Hypotensive efficacy of topical brimonidine for intraocular pressure spikes following intravitreal injections of antivascular endothelial growth factor agents: a randomised crossover trial

2018 ◽  
Vol 103 (10) ◽  
pp. 1388-1394
Author(s):  
Tina Felfeli ◽  
Avner Hostovsky ◽  
Rachel Trussart ◽  
Peng Yan ◽  
Michael H Brent ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Growth Factor ◽  
Intravitreal Injection ◽  
Crossover Trial ◽  
Anti Vegf ◽  
Antivascular Endothelial Growth Factor ◽  
Registration Number ◽  
The Mean ◽  
Brimonidine Tartrate ◽  
Endothelial Growth Factor

PurposeTo determine the effect of topical brimonidine tartrate prophylaxis on intraocular pressure (IOP) spikes following intravitreal injection of antivascular endothelial growth factor (anti-VEGF) agents.MethodsThis is a randomised crossover trial of consecutive non-glaucomatous eyes receiving intravitreal anti-VEGF injections between December 2016 and July 2017. All eyes were randomly assigned to no prophylaxis or topical brimonidine tartrate 0.15 % administered 20 min prior to injection in one of two consecutive visits. Measurements of IOP were obtained immediately (T0), 10 min (T10) and 20 min (T20) after injection during the visits with and without prophylaxis.ResultsAmong the 58 eyes of 55 patients (116 visits), the mean (SD) age was 74.3 (11.6), and 62% were female. The mean baseline IOP was 15.3 (2.3) mm Hg (range: 11–20). On average, the immediate postinjection IOP during the visit without prophylaxis was 41.6 (12) mm Hg (range: 17–81). Compared with no prophylaxis, the visit with preadministered topical brimonidine tartrate had a lower IOP at T0 (p<0.001), T10 (p=0.001) and T20 (p=0.043), and a smaller proportion of eyes with IOP elevation of greater than 20 mm Hg from preinjection (p=0.002) and IOP greater than 50 mm Hg at T0 (p=0.036). Without prophylaxis, two eyes (two patients) had an IOP of greater than 70 mm Hg at T0 and thus underwent anterior chamber paracentesis.ConclusionTopical brimonidine tartrate prophylaxis for intravitreal injection of anti-VEGF agents effectively reduces IOP spikes in non-glaucomatous eyes and may be easily incorporated into ophthalmologists’ current practice.Trial registration numberNCT03513172

scholarly journals Intraocular Pressure in Eyes Receiving Intravitreal Antivascular Endothelial Growth Factor Injections

2015 ◽  
Vol 233 (3-4) ◽  
pp. 162-168 ◽  
Author(s):  
Vanessa Lemos ◽  
Ana Cabugueira ◽  
Manuel Noronha ◽  
Luís Abegão Pinto ◽  
Maria Reina ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Growth Factor ◽  
Intravitreal Injection ◽  
Applanation Tonometry ◽  
Gender History ◽  
Topical Medication ◽  
Antivascular Endothelial Growth Factor ◽  
History Of ◽  
Injection Protocol ◽  
Endothelial Growth Factor

Purpose: The aim of the this study was to determine the effect of intravitreal antivascular endothelial growth factor injections on intraocular pressure (IOP) and identify possible risk factors for the development of increased IOP. Materials and Methods: This prospective study included a total of 106 eyes receiving intravitreal injection of bevacizumab as treatment for macular edema or active choroidal neovascularization. IOP was measured by Goldmann applanation tonometry immediately before the intravitreal injection and 5 min, 1 h and 15 days after the procedure. The records of the study patients were reviewed for age, gender, history of glaucoma, diabetes mellitus, phakic status, systemic and topical medication and number of previous injections. Subconjunctival reflux was registered. IOP elevation was defined as IOP ≥21 mm Hg and/or a change from baseline of ≥5 mm Hg recorded at least on two or more measurements on the same visit. Results: Mean preoperative IOP was 15.31 ± 3.90 mm Hg and postoperative IOP values were 27.27 ± 11.87 mm Hg (after 5 min), 17.59 ± 6.24 mm Hg (after 1 h) and 16.86 ± 3.62 mm Hg (after 15 days). The IOP variation was statistically significant between pre- and postoperative measurements (p < 0.05). Subconjunctival reflux was recorded in 11.3%, and in this subgroup the IOP at 5 min and at 1 h was lower than preoperative IOP (p < 0.05). Conclusions: More than one third of the eyes achieved IOPs >30 mm Hg 5 min after injection. Subconjunctival reflux contributed to a lower mean postoperative IOP (p < 0.05). Considerations for the management include prophylactic IOP lowering with medical therapy and/or preinjection ocular decompression for patients with a history of glaucoma or ocular hypertension and switching to an as-needed injection protocol in patients suffering a marked IOP rise in previous injections.

