Intravitreal Injection Treatment Research Articles

Intravitreal Injection and Prophylactic Laser Treatment in Pediatric Vitreoretinal Pathologies

Vascular endothelial growth factor (VEGF) is an important mediator of pathological neovascularization and vascular permeability of the eye. The increasing use of intravitreal therapies targeting VEGF has revolutionized the treatment of pediatric vitreoretinal diseases. Laser photocoagulation is the standard treatment method for retinopathy of prematurity. The aim is to ablate the avascular peripheral retina, but ablation of the peripheral retina with traditional laser therapy is destructive, causes complications, and does not prevent all vision loss, especially in cases of retinopathy of prematurity affecting zone 1 of the eye. In Coats disease, retinal telangiectasias are treated early with laser photocoagulation, but with ischemia, high levels of VEGF in the ocular fluid may contribute to increased permeability of telangiectatic blood vessels, leading to lipoprotein leakage and subsequent exudative retinal detachment. Therefore, anti-VEGF has been recommended as adjuvant therapy in the treatment of Coats disease. In this review, intravitreal injection and prophylactic laser treatment applications in Retinopathy of Prematurity and Coats Disease are mentioned.

The Role of Aflibercept (Eylea) Intravitreal Injection in Treatment of Resistant or CNV Complicated CSR (Central Serous Retinopathy)

Purpose to evaluate the benefit and side effects of intravitreal Aflibercept (Eylea) injection in the treatment of cases that are resistant to previous treatment choices or complicated with CNV due to central serous retinopathy [CSR] Methods It is retrospective study on 72 patients with diagnosed to have CSR and follow up for 12-18 months we can consider that there is complete resolution if subretinal fluid disappeare for 3 months from last intravitreal injection of Eylea We planned this research to demonstrate the efficiency of aflibercept intravitreal injection in the treatment of cases that resistant to treatment or complicated with CNV secondary to CSR.

Incidence of intraocular inflammation and its risk factors in patients treated with brolucizumab: a nationwide cohort study

This study aimed to evaluate the incidence of clinically significant intraocular inflammation (csIOI) after treatment with intravitreal injection (IVI) of brolucizumab and identify csIOI risk factors. We categorized 60,966 South Korean patients from a nationwide population-based cohort into 4 groups: groups 1 (Ranibizumab), 2 (Aflibercept), 3 (Brolucizumab), and 4 (switched to brolucizumab). We used the Kaplan–Meier method to estimate the cumulative incidence of csIOI in each group and calculated the hazard ratios (HRs) and 95% confidence intervals (CIs). We constructed a multivariate model using forward selection methods to identify risk factors for csIOI. The cumulative incidence of csIOI within 180 days of the index date in groups 1, 2, 3, and 4 was 0.36% (67/18,537), 0.49% (186/37,951), 3.47% (38/1,095), and 3.69% (125/3,383), respectively. Multivariate analysis revealed a significant increase in csIOI risk in groups 3 (HR 11.08, 95% CI 7.42–16.53, P < 0.001) and 4 (HR 10.40, 95% CI 7.67–14.09, P < 0.001). History of retinal vascular occlusion (HR 1.56, 95% CI 1.01–2.40, P = 0.043) significantly increased csIOI risk after brolucizumab IVI treatment; female sex (HR 0.78, 95% CI 0.64–0.96, p = 0.020) and diabetes (HR 0.72, 95% CI 0.58–0.90, p = 0.004) decreased the risk. csIOI incidence was higher after brolucizumab IVI treatment than after ranibizumab and aflibercept IVI treatment. Retinal vein occlusion history, female sex, and diabetes are associated with csIOI after brolucizumab IVI treatment.

Ranibizumab Port Delivery System in Neovascular Age-Related Macular Degeneration: Where Do We Stand? Overview of Pharmacokinetics, Clinical Results, and Future Directions.

