scholarly journals Impact of macular fluid features on outcomes of anti-vascular endothelial growth factor treatment for type 3 macular neovascularization

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Wontae Yoon ◽  
Jihyun Yoon ◽  
Seung Kwan Na ◽  
Jihyun Lee ◽  
Jaemin Kim ◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Visual Acuity ◽  
Growth Factor ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Significant Difference ◽  
Type 3 ◽  
Endothelial Growth Factor ◽  
The Impact ◽  
Anatomical Outcomes

AbstractWe evaluated the impact of macular fluid features on visual and anatomical outcomes in type 3 macular neovascularization (MNV) patients treated with anti-vascular endothelial growth factor (VEGF). We retrospectively enrolled 89 eyes with type 3 MNV with at least 12 months of follow-up. All patients were treatment-naïve and received a monthly loading injection of anti-VEGF for three months, followed by further injections as required. The association of baseline macular morphology, including intraretinal fluid (IRF) and subretinal fluid (SRF), with visual and anatomical outcomes was analyzed. At baseline, IRF was present in all enrolled patients (100%), and SRF was present in 43.8% (39/89) of them. After 12 months of treatment, no significant difference was found in terms of best-corrected visual acuity (BCVA) and changes in central foveal thickness between the eyes with (39) and without (50) SRF at baseline. In addition, the proportion of improved or worsened (gain or loss of more than three lines in the BCVA) visual acuity at 12 months was not significantly different among the groups. Incidence of macular atrophy during the treatment showed no difference between the groups, regardless of the presence of SRF. In conclusion, the macular fluid morphology, specifically SRF, in type 3 MNV showed no significant correlation with visual and anatomical outcomes during anti-VEGF treatment.

scholarly journals Long-term outcome of intravitreal anti-vascular endothelial growth factor treatment for pachychoroid neovasculopathy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jihyun Yoon ◽  
Wontae Yoon ◽  
Seung kwan Na ◽  
Jihyun Lee ◽  
Chul Gu Kim ◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Visual Acuity ◽  
Growth Factor ◽  
Vascular Endothelial ◽  
Long Term Outcome ◽  
Anti Vegf ◽  
Significant Difference ◽  
Pachychoroid Neovasculopathy ◽  
Endothelial Growth Factor

AbstractTo compare the long-term effectiveness of intravitreal anti-vascular endothelial growth factor (VEGF) treatment for pachychoroid neovasculopathy (PNV), polypoidal choroidal vasculopathy/aneurysmal type 1 neovascularization (PCV/AT1), and typical neovascular age-related macular degeneration (nAMD). Forty-one eyes with PNV, 68 eyes with PCV/AT1, and 56 eyes with typical nAMD were retrospectively included for analysis. All patients were treatment-naïve and received a three-monthly loading injection of anti-VEGF, followed by further injections, as required. The visual and anatomical outcomes after treatment were evaluated up to 36 months from baseline. No significant intergroup difference was found in terms of best-corrected visual acuity (BCVA) and changes in central foveal thickness at 12, 24, and 36 months after the baseline. In addition, no significant difference was found between the groups regarding the proportions of improved or worsened (increased or decreased more than 3-lines) visual acuity. However, the PNV group participants received significantly fewer anti-VEGF injections (11.7 ± 6.9) than those in the PCV/AT1 (12.4 ± 7.0; P = 0.031) and typical nAMD groups (13.2 ± 7.4; P = 0.016). The incidence of macular atrophy (MA) development was also significantly lower for the PNV (4/41 eyes, 9.8%) than the typical nAMD (15/56 eyes, 26.8%; P = 0.033) eyes. There was no significant difference between PNV, PCV/AT1, and typical nAMD regarding visual acuity improvement after anti-VEGF treatment over 36 months. However, the number of injections for PNV was significantly lower compared to that for PCV/AT1 and typical nAMD, and the incidence of MA development was significantly lower than in typical nAMD.

scholarly journals Real world evidence on 5661 patients treated for macular oedema secondary to branch retinal vein occlusion with intravitreal anti-vascular endothelial growth factor, intravitreal dexamethasone or macular laser

2020 ◽  
pp. bjophthalmol-2020-315836 ◽  
Author(s):  
Richard Gale ◽  
Maria Pikoula ◽  
Aaron Y Lee ◽  
Spiros Denaxas ◽  
Catherine Egan ◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Visual Acuity ◽  
Growth Factor ◽  
Macular Oedema ◽  
Branch Retinal Vein Occlusion ◽  
Vascular Endothelial ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
Intravitreal Dexamethasone ◽  
Endothelial Growth Factor

