Failure to Detect an Effect of Pneumatic Displacement in the Management of Submacular Haemorrhage Secondary to Age-related Macular Degeneration: A Retrospective Case Series

Objective: The study aimed to determine the outcomes and prognostic factors of vitrectomy, subretinal injection of tissue-plasminogen activator and gas tamponade in macular hemorrhage (MaH) due to age-related macular degeneration (AMD) or retinal arterial macroaneurysm (RAM). Methods: The study design utilized a multicentric retrospective case series design of consecutive patients undergoing surgery between 2014 and 2019. Results: A total of 65 eyes from 65 patients were included in the study. Surgery was performed after a mean period of 7.1 days. Displacement of MaH was achieved in 82% of the eyes. Mean best-corrected visual acuity (BCVA) improved from 20/500 to 20/125 at month(M)1 and M6 (p < 0.05). At M6, BCVA worsening was associated with an older age at diagnosis (p = 0.0002) and higher subretinal OCT elevation of MaH (p = 0.03). The use of treat and extend (TE) (OR = 16.7, p = 0.001) and small MaH fundus size (OR = 0.64 and 0.74 for horizontal and vertical fundus size, p < 0.05) were predictive of a higher likelihood of obtaining a countable BCVA at M1. Baseline BCVA was predictive of postoperative BCVA (p < 0.05). Retinal detachment and MaH recurrence occurred in 3% and 9.3% of cases at M6. Conclusion: MaH surgery stabilizes or improves BCVA in 85% of cases. Younger age at diagnosis, better baseline BCVA figures, smaller subretinal MaH height and use of TE regime were predictive of the best postoperative outcomes.

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Effect of total anti-VEGF treatment exposure on patterns of choroidal neovascularisation assessed by optical coherence tomography angiography in age-related macular degeneration: a retrospective case series

BMJ Open Ophthalmology ◽

10.1136/bmjophth-2018-000244 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000244 ◽

Cited By ~ 1

Author(s):

Livia Faes ◽

Zaria Ali ◽

Siegfried Wagner ◽

Praveen J Patel ◽

Dun Jack Fu ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Macular Degeneration ◽

Optical Coherence Tomography Angiography ◽

Case Series ◽

Choroidal Neovascularisation ◽

Age Related Macular Degeneration ◽

Optical Coherence ◽

Retrospective Case ◽

Age Related ◽

The Mean

ObjectiveTo compare clinical characteristics of patients suffering from neovascular age-related macular degeneration (nAMD) with mature and immature choroidal neovascularisation (CNV) as assessed by optical coherence tomography angiography (OCTA). To explore the effect of total anti-vascular endothelial growth factor exposure on the occurrence of mature CNV when correcting for potential confounders.Methods and analysisIn this retrospective case series, we included 40 eyes of 36 patients with nAMD with CNV assessed by OCTA at the Manchester Eye Hospital between June 2016 and June 2017. A retinal specialist masked to patient information graded CNV depicted on OCTA scans. For statistical comparisons, we used t-tests, Fisher’s exact tests and a mixed-effects logistic regression model.Results18 patients (20 eyes) were treatment naïve, and the mean number of intravitreal injections (IVI) in the remaining eyes was 18.4 (range 2–71). The mean duration of nAMD was 19.3 months (range 0–87.4). 25 eyes (62.5%) exhibited mature CNV. Eyes with mature CNV did not differ from those with immature CNV regarding age (+2.8 years; p=0.288) or duration of disease (+9.4 months; p=0.061). However, they had a higher number of IVIs (+3.1; p=0.035). Among eyes with best corrected visual acuity over 25 letters, there was a strong association between the number of IVIs (0 vs 1–20: OR 68.01 [95% CI 1.30 to 3546.99; p=0.036], 0 vs >20 IVI: OR 380.01 [95% CI 2.60 to 55 464.89; p=0.019]) and maturity status when correcting for potential confounders.ConclusionMaturity status of CNV as assessed by OCTA may indicate treatment exposure of CNV in nAMD.

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Continued anti-VEGF treatment does not prevent recurrences in eyes with stable neovascular age-related macular degeneration using a treat-and-extend regimen: a retrospective case series

Eye ◽

10.1038/s41433-021-01562-6 ◽

2021 ◽

Author(s):

Justus G. Garweg ◽

Peter G. Traine ◽

Richard A. Garweg ◽

Juliana Wons ◽

Christin Gerhardt ◽

...

