scholarly journals Incidence of endophthalmitis after intravitreal injection of an anti-VEGF agent with or without topical antibiotics

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Masakazu Morioka ◽  
Yoshihiro Takamura ◽  
Kazuki Nagai ◽  
Shigeo Yoshida ◽  
Junya Mori ◽  
...  
Keyword(s):  
Intravitreal Injection ◽  
Large Population ◽  
Vascular Endothelial ◽  
Chi Square ◽  
Topical Antibiotics ◽  
Anti Vegf ◽  
Significant Difference ◽  
Chi Square Test ◽  
Endothelial Growth Factor ◽  
Retrospective Multicenter Study

AbstractIntravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF) is the standard treatment modality in various types of retinal diseases. However, endophthalmitis remains the most serious complication. Despite the lack of evidence that antibiotics prevent endophthalmitis, topical antibiotics are still used routinely in Japan. We conducted a retrospective multicenter study by analyzing records from patients who underwent IVI of anti-VEGF agents with or without antibiotic treatment. In the analysis of a total of 147,440 eyes, the incidence of endophthalmitis was 0.007%: 0.005% with no use of antibiotics, 0.009% with antibiotic pretreatment, 0.012% with posttreatment, and 0.005% with pre- and posttreatment. There was no statistically significant difference among the four groups (chi-square test, p = 0.57). Most facilities used masks, sterilized gloves, and drapes. Nine of the 10 eyes that developed endophthalmitis received topical antibiotics, and all infected eyes underwent IVI with aflibercept, not the prefilled syringe delivery system. In four patients who received multiple IVI, the detection of causative bacteria revealed resistance to used antibiotics. Data from this large population, treated with or without antibiotics, suggests that antibiotic prophylaxis does not reduce the rate of endophthalmitis after IVI.

Safety of Intravitreal Injection Guide

2017 ◽  
Vol 2 (1) ◽  
pp. 26-31
Author(s):  
Kei Watanabe ◽  
Uematsu Masafumi ◽  
Yasser H. Mohamed ◽  
Takehito Watanabe ◽  
Yusuke Doi ◽  
...  
Keyword(s):  
Intravitreal Injection ◽  
University Hospital ◽  
Vascular Endothelial ◽  
Drug Usage ◽  
Anti Vegf ◽  
Systemic Complication ◽  
Department Of Ophthalmology ◽  
Significant Difference ◽  
Period Data ◽  
Endothelial Growth Factor

Purpose: To evaluate the safety of our developed intravitreal injection guide. Methods: Retrospective review of all case notes for consecutive patients treated with intravitreal anti-vascular endothelial growth factor (VEGF) injections at the Department of Ophthalmology, Nagasaki University Hospital in Japan between January 2013 and December 2014. We included all patients who had at least 1 intravitreal anti-VEGF injection done within the study period. Data collected included demographics, indications of intravitreal anti-VEGF injections, type of injected drug, usage of intravitreal guide, experience of physicians, and any complication that occurred during or after the procedure. Results: The study included 256 patients (154 males and 102 females) who underwent 992 intravitreal anti-VEGF injections from January 2013 until December 2014. The mean age of the patients was 70.8 ± 11.3 years. Of total injections, 907 (91.44%) were done using the intravitreal guide, 60 (6.04%) were done without using the guide, and only 25 (2.52%) injections were not determined. Local complications include 1 (0.1%) case uveitis, 1 (0.1%) case retinal tear, and 1 (0.1%) case amaurosis fugax. There were no major complications as cataract, retinal detachment, and endophthamitis. No systemic complication was encountered. All complications occurred in the guide group without statistically significant difference in comparison to without guide group ( P = 1.0). All complications were related to experienced group without significant difference in comparison to limited experienced group ( P = .28). Conclusion: We conclude that the process of intravitreal injection with our developed intravitreal injection guide is safe and easy even for limited experienced physicians.

