scholarly journals Intravitreal anti-VEGF treatment for choroidal neovascularization secondary to traumatic choroidal rupture

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
T. Barth ◽  
F. Zeman ◽  
H. Helbig ◽  
M.-A. Gamulescu
Keyword(s):  
Visual Acuity ◽  
Ocular Trauma ◽  
Specific Treatment ◽  
Case Series ◽  
Age Related Macular Degeneration ◽  
Trial Registration ◽  
Anti Vegf ◽  
Age Related ◽  
Choroidal Rupture

Abstract Background So far only single cases with short follow-up have been reported on the use of intravitreal anti-VEGF for traumatic choroidal neovascularizations (CNV). This paper reports a large case series of patients with CNV secondary to choroidal rupture after ocular trauma receiving intravitreal anti-VEGF (vascular endothelial growth factor) injections. Methods Fifty-four patients with unilateral choroidal rupture after ocular trauma diagnosed between 2000 and 2016 were retrospectively evaluated. Eleven patients with CNV secondary to choroidal rupture were identified. Five eyes with traumatic secondary CNV were treated with anti-VEGF and were systematically analysed. The other 4 patients with inactive CNV underwent watchful observation. Results Four men and one woman with a mean age of 29 years (SD 12.4; range 19–45) had intravitreal anti-VEGF therapy for traumatic CNV. Another 4 patients with a mean age of 37 years (SD 6.6; range 31–46) presented with inactive CNV and did not receive specific treatment. In all 9 cases the mean interval between the ocular trauma and the diagnosis of CNV was 5.7 months (SD 4.75; range 2–12). In the treatment group per eye 4.2 injections (SD 3.2; range 1–8) were given on average. Four eyes were treated with bevacizumab and one eye with ranibizumab. Regression of CNV was noted in all eyes. In 4 eyes visual acuity (VA) improved, one eye kept stable visual acuity. Conclusions Here, we present the up to now largest case series of traumatic CNV membranes treated with anti-VEGF injections with a mean follow-up period of 5 years. Intravitreal anti-VEGF therapy seems to be safe and effective for secondary CNV after choroidal rupture. Compared to exudative age-related macular degeneration fewer injections are needed to control the disease. Trial registration Retrospective registration with local ethics committee on 21 March 2019. Trial registration number is 19-1368-104.

One-year outcomes of anti-vascular endothelial growth factor therapy in peripapillary choroidal neovascularisation

2019 ◽  
Vol 104 (5) ◽  
pp. 678-683 ◽  
Author(s):  
Sumit Randhir Singh ◽  
Adrian T Fung ◽  
Samantha Fraser-Bell ◽  
Marco Lupidi ◽  
Sashwanthi Mohan ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Choroidal Thickness ◽  
Case Series ◽  
Choroidal Neovascularisation ◽  
Age Related Macular Degeneration ◽  
Common Disease ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Age Related

PurposeTo report the visual and anatomical outcomes in eyes with peripapillary choroidal neovascularisation (CNV) through 12 months.MethodsThis was a multicentre, retrospective, interventional case series which included treatment-naïve cases of peripapillary choroidal neovascular membrane (CNVM) with a minimum follow-up of 12 months. Multimodal imaging which comprised optical coherence tomography (OCT), fluorescein angiography and/or indocyanine green angiography was performed at baseline and follow-up visits. OCT parameters included central macular thickness (CMT), subfoveal choroidal thickness (SFCT) and retinal and choroidal thickness at site of CNV. Patients were treated with anti-vascular endothelial growth factors (VEGF) on pro re nata protocol, photodynamic therapy, laser photocoagulation or a combination. