Total Number Of Intravitreal Injections Research Articles

Optimizing Diabetic Macular Edema Treatment: A Meta-Analysis of Subthreshold Micropulse Laser and Anti-Vascular Endothelial Growth Factor Combination Therapy.

Background: Diabetic macular edema (DME) is the primary cause of visual impairment in individuals with diabetes. Anti-vascular endothelial growth factor (VEGF) is the current first-line treatment for DME owing to its effectiveness. However, frequent anti-VEGF injections may be inconvenient for patients. Therefore, this study aimed to investigate whether the addition of subthreshold micropulse laser (SML) to anti-VEGF therapy could reduce the requirement for anti-VEGF injections while maintaining the treatment efficacy for DME. Methods: Clinical trials retrieved from the databases of PubMed, EMBASE, and the Cochrane Library were evaluated to determine the effectiveness of combination treatment with SML and anti-VEGF medication compared with that of anti-VEGF treatment alone. The primary outcome measures were the changes in CMT, best-corrected visual acuity (BCVA), and the total number of intravitreal injections (IVIs). Results: The IVI + SML group revealed a substantial increase in the logarithm of the minimum angle of the resolution BCVA and a reduction in CMT at the 12-month follow-up (BCVA: random-effects; mean difference [MD], -0.05; 95% confidence interval [CI]: -0.10 to -0.01; p-value = 0.28, and CMT: random-effects; MD, -18.27; 95% confidence interval, -27.36 to -9.18; p-value = 0.20). The number of required IVIs in the IVI + SML group was lower than that in the IVI only group (random-effects; MD, -2.22; 95% CI: -3.13 to -1.31; p-value < 0.01). Conclusions: Combining SML therapy with anti-VEGF injections may reduce the total number of injections required, improve VA, and reduce CMT at the 12-month follow-up. Although the included studies used different SML regimens and anti-VEGF agents, this review indicates that the application of additional SML therapy results in positive clinical outcomes.

The incidence and prevalence of diabetic macular edema and proliferative diabetic retinopathy, their progression to visual impairment and patterns in their intravitreal treatment in the Finnish population.

The worldwide prevalence of diabetes mellitus (DM) continues to increase. As DM is linked to various ophthalmological comorbidities, it is crucial to understand the incidence and the treatment patterns of these complications to minimise the treatment burden for the patient and the healthcare system. This study aims to evaluate the incidence and prevalence of diabetic macular oedema (DME) and proliferative diabetic retinopathy (PDR) and to analyse intravitreal (IVT) treatment patterns and responses in the Finnish population with diabetes. A nationwide data register containing details of over 20-year-old individuals with diabetes was used in the analyses. The incidence and prevalence of DME and PDR among the Finnish population with diabetes either declined or remained stable during 2007-2017 (Incidence rate: DME -40.8%, PDR -65.3%; prevalence rate: DME +4.7%, PDR -11.2%). During the same period, number of persons suffering from diabetes increased by +58.3%. The total number of IVT injections increased by 261.7%; the number of patients receiving IVT treatments increased by 133.6% from 2011 to 2017, reflecting changes in patient numbers in the ophthalmology departments. Furthermore, irrespective of the rising number of patients with diabetes, the numbers with visual impairment declined by 75.8% among DME and by 75.7% among PDR patients in 2007-2017. Regardless of the considerable increase in the workload of ophthalmology departments, the healthcare system has been able to reduce both the age and sex standardised incidence of DME and PDR among the diabetic population suffering from a visual impairment associated with this disease.

Роль нутрицевтика «Ресвега форте» в комплексном лечении хориоидальной неоваскуляризации, обусловленной патологической миопией, на фоне антиангиогенной терапии ранибизумабом

