pretreated with 0.9% NaCl and bevacizumab. Infusion of angiotensin II lowered IOP in rats pretreated with 0.9% NaCl, but not in rats pretreated with bevacizumab (30 min: ∆4.22 ± 1.2 vs. baseline, p > .05; ∆0.83 ± 0.66 vs. baseline, p < .05) This effect was paralleled by an increased expression of angiotensin II type 1b and type 2 receptors in the anterior segment of the eye (AT1b: 1 ± 0.65 vs 7.35 ± 2.84, p < .05; AT2: 1 ± 0.05 vs. 12.8 ± 0.1, p < .05). Angiotensin II infusion increased BP in both groups (10 min: bevacizumab ∆44.6 ± 3.2, p < .05; 0.9%NaCl ∆37.1 ± 5.1, p < .05), whereas did not have any effect on HR. Sympathetic ocular denervation did not affect any of the analyzed parameters. CONCLUSIONS We found that low-dose bevacizumab interferes with IOP-lowering properties of angiotensin II. This effect might be related to increased expression of angiotensin II receptors in the anterior segment of the eye.
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Affiliation(s)
- J Skrzypecki
- Department of Experimental Physiology and Pathophysiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw , Warsaw, Poland
| | - K Ciepiaszuk
- Department of Experimental Physiology and Pathophysiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw , Warsaw, Poland
| | - M Gawryś-Kopczyńska
- Department of Experimental Physiology and Pathophysiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw , Warsaw, Poland
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Navarro-Partida J, Altamirano-Vallejo JC, Lopez-Naranjo EJ, Gonzalez-De la Rosa A, Manzano-Ramírez A, Apatiga-Castro LM, Armendáriz-Borunda J, Santos A. Topical Triamcinolone Acetonide-Loaded Liposomes as Primary Therapy for Macular Edema Secondary to Branch Retinal Vein Occlusion: A Pilot Study. J Ocul Pharmacol Ther 2020; 36:393-403. [PMID: 32564664 DOI: 10.1089/jop.2019.0143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purpose: To explore safety and therapeutic efficacy of a topical ophthalmic triamcinolone acetonide-loaded liposome formulation (TA-LF) as primary therapy in patients with macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Methods: Twelve eyes of 12 patients with ME secondary to BRVO were exposed to a topical instillation of 1 drop of TA-LF (TA 0.2%) 6 times a day for 12 weeks to evaluate safety and efficacy. Best corrected visual acuity (BCVA) intraocular pressure (IOP), slit lamp examination, and central foveal thickness (CFT) were analyzed at every visit. In addition, the morphology of TA-LF was analyzed using scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Results: Patients presented a significant improvement of BCVA and CFT without significant IOP modification (P = 0.94). Treated eyes showed BCVA improvement from 40 ± 12.05 to 64.83 ± 15.97 letters and CFT reduction from 682.91 ± 278.60 to 271.58 ± 57.66 μm after 12 weeks of TA-LF therapy (P < 0.001). No adverse events, including IOP rising, were registered. SEM analysis of liposomal formulations showed that liposome (LP) size depends on its concentration. As the concentration of TA increased, the average size of LPs and the number of larger particles increased as well. TEM study displayed that LP formulation efficiently solubilizes TA crystals in nanoparticles and encapsulates them. Conclusion: LPs can function as nanocarriers of TA and they could be used as topical ophthalmic primary therapy instead of intravitreal drugs in patients with ME secondary to BRVO.
