Shamim A Haji

Effect of Prophylactic Intraocular Pressure-Lowering Medication on Intraocular Pressure Spikes After Intravitreal Injections

OBJECTIVE To determine if prophylactic use of intraocular pressure (IOP)-lowering medication is effective in reducing the IOP spikes after intravitreal injections of pegaptanib, bevacizumab, and ranibizumab. METHODS Seventy-one patients with exudative age-related macular degeneration received intravitreal injections of 1 of 3 anti-vascular endothelial growth factor medications: 30 patients received pegaptanib (0.09 mL), 47 patients received bevacizumab (0.05 mL), and 42 patients received ranibizumab (0.05 mL). Intraocular pressure-lowering medication, 1 hour prior to the injection, was used 63%, 74%, and 66% of the time in eyes that received pegaptanib, ranibizumab, and bevacizumab, respectively. Intraocular pressure was measured prior to injection, within 1 minute after injection, and every 5 to 10 minutes until the pressure was reduced to a safe level. RESULTS All 3 intravitreal injections caused significant initial IOP spikes (mean [SD] IOP of 38.5 [11.56] mm Hg in the pegaptanib group, 37.75 [8.36] mm Hg in the ranibizumab group, and 34.88 [10.45] mm Hg in the bevacizumab group). The IOP reduced to less than 30 mm Hg in all 3 groups within 20 minutes. Prophylactic medication did not prevent postinjection IOP spikes. Patients with and without glaucoma showed a similar rate of IOP normalization over time in all 3 groups. CONCLUSION Intraocular pressure spikes after intravitreal injection of pegaptanib, ranibizumab, and bevacizumab are common and in most cases transient. Routine prophylactic use of IOP-lowering medications is essentially ineffective in preventing IOP spikes after intravitreal injection of pegaptanib, ranibizumab, and bevacizumab and therefore not necessary before the injection.

A protocol for the retina surgeon’s safe initial intravitreal injections

Purpose To determine the safety of a surgeon’s initial consecutive intravitreal injections using a specific protocol and to review the complications that may be attributed to the injection procedure. Design A retrospective chart review. Participants Fifty-nine patients (30 females, 29 males) received intravitreal injections of pegaptanib, bevacizumab, or ranibizumab as part of their treatment for neovascular age-related macular degeneration. The average patient age was 80 years. Twenty-two patients were diagnosed with or suspected of having glaucoma. Each patient received an average of 5.8 injections. Methods The charts of 59 patients who received a total of 345 intravitreal injections (104 pegaptanib, 74 bevacizumab, 167 ranibizumab) were reviewed. All injections were performed in an office-based setting. Povidone–iodine, topical antibiotics, and eye speculum were used as part of the pre injection procedure. Vision and intraocular pressure were evaluated immediately following each injection. Main outcome measures Incidence of post injection complications, including but not limited to endophthalmitis, retinal detachment, traumatic cataract, and vitreous hemorrhage. Results There were no cases of endophthalmitis, toxic reactions, traumatic cataracts, retinal detachment, or vitreous hemorrhage. There was one case each of lid swelling, transient floaters, retinal pigment epithelial tear, corneal edema, and corneal abrasion. There were five cases of transient no light perception following pegaptanib injections. Conclusion The incidence of serious complications was very low for the intravitreal injections given. A surgeon’s initial intravitreal injections may be performed with a very high degree of safety using this protocol.

Evaluation of the iPad as a low vision aid for improving reading ability

Purpose To evaluate the effect of the iPad as a low vision aid in improving the reading ability of low vision patients (LVPs). Methods In this study, 228 consecutive patients that came for their routine eye care examination at the University of Florida, Jacksonville eye clinic, were enrolled. Patients met inclusion criteria if they had best-corrected visual acuity (BCVA) of 20/100 or worse in the best corrected eye and were willing to participate in the study. The patient’s reading ability was assessed both with the patient’s own spectacles and an iPad. Patients were encouraged to enlarge the reading material as well as change the contrast until they could read comfortably. The number of patients able to read the text comfortably was recorded. Results Out of the total 228 participants who qualified, 103 (45%) were male and 125 (55%) were female. Only 22% could read standard newsprint-sized text (N8) without the help of an iPad. With the help of an iPad, 94% participants with impaired vision were able to read standard newsprint-sized text (N8) or smaller text (P<0.01). Conclusion The iPad, a new portable electronic media device, can be adapted by LVPs to improve their reading ability.

