Scleral Thinning After Repeated Intravitreal Injections of Antivascular Endothelial Growth Factor Agents in the Same Quadrant

Zinkernagel, Martin S.; Schorno, Petra; Ebneter, Andreas; Wolf, Sebastian

doi:10.1167/iovs.14-16204

Cited by 35 publications

(35 citation statements)

References 25 publications

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“…This approach assumes the scleral and conjunctival tissue has a common refractive index ( n = 1.40). Although this assumption is consistent with a number of previous studies of anterior scleral thickness using a range of different devices, there is evidence from in vitro studies that the bulbar conjunctiva and sclera exhibit some differences in their optical properties . However, we estimate that accounting for the small difference in refractive index between the sclera ( n = 1.41) and conjunctiva ( n = 1.38) in the determination of thickness values would result in only a −0.7% and +1.5% change in the scleral and conjunctival thickness estimates respectively.…”

Section: Discussionsupporting

confidence: 90%

“…However the effects of these distortions on the thickness values would be expected to be relatively constant between the measurement sessions, which suggest their effect on the changes in thickness observed would be minimal. It should also be noted that the relatively flat curvature of the anterior sclera, and small refractive index difference between the sclera and conjunctiva (0.03) would predict only small effects of refractive distortion upon axial thickness measures, which is the likely reason why the majority of previous studies of anterior scleral, conjunctival and ciliary body thickness in the anterior segment do not appear to have specifically adjusted for this factor in their measurements.…”

Section: Discussionmentioning

confidence: 99%

“…A number of recent studies have used AS‐OCT to examine the in vivo changes in anterior scleral morphology associated with the presence of glaucoma, glaucoma filtration surgery, ocular therapeutic procedures, keratoconus, contact lens wear and the presence of inflammatory conditions such as scleritis and episcleritis . A small number of studies have also reported upon the thickness characteristics of the anterior sclera in normal adult eyes, and others have examined the normal dimensions of the bulbar conjunctiva using AS‐OCT …”

Section: Introductionmentioning

confidence: 99%

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Diurnal variation of anterior scleral and conjunctival thickness

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Alonso‐Caneiro

Free

et al. 2016

Ophthalmic Physiologic Optic

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This study provides the first evidence of diurnal variations occurring in the thickness of the anterior sclera and conjunctiva. Studies requiring precise measures of these anatomical layers should therefore take time of day into consideration. The majority of the observed changes occurred in the early morning immediately after waking and were of larger magnitude in the conjunctiva compared to the sclera. Thickness changes at other times of the day were of smaller magnitude and generally not statistically significant.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diurnal variation of anterior scleral and conjunctival thickness

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Alonso‐Caneiro

Free

et al. 2016

Ophthalmic Physiologic Optic

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“…This route of treatment is not used in practice, and although this study did compare aflibercept versus placebo - a comparison we sought to review when drafting our protocol (Sarwar 2014) - this comparison was not relevant to this review. We excluded one study because participants were not treatment-naive (Zehetner 2015) and three studies that were not RCTs (Elshout 2014; Yoshida 2014; Zinkernagel 2015). …”

Section: Resultsmentioning

confidence: 99%

Aflibercept for neovascular age-related macular degeneration

Sarwar

Clearfield

Soliman

et al. 2016

Cochrane Database of Systematic Reviews

105

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Background Central vision loss caused by age-related macular degeneration (AMD) is the leading cause of blindness among the elderly in developed countries. Neovascular AMD is characterized by choroidal neovascularization (CNV). Growth of new blood vessels in patients with neovascular AMD is driven by a complex process that involves a signal protein called vascular endothelial growth factor A (VEGF-A). Anti-VEGF drugs that block this protein include ranibizumab, bevacizumab, and aflibercept. Objectives To assess and compare the effectiveness and safety of intravitreal injections of aflibercept versus ranibizumab, bevacizumab, or sham for treatment of patients with neovascular AMD. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (Issue 11, 2015), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to November 2015), EMBASE (January 1980 to November 2015), PubMed (1948 to November 2015), Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to November 2015), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) (last searched December 4, 2014), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on November 30, 2015. Selection criteria We included randomized controlled trials (RCTs) in which aflibercept monotherapy was compared with ranibizumab, bevacizumab, or sham for participants with neovascular AMD who were treatment-naive. Data collection and analysis We used standard methodological procedures of The Cochrane Collaboration for screening, data abstraction, and study assessment. Two review authors independently screened records, abstracted data, and assessed risk of bias of included studies; we resolved discrepancies by discussion or with the help of a third review author when needed. Main results We included two RCTs (total of 2457 participants, 2457 eyes). Trial participants had neovascular AMD with active subfoveal choroidal neovascular lesions. Both trials followed the same protocol and compared aflibercept at various doses versus ranibizumab, but they were carried out in different countries. One trial enrolled participants from the United States and Canada, and the second trial was conducted at 172 sites in Europe, Asia Pacific, Latin America, and the Middle East. The overall quality of the evidence was high, and included trials were at low risk for most bias domains assessed; however, both trials were funded by the manufacturers of aflibercept. For the purposes of analysis, we combined aflibercept groups regardless of dosing and analyzed them as a single group. Visual acuity outcomes were similar between aflibercept and ranibizumab groups...

