Therapeutic Effect Of Intravitreal Injection Research Articles

Retinopathy of Prematurity (ROP)—Risk Factors and Therapeutic Effect of Intravitreal Injection of Bevacizumab (IVB): An Observational Study from a Neonatal Intensive Care Unit in Egypt

Retinopathy of Prematurity (ROP)—Risk Factors and Therapeutic Effect of Intravitreal Injection of Bevacizumab (IVB): An Observational Study from a Neonatal Intensive Care Unit in Egypt

Clinical therapeutic effects of intravitreal injection of Conbercept for macular edema in different types of retinal vein occlusion

Clinical therapeutic effects of intravitreal injection of Conbercept for macular edema in different types of retinal vein occlusion

The short-term outcome of intravitreal injection with topotecan for refractory vitreous seeding from retinoblastoma

Objective To observe and evaluate the short-term therapeutic effect of intravitreal injection with topotecan for refractory vitreous seeding from retinoblastoma (RB). Methods Eleven patients (11 eyes) of RB with refractory vitreous seeding (received intravenous chemotherapy, intra-arterial chemotherapy, intravitreal melphalan, laser, cryotherapy and subsequently developed refractory viable vitreous seeds) were enrolled in this study. There were 6 males (6 eyes) and 5 females (5 eyes). The aged from 9 to 44 months, with the mean age of 26 months. According to International Intraocular Retinoblastoma Classification, 11 eyes were initially classified as group E (3 eyes), D (6 eyes), B (1 eye) or A (1 eye). All patients were received intravitreal injection with topotecan. A total of 32 intravitreal topotecan injections were performed with a mean of 2.9 injections (median 3 injections; range 2−4 injections). The mean follow-up was 10 months. The safety and effectiveness of intravitreal injection with topotecan for refractory vitreous seeding from RB were observed. Results Complete regression of vitreous seeds was achieved in 11 of 11 eyes (100%), including complete disappearance in 9 eyes and fibrosis in 2 eyes. None of the patients needed enucleation and occured ocular or systemic complications in the follow-up period. Conclusion Intravitreal injection with topotecan for refractory vitreous seeds from RB is effective and safe. Key words: Retinoblastoma; Vitreous seeding; Topotecan/therapeutic use

Therapeutic efficacy and significance of intravitreal injection of ranibizumab for age-related macular degeneration with subfoveal scarring and active lesion

Background Intravitreal injection of ranibizumab is a primary approach to the treatment of wet age-related macular degeneration (wAMD), but whether it is necessary for wAMD with subfoveal scarring and active lesion to receive the intravitreal injection of ranibizumab is in dispute. Objective This study was to evaluate the possible therapeutic effect of intravitreal injection of ranibizumab on wAMD with subfoveal scarring and active lesion. Methods The clinical data of the patients with wAMD with subfoveal scarring and active lesion were retrospectively analyzed, including 89 eyes of 89 cases who received diagnoses and treatments in Second Hospital of Yunnan Province from February 2013 to May 2015.Sixty-eight patients who received intravitreal injections of ranibizumab were treated group, and 21 patients who received clinical observations only served as the untreated group.Intravitreal injection of ranibizumab was carried out following the 3+ prn principle, and all of the patients were followed-up for 6-24 months.Best corrected visual acuity (BCVA) of the patients were examined with ETDRS chart.The fundus findings was examined by fundus color photography and fundus fluoresceinangiography (FFA). The subjective assessment of visual improvements was obtained from each patient, and the recession of retinal active lesions was assessed by OCT, including the absorbing state of subretinal fluid, the change of central retinal thickness (CRT) and subfoveal scarring. Results The mean injection times were (4.1±1.2) for each eye.The BCVA at the end of following-up was evidently improved in both groups, and no significant difference was found among various time points (P>0.05). However, the patient rate of BCVA improvement was 69.12% in the treated group, which was signnificantly higher than 28.58% of the untreated group (P=0.016). In the treated group, subretinal fluid was gradually absorbed in all eyes in the treating duration, however, in the untreated group, the fluid was completely absorbed in 7 eyes, unchanged in 8 eyes and increased in 6 eyes.The CRT reduced by (220.16±34.76)μm in treated group, and that in the untreated group was (101.56±31.59)μm, showing significant difference between them (P=0.004). The patient rate of perceived improvement of vision was 91.12% and 42.85% in the treated group and untreated group respectively, with significant difference between the two groups (P=0.008). Conclusions Intravitreal injection of ranibizumab can make active lesion recess in end-stage wAMD with subfoveal scarring and active lesion and improve the life quality of the patients. Key words: Ranibizumab; Wet macular degeneration/complications; Cicatrix/surgery; Antibodies, monoclonal, humanized; Tomography, optical coherence; Visual acuity; Intravitreal injections; Retrospective studied

