Sustained ocular hypertension following intravitreal injections of 0.5 mg/0.05 ml ranibizumab

To report three cases with sustained ocular hypertension following intravitreal injections of 0.5 mg/0.05 ml ranibizumab and to underline the importance of monitoring intraocular pressure (IOP) following intravitreal injections of ranibizumab (Lucentis). Three patients were found to have high IOP after intravitreal injections of 0.5 mg/0.05 ml ranibizumab. IOP was elevated after the second ranibizumab injection in patients 1 and 2, and after the third injection in patient 3. The increase in IOP was sustained, requiring treatment with anti-glaucoma eye drops in all patients, the addition of systemic carbonic anhydrase inhibitor in one patient, and the application of selective laser trabeculoplasty (SLT) in another patient. None of the patients had a previous history of glaucoma or ocular hypertension. Sustained ocular hypertension may occur after intravitreal injections of 0.5 mg/0.05 ml ranibizumab. Although the precise mechanism of the pressure rise is unknown, three eyes in our series were controlled with topical or oral medication and one with SLT. The necessity of IOP monitoring is strongly emphasized after intravitreal injections of 0.5 mg/0.05 ml ranibizumab.     

Refractory severe ocular hypertension after intravitreal triamcinolone acetonide injection

PURPOSE: To report a serious complication following intravitreal triamcinolone acetonide injection. METHODS: Observational case report. RESULTS: In 2 patients, secondary intractable severe ocular hypertension occurred 2 months after a single 4-mg intravitreal injection of triamcinolone acetonide for macular edema. Both patients required trabeculectomy intervention to control intraocular pressure (IOP). CONCLUSION: We highlight the occurrence of intractable high IOP elevation as a serious complication 2 months after intravitreal triamcinolone acetonide. Cautious monitoring of IOP for several months after this therapy is recommended. The risks of this potentially devastating complication need to be weighed against the benefits of intravitreal triamcinolone in the individual patient.     

玻璃体腔注射雷珠单抗联合小梁切除术及PRP治疗新生血管性青光眼

目的：观察玻璃体腔注射雷珠单抗联合小梁切除术及全视网膜光凝(panretinal photocoagulation, PRP)治疗新生血管性青光眼(NVG)的中期临床疗效。

方法：回顾分析我院2015-01/2017-03间收治的21例21眼新生血管性青光眼病例的临床资料,治疗上均先行玻璃体腔雷珠单抗注射,后行5-氟尿嘧啶联合下的小梁切除术及术后行全视网膜光凝。随访6mo观察治疗前后患者眼内压(intraocular pressure,IOP)、视力、虹膜及房角新生血管、抗青光眼药物的应用、术后的并发症等。

结果：患者随访至少6mo。21例患者术后眼压均得到了有效控制,患者术前平均眼压为53.17±10.52mmHg,术后6mo复查平均眼压为18.50±3.51mmHg,与术前眼压比较,差异有统计学意义(P=0.001)。术后视力均有一定程度提高。3眼出现前房出血及玻璃体出血情况,予保守治疗后消退。患者虹膜及房角新生血管明显消退。

结论：玻璃体腔注射雷珠单抗联合小梁切除术及全视网膜光凝治疗新生血管性青光眼的中期疗效稳定。     

真空小梁成形术治疗开角型青光眼及高眼压症

目的 观察真空小梁成形术对原发性开角型青光眼和高眼压患者的降眼压效果和安全性.方法 前瞻性病例系列研究.开角型青光眼及高眼压患者100例（100眼）作为研究对象.所有研究对象都接受了全面的眼科检查,包括眼压、计算机视野检查,并进行UBM或前房角镜检查,排除前房角关闭者.进行真空小梁成形术治疗仪治疗.治疗后1d、1周、1月、3月复查.首次治疗后7d重复治疗1次.观察治疗前后眼压变化.结果 100例术前眼压为（24.50±4.14） mmHg（1 mmHg=0.133 kPa）,治疗后1d、1周、1月、3月各时间点眼压为（22.96±3.66） mmHg,（21.27±2.91） mm-Hg,（19.65±2.77） mmHg,（19.80±1.79） mmHg,3个月观察期末与治疗前眼压差异均有统计学意义（P＜0.05）.3个月观察期内,无视力下降者.结论 本文短期研究显示,真空小梁成形术可安全有效地降低开角型青光眼及高眼压患者的眼压.     