Background/aimsClinical trials suggest anti-vascular endothelial growth factor is more effective than intravitreal dexamethasone as treatment for macular oedema secondary to branch retinal vein occlusion. This study asks if ‘real world’ data from a larger and more diverse population, followed for a longer period, also support this conclusion.MethodsData collected to support routine care at 27 NHS (National Health Service) Trusts between February 2002 and September 2017 contained 5661 treatment-naive patients with a single mode of treatment for macular oedema secondary to branch retinal vein occlusion and no history of cataract surgery either during or recently preceding the treatment. Number of treatment visits and change in visual acuity from baseline was plotted for three treatment groups (anti-vascular endothelial growth factor (anti-VEGF), intravitreal dexamethasone, macular laser) for up to 3 years.ResultsMean baseline visual acuity was 57.1/53.1/62.3 letters in the anti-VEGF/dexamethasone/macular laser groups, respectively. This changed to 66.72 (+9.6)/57.6 (+4.5)/63.2 (+0.9) at 12 months. Adequate numbers allowed analysis at 18 months for all groups (66.6 (+9.5)/56.1 (+3.0)/60.8 (-1.5)) and for anti-VEGF at 36 months (68.0, +10.9) Mean number of treatments were 5.1/1.5/1.2 at 12 months, 5.9/1.7/1.2 at 18 months for all three groups and 10.3 at 36 months for anti-VEGF.ConclusionsVisual acuity improvements were higher and more sustained with anti-VEGF. Higher treatment burden occurred with anti-VEGF but this reduced over 36 months. Patients with better vision at baseline than those in the clinical trials maintained high levels of vision with both anti-VEGF and dexamethasone.

scholarly journals Long-Term Outcome of Anti-Vascular Endothelial Growth Factor Therapy Following Vitrectomy for Submacular and/or Vitreous Hemorrhage in Neovascular Age-Related Macular Degeneration

2021 ◽  
Author(s):  
Setsuko Kawakami ◽  
Yoshihiro Wakabayashi ◽  
Kazuhiko Umazume ◽  
Yoshihiko Usui ◽  
Daisuke Muramatsu ◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Visual Acuity ◽  
Growth Factor ◽  
Vitreous Hemorrhage ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Age Related ◽  
Endothelial Growth Factor

Abstract Purpose: To study long-term clinical outcomes in patients with submacular hemorrhage (SMH) and/or vitreous hemorrhage (VH) associated with neovascular age-related macular degeneration (nAMD), who received pars plana vitrectomy (PPV) followed by anti-vascular endothelial growth factor (VEGF) therapy.Methods: In this retrospective case series, 25 eyes with SMH and/or VH associated with nAMD were treated by PPV and followed for at least 24 months. When exudative changes were unresolved or recurred after PPV, additional intravitreal anti-VEGF therapy was given. Results:Mean best-corrected visual acuity (BCVA) of all patients improved significantly at 1, 3, 6, 12, 18 and 24 months (P<0.01) post-PPV and at the final visit (P<0.05). Mean BCVA of 13 eyes with anti-VEGF therapy improved significantly at 1 (P<0.05), 3, 6, 12 (P<0.01), 18 and 24 months (P<0.05), while 12 eyes without anti-VEGF therapy improved at 1, 3 and 6 months (P<0.05) only. Average duration from initial PPV to anti-VEGF therapy initiation was 7.54±9.9 months. Five of 13 eyes (38.5%) with anti-VEGF therapy maintained dry macula for more than 1 year after the last injection. Conclusions:　In patients with SMH and VH caused by nAMD, administering intravitreal anti-VEGF therapy when exudative changes are unresolved or recur after PPV maintains improved visual acuity long term.

Variables Associated With Culture-Positive Endophthalmitis After Intravitreal Injection of Vascular Endothelial Growth Factor Inhibitors

2019 ◽  
Vol 3 (5) ◽  
pp. 317-323 ◽  
Author(s):  
Kunyong Xu ◽  
Eric K. Chin ◽  
David R.P. Almeida
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Visual Acuity ◽  
Growth Factor ◽  
Positive Culture ◽  
Initial Presentation ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Endothelial Growth Factor ◽  
Culture Positive ◽  
Vitreous Biopsy

