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Ranibizumab treatment administered as needed for occult and minimally classic neovascular membranes in age-related macular degeneration. Jpn J Ophthalmol 2011; 55:123-7. [PMID: 21400056 DOI: 10.1007/s10384-010-0910-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 09/29/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To report the clinical experience of intravitreal ranibizumab administered as needed for the treatment of neovascular age-related macular degeneration (AMD). METHODS We retrospectively reviewed the charts of 41 patients (41 eyes) with occult and minimally classic neovascular membrane in AMD. Patients received intravitreal injections (0.5 mg) of ranibizumab and were monitored monthly for 12 months. Forty-one eyes were retreated at the discretion of the treating physician on an as-needed basis after the first injection, instead of initially giving three monthly injections. The main outcomes measured were change in mean visual acuity and central retinal thickness, and the total number of injections received by patients during the 12 months. RESULTS At 12 months, the mean logarithm of the minimum angle of resolution (logMAR) visual acuity improved by 0.078 logMAR units (P = 0.046) and the mean central retinal thickness decreased by 85.7 μm (P < 0.001). Thirty of 41 eyes (73.2%) avoided any loss of vision, and 20 eyes (48.8 %) showed improved visual acuity. A mean of 4.07 injections were given over the 12 months. CONCLUSIONS Ranibizumab administered on an as-needed basis may stabilize visual acuity in patients with neovascular AMD.
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Tolentino M. Systemic and Ocular Safety of Intravitreal Anti-VEGF Therapies for Ocular Neovascular Disease. Surv Ophthalmol 2011; 56:95-113. [DOI: 10.1016/j.survophthal.2010.08.006] [Citation(s) in RCA: 204] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 08/25/2010] [Accepted: 08/31/2010] [Indexed: 01/11/2023]
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Kim M, Kim K, Kim DG, Yu SY, Kwak HW. Two-Year Results of Photodynamic Therapy Combined with Intravitreal Anti-Vascular Endothelial Growth Factor for Polypoidal Choroidal Vasculopathy. Ophthalmologica 2011; 226:205-13. [DOI: 10.1159/000330793] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 07/13/2011] [Indexed: 11/19/2022]
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Moon SW, Kim MS, Kim ES, Yu SY, Kwak HW. Photodynamic Therapy Combined with Intravitreal Injection of Vascu lar Endothelial Growth Factor Antibody for Polypoidal Choroidal Vasculopathy. Ophthalmologica 2011; 225:169-75. [DOI: 10.1159/000323811] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 12/14/2010] [Indexed: 01/21/2023]
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COMBINATION THERAPY OF RANIBIZUMAB AND PHOTODYNAMIC THERAPY FOR RETINAL ANGIOMATOUS PROLIFERATION WITH SEROUS PIGMENT EPITHELIAL DETACHMENT IN KOREAN PATIENTS. Retina 2011; 31:65-73. [DOI: 10.1097/iae.0b013e3181e586e3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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106
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Bhisitkul RB, Stewart JM. Alternative anti-VEGF treatment regimens in exudative age-related macular degeneration. EXPERT REVIEW OF OPHTHALMOLOGY 2010. [DOI: 10.1586/eop.10.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Berger L, Wolf-Schnurrbusch U, Brinkmann C, Wolf S. Current indications for ocular photodynamic therapy – A review of the literature and two case reports. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.mla.2010.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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An observational retrospective subgroup analysis of verteporfin photodynamic therapy-naive and previously treated patients in the focus trial. Retina 2010; 31:56-64. [PMID: 20890244 DOI: 10.1097/iae.0b013e3181e09720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To perform a retrospective post hoc subgroup analysis of the FOCUS trial to assess the visual acuity outcomes and treatment benefits for patients receiving combination therapy who, at the time of enrollment, were naive to verteporfin photodynamic therapy (PDT) or had previously received PDT. METHODS In this retrospective post hoc analysis of 24-month data from the FOCUS trial, PDT-naive and previously PDT-treated patients (n = 162) were included. Patients were randomized in a 2:1 ratio to receive 0.5 mg of ranibizumab monthly plus PDT or PDT alone. We retrospectively identified patients who had or had not received prior PDT for a post hoc subgroup analysis of 12- and 24-month outcomes. RESULTS For the PDT-naive patients, mean change in the visual acuity at 24 months was +4.1 letters for the ranibizumab plus PDT group and -11.5 letters for the PDT monotherapy group, a treatment benefit over control group of 15.6 letters (95% confidence interval: 7.1-24.2). For the previously treated patients, mean change in the visual acuity at 24 months was +5.2 letters for the ranibizumab plus PDT group and -4.3 letters for the PDT monotherapy group, a treatment benefit over control group of 9.5 letters (95% confidence interval: 2.3-16.8). CONCLUSION In the FOCUS subanalysis, the PDT-naive patients showed a trend toward greater treatment benefit over control subjects compared with patients previously treated with PDT. However, this study was not designed to address this question, and the confidence intervals were wide. Furthermore, the mean change in the visual acuity from baseline to 24 months was similar for both the PDT-naive and previously treated patients receiving combination therapy.
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109
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Veritti D, Sarao V, Lanzetta P. Update on combination therapy in wet age-related macular degeneration. EXPERT REVIEW OF OPHTHALMOLOGY 2010. [DOI: 10.1586/eop.10.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Clinical characteristics of endophthalmitis after an injection of intravitreal antivascular endothelial growth factor. Retina 2010; 30:1051-7. [PMID: 20616683 DOI: 10.1097/iae.0b013e3181cd47ed] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to describe the clinical characteristics and management of patients with bacterial endophthalmitis after an intravitreal antivascular endothelial growth factor injection. METHODS This is a retrospective chart review of all patients admitted with suspected endophthalmitis from 2006 to 2008. RESULTS Endophthalmitis was verified by positive Gram stain and culture in nine eyes. The mean preinjection visual acuity of the 9 eyes was 0.02 +/- 0.021 diopters (decimal visual acuity scale) and dropped to 0.01667 +/- 0.02449 diopters in the eyes with endophthalmitis. All nine patients presented with reduced visual acuity, of whom seven also had ocular pain. Initial treatment was administered without delay and consisted of vitreous tap and intravitreal antibiotics injection in five cases and pars plana vitrectomy with intravitreal antibiotics injection in the other four cases. Vitreous tap failed in one case. Seven patients underwent a second procedure and two underwent a third procedure. The mean posttreatment visual acuity in all 9 eyes improved significantly (0.19 +/- 0.24, P = 0.0071). Five patients had major complications (e.g., retinal detachment, phacolytic glaucoma, and recurrent endophthalmitis). CONCLUSION Acute endophthalmitis following anti-VEGF injection appears within days and can result in severe loss of vision if not treated promptly. In our series the clinical and prognostic characteristics were considerably different between culture positive endophthalmitis cases and culture negative cases.
