Initial Intravitreal Injection Research Articles

Long-term Outcomes of Diabetic Macular Edema Following Initial Intravitreal Ranibizumab Injection Based on Morphologic Pattern

Long-term Outcomes of Diabetic Macular Edema Following Initial Intravitreal Ranibizumab Injection Based on Morphologic Pattern

One year results of intravitreal ranibizumab monotherapy for retinal angiomatous proliferation: a comparative analysis based on disease stages.

BackgroundRetinal angiomatous proliferation (RAP) has been known as a variant of exudative age-related macular degeneration (AMD) with a unfavorable prognosis. To evaluate the effect of ranibizumab administered initially as three loading doses for patients with various stages of RAP.MethodsA retrospective chart review of 40 patients (41 eyes) with RAP was conducted. The study divided patients into three groups of Group I (8 eyes in stage I), Group II (17eyes in stage II), and Group III (16 eyes in stage III). All patients received three initial monthly intravitreal injections (0.5 mg) of ranibizumab and were monitored monthly for 12 months. Reinjection of ranibizumab after three initial monthly doses was administered on as-needed basis. The main outcome measures were the change in the mean of best-corrected Snellen visual acuity (BCVA) and central macular thickness (CMT), and the total number of injections received during the 12 months.ResultsThe mean change in BCVA at 12 months was-0.286,-0.165, and-0.151 (logMAR) in Group I, II, and III, respectively. CMT was also reduced by a mean of 32.72 ± 56.75, 57.45 ± 56.48 and 148.37 ± 98.59 μm. The mean number of injections in Group I was significant lower than those in Group II and III (P < 0.001, P < 0.001, and P = 0.15 for Group I versus Group II, Group I versus Group III, and Group II versus Group III, respectively).ConclusionsThe 12-month follow-up outcomes suggest that three consecutive loading doses of intravitreal ranibizumab is an effective treatment on early stage (stage I) of RAP. Patients in stage I showed a significantly lower recurrence rate than patients in later stages.

Aflibercept as primary treatment for myopic choroidal neovascularisation: a retrospective study.

AimThe aim of this study is to evaluate long-term efficacy of intravitreal injections of aflibercept as primary treatment for subfoveal/juxtafoveal myopic choroidal neovascularisation (CNV).MethodsThirty-eight treatment-naive eyes of thirty-eight patients with subfoveal/juxtafoveal myopic CNV received initial intravitreal aflibercept injections and were followed for at least 18 months. Aflibercept was applied again for persistent or recurrent CNV, as required. Statistical analysis was carried out using SPSS.ResultsMean patient age was 45.8 years, and mean eye refractive error was −7.79 D. For the total patient group (n=38 eyes), mean logMAR best-corrected visual acuity (BCVA) significantly improved from 0.69 at baseline to 0.15 at 18 months (P<0.01). Over half of the treated eyes obtained resolution with one aflibercept injection. Patients were also grouped according to age, as <50 years (n=20 eyes) and ≥50 years (n=18 eyes). Mean BCVA improvement was significantly greater in eyes of the younger myopic CNV group, compared with those of ≥50 years (0.21 vs 0.35; P<0.05). The mean number of aflibercept injections was 1.8 for the <50 years myopic CNV group, and 3.6 for the ≥50 years myopic CNV group (P<0.001). Correlation between spherical equivalent refraction and final visual acuity reached statistical significance only for the <50 years myopic CNV group (P<0.001; Levene's correlation).ConclusionsIntravitreal aflibercept provides long-term visual acuity improvement in myopic CNV. The <50 years old myopic CNV group had significantly fewer injections, with greater visual acuity improvement. Intravitreal aflibercept in myopic CNV does not require the three-injection loading phase used for aflibercept treatment of neovascular age-related macular degeneration.

