scholarly journals Pachychoroid Neovasculopathy Disguising as Age-Related Macular Degeneration Treated by Spironolactone and Anti-VEGF Combination Therapy

2021 ◽  
pp. 116-123
Author(s):  
Leonie F. Keidel ◽  
Benedikt Schworm ◽  
Siegfried G. Priglinger ◽  
Jakob Siedlecki
Keyword(s):  
Combination Therapy ◽  
Macular Degeneration ◽  
Pigment Epithelium ◽  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Chronic Central Serous Chorioretinopathy ◽  
Anti Vegf ◽  
Age Related ◽  
Therapeutic Concepts ◽  
Pachychoroid Neovasculopathy

Nonresponse of neovascular age-related macular degeneration (nAMD) to anti-vascular endothelial growth factor (anti-VEGF) therapy can often be attributed to misdiagnosis, and pathologies mimicking AMD might require different therapeutic concepts. In the following, we want to outline a case of presumed nAMD which revealed to be pachychoroid neovasculopathy (PNV) and was successfully treated by the addition of spironolactone. A 67-year-old female patient was referred for nonresponse of nAMD on her left eye after 29 intravitreal injections of aflibercept with no complete resolution of subretinal fluid. On fundoscopy, both maculae presented with pigment epithelium alterations, while the left eye showed subretinal fluid on optical coherence tomography (OCT) with an associated pigment epithelium detachment, which revealed to contain a neovascular network on OCT angiography. There was faint leakage on fluorescence (FAG) and indocyanine green angiography (ICGA) and some focal vascular dilation of the neovascular network on ICGA. Due to the absence of Drusen on any eye, a thick choroid, and the presence of a gravitational tract on blue autofluorescence (BAF), chronic central serous chorioretinopathy with a choroidal neovascularization, defined as PNV in the pachychoroid disease was diagnosed. Upon the addition of spironolactone to anti-VEGF treatment, choroidal thickness significantly decreased, and subretinal fluid resolution was observed and maintained for the first time. In conclusion, PNV should be ruled out in cases of presumed nAMD nonresponding to anti-VEGF. In these cases, a combination therapy of anti-VEGF and mineralocorticoid antagonists can facilitate fluid resorption.

scholarly journals LRG1 Expression Is Elevated in the Eyes of Patients with Neovascular Age-Related Macular Degeneration

2021 ◽  
Vol 22 (16) ◽  
pp. 8879
Author(s):  
Lucia Mundo ◽  
Gian Marco Tosi ◽  
Stefano Lazzi ◽  
Grazia Pertile ◽  
Barbara Parolini ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Aqueous Humor ◽  
Smooth Muscle Actin ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Average Concentration ◽  
Age Related Macular Degeneration ◽  
Surrounding Tissue ◽  
Anti Vegf ◽  
Age Related

Leucine-rich a-2-glycoprotein 1 (LRG1) is a candidate therapeutic target for treating the neovascular form of age-related macular degeneration (nvAMD). In this study we examined the expression of LRG1 in eyes of nvAMD patients. Choroidal neovascular membranes (CNVMs) from patients who underwent submacular surgery for retinal pigment epithelium–choroid graft transplantation were collected from 5 nvAMD patients without any prior intravitreal anti-VEGF injection, and from six patients who received intravitreal anti-VEGF injections before surgery. As controls free of nvAMD, retina sections were obtained from the eyes resected from a patient with lacrimal sac tumor and from a patient with neuroblastoma. CNVMs were immunostained for CD34, LRG1, and α-smooth muscle actin (α-SMA). Aqueous humor samples were collected from 58 untreated-naïve nvAMD patients prior to the intravitreal injection of anti-VEGF and 51 age-matched cataract control patients, and LRG1 concentration was measured by ELISA. The level of LRG1 immunostaining is frequently high in both the endothelial cells of the blood vessels, and myofibroblasts in the surrounding tissue of CNVMs of treatment-naïve nvAMD patients. Furthermore, the average concentration of LRG1 was significantly higher in the aqueous humor of nvAMD patients than in controls. These observations provide a strong experimental basis and scientific rationale for the progression of a therapeutic anti-LRG1 monoclonal antibody into clinical trials with patients with nvAMD.