Purpose. Evaluation of clinical efficacy of nutraceutical «Resvega forte» in complex treatment of myopic choroidal neovascularization (CNV) against the background of antiangiogenic therapy with ranibizumab. Material and methods. 25 patients with CNV that developed against the background of pathological myopia. In patients of the main group (16 people), a single ranibizumab 0.5 mg intravitreal injection was supplemented the appointment of two courses of the “Resvega forte” complex, 1 capsule 2 times a day continuously for 3 months and then second course after 6 months at the same dosage. Patients of the comparison group (9 people) were not prescribed the “Resvega forte” complex. For objective diagnostic, the best corrected visual acuity (BCVA), retinal electric sensitivity threshold (EST) and electric lability (EL) of optic nerve, data of optical coherence tomography (OCT) and OCT-angiography (OCT-A) of the retina were evaluated. Study monitoring was performed within 12 months from the start of treatment. Indications for repeated ranibizumab intravitreal injections were persistence of CNV activity or its recurrence. Results. By the end of observation period (12 months), BCVA in patients of the main group was 0.57 ± 0.04, and in the comparison group – 0.21 ± 0.03. In patients of the main group, retinal EST decreased to 62.5 ± 1.5µA, and EL of optic nerve increased to 35.4 ± 1.3 Hz, while in the comparison group decrease in EST and increase in EL were less significant. The total number of intravitreal injections during 12 months of observation in patients of the main group was 2–3, while in the comparison group it was 5–6. Conclusion. At comparable morphometric characteristics of remission of pathological process without signs of activity of choroidal neovascular membrane by 12 months of observation in the main group, against the background of use “Resvega forte”, compared to the comparison group, increase in visual acuity by 3.5 times and increase number of patients with improved electrophysiological parameters by 1.3 times, were achieved. Keywords: pathological myopia, myopic choroidal neovascularization, ranibizumab, “Resvega forte”.

The Effect of Blue-Light Filtering Intraocular Lenses on the Development and Progression of Neovascular Age-Related Macular Degeneration

To assess the effect of blue-light filtering (BLF) intraocular lenses (IOLs) on the prevention of neovascular age-related macular degeneration (nAMD) after cataract surgery. Cohort study. Patients who underwent uneventful cataract surgery between 2007 and 2018 at the Ophthalmology Unit of Kymenlaakso Central Hospital, Kotka, Finland. Subsequent nAMD rates were compared between patients who received BLF IOLs and those who received non-BLF IOLs. Kaplan-Meier and Cox regression analyses for the overall risk of nAMD developing were assessed. Best-corrected visual acuity (BCVA), foveal thickness, treatment interval, and total number of intravitreal injections were secondary outcomes. A separate analysis was performed on patients with pre-existing nAMD to assess the effect of BLF IOLs on nAMD progression. A single eye of each patient was included. Neovascular age-related macular degeneration-free survival. Included were 11 397 eyes of 11 397 patients with a mean age of 75.4 ± 8.3 years (62.5% women). The BLF IOL was used in 5425 eyes (47.6%), and the non-BLF IOL was used in 5972 eyes (52.4%). During follow-up (BLF IOL group, 55.2 ± 34.1 months; non-BLF IOL group, 50.5 ± 30.1 months; P < 0.001), 164 cases of new-onset nAMD were recorded (BLF group, n= 88; non-BLF group, n= 76). The nAMD-free survival was similar between the groups (P= 0.465, log-rank test). In a Cox regression analysis controlling for age, gender, and a documented diagnosis of macular degeneration, the use of a BLF IOL was not predictive of nAMD development (hazard ratio [HR], 1.075; 95% confidence interval [CI], 0.79-1.47; P= 0.652). In nAMD patients, secondary clinical outcomes at 1 year were comparable for BCVA (0.57 ± 0.4 logarithm of the minimum angle of resolution vs. 0.45 ± 0.4 logarithm of the minimum angle of resolution; P= 0.136), foveal thickness (285 ± 109 μm vs. 299 ± 103μm; P= 0.527), number of anti-vascular endothelial growth factor injections (6.5 ± 2.5 vs. 6.2 ± 2.7; P= 0.548), and treatment interval (7.5 ± 2.4 weeks vs. 8.1 ± 2.4 weeks; P= 0.271) for BLF and non-BLF IOLs, respectively. Similarly to patients in whom nAMD developed after the surgery, among patients with nAMD before surgery (BLF, n= 71; non-BLF, n= 74), the clinical outcomes again were comparable (all P > 0.05). In a large cohort of patients who underwent cataract surgery, the use of a BLF IOL resulted in no apparent advantage over a non-BLF IOL in the incidence of nAMD or its progression, nor in clinical variables related to nAMD severity.

