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Lee JH, Kim JH. Impact of Prolonged Persisting Subretinal Fluid on the Outcome of Aflibercept Treatment in Neovascular Age-Related Macular Degeneration. J Ocul Pharmacol Ther 2024; 40:136-143. [PMID: 38489060 DOI: 10.1089/jop.2023.0124] [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] [Indexed: 03/17/2024] Open
Abstract
Purpose: To evaluate the effect of prolonged residual subretinal fluid (SRF) on the outcomes of aflibercept treatment in neovascular age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). Methods: This retrospective study included patients diagnosed with neovascular AMD or PCV who presented with fovea-involving residual SRF that persisted for a minimum of 6 months while undergoing aflibercept treatment. Changes in best-corrected visual acuity (BCVA) during persistent SRF were evaluated. The factors associated with the risk of visual deterioration during this period were also investigated. Results: In total, 135 patients were included in this study. During this period, the duration of the presence of residual SRF was 17.1 ± 10.3 months and mean injection interval was 2.6 ± 0.7 months. The mean BCVA was changed from 0.30 ± 0.23(Snellen equivalents, 20/39) to 0.36 ± 0.28 (20/45). In 18 (13.3%) patients, ≥2 lines of visual deterioration was noted. The duration of persisting SRF (P = 0.008) and mean height of SRF (P = 0.005) were significantly associated with a high risk of visual deterioration. Among the 80 patients with mean SRF height <100 μm, ≥2 lines of visual deterioration were noted in 4 (5.0%) patients. Among 41 patients with the mean SRF height ≥100 μm and <200 μm and 14 patients with the mean SRF height ≥200 μm, the visual deterioration was noted in 8 (19.5%) and 6 (42.9%) patients, respectively. Conclusions: In cases of neovascular AMD or PCV in which SRF persists without complete resolution during treatment, minimizing the duration of persistent SRF and mean height of SRF is recommended to mitigate the risk of visual deterioration. ClinicalTrials.gov Identifiers: NCT05662943 (https://clinicaltrials.gov/study/NCT05662943?cond=type%201%20macular%20neovascularization&rank=2).
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Affiliation(s)
- Ji Hyun Lee
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, South Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, South Korea
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2
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Labriola LT, Vangipuram G, Zarnegar A, Tsipursky M, Besecker J, Almasov A, Garwood KC, Blinder KJ. Use of Adjunctive Corticosteroid With Antivascular Endothelial Growth Factor Agents in the Treatment of Choroidal Neovascular Membrane Associated With Presumed Ocular Histoplasmosis. J Vitreoretin Dis 2023; 7:510-520. [PMID: 37974925 PMCID: PMC10649456 DOI: 10.1177/24741264231201778] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Purpose: To evaluate the impact of combination treatment of antivascular endothelial growth factor (anti-VEGF) intravitreal injections and corticosteroids in patients with choroidal neovascularization (CNV) secondary to presumed ocular histoplasmosis syndrome (POHS). Methods: A retrospective multicenter study was conducted in a cohort from Illinois and Missouri. Patients were identified over an 8-year period, and data were evaluated over a 1-year study window commencing with treatment initiation. Group 1 included patients treated with intravitreal injections of anti-VEGF, and group 2 included those who received intravitreal injections of anti-VEGF and adjuvant corticosteroids. Optical coherence tomography (OCT) measurements and increases in Early Treatment Diabetic Retinopathy Study (ETDRS) letter score were compared between each group. Results: Using the method of last visit carried forward, the visual acuity (VA) in group 2 was 6.42 ETDRS letters better than the VA in group 1 at the final assessment. Patients in group 2 had a mean ETDRS letter gain of 21.50 (P = .06) from the initial baseline vision. The average amount of decrease in OCT central subfield thickness compared with baseline was lower in group 1 (80.9 ± 129.8 µm) vs group 2 (102.8 ± 90.40 µm) at the 1-year follow-up visit (P = .25). Conclusions: Approved treatment of CNV secondary to POHS is limited. Adjuvant corticosteroid treatment in patients with CNV secondary to POHS may provide better long-term vision and OCT outcomes than anti-VEGF alone and may offer an additional therapy option for these patients.
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Affiliation(s)
- Leanne T. Labriola
- Southwest Pennsylvania Eye Center Washington, PA, USA
- Sewickley Eye Group, Sewickley, PA, USA
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Wu F, Mukai S. Refractory Choroidal Neovascularization in a Patient With Pseudoxanthoma Elasticum and Cowden Syndrome. J Vitreoretin Dis 2023; 7:70-73. [PMID: 37008396 PMCID: PMC9954156 DOI: 10.1177/24741264221117013] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To describe a patient with concurrent pseudoxanthoma elasticum (PXE) and Cowden syndrome who developed choroidal neovascularization (CNV) secondary to angioid streaks. The CNV presented at a young age and was relatively refractory to intravitreal antivascular endothelial growth factor (anti-VEGF) therapy. Methods A retrospective chart review was performed. Results A 32-year-old man was treated for bilateral sequential CNV over 11 years. Good visual acuity was maintained with 53 anti-VEGF injections in the right eye and 82 injections in the left eye. On average, 1 injection was administered every 1.7 months in each eye to control the exudation. A skin biopsy and genetic testing confirmed a diagnosis of PXE. He was also found to harbor a PTEN mutation consistent with Cowden syndrome. Conclusions The concurrent PTEN mutation lends a possible explanation for the relative resistance of CNV to anti-VEGF therapy in this patient with PXE. Phosphatase and tensin homolog is a tumor suppressor that negatively regulates the VEGF pathway.
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Affiliation(s)
- Frances Wu
- Retina Service, Massachusetts Eye and Ear,
Boston, MA, USA
- Department of Ophthalmology, Harvard Medical
School, Boston, MA, USA
| | - Shizuo Mukai
- Retina Service, Massachusetts Eye and Ear,
Boston, MA, USA
- Department of Ophthalmology, Harvard Medical
School, Boston, MA, USA
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4
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Karesvuo P, Elbaz U, Achiron A, Hecht I, Kaarniranta K, Tuuminen R. Effect of cataract surgery on wet age-related macular degeneration activity. Acta Ophthalmol 2022; 100:e262-e269. [PMID: 33838002 DOI: 10.1111/aos.14864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/23/2020] [Revised: 03/01/2021] [Accepted: 03/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Wet age-related macular degeneration (AMD) and age-related cataract are often coexisting causes of visual impairment. Yet, the timing of cataract surgery in wet AMD patients is controversial. METHODS One hundred and eleven eyes of 111 patients with wet AMD underwent cataract surgery at Helsinki University Hospital in Finland during 2014-2018. Best-corrected visual acuity and central subfield macular thickness (CSMT) were analysed at the time of wet AMD diagnosis, at the last recording prior to cataract surgery and at the first recording and at 1 year after surgery. The cumulative number of antivascular endothelial growth factor (anti-VEGF) injections at surgery, systemic and topical medication and postoperative anti-VEGF burden were recorded. RESULTS Mean age was 78.9 ± 5.6 years at the time of surgery. Central subfield macular thickness (CSMT) significantly decreased (280.1 ± 75.0 µm preoperatively to 268.6 ± 67.6 µm at the first postoperative recording, p = 0.001, and to 265.9 ± 67.9 µm at 1 year, p = 0.003), visual acuity improved (0.70 ± 0.46 logMAR units preoperatively to 0.39 ± 0.40 at the first postoperative recording, and to 0.33 ± 0.34 at 1 year, p < 0.001 for both) and anti-VEGF treatment intervals lengthened despite the surgery (6.53 ± 2.08 weeks prior to surgery to 7.03 ± 2.23 weeks at 1 year, p = 0.246, and to 7.05 ± 2.57 weeks at the last documented visit, p = 0.035). A CSMT increase of over 30% from the preoperative values was seen in only one case (1 out of 111 eyes, 0.9%). Macular status at surgery, wet AMD subtype, comorbidity of type II diabetes, systemic drugs and topical anti-inflammatory medication were not associated with macular changes nor with treatment intervals after surgery. The cumulative number of anti-VEGF injections correlated neither with CSMT change postoperatively (r = -0.051, p = 0.619) nor with CSMT change at 1 year (r = 0.091, p = 0.426). CONCLUSION Satisfactory visual outcomes and controlled disease activity were seen in patients with wet AMD undergoing cataract surgery. We found no evidence to support delaying surgery in patients who require it.
