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Prophylactic effect of brinzolamide-brimonidine fixed combination on intraocular pressure spikes after intravitreal anti-VEGF injections. Int Ophthalmol 2021; 41:3191-3198. [PMID: 34114138 DOI: 10.1007/s10792-021-01885-z] [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: 10/03/2020] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the effect of topical prophylaxis with brinzolamide-brimonidine fixed combination on short-term intraocular pressure (IOP) elevation after intravitreal injections of anti-vascular endothelial growth factors (anti-VEGF). METHODS This prospective comparative study included 56 eyes of 47 patients treated with intravitreal injections of anti-VEGF, and they were randomly divided into two groups. In control group (25 eyes), no prophylactic medication was used, whereas in case group (31 eyes) one drop of a fixed combination of brinzolamide-brimonidine was instilled two hours before the injection. IOP was measured before the injection and at 1 min, 10 min and 30 min post-injection in all eyes. RESULTS The mean IOP before injection at 1 min, 10 min and 30 min post-injection was 16,6 ± 2,8 mmHg, 53,4 ± 12 mmHg, 26,4 ± 5,5 mmHg and 17,9 ± 4 mmHg, respectively, in control group and 15,1 ± 3,4 mmHg, 42,6 ± 8,4 mmHg, 21,4 ± 5,5 mmHg and 12,4 ± 3,5 mmHg, respectively, in case group. At 1 min, 10 min and 30 min post-injection, the mean IOP was significantly lower in case group compared with control group (p < 0,001, p = 0,0014 and p < 0,0001, respectively), but no difference at the pre-injection IOP between the two groups was found (p = 0,09). CONCLUSIONS The prophylactic administration of one drop of brinzolamide-brimonidine fixed combination significantly reduces the IOP spikes during the first 30 min after the intravitreal anti-VEGF injection.
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Pilot study of ziv-aflibercept in myopic choroidal neovascularisation patients. BMC Ophthalmol 2020; 20:414. [PMID: 33076864 PMCID: PMC7574189 DOI: 10.1186/s12886-020-01679-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 10/05/2020] [Indexed: 01/26/2023] Open
Abstract
Background Myopic choroidal neovascularization (CNV) is the most common sight-threatening complication associated with high myopia. The present study evaluated the efficacy and safety of the intravitreal injection of ziv-aflibercept in patients with myopic CNV. Methods This prospective interventional study was conducted on 20 eyes of 20 patients with active myopic CNV. Twelve patients were 40 years or older. This study was performed in the Ophthalmology Department of Tanta University Eye Hospital, Tanta University, Egypt. Optical coherence tomography (OCT) was performed for all patients at baseline and monthly after injection during the 6-month follow up period. The main outcome measures were changes in BCVA and CMT. The exploratory outcome measures were CNV size, IOP and the number of injections needed in each age group during the study period. Results Patients with myopic CNV younger than 40 years needed fewer injections (2.00 ± 0.76) than patients older than 40 years (2.50 ± 1.00), with no statistical significance detected between the two groups (p-value 0.246). CNV was smaller in the younger age group (p-value 0.209), best corrected visual acuity (BCVA) improved significantly in the younger and older age groups (p-values 0.001 and 0.028, respectively), and central macular thickness (CMT) decreased significantly after 6 months, from 242.88 ± 23.83 μm to 191.13 ± 13.83 μm in the younger age group and from 251.33 ± 26.60 μm to 197.08 ± 17.64 μm in the older age group (p = 0.001). No significant correlation was found between the final BCVA and either the spherical equivalent or central macular thickness after 6 months, with p-values of 0.135 and 0.145, respectively. No significant changes in IOP were detected in either group after the intravitreal injection. Conclusion Ziv-aflibercept is a highly effective and safe drug in cases of active myopic CNV; however, a larger number of patients and a longer follow-up period are needed to confirm our results. This study was retrospectively registered at clinicaltrials.gov (ID: NCT04290195) on 26-2-2020.
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Sakata VM, Morita C, Lavezzo MM, Rodriguez EEC, Abdallah SF, Pimentel SLG, Hirata CE, Yamamoto JH. Outcomes of Intravitreal Bevacizumab in Choroidal Neovascularization in Vogt-Koyanagi-Harada Disease- A Prospective Study. Ocul Immunol Inflamm 2019; 29:572-578. [PMID: 31746659 DOI: 10.1080/09273948.2019.1687731] [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] [Indexed: 01/10/2023]
Abstract
Purpose: To assess the effectiveness of intravitreal (IV) bevacizumab and the need for systemic immunosuppressive therapy (IMT) in choroidal neovascularization (CNV) in Vogt-Koyanagi-Harada disease (VKHD).Methods: CNV treatment consisted of three monthly IV bevacizumab injections as a loading dose; if intra/subretinal fluid (IRF) persisted, further injections were proceeded besides increment in systemic IMT. Outcome analyses at 3, 6, and 12 months were visual acuity, central foveal thickness, macular volume, IRF, and addition of IMT.Results: Seven eyes of six patients were included. Five patients (five eyes) completed a 12-month follow-up and received 12 IV bevacizumab injections. At the 12-month follow-up, visual acuity improved in four out of five eyes (p = .0568); all eyes had decreased macular volume (p = .0431) but they still had persistent IRF; and all cases needed IMT introduction/increment.Conclusion: Intravitreal bevacizumab in association with systemic IMT was effective for CNV in VKHD. Active CNV may indicate disease of inadequate clinical control.
