Ultrasound assessment of ocular vascular effects of repeated intravitreal injections of ranibizumab for wet age‐related macular degeneration

Abstract

ABSTRACT.Purpose: Determine the effect of repeated intravitreal injections of ranibizumab (0.5 mg; 0.05 ml) on retrobulbar blood flow velocities (BFVs) using ultrasound imaging quantification in twenty patients with exudative age-related macular degeneration treated for 6 months. Methods: Visualacuity(ETDRS),centralmacularthickness(OCT),peak-systolic, end-diastolic and mean-BFVs in central retinal (CRA), temporal posterior ciliary (TPCA) and ophthalmic (OA) arteries were measured before, 2 days, 3 weeks and 6 months after the first injection. Patients were examined monthly and received 1-5 additional injections depending on ophthalmologic examination results. Results: Six months after the first injection, a significant increase in visual acuity 50.9 AE 25.9 versus 44.4 AE 21.7 (p < 0.01) and decrease in mean central macular thickness 267 AE 74 versus 377 AE 115 lm (p < 0.001) were observed compared to baseline. Although mean-BFVs decreased by 16%AE3% in CRA and 20%AE5% in TPCA (p < 0.001) 2 days after the first injection, no significant change was seen thereafter. Mean-BFVs in OA decreased by 19%AE5% at week 3 (p < 0.001). However, the smallest number of injections (two injections) was associated with the longest time interval between the last injection and month 6 (20 weeks) and with the best return to baseline levels for mean-BFVs in CRA, suggesting that ranibizumab had reversible effects on native retinal vascular supply after its discontinuation. Moreover, a significant correlation between the number of injections and percentage of changes in mean-BFVs in CRA was observed at month 6 (R = 0.74, p < 0.001) unlike TPCA or OA. Conclusion: Ranibizumab could impair the native choroidal and retinal vascular networks, but its effect seems reversible after its discontinuation.

En Face Doppler Optical Coherence Tomography Measurement of Total Retinal Blood Flow in Diabetic Retinopathy and Diabetic Macular Edema

“…47–51 For the 6 eyes that received anti-VEGF treatment, the injections were given based on a treat-and-extend protocol. Therefore, the timing of the injections was different for all 6 eyes.…”

Evaluation of Flowmetry Indicators in Patients with a Wet AMD Form during Antiangiogenic Therapy

“…В исследованиях Bonnin, посвященных бевацизумабу и ранибизумабу, с помощью ультразвука оценивали скорость глазного кровотока в центральной артерии сетчатки, глазных и задних ресничных артериях. Было отмечено снижение скорости кровото-ка после интравитреального введения антиангиогенных препаратов, что, по мнению авторов, свидетельствовало о возможной способности препарата провоцировать гипоперфузию всего глаза и трактовалось авторами как его временный побочный эффект в отношении регионального сосудистого русла [20,21]. Краткосрочное снижение средних показателей глазного перфузионного давления без выраженного долгосрочного влияния на глазной кровоток также подтвердили в своей работе Lee и соавт.…”

Effect of Intravitreal Aflibercept on Central Retinal Arterial Blood Flow in Type 1 Retinopathy of Prematurity

“…Effects of anti-VEGF agents applied intravitreally on ocular hemodynamics were previously identified using CDI (16)(17)(18)20). Toklu et al (16) have reported on the blood flow analysis of CRA in patients with age-related macular degeneration (AMD) after injection of bevacizumab.…”

“…Bonnin et al (20) evaluated the effect of repeated intravitreal injections of ranibizumab on retrobulbar blood flow velocities in patients with AMD and found decreases in mean blood flow velocities (BFVs) in the CRA, temporal posterior ciliary artery, and ophthalmic artery (OA) after ranibizumab injections.…”