scholarly journals Retinal venous pressure is decreased after anti-VEGF therapy in patients with retinal vein occlusion–related macular edema

2021 ◽  
Author(s):  
Teruyo Kida ◽  
Josef Flammer ◽  
Katarzyna Konieczka ◽  
Tsunehiko Ikeda
Keyword(s):  
Macular Edema ◽  
Intravitreal Injection ◽  
Retinal Vein Occlusion ◽  
Venous Pressure ◽  
Decisive Role ◽  
Retinal Venous Pressure ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
Significant Difference ◽  
Endothelial Growth Factor

Abstract Purpose The pathomechanism leading to retinal vein occlusion (RVO) is unclear. Mechanical compression, thrombosis, and functional contractions of veins are discussed as the reasons for the increased resistance of venous outflow. We evaluated changes in the retinal venous pressure (RVP) following intravitreal injection of anti-vascular endothelial growth factor (VEGF) agent to determine the effect on RVO-related macular edema. Methods Twenty-six patients with RVO-related macular edema (16 branch RVOs [BRVOs] and 10 central RVOs [CRVOs], age 72.5 ± 8.8 years) who visited our hospital were included in this prospective study. Visual acuity (VA), intraocular pressure (IOP), central retinal thickness (CRT) determined by macular optical coherence tomography, and RVP measured using an ophthalmodynamometer were obtained before intravitreal injection of ranibizumab (IVR) and 1 month later. Results Comparison of the BRVOs and CRVOs showed that VA was significantly improved by a single injection in BRVOs (P < 0.0001; P = 0.1087 for CRVOs), but CRT and RVP were significantly decreased without significant difference in IOP after the treatment in both groups (P < 0.0001). Conclusion The anti-VEGF treatment resulted in a significant decrease in the RVP, but the RVP remained significantly higher than the IOP. An increased RVP plays a decisive role in the formation of macula edema, and reducing it is desirable.

scholarly journals De-novo multilayering in fibrovascular pigment epithelial detachment

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Manoj Soman ◽  
Jay U. Sheth ◽  
Asmita Indurkar ◽  
Padmanabhan Meleth ◽  
Unnikrishnan Nair
Keyword(s):  
De Novo ◽  
Median Number ◽  
Final Visit ◽  
Low Grade ◽  
Vascular Endothelial ◽  
Pigment Epithelial Detachment ◽  
Pigment Epithelial ◽  
Anti Vegf ◽  
Significant Difference ◽  
Endothelial Growth Factor

AbstractThis study describes the occurrence of multilayered pigment-epithelial detachment (MLPED) as a De-novo phenomenon (DN-MLPED) and compare the features with multi-layering secondary to chronic anti-vascular endothelial growth factor (anti-VEGF) therapy (s-MLPED). We did a retrospective evaluation of spectral-domain optical coherence tomography (SD-OCT) features, treatment-profile, and visual-acuity (VA) outcomes in eyes with MLPED. Out of 17 eyes with MLPED, 7 eyes had DN-MLPED and 10 eyes had s-MLPED. There was no significant difference in baseline and final VA between the groups. At the final visit, no significant visual improvement was noted in both the groups, although a possible trend towards an improvement was seen in DN-MLPED eyes while the s-MLPED demonstrated a declining trend (DN-MLPED—LogMAR-BCVA: Baseline = 0.79 [∼ 20/123] ± 0.91; Final = 0.76 [∼ 20/115] ± 0.73; p = 0.87; s-MLPED—LogMAR BCVA: Baseline = 0.43 [∼ 20/54] ± 0.68; Final = 0.94 [∼ 20/174] ± 0.71; p = 0.06). Moreover, after presentation, the median number of injections in DN-MLPED eyes were significantly lower compared to s-MLPED eyes (DN-MLPED:4; s-MLPED:12; p = 0.03) (Median follow-up: DN-MLPED = 26 months; s-MLPED = 54 months; p = 0.15). Subretinal hyperreflective-material (SHRM) deposition heralded the onset of multilayering and was seen to progress in all DN-PED eyes and 1/4 eyes of s-MLPED. To conclude, MLPED is a unique form of cicatrizing fibrovascular-PED which can evolve denovo too. Long-standing disease with intermittent or low-grade activity can potentially explain this unique phenomenon. With fewer anti-VEGF therapy, the de-novo MLPED eyes show more visual stability as compared to s-MLPED eyes.

