Effect of intravitreal aflibercept (Eylea®) on retrobulbar hemodynamics in patients with neovascular age-related macular degeneration

Gök, Mustafa; Kaptı, Hasan Burhanettin

doi:10.1007/s10792-017-0522-6

Cited by 4 publications

(4 citation statements)

References 34 publications

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“…). More recently, this was also shown for intravitreal aflibercept (Gok & Kapti ). Lately, another paper reported significant vasoconstriction of the retinal arterioles after three monthly injections of aflibercept using a computer‐based approach (Tetikoğlu et al.…”

Section: Discussionsupporting

confidence: 54%

“…Hence, enhanced and sustained effects on ocular perfusion might be anticipated. Lately, reduced retrobulbar blood flow in the ophthalmic artery, central retinal artery and posterior ciliary artery was described 1 week after Intravitreal injection of aflibercept (IVA) (Gok & Kapti ). Significant vasoconstriction of the retinal arterioles was observed by another group following three monthly injections of aflibercept (Tetikoğlu et al.…”

Section: Introductionmentioning

confidence: 99%

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Short‐term effect on the ocular circulation induced by unilateral intravitreal injection of aflibercept in age‐related maculopathy

Mursch‐Edlmayr

Luft

Podkowinski

et al. 2019

Acta Ophthalmologica

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Purpose Intravitreal injection of anti‐vascular endothelial growth factor (anti‐VEGF) is the standard treatment for neovascular age‐related macular degeneration (AMD). As VEGF is a physiological key player for regulating retinal vascular tone, questions have been raised whether the application of anti‐VEGF could induce alterations in ocular perfusion. Methods The study included 20 eyes from 20 Caucasian patients with unilateral neovascular AMD and 20 fellow eyes. All eyes were treated with standard intravitreal injection of aflibercept (IVA). Measurements of blood flow at the optic nerve head (ONH) and the choroid were performed with laser speckle flowgraphy (LSFG). The intraocular pressure (IOP), systolic and diastolic blood pressure, heart rate, mean arterial pressure (MAP) and ocular perfusion pressure (OPP) were analysed. Measurements were performed at baseline and repeated immediately after the injection and 30 and 45 min later. Results Mean time between injection of aflibercept and first follow‐up was 8:56 ± 4:25 min. The injection led to significant rise in IOP. In the injected eyes, mean blur rate (MBR, i.e. a relative measure of perfusion and the main outcome parameter of LSFG) within the major vessels of the ONH as well as at the entire ONH region decreased significantly (p < 0.001). No change in MBR was observed in the fellow eye. Choroidal blood flow was maintained stable in both eyes. Conclusion Intravitreal injection of aflibercept (IVA) led to a short‐term reduction in perfusion only in the treated eye. This was independent from IOP, indicating a direct pharmacological effect. No changes in choroidal perfusion were observed during the first 45 min after the injection.

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Section: Discussionsupporting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Short‐term effect on the ocular circulation induced by unilateral intravitreal injection of aflibercept in age‐related maculopathy

Mursch‐Edlmayr

Luft

Podkowinski

et al. 2019

Acta Ophthalmologica

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“…It is also known that anti-VEGF drugs affect the ocular circulation. It has been reported that the ocular perfusion [31][32][33] and the choroidal thickness decreased after IVA or IVBr injections [34,35]. A laser blood flowmeter was used to show that ranibizumab decreased the retinal arterial vessel diameter, velocity, and blood flow in patients with nAMD who had received fewer ranibizumab treatments [36].…”

Section: Discussionmentioning

confidence: 99%

Subclinical Ocular Changes after Intravitreal Injections of Different Anti-VEGF Agents for Neovascular Age-Related Macular Degeneration

Matsubara,

Nagashima,

Chujo

et al. 2023

JCM

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Intraocular inflammations (IOIs) have been reported to occur after intravitreal injections of brolucizumab, and one of their causes has been suggested to be drug-specific features. We evaluated the anterior chamber by the aqueous flare value (AFV) and the retina by flicker electroretinography (ERG) after the initial intravitreal injection of aflibercept (IVA), brolucizumab (IVBr), or faricimab (IVF) for neovascular age-related macular degeneration (nAMD). The AFV and flicker ERGs were determined before, 2 weeks after, and 4 weeks after the injections in 14 eyes of 14 patients for each drug. After the injections, none of the patients had an IOI, but the AFV increased significantly in the IVA and IVF groups. The increase in the IVF group was +4.6 photon count/ms, which was significantly greater than in the other groups, but was not clinically significant. The implicit time was significantly prolonged in the IVBr group but unchanged in the IVA and IVF groups. These results suggest that brolucizumab, administered at high molar doses, may cause transient retinal disturbances that are not detectable by general ophthalmologic examinations but affect the implicit ERG times.

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“…CDI was also used to analyze the effects of panretinal photocoagulation on retrobulbar hemodynamics in diabetic patients, and higher blood flow velocities after treatment were detected [181]. Moreover, in neovascular age-related macular degeneration intravitreal injections of ranibizumab or aflibercept lead to reduced blood flow velocities in retrobulbar vessels [182,183].…”

Section: Clinical and Scientific Relevance Of Measuring Retrobulbar B...mentioning

confidence: 99%

Measurement of Retrobulbar Blood Flow and Vascular Reactivity—Relevance for Ocular and Cardiovascular Diseases

Böhm,

Grauhan,

Pfeiffer

et al. 2023

Diagnostics

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Abnormal retrobulbar hemodynamics have been linked to the development of various ocular diseases, including glaucoma, age-related macular degeneration, and diabetic retinopathy. Additionally, altered retrobulbar blood flow has been observed in patients with severe cardiovascular diseases, including carotid artery occlusion, stroke, heart failure, and acute coronary syndrome. Due to the complex and intricate anatomy of retrobulbar blood vessels and their location behind the eyeball, measurement of retrobulbar blood flow and vascular reactivity, as well as the interpretation of the findings, are challenging. Various methods, such as color Doppler imaging, computed tomography angiography or magnetic resonance imaging, have been employed to assess retrobulbar blood flow velocities in vivo. Color Doppler imaging represents a fast and non-invasive method to measure retrobulbar blood flow velocities in vivo. While no information about vessel diameter can be gained performing this method, computed tomography angiography and magnetic resonance imaging provide information about vessel diameter and detailed information on the anatomical course. Additionally, ex vivo studies, such as myography, utilizing genetically modified animal models may provide high optical resolution for functional vascular investigations in these small vessels. To our best knowledge, this is the first review, presenting a detailed overview of methods aiming to evaluate retrobulbar blood flow and vascular reactivity in both humans and laboratory animals. Furthermore, we will summarize the disturbances observed in retrobulbar blood flow in retinal, optic nerve, and cardiovascular diseases.

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Effect of intravitreal aflibercept (Eylea®) on retrobulbar hemodynamics in patients with neovascular age-related macular degeneration

Abstract: Single intravitreal administration of aflibercept alters retrobulbar blood flow velocities (BFVs) in both injected and uninjected fellow eyes in the short-term period.

Cited by 4 publications

References 34 publications

Short‐term effect on the ocular circulation induced by unilateral intravitreal injection of aflibercept in age‐related maculopathy

Short‐term effect on the ocular circulation induced by unilateral intravitreal injection of aflibercept in age‐related maculopathy

Subclinical Ocular Changes after Intravitreal Injections of Different Anti-VEGF Agents for Neovascular Age-Related Macular Degeneration

Measurement of Retrobulbar Blood Flow and Vascular Reactivity—Relevance for Ocular and Cardiovascular Diseases

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