One-year outcome of intravitreal ziv-aflibercept therapy for non-responsive neovascular age-related macular degeneration

AimTo evaluate 12-month outcome of intravitreal ziv-aflibercept (IVZ) therapy in eyes with neovascular age-related macular degeneration (nAMD) that are non-responsive to bevacizumab and ranibizumab.MethodsThis retrospective study included 16 eyes (14 patients) with nAMD who were on prior treatment with bevacizumab and ranibizumab and were treated with as-needed IVZ (1.25 mg/0.05 mL) for 12 months. The primary outcome measure was the mean change in best corrected visual acuity (BCVA) and secondary outcome measures included mean change in central macular thickness (CMT), retinal pigment epithelial detachment (RPED) heights, longest treatment free interval, presence of subretinal fluid (SRF) and intraretinal fluid (IRF) and adverse events.ResultsThere was no change in the mean logarithm of minimum angle of resolution (logMAR) BCVA at baseline and following treatment with IVZ therapy (p=0.978). The mean number of IVZ injections during 12 months was 5.9±3.3, and the mean number of antivascular endothelial growth factors (VEGFs) injections prior to switching to IVZ was 8.4±4.7. The mean treatment free interval was longer during IVZ therapy (114.4±67.1 days) compared with 76.3±54.6 days before IVZ therapy (p=0.03). Five (31.25%) eyes had visual gains of at least 0.1 logMAR, 3 (18.75%) eyes had stable BCVA (within 0.1 logMAR) and 8 (50%) eyes had BCVA decline of at least 0.1 logMAR. There was no significant difference in the mean CMT, RPED heights and presence of IRF and SRF at 12 months compared with baseline. No adverse events were noted.ConclusionIVZ increased the treatment free interval in non-responders but no significant change in visual and anatomic outcomes.

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Tolerating subretinal fluid in the treatment of neovascular age-related macular degeneration with intravitreal aflibercept

Therapeutic Advances in Ophthalmology ◽

10.1177/25158414211022874 ◽

2021 ◽

Vol 13 ◽

pp. 251584142110228

Author(s):

Dilan Yildiz ◽

Akin Cakir ◽

Burak Erden ◽

Selim Bolukbasi ◽

Serkan Erdenöz ◽

...

Keyword(s):

Macular Degeneration ◽

Subretinal Fluid ◽

Age Related Macular Degeneration ◽

Age Related ◽

Intensive Treatment Group ◽

Significant Difference ◽

Intravitreal Aflibercept ◽

Treatment Naïve ◽

Change In The Mean ◽

The Mean

Objective: To compare the anatomical and functional outcomes of intensive and relaxed intravitreal aflibercept regimen in the management of neovascular age-related macular degeneration. Methods: The medical records of 50 eyes of 50 patients with treatment-naive neovascular age-related macular degeneration, who underwent intravitreal aflibercept therapy in the Retinal Department of University of Health Sciences Okmeydanı Training and Research Hospital (Istanbul, Turkey), were retrospectively reviewed. The demographic features and best-corrected visual acuities at baseline and at 1st-, 2nd-, 3rd-, 4th-, 6th-, 10th- and 12th- months, optical coherence tomography measurements, presence of intraretinal fluid, subretinal fluid and intraocular pressure values were studied. The patients were divided into two groups: intensive (subretinal fluid intolerant) and relaxed (<200 microns subretinal fluid tolerated) intravitreal aflibercept regimens. Results: The change in the mean best-corrected visual acuities from baseline to 12th month was 13.72 ± 33.97 letters in the intensive treatment group and 8.68 ± 27.22 in the relaxed group. There was no statistically significant difference between the groups ( p = 0.566). Similar proportions of both groups achieved ⩾10 letters gain (%48 vs. %40, respectively; p = 0.755) and ⩾10 letters loss (%20 vs. %24, respectively; p = 0.755). The mean central subfield thickness values decreased statistically significantly in both groups ( p < 0.001). There was no statistically significant difference between the groups (442.40 ± 161.32 to 318.0 ± 63.10 vs. 431.64 ± 151.52 to 303.08 ± 140.91, respectively; p = 0.724). The mean total injection numbers were significantly lower in the relaxed group (6.4 ± 1.65 vs. 4.8 ± 1.45, respectively; p = 0.01). Conclusion: Relaxed intravitreal aflibercept regimen has comparable efficiency and safety outcomes at 12 months with intensive intravitreal aflibercept regimen with fewer injections in the management of neovascular age-related macular degeneration.

