The Effects of Intravitreal Agents on Systemic Vascular Diseases in Patients with Diabetic Retinopathy

Abstract Purpose: To assess the risk for cerebrovascular desease (CVD) and coronary artery disease (CAD) in diabetic patients who were treated with intravitreal anti-VEGF agents and compare the rates of CVD and CAD with diabetic controls. Methods: A retrospective chart review of diabetic patients was performed. The need for intravitreal injection and type of agent were noted. If clinically significant or center-involving diabetic macular edema (DME) were determined, intravitreal anti-VEGF agents were used. The CVD and/or CAD occurred within 6 months of the intravitreal injection were accepted as the main outcomes of the study. The records of diabetic patients who were followed up but not needed intravitreal injections were accepted as the control group of the study. Comparisons between these groups were performed.Results: The number of patients enrolled in the study was 9751 (5243 female, 4508 male patients). Of these patients, 1261 patients were received various intravitreal injections. Patients who had CVD history were divided into two groups according to whether they received intravitreal injection or not. There was statistically significant difference between these groups in terms of CVD history (p<0,001). There was statistically significant difference in the hazard of CVD between different anti-VEGF treatments (p<0,001). Patients who had CAD history were divided into two groups according to whether they received intravitreal injection or not. There was no statistically significant difference between these groups in terms of CAD history (p=0,31). Discussion: The risk for CVD was seen to increase with the intravitreal anti-VEGF treatment in diabetic patients. The rate of CVD was higher in patients who received intravitreal bevacizumab treatment.

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Safety of Intravitreal Injection of Stivant, a Biosimilar to Bevacizumab, in Rabbit Eyes

Journal of Ophthalmic and Vision Research ◽

10.18502/jovr.v15i3.7453 ◽

2020 ◽

Author(s):

Alireza Lashay ◽

Hooshang Faghihi ◽

Ahmad Mirshahi ◽

Hassan Khojasteh ◽

Alireza Khodabande ◽

...

Keyword(s):

Intravitreal Injection ◽

Histological Analysis ◽

Intravitreal Bevacizumab ◽

Saline Control ◽

Control Group ◽

Control Groups ◽

Reference Drug ◽

Future Studies ◽

Significant Difference ◽

And Control

Purpose: To evaluate the safety of intravitreal injection of Stivant, a biosimilar to bevacizumab, in rabbits using electrophysiological and histological analysis. Methods: Both eyes of 41 New Zealand albino rabbits were injected with 0.1 mL (2.5 mg) of Stivant. The rabbits were scheduled to be sacrificed 1, 2, 7, 14, and 28 days after injection for histopathological evaluations. Clinical examinations and electroretinography (ERG) were performed at baseline and just before sacrificing the rabbits. Fourteen separate rabbits received a reference drug (Avastin) and were considered as the control group. Furthermore, three other rabbits received the same volume of saline (saline control group). Rabbits of both control groups were sacrificed four weeks after injection. ERG was performed 1, 2, 7, 14, and 28 days after injections. Results: No significant difference was observed in a- and b-wave amplitudes and latency after intravitreal Stivant injection between baseline and different time points. Moreover, there was no statistically significant difference in wave amplitudes and latency between the Stivant and control groups. The histology of rabbit eyes of the Stivant and control groups after intravitreal injections was not distinguishable. Conclusion: The biosimilar Stivant, up to a dose of 2.5 mg, did not appear to be toxic to the retina in albino rabbits. These results suggest that this drug could be a safe and inexpensive alternative to intravitreal bevacizumab. The efficacy of these injections was not investigated in this study and needs to be evaluated in future studies.

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Self-sealing hyaluronic acid-coated 30-gauge intravitreal injection needles for preventing vitreous and drug reflux through needle passage

Scientific Reports ◽

10.1038/s41598-021-96561-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Youngsub Eom ◽

Soomi Kim ◽

Jungah Huh ◽

Mi Young Koh ◽

Jin Young Hwang ◽

...