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Affiliation(s)
- Petteri Karesvuo
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology Helsinki University Hospital Helsinki Finland
| | - Uri Elbaz
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
- Department of Ophthalmology Rabin Medical Center Petach‐Tikva, Tel Aviv Israel
| | - Asaf Achiron
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
- Department of Ophthalmology Wolfson Medical Center Holon Israel
- Bristol Eye Hospital Bristol UK
| | - Idan Hecht
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
- Department of Ophthalmology Shamir Medical Center Tel Aviv Israel
| | - Kai Kaarniranta
- Department of Ophthalmology University of Eastern Finland Kuopio Finland
- Department of Ophthalmology Kuopio University Hospital Kuopio Finland
| | - Raimo Tuuminen
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology Kymenlaakso Central Hospital Kotka Finland
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Kodjikian L, Baillif S, Couturier A, Creuzot-Garcher C, Delyfer MN, Matonti F, Weber M. Recommendations for the management of diabetic macular oedema with intravitreal dexamethasone implant: A national Delphi consensus study. Eur J Ophthalmol 2021; 32:2845-2856. [PMID: 34779302 DOI: 10.1177/11206721211052852] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE The intravitreal dexamethasone implant (DEX-I) is an alternative to anti-VEGF for the first-line treatment of diabetic macular oedema (DME). However, several questions remain regarding its routine use and its place in certain situations not always specified in current recommendations. A national consensus approach was, therefore, initiated by French retinal experts. METHODS An iterative Delphi consensus approach was used. A steering committee (SC) of seven experts analysed data from the literature to formulate statements divided into five key areas of treatment. These statements were submitted to the independent and anonymous electronic vote of 87 French retina experts among whom 39 expressed their opinion and therefore constituted the voting panel. RESULTS After two rounds of voting, 22 and 7 of 38 statements received a strong consensus and a good consensus, respectively. The consensus level was higher for statements regarding first-line indications and safety of DEX-I compared to those regarding efficacy assessment, reprocessing time or pathophysiological biomarkers. The panellists recommended the preferential use of DEX-I for patients with limited availability for multiple injections, those who needed to undergo cataract surgery or who had a recent cardiovascular history, and as a therapeutic alternative to anti-VEGF in patients with a history of vitrectomy, retinal serous detachment, hyper-reflective points or dry exudates in optical coherence tomography (OCT). However, some statements proposed by SC experts were not validated. CONCLUSION This study provides some key recommendations to clinicians treating diabetic macular oedema, which may be useful when using intravitreal dexamethasone implants in daily practice.
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Affiliation(s)
- Laurent Kodjikian
- 386696Hospital La Croix-Rousse Ophthalmology, Lyon, Rhône-Alpes, France
| | - Stephanie Baillif
- Department of Ophthalmology, 37045Centre Hospitalier Universitaire de Nice, Nice, France
| | - Aude Couturier
- Department of Ophthalmology, 378772Hospital Lariboisière, Paris, Île-de-France, France
| | | | | | - Frédéric Matonti
- Centre Monticelli Paradis, Marseille, France.,Aix Marseille University, Marseille, France
| | - Michel Weber
- 26922University Hospital Centre Nantes, Nantes, Pays de la Loire, France
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Mitchell P, Holz FG, Hykin P, Midena E, Souied E, Allmeier H, Lambrou G, Schmelter T, Wolf S. EFFICACY AND SAFETY OF INTRAVITREAL AFLIBERCEPT USING A TREAT-AND-EXTEND REGIMEN FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: The ARIES Study: A Randomized Clinical Trial. Retina 2021; 41:1911-1920. [PMID: 33782365 PMCID: PMC8384251 DOI: 10.1097/iae.0000000000003128] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND/PURPOSE Treating neovascular age-related macular degeneration with intravitreal aflibercept treat-and-extend (T&E) can reduce treatment burden. ARIES assessed whether intravitreal aflibercept early-start T&E was noninferior to late-start T&E. METHODS A randomized, open-label, Phase 3b/4 study that included treatment-naïve patients aged ≥50 years with the best-corrected visual acuity 73-25 Early Treatment Diabetic Retinopathy Study letters and active choroidal neovascularization secondary to AMD. Patients received 2 mg intravitreal aflibercept at Week (W) 0, W4, W8, and W16. At W16, patients were randomized 1:1 to early-start (2W interval adjustments) or late-start T&E (8W intervals until W48 then 2W interval adjustments). Primary endpoint: the best-corrected visual acuity change from randomization to W104. RESULTS Two-hundred seventy-one patients were randomized. The mean (SD) best-corrected visual acuity at baseline was 60.2 (12.1; early-T&E) and 61.3 (10.8; late-T&E) letters. The mean (SD) best-corrected visual acuity change (W16-104) was -2.1 (11.4) versus -0.4 (8.4) letters (early-T&E vs. late-T&E; least-squares mean difference: -2.0; 95% confidence interval: -4.75 to 0.71; P = 0.0162 for noninferior); +4.3 (13.4) versus +7.9 (11.9) letters (W0-104). The mean (SD) number of injections was 12.0 (2.3) versus 13.0 (1.8). From baseline to W104, 93.4% and 96.2% maintained best-corrected visual acuity; the mean (SD) central retinal thickness change was -161.6 (135.6) µm and -158.6 (125.1) µm. The last injection interval (W104) was ≥12W for 47.2% and 51.9% of patients. CONCLUSION Outcomes were similar between patients with neovascular age-related macular degeneration treated with an intravitreal aflibercept early-T&E or late-T&E regimen after initial dosing, with one injection difference over 2 years. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02581891 https://clinicaltrials.gov/ct2/show/NCT02581891. Supplemental Digital Contents (files 1 http://links.lww.com/IAE/B419).
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Affiliation(s)
- Paul Mitchell
- Department of Ophthalmology, Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Frank G. Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Edoardo Midena
- Department of Ophthalmology, University of Padova, Padova, Italy
| | - Eric Souied
- Department d'Ophtalmologie, Hôpital Intercommunal de Creteil, Creteil, France
| | - Helmut Allmeier
- Bayer Consumer Care, AG, Pharmaceuticals, Basel, Switzerland
| | - George Lambrou
- Bayer Consumer Care, AG, Pharmaceuticals, Basel, Switzerland
| | | | - Sebastian Wolf
- Department for Ophthalmology, Inselspital, University Hospital, University of Bern, Bern, Switzerland
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Li C, Li J, Chen X, Lu P. Laser-induced choroidal neovascularization: A case report and some reflection on animal models for age-related macular degeneration. Medicine (Baltimore) 2021; 100:e26239. [PMID: 34115011 PMCID: PMC8202587 DOI: 10.1097/md.0000000000026239] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/19/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Laser induced maculopathy includes retinal photoreceptor disruption, macular hole, macular hemorrhage, and rarely choroidal neovascularization (CNV). Here we report a case of laser induced CNV that was treated by intravitreal anti-vascular endothelial growth factor (VEGF) injection and resulted in visual improvement and CNV resolution during 1-year follow up. In addition, the case of laser induced CNV treated with intravitreal anti-VEGF injections are reviewed for the first time in literature. PATIENT CONCERNS A 7-year-old boy presented to our department with blurred vision in his right eye for 2 months. The symptom immediately happened after the boy staring at the laser beam for a few seconds. Examination of ocular fundus with slit lamp showed yellowish lesion in macula in his right eye. DIAGNOSES CNV was confirmed by fundus examinations, including color fundus photograph, spectral domain optical coherence tomography, fluorescein angiography, and spectral domain optical coherence tomography angiography. INTERVENTIONS After the diagnosis of laser induced CNV, intravitreal ranibizumab (LUCENTIS, NOVARTIS) injection was performed. OUTCOMES After 1 injection of intravitreal ranibizumab, the best corrected visual acuity improved from 20/50 to 30/50 and CNV gradually regressed during 1-year follow up. LESSONS For young patients with laser induced CNV, intravitreal anti-VEGF injections may be helpful in visual improvement and CNV regression. Moreover, age seems to be a significant factor thus we propose that old animals may be more appropriate for laser induced CNV animal models of age-related macular degeneration.
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Affiliation(s)
- Caixin Li
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University
| | - Jianqing Li
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University
| | - Xinzhu Chen
- Department of Ophthalmology, Suzhou EENT Hospital, Suzhou, Jiangsu Province, China
| | - Peirong Lu
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University
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Jakubiak P, Alvarez-Sánchez R, Fueth M, Broders O, Kettenberger H, Stubenrauch K, Caruso A. Ocular Pharmacokinetics of Intravitreally Injected Protein Therapeutics: Comparison among Standard-of-Care Formats. Mol Pharm 2021; 18:2208-2217. [PMID: 34014104 DOI: 10.1021/acs.molpharmaceut.0c01218] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The current standard of care for antivascular endothelial growth factor (VEGF) treatment requires frequent intravitreal (IVT) injections of protein therapeutics, as a result of limited retention within the eye. A thorough understanding of the determinants of ocular pharmacokinetics (PK) and its translation across species is an essential prerequisite for developing more durable treatments. In this work, we studied the ocular PK in macaques of the protein formats that comprise today's anti-VEGF standard of care. Cynomolgus monkeys received a single IVT injection of a single-chain variable fragment (scFv, brolucizumab), antigen-binding fragment (Fab, ranibizumab), fragment crystallizable-fusion protein (Fc-fusion, aflibercept), or immunoglobulin G monoclonal antibody (IgG, VA2 CrossMAb). Drug concentrations were determined in aqueous humor samples collected up to 42 days postinjection using immunoassay methods. The ocular half-life (t1/2) was 2.28, 2.62, 3.13, and 3.26 days for scFv, Fab, Fc-fusion, and IgG, respectively. A correlation with human t1/2 values from the literature confirmed the translational significance of the cynomolgus monkey as an animal model for ocular research. The relation between ocular t1/2 and molecular size was also investigated. Size was inferred from the molecular weight (MW) or determined experimentally by dynamic light scattering. The MW and hydrodynamic radius were found to be good predictors for the ocular t1/2 of globular proteins. The analysis showed that molecular size is a determinant of ocular disposition and may be used in lieu of dedicated PK studies in animals.
