One-year real-life results on effect of intravitreal aflibercept in patients with diabetic macular oedema switched from ranibizumab

2020 ◽  
pp. 112067212092727
Author(s):  
Marko Lukic ◽  
Gwyn Williams ◽  
Zaid Shalchi ◽  
Praveen J Patel ◽  
Philip G Hykin ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Early Treatment ◽  
Macular Oedema ◽  
Real Life ◽  
Diabetic Macular Oedema ◽  
Foveal Thickness ◽  
Macular Volume ◽  
Central Foveal Thickness ◽  
The Mean

Purpose To assess visual and optical coherence tomography–derived anatomical outcomes of treatment with intravitreal aflibercept (Eylea®) for diabetic macular oedema in patients switched from intravitreal ranibizumab (Lucentis®). Design Retrospective, cohort study. Participants Ninety eyes (of 67 patients) receiving intravitreal anti–vascular endothelial growth factor therapy were included. Methods This is a retrospective, real-life, cohort study. Each patient had visual acuity measurements and optical coherence tomography scans performed at baseline and 12 months after the first injection of aflibercept was given. Main Outcome Measures We measured visual acuities in Early Treatment Diabetic Retinopathy Study letters, central foveal thickness and macular volume at baseline and at 12 months after the first aflibercept injection was given. Results Ninety switched eyes were included in this study. The mean (standard deviation) visual acuity was 63 (15.78) Early Treatment Diabetic Retinopathy Study letters. At baseline, the mean (standard deviation) central foveal thickness was 417.7 (158.4) μm and the mean macular volume was 9.96 (2.44) mm3. Mean change in visual acuity was +4 Early Treatment Diabetic Retinopathy Study letters (p = 0.0053). The mean change in macular volume was −1.53 mm 3 in SW group (p = 0.21), while the change in central foveal thickness was −136.8 μm (p = 0.69). Conclusion There was a significant improvement in visual acuity and in anatomical outcomes in the switched group at 12 months after commencing treatment with aflibercept for diabetic macular oedema.

scholarly journals Intravitreal aflibercept for diabetic macular oedema: Moorfields’ real-world 12-month visual acuity and anatomical outcomes

2019 ◽  
Vol 30 (3) ◽  
pp. 557-562 ◽  
Author(s):  
Marko Lukic ◽  
Gwyn Williams ◽  
Zaid Shalchi ◽  
Dawn Sim ◽  
Praveen J Patel ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Standard Deviation ◽  
Early Treatment ◽  
Macular Oedema ◽  
Diabetic Macular Oedema ◽  
Foveal Thickness ◽  
Central Foveal Thickness ◽  
Intravitreal Aflibercept ◽  
The Mean

Objectives: To assess structural and functional outcomes of treatment with intravitreal aflibercept (Eylea®) for diabetic macular oedema in treatment-naive patients. Design: This is a retrospective, real-life, cohort study. Participants and Methods: In all, 92 diabetic patients (102 eyes) receiving intravitreal anti–vascular endothelial growth factor therapy were included. A total of 99 aflibercept-treated eyes were included in the statistical analysis. Each patient had corrected visual acuity in Early Treatment Diabetic Retinopathy Study letters and optical coherence tomography central foveal thickness and macular volume performed at baseline and 12 months. Patients were initiated on a loading phase of five monthly intravitreal aflibercept injections, followed by injections if needed as per clinicians’ discretion. Results: The mean number of aflibercept injections received was 6.92. At baseline, the mean visual acuity (standard deviation; Snellen) was 59.7 (16.1) (20/63) Early Treatment Diabetic Retinopathy Study letters, the mean central foveal thickness (standard deviation) was 431 (129) µm, while the mean macular volume (standard deviation) was 9.53 (1.79) mm3. At 12 months, the mean visual acuity (standard deviation; Snellen) was 69.6 (15.2; 20/40) Early Treatment Diabetic Retinopathy Study letters (p < .0001). Mean central foveal thickness (standard deviation) was 306 (122) μm (p < .0001) and mean macular volume (standard deviation) was 8.43 (1.58) mm3 (p < .0001) at 12 months; 33 (33.67%) eyes gained ⩾15 Early Treatment Diabetic Retinopathy Study letters at month 12, and 50 (55.55%) eyes had a decrease in central foveal thickness of ⩾100 µm. Conclusion: There was a significant improvement in visual acuity and in anatomical outcomes in aflibercept-treated eyes at 12 months after commencing treatment for diabetic macular oedema in real-life settings.