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Affiliation(s)
- Viviane M Sakata
- Department of Ophthalmology, Faculdade de Medicina FMUSP, LIM 33, Universidade de Sao Paulo, Sao Paulo, Brazil.,Department of Ophthalmology, Hospital das Clinicas, Universidade Federal do Parana, Curitiba, Brazil
| | - Celso Morita
- Department of Ophthalmology, Faculdade de Medicina FMUSP, LIM 33, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marcelo M Lavezzo
- Department of Ophthalmology, Faculdade de Medicina FMUSP, LIM 33, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ever E C Rodriguez
- Department of Ophthalmology, Faculdade de Medicina FMUSP, LIM 33, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Smairah F Abdallah
- Department of Ophthalmology, Faculdade de Medicina FMUSP, LIM 33, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sergio L G Pimentel
- Department of Ophthalmology, Faculdade de Medicina FMUSP, LIM 33, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carlos E Hirata
- Department of Ophthalmology, Faculdade de Medicina FMUSP, LIM 33, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Joyce H Yamamoto
- Department of Ophthalmology, Faculdade de Medicina FMUSP, LIM 33, Universidade de Sao Paulo, Sao Paulo, Brazil
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Ruiz-Medrano J, Montero JA, Flores-Moreno I, Arias L, García-Layana A, Ruiz-Moreno JM. Myopic maculopathy: Current status and proposal for a new classification and grading system (ATN). Prog Retin Eye Res 2019; 69:80-115. [PMID: 30391362 DOI: 10.1016/j.preteyeres.2018.10.005] [Citation(s) in RCA: 182] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/18/2018] [Accepted: 10/22/2018] [Indexed: 02/09/2023]
Abstract
Myopia is a highly frequent ocular disorder worldwide and pathologic myopia is the 4th most common cause of irreversible blindness in developed countries. Pathologic myopia is especially common in East Asian countries. Ocular alterations associated with pathologic myopia, especially those involving the macular area-defined as myopic maculopathy-are the leading causes of vision loss in patients with pathologic myopia. High myopia is defined as the presence of a highly negative refractive error (>-6 to -8 diopters) in the context of eye elongation (26-26.5 mm). Although the terms high myopia and pathologic myopia are often used interchangeably, they do not refer to the same eye disease. The two key factors driving the development of pathologic myopia are: 1) elongation of the axial length and 2) posterior staphyloma. The presence of posterior staphyloma, which is the most common finding in patients with pathologic myopia, is the key differentiating factor between high and pathologic myopia. The occurrence of staphyloma will, in most cases, eventually lead to other conditions such as atrophic, traction, or neovascular maculopathy. Posterior staphyloma is for instance, responsible for the differences between a myopic macular hole (MH)-with and without retinal detachment-and idiopathic MH. Posterior staphyloma typically induces retinal layer splitting, leading to foveoschisis in myopic MH, an important differentiating factor between myopic and emmetropic MH. Myopic maculopathy is a highly complex disease and current classification systems do not fully account for the numerous changes that occur in the macula of these patients. Therefore, a more comprehensive classification system is needed, for several important reasons. First, to more precisely define the disease stage to improve follow-up by enabling clinicians to more accurately monitor changes over time, which is essential given the progressive nature of this condition. Second, unification of the currently-available classification systems would establish standardized classification criteria that could be used to compare the findings from international multicentric studies. Finally, a more comprehensive classification system could help to improve our understanding of the genetic origins of this disease, which is clearly relevant given the interchangeable-but erroneous-use of the terms high and pathologic myopia in genetic research.
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Affiliation(s)
- Jorge Ruiz-Medrano
- Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain
| | - Javier A Montero
- Department of Ophthalmology, Rio Hortega University Hospital, Valladolid, Spain; Red Temática de Investigación Cooperativa en Salud: ""Prevención, detección precoz, y tratamiento de la patología ocular prevalente, degenerativa y crónica" (RD16/0008/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Spain; Retina Unit, Oftalvist, Madrid, Spain
| | | | - Luis Arias
- Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain
| | - Alfredo García-Layana
- Red Temática de Investigación Cooperativa en Salud: ""Prevención, detección precoz, y tratamiento de la patología ocular prevalente, degenerativa y crónica" (RD16/0008/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Spain; Department of Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain
| | - José M Ruiz-Moreno
- Red Temática de Investigación Cooperativa en Salud: ""Prevención, detección precoz, y tratamiento de la patología ocular prevalente, degenerativa y crónica" (RD16/0008/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Spain; Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain; Department of Ophthalmology, Castilla La Mancha University, Albacete, Spain; Vissum Corporation, Spain.
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Cheung CMG, Arnold JJ, Holz FG, Park KH, Lai TY, Larsen M, Mitchell P, Ohno-Matsui K, Chen SJ, Wolf S, Wong TY. Myopic Choroidal Neovascularization. Ophthalmology 2017; 124:1690-1711. [DOI: 10.1016/j.ophtha.2017.04.028] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 04/03/2017] [Accepted: 04/24/2017] [Indexed: 02/07/2023] Open
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Song S, Yu XB, Dai H. Effect of prophylactic intraocular pressure-lowering medication (brinzolamide) on intraocular pressure after ranibizumab intravitreal injection: A case-control study. Indian J Ophthalmol 2017; 64:762-766. [PMID: 27905340 PMCID: PMC5168919 DOI: 10.4103/0301-4738.195006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: To observe the effect of prophylactic intraocular pressure (IOP)-lowering medication (brinzolamide) on IOP after ranibizumab intravitreal injections (IVIs). Materials and Methods: This prospective case–control study included 352 eyes from 352 patients (1 eye per patient) who were treated with ranibizumab intravitreal injection and divided randomly into two groups. Two hundred and three patients in control group only received the ranibizumab IVI, but 149 patients in case group received one drop of prophylactic intraocular brinzolamide preinjection. The IOP was measured by noncontact tonometer before injection, at 10, 30, 120 min and 1 day after injection in a sitting position. Results: The mean IOP measured before injection, at 10, 30, 120 min and 1 day after injection individually were 15.79 ± 2.21 mmHg, 19.33 ± 4.86 mmHg, 16.64 ± 2.93 mmHg, 16.17 ± 3.13 mmHg, and 15.07 ± 2.55 mmHg in case group and were 15.82 ± 2.57 mmHg, 21.34 ± 5.88 mmHg, 18.17 ± 4.06 mmHg, 17.59 ± 4.42 mmHg, and15.48 ± 2.92 mmHg in control group. Comparing two groups, the mean increase on IOP was statistically significant at 10, 30, 120 min postinjection (P < 0.05). Conclusions: IVI of ranibizumab causes a considerable short-term transient rise on IOP in most patients. The effect of prophylactic IOP-lowering medication on IOP after IVIs can be statistically significant from 10 min to 2 h after IVIs.
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Affiliation(s)
- Shuang Song
- Department of Ophthalmology, Beijing Hospital, National Center of Gerontology, Beijing, P. R. China
| | - Xiao-Bing Yu
- Department of Ophthalmology, Beijing Hospital, National Center of Gerontology, Beijing, P. R. China
| | - Hong Dai
- Department of Ophthalmology, Beijing Hospital, National Center of Gerontology, Beijing, P. R. China
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Korol AR, Zadorozhnyy OS, Naumenko VO, Kustryn TB, Pasyechnikova NV. Intravitreal aflibercept for the treatment of choroidal neovascularization associated with pathologic myopia: a pilot study. Clin Ophthalmol 2016; 10:2223-2229. [PMID: 27853350 PMCID: PMC5106219 DOI: 10.2147/opth.s117791] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Purpose To determine the efficacy of intravitreal aflibercept injections for the treatment of patients with choroidal neovascularization (CNV) associated with pathologic myopia. Methods In this uncontrolled, prospective cohort study, 31 eyes of 30 consecutive patients affected by CNV associated with pathologic myopia were treated with intravitreal aflibercept (2 mg) as needed following two initial monthly doses and observed over a 12-month follow-up period. The primary endpoint was change in best-corrected visual acuity (BCVA) at month 12, while central retinal thickness (CRT) on optical coherence tomography (OCT), neovascularization activity on fluorescein angiography, the number of aflibercept injections administered, and safety were examined as secondary endpoints. Results Patients received a mean of 2.6 intravitreal aflibercept injections over the 12-month study period. Compared with baseline, BCVA improved significantly at all time points (P<0.05). Mean (standard deviation [SD]) decimal BCVA was 0.2 (0.1) at baseline and 0.35 (0.16) at month 12. The greatest improvement in BCVA was seen within the first 2 months (P=0.01). Mean (SD) CRT on OCT decreased from 285 (62) µm at baseline to 227 (42) µm (P=0.01) at month 12. There was a continuous decrease in mean CRT on OCT over time. No cases of endophthalmitis, uveitis, stroke, or retinal detachment were noted. No patient demonstrated an intraocular pressure >20 mmHg during any study visit. Conclusion The 12-month results of intravitreal aflibercept for myopic CNV using an as-needed regimen were positive, showing benefits in visual and anatomic outcomes and an acceptable tolerability profile.