Keyword(s):

Hyaluronic Acid ◽

Intravitreal Injection ◽

Intravitreal Bevacizumab ◽

Vitreous Humor ◽

Interferon Γ ◽

Intravitreal Injections ◽

Control Group ◽

Prostaglandin E ◽

Expression Levels ◽

Factor Α

AbstractSelf-sealing hyaluronic acid (HA)-coated self-sealing 30-gauge needles exhibiting instant leakage prevention of intravitreal humor and injected drug were developed in this study. Ninety New Zealand rabbits were used in this study. We assessed dye regurgitation in intravitreal ICG dye injections using HA-coated needles (HA needle group) and conventional needles (control group). Vitreous humor levels of anti-vascular endothelial growth factor (VEGF) were compared between groups one, three, and seven days after intravitreal bevacizumab (0.016 mL) injections. Expression levels of inflammatory cytokines in the aqueous humor and vitreous humor, including prostaglandin E2 (PGE2), interferon-γ, tumor necrosis factor-α, interleukin (IL)-1β, IL-4, IL-6, IL-17, and IL-8, were compared between HA needle, control, and normal (in which intravitreal injection was not performed) groups following 12 intravitreal injections over a period of one week. In the HA needle group, HA remained at the injection site and blocked the hole after intravitreal injection. Dye regurgitation occurred significantly less frequently in the HA needle group (16.7%) than the control group (55.6%) after intravitreal ICG dye injection. Meanwhile, vitreous anti-VEGF levels were markedly higher in the HA needle group than the control group one and three days after intravitreal bevacizumab injections. After 12 intravitreal injections, expression levels of aqueous and vitreous IL-8 significantly increased in the control group compared to the HA needle and normal groups. Conversely, there were no significant differences in the expression of the other seven cytokines among the three groups. Intravitreal injections using HA-coated self-sealing 30-gauge needles can block the outflow of vitreous humor and drugs through the needle passage.

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Treatment results of nondamaging retinal laser therapy in diabetic macular edema

Therapeutic Advances in Ophthalmology ◽

10.1177/25158414211063284 ◽

2022 ◽

Vol 14 ◽

pp. 251584142110632

Author(s):

Burcu P. Gültekin

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Laser Therapy ◽

Diabetic Macular Edema ◽

Intravitreal Injections ◽

Diabetic Patients ◽

Efficacy And Safety ◽

Anti Vegf ◽

Significant Difference ◽

The Mean

Background: Subthreshold nondamaging retinal laser therapy (NRT) provides a greater safety profile than conventional laser methods, but more data is needed on the efficacy and safety of subthreshold NRT in diabetic macular edema. Purpose: To evaluate the efficacy and safety of NRT for the treatment of clinically significant macular edema (CSME) that is partially responsive or resistant to intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment. Methods: This was a retrospective case series study. Fifty eyes of 38 diabetic patients with CSME previously treated with at least 6-monthly intravitreal bevacizumab injections with/without intravitreal Ozurdex therapy were evaluated. The patients received 577-nm yellow wavelength laser therapy with PASCAL laser system (Topcon Medical Laser Systems, Santa Clara, CA, USA). Best-corrected visual acuity (BCVA) and central subfield thickness (CST) were evaluated before and 1, 3, 6, 12 and 24 months after laser treatment. Results: Baseline mean CST was 368.06 ± 86.9 µm. The mean CST values at the 1-, 3-, 6-, 12-, and 24-month visits were 336.93 ± 79.8, 352.40 ± 113.5, 336.36 ± 109.3, 325.10 ± 104 µm, and 310.08 ± 84.7 µm, respectively. The mean CST decreased significantly at the first ( p = 0.002) and second year visits ( p < 0.001) when compared with pretreatment values. Although visual acuity was improved at the first year compared with baseline, this difference was not statistically significant ( p = 0.03). There was no significant difference in visual acuities between pretreatment and posttreatment visits. During 24-month follow-up, while 37 eyes were treated with [mean: 5.7 ± 3.4 (1–14)] intravitreal anti-VEGF injections, 3 eyes were administered single-dose intravitreal steroids. Additional intravitreal injections were not required in 10 (20%) eyes. Conclusion: NRT is effective by itself or in combination with anti-VEGF agents in diabetic macular edema that is partially responsive or resistant to previous intravitreal injections. T role in treating this disorder should be assessed in more detail with prospective controlled studies.