Purpose: This work identifies predictive variables associated with culture-positive cases of acute endophthalmitis after vascular endothelial growth factor (VEGF) inhibitor injection. Methods: A retrospective review of cases of endophthalmitis following intravitreal anti-VEGF injection was performed. All patients received a vitreous biopsy or anterior chamber aqueous biopsy (if vitreous biopsy was not successful) that was sent for microbial cultures before initiation of treatment. Results: During a 10-year period, 258 357 anti-VEGF agent injections were performed, of which 40 patients (0.016%) developed presumed endophthalmitis. Sixty percent (n = 24) of the presumed endophthalmitis patients had a positive culture. In multivariable logistic analysis, patients who had a best-corrected visual acuity (BCVA) worse than 20/400 were 35.3 times (adjusted odds ratio [AOR], 95% CI, 2.2-576.1, P = .012) more likely to have a positive culture compared with those who had a BCVA of 20/400 or better. Patients who had pain at initial presentation were 27.0 times (AOR, 95% CI, 1.4-523.9, P = .029) more likely to have a positive culture compared with those who did not have pain at initial presentation. Age, sex, clinical diagnosis, smoking status, anti-VEGF agent injected, duration between last anti-VEGF injection and symptoms of endophthalmitis, duration between endophthalmitis symptoms and initial treatment, intraocular pressure at initial presentation, and presence of hypopyon were not associated with a difference in positive-culture yield. Conclusions: Visual acuity worse than 20/400 and pain at time of initial presentation secondary to endophthalmitis following anti-VEGF injection were strongly associated with a positive culture. Our data support consideration of vitrectomy in cases in which microbe identification is paramount.

Short-Term Visual Acuity and Intraocular Pressure Changes and Their Correlation after Anti-Vascular Endothelial Growth Factor Injection

2016 ◽  
Vol 236 (1) ◽  
pp. 36-42 ◽  
Author(s):  
Hyung-Bin Lim ◽  
Min-Su Kim ◽  
Young-Joon Jo ◽  
Jung-Yeul Kim
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Visual Acuity ◽  
Intraocular Pressure ◽  
Growth Factor ◽  
Intravitreal Injection ◽  
Sufficient Evidence ◽  
Vascular Endothelial ◽  
Short Term ◽  
Significant Difference ◽  
Endothelial Growth Factor

Purpose: To assess the effect of intravitreal anti-vascular endothelial growth factor injection on short-term changes in intraocular pressure (IOP) and visual acuity (VA) and the correlation between the two values. Methods: This study included 25 eyes of 25 patients undergoing intravitreal injection of bevacizumab (IVB) with preinjection uncorrected VA (UCVA) >20/40. IOP and UCVA were measured before injection and 1, 5, 10, 15, 20, 25, and 30 min after injection, using a Tono-Pen (Reichert, Chicago, Ill., USA). The IOP and VA values before and after injection were compared. The correlation between IOP and VA at each time point was analyzed. Results: The preinjection IOP value (17.7 mm Hg) increased sharply to 43.1 mm Hg 1 min after injection, followed by a decrease to 30.4, 24.6, 20.7, 18.7, 18.2, and 17.7 mm Hg at 5, 10, 15, 20, 25, and 30 min, respectively. The preinjection UCVA value (0.21; logMAR) increased to 0.96 one minute after injection, followed by a decrease to 0.61, 0.44, 0.33, 0.27, 0.23, and 0.22 at 5, 10, 15, 20, 25, and 30 min, respectively. Significant differences were evident between the preinjection IOP and VA values and those observed over the 5- to 25-min period after injection (p < 0.05). The correlation between IOP and VA was significant 1, 5, and 10 min after injection [p < 0.001 (1 min), p = 0.033 (5 min), and p = 0.002 (10 min)]. Conclusions: Differences in all IOP and VA values were significant up to 25 min after IVB, compared with preinjection values; however, no significant difference was found 30 min after injection. Such fluctuations in VA and IOP were positively correlated. The patients' own knowledge of VA fluctuations after injection may provide ophthalmologists with sufficient evidence to make an indirect clinical judgment regarding short-term complications of intravitreal injection.

scholarly journals Incidence of Endophthalmitis after Intravitreal Anti-Vascular Endothelial Growth Factor Injections in an Operating Room in China

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Yanyun Chen ◽  
Wenbin Wei ◽  
Demetrios G. Vavvas ◽  
Feng Zhang ◽  
Haicheng She ◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Operating Room ◽  
Mainland China ◽  
Vascular Endothelial ◽  
Sterile Technique ◽  
Anti Vegf ◽  
Single Center Study ◽  
Significant Difference ◽  
Endothelial Growth Factor

Purpose. To evaluate the rate of presumed endophthalmitis (EO) after intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections performed in an operating room (OR) under sterile conditions in mainland China. Methods. Retrospective single-center study between September 2012 and December 2017 at Beijing Tongren Eye Center, Beijing, China. Intravitreal injection database was reviewed. All anti-VEGF injections were performed using a standardized sterile technique in an OR. Injection protocols included antibiotics for 3 days pre-injection, topical 5% povidone-iodine rinsing before the procedure, and post-injection antibiotics for 3 days. Results. A total of 37,830 intravitreal injections were performed at Beijing Tongren Eye Center. Three cases were managed as presumed EO (0.0079%). Positive cultures were documented in 2 of 3 cases. EO incidence following ranibizumab and conbercept administration was 0.0088% (3 in 33,930) and 0% (0 in 3,900), respectively. No significant difference was detected between the two drugs ( P = 0.745 ). Conclusions. Very low EO rates were seen in mainland China using a standardized sterile technique in an OR. However, EO could not be completely avoided.

