Retention of good visual acuity in eyes with neovascular age-related macular degeneration and chronic refractory subfoveal subretinal fluid

Importance: To provide new insights into aflibercept effect in non-naive-treated patients with neovascular age-related macular degeneration. Purpose: To assess the efficacy of intravitreal aflibercept in patients with neovascular age-related macular degeneration without optimal response to previous anti-vascular endothelial growth factor A therapy. Design: Single-arm, multi-centre, prospective study. Participants: Patients ⩾50 years with active neovascular age-related macular degeneration, best-corrected visual acuity between 20/32 and 20/320 with suboptimal response to ranibizumab or bevacizumab. Methods: Aflibercept was administered monthly (3-first months), and bimonthly thereafter until month 8. Anatomical and functional outcomes were assessed. Main outcome measure: Percentage of eyes without intra or subretinal fluid on optical coherence tomography after 3-monthly loading doses of aflibercept. Results: A total of 46 patients were included. At week 12, 45.7% (95% confidence interval: 31.5%–60.1%) of eyes showed no fluid on optical coherence tomography. The mean (standard deviation) best-corrected visual acuity increased from 65.1 (8.3) to 69.6 (8.1) letters (+4.5 (5.8) p < 0.0001) and was stabilized at week 40 as compared to baseline. Mean central macular thickness decreased from 430 (119) µm to 323 (100) µm at week 12 (–107 (90) µm, p < 0.0001) and was reduced at week 40 (–46 (111) µm, p = 0.0056). At week 40, 21.7% (95% confidence interval: 9.8%–33.7%) had no fluid. There was a case of presumed noninfectious endophthalmitis that was successfully managed. Conclusion: Almost half of patients presented no fluid on optical coherence tomography at week 12, and there was a clinically significant improvement in best-corrected visual acuity. At week 40, one in five patients did not show intra or subretinal fluid, central macular thickness decreased and best-corrected visual acuity was stabilized compared to baseline.

Download Full-text

INTRAVITREAL BEVACIZUMAB TREATMENT FOR EXUDATIVE AGE-RELATED MACULAR DEGENERATION WITH GOOD VISUAL ACUITY

Retina ◽

10.1097/iae.0b013e31825db771 ◽

2012 ◽

Vol 32 (9) ◽

pp. 1811-1820 ◽

Cited By ~ 8

Author(s):

Ruth Axer-Siegel ◽

Elite Bor ◽

Dan H. Bourla ◽

Dov Weinberger ◽

Karin Mimouni

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

Intravitreal Bevacizumab ◽

Age Related Macular Degeneration ◽

Good Visual Acuity ◽

Age Related ◽

Bevacizumab Treatment

Download Full-text

Association between visual acuity, lesion activity markers and retreatment decisions in neovascular age-related macular degeneration

Eye ◽

10.1038/s41433-020-0799-y ◽

2020 ◽

Vol 34 (12) ◽

pp. 2249-2256 ◽

Cited By ~ 1

Author(s):

Usha Chakravarthy ◽

Natasha Pillai ◽

Annie Syntosi ◽

Lorna Barclay ◽

Catherine Best ◽

...

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

Subretinal Fluid ◽

Age Related Macular Degeneration ◽

The United Kingdom ◽

Anti Vegf ◽

Age Related ◽

Intraretinal Fluid ◽

Endothelial Growth Factor ◽

Clinic Visits

Abstract Background/objectives To investigate the association between optical coherence tomography (OCT) markers of lesion activity and changes in visual acuity (VA) during anti-vascular endothelial growth factor (anti-VEGF) therapy of eyes diagnosed with neovascular age-related macular degeneration (nAMD); and how VA and OCT markers are considered in physicians’ decision to retreat with anti-VEGFs. Subjects/methods Retrospective, non-comparative, non-randomised cohort study involving electronic medical record data collected from 1190 patient eyes with nAMD diagnosis at two sites in the United Kingdom. Two sub-cohorts consisting of 321 and 301 eyes, respectively, were selected for analyses. Results In 321 eyes, absence of IRF or SRF at ≥2 clinic visits resulted in a gain of five ETDRS letters from baseline, compared with two letters gained in eyes with <2 clinic visits with absence of IRF (p = 0.006) or SRF (p = 0.042). Anti-VEGF treatment was administered at 421 clinic visits, and 308 visits were without treatment. Comparing treatment visits with non-treatment visits, the maximum difference in frequency of OCT markers of lesion activity were for intraretinal fluid (IRF; 24% versus 5%) and subretinal fluid (SRF; 32% versus 5%). Pigment epithelial detachment (PED) was reported in 58% of treatment visits compared with 36% in non-treatment visits. VA loss was not a consistent trigger for retreatment as it was present in 63% of injection visits and in 49% of non-injection visits. Conclusions Retreatment decision making is most strongly influenced by the presence of IRF and SRF and less by the presence of PED or VA loss.

Download Full-text

Foveal-Sparing Scotomas in Advanced Dry Age-Related Macular Degeneration

Journal of Visual Impairment & Blindness ◽

10.1177/0145482x0810201004 ◽

2008 ◽

Vol 102 (10) ◽

pp. 600-610 ◽

Cited By ~ 43

Author(s):

Janet S. Sunness ◽

Gary S. Rubin ◽

Abraham Zuckerbrod ◽

Carol A. Applegate

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

Geographic Atrophy ◽

Age Related Macular Degeneration ◽

Good Visual Acuity ◽

Age Related ◽

Foveal Sparing

Foveal-sparing scotomas are common in advanced dry macular degeneration (geographic atrophy). Foveal preservation may be present for a number of years. Despite good visual acuity, these patients have reduced reading rates. Magnification may not be effective if the text becomes too large to “fit” within the central spared area.