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Randomized, double-masked, sham-controlled trial of ranibizumab for neovascular age-related macular degeneration: PIER study year 2. Am J Ophthalmol 2010; 150:315-324.e1. [PMID: 20598667 DOI: 10.1016/j.ajo.2010.04.011] [Citation(s) in RCA: 209] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 04/15/2010] [Accepted: 04/18/2010] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate efficacy and safety of quarterly (and then monthly) ranibizumab during the 2-year Phase IIIb, multicenter, randomized, double-masked, sham injection-controlled study of the efficacy and safety of ranibizumab in subjects with subfoveal CNV with or without classic CNV secondary to AMD (PIER) study. DESIGN Phase IIIb, multicenter, randomized, double-masked, sham injection-controlled trial in patients with choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). METHODS Patients were randomized 1:1:1 to sham injection (n = 63) or 0.3 mg (n = 60) or 0.5 mg (n = 61) intravitreal ranibizumab monthly for 3 months and then quarterly. During study year 2, eligible sham-group patients crossed over to 0.5 mg ranibizumab quarterly. Later in year 2, all eligible randomized patients rolled over to 0.5 mg ranibizumab monthly. Key efficacy and safety outcomes of the 2-year trial are reported. RESULTS At month 24, visual acuity (VA) had decreased an average of 21.4, 2.2, and 2.3 letters from baseline in the sham, 0.3 mg, and 0.5 mg groups (P < .0001 for each ranibizumab group vs sham). VA of sham patients who crossed over (and subsequently rolled over) to ranibizumab decreased across time, with an average loss of 3.5 letters 10 months after crossover. VA of 0.3 mg and 0.5 mg group patients who rolled over to monthly ranibizumab increased for an average gain of 2.2 and 4.1 letters, respectively, 4 months after rollover. The ocular safety profile of ranibizumab was favorable and consistent with previous reports. CONCLUSIONS Ranibizumab provided significant VA benefit in patients with AMD-related CNV compared with sham injection. Ranibizumab appeared to provide additional VA benefit to treated patients who rolled over to monthly dosing, but not to patients who began receiving ranibizumab after >14 months of sham injections.
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COMBINED RANIBIZUMAB AND PHOTODYNAMIC THERAPY TO TREAT EXUDATIVE AGE-RELATED MACULAR DEGENERATION. Retina 2010; 30:1190-6. [PMID: 20539256 DOI: 10.1097/iae.0b013e3181d2f172] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vallance JH, Johnson B, Majid MA, Banerjee S, Mandal K, Bailey CC. A randomised prospective double-masked exploratory study comparing combination photodynamic treatment and intravitreal ranibizumab vs intravitreal ranibizumab monotherapy in the treatment of neovascular age-related macular degeneration. Eye (Lond) 2010; 24:1561-7. [DOI: 10.1038/eye.2010.84] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Ruiz-Moreno JM, Montero JA, Amat P, Lugo F. Macular atrophy after combined intravitreal triamcinolone and photodynamic therapy to treat choroidal neovascularization. Int J Ophthalmol 2010; 3:161-3. [PMID: 22553543 DOI: 10.3980/j.issn.2222-3959.2010.02.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 05/23/2010] [Indexed: 11/02/2022] Open
Abstract
AIM To report the appearance of choriocapillaris atrophy after combined high dose intravitreal triamcinolone acetonide (TA) and photodynamic therapy (PDT) to treat choroidal neovascularization (CNV) associated with age related macular degeneration (AMD). METHODS The present study was retrospective about non-randomized interventional case series. Fifty-one consecutive eyes with subfoveal (all types) CNV associated with AMD were treated by PDT and intravitreal (19.4±2.1)mg per 0.1mL TA at the Alicante Institute of Ophthalmology. The appearance of macular choriocapillaris and retinal pigment epithelium (RPE) atrophy was considered at two years follow-up. Thirty consecutive eyes treated by PDT alone, matched for age, sex, and type and size of CNV were considered as control group. RESULTS Twenty-one of 47 eyes in the study group (45%) and 7 of 30 eyes in the control group (23%) developed macular RPE and choriocapillaris atrophy in the treated area at month 24 (P=0.04, Chi-square test). The greatest diameter of the atrophic areas averaged (5044±1666)µm in the study group vs (4345±1550)µm in the control group. Mean final best corrected visual acuity (logarithm of minimal angle of resolution) was (0.87±0.33) in the cases with RPE atrophy vs (0.66±0.26) in the cases with no RPE atrophy in the study group (P=0.11, Mann-Whitney U test). CONCLUSION The association of high doses of intravitreal TA and PDT may increase the risk for RPE and choriocapillaris atrophy.
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Affiliation(s)
- José M Ruiz-Moreno
- Department of Ophthalmology, Albacete Medical School, University of Castilla La Mancha, Spain
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Frennesson C, Nilsson UL, Peebo BB, Nilsson SEG. Significant improvements in near vision, reading speed, central visual field and related quality of life after ranibizumab treatment of wet age-related macular degeneration. Acta Ophthalmol 2010; 88:420-5. [PMID: 19678811 DOI: 10.1111/j.1755-3768.2009.01576.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the effects on near visual acuity, reading speed, central visual field and related quality of life of ranibizumab treatment of wet age-related macular degeneration (AMD). METHODS The study was a prospective, non-comparative consecutive case series, followed for 3 months and investigator-driven. Thirty eyes of 30 patients with wet AMD were included, mean age 75 years (range 69-95 years). In addition to a full ophthalmological examination--including best-corrected visual acuity (BCVA; Early Treatment Diabetic Research Study chart), fundus biomicroscopy, fundus photography, fluorescein angiography, indocyanine green angiography (occult cases) and ocular coherence tomography--near visual acuity, reading speed, central visual field and quality of life for related activities were also investigated at baseline and at 3 months after ranibizumab treatment. RESULTS Mean BCVA increased from 62 +/- 11 to 66 +/- 14 letters at 3 months (7%; p = 0.018). Near vision improved from 9 +/- 5 to 6 +/- 3 points (33%; p = 0.0006) and reading speed increased from 59 +/- 40 to 85 +/- 50 words/min (44%; p < 0.0001). The mean deviation from normal of the visual field improved from -9 +/- 7 to -6 +/- 5 dB (33%; p < 0.0001). Quality of life improved for distance activities from 54 +/- 28 to 63 +/- 28 points (17%; p < 0.0001) but significantly (p = 0.024) more for near activities, from 49 +/- 26 to 63 +/- 26 points (29%; p < 0.0001). Reading newspaper text in the group in which the better eye was treated showed the highest increase in quality of life score of all: 116%. CONCLUSION The increase in BCVA after ranibizumab treatment is well established. The present study also showed significant improvements in other important visual qualities, such as near visual acuity, reading speed, central visual field and several activities influencing quality of life. The improvement was greater for near activities than for distance activities. Therefore, the beneficial effects of ranibizumab treatment shown here are more extensive than those reported previously.
