Int J Curr Pharm Res, Vol 13, Issue 5, 52-55Original Article


ASSESSMENT OF INTRAOCULAR PRESSURE FOLLOWING THE INTRAVITREAL INJECTION OF ANTI-VEGF

CHAKAR TAJWIDI1,2, SHIASTA TABASSUM1,2, RAHMAM GUL2,3*

1Helper Eye Hospital Quetta, Baluchistan, 2Department of Health Government of Baluchistan, Pakistan, 3Institute of Public Health Quetta
Email: gul.dotani@yahoo.com

Received: 04 May 2021, Revised and Accepted: 02 Jul 2021

ABSTRACT

Objective: The objective of the study is to assess the frequency of raised IOP after intravitreal injection of Anti VEGF by using an applanation tonometer.

Methods: Each patients who fulfil the presence criteria were nominated by the researcher through ‘the outpatient department (OPD) of ophthalmology, Jinnah Post Graduate Medical Center. Performa was filled. Aim and process of study was explained to all patients. Conversant consent was reserved. Model ocular inspection, including IOP was done.

By using either a 30-or 32-gauge needle, 1.25 ml bevacizumab (Avastin) were administered by the researcher under the direct supervision of consultant. Patients were consistently sterilely prepped, that was comprised incerted of topical antibiotic and anesthetic drops, supplement of a lid speculum. Later pointing the injection place on the sclera with a caliper calculating 3.0 to 3.5 mm after limbus, conjunctiva was expatriate somewhat through a sterile cotton-tipped applicator immediately earlier ingoing the eye by a needle. Later injection, place was occluded provisionally it was amended through a sterile cotton-tipped applicator while the needle remained inhibited from the eye. Since the needle was inhibited, a drop of anesthetic was employed on the cornea and IOP was measured. Then next IOP interpretation was measured later 1day of intravitreal Avastin.

All pressures were measured using the applantation tonometry. IOPs were measured earlier intravitreal Avastin "baseline IOP" and instantly following injection "T0" and 1day next injection.

Results: 235 Patients exactly nominated for the research study. Intravitreal Injection, Bevacizumab was applied in 235 Eyes of overstated 235 patients. Elsewhere of the 235 patients, 133 males and 102 females, Their ages ranged from 30-70 y (mean 52.02 y. The most shared sign intravitreal with bevacizumab, diabetic retinopathy observed in 114 (48.5%) patients, indicated by exudative ARMD in 70 (29.7%) patients, BRVO in 12 (5%) patients, Myopic CNV23(9.7) with CRVO observed in 11 (4.6%) patients, Eale’s sickness in 2(0.85%) patients even as Idiopathic CNV was observed in only 3 (1%) patient. Of the 235 patients, 118 (50.2%) patients with right eye suffered, 117(49.7%) patients with left eye suffered. After 24 h of intravitreal Bevacizumab Raised IOP was observed in only 3 (1.28) patient and 232(98.2) patient IOP was in the normal range. According to our study, the result of stratification with respect to age, side of the eye and gender is not significant as p-value for age (0.838), gender (0.723) and side of the eye (0.556), respectively.

Conclusion: In our study, frequency of raised IOP after anti VEGF were found 3(1.28) patient out of 232 (98.2). Anti-VEGF treatment is the foundation for the management of numerous retinal illnesses. Notwithstanding its capable effectiveness in uncertain the sickness and refining, vision for the patients, intravitreal injection of anti-VEGF products may be related with overwhelming problems. To diminish the risk cautious care to the injection method and suitable post-injection observing are essential.

Keywords: Anti-VEGF, Intraocular pressure, Applanation tonometer

© 2021 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/)
DOI: https://dx.doi.org/10.22159/ijcpr.2021v13i5.1885 Journal homepage: https://innovareacademics.in/journals/index.php/ijcpr

INTRODUCTION

The most important reason of blindness in progressive countries are neovascularization of the choroidal and retinal tissue [1]. Vascular endothelial enlargement issue has been recognized since a main angiogenic inducement in diversity with retinal and choroidal neovascularization [2]. Vascular Endothelial Growth Factor is homodimeric glycoprotein and is a enlargement issue exact for endothelial cells [3]. It is not only indorses the enlargement and continuation of vascular endothelial cells, other than in addition causes conformational changes of tense junctions of retinal vascular endothelial cells primary to increased vascular penetrability [4].

Bevacizumab (Avastin) is a humanized monoclonal antibody which is known to stops vascular endothelial growth factor A "VEGF-A" It is a chemical signal that rouses the enlargement of novel blood vessels "angiogenesis". Today intravitreal Bevacizumab is used to heal the subsequent disorders:

1). CNV caused by pathological myopia [5].

2). Iris neovascularization with Proliferative diabetic retinopathy [6].

