Risk of dialysis in patients receiving intravitreal anti-vascular endothelial growth factor treatment: a population-based cohort study.

We utilized the Longitudinal Health Insurance Database which was stemmed from the Taiwan's National Health Insurance Research Database to conduct a retrospective cohort study investigating the risk of becoming dialysis dependent after receiving intravitreal anti-vascular endothelial growth factor (VEGF) agents for retinal diseases. Patients newly receiving intravitreal ranibizumab or aflibercept from 2000 to 2017 for age-related macular degeneration, polypoidal choroidal vasculopathy, diabetic macular edema, retinal vein occlusions, or myopic choroid neovascularization were included as the study group, and patients with same retinal diseases but did not receive intravitreal anti-VEGFs served as controls extracted by age- and sex-matched (1:4) and further propensity score matching (PSM). Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the risk of dialysis. A cohort of 2447 anti-VEGF users and 2447 controls by PSM were evaluated. Higher dialysis risks were observed among patients newly receiving anti-VEGF agents compared to controls (adjusted HR: 1.849; 95% CI: 1.378-2.482) in the PSM cohort. For subgroup analysis, patients newly receiving anti-VEGF treatment for diabetic macular edema had significant risk (adjusted HR: 1.834; 95% CI: 1.448-2.324) of becoming dialysis-dependent, while patients in other subgroups demonstrated similar risks as the controls. In conclusion, intravitreal anti-VEGF agents might increase the risk of becoming dialysis-dependent, especially in patients who are treated for diabetic macular edema.

Susac Syndrome Following COVID-19 Vaccination: A Case Report.

Due to the COVID-19 pandemic, numerous vaccines have been developed for the disease. However, with large-scale vaccination has come the gradual emergence of immunological phenomena caused by these new vaccines. Herein, we report a 48-year-old female with a sudden onset of inferior visual field defects in the left eye following her first dose of the ChAdOx1 vaccine. Dilated fundus examination combined with optical coherence tomography and fluorescein angiography confirmed the diagnosis of branch retinal artery occlusion. Within 4 weeks following vaccination, symptoms associated with hearing impairment developed, and magnetic resonance imaging revealed leptomeningeal enhancement. The diagnosis of Susac syndrome (SS) was confirmed. The development of SS may be caused by endotheliopathy resulting from the molecular mimicry of the ChAdOx1 vaccine. Clinicians should be aware of the symptoms of SS, which may develop after COVID-19 vaccination. Further experimental surveillance and case-control studies are required to confirm this relationship.

Risk of Glaucoma in Patients Receiving Hemodialysis and Peritoneal Dialysis: A Nationwide Population-Based Cohort Study.

This paper investigated the incidence and risk of newly diagnosed glaucoma after the initiation of maintenance dialysis in Taiwan. A case-control study was conducted using the National Health Insurance Research Database (NHIRD) in Taiwan. There were 3949 patients with dialysis in the study group and 78,980 non-dialysis subjects matched by age and sex in the comparison group. The incidence of newly diagnosed glaucoma after the initiation of maintenance dialysis was analyzed based on the diagnostic code for glaucoma. Patients with dialysis had a higher risk of glaucoma (adjusted hazard ratio (aHR): 1.270; 95% confidence interval (CI): 1.035-1.560) than patients without dialysis. The incidence rate of glaucoma was 8.18 per 10,000 person months in the dialysis group, which was higher than that in the non-dialysis group (5.01 per 10,000 person months). Patients with dialysis exhibited a significantly higher risk of angle-closure glaucoma (ACG) (aHR: 1.550; 95% CI: 1.074-2.239). In contrast, there was no significant risk of developing open-angle glaucoma or normal-tension glaucoma in dialysis patients. Our data suggest that dialysis patients are more susceptible to ACG. Regular ophthalmic examinations may be useful in patients with dialysis to identify high-risk individuals with glaucoma, and preventive measures can be applied to avoid permanent vision loss as soon as intraocular pressure (IOP) elevation is identified.