Intravitreal aflibercept for diabetic macular oedema in real-world: 36-month visual acuity and anatomical outcomes

2020 ◽  
pp. 112067212092503
Author(s):  
Marko Lukic ◽  
Gwyn Williams ◽  
Zaid Shalchi ◽  
Praveen J Patel ◽  
Philip G Hykin ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Standard Deviation ◽  
Early Treatment ◽  
Diabetic Macular Oedema ◽  
Foveal Thickness ◽  
Central Foveal Thickness ◽  
Intravitreal Aflibercept ◽  
The Mean ◽  
Anatomical Outcomes

Background/aims To assess structural and functional outcomes of treatment with intravitreal aflibercept (®Eylea) for diabetic macular oedema in treatment-naïve patients. Methods Sixty-four eyes receiving intravitreal anti-vascular endothelial growth factor therapy were included in the data analysis of this retrospective, real-life study which follow-up was 3 years. Each patient had corrected visual acuity in Early Treatment Diabetic Retinopathy Study letters and optical coherence tomography central foveal thickness and macular volume performed at baseline, 12, 24 and 36 months. Patients were initiated on a loading phase of five 1-monthly intravitreal aflibercept injections, followed by injections if needed as per clinicians’ discretion. Results The mean number of aflibercept injections received over 3 years was 12.59. At baseline, the mean visual acuity (standard deviation) (Snellen) was 61.45 (16.30) (20/63) Early Treatment Diabetic Retinopathy Study letters, the mean central foveal thickness (standard deviation) was 422 (138) µm, while the mean macular volume (standard deviation) was 9.51 (2.01) mm3. At 36 months, the mean visual acuity (standard deviation) (Snellen) was 68.34 (13.66) (20/50) Early Treatment Diabetic Retinopathy Study letters (p = .0003). Mean central foveal thickness (standard deviation) was 303 (106) µm (p < .0001) and mean macular volume (standard deviation) was 8.35 (1.62) mm3 (p = .0022) at 36 months. Sixteen (25%) eyes gained ≥15 ETDRS letters at month 36, and 33 (52%) eyes had a decrease in central foveal thickness of ≥ 100 µm at the same time. Conclusion There was a significant improvement in visual acuity and in anatomical outcomes in aflibercept-treated eyes at 36 months after commencing treatment for diabetic macular oedema in real-life settings. The good vision and anatomical outcomes were maintained over second and third year of treatment with mean 2.93 and 2.57 intravitreal injections, respectively.

Macular vessel reduction as predictor for recurrence of macular oedema requiring repeat intravitreal ranibizumab injection in eyes with branch retinal vein occlusion

2018 ◽  
Vol 103 (10) ◽  
pp. 1367-1372 ◽  
Author(s):  
Taiji Hasegawa ◽  
Yohei Takahashi ◽  
Ichiro Maruko ◽  
Akiko Kogure ◽  
Tomohiro Iida
Keyword(s):  
Visual Acuity ◽  
Retinal Vein Occlusion ◽  
Macular Oedema ◽  
Branch Retinal Vein Occlusion ◽  
Initial Visit ◽  
Intravitreal Ranibizumab ◽  
Foveal Thickness ◽  
Central Foveal Thickness ◽  
Vein Occlusion ◽  
The Mean

AimTo determine whether there are factors that can predict the frequency of recurrences of macular oedema associated with branch retinal vein occlusion (BRVO).MethodsWe reviewed the medical records of 31 eyes with treatment-naïve macular oedema associated with BRVO. All eyes received an intravitreal ranibizumab (IVR) injection and were followed with a pro re nata protocol for at least 12 months. A reinjection of ranibizmab was performed when the central foveal thickness was ≥300 µm. At 1 month after IVR injection, the macular vessel reduction was calculated by comparing the vessel density in the optical coherence tomography angiography in the BRVO involved half to that in the non-involved half.ResultsThe mean visual acuity improved from 0.35±0.27 logarithm of the minimal angle of resolution (logMAR) units (20/45; Snellen) at initial visit to 0.06±0.15 logMAR units (20/23) at 12 months (p<0.0001). During 12 months, the mean number of IVR injections was 3.8±1.8. Multivariate regression analysis showed that a greater macular vessel reduction at 1 month after initial IVR injection was significantly a negative predictor of frequency of IVR injections (β=−0.5065, p=0.0082). The visual acuity and the central foveal thickness at the initial visit or at 1 month after initial IVR injection were not predictive factors for frequency of IVR injections.ConclusionsPatients with BRVO with a large macular vessel reduction at 1 month after an initial IVR injection have fewer recurrences and thus lower frequency of IVR injections during 12 months.

