Evaluation of intracameral cefuroxime injection for endophthalmitis prophylaxis following phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the clinical effect of intracameral cefuroxime injection on prevention of endophthalmitis following phacoemulsification. <p>METHODS: This was a retrospective clinical study. The clinical records were reviewed for 3112 patients(4210 eyes)with cataract phacoemulsification in our hospital from January 2015 to June 2018; 1810 patients(2250 eyes)without intracameral cefuroxime injection were treated as control group from January 2015 to April 2017; 1302 cases(1960 eyes)with intracameral cefuroxime injection were treated as experimental group from May 2017 to July 2018. Patients in both groups were treated with phacoemulsification and intraocular lens implantation. The follow-up period was 1-8mo and the visual acuity and the infectious endophthalmitis were observed and compared. <p>RESULTS:There were 1 344 eyes with best corrected visual acuity >1.0, 696 eyes with 0.5-0.9, 151 eyes with 0.1-0.4, 59 eyes with <0.1 in control group within 6mo after operation; those in experimental group were 1 136 eyes, 624 eyes, 146 eyes, 54 eyes. No postoperative endophthalmitis case occurred in experimental group. Three postoperative endophthalmitis cases(3 eyes)occurred in control group, 0.13%(3/2250). There was no significant difference between the two groups(<i>P</i>=0.15). All the cases with endophthalmitis were cured. No sever complication was reported with intracameral cefuroxime, corneal endothelium decompensation, retinal toxicity. <p>CONCLUSION: Intracameral cefuroxime injection is safe and effective in prevention of endophthalmitis following phacoemulsification.

Efficacy and Safety of Intracameral Bevacizumab for Treatment of Neovascular Glaucoma

PURPOSE: To evaluate the long-term efficacy and safety of intracameral bevacizumab in patients with neovascular glaucoma. METHODS: This retrospective study included 26 eyes of 26 neovascular glaucoma patients who received intracameral bevacizumab injection between January 2013 and May 2015, and were followed-up for at least 1 year. All patients were treated with topical and/or systemic intraocular pressure (IOP)-lowering medications, intracameral bevacizumab, and panretinal photocoagulation (PRP). The main outcome measures were changes in visual acuity, IOP, and neovascularization of the iris (NVI) and the anterior chamber angle (NVA). To assess the safety of intracameral bevacizumab, corneal endothelial changes were also determined using specular microscopy. Patients whose IOP was uncontrolled received IOP-lowering surgery. Clinical factors associated with IOP-lowering surgery were also investigated. RESULTS: In all patients, intracameral bevacizumab resulted in a rapid and marked reduction of IOP, NVI, and NVA within 1 week. At 12 months after initial injection, 19 of 26 eyes (73%) underwent IOP-lowering surgery. The average interval between initial injection and surgical treatment was 33.6 ± 26.9 days. Baseline IOP (p = 0.018), NVA grade (p = 0.029), and incomplete PRP (p = 0.005) were identified as predictive factors for IOP-lowering surgery. During the follow-up period, there were no statistically significant corneal endothelial changes after intracameral bevacizumab injection. CONCLUSIONS: During 1 year of follow-up after intracameral bevacizumab, the procedure was found to be safe for the corneal endothelium. However, the IOP-lowering effect was transient, and 73% of patients eventually required IOP-lowering surgery. Predictive factors for IOP-lowering surgery were high baseline IOP and NVA grade, and incomplete PRP.

Distribution of bevacizumab in ocular tissue and its toxic effect after injection of anterior chamber / 中华实验眼科杂志

Background Bevacizumab has been widely used in the treatment of new blood vessel disease in ophthalmology.The investigation of the pharmacokinetics and safety after intracameral injection of bevacizumab can offer the basis for the management of iris neovascularization and neovascular glaucoma.Objective The present study was to observe the distribution of bevacizumab(avastin)in eye tissue and toxic effects following the injection of anterior chamber.Methods Twenty-four New Zealand albino rabbits were divided into two groups randomly.0.05 ml (1.25mg)of Bevacizumab was intracamerally injected into the left eyes in the experimental group,and a balanced salt solution of 0.05 ml was injected in the same way into the left eyes of the control group.The anterior segment of eyes and ocular fundus were examined by slit-lamp microscope and direct ophthalmoscope after injection.Intraocular pressure was measured and corneal endothelial microscopy was performed before and after the injections.Five rabbits of the two groups were sacrificed on the first day,the fourth day,the seventh day,the fourteenth day,and the thirtieth day after injection,and the eyeballs were enucleated for histopathological examination.The ultrastructure of eye tissue was observed under the transmission electron microscope on the fourth day and the thirtieth day,and then immunofluorescence staining were performed to assess the distribution of bevacizumab in the eye tissues.This experiment complied with the Regulations for the Administration of Affair Concerning Experimental Animals by State Science and Technology Commission(Version 1988).Results No abnormality in the cornea,lens,vitreous and retina was observed after the injection of bevacizumab under the slit lamp microscope and direct ophthalmoscope.No significant differences were found in intraocular pressure and corneal endothelial cell density in the bevacizumab group compared with the control group before injection and 2 hours,1 day,7 days,14 days,30 days after injection(P =0.760,P =0.956).No histopathological and ultrastructural changes of the cornea,lens,chamber angle,iris,ciliary body and retina were seen after the injection in the experimental group and control group under the light microscope and transmission electron microscope.Bevacizumab was distributed in the anterior chamber angle,iris,ciliary body,choroid and retina in injected eyes and fellow eyes after intracameral injection with red fluorescence and presented the dynamic changes with the lapse of time.The immunofluorescence response of eye tissue to bevacizumab was weaker in the fellow eyes compared with injected eyes.Bevacizumab was mainly distributed in the vessel wall and lumen.Conclusions Bevacizumab can quickly distribute in the vascular tissue of the anterior chamber angle,iris,ciliary body,choroid and retina in injected eyes after intracameral injection without obvious toxic effects to eye tissue.Bevacizumab administered intracamerally may be a new strategy or a joint strategy for iris neovascularisation.