The ranibizumab (RBZ) port delivery system (PDS) is a device designed to continuously deliver RBZ in the vitreous chamber for the treatment of neovascular age-related macular degeneration (nAMD). It is implanted during a surgical procedure and can provide sustained release of the medication for several months. This review, updated to January 2024, focuses on past clinical studies as well as current and forthcoming trials looking into a PDS with RBZ. In the phase 2 LADDER trial, the mean time to first refill of a PDS with RBZ 100 mg/mL was 15.8 months, with the pharmacokinetic (PK) profile showing a sustained concentration of RBZ in the blood and aqueous humor. More recently, a PDS with RBZ (100 mg/mL) refilled every 24 weeks was shown to be non-inferior to a monthly intravitreal injection (IVI) with RBZ (0.5 mg) over 40 and 92 weeks in the phase 3 ARCHWAY trial. The refill every 24 weeks allowed for a RBZ vitreous exposure within the concentration range of monthly intravitreal injections (IVIs), and the expected half-life (106 days) was comparable with the in vitro results. Nonetheless, vitreous hemorrhage and endophthalmitis were more common side effects in PDS patients. In conclusion, a PDS continuously delivering RBZ has a clinical effectiveness level comparable with IVI treatment. However, a greater frequency of unfavorable occurrences highlights the need for procedure optimization for a wider adoption. Ongoing trials and possible future approaches need to be addressed.

Switching to Conbercept in Diabetic Macular Edema After Unsatisfactory Response to Previous Intravitreal Injection of Ranibizumab.

To assess the functional and anatomical effects of transitioning to conbercept intravitreal injection (IVC) treatment in patients with diabetic macular edema (DME) who had inadequate responses to prior anti-vascular endothelial growth factor (anti-VEGF) injections. We retrospectively included eyes with persistent DME after at least 3 injections of intravitreal ranibizumab (IVR). The analysis included the assessment of best corrected visual acuity (BCVA) and central macular thickness (CMT) during 6 months after the switch. A total of 30 patients (30 eyes) were included. CMT dropped sharply from 437.8±40.67μm at baseline to 363.59±45.09,312.52 ± 39.15, 278.51 ± 37.92, and 292.59 ± 38.09 after 1, 2, 3 and 6 months of IVC, respectively (p <0.001). BCVA in log MAR units was significantly improved from 0.73±0.15 at baseline to 0.50±0.09,0.46±0.72, 0.40±0.06 and 0.48±0.04 after 1, 2, 3 and 6 months, respectively (p <0.001). Switching to Conbercept effectively improved visual and anatomical structure in DME patients who had not responded satisfactorily to previous anti-VEGF injections.

Automated evaluation of retinal hyperreflective foci changes in diabetic macular edema patients before and after intravitreal injection.

Fast and automated reconstruction of retinal hyperreflective foci (HRF) is of great importance for many eye-related disease understanding. In this paper, we introduced a new automated framework, driven by recent advances in deep learning to automatically extract 12 three-dimensional parameters from the segmented hyperreflective foci in optical coherence tomography (OCT). Unlike traditional convolutional neural networks, which struggle with long-range feature correlations, we introduce a spatial and channel attention module within the bottleneck layer, integrated into the nnU-Net architecture. Spatial Attention Block aggregates features across spatial locations to capture related features, while Channel Attention Block heightens channel feature contrasts. The proposed model was trained and tested on 162 retinal OCT volumes of patients with diabetic macular edema (DME), yielding robust segmentation outcomes. We further investigate HRF's potential as a biomarker of DME. Results unveil notable discrepancies in the amount and volume of HRF subtypes. In the whole retinal layer (WR), the mean distance from HRF to the retinal pigmented epithelium was significantly reduced after treatment. In WR, the improvement in central macular thickness resulting from intravitreal injection treatment was positively correlated with the mean distance from HRF subtypes to the fovea. Our study demonstrates the applicability of OCT for automated quantification of retinal HRF in DME patients, offering an objective, quantitative approach for clinical and research applications.

Factors affecting optical coherence tomography angiography signal strength index in patients receiving intravitreal injection treatment.