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Affiliation(s)
- Andrii R Korol
- The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine, Odessa, Ukraine
| | - Oleg S Zadorozhnyy
- The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine, Odessa, Ukraine
| | - Volodymyr O Naumenko
- The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine, Odessa, Ukraine
| | - Taras B Kustryn
- The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine, Odessa, Ukraine
| | - Nataliya V Pasyechnikova
- The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine, Odessa, Ukraine
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INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR CHOROIDAL NEOVASCULARIZATION SECONDARY TO PATHOLOGIC MYOPIA. Retina 2015; 35:2450-6. [PMID: 26049616 DOI: 10.1097/iae.0000000000000632] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The other CNVM: A review of myopic choroidal neovascularization treatment in the age of anti-vascular endothelial growth factor agents. Surv Ophthalmol 2015; 60:204-15. [DOI: 10.1016/j.survophthal.2014.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 10/14/2014] [Accepted: 10/31/2014] [Indexed: 01/20/2023]
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Effects of intravitreal injection of bevacizumab on nitric oxide levels. Eye (Lond) 2014; 29:436-42. [PMID: 25523201 DOI: 10.1038/eye.2014.297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 10/23/2014] [Indexed: 01/02/2023] Open
Abstract
PURPOSE This study aimed to determine the possible effects of single-dose intravitreal bevacizumab on nitric oxide (NO) levels in serum and remote organs and to reveal one of the possible mechanisms in the pathophysiology of hypertension. METHODS Thirty-eight adult New Zealand albino rabbits were divided into a control group (no injection was performed, killed on day 28 of the study), group 1 (killed on day 1 of the study), group 2 (killed on day 7 of the study), group 3 (killed on day 14 of the study), and group 4 (killed on day 28 of the study). The right eyes of the animals in groups 1-4 received an intravitreal single injection of 1.25 mg (0.05 ml) bevacizumab (Avastin), and their brain, heart, liver, kidney, and blood samples were collected. NO levels were evaluated in the serum and organ homogenates. Kidney tissues were assessed by electron microscopy. RESULTS Serum, brain, kidney, and liver NO levels significantly decreased in groups 2, 3, and 4 as compared with the control group (P<0.05). In addition, heart NO levels significantly decreased in groups 3 and 4 compared with the control group (P<0.05). There were no electron microscopic changes in the kidneys of either group. CONCLUSIONS This study demonstrated that single intravitreal injection of bevacizumab decreased NO levels in serum, brain, heart, liver, and kidneys. In addition, there were no electron microscopic changes in the kidneys.
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Pasyechnikova NV, Naumenko VO, Korol AR, Zadorozhnyy OS, Kustryn TB, Henrich PB. Intravitreal Ranibizumab for the Treatment of Choroidal Neovascularizations Associated with Pathologic Myopia: A Prospective Study. Ophthalmologica 2014; 233:2-7. [DOI: 10.1159/000369397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 10/28/2014] [Indexed: 11/19/2022]
Abstract
Purpose: It was the aim of this study to determine the efficacy of intravitreal ranibizumab as treatment of choroidal neovascularizations associated with pathologic myopia. Materials and Methods: In an uncontrolled, prospective time series cohort study, 65 eyes of 64 consecutive patients with choroidal neovascularization associated with pathologic myopia were treated with intravitreal ranibizumab and observed over 12 months. The change in best-corrected visual acuity (BCVA) at 6 and 12 months served as primary end point. Safety, central retinal thickness, neovascularization activity on fluorescein angiography and the number of ranibizumab injections were secondary end points. Results: BCVA improved significantly throughout the follow-up (p = 0.001). The mean BCVA was 0.2 at baseline (SD 0.13) and 0.4 at 12 months (SD 0.21). Improvement was strongest within the first 3 months (p = 0.0001). The mean central retinal thickness showed a reduction from 313 μm (SD 82) to 243.5 μm (SD 31; p = 0.0001). Conclusion: Intravitreal ranibizumab offers a safe and effective treatment for choroidal neovascularizations in pathologic myopia.
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Poku E, Rathbone J, Wong R, Everson-Hock E, Essat M, Pandor A, Wailoo A. The safety of intravitreal bevacizumab monotherapy in adult ophthalmic conditions: systematic review. BMJ Open 2014; 4:e005244. [PMID: 25034629 PMCID: PMC4120420 DOI: 10.1136/bmjopen-2014-005244] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To assess the safety of intravitreal bevacizumab (IVB) as a monotherapy and to evaluate the relationship between quality of treatment and adverse events. DATA SOURCES Cochrane Library, Ovid MEDLINE, MEDLINE in-process, Ovid EMBASE and Toxicology Literature Online (TOXLINE) from January 2009 to May 2012. Studies included in an earlier systematic review were also assessed for inclusion. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS Randomised controlled trials (RCTs), controlled trials or observational studies including ≥10 participants reporting adverse events data following IVB monotherapy as a primary treatment in patients (aged 18 years or more) with any eye condition were included. STUDY APPRAISAL AND SYNTHESIS METHODS Study selection was undertaken independently by a minimum of two reviewers using pre-defined criteria. Data abstraction and quality assessment were performed by one reviewer, and then checked by a second reviewer. Study quality was assessed for only RCTs in accordance to the Cochrane Risk of Bias Tool. Additional items relating to safety data were also assessed. Results were tabulated or meta-analysed as appropriate. RESULTS 22 RCTs and 67 observational studies were included. Only two RCTs reported valid safety data. Rates of serious adverse events following treatment were low. There was insufficient data to explore the relationship between the incidence of adverse events and quality of IVB injection. LIMITATIONS A majority of relevant existing studies were characterised by small sample sizes, unclear diagnostic criteria and reporting of safety outcomes. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Available evidence demonstrates low rates of serious local and systemic adverse events following treatment. However, the role of IVB quality in the incidence of adverse events remains unclear. Robust evidence is needed to examine the relationship between the incidence of adverse events and variables such as injection techniques, pre-existing risk factors (eg, immunosuppression, cross-contamination) and quality of IVB treatment.
