ABSTRACT
Ocriplasmin is a recombinant protease approved as a nonsurgical treatment for vitreomacular traction (VMT) and small macular holes with vitreomacular adhesion (VMA). Successful ocriplasmin treatment in clinical studies has been defined as nonsurgical resolution of VMA as demonstrated on optical coherence tomography (OCT) by day 28 after intravitreal injection. This report presents three eyes with improvement in visual acuity and clinical symptoms despite only partial release of VMT over 28 days after ocriplasmin injection.
Subject(s)
Eye Diseases/drug therapy , Fibrinolysin/therapeutic use , Fibrinolytic Agents/therapeutic use , Peptide Fragments/therapeutic use , Retinal Diseases/drug therapy , Vitreous Body/drug effects , Aged , Aged, 80 and over , Eye Diseases/metabolism , Eye Diseases/physiopathology , Female , Humans , Intravitreal Injections , Male , Middle Aged , Retinal Diseases/metabolism , Retinal Diseases/physiopathology , Tissue Adhesions/drug therapy , Tissue Adhesions/metabolism , Tissue Adhesions/physiopathology , Tomography, Optical Coherence , Visual Acuity/physiology , Vitreous Body/metabolismABSTRACT
PURPOSE: To report the presenting features and clinical outcomes of a series of patients with noninfectious inflammation after intravitreal aflibercept injection. DESIGN: Noncomparative consecutive case series. METHODS: Medical records of patients who presented with noninfectious inflammation after intravitreal aflibercept injection between November 18, 2011 and June 30, 2013 were retrospectively reviewed. RESULTS: A total of 20 cases of postinjection inflammation were identified in 5356 aflibercept injections. The patients presented 1-13 days after aflibercept injection (median 3 days); all noted decreased vision, while 3 of 20 (15%) had pain and 2 of 20 (10%) had conjunctival injection. One patient had a hypopyon (0.5 mm), and the average anterior chamber cell was 1.8+ (range 0 to 4+). All eyes had some degree of vitritis (average 1.8+; range 0.5+ to 4+). Patients on average had received 6 prior aflibercept injections (range 0-16). Only 1 patient-the first to present with inflammation in this series-received an intravitreal tap (culture negative) and injection of antibiotics. All patients were managed with frequent topical steroids and were followed closely for signs of improvement. All but 1 patient regained their preinjection visual acuity (average: 33 days; range: 7-73 days). Four patients were subsequently rechallenged with aflibercept, and 1 developed inflammation again after 5 additional aflibercept injections. The overall incidence of inflammation after intravitreal aflibercept injection was 20 of 5356 injections (0.37%) or 19 of 844 patients (2.25%). However, a disproportionate number of cases clustered around 1 provider (17/20, 85%; P < .001 vs all other providers) and around the 2 office locations where this physician primarily worked (16/20, 75%; P < .001 vs 5 other offices). CONCLUSIONS: Noninfectious inflammation after intravitreal aflibercept injection typically presents without pain, conjunctival injection, or hypopyon, and responds to topical steroid therapy. The visual outcomes are generally favorable, though the return to baseline acuity can take many weeks.
Subject(s)
Angiogenesis Inhibitors/adverse effects , Endophthalmitis/chemically induced , Endophthalmitis/diagnosis , Receptors, Vascular Endothelial Growth Factor/adverse effects , Recombinant Fusion Proteins/adverse effects , Retinal Vein Occlusion/drug therapy , Visual Acuity/physiology , Wet Macular Degeneration/drug therapy , Aged , Aged, 80 and over , Endophthalmitis/physiopathology , Female , Glucocorticoids/therapeutic use , Humans , Intravitreal Injections , Male , Retinal Vein Occlusion/diagnosis , Retinal Vein Occlusion/physiopathology , Retrospective Studies , Wet Macular Degeneration/diagnosis , Wet Macular Degeneration/physiopathologyABSTRACT
PURPOSE: The purpose of this study was to report the safety profile of the Alcon 23-gauge single-step preloaded transconjunctival vitrectomy system. METHODS: This was a retrospective case series examining 118 eyes of 114 patients that underwent 23-gauge vitrectomy between July and November 2007. Patients were observed postoperatively for a minimum of 6 weeks. Main outcome measures were postoperative intraocular pressure (IOP), intraoperative complications, and postoperative adverse events. RESULTS: The mean postoperative Day 1 IOP was 14.3 +/- 6.6 mmHg (median, 13 mmHg; range, 2-38 mmHg) and Month 1 IOP was 15.8 +/- 5.9 mmHg (median, 15 mmHg; range, 6-52 mmHg). Two eyes (1.7%) developed choroidal effusions. Four eyes (3.4%) developed intraoperative horseshoe tears. No retinal detachments or endophthalmitis occurred. Four eyes (3.4%) had postoperative hypotony. Intraoperative wound leak after cannula removal requiring a sclerotomy suture occurred in 38% of patients: 35 eyes requiring closure of 1 cannula site (29.6%), 8 eyes (6.8%) requiring closure of 2 cannula sites, and 2 eyes (1.7%) requiring closure of all 3 cannula sites. CONCLUSION: The Alcon 23-gauge single step preloaded transconjunctival vitrectomy system has few safety issues. Sclerotomy leaks after cannula removal are common, with 38% of eyes requiring suture closure of at least 1 cannula site.
Subject(s)
Conjunctiva/surgery , Intraoperative Complications , Microsurgery/methods , Postoperative Complications , Retinal Diseases/surgery , Vitrectomy/methods , Adult , Aged , Aged, 80 and over , Female , Humans , Intraocular Pressure , Male , Microsurgery/adverse effects , Middle Aged , Ophthalmoscopy , Retrospective Studies , Sclerostomy , Tonometry, Ocular , Vitrectomy/adverse effectsABSTRACT
BACKGROUND AND OBJECTIVE: To evaluate the effect of intravitreal ranibizumab in patients with leaking disciform scars. PATIENTS AND METHODS: In this retrospective case series, 31 eyes received one or two ranibizumab injections for treatment of choroidal neovascularization. Visual acuity, central retinal thickness, and macular volume were measured prior to injection and at 1-month follow-up. RESULTS: After one injection (n = 31), mean optical coherence tomography (OCT) central foveal thickness decreased from 317 to 242 microm (P = .00016). Mean OCT macular volume decreased from 7.89 to 6.80 mm3 (P = .00019). After two injections (n = 12), mean OCT central foveal thickness decreased from 310 to 248 microm following the second injection (P = .04). Mean OCT macular volume decreased from 7.80 to 6.43 mm3 at 1-month follow-up after a second injection (P = .006). There was no significant change in visual acuity after injections. CONCLUSION: In the short-term, ranibizumab decreases the leakage associated with choroidal neovascularization in chronic macular degeneration.