The frequency and costs of intravitreal therapy agents in retinal diseases

Background: The aim of this study is to analyze the numbers and the economic burden of intravitreal anti-VEGF agents and intravitreal dexamethasone (IVD) implants administered to patients with diabetic retinopathy (DR), age-related macular degeneration (AMD) and retinal vein occlusion (RVO). Material and methods: The retrospective case-control study included 1525 patients diagnosed with DME, neovascular AMD and RVO, and received intravitreal anti-VEGF and IVD between January 2016 and December 2018. Intravitreal anti-VEGF administration was performed within the framework of the Pro Re Nata (PRN) regimen. The prices of anti-VEGF agents and IVDs were calculated on the average of the prices in the relevant year. Results: The total number of intravitreal injections in 3 years was 5864. During the 3-year follow-up, on average, ranibizumab (Lucentis) was applied 3.56 ± 2.25 times, alfibercept (Eylea) was applied 3.31 ± 2.16 times, and IVD (Ozurdex) was applied 1.70 ± 0.83 times. The anti-VEGF numbers in 2016, 2017 and 2018 were 1997, 1801, 2066, respectively. In total, the 3-year drug cost was 3,587,812.44 USD. Conclusions: The economic burden of intravitreal anti-VEGF and IVD treatment for retinal diseases is so important to developing countries such as Turkey. The economic burden created by anti-VEGF agents and IVDs in Turkey will reduce in a serious sense, and the legal concerns of physicians will decrease thanks to the decision taken by the Turkish Medicines and Medical Devices Agency (TMMDA).

Serum pro-inflammatory factors as predictors of persistent diabetic macular oedema with limited anatomic response to anti-VEGF: association with intravitreal injection treatment profiles in real-world setting.

To study the role of serum levels of pro-inflammatory factors in the identification of persistent diabetic macular oedema (DME) cases with limited anatomic response to anti-VEGF. Additionally, possible predictive associations between serum factors and intravitreal treatment profiles were analysed. Cases with DME were treated with monthly bevacizumab (BVZ). After the sixth month of follow-up, if the change in central foveal thickness (CFT) was <20% of baseline, combination treatment with triamcinolone was initiated. All cases underwent a baseline laboratory workup including inflammatory, metabolic and prothrombotic factors. The following outcome parameters were evaluated: percentage of CFT change from baseline, occurrence of persistent DME with <20% change in CFT, achieving CFT <330μm with ≤6 BVZ injections, total number of intravitreal injections (IVI), number of IVI after the 6th month and number of triamcinolone acetonide (TCA) injections. A total of 58 cases were included receiving a mean of 7.23±1.55 IVI in 12months, resulting in a significant improvement of visual acuity (VA) and CFT. No significant differences were found for baseline CFT, baseline LogMAR VA, diabetic retinopathy grade, age or duration of DM2 between cases initiating TCA and those treated only with anti-VEGF. Significant correlations were found between total number of IVI and the following serum factors: high-sensitivity C-reactive protein (hsCRP) (p=0.004, r=0.395), creatinine (p=0.023, r=0.338) and homocysteine (p=0.037, r=0.309). Regression analysis revealed that hsCRP was a significant predictor of TCA treatment (p=0.028, r2 =0.350). Cases requiring ≤6 IVI had significantly lower values of hsCRP (1.33±1.07 versus 2.46±2.18mg/l, p=0.016) and creatinine (0.71±0.28 versus 0.94±0.19mg/dl, p=0.003). Serum markers of microvascular damage (hsCRP, homocysteine and creatinine) were associated with a higher frequency of IVI due to persistent DME, suggesting a role for such biomarkers in the identification of limited responders to anti-VEGF monotherapy.

