History Of Intravitreal Injections Research Articles

Assessment of Zonular Integrity in Phakic Eyes Following Pars Plana Vitrectomy Using Ultrasound Biomicroscopy: A Prospective Paired Eye Comparative Study

To assess zonular integrity in phakic patients post vitrectomy using ultrasound biomicroscopy (UBM). Prospective, comparative, nonrandomized, double-masked, paired eye study. We used ultrasound biomicroscopy (UBM) to evaluate phakic patients with a history of unilateral pars-plana vitrectomy. (1) phakic patients with history of pars plana vitrectomy in one eye as the only procedure; (2) normal unoperated fellow eye; and (3) complete gas or air resolution from the vitreous cavity at the time of UBM assessment. (1) monocular patients; (2) history of intraoperative lenticular trauma; (3) the use of silicone oil tamponade; (4) history of trauma or pseudoexfoliation in either eye; (5) history of other ocular conditions that can affect the integrity of zonules, such as uveitis or ectopia lentis; (6) eyes with extreme myopia or long axial length (> -8.00 D or >30.0 mm); (7) history of intravitreal injection in either eye; (8) age <18 years. A high-frequency (50 MHz) UBM device was used by a masked technician to obtain radial section images from zonular bundles at 8 different clock positions. Image quality was assessed in real time, captured, and saved. Two experienced masked observers (H.C. and C.B.) then assessed the quality of the images and graded the zonular findings. Only patients with adequate studies have been included. A unique grading system that was specifically devised for this study was used as the following: (0) clear, well-defined zonule(s); (1) uneven, disrupted zonules or stretched zonules; and (2) extensive loss of zonules. Each clock hour was graded according to this system and the total score was then calculated for each eye. In the primary outcome, 2 main groups were analyzed: vitrectomized eyes and healthy contralateral nonvitrectomized eyes. The mean total UBM score (TUS) from each group was compared and analyzed. Thirty-five patients were recruited into this study. Eleven patients were male and 24 were female. The mean age was 66.3 years. Thirty patients had vitrectomy for vitreomacular interface disorders (either macular hole or epiretinal membrane), 1 patient had vitreous hemorrhage and the remaining 4 patients had rhegmatogenous retinal detachments. With regard to tamponade agents, SF6 was used in 21 (60%) patients, air in 9 (26%) patients, and C3F8 in 5 (14%) patients. The mean TUS in the vitrectomized eyes was 2.28 (SD 1.83) vs 2.24 (SD 1.77) in the nonvitrectomized eyes (P = .9531). Overall, in the comparative analysis of mean scores based on 2 graders' assessments for each clock position in vitrectomized and nonvitrectomized eyes, there were no significant differences noted between the groups. This study found no evidence for a difference in the mean total UBM score in eyes following vitrectomy when compared to their contralateral healthy, nonvitrectomized eyes. This likely indicates that vitrectomy may not affect the integrity of zonules in phakic patients, at least for patients with vitreomacular interface disorders undergoing uncomplicated surgery.

The effect of topical ketorolac tromethamine on macular thickening after phacoemulsification in diabetic patients

BackgroundTo determine the effect of ketorolac tromethamine 0.5% in preventing post-phacoemulsification macular thickening. This randomized clinical trial. patients randomized 1:1 to receive either topical ketorolac three times a day or a placebo.MethodsA total of 101 eyes of 101 diabetic patients who were scheduled for phacoemulsification and had normal macular contour and thickness enrolled consecutively. The topical ketorolac and placebo were prescribed on the day before surgery and continued up to 4 weeks after surgery. Patients with proliferative diabetic retinopathy, a history of intravitreal injection in less than three months, a history of macular photocoagulation in less than 6 months, and any other concomitant ocular pathologies were excluded. Central macular thickness (CMT) and best corrected visual acuity (BCVA) was recorded in the follow-ups of 6, 12, and 24 weeks after the surgery and compared with the controls.Results49 eyes in the case group and 52 eyes in the control group were analyzed. Mean BCVA was significantly improved in both groups at all follow-ups (P < 0.001 for all). There was no statistically significant difference regarding the BCVA in different time points except week 12 (P = 0.028) among the study group. In the case and control groups, CMT was increased at all follow-ups (P < 0.05). There was no statistically significant difference when comparing the two groups regarding the mean of CMT at any time point postoperatively (P > 0.05 for all).ConclusionBased on our findings, topical ketorolac tromethamine 0.5% is not effective in the prevention of post-phacoemulsification macular thickening in diabetic patients.Trail registrationThe study protocol was registered into www.clinicaltrial.gov with the RCT registration number NCT03551808. (2018/06/11 )Clinical trial registration numberNCT03551808.

Visual Outcomes of Anti-VEGF Treatment on Neovascular Age-Related Macular Degeneration: A Real-World Population-Based Cohort Study.