scholarly journals Enlargement rate of geographic atrophy before and after secondary CNV conversion with associated anti-VEGF treatment

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jakob Siedlecki ◽  
Caroline Koch ◽  
Benedikt Schworm ◽  
Raffael Liegl ◽  
Thomas Kreutzer ◽  
...  
Keyword(s):  
Growth Rate ◽  
Geographic Atrophy ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Significant Difference ◽  
Before And After ◽  
Endothelial Growth Factor ◽  
Mean Time ◽  
Larger Sample

Abstract Background To study the enlargement rate of primary geographic atrophy (GA) before and after diagnosis of a secondary choroidal neovascularization (CNV) treated with anti-vascular endothelial growth factor (VEGF) therapy. Methods Five hundred twenty-two consecutive eyes with primary GA were screened for the development of a complicating secondary CNV. Geographic atrophy was measured on blue autofluorescence (BAF) by two readers and calculated into mean growth rate before and after CNV diagnosis. Results Ten eyes of six patients were included in the study (six study eyes with GA complicated by CNV, four GA only partner eyes). Follow-up was 1.42 ± 0.48 years before and 3.64 ± 2.73 years after CNV. There was no significant difference between mean growth rate before and after CNV (1.58 ± 0.99 vs. 1.39 ± 0.65 mm2/year; p = 0.44) or between study and partner eyes (p = 0.86). Over a mean time of 3.64 ± 2.73 years, a mean of 8.3 ± 2.8 anti-VEGF injections were given. No correlation between the amount of anti-VEGF injections and change in growth rate could be observed (r = 0.58; p = 0.23). Conclusion In this pilot study, primary GA enlargement did not seem to be influenced by a secondary CNV. No association between the intensity of anti-VEGF treatment and changes in atrophy enlargement rates were found. Further studies with larger sample sizes are warranted.

scholarly journals Ocular Complications of Intravitreal Avastin: a Report from Tobruk Medi-cal Center

2020 ◽  
Vol 35 (2) ◽  
pp. 85-93
Author(s):  
Fathy A. Abdolmejed ◽  
Ghamela S. Ali
Keyword(s):  
Intravitreal Injection ◽  
Medical Center ◽  
Sudden Increase ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Causative Microorganism ◽  
Pars Plana ◽  
Endothelial Growth Factor ◽  
Systemic Antibiotics

A retrospective statistical study was done at the ophthalmology department of Tobruk Medical Center on all the patients who received intravitreal medication with Avastin (anti-VEGF (anti-vascular endothelial growth factor)) in the period between August 1st and December 31st, 2018. It is aimed to report the complications of the intravitreal injection (IVI) and how they were managed. Out of the 56 recorded patients, there were 32 (51.9 %) females, all the patients received multiple intravitreal injections, with a total number of 131 injections. The average age of the patients was 56.5 years (ranged from 40-70 years). The most common complications after intravitreal injection were subconjunctival hemorrhage (19%), discomfort/pain (13.7%), blurring of vision (6 %), leaking at injection site (4.6%), floaters (3%), and increase intraocular pressure (IOP) in (13.7%). Six cases out of the eighteen that had high IOP received Diamox (Acetazolamide) Tab. 250 mg one-two hours before the time of injection which did not prevent the post-injection spike of IOP and that was statistically not significant (P=0.09). Thirteen eyes (10 %) developed sudden loss of vision due to sudden increase in IOP immediately after the injection, and all the cases of the high IOP were managed by anterior chamber paracentesis and the vision also improved. Endophthalmitis was recorded in only one case (0.8%), at the third-day post intraocular Avastin injection, the causative microorganism was unknown and treated with intravitreal antibiotics (vancomycin) along with topical and systemic antibiotics and steroids, but the patient did not recover until pars plana vitrectomy was done to him, and the patient recovered his preoperative vision. The patients who had glaucoma or rubeosis iridis suffered significantly (P = 0.01) from an increase in IOP levels (digitally measured) after injection with Avastin, while most other patients who didn't have both pathologies did not suffer from an increase in IOP. It can be concluded that despite having a dramatic effect on the quality of life by improving the central vision, Anti-VEGF can cause serious complications that could be prevented by early diagnosis and treatment