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Combined photodynamic therapy with verteporfin and intravitreal bevacizumab for polypoidal choroidal vasculopathy. Am J Ophthalmol 2010; 149:947-954.e1. [PMID: 20346441 DOI: 10.1016/j.ajo.2009.12.038] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 12/14/2009] [Accepted: 12/15/2009] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the efficacy of photodynamic therapy with verteporfin with intravitreal bevacizumab for polypoidal choroidal vasculopathy. DESIGN Retrospective case study. METHODS This study included 29 treatment-naïve patients with polypoidal choroidal vasculopathy followed up for 12 months after the first combined therapy. Patients received 1.25 mg intravitreal bevacizumab 1 week before photodynamic therapy with verteporfin. The main outcomes measures were visual acuity and the number of required retreatments. RESULTS The mean best-corrected visual acuity (BCVA) level was 0.25 at baseline and 0.31, 0.39, 0.44, 0.44, and 0.45 at 1, 3, 6, 9, and 12 months after treatment, respectively. A significant (P< .01) improvement in the mean BCVA was observed at 3, 6, 9, and 12 months after combined therapy. At 12 months, the mean improvement in BCVA from baseline was 2.69 lines; the BCVA improved in 15 eyes (51.7%) by 3 lines or more, was stable in 13 eyes (44.8%), and decreased in 1 eye (3%) because of a massive subretinal hemorrhage 7 months after the first treatment. Eighteen eyes (62%) required 1 combined treatment during follow-up. Polypoidal lesions recurred in 6 eyes (21%). An abnormal branching vascular network persisted in all eyes. The mean number of treatments with combined therapy averaged 1.59. No complications, including endophthalmitis, uveitis, or ocular hypertension, developed. CONCLUSIONS Combined treatment consisting of photodynamic therapy with verteporfin and intravitreal bevacizumab for polypoidal choroidal vasculopathy seemed to be effective for improving visual acuity and reducing retreatment rates and complications. Further study is needed to determine the long-term clinical results.
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Butler MC, Itotia PN, Sullivan JM. A high-throughput biophotonics instrument to screen for novel ocular photosensitizing therapeutic agents. Invest Ophthalmol Vis Sci 2010; 51:2705-20. [PMID: 19834043 PMCID: PMC2868480 DOI: 10.1167/iovs.08-2862] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 12/15/2008] [Accepted: 03/04/2010] [Indexed: 11/24/2022] Open
Abstract
PURPOSE High-throughput techniques are needed to identify and optimize novel photodynamic therapy (PDT) agents with greater efficacy and to lower toxicity. Novel agents with the capacity to completely ablate pathologic angiogenesis could be of substantial utility in diseases such as wet age-related macular degeneration (AMD). METHODS An instrument and approach was developed based on light-emitting diode (LED) technology for high-throughput screening (HTS) of libraries of potential chemical and biological photosensitizing agents. Ninety-six-well LED arrays were generated at multiple wavelengths and under rigorous intensity control. Cell toxicity was measured in 96-well culture arrays with the nuclear dye SYTOX Green (Invitrogen-Molecular Probes, Eugene, OR). RESULTS Rapid screening of photoactivatable chemicals or biological molecules has been realized in 96-well arrays of cultured human cells. This instrument can be used to identify new PDT agents that exert cell toxicity on presentation of light of the appropriate energy. The system is further demonstrated through determination of the dose dependence of model compounds having or lacking cellular phototoxicity. Killer Red (KR), a genetically encoded red fluorescent protein expressed from transfected plasmids, is examined as a potential cellular photosensitizing agent and offers unique opportunities as a cell-type-specific phototoxic protein. CONCLUSIONS This instrument has the capacity to screen large chemical or biological libraries for rapid identification and optimization of potential novel phototoxic lead candidates. KR and its derivatives have unique potential in ocular gene therapy for pathologic angiogenesis or tumors.
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Affiliation(s)
| | | | - Jack M. Sullivan
- From the Departments of Ophthalmology
- Pharmacology and Toxicology, and
- Physiology and Biophysics
- the Neuroscience Program, and
- the Ira G. Ross Eye Institute, SUNY University at Buffalo, Buffalo, New York; and
- the Veterans Administration Western New York Healthcare System, Buffalo, New York
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Photodynamic therapy alone versus combined with intravitreal bevacizumab for neovascular age-related macular degeneration without polypoidal choroidal vasculopathy in Japanese patients. Graefes Arch Clin Exp Ophthalmol 2010; 248:931-6. [DOI: 10.1007/s00417-010-1343-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 01/17/2010] [Accepted: 02/14/2010] [Indexed: 10/19/2022] Open
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Treatment of neovascular age-related macular degeneration with a variable ranibizumab dosing regimen and one-time reduced-fluence photodynamic therapy: the TORPEDO trial at 2 years. Graefes Arch Clin Exp Ophthalmol 2010; 248:943-56. [PMID: 20204659 DOI: 10.1007/s00417-009-1256-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Revised: 11/02/2009] [Accepted: 11/19/2009] [Indexed: 01/28/2023] Open
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Schmidt-Erfurth U. Clinical safety of ranibizumab in age-related macular degeneration. Expert Opin Drug Saf 2010; 9:149-65. [PMID: 20001757 DOI: 10.1517/14740330903418422] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD Clinical safety of pharmaceutical products in the elderly is vital because of their increased risk of cardiac and other adverse events. AREAS COVERED IN THIS REVIEW Search of the Medline database, including articles and abstracts from 1984 to 2009. WHAT THE READER WILL GAIN Knowledge of ocular and systemic risks: The rate of endophthalmitis was 0.05% per injection (MARINA) and <0.1% per injection (ANCHOR), rates confirmed in a retrospective analysis of 14,320 injections. Moderate increases in intraocular pressure were transient, and incidences of intraocular inflammation were rarely serious. Systemic arterial thromboembolic events occurred in 4.6 and 0% of ranibizumab-treated patients and in 3.8 and 0% of sham-treated patients in MARINA (2 years) and PIER (1 year), respectively. In SAILOR, there was a numerically higher rate of cerebrovascular stroke with 0.5 mg ranibizumab compared with 0.3 mg ranibizumab (1.2 vs 0.7%), which was a non-statistically significant trend in patients with a history of stroke. TAKE HOME MESSAGE Although further studies to investigate the risk of stroke with ranibizumab therapy are required, repeated intravitreal ranibizumab was well tolerated and not associated with clinically significant safety risks during up to 2 years of treatment.