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Affiliation(s)
- Jose Navarro-Partida
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Campus Guadalajara, Zapopan, Mexico.,Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro, Zapopan, Mexico
| | - Juan Carlos Altamirano-Vallejo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Campus Guadalajara, Zapopan, Mexico.,Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro, Zapopan, Mexico
| | | | - Alejandro Gonzalez-De la Rosa
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Campus Guadalajara, Zapopan, Mexico.,Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro, Zapopan, Mexico
| | | | - Luis Miguel Apatiga-Castro
- Universidad Nacional Autonoma de Mexico (UNAM), Centro de Física Aplicada y Tecnología Avanzada, Querétaro, Mexico
| | - Juan Armendáriz-Borunda
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Campus Guadalajara, Zapopan, Mexico.,Instituto de Biología Molecular y Terapia Génica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Arturo Santos
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Campus Guadalajara, Zapopan, Mexico.,Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro, Zapopan, Mexico
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Otten LS, Butterhoff-Terlingen MH, Mulder VC, Lagas-de Graaf W, van der Hage-Lie AM, van der Linden PD. Severe epistaxis related to intravitreal bevacizumab. Acta Ophthalmol 2020; 98:e137. [PMID: 31233274 PMCID: PMC7004067 DOI: 10.1111/aos.14176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Leila S Otten
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Verena C Mulder
- Rotterdam Ophthalmic Institute, Rotterdam Eye Hospital, Rotterdam, The Netherlands.,Department of Clinical Pharmacy, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
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11
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Gonzalez-De la Rosa A, Navarro-Partida J, Altamirano-Vallejo JC, Jauregui-Garcia GD, Acosta-Gonzalez R, Ibanez-Hernandez MA, Mora-Gonzalez GF, Armendáriz-Borunda J, Santos A. Novel Triamcinolone Acetonide-Loaded Liposomal Topical Formulation Improves Contrast Sensitivity Outcome After Femtosecond Laser-Assisted Cataract Surgery. J Ocul Pharmacol Ther 2019; 35:512-521. [PMID: 31486694 PMCID: PMC6839423 DOI: 10.1089/jop.2019.0032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Purpose: To assess visual results, macular modifications, and the incidence of clinically significant macular edema (CSME) in patients using a topical triamcinolone acetonide-loaded liposomal formulation (TA-LF) after femtosecond laser-assisted cataract surgery (FLACS). Methods: Fifty-six eyes after FLACS were selected. Twenty-eight eyes in the combined therapy group (P + N) were treated with prednisolone 1% and nepafenac 0.1% for 21 days postoperatively, whereas 28 eyes in the TA-LF group received a liposomal formulation containing 2 mg/mL of TA (0.2%) for the same period of time. Follow-up visits at 1 day, 6 weeks, and 12 weeks after surgery consisted of visual acuity, contrast sensitivity (CS), central foveal thickness (CFT), total macular volume (TMV) measurements, and the detection of CSME. Results: CS improved in the TA-LF group (basal value: 1.087 ± 0.339 vs. 1.276 ± 0.147 at week 12, P = 0.0346), whereas in the P + N group, CS was not different from the baseline (basal value: 1.130 ± 0.331 vs. 1.274 ± 0.133 at week 12, P = 0.1276). There were similar increases in postoperative CFT and TMV in both groups. CFT and TMV significantly correlate with CS only in the TA-LF group. The r2 for CFT and CS was 0.1963 (P = 0.0206), whereas the r2 for TMV and CS was 0.3615 (P = 0.0007) at 12 weeks. No difference was observed in the incidence of CSME between the groups. Conclusion: TA-LF is associated with better CS outcomes compared to combined therapy after FLACS.
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Affiliation(s)
- Alejandro Gonzalez-De la Rosa
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, Mexico.,Centro de Retina Médica y Quirúrgica, S.C., Centro Médico Puerta de Hierro, Zapopan, Mexico
| | - Jose Navarro-Partida
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, Mexico.,Centro de Retina Médica y Quirúrgica, S.C., Centro Médico Puerta de Hierro, Zapopan, Mexico
| | - Juan Carlos Altamirano-Vallejo
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, Mexico.,Centro de Retina Médica y Quirúrgica, S.C., Centro Médico Puerta de Hierro, Zapopan, Mexico
| | - Gerardo Daniel Jauregui-Garcia
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, Mexico.,Centro de Retina Médica y Quirúrgica, S.C., Centro Médico Puerta de Hierro, Zapopan, Mexico
| | | | | | | | - Juan Armendáriz-Borunda
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, Mexico.,Instituto de Biología Molecular y Terapia Génica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Arturo Santos
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, Mexico.,Centro de Retina Médica y Quirúrgica, S.C., Centro Médico Puerta de Hierro, Zapopan, Mexico
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12
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Gonzalez-De la Rosa A, Navarro-Partida J, Altamirano-Vallejo JC, Hernandez-Gamez AG, Garcia-Bañuelos JJ, Armendariz-Borunda J, Santos A. Novel Triamcinolone Acetonide-Loaded Liposomes Topical Formulation for the Treatment of Cystoid Macular Edema After Cataract Surgery: A Pilot Study. J Ocul Pharmacol Ther 2019; 35:106-115. [PMID: 30614750 PMCID: PMC6450453 DOI: 10.1089/jop.2018.0101] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Purpose: To report tolerability, safety, and efficacy of a topical triamcinolone acetonide-loaded liposomes formulation (TA-LF) in targeting the macular area in patients with refractory pseudophakic cystoid macular edema (PCME). Methods: For tolerability, safety and efficacy evaluation, 12 eyes of 12 patients with refractory PCME were exposed to one drop of TA-LF (TA at 0.2%) every 2 h for 90 days or until best-corrected visual acuity (BCVA) was achieved. Intraocular pressure (IOP), slit lamp examination, and central foveal thickness (CFT) were analyzed at every visit. Results: Patients with refractory PCME under TA-LF therapy showed a significant improvement in BVCA and CFT without significant IOP modification (P = 0.94). On average CFT decreased to 206.75 ± 135.72 μm and BCVA improved to 20.08 ± 10.35 letters (P < 0.0005). BCVA was achieved at 10.58 ± 6.70 weeks (range 2–18). TA-LF was well tolerated in all cases. Neither ocular surface abnormalities nor adverse events were recorded. Conclusion: TA-LF was well tolerated and improved BCVA and CFT on patients with refractory PCME.