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Affiliation(s)
- Paulina Jakubiak
- Roche Pharma Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, CH-4070 Basel, Switzerland
| | - Rubén Alvarez-Sánchez
- Roche Pharma Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, CH-4070 Basel, Switzerland
| | - Matthias Fueth
- Roche Pharma Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, CH-4070 Basel, Switzerland
| | - Olaf Broders
- Roche Pharma Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Munich, F. Hoffmann-La Roche Ltd., Nonnenwald 2, D-82377 Penzberg, Germany
| | - Hubert Kettenberger
- Roche Pharma Research and Early Development, Large Molecule Research, Roche Innovation Center Munich, F. Hoffmann-La Roche Ltd., Nonnenwald 2, D-82377 Penzberg, Germany
| | - Kay Stubenrauch
- Roche Pharma Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Munich, F. Hoffmann-La Roche Ltd., Nonnenwald 2, D-82377 Penzberg, Germany
| | - Antonello Caruso
- Roche Pharma Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, CH-4070 Basel, Switzerland
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Pitcher JD, Moshfeghi AA, Lucas G, Boucher N, Moini H, Saroj N. Evaluation of Patients Receiving Intravitreal Antivascular Endothelial Growth Factor for Diabetic Macular Edema in Clinical Practice in the United States. J Vitreoretin Dis 2021; 5:108-113. [PMID: 37009083 PMCID: PMC9979048 DOI: 10.1177/2474126420953067] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose We assessed the effect of treatment frequency with intravitreal antivascular endothelial growth factor (anti-VEGF) agents on visual acuity (VA) in diabetic macular edema (DME). Methods This retrospective analysis assessed electronic medical records of eyes newly diagnosed with DME and treated with an anti-VEGF agent at US clinics using the Vestrum Health (Naperville, Illinois) treatment and outcomes database. Eyes were divided into 2 injection frequency subcohorts (≤ 6 vs > 6 injections/y); treatment frequency and change in mean VA (Early Treatment Diabetic Retinopathy Study letters) were evaluated. Results Among 155 240 eyes assessed, 3028 met inclusion criteria for analysis in year 1 and 1292 in year 2. During year 1 of treatment, 57% (n = 1725) received > 6 injections; most continued to receive the same injection frequency during year 2. Mean VA gain from baseline at year 1 was lower in the ≤ 6 than in the > 6 injections/year subcohort (3.7 vs 8.0 letters, respectively; P < .001). Mean VA change from the end of year 1 to year 2 for eyes receiving ≤ 6 injections in year 1 generally remained unchanged, irrespective of year 2 dosing frequency. In eyes that received > 6 injections in year 1, mean VA loss was significantly greater for eyes receiving less-frequent dosing in year 2 than in those maintained on > 6 injections. Conclusions More than 50% of eyes with DME in routine clinical practice that completed at least 1 year of follow-up received > 6 injections of an anti-VEGF agent during the first year, resulting in better VA gains than eyes treated less frequently.
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Affiliation(s)
- John D. Pitcher
- Eye Associates of New Mexico, Albuquerque, NM, USA
- Department of Ophthalmology, University of New Mexico, Albuquerque,
NM, USA
| | - Andrew A. Moshfeghi
- Roski Eye Institute, University of
Southern California Department of Ophthalmology, Keck School of Medicine, Los Angeles, CA, USA
| | | | | | - Hadi Moini
- Regeneron Pharmaceuticals, Inc, Tarrytown, NY, USA
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Singh SR, Parikh R, Sakurada Y, Uplanchiwar B, Mansour A, Goud A, Modi YS, Chhablani J. Ziv-aflibercept and bevacizumab for exudative age-related macular degeneration: A retrospective comparison of clinical outcomes and cost at 1 year. Taiwan J Ophthalmol 2021; 10:289-293. [PMID: 33437603 PMCID: PMC7787097 DOI: 10.4103/tjo.tjo_3_20] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/17/2019] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The purpose of this study was to compare intravitreal ziv-aflibercept (IVZ) monotherapy to intravitreal bevacizumab (IVB) monotherapy in patients with exudative age-related macular degeneration (eAMD). MATERIALS AND METHODS Patients with treatment-naïve eAMD treated with pro re nata (PRN) monotherapy of IVZ (1.25 mg/0.05 ml) or IVB (1.25 mg/0.05 ml) with a minimum follow-up of 12 months were retrospectively analyzed. Study outcomes included change in best-corrected visual acuity (BCVA), central macular thickness, mean number of injections, and total medication cost in both the groups at 12 months. RESULTS Forty-seven eyes (IVZ, 18/47 [38.3%] and IVB, 29/47 [61.7%]) from 47 treatment-naive patients were included. The change in BCVA for patients receiving IVZ was from 0.61 ± 0.33 logarithm of the minimum angle of resolution (Snellen 20/81; range: 20/38-20/174) to 0.45 ± 0.31 (Snellen 20/56; range: 20/27-20/115) at 1 year (P = 0.02). The total number of injections needed to achieve the resolution of intraretinal or subretinal fluid was 2.6 ± 1.4 and 3.5 ± 1.3 for IVZ and IVB, respectively (P = 0.029). Direct medication cost of IVZ and IVB in our cohort on PRN basis was an average of US$78 (2.6 × US$30) and US$175 (3.5 × US$50), respectively, through 1 year. CONCLUSION IVZ-PRN monotherapy resulted in improved visual acuity, reduced treatment burden, and reduced direct medication cost in comparison to IVB-PRN monotherapy through 1 year.
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Affiliation(s)
- Sumit Randhir Singh
- Smt Kanuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Ravi Parikh
- Vitreous Retina Macula Consultants of New York, New York, USA.,Lu Esther T. Mertz Retinal Research Center New York, NY, USA.,Retina Service, Massachusetts Eye and Ear/Harvard Medical School, Department of Ophthalmology, Boston, MA, USA
| | - Yoichi Sakurada
- Vitreous Retina Macula Consultants of New York, New York, USA.,Lu Esther T. Mertz Retinal Research Center New York, NY, USA.,Retina Service, Massachusetts Eye and Ear/Harvard Medical School, Department of Ophthalmology, Boston, MA, USA.,Department of Ophthalmology, Faculty of Medicine, Yamanashi University, Yamanashi, Japan
| | - Bhushan Uplanchiwar
- Smt Kanuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Ahmad Mansour
- Department of Ophthalmology, Rafic Hariri Medical University Beirut, Lebanon
| | - Abhilash Goud
- Smt Kanuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Yasha S Modi
- Department of Ophthalmology, New York University School of Medicine, New York, USA
| | - Jay Chhablani
- Smt Kanuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India
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Kumar V, Verma S, Azad SV, Chawla R, Bhayana AA, Surve A, Vohra R, Venkatesh P. Dome-shaped macula-Review of literature. Surv Ophthalmol 2021; 66:560-71. [PMID: 33245953 DOI: 10.1016/j.survophthal.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 11/23/2022]
Abstract
Dome-shaped macula is a convex retinochoroidal elevation within the region of a posterior staphyloma seen commonly in high myopia on optical coherence tomography. With growing awareness of the condition facilitated by inclusion of optical coherence tomography in routine retinal practice, coupled with evolution of enhanced depth optical coherence tomography imaging, multiple studies have attempted to shed light on pathogenesis of this complex pathology, its clinical implications, and treatment of associated complications such as serous macular detachment and choroidal neovascularization with variable success. Our review aims to assimilate, scrutinize, and discuss the available literature for a comprehensive insight into dome-shaped macula.
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Kim JH, Kim JW, Kim CG, Lee DW. Decreased Periodicity of Reactivation Interval in Neovascular Age-Related Macular Degeneration in Patients with a Late First Reactivation After Initial Treatment. J Ocul Pharmacol Ther 2020; 36:703-710. [PMID: 32552280 DOI: 10.1089/jop.2019.0158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To evaluate the periodicity of the intervals of lesion reactivation in patients with neovascular age-related macular degeneration (AMD). Methods: This retrospective study included 139 eyes diagnosed with treatment-naive neovascular AMD and treated with antivascular endothelial growth factor (VEGF) therapy. Patients were initially treated with 3 loading anti-VEGF injections using either ranibizumab or aflibercept. Additional treatment was administered only when lesion reactivation was noted. The difference between the time intervals to the first and the second reactivations was evaluated. The included eyes were divided into 2 groups according to the time interval to the first reactivation: the early reactivation group (≤6 months, n = 86) and the late reactivation group (>6 months, n = 53). The association between the time intervals to the first and the second reactivations was evaluated within each group. Results: The mean follow-up period was 52.7 ± 8.9 months. The first reactivation was noted at mean 9.4 ± 10.4 months after the loading injections. The second reactivation was noted at mean 6.2 ± 4.9 months after the treatment for the first reactivation. The time interval to the second reactivation was significantly shorter compared with the first reactivation (P = 0.018). The association between the time interval to the first and the second reactivations was significant only in the early reactivation group (P = 0.002). Conclusions: A short first reactivation interval suggests that there is a high likelihood that the second reactivation will also be short. However, a long first reactivation interval does not suggest that the second reactivation interval will be similarly long.
