scholarly journals Anti-VEGF Agents for Ocular Angiogenesis and Vascular Permeability

2012 ◽  
Vol 2012 ◽  
pp. 1-11 ◽  
Author(s):  
Kenichi Kimoto ◽  
Toshiaki Kubota
Keyword(s):  
Intravitreal Injection ◽  
Neovascular Glaucoma ◽  
Therapeutic Window ◽  
Panretinal Photocoagulation ◽  
Drug Trials ◽  
Ocular Angiogenesis ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
Stage 4 ◽  
Treatment Paradigm

We review articles describing intravitreal injection of anti-VEGF drug trials, while discussing the mechanisms of the action of anti-VEGF antibodies, and also evaluating their outcomes. Intraocular injections of anti-VEGF drug are considered to be an effective treatment for macular edema after retinal vein occlusion, however, recurrent/persistent edema is common. The recent reports may lead to a shift in treatment paradigm for DME, from laser photocoagulation, to newer approaches using anti-VEGF drugs. There have been several well-publicized prospective, randomized studies that demonstrated the efficacy of intravitreal injection of anti-VEGF drugs for patients with AMD. Adjuvant bevacizumab for neovascular glaucoma may prevent further PAS formation, and it is likely to open up a therapeutic window for a panretinal photocoagulation and trabeculectomy. Intravitreal injection of bevacizumab (IVB) results in a substantial decrease in bleeding from the retinal vessels or new vessels during a standard vitrectomy. IVB has also been reported to be effective for inducing the regression of new vessels in proliferative diabetic retinopathy. The use of bevacizumab in stage 4 or 5 retinopahty of permaturity (ROP) is to reduce the plus sign to help reduce hemorrhage during the subsequent vitrectomy. Some authors reported cases of resolution of stage 4 A ROP after bevacizumab injection.

Anti-VEGF for Management of Neovascularization of Iris and Neovascular Glaucoma

2018 ◽  
Vol 2 (4) ◽  
pp. 194-199
Author(s):  
Tian Xia ◽  
Marco A. Zarbin ◽  
Neelakshi Bhagat
Keyword(s):  
Retinal Vein Occlusion ◽  
Anterior Segment ◽  
Vitreous Hemorrhage ◽  
Corneal Edema ◽  
Neovascular Glaucoma ◽  
Panretinal Photocoagulation ◽  
Complete Regression ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
Endothelial Growth Factor

Purpose: To study the treatment effect of antivascular endothelial growth factor (anti-VEGF) injections on eyes with iris neovascularization (NVI). Methods: Retrospective study of patients who underwent intravitreal anti-VEGF for the treatment of NVI at the Rutgers-Institute of Ophthalmology and Visual Sciences between January 1, 2007 and March 30, 2017. Results: Twenty-eight eyes (mean age, 63 ± 13 years old, 12 [43%] males) were identified. All patients had NVI, and 23 patients had concurrent neovascular glaucoma. The etiology of anterior segment ischemia was proliferative diabetic retinopathy in 20 eyes (71%), central retinal vein occlusion in 7 eyes (25%), and branch retinal vein occlusion in 1 eye (4%). Corneal edema in 25 eyes (89%), hyphema in 11 (39%), visually significant cataract in 25 (86%), and vitreous hemorrhage in 15 (54%) precluded an adequate view to the fundus to perform panretinal photocoagulation (PRP). All patients initially received anti-VEGF therapy; PRP was provided in some eyes ( n = 7) with persistent NVI if the view to the fundus improved. On average, 1.66 (median, 1; standard deviation [SD], 1.64) anti-VEGF injections were performed before complete NVI regression was achieved. Complete regression of rubeosis iridis took an average of 42 (median, 40; SD, 48) days from the first injection. Ten eyes (36%) had recurrence of rubeosis at 198 (median, 126; SD, 165) days after complete regression of NVI. Conclusions: NVI regression was noted in all eyes. Anti-VEGF may be a good supplement for initial NVI management in eyes when PRP cannot be initiated.

scholarly journals Retinal venous pressure is decreased after anti-VEGF therapy in patients with retinal vein occlusion–related macular edema

2021 ◽  
Author(s):  
Teruyo Kida ◽  
Josef Flammer ◽  
Katarzyna Konieczka ◽  
Tsunehiko Ikeda
Keyword(s):  
Macular Edema ◽  
Intravitreal Injection ◽  
Retinal Vein Occlusion ◽  
Venous Pressure ◽  
Decisive Role ◽  
Retinal Venous Pressure ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
Significant Difference ◽  
Endothelial Growth Factor