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Affiliation(s)
- Alejandro Gonzalez-De la Rosa
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, México.,2 Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro. Zapopan, Jalisco, México
| | - Jose Navarro-Partida
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, México.,2 Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro. Zapopan, Jalisco, México
| | - Juan Carlos Altamirano-Vallejo
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, México.,2 Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro. Zapopan, Jalisco, México
| | | | - Jesus Javier Garcia-Bañuelos
- 4 Instituto de Biología Molecular y Terapia Génica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | | | - Arturo Santos
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, México.,2 Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro. Zapopan, Jalisco, México
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13
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Sangroongruangsri S, Chaikledkaew U, Kumluang S, Wu O, Geue C, Ratanapakorn T, Leelahavarong P, Ingsrisawang L, Ruamviboonsuk P, Taweebanjongsin W, Choovuthayakorn J, Singalavanija A, Hanutsaha P, Kulvichit K, Ratanapojnard T, Wongsawad W, Teerawattananon Y. Real-World Safety of Intravitreal Bevacizumab and Ranibizumab Treatments for Retinal Diseases in Thailand: A Prospective Observational Study. Clin Drug Investig 2018; 38:853-865. [PMID: 30069864 PMCID: PMC6153972 DOI: 10.1007/s40261-018-0678-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is very limited evidence examining serious systemic adverse events (SSAEs) and post-injection endophthalmitis of intravitreal bevacizumab (IVB) and intravitreal ranibizumab (IVR) treatments in Thailand and low- and middle-income countries. Moreover, findings from the existing trials might have limited generalizability to certain populations and rare SSAEs. OBJECTIVES This prospective observational study aimed to assess and compare the safety profiles of IVB and IVR in patients with retinal diseases in Thailand. METHODS Between 2013 and 2015, 6354 patients eligible for IVB or IVR were recruited from eight hospitals. Main outcomes measures were prevalence and risk of SSAEs, mortality, and endophthalmitis during the 6-month follow-up period. RESULTS In the IVB and IVR groups, 94 and 6% of patients participated, respectively. The rates of outcomes in the IVB group were slightly greater than in the IVR group. All-cause mortality rates in the IVB and IVR groups were 1.10 and 0.53%, respectively. Prevalence rates of endophthalmitis and non-fatal strokes in the IVB group were 0.04% of 16,421 injections and 0.27% of 5975 patients, respectively, whereas none of these events were identified in the IVR group. There were no differences between the two groups in the risks of mortality, arteriothrombotic events (ATE), and non-fatal heart failure (HF). Adjustment for potential confounding factors and selection bias using multivariable models for time-to-event outcomes and propensity scores did not alter the results. CONCLUSIONS The rates of SAEs in both groups were low. The IVB and IVR treatments were not associated with significant risks of mortality, ATE, and non-fatal HF. TRIAL REGISTRATION Thai Clinical Trial Registry identifier TCTR20141002001.
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Affiliation(s)
- Sermsiri Sangroongruangsri
- Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayuthaya Road, Rajathevi, Bangkok, 10400, Thailand
| | - Usa Chaikledkaew
- Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayuthaya Road, Rajathevi, Bangkok, 10400, Thailand.
