Vascular endothelial growth factor (VEGF) and inflammation. VEGF-A circulates normally in the body and is essential in endothelial cell growth. In the pathological state in the eye, hypoxia increases VEGF-A, promotes growth of neovascularization and accelerates the breakdown of blood-retinal barrier and build-up of fluid in or under the neurosensory retina and retinal pigment epithelium (RPE). It has 6 isoforms; the predominant isoform (most common of which) is VEGF 165 and is most linked to neovascularization in the eye. VEGF-A provided the rationale for targeted drug development. Anti-VEGF drugs are anti-angiogenic, anti-inflammatory, antifibrotic, and anti-permeable. The rationale for the use of steroids to treat macular edema is related to their ability to reduce capillary permeability, to inhibit the expression of VEGF gene, and to inhibit the metabolic pathway of VEGF.
Vascular Endothelial Growth Factor A ; Retinal Pigment Epithelium

OBJECTIVE: 1) To describe the effects of intravitreal bevacizumab (IVB) injection for diabetic macular edema (DME) on best-corrected visual acuity (BCVA) and central foveal thickness (CFT) of Filipino patients; 2) To determine correlations between (a) CFT and BCVA, (b) CFT and optical coherence tomography (OCT) patterns of DME, (c) number of injections with BCVA and CFT, (d) number of injections with OCT pattern of DME and the presence of epiretinal membrane (ERM), (e) control and type of diabetes mellitus (DM) with BCVA and CFT;3) To describe ocular and systemic side effects of IVB injections.

METHODS: This was a retrospective non-comparative case series of patients who underwent IVB injection for DME from January 2012 to June 2013. Data gathered included: (1) BCVA, (2) CFT, (3) OCT pattern of DME,(4) presence of ERM on OCT, (5) total number of IVB injections in 12 months, (6) type and control of DM, (7)ocular and systemic side effects of IVB. All analyses were made at the first, third, sixth, and 12th month post-IVB injection.

RESULTS: Sixty-eight eyes received IVB injection, 27 eyes had incomplete data and were excluded, and only 41 eyes were analyzed. There was a consistent improvement in the mean BCVA and decrease in mean CFT from baseline up to the 12th month. There was a steady increase in the mean change in BCVA and a consistent decrease in the percent change in mean CFT until the 12th month. The change in mean BCVA and CFT appeared to have an inverse relationship. Patients who received four or more injections were also those with worse mean BCVA and greater CFT. There was no correlation between the number of injections and the OCT pattern of DME, nor the presence of ERM. The mean BCVA appeared to improve among patients with controlled DM and mean CFT was larger among patients with uncontrolled DM. There were no severe ocular or systemic adverse effects reported.

CONCLUSION: IVB injection resulted in an improvement in the BCVA and a decrease in CFT in patients with DME.No systemic or severe ocular adverse effects were observed. 

Human ; Male ; Female ; Aged ; Middle Aged ; Macular Edema ; Tomography, Optical Coherence ; Epiretinal Membrane ; Bevacizumab ; Retrospective Studies ; Diabetic Retinopathy ; Visual Acuity ; Eye ; Injections

Vascular endothelial growth factor (VEGF) has been shown to play a central role in the pathophysiologic process underlying neovascular eye diseases. As such, anti-VEGF-based pharmacologic agents have emerged as a highly effective treatment modality for various visually debilitating retinal and choroidal vascular pathologies. The introduction of these pharmacologic agents directly into the vitreous cavity by means of an injection through the pars plana has become a widely performed ophthalmic procedure both locally and overseas.
Intravitreal Injections

COVID-19 ; Retinopathy of Prematurity ; Choroid

Objective: To assess the level of awareness and practice patterns of pediatricians in various government and private hospitals in the Philippines regarding retinopathy of prematurity (ROP). Methods: This is a prospective, multicenter, cross-sectional study of the practice profile and awareness of pediatricians of the Philippine Pediatric Society (PPS) ROP screening recommendations. Six hundred selfadministered questionnaires were distributed to pediatricians from 40 randomly selected government and private hospitals in the Philippines between July and September 2013. Frequency distribution for each data was noted. Association of referral rates, distribution of barriers, and availability of protocol among the subgroups were analyzed using chi square. Results: A total of 409 eligible surveys were analyzed with a response rate of 68.1%. 92% of the respondents referred their at-risk preterm babies to ophthalmologists for ROP screening. Of those who referred, 57% considered a cut-off value of less than 32 weeks age of gestation, and 45% considered a cut-off value of less than 1500g birth weight. 47% referred at 4-6 weeks post-natal age, and 48% had a protocol for ROP screening. Only 19% were aware of the PPS ROP screening recommendations. The major barrier encountered was the inability of the families to follow up after discharge (41%). Higher referral rates were noted from private institutions (p=0.013) and tertiary hospitals (p=0.019), including those with a protocol on ROP screening (p=0.002). Conclusion Majority of the respondents referred their at-risk preterm babies for ROP screening. A significant proportion was unaware of the PPS ROP screening guidelines. More than half do not have an established protocol. There were variations in practice patterns of the pediatricians in referring babies at-risk for ROP. Based on these, there is still a need to increase awareness among pediatricians. A uniform, national, published guideline on ROP screening, establishment of referral systems, and training of qualified ophthalmologists are recommended.
Retinopathy of Prematurity ; Mass Screening ; Surveys and Questionnaires