scholarly journals Outcomes of three intravitreal injections of bevacizumab given monthly for diabetic macular oedema is a viable treatment for an economically disadvantaged population

2021 ◽  
Vol 80 (1) ◽  
Author(s):  
Aazambir S. Brar ◽  
Vivek B. Wani ◽  
Arvind L. Tenagi
Keyword(s):  
Visual Acuity ◽  
Intravitreal Injection ◽  
Macular Oedema ◽  
Diabetic Macular Oedema ◽  
Foveal Thickness ◽  
Central Foveal Thickness ◽  
Disadvantaged Population ◽  
Corrected Visual Acuity ◽  
Student’S T ◽  
Best Corrected Visual Acuity

Background: The treatment of diabetic macular oedema (DMO) by intravitreal injection (IVI) of approved anti-vascular endothelial growth factor (VEGF) is costly and hence off label use of bevacizumab is practiced in spite of concerns about its safety.Aim: To examine the effect of three IVI of bevacizumab given monthly, on best corrected visual acuity (BCVA) and central foveal thickness (CFT) of eyes with DMO.Setting: Charity hospital attached to a medical college in India.Methods: Patients with centre involving DMO with BCVA ≤ 6/9 and CFT ≥ 260 microns were recruited prospectively, and three IVI bevacizumab given monthly (from a common vial). At four months BCVA and CFT were assessed and compared with baseline data. Side effects, if any, were recorded. Best corrected visual acuity was converted to logMAR units for statistical analysis. Student’s t-test were conducted to see statistically significant changes in BCVA and CFT.Results: A total of 50 eyes of 38 patients received three monthly IVI bevacizumab. Best corrected visual acuity (logMAR) improved from baseline mean of 0.80 ± 0.49 to final mean of 0.51 ± 0.36, which was significant (p = 0.0001). The mean baseline CFT (μm) improved from 448.40 ± 149.47 to 368.76 ± 131.49, which was significant (p = 0.0001). No cases of endophthalmitis were reported. Various factors such as diabetes duration and HbA1c (hemoglobinA1c) value were not found to be significant for the improvement in BCVA and CFT.Conclusion: Intravitreal injection bevacizumab given as three monthly injections was safe, economical and effective in the management of DMO.

scholarly journals Extended real-world experience with the ILUVIEN® (fluocinolone acetonide) implant in the United Kingdom: 3-year results from the Medisoft® audit study

Eye ◽  
2021 ◽  
Author(s):  
Clare Bailey ◽  
◽  
Usha Chakravarthy ◽  
Andrew Lotery ◽  
Geeta Menon ◽  
...  
Keyword(s):  
Macular Oedema ◽  
Diabetic Macular Oedema ◽  
Clinical Effectiveness ◽  
Fluocinolone Acetonide ◽  
Prior History ◽  
Foveal Thickness ◽  
Central Foveal Thickness ◽  
Laser Trabeculoplasty ◽  
Retrospective Audit ◽  
History Of

Abstract Background This study aimed to assess the long-term effectiveness of the 0.2 μg/day fluocinolone acetonide (FAc) implant over ≥3 years for patients with diabetic macular oedema. Methods A retrospective audit of pseudo-anonymised data from patients with chronic diabetic macular oedema (cDMO) and treated with the FAc implant across 14 UK clinical sites. Safety and clinical effectiveness were measured. Results Two-hundred and fifty-six eyes had ≥3 years of follow-up (mean 4.28 years), during which a mean of 1.14 FAc implants were used per eye. Mean best-recorded visual acuity (BRVA) increased from 52.6 to 56.7 letters at month 3 and remained stable thereafter; this trend was also seen in pseudophakic eyes. The proportion of patients attaining a BRVA ≥6/12 increased from 17% at baseline to 27% 1 month after FAc implant and remained stable above 30% from month 12 onwards. Eyes with no prior history of intraocular pressure (IOP)-related events required significantly less treatment-emergent IOP-lowering medication than those with a prior history of IOP events (17.9% vs. 50.0% of eyes; p < 0.001). The incidence of an IOP increase of ≥10 mmHg, use of IOP-lowering medication, laser trabeculoplasty and IOP-lowering surgery was 28.9%, 29.7%, 0.8% and 2.7%, respectively, for the whole cohort. There were significant reductions in mean central foveal thickness and macular volume (p < 0.001). Conclusions The FAc implant was well tolerated, with predictable and manageable IOP-related events while delivering a continuous microdose of corticosteroid to eyes with cDMO, providing prolonged vision preservation and a reduced number of treatments.