| | - Suthasinee Kumluang
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Olivia Wu
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Claudia Geue
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Pattara Leelahavarong
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Lily Ingsrisawang
- Department of Statistics, Faculty of Science, Kasetsart University, Bangkok, Thailand
| | - Paisan Ruamviboonsuk
- Department of Ophthalmology, Faculty of Medicine, Rajavithi Hospital, Rangsit University, Bangkok, Thailand
| | | | - Janejit Choovuthayakorn
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Apichart Singalavanija
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prut Hanutsaha
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kittisak Kulvichit
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thitiporn Ratanapojnard
- Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Warapat Wongsawad
- Mettapracharak Eye Institute, Mettapracharak (Wat Rai Khing) Hospital, Nakhon Pathom, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
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14
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Bagheri S, Dormanesh B, Afarid M, Sagheb MM. Proteinuria and Renal Dysfunction after Intravitreal Injection of Bevacizumab in Patients with Diabetic Nephropathy: A Prospective Observational Study. Galen Med J 2018; 7:e1299. [PMID: 34466447 PMCID: PMC8344120 DOI: 10.22086/gmj.v0i0.1299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 08/16/2018] [Accepted: 09/07/2018] [Indexed: 11/30/2022] Open
Abstract
Background: Proliferative diabetic retinopathy (PDR) is one of the most important microvascular complications among the patients with diabetes. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) agent enacts a key role in PDR. Some studies have dealt with the systemic exposure to these agents after intravitreal administration. However, renal dysfunction following this therapy has scarcely been reported. Hence, this study aimed to determine the effect of intravitreal bevacizumab treatment on the deterioration of renal function and proteinuria. Materials and Methods: This present prospective observational study was performed on 40 patients with diabetic nephropathy and PDR and/or significant diabetic macular edema as the candidates for receiving intravitreal injection of bevacizumab. To evaluate renal function, changes in the urinary albumin-to-creatinine ratio (UACR), serum creatinine (SCr), and estimated glomerular filtration rate (eGFR) one month after injection were measured. Also, changes in systolic and diastolic blood pressures (BPs), plasma VEGF level, platelet, white blood cell (WBC) counts, and hemoglobin (Hb) level were measured at the baseline and one month after treatment. Results: The mean age of the patients was 60.3 ± 9.2 years, and 33 patients were female. The decrease in the plasma VEGF level and platelet count, as well as the increase in diastolic BP, and Hb level were significant. However, systolic BP and WBC count remained unchanged. There were no significant changes in UACR, SCr, and eGFR after the injection as compared to baseline (P>0.05). Conclusion: Our study indicated that intravitreal bevacizumab injection was not associated with renal dysfunction and proteinuria in patients with diabetic nephropathy. Nevertheless, diastolic BP and Hb level could increase after one month.
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Affiliation(s)
- Sina Bagheri
- Researcher, AJA University of Medical Sciences, Tehran, Iran.,Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Banafshe Dormanesh
- Pediatric Department, Medical Faculty, AJA University of Medical Sciences, Tehran, Iran
| | - Mehrdad Afarid
- Poostchi Ophthalmology Research Center and Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Mahdi Sagheb
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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15
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Downie LE, Makrai E, Bonggotgetsakul Y, Dirito LJ, Kristo K, Pham MAN, You M, Verspoor K, Pianta MJ. Appraising the Quality of Systematic Reviews for Age-Related Macular Degeneration Interventions: A Systematic Review. JAMA Ophthalmol 2018; 136:1051-1061. [PMID: 29978192 DOI: 10.1001/jamaophthalmol.2018.2620] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
Importance Age-related macular degeneration (AMD) is a leading cause of vision impairment. It is imperative that AMD care is timely, appropriate, and evidence-based. It is thus essential that AMD systematic reviews are robust; however, little is known about the quality of this literature. Objectives To investigate the methodological quality of systematic reviews of AMD intervention studies, and to evaluate their use for guiding evidence-based care. Evidence Review This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. All studies that self-identified as a systematic review in their title or abstract or were categorized as a systematic review from a medical subject heading and investigated the safety, efficacy and/or effectiveness of an AMD intervention were included. Comprehensive electronic searches were performed in Ovid MEDLINE, Embase, and the Cochrane Library from inception to March 2017. Two reviewers independently assessed titles and abstracts, then full-texts for eligibility. Quality was assessed using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool. Study characteristics (publication year, type of intervention, journal, citation rate, and funding source) were extracted. Findings Of 983 citations retrieved, 71 studies (7.6%) were deemed eligible. The first systematic review relating to an AMD intervention was published in 2003. More than half were published since 2014. Methodological quality was highly variable. The mean (SD) AMSTAR score was 5.8 (3.2) of 11.0, with no significant improvement over time (r = -0.03; 95% CI, -0.26 to 0.21; P = .83). Cochrane systematic reviews were overall of higher quality than reviews in other journals (mean [SD] AMSTAR score, 9.9 [1.2], n = 15 vs 4.7 [2.2], n = 56; P < .001). Overall, there was poor adherence to referring to an a priori design (22 articles [31%]) and reporting conflicts of interest in both the review and included studies (16 articles [23%]). Reviews funded by government grants and/or institutions were generally of higher quality than industry-sponsored reviews or where the funding source was not reported. Conclusions and Relevance There are gaps in the conduct of systematic reviews in the field of AMD. Enhanced endorsement of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement by refereed journals may improve review quality and improve the dissemination of reliable evidence relating to AMD interventions to clinicians.