Keyword(s):

Macular Degeneration ◽

Stable Disease ◽

Case Series ◽

Age Related Macular Degeneration ◽

Retrospective Case ◽

Anti Vegf ◽

Age Related ◽

Group 2 ◽

Group 1

Abstract Background The continuation of anti-vascular endothelial growth factor (anti-VEGF) treatment after achieving stability in patients with neovascular age-related macular degeneration has generally been advocated. In our own patients, we thought to assess whether continued anti-VEGF treatment is capable of preventing recurrences. Methods In this retrospective observational case series, patients with stable disease either opted to continue treatment every 12–14 weeks (Group 1) or stopped treatment with subsequent follow-up visits every 8–12 weeks (Group 2). Results Of the 103 eyes of 103 patients achieving stability, 49 eyes continued treatment (Group 1), whereas treatment was stopped in 54 eyes undergoing regular follow-up (Group 2). Recurrent disease was observed in 21 (42.9%) and 33 (61.1%) cases in Group 1 and Group 2, respectively (p = 0.08). Time between achieving stable disease and recurrence was comparable between Group 1 and Group 2 (11.1 ± 8.2 months vs. 9.2 ± 6.7 months; p = 0.43). The number of visits between achieving stability and disease recurrence was similar, but not the number of injections (3.5 ± 2.0 vs. 0.2 ± 0.4; p < 0.001). Conclusions Continuing anti-VEGF therapy after achieving functional and morphological stability every 12–14 weeks does not prevent recurrences. Patients deserve to be informed of a potential lifetime risk of recurrences, even under continued therapy.

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Simultaneous Dexamethasone Intravitreal Implant and Anti-VEGF Therapy for Neovascular Age-Related Macular Degeneration Resistant to Anti-VEGF Monotherapy

Journal of VitreoRetinal Diseases ◽

10.1177/2474126416683299 ◽

2017 ◽

Vol 1 (1) ◽

pp. 65-74 ◽

Cited By ~ 4

Author(s):

Bozho Todorich ◽

Aristomenis Thanos ◽

Yoshihiro Yonekawa ◽

Gerta Mane ◽

Madeleine Hasbrook ◽

...

Keyword(s):

Macular Degeneration ◽

Combined Treatment ◽

Case Series ◽

Dual Therapy ◽

Age Related Macular Degeneration ◽

Treatment Resistant ◽

Dexamethasone Intravitreal Implant ◽

Anti Vegf ◽

Age Related ◽

Intravitreal Implant

Purpose: To evaluate the efficacy of a dexamethasone intravitreal implant in combination with intravitreal anti-vascular endothelial growth factor (VEGF) agents for treatment-resistant neovascular age-related macular degeneration (nvAMD). Methods: This study was designed as a single-center, retrospective interventional case series. Consecutive patients with treatment-resistant nvAMD underwent simultaneous combined injection of anti-VEGF agent and dexamethasone intravitreal implant. Eighteen patients with mean age of 81.5 years were included. Patients received an average of 26.3 anti-VEGF injections before dual therapy, with a mean follow-up of 8.2 months after dual therapy. Results: Dual therapy produced a significant mean decrease in central foveal thickness (126.3 μm), compared to a mean increase in 29.9 μm when treated with anti-VEGF monotherapy ( P = .0017). Patients also had a mean decrease in macular cube volume of −0.85 mm3 with dual therapy compared to anti-VEGF monotherapy ( P = .0014). There was a moderate correlation between the number of prior anti-VEGF injections and the magnitude of anatomic response, suggesting that shorter disease duration may positively influence response to combined treatment. Although there was a slight trend toward improved mean visual acuity after dual therapy, these differences did not reach statistical significance. Nevertheless, with combination treatment, 33% of patients gained 1 or more lines of vision. Dual therapy resulted in a significantly lower number of required anti-VEGF injections (4.25 vs 5.33) and an increase in the anti-VEGF injection-free interval to 1.41 months from 1.12 months during the 6 months following dual therapy compared to the same interval before dual therapy. Dual therapy was well tolerated; 2 eyes developed mild intraocular pressure elevation effectively managed with topical therapy and 1 patient developed worsening cataract. Conclusions: Combined treatment of anti-VEGF with dexamethasone intravitreal implant is a viable alternative for treatment-resistant nvAMD and may reduce treatment burden. Earlier treatment with dual therapy may be beneficial to maximize anatomic and visual outcomes in these patients.