Intravitreal Injections Among Medicare Part B Beneficiaries, 2012-2016

Purpose: Intravitreal injection therapy (IVIT) has transformed the management of many chorioretinal diseases. Although these treatments are effective, they can also be expensive. Using the Medicare Provider and Utilization Data Report (MPUDR), we aim to quantify the costs of these drugs to Medicare and to project future cost trends. Methods: Data were harvested from the MPUDR for all ophthalmology providers who delivered intravitreal injections (IVT) (CPT code 67028) during the years 2012-2016. Linear regression utilizing the MPUDR data was used to analyze cost trends and to project Medicare costs out to year 2026. Results: From 2012 to 2016, the total number of IVTs increased from 2 286 593 to 2 936 274 ( R2 = 0.98; P = .001). The per-beneficiary Medicare cost rose significantly from $3,148 to $3,945 ( R2 = 0.92; P = .03). The total cost to Medicare for IVIT increased from $1.68 billion to $2.73 billion ( R2 = 0.99; P &lt; .005). IVIT accounts for 37% of all ophthalmology Medicare reimbursements. At the current rate, IVIT costs will exceed $5 billion per year by 2026. Conclusions: The total number of injections and costs for IVIT rose significantly from 2012 to 2016. At the current rate, Medicare reimbursement for brand-name drugs will make up a large proportion of future costs.

Analysis of Anti–Vascular Endothelial Growth Factor Injection Claims Data in US Medicare Part B Beneficiaries From 2012 to 2015

The frequency of anti-vascular endothelial growth factor (VEGF) injections has grown exponentially with the introduction of bevacizumab, ranibizumab, and most recently aflibercept. The cost associated with these medications has garnered significant national attention, warranting a granular analysis of their use. To analyze trends in anti-VEGF injections for US Medicare Part B beneficiaries from 2012 to 2015. This observational cohort study used 2012-2015 data from the Centers for Medicare & Medicaid Services Medicare Part B Provider Utilization Files to analyze trends in intravitreal injections of anti-VEGF medications among Medicare Part B beneficiaries and their health care professionals. The primary outcome measure was distribution of and change over time in the number of anti-VEGF injections performed for ranibizumab, aflibercept, and bevacizumab. A total of 2 574 124 intravitreal injections were performed by 3348 ophthalmologists in the outpatient setting for Medicare Part B beneficiaries during the 2015 calendar year; 100 ophthalmologists (3.0%) performed the highest volume of intravitreal injections. The total number of intravitreal injections administered in 2015 was 870 843 for aflibercept, 697 412 for ranibizumab, and 1 147 432 for bevacizumab. Ranibizumab injections decreased by 7.1% from 2012 to 2015 and bevacizumab injections decreased by 17.1%. From 2013 to 2015, aflibercept injections increased by 69.4%. The 100 ophthalmologists performing the highest volume of ranibizumab injections, as gauged by number of injections administered, accounted for 31.0% (95% CI, 30.994%-30.997%) of all ranibizumab injections nationally. The 100 ophthalmologists performing the highest volume of aflibercept injections accounted for 17.6% (95% CI, 17.638%-17.641%) of all aflibercept injections and the 100 ophthalmologists performing the highest volume of bevacizumab injections accounted for 19.6% (95% CI, 19.649%-19.653%) of all bevacizumab injections administered nationally to Medicare Part B beneficiaries. The highest number of injections per 1000 Medicare Part B beneficiaries occurred in Nebraska (aflibercept), Tennessee (ranibizumab), and South Dakota (bevacizumab). A total of 3.0% of ophthalmologists account for 17.6% to 31.0% of the total number of anti-VEGF injections administered nationally in the Medicare Part B population. Overall, bevacizumab and ranibizumab injections have decreased, coinciding with a 69.4% increase in aflibercept injections.

Long-Term Outcome of Punctate Inner Choroidopathy or Multifocal Choroiditis with Active Choroidal Neovascularization Managed with Intravitreal Bevacizumab

ABSTRACT Purpose: To evaluate the long-term outcome of active choroidal neovascularization (CNV) in punctate inner choroidopathy (PIC) or multifocal choroiditis (MFC) after intravitreal bevacizumab treatment. Methods: Retrospective study of consecutive patients of PIC/MFC complicated with active CNV. Outcome measures included best-corrected visual acuity (BCVA), total number of intravitreal injections of bevacizumab and recurrence of CNV. Correlation analysis was performed to find the correlation of various clinical factors and final BCVA. Results: There were 23 eyes in 22 patients with a mean age of 33.22 years included in this study. The mean duration of follow-up was 6.48 years. Improvement of BCVA was noted through the first 3 years and at the final follow-up. BCVA at 1, 6, 12 months and recurrence of CNV were correlated with final BCVA. Conclusion: Most patients of PIC/MFC complicated with CNV managed with intravitreal bevacizumab had improved BCVA over 4 years.