选择性激光小梁成形术治疗糖皮质激素性青光眼的疗效观察

背景糖皮质激素在眼科治疗过程中的应用日益广泛,而糖皮质激素的局部长期应用存在诱发青光眼的潜在危险。近年来的研究表明,选择性激光小梁成形术（SLT）可用于糖皮质激素性青光眼的治疗,但其疗效需要进一步评价。目的观察SLT治疗糖皮质激素性青光眼的降眼压效果。方法采用回顾性系列病例分析设计,对经复旦大学眼耳鼻喉科医院眼科确诊的糖皮质激素性青光眼患者9例9眼行360。SLT治疗,年龄25～52岁。其中5例5眼为准分子激光角膜原位磨镶术（LASIK）术后长期（4—6周）使用糖皮质激素滴眼液所致,4例4眼因视网膜中央静脉阻塞（CRVO）黄斑水肿接受玻璃体腔内注射0．1ml曲安奈德（4．0mg）所致。在接受SLT治疗前,虽然所有患者均无青光眼和高眼压病史,但这些患者使用糖皮质激素后出现了高眼压,所以均接受了最大可耐受剂量的降眼压治疗。所有患者行SLT治疗前停止使用糖皮质激素2～12个月,术前眼压为35～44mmHg（1mmHg=0．133kPa）。患者随访6个月,观察术眼治疗前及治疗后不同时间点的眼压变化。采用重复测量方差分析法分析治疗后各时间点术眼眼压的差异。结果所有患者均只接受1次SLT治疗。SLT治疗前患者的平均眼压为（40．0±2．9）mmHg,治疗后1h、1周及1、3、6个月的眼压分别为（37．9±8．1）、（34．9±5．9）、（27．6±6．7）、（21．6±6．9）和（17．9±2．9）mmHg。治疗后1、3、6个月时的平均眼压均较术前明显下降,差异均有统计学意义（P〈0．05）。本组患者中2例2眼因眼压控制不良分别于SLT治疗后1个月和3个月接受了滤过性手术,SLT治疗后6个月,1例患者仍然需要使用2种局部降眼压药物控制眼压,6例患者无需使用降眼压药物。结论在纳入的9眼中,SLT有效降低了6眼糖皮质激素性青光眼患眼的眼压,降眼压疗效出现于治疗后1个月,随访期内眼压保持稳定。     

The acute and chronic effects of intravitreal anti-vascular endothelial growth factor injections on intraocular pressure: A review

The acute and chronic effects of repeated intravitreal antivascular endothelial growth factor (VEGF) injections on intraocular pressure have not been fully characterized, and the development of sustained ocular hypertension could adversely affect patients who are at risk of glaucomatous optic neuropathy. As expected, volume-driven, acute ocular hypertension immediately follows intravitreal injection, but this pressure elevation is generally transient and well tolerated. Several medications have been investigated to limit acute ocular hypertension following anti-VEGF therapy, but the benefits of pretreatment are not conclusive. Chronic, sustained ocular hypertension, distinct from the short-term acute ocular hypertension after each injection, has also been associated with repeated intravitreal anti-VEGF injections. Risk factors for chronic ocular hypertension include the total number of injections, a greater frequency of injection, and preexisting glaucoma. Proposed mechanisms for chronic ocular hypertension include microparticle obstruction, toxic or inflammatory effects on trabecular meshwork, as well as alterations in outflow facility by anti-VEGF agents. Although limiting anti-VEGF therapy could minimize the risk of both acute and chronic ocular hypertension, foregoing anti-VEGF therapy risks progression of various macular diseases with resulting permanent central vision loss. While definitive evidence of damage to the retinal nerve fiber layer is lacking, patients receiving repeated injections should be monitored for ocular hypertension and patients in whom sustained ocular hypertension subsequently developed should be periodically monitored for glaucomatous changes with optic nerve optical coherence tomography and static visual fields.     