To investigate the clinical factors affecting optical coherence tomography angiography (OCTA) signal strength index (SSI) and its change after intravitreal injection treatment in patients with retinal disorders. OCTA data from 186 eyes of 166 patients with various retinal disorders including age-related macular degeneration, diabetic macular edema (DME), and retinal vein occlusions who received intravitreal injections were analyzed. The associations between SSI and clinical factors, including age, best-corrected visual acuity (BCVA), media opacity severity, and central macular thickness (CMT), were evaluated both before and after injection. After injection, BCVA improved and CMT decreased significantly, and SSI increased significantly (p = 0.030). BCVA showed a significant positive correlation with media opacity severity before and after injection and with CMT only before injection. In the multivariate analysis, age, presence of DME, BCVA, and media opacity severity were negatively associated with SSI both before and after injection, while CMT was negatively associated with SSI only before injection. After injection, a negative correlation was found between SSI change and both BCVA and CMT change. Our findings suggest that OCTA SSI is influenced by various clinical factors, including age, visual acuity, media opacity severity, and macular thickening, especially in cases of DME. The results also indicate that SSI may decrease in patients with macular disorders due to the presence of macular edema and the associated decrease in visual acuity. Therefore, it is crucial to consider these factors when interpreting OCTA data and ensure an adequate level of SSI.

Intravitreal CendR peptides target laser-induced choroidal neovascularization sites in mice

Choroidal neovascularization (CNV) is a common ocular pathology that may be associated in a variety of eye diseases. Although intravitreal injection treatment of anti-vascular endothelial growth factor (anti-VEGF) drugs shows significant clinical benefits in CNV treatment, the limitations of the current therapy need to be addressed. The aim of our study was to investigate the potential utility of three C-end Rule (CendR) peptides (RPARPAR, PL3, iRGD) for CNV targeting and to evaluate the efficacy of peptides for treating experimental CNV in mice. We observed that the CendR peptides localize to the CNV lesion sites after intravitreal injection and were mainly found in the outer nuclear cell layer (ONL) of the mouse retina. Interestingly, experimental therapy with tenascin-C (TNC-C) and neuropilin-1 (NRP-1)-targeting PL3 peptide, reduced angiogenesis and decreased vascular leakage. The results suggest that PL3 and potentially other CendR peptides could serve as affinity targeting ligands and therapeutics for ocular diseases that involve pathological CNV.

Deep learning for automated detection of neovascular leakage on ultra-widefield fluorescein angiography in diabetic retinopathy

Diabetic retinopathy is a leading cause of blindness in working-age adults worldwide. Neovascular leakage on fluorescein angiography indicates progression to the proliferative stage of diabetic retinopathy, which is an important distinction that requires timely ophthalmic intervention with laser or intravitreal injection treatment to reduce the risk of severe, permanent vision loss. In this study, we developed a deep learning algorithm to detect neovascular leakage on ultra-widefield fluorescein angiography images obtained from patients with diabetic retinopathy. The algorithm, an ensemble of three convolutional neural networks, was able to accurately classify neovascular leakage and distinguish this disease marker from other angiographic disease features. With additional real-world validation and testing, our algorithm could facilitate identification of neovascular leakage in the clinical setting, allowing timely intervention to reduce the burden of blinding diabetic eye disease.

Compliance with follow-up in patients with diabetic macular edema: Eye care center vs. diabetes care center.

The study was conducted to compare the compliance to intravitreal injection treatment and follow-up in patients with center-involving diabetic macular edema (CI-DME) and treatment outcomes between a tertiary eye care facility and a tertiary diabetes care center. A retrospective review was conducted on treatment naïve DME patients who had received intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections in 2019. Participants were people with type 2 diabetes who were under regular care at the eye care center or the diabetes care center in Chennai. The outcome measures were noted at months 1, 2, 3, 6, and 12. A review of 136 patients treated for CI-DME (72 from the eye care center and 64 from a diabetes care center) was carried out. The severity of diabetic retinopathy (DR) was similar in both centers. There was no statistically significant (P > 0.05) difference in the choice of initial intravitreal drug in the two centers. At 12-month follow-up, only 29.16% came for a follow-up in the eye center vs. 76.56% in a diabetes care center (P = 0.000). The multivariate logistic regression showed increasing age was associated with non-compliance in both the groups (eye care center: odds ratio [OR] 0.91; 95% confidence interval [CI] 0.82-1.21; P = 0.044) and diabetes care center (OR 1.15; 95% CI 1.02-1.29; P = 0.020). The follow-up rate between eye care and diabetic care center with DME showed a significant disparity. By providing comprehensive diabetes care for all complications under one roof, compliance with follow-up can be improved in people with DME.

