Intravitreal Injection Of Lucentis Research Articles

Клиническая эффективность лечения диабетического макулярного отека в авитричных глазах путем применения анти-VEGF терапии

Purpose. To analyze clinical efficacy of anti-VEGF therapy for diabetic macular edema (DME) in eyes with vitreous loss. Material and methods. 34 patients (38 eyes) with vitreous loss and DME were examined: on the background of pre-proliferative diabetic retinopathy (PPDR) (18 eyes) and proliferative diabetic retinopathy (PDR) (20 eyes) (the main group). The comparison group consisted of 40 patients (40 eyes) with native vitreous body and DME on the background of PPDR (20 eyes) and PDR (20 eyes). Intravitreal injection of Lucentis 0.5 mg (IVIL) was carried out according to scheme «three monthly injections», then — to scheme «on demand». Results. Complete regression of DME in eyes with vitreous loss occurred in 74 % of cases; in eyes with native vitreous body — in 75 %. The duration of postoperative reaction in eyes with vitreous loss was up to 10–14 days, compared with 1–3 days in eyes with native vitreous body. The results of the study revealed, that number of IVIL was significantly less in patients with DME on the background of PPDR, than with PDR. Conclusions. The presence of local neuroepithelial detachment on the background of diffuse DME is prognostically favorable factor for anti-VEGF therapy. The effectiveness of IVIL in treatment of DME is comparable in eyes with native vitreous body and vitreous loss. Keywords: diabetes mellitus, diabetic macular edema, pre-proliferative diabetic retinopathy, proliferative diabetic retinopathy, vitreous loss, Lucentis intravitreal injection

Central Retinal Vein Occlusion after COVID-19 Infection.

Central retinal vein occlusions are not well-known complications of SARS-CoV-2 infection. We describe a case of central retinal vein occlusion secondary to COVID-19, and a review of the literature was performed. A 47-year-old woman with no underlying ocular or medical condition presented to the hospital complaining about sudden onset of multiple scotomas in her left eye. A COVID-19 infection was confirmed 2 days previously by a PCR test that was performed 2 days after the onset of symptoms. Medical history revealed no risk factors and no oral contraception. Her best-corrected visual acuity was 1.0 in the right eye and 0.04 in the left eye. Clinical exam showed a left relative afferent pupillary defect and a nasally localized papilledema on fundoscopy of the left eye. Multiple dot and blot hemorrhages were also present. Optical coherence tomography revealed cystoid macular edema and paracentral acute middle maculopathy. The results of the fluoresceine angiography were consistent with central retinal vein occlusion. Laboratory workup later revealed an elevated fibrinogen level, corresponding to the COVID-19-induced hypercoagulable state. No other prothrombotic conditions were found. The patient immediately received an intravitreal injection of Lucentis (ranibizumab) after diagnosis. Complete resolution of the retinal hemorrhages and papilledema was observed 1.5 months after treatment and the final visual acuity was 1.25 in the left eye. Coagulation abnormalities are frequently observed in infectious diseases such as COVID-19 infection and the resulting prothrombotic state can sometimes lead to retinal vascular complications, including central retinal vein occlusion, irrespective of the presence of other classical risk factors. The consideration of this information could help clinicians establish a prompt diagnosis and therefore appropriate treatment, which could hopefully lead to complete healing of retinal lesions.

EXPERIENCE OF LUCENTIS APPLICATION IN TREATMENT OF NEOVASCULAR GLAUCOMA AGAINST THE BACKGROUND OF PROLIFERATIVE DIABETIC RETINOPATHY

The study involved 23 patients (23 eyes) with neovascular glaucoma against the background of proliferative diabetic retinopathy. The first stage was the intravitreal injection of Lucentis, then with IOP > 25 mm Hg - transscleral cyclophotocoagulation and after 2 weeks panretinal laser coagulation in ischemic zones; with IOP < 25 mm Hg - panretinal laser coagulation in ischemic zones. At all observation periods there was a statistically significant decrease in IOP and in rubeosis. One week after the last stage of treatment the overall decrease in IOP was 33.4 % of the initial values, rubeosis was not detected. The application of Lucentis in combination with transscleral cyclophotocoagulation in the treatment of neovascular glaucoma against the background of proliferative diabetic retinopathy allows to achieve stable IOP normalization, preserving residual visual functions and reducing the risk of hemorrhagic complications.