Concentration of Vascular Endothelial Growth Factor After Intracameral Bevacizumab Injection in Eyes With Neovascular Glaucoma

PURPOSE: To study the concentration of vascular endothelial growth factor (VEGF) in the aqueous humor before and after intracameral injection of bevacizumab in eyes with neovascular glaucoma, and to detect the duration of an anti-VEGF effect of bevacizumab in the anterior chamber. METHODS: In this prospective interventional case series, 1.25 mg of bevacizumab was injected into the anterior chamber of five eyes in five neovascular glaucoma patients. Aqueous humor samples were obtained just before intracameral injection of bevacizumab and two weeks after injection. The concentrations of VEGF in the aqueous humor were measured using ELISA. To investigate corneal endothelial damage after intrecameral bevacizumab injection, specular microscopy was performed before injection and two weeks after injection. Slit lamp photo and iris fluorescent angiography was performed to determine the regression of iris neovascularization. RESULTS: After injection, substantial regression of neovascularization or fluorescein leakage was seen in all treated eyes. The VEGF concentrations in the aqueous humor in eyes with NVG were 1181.8+/-1248.3 pg/mL before intracameral injection of bevacizumab. Two weeks after injection, the VEGF concentrations decreased to 33.2+/-12.2 pg/mL (p=0.04, Wilcoxon signed rank test). There were no significant changes in IOP or corneal endothelial cells. CONCLUSIONS: Intracameral bevacizumab injection can remarkably reduce iris neovascularization in neovascular glaucoma patients. VEGF levels were significantly decreased two weeks after injection and corneal toxicity was not observed during short term follow-up.

Prophylactic usage of intracameral cefuroxime in the prevention of postoperative endophthalmitis / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the prophylactic usage of intracameral cefuroxime in the prevention of postoperative endophthalmitis (PE). METHODS: Phacoemulsification surgery of 6 099 patients with age-related cataract was studied retrospectively. In control group, 3 075 patients (3 075 eyes) had undergone surgery without use of intraocular antibiotics (IOA) between October 2001 and May 2004; and in study group 3 024 patients (3 024 eyes) had undergone the surgery with intracameral cefuroxime 1mg in 0.1mL between June 2004 and April 2007. Peroperative prophylaxis and operative procedures were the same in both groups. RESULTS: PE developed in 13 (0.42%) and 4 (0.13%) patients in the control and the study groups respectively [P=0.031;odds ratio= 3.20(1.04-9.84)]. PE developed 30 (3-75) days, and 25 (2-35) days after the surgeries in the two groups (P=0.35) respectively. Monomicrobial infections were observed. In the study group Aspergillus fumigatus and Pseudomonas aeruginosa were resistant to cefuroxime; however, Streptococcus pneumonia was sensitive to cefuroxime. No sign of toxicity or allergy from intracameral cefuroxime was noted.CONCLUSION: Intracameral prophylactic cefuroxime appears safe. It may provide considerable protection against bacterial PE; however, possibility of insufficient antibiotic coverage and antibiotic resistance of causative microorganism should be considered.

A Case Report of Intracameral Amphotericin B Injection in the Management of Deep Keratomycosis

PURPOSE: The management of fungal keratitis can be difficult because fungi are capable of penetrating the intact Descemet's membrane and entering the anterior chamber and because ocular penetration of topical antifungal agents is poor. The authors report the first case of intracameral amphotericin B injection in the management of deep keratomycosis. METHODS: A 73-year-old woman developed pain and decreased vision in her right eye. Corneal ulcer with hypopyon was found, and 10% KOH smear revealed hyphae. There was an initial response after administrating topical amphotericin B along with systemic fluconazole. But deep infiltrates and hypopyon remained. The corneal scraping grew Fusarium on culture. Ten micrograms of amphotericin B in 0.1 mL was injected into the anterior chamber on day 22 after admission. Two months after the intracameral injection, the ulcer and hypopyon cleared completely leaving only a central corneal scar. RESULTS: The results were favorable, with the ulcer and hypopyon clearing completely after the intracameral injection of amphotericin B. CONCLUSIONS: Intracameral amphotericin B may be a useful modality in the treatment of deep keratomycosis not responding to topical antifungal agents.