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Effect of Ranibizumab Treatment in Cases of Choroidal Neovascular Membranes Secondary to Pathological Myopia versus Age-Related Macular Degeneration

QJM ◽

10.1093/qjmed/hcaa058.011 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M S Abdaltawab ◽

Z F Ismail ◽

W M A Ebeid ◽

S M Fawzy

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

Age Related Macular Degeneration ◽

Intravitreal Injections ◽

P Value ◽

Newly Diagnosed ◽

Pathological Myopia ◽

Age Related ◽

Significant Difference ◽

The Mean

Abstract Aim of the Work The aim of this work is to compare the response of treatment with ranibizumab in terms of visual acuity in cases of CNV secondary to pathological myopia versus CNV secondary to age-related macular degeneration. Methods This prospective, comparative study included ten eyes newly diagnosed as having CNV secondary to pathological myopia, and 10 eyes newly diagnosed as having subfoveal active CNV secondary to AMD. All patients had 3 monthly intravitreal Injections of 0.50 mg (in 0.05 ml of solution) ranibizumab with monthly evaluation of best corrected visual acuity (BCVA) by Landolt C chart, and also calculated in Logarithm of Minimum Angle of Resolution (Log MAR). Results pretreatment there was no significant difference between the two groups as the mean VA (Log Mar) was 1.31 ± 0.2 in AMD group and 1.17 ± 0.3 in MCNV group of P value = 0.431 and also post three IVI of ranibizumab showed no significant difference between the two groups as the mean VA (Log Mar) was 1.22 ± 0.2 for AMD and 1.22 ± 0.5 for MCNV of P value = 0.635. Conclusion there was no significant difference in BCVA between AMD and MCNV groups after three intravitreal injections of ranibizumab.

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Efficacy Comparison of Intravitreal Anti-VEGF Therapy for Three Subtypes of Neovascular Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis

Journal of Ophthalmology ◽

10.1155/2018/1425707 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 4

Author(s):

Jianqing Li ◽

Jiayi Xu ◽

Yiyi Chen ◽

Jiaju Zhang ◽

Yihong Cao ◽

...

Keyword(s):

Systematic Review ◽

Macular Degeneration ◽

Meta Analysis ◽

Age Related Macular Degeneration ◽

Cochrane Library ◽

Anti Vegf ◽

Age Related ◽

Significant Difference ◽

The Mean

Purpose. Intravitreal antivascular endothelial growth factor (anti-VEGF) therapy has been widely used for the treatment of neovascularization (NV) secondary to age-related macular degeneration (AMD). This study aimed to compare the efficacy among different subtypes of neovascular age-related macular degeneration (nAMD). Methods. PubMed, Embase, and the Cochrane Library were searched for eligible studies. We performed meta-analysis using Review Manager 5.3 and Stata/SE 12.0. Results. A total of 24 studies met our inclusion criteria and were included in the systematic review. At 3 months, the mean logarithm of the minimum angle of resolution (logMAR) improvements were −0.09, −0.18, and −0.23 for type 1, 2, and 3, respectively, while the mean macular thickness (MT) changes were −104.83, −130.76, and −196.29 μm. At 12 months, the mean changes in Early Treatment of Diabetic Retinopathy Study (ETDRS) letters were 6.38, 8.12, and 9.37, while the MT decrease was 126.51, 126.52, and 139.85 μm, respectively. However, statistically significant difference was only found between type 1 and 3 in vision improvement, both in the short term (p=0.0002) and long term (p=0.01). Conclusions. The reactivity to VEGF inhibitors varied among different subtypes of nAMD. The efficacy of intravitreal anti-VEGF therapy in type 3 nAMD was statistically better than type 1 when considering vision improvement at 3 and 12 months. Thus, the lesion subtype is a predictor for the treatment outcome which can help guide prognosis.