Efficacy of intravitreal Lucentis injection on major and macular branch retinal vein occlusion

BackgroundThe objective of our study was to assess the efficacy of intravitreal Lucentis injection on major and macular branch retinal vein occlusion (BRVO).MethodsIn this retrospective analysis, 43 patients (major BRVO n = 24; macular BRVO, n = 19) were treated with intravitreal injection of Lucentis with a 1 + PRN regimen, which is diagnosed by fluorescein fundus angiography (FFA). “1 + PRN”, namely, one intravitreal injection of Lucentis at the baseline, and then continue or stop according to the condition of the patient. The following observation indexes were measured at baseline and follow-up (1–6 months): best corrected visual acuity (BCVA), foveal thickness (CFT), total retinal volume with macular diameter of 6 mm. During the follow-up, repeated injections were given according to patients’ demand, and the number of injections was recorded.ResultThe observation indexes of patients with BRVO were significantly improved after 6 months of Lucentis treatment in both major and macular groups, including BCVA, CFT and the retinal volume of the 6 mm-diameter macula. Interestingly, there were significant differences in the therapeutic effect between the two groups, and the macular group had better therapeutic effect than the major group with the less number of repeated injections.ConclusionsTo sum up, intravitreal injection of Lucentis was effective for both major and macular BRVO, and the efficacy in macular subtype group was better than that in major subtype group with the more obviously improvement and the less number of injections.

Efficacy of different methods of treatment for macular edema secondary to branch retinal vein occlusion

Objective To compare the efficacy of different treatments for macular edema secondary to branch retinal vein occlusion. Methods The data of 64 eyes of 64 cases of macular edema secondary to branch retinal vein occlusion from Jun. 2015 to Feb. 2017 were analyzed prospectively. Group A, 32 eyes of 32 patients, received intravitreal injection of Triamcinolone acetonide and retinal photocoagulation. Group B, 32 eyes of 32 patients, underwent intravitreal Lucentis injection and retinal photocoagulation. The follow-up time was 6 months. The visual acuity, central macular retinal thickness (CMT), the recurrence and complications were compared between the two groups. Results The BCVA (LogMAR) of group A and group B were (0.72±0.19) and (0.74±0.23) before surgery. The difference in BCVA before operation was not significant between the two groups (P>0.05). Six months after operation, BCVA of group A and group B were (0.53±0.27) and (0.36±0.26). The BCVA of two groups were improved after operation (P=0.002, 0.000). BCVA of group B was better than that of group A (P=0.013). The difference in CMT was not significant between the two groups (P>0.05). The recurrence rate of group A was 25.0% after operation, which was higher than that of group B (3.1%) (P=0.031). No obvious adverse reaction during treatment occurred. Conclusion Intravitreal injection of Ranibizumab combined with retinal photocoagulation for the treatment of macular edema secondary to branch retinal vein occlusion is effective. Key words: Edema, macular; Occlusion, retinal vein, branch; Ranibizumab, intravitreal injection; Photocoagulation, retinal; Visual acuity

Multifocal electroretinography for therapeutic effect evaluation of intravitreal injection Lucentis for wet age-related macular degeneration

To evaluate the changes in retinal functions using multifocal electroretinography (mfERG) following intravitreal injection of Lucentis for treatment of wet age-related macular degeneration. This prospective study was conducted in 14 patients (9 men and 5 women, 14 eyes) with wet age-related macular degeneration receiving treatment with intravitreal injections of ranibizumab (Lucentis) in our hospital between October, 2014 and January, 2016. All the patients received the treatment following a 1+PRN protocol and after the initial injection, the patients were followed up monthly for 6 months to decide if additional injections were needed. The corrected visual acuity and mfERG findings of the patients were assessed before and at l, 3 and 6 months after the initial injection. At the last follow-up, the patients received injections for a mean of 2.86∓1.58 times. The best corrected visual acuity (BCVA) at 1 month after the initial treatment was not significantly different from that before treatment (P=0.07), but showed significant improvements at 3 and 6 months (P<0.05). In mfERG, the implicit time of the 6 rings showed no significant decrease after the treatment, but the amplitude density of P1 and N1 in rings 1 and 2 improved significantly at 1, 3, and 6 months after the initial injection (P<0.05). Multifocal electroretinography can serve as a useful modality for evaluating visual function changes in patients receiving intravitreal injection of Lucentis for wet age-related macular degeneration.