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Affiliation(s)
- Laura E Downie
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Eve Makrai
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Yokim Bonggotgetsakul
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Lucy J Dirito
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Kresimir Kristo
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Minh-An N Pham
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Mina You
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Karin Verspoor
- School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia
| | - Michael J Pianta
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia
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16
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Sangroongruangsri S, Ratanapakorn T, Wu O, Anothaisintawee T, Chaikledkaew U. Comparative efficacy of bevacizumab, ranibizumab, and aflibercept for treatment of macular edema secondary to retinal vein occlusion: a systematic review and network meta-analysis. Expert Rev Clin Pharmacol 2018; 11:903-916. [PMID: 30071180 DOI: 10.1080/17512433.2018.1507735] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Anti-vascular endothelial growth factor (VEGF) therapy has become the most commonly used treatment for macular edema secondary to retinal vein occlusion (RVO). Although its superior efficacy as compared to other interventions has been proven, there is a lack of evidence for relative efficacy among anti-VEGF drugs. Areas covered: This work systematically reviewed and compared the efficacy of intravitreal bevacizumab, ranibizumab, and aflibercept for treating macular edema due to RVO. PubMed, EMBASE, and the Cochrane Library were searched from their inception until October 2017. Eleven randomized controlled trials (18 articles; 1830 adult patients) were identified. The proportion of patients who gained at least 15 letters in best-corrected visual acuity (BCVA), mean change from baseline in BCVA, and mean change from baseline in central macular thickness (CMT) were reported and these efficacy outcomes at 6 months were analyzed in network meta-analysis. Expert commentary: Apparently, bevacizumab, ranibizumab, and aflibercept were significantly superior to sham injection in terms of BCVA improvement and CMT reduction and had good safety profiles. However, there were no statistically significant differences in any outcomes among anti-VEGF drugs. In selecting an anti-VEGF drug for individual patients, other factors including affordability, drug availability, and patient characteristics should be considered.
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Affiliation(s)
- Sermsiri Sangroongruangsri
- a Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy , Mahidol University , Bangkok , Thailand
| | - Tanapat Ratanapakorn
- b Department of Ophthalmology, Faculty of Medicine , Khon Kaen University , Khon Kaen , Thailand
| | - Olivia Wu
- c Health Economics and Health Technology Assessment , Institute of Health and Wellbeing, University of Glasgow , Glasgow , UK
| | - Thunyarat Anothaisintawee
- d Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital , Mahidol University , Bangkok , Thailand
| | - Usa Chaikledkaew
- a Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy , Mahidol University , Bangkok , Thailand
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17
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Mérida S, Sancho-Tello M, Almansa I, Desco C, Peris C, Moreno ML, Villar VM, Navea A, Bosch-Morell F. Bevacizumab Diminishes Inflammation in an Acute Endotoxin-Induced Uveitis Model. Front Pharmacol 2018; 9:649. [PMID: 29971005 PMCID: PMC6018210 DOI: 10.3389/fphar.2018.00649] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 05/31/2018] [Indexed: 12/14/2022] Open
Abstract
Introduction: Uveitis is an eye disease characterized by inflammation of the uvea and an early and exhaustive diagnosis is essential for its treatment. The aim of our study is to assess the potential toxicity and anti-inflammatory efficacy of Bevacizumab in an experimental uveitis model by subcutaneously injecting lipopolysaccharide into Lewis rats and to clarify its mechanism. Material and Methods: Blood-aqueous barrier integrity was assessed 24 h after endotoxin-induced uveitis (EIU) by analyzing two parameters: cell count and protein concentration in aqueous humors. Histopathology of all eye structures was also studied. Enzyme-linked immunosorbent analyses of the aqueous humor samples were performed in order to calculate the diverse chemokine and cytokine protein levels and oxidative stress-related markers were also evaluated. Results: The aqueous humor's cellular content significantly increased in the group treated with only Bevacizumab, but it had no effect on retina histopathological grading. Nevertheless, the inflammation noted in ocular structures when administering Bevacizumab with endotoxin was mostly prevented since aqueous humor cell content considerably lowered, and concomitantly with a sharp drop in uveal, vitreous, and retina histopathological grading. The values of the multi-faceted cytokine IL-2 also significantly decreased (p < 0.05 vs. endotoxin group), and the protective IL-6 and IL-10 cytokines values rose with related anti-oxidant system recovery (p < 0.05 vs. endotoxin group). Concurrently, some related M1 macrophage chemokines substantially increased, e.g., GRO/KC, a chemokine that also displays any kind of protective role. Conclusion: All these results revealed that 24 h after being administered, Bevacizumab treatment in EIU significantly prevented inflammation in various eye structures and correct results in efficacy vs. toxicity balance were obtained.
