Morphometric analysis of fibrovascular pigment epithelial detachments treated with ranibizumab and aflibercept

2021 ◽  
pp. 112067212110057
Author(s):  
Michael Karampelas ◽  
Maria Syriga ◽  
Petros Petrou ◽  
Ilias Georgalas ◽  
Dimitrios Papaconstantinou ◽  
...  
Keyword(s):  
Morphometric Analysis ◽  
Maximum Height ◽  
Strongly Correlated ◽  
Base Area ◽  
Pigment Epithelial ◽  
Anti Vegf ◽  
Custom Made ◽  
Significant Difference ◽  
Treatment Naïve ◽  
Internal Reflectivity

Purpose: To assess fibrovascular pigment epithelial detachments (PED) and their response to two different anti-VEGF agents using optical coherence tomography (OCT) morphometric analysis. Methods: Seventy-three consecutive, treatment-naïve eyes with fibrovascular PED (>125 μm) treated with ranibizumab or aflibercept were retrospectively included. A custom-made software was used to manually segment and calculate PED maximum height, base area, volume and internal reflectivity at baseline, after three injections and 1 year. Results: Visual acuity (VA) change was 2 ETDRS letters ± 7.6 after three injections and 3.2 ETDRS letters ± 10.3 at 1 year. There was no significant difference between VA changes amongst the two drugs. At 1 year, anti-VEGF treatment resulted in a mean reduction of 125 μm in maximum PED height, of 2.26 mm2 in base area and of 0.54 mm3 in volume with a corresponding increase in reflectivity. These changes were more prominent in the aflilbercept group. The observed PED and VA changes at year 1 were strongly correlated with their values at baseline and after three injections. Conclusions: Anti-VEGF treatment resulted in a reduction of all PED dimensions and a corresponding increase in optical reflectivity. Higher, larger and more hypo-reflective PEDs demonstrated a better anatomical response, especially with aflibercept, but this was not correlated with VA.

scholarly journals De-novo multilayering in fibrovascular pigment epithelial detachment

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Manoj Soman ◽  
Jay U. Sheth ◽  
Asmita Indurkar ◽  
Padmanabhan Meleth ◽  
Unnikrishnan Nair
Keyword(s):  
De Novo ◽  
Median Number ◽  
Final Visit ◽  
Low Grade ◽  
Vascular Endothelial ◽  
Pigment Epithelial Detachment ◽  
Pigment Epithelial ◽  
Anti Vegf ◽  
Significant Difference ◽  
Endothelial Growth Factor

AbstractThis study describes the occurrence of multilayered pigment-epithelial detachment (MLPED) as a De-novo phenomenon (DN-MLPED) and compare the features with multi-layering secondary to chronic anti-vascular endothelial growth factor (anti-VEGF) therapy (s-MLPED). We did a retrospective evaluation of spectral-domain optical coherence tomography (SD-OCT) features, treatment-profile, and visual-acuity (VA) outcomes in eyes with MLPED. Out of 17 eyes with MLPED, 7 eyes had DN-MLPED and 10 eyes had s-MLPED. There was no significant difference in baseline and final VA between the groups. At the final visit, no significant visual improvement was noted in both the groups, although a possible trend towards an improvement was seen in DN-MLPED eyes while the s-MLPED demonstrated a declining trend (DN-MLPED—LogMAR-BCVA: Baseline = 0.79 [∼ 20/123] ± 0.91; Final = 0.76 [∼ 20/115] ± 0.73; p = 0.87; s-MLPED—LogMAR BCVA: Baseline = 0.43 [∼ 20/54] ± 0.68; Final = 0.94 [∼ 20/174] ± 0.71; p = 0.06). Moreover, after presentation, the median number of injections in DN-MLPED eyes were significantly lower compared to s-MLPED eyes (DN-MLPED:4; s-MLPED:12; p = 0.03) (Median follow-up: DN-MLPED = 26 months; s-MLPED = 54 months; p = 0.15). Subretinal hyperreflective-material (SHRM) deposition heralded the onset of multilayering and was seen to progress in all DN-PED eyes and 1/4 eyes of s-MLPED. To conclude, MLPED is a unique form of cicatrizing fibrovascular-PED which can evolve denovo too. Long-standing disease with intermittent or low-grade activity can potentially explain this unique phenomenon. With fewer anti-VEGF therapy, the de-novo MLPED eyes show more visual stability as compared to s-MLPED eyes.