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Affiliation(s)
- Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Dong Won Lee
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
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Spooner K, Fraser-Bell S, Hong T, Chang A. Patient-reported outcomes from a phase IV study of aflibercept in patients with refractory retinal vein occlusions. Taiwan J Ophthalmol 2020; 11:244-250. [PMID: 34703739 PMCID: PMC8493984 DOI: 10.4103/tjo.tjo_19_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/11/2020] [Accepted: 04/09/2020] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To determine the patient-centered effectiveness of switching patients with persistent macular edema due to retinal vein occlusion (RVO) to aflibercept using the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25). MATERIALS AND METHODS Prospective study of eyes with persistent cystoid macular edema due to RVO despite regular treatment with bevacizumab or ranibizumab switched to aflibercept. Three loading doses of intravitreal aflibercept were administered every 4 weeks and thereafter every 8 weeks until week 48. Vision-related quality of life (VRQoL) using NEI-VFQ-25 was measured at baseline, 24 weeks, and 48 weeks following the switch. Baseline scores were compared to week 24 and 48 using paired t-test. Relationship between best-corrected visual acuity (BCVA) in the study eye and the NEI-VFQ-25 composite and subscale scores was investigated. RESULTS Eighteen patients with RVO were enrolled in the study with a mean age of 70.3 ± 8.6 years. The mean change in BCVA and central macular thickness (CMT) from baseline to 48 weeks was +20.6 ± 5.2 Early Treatment of Diabetic Retinopathy Score letters and -109.2 ± 82.8 µm, respectively. VRQoL improved significantly, with an increase of mean NEI-VFQ composite score of 11.5 ± 9.5; the corresponding improvements in near and distant activities were 13.3 ± 19.4 and 8.4 ± 10.4, respectively (P < 0.001 for both). Logistic regression analysis demonstrated that BCVA gain of >15 letters and CMT < 300 µm at the end of the study predicted a higher change in VFQ-25. CONCLUSION Switching eyes with persistent macular edema due to RVO to aflibercept resulted in significant improvement in visual function and patient satisfaction.
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Affiliation(s)
- Kimberly Spooner
- Sydney Retina, NSW, Australia.,Sydney Institute of Vision Science, NSW, Australia.,University of Sydney, NSW, Australia
| | | | - Thomas Hong
- Sydney Retina, NSW, Australia.,Sydney Institute of Vision Science, NSW, Australia
| | - Andrew Chang
- Sydney Retina, NSW, Australia.,Sydney Institute of Vision Science, NSW, Australia.,University of Sydney, NSW, Australia
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Gao S, Lin Z, Chen Y, Xu J, Zhang Q, Chen J, Shen X. Intravitreal Conbercept Injection as an Adjuvant in Vitrectomy with Silicone Oil Infusion for Severe Proliferative Diabetic Retinopathy. J Ocul Pharmacol Ther 2020; 36:304-310. [PMID: 32186940 DOI: 10.1089/jop.2019.0149] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To assess the clinical effects of preoperative, intraoperative, or preoperative combined with intraoperative intravitreal conbercept (IVC) injection in vitrectomy with silicone oil tamponade for severe proliferative diabetic retinopathy (PDR). Methods: Ninety-eight eyes of 98 severe PDR patients undergoing vitrectomy with silicone oil tamponade were randomly assigned to 3 groups: Group 1 (34 eyes) received IVC injections 3 to 5 days before surgery; Group 2 (35 eyes) received IVC injections at the end of surgery; and Group 3 (29 eyes) received IVC injections 3 to 5 days before and at the end of operation. Follow-up examinations were performed for 6 months. Results: The incidence and severity of intraoperative bleeding were not significantly different (P = 0.233). However, the duration of surgery was significantly shorter in Group 1 and Group 3 compared with Group 2 (P < 0.001). The incidences of early and late recurrent vitreous hemorrhage (VH) were 32.35%, 28.57%, and 13.80%, respectively. At 6-month follow-up, mean best-corrected visual acuity had significantly increased to 1.25 ± 0.45 logMAR in Group 1, 1.29 ± 0.46 logMAR in Group 2, 1.16 ± 0.44 logMAR in Group 3 (all P < 0.001). The incidence of postoperative VH, neovascular glaucoma, and retinal detachment in Group 3 was slightly lower, however, no significant differences were observed (all P > 0.05). In young patients, similar results were observed and Group 3 had better visual improvements (P = 0.037). Conclusions: Preoperative IVC injection could be a safe and effective adjunct in pars plana vitrectomy with silicone oil tamponade for severe PDR. Preoperative combined with intraoperative IVC are promising, especially in young patients.
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Affiliation(s)
- Shuang Gao
- Department of Ophthalmology, Ruijin Hospital Affiliated Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhongjing Lin
- Department of Ophthalmology, Ruijin Hospital Affiliated Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yanwei Chen
- Department of Ophthalmology, Ruijin Hospital Affiliated Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jianmin Xu
- Department of Ophthalmology, Ruijin Hospital Affiliated Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qiong Zhang
- Department of Ophthalmology, Ruijin Hospital Affiliated Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jili Chen
- Department of Ophthalmology, Shibei Hospital of Jingan District, Shanghai, China
| | - Xi Shen
- Department of Ophthalmology, Ruijin Hospital Affiliated Shanghai Jiaotong University School of Medicine, Shanghai, China.,Department of Ophthalmology, Ruijin Hospital, LuWan Branch, Affiliated Shanghai Jiaotong University School of Medicine, Shanghai, China
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15
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Wei Q, Jiang C, Ye X, Huang X, Jin H, Xu G. Vitreous Proteomics Provides New Insights into Antivascular Endothelial Growth Factor Therapy for Pathologic Myopia Choroid Neovascularization. J Interferon Cytokine Res 2019; 39:786-796. [PMID: 31718389 DOI: 10.1089/jir.2019.0030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
This study aimed to investigate the protein expression profile of vitreous humor (VH) from pathologic myopic retinoschisis (PMRS) patients with or without intravitreal antivascular endothelial growth factor (anti-VEGF) therapy. VH samples from PMRS patients were subjected to proteomic analysis. Clinical data, including visual acuity, refractive error, and axial length, were recorded, and the fundus optical coherence tomography was performed. Seven PMRS patients were enrolled: 3 PMRS patients as control group, 3 PMRS patients with coexisting choroidal neovascularization (CNV) who developed retinoschisis aggravation after multiple intravitreal conbercept (IVC) injections, and one PMRS patient with coexisting CNV without leakage CNV (CNV-). A total of 310 differentially expressed proteins were identified in these VH samples. The expression of 28 proteins, related to cellular adhesion, protease inhibitors, proangiogenic factors, and antiangiogenic factors, was significantly downregulated in the IVC-treated eyes than in control- and CNV-eyes. α-smooth muscle actin (α-SMA) expression was significantly upregulated in the IVC-treated eyes. Furthermore, the expression of αA-crystallin and fibrillin-1 was significantly upregulated in both IVC and CNV-eyes than in control eyes. These suggest that multiple IVC injections may increase the VH αSMA concentration, which may contribute to posterior hyaloid membrane or retinal inner limiting membrane contraction. Label-free proteomics is an efficient method to provide further insight into the pathogenesis of vitreoretinal diseases.
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Affiliation(s)
- Qiaoling Wei
- Department of Ophthalmology, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Chen Jiang
- Department of Ophthalmology, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Xiaofeng Ye
- Department of Ophthalmology, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Xin Huang
- Department of Ophthalmology, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Hong Jin
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Gezhi Xu
- Department of Ophthalmology, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
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16
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Eski Yucel O, Birinci H, Sullu Y. Outcome and Predictors for 2-Year Visual Acuity in Eyes with Diabetic Macular Edema Treated with Ranibizumab. J Ocul Pharmacol Ther 2019; 35:229-234. [PMID: 30896316 DOI: 10.1089/jop.2018.0082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose: To determine the role of baseline characteristics in predicting visual outcome in patients with diabetic macular edema (DME) treated with ranibizumab. Methods: A review was carried out of the charts of 97 eyes that received pro re nata (PRN) intravitreal ranibizumab (IR) 0.5 mg treatment for DME. The change in the mean best-corrected visual acuity (BCVA) was analyzed. The baseline demographics and ocular and optic coherence tomography findings were analyzed to determine the association with the 2-year visual acuity (VA). Results: BCVA increased from 0.54 ± 0.2 (0.05-1.0) to 0.41 ± 0.3 (0.0-1.0) log of the minimum angle of resolution (P < 0.001). Age (P = 0.012), gender (P = 0.018), baseline BCVA (P < 0.001), presence of leaking microaneurysms (MA) (P = 0.018), development of vitreomacular traction (VMT) (P = 0.001), development of posterior vitreous detachment (PVD) (P = 0.040), and disruption of ellipsoid zone (EZ) (P = 0.007) were found as predictors of 2-year VA. There was no association between visual outcome and the other characteristics. Conclusions: PRN treatment of IR provides significant benefits in VA gain and anatomic improvement in eyes with DME. Older age, female sex, lower baseline VA, VMT development, and EZ disruption are predictors for the poor final VA. Development of PVD and leaking MA are predictors for the good final VA.
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Affiliation(s)
- Ozlem Eski Yucel
- Department of Ophthalmology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Hakki Birinci
- Department of Ophthalmology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Yuksel Sullu
- Department of Ophthalmology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
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Siempis T, El Abiary M, Patel R, Gupta M. Twenty-four-month real-world visual outcomes of intravitreal aflibercept as monotherapy for the treatment of neovascular age-related macular degeneration. Oman J Ophthalmol 2019; 12:99-103. [PMID: 31198295 PMCID: PMC6561052 DOI: 10.4103/ojo.ojo_24_2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Aflibercept is widely used as a treatment for neovascular age-related macular degeneration (nAMD). Nevertheless, there is no consensus in the optimal injection frequency in the 2nd year of treatment along with little real-world data on visual outcomes. On that basis, the primary aim of this study was to assess the visual acuity (VA) and the total number of injections needed on average for these patients during the 24-month follow-up. MATERIALS AND METHODS This is a retrospective observational study from an electronic medical record of consecutive patients treated with intravitreal aflibercept (both naïve and nonnaïve eyes) who had completed the 24-month follow-up since the commencement of treatment. Patients followed the VIEW protocol in year 1 whereas in year 2, an as required approach/Pro Re Nata (PRN) was used. RESULTS Eighty-seven eyes of 78 patients were analyzed. 43.7% were nonnaive eyes. Baseline VA for all eyes (logMAR) was 52.6 letters, improving to 56.2 letters at 12 months and 55 at 24 months. Almost 83.9% of the treated eyes (81.3% of the patients) did not experience any significant visual loss receiving on average of 9.9 injections in the 24 months of follow-up and attending the hospital eye service 20.3 times in total. CONCLUSIONS Aflibercept as monotherapy for the treatment of nAMD is associated with good 2 nd year outcomes in a real-world setting using the PRN approach in year 2 and fewer injections comparing to the clinical studies, but a higher proportion of follow-up visits compared to the treat and extend regimen.