ОПЫТ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ПРОЛИФЕРАТИВНОЙ ДИАБЕТИЧЕСКОЙ РЕТИНОПАТИИ

The study included 48vitreoretinal surgeries performed during 2014-2015 in 39patients with advanced fibrovascular stage of proliferative diabetic retinopathy. Visual acuity before the surgery averaged from pr. l. certae to 0.01. In 7cases patients underwent intravitreal injection of Lucentis 2–3weeks before the surgery. The surgery was performed according to the standard 3-port 25G vitrectomy. In some cases, short-term tamponade of vitreous cavity by fluid perfluororganic compounds (PFOS) was performed for 2–3days. This was due to prolonged bleeding during the surgery. In these cases, fibrinolytic of direct action (hemasa) was injected directly to the blood clot. In 4 cases circular retinotomy was needed. In 35cases tamponade was made by silicone oil 5700cSt, in 13 – by air-gas mixture. In cases of air-gas tamponade 3 patients had a relapse. After vitreous cavity revision it was plugged with silicone oil 5700cSt. In 17cases visual function remained unchanged, in 18 cases the changes were imperceptible, in 9cases visual acuity improved to 0.2, in 3cases – visual function increased to 0.4 and in 1patient – to 0.7. In postoperative period IOP increased in 7 cases. In 5 of these cases compensation was achieved with antihypertensive drugs. In one case the patient was implanted leukosapphire drainage, and in one more case transscleral cyclophotocoagulation about terminal aching glaucoma was performed. The silicone oil was removed in 6patients at the period of 6 months up to 2years.

睫状体冷凝联合小梁切除术治疗新生血管性青光眼25例疗效观察

目的：探索睫状体冷凝术联合小梁切除术治疗新生血管性青光眼的疗效。方法：选择2012.1~2014.12于昆明医科大学第一附属医院眼科住院治疗的新生血管性青光眼患者，共25例(25眼)，先进行全视网膜激光光凝，所有患者均给予经睫状体平坦部玻璃体腔注射Lucentis 0.1 ml (1.0 mg)。注药3天后，行睫状体冷凝术联合小梁切除术，观察手术前至术后1 w、1 m、3 m、6 m，分别记录两组的病人自觉症状、眼压、视力、并发症情况。结果：术后所有患者的眼部胀痛消失，术后1 w、1 m、3 m、6 m平均眼压较术前明显降低，分别降低22.64 mmHg，23.6 mmHg，24.2 mmHg，26.16 mmHg。差异有统计学意义(P < 0.001)。1例术后低眼压，1例浅前房，8例前房积血，3例眼球萎缩，2例行眼内容物剜出。结论：睫状体冷凝术联合小梁切除术对于治疗新生血管性青光眼有显著效果。 Objective: To observe the results of cyclocryotherapy combined with trabeculectomy to neovascular glaucoma. Methods: 25 eyes in 25 cases with neovascular glaucoma in the First Affiliated Hospital of Kunming Medical University from Jan. 2012 to Dec. 2014 were analyzed retrospectively. Pan-retina photocoagulations were executed firstly. All patients were treated with intravitreal injection of Lucentis 0.1 ml (1.0 mg) pars plana at first. 3 days latter, 25 eyes were treated by cyclocryostherapy combined with trabeculectomy. Pre- and post-operative (1 week, 1 month, 3 months, 6 months) swelling pain of eye, intraocular pressures (I0P), visual acuity and complications were observed. Results: All the swelling pain of the eye disappeared. The average IOP reduced greatly. The IOP decreased 22.64 mmHg, 23.6 mmHg, 24.2 mmHg, 26.16 mmHg in 1 week, 1 month, 3 months and 6 months in post-operation, respectively. The difference was statistically significant (P < 0.001). After operations, intraocular hypotension in 1 case, shallow anterior chamber in 1 case, anterior chamber hemorrhage in 8 cases, and eyeball atrophy in 3 cases were observed, respectively. 2 eyes were enucleated lastly. Conclusions: Cyclocryotherapy combined with trabeculectomy should be a good method for controlling neovascular glaucoma.