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Profiling Cognitive Performance and Sleep Quality Measures in Patients with Age-Related Macular Degeneration (Preprint)

10.2196/preprints.27040 ◽

2021 ◽

Author(s):

Mehrdad Afarid ◽

Hooman Rezaie ◽

Behzad Khademi1 ◽

Mohammad Nami

Keyword(s):

Sleep Quality ◽

Macular Degeneration ◽

Cognitive Performance ◽

Cognitive Functions ◽

Age Related Macular Degeneration ◽

Control Groups ◽

Age Related ◽

Significant Difference ◽

The Mean ◽

And Control

BACKGROUND This study aimed at profiling cognitive functions in patients with age-related macular degeneration (AMD). OBJECTIVE The aim of our study was to evaluate cognitive functions in patients diagnosed with AMD METHODS This cross-sectional investigation enrolled 45 patients with AMD and 45 age- and sex-matched controls. The overall cognitive performance in AMD sufferer versus control subjects was asses using the Persian version of the Addenbrooke’s Cognitive Examination battery (ACE-R). Subjects’ sleep quality was also evaluated using the Pittsburgh Sleep Quality Index (PSQI). The mean global assessment and subscale scores were statistically compared between groups. RESULTS The mean global scores for ACE-R in AMD and control groups (80.4±12.3 and 86 ± 9.6, respectively) were found to be statistically different (p=0.018). On the other hand there was no significant difference (p=0.793) between the AMD and control groups in terms of PSQI scores (9.7±2.8 and 9.8±2.8, respectively). CONCLUSIONS AMD patients seem to have cognitively underperformed in memory and verbal fluency domains compared to the control group. Evidence on cognitive impairments in patients with AMD may possibly herald neurocognitive insufficiencies and have common pathological mechanisms with dementias.

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Comparison of Progression Rate of Retinal Pigment Epithelium Loss in Patients with Neovascular Age-Related Macular Degeneration Treated with Ranibizumab and Aflibercept

Journal of Ophthalmology ◽

10.1155/2017/7432739 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Juliana Wons ◽

Magdalena A. Wirth ◽

Nicole Graf ◽

Matthias D. Becker ◽

Stephan Michels

Keyword(s):

Retinal Pigment Epithelium ◽

Macular Degeneration ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Age Related Macular Degeneration ◽

Progression Rate ◽

Intravitreal Ranibizumab ◽

Age Related ◽

Significant Difference ◽

One Year

Purpose. Retinal pigment epithelium (RPE) loss in neovascular age-related macular degeneration (nAMD) seem to have a linear progression but might be influenced by the treatment. The purpose of the study is the comparison of RPE loss over three years in patients treated with intravitreal ranibizumab to patients who were switched to aflibercept. Methods. A retrospective analysis with 96 eyes switched to aflibercept was conducted. The progression rate of RPE loss was evaluated in patients who showed atrophy one year prior to switch (n=17) or on switch date (n=19). The RPE loss was evaluated by spectral domain optical coherence tomography (SD-OCT). Further, 22 eyes from patients treated with ranibizumab were compared. Results. The median yearly progression of RPE loss after square root transformation showed no significant difference in the year prior to switch compared to the year after switch (p=0.854). In patients who received only ranibizumab, the median yearly progression of RPE loss was 0.15 mm/y, for aflibercept patients, 0.13 mm/y. This difference was not statistically significant (p=0.172). Conclusions. There seems to be a linear progression rate of RPE loss in patients treated with ranibizumab as well as in patients with aflibercept. No significant increase of progression rate was found after switch to aflibercept.

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Comparative Safety of Bevacizumab, Ranibizumab, and Aflibercept for Treatment of Neovascular Age-Related Macular Degeneration (AMD): A Systematic Review and Network Meta-Analysis of Direct Comparative Studies

Journal of Clinical Medicine ◽

10.3390/jcm9051522 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1522 ◽

Cited By ~ 1

Author(s):

Anna A. Plyukhova ◽

Maria V. Budzinskaya ◽

Kirill M. Starostin ◽

Robert Rejdak ◽

Claudio Bucolo ◽

...