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Affiliation(s)
- Ursula Schmidt-Erfurth
- Medical University of Vienna, Department of Ophthalmology, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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INTRAVITREAL ANTI-VEGF VERSUS PHOTODYNAMIC THERAPY WITH VERTEPORFIN FOR TREATMENT OF MYOPIC CHOROIDAL NEOVASCULARIZATION. Retina 2010; 30:418-24. [PMID: 20094012 DOI: 10.1097/iae.0b013e3181bd2fe4] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Debefve E, Pegaz B, Ballini JP, van den Bergh H. Combination therapy using verteporfin and ranibizumab; optimizing the timing in the CAM model. Photochem Photobiol 2010; 85:1400-8. [PMID: 19706144 DOI: 10.1111/j.1751-1097.2009.00604.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Combining photodynamic therapy (PDT) using verteporfin (Visudyne) with ranibizumab (Lucentis) can optimize the overall treatment outcome by providing more efficacy in vessel closure, and thus reduce the need for retreatment in patients with wet age-related macular degeneration. In this preclinical study in the chorioallantoic membrane (CAM) of the chicken embryo, we compare the vascular occlusion effects of verteporfin and ranibizumab as monotherapies with those observed in the combined therapy. In order to optimize the combination therapy, we varied the timing and sequence of the PDT and antivascular endothelial growth factor modalities. We observed that 1 day after PDT, the smaller blood vessels (Ø < 70 microm) of the CAM were selectively occluded, but as early as 2 days after PDT, both significant reperfusion and regrowth of new vessels were observed. Both these phenomena could be significantly delayed by application of ranibizumab. Ranibizumab itself did not induce any vascular occlusion. Under the applied conditions of combination therapy, the occlusion of the targeted blood vessels could be significantly extended to 3 days in this model compared with 1 day in the case of verteporfin monotherapy. Thus, in the present preclinical study, we demonstrate that for the applied conditions, the optimal time to administer ranibizumab is 24 h after PDT.
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Affiliation(s)
- Elodie Debefve
- Laboratory of Photomedicine, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
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Baseline clinical measures and early response predict success in verteporfin photodynamic therapy for neovascular age-related macular degeneration. Eye (Lond) 2010; 24:1213-9. [PMID: 20075972 DOI: 10.1038/eye.2009.319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To analyse the influence of baseline clinical characteristics on the outcome of verteporfin photodynamic therapy (VPDT) for neovascular age-related macular degeneration (nAMD). METHODS A total of 1008 patients commencing VPDT for nAMD in a single UK centre entered a prospective observational study between 1999 and 2006 and were followed for 2 years. Longitudinal linear mixed-effects modelling was applied to assess the influence of baseline covariates, such as best corrected visual acuity (BCVA), contrast sensitivity (CS), age, lesion size, and lesion type, on changes of BCVA over time in patients after VPDT. A logistic regression analysis was used to analyse clinical features significantly associated with treatment failure. RESULTS Study eye BCVA was significantly better on average throughout the course of treatment in patients with better baseline BCVA and CS in the study eye (P<0.001 and P<0.01, respectively) and lower age (P=0.01). Mean BCVA showed a significant reduction over time with a significant quadratic relationship between 0 and 6 months and with stabilisation between 6 and 9 months. Patients with better BCVA and worse CS at baseline, and those in whom BCVA dropped during the first 3 months of follow-up, were more likely to lose >/=15 letters after 12 months. CONCLUSIONS Findings from our large longitudinal data set provide estimates of likely outcome based on baseline features and response at 3 months in patients commencing a course of VPDT for nAMD. Statistical modelling built up for this large data set can be applicable to other studies in ophthalmology research.
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Peyman GA, Conway MD, Fiscella R. Interaction of intravitreal combination drugs and the effect on the targeted site. J Ocul Pharmacol Ther 2010; 25:387-94. [PMID: 19857099 DOI: 10.1089/jop.2009.0027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND After evaluating experimentally the diffusion processes in the retina using peroxidase as a tracer material (previously published work), we found that junctional complexes of the retinal pigment epithelium and retinal capillaries were the major impediment to free diffusion between the retina and choroidal-retinal blood vessels. These experiments indicated that to achieve high therapeutic concentrations of medications inside the eye, it was necessary to administer them by intravitreal injection. Soon after initial experimental work the necessity of combining antibiotics or antibiotics with steroids became obvious. As the use of intravitreal injection grew over the last 2 decades, so did the concept of combination therapy. METHODS This review describes potential causes of drug-drug interaction and the rationale for combination therapy when injected into the vitreous cavity, encompassing publications between 1971 and 2008. RESULTS We describe the conditions that can cause physical-chemical interactions between the medications and the need for combination therapy for treatment of various intraocular disease processes. CONCLUSIONS The intravitreal injection of medication and their combinations has become a part of standard care for many diseases of the retina and choroid. This article reviews the potential interaction of nontoxic doses of medications when injected simultaneously in the vitreous cavity, and disease processes that are now treated with these combination therapies.
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Affiliation(s)
- Gholam A Peyman
- Department of Ophthalmology and Vision Science, University of Arizona College of Medicine, Tucson, Arizona 85351, USA.
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Lew YJ, Park HJ, Lee TG, Lee DW, Cho SW, Lee JH. Primary Combined Photodynamic Therapy and Intravitreal Bevacizumab Injection for Neovascular Age-related Macular Degeneration. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2010. [DOI: 10.3341/jkos.2010.51.1.35] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Young Ju Lew
- MyungGok Eye Research Institute, Konyang University, Kim's Eye Hospital, Seoul, Korea
| | - Hae Jin Park
- MyungGok Eye Research Institute, Konyang University, Kim's Eye Hospital, Seoul, Korea
| | - Tae Gon Lee
- Department of Ophthalmology, College of Medicine, Konyang University, Deajeon, Korea
| | - Dong Won Lee
- MyungGok Eye Research Institute, Konyang University, Kim's Eye Hospital, Seoul, Korea
| | - Sung Won Cho
- MyungGok Eye Research Institute, Konyang University, Kim's Eye Hospital, Seoul, Korea
| | - Jae Heung Lee
- MyungGok Eye Research Institute, Konyang University, Kim's Eye Hospital, Seoul, Korea
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Stein JD, Zacks DN, Grossman D, Grabe H, Johnson MW, Sloan FA. Adverse events after pars plana vitrectomy among medicare beneficiaries. ACTA ACUST UNITED AC 2009; 127:1656-63. [PMID: 20008722 DOI: 10.1001/archophthalmol.2009.300] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To assess the complication rates of pars plana vitrectomy (PPV) among older Americans and to determine whether rates of adverse events and additional operations have changed during the past decade. METHODS Claims data were reviewed to identify all adults aged 68 years or older in the 5% Medicare sample who underwent their first PPV during 1994-1995, 1999-2000, and 2004-2005. One-year rates of severe complications (endophthalmitis, suprachoroidal hemorrhage, or retinal detachment), less severe complications, receipt of an additional operation, and blindness were calculated and compared among the 3 groups using Cox regression. Analyses were adjusted for prior adverse events (during the previous 3 years), demographic characteristics, and comorbid conditions. RESULTS The 1994-1995, 1999-2000, and 2004-2005 cohorts had 3263, 5064, and 5263 patients, respectively. The 1-year severe complication rates did not differ among the 3 groups (range, 4.8%-5.5%). The hazard of a less severe complication or an additional operation was higher in the 2004-2005 cohort than in the earlier cohorts (P < .05 for all comparisons). The hazard of endophthalmitis was higher in black individuals (P = .07) and those of other races (P = .02) than in white patients. CONCLUSIONS During the past decade, rates of severe complications after PPV remained stable, but rates of less severe complications and subsequent operations increased. Future studies should explore the potential factors that explain these changes and the alarming elevated incidence of post-PPV endophthalmitis among nonwhite individuals.