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Affiliation(s)
- Edith Poku
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - John Rathbone
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Ruth Wong
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Emma Everson-Hock
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Munira Essat
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Abdullah Pandor
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Allan Wailoo
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
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Iacono P, Battaglia Parodi M, Papayannis A, Kontadakis S, Da Pozzo S, Cascavilla ML, La Spina C, Varano M, Bandello F. Fluorescein angiography and spectral-domain optical coherence tomography for monitoring anti-VEGF therapy in myopic choroidal neovascularization. Ophthalmic Res 2014; 52:25-31. [PMID: 24861045 DOI: 10.1159/000358331] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 01/03/2014] [Indexed: 01/02/2023]
Abstract
AIM To evaluate the agreement between fluorescein angiography (FA) and spectral-domain optical coherence tomography (SD-OCT) in detecting myopic choroidal neovascularization (CNV) activity during bevacizumab treatment. METHODS Thirty-four patients with subfoveal myopic CNV were prospectively enrolled. FA and SD-OCT were performed at baseline and at all planned monthly visits. After the first injection, additional treatments were administered following detection of fluid on SD-OCT and/or leakage on FA. κ-Analysis was performed to examine the agreement between FA and SD-OCT. RESULTS At baseline, FA and SD-OCT agreed in 26/34 cases (κ=0.23); sensitivity and specificity were 77.4 and 66.7%, respectively. Seven eyes presented leakage on FA with no fluid on SD-OCT, 1 case showed intraretinal fluid on SD-OCT and no leakage on FA. At the 1-month examination, specificity and κ-value improved, and 30/34 cases showed complete concordance. At the 3- and 4-month examinations, a discordance was noted in 6 cases. From the 5-month examination on, a correspondence was achieved in at least 30/34 cases and reached a perfect match in 11 sessions. CONCLUSIONS Our study confirms the key role of FA in diagnosing myopic CNV. It seems possible there may be a role for SD-OCT in assisting FA to monitor the myopic CNV activity during anti-vascular endothelial growth factor antibody treatment.
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Affiliation(s)
- Pierluigi Iacono
- G.B. Bietti Foundation for Ophthalmology, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
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Intravitreal anti-vascular endothelial growth factor for choroidal neovascularization secondary to pathologic myopia: systematic review and meta-analysis. Retina 2014; 33:1375-92. [PMID: 23514793 DOI: 10.1097/iae.0b013e31827d260a] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSES To update existing evidence and evaluate intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections for myopic choroidal neovascularization. METHODS The authors conducted comprehensive search in PubMed, EMBASE, Cochrane Library, Biosis Preview, and LILACS. Included studies were categorized by study design. Comparative studies were classified as randomized controlled trials (RCTs) and non-RCT studies, and these two types of studies were presented and meta-analyzed separately for the following comparisons: 1) anti-VEGF versus photodynamic therapy, 2) anti-VEGF monotherapy versus combination therapy with photodynamic therapy, 3) single versus 3 monthly injections followed by pro re nata (PRN) treatment, and 4) ranibizumab versus bevacizumab. Noncomparative prospective series were pooled to estimate mean visual gain, mean retinal thickness change, and the average number of anti-VEGF injections required for myopic choroidal neovascularization. Ocular and systemic adverse events were also summarized. RESULTS Literature search yielded 18 comparative studies and 83 noncomparative studies. Superiority of anti-VEGF over photodynamic therapy in a 24-month period was confirmed by 2 RCTs and 6 non-RCT studies. The influence of combined photodynamic therapy was uncertain based on two non-RCT studies. Three non-RCT studies showed that the visual outcomes of 3+PRN injections might be slightly better than 1+PRN injections within 1 year. No difference was observed between ranibizumab and bevacizumab in two RCTs and one non-RCT study. The estimated visual improvement was two lines on average. Adverse events were uncommon as reported. CONCLUSION Accumulating evidence confirmed that anti-VEGF injections should be the first-line therapy for myopic choroidal neovascularization.
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MULTIFOCAL ELECTRORETINOGRAPHY AND OPTICAL COHERENCE TOMOGRAPHY CHANGES AFTER REPEATED INTRAVITREAL BEVACIZUMAB (AVASTIN) IN MYOPIC CHOROIDAL NEOVASCULARIZATION. Retina 2013; 33:598-605. [DOI: 10.1097/iae.0b013e3182681066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wang J, Kang Z. Summary of prognostic factors for choroidal neovascularization due to pathological myopia treated by intravitreal bevacizumab injection. Graefes Arch Clin Exp Ophthalmol 2012; 250:1717-23. [PMID: 23007232 DOI: 10.1007/s00417-012-2159-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 09/01/2012] [Accepted: 09/04/2012] [Indexed: 12/21/2022] Open
Abstract
AIM This systematic review assesses the prognostic factors for intravitreal bevacizumab injection (IVB) in the treatment of choroidal neovascularization (CNV) due to pathological myopia. METHODS The literature searches were performed in Ovid Medline, EMBASE and CENTRAL. Relevant studies with prognostic data on best corrected vision acuity (BCVA) after intravitreal bevacizumab injection were included for review. Two reviewers participated in the data retrieval and independently assessed each included study. RESULTS A total 252 articles were retrieved, including 16 studies containing the most updated and complete data on prognostic factors for neovascularization due to pathological myopia treated by intravitreal bevacizumab injection. A great number of quantitative, clinical, and treatment-related factors were determined to have a positive influence on vision outcome after intravitreal bevacizumab. CONCLUSION A lower rate of development of chorioretinal atrophy, smaller pretreatment CNV size, and younger age were indentified as the most consistently significant prognostic factors affecting the efficacy of IVB in eyes of myopic CNV and were associated with improved BCVA. A worse BCVA after IVB in eyes with myopic CNV probably was associated with subfoveal CNV, lower baseline BCVA, longer duration of CNV, incomplete regression of CNV, subretinal hemorrhage, and previous PDT treatment. No apparent association were observed between the refraction error, axial length, lens status and change in BCVA after IVB. We indentified significant prognostic factors in this systematic review study that might allow for the selection of patients with myopic CNV which are most likely to benefit from IVB.
