Visual perceptions induced by intravitreous injections of therapeutic agents

Purpose

The purpose of this study was to conduct a questionnaire-based survey of subjective visual perceptions induced by intravitreous (IVT) injections of therapeutic agents.

Patients and methods

Patients undergoing an IVT injection of ranibizumab, pegaptanib sodium, or triamcinolone acetonide were administered a questionnaire in the immediate post-injection period and at 2 weeks of follow-up.

Results

In the immediate post-injection period (75 IVT injections, 75 eyes, 75 patients), lights and floaters were reported after 20 (27%) and 24 (32%) IVT injections, respectively. In comparison, at the 2-week follow-up, the incidence of reported lights (11; 15%) was similar (P>0.05), but the incidence of reported floaters was higher (48; 64% P=0.00). Subgroup analysis for various injection subgroups (no previous injection vsprevious injection(s) in the study eye; injections in study eyes with good VA (logarithm of minimal angle of resolution [logMAR] ≤0.3) vsmoderate VA (0.7 0.3) vspoor VA (logMAR ≥0.7); injections according to pharmacological agent (ranibizumab vspegaptanib vstriamcinolone acetonide); injections in study eyes with choroidal neovascularization (of various causes) vsstudy eyes with macular edema (of various causes); and injections in phakic vspseudophakic eyes) did not reveal any statistically significant associations. Visual perceptions experienced following 15% of IVT injections gave cause for concern to the patient (mean visual analog scale score (±SD): 4.5 (±1.7)), and in 64% of cases, the patients believed that preoperative counseling would have averted the concern.

Conclusions

Lights and floaters are frequent visual perceptions following IVT injections of therapeutic agents. They can give rise to concern that could be alleviated with preinjection counseling.     

气相色谱(内标)法测定酒中甲醇、杂醇油含量

[目的]建立用FFAP毛细管色谱柱,以乙欧正戊酯作内标,检测酒中甲醇、杂醇油含量的方法.[方法]采用毛细管气相色谱法,氢火焰离子化检测器检测,以保留时间定性,乙酸正戊酯作内标定量.[结果]本方法精密度高,RSD为0.28%～1.28%,回收率在96.9%～1.08%之间.[结论]本方法操作简单快速、灵敏度高,结果不受进样误差影响,适合测定酒中甲醇、杂醇油含量.     

Reduced community access to a key contraceptive: public health consequence from false suspicion of HIV-contaminated injectables

Background

This study was conducted to investigate a report of positive test results with DMPA on an HIV rapid test. Suspecting HIV contamination, the Zambian Ministry of Health initiated a product withdrawal pending full evaluation.

Study Design

DMPA was evaluated for compliance to product specifications. Contamination with HIV and blood components was investigated with PCR and human IgG ELISA. The performance of Genie II, Unigold™ and Determine™ HIV rapid tests was evaluated using DMPA.

Results

DMPA was found compliant with product specifications and negative for HIV and human IgG. DMPA impaired the performance of HIV rapid tests resulting in false-positive/indeterminant results. Rapid test results using polysorbate 80 (formulation component of DMPA) mimicked results obtained with DMPA.

Conclusions

The DMPA sample was negative for HIV and human IgG. Formulation components may have led to the interpretation of false-positive results, reinforcing the need to validate the sample type used in any test. DMPA use was reinstated in Zambia, minimizing the public health impact that resulted from the initial rapid test results.     

An open-label, comparative study of the effects of a dose-reduced oral contraceptive containing 0.02 mg ethinylestradiol/2 mg chlormadinone acetate on hemostatic parameters and lipid and carbohydrate metabolism variables

Objective

The study was conducted to compare the effects of 0.02 mg ethinylestradiol (EE)/2 mg chlormadinone acetate (CMA), given for 24 days each cycle, with those of 0.02 mg EE/0.15 mg desogestrel (DSG) and 0.03 mg EE/0.15 mg levonorgestrel (LNG), given for 21 days each cycle, on hemostatic, lipid, and carbohydrate metabolism parameters in healthy subjects, over six medication cycles.

Study design

A randomized, multicentre, open-label, Phase II trial measured markers of hemostasis, and of lipid and carbohydrate metabolism in 165 subjects randomly assigned to treatment with one of three combined oral contraceptives (COCs).

