Sustained Increased Intraocular Pressure Related to Intravitreal Antivascular Endothelial Growth Factor Therapy for Neovascular Age-related Macular Degeneration
The following article, Sustained Increased Intraocular Pressure Related to Intravitreal Antivascular Endothelial Growth Factor Therapy for Neovascular Age-Related Macular Degeneration (J. Glaucoma; Volume 21, Number 4, April/May 2012), makes note of increased intraocular pressure following anti-VEGF drug therapy that we have noted in our practice as well. It appears that after seven (7) shots, there is an increased risk of patients developing sustained elevated intraocular presure, which they have never experienced in the past. The second observation is that it appears patients with an open capsule have an increased risk over patients with intact capsules for this sustained increased intraocular pressure. Most patients respond well to medical therapy with eye drops over time as the pressure goes down, but a few may proceed on to require filtering bleb surgery.
Proposed etiologies for the elevated pressure have been looked for. Researchers began looking for microscopic particulate contaminates. It has been thought that the molecular weight of the drugs may play a role in a blockage of the trabecular meshwork as well as some people thinking that the lubricant primarily used in tuberculin syringes was the culprit. This is the reason that many compounding pharmacies no longer send their drugs in tuperculin syringes.
At this point, the definite etiology for the pressure rise is unknow but is under continued investigation. It is important to note that this is a secondary complication with Avastin, Lucentis, and Eylea therapy that is just now coming to the forefront.
If we can answer any of your questions regarding this form of therapy, please feel free to let us know.
We are certain our Avastin (bezacizumab) is not counterfeit due to the following:
- We only order our Avastin (bezacizumab) from a local compounding pharmacy, accredited by the Professional Compounding Accreditation Board, who receives their supply directly from Genentech, the manufacturer of Avastin (bezacizumab). Each order is shipped in FDA-approved cartons directly from the manufacturer with the words “Genentech” or “Genentech – A Member ofthe Roche Group” printed on the packaging.
- FDA-approved Avastin (bezacizumab) contains a six-digit lot number on the product’s packaging and all packaging is printed in English. All lot numbers are logged and confirmed with Genentech as the product is received by the compounding pharmacy.
- Counterfeit A vastin (bezacizumab) has letters in the lot numbers and is printed in multiple languages instead of English. Authentic Avastin (bezacizumab) does not have letters in the lot numbers.
- The counterfeit product packaging does not come close to looking similar to authentic A vastin (bezacizumab) packaging.
We are certain that our local compounding pharmacy is giving us only FDA-approved Avastin (bezacizumab) direct from the manufacturer.
If you have any further questions, concerns or comments, we will be happy to discuss this matter further with you.
The Preliminary CATT (Comparison of AMD Treatment Trials) results are in and they support the use of either Avastin or Lucentis for the treatment of neovascular AMD. The May 2011 edition of the New England Journal of Medicine contained an editorial written by Philip J. Rosenfeld, M.D., Ph.D. which stated, “The CATT data support the continued global use of intravitreal bevacizumab as an effective, low-cost alternative to ranibizumab.”
Avastin dose of 2.5 mg is associated with greater visual acuity and fewer follow-up injections than the 1.25 mg dose of Avastin.
Reported at the Retina Society meeting by P. Yoganathan, M. D. from the University of Toronto.
Dietary intake of Lutein/Zeaxanthin is independently associated with decreased likelihood of neovascular AMD, geographic atrophy and large or extensive intermediate drusen in AREDS report No. 22.
If these cross-sectional results can be confirmed in prospective samples and experimental studies Lutein and Zeaxanthin may be considered an useful agent in food or supplement-based interventions designed to reduce the risk of AMD.
TruSopt (dorzolamide) reduces cystoid macular edema in patients with Retinitis Pigmentosa.
Gerald Fishman, M.D., University of Illinois at Chicago, demonstrated that all patients in his study showed a significant reduction in swelling in at least one eye after using TruSopt three times a day for one to two months. Results of the study were published in the January 10, 2007, issue of the British Journal of Ophthalmology.
POT-4 is a derivative of Compstatin, a peptide that inhibits complement activation. Complement activation plays a significant role in the cause of AMD. POT-4 is initially being developed for treatment of AMD. Potentia Pharmaceuticals, Inc. is beginning Phase I clinical trials in Tucson and Miami.
Regeneron Pharmaceuticals, Inc., will be testing the investigational drug, VEGF Trap, in a Phase III clinical trial. VEGF Trap is a human Fc-fusion protein that binds and blocks VEGF in the retina when injected intravitreally. VEGF Trap may prove to be a long acting therapy since it is able to more potently bind VEGF than currently available anti-VEGF therapies. This trial will compare VEGF Trap to Lucentis.