scholarly journals Anti-VEGF-resistant subretinal fluid is associated with better vision and reduced risk of macular atrophy

2021 ◽  
pp. bjophthalmol-2020-318688
Author(s):  
Marco A Zarbin ◽  
Lauren Hill ◽  
Andreas Maunz ◽  
Martin Gliem ◽  
Ivaylo Stoilov
Keyword(s):  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Treatment Resistant ◽  
Corrected Visual Acuity ◽  
Macular Atrophy ◽  
Age Related ◽  
Fundus Photographs ◽  
Post Hoc ◽  
Baseline Screening ◽  
Sd Oct

Background/aimTo evaluate relationships between subretinal fluid (SRF), macular atrophy (MA) and visual outcomes in ranibizumab-treated neovascular age-related macular degeneration (nAMD).MethodsThis post hoc HARBOR trial (NCT00891735) analysis included ranibizumab-treated (0.5 or 2.0 mg, monthly or as-needed, all treatment arms pooled) eyes with nAMD and baseline (screening, baseline and week 1) SRF. SRF presence, SRF thickness (0, >0–50, >50–100 and >100 µm) and subretinal fluid volume (SRFV) were determined by spectral domain optical coherence tomography (SD-OCT). Best-corrected visual acuity (BCVA) was assessed. MA was identified using fluorescein angiograms and colour fundus photographs, as well as SD-OCT.ResultsSeven hundred eighty-five of 1097 eyes met analysis criteria. In eyes without baseline MA, residual versus no SRF at month (M) 3 was associated with lower MA rates at M12 (5.1% vs 22.1%) and M24 (13.3% vs 31.2%) (both p<0.0001); MA percentages at M12/M24 were similar among patients with residual SRF at M6. Higher baseline SRFV was associated with a lower MA rate. Greater mean BCVA was observed with residual SRF of any thickness (>0–50 µm, 71.2 letters; >50–100 µm, 71.3 letters; >100 µm, 69.2 letters) versus no SRF (63.6 letters), but the change in BCVA from baseline to M12 or M24 was the same for eyes with or without treatment-resistant subretinal fluid (TR-SRF) at M3 or M6.ConclusionTR-SRF was not detrimental to vision outcomes over 2 years, regardless of thickness. MA rates were significantly higher without TR-SRF.

scholarly journals ORCA study: real-world versus reading centre assessment of disease activity of neovascular age-related macular degeneration (nAMD)

2020 ◽  
pp. bjophthalmol-2019-315717 ◽  
Author(s):  
Sandra Liakopoulos ◽  
Georg Spital ◽  
Christian K Brinkmann ◽  
Tina Schick ◽  
Focke Ziemssen ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Image Interpretation ◽  
Subretinal Fluid ◽  
Treatment Decisions ◽  
Age Related Macular Degeneration ◽  
Correct Identification ◽  
Age Related ◽  
Ocean Study ◽  
The Impact ◽  
Sd Oct

Background/aimsThe prospective, non-interventional ORCA module of the OCEAN study (Observation of Treatment Patterns with Lucentis in Approved Indications) evaluated the qualiy of spectral domain-optical coherence tomography (SD-OCT) image interpretation and treatment decisions by clinicians in Germany and the impact on visual outcomes over 24 months in patients with neovascular age-related macular degeneration (nAMD).Methods2286 SD-OCT scans of 205 eyes were independently evaluated by clinicians and reading centres (RCs) regarding signs of choroidal neovascularisation (CNV) activity, including presence of intraretinal fluid, subretinal fluid, and/or increase in pigment epithelial detachments. Agreement between clinicians and RCs was calculated. Treatment decisions by clinicians and the impact on treatment outcomes were evaluated.ResultsCNV activity was detected by RCs on 1578 scans (69.0%) and by clinicians on 1392 scans (60.9%), with agreement in 74.9% of cases. Of the 1578 scans with RC detected CNV activity, anti-vascular endothelial growth factor injections were performed by clinicians in only 35.5% (560/1578). In 19.7% of cases (311/1578), lack of treatment was justified by patients request, termination criteria or chronic cystoid spaces without other signs for CNV activity. In 44.8% of cases (707/1578) with RC detected CNV activity, clinicians claimed no treatment was necessary despite having correctly detected CNV activity in about 2/3 of these cases. In 34% of cases with presumed undertreatment, visual acuity declined in the following visit.ConclusionAlthough broad agreement on CNV activity parameters was observed between clinicians and RCs, correct identification of CNV activity did not always lead to the initiation of (re-)treatment. To preserve vision over time, correct interpretation of SD-OCT scans and careful retreatment decisions are required.Trial registration numberNCT02194803.