Results

EE/CMA and EE/DSG had a similar effect on hemostatic parameters, the EE/LNG group showed comparatively smaller increases in the activity of factor VII [8.1% vs. 36.6% (EE/CMA) and 28.2% (EE/DSG)], protein C [5.9% vs. 32.9% (EE/CMA) and 21% (EE/DSG)] and endogenous thrombin potential-based activated protein C resistance [44.1% vs. 93.5% (EE/CMA) and 108.1% (EE/DSG)], and in contrast, free protein S levels decreased in the EE/CMA and EE/DSG groups (−12.7% and −4.3%, respectively) but rose in the EE/LNG group (20.4%). In all treatments, total cholesterol, total triglyceride and apolipoproteins increased. Levels of very low-density lipoprotein cholesterol particularly rose across all groups. Slight increases in high-density lipoprotein (HDL) cholesterol were observed for EE/CMA (14.6%) and EE/DSG (8.5%), with a rise above the upper limit of normal in 30% of the subjects taking EE/CMA. Conversely, for EE/LNG slight decreases in HDL cholesterol were observed (−12.4%) lipoprotein (a) levels decreased in the EE/CMA (−6.6%) and EE/LNG (−16.9%) groups and were unchanged in the EE/DSG group.

Conclusions

The changes observed were typical of those seen across low-dose COCs that differ according to commonly-used progestogens.     

曲安奈德染色玻璃体辅助玻璃体切割术治疗孔源性视网膜脱离

目的 探讨曲安奈德（TA）染色玻璃体辅助玻璃体切割术在治疗孔源性视网膜脱离中的应用价值。设计回顾性病例系列。研究对象北京英智眼科医院2006～2009年孔源性视网膜脱离经睫状体平坦部玻璃体切割术的患者425例（428眼）。方法比较TA辅助组（302例,304眼）与未进行TA辅助的对照组（123例,124眼）两组间术前术后的视力及并发症差异（X^2检验）。TA组及对照组平均随访分别为（18．3±6.3）、（21．3±4．2）个月。主要指标最佳矫正视力,术后并发症。结果TA组术后视力改善与对照组比较差异有统计学意义（P〈0．05）。TA组术后视网膜复发性脱离、黄斑前膜的复发率较对照组明显减少（P均〈0．05）。术后一过性眼压增高两组未见明显差异（P〉0．05）。结论使用TA染色的玻璃体切割视网膜复位手术能够降低术后复发性视网膜脱离和视网膜前膜的发生率,而且未增加手术并发症。     

玻璃体腔内注射曲安奈德后的眼压变化

目的观察玻璃体腔内注射曲安奈德（TA）后的眼压变化。方法回顾性收集我院接受TA玻璃体腔注射治疗黄斑水肿的138例（138只眼）患者的临床资料。治疗前1d测量眼压,每眼测3次,取平均值。所有患者均接受4mgTA常规玻璃体腔内注射。治疗后1周、2周、1个月同样方法测量眼压,以后每个月复查1次,随诊半年。以眼压≥21mmHg为眼压升高。对比分析治疗前后眼压的变化。结果治疗后有22只眼眼压升高,占15.94%,其中92.8%的患者高眼压出现在3个月内,治疗后5个月有21只眼恢复到基础水平,有1只眼行小梁切除术,随访期峰值平均眼压（16.39±4.37）mmHg,注药前平均眼压（14.77±2.80）mmHg,对所有数据进行t检验（P=0.004,P〈0.01）有显著差异,按照性别、年龄因素分组分析,采用方差分析,各组之间无显著统计学意义。结论 TA玻璃体腔内注射后眼压升高较常见,眼压升高多发生于3个月内,注射后至少随诊观察6个月。大多数眼压高的患者眼压能控制到基础水平,极少数患者引起激素性青光眼需手术治疗。     

玻璃体注射曲安奈德联合视网膜光凝治疗黄斑水肿30眼

目的 观察玻璃体内注射曲安奈德联合多波长氪激光视网膜光凝治疗弥漫性黄斑水肿的疗效和安全性.方法 对符合入选条件的25例(30眼)弥漫性黄斑水肿患者行玻璃体腔内注射曲安奈德,水肿明显减轻或消失者行多波长氪激光视网膜光凝.结果 所有病例中有5眼视力稳定,2眼视力下降,23眼视力有不同程度提高.所有病例荧光素眼底血管造影均显示治疗后弥漫性黄斑水肿渗漏减轻或消失.5眼眼压大于21 mm Hg(1 mm Hg=0.133 kPa).结论玻璃体内注射曲安奈德联合多波长氪激光视网膜光凝治疗糖尿病性视网膜病变及视网膜静脉阻塞引起的弥漫性黄斑水肿不失为一种可取的方法 .     