Sustained effect of travoprost on diurnal and nocturnal intraocular pressure

PURPOSE: To assess the diurnal and nocturnal persistency of intraocular pressure (IOP) reduction after omission of up to two doses of once-daily topical travoprost in patients with open-angle glaucoma or ocular hypertension. DESIGN: Prospective, open-label study. METHODS: Twenty subjects underwent three sessions of 24-hour IOP monitoring. The first session occurred before initiating treatment of newly diagnosed patients or after a four-week washout in patients already receiving medical therapy. The second session occurred after four weeks or more of travoprost treatment. The third session was performed 41 to 63 hours after the last travoprost dose. RESULTS: IOP lowering persisted after omission of one to two doses. Between 41 to 63 hours after the last dose, diurnal IOP reduction was attenuated, but nocturnal IOP reduction sustained. CONCLUSIONS: IOP lowering effect after omission of one to two doses of travoprost is attenuated in the diurnal period but sustained in the nocturnal period, the time corresponding to the highest baseline habitual IOP.     

玻璃体注射雷珠单抗治疗老年性黄斑变性黄斑水肿与视网膜静脉阻塞性黄斑水肿的短期疗效观察

目的 观察玻璃体注射雷珠单抗治疗老年黄斑变性黄斑水肿（AMD-ME）与视网膜静脉阻塞性黄斑水肿（RVO-ME）的短期临床效果。设计 回顾性病例系列。研究对象 2015年10月至2016年7月确诊为AMD-ME 及RVO-ME 的患者共30例（30眼）,各15例（15眼）。方法 患眼接受玻璃体注射雷珠单抗（0.5 mg/0.05 ml）治疗,采用1+PRN的注射方法,比较治疗前和治疗后 1 天、1个月最佳矫正视力（BCVA）、眼压（IOP）、黄斑中心凹视网膜厚度（CMT）、注射后消除的水肿高度,评价每次随访时检查结果。主要指标 BCVA、CMT、消除的水肿高度、IOP。结果 AMD-ME组及RVO-ME 组注射雷珠单抗后1天、1个月的BCVA均较术前提高（P=0.000、0.000）。AMD-ME组 及RVO-ME 组每次治疗前和治疗后1个月CMT厚度均降低（P＝0.000、0.000）。治疗过程中患者眼压与治疗前比较并无明显变化 （P=0.096、0.066、0.213、0.088、0.240、0.337）。结论 玻璃体注射雷珠单抗治疗 AMD-ME 及 RVO-ME 在短期内均可减轻黄斑水肿和改善视力,两者治疗效果无明显差异。（眼科, 2017, 26： 120-124）     

雷珠单抗对房水中炎症相关细胞因子含量的影响

目的:比较新生血管性青光眼(neovascular glaucoma,NVG)与年龄相关性白内障患者房水中炎症相关细胞因子浓度,观察玻璃体腔内注射雷珠单抗前后房水中炎症相关细胞因子表达变化.方法:纳入21例21眼NVG患者以及20例20眼年龄相关性白内障患者作为对照.NVG患者先予玻璃体腔内注射雷珠单抗,再行青光眼房水引流阀植入术.在玻璃体腔内注射雷珠单抗以及2~7d后行青光眼房水引流阀植入术术前抽取NVG患者房水,同时在白内障手术时抽取年龄相关性白内障患者房水.用Multiplex微珠免疫分析系统检测房水中细胞因子浓度.结果:NVG组患者玻璃体腔内注射雷珠单抗前房水中IL-1β,IL-6,IL-8,MCP-1以及VEGF浓度明显高于年龄相关性白内障患者,差异均有统计学意义(均P<0.001).玻璃体腔内注射雷珠单抗后,NVG患者房水中IL-6,IL-8,MCP-1以及VEGF浓度较注射雷珠单抗前明显降低,差异有统计学意义(P<0.05).NVG患者房水中检测的炎症相关细胞因子的浓度与患者年龄、术前眼压均无明显相关性.结论:NVG患者玻璃体腔内注射雷珠单抗前房水中与炎症相关的细胞因子表达明显上调.NVG患者行雷珠单抗治疗后,房水中与炎症相关的细胞因子明显下调.     