Intravitreal aflibercept efficacy in neovascular age-related macular degeneration with suboptimal response to anti-vascular endothelial growth factor-A therapy

2019 ◽  
Vol 30 (5) ◽  
pp. 1082-1090
Author(s):  
Jordi Monés ◽  
Marc Biarnés ◽  
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Macular Degeneration ◽  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Optical Coherence ◽  
Corrected Visual Acuity ◽  
Age Related ◽  
Endothelial Growth Factor ◽  
Best Corrected Visual Acuity

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.

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

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.

scholarly journals An Approach to the Quantitative Assessment of Retinal Layer Distortions and Subretinal Fluid in SD-OCT Images

2017 ◽  
Vol 23 (2) ◽  
pp. 615-628 ◽  
Author(s):  
Melinda Katona ◽  
László G. Nyúl
Keyword(s):  
Reading Ability ◽  
Subretinal Fluid ◽  
Developed Countries ◽  
Age Related Macular Degeneration ◽  
Retinal Layer ◽  
Central Vision ◽  
Cross Sectional ◽  
Retinal Layers ◽  
Age Related ◽  
Sd Oct

A modern tool for age-related macular degeneration (AMD) investigation is Optical Coherence Tomography (OCT), which can produce high resolution cross-sectional images of retinal layers. AMD is one of the most frequent reasons for blindness in economically developed countries. AMD means degeneration of the macula, which is responsible for central vision. Since AMD affects only this specific part of the retina, untreated patients lose their fine shape- and face recognition, reading ability, and central vision. Here, we deal with the automatic localization of subretinal fluid areas and also analyze retinal layers, since layer information can help to localize fluid regions. We present an algorithm that automatically delineates the two extremal retinal layers, successfully localizes subretinal fluid regions, and computes their extent. We present our results using a set of SD-OCT images. The quantitative information can also be visualized in an anatomical context for visual assessment.

Non-neovascular age-related macular degeneration with subretinal fluid

2020 ◽  
pp. bjophthalmol-2020-317326 ◽  
Author(s):  
Assaf Hilely ◽  
Adrian Au ◽  
K Bailey Freund ◽  
Anat Loewenstein ◽  
Eric H Souied ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Retinal Pigment Epithelial ◽  
Retinal Pigment ◽  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Neovascular Amd ◽  
Pigment Epithelial ◽  
Age Related ◽  
Sd Oct

PurposeTo evaluate the various patterns of subretinal fluid (SRF) in eyes with age-related macular degeneration (AMD) in the absence of macular neovascularisation (MNV) and to assess the long-term outcomes in these eyes.MethodsThis retrospective study included only eyes with non-neovascular AMD and associated SRF. Eyes with evidence of MNV were excluded. Spectral-domain optical coherence tomography (SD-OCT) was obtained at baseline and at follow-up, and qualitative and quantitative SD-OCT analysis of macular drusen including drusenoid pigment epithelial detachment (PED) and associated SRF was performed to determine anatomic outcomes.ResultsForty-five eyes (45 patients) were included in this analysis. Mean duration of follow-up was 49.7±36.7 months. SRF exhibited three different morphologies: crest of fluid over the apex of the drusenoid PED, pocket of fluid at the angle of a large druse or in the crypt of confluent drusen or drape of low-lying fluid over confluent drusen. Twenty-seven (60%) of the 45 eyes with fluid displayed collapse of the associated druse or drusenoid PED and 24 (53%) of the 45 eyes developed evidence of complete or incomplete retinal pigment epithelial and outer retinal atrophy.ConclusionNon-neovascular AMD with SRF is an important clinical entity to recognise to avoid unnecessary anti-vascular endothelial growth factor therapy. Clinicians should be aware that SRF can be associated with drusen or drusenoid PED in the absence of MNV and may be the result of retinal pigment epithelial (RPE) decompensation and RPE pump failure.