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Affiliation(s)
- Thomas Siempis
- Department of Ophthalmology, Tennent Institute of Ophthalmology, Glasgow, Scotland, UK
| | - Mariam El Abiary
- Department of Ophthalmology, Tennent Institute of Ophthalmology, Glasgow, Scotland, UK
| | - Radhika Patel
- Department of Ophthalmology, Tennent Institute of Ophthalmology, Glasgow, Scotland, UK
| | - Manish Gupta
- Department of Ophthalmology, Tennent Institute of Ophthalmology, Glasgow, Scotland, UK
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18
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Mottet B, Aptel F, Geiser MH, Hera R, Zhou T, Almanjoumi A, Vinh V, Chiquet C. Choroidal blood flow after the first intravitreal ranibizumab injection in neovascular age-related macular degeneration patients. Acta Ophthalmol 2018; 96:e783-e788. [PMID: 30203609 DOI: 10.1111/aos.13763] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 01/29/2017] [Accepted: 02/15/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE To analyse choroidal blood flow (ChBF) changes after the first intravitreal ranibizumab injection in naïve, age-related macular degeneration (ARMD) patients. METHODS Subfoveal ChBF was assessed by laser Doppler flowmetry (LDF) in newly diagnosed ARMD patients. Both treated and untreated eyes were assessed in each subject at each visit before the first intravitreal ranibizumab injection as well as 24 hr (day 1) and 7 days after (day 7). Central macular thickness (CMT), best-corrected visual acuity (BVCA), systemic haemodynamic parameters and LDF parameters were evaluated at each visit. Nonparametric tests were used to compare data between visits and between treated and untreated eyes. RESULTS Seventeen ARMD patients were included (12 women and five men, 78 ± 8 years old). At day 7 postintravitreal ranibizumab injection, the normalized choroidal blood velocity (ChBVel) change in the treated eye group was significant (-10.2%; p = 0.006). The choroidal blood volume (ChBVol) did not change significantly after intravitreal injection of ranibizumab. There was a trend for a reduction in ChBF at day 7 (-9.1%, p = 0.08). The sensitivity of the experiment was 12% for ChBVel, 16% for ChBVol and 9% for ChBF. CONCLUSION In conclusion, the laser Doppler technique provides feasible and noninvasive measurements of blood flow parameters before and after intravitreal injection of antivascular endothelial growth factor (anti-VEGF) in patients with exudative ARMD. Choroidal blood velocity decreased as early as 7 days after intravitreal ranibizumab injection, suggesting a vasoconstriction effect of anti-VEGF in large choroidal vessels in front of choriocapillaris (the site of LDF measurement).
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Affiliation(s)
- Benjamin Mottet
- Grenoble Alpes University; Grenoble France
- Department of Ophthalmology; University Hospital; CHU Grenoble-Alpes; Grenoble France
| | - Florent Aptel
- Grenoble Alpes University; Grenoble France
- Department of Ophthalmology; University Hospital; CHU Grenoble-Alpes; Grenoble France
- INSERM U1042; Lab Hypoxia and Physiopathology; Grenoble-Alpes University; Grenoble France
| | | | - Ruxandra Hera
- Department of Ophthalmology; University Hospital; CHU Grenoble-Alpes; Grenoble France
| | - Thierry Zhou
- Grenoble Alpes University; Grenoble France
- Department of Ophthalmology; University Hospital; CHU Grenoble-Alpes; Grenoble France
| | - Ahmed Almanjoumi
- Department of Ophthalmology; University Hospital; CHU Grenoble-Alpes; Grenoble France
| | - Viviane Vinh
- Department of Ophthalmology; University Hospital; CHU Grenoble-Alpes; Grenoble France
| | - Christophe Chiquet
- Department of Ophthalmology; University Hospital; CHU Grenoble-Alpes; Grenoble France
- INSERM U1042; Lab Hypoxia and Physiopathology; Grenoble-Alpes University; Grenoble France
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Huang ST, Tian BS, Xiao O, Yang YJ, Zhou SY. Safety of antivascular endothelial growth factor administration in the ocular anterior segment in pterygium and neovascular glaucoma treatment: Systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e11960. [PMID: 30142821 PMCID: PMC6112962 DOI: 10.1097/md.0000000000011960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Anti-VEGF agents has been widely used in ocular diseases, but its safety for treating anterior segment disorders, the conclusions are controversial. METHODS Several major databases, including CENTRAL, MEDLINE, and EMBASE, were searched. Safety data from 18 randomized controlled trials (RCTs) were used to compare anti-VEGF treatment in the ocular anterior segment in pterygium and neovascular glaucoma treatment with placebo/sham treatment for eye diseases. A meta-analysis for adverse events was performed. RESULTS Eighteen RCT studies with 955 eyes were included in the meta-analysis. Significant difference in conjunctival disorders (OR: 1.62; 95% CI, 1.01-2.59; P = .05) was noted among the included studies, but not in ocular intolerance (odds ratio [OR]: 0.75; 95% CI, 0.34-1.62; P = .46), corneal disorders (OR: 0.71; 95% CI, 0.37-1.37; P = .31), or the subgroup analysis of conjunctival disorders. CONCLUSIONS The administration of anti-VEGF agents in the ocular anterior segment for patients with pterygium and glaucoma was tolerable in tolerance and cornea, but was the risk factor of conjunctival disorders. The healing of corneal epithelium may be delayed in patients with primary corneal epithelial defects after anti-VEGF application. However, due to the limited evidence, further research should be performed on the safety of anti-VEGF administration in patients with different corneal disorders.
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Miotto S, Zemella N, Gusson E, Panozzo G, Saviano S, Scarpa G, Boschi G, Piermarocchi S. Morphologic Criteria of Lesion Activity in Neovascular Age-Related Macular Degeneration: A Consensus Article. J Ocul Pharmacol Ther 2017; 34:298-308. [PMID: 29148864 PMCID: PMC5899278 DOI: 10.1089/jop.2017.0022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Indexed: 11/13/2022] Open
Abstract
Intravitreal antivascular endothelial growth factor drugs represent the current standard of care for neovascular age-related macular degeneration (nAMD). Individualized treatment regimens aim at obtaining the same visual benefits of monthly injections with a reduced number of injections and follow-up visits, and, consequently, of treatment burden. The target of these strategies is to timely recognize lesion recurrence, even before visual deterioration. Early detection of lesion activity is critical to ensure that clinical outcomes are not compromised by inappropriate delays in treatment, but questions remain on how to effectively monitor the choroidal neovascularization (CNV) activity. To assess the persistence/recurrence of lesion activity in patients undergoing treatment for nAMD, an expert panel developed a decision algorithm based on the morphological features of CNV. After evaluating all current retinal imaging techniques, the panel identified optical coherent tomography as the most reliable tool to ascertain lesion activity when funduscopy is not obvious.