Argon laser trabeculoplasty in triamcinolone acetonide induced ocular hypertension refractory to maximal medical treatment

PURPOSE: To report two cases of intraocular hypertension after intravitreal injection of triamcinolone acetonide (iTAA) that were refractory to maximal medical therapy and were successfully treated with argon laser trabeculoplasty (ALT). METHODS: Two patients with history of primary open angle glaucoma were treated with intravitreal injection of triamcinolone acetonide for chronic macular edema secondary to branch retinal vein occlusion. Both patients (Case 1 after 2 months and Case 2 after 5 days) developed intraocular hypertension that did not respond to maximal medical therapy. Despite medical therapy, intraocular pressure (IOP) was 45 mmHg in Case 1 and between 34 and 37 mmHg in Case 2. ALT was performed in the inferior 180 degrees angle using the following parameters: 50 microm size, 700 mW, 0.50 sec, 100 spots. RESULTS: In both patients IOP returned to normal level a few days after ALT. CONCLUSIONS: ALT seems to be effective at reducing IOP in patients with intraocular hypertension secondary to iTAA that does not respond to maximal medical treatment.     

雷珠单抗辅助玻璃体切割和PRP联合小梁切除术治疗NVG的疗效

目的：观察雷珠单抗辅助玻璃体切割+全视网膜光凝(PRP)+小梁切除术治疗新生血管性青光眼(NVG)的临床疗效。

方法：回顾性分析2017-03/2018-10收治的NVG患者44例44眼,采用玻璃体腔内注射雷珠单抗+玻璃体切割+PRP+小梁切除手术治疗的患者22例22眼(A组),采用玻璃体腔内注射雷珠单抗+小梁切除+PRP治疗的患者22例22眼(B组)。术后随访6mo,观察患者视力、眼压、眼压控制率、新生血管及并发症等情况。

结果：治疗前两组患者眼压无差异(46.2±9.41mmHg vs 49.1±10.15mmHg,P>0.05),治疗后1wk,1、6mo A组患者眼压均低于B组(P<0.05)。治疗后6mo,A组视力、眼压控制率(95%)、新生血管消退情况(91%)均优于B组(P<0.05),但随访期间两组患者并发症发生率无差异(P>0.05)。

结论：雷珠单抗辅助玻璃体切割+PRP+小梁切除术治疗NVG安全有效,可稳定持久地控制眼压,改善部分患者视力。     

Intraocular pressure modifications in patients with acute central/hemicentral retinal vein occlusions

AIM: To explore levels and determinants of awareness and knowledge about glaucoma among patients. METHODS: This was a cross-sectional study that included adult patients from October to the end of December 2018. A semi-structured questionnaire was designed by the researchers to measure the levels of awareness and knowledge about 18 basic information about glaucoma. The sheet was divided into 4 domains: types of glaucoma; risk factors; clinical features; and management. A knowledge score (KS, range= 0-18) was calculated, with higher scores indicating higher levels. RESULTS: A total of 383 patients responded to the questionnaire, 61.9% males, mean±SD age was 38.5±12.94 years old, and 61.6% had a university degree or higher. Of them, 6.3% and 23.2% reported personal and family history of glaucoma, respectively. The most frequently reported source of information about glaucoma was another person with glaucoma (28.2%), followed by physicians (24.8%) and TV (19.6%). Knowledge by item ranged from 3.1% to 82.5% correctness rate, while KS showed mean=5.91 and median=5; and reliability testing of the knowledge scale showed Cronbach’s alpha=0.782. Higher KS were found among respondents with higher educational level (P =0.036), diabetes history (P=0.025), and personal (P<0.001) and family (P<0.001) history of glaucoma. CONCLUSION: This study reveals low awareness and knowledge levels about glaucoma among the attendees of a local eye care hospital, where several misconceptions about disease risk factors, clinical features, and management are identified.     