scholarly journals Concomitant Bilateral Intravitreal Injection of Anti-Vascular Endothelial Growth Factor: Experience in Covid-19 Pandemic

2021 ◽  
Author(s):  
SERKAN ÖZEN ◽  
Hakan Koc ◽  
Hasan Burhanettin Kaptı ◽  
Murat Atabey Ozer
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Adverse Events ◽  
Macular Edema ◽  
Intravitreal Injection ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Before And After ◽  
The Mean ◽  
Endothelial Growth Factor

Abstract Purpose: To report the concomitant bilateral intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection preference rates of patients before and after the Covid-19 outbreak and to evaluate whether this practice is safe when compared to unilateral injection. Materials and Methods: This is a single-center, retrospective study including consecutive series of 198 eyes of 112 patients received bilateral same-day (concomitant) or unilateral anti-VEGF injections of bevacizumab, ranibizumab, and aflibercept in the operating-room between January 2020 and January 2021. One-year medical record data including preference of bilateral over unilateral injection and adverse events were reviewed with 3-month intervals as before and after Covid-19 pandemic due to the labile Covid-19 outbreak course.Results: A total of 504 injections with 234 concomitant bilateral (%46) were administered to 112 patients. The study group consisted of 58 neovascular age-related macular degeneration (nAMD- 63.7% had bilateral nAMD), 46 diabetic macular edema (DME- 67.3% had bilateral DME) and 8 macular edema complicating retinal vein occlusion (RVO- 25% had bilateral RVO) patients. Of the injections, 156 (31%) were bevacizumab, 144 (29%) were aflibercept, and 204 (40%) were ranibizumab. The mean follow-up time per patient was 7.4 ± 4.3 months (range 4-11 months) and the mean number of injections was 3.6 ± 2.1 (range 2-10). None of the patients experienced serious vision-threatening complications or non-ocular adverse events. 85% of patients whose both eyes involved strongly preferred concomitant bilateral injection during Covid-19 pandemic while it was %35 before Covid-19 (P<0.001). The ratio of the number of concomitant bilateral injections to a total of injections increased from 30% to 57% after Covid-19 (P=0.03). Only 3 patients (2.6%) requested alternating unilateral injections after receiving the second concomitant bilateral injections.Conclusion: Concomitant bilateral injection approach was preferred by the majority of patients and did not increase the adverse event rate when applied under meticulous precautions; This intravitreal injection option may be preferred during still ongoing pandemic to reduce the clinical visits of patients at risk of Covid-19 related mortality due to their comorbidities and age.

Evaluation of Patients Receiving Intravitreal Antivascular Endothelial Growth Factor for Diabetic Macular Edema in Clinical Practice in the United States

2020 ◽  
pp. 247412642095306
Author(s):  
John D. Pitcher ◽  
Andrew A. Moshfeghi ◽  
Genevieve Lucas ◽  
Nick Boucher ◽  
Hadi Moini ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Growth Factor ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
The United States ◽  
Treatment Frequency ◽  
Anti Vegf ◽  
Injection Frequency ◽  
Antivascular Endothelial Growth Factor ◽  
Endothelial Growth Factor

Purpose: We assessed the effect of treatment frequency with intravitreal antivascular endothelial growth factor (anti-VEGF) agents on visual acuity (VA) in diabetic macular edema (DME). Methods: This retrospective analysis assessed electronic medical records of eyes newly diagnosed with DME and treated with an anti-VEGF agent at US clinics using the Vestrum Health (Naperville, Illinois) treatment and outcomes database. Eyes were divided into 2 injection frequency subcohorts (≤ 6 vs > 6 injections/y); treatment frequency and change in mean VA (Early Treatment Diabetic Retinopathy Study letters) were evaluated. Results: Among 155 240 eyes assessed, 3028 met inclusion criteria for analysis in year 1 and 1292 in year 2. During year 1 of treatment, 57% (n = 1725) received > 6 injections; most continued to receive the same injection frequency during year 2. Mean VA gain from baseline at year 1 was lower in the ≤ 6 than in the > 6 injections/year subcohort (3.7 vs 8.0 letters, respectively; P < .001). Mean VA change from the end of year 1 to year 2 for eyes receiving ≤ 6 injections in year 1 generally remained unchanged, irrespective of year 2 dosing frequency. In eyes that received > 6 injections in year 1, mean VA loss was significantly greater for eyes receiving less-frequent dosing in year 2 than in those maintained on > 6 injections. Conclusions: More than 50% of eyes with DME in routine clinical practice that completed at least 1 year of follow-up received > 6 injections of an anti-VEGF agent during the first year, resulting in better VA gains than eyes treated less frequently.