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“…These cells are enriched with the NO-producing enzyme eNOS (Nathanson and McKee, 1995), and can sense mechanical forces. During the last decade, advances in spectral domain optical coherence tomography (SD-OCT) have enabled the quantitative assessment of a range of anterior segment structures in living human eyes (Wong et al, 2009;Kagemann et al, 2010;Yoo et SHong et al, 2013;Day et al, 2013;Kagemann et al, 2014a;Ebneter et al, 2015;Zinkernagel et al, 2015;Read et al, 2016a). Several recent studies have used anterior segment OCT (AS-OCT) to examine the in vivo changes of the trabecular outflow pathways (Kagemann et al, 2010;Francis et al, 2012;Chen et al, 2013;Kagemann et al, 2014a).…”

Section: Introductionmentioning

confidence: 99%

The Influence of the Autonomic Nervous System on the Human Choroid

Sander¹

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v AbstractThe impact of myopia is greater than just its optical consequences and in severe cases it can lead to a loss of vision. It is a highly prevalent eye disorder, with about one third of the population worldwide affected by this refractive error. Despite extensive research, the pathogenesis of myopia is still only partially understood. An improved knowledge of mechanisms underlying myopia is critical to developing new therapies to prevent myopia or to slow its progression.Although there is no fully effective and satisfactory myopia control treatment available, growing evidence has suggested that the choroid has a passive or active role in the regulation of eye growth and refractive error development. Numerous human and animal studies have shown that the retina can be moved forward or backward towards the image plane through changes in choroidal thickness, and these changes are likely to be associated in the longer term with eye growth and the development of refractive errors. As the choroid receives a rich innervation from the autonomic nervous system, many previous animal studies have utilized pharmacological agents and neurotoxins to elucidate the possible role of muscarinic signaling in the regulation of choroidal thickness, but only a few studies have investigated this issue in humans. An improved understanding of the mechanisms that control choroidal thickness may be important in developing new therapies for combating the development and progression of myopia.The research described in the thesis aimed to investigate the role of the autonomic nervous system in the control of choroidal thickness, axial length and the morphology In a series of experiments, we have confirmed that in humans under normal visual conditions, the parasympathetic nervous system is involved in the short-term regulation of subfoveal and parafoveal choroidal thickness, axial length and the morphology of the anterior sclera. The muscarinic blocker homatropine caused a significant subfoveal and parafoveal choroidal thickening, shortening of axial length, an enlargement of Schlemm's canal area and an increase in thickness of the conjunctival/episcleral complex. On the other hand, no notable changes in ocular parameters, except a decrease in the thickness of the conjunctival/episcleral tissues were found after instillation of the sympathomimetic drug phenylephrine.In an attempt to further improve our understanding of the myopigenic mechanisms influencing the thickness of the choroid in humans, we investigated the short-term influence of mixed interventions (positive and negative lens-imposed defocus / 2% homatropine) on choroidal thickness and axial length in emmetropic and myopic subjects. Homatropine prevented choroidal thinning in response to hyperopic defocus.This finding is consistent with the anti-myopia effects of muscarinic blockers and supports the potential importance of hyperopic defocus in the development of human myopia. By contrast, co-administration of homatropine with myopic defocus did not enhance the thicken...

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Scleral Thinning After Repeated Intravitreal Injections of Antivascular Endothelial Growth Factor Agents in the Same Quadrant

Abstract: Intravitreal injections may lead to scleral changes when applied repeatedly in the same quadrant. Thus, alternating the injection site should be considered in patients requiring multiple intravitreal injections.

Cited by 35 publications

References 25 publications

Diurnal variation of anterior scleral and conjunctival thickness

Diurnal variation of anterior scleral and conjunctival thickness

Aflibercept for neovascular age-related macular degeneration

The Influence of the Autonomic Nervous System on the Human Choroid

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