scholarly journals Impact of macular fluid features on outcomes of anti-vascular endothelial growth factor treatment for type 3 macular neovascularization

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Wontae Yoon ◽  
Jihyun Yoon ◽  
Seung Kwan Na ◽  
Jihyun Lee ◽  
Jaemin Kim ◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Visual Acuity ◽  
Growth Factor ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Significant Difference ◽  
Type 3 ◽  
Endothelial Growth Factor ◽  
The Impact ◽  
Anatomical Outcomes

AbstractWe evaluated the impact of macular fluid features on visual and anatomical outcomes in type 3 macular neovascularization (MNV) patients treated with anti-vascular endothelial growth factor (VEGF). We retrospectively enrolled 89 eyes with type 3 MNV with at least 12 months of follow-up. All patients were treatment-naïve and received a monthly loading injection of anti-VEGF for three months, followed by further injections as required. The association of baseline macular morphology, including intraretinal fluid (IRF) and subretinal fluid (SRF), with visual and anatomical outcomes was analyzed. At baseline, IRF was present in all enrolled patients (100%), and SRF was present in 43.8% (39/89) of them. After 12 months of treatment, no significant difference was found in terms of best-corrected visual acuity (BCVA) and changes in central foveal thickness between the eyes with (39) and without (50) SRF at baseline. In addition, the proportion of improved or worsened (gain or loss of more than three lines in the BCVA) visual acuity at 12 months was not significantly different among the groups. Incidence of macular atrophy during the treatment showed no difference between the groups, regardless of the presence of SRF. In conclusion, the macular fluid morphology, specifically SRF, in type 3 MNV showed no significant correlation with visual and anatomical outcomes during anti-VEGF treatment.

Short-Term Visual Acuity and Intraocular Pressure Changes and Their Correlation after Anti-Vascular Endothelial Growth Factor Injection

2016 ◽  
Vol 236 (1) ◽  
pp. 36-42 ◽  
Author(s):  
Hyung-Bin Lim ◽  
Min-Su Kim ◽  
Young-Joon Jo ◽  
Jung-Yeul Kim
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Visual Acuity ◽  
Intraocular Pressure ◽  
Growth Factor ◽  
Intravitreal Injection ◽  
Sufficient Evidence ◽  
Vascular Endothelial ◽  
Short Term ◽  
Significant Difference ◽  
Endothelial Growth Factor

