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van der Reis MI, Elshout M, Berendschot TTJM, de Jong-Hesse Y, Webers CAB, Schouten JSAG. A systematic approach to evaluate practice-based process- and outcome data applied to the treatment of neovascular age-related macular degeneration. BMC Ophthalmol 2020; 20:21. [PMID: 31918701 PMCID: PMC6953304 DOI: 10.1186/s12886-020-1303-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 12/31/2019] [Indexed: 11/24/2022] Open
Abstract
Background Following the principles of value-based health care, outcomes and processes of daily-practice eye care need to be systematically evaluated. We illustrate an approach that can be used to support data-driven quality improvements. We used patient data regarding the treatment of neovascular age-related macular degeneration (nAMD). Methods In a cohort study, we reviewed medical records of patients with nAMD confirmed on fluorescein angiography (FA). Patients were treated with intravitreal injections with bevacizumab; ranibizumab; or photodynamic therapy (PDT). Visual acuity (VA), ophthalmic exam results and treatments were recorded. VA was compared between treatments by linear mixed model. Diagnosis was re-evaluated on the original FAs. Outcome analysis was performed by 1) selecting VA as the relevant outcome parameter; 2) Preventing selection by comparing treatments with historical untreated cohort and cohorts from the literature, 3) correcting for confounding due to lesion type, and 4) identifying relevant process variables that affect the outcome. These were severity of disease at presentation, and doctor- and patient dependent process variables. Results In total, 473 eyes were included. At 12 months, change in VA was 0.54, 0.48, 0.09, and 0.07 LogMAR in the no-treatment, photodynamic therapy (PDT), bevacizumab, and ranibizumab groups, respectively. Lesion type on FA differed between groups. Diagnosis of nAMD could not be confirmed in 104 patients. Patient delay, inaccurate diagnosis and treatment intervals may have impacted outcomes. Conclusions The effect of PDT was small to absent. Anti-VEGFs were effective and appeared as effective as in RCTs. Correct selection of a comparator cohort and addressing confounding, including confounding by indication and effect modification, are needed to achieve valid results and interpretation. Patient delay, diagnosis accuracy, indication for and application of treatment can potentially be improved to improve treatment outcomes. In a value-based care perspective, systematic evaluation of diagnostic accuracy, treatment indication, protocols, and outcomes of new interventions is needed at an early stage to improve outcomes.
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A Multicenter, Retrospective Study (RE-ENACT 2) on the Use of Razumab™ (World's First Biosimilar Ranibizumab) in Wet Age-Related Macular Degeneration. Ophthalmol Ther 2019; 9:103-114. [PMID: 31883056 PMCID: PMC7054591 DOI: 10.1007/s40123-019-00228-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION The REal life assessmENt of safety And effeCTiveness of Razumab (RE-ENACT) and long-term RE-ENACT 2 retrospective studies have evaluated the use of Razumab™ (world's first biosimilar ranibizumab) in retinal disorders in Indian patients. This report presents the subgroup analysis from the RE-ENACT 2 study in patients with wet age-related macular degeneration (wet AMD). METHODS Medical charts of patients administered biosimilar ranibizumab injections as PRN treatment regimen between September 2015 and June 2018, at 17 centers across India, were reviewed. Changes from baseline in best-corrected visual acuity (BCVA, based on Snellen's or logMAR chart), central subfield thickness (CSFT), intraocular pressure (IOP), and proportions of patients having intraretinal fluid (IRF) and subretinal fluid (SRF) at weeks 4, 8, 12, 16, 20, 24, 30, 36, and 48 were evaluated. RESULTS Of 103 patients with wet AMD, 62.1% were men and the majority (74.8%) were treatment naïve. The majority (57.9%) of the patients had received 3 (range 1-5) injections. Significant improvements were observed from baseline to all timepoints for BCVA (baseline, 0.92 ± 0.6 [n = 94]; week 48, 0.51 ± 0.4 [n = 14]; P = 0.0014) and CSFT (baseline, 430.83 ± 14.4 [n = 85]; week 48, 301.26 ± 11.6 [n = 15]; P < 0.0001). Changes in IOP from baseline to 48 weeks were minimal and not significant (14.92 ± 3.2 [n = 94] vs. 14.50 ± 2.1 [n = 18]; P = 0.9068). A decrease in proportions of patients having IRF (baseline, 63.6% [n = 99] vs. week 48, 15% [n = 20]) and SRF (baseline, 82.3% [n = 96] vs. week 48, 5% [n = 20]) were also observed. Similar results were observed for occult and classic subgroups. There were no new safety concerns. CONCLUSION Razumab (biosimilar ranibizumab) demonstrated improvements in visual acuity and disease outcomes in patients with wet age-related macular degeneration without new safety issues.
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PREDICTORS OF ONE-YEAR VISUAL OUTCOMES AFTER ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENT FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION. Retina 2018; 38:1492-1499. [PMID: 28654629 DOI: 10.1097/iae.0000000000001736] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To determine predictors of best-corrected visual acuity (BCVA) outcomes 1 year after ranibizumab or bevacizumab treatment for neovascular age-related macular degeneration, within the French Study Group Avastin versus Lucentis for neovascular age-related macular degeneration (GEFAL). METHODS Patients aged ≥50 years presenting subfoveal neovascular age-related macular degeneration were randomized to receive ranibizumab or bevacizumab (3 monthly intravitreal injections followed by an as-needed regimen). The main outcome measures were BCVA and its change from baseline at 1 year. Variables with a P value <0.20 in the univariate model and/or which were clinically relevant were included in the multivariate analysis. RESULTS The following baseline factors were associated with a lower BCVA score at 1 year and with less improvement in BCVA (multivariate analysis): intraretinal fluid, thickness of central subfield macular ≤277 μm, predominantly classic choroidal neovascularization, and total area of choroidal neovascularization (all P ≤ 0.01). Pigment epithelium detachment and high baseline BCVA were associated with less improvement in BCVA (P = 0.03, P = 0.05, respectively). Patients who met retreatment criteria but did not receive the corresponding injection had significantly poorer outcomes (only tested in the univariate analysis). CONCLUSION This study confirms the predictors of BCVA score at 1 year posttreatment; the presence of intraretinal fluid was associated with a poor prognosis.
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WRINKLED VASCULARIZED RETINAL PIGMENT EPITHELIUM DETACHMENT PROGNOSIS AFTER INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY. Retina 2018; 38:1100-1109. [PMID: 28520639 DOI: 10.1097/iae.0000000000001698] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE Neovascular age-related macular degeneration (nAMD) is frequently associated with vascularized pigment epithelial detachment (v-PED). We observed a peculiar characteristic of v-PED characterized by small lacy folds of the retinal pigment epithelium, appearing as a wrinkled PED (w-PED) on spectral domain optical coherence tomography (SD-OCT). Our purpose was to describe the visual prognosis and number of intravitreal injections in w-PED compared with non-w-PED. METHODS In this retrospective, case-control series, we reviewed retrospectively medical records of 52 eyes of 51 patients who were consecutively included between November 1 and 30, 2015 with a previous minimum 3-year follow-up. Inclusion criteria were: neovascular age-related macular degeneration, affected with w-PED. Baseline characteristics, best-corrected visual acuity (BVCA), number of intravitreal anti-vascular endothelial growth factor injections (anti-VEGF IVT) and maximal recurrence-free interval, that is, without intravitreal anti-vascular endothelial growth factor injection, were analyzed. A w-PED was defined as a v-PED ≥200 μm in height on SD-OCT imaging, presenting with at least 4 small lacy folds on the surface of the retinal pigment epithelium. Patients were compared with a control group, that is, patients harboring PED without wrinkle shape (non-w-PED). All patients had been treated by intravitreal anti-vascular endothelial growth factor injection of either ranibizumab (IVR) or aflibercept (IVA) using a pro re nata (PRN) protocol after three initial monthly treatments, with a minimum of follow-up of 3 years. RESULTS Two groups of patients were compared, w-PED (29 eyes, from 29 patients), and non-w-PED (23 eyes from 22 patients). In the w-PED group, mean BCVA evolved from 0.28 (±0.18) log MAR (20/40, range 20/25-20/63) at baseline, to 0.29 (±0.21) log MAR (20/40, range 20/25-20/63) at 1 year (P = 0.41), 0.34 (±0.26) log MAR (20/40, range 20/25-20/80) at 2 years (P = 0.49), 0.35 (±0.28) log MAR (20/40, range 20/25-20/80) at 3 years (P = 0.54). In the non-w-PED group, mean BCVA was 0.40 (±0.28) log MAR (20/50, range 20/25-20/100) at baseline and decreased to 0.48 (±0.46) log MAR (20/63, range 20/20-20/160) at 1 year (P = 0.19), 0.48 (±0.35) log MAR (20/63, range 20/25-20/125) at 2 years (P = 0.02), 0.60 (±0.38) log MAR (20/80, range 20/32-20/200) at 3 years (P = 0.002). In the w-PED group, the mean maximal documented recurrence-free interval was 7.87 (±2.94) months at Year 1, 13.5 (±7.52) at Year 2 and 14.78 (±10.70) at Year 3, versus 4.59 (±2.95) months at Year 1, 7.83 (±6.62) at Year 2, 8.57 (±11.18) at Year 3 in the non-w-PED group (P = 0.0004; 0.0101; 0.0168 respectively at Years 1, 2 and 3). DISCUSSION The evolution of v-PED after intravitreal anti-vascular endothelial growth factor injection is still difficult to predict despite intense clinical research in this topic. In our study, we noticed that w-PED might be a phenotypic prognosis factor for better visual acuity and longer maximal recurrence-free interval.