scholarly journals Five-year visual outcomes after anti-VEGF therapy with or without photodynamic therapy for polypoidal choroidal vasculopathy

2018 ◽  
Vol 103 (5) ◽  
pp. 617-622 ◽  
Author(s):  
Manabu Miyata ◽  
Sotaro Ooto ◽  
Kenji Yamashiro ◽  
Hiroshi Tamura ◽  
Masayuki Hata ◽  
...  
Keyword(s):  
Photodynamic Therapy ◽  
Combination Therapy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Fundus Photography ◽  
Combination Group ◽  
Macular Atrophy ◽  
Anti Vegf ◽  
Significant Difference ◽  
Treatment Naïve ◽  
Choroidal Vasculopathy

Background/aimsTo evaluate the 5-year visual and anatomical outcomes after anti-vascular endothelial growth factor (VEGF) therapy alone or in combination with photodynamic therapy (PDT), followed by pro re nata (PRN) anti-VEGF therapy with or without PDT, for polypoidal choroidal vasculopathy (PCV).MethodsThis retrospective, observational study included 61 consecutive patients with treatment-naïve symptomatic PCV who were followed for 5 years. Twenty eyes (20 patients) initially received PDT and intravitreal injection of ranibizumab (IVR), followed by a PRN regimen of anti-VEGF therapy with or without PDT (combination group), while 41 eyes (41 patients) initially received only IVR every 3 months, followed by a PRN regimen of anti-VEGF monotherapy (IVR group). Macular atrophy including the fovea was confirmed using colour fundus photography and spectral-domain optical coherence tomography.ResultsIn both groups, the visual acuity (VA) at 1 year was better than the baseline VA, whereas the 3-year, 4-year and 5-year VA values were similar to the baseline VA. There was no significant difference in the 5-year VA, 5-year central retinal thickness and incidence of macular atrophy between the two groups (p=0.63, 0.72 and 0.06, respectively). In the combination group, the 5-year VA was correlated with the 5-year incidence of macular atrophy (p=0.02, r=0.51).ConclusionsA PRN regimen for PCV may have a limited effect for the long-term maintenance of improved VA. Macular atrophy may occur more frequently with combination therapy and is possibly associated with the 5-year VA. Thus, combination therapy should be carefully selected for patients susceptible to macular atrophy.

scholarly journals Comparison of Intravitreal Bevacizumab versus Intravitreal Ranibizumab in Treatment Naive Macular Edema Patients (Real World Evidence in Pakistan)

2021 ◽  
Vol 37 (2) ◽  
Author(s):  
Hajra Arshad Malik ◽  
Rayyan Sabih ◽  
Hina Khan ◽  
Aamir Asrar ◽  
Muhammad Asif
Keyword(s):  
Macular Edema ◽  
Treatment Options ◽  
Intravitreal Bevacizumab ◽  
Functional Results ◽  
Intravitreal Ranibizumab ◽  
Macular Volume ◽  
Anti Vegf ◽  
Significant Difference ◽  
Quasi Experimental ◽  
Treatment Naïve

Purpose:  To compare the short-term efficacy and safety of intraocular Ranibizumab and Bevacizumab in patients with treatment Naïve macular edema. Study Design:  Quasi experimental study. Place and Duration of Study:  Amanat Eye Hospital, from August 2018 to November 2019. Methods:  Patients with macular edema confirmed with optical coherence tomography (OCT) or leakage on fluorescein angiography were included. Patients with NVE, PDR without macular edema and patients who switched to alternative anti-VEGF compounds prior to the completion of three consecutive monthly injections of their respective anti-VEGF or switched to other treatment options were excluded from the study. A thorough clinical examination was conducted including best corrected visual acuity (BCVA, intraocular pressure (IOP), anterior and posterior segment examination and OCT macula. The patients were then allocated to one of the two study arms (either Bevacizumab or Ranibizumab) based on the doctor’s input and patient affordability. All patients underwent three consecutive injections of the selected molecule at one month intervals. BCVA, CRT and macular volume were then recorded 04 weeks after the third injection. Results:  A statistically significant mean vision gain was observed from baseline in both groups (p < 0.05). However, the change in BCVA was not significantly different between intravitreal Bevacizumab group and intravitreal Ranibizumab group (p > 0.05). Similarly, although there was improvement in CRT and macular volume in both groups but there was no statistically significant difference between the two. Conclusions:  Treatment with intravitreal Bevacizumab and Ranibizumab injections cause statistically similar anatomical and functional results in cases of treatment naïve macular edema. Key Words:  Bevacizumab, Ranibizumab, Macular Edema, Diabetic Retinopathy, Macular Degeneration, Retinal Vein Occlusion.

