ASSESSMENT OF INTRAOCULAR PRESSURE FOLLOWING THE INTRAVITREAL INJECTION OF ANTI-VEGF

Objective: The objective of the study is to assess the frequency of raised IOP after intravitreal injection of Anti VEGF by using an applanation tonometer. Methods: Each patients who fulfil the presence criteria were nominated by the researcher through ‘the outpatient department (OPD) of ophthalmology, Jinnah Post Graduate Medical Center. Performa was filled. Aim and process of study was explained to all patients. Conversant consent was reserved. Model ocular inspection, including IOP was done. By using either a 30-or 32-gauge needle, 1.25 ml bevacizumab (Avastin) were administered by the researcher under the direct supervision of consultant. Patients were consistently sterilely prepped, that was comprised incerted of topical antibiotic and anesthetic drops, supplement of a lid speculum. Later pointing the injection place on the sclera with a caliper calculating 3.0 to 3.5 mm after limbus, conjunctiva was expatriate somewhat through a sterile cotton-tipped applicator immediately earlier ingoing the eye by a needle. Later injection, place was occluded provisionally it was amended through a sterile cotton-tipped applicator while the needle remained inhibited from the eye. Since the needle was inhibited, a drop of anesthetic was employed on the cornea and IOP was measured. Then next IOP interpretation was measured later 1day of intravitreal Avastin. All pressures were measured using the applantation tonometry. IOPs were measured earlier intravitreal Avastin "baseline IOP" and instantly following injection "T0" and 1day next injection. Results: 235 Patients exactly nominated for the research study. Intravitreal Injection, Bevacizumab was applied in 235 Eyes of overstated 235 patients. Elsewhere of the 235 patients, 133 males and 102 females, Their ages ranged from 30-70 y (mean 52.02 y. The most shared sign intravitreal with bevacizumab, diabetic retinopathy observed in 114 (48.5%) patients, indicated by exudative ARMD in 70 (29.7%) patients, BRVO in 12 (5%) patients, Myopic CNV23(9.7) with CRVO observed in 11 (4.6%) patients, Eale’s sickness in 2(0.85%) patients even as Idiopathic CNV was observed in only 3 (1%) patient. Of the 235 patients, 118 (50.2%) patients with right eye suffered, 117(49.7%) patients with left eye suffered. After 24 h of intravitreal Bevacizumab Raised IOP was observed in only 3 (1.28) patient and 232(98.2) patient IOP was in the normal range. According to our study, the result of stratification with respect to age, side of the eye and gender is not significant as p-value for age (0.838), gender (0.723) and side of the eye (0.556), respectively. Conclusion: In our study, frequency of raised IOP after anti VEGF were found 3(1.28) patient out of 232 (98.2). Anti-VEGF treatment is the foundation for the management of numerous retinal illnesses. Notwithstanding its capable effectiveness in uncertain the sickness and refining, vision for the patients, intravitreal injection of anti-VEGF products may be related with overwhelming problems. To diminish the risk cautious care to the injection method and suitable post-injection observing are essential.

Download Full-text

Change in Visual Acuity in Relation to Central Macular Thickness after Intravitreal Bevacizumab in Diabetic Macular Edema

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v36i3.1051 ◽

2020 ◽

Vol 36 (3) ◽

Author(s):