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One-Year Outcome of Ranibizumab for Neovascular Age-Related Macular Degeneration: A Thorough Analysis in a Real-World Clinical Setting. Eur J Ophthalmol 2018; 24:396-401. [DOI: 10.5301/ejo.5000385] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2013] [Indexed: 01/22/2023]
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El Bahloul M, Chraïbi F, Aounzou S, Salam Diarra A, Abdellaoui M, Benatiya I, Tahri H. Traitement par bévacizumab et évolution des néovaisseaux choroïdiens compliquant les stries angioïdes : expérience du service d’ophtalmologie du CHU Hassan II. J Fr Ophtalmol 2017; 40:731-737. [DOI: 10.1016/j.jfo.2017.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/05/2017] [Accepted: 03/27/2017] [Indexed: 11/25/2022]
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Zerbib J, Bourhis A, Cornut PL, De Bats F, Grenet T, Gualino V, Halfon J, Massé H, Srour M, Streho M, Tick S, Wolff B, San Nicolas N. [Management of wet AMD in France in 2015]. J Fr Ophtalmol 2017; 40:723-730. [PMID: 29055730 DOI: 10.1016/j.jfo.2017.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 05/17/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE AND CONTEXT Intravitreal administration of anti-VEGF agents, available in France since 2007, allows stabilization and improvement in visual acuity in wet age-related macular degeneration (AMD). In the past few years, the management of this disease has evolved in terms of both diagnostic methods and treatment schedules, which have been adapted to the pathophysiology of AMD. The goal of this survey, performed in a representative sample of French ophthalmologists, was to describe the evolution of medical practices one year after a similar survey (Massé et al., J Fr Ophtalmol 2016; 39: 40-7). METHOD The survey was performed from December, 2014 to March, 2015 in 191 ophthalmologists (53 general ophthalmologists and 98 retina specialists) with an on-line questionnaire. This questionnaire was designed by a committee of ophthalmologists to describe practices concerning screening, diagnosis, treatment and follow-up of wet AMD. RESULTS An initial intravitreal injection of an anti-VEGF agent was usually performed within 10 days after the diagnosis of wet AMD by 98% of ophthalmologists and within 5 days by 63%. The treatment protocols favored by retina specialists were pro re nata (PRN) for 58%, Observe and Plan for 25% and Treat and Extend for 17%. Bilateral intravitreal injections were performed on the same day by 46% of retina specialists, mostly for the convenience of the patient and because of the low infectious risk. The initial protocol was maintained by one third of retina specialists throughout the course of treatment, while two thirds of them reported that they reassessed the protocol on average after 5 months. CONCLUSION This survey on the practices of the ophthalmologists in wet AMD highlights an improvement in the time course of patient management and an evolution of treatment schedules toward individualized protocols.
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Affiliation(s)
- J Zerbib
- Nice Rétina, 5, rue Eugène-Emmanuel, 06000 Nice, France.
| | - A Bourhis
- Polyclinique Atlantique, avenue Claude-Bernard, BP 40419, 44819 Saint-Herblain cedex, France
| | - P L Cornut
- Centre ophtalmologique pôle vision, clinique du Val-d'Ouest, 39, chemin de la Vernique, 69130 Écully, France
| | - F De Bats
- Centre ophtalmologique pôle vision, clinique du Val-d'Ouest, 39, chemin de la Vernique, 69130 Écully, France
| | | | - V Gualino
- Clinique Honoré-Cave, 406, boulevard Montauriol, 82017 Montauban, France
| | - J Halfon
- Cabinet d'ophtalmologie des Halles-de-Tours, 13, place Gaston-Paillhou, 37000 Tours, France
| | - H Massé
- Centre hospitalier universitaire de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - M Srour
- Centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94010 Créteil cedex, France
| | - M Streho
- Explore Vision, 4, rue Grandes-Terres, 92500 Rueil-Malmaison, France
| | - S Tick
- Hôpital des Quinze-Vingts, 28, rue de Charenton, 75571 Paris cedex, France
| | - B Wolff
- Centre ophtalmologique, Maison-Rouge, 6, rue de l'Église, 67000 Strasbourg, France; Fondation Adolphe-de-Rothschild, 25, rue Manin, 75019 Paris, France
| | - N San Nicolas
- Novartis France, 2 et 4, rue Lionel-Terray, BP 308, 92506 Rueil-Malmaison cedex, France
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Relationships of orientation discrimination threshold and visual acuity with macular lesions in age-related macular degeneration. PLoS One 2017; 12:e0185070. [PMID: 28922378 PMCID: PMC5602672 DOI: 10.1371/journal.pone.0185070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 09/06/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To measure visual acuity and metamorphopsia in patients with age-related macular degeneration (AMD) and to explore their relationship with macular lesions. METHODS In this cross-sectional study, a total of 32 normal subjects (32 eyes) and 35 AMD patients (35 eyes) were recruited. They were categorized into 4 groups: normal, dry AMD, non-active wet AMD, and active wet AMD. Best-corrected visual acuity (BCVA) was measured using the Early Treatment Diabetic Retinopathy Study protocol. Metamorphopsia was quantified with the orientation discrimination threshold (ODT). Macular lesions, including drusen, sub-retinal fluid (SRF), intra-retinal fluid (IRF), pigmented epithelium detachment (PED), and scarring, were identified with spectral-domain optical coherence tomography (SD-OCT). A linear regression model was established to identify the relationships between the functional and structural changes. RESULTS BCVA progressively worsened across the normal, dry AMD, non-active wet AMD, and active wet AMD groups (P < 0.001), and ODT increased across the groups (P < 0.001). The correlation between BCVA and ODT varied among the groups. The partial correlation between BCVA and ODT was -0.61 (P < 0.001). Linear regression showed that ODT significantly depended on IRF (β = 0.61, P < 0.001), SRF (β = 0.34, P = 0.003), and scarring (β = 0.26, P = 0.050), while BCVA significantly depended only on scarring (β = -0.52, P < 0.001), and IRF (β = -0.36, P = 0.016). CONCLUSIONS From dry AMD to active wet AMD, BCVA gradually worsened while ODT increased. The correlation between BCVA and ODT varied among these groups, indicating that AMD lesions affect them differently. ODT and BCVA should be used concurrently for better monitoring of the disease.