COMPARATIVE EFFECTIVENESS OF ANTI-VEGF AGENTS FOR DIABETIC MACULAR EDEMA

2013 ◽  
Vol 29 (4) ◽  
pp. 392-401 ◽  
Author(s):  
Daniel A. Ollendorf ◽  
Jennifer A. Colby ◽  
Steven D. Pearson
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Visual Acuity ◽  
Growth Factor ◽  
Macular Edema ◽  
Comparative Effectiveness ◽  
Laser Photocoagulation ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Meta Analyses ◽  
Endothelial Growth Factor

Objectives: The aim of this study was to evaluate the comparative effectiveness of anti-vascular endothelial growth factor therapy in the treatment of diabetic macular edema (DME).Methods: Searches focused on reports concerning treatment of DME with aflibercept, bevacizumab, pegaptanib, or ranibizumab published between January 2000 and June 30, 2012, with comparisons to laser photocoagulation, sham injection, or other control (e.g., triamcinolone). Effectiveness was based on best-corrected visual acuity (BCVA), in terms of letters gained. Direct meta-analyses were conducted on BCVA for each anti-vascular endothelial growth factor (VEGF) agent; indirect comparisons also were performed for each anti-VEGF pair.Results: A total of fifteen randomized controlled trials (eleven fair- or good-quality) and eight observational studies were included. No direct comparative studies were identified. Improvement in visual acuity versus control was seen with all agents (range: 4–9 letters); outcomes were consistent across multiple timepoints. Meta-analyses showed no statistically significant and/or consistent differences between agents in BCVA changes or the percentage of patients gaining more than ten letters. No discernible differences in the potential harms of anti-VEGFs, including ocular events, MI, stroke, and other cardiovascular events, as well as death, were noted between aflibercept, pegaptanib, and ranibizumab. Data on harms for bevacizumab were underreported.Conclusions: All anti-VEGF agents are effective in improving visual acuity in comparison to laser photocoagulation. Evidence is insufficient to distinguish the performance of any single anti-VEGF agent over others. The safety of bevacizumab remains the greatest element of uncertainty.

scholarly journals Screening auf Frühgeborenenretinopathie – die wichtigsten Änderungen in der neuen deutschen Leitlinie 2020

2021 ◽  
Author(s):  
Jeany Q. Li ◽  
Ulrich Kellner ◽  
Birgit Lorenz ◽  
Andreas Stahl ◽  
Tim U. Krohne
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Retinopathy Of Prematurity ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Zone Ii ◽  
Endothelial Growth Factor ◽  
Rop Screening

Zusammenfassung Hintergrund Durch Verbesserungen in der neonatologischen Versorgung von Frühgeborenen und die Entwicklung neuer Behandlungsmöglichkeiten der Frühgeborenenretinopathie („retinopathy of prematurity“ [ROP]) haben sich die Anforderungen an das ROP-Screening seit der Veröffentlichung der letzten Fassung der deutschen Leitlinie zum ROP-Screening im Jahr 2008 verändert. Auf Grundlage aktueller Studiendaten wurde die Leitlinie in 2020 grundlegend überarbeitet und in einer aktualisierten Fassung veröffentlicht. Ziel Dieser Artikel fasst die wichtigsten Änderungen in der neuen Leitlinie zusammen. Ergebnisse Die Altersgrenze für einen Screeningeinschluss wurde für Kinder ohne zusätzliche Risikofaktoren auf ein Gestationsalter von unter 31 Wochen gesenkt. Die Mindestdauer für eine Sauerstoffsupplementation, die einen Einschluss in das Screening bei Frühgeborenen erforderlich macht, wurde auf über 5 Tage angehoben. Eine Behandlung bei ROP in Zone II kann nun schon bei jedem Stadium 3 mit Plus-Symptomatik unabhängig von der Anzahl der betroffenen Uhrzeiten erfolgen. Für die Nachkontrollen nach Anti-VEGF („vascular endothelial growth factor“)-Therapie wurden Kriterien zur Frequenz und Dauer definiert. Das verbindliche Dokument für diese und weitere neue Empfehlungen ist die Leitlinie selber. Schlussfolgerungen Die Empfehlungen der Leitlinie ermöglichen eine zuverlässige Identifikation von Kindern mit ROP-Risiko für den Einschluss in das Screening und eine rechtzeitige Erkennung fortgeschrittener Krankheitsstadien für die Therapieeinleitung, um so Erblindung durch ROP zu verhindern.

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