3). Idiopathic CNV [7].

4). Retinal vein occlusion [8].

5). CNV caused by Age related Macular Degeneration [9].

6). Proliferative diabetic retinopathy [10].

The inducing of extra solution into the hollow vitreous space by intravitreal treatment must be predictable to cause an instant increase in the intraocular pressure "IOP". This fleeting, temporary IOP promotion following intravitreal anti-VEGF treatment has been sound defined [11-14].

As per Centre for Medicare and Medicaid Services, intravitreal injections could be the speedy rising ophthalmic technique in 2006. as a result, it is significant to examine behavior to guarantee patient security whereas refining in general patient knowledge and effectiveness of patient flow in the place of work with these theraphies. According to the research done by kampougeris G, Spyropoulos D prevalence of raised IOP is 2.5% after intravitreal injection of Anti VEGF.

The rationale of this study is to evaluate raised IOP after intravitreal injection of 1.25 mg of "Avastin". Although many researches have done on intravitreal Avastin but its effect on IOP is not available. The study will generate data, which will facilitate the healthcare system by assessing temporary tendencies and the essential to screen intraocular pressure "IOP" changes directly after intravitreal injections of Anti VEGF to safeguard patient safety.

MATERIALS AND METHODS

Subjects and methods

This cross-section study was conducted at Jinnah Post Graduate Medical center. All patients who fulfill the inclusion criteria were selected by ‘the outpatient department "OPD" of ophthalmology, Jinnah Post Graduate Medical Center. Performa was filled. Purpose and technique of the study were explained to all patients. Conversant consent was received. Baseline ocular examination, including IOP was done.

By using either a 30-or 32-gauge needle, 1.25 ml bevacizumab (Avastin) were administered by the researcher under the direct supervision of a consultant. Patients were evenly sterilely prepped, that incorporated insertion of topical antibiotic and anesthetic drops, installation of a lid speculum. Later design, the injection site on the sclera through a calliper measuring 3.0-3.5 mm after the limbus, the conjunctiva was expatriate somewhat among a sterile cotton-tipped applicator immediately earlier toward the inside the eye with a needle. Later injection, spot was occluded provisionally and was rubbed among a sterile cotton-tipped applicator while the needle was removed since the eye. By way of the needle was removed, a drop of anesthetic was located on the cornea and IOP was observed. Then next, IOP appraisal was observed after 1 day of intravitreal Avastin.

Entirely pressures were observed using the applanation tonometr. IOPs were observed before intravitreal Avastin (baseline IOP) and instantly after injection (T0) and 1day after injection.

Data anylasis

Statistical analysis were done utilizing IBM SPSS software version 20.0. Incidences and fractions, calculated for definite variables similar to gender, side of the eye and raised IOP. Standard deviation and mean of quantitative variables similar to age were calculated. Stratification with respect to age, side of the eye and gender was completed. Post-stratification chi-square test was practical. P<0.05, observed as significant.

RESULTS

235 Patients completed this study. Intravitreal Injection of Bevacizumab was given in 235 Eyes of above mentioned 235 Patients. Out of the 235 patients, 133 were males and 102 were females (table 4 and fig. 32). Their ages ranged from 30to 70 y (mean 52.02 y). The most shared sign of intravitreal bevacizumab would be diabetic retinopathy found in 114(48.5%) patients, followed by exudative ARMD in 70 (29.7%) patients, BRVO in 12 (5%) patients, Myopic CNV23(9.7) and CRVO found in 11 (4.6%) patients, Eale’s disease in 2(0.85%) patients while Idiopathic CNV was found in only 3 (1%) patient. Table 1. Of the 235 patients, 118 (50.2%) patients with right eye suffered, 117(49.7%) patients with the left eye suffered. After 24 h of intravitreal Bevacizumab Raised IOP was seen in only 3 (1.28) patients and 232(98.2) patient IOP was in normal range. According to our study, the result of stratification with respect to age, side of the eye and gender is not significant as the p-value for age (0.838), gender (0.723) and side of the eye (0.556), respectively (table 6, 7, 8).

