First Author: E.Ciloglu TURKEY
Co Author(s): F. Unal
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Although the safety and efficacy of intravitreal ranibizumab injection in many retinal disorders is well-established in the literature, these may cause ocular adverse effects. There is a few study in the literature researched that intraocular pressure (IOP) elevation and changes in anterior segment parameters following ranibizumab for diabetic macular edema (DME). This study aimed to observe IOP, central corneal thickness (CCT), anterior chamber parameters including anterior chamber depht (ACD), iridocorneal angle (ICA) after single-dose intravitreal injection of ranibizumab in diabetic patients.
Prospective observational clinical trial
This is a prospective observational clinical trial was conducted with 40 patients undergoing intravitreal injection of ranibizumab (Lucentis;Genentech) due to DME. All patients underwent a complete ophthalmologic examination including visual acuity, slit lamp biomicroscopy, tonometry, gonioscopy and fundoscopy. Patients with glaucoma, pseudoexfoliation syndrome, uveitis, rubeozis iridis, matur cataract, shallowed anterior chamber, any other ocular or retinal pathologies (proliferative diabetic retinopathy), any previous ocular trauma were excluded. Patients who had previous ocular surgery or intravitreal injection of corticosteroid or anti-VEGF excluded from the study. CCT,ACD,ICA measurements were obtained with Pentacam Scheimpflug imaging (OculusOptikgerate GmbH, Wetzlar, Germany).IOP measurements were taken with Goldmann applantion tonometer. Measurements were taken before and after injection 1 day, 1 week and 1 month later.
The mean age of the patients was 57,25 years (range 46 to 75 years), with 18 men (45%) and 22 women (55%). All of the patients were phakic. Patients received intravitreal injections of 0.05 ml ranibizumab for DME. Mean baseline IOP before injection was 12.41±2.77 mmHgAppl (range 9 to 21 mmHg). Mean IOP 1 day after injection was 12.96±3.016 mmHgAppl (range 8-22 mmHg). 1 week after injection was 12.54±2.93 mmHgAppl (range 9-22 ). 1 month after injection was 12.54 ±2.40 mmHgAppl (range 8-21) (p=0.341). The mean CCT was 535.83±27.35µm (489 to 605). Corrected IOP values according to CCT were calculated. Mean baseline ACD before injection was 3.17±0.45 (2.41 to 4.45). Mean ACD 1 day after injection was 3.10±0.37 (2.21 to 3.76). One week after injection was 3.10±0.387 (2.35 to 3.76). One month after injection was 3.14 ±0.39 (2.43 to 3.90) (p=0.408). Mean ICA before injection was 31.19±5.48 (21.30 to 41.70). One day after injection was 30.36 ±5.43 (22.50 to 36.90). One week after injection was 30.96±5.38 (24.20 to 41.90). One month after injection was 31.20±6.09 (25.70 to 40.30) (p=0.340).
: Intravitreal injection has become an increasingly common intervention in the treatment of retinal disease. Despite the therapeutic benefits of these agents, repeat injections often are required, with agents such as ranibizumab injected as often as every four weeks . The intravitreal half-lives of ranibizumab, bevacizumab, and the aflibercept( VTE) were estimated to be 3.2, 5.6, and 4.8 days, respectively. According to these findings, 1 month followup period may be sufficient for evaluation of the effects of single-dose intravitreal ranibizumab injection . Diabetic macular edema therapy is a chronic process requiring repeated injections. It is a known fact that corticosteroids used in the treatment of DME cause elevation in IOP. We found that ranibizumab injection in phakic diabetic patients did not significantly change the IOP, ACD and ICA values at 1 month. In this context, it is possible to say that ranibizumab can be safely used in phakic, diabetic patients requires repetitive injection. Long-term follow-up studies may provide additional contributions to the literature.