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Affiliation(s)
- Stefania Miotto
- 1 Department of Ophthalmology, Camposampiero Hospital, ULSS 6 Euganea , Padua, Italy
| | - Nicola Zemella
- 2 Department of Ophthalmology, Mestre Hospital, ULSS 3 Serenissima , Venice, Italy
| | - Elena Gusson
- 3 Department of Ophthalmology, University of Verona , Verona, Italy
| | - Giacomo Panozzo
- 4 Department of Ophthalmology, Bussolengo Hospital, ULSS 9 Scaligera , Verona, Italy
| | - Sandro Saviano
- 5 Department of Ophthalmology, University of Trieste , Trieste, Italy
| | - Giuseppe Scarpa
- 6 Department of Ophthalmology, Ca Foncello Hospital, ULSS 2 Marca Trevigiana , Treviso, Italy
| | - Giorgio Boschi
- 6 Department of Ophthalmology, Ca Foncello Hospital, ULSS 2 Marca Trevigiana , Treviso, Italy
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Clemens CR, Wolf A, Alten F, Milojcic C, Heiduschka P, Eter N. Response of vascular pigment epithelium detachment due to age-related macular degeneration to monthly treatment with ranibizumab: the prospective, multicentre RECOVER study. Acta Ophthalmol 2017; 95:683-689. [PMID: 28084038 DOI: 10.1111/aos.13359] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 04/23/2016] [Accepted: 11/07/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE To assess the effects of monthly intravitreal ranibizumab injections in patients with vascularized pigment epithelium detachment (vPED) secondary to age-related macular degeneration (AMD). METHODS A total of 40 patients were prospectively observed and treated monthly with 0.5 mg ranibizumab injections (ClinicalTrials.gov Ident. NCT00976222). Inclusion criterion was a treatment-naïve vPED lesion with a minimum height of ≥200 μm. Best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) were evaluated at all visits. Fluorescein angiography and indocyanine green angiography were performed at baseline and quarterly. Lesions were differentiated between serous vascular PED (svPED, group A, 29 patients) and fibrovascular PED (fPED, group B, 11 patients). Primary outcome was the effectivity of continuous monthly treatment during a 12-month period as measured in change in BCVA. Secondary outcomes were change in PED height and PED greatest linear diameter (GLD). Further secondary outcomes were the presence of subretinal fluid and prognostic markers of an impending retinal pigment epithelium (RPE) tear: PED lesion height and diameter, ratio of choroidal neovascularization (CNV) size to PED size, hyperreflective lines in near-infrared images, microrips and subretinal cleft. RESULTS Mean BCVA was 56.9 ± 11.5 letters (A: 55.4 ± 10.8; B: 59.1 ± 13.4) at baseline and 55.1 ± 15.9 (A: 53.7 ± 17.0; B: 58.9 ± 12.7) at 12-month follow-up. Excluding the RPE tear patients, the svPED group showed an increase in BCVA from 56.1 ± 10.3 at baseline to 62.4 ± 10.2 at 12-month follow-up (p = 0.048). Best-corrected visual acuity in patient who developed a RPE tear was 55.8 ± 12.5 at baseline and 37.1 ± 14.9 at 12-month follow-up. The mean change in PED height was -242.1 μm ± 285.5 (A: -427.3 μm ± 299.7; B: -51.6 μm ± 99.5). The mean decrease in PED GLD was -471.8 μm ± 727.6 (A: -738.9 μm ± 788.2; B: -10.4 μm ± 185.6). In group A, 10 patients developed a RPE tear (25%) after a mean of 3.6 injections. No tear was documented in group B. Lesion height, ratio of CNV size to PED size and presence of hyperreflective lines differed significantly between patients with and without RPE tear development. CONCLUSION Serous vascular PED lesions showed an improvement regarding BCVA and morphologic characteristics unless an RPE tear occurred. In fPED lesions, a functional and morphological stabilization was observed. Monthly ranibizumab injections are an effective treatment regarding the resorption of subretinal fluid in vPED due to AMD. Patients should be screened for the presence of morphologic risk factors for RPE tear development before and during treatment.
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Affiliation(s)
- Christoph R. Clemens
- Department of Ophthalmology; University of Muenster Medical Center; Muenster Germany
| | - Armin Wolf
- Department of Ophthalmology; University of Munich; Munich Germany
| | - Florian Alten
- Department of Ophthalmology; University of Muenster Medical Center; Muenster Germany
| | | | - Peter Heiduschka
- Department of Ophthalmology; University of Muenster Medical Center; Muenster Germany
| | - Nicole Eter
- Department of Ophthalmology; University of Muenster Medical Center; Muenster Germany
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Bracha P, Moore NA, Ciulla TA, WuDunn D, Cantor LB. The acute and chronic effects of intravitreal anti-vascular endothelial growth factor injections on intraocular pressure: A review. Surv Ophthalmol 2017; 63:281-295. [PMID: 28882597 DOI: 10.1016/j.survophthal.2017.08.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [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: 04/08/2017] [Revised: 08/27/2017] [Accepted: 08/28/2017] [Indexed: 01/18/2023]
Abstract
The acute and chronic effects of repeated intravitreal antivascular endothelial growth factor (VEGF) injections on intraocular pressure have not been fully characterized, and the development of sustained ocular hypertension could adversely affect patients who are at risk of glaucomatous optic neuropathy. As expected, volume-driven, acute ocular hypertension immediately follows intravitreal injection, but this pressure elevation is generally transient and well tolerated. Several medications have been investigated to limit acute ocular hypertension following anti-VEGF therapy, but the benefits of pretreatment are not conclusive. Chronic, sustained ocular hypertension, distinct from the short-term acute ocular hypertension after each injection, has also been associated with repeated intravitreal anti-VEGF injections. Risk factors for chronic ocular hypertension include the total number of injections, a greater frequency of injection, and preexisting glaucoma. Proposed mechanisms for chronic ocular hypertension include microparticle obstruction, toxic or inflammatory effects on trabecular meshwork, as well as alterations in outflow facility by anti-VEGF agents. Although limiting anti-VEGF therapy could minimize the risk of both acute and chronic ocular hypertension, foregoing anti-VEGF therapy risks progression of various macular diseases with resulting permanent central vision loss. While definitive evidence of damage to the retinal nerve fiber layer is lacking, patients receiving repeated injections should be monitored for ocular hypertension and patients in whom sustained ocular hypertension subsequently developed should be periodically monitored for glaucomatous changes with optic nerve optical coherence tomography and static visual fields.
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Affiliation(s)
- Peter Bracha
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA.
| | - Nicholas A Moore
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Thomas A Ciulla
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA; Retina Service, Midwest Eye Institute, Indianapolis, Indiana, USA
| | - Darrell WuDunn
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Louis B Cantor
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Cho HJ, Kim JM, Kim HS, Lee DW, Kim CG, Kim JW. Effect of Epiretinal Membranes on Antivascular Endothelial Growth Factor Treatment for Neovascular Age-Related Macular Degeneration. J Ocul Pharmacol Ther 2017; 33:452-458. [PMID: 28445077 DOI: 10.1089/jop.2016.0178] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To evaluate the effect of epiretinal membranes (ERMs), detected with spectral-domain optical coherence tomography (SD-OCT), on the outcome of antivascular endothelial growth factor (VEGF) treatment for neovascular age-related macular degeneration (nAMD). METHODS A total of 434 eyes with treatment-naive nAMD were retrospectively included and analyzed. All patients were administered an initial series of 3 monthly loading injections of ranibizumab or aflibercept, followed by further injections as required. The visual and anatomical outcomes were compared between the eyes with ERMs and those without. Features of ERMs at baseline assessed with SD-OCT were evaluated and correlated with visual outcomes. RESULTS Sixty-eight eyes (15.7%) with nAMD presented ERMs at baseline. The mean best-corrected visual acuity (BCVA) of these eyes, expressed as the logarithm of the minimum angle of resolution, improved from 0.75 ± 0.48 (Snellen equivalent: 20/112) to 0.59 ± 0.44 (20/77) after 12 months of treatment (P = 0.021). Central foveal thickness also decreased from 381 ± 191 μm to 294 ± 167 μm (P < 0.001). Compared to the eyes without ERMs (366 eyes), the eyes with ERMs had a significantly thicker central fovea after treatment (P = 0.020). However, the intergroup differences in BCVA improvement were not significant. No significant association was found between visual outcome after treatment and ERM features on OCT at baseline. CONCLUSIONS In eyes with nAMD, ERMs were infrequent. Central foveal thickness was significantly greater after anti-VEGF treatment in eyes with nAMD and ERMs. However, the presence of ERMs in eyes with nAMD did not affect visual outcome.
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Affiliation(s)
- Han Joo Cho
- Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine , Seoul, South Korea
| | - Jae Min Kim
- Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine , Seoul, South Korea
| | - Hyoung Seok Kim
- Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine , Seoul, South Korea
| | - Dong Won Lee
- Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine , Seoul, South Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine , Seoul, South Korea
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine , Seoul, South Korea
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Kim JH, Chang YS, Lee DW, Kim CG, Kim JW. Incidence and Timing of the First Recurrence in Neovascular Age-Related Macular Degeneration: Comparison Between Ranibizumab and Aflibercept. J Ocul Pharmacol Ther 2017; 33:445-451. [PMID: 28384009 DOI: 10.1089/jop.2016.0098] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To compare the incidence and timing of first recurrence between patients who were treated with ranibizumab and aflibercept in neovascular age-related macular degeneration (AMD). METHODS This retrospective study included 120 patients who received the diagnosis of treatment-naive typical neovascular AMD or polypoidal choroidal vasculopathy (PCV) and were treated using either ranibizumab (n = 73) or aflibercept (n = 47). Recurrence within 10 months of the third injection was compared between the 2 treatment groups. RESULTS In all 120 patients, there was no difference in recurrence between the ranibizumab and the aflibecept groups (P = 0.846). One hundred five patients completed 12 months follow-up. In typical neovascular AMD, disease recurred in 69.6% (16/23) of patients in the ranibizumab group, with a mean period of 4.4 ± 1.8 months after the third injection. In the aflibercept group, the equivalent values were 68.8% (11/16) and 4.5 ± 1.4 months. In PCV, disease recurred in 72.5% (29/40) of patients in the ranibizumab group, with a mean period of 3.8 ± 1.7 months after the third injection. In the aflibercept group, the equivalent values were 69.2% (18/26) and 4.3 ± 2.0 months. CONCLUSIONS Although the incidence of recurrence was slightly higher and the duration between the third injection and the first recurrence was slightly shorter in patients treated using ranibizumab, the differences were not significant. Our results require confirmation in further studies.
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Affiliation(s)
- Jae Hui Kim
- 1 Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine , Seoul, South Korea
| | - Young Suk Chang
- 2 Department of Ophthalmology, Konyang University College of Medicine , Daejeon, South Korea
| | - Dong Won Lee
- 1 Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine , Seoul, South Korea
| | - Chul Gu Kim
- 1 Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine , Seoul, South Korea
| | - Jong Woo Kim
- 1 Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine , Seoul, South Korea
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Abstract
Central retinal vein occlusion (CRVO) can cause vision loss. The pathogenesis of CRVO involves a thrombus formation leading to increased retinal capillary pressure, increased vascular permeability, and possibly retinal neovascularization. Vision loss due to CRVO is commonly caused by macular edema. Multiple treatment modalities have been used to treat macular edema. Currently, the most common therapy used is intravitreal inhibition of vascular endothelial growth factor (VEGF). The three most widely used agents are aflibercept, bevacizumab, and ranibizumab and they are effective at blocking VEGF. In addition, intraocular steroids can be used to treat macular edema. This review will briefly cover the treatment options and discuss in greater detail the efficacy and safety of aflibercept.