scholarly journals A Case of Sustained Intraocular Pressure Elevation after Multiple Intravitreal Injection of Ranibizumab and Aflibercept for Neovascular Age-Related Macular Degeneration

2016 ◽  
Vol 7 (1) ◽  
pp. 230-236 ◽  
Author(s):  
Hisashi Matsubara ◽  
Ryohei Miyata ◽  
Maki Kobayashi ◽  
Hideyuki Tsukitome ◽  
Kengo Ikesugi ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Macular Degeneration ◽  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Intravitreal Injections ◽  
Multiple Injections ◽  
Anti Vegf ◽  
Age Related ◽  
Intravitreal Aflibercept ◽  
Iop Elevation

Intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents are widely used to treat neovascular age-related macular degeneration (nAMD). Although these treatments are effective, multiple injections have recently been recommended to ensure that there is a good long-term prognosis. However, sustained intraocular pressure (IOP) elevations have been reported to develop after multiple injections of anti-VEGF agents. We present our findings of a case of uncontrolled and persistent IOP elevation after switching from intravitreal ranibizumab injections to intravitreal aflibercept injections. A 74-year-old Japanese man without a history of glaucoma underwent 22 ranibizumab injections for nAMD and suddenly developed an elevated IOP after the 22nd injection. Although the subsequent medical treatment led to normalization of his IOP, the subretinal fluid under the central fovea remained even after the 25th injection of ranibizumab. Thus, ranibizumab treatment was switched to bimonthly intravitreal aflibercept injections in conjunction with glaucoma medications. His IOP recovered to within the normal range; however, after the 11th aflibercept injection, there was a sudden elevation of his IOP in spite of the continued glaucoma medications. Due to this sustained IOP elevation, his aflibercept injections were suspended for 16 weeks. Because his IOP could not be normalized by a full glaucoma medication regimen, the patient underwent trabeculotomy, which resulted in a lowering of the IOP to normal levels. We conclude that patients who receive serial intravitreal injections of anti-VEGF agents need to be closely monitored because severe and sustained ocular hypertension can develop.

scholarly journals Analyses of the effects of persistent subretinal fluid on visual/anatomic outcomes according to the type of macular neovascularization during the relaxed treat-and-extend protocol in age-related macular degeneration patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kyung Tae Kim ◽  
Ju Byung Chae ◽  
Seungheon Lee ◽  
Eoi Jong Seo ◽  
Dong Yoon Kim
Keyword(s):  
Macular Degeneration ◽  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Long Term Effects ◽  
Treat And Extend ◽  
Anti Vegf ◽  
Age Related ◽  
Treat And Extend Regimen

Abstract Background To analyze the long-term effects of persistent subretinal fluid (SRF) on visual/anatomic outcomes according to the type of macular neovascularization (MNV) during relaxed treat-and-extend regimen with anti-vascular endothelial growth factor (anti-VEGF) agents in age-related macular degeneration (AMD) patients. Methods Patients with fovea-involving type 1 or type 2 MNV, treated with a relaxed treat-and-extend regimen for 2 years were retrospectively reviewed. Eyes with SRF observed more than three times per year were defined as the ‘persistent SRF (+) group’. To exclude the effects of IRF as much as possible, the eyes with persistent IRF were excluded. The effects of persistent SRF on the best-corrected visual acuity (BCVA), central subfield retinal thickness (CST), and changes in the photoreceptor layer (PRL) thickness and outer retinal bands (external limiting membrane, ellipsoid zone, and cone outer segment tip line) after anti-VEGF injection were analyzed for each MNV type. Results Seventy-seven eyes with type 1 MNV (44 eyes with persistent SRF) and 53 eyes with type 2 MNV (18 eyes with persistent SRF) were enrolled. Following a relaxed treat-and-extend regimen with anti-VEGF agents, BCVA and CST improved for each MNV type. In comparison between persistent SRF (+) and persistent SRF (−) group, there were no differences in the amount of change in BCVA and CST between the two groups for each MNV type during 2-year follow-up periods. In addition, there were no differences in the amount of reduction in PRL thickness and state of the outer retinal bands between the two groups for each MNV type. Conclusions Using a relaxed treat-and-extend regimen with anti-VEGF agents, persistent SRF did not have additional effects on visual and anatomic outcomes by 2 years, regardless of the MNV type.