Autophagy dysregulation mediates the damage of high glucose to retinal pigment epithelium cells

Intraocular pressure (IOP) modifications in patients with acute central/hemicentral retinal vein occlusions (RVOs) consist in IOP reductions and increases. The IOP reduction is due to a transitional hyposecretory phase of the aqueous humor, that increases gradually until 3mo after the venous occlusion onset, and then finally disappears after month 4th. The IOP increases lead to the ocular hypertension and glaucoma. The possible pathogenetic correlations between ocular hypertension/glaucoma and acute central/hemicentral RVOs have been classified into three groups: 1) the venous occlusion precedes the ocular hypertension/glaucoma causing neovascular glaucoma and secondary angle-closure glaucoma without rubeosis; 2) the ocular hypertension and the glaucoma precede the venous occlusion and favor its appearance (ocular hypertension, primary angle-closure, primary angle-closure glaucoma, and open angle glaucomas); and 3) the venous occlusion and the ocular hypertension/glaucoma are mostly age dependent appearances due to common vascular and collagen alterations, lacking a causal connection between the 2 conditions.     

The effect of selective laser trabeculoplasty on intraocular pressure in patients with intravitreal steroid-induced elevated intraocular pressure

PURPOSE: To assess effectiveness of selective laser trabeculoplasty (SLT) in lowering intraocular pressure (IOP) in patients with steroid-induced elevated IOP. METHODS: Retrospective review of 7 patients (7 eyes) with IOP elevation after intravitreal triamcinolone acetonide (4.0 mg/0.1 mL) injections for macular edema (6 patients) or central retinal vein occlusion (1 patient). Three patients had preexisting open angle glaucoma; 2 patients had preexisting ocular hypertension. Time between intraocular corticosteroid injection and subsequent increased IOP ranged from 5 to 29 weeks. After unsuccessful maximum tolerated medical therapy, patients underwent unilateral SLT between April 2003 and June 2005. IOP was measured 4 weeks prelaser; on the day of laser; within 3 weeks, and at 1, 3, and 6 months postlaser. Two-sample t test was used for analysis. RESULTS: The pre-SLT and post-SLT IOP measurements were the major outcome measures used to define the relative success of the SLT procedure. Seven patients were taking 4.0+/-0.8 ocular hypotensive medications before SLT. Preoperative IOP (mm Hg+/-SD) 38.4+/-7.3 decreased postoperative to 25.6+/-7.1 within 3 weeks (P<0.003), 25.9+/-8.8 at 1 month (P<0.007), 23.9+/-10.6 at 3 months (P<0.006), and 15.7+/-2.2 at 6 months (P<0.001). Four patients underwent a second SLT procedure. Two patients failed after the 3-month visit. IOP in fellow eyes of all patients was unchanged (P>0.080). CONCLUSIONS: SLT lowered (P<0.007) IOP in 5 eyes of 7 patients with steroid-induced increased IOP from 3 weeks to 6 months postoperative. Two patients required additional surgical procedures. Repeat SLT treatments may be necessary. SLT is a temporizing procedure to consider in patients with steroid-induced elevated IOP.     

