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Airody A, Baseler HA, Seymour J, Allgar V, Mukherjee R, Downey L, Dhar-Munshi S, Mahmood S, Balaskas K, Empeslidis T, Hanson RLW, Dorey T, Szczerbicki T, Sivaprasad S, Gale RP. Treatment of age-related macular degeneration with aflibercept using a treat, extend and fixed protocol; A 4-year study of treatment outcomes, durability, safety and quality of life (An extension to the MATE randomised controlled trial). Acta Ophthalmol 2024; 102:e328-e338. [PMID: 37776074 DOI: 10.1111/aos.15774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 07/05/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE Data are limited pertaining to the long-term benefits of aflibercept treatment for neovascular age-related macular degeneration (nAMD). The aim of this study was to provide outcomes, safety, durability and quality-of-life data with aflibercept using a modified treat, extend and fixed regime over 4 years. METHODS Prospective, multicentre, single cohort observational study of treatment-naïve nAMD participants treated with aflibercept as 2-year extension of the MATE-trial that compared early and late Treat-and-Extend for 2 years. Refracted ETDRS best corrected visual acuity (BCVA), central retinal thickness (CRT), treatment interval and adverse events were assessed. Quality-of-life was measured using the Macular Disease Dependent Quality of Life (MacDQoL) and Macular Disease Treatment Satisfaction Questionnaires (MacTSQ). RESULTS Twenty-six of 40 participants completing the MATE-trial were enrolled with 20 completing the total 4-year study. Mean BCVA was 60.7 at Month 0 and 64.8 ETDRS letters at Month 48 while CRT decreased from 423.7 μm to 292.2 μm. Five participants discontinued treatment due to inactivity. The mean number of treatments and visits for the remaining participants was 27 and 30.0, respectively, with treatment intervals extended to 12 weeks in four participants at Month 48. Both AMD-specific QoL and treatment satisfaction remained stable between Months 0 and 48 and mean BCVA significantly correlated with AMD-specific QoL scores at Months 12, 24 and 48. CONCLUSIONS Results suggest that BCVA can be maintained over 48 months when following a treat-extend-and-fix regimen of aflibercept with intervals out to 12 weeks, while maintaining AMD-specific QoL and treatment satisfaction.
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Affiliation(s)
- Archana Airody
- Academic Unit of Ophthalmology, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
- Hull York Medical School, University of York, York, UK
| | - Heidi A Baseler
- Hull York Medical School, University of York, York, UK
- Department of Psychology, University of York, York, UK
| | - Julie Seymour
- Hull York Medical School, University of Hull, Hull, UK
| | - Victoria Allgar
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | | | | | - Sushma Dhar-Munshi
- Kings Mill Hospital, Sherwood Forest Hospitals NHS Foundation Trust, Sutton-in-Ashfield, UK
| | | | - Konstantinos Balaskas
- University of Manchester, Manchester, UK
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Theo Empeslidis
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Rachel L W Hanson
- Academic Unit of Ophthalmology, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
- Hull York Medical School, University of York, York, UK
| | - Tracey Dorey
- Academic Unit of Ophthalmology, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - Tom Szczerbicki
- Academic Unit of Ophthalmology, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Richard P Gale
- Academic Unit of Ophthalmology, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
- Hull York Medical School, University of York, York, UK
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Csincsik L, Muldrew KA, Bettiol A, Wright DM, Rosenfeld PJ, Waheed NK, Empeslidis T, De Cock E, Yamaguchi TCN, Hogg RE, Peto T, Chakravarthy U. The Double Layer Sign Is Highly Predictive of Progression to Exudation in Age-Related Macular Degeneration. Ophthalmol Retina 2024; 8:234-245. [PMID: 37839548 DOI: 10.1016/j.oret.