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Affiliation(s)
- Joshua D Stein
- Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall St, Ann Arbor, MI 48105, USA.
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128
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Abstract
BACKGROUND Diabetic macular edema (DME), cystoid macular edema (CME), age-related macular degeneration (AMD), retinal vascular occlusion (RVO) and uveitis are responsible for severe visual impairment worldwide. In some patients with these conditions, treatment with intraocular corticosteroids may be beneficial. Although off-label use of these agents has occurred for many years, novel agents including preservative-free and sustained-release intravitreal implants are currently being studied in clinical trials (CTs). OBJECTIVE To review the use of intraocular corticosteroids. METHODS Literature review. RESULTS Used alone, intravitreal corticosteroids may benefit disorders such as DME, RVO and uveitis compared with standard therapy or observation. Patients with AMD may benefit more from combination treatment with photodynamic therapy, intravitreal corticosteroid and intravitreal anti-VEGF injections. Intraoperative use of these agents may assist in visualization and manipulation of fine retinal structures. Sustained-release intraocular implants have been approved for severe posterior uveitis, and have shown benefits in ongoing CTs. CONCLUSION Although intraocular corticosteroid injections have a limited duration of action requiring frequent re-treatment, and significant side effects including cataract and glaucoma development, intraocular injections may be of benefit in certain ocular disorders. Corticosteroid implants are emerging as potential treatments for macular edema due to uveitis, DME or RVO.
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Affiliation(s)
- Daniel F Kiernan
- Department of Ophthalmology & Visual Sciences, University of Illinois at Chicago, Illinois 60612, USA
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129
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A Phase IIIb Study to Evaluate the Safety of Ranibizumab in Subjects with Neovascular Age-related Macular Degeneration. Ophthalmology 2009; 116:1731-9. [DOI: 10.1016/j.ophtha.2009.05.024] [Citation(s) in RCA: 259] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 05/13/2009] [Accepted: 05/13/2009] [Indexed: 11/30/2022] Open
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130
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Dixon JA, Oliver SCN, Olson JL, Mandava N. VEGF Trap-Eye for the treatment of neovascular age-related macular degeneration. Expert Opin Investig Drugs 2009; 18:1573-80. [DOI: 10.1517/13543780903201684] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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131
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132
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Kuzmin AG, Smirnova OM, Lipatov DV, Shestakova MV. Prospects for the treatment of diabetic retinopathy: Modulation of endothelial growth factor. DIABETES MELLITUS 2009. [DOI: 10.14341/2072-0351-5395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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133
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Combined intravitreal anti-VEGF and verteporfin photodynamic therapy for juxtafoveal and extrafoveal choroidal neovascularization as an alternative to laser photocoagulation. Eye (Lond) 2009; 24:713-6. [DOI: 10.1038/eye.2009.122] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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134
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Abstract
Purpose: Although important progress has been made in understanding age-related macular degeneration (AMD), management of the disease continues to be a challenge. AMD research has led to a widening of available treatment options and improved prognostic perspectives. This essay reviews these treatment options. Design: Interpretative essay. Methods: Literature review and interpretation. Results: Current treatments to preserve vision in patients with non-exudative AMD include antioxidant vitamins and mineral supplementations. Exudative AMD is currently most often treated monthly with anti-VEGF intravitreal injections. However, investigators are beginning to experiment with combination therapy and surgical approaches in an attempt to limit the number of treatment and reduce the financial burden on the health care system. Conclusion: By better understanding the basis and pathogenesis of AMD, newer therapies will continue to be developed that target specific pathways in patients with AMD, with the hoped for outcome of better management of the disease and improved visual acuity.
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Affiliation(s)
- Jean Pierre Hubschman
- Jules Stein Eye Institute, Department of Ophthalmology, University of California, David Geffen School of Medicine, Los Angeles, California, USA
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135
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Joussen AM, Wong D, Walter P, Kirchhof B, Dreyhaupt J, Bauer C, Munzinger J, Unnebrink K, Freiberger A, Seibert-Grafe M, Victor N. Surgical management of subfoveal choroidal neovascular membranes in age-related macular degeneration by macular relocation: experiences of an early-stopped randomised clinical trial (MARAN Study). Eye (Lond) 2009; 24:284-9. [PMID: 19478822 DOI: 10.1038/eye.2009.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
RATIONALE The MARAN (Macular Relocation in Age-related Neovascular disease) trial was planned to assess the effectiveness of full macular relocation (MR) in patients with neovascular age-related macular degeneration (AMD). DESIGN Randomised, prospective, controlled clinical trial. METHODS Patients suffering from visual loss because of AMD were randomised to either surgery or a control group receiving standard treatment (observation or photodynamic therapy (PDT)). The primary end point was the change of visual acuity (VA) (ETDRS) 52 weeks after randomisation compared with initial VA, and secondary end points included reading performance, contrast sensitivity, stability of fixation, eye-specific quality of life, and the absolute number of letters read correctly at 52 weeks compared with initial examination. RESULTS Owing to early determination, only 28 patients were included in the study. The study did not show a difference between the two groups with respect to the final visual result or any of the secondary outcomes measured. The study was limited by the low recruitment that was, at least in part, attributed to the inherent risks for those patients randomised to the surgical arm of the study as well as to the emerging new treatments for AMD. CONCLUSION The results of the MARAN trial failed to recruit a sufficient number of patients and a superiority of surgery over observation or PDT in patients with exudative AMD was not shown. There was a trend that the reading function was superior after surgery. In the light of the new pharmacological treatments, surgical options such as MR will be an option for only selected cases.
