To report the changes and trends in intraocular pressures (IOP) following intravitreal injection of Pegaptanib (Macugen) for the treatment of exudative age-related macular degeneration.
Retrospective chart review.
Review of 79 patients who underwent 122 consecutive Pegaptanib injections. Analysis of the short-term effect of Pegaptanib injections on IOP was performed.
Baseline mean IOP was 15.73 +/- 3.41 mm Hg (mean +/- standard deviation) with a range of 9 to 27 mm Hg. Postinjection mean IOP was 24.47 +/- 6.29 mm Hg with a range of 8 to 36 mm Hg. Mean IOP change from baseline to roughly 30 minutes after Pegaptanib injection was 8.74 +/- 7.23 mm Hg. At the 5- to 7-day follow-up visit, IOP had normalized.
Pegaptanib injection in this limited series seems to be safe from an IOP standpoint in the short-term. IOP monitoring postinjection may not be necessary.
"According to earlier publications on pegaptanib injections and their effect on IOP, anterior chamber paracentesis has not been used as part of the routine procedure (Hariprasad et al. 2006; Bakri et al. 2007; Frenkel et al. 2007). "
[Show abstract][Hide abstract] ABSTRACT: To investigate how prophylactic anterior chamber paracentesis affects the intraocular pressure (IOP) after intravitreal pegaptanib injections.
In this prospective study, 41 eyes of 41 patients receiving intravitreal pegaptanib injections were randomly assigned either to receive anterior chamber paracentesis prior to the injection (Group A, 20 patients, n = 35 injections) or not (Group B, 21 patients, n = 38 injections). IOP was measured before the pegaptanib injection (T0) and 2 min (T1), 30 min (T2) and 1 week (T3) after the injection. A four-point scale was used to evaluate the subjective pain experienced during the procedure.
The mean IOP at T1 was 15.3 ± 7.5 mmHg in group A and 47.1 ± 24.1 mmHg in group B (difference -31.85 mmHg, 95% Confidence interval -40.13 to -23.56; p < 0.0001). In 45% of the injections without paracentesis, IOP was higher than 50 mmHg 2 min after the pegaptanib injection. No significant difference in IOP was observed at T0, T2 and T3 between the two study groups. The mean pain scores did not differ significantly (0.97 in group A versus 1.32 in group B; p = 0.08).
The results suggest that prophylactic anterior chamber paracentesis helps to prevent the high postoperative IOP spike without causing patients any additional pain.
"In phase III, most of the undesirable effects were attributed to injection procedures. Following intravitreous Pegaptanib injection a mild increase of intraocular pressure was observed (Hariprasad et al 2006). Consequently, the FDA recommends tonometry within 30 minutes following injection and biomicroscopy between two and seven days subsequent to the injection. "
[Show abstract][Hide abstract] ABSTRACT: Age-related macular degeneration (AMD) is the main cause of loss of sight in the world and is characterized by neovascularization of the macula. The factors producing choroidal vascularization involve various growth factors, including the vascular endothelial growth factor (VEGF(165)). In this context, the systematic evolution of ligands by exponential enrichment (SELEX) became a tool for developing new therapeutic agents for AMD treatment. The SELEX is a combinatorial oligonucleotide library-based in vitro selection approach in which DNA or RNA molecules (aptamers) are identified by their ability to bind their targets with high affinity and specificity. Recently, the use of the SELEX technique was extended to isolate oligonucleotide ligands for a wide range of proteins of clinical importance. For instance, Pegaptanib sodium, a 28-nucleotide polyethylene glycol RNA aptamer that selectively binds to VEGF(165) and inhibits angiogenesis, was approved by the Food and Drug Administration for the treatment of wet AMD, thereby providing significant benefits to a great number of patients with minimal adverse effects.
[Show abstract][Hide abstract] ABSTRACT: To assess whether the transient intraocular pressure rise, frequent intraocular pressure fluctuations, or antivascular endothelial growth factor (VEGF) effects of repeated intravitreal injection of anti-VEGF agents can lead to changes in the optic nerve vertical cup-to-disk ratio (C/D).
Patients with a known history of glaucoma and those receiving triamcinolone acetonide were excluded from the study. Fundus photographs were cropped to optic disk images only, which were then randomized and independently graded by two glaucoma specialists. In patients who received treatments in only one eye, the fellow eye was used as a control.
Twenty-three eyes of 21 patients met inclusion criteria. The mean change in C/D was -0.012 (95% confidence interval [CI], -0.053 to 0.029) for the treated group and -0.006 (95% CI, -0.106 to 0.095) for the control group, with no statistically significant difference (P = 0.90). The mean change in C/D for eyes receiving < or =5 injections (n = 9) was 0.003 (95% CI, -0.089 to 0.095) in the treated group and 0.054 (95% CI, -0.033 to 0.142) in the control group, with no statistically significant difference (P = 0.33). In eyes receiving >5 injections (n = 14), the mean change in C/D was -0.021 (95% CI, -0.095 to 0.052) in the treated group and -0.057 (95% CI, -0.231 to 0.116) in the control group, with no statistically significant difference (P = 0.70).
There was no statistically significant change in the vertical C/D of optic nerves in patients receiving multiple intravitreal injections of anti-VEGF agents, regardless of whether they received fewer or more than five total injections. This suggests that the short-term intraocular pressure rise and frequent intraocular pressure fluctuation, as well as the anti-VEGF properties of these drugs, do not adversely change the optic nerve C/D. Additional prospective studies are warranted to confirm these conclusions.
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