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE The presences of a double layer sign (DLS) and a shallow irregular retinal pigment epithelium (RPE) elevation (SIRE) were investigated using spectral domain-OCT (SD-OCT) imaging to determine their ability to predict progression to exudative macular neovascularization (eMNV) in the unaffected fellow eyes (study eye) of participants with age-related macular degeneration (AMD) with newly diagnosed unilateral eMNV. DESIGN Retrospective, reanalysis of SD-OCT scans of study eyes from the Early Detection of Neovascular AMD (EDNA) study with 3 years follow-up (FU). PARTICIPANTS The EDNA study repository of SD-OCT scans was assessed for inclusion. Cases with incomplete data sets, low quality scans, or exhibiting other pathology were excluded, which resulted in 459 eligible cases. METHODS Spectral domain-OCT volume scans of study eyes were graded for irregular elevation of the RPE (IE), with length, and height measurements made on the most affected B-scan. Eyes with heterogeneous reflectivity within the IE were classified as exhibiting the DLS. Eyes with DLS where the length of separation between RPE and Bruch's membrane was ≥ 1000 μm in length and < 100 μm in height were subclassified as SIRE. MAIN OUTCOME MEASURES Hazard of progression to eMNV for DLS and SIRE. RESULTS Of the 459 eyes, 268 had IE, of which 101 were DLS-like and 51 also fulfilled criteria for SIRE. Over the 3 years FU period, 104 (23%) eyes progressed to eMNV. After an FU of 18 months, a significantly higher proportion of study eyes (P < 0.001) with IE, DLS, and SIRE developed eMNV compared with those without these features (IE: 17% vs. no IE 6.3%; DLS: 23% vs. no DLS 9.9%; SIRE: 22% vs. no SIRE 11%). In the adjusted Cox regression models, a significantly greater hazard of progression (P < 0.001) was associated with the presence of IE (adjusted hazard ratio [HR], 3.01; 95% confidence interval [CI], 1.88-4.82), DLS (adjusted HR, 3.41; 95% CI, 2.26-5.14), or SIRE (adjusted HR, 2.83; 95% CI, 1.68-4.75). CONCLUSION The DLS is a highly sensitive predictor of progression to eMNV, and the use of SIRE does not improve predictability. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Lajos Csincsik
- Centre for Public Health, Faculty of Medicine and Health Sciences, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Katherine A Muldrew
- Centre for Public Health, Faculty of Medicine and Health Sciences, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - David M Wright
- Centre for Public Health, Faculty of Medicine and Health Sciences, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Philip J Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Nadia K Waheed
- The Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts
| | - Theo Empeslidis
- Therapeutic Area CNS, Retinopathies & EA Retinopathies Medicine, Boehringer Ingelheim International GmbH, Germany
| | - Eduard De Cock
- Therapeutic Area CNS, Retinopathies & EA Retinopathies Medicine, Boehringer Ingelheim International GmbH, Germany
| | - Taffeta Ching Ning Yamaguchi
- Therapeutic Area CNS, Retinopathies & EA Retinopathies Medicine, Boehringer Ingelheim International GmbH, Germany
| | - Ruth E Hogg
- Centre for Public Health, Faculty of Medicine and Health Sciences, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Tunde Peto
- Centre for Public Health, Faculty of Medicine and Health Sciences, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Usha Chakravarthy
- Centre for Public Health, Faculty of Medicine and Health Sciences, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
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Chandra S, Tan EY, Empeslidis T, Sivaprasad S. Tyrosine Kinase Inhibitors and their role in treating neovascular age-related macular degeneration and diabetic macular oedema. Eye (Lond) 2023; 37:3725-3733. [PMID: 37286867 PMCID: PMC10697959 DOI: 10.1038/s41433-023-02610-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/02/2023] [Accepted: 05/26/2023] [Indexed: 06/09/2023] Open
Abstract
The advent of intravitreal anti-VEGF injections has revolutionised the treatment of both neovascular age-related macular degeneration (nAMD or wet AMD) and diabetic macular oedema (DMO). Despite their efficacy, anti-VEGF injections precipitate significant treatment burden for patients, caregivers and healthcare systems due to the high frequency of injections required to sustain treatment benefit. Therefore, there remains an unmet need for lower-burden therapies. Tyrosine kinase inhibitors (TKI) are a novel class of drugs that may have considerable potential in addressing this issue. This review will summarise and discuss the results of various pilot studies and clinical trials exploring the role of TKIs in treatment of nAMD and DMO, highlighting promising candidates and possible challenges in developments.
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Affiliation(s)
- Shruti Chandra
- National Institute of Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK
- University College London, Institute of Ophthalmology, London, EC1V 9EL, UK
| | - Emanuel Yuquan Tan
- National Institute of Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK
- Queen Mary University of London, Faculty of Medicine and Dentistry, Bethnal Green, London, E1 4NS, UK
| | | | - Sobha Sivaprasad
- National Institute of Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK.
- University College London, Institute of Ophthalmology, London, EC1V 9EL, UK.