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Affiliation(s)
- Salvador Mérida
- Departamento de Ciencias Biomédicas, Instituto de Ciencias Biomédicas, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | | | - Inmaculada Almansa
- Departamento de Ciencias Biomédicas, Instituto de Ciencias Biomédicas, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | - Carmen Desco
- Department of Medical Ophtalmology, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Valencia, Spain
| | - Cristina Peris
- Department of Medical Ophtalmology, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Valencia, Spain
| | - Mari-Luz Moreno
- Department of Basic Sciences, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | - Vincent M. Villar
- Departamento de Ciencias Biomédicas, Instituto de Ciencias Biomédicas, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | - Amparo Navea
- Departamento de Ciencias Biomédicas, Instituto de Ciencias Biomédicas, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | - Francisco Bosch-Morell
- Departamento de Ciencias Biomédicas, Instituto de Ciencias Biomédicas, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
- Department of Medical Ophtalmology, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Valencia, Spain
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18
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Altamirano-Vallejo JC, Navarro-Partida J, Gonzalez-De la Rosa A, Hsiao JH, Olguín-Gutierrez JS, Gonzalez-Villegas AC, Keller BC, Bouzo-Lopez L, Santos A. Characterization and Pharmacokinetics of Triamcinolone Acetonide-Loaded Liposomes Topical Formulations for Vitreoretinal Drug Delivery. J Ocul Pharmacol Ther 2018; 34:416-425. [PMID: 29584529 DOI: 10.1089/jop.2017.0099] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE To achieve a safer alternative to intravitreal injection of corticosteroids, we developed and characterized triamcinolone acetonide-loaded liposomes formulations (TA-LFs) to be used topically for vitreoretinal drug delivery. METHODS Four different 0.2% TA-LFs (TA-LF1 to TA-LF4) were generated and submitted to physicochemical characterization. Posteriorly, an ex vivo diffusion assay was performed using rabbit corneas as membranes. Finally, concentrations of triamcinolone acetonide (TA) were determined by high-performance liquid chromatography in ocular tissues from New Zealand white rabbits after multiple topical doses of TA-LF2 (6 times per day, 14 days). In addition, toxicity and tolerability of TA-LF2 was evaluated by cell viability assay and eye examination of study animals, respectively. RESULTS TA-LF2 was the most stable formulation maintaining a stable hidrogenion potential (pH) at 30 and 40°C and even improving encapsulation with higher temperature. TA-LF2 and TA-LF3 presented the best diffusion performance in vitro reaching the highest TA concentrations after 8 h of follow-up. In vivo diffusion and pharmacokinetics analysis showed that concentrations of TA in retina and vitreous reached the highest peak at 12 h after topical administration of TA-LF2 (252.10 ± 90.00 ng/g and 32.6 ± 10.27 ng/g, respectively) and subsequently decline to 24.0 ± 11.72 ng/g and 19.5 ± 13.14 ng/g, respectively, at 14 days of follow-up. Finally, cell viability was unaffected by TA-LF2, and no increase in intraocular pressure nor ocular alterations were observed after topical administration of this formulation in rabbits. CONCLUSION TA-loaded liposomes, administered topically, can deliver TA in the vitreous cavity and reach the retina efficiently.