The role of serum metrics in anti- VEGF treatment for macular edema induced by retinal vein occlusion

AimTo evaluate association between pretreatment serum metrics and best corrected visual acuity ( BCVA) of patients with macular edema secondary to retinal vein occlusion and its subtypes after intravitreal ranibizumab or conbercept implant.MethodsThis prospective research included 201 patients(201 eyes) who were diagnosed with macular edema secondary to retinal vein occlusion at Heibei Eye Hospital between January 2020 and January 2021, who all received intravitreal anti- vascular endothelial growth factor treatment. Serum metrics were measured before the first treatment, and correlations between BCVA and each of four parameters— platelets, neutrophil- to- lymphocyte ratio(NLR), platelet- to- lymphocyte ratio(PLR) and monocyte- to- lymphocyte ratio(MLR)— were analyzed to identify predictors of effective intravitreal injection treatment outcomes.ResultsThe mean platelets was significantly different in the effective and ineffective group for RVO-ME (273.02 ± 41.49 × 109/L,214.54 ± 44.08 × 109/L P < 0.01),BRVO-ME (269.43 ± 49.52 × 109/L,214.72 ± 40.42 × 109/L P < 0.01), and CRVO-ME (262.32 ± 32.41 × 109/L,209.27 ± 42 0.91 × 109/L P < 0.01). The cutoff value of the platelets was 266.500, the area under the curve was 0.857,and the sensitivity and specificity were 59.8% and 93.6%, respectively. The mean PLR was significantly different in the effective and ineffective group for RVO-ME (154.66 ± 49.60, 122.77± 44.63 P < 0.01),BRVO-ME (152.24 ± 54.99, 124.72 ± 41.46 P = 0.003), and CRVO-ME (152.06±44.23, 118.67 ± 41.80 P = 0.001). The cutoff value of the platelets was 126.734, the area under the curve was 0.699, and the sensitivity and specificity were 70.7% and 63.3%, respectively. There were no statistical differencies between the effective and ineffective group(RVO- ME and its subtypes) in NLR and MLR.ConclusionHigher pretreatment platelets and PLR were associated with BCVA in patients with RVO- ME and its subtypes who were treated with anti- VEGF drugs. The platelets and PLR may be used as predictive and prognostic tools for effective intravitreal injection treatment outcomes.

Development of Knowledge, Attitude and Practice Questionnaire for age-related macular degeneration patients.

To develop and validate a questionnaire to evaluate knowledge, attitude and practice of patients diagnosed with age-related macular degeneration (AMD) who have undergone intravitreal injection treatment. This study was conducted among patients diagnosed with AMD in Kuala Lumpur. The generation of the instrument included four phases which included item and domains development, content, face validity and exploratory factor analysis. Content validity and modified Kappa was used for validation of knowledge domain. Exploratory factor analysis was used for validation of both attitude and practice domains. Face validity was conducted in 12 patients, content validity was ascertained in 120 patients and test-retest reliability was determined in 39 patients with AMD. Content validity index (CVI) and modified kappa showed excellent values for most items in the knowledge domain with CVI for item (I-CVI) values between 0.78-1.0 and Kappa values of >0.74. The Kaiser-Meyer-Olkin (KMO) sampling adequacy showed acceptable scores of 0.70 and 0.75 for both attitude and practice domains respectively and Bartlett's Test of sphericity were significant (χ2 =0.00, P<0.001). Factor analysis resulted in five factors with thirty items for attitude domain and four factors with twenty items for practice domain. The Cronbach's alpha showed acceptable values for all items in knowledge, attitude and practice domain with values >0.70 and good test-retest reliability. The final version of the questionnaire consisted of 93 items from four sections consisting of demographic details, knowledge, attitude and practice. The findings of this validation and reliability study show that the developed questionnaire has a satisfactory psychometric property for measuring KAP of patients diagnosed with AMD undergoing intravitreal injection treatment.