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Airody A, Baseler HA, Seymour J, Allgar V, Mukherjee R, Downey L, Dhar-Munshi S, Mahmood S, Balaskas K, Empeslidis T, Hanson RLW, Dorey T, Szczerbicki T, Sivaprasad S, Gale RP. The MATE trial: a multicentre, mixed-methodology, pilot, randomised controlled trial in neovascular age-related macular degeneration. Pilot Feasibility Stud 2023; 9:63. [PMID: 37081576 PMCID: PMC10116669 DOI: 10.1186/s40814-023-01288-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 03/30/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND/OBJECTIVES In healthcare research investigating complex interventions, gaps in understanding of processes can be filled by using qualitative methods alongside a quantitative approach. The aim of this mixed-methods pilot trial was to provide feasibility evidence comparing two treatment regimens for neovascular age-related macular degeneration (nAMD) to inform a future large-scale randomised controlled trial (RCT). SUBJECTS/METHODS Forty-four treatment-naïve nAMD patients were followed over 24 months and randomised to one of two treatment regimens: standard care (SC) or treat and extend (T&E). The primary objective evaluated feasibility of the MATE trial via evaluations of screening logs for recruitment rates, nonparticipation and screen fails, whilst qualitative in-depth interviews with key study staff evaluated the recruitment phase and running of the trial. The secondary objective assessed changes in visual acuity and central retinal thickness (CRT) between the two treatment arms. RESULTS The overall recruitment rate was 3.07 participants per month with a 40.8% non-participation rate, 18.51% screen-failure rate and 15% withdrawal/non-completion rate. Key themes in the recruitment phase included human factors, protocol-related issues, recruitment processes and challenges. Both treatment regimens showed a trend towards a visual acuity gain at month 12 which was not maintained at month 24, whilst CRT reduced similarly in both regimens over the same time period. These were achieved with one less treatment following a T&E regimen. CONCLUSION This mixed-methodology, pilot RCT achieved its pre-defined recruitment, nonparticipation and screen failure rates, thus deeming it a success. With some minor protocol amendments, progression to a large-scale RCT will be achievable.
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Affiliation(s)
- Archana Airody
- Academic Unit of Ophthalmology, York & Scarborough Teaching Hospitals NHS Foundation Trust, York, YO31 8HE, UK.
| | - Heidi A Baseler
- Department of Psychology, University of York, York, UK
- Hull York Medical School, University of York, York, UK
| | - Julie Seymour
- Hull York Medical School, University of Hull, Hull, UK
| | - Victoria Allgar
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | | | | | - Sushma Dhar-Munshi
- Kings Mill Hospital, Sherwood Forest Hospitals NHS Foundation Trust, Sutton-in-Ashfield, UK
| | | | - Konstantinos Balaskas
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Theo Empeslidis
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Rachel L W Hanson
- Academic Unit of Ophthalmology, York & Scarborough Teaching Hospitals NHS Foundation Trust, York, YO31 8HE, UK
| | - Tracey Dorey
- Research and Development, York & Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - Tom Szczerbicki
- Research and Development, York & Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Richard P Gale
- Academic Unit of Ophthalmology, York & Scarborough Teaching Hospitals NHS Foundation Trust, York, YO31 8HE, UK
- Hull York Medical School, University of York, York, UK
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Foss A, Rotsos T, Empeslidis T, Chong V. The Development of Macular Atrophy in Patients with Wet Age-Related Macular Degeneration Receiving Anti-VEGF Treatment. Ophthalmologica 2021; 245:204-217. [PMID: 34695835 DOI: 10.1159/000520171] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/08/2021] [Indexed: 11/19/2022]
Abstract
Age-related macular degeneration (AMD) is a leading cause of blindness. Late AMD can be classified into exudative (commonly known as wet AMD [wAMD]) or dry AMD, both of which may progress to macular atrophy (MA). MA causes irreversible vision loss and currently has no approved pharmacological treatment. The standard of care for wAMD is treatment with anti-vascular endothelial growth factors (VEGF). However, recent evidence suggests that anti-VEGF treatment may play a role in the development of MA. Therefore, it is important to identify risk factors for the development of MA in patients with wAMD. For example, excessive blockade of VEGF through intense use of anti-VEGF agents may accelerate the development of MA. Patients with type III macular neovascularisation (retinal angiomatous proliferation) have a particularly high risk of MA. These patients are characterised as having a pre-existing thin choroid (age-related choroidopathy), suggesting that the choroidal circulation is unable to respond to increased VEGF expression. Evidence suggests that subretinal fluid (possibly indicative of residual VEGF activity) may play a protective role. Patients receiving anti-VEGF agents must be assessed for overall risk of MA and there is an unmet medical need to prevent the development of MA without undertreating wAMD.