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Affiliation(s)
- A M Joussen
- Department of Ophthalmology, University of Duesseldorf, Duesseldorf, Germany.
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136
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Safety and efficacy of intravitreal anti-VEGF injections for age-related macular degeneration. Curr Opin Ophthalmol 2009; 20:223-5. [PMID: 19367163 DOI: 10.1097/icu.0b013e328329b656] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To report the safety and efficacy of intravitreal injections for age-related macular degeneration (AMD). RECENT FINDINGS Injecting antivascular endothelial growth factor drugs into the vitreal cavity brings new hope to many AMD patients. Currently, several antivascular endothelial growth factor drugs such as pegaptanib, ranibizumab, and bevacizumab are used via the intravitreal route for neovascular AMD. However, these injections are not without ocular or systemic complications. SUMMARY Review of current literature suggests that intravitreal antivascular endothelial growth factor agents are generally a safe and effective treatment for neovascular AMD for up to 2-3 years. Presently, there is level I evidence to substantiate this conclusion for pegaptanib and ranibizumab, but not bevacizumab.
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137
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Subfoveal exudative age-related macular degeneration: evidence for preoccult disease. Curr Opin Ophthalmol 2009; 20:182-7. [DOI: 10.1097/icu.0b013e328329b669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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138
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Ranchod TM, Brucker AJ, Liu C, Cukras CA, Hopkins TB, Ying GS. Evaluation of actual vs expected photodynamic therapy spot size. Am J Ophthalmol 2009; 147:859-64, 864.e1. [PMID: 19195634 DOI: 10.1016/j.ajo.2008.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 11/10/2008] [Accepted: 11/14/2008] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the accuracy of the photodynamic therapy (PDT) laser spot size on the retina as generated by 2 Food and Drug Administration (FDA)-approved lasers. DESIGN Prospective observational case series. METHODS Fundus photographs were taken of 1 eye of each of 10 subjects with the WinStation 4000 fundus photography system (OIS; Ophthalmic Imaging Systems, Sacramento, California, USA); disc size was calculated using OIS software. Slit-lamp photographs were taken of the PDT laser spot focused on the retina adjacent to the optic disc, using various spot sizes in combination with 3 different contact lenses and 2 different lasers. Spot size at the retina was determined by measuring the ratio of disc diameter to spot diameter in Adobe Photoshop (San Jose, California, USA) and applying this ratio to the OIS disc measurements. RESULTS Spot size at the retina averaged 87% of expected spot size for the Coherent Opal laser (Coherent Inc, Santa Clara, California, USA) and 104% of expected spot size for the Zeiss Visulas laser (Carl Zeiss Meditec Inc, Dublin, California, USA)(P = .002). Multivariate analysis demonstrated that percentage of expected spot size decreased with larger spot diameter (P = .01 for Coherent laser; P = .02 for Zeiss laser). CONCLUSIONS PDT spot size at the retina appears to be consistently smaller than expected for the Coherent laser while the spot size was consistently within 10% of expected size for the Zeiss laser. The deviation from expected size increased with larger spot size using the Coherent laser.
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Kaiser PK, Boyer DS, Garcia R, Hao Y, Hughes MS, Jabbour NM, Kaiser PK, Mieler W, Slakter JS, Samuel M, Tolentino MJ, Roth D, Sheidow T, Strong HA. Verteporfin Photodynamic Therapy Combined With Intravitreal Bevacizumab for Neovascular Age-Related Macular Degeneration. Ophthalmology 2009; 116:747-55, 755.e1. [PMID: 19243834 DOI: 10.1016/j.ophtha.2008.12.057] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Revised: 10/23/2008] [Accepted: 12/22/2008] [Indexed: 11/29/2022] Open
Affiliation(s)
- Peter K Kaiser
- Cole Eye Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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140
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Verteporfin combination regimens in the treatment of neovascular age-related macular degeneration. Retina 2009; 29:133-48. [PMID: 19202423 DOI: 10.1097/iae.0b013e3181960a28] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Neovascular age-related macular degeneration is characterized by choroidal neovascularization that has a complex pathogenesis. Combining agents that have different mechanisms of action (i.e., verteporfin photodynamic therapy, antivascular endothelial growth factor, and/or anti-inflammatory therapies) could maximize clinical benefits through potential complementary effects. This review discusses findings from studies investigating this hypothesis. METHODS Articles were retrieved from PubMed using relevant search terms. Abstracts from recent scientific meetings and details of ongoing trials from clinicaltrials.gov were also included. RESULTS Following its approval, verteporfin was important in the management of choroidal neovascularization due to age-related macular degeneration for several years. Improved visual outcomes have now been reported with antiangiogenic agents (e.g., intravitreal ranibizumab), especially when frequently administered. Results from investigator-sponsored trials, retrospective case studies and Registries, which have provided insights into the latest findings from clinical practice in the "real-world" setting, as well as randomized controlled trials, suggest that a combination approach is generally well tolerated and may maintain improvements in visual and anatomic outcomes with fewer retreatments. CONCLUSION A rationale exists for investigating combination approaches to target different processes in choroidal neovascularization pathogenesis, which may optimize treatment benefits in neovascular age-related macular degeneration. Encouraging data suggest that combination strategies are not associated with major adverse events.
