Role of bevacizumab intraocular injection in the management of neovascular glaucoma

AIM:To assess the long-term effects of intraocular bevacizumab(Avastin)injections as an adjunctive drug to manage patients with neovascular glaucoma(NVG).METHODS:A retrospective study was conducted consisting of 34 eyes with secondary NVG caused by proliferative diabetic retinopathy(n=25),ischemic central retinal vein occlusion(n=8),and retinal ischemia resulting from persistent detachment(n=1)were managed by intraocular injections of bevacizumab(1.25 mg/0.05 m L),in addition to other treatments.The main outcome measure was the change in the degree of iris neovascularization.Secondary outcomes included intraocular pressure and the number of additional interventions or antiglaucoma medications administered after injection.RESULTS:All patients were followed-up for at least 12 mo.At the last follow-up,complete regression of rubeosis irides was detectable in 13(38.2%)eyes and incomplete regression in 21 eyes(61.8%).The mean intraocular pressure was 45.32±7.185 mm Hg at baseline and significantly decreased to 26.15±5.679 mm Hg at the last follow-up visit(P=0.000005).Patients received an average of 4.97 injections.As additional treatments,12 eyes(35%)received laser photocoagulation and 6 eyes(18%)underwent retinocryopexy.No further treatment was needed in 16 eyes(47.1%).CONCLUSION:Intravitreal bevacizumab injection can have a favorable effect in controlling intraocular pressure and pain control in patients with NVG because it decreases the angiogenesis and helps to augment the results of conventional procedures.The primary cause of retinal ischemia should be always targeted.

Effects of multiple intravitreal anti-VEGF injections on retinal nerve fiber layer and intraocular pressure: a comparative clinical study

Dear Sir,Ifound the article by Sobac1etal[1]very interesting.The authors concluded that repeated intravitreal injection(IVI)of ranibizumab or bevacizumab didn’t seem have adverse effects on retinal nerve fiber layer(RNFL)thickness in wet age-related macular degeneration(AMD)patients.

Intravitreal stem cell paracrine properties as a potential neuroprotective therapy for retinal photoreceptor neurodegenerative diseases

Retinal degenerations are the leading causes of irreversible visual loss worldwide. Many pathologies included under this umbrella involve progressive degeneration and ultimate loss of the photoreceptor cells, with age-related macular degeneration and inherited and ischemic retinal diseases the most relevant. These diseases greatly impact patients' daily lives, with accompanying marked social and economic consequences. However, the currently available treatments only delay the onset or slow progression of visual impairment, and there are no cures for these photoreceptor diseases. Therefore, new therapeutic strategies are being investigated, such as gene therapy, optogenetics, cell replacement, or cell-based neuroprotection. Specifically, stem cells can secrete neurotrophic, immunomodulatory, and anti-angiogenic factors that potentially protect and preserve retinal cells from neurodegeneration. Further, neuroprotection can be used in different types of retinal degenerative diseases and at different disease stages, unlike other potential therapies. This review summarizes stem cell-based paracrine neuroprotective strategies for photoreceptor degeneration, which are under study in clinical trials, and the latest preclinical studies. Effective retinal neuroprotection could be the next frontier in photoreceptor diseases, and the development of novel neuroprotective strategies will address the unmet therapeutic needs.

A Systematic Review of Clinical Studies Using VEGF Inhibitors in the Treatment of Macular Edema from Diabetic Retinopathy

Purpose: To synthesize the present clinical evidence of efficacy and adverse events of commonly used anti-VEGF drugs for Diabetic Macular Edema. Methods: A systematic review was undertaken from the Medline, Biosis, CINAHL, Cochrane and Web of Science databases. Grey literature that consisted of lectures, seminars and conferences was also retrieved. The cut-off date was January 1 2014. A two-stage screening process was undertaken followed by a data extraction stage using the systematic review software EPPI. These were done by two reviewers. Heterogeneous meta-analysis was performed on the primary outcome which was change in macular thickness from baseline after injection. Side effects were tabulated. Results: From 846 articles that were initially screened, 18 papers were included in the data extraction stage. For all anti-VEGF treatments, the average decrease in macular thickness was 114.4 microns (95% CI: 66.8 - 162 μM). The average decrease in thickness from Lucentis (161.9 μM) was larger than that for Avastin (96.5 μM) but this was not statistically significant (p = 0.23). The most common complications were vitreous hemorrhage, endophthalmitis and retinal detachment. Vision threatening complications were rare but were reported regularly. Conclusions: The synthesized clinical evidence to date supports both of these treatments as efficacious and safe for diabetic macular edema (DME). There is a trend toward greater efficacy for Lucentis over Avastin but this is not statistically significant and will need a head-to-head RCT to assess accurately.

Does amaurosis fugax after retrobulbar injection need any treatment？

Many potential complications resulting from .retrobulbar injection have been reported, from themore commonly encountered retrobulbar hemorrhage to the life-threatening respiratory arrest. As one of the major complications, the occurrence of amaurosis fugax may not be noted by the doctor during surgery since the patient may take it as normal and not report it to the surgeon after injection. Fortunately, in most of the cases the visual loss is transient and the patients with amaurosis fugax may recover their vision soon after an injection.