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Verrecchia S, Chiambaretta F, Kodjikian L, Nakouri Y, El Chehab H, Mathis T, Badri Y, Chudzinski R, Levron A, Chaperon M, Agard E, Pradat P, Dot C. A prospective multicentre study of intravitreal injections and ocular surface in 219 patients: IVIS study. Acta Ophthalmol 2021; 99:877-884. [PMID: 33733603 DOI: 10.1111/aos.14797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE To assess the impact of intravitreal injections (IVTI) on ocular surface of patients treated with multiple injections. METHODS Prospective, tricentric study conducted in patients treated with unilateral IVTI. An asepsis protocol with povidone-iodine was used for all patients during IVTI. The primary endpoint was the difference between the pre-IVTI Ocular Surface Disease Index (OSDI 1) score and that measured on day one (D1) post-IVTI (OSDI 2). Secondary endpoints were the evaluation of predictive factors for OSDI scores, pain assessment on D1, and the Lacrydiag® analysis of tears from the injected eye versus contralateral eye before IVTI. RESULTS Two hundred and nineteen patients with a mean age of 75.9 ± 10 years were included. The mean OSDI2-OSDI1 difference was 19.2 ± 20.6 (p < 0.001). The mean noninvasive tear break-up time was 6.41 ± 4.59 seconds in the injected eye versus 7.36 ± 4.36 seconds in the contralateral eye (p < 0.001). In the multivariate analysis, the factors significantly associated with the OSDI 2 score were the OSDI 1 score (p < 0.001), the pain score on D1 (p < 0.001) the number of instilled glaucoma eye drop (p = 0.01) and a centre effect (centres 2 and 3 versus centre 1, p < 0.001). CONCLUSION Our results confirm the impairment of the ocular surface and quality of life immediately after an IVTI. These results suggest 3 levels of action to improve the immediate tolerance: improving the basal status of the ocular surface, reducing the contact time with povidone-iodine that might be toxic to the surface, and improving immediate post-IVTI treatment.
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Affiliation(s)
- Sarah Verrecchia
- Department of Ophthalmology Desgenettes Military Hospital Lyon France
- Department of Ophthalmology Croix‐Rousse University Hospital Hospices Civils de Lyon Lyon France
| | | | - Laurent Kodjikian
- Department of Ophthalmology Croix‐Rousse University Hospital Hospices Civils de Lyon Lyon France
- UMR‐CNRS 5510 Matéis Villeurbanne Université Claude Bernard Lyon 1 University of Lyon Lyon France
| | - Yasemin Nakouri
- Gabriel‐Montpied University Hospital Center Clermont Ferrand France
| | - Hussam El Chehab
- Department of Ophthalmology Desgenettes Military Hospital Lyon France
| | - Thibaud Mathis
- Department of Ophthalmology Croix‐Rousse University Hospital Hospices Civils de Lyon Lyon France
| | - Yannis Badri
- Department of Ophthalmology Desgenettes Military Hospital Lyon France
| | - Roman Chudzinski
- Department of Ophthalmology Desgenettes Military Hospital Lyon France
| | - Antoine Levron
- Department of Ophthalmology Desgenettes Military Hospital Lyon France
| | - Mayeul Chaperon
- Department of Ophthalmology Desgenettes Military Hospital Lyon France
| | - Emilie Agard
- Department of Ophthalmology Desgenettes Military Hospital Lyon France
| | - Pierre Pradat
- Department of Ophthalmology Croix‐Rousse University Hospital Hospices Civils de Lyon Lyon France
| | - Corinne Dot
- Department of Ophthalmology Desgenettes Military Hospital Lyon France
- French Military Health Service Academy Val de Grâce Paris France
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D'Souza HS, Kapoor KG, Wagner AL. Ziv-aflibercept for Better Regulating Neovascular Age-Related Macular Degeneration (ZEBRA): A Prospective, Randomized Trial. Semin Ophthalmol 2021; 36:28-34. [PMID: 33577373 DOI: 10.1080/08820538.2021.1884269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study is to determine if ziv-aflibercept is a safe and effective maintenance drug for nAMD. STUDY DESIGN AND METHODS This is a randomized, prospective, single-blinded trial. Inclusion criteria were active nAMD, prior anti-VEGF treatment, and BCVA ≤20/200. The treatment group received ziv-aflibercept. The control group continued their existing anti-VEGF regimen. The main outcome measures were BCVA, CFT, and safety. RESULTS Mean baseline BCVA was 1.58 ± 0.44 logMAR and 1.71 ± 0.39 logMAR in the control (n = 27) and treatment (n = 29) groups, respectively. After 24 months, the mean change in BCVA was 0.11 in the control group (equivalent to a loss of 5 ETDRS letters) and 0.01 logMAR in the treatment group (p = .48). Baseline CFT was 257 ± 33 μm and 247 ± 30 μm in the control and treatment groups, respectively, and after 24 months mean change in CFT was 26 μm and -5 μm (p = .24). There were no ocular or systemic adverse events during the study. CONCLUSION Ziv-aflibercept is a safe and effective as a maintenance drug for patients with nAMD. It may represent a cost-effective alternative to aflibercept and second-line therapy for eye resistant bevacizumab or ranibizumab.
