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Long-term efficacy of anti-VEGF therapy and injection safety considerations during the epidemic

Posting time:2022-10-06 01:12:23

Long-term efficacy of anti-VEGF therapy and injection safety considerations during the epidemic

Editor's note: The 22nd European Society of Retina Experts (Euretina) Congress in 2022 was successfully held in Hamburg, Germany from September 1st to 4th, 2022. More than 5,000 retinal experts from all over the world participated in online and offline methods. Get together. Euretina is committed to promoting knowledge exchange among vitreoretinal experts in Europe and around the world, promoting the development of vitreoretinal research, and disseminating the latest professional knowledge to general ophthalmologists. In recent years, anti-VEGF drugs have become the standard treatment for nAMD, DME and other ocular fundus diseases. The visual acuity and ocular anatomical indicators of most patients can be significantly improved. However, their long-term efficacy and injection-related safety have always been the focus of attention. Hot Issues. Let's take a look at the relevant research progress at this Euretina conference! 10-year follow-up to explore the long-term effects of anti-VEGF therapy in nAMD patients Prof. VARONIUKAITE A. and his research team from Lithuanian University of Health Sciences and their research team carried out an intravitreal anti-VEGF treatment for neovascular age-related macular degeneration based on ten years of real data ( Changes in best-corrected visual acuity in patients with nAMD). This retrospective single-center cohort study, based on medical records from real-world clinical work, analyzed the effects of intravitreal anti-VEGF injections in nAMD patients from 2009 to 2012 and followed up from 2018 to 2021. Patients were divided into three groups based on best-corrected visual acuity (BCVA) at baseline: group 1 (BCVA ≤ 0.1), group 2 (BCVA between 0.1-0.5), and group 3 (BCVA ≥ 0.5). The study included 49 eyes of 45 patients with an average age of 73.7 years and an average of 28.39 anti-VEGF injections per eye. The visual acuity distribution of the three groups of patients is shown in the table below. After ten years of treatment and follow-up, the proportion of patients with BCVA ≥ 0.5 decreased significantly, and 26.6% of patients had BCVA decreased to 0.1 or below. The results of the study showed that patients' mean BCVA decreased over the course of ten years of treatment. After long-term treatment, the visual acuity of the patients in the ll group was better, and the visual acuity of the patients in the lll group decreased significantly compared with the baseline. During the new crown epidemic, did intravitreal injection lead to an increase in the incidence of endophthalmitis? Professor Yasir Khan and team members from Moorfields Eye Hospital conducted a study to explore the impact of intravitreal injections performed by nurses on the incidence of endophthalmitis complications in patients during the COVID-19 pandemic. Nurses at Moorfields Eye Hospital perform, on average, more than 40,000 intravitreal injections per year, increasing the ability to serve AMD/DME patients. Previous studies have shown that intravitreal injection of anti-VEGF drugs by nurses has a lower incidence of endophthalmitis, and the service is considered safe. However, to improve patient and staff safety during the COVID-19 pandemic, the hospital has changed the injection assessment process, including requiring patients to wear masks during their visits, and eliminating routine vision measurements, OCT scans, slit lamp examinations, and more. While this reduces patient visit time and reduces contact between patients and staff, it has the potential to increase the incidence of endophthalmitis. We retrospectively collected patient data from April 1, 2020 to March 31, 2021, analyzing cases of intravitreal injection-related endophthalmitis recorded in the Incident Reporting System. A total of 32,403 intravitreal injections were included, of which 4337 were injections in both eyes, and 13 cases of suspected post-injection endophthalmitis were found, 5 cases were positive for vitreous culture, and the incidence of intravitreal injection-related endophthalmitis was 0.04%. After analyzing the relevant factors, it was found that the incidence of endophthalmitis was higher after using chlorhexidine (P=0.101); when the injection site was the inferior temporal side, the incidence of endophthalmitis was higher (P=0.004); intraocular lens Patients had a higher incidence of endophthalmitis (P=0.002). The incidence of endophthalmitis was lower (1/400) after intravitreal injection without antibiotic coverage; disinfection with povidone-iodine × 10 at the time of injection was more effective. The results of the study show that nurses can provide safe and effective intravitreal injection services, and nurses provide intravitreal injection services safely and effectively. Lack of slit-lamp examination before injection may result in undetected active infection or blepharitis; wearing a mask during injection may increase the chance of bacterial deposition on the ocular surface, all of which can contribute to post-injection endophthalmitis. Incidence increased. Summary: Domestic and foreign researchers actively use various methods to explore the effectiveness and safety of vitreoretinal disease treatment methods, which can not only help understand the clinical effect of treatment methods, but also promote the reform of treatment methods to improve the prognosis of patients.

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