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Affiliation(s)
- Alexander Foss
- University of Nottingham Medical School, Queen's Medical Centre, Nottingham, United Kingdom
| | - Tryfon Rotsos
- Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Theo Empeslidis
- Boehringer Ingelheim International GmbH, Ingelheim Am Rhein, Germany
| | - Victor Chong
- Boehringer Ingelheim International GmbH, Ingelheim Am Rhein, Germany
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Empeslidis T, Tsaousis KT, Katopodis P, Tyradellis S. Patient's satisfactory outcomes after implementation of follow-up 'virtual clinics' in age-related macular degeneration treatment. Clin Exp Optom 2021; 105:94-95. [PMID: 33689648 DOI: 10.1080/08164622.2021.1878841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Theo Empeslidis
- Ophthalmology Department, Medical Retina, Leicester Royal Infirmary, Leicester, UK,
| | | | - Periklis Katopodis
- Ophthalmology Department, Medical Retina, Leicester Royal Infirmary, Leicester, UK,
| | - Straton Tyradellis
- Ophthalmology Department, Medical Retina, Leicester Royal Infirmary, Leicester, UK,
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Foss A, Haydock R, Childs M, Duley LM, Empeslidis T, Dhar-Munshi S, Montgomery AA, Ogollah R, Ozolins M, Tesha P, Mitchell E. TANDEM TRIAL: a factorial randomised controlled trial of dose and review schedule of bevacizumab (Avastin) for neovascular macular degeneration in the East Midlands. BMJ Open Ophthalmol 2020; 5:e000588. [PMID: 33344775 PMCID: PMC7725082 DOI: 10.1136/bmjophth-2020-000588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 11/26/2022] Open
Abstract
Objective Neovascular age-related macular degeneration (nAMD) causes damage to the macula and severe vision loss. Bevacizumab is the most cost-effective nAMD treatment. The TANDEM trial was designed to determine whether, in patients with nAMD, low-dose bevacizumab is non-inferior to the standard dose in terms of visual deterioration and whether a bimonthly regimen is non-inferior to monthly, treatment as required, regimens. Methods This was a multicentre, 2×2 factorial, double-masked, non-inferiority randomised trial with patients considered eligible if they met the National Institute for Health and Care Excellence criteria for nAMD treatment with ranibizumab. Participants were randomly assigned to standard (1.25 mg) or low (0.625 mg) dose bevacizumab and either monthly or bimonthly review regimen. The primary outcome was time to vision deterioration, defined as reduction of ≥15 letters (three lines) during the loading phase (visual acuity scores at visits B and C compared with the initial visit A), or ≥6 letters (one line) during the maintenance phase (visual acuity scores at subsequent visits compared with mean vision at visits A–C). Results In total 812 participants (918 eyes) were randomised into the trial. The low dose showed some evidence of being non-inferior to standard dose (HR 1.07; 95% CI 0.80 to 1.42), however, there was no strong evidence of bimonthly review being non-inferior to monthly review (HR 1.45; 95% CI 1.09 to 1.94). There was no difference in visual acuity when assessed at 9 months and no major differences in the frequency of serious adverse events or reactions between the groups. Conclusion The standard dose of bevacizumab can be halved without compromising efficacy. Bimonthly review cannot be considered to be no worse than monthly review.