Download Full-text

Pattern Dystrophies and Choroidal Neovascularization

Güncel Retina Dergisi (Current Retina Journal) ◽

10.37783/crj-0053 ◽

2017 ◽

pp. 313-320

Keyword(s):

Visual Acuity ◽

Choroidal Neovascularization ◽

Middle Ages ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Subretinal Fluid ◽

Age Related Macular Degeneration ◽

Pattern Dystrophy ◽

Good Visual Acuity ◽

Age Related

Pattern dystrophies are hereditary dystrophies that come from retinal pigment epithelium and located in the macula. The diagnosis is usually made around the middle ages. Pigment accumulations in the macula and around the macula, are seen bilaterally and symmetrical in the beginning, are sub-divided depending on pigment scattering pattern. These are adult-onset foveomacular vitelliform dystrophy, butterfly-like pattern dystrophy, reticular pattern dystrophy, and fundus pulverulentus. Usually in patients with pattern dystrophy have good visual acuity, after progression central visual acuity lessens with RPE atrophy or choroidal neovascularization development. In choroidal neovascularization secondary to age-related macular degeneration there is no typical pigmentation in the macula. On the other hand, in choroidal neovascularization related to pattern dystrophy, hemorrhage, and intra/subretinal fluid do not exist. Today choroidal neovascularization prognosis, which is treated with intravitreal anti-VEGF injections, is quite good. At least, one eye of the patients has satisfactory vision. Sometimes, in especially patients with isolated pattern dystrophy, not hereditary, there may be spontaneous regression of choroidal neovascularization.

Download Full-text

The Presence of Intra- or Subretinal Fluid during the Loading Phase in the Treatment of Exudative Age-Related Macular Degeneration with Intravitreal Ranibizumab Assessed by Optical Coherence Tomography

Ophthalmologica ◽

10.1159/000430103 ◽

2015 ◽

Vol 234 (2) ◽

pp. 61-66

Author(s):

Andreas Ebneter ◽

Boris Gekkiev ◽

Bhuvan Chanana ◽

Sebastian Wolf ◽

Martin S. Zinkernagel

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Macular Degeneration ◽

Subretinal Fluid ◽

Age Related Macular Degeneration ◽

Optical Coherence ◽

Intravitreal Ranibizumab ◽

Visual Improvement ◽

Age Related ◽

Treatment Naïve

Purpose: To assess intra- and subretinal fluid during the loading phase with intravitreal ranibizumab in exudative age-related macular degeneration and to quantify the accuracy of crosshair scan spectral-domain optical coherence tomography with regard to retinal fluid. Methods: This is a retrospective study of 31 treatment-naive patients who received 3 monthly intravitreal ranibizumab injections. Visual acuity and the presence of retinal fluid were assessed at each visit using volume and crosshair scan protocols. Results: Visual acuity improved and central retinal thickness decreased significantly during the loading phase. However, retinal fluid persisted in two thirds of the patients. The accuracy of the crosshair scan to detect fluid was 93%. Conclusions: A substantial proportion of eyes had persistent fluid after 3 months of ranibizumab injections. However, visual improvement was independent of residual fluid. Message: Crosshair scans detect relevant collections of retinal fluid accurately and may be sufficient in daily clinical practice.

Download Full-text

Refractory subretinal fluid in patients with neovascular age-related macular degeneration treated with intravitreal ranibizumab: visual acuity outcome

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-014-2789-x ◽

2014 ◽

Vol 253 (8) ◽

pp. 1211-1216 ◽

Cited By ~ 10

Author(s):

Liuna Jang ◽

Christina Gianniou ◽

Aude Ambresin ◽

Irmela Mantel

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

Subretinal Fluid ◽

Age Related Macular Degeneration ◽

Intravitreal Ranibizumab ◽

Age Related

Download Full-text

High frequency SD-OCT follow-up leading to up to biweekly intravitreal ranibizumab treatment in neovascular age-related macular degeneration

Scientific Reports ◽

10.1038/s41598-021-86348-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Cengiz Tuerksever ◽

Christian Pruente ◽

Katja Hatz

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

High Frequency ◽

Subretinal Fluid ◽

Age Related Macular Degeneration ◽

Intravitreal Ranibizumab ◽

Age Related ◽

Ranibizumab Treatment ◽

Sd Oct

AbstractA remarkable proportion of neovascular age-related macular degeneration (nAMD) patients respond rather poorly to ranibizumab treatment, in spite of the minimum 4-week follow-up and treatment interval. Usually, retreatments are based on nAMD activity as evaluated by Spectral-domain Optical coherence Tomography (SD-OCT), biomicroscopic fundus examination and visual acuity changes. In this prospective pilot study, we aimed to study SD-OCT changes in a high-frequent follow-up manner (weekly (month 0–6), biweekly (month 7–12)) throughout the first year, which consequently led to intravitreal ranibizumab being administered up to biweekly. Best corrected visual acuity (BCVA) was already significantly improved at week 2. Central retinal thickness (CRT), intraretinal and subretinal fluid (SRF) were significantly improved from week 1 onwards. Half of the patients showed nAMD activity at week 2 or 3 and received the first retreatment earlier than 4 weeks after baseline injection. In total, 46% of retreatments were already applied 2 or 3 weeks after the previous treatment. Greater range of CRT and SRF fluctuation during follow-up was associated with lower final BCVA. Lower baseline BCVA and better SRF improvement at week 2 was associated with greater BCVA improvement. In conclusion, high-frequency SD-OCT follow-up provided a good option for adapting treatment in nAMD individually.

Download Full-text