Initial intravitreal injection of high-dose ganciclovir for cytomegalovirus retinitis in HIV-negative patients

BackgroundThe purpose of this study is to examine the clinical outcomes achieved by using initial high-dose intravitreal ganciclovir injections to treat cytomegalovirus retinitis in patients without human immunodeficiency virus (HIV) infection.MethodsTwenty-four eyes (24 patients) with cytomegalovirus retinitis received multiple intravitreal injections of ganciclovir in weekly intervals. A higher dose (6 mg) of ganciclovir was applied at the first intravitreal injection, and a lower dose was used for maintenance. Anterior aqueous humour was obtained before each injection. The best-corrected visual acuity and cytomegalovirus loads in the anterior aqueous humour were measured.ResultsThe mean cytomegalovirus DNA load in aqueous humour decreased significantly from (2.59 ± 2.28) × 105 copies/mL at baseline to (1 ± 1.76) × 104 copies/mL one month later. The aqueous cytomegalovirus DNA load was negative in 17 eyes (70.8%) one month later. No obvious improvement of best-corrected visual acuity was found during the treatment. A positive correlation was proven between initial cytomegalovirus DNA titers in aqueous humour and the total number of intravitreal injections of ganciclovir, as well as between the baseline and final best-corrected visual acuities. No severe complications developed.ConclusionsAn initial high dose of ganciclovir (6 mg) and continuous intravitreal injections of ganciclovir could significantly decrease the cytomegalovirus load in HIV-negative patients with cytomegalovirus retinitis.Trial registrationhttp://clinicaltrials.gov, NCT03598452, retrospectively registered on 24 July 2018.

Incidence of Endophthalmitis after Intravitreal Injections: Risk Factors, Microbiology Profile, and Clinical Outcomes

ABSTRACTPurpose: To report the incidence and characteristics of endophthalmitis after intravitreal injections (IVI) of antivascular endothelial growth factor agents and triamcinolone acetonide.Methods: Patients’ medical records were retrospectively reviewed from January 2009 to June 2016, and the incidence, risk factors, clinical and microbiological characteristics of post-IVI endophthalmitis were evaluated.Results: The total number of intravitreal injections given, which included ranibizumab, bevacizumab, and triamcinolone acetonide, was 20,566, of which 27 cases developed endophthalmitis, giving an overall incidence of 0.131%. Significant reduction (p < 0.003) in incidence of endophthalmitis was observed in patients who received prefilled compounded bevacizumab injections (0.050%) compared to multiple bevacizumab injections from a single vial (0.235%). In the triamcinolone acetonide group, the incidence was 0.26%. Staphylococcus species were isolated from 18 cases (67%), and all strains were sensitive to vancomycin.Conclusions: Adherence to strict aseptic protocols and use of prefilled compounded bevacizumab injections reduces the rate of post-IVI endophthalmitis.

Nine-Year Outcome of Ranibizumab Monotherapy for Choroidal Neovascularization Secondary to Pathologic Myopia

Purpose: The aim of this study was to evaluate the 9-year outcome of ranibizumab monotherapy for myopic choroidal neovascularization (mCNV). Methods: This was a retrospective, nonrandomized, multicentric study to evaluate the long-term outcomes of mCNV treated with ranibizumab monotherapy for at least 9 years according to a strict pro re nata regimen. Results: Seventeen eyes of 17 patients (12 women, mean age 57.9 ± 7.7 years) were included. The mean follow-up period was 112.4 ± 3.9 months (range 108–120). The mean difference in best-corrected visual acuity (BCVA) from baseline to the last follow-up was +1.2 ± 15.6 ETDRS letters (p = 0.004, between initial vs. 12 and 24 months). The mean total number of intravitreal injections for each patient was 1.24 ± 1.70 per year (range 2–25). No systemic adverse reactions related to the drug treatment were detected during the 9-year follow-up period. Conclusions: Long-term ranibizumab monotherapy treatment induces unchanged or better BCVA compared to baseline after a 9-year treatment in almost all eyes.