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Affiliation(s)
- Haley S D'Souza
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Kapil G Kapoor
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, VA, USA.,Wagner and Kapoor Retina Institute, Virginia Beach, VA, USA
| | - Alan L Wagner
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, VA, USA.,Wagner and Kapoor Retina Institute, Virginia Beach, VA, USA
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Mansour AM, Stewart MW, Farah ME, Mansour HA, Chhablani J. Ziv-aflibercept: A cost-effective, off-label, highly potent antagonist of vascular endothelial growth factor. Acta Ophthalmol 2020; 98:e540-e548. [PMID: 31863550 DOI: 10.1111/aos.14328] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 11/13/2019] [Indexed: 01/14/2023]
Abstract
Ziv-aflibercept (Zaltrap® ), a recombinant fusion protein that binds diffusible vascular endothelial growth factor (VEGF), is approved for the treatment of metastatic colorectal carcinoma. Its molecular structure is the same as aflibercept (Eylea® ), thus making it an attractive option for the off-label treatment of chorioretinal vascular conditions. Ziv-aflibercept is distributed in 4 and 8 ml vials for intravenous use, and its cost after compounding is similar to bevacizumab. Studies with retinal pigment epithelium cytotoxicity, animal histologic sections and electroretinography have demonstrated its safety, and mathematical modelling combined with over four dozen clinical publications from different ophthalmic centres throughout the world attest to its efficacy. No appreciable differences in visual or anatomic outcomes between 1.25 mg (0.05 ml) and 2.5 mg (1.0 ml) doses have been noted. The long duration of action combined with the low cost make ziv-aflibercept an attractive anti-VEGF treatment option, especially in low- and middle-income countries where its popularity is increasing.
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Affiliation(s)
- Ahmad M Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon.,Department of Ophthalmology, Rafik Hariri University Hospital, Beirut, Lebanon
| | | | - Michel E Farah
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Hana A Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon.,Department of Ophthalmology, Rafik Hariri University Hospital, Beirut, Lebanon
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
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Ang JL, Ah-Moye S, Kim LN, Nguyen V, Hunt A, Barthelmes D, Gillies MC, Mehta H. A systematic review of real-world evidence of the management of macular oedema secondary to branch retinal vein occlusion. Eye (Lond) 2020; 34:1770-1796. [PMID: 32313172 PMCID: PMC7608462 DOI: 10.1038/s41433-020-0861-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 02/19/2020] [Accepted: 03/24/2020] [Indexed: 01/10/2023] Open
Abstract
This review assessed the real-world evidence of the management of macular oedema secondary to branch retinal vein occlusion (BRVO). A meta-analysis of 2530 eyes from 48 real-world studies of therapies for macular oedema secondary to BRVO was conducted. Baseline characteristics, visual, anatomical and safety outcomes were recorded. The weighted mean and weighted estimates from random-effects models were calculated for visual acuity (VA) and central subfield thickness (CST) changes at 6, 12 and 24 months. Primary outcome was change in VA (logMAR letters) at 12 months. Study quality was assessed using the quality appraisal checklist for case series developed by Institute of Health Economics. The mean baseline VA for the pooled data was 54.0 (51.5, 56.5) letters and the mean baseline CST was 501.3 (483.5, 519.1) µm. The random-effects estimate for mean (95% CI) change in VA was 14.6 (12.5, 16.7) letters at 12 months (n = 1727). The random-effects estimate for mean (95% CI) change in CST was -181.7 (-230.7, -132.7) µm at 12 months (n = 1325). The quality of studies varied considerably. Ocular and systemic adverse events were discussed in 79% and 42% of treatment arms respectively, with possible under-reporting. Visual and anatomical gains achieved in the real-world for anti-VEGF therapy were not as impressive as seminal RCTs, possibly due to reduced injection frequency in the real world and differences in baseline characteristics. There is an urgent need for consensus on the minimum efficacy, treatment burden and safety data to collect to strengthen the real-world evidence base.