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Prise en charge individualisée des patients atteints de DMLA exsudative, le protocole IOI : injection–observation–individualisation. J Fr Ophtalmol 2017; 40:169-176. [DOI: 10.1016/j.jfo.2016.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 12/15/2016] [Accepted: 12/19/2016] [Indexed: 01/24/2023]
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RETICULAR PSEUDODRUSEN ARE NOT A PREDICTIVE FACTOR FOR THE 1-YEAR RESPONSE TO INTRAVITREAL RANIBIZUMAB IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION. Retina 2017; 37:53-59. [DOI: 10.1097/iae.0000000000001134] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ranibizumab for vascularized pigment epithelial detachment: 1-year anatomic and functional results. Graefes Arch Clin Exp Ophthalmol 2016; 255:743-751. [DOI: 10.1007/s00417-016-3564-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 10/04/2016] [Accepted: 11/09/2016] [Indexed: 02/01/2023] Open
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Follow-up after surgery for hemorrhagic AMD. J Fr Ophtalmol 2016; 39:661-667. [PMID: 27658564 DOI: 10.1016/j.jfo.2016.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 05/12/2016] [Accepted: 05/27/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The long-term functional results of macular hematoma (MH) surgery in exudative AMD are often limited. The goal of this study was to compare visual outcomes of monthly versus bimestrial follow-up in these patients. METHODS Retrospective, interventional case series. Population : 21 eyes of 21 patients with SMH associated with exudative AMD. INCLUSION CRITERIA first SMH associated with exudative AMD, with 1-year postoperative follow-up. EXCLUSION CRITERIA blood located exclusively underneath the retinal pigment epithelium on OCT imaging, SMH due to different etiology, lost to follow-up, ≤5 postoperative visits and a different surgical protocol as described. Patients were divided into two groups according to the number of postoperative visits (number of intravitreal injections [IVT] combined with the number of consultations, only one visit was recorded when IVT and consultation occurred on the same day) during the 1-year postoperative follow-up: group 1 had ≥11 visits (n=8); group 2 had 6 to 10 visits (n=13). All eyes underwent vitrectomy with subretinal injection of recombinant tissue plasminogen activator, fluid-gas exchange and anti-VEGF intravitreal injection. The main outcome was change in best-corrected visual acuity (BCVA). RESULTS Considering visual acuity (VA) change between 1-month and 1-year postoperative follow-up examinations, group 1 had statistically significant greater VA changes (logMAR -0.29±0.44 vs logMAR 0.42±0.73; P=0.016; P=0.016). In patients that had exudative recurrences (ER), group 1 received more anti-VEGF IVT than group 2 (P=0.045). CONCLUSION Our results showed that monthly follow-up, between the IVT series, is highly recommended to preserve postoperative VA in patients undergoing surgery for SMH associated with AMD.
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METAANALYSIS OF REAL-WORLD OUTCOMES OF INTRAVITREAL RANIBIZUMAB FOR THE TREATMENT OF NEOVASCULAR AGE-RELATED MACULAR DEGENERATION. Retina 2016; 36:1418-31. [DOI: 10.1097/iae.0000000000001142] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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CHANGES IN VISUAL ACUITY IN PATIENTS WITH WET AGE-RELATED MACULAR DEGENERATION TREATED WITH INTRAVITREAL RANIBIZUMAB IN DAILY CLINICAL PRACTICE: The TWIN Study. Retina 2016; 35:1743-9. [PMID: 25901835 DOI: 10.1097/iae.0000000000000548] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The real-life LUMIERE study on patients with wet age-related macular degeneration treated with intravitreal ranibizumab in 2006 to 2009 showed that failure to follow recommendations was associated with lower efficacy than had been observed in the development phase. The TWIN Study reviewed the situation in 2010 to 2011. METHODS Retrospective, descriptive purely observational study of data acquired after 12 months of treatment with intravitreal ranibizumab. RESULTS In 881 patients (68% women, mean age, 79 years) treated by 21 ophthalmologists, the mean gain in visual acuity was +4.3 ± 15.4 letters (up from 3.2 ± 14.8 in 2006-2009; NS). Significant improvements were documented in the mean interval between diagnosis and treatment initiation (down from 12.6 ± 26.4-7.7 ± 10.9 days; P < 0.001), and in the percentage of patients who received a full course of induction treatment (56.6 vs. 39.6%; P < 0.001). After induction, hardly any patients were monitored every month as recommended, although retreatment was more assiduous (5.6 ± 2.3 vs. 5.1 ± 2.1 injections; P < 0.001). CONCLUSION Despite improvements in key parameters, the effectiveness of intravitreal ranibizumab is still compromised by poor compliance with the guidelines, especially the frequency of postinduction monitoring that is now the most important determinant of successful treatment.
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Boulanger-Scemama E, Querques G, About F, Puche N, Srour M, Mane V, Massamba N, Canoui-Poitrine F, Souied E. Ranibizumab for exudative age-related macular degeneration: A five year study of adherence to follow-up in a real-life setting. J Fr Ophtalmol 2015; 38:620-7. [DOI: 10.1016/j.jfo.2014.11.015] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/14/2014] [Accepted: 11/17/2014] [Indexed: 11/24/2022]
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Matamoros E, Maurel F, Léon N, Solomiac A, Bardoulat I, Joubert M, Hermans M, Moser E, Le Picard S, Souied EH, Leveziel N. Quality of Life in Patients Suffering from Active Exudative Age-Related Macular Degeneration: The EQUADE Study. Ophthalmologica 2015; 234:151-9. [PMID: 26337381 DOI: 10.1159/000433448] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 05/18/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE Age-related macular degeneration (AMD) is the main cause of visual loss in the elderly population. With the use of anti-vascular endothelial growth factor, the visual outcomes of exudative AMD patients have been improved. This study was aimed at assessing the quality of life (QoL) of exudative AMD patients treated with ranibizumab and at determining its drivers in a real-life setting. METHODS We performed a national, cross-sectional, observational survey based on questionnaires sent to members of French associations relative to AMD between December 2012 and March 2013. Patients suffering from exudative AMD with at least one intravitreal injection of ranibizumab within the last 6 months were included. Demographics, AMD characteristics, visual acuity (VA) and past and ongoing treatments were collected. The 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) was self-administered. A multivariate model was used to identify QoL drivers. RESULTS 416 questionnaires fulfilled the complete criteria for both QoL and cost analyses. The mean age of exudative AMD patients was 78.0 years and bilateral involvement was reported in 60.4%. The overall mean QoL score was 53.4. Mental health, driving and role difficulties were the most widely affected domains. After bivariate analyses, long-term illness status, worse VA and higher number of unpaid aids were associated with worse QoL, with odds ratios of 2.4, 5.2 and 11.6, respectively. The mean cost per year and per patient was 1,741 EUR. The main components of costs were aids and services and the purchase of visual equipment. CONCLUSIONS The main predictors of QoL in exudative AMD patients treated with ranibizumab are VA outcomes, home healthcare and social services provided to the patients.
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Affiliation(s)
- Emilie Matamoros
- Department of Ophthalmology, University Hospital of Poitiers, Poitiers, France
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Visual acuity at presentation in the second eye versus first eye in patients with exudative age-related macular degeneration. Eur J Ophthalmol 2015; 26:44-7. [PMID: 26165330 DOI: 10.5301/ejo.5000649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the difference in best-corrected visual acuity (BCVA) at presentation between the first and second eye in patients with bilateral neovascular age-related macular degeneration (AMD). METHODS We reviewed the charts of all patients who had a clinical examination for neovascular AMD at the University Eye Clinic of Creteil in January 2013. We retrospectively analyzed demographic and clinical data for 264 patients. RESULTS In the fellow eye, choroidal neovascularization (CNV) developed in 75/264 patients (28.4%) with a time interval between the 2 events of 30.3 months (range 6-145). Data were available on 65 patients: 14/65 (21.5%) were asymptomatic, 24/65 (36.9%) had BCVA >20/40, whereas at the time of CNV diagnosis in the first eye, no patient was asymptomatic (p<0.0001), and 11/65 (16.9%) eyes had BCVA >20/40 (p<0.0001). The mean BCVA of the first affected eye was 0.68 (± 0.41) logarithm of minimum angle of resolution (logMAR) and the mean BCVA for the second eye was 0.36 (± 0.29) logMAR (p<0.0001). CONCLUSIONS The BCVA at the time of diagnosis of CNV was higher in the second eye than in the first affected eye. This was possibly due to several factors including systematic bilateral examination in follow-up of unilateral exudative AMD that allowed detection of 20% of cases.
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Cazet-Supervielle A, Gozlan J, Cabasson S, Boissonnot M, Manic H, Leveziel N. Intravitreal Ranibizumab in Daily Clinical Practice for Age-Related Macular Degeneration: Treatment of Exudative Age-Related Macular Degeneration in Real Life. Ophthalmologica 2015; 234:26-32. [DOI: 10.1159/000430470] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 04/14/2015] [Indexed: 11/19/2022]
Abstract
Purpose: To describe the anatomical and functional outcomes in patients with exudative age-related macular degeneration (AMD) undergoing ranibizumab therapy in real-life practice. Methods: This is a retrospective analysis of patients with exudative AMD treated with ranibizumab. Visual acuity (VA) and optic coherence tomography characteristics at baseline and at the end of the follow-up, clinical forms of the disease, delay between diagnosis and treatment as well as the number of follow-up visits and of intravitreal injections were collected. Results: One hundred and seventy-nine patients (220 eyes) were followed up during a mean of 24 months. The mean delay between diagnosis and treatment was 20.3 days (SD ±16.8). VA stabilization was observed in 46.4% of eyes, 21.7% of eyes gained ≥15 ETDRS (Early Treatment Diabetic Retinopathy Study) letters and 31.9% lost ≥15 ETDRS letters. The mean central retinal thickness decreased from 380.6 μm at baseline to 295.6 µm at the final examination. A lower baseline VA score was associated with a greater gain of letters (OR 1.04, 95% CI 1.02-1.06; p < 0.001). Conclusion: Shortening the delays in diagnosis appears to be a key point in real-life situations.