Progression of Retinal Pigment Epithelium Atrophy in Patients with Long-Term Anti-Vegf Treatment for Exudative Age-Related Macular Degeneration

Abstract Introduction.Age-related macular degeneration is the leading cause of visual impairment in developed world. The reason for using intravitreal injections of anti-vascular endothelial growth factor (VEGF) is to prevent choroidal neovascularization which is the main pathogenic mechanism for exudative age-related macular degeneration. Although injections may improve visual acuity, there are evidence showing association of anti-VEGF injections with progression of retinal pigment epithelium (RPE) atrophy. Aim of the Study.The purpose of this study was to investigate the intravitreal anti-vascular endothelial growth factor impact on retinal pigment epithelium atrophy development and progression. Material and methods.A single-centre retrospective study was conducted. Total 51 eyes of 39 patients with exudative age-related macular degeneration undergoing intravitreal anti-vascular endothelial growth factor therapy for 48 months. Heidelberg Spectralis Optical Coherence Tomography and fundus autofluorescence were used for evaluation of retinal pigment epithelium atrophy area and retinal thickness. Measurements were made manually. Best-corrected visual acuity (BCVA) measurements were taken from patient medical histories. For statistical analysis, IBM Statistical Package for the Social Sciences, version 23.0 was used. Results.The average age of patients was 81.6 ± 6.7 years. After first year of intravitreal anti-VEGF therapy, retinal pigment epithelium atrophy area enlarged from baseline (from 1.91 ± 2.3 mm2 to 2.74 ± 2.3mm2, p &lt; 0.001). The mean number of intravitreal anti- VEGF injections received in 48 months was 15.47 ± 5.14. There was a statistically significant correlation between total number of intravitreal injections and RPE atrophy (R = 0.757, p &lt; 0.001). After first year of anti-VEGF therapy best-corrected visual acuity (decimals) was statistically improved from baseline (0.32 ± 0.26 to 0.37 ± 0.24, p = 0.04). However, despite significant improvement at first year, the further treatment contributed BCVA reduction. Conclusions.Retinal pigment epithelium atrophy is a frequent finding in eyes with exudative age-related macular degeneration before and after anti-VEGF therapy. Our data show statistically significant association between total number of intravitreal anti-VEGF injections and retinal pigment epithelium atrophy area enlargement. Also there was statistically significant best-corrected visual acuity improvement after first year of anti-VEGF therapy.

Real-World Cost Savings Demonstrated by Switching Patients with Refractory Diabetic Macular Edema to Intravitreal Fluocinolone Acetonide (Iluvien): A Retrospective Cost Analysis Study.

IntroductionIt is hypothesized that using fluocinolone acetonide (FAc) implants such as Iluvien for the treatment of diabetic macular edema (DME) may reduce the total number of intravitreal injections and clinic visits, resulting in an overall treatment cost reduction. The primary aim of this study is to identify the real-world cost savings achievable in a tertiary National Health Service (NHS) hospital.MethodsA retrospective cost analysis study was conducted. The inclusion criteria were patients with refractory DME who were switched to Iluvien. The average yearly costs were calculated both before and after the switch to Iluvien. All costs including medicines, investigations, clinics, and management of raised intraocular pressure (IOP) were calculated. The cost differences over the 3 years’ worth of Iluvien treatment were calculated and analyzed. To ensure non-inferiority of this treatment intervention, the best corrected visual acuity (BCVA) and central retinal thickness (CRT) were also analyzed. Statistical analysis was conducted with a Student t test where appropriate and statistical significance is identified where p < 0.05.ResultsFourteen eyes of 13 patients met the inclusion criteria. Switching patients to Iluvien achieved on average a saving of £2606.17 per patient (p = 0.33) over the 3 years. However, seven cases (50%) had a rise in IOP after Iluvien that warranted medical treatment and two cases (14.3%) required glaucoma surgery. Incorporating the costs of glaucoma management reduced the overall savings over 3 years to £1064.66 per patient. The BCVA and CRT analysis showed a non-inferiority relationship between Iluvien and any previous treatment.ConclusionsThe use of Iluvien in refractory DME patients represents a cost- and time-saving procedure, while showing non-inferiority in terms of efficacy.