scholarly journals De-novo Multilayering in Fibrovascular Pigment Epithelial Detachment

2021 ◽  
Author(s):  
Manoj Soman ◽  
Jay U Sheth ◽  
Asmita Indurkar ◽  
Padmanabhan Meleth ◽  
Unnikrishnan Nair
Keyword(s):  
De Novo ◽  
Median Number ◽  
Final Visit ◽  
Low Grade ◽  
Vascular Endothelial ◽  
Pigment Epithelial Detachment ◽  
Pigment Epithelial ◽  
Anti Vegf ◽  
Significant Difference ◽  
Endothelial Growth Factor

Abstract This study describes the occurrence of multilayered pigment-epithelial detachment (MLPED) as a De-novo phenomenon (DN-MLPED) and compare the features with multi-layering secondary to chronic anti-vascular endothelial growth factor(anti-VEGF) therapy(s-MLPED). We did a retrospective evaluation of spectral-domain optical coherence tomography(SD-OCT) features, treatment-profile, and visual-acuity (VA) outcomes in eyes with MLPED. Out of 17 eyes with MLPED, 7 eyes had DN-MLPED and 10 eyes had s-MLPED. There was no significant difference in baseline and final VA between the groups. At the final visit, the DN-MLPED eyes showed improvement in VA (LogMAR-BCVA: Baseline=0.79±0.91; Final=0.76±0.73; p=0.87) while the s-MLPED eyes showed decline (LogMAR BCVA: Baseline=0.43±0.68; Final=0.94±0.71; p=0.87), although not significantly. Moreover, after presentation, the median number of injections in DN-MLPED eyes were significantly lower compared to s-MLPED eyes (DN-MLPED:4; s-MLPED:12; p=0.03) (Median follow-up: DN-MLPED=26months; s-MLPED=54months; p=0.15). Subretinal hyperreflective-material (SHRM) deposition heralded the onset of multilayering and was seen to progress in all DN-PED eyes and 1/4 eyes of s-MLPED. To conclude, MLPED is a unique form of cicatrizing fibrovascular-PED which can evolve denovo too. Long-standing disease with intermittent or low-grade activity can potentially explain this unique phenomenon. With fewer anti-VEGF therapy, the de-novo MLPED eyes show more visual stability as compared to s-MLPED eyes.

Treatment Patterns and Clinical Outcomes for Branch Retinal Vein Occlusion: An 8-Year Experience at a Tertiary Eye Center

2021 ◽  
pp. 247412642097887
Author(s):  
Terry Lee ◽  
Cason B. Robbins ◽  
Akshay S. Thomas ◽  
Sharon Fekrat
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Retinal Vein Occlusion ◽  
Real World ◽  
Early Treatment ◽  
Branch Retinal Vein Occlusion ◽  
Treatment Patterns ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
Treatment Naïve

Purpose: This work aims to investigate real-world treatment patterns and outcomes in eyes with branch retinal vein occlusion in the antivascular endothelial growth factor (anti-VEGF) era. Methods: A retrospective, nonrandomized, comparative study was conducted on eyes diagnosed with branch retinal vein occlusion at a single tertiary center between 2009 and 2017. Medical history, treatment patterns, and visual acuity outcomes were examined. Subanalysis was performed for eyes that met the eligibility criteria for the BRAVO (Ranibizumab for the Treatment of Macular Edema Following Branch Retinal Vein Occlusion) trial. Results: A total of 315 eyes were included, of which 244 were treatment naive. In all eyes, the most common first treatment was the following: intravitreal bevacizumab (38.4%), aflibercept (15.1%), ranibizumab (8.1%), sectoral scatter laser (6.2%), and triamcinolone (3.1%). At 1 year, treatment-naive eyes had received an average of 2.43 anti-VEGF injections. During follow-up, treatment-naive eyes gained an average of 0.21 Early Treatment Diabetic Retinopathy Study lines. Forty eyes that met BRAVO trial criteria received an average of 5.05 anti-VEGF injections in the first year and gained an average of 1.83 Early Treatment Diabetic Retinopathy Study lines. Conclusions: This real-world cohort received fewer anti-VEGF injections at year 1 and experienced less improvement in visual acuity during the course of treatment than clinical trial participants. Trial-eligible patients received more injections and had greater visual gains than those who would not have been eligible for the trial.