Intravitreal ranibizumab for choroidal neovascularization related to traumatic Bruch’s membrane rupture

Purpose  Choroidal neovascularization (CNV) secondary to traumatic rupture of Bruch’s membrane is a rare condition, without standardized treatment. Here we describe one case of CNV related to traumatic rupture of Bruch’s membrane which was successfully treated with intravitreal injection of ranibizumab. Methods  A 14-year-old patient was referred for ocular contusion, complicating interpapillomacular rupture of Bruch’s membrane in left eye. Indeed, a correct initial visual acuity, juxtafoveolar CNV appeared 4 months later on the border of Bruch’s membrane rupture. The patient was treated with an off-label intravitreal ranibizumab because of worsening of visual acuity. Results  One month after intravitreal injection, visual acuity improved, from 20/40 to 20/25. At 12-month follow-up, visual acuity remained at 20/25, fundus examination. Fluorescein angiography, indocyanine green angiography and optic coherence tomography showed fibrotic evolution of CNV. The Bruch’s membrane rupture remained stable. No side-effect of intravitreal injection of ranibizumab was observed. Conclusion  For this patient affected with CNV secondary to traumatic Bruch’s membrane, one single intravitreal ranibizumab injection was efficient, with 1-year follow-up. The authors have no proprietary interest in the materials used in this study.     

Intraocular pressure changes after repeated intravitreal antivascular endothelial growth factor injections in patients with neovascular age-related macular degeneration with or without glaucoma

PurposeTo investigate the long-term effects of multiple intravitreal injections on intraocular pressure (IOP) in patients with exudative age-related macular degeneration, and to determine whether this is related to a pre-existing diagnosis of glaucoma.MethodsA retrospective study was carried out on 209 eyes in 173 patients with neovascular age-related macular degeneration who received at least three intravitreal injections of bevacizumab or ranibizumab, or both, from January 2006 to December 2012 at Shin Kong Wu Ho-Su Memorial Hospital. Sequential changes in IOP following the intravitreal injections were documented and the incidence and characteristics of the patients diagnosed with glaucoma were recorded and analyzed.ResultsTwo hundred and nine eyes in 173 patients were included in this study. The mean number of injections was 10.1 (range 3–23). No significant change was found in IOP (p = 0.41, paired t test) and none of the patients experienced delayed ocular hypertension during the treatment course. No correlation was found between differences in IOP and the number of injections (correlation coefficient −0.086) and no significant change in IOP was found in patients with or without glaucoma (p = 0.42 and 0.37, respectively, paired t test). In addition, the use of drugs to lower IOP did not increase with repeated intravitreal injections in patients with glaucoma [single drug, 24 (63.2%) patients; two drugs 14 (36.8%) patients].ConclusionRepeated intravitreal antivascular endothelial growth factor injections of bevacizumab or ranibizumab, or both, did not increase the risk of increasing IOP in patients with exudative age-related macular degeneration, with or without glaucoma.     

Early rapid rise in intraocular pressure after intravitreal triamcinolone acetonide injection

PURPOSE: To report the occurrences of early rapid increases in intraocular (IOP) after intravitreal glucocorticoid injection. DESIGN: Observational case series. METHODS: We retrospectively reviewed the records of three patients seen and treated at Duke Eye Center. RESULTS: In all three cases, a significant rise in IOP occurred within 1 week of intravitreal triamcinolone injection for refractory macular edema. In one patient, a white material was found in the angle on gonioscopy. All three cases required surgical intervention to reduce the IOP. CONCLUSIONS: Considering the early rapid rise in IOP in these three cases, we suggest that clinicians closely monitor patients after intravitreal triamcinolone injections for the development of acute glaucoma. Additionally, it may be advisable to perform gonioscopic examinations to look for any abnormal accumulation of material in the angle.     