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Basheer K, Mensah E, Khanam T, Minakaran N. Visual outcomes of age-related macular degeneration patients undergoing intravitreal ranibizumab monotherapy in an urban population. Clin Ophthalmol 2015; 9:959-65. [PMID: 26060392 PMCID: PMC4454212 DOI: 10.2147/opth.s76754] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim To compare the visual outcomes of an urban population with age-related macular degeneration (AMD) undergoing ranibizumab monotherapy to the results from major clinical trials. Procedures Prospective data was collected from 164 wet AMD patients receiving intravitreal ranibizumab. Visual acuities were obtained with the Early Treatment Diabetic Retinopathy Study chart. All patients underwent a loading phase of three monthly treatments of ranibizumab. Patients were monitored monthly using a retreatment criterion. Treatment was further individualized by sequentially lengthening follow-up intervals when stable. Results At 12 and 24 months, respectively, the percentage of eyes that maintained vision was 91% and 88.6%. We found that 20.3% of eyes had improved vision at 12 months and 20% at 24 months. At 12 months, 8.3% of eyes’ vision worsened and 12% worsened at 24 months. Conclusion Individualized ranibizumab monotherapy is effective in preserving vision in wet AMD and follows the same trends as the pivotal trials.
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Affiliation(s)
- Khadijah Basheer
- Ophthalmology Department, Central Middlesex Hospital, London, UK
| | - Evelyn Mensah
- Ophthalmology Department, Central Middlesex Hospital, London, UK
| | - Tina Khanam
- Ophthalmology Department, Central Middlesex Hospital, London, UK
| | - Neda Minakaran
- Ophthalmology Department, Central Middlesex Hospital, London, UK
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[Interest of optical coherence tomography performed immediately before intravitreal injection of anti-VEGF in exudative AMD]. J Fr Ophtalmol 2015; 38:573-9. [PMID: 25997681 DOI: 10.1016/j.jfo.2015.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/06/2015] [Accepted: 01/07/2015] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Two or three systematic intravitreal injections (IVT) may be prescribed in a PRN approach to treat an exudative recurrence of neovascular age-related macular degeneration (AMD), according to the phenotype. Optical coherence tomography (OCT) may be performed immediately before the 2nd or the 3rd scheduled IVT, making it possible to cancel the procedure in the absence of exudation. The aim of the study was to evaluate the usefulness of this OCT examination and to assess the percentage of IVT cancelled, in order to evaluate a potential medico-economic benefit. METHODS Monocentric retrospective study, in which were included 292 consecutive eyes with exudative recurrence of AMD, for which 2 or 3 IVT were scheduled between January 1st and April 30th, 2014. All patients received a first systematic IVT in the seven days following the diagnosis. Then, on the days of the 2nd and 3rd scheduled IVT, each patient had a visual acuity measurement and a Spectral domain-OCT (Spectralis, HRA Heidelberg Engineering). This measurement allowed for the IVT to be either performed as scheduled or cancelled. Both ranibizumab and aflibercept were used. A Chi(2) test was used to compare the qualitative variables and an adjusted Wilcoxon test for the quantitative values. RESULTS Two hundred and ninety-two consecutive eyes were included; 172 in the "2 scheduled IVT" group (group A) and 120 in the "3 scheduled IVT" group (group B). At the first follow-up, 37.6% of scheduled IVT were cancelled after the OCT (44.1% in group A and 28.3% in group B). At the second follow-up, 33.3% of IVT were cancelled in group B. Overall, 150/412 (36.4%) IVT were avoided in this series. Presence of serous retinal detachment, retinal edema and increased central macular thickness were statistically correlated with confirmation of the scheduled IVT at the two follow-ups (P<0.001, P<0.001 and P=0.002, respectively). A savings of 429.80 € per patient was calculated during this short period of follow-up. CONCLUSION An average non-injection rate of 36.4% of scheduled IVT was found in this protocol of management of recurrences with OCT performed the day of IVT. This protocol allowed to avoid unnecessary IVT one-third of the time and appeared highly cost-effective.
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The efficacy of ranibizumab treatment in clinical practice in patients with the wet form of age-related macular degeneration. The results of the Czech National Registry. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2015; 159:407-12. [PMID: 25916281 DOI: 10.5507/bp.2015.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 04/08/2015] [Indexed: 11/23/2022] Open
Abstract
AIMS The aim of this communication was to evaluate ranibizumab in the treatment of wet age-related macular degeneration. METHODS Anonymised data on treatment efficacy and safety were consecutively entered into the Czech national database. From 01/09/2008 to 25/10/2011, 671 patients/685 eyes treated with ranibizumab monotherapy were entered in the registry. 454 ranibizumab treated eyes and 444 patients were monitored for 12-months. The dependent variable used to monitor disease progression and treatment results was change in visual acuity in the ETDRS (Early Treatment Diabetic Retinopathy Study) chart over time. RESULTS After 12 months of treatment, a loss of < 15 letters in the ETDRS chart was found in 81.5% of eyes treated with ranibizumab. A gain of ≥ 15 letters was found in 9.7% of eyes on ranibizumab. The results for our patients treated in clinical practice with ranibizumab were poorer than those in the SUSTAIN (Ranibizumab in Patients With Subfoveal Choroidal Neovascularization Secondary to Age-Related Macular Degeneration) study. A rationale for this was sought in a sub-analysis. CONCLUSIONS Sub-analysis demonstrated that treatment naive CNV (choroidal neovascularization), occult CNV and lower height of the macular oedema at the outset of the disease may be positive prognostic factors for final visual acuity in anti-VEGF (vascular endothelial growth factor) treated patients.
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van Asten F, Evers-Birkenkamp KU, van Lith-Verhoeven JJC, de Jong-Hesse Y, Hoppenreijs VPT, Hommersom RF, Scholten AM, Hoyng CB, Klaver JHJ. A prospective, observational, open-label, multicentre study to investigate the daily treatment practice of ranibizumab in patients with neovascular age-related macular degeneration. Acta Ophthalmol 2015; 93:126-33. [PMID: 25488348 DOI: 10.1111/aos.12610] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 10/30/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE The HELIOS (Health Economics with Lucentis in Observational Settings) study was designed on request of the Dutch Health Authority for an observational study to assess the effectiveness and safety of ranibizumab for neovascular age-related macular degeneration (wet AMD) in daily practice. METHODS The HELIOS study was a 2-year prospective, observational, open-label, multicentre study involving 14 sites. Patients with wet AMD were enrolled and observed for a period of 24 months. The data were collected at baseline and at the visits closest around the time-points 3, 6, 12, 18 and 24 months after inclusion. RESULTS Treatment with ranibizumab resulted in prevention of vision loss. The mean ETDRS score increased from 45.1 letters at baseline to 48.5 letters at 24 months. This was achieved with a mean of 7.8 injections over 24 months. Stabilization of visual acuity was also reflected by the scores on the quality of life EQ-5D questionnaire, which did not significantly change over the study period. The more subjective EQ-VAS questionnaire showed an overall improvement. The VFQ-25 questionnaire was also mostly stable over time. After 24 months, 32.2% of the patients gained ≥1 letter and 17.1% gained >15 letters. Patients completing the loading phase were better responders, as demonstrated by increased long-term visual acuity. In addition, ranibizumab was well tolerated and had a safety profile commonly seen in routine clinical practice. CONCLUSION This study demonstrates that also in daily practice ranibizumab was effective in preventing vision loss over a period of 24 months. No new safety findings were identified.