Fiji-Assisted Automatic Quantitative Volumetric Analysis of Choroidal Neovascularization in a Laser-Induced Choroidal Neovascularization Mouse Model.

The laser-induced choroidal neovascularization (CNV) mouse model is the most frequently used animal model of CNV. To test new therapeutic agents that suppress CNV, CNV measurement in an accurate, precise, and efficient manner is important. We present the utility of Fiji-assisted automatic volumetric quantification of CNV in comparison with two-dimensional CNV analyses. Laser-induced CNV was induced in C57BL/6J mice according to the established protocol. After CNV induction, mice were treated with intravitreal injection of either phosphate-buffered saline solution (PBS) or Aflibercept, an anti- vascular endothelial growth factor agent. One week after intravitreal injection treatment, retina pigment epithelium/choroid flat mounts were stained with rhodamine-conjugated Griffonia simplicifolia lectin B4. Z-stacks of the entire CNV lesion obtained using laser confocal microscopy were converted to binary stacks using Fiji for volumetric analysis. Data from volumetric analysis and multiple area analyses from z-stack projection, the maximum, blindly selected, and mean area were compared using Fiji. Fiji-assisted automatic quantitative volumetric analysis of CNV was useful in detecting experimental outliers in laser-induced CNV genesis and provided accurate and precise measurements of total areas of CNV with a lower coefficient of variance (63%) than in multiple area analyses, including the z-stack projection, maximum, blindly selected, and mean areas (67%, 67%, 76%, and 69%, respectively). A lower coefficient of variance in volumetric analysis than in multiple area analyses resulted in increased statistical significance when comparing CNV lesions in PBS, and Aflibercept-treated groups; P = 0.004 in volumetric analysis versus P value range between 0.03 and 0.05 in multiple area analyses. Fiji-assisted automatic quantitative volumetric analysis can be useful for accurate, precise, and efficient measurements of total areas of CNV. Volumetric measurement for CNV lesions can be advantageous in verifying the efficacy of therapeutic agents in the laser-induced CNV mouse model.

The effect of a brief, unplanned treatment delay on neovascular age-related macular degeneration patients: a retrospective cohort study

Non-compliance to intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy can result in increased disease activity in neovascular age-related macular degeneration (nAMD). Our study aims to determine effects of unplanned delay in anti-VEGF injection treatment for nAMD. This retrospective observational study included patients with delays in receiving intravitreal injections for nAMD treatment from March to May 2020 by at least 21 days. Baseline demographic and clinical characteristics, visual acuity (VA), central macular thickness (CMT) measured on optical coherence tomography (OCT), and duration of delayed treatment were analyzed for 3 time points, the pre-delay visit (v1) and post-delay visits (v2 and v3). Data were compared to age-matched controls treated for nAMD in 2019 without delay. Demographic characteristics were compared using two-sample t-tests for continuous variables and Pearson’s chi-square tests for categorical variables. For the two primary outcomes of interest, VA and CMT, means and standard deviations were reported for each combination of group and time. Each outcome was modeled using a linear mixed model with the group, time and group-time interaction as fixed effects. A total of 69 patients (99 eyes) in the treatment delay group and 44 patients (69 eyes) in the control group were identified. Statistically significant differences between control and delayed groups were detected for VA (difference in mean logMAR = 0.16; 95% CI 0.06, 0.27; p = 0.002) and CMT (difference in mean CMT = 29; 95% CI 12, 47; p = 0.001) at v2. No differences were detected for v1 and v3 time points for both outcomes. An unplanned delay in intravitreal injection treatment for nAMD resulted in an increase in CMT and worsening of VA compared to controls observed at v2. At v3, CMT and VA recovered to near v1 levels. This study demonstrates that a one-time, brief interruption in treatment for nAMD results in reversible, temporary worsening.

