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Han F, Chen X, Zhao R, Jin X, Tan W, Zhang Y. The effect of vitreomacular interface in neovascular age-related macular degeneration treated with intravitreal injection of anti-VEGF. BMC Ophthalmol 2022; 22:419. [PMID: 36329392 PMCID: PMC9632110 DOI: 10.1186/s12886-022-02640-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this study is to study the effect of repeated intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) drugs on vitreomacular interface. METHODS Neovascular age-related macular degeneration patients who received intravitreal injections of anti-VEGF drugs were included. Eyes with severe vitreous opacity, uveitis, complicated cataract surgery and previous vitrectomy were excluded. Vitreomacular interface, best corrected visual acuity (BCVA) and central retinal thickness (CRT) assessment were performed once a month for at least 3 months. The nature and time of the change event are recorded. Groups were divided according to whether vitreomacular interface change events occurred. To analyse the risk factors of vitreomacular interface changes and their influence on treatment effect. RESULTS A total of 87 eyes were evaluated. Vitreomacular interface change event occurred in 9 eyes. Pre-existing vitreomacular interface abnormality (VMIA) was a risk factor for the VMI change (P = 0.033, OR = 16.518, 95% CI: 1.258 to 216.939). 60% of interface events occurred in the first 3 months of treatment. The final BCVA of eyes with vitreomacular interface unchanged was significantly higher than that at baseline (P = 0.001), and the final CRT was also significantly lower than that at baseline (P < 0.001). The final CRT of eyes vitreomacular interface changed was significantly lower than that at baseline (P = 0.015), however, there was no statistical significance in BCVA (P = 0.468). CONCLUSION Intravitreal injection of anti-VEGF drugs has a certain probability to cause changes in the vitreomacular interface, and the risk is higher in eyes with pre-existing vitreomacular interface abnormality. The effect of intravitreal injections on the vitreomacular interface was concentrated in the first three injections, and subsequent increases in the number of injections did not significantly increase the risk of vitreomacular interface abnormality. Ophthalmologists should increase attention to the vitreomacular interface in the early stages of anti-VEGF therapy and counsel patients accordingly.
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Affiliation(s)
- Fangyuan Han
- Department of Ophthalmology, The First People's Hospital of Zunyi (the Third Affiliated Hospital of Zunyi Medical University), 98 Fenghuang North Road, Huichuan District, Zunyi, Guizhou Province, 563000, China
| | - Xingwang Chen
- Department of Ophthalmology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi Medical University, Zunyi, China
| | - Ruyi Zhao
- Department of Ophthalmology, The First People's Hospital of Zunyi (the Third Affiliated Hospital of Zunyi Medical University), 98 Fenghuang North Road, Huichuan District, Zunyi, Guizhou Province, 563000, China
| | - Xin Jin
- Department of Ophthalmology, The First People's Hospital of Zunyi (the Third Affiliated Hospital of Zunyi Medical University), 98 Fenghuang North Road, Huichuan District, Zunyi, Guizhou Province, 563000, China
| | - Wei Tan
- Department of Ophthalmology, The First People's Hospital of Zunyi (the Third Affiliated Hospital of Zunyi Medical University), 98 Fenghuang North Road, Huichuan District, Zunyi, Guizhou Province, 563000, China.,Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi Medical University, Zunyi, China
| | - Ying Zhang
- Department of Ophthalmology, The First People's Hospital of Zunyi (the Third Affiliated Hospital of Zunyi Medical University), 98 Fenghuang North Road, Huichuan District, Zunyi, Guizhou Province, 563000, China. .,Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi Medical University, Zunyi, China.
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Veritti D, Sarao V, Soppelsa V, Danese C, Chhablani J, Lanzetta P. Managing Neovascular Age-Related Macular Degeneration in Clinical Practice: Systematic Review, Meta-Analysis, and Meta-Regression. J Clin Med 2022; 11:jcm11020325. [PMID: 35054021 PMCID: PMC8781865 DOI: 10.3390/jcm11020325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 12/23/2022] Open
Abstract
The use of anti-vascular endothelial growth factor (VEGF) agents has profoundly changed the prognosis of neovascular age-related macular degeneration (nAMD). As clinical experiences have accumulated, it has become mandatory to summarize data to give information that can be useful in everyday practice. We conducted a systematic review to identify randomized controlled trials (RCTs) and observational studies that reported 12-month changes in best-corrected visual acuity (BCVA) in patients with nAMD on anti-VEGF monotherapy. Data were analyzed in a random-effects meta-analysis with BCVA change as the primary outcome. Meta-regression was conducted to evaluate the impact of multiple covariates. Four hundred and twelve heterogeneous study populations (109,666 eyes) were included. Anti-VEGFs induced an overall improvement of +5.37 ETDRS letters at 12 months. Meta-regression showed that mean BCVA change was statistically greater for RCTs (p = 0.0032) in comparison with observational studies. Populations following a proactive regimen had better outcomes than those following a reactive treatment regimen. Mean BCVA change was greater in younger populations, with lower baseline BCVA and treated with a higher number of injections (p < 0.001). Our results confirm that anti-VEGFs may produce a significant functional improvement at 12 months in patients with nAMD.