394. Baseline Data for Patients Participating in the Phase 2a rAAV.sFlt-1 Gene Therapy Trial for Exudative Age-Related Macular Degeneration

rAAV.sFlt-1 has the potential to provide long-term treatment of retinal neovascular diseases following a single injection by driving expression of sFlt-1, a potent (Kd 10 pM), naturally-occurring VEGF inhibitor. Here we present the baseline data for subjects with exudative age-related macular degeneration (AMD) enrolled in an investigator-sponsored, single center, Phase 2a safety study of rAAV.sFlt-1 gene therapy. Of the 32 randomized subjects, 21 were randomized to the rAAV.sFlt-1 group and 11 to the ranibizumab control group. All subjects were treated with two initial intravitreal injections of ranibizumab and then followed monthly for the need for rescue ranibizumab injections based on pre-specified criteria for evidence of active exudative AMD. Subjects underwent a thorough ophthalmic examination at baseline, and clinical laboratory assessments included blood biochemistry, complete blood count, and T-cell response. Anti-AAV antibodies (both total and neutralizing), AAV capsid protein, and sFlt-1 protein levels were also measured. Baseline demographics were 100% Caucasian, 59% female, and average age 79+7 years. All subjects had active subfoveal choroidal neovascularization secondary to exudative AMD, and the average visual acuity was 59+15 EDTRS letters (Snellen equivalent 20/63). Subjects had received an average of 10 anti-VEGF injections prior to enrolment. Anti-AAV antibody results indicated that 25% of subjects serum contained neutralizing antibody titres 1/100-1/500 while 19% had titres 1/20-1/100. All subjects tested negative for presence of AAV capsid in fluids at baseline. sFlt-1 protein averaged 13.9+5.4 pg/ml in urine, 116+5.9 pg/ml in serum, and 229+12.7 pg/ml in saliva. One patient had IgM deficiency and 6/32 patients had lymphopenia or T cell deficiency and/or CD8 lymphopenia. No other immune defects that might pose a hazard to the use of the rAAV vector were identified. In conclusion, the study subjects had characteristics representative of a population with exudative AMD and are appropriate for enrollment in a safety study for rAAV.sFlt-1.

Effects of three consecutive monthly intravitreal injection of ranibizumab for polypoidal choroidal vasculopathy in Korea.

To evaluate the efficacy and safety of three consecutive monthly injections of intravitreal ranibizumab for the treatment of polypoidal choroidal vasculopathy (PCV) in Korea. A retrospective chart review of 25 patients (27 eyes) with PCV was conducted. Patients received three initial monthly intravitreal injections (0.5 mg) of ranibizumab and were monitored monthly for 12mo between January 2010 and October 2011. Reinjection of ranibizumab after three initial monthly loading was administered on an as-needed basis, guided by the optical coherence tomography (OCT), fluorescein angiography (FA) and indocyanine green angiography (ICGA). The main outcomes were the changes of the mean best corrected Snellen visual acuity (VA), central macular thickness (CMT) by OCT, the changes of polyps and branching vascular network by FA and ICGA, and total number of injections received by patients during the 12mo. The mean best corrected Snellen visual acuities at baseline, 1, 3, 6 and 12mo after primary injection were 0.77±0.59, 0.76±0.53, 0.70±0.47, 0.63±0.43, 0.61±0.43, 0.62±0.42 logMAR, respectively, and showed significant improvement at 3, 6, 12mo (P=0.003, P=0.002, P=0.018, Wilcoxon signed-rank test). The mean CMT at baseline, 1, 2, 3, 6, and 12mo was 312.41±66.38 µm, 244.59±71.47 µm, 232.32±69.41 µm, 226.69±69.03 µm, 228.62±37.07 µm, 227.59±51.01 µm respectively, and showed significant reduction (all P<0.001, Wilcoxon signed-rank test). Polypoidal lesions resolved on ICGA in 3 eyes (11.1%) and a branching vascular network remained in all 24 eyes (88.9%). A total of 106 injections were given in the 12-month period, which equaled to a mean of 3.92 (range, 3-6) times. Sixteen of the 27 treated eyes had additional 1.56±0.91 injections. The others (11 eyes) had just 3 consecutive injections. An initial loading dose of three monthly ranibizumab injections is a safe and effective method in treating PCV, with visual and anatomical improvement over one year follow-up.