曲安奈德在增生性糖尿病视网膜病变玻璃体切除术中的应用

目的:讨论曲安奈德(triamcinolone acetonide,TA)在增生性糖尿病视网膜病变(proliferate diabetic retinopathy,PDR)玻璃体切除术(pars plana vitrectomy,PPV)中的辅助作用。方法:增生性糖尿病视网膜病变患者107例107眼随机分为曲安奈德玻璃体切除组(治疗组53眼)和传统玻璃体切除组(对照组54眼),其中TA组经大部分玻璃体切除后,术中抽取0.3~0.5mLTA注入玻璃体腔,完成余下玻璃体皮质切除及视网膜前膜的剥离。观察术中并发症如视网膜裂孔形成、视网膜脱离、玻璃体出血。术后最佳矫正视力(BCVA)、眼压、黄斑水肿情况。结果:总共有104例(97.2%)患者完成6~12mo随访,其中TA组51例(96.2%),传统玻璃体切除组53例(98.1%)。TA组术中视网膜裂孔明显低于对照组(P<0.05),术中视网膜脱离、玻璃体出血及术后BCVA、眼压、黄斑水肿两组无明显差异。结论:增生性糖尿病视网膜病变玻璃体切除时注射TA能够加玻璃体皮质的可视性,使视网膜前膜的剥离更安全有效,减少术中视网膜破裂,术后没有与之相关的严重不良反应。     

Combined intravitreal bevacizumab and triamcinolone in exudative age‐related macular degeneration

Acta Ophthalmol. 2010: 88: 630–634

Abstract.

Purpose: We report on the combined application of intravitreal bevacizumab and triamcinolone acetonide for treatment of exudative age‐related macular degeneration (AMD). Methods: The clinical interventional case‐series study included 16 patients (16 eyes) with exudative AMD who had previously received 3.5 ± 1.8 mono‐injections of bevacizumab (1.5 mg) without significant improvement in visual acuity (VA) or reduction in macular exudation. All patients underwent a combined intravitreal injection of bevacizumab (1.5 mg) and triamcinolone acetonide (about 20 mg). Main outcome measures were VA and macular thickness as determined by optical coherence tomography. All patients were re‐examined at 2–3 months after the intervention. Results: Visual acuity improved significantly (p = 0.03) from 0.80 ± 0.40 logMAR prior to the combined injection to 0.65 ± 0.42 logMAR at 3 months after the injection. An improvement of ≥ 1 Snellen line was found in eight subjects, an increase of ≥ 2 lines in five subjects, and an improvement of ≥ 3 lines in two subjects. One patient lost 1 line and one patient lost 3 lines. Central retinal thickness decreased significantly from 272 ± 62 μm to 220 ± 47 μm (p = 0.03). At the 6‐month follow‐up examination, central retinal thickness had increased again to 319 ± 142 μm, which was not significantly (p = 0.30) different from baseline measurements. Conclusions: The combined intravitreal application of bevacizumab and triamcinolone may temporarily be helpful in the treatment of exudative AMD if previous intravitreal bevacizumab mono‐injections have failed to improve vision and reduce macular oedema.     

氪黄激光联合曲安奈德治疗糖尿病弥漫性黄斑水肿的临床疗效观察

目的　探讨氪黄激光联合曲安奈德治疗糖尿病弥漫性黄斑水肿的临床疗效。方法　糖尿病弥漫性黄斑水肿患者６５例（８０眼）按照就诊时间的顺序分为治疗组与对照组各４０眼,两组均应用氪黄激光进行黄斑区格栅样光凝,需行全视网膜光凝者在黄斑格栅样光凝后进行,在此基础上治疗组给予曲安奈德治疗。结果　治疗组与对照组的有效率分别为９５．０％和８５０％,组间比较差异有统计学意义（Ｐ＜０．０５）。治疗前视网膜厚度治疗组为（６３２．２５±９１．２５）μｍ,对照组为（６３５．２１±１７２５）μｍ,两组差异无统计学意义（Ｐ＝０．６９６）,治疗后都有明显下降,分别为（２７６．２５±１７．６２）μｍ和（３１２．５２±９３．１２）μｍ,同时期组间比较差异有统计学意义（Ｐ＜０．０５）。两组治疗前视力对比无明显差异,治疗后１个月与治疗后３个月都有明显提高,同时期组间比较差异无统计学意义（Ｐ＞０．０５）。治疗组与对照组的渗漏消失率分别为５２．５％和３７．５％,组间比较差异有统计学意义（Ｐ＜００５）。结论　氪黄激光联合曲安奈德治疗糖尿病弥漫性黄斑水肿能有效提高综合疗效,降低视网膜厚度及荧光渗漏。