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Affiliation(s)
- Daniele Veritti
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy; (D.V.); (V.S.); (V.S.); (C.D.)
| | - Valentina Sarao
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy; (D.V.); (V.S.); (V.S.); (C.D.)
- Istituto Europeo di Microchirurgia Oculare (IEMO), 33100 Udine, Italy
| | - Valentina Soppelsa
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy; (D.V.); (V.S.); (V.S.); (C.D.)
| | - Carla Danese
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy; (D.V.); (V.S.); (V.S.); (C.D.)
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, Pittsburg, PA 15261, USA;
| | - Paolo Lanzetta
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy; (D.V.); (V.S.); (V.S.); (C.D.)
- Istituto Europeo di Microchirurgia Oculare (IEMO), 33100 Udine, Italy
- Correspondence: ; Tel.: +39-04-3255-9907
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Taniguchi H, Yoshida I, Sakamoto M, Maeno T. Epiretinal membrane appearance or progression after intravitreal injection in age-related macular degeneration. BMC Ophthalmol 2021; 21:190. [PMID: 33906612 PMCID: PMC8080384 DOI: 10.1186/s12886-021-01944-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study is to evaluate the influence of anti-vascular endothelial growth factor (VEGF) in the appearance or progression of epiretinal membranes (ERMs) in age-related macular degeneration (ARMD) and investigate confounding factors causing ERMs. METHODS Seventy-six eyes that were treated for more than 36 months from the first anti-VEGF injection were assessed. Binary logistic regression analysis was performed between smoking, lens status, subretinal hemorrhage, posterior vitreous detachment (PVD) status, peripheral retinal degeneration, type of AMD, conditions of contralateral eye, and the number of injections as independent variables and appearance or progression of ERMs during 36 months as dependent variables. RESULTS The presence of vitreomacular adhesion (VMA) or development of PVD during the observation period was significantly associated (Odds ratio [OR]: 5.77; 95% confidence interval [CI], 1.72-19.4; p = 0.005) with the appearance or progression of ERMs. Moreover, peripheral retinal degeneration was significantly associated (OR: 3.87; 95% CI, 1.15-13.0; p = 0.029). Injection number of anti-VEGF was not significantly associated (OR: 1.02; 95% CI, 0.90-1.16; p = 0.72). CONCLUSION This study suggests possibilities that anti-VEGF injections alone are unable to cause the development of ERMs, that VMA or developing PVD has a prior impact on the developing ERMs in ARMD similar to that of idiopathic ERMs, and that peripheral retinal degenerations and vitreomacular adhesion were both related to ERMs development and pathogenesis of ARMD.
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Affiliation(s)
- Hikari Taniguchi
- Sakura Medical Center, Toho University, 285-8741 Sakura-shi, Chiba, Japan
| | - Izumi Yoshida
- Sakura Medical Center, Toho University, 285-8741 Sakura-shi, Chiba, Japan. .,Toho-Kamagaya Hospital, 273-0132 Kamagaya-shi, Chiba, Japan.
| | - Masashi Sakamoto
- Sakura Medical Center, Toho University, 285-8741 Sakura-shi, Chiba, Japan
| | - Takatoshi Maeno
- Sakura Medical Center, Toho University, 285-8741 Sakura-shi, Chiba, Japan
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Kocak Altintas AG, Ilhan C, Cankurtaran M. The effects of epiretinal membranes on the treatment outcomes of intravitreal aflibercept injection in diabetic macular edema: a real-life study. Int Ophthalmol 2020; 40:2635-2641. [PMID: 32472420 DOI: 10.1007/s10792-020-01444-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 05/23/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the effects of epiretinal membrane (ERM) formation on the anatomic and functional results of subjects with diabetic macular edema (DME) who are receiving intravitreal aflibercept injections (IAIs). MATERIALS AND METHODS This retrospective comparative study includes 29 eyes with DME (Group 1) and 43 eyes with DME and ERM (Group 2). After three consecutive monthly 2.0 mg IAIs, subjects received monthly follow-ups and retreatment was performed if needed. Corrected visual acuity (CVA), central macular thickness (CMT), and central macular volume (CMV) parameters were recorded tri-monthly, and the 36-month follow-up was designated the primary endpoint of the study. RESULTS There was no significant difference between groups when comparing the mean ages and male-to-female ratios (p > 0.05, for both). At the baseline, the mean CVA value was significantly worse (p = 0.002), and the mean CMT was significantly lower (p = 0.016) in Group 1, while there was no significant difference in terms of the mean CMV (p = 0.625). The mean number of IAIs was similar at the first (p < 0.102), second (p = 0.363), and third year (p = 0.850) follow-ups. The mean CVA was significantly worse, and CMT was significantly lower in Group 1 at most of the visits in the first half of the follow-up period (p < 0.05, for all), while there was no significant difference in the second half of the follow-up period. There was no significant difference between groups in terms of CMV at any visit (p > 0.05, for all). CONCLUSION Despite a similar number of IAIs needed, worse baseline clinical parameters are associated with poorer early- or mid-term outcomes. At the long-term follow-up, CVA and CMT became similar in DME independent of ERM.