雷珠单抗治疗视网膜中央静脉阻塞引起的眼前段新生血管

目的：探讨雷珠单抗治疗视网膜中央静脉阻塞（ central retinal vein occlusion , CRVO ）引起的眼前段新生血管（ anterior segment neovascularization ,ASNV）的疗效。方法：回顾性研究,选取2013－01／2014－12我院门诊及住院的因CRVO引起的ASNV并经过雷珠单抗玻璃体腔注射治疗的连续病例18例18眼。观察患者的最佳矫正视力、眼压、虹膜情况、房角镜检查等,随访时间6～13（平均9．1±2．9）mo。结果：患者18例18眼都接受了雷珠单抗治疗,15例15眼行视网膜光凝,3例3眼因玻璃体混浊仅行抗VEGF治疗,1例1眼行青光眼阀植入。其中6例6眼为仅有虹膜新生血管而没有眼压升高的患者,这6例6眼患者经过雷珠单抗联合全视网膜光凝（ panretinal photocoagulation ,PRP）后视力提高,眼压控制。已经伴有新生血管性青光眼的患者中,经过雷珠单抗及PRP治疗后,眼压可以控制者4例4眼;另有7例7眼眼压在雷珠单抗治疗后可以降低,但仍需药物控制;1例1眼药物控制不良者植入青光眼阀治疗,术后眼压控制,但视力较注射雷珠单抗前变差。所有患者的虹膜新生血管均可以消退。结论：雷珠单抗可以有效地使虹膜新生血管消退并对眼压控制有所帮助,在早期没有眼压升高的时候效果更好,提示要早期发现虹膜血管并尽早干预。     

Local and Systemic Complications after Intravitreal Administration of Anti-Vascular Endothelial Growth Factor Agents in the Treatment of Different Ocular Diseases: A Five-Year Retrospective Study

Abstract

Purpose: To observe the frequency of complications in patients undergoing intravitreal anti-VEGF injections for different ocular diseases in a five-year period. Materials and Methods: Charts of patients receiving intravitreal anti-VEGF were retrospectively reviewed. Out of 1173 eyes, 762 were treated with bevacizumab, 382 with ranibizumab, and 29 with pegaptanib. Data recorded included demographic information, clinical findings, total injections received, and info about the onset of adverse effects. Results: 12.86% of the eyes treated with bevacizumab presented side-effects, while ratings in the ranibizumab and pegaptanib groups were 15.97% and 20.69%, respectively. Odds ratios calculated comparing incidences after each anti-VEGF are 0.78 (bevacizumab versus ranibizumab, p?=?0.152), 0.57 (bevacizumab versus pegaptanib, p?=?0.227), and 0.73 (ranibizumab versus pegaptanib, p?=?0.508). A total of 185 complications were detected (62.16% after bevacizumab). Ocular side-effects registered were 40 cases of sustained intraocular pression (IOP) elevation, one infectious uveitis, one retinal detachment, and one sub-retinal hemorrhage. Other cases were related to transient IOP elevation immediately after injection. Systemic complications registered were one case of nausea, one episode of chest pain with acute vision loss, and one case of acute blood hypertension. Conclusions: The majority of significant complications occurred in patients receiving multiple bevacizumab administrations. However, results may be affected by the difference in the utilization amount for each drug. AMD patients were the most represented, probably due to greater indication to treatment.     

Diffuses diabetisches Makulaödem

BACKGROUND: Intraocular pressure (IOP) after intravitreal triamcinolone acetonide (TA) for diffuse diabetic macular edema will be analyzed.PATIENTS AND METHODS: This prospective, non-randomized interventional case-series study included 69 patients (n=81 eyes) with diffuse diabetic macular edema receiving intravitreal TA (about 20 mg); 4 eyes had re-injection. Follow-up was 7.66+/-7.36 months.RESULTS: IOP increased significantly (p<0.001, Wilcoxon) from mean preoperative 15.4+/-3.2 mmHg to mean maximum postoperative 20.4+/-4.7 mmHg. An increase of >21 mmHg in 31 eyes (38.3%) was noted. In eyes with secondary hypertension, IOP was controlled with antiglaucomatous drops; 6 months after injection IOP was normal without medication.CONCLUSION: After intravitreal TA, secondary ocular hypertension develops in 38.3% in eyes with diabetic diffuse macular edema after 1 month, which can be controlled by antiglaucomatous drops. Diffuse diabetic macular edema may not imply a contraindication for intravitreal TA.