Combination surgery for wet age-related macular degeneration and chronic peripheral uveitis

To develop a combination surgery for wet age-related macular degeneration and concurrent chronic peripheral uveitis that would include intravitreal injection of Lucentis and cryocerclage of the peripheral retina. A total of 75 patients were examined and divided into 2 groups: the main group (37 patients) and the controls (38 patients). Patients from the main group underwent the new combination surgery, while the controls received intravitreal Lucentis alone (peripheral uveitis was managed therapeutically). It has been found that the new combination method provides a significant and stable improvement in visual acuity (by a factor of 10) and a decrease in the area of central scotoma (by a factor of 2.95) in the postoperative period. The period needed for recovery in the central retinal thickness is also 1.6 times shorter. The new combination surgery for wet age-related macular degeneration and concurrent chronic peripheral uveitis provides rapid reduction of inflammation in the extreme periphery of the fundus and a 1.5 times faster (as compared to traditional methods) primary restoration of topographic anatomy of the retina in the macular region.

Clinical characteristics and combined treatment for choroidal neovascularization secondary to angioid streaks

Objective To investigate the clinical characteristics and evaluate photodynamic therapy treatment combined with intravitreal injection of Lucentis for choroidal neovascularization secondary to angioid streaks. Methods This was an interventional retrospective analysis of 21 patients (42 eyes). For clinical data, best corrected visual acuity (BCVA), fundus appearance, fundus fluorescence angiography (FFA) , indocyanine green angiography (ICGA) and optical coherence tomography (OCT) were assessed. Twenty-two eyes of 18 patients with macular choroidal neovascularizaiton (CNV) were treated first with photodynamic therapy (PDT) and then with an intravitreal injection of Lucentis. The patients were followed up for at least 12 months. Another injection was given if one of the following appeared: decreased visual acuity, new macular lesions, subretinal or intraretinal fluid, or CNV leakage. Data were analyzed using an independent-samples t test or a paired-samplest test. Results Both eyes of all 21 patients were involved. Only 5 patients (24%) had complications with hologathy. Males were more affected (76%). Of all the patients, 18 cases (86%) were diagnosed with CNV secondary to AS. BCVA was much worse in eyes with CNV. At the final follow-up after the combination treatment, BCVA had improved 10.4 characters. OCT showed macular retinal thickness decreased from 338.4±55.2 μm at baseline to 212.6±36.2 μm. FFA (ICGA) showed CNV leakage in 15 eyes (68%) had disappeared completely, and 5 eyes had scar staining. All patients received 1 treatment of PDT and a mean 3.2 intravitreal injections. Macular subretinal hemorrhage presented in 1 patient after PDT, but was absorbed completely after intravitreal injection. Five patients presented with transient elevated intraocular pressure and 4 patients had subconjunctival hemorrhage but all recovered quickly. No other ocular or adverse reactions occurred. Conclusion Angioid streaks present a special fundus appearance, and FFA(ICGA) is valuable in the diagnosis. A considerable proportion of patients are affected with CNV secondary to AS. PDT treatment combined with intravitreal injection of Lucentis is effective in preventing disease progression, improving visual acuity, and reducing CNV leakage. Adverse reactions are mild. Key words: Angioid streaks; Choroidal neovascularization; Fluorescein angiography; Photochemo therapy; Vascular endothelial growth factor A

Use of Optical Coherence Tomography for Evaluation of the Results of the Treatment of Diabetic Macular Edema with Laser Coagulation of the Ocular Fundus Tissues and Intravitreal Injection of Ranibizumab (Lucentis)