scholarly journals Is Spectral-Domain Optical Coherence Tomography Essential for Flexible Treatment Regimens with Ranibizumab for Neovascular Age-Related Macular Degeneration?

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Abdullah Ozkaya ◽  
Zeynep Alkin ◽  
Hande Mefkure Ozkaya ◽  
Alper Agca ◽  
Engin Bilge Ozgurhan ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Degeneration ◽  
Clinical Examination ◽  
Pigment Epithelium ◽  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Spectral Domain ◽  
Optical Coherence ◽  
Age Related ◽  
Sd Oct

Purpose. To evaluate the ability of spectral-domain optical coherence tomography to detect subtle amounts of retinal fluid when the choroidal neovascularization is detected as inactive via time-domain optical coherence tomography and clinical examination in neovascular age-related macular degeneration (nAMD) patients.Methods. Forty-nine eyes of 49 patients with nAMD after ranibizumab treatment were included in this cross-sectional, prospective study. All patients were imaged with TD-OCT and SD-OCT at the same visit one month after a ranibizumab injection. The presence of subretinal, intraretinal, and subretinal pigment epithelium fluid (subRPE) in SD-OCT was evaluated; also mean central retinal thickness (CRT) and the rate of vitreoretinal surface disorders detected via the two devices were evaluated.Results. The mean CRT via TD-OCT and SD-OCT was218.1±51.3and325.7±78.8microns. Sixteen patients (32.6%) showed any kind of retinal fluid via SD-OCT. In detail, 8 patients (16.3%) showed subretinal fluid, 10 patients (20.4%) showed intraretinal fluid, and 3 patients (6.1%) showed SubRPE fluid. The ability of detecting vitreoretinal surface disorders was comparable between the two devices, except vitreomacular traction.Conclusion. SD-OCT is essential for the nAMD patients who are on an as-needed treatment regimen with ranibizumab. Only TD-OCT and clinical examination may cause insufficient treatment in this group of patients.

scholarly journals Effect of COVID-19 Lockdown in Spain on Structural and Functional Outcomes of Neovascular AMD Patients

2021 ◽  
Vol 10 (16) ◽  
pp. 3551
Author(s):  
Alicia Valverde-Megías ◽  
Daniela Rego-Lorca ◽  
José Ignacio Fernández-Vigo ◽  
Antonio Murciano-Cespedosa ◽  
Alicia Megías-Fresno ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Visual Loss ◽  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Neovascular Amd ◽  
Corrected Visual Acuity ◽  
Age Related ◽  
Single Center Study ◽  
Center Study

This is a retrospective single-center study of patients with neovascular age-related macular degeneration whose follow-up was delayed due to COVID-19 pandemic with at least three months between visits in Madrid, Spain. The purpose of the study was to evaluate best corrected visual acuity (BCVA) changes and try to identify features in optical coherence tomography (OCT) that could be related to more profound visual loss. It included 270 eyes. The two last visits before lockdown were used for comparison with the visit after lockdown. BCVA changed from 60.2 ± 18.2 to 55.9 ± 20.5 ETDRS letters. 29% of the eyes lost more than 5 letters. OCT was active in 67% of eyes before lockdown and in 80.4% after lockdown. Multiple lineal analysis showed that patients whose OCT before lockdown presented with a combination of intra and subretinal fluid were more likely to suffer a greater visual loss (p = 0.002). These patients should be encouraged to not miss any visits in case a new lockdown is imposed.

