Anterior chamber paracentesis during intravitreal injections in observational trials: effectiveness and safety and effects

Saxena, Sandeep; Lai, Timothy Y Y; Koizumi, Hideki; Farah, Michel Eid; Ferrara, Daniela; Pelayes, David E.; Sato, Tomohito; Meyer, Carsten H.; Murray, Timothy G.

doi:10.1186/s40942-019-0157-z

Cited by 24 publications

(16 citation statements)

References 48 publications

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“…The mean IOP normalized at 15 min for the pretreatment group, whereas this was only the case after 30 min for the control group 112 . Additionally, several studies have shown that prophylactic anterior chamber paracentesis is a safe and effective option for preventing IOP spikes after an intravitreal injection 87,113,114 . Most notably, Enders et al found a significant RNFL-loss in patients who had not undergone anterior chamber paracentesis prior to their intravitreal injections, but could not find a significant reduction in RNFL-thickness in those who did 115 .…”

Section: Summary Of Findingsmentioning

confidence: 99%

The effects of intravitreal injections on intraocular pressure and retinal nerve fiber layer: a systematic review and meta-analysis

Vries

Bassil

Ramdas

2020

Sci Rep

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The number of eye diseases treated with intravitreal injections is increasing. Obviously, an injection of fluid into the eye results in an increase of intraocular pressure (IOP), the main risk factor for glaucoma. However, the effect of these repeated IOP increases on the eye is unclear. Therefore, we performed a systematic review with meta-analyses. PubMed, Embase and Clinical Trials Registries were searched for articles investigating the relationship between intravitreal injections (anti-vascular endothelial growth factor [anti-VEGF] or steroids) and either IOP, retinal nerve fiber layer (RNFL)thickness and glaucoma. Multiple meta-analyses were performed, combining data on intravitreal injection of anti-VEGF medication and dexamethasone implants. A total of 74 articles were eligible for meta-analyses. The short-term effect of an intravitreal injection of anti-VEGF showed a statistically significant increase in IOP. One day after injection of anti-VEGF, however, IOP was significantly lower than baseline. The long-term time-intervals showed no significant difference in IOP. After intravitreal injection of a dexamethasone implant, IOP was significantly higher than baseline 1 month postinjection. RNFL-thickness was significantly reduced 6 and 12 months post-injection of anti-VEGF, as well as at end of follow up. Caution is advised when using intravitreal medication, especially when treating patients with advanced glaucoma; in these cases, prophylactic IOP-lowering medication may be considered.

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Section: Summary Of Findingsmentioning

confidence: 99%

The effects of intravitreal injections on intraocular pressure and retinal nerve fiber layer: a systematic review and meta-analysis

Vries

Bassil

Ramdas

2020

Sci Rep

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“…Ocular fluids comprising AH and vitreous humor have been reported to reflect intraocular immune environment in AMD ( 17 , 18 , 31 ), proliferative diabetic retinopathy ( 32 ), and uveitis ( 33 , 34 ). Since sampling of AH is easier and safer compared to vitreous fluid ( 17 , 18 ), AH has been recognized as an ideal biological specimen to examine the pathology of ocular diseases ( 35 ). Our group has reported the participation of inflammatory cytokines including IP-10, MCP-1, and MIP-1β in the pathophysiology of nAMD ( 17 , 18 ).…”

Section: Discussionmentioning

confidence: 99%

Inflammatory Factors of Macular Atrophy in Eyes With Neovascular Age-Related Macular Degeneration Treated With Aflibercept

et al. 2021

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BackgroundNeovascular age-related macular degeneration (nAMD) is a leading cause of blindness in older people. Low-grade inflammation is well-known as one of the pathogenic mechanisms in nAMD. Anti-vascular endothelial growth factor (VEGF) therapy is the first-line treatment for nAMD, although macula atrophy (MA) developed under anti-VEGF therapy causes irreversible visual function impairment and is recognized as a serious disorder. Here, we show specific expression patterns of aqueous humor (AH) cytokines in nAMD eyes developing MA under intravitreal injection of aflibercept (IVA) as an anti-VEGF antibody and present predictive cytokines as biomarkers for the incidence of MA in nAMD eyes under IVA treatment.MethodsTwenty-eight nAMD patients received three consecutive monthly IVA, followed by a pro re nata regimen for 2 years. AH specimens were collected before first IVA (pre-IVA) and before third IVA (post-IVA). AH cytokine levels, visual acuity (VA), and central retinal thickness (CRT) were measured.ResultsTwo-year incidence of MA was 21.4%. In nAMD eyes developing MA [MA (+) group], pre-IVA levels of monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein (MIP)-1β, VEGF and post-IVA level of MCP-1 were higher than those in nAMD eyes without MA [MA (−) group]. In hierarchical cluster analysis, pre-IVA MCP-1 and VEGF were grouped into the same subcluster, as were post-IVA MCP-1 and CRT. In principal component analysis, principal component loading (PCL) of pre-IVA interferon-γ-inducible protein 10 (IP-10) was 0.61, but PCL of post-IVA IP-10 decreased to −0.09. In receiver operating characteristic analysis and Kaplan–Meier curves, pre-IVA MCP-1, MIP-1β, and VEGF and post-IVA interleukin-6, MCP-1, and MIP-1β were detected as predictive factors for MA incidence. In 2-year clinical course, changes of VA in groups with high levels of pre-IVA MIP-1β (over 39.9 pg/ml) and VEGF (over 150.4 pg/ml) were comparable to those in MA (+) group.ConclusionSubstantial loss of IP-10 effects and persistent inflammation contribute to incidence of MA, and screening of AH cytokine levels could be a useful method to predict MA incidence in nAMD eyes under anti-VEGF therapy.