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Affiliation(s)
- Freekje van Asten
- Department of Ophthalmology; Radboud University Medical Center; Nijmegen The Netherlands
| | | | | | | | | | | | | | - Carel B. Hoyng
- Department of Ophthalmology; Radboud University Medical Center; Nijmegen The Netherlands
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García-Layana A, Arias L, Figueroa MS, Araiz J, Ruiz-Moreno JM, García-Arumí J, Gómez-Ulla F, López-Gálvez MI, Cabrera-López F, García-Campos JM, Monés J, Cervera E, Armadá F, Gallego-Pinazo R, Piñero-Bustamante A, Serrano-Garcia MA. A delphi study to detect deficiencies and propose actions in real life treatment of neovascular age-related macular degeneration. J Ophthalmol 2014; 2014:595132. [PMID: 25587438 PMCID: PMC4283441 DOI: 10.1155/2014/595132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 11/07/2014] [Indexed: 02/01/2023] Open
Abstract
Purpose. Spanish retina specialists were surveyed in order to propose actions to decrease deficiencies in real-life neovascular age macular degeneration treatment (nv-AMD). Methods. One hundred experts, members of the Spanish Vitreoretinal Society (SERV), were invited to complete an online survey of 52 statements about nv-AMD management with a modified Delphi methodology. Four rounds were performed using a 5-point Linkert scale. Recommendations were developed after analyzing the differences between the results and the SERV guidelines recommendations. Results. Eighty-seven specialists completed all the Delphi rounds. Once major potential deficiencies in real-life nv-AMD treatment were identified, 15 recommendations were developed with a high level of agreement. Consensus statements to reduce the burden of the disease included the use of treat and extend regimen and to reduce the amount of diagnostic tests during the loading phase and training technical staff to perform these tests and reduce the time between relapse detection and reinjection, as well as establishing patient referral protocols to outside general ophthalmology clinics. Conclusion. The level of agreement with the final recommendations for nv-AMD treatment among Spanish retinal specialist was high indicating that some actions could be applied in order to reduce the deficiencies in real-life nv-AMD treatment.
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Affiliation(s)
| | - Luis Arias
- Hospital de Bellvitge, C/Feixa Llargasn, L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Marta S. Figueroa
- Hospital Universitario Ramon y Cajal, Carretera de Colmenar km 9, 28034 Madrid, Spain
- Vissum Madrid, Santa Hortensia 58, 28002 Madrid, Spain
| | - Javier Araiz
- Hospital de San Eloy, Avenida Antonio Miranda 5, 48902 Baracaldo, Spain
| | | | - José García-Arumí
- Hospital VallD'Hebron, Passeig de la Valld'Hebron 119-129, 08035 Barcelona, Spain
| | - Francisco Gómez-Ulla
- Instituto Oftalmológico Gómez-Ulla, Calle Maruja Mallo 3, 15706 Santiago de Compostela, Spain
| | | | - Francisco Cabrera-López
- Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Avenida Marítima del Sur, s/n, 35016 Las Palmas de Gran Canaria, Spain
| | | | - Jordi Monés
- Institut de la Macula i de la Retina, Carrer de Vilana 12, 08022 Barcelona, Spain
| | - Enrique Cervera
- Hospital General de Valencia, Avenida Tres Cruces 2, 46014 Valencia, Spain
| | - Felix Armadá
- Hospital la Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Roberto Gallego-Pinazo
- Hospital la Fe, Valencia, Avenida de Fernando Abril Martorell 106, 46026 Valencia, Spain
| | | | - Miguel Angel Serrano-Garcia
- Hospital Universitario Nuestra Señora de la Candelaria, Carretera del Rosario 145, 38010 Santa Cruz de Tenerife, Spain
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Kamami-Levy C, Querques G, Rostaqui O, Blanco-Garavito R, Souied EH. Choroidal neovascularization associated with extensive macular atrophy with pseudodrusen-like appearance. J Fr Ophtalmol 2014; 37:780-6. [DOI: 10.1016/j.jfo.2014.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 06/04/2014] [Accepted: 06/11/2014] [Indexed: 12/01/2022]
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Cohen SY, Nghiem-Buffet S, Grenet T, Dubois L, Ayrault S, Fajnkuchen F, Delahaye-Mazza C, Quentel G, Tadayoni R. Long-term variable outcome of myopic choroidal neovascularization treated with ranibizumab. Jpn J Ophthalmol 2014; 59:36-42. [DOI: 10.1007/s10384-014-0363-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 10/14/2014] [Indexed: 01/21/2023]
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REASONS FOR DISCONTINUATION OF INTRAVITREAL VASCULAR ENDOTHELIAL GROWTH FACTOR INHIBITORS IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION. Retina 2014; 34:1774-8. [DOI: 10.1097/iae.0000000000000173] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Finger RP, Guymer RH, Gillies MC, Keeffe JE. The impact of anti-vascular endothelial growth factor treatment on quality of life in neovascular age-related macular degeneration. Ophthalmology 2014; 121:1246-51. [PMID: 24518613 DOI: 10.1016/j.ophtha.2013.12.032] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 12/19/2013] [Accepted: 12/19/2013] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To assess the impact of anti-vascular endothelial growth factor (VEGF) treatment in routine medical practice on vision-related quality of life (VRQoL) in neovascular age-related macular degeneration (AMD). DESIGN Prospective case series. PARTICIPANTS A total of 169 patients with neovascular AMD undergoing anti-VEGF treatment. METHODS The VRQoL interviews at baseline (n = 169), 6 months (n = 138), and 12 months (n = 120), routine anti-VEGF treatment with up to monthly follow-ups, and re-treatment as indicated. The Impact of Vision Impairment (IVI) questionnaire was subjected to Rasch analysis to assess its measurement performance and generate interval-level estimates of VRQoL at all time points, anchoring the instrument to its baseline measurement characteristics. Factors associated with a change in reported VRQoL were assessed using generalized linear regression models. MAIN OUTCOME MEASURES The VRQoL as measured by the IVI using its 3 subscales: Accessing Information, Mobility, and Emotional Well-being. FINDINGS The mean age was 70 years (±6 years standard deviation [SD]); 56% were female. Visual acuity (VA) improved by a mean of 8 letters (±17 SD), and mean retinal thickness decreased by 87 (±89.7) μm with an average of 6.5 (±2.6) injections over 12 months. Those who lost >2 lines (n = 13, 11%) reported worse VRQoL at 12 months on the Accessing Information and Mobility subscales (P = 0.007 and P = 0.050, respectively). Conversely, those who gained >2 lines (n = 29, 24%) reported better VRQoL on the Accessing Information and Emotional Well-being subscales (P = 0.009 and P = 0.008, respectively). Patients who did not experience a change in VA reported no change in their VRQoL. In multivariate analyses, only a change in VA but not whether the better or worse eye was treated predicted a change in VRQoL on the Accessing Information (P = 0.004) and the Emotional Well-being (P = 0.008) subscales. CONCLUSIONS We confirmed that anti-VEGF treatment for neovascular AMD improves patients' VRQoL in those who gain vision and maintains VRQoL in those who maintain VA in their treated eye, irrespective of whether the worse or better eye is treated. Against this background, the best possible outcomes should be aimed for even if the worse eye is treated because a loss of VA in the worse eye will adversely affect patients' VRQoL.
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Affiliation(s)
- Robert P Finger
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia.
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
| | - Mark C Gillies
- Save Sight Institute, University of Sydney, Sydney, Australia
| | - Jill E Keeffe
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
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Lukács R, Resch M, Papp A, Szabó A, Borbándy Á, Menkens H, Kiss H, Németh J. [Long-term treatment with intravitreal ranibizumab for exudative age-related macular degeneration]. Orv Hetil 2014; 154:1790-7. [PMID: 24184931 DOI: 10.1556/oh.2013.29729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The results of intravitreal ranibizumab treatment for exsudative age-related macular degeneration have been favourable until this time. AIM To evaluate the two-year functional and anatomic results of intravitreal ranibizumab treatment. METHOD 46 patients (age: 75 ± 9.1 years) were included in a prospective single center study. Treatment regimen was the following: monthly 0.5 mg ranibizumab was administered in the first 3 months, and later as required (pro re nata). The change of best corrected visual acuity and central retinal thickness was followed. RESULTS The visus change at the end of the follow-up time was not statistically significant compared to baseline (p = 0.760) and the at the end of the first year (p = 0.154). Central retinal thickness decreased significantly compared to baseline (p = 0.000001), but the change was not statistically significant compared to the end of the first year (p = 0.875). CONCLUSIONS Patients with neovascular macular degeneration treated with intravitreal ranibizumab using pro re nata regimen have stable visus for long term, and the exsudation could be reduced efficiently.