The effects of the frequency of the initial treatment with intravitreal bevacizumab on macular volume and visual acuity.

The ideal notion of monthly intravitreal injections is difficult to achieve when it comes to real-life scenarios. In reality, patients often are treated with larger intervals due to circumstances. The purpose of this study was to compare the results of intravitreal bevacizumab injections with shorter intervals versus longer intervals for the treatment of choroidal neovascularization (CNV) in age-related macular degeneration (AMD) in a real-life clinic. A retrospective, consecutive cohort study of naive eyes of patients with CNV secondary to AMD treated with intravitreal bevacizumab. Patients included underwent at least 3 consecutive injections with intervals <45 days in between them (Group A) or >45 days (Group B). Best corrected visual acuity (BCVA) and optical coherence tomography were performed before the initial intravitreal injections and after the last injection. Group A consisted of 24 eyes of 18 patients and Group B 30 eyes of 25 patients. There was a significantly larger mean of consecutive (5.0 vs. 3.78, P = 0.013) and total (9.44 vs. 7.2, P = 0.021) injections in Group B. There was a significant improvement in average BCVA in Group A only (0.65-0.52, P=0.006). However, a significant and similar improvement in retinal volume was found in both groups (P < 0.05). This study emphasizes the importance of achieving consecutive injections with short intervals. Practitioners and decision makers should be mindful that providing additional resources to accomplish proper frequency may be more effective (visual outcome), cost effective (less injections), and safer (less exposure) for the patient.

Pharmacogenetic Effect of Complement Factor H Gene Polymorphism in Response to the Initial Intravitreal Injection of Bevacizumab for Wet Age-Related Macular Degeneration

Purpose: To compare the functional and morphological response to the initial intravitreal (IVT) injection of bevacizumab in exudative age-related macular degeneration (AMD) patients with the complement factor H (CFH) gene polymorphism T1277C in the Brazilian population. Methods: Twenty-five unrelated patients with treatment-naive exudative AMD underwent an IVT injection of 1.25 mg bevacizumab at the initial presentation (D0) and were reexamined 7 days (D7) and 28 days (D28) later. The time and extent of visual acuity (VA) and central retinal thickness (CRT) changes were evaluated according to the presence of the T1277C polymorphism. Results: In the homozygous risk group (CC), VA improvement was detected mostly from D7 to D28, while in the heterozygous (CT) and homozygous for the wild-type allele (TT) groups, functional response occurred earlier, from D0 to D7. Morphological response to the first IVT injection of bevacizumab was significant in the CT and TT groups, while the CC group presented no significant change in CRT up to D28. Conclusion: The CC variant of the CFH gene polymorphism T1277C is related to delayed functional and limited morphological response to the initial IVT injection of bevacizumab in exudative AMD patients in a sample of the Brazilian population.

Fibrovascular pigment epithelial detachment is a risk factor for long-term visual decay in neovascular age-related macular degeneretion.

The individual outcome of anti-vascular endothelial growth factor treatment in neovascular age-related macular degeneration is variable. To investigate the prognostic value of spectral domain optical coherence tomography structures for best-corrected visual acuity (BCVA) outcome, volumetric analysis of spectral domain optical coherence tomography structures was performed in neovascular age-related macular degeneration correlated with BCVA after 24 months. At the Department of Ophthalmology, University of Cologne, Germany, 75 patients with neovascular age-related macular degeneration were analyzed prospectively over 24 months. Patients received three initial consecutive monthly intravitreal ranibizumab injections followed by monthly spectral domain optical coherence tomography controls. Therapy was continued as a pro re nata regimen. Volumetric analysis of spectral domain optical coherence tomography images was performed using commercially available software (3D-Doctor). Subretinal tissue, subretinal fluid, serous pigment epithelial detachment, and fibrovascular pigment epithelial detachment (FPED) were identified. By contrast to all other structures, FPED did not respond to ranibizumab therapy. Volume of FPED at baseline and after the loading phase correlated most with impaired BCVA after 24 months (r = -0.0215, P = 0.9263 [subretinal tissue]; r = -0.3120, P = 0.0216 [subretinal fluid]; r = -0.0757, P = 0.6470 [serous pigment epithelial detachment]; r = -0.4182, P = 0.0111 (FPED baseline); r = -0.4768; P = 0.0002 [FPED after loading phase]). Of all identified structures, FPED was most deleterious for BCVA after 24 months. The knowledge about possible BCVA course can influence the decision for more intense treatment regimens.