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

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-020-05068-x ◽

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.

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Evaluation of the Relationship between Vitamin D Deficiency and Atherogenic Factors in Diabetic Patients with Metabolic Syndrome

Tabari Biomedical Student Research Journal ◽

10.18502/tbsrj.v3i4.7794 ◽

2021 ◽

Author(s):

Leila Akbarbaglu ◽

Elham Nozari Mirarkolaei ◽

Massoumeh Hotelchi ◽

Abbas Khonakdar-Tarsi ◽

Mahboobeh Ghanbari ◽

...

Keyword(s):

Metabolic Syndrome ◽

Vitamin D ◽

Serum Level ◽

Total Cholesterol ◽

Vitamin D3 ◽

Atherogenic Index ◽

Control Group ◽

Diabetic Patients ◽

Significant Difference ◽

25 Oh Vitamin D

Introduction: Metabolic syndrome includes a range of disorders that increase the risk of cardiovascular disease and diabetes mellitus. In this study, we examined the serum level of vitamin D3 in diabetic individuals with metabolic syndrome compared with non-diabetic individuals without metabolic syndrome and the association of serum vitamin D3 levels with metabolic syndrome and atherogenic factor (LDL/HDL). Material and Methods: In a case-control study, we included 110 women with metabolic syndrome according to ATP III criteria and 127 healthy women as a control group. Serum concentration of total cholesterol, LDL-C, FBS, HDL-C and serum triglyceride determined by enzymatic method and colorimetric and, serum level 25-(OH) vitamin D determined by ELISA. Results: It was found that the two healthy and metabolic groups were significantly different in terms of total cholesterol levels, LDL and triglyceride levels, HDL, VLDL, FBS, atherogenic index (LDL/HDL) and vitamin D levels (p<0.05). All participants in the control group and the patient and the whole study population were divided into two categories of insufficient and sufficient based on their measured serum concentrations of 25-(OH) vitamin D. There was a significant difference between the group with insufficient levels of vitamin D in comparison with the group with sufficient levels of vitamin D in terms of total cholesterol, LDL and triglyceride levels, HDL, VLDL, FBS and atherogenic index (LDL/HDL) (p=0.000). Conclusion: The present results showed that there is a significant relationship between level 25-(OH) D and atherogenic index (LDL/HDL) and the incidence of metabolic syndrome.

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Safety and efficacy of nurse led intravitreal injection service with Precivia® injection assist device

European Journal of Ophthalmology ◽

10.1177/11206721211060947 ◽

2021 ◽

pp. 112067212110609

Author(s):

Ibrar Ahmed ◽

Panayiotis Maghsoudlou ◽

Hani Hasan ◽

Allaaeldin Abumattar ◽

Nimish Shah

Keyword(s):

Intravitreal Injection ◽

Age Related Macular Degeneration ◽

Intravitreal Injections ◽

Annual Number ◽

Assist Device ◽

Allied Health Professionals ◽

Safe Delivery ◽

Anti Vegf ◽

Age Related ◽

The Uk

Introduction Intravitreal anti-VEGF injections are the most frequently performed outpatient procedure in the UK. Ophthalmic allied healthcare professionals are replacing medical professionals in delivering injections nationwide. The use of injection assist devices such as Precivia® has been well established and increasingly adopted to aid in their safe delivery. We present outcomes of nurse-led intravitreal injections using the Precivia® injection assist device over a five-year period in the UK. Methods A retrospective review was completed of all anti-VEGF intravitreal injections delivered at the Great Western Hospital between May 2015 and May 2020. Results Over the five-year study period, 2318 patients underwent a total of 26,923 intravitreal injections; 20,421 (75.8%) of which were delivered by appropriately trained ophthalmic nurses. The annual number of injections increased year-on-year from 2112 injections in 2015-2016 to 5410 injections in 2019-2020. The mean age of patients was 75.7±12.2 years with a female-to-male ratio was 1.17:1. Wet age-related macular degeneration represented the major indication for injections followed by retinal vein occlusion and diabetic maculopathy respectively. Three cases of post-injection endophthalmitis out of 20,421 (0.015%) injections in nurse injection group were identified during the study period. There were no cases of lens touch, retinal detachment or systemic thromboembolic events. Conclusion Use of the Precivia® intravitreal injection assist device by trained ophthalmic allied health professionals is a safe and cost-effective way to deliver intravitreal injections service.