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Affiliation(s)
- Alexander Foss
- Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Rebecca Haydock
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Margaret Childs
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Lelia M Duley
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Theo Empeslidis
- Department of Ophthalmology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sushma Dhar-Munshi
- Department of Ophthalmology, Kings Mill Hospital, Sherwood Forest Hospitals NHS Foundation Trust, Sutton-In-Ashfield, Nottinghamshire, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Reuben Ogollah
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Mara Ozolins
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Paul Tesha
- Department of Ophthalmology, Lincoln County Hospital, United Lincolnshire Hospitals NHS Trust, Lincoln, Lincolnshire, UK
| | - Eleanor Mitchell
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, Nottinghamshire, UK
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Tsaousis KT, Nassr M, Kapoor B, Konidaris VE, Tyradellis S, Empeslidis T. Long-term results of intravitreal bevacizumab and dexamethasone for the treatment of punctate inner choroidopathy associated with choroidal neovascularization: A case series. SAGE Open Med Case Rep 2018; 6:2050313X18772478. [PMID: 29760922 PMCID: PMC5946604 DOI: 10.1177/2050313x18772478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/29/2018] [Indexed: 11/16/2022] Open
Abstract
Introduction To present a case series of three female patients with punctate inner choroidopathy. We report the outcomes after an essentially long follow-up period of up to 14 years and provide evidence of the effectiveness of intravitreal injections of bevacizumab and dexamethasone 0.7 mg in punctate inner choroidopathy patients with choroidal neovascular membrane formation. Case series presentation This is a retrospective case series of three female patients with punctate inner choroidopathy who were treated with intravitreal injections anti-vascular endothelial growth factor agent (bevacizumab, 1.25 mg/0.05 mL). Two patients also received intravitreal dexamethasone 0.7 mg. Once a choroidal neovascular membrane developed, the outcome was poor with a best-corrected visual acuity of 6/60 or counting fingers in the affected eyes. The patients were followed up for 5, 14 and 8 years. Conclusion The use of dexamethasone 0.7 mg in punctate inner choroidopathy yielded encouraging results and long periods of stability. When choroidal neovascular membrane complicates the primary disease, the prognosis is unfavourable, especially if the macula integrity has already been considerably affected. On the contrary, aggressive early therapy and continued monthly monitoring can prevent severe fibrosis, as showed in previous reports. Further larger-scale studies are needed to evaluate the efficacy of intravitreal dexamethasone 0.7 mg and bevacizumab as an alternative treatment in non-infectious uveitis.
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Affiliation(s)
| | - Mohamed Nassr
- Medical Retina, Ophthalmology Department, Leicester Royal Infirmary, Leicester, UK
| | - Bharat Kapoor
- Medical Retina, Ophthalmology Department, Leicester Royal Infirmary, Leicester, UK
| | | | - Straton Tyradellis
- Medical Retina, Ophthalmology Department, Leicester Royal Infirmary, Leicester, UK
| | - Theo Empeslidis
- Medical Retina, Ophthalmology Department, Leicester Royal Infirmary, Leicester, UK
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Tsaousis KT, de la Mata G, Burgula S, Empeslidis T. Comment on «One-year outcomes of the treat-and-extend approach with aflibercept in age-related macular degeneration: Effects on typical choroidal neovascularization and retinal angiomatous proliferation». ACTA ACUST UNITED AC 2018; 93:e29-e30. [PMID: 29402496 DOI: 10.1016/j.oftal.2017.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 11/28/2022]
Affiliation(s)
- K T Tsaousis
- Servicio de Oftalmología, Leicester Royal Infirmary, Leicester, Reino Unido.
| | - G de la Mata
- Servicio de Oftalmología, Leicester Royal Infirmary, Leicester, Reino Unido
| | - S Burgula
- Servicio de Oftalmología, Leicester Royal Infirmary, Leicester, Reino Unido
| | - T Empeslidis
- Servicio de Oftalmología, Leicester Royal Infirmary, Leicester, Reino Unido
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Konidaris VE, Tsaousis KT, Al-Hubeshy Z, Pieri K, Deane J, Empeslidis T. Clinical real-world results of switching treatment from ranibizumab to aflibercept in patients with diabetic macular oedema. Eye (Lond) 2017. [PMID: 28622326 DOI: 10.1038/eye.2017.122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- V E Konidaris
- Ophthalmology Department, Leicester Royal Infirmary, Leicester, UK
| | - K T Tsaousis
- Ophthalmology Department, Leicester Royal Infirmary, Leicester, UK
| | - Z Al-Hubeshy
- Ophthalmology Department, Leicester Royal Infirmary, Leicester, UK
| | - K Pieri
- Ophthalmology Department, Leicester Royal Infirmary, Leicester, UK
| | - J Deane
- Ophthalmology Department, Leicester Royal Infirmary, Leicester, UK
| | - T Empeslidis