Neovascular age-related macular degeneration (nAMD) leads to visual impairment if not treated promptly. Intravitreal anti-VEGF drugs have revolutionized nAMD treatment in the past two decades. We evaluated the visual outcomes of anti-VEGF treatment in nAMD. A real-life population-based cohort study. The data included parameters for age, sex, age at diagnosis, laterality, chronicity, symptoms, visual outcomes, lens status, and history of intravitreal injections. A total of 1088 eyes (827 patients) with nAMD were included. Visual acuity was stable or improved in 984 eyes (90%) after an average of 36 ± 25 months of follow-up. Bevacizumab was the first-line drug in 1083 (99.5%) eyes. Vision improved ≥15 ETDRS letters in 377 (35%), >5 ETDRS letters in 309 (28%), and was stable (±5 ETDRS letters) in 298 (27%) eyes after anti-VEGF treatment. The loss of 5 ≤ 15 ETDRS letters in 44 (4%) eyes and ≥15 ETDRS letters in 60 (6%) eyes was noted. At the diagnosis of nAMD, 110 out of 827 patients (13%) fulfilled the criteria for visual impairment, whereas 179 patients (22%) were visually impaired after the follow-up. Improvement or stabilization in vision was noted in 90% of the anti-VEGF-treated eyes with nAMD. In addition, anti-VEGF agents are crucial in diminishing nAMD-related visual impairment.

Risk factors, complications, and outcomes of phacoemulsification cataract surgery complicated by retained lens fragments in Asian eyes: A 10-year retrospective study.

PURPOSE:To study the risk factors, visual outcomes, and sequelae of phacoemulsification surgery complicated by retained lens fragments (RLFs).METHODS:This single-center case–control study enrolled consecutive eyes complicated by RLF and compared them to age- and gender-matched uneventful cataract surgery cases at a tertiary care teaching hospital. Biometric, intraoperative, and postoperative data were collected. The primary outcome measures were risk factors, visual outcomes, and rate of postoperative complications.RESULTS:The study and control groups included 282 and 289 eyes, respectively. The estimated incidence of RLF was 1.47% during the study. We found a statistically higher risk of RLF among diabetics (P < 0.001), those with a history of intravitreal injections (P = 0.001), eyes with dense nuclear sclerosis, anterior capsular cataract (P < 0.001), and posterior polar cataract (P = 0.01). There was a statistically higher risk of RLF in eyes with a higher mean preoperative visual acuity (logarithm of the minimum angle of resolution) (P < 0.001) and in cases performed by trainees (P < 0.001). Most eyes in the RLF group (n = 207, 73.4%) retained their preoperative vision or experienced a one-line improvement in visual acuity and 14 eyes (5.3%) experienced more than one-line improvement in vision.CONCLUSION:Although RLFs are rare, they can affect the quality of postoperative vision and outcomes of complicated phacoemulsification surgery.

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

Purpose: To compare the anesthetic effect of topical proparacaine hydrochloride 0.5% with sub-conjunctival lidocaine 2% for intravitreal injection of Bevacizumab.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: Department of Ophthalmology Fauji Foundation Hospital, Rawalpindi, from July 2017 to January 2018.&#x0D; 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.&#x0D; 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).&#x0D; Conclusion: Sub-conjunctival anaesthesia results in less pain during intravitreal drug administration as compared to the topical anaesthesia.&#x0D; Key Words: Intravitreal injections, Bevacizumab, Intravitreal Anti-VEGF, Anesthesia.

Conjunctival microflora and its antibiotic sensitivity after serial intravitreal injections

The approach to post-procedure management of patients undergoing intravitreal injections should be unified and consistent. Frequent use of antibiotic drugs leads to generation of resistant conjunctival strains. To study the composition of conjunctival microflora and its antibiotic susceptibility in patients who received 20 or more intravitreal injections and concomitant antibiotic therapy, and in a group of patients of the same age without history of intravitreal injections or ophthalmological operations. A total of 40 inoculations were performed (20 patients in each group, 40 eyes). In case of culture growth, species identification and antibiotic sensitivity of the microorganisms were investigated using automated identification and susceptibility testing system BD Phoenix 100. Culture growth was observed in 70% of the control group patients. All isolated microorganisms were different types of staphylococci - Staphylococcus epidermidis (78.57%), S. caprae (7.14%), S. hominis (7.14%), and S. aureus (7.14%). In the second group, we observed culture growth in 55% of cases. Eleven cultures were Gram-positive bacteria: S. epidermidis (72.73%), S. haemolyticus (18.18%), S. aureus (9.09%). Gram-negative Pseudomonas aeruginosa was detected in 1 patient. In the control group, multi-resistant cultures accounted for 42.86%. In the group of patients with multiple intravitreal injections, 75% of cases showed multiresistance (9 out of 12 isolates). In the group of patients who have undergone 20 or more injections, greatest resistance was observed to penicillin G, doxycycline, gentamicin, erythromycin, clindamycin, moxifloxacin, fusidic acid, chloramphenicol, and trimethoprim/sulfamethoxazole compared to the control group. Overuse of antibiotics in the management of patients receiving intravitreal injections leads to selection of resistant strains.