Abstract Purpose The pathomechanism leading to retinal vein occlusion (RVO) is unclear. Mechanical compression, thrombosis, and functional contractions of veins are discussed as the reasons for the increased resistance of venous outflow. We evaluated changes in the retinal venous pressure (RVP) following intravitreal injection of anti-vascular endothelial growth factor (VEGF) agent to determine the effect on RVO-related macular edema. Methods Twenty-six patients with RVO-related macular edema (16 branch RVOs [BRVOs] and 10 central RVOs [CRVOs], age 72.5 ± 8.8 years) who visited our hospital were included in this prospective study. Visual acuity (VA), intraocular pressure (IOP), central retinal thickness (CRT) determined by macular optical coherence tomography, and RVP measured using an ophthalmodynamometer were obtained before intravitreal injection of ranibizumab (IVR) and 1 month later. Results Comparison of the BRVOs and CRVOs showed that VA was significantly improved by a single injection in BRVOs (P < 0.0001; P = 0.1087 for CRVOs), but CRT and RVP were significantly decreased without significant difference in IOP after the treatment in both groups (P < 0.0001). Conclusion The anti-VEGF treatment resulted in a significant decrease in the RVP, but the RVP remained significantly higher than the IOP. An increased RVP plays a decisive role in the formation of macula edema, and reducing it is desirable.

scholarly journals Aflibercept as Adjunctive Treatment for Filtration Surgery in Neovascular Glaucoma

2022 ◽  
Vol 74 (1) ◽  
pp. 27-33
Author(s):  
Naris Kitnarong ◽  
Janyawassamon Kittipiriyakul ◽  
Anuwat Jiravarnsirikul
Keyword(s):  
Neovascular Glaucoma ◽  
Additional Treatment ◽  
Adjunctive Treatment ◽  
Panretinal Photocoagulation ◽  
Vein Occlusion ◽  
Corrected Visual Acuity ◽  
Intravitreal Aflibercept ◽  
The One ◽  
Ischemic Syndrome

Objective: To investigate intravitreal aflibercept (IVA) injection as an adjunctive treatment to trabeculectomy with mitomycin C (TMC) and panretinal photocoagulation (PRP) for neovascular glaucoma (NVG).Materials and Methods: PRP and IVA (2 mg/0.05 ml) injection were given, and TMC was performed within 2weeks after IVA. Additional PRP, laser suture lysis, subconjunctival 5-fluorouracil injection, and bleb needlingwere performed after TMC if indicated. Best corrected visual acuity (BCVA), intraocular pressure (IOP), surgicalcomplications, and number of anti-glaucoma medications were collected.Results: Five eyes from 5 consecutive patients were included. Two eyes had proliferative diabetic retinopathy (PDR), 2 central retinal vein occlusion, and 1 ocular ischemic syndrome (OIS) (mean initial IOP: 46.8±6.8 mmHg). NVI regression occurred in one eye after PRP alone, and in one eye after PRP and IVA resulting in a good IOP control with topical medical therapy. The other 3 underwent TMC. The preoperative IOP was 34 (OIS), 54 (PDR), and 50 (PDR) mmHg. The 3-month postoperative IOP decreased to 8, 8, and 4 mmHg, respectively, and to 21, 10, and 6 mmHg, respectively, at the last visit. Only the one OIS eye required postoperative topical IOP-lowering medications. Final BCVA was improved, unchanged, and decreased in 2, 2, and 1 eye, respectively. No intraoperative/postoperative complications or NVI recurrence were observed (mean follow-up: 10.7 months).Conclusion: Intravitreal aflibercept was shown to be a potentially effective additional treatment to PRP and TMC in patients with NVG.

scholarly journals The Effect of Antivascular Endothelial Growth Factor Therapy on the Development of Neovascular Glaucoma after Central Retinal Vein Occlusion: A Retrospective Analysis

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Christina L. Ryu ◽  
Adrian Elfersy ◽  
Uday Desai ◽  
Thomas Hessburg ◽  
Paul Edwards ◽  
...  
Keyword(s):  
Macular Edema ◽  
Retinal Vein Occlusion ◽  
Central Retinal Vein Occlusion ◽  
Significant Risk ◽  
Case Series ◽  
Neovascular Glaucoma ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
Central Retinal Vein

Purpose. Ischemic central retinal vein occlusion (CRVO) eyes are at high risk of developing neovascular glaucoma (NVG). Our purpose is to investigate the effect of anti-VEGF therapy for macular edema after CRVO on the development of neovascular glaucoma (NVG) in ischemic CRVO eyes.Methods. This is a retrospective case series of 44 eyes from 44 patients with CRVO treated with anti-VEGF therapy for macular edema. The primary outcome was the development of NVG.Results. Of the 44 eyes, 14 eyes had ischemic CRVO, and 30 eyes had nonischemic CRVO. Nonischemic eyes received a mean of 8.4 anti-VEGF doses, over mean follow-up of 24 months. One nonischemic eye (3.3%) developed NVD but not NVG. The 14 ischemic eyes received a mean of 5.6 anti-VEGF doses, with mean follow-up of 23 months. Of these 14 ischemic eyes, two eyes (14%) developed iris neovascularization and 3 eyes (21%) developed posterior neovascularization. Three of these 5 eyes with neovascularization progressed to NVG, at 19.7 months after symptom onset, on average.Conclusion. Anti-VEGF therapy for macular edema may delay, but does not prevent, the development of ocular NV in ischemic CRVO. Significant risk of NVG still exists for ischemic CRVO eyes.