Purpose: To assess the effect of intravitreal anti-vascular endothelial growth factor injection on short-term changes in intraocular pressure (IOP) and visual acuity (VA) and the correlation between the two values. Methods: This study included 25 eyes of 25 patients undergoing intravitreal injection of bevacizumab (IVB) with preinjection uncorrected VA (UCVA) >20/40. IOP and UCVA were measured before injection and 1, 5, 10, 15, 20, 25, and 30 min after injection, using a Tono-Pen (Reichert, Chicago, Ill., USA). The IOP and VA values before and after injection were compared. The correlation between IOP and VA at each time point was analyzed. Results: The preinjection IOP value (17.7 mm Hg) increased sharply to 43.1 mm Hg 1 min after injection, followed by a decrease to 30.4, 24.6, 20.7, 18.7, 18.2, and 17.7 mm Hg at 5, 10, 15, 20, 25, and 30 min, respectively. The preinjection UCVA value (0.21; logMAR) increased to 0.96 one minute after injection, followed by a decrease to 0.61, 0.44, 0.33, 0.27, 0.23, and 0.22 at 5, 10, 15, 20, 25, and 30 min, respectively. Significant differences were evident between the preinjection IOP and VA values and those observed over the 5- to 25-min period after injection (p < 0.05). The correlation between IOP and VA was significant 1, 5, and 10 min after injection [p < 0.001 (1 min), p = 0.033 (5 min), and p = 0.002 (10 min)]. Conclusions: Differences in all IOP and VA values were significant up to 25 min after IVB, compared with preinjection values; however, no significant difference was found 30 min after injection. Such fluctuations in VA and IOP were positively correlated. The patients' own knowledge of VA fluctuations after injection may provide ophthalmologists with sufficient evidence to make an indirect clinical judgment regarding short-term complications of intravitreal injection.

scholarly journals Retinal Function determined by Flicker ERGs before and after Intravitreal Injection of Anti-VEGF Agents

2019 ◽  
Author(s):  
Gaku Terauchi ◽  
Kei Shinoda ◽  
Hiroyuki Sakai ◽  
Makoto Kawashima ◽  
Soichi Matsumoto ◽  
...  
Keyword(s):  
Macular Edema ◽  
Intravitreal Injection ◽  
Phase 1 ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
Age Related ◽  
Before And After ◽  
Endothelial Growth Factor

Abstract Background: To evaluate the retinal function before and after intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents in the injected and non-injected eyes. Methods: Seventy-nine eyes of 79 patients that were treated by an intravitreal injection of an anti-VEGF agent for age-related macular degeneration (AMD), diabetic macular edema (DME), or retinal vein occlusion (RVO) with macular edema (ME) were studied. The RETeval® system was used to record 28 Hz flicker electroretinograms (ERGs) from both eyes before (phase 1), within 2 hours after the injection (phase 2), and 2 to 24 hours after the injection (phase 3). Patients were grouped by disease or by the injected agent and compared. The significance of the changes in the implicit times and amplitudes was determined by t tests. Results: The amplitudes were not significantly different among the groups. The implicit times were significantly longer or tended to be longer at phase 2 and 3 compared to phase 1 for each disease and for each injected agent in the injected and non-injected eyes. Conclusions: The results show that an intravitreal anti-VEGF injection will prolong the implicit times not only in the injected eye but also in the non-injected eye soon after the intravitreal injection. Trial registration: All of the patients gave a written informed consent and the study was conducted in accordance with the tenets of Declaration of Helsinki and approved by the Ethics Committee of the Teikyo University School of Medicine (study ID number: 14-122). Keywords: Aflibercept, age-related macular degeneration, electroretinogram, intravitreal injection, macular edema, ranibizumab, retinal vein occlusion, vascular endothelial growth factor.

Outcomes and Practice Preferences After Endophthalmitis Following Anti-VEGF Intravitreal Injection

2019 ◽  
Vol 3 (6) ◽  
pp. 411-419
Author(s):  
Yicheng Chen ◽  
Gaurav K. Shah ◽  
Vaishali Shah ◽  
Kevin J. Blinder ◽  
Abdallah M. Jeroudi ◽  
...  
Keyword(s):  
Intravitreal Injection ◽  
Median Number ◽  
Significant Shift ◽  
Anti Vegf ◽  
Before And After ◽  
Significant Change ◽  
The Difference ◽  
Endothelial Growth Factor ◽  
Retrospective Multicenter Study ◽  
Medication Choice