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Affiliation(s)
- Ayse Gul Kocak Altintas
- Ankara Ulucanlar Eye Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Cagri Ilhan
- Hatay State Hospital, Ekinci Mah. Cevreyolu Cad. Royals Park 13/1 No: 23, Antakya, Hatay, Turkey.
| | - Mahmut Cankurtaran
- Ankara Ulucanlar Eye Education and Research Hospital, University of Health Sciences, Ankara, Turkey
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Incidence and treatment outcomes of secondary epiretinal membrane following intravitreal injection for diabetic macular edema. Sci Rep 2020; 10:528. [PMID: 31953511 PMCID: PMC6969073 DOI: 10.1038/s41598-020-57509-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 01/02/2020] [Indexed: 12/14/2022] Open
Abstract
The purpose of this study was to investigate the incidence of secondary epiretinal membrane (ERM) after intravitreal injection and the effect of ERM on visual acuity and central macular thickness (CMT) in patients with diabetic macular edema (DME). We included 147 eyes of 95 patients over 18 years old who were diagnosed with DME from 2012 to 2016, treated with intravitreal injection, and followed-up more than 24 months. Mean CMT in the ERM group was significantly thicker than in the non-ERM group after 9, 12, 18, and 24 months. Secondary ERM developed in 9.5% of patients during follow-up. Compared to other agents, the incidence of secondary ERM was significantly higher after intravitreal injection of dexamethasone implant. Among patients in the ERM group, the mean decrease of CMT between pre-injection and 2 weeks post-injection was significantly less after secondary ERM formation than before ERM formation. Secondary ERM formation was significantly associated with the number of intravitreal injections and the use of dexamethasone implant. Therefore, secondary ERM develops more frequently as the number of intravitreal injections increases and after intravitreal dexamethasone implant injection. The therapeutic effects of intravitreal injections for DME patients decrease after secondary ERM formation.
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Cakir A, Erden B, Bolukbasi S, Aydin A, Yurttaser Ocak S, Maden G, Elcioglu MN. Comparison of the effect of ranibizumab and dexamethasone implant in diabetic macular edema with concurrent epiretinal membrane. J Fr Ophtalmol 2019; 42:683-689. [PMID: 31088741 DOI: 10.1016/j.jfo.2019.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/30/2019] [Accepted: 02/11/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of intravitreal ranibizumab (RZB) injections and intravitreal dexamethasone (DEX) implant in diabetic macular edema (DME) with concurrent epiretinal membrane (ERM). METHODS This was a retrospective, observational, comparative study. Medical records of DME patients with concurrent ERM were retrospectively reviewed. Seventeen eyes of 16 patients treated with 3 consecutive monthly RZB injections (RZB group) and 22 eyes of 18 patients treated with a DEX implant (DEX group) were included. The groups were compared at baseline, 1st, 2nd, 3rd and 4th months in terms of best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP). RESULTS Eighteen of the 39 eyes (46.1%) were phakic at baseline, 9 (52.9%) of which were treated with RZB, whereas 9 (40.9%) were treated with DEX implant (P=0.528). Although CMT improved significantly in both the RZB and DEX groups (P<0.001); the trend was different (P=0.003). The mean change in CMT at 1month in the DEX group was greater (DEX: 188.2±142.7μm; RZB: 95.7±110.7μm; P=0.034); it was in favor of RZB group at the 3rd and 4th months (DEX: -52.7±86.9μm; RZB: 1.4±31.4μm; P=0.012. DEX: -63±67.3μm; RZB: -5.8±43.9μm; P=0.004, respectively). BCVA improved significantly in both groups (P<0.001). There was no statistical difference between the groups with regard to gain in BCVA or IOP change throughout the study period (P=0.572, P=0.064, respectively). CONCLUSION Both RZB and DEX are effective in improving anatomical and visual outcomes in DME with concurrent ERM. The DEX group was associated with a prompt anatomic response, but with a gradual decrease from 3rd month.