Safety of intrastromal injection of polyhexamethylene biguanide and propamidine isethionate in a rabbit model.

Acanthamoeba keratitis (AK) is difficult to treat, especially when the corneal deep stroma is involved. Intrastromal injection of antimicrobial agents is an effective adjuvant therapy for deep recalcitrant microbial keratitis; however, it has not been used to treat AK due to suspected drug toxicity. The purpose of this study was to evaluate the toxicity of corneal intrastromal injection of polyhexamethylene biguanide (PHMB) and propamidine isethionate (Brolene®, Sanofi) in New Zealand white rabbits. We performed intrastromal injections of PHMB (0.02 or 0.01%) and propamidine isethionate (0.1 or 0.05%) into the rabbits' right corneas. The left corneas were injected with phosphate-buffered saline as controls. The rabbits were sacrificed on the 7th day after injection, and the corneal buttons were harvested for further evaluation by slit lamp microscopy, specular microscopy, hematoxylin and eosin staining, scanning electron microscopy, terminal deoxynucleotidyl transferase (TdT) dUTP nick-end labeling assays, and WST-1 assays. We found that intrastromal injection of 0.02% PHMB or 0.1% propamidine isethionate resulted in corneal epithelial erosion, corneal edema, and severe neovascularization. However, 0.01% PHMB or 0.05% propamidine isethionate did not induce obvious cornea toxicity. In conclusion, intrastromal injection of 0.01% PHMB or 0.05% propamidine isethionate may be promising adjunctive treatments for deep stromal AK.

Real-world use of ranibizumab for neovascular age-related macular degeneration in Taiwan.

This study investigated the "real-world" use of ranibizumab for neovascular age-related macular degeneration (nAMD) in Taiwan and assessed the visual outcome. We reviewed the medical records at National Cheng Kung University Hospital, Taiwan, during 2012-2014 for 264 consecutive eyes of 229 patients with nAMD, who applied for ranibizumab covered by national health insurance. A total of 194 eyes (73.5%) in 179 patients (65.5% men; mean ± standard deviation age 69.4 ± 10.7 years) were pre-approved for treatment. Applications for treatment increased year by year, but approval rates decreased during this time. The major causes of rejection for funding were diseases mimicking nAMD, including macular pucker/epiretinal membrane, macular scarring, dry-type AMD, and possible polypoidal choroidal vasculopathy. After completion of three injections in 147 eyes, visual acuity significantly improved, gaining ≥1 line in 51.8% of eyes and stabilising in 38.3% of 141 eyes in which visual acuity was measured. The 114 eyes approved with only one application had a better visual outcome than the 27 eyes approved after the second or third applications. In conclusion, ranibizumab is effective for nAMD; however, approval after the second or third application for national health insurance cover is a less favourable predictor of visual outcome.

Airbag-Associated Severe Blunt Eye Injury Causes Choroidal Rupture and Retinal Hemorrhage: A Case Report.

A case of choroidal rupture caused by airbag-associated blunt eye trauma and complicated with massive subretinal hemorrhage and vitreous hemorrhage that was successfully treated with intravitreal injection of expansile gas and bevacizumab is presented. A 53-year-old man suffered from loss of vision in his right eye due to blunt eye trauma by a safety airbag after a traffic accident. On initial examination, the patient had no light perception in his right eye. Dilated ophthalmoscopy revealed massive subretinal hemorrhage with macular invasion and faint vitreous hemorrhage. We performed intravitreal injection of pure sulfur hexafluoride twice for displacement, after which visual acuity improved to 0.03. For persistent subretinal hemorrhage and suspicion of choroidal neovascularization (CNV), intravitreal bevacizumab (1.25 mg/0.05 mL) injection was administered. After 3 weeks, the visual acuity of his right eye recovered to 0.4. For early-stage choroidal rupture-induced subretinal hemorrhage and complications of suspected CNV, intravitreal injection of expandable gas and intraocular injection of antiangiogenesis drugs seem to be an effective treatment.