Iatrogenic intraocular pressure elevation after repeated intravitreal injection, a prospective cohort study

PurposeTo report the rate of intraocular pressure (IOP) elevation after repeated intravitreal injections (IVIs) of anti–vascular endothelial growth factor (anti‐VEGF) agents and to assess its evolution over time.MethodsOur study was a prospective cohort including 221 patients (253 eyes) with exudative age‐related macular degeneration (AMD) or diabetic macular edema, undergoing ranibizumab (n =207) or aflibercept (n=44) or bevacizumab (n = 21) IVIs. Patients who received intravitreal or periocular corticosteroid injection were excluded. The incidence of ocular hypertension (OHT) after these injections was investigated with respect to the number of injections, pre‐existing open‐angle glaucoma, diabetes, YAG capsulotomy, age, and sex.Results1721 IVIs was performed. After a mean of 7.3‐4.1 IVIs (range 3‐62), 10 (4.6%) had IOP elevation more than 25 mmHg and required medical treatment, 1.4% of them spiked above 30 mmHg. 12 patients received medical treatment (10 monotherapies and 2 dual therapies), no surgical or laser treatment was required.Patients with pre‐existing glaucoma experienced higher prevalence of OHT (11.9%) and greater rates than the control group (19.3‐6.2 mmHg vs 15.6‐5.2 mmHg, p&lt;0.001). No significant difference was found in the diabetes subgroup (81(??%, p=0.55) or in the YAG capsulotomy subgroup (32(??%, p= 0.44) compared with the control group. The IOP peak was significantly correlated with the total number of IVIs (p=0.0002). Results are consistent with previous work on the oldest cohort.ConclusionsSerial IVIs may lead to persistent IOP elevation that requires medical IOP‐lowering therapy. The risk is correlated with the number of injections and increases in the glaucoma population, therefore should be checked during follow‐up.

Two-year results of a treat-and-extend regimen with aflibercept for polypoidal choroidal vasculopathy.

To evaluate the effects of aflibercept therapy using a treat-and-extend regimen on treatment-naïve polypoidal choroidal vasculopathy (PCV). In a retrospective interventional case series of 58 eyes of 58 patients with PCV, we assessed best-corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT), and number of injections for 2years. Polypoidal lesions were also evaluated before treatment and after the loading phase by indocyanine green angiography. BCVA significantly improved after the loading phase and was maintained in the maintenance phase. CMT and CCT significantly reduced after the loading phase and were maintained throughout the follow-up period. The number of injections averaged 7.72 in the first year and 4.67 in the second year. The average number of polypoidal lesions per patient was 2.43 before treatment. In 32 patients (55.2%), polypoidal lesions regressed completely after the loading phase; these patients also needed significantly fewer injections compared to other patients. CCT at baseline was positively correlated with the decreased amount of CCT after 2years and negatively correlated with the number of injections for 2years. Treat-and-extend intravitreal therapy with aflibercept may be effective for improving BCVA and exudative change in eyes with PCV. The regression of polypoidal lesions after the loading phase and thicker choroid at baseline might lead to fewer total number of intravitreal injections of aflibercept.

Experience of intravitreal triamcinolone acetonide for treatment of diabetic macular edema among Omani population.

PURPOSE:The purpose of this study was to evaluate the outcome of intravitreal (IVT) triamcinolone in diabetic macular edema (DME).MATERIALS AND METHODS:A retrospective study of 42 eyes diagnosed clinically and supported with optical coherence tomography (OCT), with DME of more than 300 μm in thickness. All eyes were injected with a single IVT injection of preservative free triamcinolone acetonide (TA) with dose of 4 mg. Patients were subjected to visual acuity (VA) and OCT on each follow-up visit which was continued for 6 months. The total number of IVT injections given was 48. Six eyes had a repeat injection. None of the eyes had any other IVT injection within 6 weeks of TA. Twenty-one eyes were pseudophakic.RESULTS:Mean age of the patients was 58.8 years. The mean central subfield thickness (CST) at baseline was 504.6 μm. At 6 weeks, the mean CST dropped by 183.6 μm (P < 0.00001). At 6-month follow-up, the mean CST had increased by 74.6 μm from 6 weeks level; however, the 6-month mean CST was 109 μ less than mean baseline thickness (P < 0.0005). The mean baseline VA was 0.80 LogMAR units. At 6 weeks, the mean VA dropped by 0.01 LogMAR. At 6 months, VA improved by 0.02 LogMAR units from baseline. Overall, VA improved in 47% eyes, dropped from baseline in 35% eyes, and remained unchanged in 18% eyes.CONCLUSION:Triamcinolone acetonide is a safe, effective, and promising therapy in DME.