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Affiliation(s)
- Juan C Altamirano-Vallejo
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud , Campus Guadalajara, Zapopan, México.,2 Centro de Retina Medica y Quirurgica , S.C., Centro Medico Puerta de Hierro, Zapopan, México
| | - Jose Navarro-Partida
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud , Campus Guadalajara, Zapopan, México.,2 Centro de Retina Medica y Quirurgica , S.C., Centro Medico Puerta de Hierro, Zapopan, México
| | - Alejandro Gonzalez-De la Rosa
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud , Campus Guadalajara, Zapopan, México.,2 Centro de Retina Medica y Quirurgica , S.C., Centro Medico Puerta de Hierro, Zapopan, México
| | | | | | | | | | | | - Arturo Santos
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud , Campus Guadalajara, Zapopan, México.,2 Centro de Retina Medica y Quirurgica , S.C., Centro Medico Puerta de Hierro, Zapopan, México
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19
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Haji Mohd Yasin NAB, Gray AR, Bevin TH, Kelly LE, Molteno AC. Choroidal melanoma treated with stereotactic fractionated radiotherapy and prophylactic intravitreal bevacizumab: The Dunedin Hospital experience. J Med Imaging Radiat Oncol 2016; 60:756-763. [PMID: 27378522 DOI: 10.1111/1754-9485.12489] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/28/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Choroidal melanoma (CM) is the most common primary ocular malignancy in adults. This study reviewed the Dunedin Hospital (DH) experience in the treatment of CM with stereotactic fractionated radiotherapy (SRT) and the outcome of prophylactic use of intravitreal injection bevacizumab (PIB) in preventing radiation retinopathy (RR). METHODS A retrospective study was conducted of patients at DH who underwent SRT for CM with and without PIB from 1 January 2001 to 31 January 2012. In DH, some patients who had SRT following the introduction of intravitreal bevacizumab in December 2006 were also treated with PIB with the expectation that this might reduce the risk of developing RR, although the evidence of its effectiveness in this respect is not clear. The primary outcome measure was local progression as monitored with regular ultrasound. Secondary outcome measures were metastatic progression incidence, enucleation incidence, no functional vision incidence, overall survival, disease-specific mortality, incidence of RR, and radiotherapy to clinical diagnosis of RR time. RESULTS Twenty-seven patients who were followed up at DH were reviewed after a mean follow-up of 5.1 years (range 0.4-12.6). Fourteen patients received PIB. The local progression, metastatic progression and enucleation rate were 4%, 8% and 11%, respectively. The no functional vision (hand movements or less) rate was 62%. Overall survival was 63%, but only three (11%) deaths were due to metastatic choroidal melanoma. Incidence of RR was 57% and 54% for those that received PIB and those who did not, respectively. PIB did not reduce the rate of RR (P = 1.00). CONCLUSION This study reaffirmed that SRT achieves very good local control and eye retention rates. PIB did not appear to reduce the radiation retinopathy rate in this study, and more studies are required especially Phase II and III trials to determine PIB efficacy in preventing RR.
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Affiliation(s)
| | - Andrew R Gray
- University of Otago Dunedin School of Medicine, Dunedin, New Zealand
| | - Tui H Bevin
- University of Otago Dunedin School of Medicine, Dunedin, New Zealand
| | | | - Anthony C Molteno
- University of Otago Dunedin School of Medicine, Dunedin, New Zealand
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Oztas Z, Akkin C, Afrashi F, Nalcaci S. The short-needle intravitreal injection technique. Int J Ophthalmol 2016; 9:929-30. [PMID: 27366700 DOI: 10.18240/ijo.2016.06.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 07/09/2015] [Indexed: 11/23/2022] Open
Affiliation(s)
- Zafer Oztas
- Department of Ophthalmology, Ege University Faculty of Medicine, Izmir 35040, Turkey
| | - Cezmi Akkin
- Department of Ophthalmology, Ege University Faculty of Medicine, Izmir 35040, Turkey
| | - Filiz Afrashi
- Department of Ophthalmology, Ege University Faculty of Medicine, Izmir 35040, Turkey
| | - Serhad Nalcaci
- Department of Ophthalmology, Ege University Faculty of Medicine, Izmir 35040, Turkey
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21
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Hassall MM, Andrew NH. Single-eye trial of a topical carbonic anhydrase inhibitor versus intravitreal bevacizumab for the treatment of taxane drug-induced cystoid macula oedema. BMJ Case Rep 2016; 2016:10.1136/bcr-2015-212733. [PMID: 27095804 DOI: 10.1136/bcr-2015-212733] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Taxanes are a class of microtubule stabilising agents used to treat a wide range of malignancies. Taxane drug-induced cystoid macula oedema (TDICMO) is a known but rare complication of therapy. First reported with Docetaxel in 2003 and Paclitaxel in 2007, there are currently less than 20 cases of TDICMO in the literature. Although most cases resolve following taxane cessation, several authors have tried using carbonic anhydrase inhibitors or intravitreal bevacizumab to accelerate resolution or when taxane therapy cannot be discontinued. We report the first published case of TDICMO treated with a single-eye trial of topical dorzolamide versus intravitreal bevacizumab.