- Ophthalmology Department, Leicester Royal Infirmary, Leicester, UK
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Konidaris V, Gorgoli K, Burgula S, Deane J, Banerjee S, Empeslidis T. Treatment outcome of switching from ranibizumab to aflibercept in patients with central retinal vein occlusion. Acta Ophthalmol 2016. [DOI: 10.1111/j.1755-3768.2016.0316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Foss AJE, Childs M, Reeves BC, Empeslidis T, Tesha P, Dhar-Munshi S, Mughal S, Culliford L, Rogers CA, Tan W, Montgomery A. Comparing different dosing regimens of bevacizumab in the treatment of neovascular macular degeneration: study protocol for a randomised controlled trial. Trials 2015; 16:85. [PMID: 25873213 PMCID: PMC4376508 DOI: 10.1186/s13063-015-0608-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 02/16/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Bevacizumab (Avastin®) is as effective as ranibizumab (Lucentis®) in the treatment of neovascular age-related macular degeneration (nAMD). However it has two important structural differences. First, it has two active sites instead of one; second, it retains the Fc portion of the antibody which would be expected to confer a significantly longer half-life. These agents have been associated with systemic complications including strokes, so it is desirable to use the smallest effective dose. Furthermore, the standard dosing regimen requires monthly hospital visits, which present a significant challenge both to the hospital services and to the patients (who are elderly). METHODS/DESIGN Patients ≥50 years who are eligible for anti-vascular endothelial growth factor (VEGF) treatment of nAMD in the NHS, who are either newly referred for treatment or have reactivation of nAMD and who have not received treatment to either eye for the previous six months. We have designed a factorial multi-centre masked randomised controlled trial using bevacizumab as the intervention, with patients randomised to one of four arms: to standard or low dose and to monthly or two-monthly patient review. The aim is to recruit sufficient patients (around 1,000) to obtain 304 patients meeting the endpoint over a four-year period. The primary endpoint is time to treatment failure to be analysed using Cox regression. DISCUSSION This randomised control trial will show if half dose and two monthly as required is as effective as full dose and monthly regimes. A two monthly as required regimen of Bevacizumab would significantly reduce both the cost and the service delivery burden for the treatment of nAMD while a reduced dose would be expected to enhance the safety profile of this treatment regime. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number: ISRCTN95654194 , registered on 22 September 2009.
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Affiliation(s)
- Alexander J E Foss
- Department of Ophthalmology, Queen's Medical Centre, Middleton Boulevard, Nottingham, NG7 2UH, England.
| | - Margaret Childs
- Nottingham Clinical Trials Unit, Queen's Medical Centre, C-Floor, South Block, Nottingham, NG7 2UH, England.
| | - Barnaby C Reeves
- Clinical Trials and Evaluation Unit, University of Bristol, Bristol Royal Infirmary, Level 7, Bristol, BS2 8HW, England.
| | - Theo Empeslidis
- Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, England.
| | - Paul Tesha
- Lincoln County Hospital, Greetwell Road, Lincoln, LN2 5QY, England.
| | - Sushma Dhar-Munshi
- Department of Ophthalmology, Kings Mill Hospital, Mansfield Road, Sutton-in-Ashfield, NG17 4JL, England.
| | - Samah Mughal
- Nottingham Clinical Trials Unit, Queen's Medical Centre, C-Floor, South Block, Nottingham, NG7 2UH, England.
| | - Lucy Culliford
- Clinical Trials and Evaluation Unit, University of Bristol, Bristol Royal Infirmary, Level 7, Bristol, BS2 8HW, England.
| | - Chris A Rogers
- Clinical Trials and Evaluation Unit, University of Bristol, Bristol Royal Infirmary, Level 7, Bristol, BS2 8HW, England.
| | - Wei Tan
- Nottingham Clinical Trials Unit, Queen's Medical Centre, C-Floor, South Block, Nottingham, NG7 2UH, England.
| | - Alan Montgomery
- Nottingham Clinical Trials Unit, Queen's Medical Centre, C-Floor, South Block, Nottingham, NG7 2UH, England.
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Empeslidis T, Tsaousis KT, Konidaris V, Pradeep A, Deane J. Multifocal chorioretinitis caused by Bartonella henselae: imaging findings of spectral domain optical coherence tomography during treatment with trimethoprim-sulfamethoxazole. Eye (Lond) 2014; 28:907-9. [PMID: 24763244 DOI: 10.1038/eye.2014.86] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- T Empeslidis
- Ophthalmology Department, Medical Retina, Leicester Royal Infirmary, Leicester, UK
| | - K T Tsaousis
- Ophthalmology Department, Medical Retina, Leicester Royal Infirmary, Leicester, UK
| | - V Konidaris
- Ophthalmology Department, Medical Retina, Leicester Royal Infirmary, Leicester, UK
| | - A Pradeep
- Ophthalmology Department, Medical Retina, Leicester Royal Infirmary, Leicester, UK
| | - J Deane
- Ophthalmology Department, Medical Retina, Leicester Royal Infirmary, Leicester, UK
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