Continuous Monitoring of Intraocular Pressure

To date, the only way to directly measure intraocular pressure (IOP) is by manometry. The true pressure inside the eye cannot be determined by pressing on the outside of the eye (tonometry). At present, there are two problems with our current clinical methods of measuring IOP: namely, the lack of true accuracy and the inability to detect variations.

nampt/PBeF/visfatin serum levels: a new biomarker for retinal blood vessel occlusions

The main objective of the study was to quantify serum levels of nicotinamide phosphoribosyltransferase (Nampt/pre-B-Cell colony-enhancing factor 1/visfatin) in subjects with a history of retinal vascular occlusions (RVOs), disease conditions characterized by pronounced ischemia, and metabolic energy deficits. A case–control study of 18 subjects with a history of RVO as well as six healthy volunteers is presented. Serum Nampt levels were quantified using a commercially available enzyme-linked immunosorbent assay kit. Serum Nampt levels were 79% lower in patients with a history of RVO compared with that in healthy volunteers (P<0.05). There was no statistically significant difference among the types of RVOs, specifically branch retinal vein occlusions (n=7), central retinal vein occlusions (n=5), hemiretinal vein occlusions (n=3), and central retinal artery occlusions (n=3; P=0.69). Further studies are needed to establish the temporal kinetics of Nampt expression and to determine whether Nampt may represent a novel biomarker to identify at-risk populations, or whether it is a druggable target with the potential to ameliorate the long-term complications associated with the condition, ie, macular edema, macular ischemia, neovascularization, and permanent loss of vision.

Hyperbaric oxygen therapy for the treatment of radiation-induced macular ischemia.

Purpose: To report a case of radiation-induced macular ischemia where vision and macular perfusion improved after hyperbaric oxygen (HBO) therapy. Methods: A 62-year-old male patient developed radiation-induced macular ischemia after he was treated with radiation for brain glioma. The patient presented with best spectacle-corrected visual acuity (BSCVA) acuity of 20/400 in his right eye. Optical coherence tomography (OCT) showed central macular thickness of 468 μm. The patient received focal laser, intravitreal triamcinolone, and HBO therapy. Results: The patient’s vision improved from 20/400 to 20/100 after focal laser and intravitreal triamcinolone. His central macular thickness improved from 468 μm to 132 μm. After receiving HBO therapy, his VA improved to 20/50 and fluorescein angiography showed improvement in macular perfusion. Conclusion: HBO therapy improves macular perfusion in patients with radiation-induced macular ischemia.

Intraocular Pressure in Premature Low Birth Weight Infants

PURPOSE To evaluate the intraocular pressure (IOP) and central corneal thickness (CCT) in premature low birth weight (LBW) infants and their correlation with gestational age (GA). METHODS IOP and CCT were measured in premature LBW infants (defined as a birth weight ≤ 1,500 g or birth GA ≤ 30 weeks) admitted to the neonatal intensive care unit at the University of Florida Division of Neonatology, UF Health Jacksonville. RESULTS Ninety eyes of 45 premature LBW infants with mean birth GA of 28.2 ± 2.3 weeks and mean birth weight of 1,131.5 ± 380.1 g were evaluated. The mean IOP and CCT were 29.0 ± 9.0 mm Hg and 660.0 ± 65.0 µm, respectively. There was no correlation between the IOP and CCT (r = 0.09; P = .38). There was a negative correlation between IOP and GA (r = -0.41) and between CCT and GA (r = -0.26). CONCLUSIONS IOP is higher and CCT is thicker in premature infants compared to adults; however, there was no correlation between IOP and CCT. [J Pediatr Ophthalmol Strabismus. 2016;53(5):300-304.].