Muhammad Ali Haider ◽

Uzma Sattar ◽

Syeda Rushda Zaidi

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Intravitreal Bevacizumab ◽

Macular Thickness ◽

Rank Test ◽

P Value ◽

Central Macular Thickness ◽

Anti Vegf ◽

Quasi Experimental

Purpose: To evaluate the change in visual acuity in relation to decrease in central macular thickness,after a single dose of intravitreal Bevacizumab injection.Study Design: Quasi experimental study.Place and Duration of Study: Punjab Rangers Teaching Hospital, Lahore, from January 2019 to June 2019.Material and Methods: 70 eyes with diabetic macular edema were included in the study. Patients having high refractive errors (spherical equivalent of > ± 7.5D) and visual acuity worse than +1.2 or better than +0.2 on log MAR were excluded. Central macular edema was measured in μm on OCT and visual acuity was documentedusing Log MAR chart. These values were documented before and at 01 month after injection with intravitrealBevacizumab. Wilcoxon Signed rank test was used to evaluate the difference in VA beforeand after the anti-VEGF injection. Difference in visual acuity and macular edema (central) was observed,analyzed and represented in p value. P value was considered statistically significant if it was less than 0.01%.Results: Mean age of patients was 52.61 ± 1.3. Vision improved from 0.90 ± 0.02 to 0.84 ± 0.02 on log MARchart. The change was statistically significant with p value < 0.001. Central macular thickness reduced from 328 ±14 to 283 ± 10.6 μm on OCT after intravitreal anti-VEGF, with significant p value < 0.001.Conclusion: A 45 μm reduction in central macular thickness was associated with 0.1 Log MAR unit improvementin visual acuity after intravitreal Bevacizumab in diabetic macular edema.

Download Full-text

Immediate Effect of Intravitreal Bevacizumab Injection on Intraocular Pressure

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v36i4.1109 ◽

2020 ◽

Vol 36 (4) ◽

Author(s):

Rabeeah Zafar ◽

Amna Rizwan ◽

Badar-ud-din Ather Naeem ◽

Asfandyar Asghar ◽

Naila Obaid

Keyword(s):

Intraocular Pressure ◽

Case Series ◽

Intravitreal Bevacizumab ◽

P Value ◽

Diabetic Patients ◽

Vascular Endothelial ◽

Post Injection ◽

Intravitreal Bevacizumab Injection ◽

Applanation Tonometer ◽

Endothelial Growth Factor

Purpose: To determine the immediate effect of intravitreal Bevacizumab on intraocular pressure (IOP) in eyes with retinal vascular disorders. Study Design: Interventional case series. Place and Duration of Study: Ophthalmology Department, Fauji Foundation Hospital, Rawalpindi, from January 2019to July 2019. Methods: One hundred and thirty one patients were included in this study using non probability consecutive sampling. IOP was measured before intravitreal injection (baseline) and at 5 and 30 minutes post-injection. Descriptive statistics were obtained using SPSS version 21.0. Results: One hundred and thirty one eyes of 131 patients were observed for IOP change after intra vitreal injection of Bevacizumab. Among them 23 (18%) were males and 108 (82.4%) were females. Mean age was 57.57 ± 13.09 years. Mean IOP at baseline was 16.16 ± 2.52 mmHg. At 5 minutes after injection, 108 eyes (82.4%) had raised IOP, maximum IOP recorded was 44 mmHg. There was a statistically significant correlation between IOP at baseline and 5 minutes with p = 0.005 (≤0.05). At 30 minutes, 94 eyes (71.7%) had IOP fallen back to normal. Statistically, an insignificant correlation was present between IOP at baseline and 30 minutes (p = 0.081) post-injection. IOP rise was not significantly correlated to gender, age, hypertension and asthma at any interval (p value > 0.05). However, IOP rise was significantly correlated in diabetic patients at 30 minutes. Conclusion: IOP elevation has been observed after intravitreal bevacizumab in immediate post-injection period which warrants the monitoring of IOP in this critical period to avoid serious blinding complications. Key Words: Bevacizumab, Vascular endothelial growth factor, Intraocular pressure, Goldmann applanation tonometer.

Download Full-text

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

AL-MUKHTAR JOURNAL OF SCIENCES ◽

10.54172/mjsc.v35i2.317 ◽

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

Download Full-text

Shortening Activated Partial Tromboplastin Time (APTT) Between Hypertension and Nonhypertension in Diabetic Mellitus Patients with Bevacizumab Intravitreal Injection

International Journal of Retina ◽

10.35479/ijretina.2019.vol002.iss002.98 ◽

2019 ◽

Vol 2 (2) ◽

Author(s):

Anik Ika Winarni ◽

Ni Luh Putu Widyasti ◽

Natalia Christina Angsana ◽

Rizto Wisuda Senuari ◽

Angela Nurini Agni ◽

...

