Ocular Hypertension and Intraocular Pressure Asymmetry After Intravitreal Injection of Anti–Vascular Endothelial Growth Factor Agents

Pershing, Suzann; Bakri, Sophie J.; Moshfeghi, Darius M.

doi:10.3928/23258160-20130909-07

Cited by 41 publications

(25 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…74,75 While some patients respond to intravitreal injection with sustained elevation of IOP, most do not even after multiple injections. [76][77][78][79][80][81][82] In our study, we performed intravitreal injection of drug-loaded NS once and observed IOPlowering effects out to 32 days (Fig. 4).…”

Section: Discussionmentioning

confidence: 62%

Nanosponge-Mediated Drug Delivery Lowers Intraocular Pressure

Lambert

Carlson

Ende

et al. 2015

Trans. Vis. Sci. Tech.

View full text Add to dashboard Cite

Purpose: We examined the efficacy of an extended-release drug delivery system, nanosponge (NS) encapsulated compounds, administered intravitreally to lower intraocular pressure (IOP) in mice.Methods: Bilateral ocular hypertension was induced in mice by injecting microbeads into the anterior chamber. Hypertensive mice received NS loaded with ocular hypotensive drugs via intravitreal injection and IOP was monitored. Retinal deposition and retinal ganglion cell (RGC) uptake of Neuro-DiO were examined following intravitreal injection of Neuro-DiO-NS using confocal microscopy.Results: Brimonidine-loaded NS lowered IOP 12% to 30% for up to 6 days (P , 0.02), whereas travoprost-NS lowered IOP 19% to 29% for up to 4 days (P , 0.02) compared to saline injection. Three bimatoprost NS were tested: a 400-nm NS and two 700-nm NS with amorphous (A-NS) or amorphous/crystalline (AC-NS) crosslinkers. A single injection of 400 nm NS lowered IOP 24% to 33% for up to 17 days compared to saline, while A-NS and AC-NS lowered IOP 22% to 32% and 18% to 26%, respectively, for up to 32 days (P , 0.046). Over time retinal deposition of Neuro-DiO increased from 19% to 71%; Neuro-DiO released from NS was internalized by RGCs.Conclusions: A single injection of NS can effectively deliver ocular hypotensive drugs in a linear and continuous manner for up to 32 days. Also, NS may be effective at targeting RGCs, the neurons that degenerate in glaucoma.Translational Relevance: Patient compliance is a major issue in glaucoma. The use of NS to deliver a controlled, sustained release of therapeutics could drastically reduce the number of patients that progress to vision loss in this disease.

show abstract

Section: Discussionmentioning

confidence: 62%

Nanosponge-Mediated Drug Delivery Lowers Intraocular Pressure

Lambert

Carlson

Ende

et al. 2015

Trans. Vis. Sci. Tech.

View full text Add to dashboard Cite

show abstract

“…Most studies report a return to baseline by 30-min post-procedure. There is also a suggestion of longterm IOP elevation in those with repeated antivascular endothelial growth factor injections, [15][16][17][18][19][20][21][22][23][24] although this is not universally accepted. 25,26 Studies have been performed on cadaver eyes to measure pressure changes with intraocular injections although these were performed decades ago, with different needle gauges and volumes than are currently used for common intravitreal injections.…”

Section: Introductionmentioning

confidence: 99%

Real‐time measurement of needle forces and acute pressure changes during intravitreal injections

Christensen¹,

Cerda²,

Olson³

2017

Clinical Exper Ophthalmology

View full text Add to dashboard Cite

Real-time continuous recordings of pressure reveal that an instantaneous intraocular pressure spike occurs during intravitreal injection and appears to be separate from the intraocular pressure spike that occurs during needle insertion. This pressure spike is transient and has not been captured by previous methods of intraocular pressure measurement, which rely on single time point measurements. The clinical significance of this brief intraocular pressure spike is unclear and warrants further investigation.

show abstract

“…5–9 Considering sustained IOP elevation may increase the risk of developing glaucoma, further evaluation of a possible association between repeated intravitreous anti-VEGF injections and sustained IOP elevation is indicated. 5, 6, 10–13 An exploratory ad hoc analysis that assesses whether repeated intravitreous injections of ranibizumab increase the risk of sustained elevation in IOP or initiation or augmentation of IOP-lowering treatment in eyes with DME compared with eyes receiving focal/grid laser through 3 years is reported herein.…”

Section: Introductionmentioning

confidence: 99%

Repeated Intravitreous Ranibizumab Injections for Diabetic Macular Edema and the Risk of Sustained Elevation of Intraocular Pressure or the Need for Ocular Hypotensive Treatment

et al. 2015

View full text Add to dashboard Cite

IMPORTANCE For the management of retinal disease, the use of intravitreous injections of anti-vascular endothelial growth factor has increased. Recent reports have suggested that this therapy may cause sustained elevation of intraocular pressure (IOP) and may potentially increase the risk of glaucoma for patients with retinal disease.OBJECTIVE To assess the risk of sustained IOP elevation or the need for IOP-lowering treatments for eyes with diabetic macular edema following repeated intravitreous injections of ranibizumab. DESIGN, SETTING, AND PARTICIPANTS An exploratory analysis was conducted within a Diabetic Retinopathy Clinical Research Network randomized clinical trial. Study enrollment dates were from March 20, 2007, to December 17, 2008. Of 582 eyes (of 486 participants) with center-involved diabetic macular edema and no preexisting open-angle glaucoma, 260 were randomly assigned to receive a sham injection plus focal/grid laser treatment, and 322 were randomly assigned to receive ranibizumab plus deferred or prompt focal/grid laser treatment. MAIN OUTCOMES AND MEASURESThe cumulative probability of sustained IOP elevation, defined as IOP of at least 22 mm Hg and an increase of at least 6 mm Hg from baseline at 2 consecutive visits, or the initiation or augmentation of ocular hypotensive therapy, through 3 years of follow-up. RESULTSThe mean (SD) baseline IOP in both treatment groups was 16 (3) mm Hg (range, 5-24 mm Hg). The cumulative probability of sustained IOP elevation or of initiation or augmentation of ocular hypotensive therapy by 3 years, after repeated ranibizumab injections, was 9.5% for the participants who received ranibizumab plus prompt or deferred focal/grid laser treatment vs 3.4% for the participants who received a sham injection plus focal/grid laser treatment (difference, 6.1% [99% CI, −0.2% to 12.3%]; hazard ratio, 2.9 [99% CI, 1.0-7.9]; P = .01). The distribution of IOP and the change in IOP from baseline at each visit through 3 years were similar in each group. CONCLUSIONS AND RELEVANCEIn eyes with center-involved diabetic macular edema and no prior open-angle glaucoma, repeated intravitreous injections of ranibizumab may increase the risk of sustained IOP elevation or the need for ocular hypotensive treatment. Clinicians should be aware of this risk and should consider this information when following up with patients who have received intravitreous injections of anti-vascular endothelial growth factor for the treatment of diabetic macular edema.

show abstract

Ocular Hypertension and Intraocular Pressure Asymmetry After Intravitreal Injection of Anti–Vascular Endothelial Growth Factor Agents

Cited by 41 publications

References 39 publications

Nanosponge-Mediated Drug Delivery Lowers Intraocular Pressure

Nanosponge-Mediated Drug Delivery Lowers Intraocular Pressure

Real‐time measurement of needle forces and acute pressure changes during intravitreal injections

Repeated Intravitreous Ranibizumab Injections for Diabetic Macular Edema and the Risk of Sustained Elevation of Intraocular Pressure or the Need for Ocular Hypotensive Treatment

Contact Info

Product

Resources

About