Idiopathic macular hole surgery using inverted temporal internal limiting membrane flap technique

AbstractPurpose: To investigate the anatomic success rate of single‐layered, inverted temporal internal limiting membrane flap (ITF) cover technique for idiopathic macular hole (MH) surgery.Methods: Clinical records of idiopathic MH patients who underwent surgery using ITF technique. Two techniques were used. Group A had circular internal limiting membrane (ILM) peeling and ITF surgery. Group B had hemicircular ILM peeling and ITF surgery. Postop closure of MH was examined by optical coherence tomography.Results: Group A included 18 eyes and Group B included 42 eyes. Immediate postop closure of MH was observed in 83.3% (50 eye); 88.9% (16 eyes) in Group A and 81% (34 eyes) in Group B. Anatomic success rate of large MH was 88.9% (24/27 eyes). Among 10 eyes showing persistent MH after the surgery, 6 eyes had additional intravitreal gas injection treatment and MHs were closed. MHs in other 4 eyes were also closed after the second surgery. In two eyes, ITF flipped back to the original position was observed during the surgery, and reinverting the previous flap induced MH closure.Conclusions: Single‐layered ITF cover technique showed high anatomic success rate in idiopathic MH surgery. However, more attention is needed to prevent the flap flipping.

Intravitreal injection versus systematic treatment in patients with uveitis undergoing cataract surgery: a systematic review and meta-analysis.

Cataract surgery in patients with uveitis is challenging, and postoperative inflammation control is crucial for successful outcomes. No consensus exists regarding the optimal method of controlling postoperative inflammation. In this systematic review and meta-analysis, we compared the outcome of intravitreal injection (IVI), including steroid (triamcinolone acetonide) or steroid implant (dexamethasone), with systemic anti-inflammatory therapy (ST), such as systemic steroids with or without immunomodulatory therapy, in patients with uveitis undergoing cataract surgery. We searched PubMed, EMBASE, and Cochrane Library databases for randomized controlled trials (RCTs), comparative cohort studies, and case-control studies published through May 2021 that compared intraoperative IVI of triamcinolone acetonide or steroid implant with ST with or without immunomodulatory therapy. The following outcomes were evaluated: preoperative best-corrected visual acuity, intraocular pressure, laser flare photometry, central macular thickness and cystoidmacular edema rate. Five studies were selected. Our analysis indicated that compared with ST, IVI treatment may be associated with less anterior chamber inflammation and a lower cystoidmacular edema rate, but the difference in best-corrected visual acuity, intraocular pressure, or central macular thickness was not significant. IVI of steroid or steroid implants might be beneficial in controlling postoperative inflammation for uveitis cataract, especially in patients who cannot tolerate ST. To the best of our knowledge, this is the first meta-analysis to compare the efficacy of intraoperative IVI of steroids with standard-of-care treatment as a prophylaxis for uveitis cataract. However, large-scale RCTs are warranted to compare the IVI of steroid implants and steroids.

Venöse retinale Gefäßverschlüsse

Intravitreale Injektionstherapien zur Behandlung des Makulaödems als Ausdruck von Schrankenstörungen stellen den zentralen Ansatz in der Therapie venöser retinaler Gefäßverschlüsse dar. Im Gegensatz zur diabetischen Retinopathie oder der neovaskulären altersbedingten Makuladegeneration kann dabei eine dauerhafte, vollständige funktionelle und morphologische Wiederherstellung erreicht werden, da venöse retinale Gefäßverschlüsse in der Regel zwar mit Risikofaktoren assoziiert sind, jedoch nicht als Manifestationsform einer systemischen oder degenerativen Grunderkrankung einen zwangsläufig chronischen Charakter aufweisen. Eine dauerhaft erfolgreiche Therapie des RVO(„retinal vein occlusion“)-assoziierten Makulaödems setzt allerdings eine möglichst intensive und mitunter langfristig fortgesetzte Behandlung mit VEGF(„vascular endothelial growth factor“)-Hemmern oder dem mit einem ungünstigeren Nebenwirkungsspektrum verbundenen Dexamethason voraus. Dabei kann sowohl mit einer PRN(pro re nata)- als auch mit einer T&E(„treat and extend“)-Strategie ein funktioneller Behandlungserfolg langfristig aufrechterhalten werden. Hingegen ergibt die Kombination der Anti-VEGF-Gabe mit einer Laserkoagulation nach aktueller Datenlage keinen zusätzlichen therapeutischen Nutzen im Vergleich zur Monotherapie. In therapierefraktären Fällen kann im Verlauf ein Medikamentenwechsel in Erwägung gezogen werden, wenngleich ein therapeutischer Nutzen hinsichtlich der Visusentwicklung bislang nicht belegt ist. Die vorliegende Übersichtsarbeit fasst die bei der Behandlung des RVO-assoziierten Makulaödems maßgeblichen Aspekte zusammen und vermittelt die Grundlagen zur Anwendung erfolgreicher Therapiestrategien.