Keyword(s):

Diabetes Mellitus ◽

Intravitreal Injection ◽

Antihypertensive Drugs ◽

Intravitreal Bevacizumab ◽

Mean Value ◽

P Value ◽

Diabetic Mellitus ◽

Hypertensive Patients ◽

Patients With Diabetes ◽

The Difference

Introduction : Bevacizumab intravitreal injection could be detectable in plasma that might interfere the coagulopathy and hemostasis condition. The purpose of this study was to investigate the difference of APTT between hypertensive and nonhypertensive diabetic mellitus patients with bevacizumab intravitreal injection. Methods : This was cohort study conducted at Sardjito General Hospital from March 2019 to June 2019. Thirty-two hypertension patients and 30 nonhypertension patients with diabetes mellitus who underwent bevacizumab intravitreal injection were included. Value of APTT was measured using ACLTOP300 machine prior and 1 week after IVB. The difference in mean APTT value prior and after IVB, range APTT value between two groups were assessed using independent t-test. The percentage of patients who had shortening of APTT in both groups was tested by two populations proportion test. Results : Mean APTT before IVB in hypertensive patients was 36.47 ± 2.92 seconds and in nonhypertensive patients was 36.33 ± 4.39 seconds with p value > 0.05. Mean value of APTT after IVB in hypertension patients was 35.42 ± 3.63 seconds and in nonhypertensive patients was 35.60 ± 3.13 seconds with p value > 0.05. APTT shortening in hypertensive patients was -1.03 ± 3.65 and nonhypertensive patients was -0.73 ± 2.55 with p value > 0.05. The risk of APTT shortening in hypertensive patients was 1.370 (0.831-2.258). The risk of APTT shortening in hypertensive patients who used antihypertensive drugs regularly was 0.538 (0.331- 0.874). Conclusion : There was no difference in shortening of APTT value 1 week after intravitreal bevacizumab injection between hypertensive and nonhypertensive groups in patients with diabetes mellitus. Hence, administration of IVB in hypertensive patients with regular antihypertensive therapy might be safe.

Download Full-text

Compression between Combined Anti-VGEF with Steroids Versus Pure Anti-VEGF in Retinal Vein Occlusion

Journal of Ophthalmic Science ◽

10.14302/issn.2470-0436.jos-20-3400 ◽

2020 ◽

Vol 2 (3) ◽

pp. 36-44

Author(s):

Eman Abo Taleb ◽

Altaf Alsowaidi

Keyword(s):

Macular Edema ◽

Retinal Vein Occlusion ◽

Intravitreal Bevacizumab ◽

P Value ◽

Vein Occlusion ◽

Anti Vegf ◽

Study Results ◽

Significant Difference ◽

Group 2 ◽

Group 1

Aim To compare the efficacy of combined anti-VGEF (IVB) with steroids versus pure anti-VEGF for the treatment of macular edema secondary to retinal vein occlusion (RVO). Methods In this prospective study, 51 eyes were randomized into 2 groups according to treatment of clinically identified macular edema secondary to retinal vein occlusion within 4 weeks of onset: Group 1 (19 eyes) was given intravitreal Bevacizumab (IVB) (1.25mg/.05ml) + Triamcinolone (IVTA) (2mg/.05ml); Group 2 (22 eyes) was given pure intravitreal Bevacizumab (IVB) (1.25mg/.05ml) at baseline, at month 1, and at month 2. The outcome of the study represented the EDRTS letters gain, IOP change and (CRT) by using Spectral domain optical coherence tomography (OCT) at month 1, 2, 3 and 6 in each group. Both central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) patients with at least 6 months FU were enrolled in the study. Results EDRTS letters gain was (20.37±15.28, 28.05±16.68, 35.16±17.12, 36.47±18.17) in group1 and (14.50±14.56, 18.41±14.56, 20.59±16.13, 21.06±15.72) in group2 at month 2,3 and 6 p value (0.18, .04, 0.004, 0.002). Mean IOP pre-injection (14.00±2.67) in group 1 and (13.5±5.89) in group 2. Group 1 has transient increase in IOP at month 1 and then return to baseline over 6 months. CRT from baseline to final FU decrease by 264.82 (µm) ±147.66 in group 1 and 308.42(µm) ±226.78 in group 2 with no significant difference between two group p value 0.57. There was no significant difference in EDRTS letters gain between CRVO patients and BRVO patients at month 1, 2, 3 and 6 p values (0.83, 0.23, 0.29, 0.13). Conclusion Early treatment macular edema in RVO patients by combined anti-VGEF+ steroid effectively improve functional outcome better than pure anti-VGEF injection.