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Affiliation(s)
- Jianghui Wang
- Eye hospital of China academy of Chinese medical sciences, Shijingshan District, Beijing, 100040, China
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Two-year outcomes of intravitreal bevacizumab for choroidal neovascularization in Japanese patients with pathologic myopia. Retina 2012; 32:687-95. [PMID: 22173286 DOI: 10.1097/iae.0b013e3182278bae] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To determine the 2-year results of intravitreal bevacizumab in highly myopic eyes with choroidal neovascularization (CNV). METHODS An open-label, consecutive, interventional case series. Seventy-five eyes of 69 consecutive Japanese patients with either subfoveal or nonsubfoveal myopic CNVs were studied. The eyes were treated with intravitreal bevacizumab and followed-up for at least 2 years. The best-corrected visual acuities at the baseline in eyes with subfoveal CNV were compared with that in eyes with nonsubfoveal CNV at 2 years after the intravitreal bevacizumab. RESULTS The difference between the mean best-corrected visual acuity at the baseline and that at 2 years in eyes with a subfoveal CNV was not significant. However, the mean best-corrected visual acuity in eyes with nonsubfoveal CNV was significantly improved from 0.53 ± 0.36 logarithm of the minimal angle of resolution units (Snellen 20/66) before intravitreal bevacizumab to 0.29 ± 0.36 logMAR units (Snellen 20/40) (P < 0.001) 2 years after intravitreal bevacizumab. The incidence of chorioretinal atrophy after 2 years was 3 of 49 (6.1%) in eyes with nonsubfoveal CNV and 21 of 26 (80.8%) in eyes with which subfoveal CNV (P < 0.001). Furthermore, the chorioretinal atrophy area with nonsubfoveal CNV was 0.05 ± 0.21 mm, which was also significantly smaller than that of subfoveal CNV at 1.76 ± 1.60 mm (P < 0.001). CONCLUSION Intravitreal bevacizumab is a good treatment for eyes with nonsubfoveal CNV; however, another treatment is necessary for eyes with a subfoveally located CNV.
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Neelam K, Cheung CMG, Ohno-Matsui K, Lai TYY, Wong TY. Choroidal neovascularization in pathological myopia. Prog Retin Eye Res 2012; 31:495-525. [PMID: 22569156 DOI: 10.1016/j.preteyeres.2012.04.001] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 04/13/2012] [Accepted: 04/16/2012] [Indexed: 12/21/2022]
Abstract
Myopic choroidal neovascularization (CNV) is one of the leading causes of visual impairment worldwide. The clinical and socioeconomic impact of myopic CNV in Asian countries is particularly significant due to rising trend in the prevalence and severity of pathological myopia. The exact pathogenesis of myopic CNV remains unclear and there is paucity of information with respect to incidence and risk factors for myopic CNV from prospective studies. Furthermore, there are no recognized measures that may prevent or delay the development of CNV in eyes with pathological myopia. Advances have been made in the diagnosis and characterization of myopic CNV over the years. Until recently, treatment modalities for myopic CNV were limited to thermal laser photocoagulation and photodynamic therapy with verteporfin, both these modalities primarily aim at prevention of further visual loss. In the last 5 years, inhibitors of vascular endothelial growth factor (VEGF) have been used successfully and may improve vision to some extent. Nevertheless, the long-term safety and efficacy of anti-VEGF agents remains unknown. Furthermore, the risk of developing chorioretinal atrophy remains the key factor in determining the final visual outcome. This review article summarizes the current literature on myopic CNV, highlighting new evolving diagnostic and treatment modalities, prognostic factors influencing visual outcome, and areas of future research.
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Affiliation(s)
- Kumari Neelam
- Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore
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Ng DS, Kwok AKH, Chan CW. Anti-vascular endothelial growth factor for myopic choroidal neovascularization. Clin Exp Ophthalmol 2012; 40:e98-e110. [PMID: 21902785 DOI: 10.1111/j.1442-9071.2011.02684.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Myopic choroidal neovascularization (CNV) is a vision-threatening complication in the eyes with pathological myopia, which is particularly prevalent among young and middle-aged Asians globally. To date, the verteporfin in photodynamic therapy study is the only randomized-controlled study in treatment of subfoveal myopic CNV. However, its long-term benefit is controversial. Recently, intravitreal injections of anti-vascular endothelial growth factors have shown promising results. In the absence of randomized-controlled trial comparing the efficacy of anti-vascular endothelial growth factors with photodynamic therapy and placebo, the purpose of this article is to review the current studies on functional and anatomical outcomes in both subfoveal and juxtafoveal myopic CNV. Furthermore, the influences of various doses and frequencies, as well as age and previous photodynamic therapy treatment on its effect are described.
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Affiliation(s)
- Danny S Ng
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong
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Predictive factors for visual outcome to intravitreal bevacizumab in young Chinese patients with myopic choroidal neovascularization. Retina 2012; 31:1835-40. [PMID: 21878845 DOI: 10.1097/iae.0b013e31821ba2dc] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To report the anatomical and functional outcomes of intravitreal bevacizumab in both young and old Chinese patients with myopic choroidal neovascularization. METHODS Consecutive series of 56 eyes (52 patients) with myopic choroidal neovascularization treated exclusively with intravitreal bevacizumab were reviewed retrospectively. Data from clinical examination, fundus photography, fluorescein angiography, and optical coherence tomography were collected. RESULTS Vision significantly improved after intravitreal bevacizumab in this patient series (P < 0.0001), with an average of 2.2 injections. Higher myopia was positively correlated to a worse outcome (r = -0.3, P = 0.036). Stratifying by age, the correlation between spherical equivalent and final outcome showed statistical significance (r = -0.44, P = 0.027) only in younger patients. In younger patients, both spherical equivalent (P = 0.036) and initial visual acuity (P = 0.004) were predictive factors for visual outcome after adjusting for age, spherical equivalent, and number of injections, whereas in older patients, only initial visual acuity (P < 0.0001) was predictive of visual outcome after similar adjustments. CONCLUSION Younger patients do not have a better outcome when compared with older patients. Initial visual acuity, regardless of age, plays a more significant role. Both initial visual acuity and spherical equivalent are predictive factors for final visual acuity in young Chinese patients.
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Empeslidis T, Vardarinos A, Deane J, Banerjee S. Intravitreal ranibizumab in the treatment of butterfly-shaped pattern dystrophy associated with choroidal neovascularization: a case report. Case Rep Ophthalmol 2012; 3:77-82. [PMID: 22529806 PMCID: PMC3331880 DOI: 10.1159/000336987] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Purpose To present and document the effectiveness of intravitreal ranibizumab in the treatment of patients with choroidal neovascularization due to butterfly-shaped pattern dystrophy (PD) of the macula. Methods Three intravitreal ranibizumab injections of 0.5 mg/0.05 ml in monthly intervals were given to a patient with a previously diagnosed butterfly-shaped PD who subsequently developed subfoveal choroidal neovascularization on the right eye. The patient had previously received a combination of verteporfin/photodynamic therapy for a juxtafoveal choroidal neovascular membrane on the left eye. Results At the end of the treatment course, there was significant improvement of the patient's vision and the appearance of the macula on optic coherence tomography and fluorescein angiography. Best-corrected visual acuity improved from 6/12 to 6/6 and retinal thickness at the macula decreased from 323 to 247 μm. No subretinal fluid remained. The patient is clinically stable over a 12-month follow-up period. Conclusions Intravitreal ranibizumab seems to be an effective and safe option for the treatment of subfoveal choroidal neovascularization in patients with butterfly-shaped PD.