Therapeutic Effect of Intravitreal Injection of Triamcinolone in the Treatment of Endothelial Graft Rejection

To investigate the efficacy of intravitreal triamcinolone acetonide (IVTA) injection in the treatment of endothelial graft rejection and the expression of T-helper type 1 (Th-1) chemokines in the aqueous humor. Eleven patients (11 eyes) with acute endothelial graft rejection underwent IVTA (4 mg/0.1 mL) injection in addition to conventional treatment, including systemic and topical steroids and cyclosporine A (group A); 13 patients (13 eyes) received conventional treatment only (group B). Clinical characteristics were analyzed. In group A, Th-1 chemokines (CXCL-9, -10, and -11) in aqueous humor were measured by enzyme-linked immunosorbent assay and CXCR3(+) cells were counted by flow cytometry before treatment and at the period of improvement. There were no significant differences in visual acuity, intraocular pressure, and recurrence rate between the 2 groups. The mean time to improvement was 9.1 ± 3.9 days in group A and 15.4 ± 5.5 days in group B (P = 0.04). The concentrations of CXCL-9, -10, and -11 were 562.7 ± 109.4, 30293.1 ± 12537.1, and 228.3 ± 80.8 pg/mL before treatment and 6.7 ± 6.8 (P < 0.01), 207.5 ± 209.8 (P < 0.01), and 18.9 ± 19.5 (P < 0.01) pg/mL after treatment, respectively. The CXCL-10 level correlated with the time to improvement of graft rejection (P = 0.02). Flow cytometry demonstrated a significantly decreased number of CXCR3(+) and CXCR3(+)CD4(+) cells in the aqueous humor after treatment. IVTA injection was effective in reducing the time to improvement of endothelial graft rejection. Increased expression of CXCL-9, -10, and -11, and their receptors in the aqueous humor of patients with endothelial graft rejection decreased after treatment.

Treatment of peripheral exudative hemorrhagic chorioretinopathy by intravitreal injections of ranibizumab

Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is a rare disorder that sometimes causes sudden subretinal and/or vitreous hemorrhage. Choroidal neovascularization is involved in the pathogenesis, but the etiology is unknown. Treatments with photocoagulation, cryopexy, and intravitreal bevacizumab injection have been reported. However, the therapeutic effect of intravitreal injection with ranibizumab for PEHCR is unclear. A 70-year-old woman visited our department because of sudden loss of superior visual field in her left eye. She had a history of surgical removal of hematoma due to subretinal hemorrhage associated with age-related macular degeneration 5 years ago. Peripheral subretinal hemorrhage was observed in the left eye, and fluorescein and indocyanine green angiography revealed choroidal neovascularization in the subretinal hemorrhagic region. PEHCR was diagnosed. Considering her past history, intravitreal ranibizumab injection was used for treatment. After three injections in the left eye, subretinal hemorrhage and choroidal neovascularization resolved completely. No recurrence was observed during 1 year of follow-up. This case demonstrates that intravitreal injection of ranibizumab is an effective treatment for PEHCR with subretinal hemorrhage.

Therapeutic effects of intravitreal injection of bevacizumab on exudative age-related macular degeneration and non-responders analysis

Objective To observe the effect of intravitreal bevacizumab (IVB) for exudative agerelated macular degeneration (eAMD),and analyze the reasons for treatment failure.Methods Eighteen eyes of 17 patients with eAMD who have been diagnosed by fundus fluorescein angiography (FFA),indocyanine green angiography (ICGA) and optical coherence tomography (OCT) were enrolled in this openlabel,single treatment group and prospective study.The patients received the first IVB treatment after diagnosis,and received the 2nd,3rd,4th,5th and 6th IVB treatment at 6,12,24,36,48 weeks after the first injection.The examinations of best corrected visual acuity (BCVA),intraocular pressure,slit lamp microscope,fundus photography,FFA,ICGA and OCT were performed before and after treatment.Nonresponders were defined as patients who had BCVA loss more than 5 letters at week 52 compared with BCVA before treatment.The therapeutic effects of IVB for eAMD were observed.The central macular thickness (CMT),maximum retinal thickness (MRT) and morphological changes of FFA,ICGA and OCT before and after treatment were comparative analyzed.Results Of the 18 eyes,12 eyes (66.67％) were effective to IVB,6 eyes (33.33％) were non-responders.The average CMT and MRT of non-responders were 506.83,635.33 μm before treatment,which decreased to 446.17,563.67 μtm at 52 weeks.They were reduced by 60.67 and 71.67 μtm respectively,but there was no statistically significant differences (t =-1.572,-0.943; P=0.116,0.345).FFA and ICGA examination found that the CNV lesions of 3 nonresponder eyes located in the foveal region,and became scars after the 6th treatment.The other 3 nonresponder eyes developed CNV repeatedly during the treatments,and after the 6th injections of bevacizumab the lesions were under control with less fluorescein leakage and macular retinal edema.Conclusion IVB treatment is effectivefor some eAMD patients,but is ineffective for patients with extensive expanded CNV and foveal CNV. Key words: Macular degeneration/therapy; Choroidal neovascularization/therapy; Antibodies; monoclonal/therapeutic use; Medical futility