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Diverticular fistulation is associated with nicorandil usage

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2010.92.6.463 ◽

2010 ◽

Vol 92 (6) ◽

pp. 463-465 ◽

Cited By ~ 11

Author(s):

James McDaid ◽

Claire Reichl ◽

Ihsan Hamzah ◽

Samantha Fitter ◽

Laura Harbach ◽

...

Keyword(s):

Diverticular Disease ◽

Fistula Formation ◽

Control Group ◽

Number Of Patients ◽

Significant Difference ◽

Patient Groups ◽

The Mean ◽

Uncomplicated Diverticular Disease ◽

And Control ◽

Control Study

INTRODUCTION We observed that a number of patients presenting to our clinic with diverticular fistulation were taking nicorandil for angna. Recognised side effects of nicorandil include gastrointestinal and genital ulceration. The aim of our study was to determine whether nicorandil is an aetiological agent in diverticular fistulation. PATIENTS AND METHODS We conducted a case-control study of patients with diverticular disease related enteric fistulae. Two patient groups were identified: a study group of patients with diverticular fistulae, and a control group with uncomplicated diverticular disease. The proportion of patients who had ever used nicorandil was compared between the two groups. RESULTS A total of 153 case notes were analysed, 69 patients with fistulae and 84 control patients with uncomplicated diverticular disease. Female to male ratio in both groups was 2:1. The mean age was 71 years in the fistula group and 69 years in the control diverticular disease group (P = ns). Of those with colonic fistulae, 16% were taking nicorandil compared with 2% of the control group (odds ratio 7.8; 95% confidence interval 1.5–39.1; P = 0.008). There was no significant difference in rates of ischaemic heart disease between fistula and control groups. CONCLUSIONS Nicorandil is associated with fistula formation in diverticular disease.

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Correlation of salivary neopterin and plasma fibrinogen levels in patients with chronic periodontitis and/or type 2 diabetes mellitus

Pteridines ◽

10.1515/pterid-2017-0007 ◽

2017 ◽

Vol 28 (3-4) ◽

pp. 177-183 ◽

Cited By ~ 1

Author(s):

Angel Fenol ◽

V.R. Swetha ◽

Sajitha Krishnan ◽

Jayachandran Perayil ◽

Rajesh Vyloppillil ◽

...

Keyword(s):

Diabetes Mellitus ◽

Chronic Periodontitis ◽

Study Groups ◽

Control Group ◽

Diabetic Patients ◽

Potential Biomarker ◽

Whole Saliva ◽

Nonsurgical Periodontal Therapy ◽

Significant Difference

AbstractNeopterin is a novel predictor for coronary events especially in diabetic patients and also an indicator for the effectiveness of the periodontal treatment. In this study, we assessed whether salivary neopterin can be used as a potential biomarker in evaluating the risk of cardiovascular disease in type 2 diabetic patients with chronic periodontitis. Forty subjects between 25 and 75 years of age and who matched the criteria were selected and divided into four groups. Their periodontal status was evaluated. Stimulated whole saliva and blood were collected for analysis of salivary neopterin and fibrinogen and HbA1c levels, respectively. Nonsurgical periodontal therapy was carried out. Patients were recalled after 3 months, and the same procedure was repeated. A reduction in all the parameters was seen after treatment in all the four groups. Salivary neopterin levels showed significant difference (p<0.001) in the values between the study groups and the control group before treatment. After 3 months of treatment, salivary neopterin levels showed a statistical significant reduction (p<0.001) in all the study groups. Neopterin could serve as an effective tool to assess the inflammatory process related to periodontitis and diabetes mellitus and also predict future cardiovascular events in diabetic patients.