PCR61 Burden and Impacts Associated with Caring for Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema Patients: A Multinational Caregiver Survey

Optimal real-world outcomes in neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) require frequent and potentially burdensome visits for patients and their caregivers. This study aimed to understand the caregiver perspective on treatment burden, barriers and the impact of caregiving, with a particular focus on the demands of frequent anti-vascular endothelial growth factor (anti-VEGF) intravitreal injection treatment.

Evaluation of YouTube videos as a patient information source on intravitreal injection procedures

To evaluate the content, reception and quality of YouTube videos on intravitreal injection (IVI) procedures as an educational resource for patients. Our study was a retrospective, cross-sectional, register-based study. The terms "intravitreal injection," "intravitreal injection treatment," "eye injection," "eye injection treatment," "dexamethasone intraocular injection," "anti-VEGF injection," "Ozurdex®," "Lucentis®," and "Eylea®" were searched on YouTube. Video duration, total views, number of likes, number of dislikes, and number of comments were recorded. Quality and reliability of video content was assessed using the DISCERN questionnaire, Journal of the American Medical Association (JAMA) score, and the Global Quality Score (GQS). The video power index (VPI) was used to determine the popularity of the videos. One hundred eleven videos were included in the study. The mean duration was 4.30minutes, and the mean number of views was 27,415.90. The mean DISCERN, JAMA, and GQS scores were 45.39±9.7, 1.76±0.49, and 3.60±0.84 respectively. The mean VPI was 12.16±35.56 (0-277.80). Video publishers were as follows: 31 (27.9%) private hospital YouTube channels, 17 (15.3%) ophthalmologists, 45 (40.5%) health-related YouTube channels, 18 (16.2%) "other channels." Seventy-two (64.9%) of the main narrators of the videos were ophthalmologists. The DISCERN, GQS and JAMA scores were correlated (P = 0.001). There was no correlation between the VPI scores and the DISCERN, JAMA and GQS scores (P = 0.05). This study showed that YouTube videos on IVIs contain moderately useful information for patients. YouTube videos may be helpful for patients seeking information about IVIs, but physicians must be careful to correct any misunderstandings.

Proliferative Diabetic Retinopathy Events in Patients With Diabetic Macular Edema: Post Hoc Analysis of VISTA and VIVID Trials.

This work aimed to assess the incidence of proliferative diabetic retinopathy (PDR) events and improvement to mild non-PDR (NPDR) or better after intravitreal aflibercept injection (IAI) or laser treatment (control) in diabetic macular edema (DME). PDR events in the VISTA (NCT01363440) and VIVID (NCT01331681) phase 3 clinical trials were evaluated in a combined IAI-treated group (IAI 2 mg every 4 weeks or 2 mg every 8 weeks after 5 initial monthly doses; n = 475) and a macular laser control group (n = 235) through week 100 in eyes without PDR at baseline (Diabetic Retinopathy Severity Scale [DRSS] score ≤ 53). Improvement in the DRSS score to 35 or better was evaluated in those with a baseline DRSS score of 43 or greater. A lower proportion of eyes in the IAI group than in the laser group developed a PDR event through week 100 (4.4% vs 11.1%; adjusted difference, -6.7%; 97.5% CI, -11.7 to -1.6; nominal P = .0008). All PDR events occurred in eyes with a baseline DRSS score of 43, 47, or 53 and not in those with a score of 35 or less. A greater proportion of eyes in the IAI group than in the control group achieved a DRSS score of 35 or less (20.0% vs 3.8%; nominal P < .0001). Fewer eyes with NPDR and DME treated with IAI than eyes treated with a laser had a PDR event. More eyes treated with IAI improved to mild NPDR or better (DRSS score ≤ 35) through 100 weeks.