scholarly journals Comparison of irinotecan and oxaliplatin as the first-line therapies for metastatic colorectal cancer: a meta-analysis

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sadayuki Kawai ◽  
Nozomi Takeshima ◽  
Yu Hayasaka ◽  
Akifumi Notsu ◽  
Mutsumi Yamazaki ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Significant Heterogeneity ◽  
Cochrane Central Register ◽  
First Line ◽  
Anti Vegf ◽  
Significant Difference ◽  
High Incidence

Abstract Background Irinotecan (IRI) and oxaliplatin (Ox) are standard therapeutic agents of the first-line treatments for metastatic colorectal cancer (mCRC). Previous meta-analyses of randomized controlled trials (RCTs) showed that treatment with Ox-based compared with IRI-based regimens was associated with better overall survival (OS). However, these reports did not include trials of molecular targeting agents and did not take methods for the administration of concomitant drugs, such as bolus or continuous infusion of 5-fluorouracil, into account. A systematic literature review was performed to compare the efficacy and toxicity profiles between IRI- and Ox-based regimens as the first-line treatments for mCRC. Methods This meta-analysis used data from the Cochrane Central Register of Controlled Trials, PubMed, and SCOPUS. The primary endpoint was OS, and the secondary endpoints were progression-free survival (PFS), objective response rate (ORR), and adverse events (AEs). Results Nineteen trials involving 4571 patients were included in the analysis. No statistically significant difference was observed between the two groups in terms of OS, PFS, and ORR. There was no significant heterogeneity. Regarding ≥ grade 3 AEs, IRI-based regimens were associated with a high incidence of leukopenia, febrile neutropenia, and diarrhea. Moreover, there was a high incidence of thrombocytopenia and peripheral sensory neuropathy in patients who received Ox-based regimens. In a subgroup analysis, IRI combined with bevacizumab was correlated with a better PFS (HR = 0.90, 95% CI = 0.82–0.98, P = 0.02), but not with OS (pooled HR = 0.91, 95% CI = 0.80–1.03, P = 0.15). Conclusion Although the safety profiles of IRI- and Ox-based regimens varied, their efficacy did not significantly differ. The combination of anti-VEGF antibody and IRI was associated with better PFS compared with anti-VEGF antibody and Ox. Both regimens could be used as the first-line treatments for mCRC with consideration of the patients’ condition or toxicity profiles.

scholarly journals Retinal venous pressure is decreased after anti-VEGF therapy in patients with retinal vein occlusion–related macular edema

2021 ◽  
Author(s):  
Teruyo Kida ◽  
Josef Flammer ◽  
Katarzyna Konieczka ◽  
Tsunehiko Ikeda
Keyword(s):  
Macular Edema ◽  
Intravitreal Injection ◽  
Retinal Vein Occlusion ◽  
Venous Pressure ◽  
Decisive Role ◽  
Retinal Venous Pressure ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
Significant Difference ◽  
Endothelial Growth Factor

Abstract Purpose The pathomechanism leading to retinal vein occlusion (RVO) is unclear. Mechanical compression, thrombosis, and functional contractions of veins are discussed as the reasons for the increased resistance of venous outflow. We evaluated changes in the retinal venous pressure (RVP) following intravitreal injection of anti-vascular endothelial growth factor (VEGF) agent to determine the effect on RVO-related macular edema. Methods Twenty-six patients with RVO-related macular edema (16 branch RVOs [BRVOs] and 10 central RVOs [CRVOs], age 72.5 ± 8.8 years) who visited our hospital were included in this prospective study. Visual acuity (VA), intraocular pressure (IOP), central retinal thickness (CRT) determined by macular optical coherence tomography, and RVP measured using an ophthalmodynamometer were obtained before intravitreal injection of ranibizumab (IVR) and 1 month later. Results Comparison of the BRVOs and CRVOs showed that VA was significantly improved by a single injection in BRVOs (P < 0.0001; P = 0.1087 for CRVOs), but CRT and RVP were significantly decreased without significant difference in IOP after the treatment in both groups (P < 0.0001). Conclusion The anti-VEGF treatment resulted in a significant decrease in the RVP, but the RVP remained significantly higher than the IOP. An increased RVP plays a decisive role in the formation of macula edema, and reducing it is desirable.