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Serum Selenium Status in Patients with Type 2 Diabetes and Control Group

Global Journal of Health Science ◽

10.5539/gjhs.v9n5p234 ◽

2016 ◽

Vol 9 (5) ◽

pp. 234

Author(s):

Zahra Heidari ◽

Zahra Sepehri ◽

Aleme Doostdar

Keyword(s):

Type 2 Diabetes ◽

Serum Level ◽

Control Group ◽

Diabetic Patients ◽

Diabetes Incidence ◽

Serum Selenium ◽

Type 2 Diabetic Patients ◽

Significant Difference ◽

The Mean

<p>In addition to known risk factors, the role of different micronutrients such as selenium in diabetes incidence has been proposed. Some previous studies have shown an association of selenium deficiency and type 2 diabetes mellitus, while other studies have not confirmed such a relationship. The aim of this study was to evaluate serum level of selenium in patients with Type 2 diabetes compared with the control group. This cross-sectional study was carried out on patients with type 2 diabetes in Zahedan, southeastern Iran. One hundred newly diagnosed type 2 diabetic patients were evaluated for serum selenium level. One hundred subjects from the general population who had normal fasting blood sugar levels were selected as the control group. The control group subjects were matched in pairs with each of patients on the basis of sex, age (± one year), and body mass index (±1). Serum level of selenium was determined by spectrometry method. Results were compared using t-test. The mean serum level of selenium in patients was 94.47±18.07 µg/L whereas in control group was 142.79±23.67 µg/L. The mean serum level of selenium was significantly different between the two groups (P<0.001). Serum levels of selenium in diabetic patients with significant difference statistically were lower than the control group. In order to evaluate serum level of selenium in patients with diabetes, studies with larger sample size are required. Likewise, prospective studies along with selenium supplementation and investigating its effect on incidence of diabetes are accordingly needed.</p>

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What is the prevalence of dyslipidemia in patients with idiopathic tinnitus?

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20203451 ◽

2020 ◽

Vol 8 (8) ◽

pp. 2983

Author(s):

Suleyman Erdogdu

Keyword(s):

Blood Lipid ◽

Control Group ◽

Test Results ◽

Cochlear Blood Flow ◽

Number Of Patients ◽

Significant Difference ◽

Low Hdl ◽

Training And Research ◽

Male Patients ◽

And Gender

Background: Dyslipidemia is a metabolic disorder that results from imbalanced and overfeeding as well as sedentary life. Elevated blood lipid levels can affect cochlear blood flow and fluidity, leading to decreased hearing and tinnitus. We aimed to determine whether there is a relationship between tinnitus and dyslipidemia by investigating the blood lipoprotein values of patients with tinnitus.Methods: The lipid profiles of the patients with idiopathic tinnitus who were selected among the patients who applied to Istanbul Haydarpaşa Numune Training and Research Hospital with the complaint of tinnitus between January 2019 and May 2020 were examined. The test results and age and gender distributions were compared with control groups without tinnitus complaints and statistical evaluation was performed.Results: Hypercholesterolemia in 42% of 6472 patients with idiopathic tinnitus, 18% low HDL, 50% high LDL, Hyperlipidemia was detected in 21%. 1942 (30%) of these patients were male; 4530 (70%) are women. The number of patients in the control group without tinnitus was 6470. Hypercholesterolemia in 49% of this group; 21% low HDL, 42% high LDL, 16% hyperlipidemia was detected. In this control group, 1950 (30%) of the patients were male and 4520 (70%) were female. Cholesterol of male and female patients with tinnutus. When the cholesterol, LDL and triglyceride values of HDL and LDL values and female and male patients in the control group were examined, a statistically significant difference was found (p <0.005). No statistically significant difference was found between HDL values of female and male patients with tinnutus and HDL values of female and male patients in the control group (P> 0.05).Conclusions: There is a statistically relationship between tinnitus and dyslipidemia. The presence of dyslipidemia is vital due to atherosclerosis caused by dyslipidemia, especially coronary artery involvement. Therefore, dyslipidemia should be treated as it causes many diseases.

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