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Affiliation(s)
- Mark M Hassall
- Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford, UK
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Trinh HM, Joseph M, Cholkar K, Pal D, Mitra AK. Novel strategies for the treatment of diabetic macular edema. World J Pharmacol 2016; 5:1-14. [DOI: 10.5497/wjp.v5.i1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/19/2015] [Accepted: 01/07/2016] [Indexed: 02/06/2023] Open
Abstract
Macular edema such as diabetic macular edema (DME) and diabetic retinopathy are devastating back-of-the-eye retinal diseases leading to loss of vision. This area is receiving considerable medical attention. Posterior ocular diseases are challenging to treat due to complex ocular physiology and barrier properties. Major ocular barriers are static (corneal epithelium, corneal stroma, and blood-aqueous barrier) and dynamic barriers (blood-retinal barrier, conjunctival blood flow, lymph flow, and tear drainage). Moreover, metabolic barriers impede posterior ocular drug delivery and treatment. To overcome such barriers and treat back-of-the-eye diseases, several strategies have been recently developed which include vitreal drainage, laser photocoagulation and treatment with biologics and/or small molecule drugs. In this article, we have provided an overview of several emerging novel strategies including nanotechnology based drug delivery approach for posterior ocular drug delivery and treatment with an emphasis on DME.
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Robert MC, Frenette M, Zhou C, Yan Y, Chodosh J, Jakobiec FA, Stagner AM, Vavvas D, Dohlman CH, Paschalis EI. A Drug Delivery System for Administration of Anti-TNF-α Antibody. Transl Vis Sci Technol 2016; 5:11. [PMID: 26981333 PMCID: PMC4790433 DOI: 10.1167/tvst.5.2.11] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 02/09/2016] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To describe the fabrication, evaluation, and preliminary in vivo safety of a new drug delivery system (DDS) for topical anti-TNF-α antibody administration. METHODS A DDS was fabricated using inverse template fabrication of a hydrophobic three-dimensional porous scaffold (100-300 μm in diameter porosity) loaded with 10% polyvinyl alcohol hydrogel carrying 5 mg/ml (weight/volume) of anti-TNF-α antibody. Drug-loaded DDS was sterilized with 25 kGy of gamma irradiation. Long-term in vitro antibody affinity and release was evaluated at room temperature or 37°C using enzyme-linked immunosorbent assay (ELISA) and protein fluorescence. In vivo clinical and histolopathological assessment was performed by subcutaneous implantation in BALB/c mice for 3 months. RESULTS Gamma irradiation, repeated dry/wet cycles, and storage at room temperature for 1 year or 37°C for 1 month had no deleterious effects on antibody affinity. Anti-TNF-α release was high during the first minutes of aqueous exposure, followed by stabilization and gradual, low-dose, antibody release over the next 30 days. Histopathologic evaluation of explanted DDS showed a fibrous pseudocapsule and a myxoid acute/chronic inflammation without granuloma formation surrounding the implants. CONCLUSIONS Sustained local delivery of anti-TNF-α antibody is feasible using the described DDS, which provides stability of the enclosed antibody for up to 1 year of storage. Preliminary results show good in vivo tolerance following subcutaneous placement for 3 months. The proposed fabrication and sterilization process opens new possibilities for the delivery of biologic agents to the anterior surface of the eye. TRANSLATIONAL RELEVANCE The described DDS will facilitate the treatment of ocular surface diseases amenable to biologic therapy.
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Affiliation(s)
- Marie-Claude Robert
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA ; Massachusetts Eye and Ear Infirmary/Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Harvard Medical School, Boston, MA, USA
| | - Mathieu Frenette
- Université du Québec à Montréal, Department of Chemistry, Montreal, QC, Canada
| | - Chengxin Zhou
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Yueran Yan
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Angiogenesis Laboratory, Harvard Medical School, Boston, MA, USA
| | - James Chodosh
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Frederick A Jakobiec
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA ; Massachusetts Eye and Ear Infirmary, David G. Cogan Laboratory of Ophthalmic Pathology, Harvard Medical School, Boston, MA, USA
| | - Anna M Stagner
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA ; Massachusetts Eye and Ear Infirmary, David G. Cogan Laboratory of Ophthalmic Pathology, Harvard Medical School, Boston, MA, USA
| | - Demetrios Vavvas
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Angiogenesis Laboratory, Harvard Medical School, Boston, MA, USA
| | - Claes H Dohlman
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA ; Massachusetts Eye and Ear Infirmary/Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Harvard Medical School, Boston, MA, USA
| | - Eleftherios I Paschalis
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA ; Massachusetts Eye and Ear Infirmary/Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Harvard Medical School, Boston, MA, USA
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25
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Dashti-Khavidaki S, Abdollahi M. Intravitreal administration of bevacizumab: pros and cons. ACTA ACUST UNITED AC 2015; 23:27. [PMID: 25896903 PMCID: PMC4406161 DOI: 10.1186/s40199-015-0110-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 04/11/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | - Mohammad Abdollahi
- Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, 1417614411, Iran.
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