DOI 10.17691/stm2015.7.1.10 Received December 2, 2014Yu.S. Batischeva, Postgraduate Student, Assistant, Department of Eye Diseases; I.О. Kolbenev, PhD, Assistant, Department of Eye Diseases; N.R. Nugaeva, MD, PhD, Ophthalmologist, Clinic of Eye Diseases;А.F. tsypyashuk, PhD, Chief Physician, Clinic of Eye Diseases; Т.G. Kamenskikh, D.Med.Sc., Head of the Department of Eye DiseasesV.I. Razumovsky Saratov State Medical University, 12 Bolshaya Kazachia St., Saratov, 410012, Russian FederationOne of the most informative methods of noninvasive investigation of the retina is optical coherence tomography (OCT). OCT is successfully applied to the diagnosis of diabetic retinopathy especially if there is diabetic macular edema (DME).the objective of the investigation is evaluating the results of the treatment of DME with laser coagulation of the ocular fundus tissues and intravitreal injection of ranibizumab (Lucentis), on the basis of imaging data derived from OCT.Materials and Methods. Examination, treatment and dynamic observations were carried out on 108 patients (214 eyes at the stage of proliferative diabetic retinopathy with clinically relevant DME); they included 68 women and 40 men. The patients were divided into three groups depending on the overall term of DME occurrence: group I — up to 1 month (73 eyes), group II — from 1 to 3 months (69 eyes), group III — 3 months or longer (72 eyes). Within each group, all the patients were divided into three subgroups which underwent either intravitreal injection of ranibizumab, or laser coagulation of the eye fundus tissues, or both treatments combined. The effectiveness of the treatment was evaluated on the basis of OCT and visometry data recorded at both 5 days and 1 month.Results. According to OCT of retina, the effect of the intravitreal injection of Lucentis alone was considerable but unstable. In the case of DME having been present for less than 1 month, the combined treatment was the most effective. In cases where DME had been present for 1 to 3 months or for more than 3 months, both laser-only and the combined treatment are effective.conclusion. We have therefore shown that choice of optimum treatment is dependent on the previous duration of DME and that OCT is a highly informative method for evaluation of DME.Key words: diabetic macular edema; optical coherence tomography; laser coagulation of eye fundus tissues; ranibizumab.corresponding author: Kamenskikh Tatyana Grigoryevna, e-mail: kamtanvan@mail.ru

Intravitreal injection of Lucentis combined with trabeculectomy for neovascular glaucoma

Objective To investigate the clinical efficacy of intravitreal injection of Lucentis combined with panretinal photocoagulation and trabeculectomy for neovascular glaucoma (NVG). Methods Thirty-seven eyes of 37 NVG patients who received treatment in our hospital were randomly divided into 2 groups. Nineteen patients were treated with intravitreal injection of Lucentis 0.5 mg, combined with panretinal photocoagulation and complex trabeculectomy in group A. Eighteen patients were treated with panretinal photocoagulation combined with transscleral cyclophotocoagulation in group B. Changes of visual acuity, intraocular pressure (IOP), iris neovascular vessels and complications were observed before and after operation in both groups. Results Two to three days after intravitreal injection of Lucentis, iris neovascular vessels disappeared in all patients of group A. Panretinal photocoagulation was completed within 1 month. IOP of 19 eyes were higher than 30 mmHg one month after injection. After complex trabeculectomy, IOP was (11.35±3.28)mmHg (1 mmHg=0.133 kPa) in one week. The IOP were (12.37±5.13)mmHg, (14.45±5.38)mmHg and (16.27±4.28)mmHg respectively in 1, 3 and 6 months. The 18 patients in group B taken transscleral cyclophotocoagulation after panretinal photocoagulation. The IOP were (13.35±3.27)mmHg, (20.48±4.25)mmHg, (24.45±6.27)mmHg and(26.27±7.28)mmHg respectively 1 week, 1 month, 3 months and 6 months after operation. There was statistically significant difference in IOP between the two groups (P<0.05). Neovascular vessels were found on the iris in 2 eyes of group A and in 8 eyes of group B, and there was statistically significant difference between the two groups (P<0.05). Conclusion Intravitreal injection of Lucentis combined with panretinal photocoagulation and trabeculectomy is effective for NVG. Key words: Glaucoma, neovascular; Lucentis; Trabeculectomy, complex; Photocoagulation, panretinal; Cyclophotocoagulation, transscleral

Living with age-related macular degeneration treatment: Patient experiences of being treated with ranibizumab (Lucentis)(R) intravitreal injections

This study reports the results of a qualitative study of patient experiences of receiving treatment for wet age-related macular degeneration with ranibizumab (Lucentis)(R). Treatment involved monthly hospital visits for assessment and, where required, an intravitreal Lucentis injection. Qualitative narrative interviews were conducted with 22 patients, 18 of whom received treatment and were interviewed at two points during their treatment journey. Interviews allowed participants to reflect on their experiences of being assessed for and receiving this treatment. Overall, treated participants reported that while they had been apprehensive about treatment, the actual experience of it was far less unpleasant than they had expected. However, the data also revealed a number of issues surrounding the provision of information about treatment, as well as service delivery issues, which had considerable impact upon their experience.