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Affiliation(s)
- Juan Lyn Ang
- Ophthalmology Department, Royal Free London NHS Foundation Trust, London, UK
| | - Sarah Ah-Moye
- Ophthalmology Department, Royal Free London NHS Foundation Trust, London, UK
| | - Leah N Kim
- Macular Research Group, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Vuong Nguyen
- Macular Research Group, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Adrian Hunt
- Macular Research Group, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Daniel Barthelmes
- Macular Research Group, Save Sight Institute, University of Sydney, Sydney, NSW, Australia.,Department of Ophthalmology, University Hospital Zurich & University of Zurich, Zurich, Switzerland
| | - Mark C Gillies
- Macular Research Group, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Hemal Mehta
- Ophthalmology Department, Royal Free London NHS Foundation Trust, London, UK. .,Macular Research Group, Save Sight Institute, University of Sydney, Sydney, NSW, Australia.
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Singh SR, Chattannavar G, Ayachit A, Pimentel MC, Alfaro A, Tiwari S, Heranjal A, Subramanyam A, Braimah IZ, Dhami A, Sachdev P, Mansour A, Chhablani J. Intravitreal Ziv-Aflibercept : Safety Analysis in Eyes Receiving More Than Ten Intravitreal Injections. Semin Ophthalmol 2019; 35:2-6. [PMID: 31690175 DOI: 10.1080/08820538.2019.1686528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To report the ocular and systemic adverse events in eyes receiving ≥10 intravitreal ziv-aflibercept (IVZ) injections.Methods: Medical records of patients who received ≥10 IVZ for various chorioretinal conditions with minimum follow up period of 12 months were retrospectively analysed. These eyes received standard dose of IVZ (1.25 mg/0.05 ml) on pro-re-nata (PRN) or treat and extend (T&E) protocol. The primary study outcome was ocular and systemic adverse events related to IVZ injections whereas secondary outcomes were change in best corrected visual acuity (BCVA) and central macular thickness (CMT) on optical coherence tomography (OCT) at last visit compared to baseline. Comparison of BCVA and CMT at baseline and final visit was done using paired t-test.Results: A total of 94 eyes which received a mean ± standard deviation (mean±SD = 14.4 ± 4.6) IVZ injections were studied. A total of 41 eyes were treatment naïve whereas 53 eyes received intravitreal injections in the past with last injection at least 3 months prior. Mean (±SD) follow up period was 26.7 ± 8.7 months. Ocular adverse events were limited with a case each of acute iridocyclitis, endophthalmitis, cataract progression and early epiretinal membrane formation. No systemic events were recorded within a month of IVZ injection. There was a significant improvement in BCVA (p = 0.001) and change in CMT (p = 0.001) at last visit.Conclusion: Ocular use of ziv-aflibercept is safe with limited ocular and systemic side effects. Multiple injections of IVZ can be used in various chorioretinal diseases over the long term.
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Affiliation(s)
- Sumit Randhir Singh
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad-34, India.,Retina and Uveitis Department, GMR Varalakshmi Campus, LV Prasad Eye Institute, Visakhapatnam, India
| | - Goura Chattannavar
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad-34, India
| | - Apoorva Ayachit
- Department of vitreoretina, K B Haji Bachooali Charitable ophthalmic and ENT hospital, Mumbai, India
| | - Miguel Cruz Pimentel
- Ophthalmology Department, Hospital Dr. Elias Santana, Santo Domingo, Dominican Republic
| | - Alex Alfaro
- Ophthalmology Department, Hospital Dr. Elias Santana, Santo Domingo, Dominican Republic
| | - Sarvesh Tiwari
- Department of vitreoretina, K B Haji Bachooali Charitable ophthalmic and ENT hospital, Mumbai, India
| | - Abhishek Heranjal
- Department of vitreoretina, K B Haji Bachooali Charitable ophthalmic and ENT hospital, Mumbai, India
| | - Anand Subramanyam
- Department of vitreoretina, K B Haji Bachooali Charitable ophthalmic and ENT hospital, Mumbai, India
| | - Imoro Zeba Braimah
- University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana.,Lions International Eye Centre, Korle-Bu Teaching Hospital, Accra, Ghana
| | | | | | - Ahmad Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon.,Department of Ophthalmology, Rafik Hariri University Hospital, Beirut, Lebanon
| | - Jay Chhablani
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad-34, India.,UPMC Eye Center, University of Pittsburgh, Pittsburgh, PA, USA
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