Download Full-text

Evaluation of the Effect of Intravitreal Bevacizumab (Avastin) in Patients with Diabetic Macular Edema

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v12i2.28959 ◽

2020 ◽

Vol 12 (2) ◽

pp. 236-244

Author(s):

Pawan Mahat ◽

Purushottam Joshi ◽

Eli Pradhan ◽

Prabha Subedi

Keyword(s):

Diabetes Mellitus ◽

Visual Acuity ◽

Macular Edema ◽

Intravitreal Injection ◽

Diabetic Macular Edema ◽

San Francisco ◽

Retinal Thickness ◽

Intravitreal Bevacizumab ◽

Macular Thickness ◽

P Value

Introduction: Diabetic macular edema (DME) is the leading cause of visual impairment in patients with diabetes mellitus. The objectives of the study was to figure out the effect of intravitreal injection bevacizumab on visual acuity and retinal thickness in people with DME. Materials and methods: We observed the case records of patients with DME requiring injection Avastin (Genentech Inc., San Francisco, CA, USA) intravitreal from January to July 2016 in Mechi Eye Hospital. The eighty seven eyes of 60 patients with DME were included in the study. Inclusion criteria were determined independently of the age, metabolic control, type of diabetes mellitus, visual acuity, leakage area size,retinal thickness as measured by optical coherence tomography. All the patients were treated with 0.05 ml injection containing 1.25 mg of Avastin (Genentech Inc., San Francisco, CA, USA) after written informed consent. Results: The mean age group was 55.86 ± 9.61 years with 47 males and 13 females. At baseline the median BCVA was 1.00 (0.60-1.30) which improved to 0.78 (0.48- 1.00) at 6 weeks (p=0.001) which further improved to 0.78 (0.48-1.00) Log MAR (p value- 0.005) at 12 weeks and 0.60 (0.43- 1.00) Log MAR at 18 weeks (p value= 0.006). Baseline mean central macular thickness (CMT) on OCT was 436.24 ± 142.2μm which decreased to 387.74±130.98μm at 6 weeks, 346.82 ±116.79 μm at 12 weeks and 307.1 ±105.49μm. Changes in VA and decrease in central subfield macular thickness during follow up visit was statistically significant (p<0.05). Conclusion: In this study, intravitreal injection Avastin resulted in improvement in VA and decrease in retinal thickness in patients with DME.

Download Full-text

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

10.21203/rs.3.rs-1208757/v1 ◽

2021 ◽

Author(s):

Sedat Ozmen ◽

burçin çakır ◽

nilgün özkan aksoy ◽

erkan çelik ◽

yeşim güzey aras ◽

...

Keyword(s):

Intravitreal Injection ◽

Vascular Diseases ◽

Intravitreal Bevacizumab ◽

Retrospective Chart Review ◽

Intravitreal Injections ◽

Control Group ◽

Diabetic Patients ◽

Anti Vegf ◽

Number Of Patients ◽

Significant Difference

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.

Download Full-text

Effect of Topical Versus Sub-conjunctival Anaesthesia during Administration of Intravitreal Bevacizumab Injection

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v37i4.1249 ◽

2021 ◽

Vol 37 (4) ◽

Author(s):

Amna Rizwan ◽

Rabeeah Zafar ◽

Asfandyar Asghar ◽

Naila Obaid ◽

B A Naeem

Keyword(s):