Enzymatic vitrectomy for diabetic retinopathy and diabetic macular edema

The aim of this paper is to determine the role of enzymatic vitrectomy performed by intravitreal injection of autologous plasmin enzyme (APE) in the management of diabetic retinopathy and diabetic macular edema (DME). Diabetic patients with proliferative diabetic retinopathy or DME and evident posterior hyaloid adherence to the retinal surface were included. All cases were treated with an initial intravitreal injection of APE and reevaluated one month later, measuring changes in best-corrected visual acuity (BCVA), macular thickness and the status of the posterior hyaloid. A second APE injection was performed in cases with no evident posterior vitreous detachment (PVD) after the initial treatment. Sixty-three eyes were included in the present review. A complete PVD appeared in 38% of cases (24 eyes) after one injection of plasmin and the total increased to 51% (32 eyes) after the second injection, separated at least by one month. The central macular thickness improved in all cases (100%) and BCVA in 89%. Finally, in 50% of eyes with proliferative diabetic retinopathy, a high reduction of new vessels regression was observed. Enzymatic vitrectomy could be considered a good therapeutic alternative in diabetic retinopathy and macular edema.

The significance of early treatment of exudative age-related macular degeneration: 12 months’ results

To assess whether the period between initial symptoms and therapy with ranibizumab in patients with choroidal neovascularization (CNV) influences visual outcome after a follow-up of 12 months. Fifty patients with CNV were retrospectively split into three groups depending on the duration of visual symptoms: group I: < 1 month, group II: 1-6 months, and group III: > 6 months. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were recorded at baseline, 2, 6, and 12 months. Patients received two initial intravitreal injections of 0.5 mg ranibizumab at baseline and reinjections as needed. The mean time span between initial symptoms and treatment was 66 ± 63 days. A longer duration of visual symptoms was significantly correlated with a lower BCVA at baseline, but also after 6 and 12 months. Shorter duration of visual symptoms prior to treatment is associated with a better visual outcome.

Different dosages of intravitreal triamcinolone acetonide injections for macular edema secondary to central retinal vein occlusion.

To study the effect of intravitreal injections of triamcinolone acetonide (TA) for the treatment of macular edema secondary to central retinal vein occlusion (CRVO) in a sample of Chinese patients from Shaanxi province. The 50 eyes from 50 patients were separated into three TA treatment groups: 17 patients were given 4mg /0.1ml, 19 patients were given 8mg /0.2ml, and 14 patients were given 16mg /0.4ml. Patients were followed up for 12 months. Foveal thickness, intraocular pressure (IOP), and best-corrected visual acuity (BCVA) were measured. Macular edema responded well both anatomically and functionally to the TA injections. After the initial intravitreal injection, macular edema recurred at 2-4 months in the low-dose group (4 mg), at 3-5 months in the medium-dose group (8 mg), and at 6-9 months in the high-dose group (16 mg). No significant difference in BCVA or in foveal thickness were observed between the first intravitreal injection and the re-injection. There was no increase in IOP after re-injection of 16mg TA, if the patient did not have an elevated IOP after the initial intravitreal injection of 4/8 mg TA. A low dosage of TA(4 mg) administered via intravitreal injection might be useful as an initial treatment for macular edema secondary to CRVO. A higher dosage of TA (16mg) can be used if there is no IOP elevation with the initial TA injection.

