Changes of Ocular Biometry and Intraocular Pressure in Patients Treated With Intravitreal Injection of Antivascular Endothelial Growth Factors

@#Introduction: Anti-vascular endothelial growth factors (anti-VEGF) intravitreal injection is one of the popular procedures for medical retina diseases. However, the incidence of angle-closure post intravitreal injection was reported. Several similar studies were conducted previously, but the results were inconsistent and mostly focused on bevacizumab. Methods: A prospective cohort study was conducted. After informed consent, patients who were more than 17 years old and received the first intravitreal anti-VEGF injections (ranibizumab or aflibercept) were recruited. Exclusion criteria included patients with underlying glaucoma, ocular hypertension, intumescence cataract, high refractive error or those with history of intraocular operation or ocular trauma. Pre- and post-injection’s intraocular pressure (IOP) and ocular biometry included “central anterior chamber depth” (CACD), “angle opening distance” (AOD500), and “trabeculo-iris angle” (TIA500) at nasal and temporal 500 µm away the scleral spur were acquired and analyzed. Results: 72 eyes from 66 patients were studied. Mean (SD) increment of IOP following injection within 30 minutes and 1 hour were 6.16 (0.68) mmHg (p<0.001) and 1.26 (0.35) mmHg (p=0.002) respectively. Mean (SD) differences of temporal TIA500 between pre with within 30 minutes and 1-hour post-injection were 1.66 (0.66) degrees (p=0.04) and 1.45 (0.57) degrees (p=0.04) respectively. No significant relationship between the changes of IOP and ocular biometry was found. Conclusion: A single dose of anti-VEGF in a normal population is relatively safe. However, concern on the risk of glaucoma progression and acute angle-closure still needs to be addressed. Further studies on at-risk populations and repeated injections are useful.

Case Series on Drug Reaction with Eosinophilia and Systemic Syndrome (DRESS) with Different Ocular Manifestation

@#“Drug reaction with eosinophilia and systemic syndrome” (DRESS) is a rare type of “severe cutaneous adverse reaction” (SCAR). We report 3 patients with DRESS who had different presentations. The first case developed DRESS following initiation of Allopurinol a month earlier. He presented with bilateral pseudomembranous conjunctivitis which resolved after 2 weeks. Two months later he presented with bilateral severe meibomian gland dysfunction (MGD), ocular surface disease (OSD) with severe dry eyes and left eye corneal perforation. The second case developed DRESS following initiation of allopurinol and had bilateral conjunctivitis. As for the third case, DRESS happened after taking Roxithromycin. She was diagnosed to have bilateral MGD, blepharitis and dry eyes. Case 2 and 3 did not develop ocular long-term complications. DRESS can cause acute and long-term ocular complications and therefore, following up patients with DRESS is essential to treat any complications with the aim to prevent corneal perforation.