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Silva R. Myopic Maculopathy: A Review. Ophthalmologica 2012; 228:197-213. [DOI: 10.1159/000339893] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 05/27/2012] [Indexed: 11/19/2022]
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Different dosing of intravitreal bevacizumab for choroidal neovascularization because of pathologic myopia. Retina 2011; 31:880-6. [PMID: 21242860 DOI: 10.1097/iae.0b013e3181f2a293] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To compare the visual outcomes and retreatment rate of single injection of intravitreal bevacizumab followed by pro re nata (PRN) treatment and three monthly injections of intravitreal bevacizumab followed by PRN treatment for myopic choroidal neovascularization. METHODS Thirty-one consecutive eyes of 31 patients with myopic choroidal neovascularization were retrospectively evaluated. Nineteen eyes were treated with a single injection + PRN and 12 eyes with 3 monthly injections + PRN. The best-corrected visual acuity 12 months after the initial injection, logarithm of the minimum angle of resolution gain from baseline, recurrence rate, and number of injections were statistically compared. RESULTS Baseline best-corrected visual acuity (logarithm of the minimal angle of resolution) was 0.42 ± 0.31 in the single injection + PRN group and 0.47 ± 0.29 in the 3 monthly injections + PRN group (P = 0.64). The best-corrected visual acuity improved significantly at 3, 6, and 12 months in both groups (P < 0.05 at each time point). Mean logarithm of the minimal angle of resolution gain at 3, 6, and 12 months did not differ significantly between groups. The single injection + PRN group required significantly fewer intravitreal bevacizumab treatments (P = 0.005). The rate of recurrence and choroidal neovascularization persistence did not differ significantly between groups. CONCLUSION Compared with 3 monthly injections followed by PRN, single injection followed by PRN for myopic choroidal neovascularization required fewer injections and produced a similar visual outcome over 12 months.
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A SYSTEMATIC REVIEW OF THE ADVERSE EVENTS OF INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR INJECTIONS. Retina 2011; 31:1449-69. [PMID: 21817960 DOI: 10.1097/iae.0b013e3182278ab4] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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The use of intravitreal ranibizumab for choroidal neovascularization associated with vogt-koyanagi-harada syndrome. Case Rep Med 2011; 2011:747648. [PMID: 21826150 PMCID: PMC3151517 DOI: 10.1155/2011/747648] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 06/10/2011] [Indexed: 11/23/2022] Open
Abstract
Purpose. To describe the use of intravitreal ranibizumab for choroidal neovascular membrane (CNVM) secondary to Vogt-Koyanagi-Harada (VKH) syndrome. Methods. Interventional case report. Results. A 50-year-old woman presented with conjunctival injection and bilateral eye pain. Vision was 20/400 and 20/80 in the right and left eyes, respectively. Bilateral iritis, vitritis, and choroidal thickening were evident. Exudative retinal detachment was present in the left eye. Corticosteroid treatment improved vision to 20/40 bilaterally. Methotrexate (MTX) was initiated and vision remained stable for 3 months. After a 5-month loss to follow-up, vision in the left eye decreased to finger counting (CF) and a parafoveal CNVM was identified. After 3 intravitreal ranibizumab injections, vision improved to 20/40. Twelve months later, despite inflammation control, vision decrease to CF due to recurrent CNVM. A fourth ranibizumab injection was given. Twenty months later, best-corrected vision was 20/400, and an inactive CNVM was present in the left eye. Conclusion. After initial CNVM regression and visual acuity improvement due to ranibizumab, the CNVM recurred and became refractory to treatment. Despite control of inflammation and neovascularization, VKH chronicity lead to permanent vision loss in our patient. A combinational treatment approach may be required in such patients.
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Qureshi F, Saeed MU, Kamal A. Primary intravitreal ranibizumab for myopic choroidial neovascularisation. Semin Ophthalmol 2011; 26:52-4. [PMID: 21469965 DOI: 10.3109/08820538.2011.559515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Myopic chorodial neovascularisation (mCNV) is an important cause of visual loss in high myopia with almost 10% of eyes with pathological myopia developing mCNV. Intravitreal anti-VEGF agents have recently been documented to be effective in mCNV. However, controversy exists regarding the optimal drug, its dose, and the frequency of administration. We performed a retrospective case review examining patients who had myopia of less than -6D and a chorodial neovascular membrane diagnosed on fundus fluorescein angiography (FFA) that were treated with 3 injections of ranibizumab (Lucentis) 5mg/0.05ml given at monthly intervals. The course was repeated if the ocular coherence tomography (OCT) continued to show intra-retinal oedema at review. We recorded logMAR visual acuities and central foveal thickness (CFT) at baseline and final review. Improvement in visual acuity was significantly improved (p = 0.049) by a mean of 0.24 logMAR (range 0 to 0.74). Every patient achieved at least visual stability. Mean CFT reduction was also significantly improved (p = 0.02) by a mean of 109 microns (range -8 to 198). Our series and current literature seem to support as primary treatment a standard dose of an anti-VEGF agent. Further, larger studies are required to clarify whether any particular injection strategy is clearly superior.