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141
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Hernandez-Pastor LJ, Ortega A, Garcia-Layana A, Giraldez J. Cost-effectiveness of ranibizumab compared with photodynamic treatment of neovascular age-related macular degeneration. Clin Ther 2009; 30:2436-51. [PMID: 19167602 DOI: 10.1016/j.clinthera.2008.12.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study compared the cost-effectiveness of ranibizumab with that of photodynamic therapy (PDT) in the treatment of predominantly classic choroidal neovascularization secondary to age-related macular degeneration (AMD) from the perspective of a third-party payer in a Spanish setting. METHODS We constructed a Markov model with 5 states defined by visual acuity (VA) in the better-seeing eye (Snellen scale), as follows: VA >20/40, <or=20/40 to >20/80, </or20/80 to >20/200, <or=20/200 to >20/400, and <or=20/400. A death state was also included. We took transition probabilities, number of ranibizumab injections, and number of PDT treatments from the ANCHOR (Anti-Vascular Endothelial Growth Factor Antibody for the Treatment of Predominantly Classic Choroidal Neovascularization in Age-Related Macular Degeneration) trial. Utilities were taken from a published study of patients' preferences. We used unit costs from our hospital and drug costs from a national database. Resource utilization was determined by an ophthalmologist according to current clinical practice. We performed univariate, threshold, and probabilistic sensitivity analyses. Incremental costs (2007 euro) and quality-adjusted life-years (QALYs), both discounted at a 3% annual rate, and incremental cost-effectiveness ratios (ICERs; euro/QALY) were determined for the 2-year and life-expectancy time horizons. RESULTS Treating patients with varying degrees of visual impairment with ranibizumab instead of PDT, with a 2-year time horizon, was found to be euro18,328 more costly and to confer 0.140 additional QALY (euro131,275/QALY). This ICER was reduced to euro39,398/ QALY for the longer life-expectancy time horizon. According to the probabilistic sensitivity analysis, PDT is the therapy of choice in all cases below the threshold of euro30,000/QALY for the 2-year time horizon. Ranibizumab was the optimal intervention in 26% of cases in the longer lifetime horizon. When the initial VA was <or=20/400, the ICER increased to euro255,477 over 2 years. When ranibizumab was administered on an as-needed basis, as in the PrONTO (Prospective Optical coherence tomography imaging of patients with Neovascular AMD Treated with intra-Ocular ranibizumab) trial, the ICERs were reduced to euro29,566/QALY and euro11,469/QALY in the 2-year and life-expectancy horizons, respectively. CONCLUSIONS Based on these results, ranibizumab was not cost-effective when administered on a monthly basis. When administered as needed, ranibizumab was cost-effective compared with PDT for the treatment of AMD.
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MESH Headings
- Aged, 80 and over
- Angiogenesis Inhibitors/administration & dosage
- Angiogenesis Inhibitors/economics
- Angiogenesis Inhibitors/therapeutic use
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/economics
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Aptamers, Nucleotide/economics
- Aptamers, Nucleotide/therapeutic use
- Choroidal Neovascularization/drug therapy
- Choroidal Neovascularization/etiology
- Cost-Benefit Analysis
- Humans
- Injections
- Insurance, Health, Reimbursement/economics
- Macular Degeneration/complications
- Macular Degeneration/drug therapy
- Markov Chains
- Middle Aged
- Photochemotherapy/economics
- Photochemotherapy/methods
- Quality of Life
- Ranibizumab
- Reproducibility of Results
- Spain
- Visual Acuity
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142
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Yip PP, Woo CF, Tang HHY, Ho CK. Triple therapy for neovascular age-related macular degeneration using single-session photodynamic therapy combined with intravitreal bevacizumab and triamcinolone. Br J Ophthalmol 2009; 93:754-8. [PMID: 19273471 PMCID: PMC2680096 DOI: 10.1136/bjo.2008.150987] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To evaluate the efficacy and safety of triple therapy consisting single-session photodynamic therapy (PDT), intravitreal bevacizumab (IVB) and intravitreal triamcinolone (IVTA) for treatment of neovascular age-related macular degeneration (AMD) METHODS: Consecutive patients with subfoveal choroidal neovascularisation (CNV) secondary to AMD were treated with PDT using a standard protocol immediately followed by 1.25 mg of IVB and 4 mg of IVTA. 1.25 mg of IVB was given at 3 months for residual leakage. Best-corrected Snellen visual acuity (BCVA) and fluorescein angiography (FA) were performed prior to treatment. BCVA, intraocular pressure (IOP) and presence of vitritis were documented at 1 and 6 weeks, 3 and 6 months. FA was repeated at 3 and 6 months. Outcome measures included visual improvement measured by logMAR equivalent, angiographic evident of leakage and safety profile. RESULTS 36 eyes of 33 patients, aged 76.4 (SD 10.5) years with mean follow-up of 14.7 (6.9-19.2) months were analysed. Baseline logMAR acuity was 1.22 (0.71). The mean logMAR acuity was 1.14 (0.62) and 1.18 (0.63) at 3 and 6 months respectively. At 6 months, 61.1% (22/36) showed stable or gaining vision, and 27.8% (10/36) gained three or more lines. Twenty-eight eyes (77.8%) achieved CNV resolution by single session of triple therapy. One eye lost more than six lines due to retinal pigment epithelium rip, three eyes showed a significant cataract requiring surgery, and two showed persistent raised IOP at 6 months. None resulted in endophthalmitis or reported thromboembolic event. CONCLUSIONS Short-term results of single session triple therapy suggested that it might be a useful treatment option for neovascular AMD based on its low retreatment rates, sustainable CNV eradication result and visual gain achievement. However, the risk and benefits of using intravitreal triamcinolone in addition to combined PDT and IVB warrant further evaluation.
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Affiliation(s)
- P P Yip
- Department of Ophthalmology, Tuen Mun Hosptial, Tsing Chung Koon Road, Tuen Mun, Hong Kong.
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143
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One-year follow-up of combined customized therapy. Photodynamic therapy and bevacizumab for exudative age-related macular degeneration. Retina 2009; 29:13-9. [PMID: 18854782 DOI: 10.1097/iae.0b013e31818a1fd3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate whether combined, personalised photodynamic therapy (PDT) and Bevacizumab in choroidal neovascularization associated with age-related macular degeneration can improve vision, and whether it is possible to decrease the frequency and number of intravitreal antiangiogenics. METHODS A prospective, noncomparative, interventional study of a case series of 63 patients with exudative age-related macular degeneration, treated with an initial dose of PDT and intravitreal Bevacizumab 24 to 48 hours afterwards. Retreatments were carried out as required with monthly Bevacizumab and PDT every 3 months if there were relapses. Follow-up lasted 1 year in all cases. RESULTS After the first month of treatment, the mean best-corrected visual acuity increased by 4.85 letters, reaching 5.65 letters at the 12-month follow-up (P < 0.05). Compared with initial vision, 79.3% of the eyes had the same or better vision and 95.2% lost fewer than 15 letters. The total number of PDT treatments was 92 (a mean of 1.46 treatments per patient). The mean number of Bevacizumab injections was two per patient. In 29 cases (46%), only one initial treatment with PDT + Bevacizumab was necessary. In 15 cases (23.8%), more than two combined treatments per patient were necessary. CONCLUSIONS Combined, customized PDT + Bevacizumab therapy makes it possible to obtain visual results similar to those obtained in monotherapy, but with fewer intravitreal injections. It appears to be an interesting option for this type of patients.