scholarly journals Minimum Detectable Change of Visual Acuity Measurements Using ETDRS Charts (Early Treatment Diabetic Retinopathy Study)

2021 ◽  
Vol 18 (15) ◽  
pp. 7876
Author(s):  
María Carmen Sánchez-González ◽  
Raquel García-Oliver ◽  
José-María Sánchez-González ◽  
María-José Bautista-Llamas ◽  
José-Jesús Jiménez-Rejano ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Early Treatment ◽  
High Reliability ◽  
Minimal Detectable Change ◽  
High Contrast ◽  
Detectable Change ◽  
Low Contrast ◽  
Minimum Detectable Change ◽  
The Mean

In our work, we determined the value of visual acuity (VA) with ETDRS charts (Early Treatment Diabetic Retinopathy Study). The purpose of the study was to determine the measurement reliabilities, calculating the correlation coefficient interclass (ICC), the value of the error associated with the measure (SEM), and the minimal detectable change (MDC). Forty healthy subjects took part. The mean age was 23.5 ± 3.1 (19 to 26) years. Visual acuities were measured with ETDRS charts (96% ETDRS chart nº 2140) and (10% SLOAN Contrast Eye Test chart nº 2153). The measurements were made (at 4 m) under four conditions: Firstly, photopic conditions with high contrast (HC) and low contrast (LC) and after 15 min of visual rest, mesopic conditions with high and low contrast. Under photopic conditions and high contrast, the ICC = 0.866 and decreased to 0.580 when the luminosity and contrast decreased. The % MDC in the four conditions was always less than 10%. It was minor under photopic conditions and HC (5.83) and maximum in mesopic conditions and LC (9.70). Our results conclude a high reliability of the ETDRS test, which is higher in photopic and high contrast conditions and lower when the luminosity and contrast decreases.

scholarly journals Intravitreal aflibercept partially reverses severe non-proliferative diabetic retinopathy in treatment-naïve patients

2021 ◽  
Vol 49 (1) ◽  
pp. 030006052098536
Author(s):  
Yuan Tao ◽  
Pengfei Jiang ◽  
Min Liu ◽  
Ying Liu ◽  
Lihua Song ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Intravitreal Injection ◽  
Proliferative Diabetic Retinopathy ◽  
Posterior Pole ◽  
Foveal Thickness ◽  
Hard Exudates ◽  
Central Foveal Thickness ◽  
Treatment Naïve ◽  
The Mean ◽  
Retinal Microaneurysms

Objective To evaluate whether diabetic retinopathy can be reversed after aflibercept, based on improvements in diabetic macular edema, hard exudates (HEs) of the posterior pole, and retinal microaneurysms (MAs). Methods This was a single-center retrospective study of 30 patients (34 eyes) with severe non-proliferative diabetic retinopathy (NPDR) who were treated between August and October 2018. Best-corrected visual acuity (BCVA), central foveal thickness (CFT), area of HEs, and number of MAs were compared before and after treatment. Results The mean patient age was 61.4 ± 7.1 years; 14 patients (46.7%) were men. The mean number of injections per patient was 3.5 ± 0.5. The time between the last injection and the last follow-up was 82 days (range, 78–110 days). Six months after the first intravitreal injection, significant improvement was observed in BCVA (from 0.70 ± 0.18 to 0.42 ± 0.19 logMAR), CFT (from 377.17 ± 60.41 to 261.21 ± 31.50 µm), and number of MAs (from 182.2 ± 77.4 to 101.5 ± 59.6). Observations over 6 months after the first intravitreal injection showed a statistically significant reduction in the area of HEs (P = 0.007). No adverse events occurred during the treatment period. Conclusion Diabetic retinopathy might be partially reversed by aflibercept treatment, as indicated by BCVA, CFT, number of MAs, and area of HEs.

scholarly journals Real-Life ILUVIEN (Fluocinolone Acetonide) Case Study: Rapid Drying of the Macula and Improved Vision within 2 Years after Therapy Initiation