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Lorenzo D, Arias L, Alcubierre R, Pujol O, Caminal J, Rubio M, Català J, Garcia-Bru P, Arruga J. Intravitreal Ranibizumab for Choroidal Neovascularization Secondary to Pathological Myopia: 12-Month Follow-Up. Ophthalmologica 2011; 226:103-9. [DOI: 10.1159/000328980] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 04/21/2011] [Indexed: 12/29/2022]
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TWELVE-MONTH OUTCOME AFTER ONE INTRAVITREAL INJECTION OF BEVACIZUMAB TO TREAT MYOPIC CHOROIDAL NEOVASCULARIZATION. Retina 2010; 30:1609-15. [DOI: 10.1097/iae.0b013e3181e22659] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Ouhadj O, Bouarfa A, Akel S, Mendil L, Nebab A, Nouri M. Néovaisseaux choroïdiens du myope fort : traitement par injection intravitréenne de ranibizumab. J Fr Ophtalmol 2010; 33:649-54. [DOI: 10.1016/j.jfo.2010.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Revised: 09/02/2010] [Accepted: 09/08/2010] [Indexed: 10/18/2022]
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Therapeutic effect of oral bisphosphonates on choroidal neovascularization in the human eye. J Ophthalmol 2010; 2010. [PMID: 20706646 PMCID: PMC2913841 DOI: 10.1155/2010/206837] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 06/12/2010] [Accepted: 06/24/2010] [Indexed: 11/17/2022] Open
Abstract
Purpose. Choroidal neovascularization (CNV) is often associated with age-related macular degeneration (AMD) and pathological myopia (PM). Bisphosphonates, the drug of choice to treat osteoporosis, have been recently reported to have anti-angiogenic effects. The purpose of this study is to investigate the therapeutic effects of oral bisphosphonates for CNV in humans. Methods. Thirty-six consecutive cases with CNV due to AMD or PM who declined anti-VEGF therapy were recruited. The patients were prescribed 5 mg of oral alendronates daily for 6 months. The best-corrected visual-acuity (BCVA), the lesion size in fundus photographs and fluorescein angiography, foveal thickness and total macular volume in optical coherence tomography were compared between pre- and post-treatment. Results. The mean BCVA of the patients was significantly improved after a months with the treatment in the AMD group. In the PM group, the mean BCVA was maintained up to 6 months with the treatment. The mean lesion size was significantly decreased by 3 months in both groups. The averages of foveal thickness and total macular volume were significantly reduced after 1 month of treatment in the AMD group.Conclusions. Oral bisphosphonate should be further investigated as a possible therapeutic and preventive drug for CNV due to AMD and PM.
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LONG-TERM OUTCOMES OF INTRAVITREAL ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR THE MANAGEMENT OF CHOROIDAL NEOVASCULARIZATION IN PSEUDOXANTHOMA ELASTICUM. Retina 2010; 30:748-55. [DOI: 10.1097/iae.0b013e3181c596b1] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Ruiz-Moreno JM, Montero JA. Intravitreal bevacizumab to treat myopic choroidal neovascularization: 2-year outcome. Graefes Arch Clin Exp Ophthalmol 2010; 248:937-41. [PMID: 20221624 DOI: 10.1007/s00417-010-1340-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2009] [Revised: 02/11/2010] [Accepted: 02/14/2010] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Myopic maculopathy is the leading cause of subfoveal choroidal neovascularization (CNV) among patients under 50 years of age. New antiangiogenic drugs are being used off-label to treat myopic CNV and the short-term outcome of these therapies has been reported. The aim of this study is to report the changes in best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) in highly myopic CNV treated by intravitreal bevacizumab at 2 years. METHODS Prospective non-randomized, interventional case series study of 19 highly myopic eyes from 18 patients with subfoveal and juxtafoveal CNV treated by three monthly intravitreal injections of 1.25 mg bevacizumab. Patients were evaluated for BCVA and OCT at baseline and then monthly for 2 years. RESULTS Eleven eyes were naive for treatment and eight eyes had been previously treated by photodynamic therapy. LogMAR BCVA averaged 0.54 (SD 0.25, range 0.2-1.0; Snellen 20/69) at baseline; 0.40 (SD 0.35, range 0.0-1.2; Snellen 20/50) at 1 year; and 0.47 (SD 0.31, range 0.0-1.0; Snellen 20/59) at 2 years (p = 0.04 and p = 0.20, respectively, Student's t test paired data). Re-treatment was performed in four eyes during the first year: three eyes at month six and one eye at month 12. Four eyes required one re-injection during the second year at months 14, 18, 20, and 24. Neither ocular nor systemic adverse reactions were detected. CONCLUSIONS Intravitreal bevacizumab seems to be effective for subfoveal and juxtafoveal CNV in highly myopic eyes. BCVA gain decreases and is no longer significant by the end of the second year.
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Affiliation(s)
- Jose M Ruiz-Moreno
- Department of Ophthalmology, Castilla La Mancha University, Albacete, Spain.
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Bevacizumab for choroidal neovascularization secondary to pathologic myopia: Is there a decline of the treatment efficacy after 2 years? Graefes Arch Clin Exp Ophthalmol 2010; 248:543-50. [PMID: 20111971 DOI: 10.1007/s00417-009-1285-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 12/13/2009] [Accepted: 12/20/2009] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND The Verteporfin in Photodynamic Therapy (VIP) Study failed to prove a statistically significant benefit for myopic choroidal neovascularization (CNV) at the end of the second year. Therefore, we wanted to evaluate whether the early effects seen under anti-VEGF treatment can be maintained over longer follow-up intervals. METHODS This consecutive case series included all patients at the Centre for Ophthalmology, Tuebingen, with a 2-year follow-up after treatment with 1.25 mg of bevacizumab alone or in combination with photodynamic therapy. Twenty-one eyes from 19 patients were analyzed in the retrospective evaluation of best-corrected visual acuity (BCVA) and central foveal thickness (CFT). RESULTS Mean logMAR BCVA improved from 0.64 at baseline to 0.55 after 1 year (p = 0.32) and remained 0.55 at 2 years (p = 0.23). A subgroup analysis showed that mean logMAR BCVA in the monotherapy group improved from 0.7 to 0.5 at 2 years (n = 11, p = 0.06). In the combined therapy group, mean logMAR BCVA changed from 0.55 to 0.59 at 2 years (n = 10, p = 0.69). Mean CFT decreased significantly in both groups by 168 microm (p < 0.001) and 76 microm (p < 0.05) in the monotherapy and in the combined groups, respectively. No complications or adverse effects were observed. CONCLUSION Although the limitations of the study design have to be acknowledged and carefully discussed, we found no obvious superiority of a combined treatment for myopic CNV, at least in terms of the functional outcome and the injection frequency. The results indicate that bevacizumab might be beneficial in the treatment of patients with CNV secondary to pathologic myopia.