scholarly journals Anti-VEGF Therapy and the Retina: An Update

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
Vikas Tah ◽  
Harry O. Orlans ◽  
Jonathan Hyer ◽  
Edward Casswell ◽  
Nizar Din ◽  
...  
Keyword(s):  
Macular Oedema ◽  
Diabetic Macular Oedema ◽  
Visual Outcome ◽  
Retinal Diseases ◽  
Ocular Angiogenesis ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
Sight Loss ◽  
Endothelial Growth Factor ◽  
The Impact

Ocular angiogenesis and macular oedema are major causes of sight loss across the world. Aberrant neovascularisation, which may arise secondary to numerous disease processes, can result in reduced vision as a result of oedema, haemorrhage, and scarring. The development of antivascular endothelial growth factor (anti-VEGF) agents has revolutionised the treatment of retinal vasogenic conditions. These drugs are now commonly employed for the treatment of a plethora of ocular pathologies including choroidal neovascularisation, diabetic macular oedema, and retinal vein occlusion to name a few. In this paper, we will explore the current use of anti-VEGF in a variety of retinal diseases and the impact that these medications have had on visual outcome for patients.

scholarly journals What is the impact of intravitreal injection of conbercept on neovascular glaucoma patients: a prospective, interventional case series study

2019 ◽  
Author(s):  
Liukun Shi ◽  
Jin Yang ◽  
Jinyong Lin
Keyword(s):  
Electron Microscopy ◽  
Light Microscopy ◽  
Intravitreal Injection ◽  
Aqueous Humour ◽  
Neovascular Glaucoma ◽  
Panretinal Photocoagulation ◽  
The Mean ◽  
The Impact ◽  
Tgf Β1

Abstract Background The aim of the present study was to evaluate the efficacy and safety of intravitreal conbercept combined with trabeculectomy and panretinal photocoagulation for neovascular glaucoma (NVG). Methods Fifty patients (54 eyes) with NVG were included in this prospective study. Fifty-two eyes initially underwent intravitreal conbercept (0.5mg/0.05ml), and then trabeculectomy and panretinal photocoagulation were performed. Preoperative and postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of antiglaucoma medications, and surgical complications were recorded. The levels of VEGF-A, TGF-β1 and PLGF in aqueous humour that were collected during surgery were measured by enzyme-linked immunoabsorbent assay (ELISA). Light microscopy and transmission electron microscopy were used to observe the surgically excised trabecular tissue; enucleation was performed for 2 eyes, and light microscopy was used as the histopathological control. Results The follow-up period after trabeculectomy was 1 year. Of the 52 eyes, 39 eyes completed the 1-year follow-up and 13 eyes were lost to follow up. Recurrence of iris neovascularization was observed in 5 eyes, 9 eyes had hyphema, 16 eyes had filter bled scarring, no eye had complication attributable to the drug. The mean IOP was reduced from 48.1±14.2 mmHg to 23.2±8.7 mmHg, and the mean number of antiglaucoma medications used decreased from 3.0 (3.0, 4.0) to 1.0 (0.0, 1.0) at 1 year (both P < 0.05). The complete success rate was 76.9%, 76.9%, 71.0%, 51.6%, 32.3% at 1week, 1 month, 3 months, 6 months and 12months when the cut off of IOP was 18mmHg. After patients underwent intravitreal injection, the concentrations of VEGF-A and TGF-β1 in aqueous humour in NVG patients decreased from 168.8±13.4 pg/ml and 159.6±15.4 pg/ml to 160.2±7.6 pg/ml and 151.9±2.3 pg/ml, respectively (both P < 0.05). Light microscopy revealed neovascularization regression in the iris in specimens with intravitreal conbercept. Electron microscopy revealed trabecular endothelial cells degeneration in the conbercept-treated specimens. Conclusions Our initial findings suggest that intravitreal conbercept is an effective treatment for managing neovascular glaucoma, with fewer postoperative complications in the short-term. Trial registration Current Controlled Trials ChiCTR1800019918, 8 December 2018, Retrospectively registered.

scholarly journals Retinal Function determined by Flicker ERGs before and soon after Intravitreal Injection of Anti-VEGF Agents