Pharmacogenetic Influence of LOC387715/HTRA1 on the Efficacy of Bevacizumab Treatment for Age-Related Macular Degeneration in a Korean Population

PurposeThe purpose of this study was to determine the pharmacogenetic effects of complement factor H (CFH) Y402H, LOC387715 and high-temperature requirement factor A1 (HTRA1) genotypes on the treatment of exudative age-related macular degeneration (AMD) by intravitreal bevacizumab injection in a Korean population.MethodsSeventy-five patients diagnosed with exudative AMD were treated with intravitreal bevacizumab (2.5 mg) monotherapy. All patients received three initial intravitreal bevacizumab injections every four weeks and were then treated "as needed" based on clinical findings, optical coherence tomography and fluorescein angiography during the 12 month follow-up period after the third injection.ResultsThe difference in visual acuity improvement among the three genotypes of LOC387715 were statistically significant at six months post-treatment (logarithm of the minimum angle of resolution; TT, 0.346; GT, 0.264; GG, 0.188; p = 0.037). Among the LOC387715 genotypes, the number of additional injections was lower in patients who had the risk T allele (GG, 2.143; GT, 2.000; TT, 1.575; p = 0.064). There was no significant difference between visual acuity and central macular thickness change in the CFH Y402H polymorphism group during the 12 month follow-up period. However, the TC group of CFH Y402H required more additional bevacizumab injections than the TT group (TT, 1.517; TC, 3.363; p = 0.020).ConclusionsThis study demonstrated that different LOC387715/HTRA1 genotypes resulted in different bevacizumab treatment responses on exudative AMD. Patients with the risk allele had an improved treatment response and less need for additional injections. However, patients with the CFH Y402H risk allele needed more additional injections of bevacizumab in order to improve visual acuity. This study illustrates how pharmacogenetic factors may help determine treatment modality and dosing. This could ultimately provide basic data for 'personalized medicine' in AMD.

Intravitreal Ranibizumab for Macular Edema Secondary to Retinal Vein Occlusion

Background/Aims: To investigate the effects of intravitreal ranibizumab treatment for macular edema (ME) secondary to retinal vein occlusion (RVO) and the relationship between spectral-domain optical coherence tomography (SD-OCT) findings and visual outcome after successful resolution of ME. Methods: Forty consecutive eyes with ME secondary to branch RVO (BRVO; 29 eyes of 29 patients) or central RVO (CRVO; 11 eyes of 11 patients) were included in a prospective study and treated with 3 initial intravitreal injections of 0.5 mg ranibizumab at monthly intervals. Retreatment was based on visual acuity changes and OCT findings. Patients with complete resolution of ME were classified into two groups according to final best-corrected visual acuity (BCVA) of better than 0.30 logMAR (group 1) or poorer than 0.30 logMAR (group 2), and SD-OCT findings were analyzed at baseline and at 12 months. Results: In patients with BRVO, mean BCVA at 12 months (0.19 ± 0.18) was significantly better than that at baseline (0.76 ± 0.37; p = 0.000). The mean number of injections was 4.4 ± 1.2. In patients with CRVO, the mean BCVA at 12 months (0.39 ± 0.23) was slightly improved from that at baseline (0.84 ± 0.68), but the difference was not significant (p = 0.063). Patients with CRVO received a mean number of 6.1 ± 1.4 injections of ranibizumab. Baseline SD-OCT more frequently detected the foveal inner/outer segment (IS/OS) line and external limiting membrane (ELM) in group 1 (p = 0.003) than in group 2 (p = 0.012). Preservation of the foveal IS/OS line (odds ratio = 5.400; p = 0.036) and ELM (odds ratio = 7.312; p = 0.016) at baseline correlated with good final visual outcome. Conclusion: Intravitreal ranibizumab injections effectively treat ME secondary to RVO. Good visual outcome was associated with preservation of the foveal IS/OS line and ELM at baseline.

