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Multiphasic changes in systemic VEGF following intravitreal injections of ranibizumab in a child
E H Shao1, V Sivagnanavel2, A Dabbagh2
11] Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK [2] Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, UK.
Insights
Intravitreal ranibizumab injections in a child caused significant, fluctuating changes in systemic vascular endothelial growth factor (VEGF) 165 levels. These systemic VEGF level alterations may have clinical implications, especially in pediatric patients.
Area of Science:
- Ophthalmology
- Vascular Biology
- Pediatric Medicine
Background:
- Choroidal neovascularization (CNV) secondary to trauma can impair vision.
- Intravitreal anti-VEGF agents like ranibizumab are used to treat CNV.
- Systemic effects of intravitreal injections, particularly in children, require investigation.
Observation:
- A 9-year-old child with traumatic CNV received five intravitreal ranibizumab injections over 8 months.
- Plasma samples were collected over 12 months to measure vascular endothelial growth factor (VEGF) 165 levels.
- VEGF 165 levels were quantified using ELISA, both pre- and post-immunodepletion.
Findings:
- Systemic plasma VEGF 165 levels demonstrated labile changes post-injection.
- An initial 30% increase was observed after the first injection, followed by a return to baseline.
- A subsequent injection led to a 67% rebound increase, remaining elevated for 12 weeks.
Implications:
- Intravitreal ranibizumab can induce significant, multiphasic systemic VEGF level alterations.
- These findings are clinically relevant for pediatric patients due to VEGF's role in organ development and function.
- Further research is warranted to understand the long-term systemic consequences of anti-VEGF therapy in children.
Purpose:
To investigate whether intravitreal ranibizumab injections administered to a child alter systemic plasma levels of total and free VEGF 165.
Methods:
A 9-year-old child sustained a choroidal rupture from blunt trauma. He subsequently developed a secondary choroidal neovascular membrane, which was treated with five ranibizumab injections over a period of 8 months. Peripheral venous blood samples were taken at each visit over a period of 12 months and plasma was extracted. Plasma VEGF 165 levels were determined using enzyme-linked immunosorbent assay and were assayed both pre- and post-immunodepletion to remove complexed VEGF.
Results:
Plasma VEGF 165 levels proved labile following intravitreal injection of ranibizumab. Levels increased by 30% above baseline following the first intravitreal ranibizumab injection, but then returned to baseline despite two subsequent injections. There was then a rebound increase of 67% in total plasma VEGF levels following a further injection, which remained above baseline for 12 weeks despite two further intravitreal ranibizumab injections. Baseline levels were re-attained 26 weeks after the final injection.
Conclusions:
These results suggest intravitreal ranibizumab injections can cause significant, multiphasic changes in systemic VEGF levels. This may be of particular clinical significance in children as VEGF is known to be vital in the development of major organs, in addition to its role in the maintenance of normal organ function in adults.
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