scholarly journals The Development of Macular Atrophy in Patients with Wet Age-Related Macular Degeneration Receiving Anti-VEGF Treatment

2021 ◽  
Author(s):  
Alexander Foss ◽  
Tryfon Rotsos ◽  
Theo Empeslidis ◽  
Victor Chong
Keyword(s):  
Macular Degeneration ◽  
Vision Loss ◽  
Subretinal Fluid ◽  
Standard Of Care ◽  
Protective Role ◽  
Age Related Macular Degeneration ◽  
Macular Atrophy ◽  
Anti Vegf ◽  
Age Related ◽  
Expression Evidence

Age-related macular degeneration (AMD) is a leading cause of blindness. Late AMD can be classified into exudative (commonly known as wet AMD [wAMD]) or dry AMD, both of which may progress to macular atrophy (MA). MA causes irreversible vision loss and currently has no approved pharmacological treatment. The standard of care for wAMD is treatment with anti-vascular endothelial growth factors (VEGF). However, recent evidence suggests that anti-VEGF treatment may play a role in the development of MA. Therefore, it is important to identify risk factors for the development of MA in patients with wAMD. For example, excessive blockade of VEGF through intense use of anti-VEGF agents may accelerate the development of MA. Patients with type III macular neovascularisation (retinal angiomatous proliferation) have a particularly high risk of MA. These patients are characterised as having a pre-existing thin choroid (age-related choroidopathy), suggesting that the choroidal circulation is unable to respond to increased VEGF expression. Evidence suggests that subretinal fluid (possibly indicative of residual VEGF activity) may play a protective role. Patients receiving anti-VEGF agents must be assessed for overall risk of MA and there is an unmet medical need to prevent the development of MA without undertreating wAMD.

scholarly journals Anti-VEGF Treatment and Optical Coherence Tomography Biomarkers in Wet Age-Related Macular Degeneration

2021 ◽  
Author(s):  
Maja Vinković ◽  
Andrijana Kopić ◽  
Tvrtka Benašić
Keyword(s):  
Optical Coherence Tomography ◽  
High Resolution ◽  
Macular Degeneration ◽  
Real World ◽  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Optical Coherence ◽  
Anti Vegf ◽  
Age Related ◽  
Sd Oct

Age-related macular degeneration (AMD) is one of the most common causes of severe visual loss in middle and old-age population, and often leads to serious deterioration in quality of life. Currently, the first-line treatment for neovascular AMD (nAMD) are intravitreal injections of anti-vascular endothelial growth factor (VEGF) medications, including bevacizumab, ranibizumab, and aflibercept and also latest commercially available drug, brolucizumab. During initial examination and imaging and treatment follow-up for patients with nAMD, optical coherence tomography (OCT) is used to predict and assess the therapeutic response and guide the treatment. Several OCT-based biomarkers, including the central subfoveal thickness (CSFT), the presence of intraretinal cysts (IRCs) or subretinal fluid (SRF), and the presence of pigment epithelial detachment (PED), were found to influence baseline visual acuity or visual improvements. Recent analyses of large randomized control trials (RCTs) summarized the usefulness of these OCT-based biomarkers. However, many of these early studies relied on time-domain OCT to evaluate the retinal structures thus providing less precise evaluation of the retinal details. After introduction of spectral-domain OCT (SD-OCT) which provided high resolution images, recent studies offered new insights in specific morphological changes and their different impact on visual function in nAMD. For example, these advancement in resolution offered new classification of IRCs into degenerative and exudative which impacts treatment strategy and final outcome in the treatment of nAMD. Moreover, the recent data disclose a substantial difference between RCTs and real-world studies regarding the response to anti-VEGF therapy. In conclusions, IRCs and PED are associated with poor visual improvement in nAMD in a realworld setting. Both IRCs and SRF responded better than PED to anti-VEGF therapy. These observations mandate large longitudinal studies focusing on the usefulness of these high resolution SD-OCT biomarkers in real-world situations.

Sign in / Sign up

Export Citation Format

Share Document