2019 ◽  
Author(s):  
Gaku Terauchi ◽  
Kei Shinoda ◽  
Hiroyuki Sakai ◽  
Makoto Kawashima ◽  
Soichi Matsumoto ◽  
...  
Keyword(s):  
Macular Edema ◽  
Intravitreal Injection ◽  
Phase 1 ◽  
Retinal Function ◽  
Age Related Macular Degeneration ◽  
Implicit Time ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
Age Related ◽  
Endothelial Growth Factor

Abstract Background: To evaluate the retinal function before and soon after an intravitreal injection of an anti-vascular endothelial growth factor (anti-VEGF) agents. Methods: Seventy-nine eyes of 79 patients that were treated by an intravitreal injection of an anti-VEGF agent for age-related macular degeneration (AMD), diabetic macular edema (DME), or retinal vein occlusion (RVO) with macular edema (ME) were studied. The RETeval® system was used to record 28 Hz flicker electroretinograms (ERGs) from the injected and non-injected eyes before (Phase 1, P1), within 2 hours after the injection (P2), and 2 to 24 hours after the injection (P3). Patients were grouped by disease or by the injected agent and compared. The significance of the changes in the implicit times and amplitudes was determined by t tests. Results: The amplitudes were not significantly different at the three phases. The implicit time of the injected eye was 31.2±3.2 msec at P1, and it was not significantly different at P2 (31.7±3.1 msec) but it was significantly longer at P3 (32.2±3.3 msec, P<0.01, ANOVA for both). The implicit time in the non-injected fellow eye was 30.5±3.3 msec at P1, and it was significantly longer at P2 (31.1±3.2 msec) and phase 3 (31.3±3.4 msec, P<0.01, ANOVA for both). Conclusions: The results indicate that an intravitreal anti-VEGF injection will increase the implicit times not only in the injected eye but also in the non-injected eye soon after the intravitreal injection.

scholarly journals The Role of Steroids in the Management of Macular Edema from Retinal Vein Occlusion

2019 ◽  
Vol 16 (1) ◽  
pp. 95-101
Author(s):  
M. V. Budzinskaya ◽  
A. V. Shelankova ◽  
A. A. Plukhova ◽  
N. M. Nuriyeva ◽  
A. S. Sorokin
Keyword(s):  
Macular Edema ◽  
Intravitreal Injection ◽  
Retinal Vein Occlusion ◽  
Intravitreal Injections ◽  
Ophthalmological Examination ◽  
Dexamethasone Implant ◽  
Duration Of Treatment ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
Group 1

Aim: To analyze the effectiveness of intravitreal injection of an anti-VEGF agent (ranibizumab) and an dexametazon implant for the intravitreal injection, in real clinical life.Patients and Methods. 137 patients with MO due to retinal venous occlusion were included in the study. Patients were retrospectively divided into groups: patients who received monotherapy with ranibizumab 94 people; and monotherapy with dexamethasone implant — 15 patients; patients who initially were injected with a dexamethasone implant, but due the study transferred to ranibizumab 15 patients; patients who initially received ranibizumab, but then transferred to the dexamethasone implant -13. For the treatment of macular edema were used an anti-VEGF agent — ranibizumab (Lucentis) 0.05 ml (0.5 mg) manufactured by Novartis (Switzerland) or glucocorticosteroid — dexamethasone implant for intravitreal injection of 0.7 mg (Ozurdex) manufactured by Allergan Pharmaceutical Ireland (Ireland). The injections were administered on a pro re nata basis (the presence of macular edema). Standard ophthalmological examination and fluorescent angiography (PAG), optical coherent tomography (OCT), optical coherence tomography angiography (OCT-A) were used. Visual acuity changes (BCVA), central retinal thickness (CRT) and intraocular pressure (IOP) were analyzed depending on the study group (group 1–4), the duration of treatment and the number of injections. Results: In group 1, from 1 to 8 IVVs were performed in 24 months, an average of 3.77. In group 2, from 1 to 4 intravitreal injections were performed in 24 months, an average of 1.37. In group 3, from 1 to 2 of intravitreal injections Ozurdex and from 1 to 4 intravitreal injections of ranibizumab for 24 months. In group 4, from 1 to 4 intravitreal injections of anti-VEGF drug and from 1 to 4 intravitreal dexamethasone implant were performed in 24 months of follow-up. Monotherapy with the Ozurdex drug (12 months) had the most stable effect, with a relapse of the process, repeated injections were required, conducted only in 3 out of 15 patients. Conclusion: In real clinical practice, the dexamethasone implant showed a good safety profile and high efficacy in the resorption of macular edema in patients with retinal vein occlusion, which corresponds to the clinical trials that was made earlier. 

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