scholarly journals Progression from Type 2 Macular Neovascularization to Fibrovascular Pigment Epithelial Detachment

Vision ◽  
2021 ◽  
Vol 5 (2) ◽  
pp. 16
Author(s):  
Hoang Mai LE ◽  
Gérard Mimoun ◽  
Salomon Y. Cohen ◽  
Camille Jung ◽  
Oudy Semoun ◽  
...  
Keyword(s):  
High Myopia ◽  
Case Series ◽  
Age Related Macular Degeneration ◽  
Series Data ◽  
Pigment Epithelial Detachment ◽  
Angioid Streaks ◽  
Pigment Epithelial ◽  
Anti Vegf

The aim of this study was to report unusual progression of type 2 macular neovascularization (MNV) associated with age-related macular degeneration (AMD), high myopia or angioid streaks. Retrospective multicentric observational case series data were used. Eyes that progressed from type 2 MNV secondary to AMD, high myopia or angioid streaks to fibrovascular pigment epithelial detachment (PED) were included. A total of 29 treatment-naive eyes from 29 patients with type 2 MNV secondary to AMD (n = 14), high myopia (n = 10) or angioid streaks (n = 5) that progressed to a fibrovascular PED on Spectral Domain-Optical Coherence Tomography were used. This progression occurred within 3 months after anti-VEGF therapy initiation. Logarithm of minimum angle of resolution (LogMAR) visual acuity improved significantly after anti-VEGF therapy, from 0.55 (SD ± 0.30) (20/63–20/80) at baseline to 0.30 (20/40) at 3 months, and 0.33 (20/40) at the final follow-up (mean follow up: 3.68 years). Mean number of intravitreal injections per year for patients with a total follow-up ≥ 12 months (n = 24) was 4.3 ± 2.1 per year. Progression from type 2 MNV to a fibrovascular PED may occur in patients suffering from AMD, high myopia or angioid streaks. This progression appears early after initiation of anti-VEGF therapy and is associated with a favorable visual and anatomical outcome, at least on a short follow up basis.

Plant height and height of the main ear in maize (Zea mays L.) at different locations and different plant densities

2002 ◽  
Vol 50 (1) ◽  
pp. 75-84 ◽  
Author(s):  
Z. Gyenes-Hegyi ◽  
I. Pók ◽  
L. Kizmus ◽  
Keyword(s):  
Plant Height ◽  
Plant Density ◽  
Close Correlation ◽  
Plant Size ◽  
Considerable Effect ◽  
Maximum Height ◽  
The Best Approximation ◽  
Significant Difference ◽  
Plant Densities ◽  
Ear Height

The plant height and the height of the main ear were studied over two years in twelve single cross maize hybrids sown at three different plant densities (45, 65 and 85 thousand plants/ha) at five locations in Hungary (Keszthely, Gönc, Gyöngyös, Sopronhorpács, Martonvásár). The results revealed that plant height and the height of the main ear are important variety traits and are in close correlation with each other. It was found that the hybrids grew the tallest when the genetic distance between the parental components was greatest (Mv 4, Mv 5). The height of the main ear was also the greatest in these hybrids, and the degree of heterosis was highest (193% for plant height, 194% for the height of the main ear). The shortest hybrids were those developed between related lines (Mv 7, Mv 11). In this case the heterosis effect was the lowest for both plant height (128%) and the height of the main ear (144%). The ratio of the height of the main ear to the plant height was stable, showing little variation between the hybrids (37–44%). As maize is of tropical origin it grows best in a humid, warm, sunny climate. Among the locations tested, the Keszthely site gave the best approximation to these conditions, and it was here that the maize grew tallest. The dry, warm weather in Gyöngyös stunted the development of the plants, which were the shortest at this location. Plant density had an influence on the plant size. The plants were shortest when sown at a plant density of 45,000 plants/ha, and the main ears were situated the lowest in this case. At all the locations the plant and main ear height rose when the plant density was increased to 65,000 plants/ha. At two sites (Gönc and Sopronhorpács) the plants attained their maximum height at the greatest plant density (85,000 plants/ha). In Keszthely there was no significant difference between these two characters at plant densities of 65 and 85 thousand plants/ha, while in Gyöngyös and Martonvásár the greatest plant density led to a decrease in the plant and main ear height. The year had a considerable effect on the characters tested.

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