Intravitreal injection with bevacizumab combined with extra panretinal photocoagulation for high-risk proliferative diabetic retinopathy

Objective To evaluate the therapeutic effect of intravitreal injection with bevacizumab (Avastin) (IVB)combined with extra-panretinal photocoagulation (E-PRP) for high-risk proliferative diabetic retinopathy (PDR). Methods A total of 57 eyes of 53 patients with high-risk PDR underwent intravitreal injection combined with E-PRP. The examinations of vision acuity, intraoeular pressure, iris fluorescein angiography (IFA), fundus photos and fundus fluorescein angiography (FFA) were performed on all of the patients before and 1, 2, 3, and 6 months after the treatment; the results of the examinations before and after the treatment were compared and analyzed. The average follow up was 6 months. Results The mean visual acuity was (0. 143 ± 0. 072) before the treatment and (0. 218 ± 0. 128) 7 days after the tretment; the difference was significant (t= -7. 940, P 0.05). The mean intraoeular pressure of 21 eyes which had the neovascularization of pupil margin and iris surface before and 7 days after IVB was (26. 632±2. 629) and (19. 316±3. 092) mm Hg (1 mm Hg=0. 133 kPa), respectively; the difference was significant (t=12. 838, P<0. 05) . The mean intraocular pressure 1, 3, and 6 months after E-PRP was (16. 947±2. 345), ( 16.474 ± 1.611 ), and (16. 421±4. 702 )mm Hg, respectively, which differed much from that before and after IVB (P<0. 05). Neovascularization on the disc and the retinae of 57 eyes were subsided partly, and a significant reduction or disappeared of the area of retinal neovascularization and the blood vessel leakage were observed 7 days after IVB. The neovascularization of pupil margin and iris surface of 21 eyes disappeared, and the IFA leakage decreased. The results of FFA 2 months after E-PRP showed that the one-off efficiency of E-PRP was 68.4%; 12 eyes (21.1%) needed an additional laser, in which 6 eyes (10.5 %) underwent vitreous surgery. Conclusion IVB combined with E-PRP as a treatment for high-risk PDR may improve the regression of retinal neovascularization and the reduction of vascular permeability, and prevent or reduce the complications and improve the therapeutic effect. Key words: Diabetic retinopathy/therapy; Laser coagulation/methods; Antibodies, monoclonal/drug effects

EXPERIMENTAL MODEL OF INTRAVITREAL INJECTION TECHNIQUES

To evaluate the amount of drug reflux and vitreous leakage from the needle tract after various intravitreal (IVT) injection techniques in porcine cadaver eyes. The reflux after IVT injection was quantified by methylene blue injection through the pars plana of fresh pig eyes (0.05 mL per eye, n = 150) and the vitreous incarceration measured after balanced salt solution (BSS) IVT injection (0.05 mL per eye, n = 150) into eyes with vitreous previously stained with methylene blue. Blue spots observed on the ocular surface after injection quantified both reflux and vitreous incarceration. We tested different needle sizes (27, 30, and 32 gauge) and different techniques (depth and speed of injection). We used an ocular endoscope to observe the flow and diffusion of injected methylene blue and the vitreous incarceration at the puncture site after IVT injection using the different techniques. Thirty-gauge needles showed less drug reflux than the 32-gauge or 27-gauge needles (P < 0.01). Thirty-two-gauge needles demonstrated less incarceration of vitreous at the tract site (P < 0.01), but with the endoscope, all needle tracts showed vitreous incarceration at their internal aspect. Deep IVT injection showed less reflux than superficial IVT injection, but vitreous incarceration did not differ. The delay between the scleral puncture and the injection did not modify the reflux or the vitreous incarceration. Thirty-gauge needles and deep placement of the needle tip into the vitreous before injection may reduce reflux and vitreous incarceration. This could maximize the therapeutic effect of IVT injection and may decrease the rates of severe complications such as retinal detachment and endophthalmitis.