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Affiliation(s)
- Regina Lukács
- Semmelweis Egyetem, Általános Orvostudományi Kar Szemészeti Klinika Budapest Mária u. 39. 1085 Fejér Megyei Szent György Egyetemi Oktató Kórház Székesfehérvár
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Cohen SY, Maloberti B, Fajnkuchen F, Nghiem-Buffet S, Delahaye-Mazza C, Grenet T, Quentel G. Bimonthly ranibizumab for neovascular age-related macular degeneration. ACTA ACUST UNITED AC 2013; 231:80-5. [PMID: 24356074 DOI: 10.1159/000356401] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 09/05/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND/PURPOSE Recently, aflibercept was proposed with a protocol of a bimonthly fixed regimen. Our purpose was to evaluate the results of this regimen in patients treated with ranibizumab. METHOD We conducted a retrospective analysis of consecutive patients with naïve neovascular age-related macular degeneration treated with a bimonthly fixed regimen of intravitreal injections of ranibizumab after 3 monthly injections. Examination was performed every 4 weeks for 52 weeks, with the possibility of unscheduled rescue injections of ranibizumab. RESULTS A total of 27 patients, 24 women and 3 men, aged from 68 to 90 years (mean: 81.2) were analyzed; 25 eyes (92.5%) lost <15 letters. Mean BCVA rose from 58.3 (range ± 12.9) to 66.7 (range ± 14.3) letters. The mean visual gain was 8.40 (range ± 13.2) letters; 11 patients (40.7%) gained ≥ 15 letters. The mean number of injections of ranibizumab was 8.77. CONCLUSION Bimonthly intravitreal ranibizumab achieved satisfactory visual results. However, patients who required additional injections did not experience significant visual gain.
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Comparison of outcomes from a phase 3 study of age-related macular degeneration with a matched, observational cohort. Ophthalmology 2013; 121:676-81. [PMID: 24290801 DOI: 10.1016/j.ophtha.2013.09.050] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/23/2013] [Accepted: 09/30/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To compare outcomes of intravitreal therapy from an observational study cohort with those of participants receiving treatment in the Minimally Classic/Occult Trial of the Anti-VEGF Antibody Ranibizumab (MARINA) for the treatment of neovascular age-related macular degeneration (wet AMD). DESIGN Database observational study. Participants in the observational cohort were chosen to match demographic features and entry criteria of the treatment group from MARINA. Outcomes over 12 months were compared. PARTICIPANTS Eight hundred twenty-one anti-vascular endothelial growth factor (anti-VEGF)-naïve eyes treated with ranibizumab with 12 months or more of follow-up were included in the total Fight Retinal Blindness! (FRB-All) cohort, whereas a subset of this cohort of 401 eyes who were matched to the MARINA treatment group were included as the FRB-MARINA cohort. INTERVENTION Intravitreal ranibizumab therapy of 0.5 mg for wet AMD. METHODS Visual acuity (VA) in logarithm of the minimum angle of resolution (logMAR) letters and treatments given were recorded continuously and anonymously in an electronic database for 12 months. Locally weighted scatterplot smoothing (LOESS) regression was used to plot change in visual acuity data over the course of 12 months for both the FRB-All cohort and the FRB-MARINA cohort, whereas results from the MARINA trial were taken from the published study report. MAIN OUTCOME MEASURES Change in VA in logMAR letters over 12 months, treatment, and visit intensity. RESULTS Mean visual acuity improvement after 12 months in FRB-MARINA (+5.5 letters) was similar to that of the 0.5-mg group from MARINA (+7.2 letters). Improvement in FRB-ALL was slightly less (+4.9 letters). Mean treatment effect compared with the MARINA control group was similar for the MARINA treated group (+17.6 letters) and the FRB-MARINA cohort (+15.9 letters). A mean of 7.3 injections in 12 months was received by the observational cohorts. CONCLUSIONS Similarity of mean VA improvement in the matched observational cohort with that of the phase 3 clinical trial suggests that these results can be achieved in real-world clinical practice with a modified treatment regimen.
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Frampton JE. Ranibizumab: a review of its use in the treatment of neovascular age-related macular degeneration. Drugs Aging 2013; 30:331-58. [PMID: 23539234 DOI: 10.1007/s40266-013-0077-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Ranibizumab (Lucentis(®)), an inhibitor of all vascular endothelial growth factor (VEGF) A isoforms, is approved for the intravitreal treatment of neovascular age-related macular degeneration (AMD). In pivotal trials, monthly injections of ranibizumab were superior to verteporfin photodynamic therapy in the treatment of predominantly classic choroidal neovascularization (CNV) due to neovascular AMD (ANCHOR) and sham in the treatment of minimally classic or occult CNV due to neovascular AMD (MARINA). Monthly or less frequent injections of ranibizumab are generally well tolerated and associated with low rates of ocular and systemic serious adverse events (SAEs). Less frequent dosing has been evaluated with the aim of reducing the burden, risk and cost of monthly injections. In the landmark CATT trial, monthly monitoring and retreatment as-needed with ranibizumab was equivalent to monthly treatment in terms of the vision gain at 1 year, but reduced the number of injections (and the related cost) by approximately one-half. In head-to-head comparisons, aflibercept administered bimonthly was noninferior to ranibizumab administered monthly (VIEW 1 and 2), bevacizumab administered monthly was equivalent to ranibizumab administered monthly (CATT), and bevacizumab administered as-needed was equivalent to ranibizumab administered as-needed (CATT). Bevacizumab is widely used (off-label) for economic reasons; while it was less costly than ranibizumab, it was associated with more systemic SAEs. Notwithstanding the availability of other similarly effective anti-VEGF therapies that are approved (aflibercept) or unapproved (bevacizumab), ranibizumab continues to set the standard as regards the totality of evidence from randomized clinical trials demonstrating its efficacy and tolerability (particularly that of the monthly regimen) in the treatment of neovascular AMD.
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Affiliation(s)
- James E Frampton
- Adis, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, North Shore 0754, Auckland, New Zealand.
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Ocular and systemic safety of bevacizumab and ranibizumab in patients with neovascular age-related macular degeneration. Curr Opin Ophthalmol 2013; 24:205-12. [PMID: 23518613 DOI: 10.1097/icu.0b013e32835f8ec0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW This study reviews differences in both ocular and systemic safety between intravitreal bevacizumab and ranibizumab in the setting of neovascular age-related macular degeneration. RECENT FINDINGS Serious adverse events associated with either bevacizumab or ranibizumab injections are generally rare. However, acute intraocular inflammation (AII) tends to occur more frequently following bevacizumab injection. Systemic absorption of bevacizumab is greater than with ranibizumab, and many studies have shown an increased risk of systemic adverse events in patients receiving bevacizumab compared with those receiving ranibizumab. SUMMARY Although rare, adverse events with off-label use of bevacizumab are more common than with ranibizumab. Continued study into long-term safety of the two agents is warranted.
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Muniraju R, Ramu J, Sivaprasad S. Three-year visual outcome and injection frequency of intravitreal ranibizumab therapy for neovascular age-related macular degeneration. Ophthalmologica 2013; 230:27-33. [PMID: 23635665 DOI: 10.1159/000350238] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 02/25/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND To assess the 3-year visual outcome and injection frequency for patients on ranibizumab for neovascular age-related macular degeneration (NV-AMD). METHODS Retrospective case-note review of 174 treatment-naïve eyes of 156 patients with NV-AMD with 3-year follow-up was done at specific time points closest to 12, 24 and 36 months. RESULTS The median baseline visual acuity (VA) of 50 Early Treatment Diabetic Retinopathy Study letters (mean 48.2 ± 16.9) improved significantly to 55 (mean 51.2 ± 18.7) by the end of 12 months (p = 0.04). At 24 months, the median letter score remained unchanged at 55 (mean 50.4 ± 20.8; p = 0.14 as compared to baseline) and at 36 months, the median VA was 54 letters (mean 49.1 ± 21.7; p = 0.34 compared to baseline). The mean numbers of injections were 4.8 ± 2.2 at 1 year, 7.8 ± 4.2 at 2 years (2.9 in the second year) and 10.2 ± 6.2 at the end of the third year (2.4 in the third year). CONCLUSION Our study demonstrates the efficacy of a variable dosing regimen of ranibizumab for the treatment of NV-AMD. The mean gain in VA is inversely proportional to the baseline VA and did not correlate with the number of injections.