Exsudative AMD: Regressionsanalyse von transpupillarer Thermotherapie mit und ohne intravitrealer Injektion von Triamcinolon sowie Bevacizumab und Ranibizumab

The aim of this study was to evaluate therapies for exsudative age-related macular degeneration (AMD) in a regression analysis. Transpupillary thermotherapy (TTT) with and without intravitreal injection (IVI) of triamcinolone, IVI of bevacizumab, and ranibizumab was investigated. 413 patients with an at least 6-month control were included in this retrospective single-centre study. 209 patients were treated with TTT, 36 received TTT with IVI of triamcinolone, and 70 avastin. All subjects underwent a full ophthalmological examination including fluorescein angiography (FA) at baseline and after 1, 3 and every 6 months. All patients were re-treated immediately after FA if necessary using the same method with ophthalmological controls starting again one month after therapy. 98 patients were treated with IVI of Lucentis. Lucentis patients received an upload with three injections and entered the examination protocol thereafter. Taking into account the natural course of exsudative AMD, therapies started at an advanced stage of the disease. Main outcome measures were best corrected visual acuity (log MAR), mean defect (MD), and pattern standard deviation (PSD) in a 10° visual field threshold test. The time-dependent course was estimated by linear regression analysis and tested for significant differences by pairs. A two-tailed α = 0.05 was considered significant. Linear regression analysis demonstrated a moderate loss of visual functions in each therapy. Linear regressions did not show significant differences between the therapies with regard to log MAR, MD, and PSD. Taking into account the natural course of exsudative AMD, the contemporary therapy with ranibizumab is initiated earlier than the previous therapies. Linear regression analysis of an advanced stage of exsudative AMD did not reveal any significant differences between TTT with and without IVI of triamcinolone, IVI of bevacizumab, and ranibizumab in a clinical setting. As therapies are expected to be more efficious in an early stage of disease, a macula screening is recommended.

Effect of Brimonidine/Timolol Fixed Combination on Preventing the Short-Term Intraocular Pressure Increase after Intravitreal Injection of Ranibizumab

The aim of this study was to evaluate the safety and efficacy of brimonidine 0.2 % and timolol 0.5 % instillation as a fixed combination (Combigan, Allergan Inc.) to prevent acute intraocular pressure (IOP) increase occurring after intravitreal injection of ranibizumab (Lucentis, Novartis Pharma AG). A prospective double-blind placebo-controlled study was carried out. One eye of 88 consecutive normotensive age-related macular degeneration patients receiving Lucentis was randomized into placebo drops (artificial tears, 44 patients) or Combigan drops (44 patients) given twice a day the day before and the day of injection. IOP was measured before and 5, 10, 15 minutes and 1 hour after the intravitreal injection. The placebo group had the higher mean IOP at all time points after injection. Maximum IOP increase for both groups occurred at the 5-minutes time point. Mean post-injection IOP in the placebo group was 34.1 +/- 2.7 mmHg at 5 minutes post-injection versus 28.4 +/- 1.1 mmHg in the Combigan group (P < 0.001). IOP decreased to 24.9 +/- 1.8 mmHg (placebo group) and 19.9 +/- 1.1 mmHg (Combigan group) at 10 minutes post-injection. At 15 minutes post-injection, IOP was below 20 mmHg in all eyes of the Combigan group (100 %), whereas at the same time point these IOP levels were reached only by 34 % of the eyes of the placebo group (15 eyes). All eyes of both groups had a normal IOP 1 hour post-injection. No systemic or ocular side effect was recorded in either group. The use of Combigan drops twice a day the day before and the day of injection in eyes scheduled for intravitreal injection of Lucentis is a safe and effective prophylaxis to reduce the acute IOP spikes of the post-injection period.

Inadvertent injection of intravitreal air during intravitreal Lucentis injection for wet age-related macular degeneration: an undescribed complication

Inadvertent injection of intravitreal air during intravitreal Lucentis injection for wet age-related macular degeneration: an undescribed complication