Table 1: Gender frequency

Gender Frequency Percent
Male 133 56.6
Female 102 43.4
Total 235 10s0

Table 2: Descriptive statistics of age profile

n Minimum Maximum Mean Std. Deviation Median
235 30 70 52.2766 9.59278 52.2766

Table 3: Diagnosis

No. of patients n (%)
DR 114 [48.5]
ARMD 70 [29.7]
Myopic CNV 23 [9.7]
CRVO 11 [4.6]
BRVO 12 [5]
Idiopathic CNV 3 [1.2]

DR: diabetic retinopathy, ARMD: age-related macular degenerations, Myopic CNV: myopic choroidal neovascularisation, CRVO: central retinal view occlusion, BRVO: branch retinal view occlusion, Eale’s Disease, Idiopathic CNV: idiopathic choroidal neovascularization

Table 4: Side of the eye

Side of the eye Frequency Percent
Right eye 118 50.21
Left eye 117 49.79
Total 235 100

Table 5: Raised IOP after 24h

Raised IOP after 24 h Frequency Percent
YES 3 1.28
NO 232 98.72
Total 235 100.0

Table 6: Stratification by age

Age group 30-40 41-50 51-60 61-70 Total p-value
YES 0 1 1 1 3 0.838
NO 35 53 95 49 232
Total 35 54 96 50 235

Table 7: Stratification by gender

Raised IOP after 24 h
NO YES Total p-value
Male 131 2 133 0.723
Female 101 1 102
Total 232 3 235

Table 8: Stratification by side of eye

Raised IOP after 24 h
NO YES Total p-value
Right eye 117 1 118 0.556
Left eye 115 2 117
Total 232 3 235

DISCUSSION

Ischemic conditions of eye identical central retinal vein occlusion and diabetic or hypertensive retinopathy reasons microangiopathies at tissue stage. The subsequent hypoxia leads to the issue of vascular endothelial growth factor (VEGF) 1. VEGF has double-dealings, one it reasons neovessels development, other it rises vascular penetrability, which leads to retinal edema [15].

The approach of action of Bevacizumab is to constrain the upregulation of VEGF. This in turn, will opposite the phenomena of neovascularization and edema creation [16]. Additional utilization of intravitreal Bevacizumab are retinopathy of prematurity "ROP", pseudophakic, macular edema, serious central chorioretinopathy "CSCR" and radiation retinopathy [17].

Bevacizumab has been utilized on an “off-label” foundation since the fall of 2005. While it is of abundant lesser cost than either Lucentis and Macugen "FDA approved anti-VEGF", it is utilized as the first-line theraphy in most macular degeneration patients. While no work has been conducted elsewhere before on this subject in our local system, this research study would be significant in resolution-making concerning the safety of intravitreal bevacizumab in choroidal and retinal neovascular illnesses. The most shared signs of Bevacizumab in one paper by Lihteh Wu et al. were diabetic retinopathy and CNV of several etiologies.

The main suggestions in our research study were diabetic retinopathy (48.5%) followed by CNV of a variety of etiologies as well.

The manner of intravitreal anti-VEGF therapy donates to ocular hypertension is unidentified, but numerous possible mechanisms are thinkable. The drugs may have a direct pharmacologic effect on aqueous outflow via the trabecular meshwork, uveoscleral pathway, or Schlemmcanal. Reports have diverse as to whether ranibizumab or bevacizumab is toxic to anterior section cells at pharmacological doses [18, 19]. The recurrent transient IOP rise connected to the volume of drug presented could also change aqueous outflow pathways. Chronic inflammation or trabeculitis related to recurrent intravitreal injections could theoretically donate to sustained IOP elevation [20].

Mechanical obstacle to seeping away, either by the anti-VEGF mediator or byproducts, pharmacologic formulations or storage, might be concerned. Kahook et al. [21]. Originate variable stages of high-molecular-weight protein aggregates when associating various samples of formulated preparations of bevacizumab and hypothesized that this large specific substance could lead to raised IOP by hindering aqueous outflow.

In our present study, there were just 3 cases of elevated IOP, which reappearance to usual with glaucoma medicine, thus requiring checking IOP afterward injection as protection.

A total of 253 Patients, designated for this research study. Intravitreal Injection of Bevacizumab was introduced in 253 Eyes of the above-stated Patients. Out of the 253 Patients, 133were Males and 102 were Females. Their ages ranged from 30 to 70 y (mean 52.02 y). The highest numbers of patients were in their 5th decade. While the study was conducted in a government eye hospital, bigger numbers of our patients belonging from a poor monetary background, reasonably smaller concentration towards health care problems and observance towards pursue ups.

CONCLUSION

In our study, frequency of raised IOP after anti-VEGF were found 3(1.28) patient out of 232(98.2). Anti-VEGF treatment is the mainstay for the management of numerous retinal problems. Notwithstanding its promising efficacy in hesitant the disease and refining the vision for the patients, intravitreal injection of anti-VEGF agents may be related with overwhelming problems. To diminish the risk, wary care to the injection system and suitable post-injection monitoring are crucial

ACKNOWLEDGEMENT

We are thankful to the Medical superintendent, Jinnah Post Graduate Medical center, Karachi and Health Department, Government of Balochistan for their timely support to outright this research.

FUNDING

None

AUTHORS CONTRIBUTIONS

All the authors have contributed equally.

CONFLICT OF INTERESTS

We have no conflict of interest

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