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Affiliation(s)
| | - Drew Dickson
- University of Nebraska Medical School, Omaha, Nebraska, USA
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Diana V Do
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
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26
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Wong KH, Lau KP, Chhablani J, Tao Y, Li Q, Wong IY. Central serous chorioretinopathy: what we have learnt so far. Acta Ophthalmol 2016; 94:321-5. [PMID: 26132864 DOI: 10.1111/aos.12779] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [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: 10/05/2014] [Accepted: 05/11/2015] [Indexed: 11/26/2022]
Abstract
Central serous chorioretinopathy (CSCR) is a common retinal cause of visual loss. The mainstays of management are observation, photodynamic therapy (PDT) and laser procedures. Over the past decade, there has been rapid development in the existing and novel imaging techniques, functional testing and management of CSCR. However, there is no convincing treatment designed for CSCR yet. In recent years, the advances in PDT, with various adjustments in fluence and verteporfin dosage, and the comparisons between different types of PDT for acute and chronic CSCR in recent studies have provided greater insights into the role of PDT in treating CSCR. Novel laser procedures, such as the diode micropulse laser, have shown comparable efficacy to conventional lasers without laser-induced damage. Antivascular endothelial growth factor, which was originally developed for treating cancers, has emerged to be a potentially effective treatment for CSCR. The potential role of mineralocorticoid receptor antagonists in treating CSCR has provided greater understanding of the pathogenesis. Based on the relevant studies, mainly from the past decade, we discuss updates to the management of CSCR according to the risk factor modifications, pharmacological interventions, PDT and laser procedures and concluded that PDT is the current best option for CSCR.
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Affiliation(s)
- Kah Hie Wong
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong Hong Kong
| | - Kin Pong Lau
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong Hong Kong
| | - Jay Chhablani
- Smt. Kanuri Santhamma Retina Vitreous Centre; L. V. Prasad Eye Institute; Hyderabad India
| | - Yong Tao
- Department of Ophthalmology; People's Hospital; Peking University and Key Laboratory of Vision Loss and Restoration; Ministry of Education; Beijing China
| | - Qing Li
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong Hong Kong
| | - Ian Y. Wong
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong Hong Kong
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Shirakata Y, Fukuda K, Fujita T, Nakano Y, Nomoto H, Yamaji H, Shiraga F, Tsujikawa A. Pars plana vitrectomy combined with internal limiting membrane peeling for recurrent macular edema due to branch retinal vein occlusion after antivascular endothelial growth factor treatments. Clin Ophthalmol 2016; 10:277-83. [PMID: 26917950 PMCID: PMC4751895 DOI: 10.2147/opth.s85751] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the anatomic and functional outcomes of pars plana vitrectomy combined with internal limiting membrane peeling for recurrent macular edema (ME) due to branch retinal vein occlusion (BRVO) after intravitreal injections of antivascular endothelial growth factor (anti-VEGF) agents. METHODS Twenty-four eyes of 24 patients with treatment-naive ME from BRVO were treated with intravitreal injections of anti-VEGF agents. Recurred ME was treated with pars plana vitrectomy combined with internal limiting membrane peeling. RESULTS After the surgery, ME was significantly reduced at 1 month (P=0.031) and the reduction increased with time (P=0.007 at the final visit). With the reduction in ME, treated eyes showed a slow improvement in visual acuity (VA). At the final visit, improvement in VA was statistically significant compared with baseline (P=0.048). The initial presence of cystoid spaces, serous retinal detachment, or subretinal hemorrhage under the fovea, as well as retinal perfusion status, showed no association with VA improvement. However, the presence of epiretinal membrane showed a significant association with the visual recovery. Although eyes without epiretinal membrane showed visual improvement (-0.10±0.32 in logarithm of the minimum angle of resolution [logMAR]), eyes with epiretinal membrane showed greater visual improvement (-0.38±0.12 in logMAR, P=0.012). CONCLUSION For recurrent ME due to BRVO after anti-VEGF treatment, particularly when accompanied by epiretinal membrane, pars plana vitrectomy combined with internal limiting membrane peeling might be a possible treatment option.
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Affiliation(s)
- Yukari Shirakata
- Department of Ophthalmology, Faculty of Medicine, Kagawa University, Miki-cho, Japan
| | - Kouki Fukuda
- Department of Ophthalmology, Faculty of Medicine, Kagawa University, Miki-cho, Japan
| | - Tomoyoshi Fujita
- Department of Ophthalmology, Faculty of Medicine, Kagawa University, Miki-cho, Japan
| | - Yuki Nakano
- Department of Ophthalmology, Faculty of Medicine, Kagawa University, Miki-cho, Japan
| | | | - Hidetaka Yamaji
- Department of Ophthalmology, Shirai Eye Hospital, Mitoyo, Japan
| | - Fumio Shiraga
- Department of Ophthalmology, Okayama University, Okayama, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology, Faculty of Medicine, Kagawa University, Miki-cho, Japan
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Rezar S, Eibenberger K, Bühl W, Georgopoulos M, Schmidt-Erfurth U, Sacu S. Anti-VEGF treatment in branch retinal vein occlusion: a real-world experience over 4 years. Acta Ophthalmol 2015; 93:719-25. [PMID: 26109209 DOI: 10.1111/aos.12772] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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: 10/27/2014] [Accepted: 04/26/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE To determine long-term outcome of intraocular antagonism of vascular endothelial growth factor (VEGF) in macular oedema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS A total of 28 consecutive patients were treated with either intravitreal bevacizumab (IVB) or intravitreal ranibizumab (IVR) in the first series and were evaluated after a mean follow-up of 5 years for their functional and anatomical outcome. RESULTS Time between onset of macular oedema and initial treatment was 5.2 ± 0.4/0.1 ± 0.1 (IVB/IVR) months. A mean of 4 intravitreal injections were given per patients in the first 6 months. In months 7-12 intravitreal injections decreased to 2 and further decreased in the second year (months 13-18: 1.14; months 19-24: 0.5) and third year (months 25-30: 0.4; months 31-36: 0.2). After the fourth year, only two of the 28 patients received further treatment. Average visual acuity (VA) increased by 16 letters after 1 year (p < 0.01) and although not statistically significantly, by a mean of 5 letters (p = 0.3) at long-term evaluation (IVB-group). However, after mean of 5 years, central retinal sensitivity (CRS) improved by 3.6 dB (p = 0.01) and central retinal thickness (CRT) decreased by 161 μm (p = 0.02). In the IVR-group, VA and CRS increased significantly (31 letters and respectively 4.4 dB, p < 0.001) and CRT decreased by 229 μm (p < 0.001) after long-term follow-up. Final functional results were significantly better in patients with treatment initiation <3 months (79 versus 55 letters, p = 0.01). Microvascular abnormalities were detected in 88% (21 of 24 patients), hyperfluorescence in 42% (10 of 24 patients) on wide-field fluorescein angiography in both groups. CONCLUSIONS Inhibition of VEGF provides substantial long-term benefits for patients with ME secondary to BRVO. Early treatment with anti-VEGF agents and extended therapeutic surveillance was associated with improved visual recovery.
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Affiliation(s)
- Sandra Rezar
- Department of Ophthalmology; Medical University of Vienna; Vienna Austria
| | | | - Wolf Bühl
- Department of Ophthalmology; Medical University of Vienna; Vienna Austria
| | | | | | - Stefan Sacu
- Department of Ophthalmology; Medical University of Vienna; Vienna Austria
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Kasetsuwan N, Reinprayoon U, Satitpitakul V. Prevention of recurrent pterygium with topical bevacizumab 0.05% eye drops: a randomized controlled trial. Clin Ther 2015; 37:2347-51. [PMID: 26409291 DOI: 10.1016/j.clinthera.2015.08.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 03/31/2015] [Revised: 08/17/2015] [Accepted: 08/31/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE We assessed the efficacy and tolerability of topical bevacizumab 0.05% when used as an adjunctive therapy after excision of primary pterygia. METHODS This randomized double-masked study included 22 patients (22 eyes) with primary pterygia who underwent pterygium surgery with the use of the bare sclera technique. After pterygium excision, 22 patients were randomized to receive the topical bevacizumab 0.05% (12 eyes) or the placebo (10 eyes) with the use of the block of four randomization method. Topical bevacizumab and placebo were applied in the respective groups 4 times daily for 3 months. Follow-up evaluations for recurrence by slit-lamp photography were conducted once monthly. Ocular and systemic adverse events were assessed every 2 weeks during the 3 months of treatment. The slit-lamp photographs were masked and analyzed. The primary and secondary outcomes were the differences in the pterygial recurrence rates between the groups and adverse events at 3 months, respectively. Corneal recurrence was defined as recurrent fibrovascular tissue invading the cornea; conjunctival recurrence was defined as either recurrent vessels or fibrous tissue in the excised area without corneal invasion. FINDINGS All 22 patients completed follow-up at 3 months after the start of the trial medications. After 3 months of treatment, 1 patient (8.33%) and 3 patients (30.00%) from the bevacizumab and placebo groups, respectively, had a corneal recurrence. No significant (P = 0.293) differences were found between the groups as determined by Fisher's exact test. However, conjunctival and corneal recurrences were found in 4 (33.33%) and 9 (90.00%) patients, respectively, in the bevacizumab and placebo groups, a difference that reached significance (P = 0.01). No significant adverse events developed. IMPLICATIONS Topical bevacizumab, as an adjunctive treatment after pterygium excision, was well tolerated. The trend for recurrence was lower in the topical bevacizumab group. ClinicalTrials.gov identifier: NCT01311960.