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Affiliation(s)
- A Cakir
- Department of Ophthalmology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey.
| | - B Erden
- Department of Ophthalmology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - S Bolukbasi
- Department of Ophthalmology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - A Aydin
- Clinique Universitaire d'Ophtalmologie, Faculté de Médecine, Université d'Istanbul Medipol, Fatih Caddesi, Yenibosna, Istanbul, Turkey
| | - S Yurttaser Ocak
- Department of Ophthalmology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - G Maden
- Department of Ophthalmology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - M N Elcioglu
- Department of Ophthalmology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
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Jang M, Kim JY, Lee SY, Jeong JH, Lee EK. The Effect of Epiretinal Membrane on Dexamethasone Implant for Branch Retinal Vein Occlusion Macular Edema. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.9.843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Mirinae Jang
- Department of Ophthalmology, Jeju National University School of Medicine, Jeju, Korea
| | - Jin Young Kim
- Department of Ophthalmology, Jeju National University School of Medicine, Jeju, Korea
| | - Sang-Yoon Lee
- Department of Ophthalmology, Jeju National University School of Medicine, Jeju, Korea
| | - Jin Ho Jeong
- Department of Ophthalmology, Jeju National University School of Medicine, Jeju, Korea
| | - Eun Kyoung Lee
- Department of Ophthalmology, Jeju National University School of Medicine, Jeju, Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
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Chatziralli I, Stavrakas P, Theodossiadis G, Ananikas K, Dimitriou E, Theodossiadis P. The Impact of Epiretinal Membrane in Neovascular Age-Related Macular Degeneration Treatment: A Spectral-Domain Optical Coherence Tomography Study. Semin Ophthalmol 2017; 33:651-656. [PMID: 29115893 DOI: 10.1080/08820538.2017.1395892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE The purpose of this prospective study was to evaluate the impact of epiretinal membrane (ERM) on anatomical and functional results in patients with wet age-related macular degeneration (AMD) treated with intravitreal anti-vascular endothelial growth (anti-VEGF) injections. METHODS Participants in the study were 48 patients with either wet AMD alone (AMD group, n = 27) or AMD and ERM (AMD/ERM group, n = 21). All patients received intravitreal anti-VEGF injections (three monthly injections and PRN thereafter) and were followed up for at least 12 months. All participants had best-corrected visual acuity (BCVA) measurement and spectral domain-optical coherence tomography (SD-OCT) at each visit, while fluorescein angiography was performed at baseline and then at the discretion of the physician. RESULTS There was a statistically significant improvement in BCVA at month 12 compared to baseline in each group (p < 0.001 for both groups), while the two groups did not differ significantly regarding BCVA at the end of the follow-up (p = 0.056). Additionally, there was a statistically significant reduction in CRT in both groups at month 12 (p < 0.001 for AMD group and p = 0.004 for AMD/ERM group) with no statistically significant difference between the groups (p = 0.183). Patients in the AMD group had a lower percentage of subretinal fluid (25.9%) than patients in the AMD/ERM group (52.4%) at the end of the follow-up, while ellipsoid zone disruption was found to be more profound in the AMD/ERM group (38.1%) than in the AMD group (18.5%). Patients in the AMD/ERM group needed more injections (7.1 ± 2.0 injections) than patients in the AMD group (4.8 ± 1.7 injections). CONCLUSIONS Patients in the AMD/ERM group had a higher percentage of subretinal and intraretinal fluid and ellipsoid zone interruption during the follow-up period. Anti-VEGF treatment appeared to have a beneficial effect in both groups, although the AMD/ERM group needed more injections compared to the AMD group.
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Affiliation(s)
- Irini Chatziralli
- a Second Department of Ophthalmology , Attikon Hospital, University of Athens , Athens , Greece
| | - Panagiotis Stavrakas
- a Second Department of Ophthalmology , Attikon Hospital, University of Athens , Athens , Greece
| | - George Theodossiadis
- a Second Department of Ophthalmology , Attikon Hospital, University of Athens , Athens , Greece
| | - Konstantinos Ananikas
- a Second Department of Ophthalmology , Attikon Hospital, University of Athens , Athens , Greece
| | - Eleni Dimitriou
- a Second Department of Ophthalmology , Attikon Hospital, University of Athens , Athens , Greece
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