Keyword(s):

Systematic Review ◽

Adverse Events ◽

Macular Degeneration ◽

Pigment Epithelium ◽

Meta Analysis ◽

Retinal Pigment ◽

Age Related Macular Degeneration ◽

Macular Atrophy ◽

Age Related

Background: Since the efficacy of ranibizumab (RBZ), bevacizumab (BVZ) and aflibercept (AFB) is comparable in neovascular age-related macular degeneration (AMD), we conducted a systematic review and meta-analysis to evaluate the long-term safety profiles of these agents, including ocular safety. Methods: Systematic review identifying randomized controlled trials (RCTs) comparing RBZ, BVZ and AFB directly published before March 2019. Serious ocular adverse events (SOAE) of special interest were endophthalmitis, pseudo-endophthalmitis, retinal pigment epithelium tear and newly identified macular atrophy. Results: Thirteen RCTs selected for meta-analysis (4952 patients, 8723 people-years follow-up): 10 compared RBZ vs. BVZ and three RBZ vs. AFB. There were no significant differences in almost all adverse events (systemic and ocular) between BVZ, RBZ and AFB in up to two years’ follow-up. Macular atrophy was reported heterogeneously and not reported as SOAE in most trials. Conclusions: Direct comparison of RBZ, BVZ and AFB safety profiles in the RCT network meta-analytical setting have not revealed a consistent benefit of these three commonly used anti-vascular endothelial growth factor (anti-VEGF) agents in AMD. Network model ranking highlighted potential benefits of RBZ in terms of a systemic safety profile; however, this appears a hypothesis rather than a conclusion. Newly identified macular atrophy is underestimated in RCTs—future real-world data should be focused on SOAE.

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Profiling Cognitive Performance and Sleep Quality Measures in Patients with Age-Related Macular Degeneration

10.31235/osf.io/ksc9e ◽

2021 ◽

Author(s):

Amirsaeid Moloodi ◽

Hooman Rezaie ◽

Behzad Khademi ◽

Mohammad Nami

Keyword(s):

Sleep Quality ◽

Macular Degeneration ◽

Cognitive Performance ◽

Age Related Macular Degeneration ◽

Control Group ◽

Control Groups ◽

Age Related ◽

Significant Difference ◽

The Mean ◽

And Control

Objective: This study aimed at profiling cognitive functions in patients with age-related macular degeneration (AMD).Method: This cross-sectional investigation enrolled 45 patients with AMD and 45 age- and sex-matched controls. The overall cognitive performance in AMD sufferer versus control subjects was asses using the Persian version of the Addenbrooke’s Cognitive Examination battery (ACE-R). Subjects’ sleep quality was also evaluated using the Pittsburgh Sleep Quality Index (PSQI). The mean global assessment and subscale scores were statistically compared between groups.Results: The mean global scores for ACE-R in AMD and control groups (80.4±12.3 and 86 ± 9.6, respectively) were found to be statistically different (p=0.018). On the other hand there was no significant difference (p=0.793) between the AMD and control groups in terms of PSQI scores (9.7±2.8 and 9.8±2.8, respectively). Conclusion: AMD patients seem to have cognitively underperformed in memory and verbal fluency domains compared to the control group. Evidence on cognitive impairments in patients with AMD may possibly herald neurocognitive insufficiencies and have common pathological mechanisms with dementias.

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Comparison between different techniques for treatment of sub macular haemorrhage due to Age Related Macular Degeneration

10.21203/rs.2.14176/v1 ◽

2019 ◽

Author(s):

Ahmed Abdelwahab Saad ◽

Daniela Vaideanu-Collins ◽

Lyudmila Kishikova ◽

Marco Isac ◽

Dina Hamada ◽

...

Keyword(s):

Macular Degeneration ◽

Visual Outcome ◽

Age Related Macular Degeneration ◽

University Hospital ◽

James Cook ◽

Age Related ◽

Significant Difference ◽

The Mean ◽

Group 2 ◽

Group 1

Abstract Background To compare the outcome of vitrectomy, subretinal tissue plasminogen activator (TPA), and gas with and without subretinal air versus Intravitreal TPA and gas in the treatment of sub macular haemorrhage (SMH) due to Neovascular age related macular degeneration Methods We analysed the notes of 29 cases presented with SMH in the period between 01/2016 and 09/2018 in James Cook University Hospital. Presenting visual acuity (BCVA), size and location of SMH, Procedure done, final BCVA at 6 months and any surgical complications were recorded. 11 Cases (Group 1) received intravitreal TPA (50ug in 0.1 ML), 0.3 ml of pure SF6. 18 cases (Group 2) received 23 G Pars Plana vitrectomy, Subretinal TPA injection (25ug in 0.1 ml), and 20% SF6 gas filling. Group 2 was further divided into 2A (10 patients) who received only subretinal TPA and group 2B (8 patients) who received additional 0.1 ml subretinal air.Results The mean BCVA at presentation was 0.0068 in group 1 and 0.0067 in group 2 (p= 0.8734). The mean postoperative BCVA at six months was 0.31 in group 1 and 0.58 in group 2 (p=0.0015). Subgroup analysis of group 2 didn’t show statistically significant difference in outcome when adding subretinal air to the vitrectomy procedure (p=0.7009).Conclusion Vitrectomy, gas and subretinal TPA has more successful displacement rate and better visual outcome than Intravitreal TPA & Gas alone in treating SMH involving the fovea in AMD. Additional subretinal air doesn't seem to improve the outcome in cases having vitrectcomy.