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Affiliation(s)
- Ramu Muniraju
- Laser and Retinal Research Unit, Department of Ophthalmology, King's College Hospital, London SE5 9RS, UK
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Ranibizumab for exudative AMD in a clinical setting: differences between 2007 and 2010. Graefes Arch Clin Exp Ophthalmol 2013; 251:2499-503. [PMID: 23604514 DOI: 10.1007/s00417-013-2338-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 03/04/2013] [Accepted: 03/25/2013] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND/PURPOSE Visual results of ranibizumab given pro re nata in clinical settings depend greatly from the achievement of the monthly follow-up. In 2007, a previous study performed in our tertiary care showed a mean visual gain of only + 0.7 ETDRS chart letters, probably because of insufficient number of follow-up visits and injections. We report a second retrospective study of patients whose eyes were treated in the same setting, and whose first injection was performed after April 1 2010. The aim was to check if the changes in the management of AMD patients between 2010 and 2007 achieved better visual results. METHOD One hundred and twenty-two patients (125 eyes) with exudative age-related macular degeneration (AMD) were included. Age, gender, side, type of CNV, VA measured on an ETDRS chart at baseline and at 52 ± 6 weeks, the number of IVT performed, and follow-up visits were recorded. The series was compared to our former series of the year 2007. Results are expressed as means ± standard deviation. Mann-Whitney's non-parametric test was used to compare the statistical distribution of the parameters measured. Fisher's exact test was used for 2 × 2 categorical variables, and the chi-square test for others. RESULTS In the 2010 series, the mean visual gain was +6.0 ± 11.0 l (-35 to + 34). During this period, the eyes had 5.0 ± 1.8 IVT and 7.8 ± 1.4 follow-up visits. No correlation was found between the change in VA and gender, type of CNV, age, or the numbers of IVT and visits. There was a reverse correlation between baseline VA and VA changes (r = -0.413, p < 0.0001): i.e., the higher the VA at presentation, the smaller the gain. Comparison between 2010 and 2007 showed that in 2010, patients were older (82.2 ± 7.0 vs 78.3 ± 7.0 y, p < 0.0001), had a better baseline VA (60.6 ± 12.7 vs 56.1 ± 14.6 l, p = 0.0191) and, despite the reverse correlation between change in VA and VA at presentation, visual results were better: +6.0 ± 11.0 vs +0.7 ± 11.99 l, p = 0.0003. In 2010, eyes received more injections: 5.0 ± 1.8 vs 3.8 ± 1.4 in 2007, p < 0.0001. However, the series did not differ for the number of visits, gender, side or type of CNV. CONCLUSIONS In 2010, monotherapy with ranibizumab for exudative AMD achieved better visual results than in 2007 in our clinical setting, despite the treatment of older patients with better baseline VA. This is probably due to the greater number of IVT performed. Alternate strategies, such as "inject and extend" or maintenance therapy, may also account for the better visual results.
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RANIBIZUMAB FOR CHOROIDAL NEOVASCULARIZATION ASSOCIATED WITH ADULT-ONSET FOVEOMACULAR VITELLIFORM DYSTROPHY. Retina 2013; 33:513-21. [DOI: 10.1097/iae.0b013e3182753adb] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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CHANGES IN VISUAL ACUITY IN PATIENTS WITH WET AGE-RELATED MACULAR DEGENERATION TREATED WITH INTRAVITREAL RANIBIZUMAB IN DAILY CLINICAL PRACTICE. Retina 2013; 33:474-81. [DOI: 10.1097/iae.0b013e31827b6324] [Citation(s) in RCA: 149] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Saleh M, Kheliouen M, Tebeanu E, Ballonzoli L, Bourcier T, Speeg-Schatz C, Gaucher D. Retreatment by series of three intravitreal injections of ranibizumab in neovascular age-related macular degeneration: long-term outcomes. Graefes Arch Clin Exp Ophthalmol 2013; 251:1901-7. [PMID: 23430191 DOI: 10.1007/s00417-013-2284-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 12/20/2012] [Accepted: 02/06/2013] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The purpose of this study was to analyze the results of a retreatment regimen using a series of three monthly intravitreal ranibizumab injections (IVR), instead of one injection, and to determine if this treatment scheme can safely reduce the number of injections and the number of visits compared to the widely used PrONTO study retreatment protocol. METHODS >Sixty-six eyes of 60 patients with exudative age-related macular degeneration (AMD) were included. The mean follow-up period was 27 months (range, 11-48 months). The mean age of the patients was 79 years (range, 65-93 years). All patients received three initial IVRs, and were retreated with a new series of three monthly IVRs when needed. The retreatment criteria were: visual loss of ≥5 ETDRS letters and/or signs of retinal exudation on OCT, new macular hemorrhage, expansion of new vessels. Follow-up visits were conducted 1 month after the last IVR of each series, and renewed on a monthly basis when no retreatment was required. Each visit included a comprehensive ophthalmological examination with BCVA measurement and OCT examination. RESULTS Mean VA did not improve during follow-up (53.18 letters at the initial visit versus 54.18 at the last visit, p > 0.05). However, VA stabilized or improved in 66.6 % of the eyes. A gain of ≥15 letters was observed in 28.8 % of eyes. On average, over 2 years, the number of IVRs was five per year, and the number of follow-up visits was four per year. CONCLUSION Even if no gain in VA is observed after 2 years, this treatment regimen reduces the number of IVRs and control visits. The proportion of patients with a VA gain of three lines or more was smaller than the one reported in the original PrONTO study, but higher than the rates reported in other studies implementing the PrONTO recommendations in everyday practice. The benefit of the three IVR retreatment scheme should be prospectively studied and compared to the PRN regimen.
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Affiliation(s)
- Maher Saleh
- Department of Ophthalmology, University Hospital Jean Minjoz of Besançon, Franche-Comté University, 25000 Besançon, France
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Tilleul J, Querques G, Canoui-Poitrine F, Leveziel N, Souied EH. Assessment of a Spectral Domain OCT Segmentation Software in a Retrospective Cohort Study of Exudative AMD Patients. Ophthalmologica 2013; 229:80-5. [DOI: 10.1159/000342980] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 08/14/2012] [Indexed: 12/15/2022]
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Marques IP, Fonseca P, Luz Cachulo M, Pires I, Figueira J, Faria de Abreu J, Silva R. Treatment of Exudative Age-Related Macular Degeneration with Intravitreal Ranibizumab in Clinical Practice: A 3-Year Follow-Up. Ophthalmologica 2013; 229:158-67. [DOI: 10.1159/000343709] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 09/19/2012] [Indexed: 11/19/2022]
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Krüger Falk M, Kemp H, Sørensen TL. Four-year treatment results of neovascular age-related macular degeneration with ranibizumab and causes for discontinuation of treatment. Am J Ophthalmol 2013; 155:89-95.e3. [PMID: 23022167 DOI: 10.1016/j.ajo.2012.06.031] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 06/27/2012] [Accepted: 06/30/2012] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate 4-year treatment results of neovascular age-related macular degeneration with ranibizumab using a variable dosing regimen. DESIGN Retrospective, single-center chart review. METHODS This was a retrospective single-center study that included 855 patients with neovascular age-related macular degeneration receiving treatment with ranibizumab during a 4-year period. Included in the study were patients with a minimum follow-up of 15 months and all patients who terminated treatment regardless of follow-up. RESULTS A total of 1321 patients were treated over the 4-year period, and 855 patients were eligible for inclusion. Of those, 456 patients were still receiving active treatment, whereas 399 patients had discontinued treatment. Overall treatment results showed a significant decrease in vision from 53.2 Early Treatment Diabetic Retinopathy Study letters (range, 1 to 85 letters) to 50.5 letters (range, 1 to 87 letters; P < .001). Mean follow-up was 23.3 months (range, 4 to 48 months). The reason for discontinuing treatment in 181 patients was no signs of activity, whereas 113 patients were judged to be nontreatable. Thirty-six patients declined further treatment for various reasons. CONCLUSIONS This report shows that when follow-up extends beyond 2 to 3 years, visual acuity does seem to decrease. Our data show that different responder groups can be identified: bad or nonresponders (approximately 15% of all patients) and good responders (approximately 21% of all patients). These 2 groups in general can be identified within the first 2 years of treatment, whereas the third group of regular responders (approximately 64% of all patients) require continuous monitoring and treatment for years.
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Affiliation(s)
- Mads Krüger Falk
- Department of Ophthalmology, Copenhagen University Hospital Roskilde, Roskilde, Denmark.