Arteriosclerotic Changes after Intravitreal Injections of Anti-Vascular Endothelial Growth Factor Drugs in Patients with Exudative Age-Related Macular Degeneration

Purpose: The aim of this study was to determine whether multiple intravitreal injections of anti-vascular endothelial growth factor (VEGF) drugs for age-related macular degeneration (AMD) exacerbate systemic arteriosclerosis, using the cardio-ankle vascular index (CAVI) and intima-media thickness (IMT). Methods: We analyzed the data of 45 AMD patients who received intravitreal injections of anti-VEGF drugs (ranibizumab and/or aflibercept) and underwent systemic evaluations at baseline and after treatment. Reevaluation was conducted at ≥12 months from the initial treatment. Results: The total number of intravitreal injections of overall anti-VEGF drugs was significantly correlated with Δserum cystatin C. The cumulative number of aflibercept injections was identified as an independent protective factor for ΔCAVI. An increase in the cumulative number of intravitreal injections of overall anti-VEGF drugs was identified as a protective factor for Δmean IMT. Conclusion: Repeated intravitreal injections of an anti-VEGF drug for AMD may lead to morphological and functional changes in large arteries.

INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR CHOROIDAL NEOVASCULARIZATION SECONDARY TO PATHOLOGIC MYOPIA

To report the visual outcome after 6-year follow-up in highly myopic eyes with choroidal neovascularization treated with anti-vascular endothelial growth factor drugs. Retrospective, nonrandomized, multicenter, consecutive, and interventional case series. Seventy-eight patients were treated with intravitreal bevacizumab and 19 with ranibizumab. Mean age of the patients was 56.5 years (SD, 13.3). The average number of letters read was 56.7 (SD, 19.0) at baseline; 65.7 (SD, 18.4) at 12 months; 63.6 (SD, 20.6) at 24 months; 62.4 (SD, 21.4) at 36 months; 60.6 (SD, 22.0) at 48 months; 58.9 (SD, 22.9) at 60 months, and 58.4 (SD, 22.7) at 72 months (P < 0.01, between initial vs. 12, 24, and 36 months; P = 0.07, 0.3, and 0.5 between initial vs. 48, 60, and 72 months, respectively; Student's t-test paired data). The mean total number of intravitreal injections was 3.3 (SD, 2.3; range, 1-9). Bevacizumab and ranibizumab are effective therapies and show similar clinical effects in myopic eyes with choroidal neovascularization. Visual acuity gain is maintained at a 3-year follow-up. The improvement is no longer statistically significant at Years 4, 5, and 6.

Repeated intravitreal anti–vascular endothelial growth factor injections can induce iatrogenic ocular hypertension, especially in patients with open-angle glaucoma

ObjectiveTo report the rate of intraocular pressure (IOP) elevation after repeated intravitreal injections (IVIs) of anti–vascular endothelial growth factor (anti-VEGF) agents and to determine the risk factors. MethodsA total of 193 patients (217 eyes) undergoing ranibizumab (n = 196) or bevacizumab (n = 21) IVIs were prospectively examined. The incidence of ocular hypertension (OHT) after these injections was investigated with respect to the number of injections, pre-existing open-angle glaucoma, diabetes, YAG capsulotomy, age, and sex. ResultsA total of 1461 IVIs was performed. After a mean of 6.7 ± 7.1 IVIs (range, 1–49), 4.6% (n = 10) had IOP elevation more than 25 mm Hg and required medical treatment (1.4% of them spiked above 30 mm Hg). Patients with pre-existing glaucoma experienced higher prevalence of OHT (12.9%) and greater rates than the control group (19.6 ± 5.7 mm Hg vs 16.4 ± 3.9 mm Hg, p < 0.001). No significant difference was found in the diabetes subgroup (n = 66, p = 0.62) or in the YAG capsulotomy subgroup (n = 24, p = 0.51) compared with the control group. The IOP peak was significantly correlated with the total number of IVIs (p = 0.0002, r = 0.25). ConclusionsSerial IVIs may lead to persistent IOP elevation that requires IOP-lowering therapy. The risk is correlated with the number of injections and increases in the glaucoma population, and must be checked during follow-up.