Functional and Anatomic Response of the Retina and the Choroid to Intravitreal Bevacizumab for Macular Edema

This study evaluated the rate of change of best corrected visual acuity (BCVA), central retinal sensitivity, and retinal and choroidal thickness in patients with macular edema after intravitreal bevacizumab. This was a prospective, nonrandomized, interventional study. Thirty-four consecutive eyes (34 patients) with macular edema were included in the study. Choroidal neovascularization was present in 21 cases, stage 1 retinal angiomatous proliferation in 6 cases, branch retinal vein occlusion in 4 cases, and diabetic edema in 3 cases. Evaluation of BCVA (Early Treatment Diabetic Retinopathy Study [ETDRS] logarithm of the minimum angle of resolution [LogMAR]), central retinochoroidal thickness (RCT) at standardized A-scan, combined optical coherence tomography/microperimetric assessment of central retinal thickness (RT), central scotoma, and fixation behavior was performed during 12 months after treatment. Choroidal thickness was considered as the difference between RCT and RT. All patients received two initial intravitreal bevacizumab injections (1.25 mg/0.05 mL) at a 1-month interval. BCVA and RT during follow-up were significantly better than at baseline. BCVA was improved of 0.32±0.3 LogMAR (P<0.001) at month 1, 0.18±0.4 LogMAR (P=0.05) at month 6, and 0.14±0.2 (P=0.09) at month 12. RT was reduced by 172.9±192.8 μm (P<0.001) at month 1, 157.7±134.2 μm (P=0.003) at month 6, and 164.3±122.3 (P=0.002) at month 12. Mean retinal sensitivity significantly increased during the first month; it decreased afterward, but an improvement if compared with baseline was present at each visit during follow-up. In 23.5% of cases, a choroidal thinning was present during follow-up, and in this group visual acuity at baseline and final visual improvement were significantly greater if compared with patients showing a choroidal thickening. Intravitreal bevacizumab for macular edema determines significant functional and anatomic improvement at the 12-month follow-up. Visual acuity at baseline and following treatment could be influenced by the choroidal involvement.

Intravitreal Bevacizumab for Treatment of Macular Edema Secondary to Central Retinal Vein Occlusion: Eighteen-Month Results of a Prospective Trial

The purpose of this article was to evaluate the efficacy and safety of intravitreal bevacizumab (Avastin) in eyes with macular edema secondary to central retinal vein occlusion (CRVO). Forty-five consecutive eyes with macular edema secondary to CRVO were included in a prospective clinical trial. Eyes were treated with 3 initial intravitreal bevacizumab injections of 1.25 mg at monthly intervals. Retreatment was based on central retinal thickness (CRT) measured by optical coherence tomography (OCT). OCT was performed monthly; fluorescein angiography was performed every 3 months. Main outcome parameters were visual acuity (VA, using the Early Treatment of Diabetic Retinopathy Study protocol) and CRT in an 18-month follow-up period. After 18 months of follow-up, mean VA increased from 40.9 letters at baseline to 61.9 letters (+21 letters; P<0.001) at month 18; CRT decreased from 572.3 μm at baseline to 273.2 μm at month 18 (-299.1 μm; P<0.001). Neither age, duration of CRVO, baseline VA, nor baseline CRT was correlated with the change in VA. No drug-related systemic or ocular side effects were observed following intravitreal bevacizumab treatment. Intravitreal bevacizumab is generally well tolerated and may improve VA and decrease CRT in patients with macular edema secondary to CRVO over a period of 18 months.

Intravitreal Bevacizumab and Cytokine Levels in Major and Macular Branch Retinal Vein Occlusion

Purpose: My aim was to evaluate the effect of intravitreal bevacizumab and to determine the concentrations of inflammatory cytokines in patients with macular edema due to branch retinal vein occlusion (BRVO), according to the site of the occlusion. Methods: In a prospective interventional case series, 46 eyes of patients with macular edema due to major (n = 30) or macular BRVO (n = 16) were included. The patients were treated primarily with intravitreal bevacizumab (1.25 mg/0.05 ml) and completed 12 months of follow-up. Reinjections were performed if optical coherence tomography showed persistent or recurrent macular edema. Aqueous humor samples were collected at the time of initial intravitreal injection. Multiplex bead assays were used for the measurement of cytokines. Results: The visual acuity and central macular thickness were improved significantly in patients with major and macular BRVO at 12 months. During 12 months, the eyes with major BRVO received a mean of 3.8 intravitreal injections, whereas those with macular BRVO received a mean of 1.9 intravitreal injections (p = 0.009). Significantly increased concentrations of IL-6, IL-8 and MCP-1 were observed in the aqueous humor of BRVO patients compared with control samples. Higher concentrations of IL-6, VEGF, PDGF-AA and MCP-1 were measured in the aqueous humor of patients with major BRVO compared with macular BRVO at baseline (p < 0.05). Conclusion: Intravitreal bevacizumab was similarly effective for improving macular edema in patients with major and macular BRVO. However, macular BRVO required fewer injections and had lower cytokine levels in the aqueous humor than major BRVO.