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

Eye ◽  
2020 ◽  
Vol 34 (12) ◽  
pp. 2249-2256 ◽  
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.

Intravitreal Anti-VEGF Therapy for Vascularized Pigment Epithelium Detachment in Age-Related Macular Degeneration

2014 ◽  
Vol 24 (3) ◽  
pp. 402-408 ◽  
Author(s):  
Fabrizio Giansanti ◽  
Daniela Bacherini ◽  
Giovanni Giacomelli ◽  
Gianni Virgili ◽  
Lucia Finocchio ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Pigment Epithelium ◽  
Age Related Macular Degeneration ◽  
Pigment Epithelium Detachment ◽  
Anti Vegf ◽  
Age Related

scholarly journals Incidence of Retinal Pigment Epithelial Tears and Associated Risk Factors After Treatment of Age-Related Macular Degeneration with Intravitreal Anti-VEGF Injections§

2014 ◽  
Vol 8 (1) ◽  
pp. 101-104 ◽  
Author(s):  
Theodoros Empeslidis ◽  
Athanasios Vardarinos ◽  
Vasileios Konidaris ◽  
Soon Wai Ch'ng ◽  
Bharat Kapoor ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retinal Pigment Epithelium ◽  
Macular Degeneration ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Age Related Macular Degeneration ◽  
Anti Vegf ◽  
Age Related ◽  
Associated Risk Factors ◽  
Rpe Tear

Purpose : To study the incidence and risk factors for retinal pigment epithelium tears following intravitreal anti-vascular endothelial growth factor (VEGF) injections. Methods : Retrospective longitudinal study. 4027 intravitreal anti-VEGF injections in 628 patients (676 eyes) for choroidal neovascularisation associated with age related macular degeneration in a period of 18 months were studied. Results : Seventeen patients (mean age 83.95±5.84) developed retinal pigment epithelium tears. The incidence rate was 0.4%. Fibrovascular pigment epithelium detachment (PED) was previously observed in all cases. In 88 % (15/17) of AMD patients that had a RPE tear, PED height was found to be less than 400 microns at presentation. In 5 of 7 patients with RPE tear grade <4, continuing of anti-VEGF treatment resulted to improvement of visual acuity. Conclusion : Critical risk factors for RPE tears are presence of PED as well as advanced age. Visual improvement appears to depend more on the extent and location of the RPE tear and less on the PED height.

Nutraceutical «Resvega Forte» in complex treatment of neovascular age-related macular degeneration against the background of anti-VEGF therapy

2021 ◽  
pp. 312-316
Author(s):  
L.P. Danilova ◽  
◽  
V.V. Egorov ◽  
G.P. Smoliakova ◽  
D.А. Povalyaeva ◽  
...  
Keyword(s):  
Disease Activity ◽  
Macular Degeneration ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Angiogenesis Inhibitor ◽  
Age Related Macular Degeneration ◽  
Morphological Parameters ◽  
Complex Treatment ◽  
Anti Vegf ◽  
Age Related