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144
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Cruess AF, Zlateva G, Pleil AM, Wirostko B. Photodynamic therapy with verteporfin in age-related macular degeneration: a systematic review of efficacy, safety, treatment modifications and pharmacoeconomic properties. Acta Ophthalmol 2009; 87:118-32. [PMID: 18577193 DOI: 10.1111/j.1755-3768.2008.01218.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Photodynamic therapy (PDT) with verteporfin has been used less comprehensively in the treatment of exudative age-related macular degeneration (AMD), and specifically of choroidal neovascularization (CNV), since the advent of antiangiogenic therapies. Recently, there has been a renewed interest in PDT as an adjunct to these and other agents in the treatment of neovascular AMD. In light of this new development and the European Medicines Evaluation Agency's (EMEA) recent labelling decision to rescind approval for the use of PDT in occult CNV lesions, the present systematic review was undertaken to revisit the evidence supporting its clinical application. Photodynamic therapy provided the first pharmacological treatment for patients suffering from subfoveal CNV, the major cause of severe vision loss in AMD. Key clinical trials evaluating efficacy and safety have examined patients with all lesion subtypes, with the primary labelled indication (i.e. lesions containing a classic component of > or = 50% ) deriving from the results of the Treatment of Age-related Macular Degeneration with Photodynamic Therapy (TAP) Study. The subsequent TAP Study Group post hoc categorization of lesions as predominantly classic is open to question, however, as it appears that the overall efficacy in this group only may have reflected the especially strong response in 100% classic lesions. Based on a subgroup analysis of the Verteporfin in Photodynamic Therapy Study, the indication for PDT subsequently was expanded in some jurisdictions, including that of the EMEA, to include occult lesions with no classic component. However, the subsequent Visudyne in Occult Study found no benefit in 100% occult lesions, resulting in the EMEA rescinding its approval for this indication.
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Affiliation(s)
- Alan F Cruess
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada.
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145
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Smiddy WE. Economic implications of current age-related macular degeneration treatments. Ophthalmology 2009; 116:481-7. [PMID: 19157562 DOI: 10.1016/j.ophtha.2008.10.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 10/23/2008] [Accepted: 10/29/2008] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To measure the cost versus benefit of age-related macular degeneration (AMD) treatment strategies, existing and proposed, in the postranibizumab era. DESIGN Cost-effectiveness model. PARTICIPANTS None. METHODS University with hospital-based practice modeling of clinical examination, imaging, and treatment schedules were constructed considering published protocols where available, or by estimating usual practices. Medicare-allowable reimbursement schedules for a hospital-based, south Florida practice in 2007 were used to calculate costs of treatment. The lines of vision saved were deduced from published reports or using identified assumptions. This information was used to calculate cost per lines saved and, using actuarial tables data, costs per line-year saved were calculated. MAIN OUTCOME MEASURE Cost ($US) per line-year. RESULTS Consensus control values of expected lines loss if untreated (natural history) were established from published reports (2.5 lines at 1 year; 3.5 at 2 years) and photodynamic therapy (2.0 lines at 1 year; 3.0 at 2 years) for use in calculating lines of vision saved in studies without untreated control groups. The cost per line-year for 1 year of treatment ranged from a low of $84 with as-needed bevacizumab to $766 for protocol-style use of ranibizumab. Combination treatment regimens yielded a range of $71 to $269. The pharmaceutical proportion of treatment costs is higher than professional or facility costs, ranging to 83% for protocol-style ranibizumab. CONCLUSIONS Pharmaceutical-based treatments of AMD have markedly improved visual outcomes, but also have escalated costs markedly. Treatment regimens involving as-needed dosing, alternate medications, and combination therapy may preserve benefit for substantially lower costs. Disparate safety profiles would require consideration in choosing treatment regimens. Cost-benefit issues must be considered in AMD treatment regimens.
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Affiliation(s)
- William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida 33136, USA
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146
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Oh SB, Cho WB, Moon JW, Kim HC. Effects and Prognostic Factors of Intravitreal Bevacizumab Injection on Choroidal Neovascularization from Age-Related Macular Degeneration. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2009. [DOI: 10.3341/jkos.2009.50.2.202] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Se Beum Oh
- Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Won Bin Cho
- Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Jun Woong Moon
- Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Hyung Chan Kim
- Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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147
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Rosenfeld PJ, Martidis A, Tennant MT. Age-Related Macular Degeneration. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00100-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Schlingemann RO, Witmer AN. Treatment of retinal diseases with VEGF antagonists. PROGRESS IN BRAIN RESEARCH 2009; 175:253-67. [PMID: 19660661 DOI: 10.1016/s0079-6123(09)17517-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Diabetic retinopathy (DR) and age-related macular degeneration (AMD) are the most prevalent causes of blindness in the Western world. The pathogenesis of neovascularization and vascular leakage, both hallmarks of these diseases, appears to have one common denominator: vascular endothelial growth factor (VEGF). Since the recent introduction of anti-VEGF therapy, intravitreal injections with these agents have become standard care in neovascular AMD, and have been found to be a valuable additional treatment strategy in several other vascular retinal diseases. This review provides an overview of the history of anti-VEGF treatment in the eye, its rationale, its efficacy, and its potential drawbacks.
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Affiliation(s)
- R O Schlingemann
- Department of Ophthalmology, University of Amsterdam, Academic Medical Centre, Amsterdam, The Netherlands.
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149
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Combination photodynamic therapy and intravitreal ranibizumab in neovascular AMD in a north Indian population: a pilot study. Retina 2008; 28:1132-7. [PMID: 18779720 DOI: 10.1097/iae.0b013e318170d76d] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To evaluate photodynamic therapy (PDT) with verteporfin along with intravitreal Ranibizumab in treatment of neovascular age related macular degeneration. METHODS This prospective interventional care series included 16 patients (17 eyes) of choroidal neovascularization secondary to neovascular AMD, who were treated with PDT with verteporfin followed by an injection of 0.5mg Ranibuzimab on the same day. The main outcome measures were best corrected visual acuity (VA) as recorded by both Snellen's and ETDRS charts (logMAR), contrast sensitivity (Pelli-Robson Chart), retreatment frequency and frequency of side effects. RESULTS Seventeen eyes underwent PDT with verteporfin and intravitreal 0.5mg Ranibizumab, following PDT. Patients were followed up every month for a total period of 6 months. Initial VA ranged from CF to 20/32 and final acuity ranged from CF to 20/20. VA stabilizes (gain/loss <2 lines) in 14 out of 17 eyes (82.24%) and improved in 3 out of 17 (17.65%). Contrast sensitivity improved in 15 out of 17 eyes (82.24%) Lesion type, patient age had no influence on the outcome. There were no cases of ocular/systematic adverse events. Retreatment was required in only 2 out of 17 cases (11.76%) with only a single injection of ranibizumab. CONCLUSION The combination of PDT with intravitreal Ranibizumab improves contrast sensitivity and stabilizes vision and reduces the number of retreatments, without significant ocular and/or systematic risks.
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150
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Ahmadi MA, Lim JI. Pharmacotherapy of age-related macular degeneration. Expert Opin Pharmacother 2008; 9:3045-52. [DOI: 10.1517/14656560802473480] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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