2016 ◽  
Vol 7 (3) ◽  
pp. 579-585 ◽  
Author(s):  
Hibba Quhill ◽  
Fahd Quhill
Keyword(s):  
Real Life ◽  
Diabetic Macular Oedema ◽  
Fluocinolone Acetonide ◽  
Intravitreal Injections ◽  
Functional Responses ◽  
Foveal Thickness ◽  
Prior Therapy ◽  
Central Foveal Thickness ◽  
Interfering Rna

Importance: A case showing sustained structural and functional responses 2 years after a single treatment with ILUVIEN (0.2 µg/day fluocinolone acetonide, FAc) despite suboptimal responses to ranibizumab. Observations: A 68-year-old female patient with diabetic macular oedema (DME) from type 2 diabetes mellitus was first diagnosed in October 2010 and had a baseline visual acuity (VA) of 46 Early Treatment Diabetic Retinopathy Study (ETDRS) letters in the left eye. Central foveal thickness (CFT) was 712 microns. The patient was treated with 11 intravitreal injections of ranibizumab (5 in combination with a small-interfering RNA agent), and by March 2014, VA and CFT were largely unchanged (55 ETDRS letters and 774 microns). The patient was treated with ILUVIEN as she had a pseudophakic lens and a clearly suboptimal response to the prior therapy with ranibizumab. An implant releasing FAc at a dosage of 0.2 µg/day was administered in March 2014, and the optical coherence tomography indicated that the macula was dry after 7 days (CFT was below 300 microns). This was sustained at 6, 12, and 24 months after the treatment. VA improved by 5 letters within 7 days and by 15 letters within 14 days, and this was maintained after 24 months. Throughout the duration of this study, the intraocular pressure was ≤22 mm Hg, and no glaucoma medication was administered. Conclusions and Relevance: In real-life UK practice, this DME patient showed a suboptimal response to multiple intravitreal injections of ranibizumab. When subsequently treated with a single injection of ILUVIEN, there were large and rapid improvements in VA and CFT that were maintained for the following 2 years.

Long-Term Efficacy of Dexamethasone Intravitreal Implant in the Treatment of Vogt-Koyanagi-Harada (VKH) Disease Relapsing Posterior Uveitis

2021 ◽  
Author(s):  
Tarek Roshdy Elhamaky
Keyword(s):  
Visual Acuity ◽  
Posterior Uveitis ◽  
Systemic Steroid ◽  
Foveal Thickness ◽  
Dexamethasone Intravitreal Implant ◽  
Central Foveal Thickness ◽  
Intravitreal Implant ◽  
The Mean ◽  
Vkh Disease

Abstract Purpose: To investigate the efficacy and safety of dexamethasone intravitreal implant in the treatment of relapsing posterior uveitis in patients with chronic recurrent VKH disease.Methods: This is a prospective study of 29 eyes of 16 patients with posterior uveitis in chronic recurrent VKH disease. All patients received previous systemic steroid and immunosuppressive regimens. All patients underwent a comprehensive ophthalmic examination, including BCVA (log MAR), IOP, FFA, and SD-OCT. All patients underwent intravitreal injection with sustained-release dexamethasone 0.7 mg implant (Ozurdex®). Primary outcome measures included mean change in best corrected visual acuity (BCVA) and central foveal thickness (CFT) at 24 months follow-up compared to baseline. Results: At 24 months follow-up, the mean BCVA improved from 0.82 ± 0.13 to 0.38 ± 0.06logMAR (P <0.0001). The mean CFT reduced from 505 ± 29 to 244 ± 23 um (P <0.0001). The mean IOP changed from 15.1±2.2 to16.9±3.1 mmHg with no significant value. Twenty-one eyes (72.4%) received one injection, while eight eyes (27.6%) required two injections. The mean number of injections was 1.2± 0.60. The mean follow-up time was 24.75± 0.9months. No serious ocular or systemic adverse events were noted during the follow-up period. Ocular hypertension was recorded in there (10.3%) eyes and controlled by IOP lowering medications. Cataract progression occurred in 11 (37.9%) eyes.Conclusions: Our cohort highlights the beneficial effects of the Dexamethasone implant 0.7 mg in the treatment of VKH disease relapsing posterior uveitis improving visual acuity, reducing macular edema, and minimizing the burden of systemic steroid in this sample study.

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