Pain Score ◽

Intravitreal Injection ◽

Intravitreal Bevacizumab ◽

Vitreous Hemorrhage ◽

Pain Scale ◽

Ethical Review ◽

P Value ◽

Intravitreal Bevacizumab Injection ◽

Department Of Ophthalmology ◽

Group B

Purpose: To compare the anesthetic effect of topical proparacaine hydrochloride 0.5% with sub-conjunctival lidocaine 2% for intravitreal injection of Bevacizumab. Study Design: Quasi experimental study. Place and Duration of Study: Department of Ophthalmology Fauji Foundation Hospital, Rawalpindi, from July 2017 to January 2018. Methods: Sixty 60 patients who needed intravitreal Bevacizumab were included in the study after approval from the ethical review board. Exclusion criteria were patients with conditions that could affect pain sensation, acute ocular inflammation, history of intravitreal injection, using systemic analgesic/sedatives, uncooperative patients and unable to understand the pain scale. Written informed consent was taken. Name, age, gender, diagnosis, previous intravitreal injection, hospital registration number, address and contact numbers were noted. Patients were briefed about the visual analogue scale. Patients were divided into two groups. Group A received proparacaine drops and group B was given subconjunctival lidocaine injections before intravitreal bevacizumab. Results: The mean age of patients in this study was 60.38 ± 10.55 years. There were 03 (5.0%) males and 57 (95.0%) females. Majority of the patients (30%) presented with choroidal neovascularization followed by diabetic maculopathy, vitreous hemorrhage, central retinal vein occlusion and proliferative diabetic retinopathy. Mean pain score among both the groups was 3.67 ± 1.97 (topical group) and 1.70 ± 1.51 (sub-conjunctival group) respectively which was statistically significant (p-value 0.000). Among age, diabetes, duration of diabetes and hypertension, only hypertension had moderate correlation with the pain score (correlation coefficient = 0.316, p values = 0.017). Conclusion: Sub-conjunctival anaesthesia results in less pain during intravitreal drug administration as compared to the topical anaesthesia. Key Words: Intravitreal injections, Bevacizumab, Intravitreal Anti-VEGF, Anesthesia.

Download Full-text

Making Youth Matter

Boyhood Studies ◽

10.3167/bhs.2018.110205 ◽

2018 ◽

Vol 11 (2) ◽

pp. 70-93

Author(s):

Celeste Hawkins

Keyword(s):

African American ◽

African American Students ◽

African American Male ◽

Research Study ◽

Educational Experiences ◽

Male Students ◽

African American Male Students ◽

American Students ◽

And Gender ◽

K 12

This article focuses on findings from a subgroup of African-American male students as part of a broader qualitative dissertation research study, which explored how exclusion and marginalization in schools impact the lives of African-American students. The study focused on the perspectives of youth attending both middle and high schools in Michigan, and investigated how students who have experienced forms of exclusion in their K–12 schooling viewed their educational experiences. Key themes that emerged from the study were lack of care, lack of belonging, disrupted education, debilitating discipline, and persistence and resilience. These themes were analyzed in relation to their intersectionality with culture, ethnicity, race, class, and gender.

Download Full-text

Perinatal Asphyxia Among Neonates Admitted Jimma Medical Center, Jimma, Ethiopia

Global Pediatric Health ◽

10.1177/2333794x20981304 ◽

2020 ◽

Vol 7 ◽

pp. 2333794X2098130

Author(s):

Ebissa Bayana Kebede ◽

Adugna Olani Akuma ◽

Yonas Biratu Tarfa

Keyword(s):

Gestational Age ◽

Medical Center ◽

Perinatal Asphyxia ◽

Mode Of Delivery ◽

Large For Gestational Age ◽

Systematic Sampling ◽

P Value ◽

Health Extension Workers ◽

Severe Problem ◽

Prolonged Labor

Background: Perinatal asphyxia is a severe problem which causes serious problem in neonates in developing countries. This study is aimed to determine magnitude of perinatal asphyxia and its associated factors. Methods: A cross-sectional study design was conducted among neonates admitted over a period of 4 years on 740 samples. Systematic sampling method was employed to get required samples from log book. Epi-data 3.1 is used for data entry and the entered data was exported to SPSS Version 23 for analysis. Bivariable and multiple variable logistic regressions analysis were applied to see the association between dependent and independent variables. Finally, P-value <.05 at 95% CI was declared statistically significant. Results: The main significant factor associated to perinatal asphyxia were prolonged labor ( P = .04, AOR = 1.68 95%CI: [1.00, 2.80]), being primipara ( P = .003, AOR = 2.06, 95%CI: [1.28, 3.30]), Small for Gestational Age (SGA) ( P = .001, AOR = 4.35, 95%CI: [1.85, 10.19]), Large for Gestational Age ( P = .001, AOR = 16.75, 95%CI: [3.82, 73.33]) and mode of delivery. Conclusion: The magnitude of perinatal asphyxia was 18%. Prolonged labor, parity, birth size, mode of delivery, and APGAR score at 1st minute were significantly associated with perinatal asphyxia. So, Nurses, Midwives, Medical Doctors, and health extension workers have to engage and contribute to on how to decrease the magnitude of perinatal asphyxia.

Download Full-text