scholarly journals Antivascular Endothelial Growth Factor Treatment Might Be Continued Even After Vitrectomy for Endophthalmitis in Neovascular Age-Related Macular Degeneration

2019 ◽  
Vol 4 (1) ◽  
pp. 6-12
Author(s):  
Zofia Michalewska ◽  
Jerzy Nawrocki
Keyword(s):  
Growth Factor ◽  
Macular Degeneration ◽  
Visual Outcome ◽  
Age Related Macular Degeneration ◽  
Anti Vegf ◽  
Age Related ◽  
Antivascular Endothelial Growth Factor ◽  
Endothelial Growth Factor ◽  
Mean Time

Purpose: This article studies visual outcome and frequency of antivascular endothelial growth factor (anti-VEGF) injections continued in patients with neovascular age-related macular degeneration (AMD) who had an earlier vitrectomy for postinjection endophthalmitis. Methods: A retrospective interventional study was conducted reviewing our database for patients with a diagnosis of endophthalmitis in the course of anti-VEGF injections. Endophthalmitis diagnosis was made on clinical examination of pain, rapid decrease in visual acuity (VA), conjunctival hyperemia, hypopyon, and vitritis. In all eyes, core vitrectomy with intravitreal antibiotics was performed. Spectral-domain optical coherence tomography was performed monthly before and after surgery during follow-up. Anti-VEGF injections were continued after surgery in all cases. Results: Eight eyes with postinjection endophthalmitis were included. Mean VA immediately before endophthalmitis was 20/50 Snellen with a mean of 19 intravitreal anti-VEGF injections ( P = .45). At time of endophthalmitis diagnosis, mean VA was 20/1000 (range, 20/2000-20/200). Mean time from injection to when the patient noted first symptoms was 4.3 days (range, 1-8 days). Mean time from first symptoms to surgery was 12 hours (range, 2.5-26 hours). Final mean VA at the end of follow-up (range, 12-84 months) did not statistically differ from VA at the visit immediately before endophthalmitis diagnosis ( P = .69). Mean frequency of injections after vitrectomy did not significantly differ from the presurgical course of treatment ( P =.97). Conclusions: Anti-VEGF treatment might be continued after vitrectomy for endophthalmitis and results in satisfactory anatomical and visual outcome. Surgery did not influence the frequency of anti-VEGF injections for neovascular AMD.

scholarly journals Outcome of anti-vascular endothelial growth factor therapy for neovascular age-related macular degeneration in real-life setting

2017 ◽  
Vol 102 (7) ◽  
pp. 959-965 ◽  
Author(s):  
Maria Kataja ◽  
Pekko Hujanen ◽  
Heini Huhtala ◽  
Kai Kaarniranta ◽  
Anja Tuulonen ◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Real Life ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Age Related ◽  
Real Life Setting ◽  
The Mean ◽  
Endothelial Growth Factor

AimsTo evaluate outcome of anti-vascular endothelial growth factor (VEGF) therapy for the treatment of neovascular age-related macular degeneration (nAMD) in the real-life setting and to compare incidence of ocular serious adverse events (SAE) after injections administered by nurses and physicians.MethodsRetrospective, single-centre study. Medical records of patients receiving anti-VEGF treatment for nAMD between 2008 and 2013 with three-loading-dose regimen were evaluated. Outcome measures were baseline visual acuity (VA), change in VA, number of intravitreal injections, incidence of ocular SAE and patients’ baseline characteristics affecting VA change. In addition, the number of injections per 1000 citizens living in the serving area and per individuals over 65 years old were estimated.Results1349 eyes in 1117 patients received a total of 11 562 intravitreal anti-VEGF injections. Twenty-one per cent of patients received treatment for both eyes. The mean baseline Snellen VA was 0.32. The mean change of VA from baseline was +2, +2 and ±0 Early Treatment Diabetic Retinopathy Study letters and the mean numbers of injections were 5.7, 4.7 and 4.9 at years 1, 2 and 3, respectively. There was a negative correlation between baseline VA and change of VA. Incidence of endophthalmitis was 0.086%. No difference in the incidence of ocular SAE was identified between injections given by nurses or by physicians. The number of intravitreal injections per all citizens was 9 per 1000 inhabitants and 45 per 1000 inhabitants over 65 years.ConclusionThe VA was maintained at the baseline level (±0 letters) with the mean of 15.3 anti-VEGF injections in real-world clinical practice during 3-year follow-up.

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