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Affiliation(s)
- Ngamjit Kasetsuwan
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Usanee Reinprayoon
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Vannarut Satitpitakul
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
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Shin JY, Kwon KY, Byeon SH. Association between choroidal thickness and the response to intravitreal ranibizumab injection in age-related macular degeneration. Acta Ophthalmol 2015; 93:524-32. [PMID: 25581639 DOI: 10.1111/aos.12653] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 04/30/2014] [Accepted: 11/24/2014] [Indexed: 01/13/2023]
Abstract
PURPOSE To investigate the relationship between the choroidal thicknesses of eyes of patients with age-related macular degeneration (AMD) and the outcomes of intravitreal ranibizumab injection. METHODS We reviewed the medical records of 141 consecutive eyes (80 with typical neovascular AMD and 61 with polypoidal choroidal vasculopathy [PCV]) treated by intravitreal ranibizumab and 121 normal control eyes matched in terms of age and spherical equivalent (SE). Eyes of patients were divided into three subgroups with thin, medium and thick choroids. We investigated the relationships between choroidal thickness and treatment outcomes of intravitreal ranibizumab. RESULTS In eyes with typical neovascular AMD, thin choroids were associated with older age (linear regression; p < 0.0001) and larger choroidal neovascularization (CNV) lesions (p = 0.049). Patients with thin choroids had a higher prevalence of intra-/subretinal fluid (generalized estimated equation; thin versus medium p < 0.0001; thin versus thick p = 0.003), and less visual gain from baseline to 12 months after treatment, than did other subgroups (linear mixed model; thin versus medium p < 0.0001; thin versus thick p = 0.023). PCV eyes with thick choroids more often had retinal fluid, and eyes with thin choroids experienced more frequent resolution of retinal fluid, from baseline to 12 months after treatment (thick versus medium p < 0.0001, thick versus thin p < 0.0001, thin versus medium p = 0.001). No intergroup difference in post-treatment functional outcome was noted in eyes with PCV (p = 0.584). CONCLUSIONS Subfoveal choroidal thickness was associated with functional and anatomical outcomes after intravitreal ranibizumab injection in eyes with typical neovascular AMD and PCV.
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Affiliation(s)
- Joo Youn Shin
- Department of Ophthalmology; Severance Hospital; Institute of Vision Research; Yonsei University College of Medicine; Seoul Korea
| | - Kye Yoon Kwon
- Department of Ophthalmology; Severance Hospital; Institute of Vision Research; Yonsei University College of Medicine; Seoul Korea
| | - Suk Ho Byeon
- Department of Ophthalmology; Severance Hospital; Institute of Vision Research; Yonsei University College of Medicine; Seoul Korea
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31
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Abstract
We report an unusual case of choroidal neovascularization secondary to intraocular foreign body (IOFB) penetrating trauma. A 44-year-old man was referred to our department for IOFB trauma in the right eye. Vitrectomy and IOFB extraction was performed with good visual results. However, 2 months after surgery, he returned complaining of a drop in visual acuity. Choroidal neovascularization originating from a direct choroidal rupture at the IOFB impact site was observed. The patient was treated with 6-monthly intravitreal injections of antivascular endothelial growth factor, and showed regression of neovascularization and a final visual acuity of 20/80. IOFB trauma is a serious condition, indeed in spite of initially good results after a favorable surgical outcome. Choroidal neovascularization after direct traumatic choroidal rupture is usually aggressive and requires more active antivascular endothelial growth factor therapy.
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Affiliation(s)
| | | | | | | | - Amparo Navea
- Department of Vitreoretinal Diseases, FISABIO Oftalmología Médica, Valencia, Spain
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32
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Shin HJ, Shin KC, Chung H, Kim HC. Change of retinal nerve fiber layer thickness in various retinal diseases treated with multiple intravitreal antivascular endothelial growth factor. Invest Ophthalmol Vis Sci 2014; 55:2403-11. [PMID: 24609624 DOI: 10.1167/iovs.13-13769] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To investigate the effect of multiple intravitreal injection of anti-VEGF on the retinal nerve fiber layer (RNFL) in AMD, diabetes mellitus retinopathy (DMR), and retinal vein occlusion (RVO). METHODS In this retrospective controlled case series, we reviewed the AMD, DMR, and RVO patients who received more than three anti-VEGF injections (injection group: 148 eyes). Patients without treatment were included as a control group (noninjection group: 183 eyes). RNFL thickness was measured by SD-OCT. Also, correlation between RNFL change and associated factors, including intraocular pressure (IOP), injection times, and severity of retinal ischemia, were analyzed using multivariate logistic regression. RESULTS RNFL thickness (μm) had not changed in AMD, but it decreased from 100.0 to 97.1, and from 101.1 to 98.0 in injection groups of DMR and RVO, respectively, as well as the noninjection group. However, decreased RNFL thickness of the injection groups was not significantly different from those of the noninjection groups. Severity of retinal ischemia was associated with decreased RNFL thickness (odds ratio: 4.667). However, number of injections and IOP-related variables had no association with RNFL change. CONCLUSIONS Multiple intravitreal injections of anti-VEGF did not lead to significant change in RNFL thickness in wet AMD, DMR, and RVO patients. Furthermore, IOP fluctuations and number of injections did not appear to adversely affect RNFL thickness. Decreased RNFL thickness associated with severity of retinal ischemia in the DMR and RVO patients suggests that inner retinal ischemia itself could be a cause of RNFL loss rather than anti-VEGF effect.
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Affiliation(s)
- Hyun Jin Shin
- Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
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33
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Lala C, Framme C, Wolf‐Schnurrbusch UEK, Wolf S. Three-year results of visual outcome with disease activity-guided ranibizumab algorithm for the treatment of exudative age-related macular degeneration. Acta Ophthalmol 2013; 91:526-30. [PMID: 22697404 DOI: 10.1111/j.1755-3768.2012.02457.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate 3-year follow-up treatment outcomes with ranibizumab (Lucentis(®)) 0.5 mg administered either monthly or quarterly on a pro re nata (PRN) basis according to a disease activity-guided monitoring and treatment algorithm. METHODS A total of 316 treatment-naive eyes of 316 patients with exudative age-related macular degeneration met the criteria for inclusion in this retrospective, interventional case series. Patients were treated with ranibizumab 0.5 mg according to a disease activity-guided algorithm with monthly monitoring. Optical coherence tomography and fluorescein angiography were routinely used to assess disease activity: active lesions were treated with a series of three monthly injections, whereas inactive lesions were treated with quarterly injections. RESULTS Mean Early Treatment Diabetic Retinopathy Study best-corrected visual acuity improved from 52 letters at baseline to 59 letters at 12 months, achieved with a mean of 7.1 injections, 61 letters at 24 months with a mean of 5.0 injections administered in the second year and 60 letters at 36 months with a mean number of 5.2 injections. CONCLUSIONS Monthly visits and a morphology-driven PRN regimen with 3 injections in case of recurrence plus quarterly injections in case of inactive CNV resulted in an average VA gain of 7-9 letters that could be maintained over 3 years.
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Affiliation(s)
- Ceklic Lala
- Universitätsklinik für Augenheilkunde, University of Bern, Bern, Switzerland
- Clinical Center of Eastern Sarajevo, Eye Clinic ‘Kasindo’, E. Sarajevo, Bosnia and Herzegovina
| | - Carsten Framme
- Universitätsklinik für Augenheilkunde, University of Bern, Bern, Switzerland
| | | | - Sebastian Wolf
- Universitätsklinik für Augenheilkunde, University of Bern, Bern, Switzerland
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34
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Abstract
Treatment for diabetic macular edema (DME) is continuously evolving with the advent of pharmacologic therapies. Focal laser photocoagulation remains the historical standard of care; however, a new wave of studies is rapidly emerging that shows the benefit of intravitreal antivascular endothelial growth factor medications and corticosteroids. The goal of this review is to compare the various treatment options for DME, and include data from the most recent clinical trials of therapies for this complex condition.
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Affiliation(s)
- Amol D. Kulkarni
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - Michael S. Ip
- University of Wisconsin Fundus Photograph Reading Center, 8010 Excelsior Drive, Suite 100, Madison, WI 53717 USA
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35
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Abstract
Clinical question: Is there any new knowledge about the pathogenesis and treatment of age-related macular degeneration (AMD)? Results: We now understand better the biochemical and pathological pathways involved in the genesis of AMD. Treatment of exudative AMD is based on intravitreal injection of new antivascular endothelial growth factor drugs for which there does not yet exist a unique recognized strategy of administration. No therapies are actually available for atrophic AMD, despite some experimental new pharmacological approaches. Implementation: strategy of administration, safety of intravitreal injection
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Affiliation(s)
- Giuseppe Querques
- Service d'Ophtalmologie, Centre Hospitalier Intercommunal Créteil, Université Paris-Est Créteil, Créteil, France
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