Purpose. To evaluate clinical efficacy of using nutraceutical "Resvega Forte" in complex treatment neovascular age-related macular degeneration (nAMD) against the background anti-VEGF therapy using ranibizumab (LUCENTIS®). Material and methods. The object of the study was 30 patients (30 eyes) with nAMD, who received 3 "loading" intravitreal injections (IVI) of 0,5 mg (0,05 ml) ranibizumab at intervals of 1 time per month, then within a year – by the protocol "Tread-and-Extend" with increase interval between injections by 2 weeks in the absence of disease activity and its reduction in case of resumption of activity. Patients of the 1st group (16 people) were supplemented with 3 "loading" IVI of ranibizumab with appointment of "Resvega Forte" complex for 3 months and then after 6 months. Patients of the 2nd group (14 people) did not receive "Resvega Forte" complex. To assess the effectiveness of treatment, in addition to standard methods, optical coherence tomography was performed with assessment of the central retinal thickness (CRT), the presence of detachment of the retinal pigment epithelium (RPE), retinal neuroepithelium (RNE), sub- and intraretinal fluid under PE. Results. By the 12th month of observation, none of the patients of the 1st group against the background of using two complexes "Resvega Forte" was found to have resumption of disease activity: the BCVA increased 3 times and amounted to 0,78±0,04, the average indexes of CRT corresponded to the norm (249,5±12,1 µm). The interval between injections increased to 12 weeks, and their total number was 7. In the 2nd group, the resumption of disease activity was noted twice, which was accompanied by decrease in the functional and morphological parameters of retina and required decrease in the intervals between injections to 10 weeks, which accordingly led to an increase in their number to 9-10. Conclusion. The inclusion of nutraceutical "Resvega Forte" in the treatment regimen of nAMD against the background of the therapy using angiogenesis inhibitor LUCENTIS® in the protocol "Tread-and-Extend" mode allows to reduce the risk of progression of nAMD, as well as to improve the functional and morphological parameters of retina. An integrated approach makes it possible to increase the interval between injections and reduce additional monitoring, which reduces the burden on both the patient and the doctor. Key words: neovascular age-related macular degeneration, aflibercept, nutraceuticals, "Resvega forte".

Risk Factors for Retinal Pigment Epithelium Tears after Anti-VEGF Agent Injection in Age-Related Macular Degeneration

2013 ◽  
Vol 54 (10) ◽  
pp. 1546 ◽  
Author(s):  
Woo Seok Choae ◽  
Jae Hong Park ◽  
Woo Seok Lee ◽  
Sang Won Kim ◽  
Hee Seong Yoon
Keyword(s):  
Risk Factors ◽  
Retinal Pigment Epithelium ◽  
Macular Degeneration ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Age Related Macular Degeneration ◽  
Anti Vegf ◽  
Age Related

scholarly journals Transient accumulation of subretinal fluid after half-fluence photodynamic therapy in neovascular age-related macular degeneration

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Min Ho Kim ◽  
Yoo-Ri Chung ◽  
Ji Hun Song
Keyword(s):  
Visual Acuity ◽  
Photodynamic Therapy ◽  
Macular Degeneration ◽  
Pigment Epithelium ◽  
Subretinal Fluid ◽  
Post Treatment ◽  
Age Related Macular Degeneration ◽  
Age Related ◽  
The Mean ◽  
Pre Treatment

Abstract Background Photodynamic therapy (PDT) is known to occlude choroidal neovascularisation selectively, and there have been several reports on its adverse effects on the normal choroid and retinal pigment epithelium, resulting in decreased vision. Methods This retrospective interventional case series aimed to investigate the changes in visual acuity and retinal thickness in the immediate post-treatment period after half-fluence PDT, administered alone or with anti-vascular endothelial growth factor and steroids, in 29 eyes (26 patients) with neovascular age-related macular degeneration. The patients’ best-corrected visual acuity (BCVA) and central foveal thickness (CFT) on optical coherence tomography images were measured 1 day, 1 week, and 1 month post-treatment. Results Compared to the pre-treatment CFT (270.38 μm), the mean CFT was significantly increased 1 day post-treatment (387.07 μm, P = 0.001), which then started to decrease, with a mean CFT of 269.32 μm (P = 0.516) at 1 week, and of 240.66 μm (P = 0.066) at 1 month post-treatment. All CFT increases were due to the accumulation of subretinal fluid (SRF), rather than the intraretinal or subretinal pigment epithelium fluid. Relative to the pre-treatment BCVA (0.59 logMAR), the mean BCVA at 1 day (0.74 logMAR, P = 0.005) and 1 week (0.75 logMAR, P = 0.002) post-treatment was significantly deteriorated; however, it recovered to 0.62 logMAR at 1 month. The patterns of change in CFT and BCVA did not differ according to treatment modality. Conclusions Half-fluence PDT resulted in accumulation of SRF in the immediate post-treatment period; this damage mostly recovered within a week, and the BCVA was restored within a month.

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