Purpose: This study examines treatment-based outcomes of endophthalmitis due to antivascular endothelial growth factor (anti-VEGF) intravitreal injection and its effect on subsequent management of neovascular disease. Methods: A retrospective multicenter study was conducted of 157 patients with a diagnosis of endophthalmitis following anti-VEGF intravitreal injection at 10 major ophthalmic centers. Results: The median number of injections before endophthalmitis was 10 (range, 1 to 84 injections). Initial treatment with tap and inject with or without subsequent vitrectomy trended toward smaller visual acuity changes from baseline (4 ETDRS [Early Treatment Diabetic Retinopathy Study] letter difference vs 19 ETDRS letter difference) compared with initial vitrectomy, but the difference was not statistically significant. There was no significant change in medication choice among injections after endophthalmitis. There was a statistically significant shift away from regular interval (1- to 2-month) injections and a shift toward treat-and-extend and as-needed injection algorithms. Conclusions: The visual outcomes were not significantly different between patients who initially underwent tap and injection of antibiotics and those who underwent vitrectomy. There was no significant change in medication choice before and after endophthalmitis but there was a shift toward lower-frequency injection algorithms after postintravitreal injection endophthalmitis compared with prior.

Antiangiogenetic-induced hypertension and improved outcome in cancer patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21651-e21651
Author(s):  
Sandro Barni ◽  
Giuseppina Patrizia Dognini ◽  
Fausto Petrelli ◽  
Karen Borgonovo ◽  
Mara Ghilardi ◽  
...  
Keyword(s):  
Kinase Inhibitors ◽  
Statistical Correlation ◽  
Hazard Ratio ◽  
Rank Test ◽  
Vascular Endothelial ◽  
Chi Square ◽  
Chi Square Test ◽  
Endothelial Growth Factor ◽  
The Impact ◽  
Improved Outcome

e21651 Background: Hypertension (HTN) is one of the most common adverse events observed during treatment with antiangiogenetic drugs (AAG) inhibiting the Vascular Endothelial Growth Factor Pathway. It may rise few days after anti-AAG starting, is dose dependent and reversible after its withdrawal. Some reports seem to suggest an improved outcome in patients (pts) developing HTN after AAG initiation (AAG-HTN). The aim of this study was to evaluate the impact of AAG-HTN on ORR, OS and EFS in pts receiving AAG, particularly tyrosine kinase inhibitors. Methods: All consecutive pts referred to ASST Bergamo Ovest between March 2012 and January 2017, and receiving sunitinib, sorafenib, regorafenib, pazopanib or axitinib, were evaluated. AAG- HTN was defined either as ex novo HTN or worsening of a pre-existing and pharmacologically controlled HTN, arising after AAG starting, and graded according to the NCI CTCAE 4.03. Overall survival was estimated using the Kaplan-Meyer method and hazard ratio with 95% CI was calculated, the primary endpoint was analyzed with a stratified log-rank test. Overall response rates were compared applying the chi-square test. Results: Overall 43 pts (male/female = 30/13, median age = 65yrs, range: 49-84) were evaluated. The AAG used were: sunitinib (n = 20), sorafenib (14), regorafenib (4), axitinib (3), pazopanib (2). Hypertension was present and pharmacologically controlled before AAG in 35 pts. Antiangiogenetic-related hypertension was developed in 27 pts (62.8%). Thirty-four pts were evaluable for ORR, which was observed in 44% of pts developing AAG-HTN versus 9% of those not developing AAG-HTN (p = 0.045). A trend to improved OS (hazard ratio [HR] 0.71 95%CI 0.33-1.5; P = 0.33) and EFS (HR 0.7, 95%CI 0.33-1.49; P = 0.29) in pts developing HTN was observed too. Conclusions: the development of AAG-HTN is related to an increased ORR. An improvement in OS and EFS has been postulated too, but the small number of this series did not allow to find a statistical correlation. For its potential impact on pts’ prognosis, further studies to better explore this issue should be performed and, importantly, AAG-HTN should be early recognized and properly managed.

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