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Wakabayashi T, Ikuno Y, Gomi F, Hamasaki T, Tano Y. Intravitreal bevacizumab vs sub-tenon triamcinolone acetonide for choroidal neovascularization attributable to pathologic myopia. Am J Ophthalmol 2009; 148:591-596.e1. [PMID: 19589497 DOI: 10.1016/j.ajo.2009.05.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2009] [Revised: 05/23/2009] [Accepted: 05/26/2009] [Indexed: 11/15/2022]
Abstract
PURPOSE To compare the visual outcomes of intravitreal bevacizumab (Avastin; Genentech Inc, South San Franciso, California, USA) and sub-Tenon triamcinolone acetonide (TA) for choroidal neovascularization attributable to pathologic myopia (mCNV). DESIGN Retrospective, comparative, interventional case series. METHODS Fifty-four consecutive eyes of 53 patients with mCNV treated with either sub-Tenon TA or intravitreal bevacizumab in an institutional setting were included. Twenty eyes were treated with sub-Tenon TA and 34 eyes were treated with intravitreal bevacizumab. The main outcome measures included best-corrected visual acuity (BCVA) 12 months after the initial injection and logarithm of the minimum angle of resolution gain from baseline compared with analysis of covariance (ANCOVA). RESULTS At 12 months, the BCVA improved by 1.9 lines in the intravitreal bevacizumab group and worsened by 0.3 lines in the sub-Tenon TA group. Thus, the intravitreal bevacizumab group had significantly greater visual improvement than the sub-Tenon TA group (P < .01). Statistical analysis (ANCOVA) revealed that age (P = .01), pretreatment BCVA (P < .01), and the treatment choice (intravitreal bevacizumab or sub-Tenon TA; P < .01) correlated significantly with the BCVA and the BCVA gain at 12 months. The refractive error was of borderline significance (P = .06). CONCLUSIONS Although this study is limited because of its retrospective nature, intravitreal bevacizumab seems to result in a more favorable visual outcome than sub-Tenon TA in the treatment of mCNV. Patient age, the BCVA before treatment, and the refractive error must be considered to initiate the treatment.
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Affiliation(s)
- Taku Wakabayashi
- Department of Ophthalmology, Osaka University Medical School, Osaka, Japan
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ANTI-VEGF DRUGS AS THE 2009 FIRST-LINE THERAPY FOR CHOROIDAL NEOVASCULARIZATION IN PATHOLOGIC MYOPIA. Retina 2009; 29:1062-6. [DOI: 10.1097/iae.0b013e3181b1bb1a] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Hayashi K, Ohno-Matsui K, Teramukai S, Shimada N, Moriyama M, Hayashi W, Yoshida T, Tokoro T, Mochizuki M. Comparison of visual outcome and regression pattern of myopic choroidal neovascularization after intravitreal bevacizumab or after photodynamic therapy. Am J Ophthalmol 2009; 148:396-408. [PMID: 19427991 DOI: 10.1016/j.ajo.2009.03.026] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 03/11/2009] [Accepted: 03/16/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To compare the 1-year visual and anatomic outcomes in myopic eyes with choroidal neovascularization (CNV) treated by intravitreal bevacizumab (IVB) to those treated by photodynamic therapy (PDT). DESIGN An open-label, consecutive, interventional case series. METHODS Forty-four eyes of 42 consecutive patients with myopic CNV treated with PDT, and 43 eyes of 43 consecutive patients with myopic CNV treated with IVB, were evaluated. For control, 74 eyes of 71 consecutive patients with untreated myopic CNV were evaluated. The comparison of best-corrected visual acuity (BCVA) using analysis of covariance (ANCOVA) during the 12-month follow-up period was performed among the 26 IVB-treated patients without prior treatment, 35 PDT-treated patients without prior treatment, and 71 nontreated controls. RESULTS Thirty-nine of the IVB-treated eyes (91%) had angiographic closure, and 21 (48.8%) had an improvement of >2 lines in the BCVA at 1 year. IVB-treated patients had significantly better BCVA than PDT-treated and control eyes at 1 year. The CNV size continued to decrease during the 12-month follow-up in the successfully treated IVB eyes, and the size did not decrease, or even increased, in 65% of the successfully treated PDT eyes. Chorioretinal atrophy developed significantly more frequently in PDT-treated than IVB-treated eyes. CONCLUSIONS IVB is more effective for myopic CNV than PDT. The differences in the regression pattern of CNVs and the rate of chorioretinal atrophy probably explain the better BCVA in the IVB-treated eyes.
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40
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Gupta B, Elagouz M, Sivaprasad S. Intravitreal bevacizumab for choroidal neovascularisation secondary to causes other than age-related macular degeneration. Eye (Lond) 2009; 24:203-13. [DOI: 10.1038/eye.2009.201] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Abstract
The use of intravitreal bevacizumab (Avastin) has greatly expanded since its introduction into ophthalmic care 3 years ago. A PubMed search on 1 August 2008 revealed 51 ocular disease processes that have been treated with bevacizumab. The majority of publications consist of case reports or retrospective case series and their number is increasing quickly. It is important to collate the experiences gained to date to properly inform our clinical decision making and improve the design of future clinical trials. Current studies cannot easily be combined in a meta-analysis given the lack of standardized data and the wide variety of disorders studied in small numbers. This paper will describe the attempted uses of intravitreal bevacizumab and its efficacy for each ocular disease in addition to discussing safety. Comments regarding appropriate use of this treatment are based on our current level of knowledge. It is clear that the initial encouraging results described in this paper warrant further study of intravitreal bevacizumab in larger, controlled, randomized trials.
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Affiliation(s)
- Jonathan B Gunther
- University of Wisconsin Department of Ophthalmology and Visual Sciences, Madison, Wisconsin, USA
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42
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43
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Intravitreal bevacizumab for CNV-complicated tilted disk syndrome. Graefes Arch Clin Exp Ophthalmol 2009; 247:1179-82. [DOI: 10.1007/s00417-009-1096-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 04/07/2009] [Accepted: 04/13/2009] [Indexed: 11/27/2022] Open
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44
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Intravitreal bevacizumab for subfoveal choroidal neovascularization secondary to traumatic choroidal rupture. Eye (Lond) 2009; 23:2125-6. [PMID: 19169235 DOI: 10.1038/eye.2008.434] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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45
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Hayashi K, Ohno-Matsui K, Shimada N, Moriyama M, Hara W, Yoshida T, Tokoro T, Mochizuki M. Intravitreal bevacizumab on myopic choroidal neovascularization that was refractory to or had recurred after photodynamic therapy. Graefes Arch Clin Exp Ophthalmol 2009; 247:609-18. [DOI: 10.1007/s00417-008-1021-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 11/24/2008] [Accepted: 12/02/2008] [Indexed: 11/30/2022] Open
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46
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Song MH, Kim JY, Roh YJ. Short-term Efficacy of Intravitreal Ranibizumab for Myopic Choroidal Neovascularization. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2009. [DOI: 10.3341/jkos.2009.50.7.1027] [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)
- Min Hye Song
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon Yong Kim
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Jung Roh
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Stur M. Indikationen für photodynamische Therapie mit Verteporfin im Zeitalter der intravitrealen Therapie – eine Übersicht. SPEKTRUM DER AUGENHEILKUNDE 2008. [DOI: 10.1007/s00717-008-0294-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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48
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Sterling JA. Recent Publications on Medications and Pharmacy. Hosp Pharm 2008. [DOI: 10.1310/hpj4310-846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hospital Pharmacy presents this feature to keep pharmacists abreast of new publications in the medical/pharmacy literature. Articles of interest regarding a broad scope of topics are abstracted monthly.
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