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“…ППК регулярно применяют в качестве профилактики повышения ВГД после интравитреальных инъекции анти-VEGF препаратов, глюкокортикостероидов и др. [6,20].…”

Section: Discussionunclassified

Safety and efficacy of anterior chamber paracentesis with simultaneous intracameral administration of 0.5% pilocarpine in dogs and cats with glaucoma of various etiologies

Бояринов¹,

Boyarinov

2019

Russian Veterinary Journal

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Purpose. In animals with glaucoma to determine the technique for conducting ACP with simultaneous administration of a 0.5 % pilocarpine solution, to identify the dynamics of IOP reduction, as well as effectiveness of this procedure both after and in the long term. Based on analysis of data obtained, highlight the complications of this procedure. Materials and methods. Study included 37 animals (39 eyes): 24 dogs and 13 cats with glaucoma, which, according to anamnesis, developed no more than 10 days without any preliminary ocular hypotensive therapy. All animals underwent ACP without general anesthesia or sedation. Immediately before procedure, animals were instilled with a local anesthetic in conjunctival sac (0.5% proxymethacaine). ACP was performed under 6-fold magnification using a 27G headlamp with 9 hours for right eye and 3 hours for left eye. A puncture was carried out at periphery of cornea 1 mm from limbus. Volume of aspirated AH was no more than 2 drops. After that, needle was removed from the AC. Next step was intracameral injection of 0.5% solution of pilocarpine through hole of paracentesis. Volume of injected solution did not exceed 0.3 ml. After paracentesis and administration of pilocarpine solution, subconjunctival administration of dexamethasone solution in combination with gentamicin and novocaine was performed. Immediately after ACP, antihypertensive therapy was prescribed from a combination of eye drops: synthetic analogues of prostaglandins F2α (travoprost 0.004%) in combination with non-selective beta-blockers (timolol maleate 0.5%), as well as carbonic anhydrase inhibitors (brinzolamide 1%) every 12 hours. Results. Average IOP was in animals before ACP 60.26 ± 16.32 mmHg; immediately after procedure ― 10.15 ± 3.23 mm Hg; 1 hour after ACP ― 13.28 ± 3.09 mm Hg; after 7 days ― 17.61 ± 6.03. Immediately after intracameral administration of a 0.5% pilocarpine solution, we observed a rapid and pronounced narrowing of the pupil within 1…2 minutes. Myosis was noted for at least 1 hour after procedure. There were no adverse reactions from administration of pilocarpine solution in AC. Among complications after immediately 1 hour after the ACP, we encountered aqueous flare in 12 eyes (31% of cases) and moderate hyphema in 5 eyes (13% of cases). 7 days after procedure, no complications were observed. Conclusion. This study shows that ACP with simultaneous intracameral administration of 0.5% pilocarpine solution is effective in dogs and cats without any significant side effects. These results allow us to offer ACP as a procedure for an emergency reduction in IOP, especially in acute attacks of glaucoma in dogs and cats.

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Anterior chamber paracentesis during intravitreal injections in observational trials: effectiveness and safety and effects

Cited by 24 publications

References 48 publications

The effects of intravitreal injections on intraocular pressure and retinal nerve fiber layer: a systematic review and meta-analysis

The effects of intravitreal injections on intraocular pressure and retinal nerve fiber layer: a systematic review and meta-analysis

Inflammatory Factors of Macular Atrophy in Eyes With Neovascular Age-Related Macular Degeneration Treated With Aflibercept

Safety and efficacy of anterior chamber paracentesis with simultaneous intracameral administration of 0.5% pilocarpine in dogs and cats with glaucoma of various etiologies

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