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RETINAL PIGMENT EPITHELIAL ATROPHY IN PATIENTS WITH EXUDATIVE AGE-RELATED MACULAR DEGENERATION UNDERGOING ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY. Retina 2013; 33:13-22. [DOI: 10.1097/iae.0b013e3182657fff] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Which visual acuity measurements define high-quality care for patients with neovascular age-related macular degeneration treated with ranibizumab? Eye (Lond) 2012; 27:56-64. [PMID: 23174752 DOI: 10.1038/eye.2012.225] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The purpose of this study is to define which visual acuity (VA) measurements are the best indicators of high-quality care for patients receiving intravitreal ranibizumab for neovascular age-related macular degeneration (nAMD). METHODS Analysis of prospectively collected data recorded within an electronic medical record system on treatment-naive, first-eligible eyes with nAMD, treated with ranibizumab using an as-needed treatment regimen with a minimum follow-up of 1 year. Data collection included the following: age, gender, laterality, type of nAMD, VA, central 1 mm OCT retinal thickness, number of intravitreal injections, and number of follow-up assessments. RESULTS Data were available on the first-treated eye from 406 patients with at least 1 year follow-up; of these, 198 had data at 2 years. The mean baseline VA of 54.4 Early Treatment Diabetic Retinopathy Study letters improved to 58.5 letters at 12 months and to 56.8 letters at 24 months. The mean VA changes from baseline to 1 year were +6.5, +7.5, +1.7, and -1.5 letters, respectively, for baseline VA categories of 23-35, 36-55, 56-70, and >70 letters. Change in mean VA from the end of the loading phase to year 1 ranged from -2.9 to +1.4 letters for the different baseline VA categories. The mean number of injections were similar across baseline VA categories ranging from 5.7 to 6.0 injections in year 1 and from 3.3 to 3.8 in year 2. CONCLUSIONS This large, real-world series demonstrates that mean change in VA is largely a function of selection criteria and baseline VA. The quality of a service is therefore better judged by actual VA outcomes and maintenance of vision after the loading phase.
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Hessellund A, Larsen DA, Bek T. The predictive value of subjective symptoms and clinical signs for the presence of treatment-requiring exudative age-related macular degeneration. Acta Ophthalmol 2012; 90:471-5. [PMID: 21232080 DOI: 10.1111/j.1755-3768.2010.02074.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The introduction of vascular endothelial growth factor inhibitors for the treatment of exudative age-related macular degeneration (AMD) has increased the referral rates of AMD patients with visual symptoms to treating centres considerably. However, a large proportion of the referred patients do not qualify for treatment implying that considerable resources could be saved if these patients could be identified on the basis of the clinical data available in the referring nonspecialized setting. METHODS A prospective observational study of 1682 consecutive patients referred with suspicion of exudative AMD qualifying for intravitreal angiostatic treatment. On the basis of the structured interviewing about symptoms, ophthalmoscopy, optical coherence tomography scanning, and fluorescein angiography, the patients were divided into two groups: one qualifying for and another not qualifying for treatment. Multiple logistic regression was used to identify independent parameters predicting the need for treatment. RESULTS The presence of metamorphopsia, dyschromatopsia, retinal haemorrhages and exudates, central retinal thickness, and the absence of micropsia were highly significant individual determinants of treatment-requiring AMD. Sudden onset and worsening of symptoms and the presence of a central dark spot covaried with the occurrence of retinal haemorrhages, whereas reduced visual acuity and blurred vision covaried with the presence of both haemorrhages and exudates. CONCLUSION Patients with treatment-requiring AMD can be reliably identified by questioning about the presence of metamorphopsia and dyschromatopsia and the absence of micropsia, combined with ophthalmoscopical detection of retinal haemorrhages and exudates. This information may improve the triage of patients considered for referral.
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Affiliation(s)
- Anders Hessellund
- Department of Ophthalmology, Århus University Hospital, Århus C, Denmark
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COMBINED FLUORESCEIN ANGIOGRAPHY AND SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY IMAGING OF CLASSIC CHOROIDAL NEOVASCULARIZATION SECONDARY TO AGE-RELATED MACULAR DEGENERATION BEFORE AND AFTER INTRAVITREAL RANIBIZUMAB INJECTIONS. Retina 2012; 32:1069-76. [DOI: 10.1097/iae.0b013e318240a529] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Effectiveness at 1 year of monthly versus variable-dosing intravitreal ranibizumab in the treatment of choroidal neovascularization secondary to age-related macular degeneration. Retina 2012; 32:293-8. [PMID: 21926941 DOI: 10.1097/iae.0b013e31821e20b0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate the visual acuity results of monthly ranibizumab injections compared with a variable-dosing schedule for the treatment of neovascular age-related macular degeneration. METHODS A retrospective study that compared two cohorts of consecutive patients. All patients were treatment naive, with baseline visual acuity of 20/400 or better, and completed 12 months of therapy. In the first group all patients received monthly injections. In the other group, after 3 monthly loading doses, a variable-dosing schedule was used, based on a monthly clinical assessment and optical coherence tomography. RESULTS Fifty-six consecutive patients (60 eyes) were included. At 12 months the median number of injections were 12 and 8, respectively, and the mean change in Snellen visual acuity was an improvement of 0.27 logarithm of the minimum angle of resolution in the monthly treated group versus 0.21 logarithm of the minimum angle of resolution improvement in the variable-dosing group (P = 0.53). In the monthly treated group 96.8% of eyes lost <0.3 logarithm of the minimum angle of resolution versus 96.6% of eyes in the variable-dosing group (P = 1.0). CONCLUSION We were able to show that in our clinical setting patients achieved similar visual acuity results with either monthly injections or with a variable-dosing protocol. There was a trend toward better results with monthly treatment.
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Regatieri CV, Branchini L, Duker JS. The role of spectral-domain OCT in the diagnosis and management of neovascular age-related macular degeneration. Ophthalmic Surg Lasers Imaging Retina 2012; 42 Suppl:S56-66. [PMID: 21790112 DOI: 10.3928/15428877-20110627-05] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 04/11/2011] [Indexed: 02/05/2023]
Abstract
Spectral-domain optical coherence tomography (SD-OCT) has emerged as the ancillary examination of choice to assist the diagnosis and management of neovascular age-related macular degeneration (AMD). SD-OCT provides more detailed images of intraretinal, subretinal, and subretinal pigment epithelium fluid when compared to time-domain technology, leading to higher and earlier detection rates of neovascular AMD activity. Improvements in image analysis and acquisition speed make it important for decision-making in the diagnosis and treatment of this disease. However, this new technology needs to be validated for its role in the improvement of visual outcomes in the context of anti-angiogenic therapy.
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Affiliation(s)
- Caio V Regatieri
- New England Eye Center, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
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One-year outcomes using ranibizumab for neovascular age-related macular degeneration: results of a prospective and retrospective observational multicentre study. J Ophthalmol 2011; 2011:405724. [PMID: 22174994 PMCID: PMC3228303 DOI: 10.1155/2011/405724] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 09/07/2011] [Indexed: 11/30/2022] Open
Abstract
The Swedish Lucentis Quality Registry is a 12-month, open-label, observational, prospective, and retrospective study of ranibizumab administration for wet AMD. Visual acuity (VA) was measured with Snellen or ETDRS chart in 370 patients (66.8% women; age range 46–93 years). In total, a mean of 4.7 ± 1.6 injections per patient (range 1–10) was given to month 12. Mean VA score was 58.3 ± 12.2 letters before treatment, 63.3 ± 12.5 after 3 injections (Δ4.9 ± 10.1 letters from baseline), and 59.3 ± 16.2 at 12 months (Δ1.0 ± 13.6). VA score from baseline to month 12 was stable in 74.4% of patients, improved by 15 letters/3 lines or more in 14.7%, and decreased by ≥15 letters/3 lines in 10.9% of patients. With a mean of 4.7 ranibizumab injections per patient per year, mean VA was stabilised but not increased. To maintain the initial gain seen after the first three injections, an average of 1.8 ± 1.5 additional injections does not appear to be adequate.
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Tran THC, Querques G, Forzy G, Souied EH. Angiographic Regression Patterns After Intravitreal Ranibizumab Injections for Neovascular Age-Related Macular Degeneration. Ophthalmic Surg Lasers Imaging Retina 2011; 42:498-508. [DOI: 10.3928/15428877-20110804-04] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 06/03/2011] [Indexed: 11/20/2022]
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