Evaluation of the effect of intraocular ranibizumab injection on optic nerve by pattern VEP

Year 2018, Volume: 10 Issue: 4, 471 - 475, 01.12.2018

Serkan Demiryürek , Zafer Onaran , Tevfik Oğurel , Nesrin Büyüktortop , Nurgül Örnek

https://doi.org/10.21601/ortadogutipdergisi.356239

Abstract

Purpose: To evaluate the effect
of intravitreal injection of 
ranibizumab, an anti-VEGF agent commonly used for the treatment of
choroidal neovascularization, on optic nerve by pattern VEP test.

Material and
Method: Pattern VEP test was applied to 20 eyes of 20 patients who received
0.5 mg of ranibizumab injection because of age related choroidal neovascularization
maculopathy and also to other non-injected eyes of the same patients in 1st and
6th weeks. Results are compared with 10 control patients of same age distribution.

Results: Mean age was 73.45 in 20 age related maculopathy patients ranging
between 64 and 82. Mean best corrected visual acuity of eyes receiving injection
was 9/100 before injection and 14/100 finally on 6th week. Mean intraocular pressure
was 13.85mmHg in eyes receiving  before the
injection, 16.75mmHg at 1st week and finally 14mmHg at 6th week. There was no statistically
significant difference between the VEP wavelengths and latencies of the patient
group and the control group (p> 0.05). There was no statistically significant
difference between VEP wavelengths and latencies in 1st and 6th weeks between injection
receiving eyes and the other eyes (p> 0.05).

Conclusion: As a result of
VEP evaluation it is concluded that 0.5 mg intravitreal ranibizumab injection does
not have an indirect toxic effect to the optic nerve.

Keywords

Ranibizumab, optic nerve, intraocular pressure

İntravitreal ranibizumab enjeksiyonunun optik sinir üzerine etkisinin patern VEP ile değerlendirilmesi

Abstract

Amaç: Koroid neovaskülarizasyonu
tedavisi için sık olarak kullanılan anti-VEGF ajan olan ranibizumabın intravitreal
enjeksiyonunun optik sinir üzerine etkisinin patern VEP testi ile
değerlendirilmesidir.

Gereç ve Yöntem: Yaşa bağlı makula dejenerasyonu nedeniyle koroid neovaskülarizasyonu
gelişmiş ve 0,5mg intravitreal ranibizumab enjeksiyonu yapılan 20 hastanın 20
gözüne ve diğer gözlerine enjeksiyon öncesi ve sonrası 1. ve 6. haftalarda
patern VEP testi yapıldı. Aynı yaş grubunda 10 kontrol grubu hastasına patern
VEP testi yapılarak sonuçlar karşılaştırıldı.

Bulgular: Yaşları 64 ve
82 arasında olan 20 yaşa bağlı maküla dejenerasyonlu hastanın yaş ortalaması
73,45 idi. Enjeksiyon yapılan gözlerin başlangıç en iyi görme keskinliği
ortalaması 9/100 idi ve son olarak 6. haftadaki en iyi görme keskinliği 14/100'
dü. Enjeksiyon yapılan gözlerde başlangıç göziçi basıncı ortalaması 13,85mmHg
idi. 1. haftadaki göziçi basınca ortalaması 16,75mmHg ve son olarak 6.
haftadaki göziçi basıncı ortalaması ise 14mmHg idi. Hasta grubu ve kontrol
grubu VEP dalga boyları ve latansları arasında istatistiksel olarak anlamlı bir
fark saptanmadı (p>0.05). Enjeksiyon yapılan ve diğer gözlerde enjeksiyon
sonrası 1. ve 6. haftalardaki VEP dalga boylarında ve latanslarında
istatistiksel olarak anlamlı bir gerileme yoktu (p>0.05).

Sonuç: Çalışmamızda
VEP incelemesi ile 0.5 mg ranibizumabın intravitreal enjeksiyonunun optik
sinire dolaylı hasarı olmadığı gösterilmiştir.

Keywords

Ranibizumab, optik sinir, göziçi basınç

References

• REFERANSLAR
• 1. Wang F, Rendahl KG, Manning WC, Quiroz D, Coyne M, Miller SS. AAV–Mediated expression of vascular endothelial growth factor induces choroidal neovascularization in rat. Invest Ophthalmol Vis Sci. 2003; 44: 781-790. 2. Yu MJ, Shen WY, Lai MC, Constable IJ, Papadimitriou JM, Rakoczy PE. The role of vascular endothelial growth factor (VEGF) in abnormal vascular changes in the adult rat eye. Growth Factors. 2000; 17: 301-312. 3. Shen WY, Yu MJ, Barry CJ, Constable IJ, Rakoczy PE. Expression of cell adhesion molecules and vascular endothelial growth factor in experimental choroidal neovascularization in the rat. Br J Ophthalmol. 1998; 82: 1063 -1071. 4. Yi X, Ogata N, Komada M, Yamamoto C, Takahashi K, Omori K, Uyama M. Vascular endothelial growth factor expression in choroidal neovascularization in rats. Graefes Arch Clin Exp Ophthalmol. 1997; 235: 313-319. 5. Lassota N. Clinical and histological aspects of CNV formation: studies in an animal model. Acta Ophthalmol. 2008; 86: 1-24. 6. Luthra S, Narayanan R, Eduardo L, et al. Evaluation of invitro effects of bevacizumab on retinal pigment epithelial, nörosensory retinal and microvascular endothelial cells. RETINA 2006; 26: 512-518. 7. Manzano A, Roberta P, Gholam A, et al. Testing intravitreal toxicity of bevacizumab. RETINA 2006; 26: 257-261. 8. Bakri J, Cameron D, Pulido J, et al. Absence of histologic retinal toxicity of intravitreal bevacizumab in a rabbit model. Am J Ophtalmol 2006; 142: 162-164. 9. Christoforidis JB, Carlton MM, Knopp MV, Hinkle GH. PET/CT imaging of I-124 radiolabeled bevacizumab and ranibizumab after intravitreal injection in a rabbit model. Invest Ophthalmol Vis Sci. 2011; 52(8): 5899-9037 10. Myers A, Adrian M, Bruun A, et. al. Retinal Function and Morphology in Rabbit After Intravitreal Injection of VEGF Inhibitors Current Eye Research. 2012; 37(5): 399–407. 11. Tamer A. Macky and Mohamed M. Mahgoub. Electrophysiological Assessment of Optic Nerve and Retinal Functions Following Intravitreal Injection of Bevacizumab (Avastin). Journal of Ocular Pharmacology and Therapeutics: DOI. 2011; 141: 10-1089. 12. Ferrara N. Vascular endothelial growth factor: basic science and clinical progress. Endocr Rev 2004; 25: 581–611. 13. Lüke M, Januschowski K, Lüke J, et. al. The effects of ranibizumab (Lucentis) on retinal function in isolated perfused vertebrate retina. Br J Ophthalmol 2009; 93: 1396–1400. 14. Nishimura T, Machida S, Harada T, et al. Retinal ganglion cell function after repeated intravitreal injections of ranibizumab in patients with age-related macular degeneration. Clinic Ophthalmol. 2012; 6: 1073-82. 15. Andre Messias, Jose Afonso Ramos Filho, Katharina Messias, et. al. Electroretinographic findings associated with panretinal photocoagulation (PRP) versus PRP plus intravitreal ranibizumab treatment for high-risk proliferative diabetic retinopathy. Doc Ophthalmol 2012; 124:225–236