The efficacy of intravitreal bevacizumab for idiopathic central serous chorioretinopathy

To evaluate the efficacy of intravitreal bevacizumab injection in the treatment of central serous chorioretinopathy (CSC). In a prospective interventional case series, 40 eyes of 40 patients with idiopathic CSC at least 3months in duration were included. Patients were treated with once or twice intravitreal bevacizumab injections initially and completed at least 12months follow-up. Main outcomes measures were the resolution of neurosensory detachment, best-corrected visual acuity, and findings on fluorescein and indocyanine green angiography. Thirty-three of 40 eyes (82.5%) showed complete absence of subretinal fluid at the macula within 3months following initial intravitreal bevacizumab injection. Eyes exhibiting resolution of subretinal fluid revealed improvement in fluorescein and indocyanine green angiographic findings. The rate of intense hyperfluorescence on indocyanine green angiography was higher in eyes exhibiting resolution of subretinal fluid than eyes exhibiting incomplete absorption of subretinal fluid after intravitreal bevacizumab (72.7 and 28.5%, respectively, p = 0.039). Intravitreal bevacizumab injections generally resulted in anatomic improvement for CSC and may constitute a therapeutic option in CSC. The effect after intravitreal bevacizumab injection for CSC might be related to the hyperfluorescence on indocyanine green angiography.

Results of bevacizumab as the primary treatment for retinal vein occlusions

BackgroundThe purpose of this study is to evaluate the efficacy of intravitreal bevacizumab as the primary treatment of macular oedema due to retinal vein occlusions.MethodsPatients diagnosed as having central retinal...

A protocol for the retina surgeon&amp;rsquo;s safe initial intravitreal injections

PurposeTo determine the safety of a surgeon’s initial consecutive intravitreal injections using a specific protocol and to review the complications that may be attributed to the injection procedure.DesignA retrospective chart review.ParticipantsFifty-nine patients (30 females, 29 males) received intravitreal injections of pegaptanib, bevacizumab, or ranibizumab as part of their treatment for neovascular age-related macular degeneration. The average patient age was 80 years. Twenty-two patients were diagnosed with or suspected of having glaucoma. Each patient received an average of 5.8 injections.MethodsThe charts of 59 patients who received a total of 345 intravitreal injections (104 pegaptanib, 74 bevacizumab, 167 ranibizumab) were reviewed. All injections were performed in an office-based setting. Povidone–iodine, topical antibiotics, and eye speculum were used as part of the pre injection procedure. Vision and intraocular pressure were evaluated immediately following each injection.Main outcome measuresIncidence of post injection complications, including but not limited to endophthalmitis, retinal detachment, traumatic cataract, and vitreous hemorrhage.ResultsThere were no cases of endophthalmitis, toxic reactions, traumatic cataracts, retinal detachment, or vitreous hemorrhage. There was one case each of lid swelling, transient floaters, retinal pigment epithelial tear, corneal edema, and corneal abrasion. There were five cases of transient no light perception following pegaptanib injections.ConclusionThe incidence of serious complications was very low for the intravitreal injections given. A surgeon’s initial intravitreal injections may be performed with a very high degree of safety using this protocol.

Morphological and functional analysis of the loading regimen with intravitreal ranibizumab in neovascular age-related macular degeneration

AimTo quantify and correlate the morphological and functional effects of the recommended loading regimen with intravitreal ranibizumab in neovascular age-related macular degeneration (AMD).MethodsIn a prospective, interventional clinical trial, 29 consecutive...