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Baseline predictors for subretinal fibrosis in neovascular age-related macular degeneration

Scientific Reports ◽

10.1038/s41598-021-03716-8 ◽

2022 ◽

Vol 12 (1) ◽

Author(s):

Philipp K. Roberts ◽

Markus Schranz ◽

Alice Motschi ◽

Sylvia Desissaire ◽

Valentin Hacker ◽

...

Keyword(s):

Macular Degeneration ◽

Subretinal Fluid ◽

Retinal Hemorrhage ◽

Age Related Macular Degeneration ◽

Fundus Photography ◽

Age Related ◽

Increased Risk ◽

Significant Difference ◽

Subretinal Fibrosis ◽

Treatment Naïve

AbstractTo find baseline predictors for subretinal fibrosis (SF) in neovascular age-related macular degeneration (nAMD). Forty-five eyes of 45 participants with treatment-naïve nAMD were consecutively enrolled and treated according to a standardized treat-and-extend protocol. Spectral-domain optical coherence tomography (OCT), color fundus photography and fluorescein angiography as well as novel imaging modalities polarization-sensitive OCT and OCT angiography (OCTA) were performed to detect SF after 1 year and find baseline predictors for SF development. Baseline OCTA scans were evaluated for quantitative features such as lesion area, vessel area, vessel junctions, vessel length, vessel endpoints and mean lacunarity. Additionally, the type of macular neovascularization, the presence of subretinal fluid, intraretinal fluid (IRF), subretinal hyperreflective material (SHRM), retinal hemorrhage as well as best-corrected visual acuity (BCVA) were evaluated. After 12 months 8 eyes (18%) developed SF. Eyes with SF had worse baseline BCVA (p = .001) and a higher prevalence of IRF (p = .014) and SHRM at baseline (p = .017). There was no significant difference in any of the evaluated quantitative OCTA parameters (p > .05) between eyes with and without SF. There were no quantitative baseline microvascular predictors for SF in our study. Low baseline BCVA, the presence of IRF and SHRM, however, are easily identifiable baseline parameters indicating increased risk.

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Aflibercept as a Treatment for Age-related Macular Degeneration

US Ophthalmic Review ◽

10.17925/usor.2013.06.01.58 ◽

2013 ◽

Vol 06 (01) ◽

pp. 58 ◽

Cited By ~ 1

Author(s):

Michael W Stewart ◽

Keyword(s):

Macular Degeneration ◽

Vision Loss ◽

Retinal Pigment ◽

Subretinal Fluid ◽

Age Related Macular Degeneration ◽

Unit Price ◽

Vegf Receptor ◽

Duration Of Action ◽

Age Related ◽

Endothelial Growth Factor

Vascular endothelial growth factor (VEGF) plays a central role in the development of several chorioretinal vascular disorders including exudative age-related macular degeneration (AMD). Detailed understanding of VEGF biochemistry has led to the development of four drugs which specifically inhibit its actions. Bevacizumab and ranibizumab have been the dominant ophthalmic anti-VEGF drugs for seven years and their regular use has significantly decreased vision loss. In late 2011, aflibercept, a high-affinity, fusion protein that acts as a soluble VEGF receptor, was approved for the treatment of exudative AMD. Phase three trials showed that monthly and bimonthly aflibercept maintained vision in 95 % of patients, improved average visual acuity by +8.3 to +9.4 letters, and thinned the macula comparably to monthly ranibizumab. Since its approval, aflibercept has been shown to decrease retinal edema and subretinal fluid, and flatten retinal pigment epithelial detachments in eyes that have responded incompletely to frequent ranibizumab and bevacizumab injections. Aflibercept’s longer duration of action coupled with its comparable unit price (versus ranibizumab) promise to decrease the total cost of treatment.

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