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Four-Year Outcome of Aflibercept Treatment-Naïve Patients for Neovascular Age-Related Macular Degeneration: Evidence from a Clinical Setting

Journal of Ophthalmology ◽

10.1155/2020/7465270 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Yanel Gayadine-Harricham ◽

Virginie Rufin ◽

Sandrine Law-Koune ◽

Thi Ha Chau Tran

Keyword(s):

Macular Degeneration ◽

Clinical Setting ◽

Real Life ◽

Case Series ◽

Analysis Data ◽

Age Related Macular Degeneration ◽

Age Related ◽

Treatment Naïve ◽

Number Of Injections

Introduction. The objective of the study is to report 4-year treatment outcome with intravitreal Aflibercept injections for neovascular age-related macular degeneration (nAMD) as first life therapy in real-life. Patients and Methods. This is a prospective, monocenter, observational case series analysis. Data from treatment-naïve patients with nAMD with at least 4 years of follow-up were included in the analysis. Data including age, gender, and visual acuity measured on Early Treatment of Diabetic Retinopathy Study charts (ETDRS) and injection numbers were recorded. Spectral domain optical coherence tomography (SD-OCT) data at baseline, month 3, month 6, month 12, year 2, 3, and 4 were also recorded. Patients were treated with a modified treat and extend (T&E) regimen. Results. Of the 48 eyes with nAMD treated, only 31 eyes were available at the 4-year follow-up. The mean age was 81 ± 8 years. The VA gain was 7.3 ± 12.7 letters at 1 year 6.5 ± 12.5 letters at 2 years, VA gain 5.2 ± 17 letters at 3 years, and 6.2 ± 18.6 letters at 4 years. The reduction of central retinal thickness was 118 ± 187 μm at 4 years. Complete resolution of fluid was obtained in 18/31 eyes. The total number of injections was 5.7 ± 2.0 during the first year, 2.9 ± 2.9 during the second year, 3.5 ± 3.3 during the third year, and 4.0 ± 3.4 during the fourth year. The total number of injections was 16 ± 10.6, ranging from 3 to 52 injections. Ten eyes developed macular atrophy over the 4-year period. Conclusion. The results suggest that good long-term morphological and functional outcome can be achieved using Aflibercept in clinical setting.

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Cardiovascular risk in patients receiving ranibizumab for exudative age-related macular degeneration: a nationwide self-controlled case-series study

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-316373 ◽

2020 ◽

pp. bjophthalmol-2020-316373

Author(s):

Ha-Lim Jeon ◽

Seong Jun Byun ◽

Nicole L Pratt ◽

Janet Sultana ◽

Sang Jun Park ◽

...

Keyword(s):

Cardiovascular Risk ◽

Macular Degeneration ◽

Case Series ◽

Haemorrhagic Stroke ◽

Incidence Rates ◽

Age Related Macular Degeneration ◽

Age Related ◽

Case Series Study ◽

Risk Patients ◽

Rate Ratios

AimsTo identify the association between ranibizumab and risk of stroke and acute myocardial infarction (AMI) in patients with exudative age-related macular degeneration (AMD).MethodsWe identified patients aged ≥45 years who received ranibizumab for exudative AMD from the Korean National Health Insurance database. Of these, we selected patients suffering stroke or AMI for the self-controlled case series. We estimated incidence rate ratios (IRR) for stroke or AMI by comparing incidence rates of ranibizumab-exposed periods to that of baseline using conditional Poisson regression. The risks of haemorrhagic and ischaemic strokes were also calculated separately.ResultsAmong 33 134 patients receiving ranibizumab, 2397 patients had stroke or AMI. The risk of stroke (IRR=0.83, 95% CI 0.75 to 0.91) was not increased during the overall exposed period; however, there was a marginally elevated risk in ≥57 days exposed period (IRR=1.14, 95% CI 1.001 to 1.31). When analysing by the types of stroke, no increased risks of haemorrhagic (IRR=1.01, 95% CI 0.80 to 1.26) and ischaemic stroke (IRR=0.78, 95% CI 0.71 to 0.86) were observed during the exposed period, although the risks of ischaemic and haemorrhagic stroke were slightly elevated during ≥57 days exposed period. We could not find an association between ranibizumab and AMI.ConclusionsRanibizumab intravitreal injections did not increase the overall risk of stroke or AMI. Although the cardiovascular risk in patient receiving ranibizumab seems to be low, continuous monthly use of ranibizumab for high-risk patients should be judged carefully.

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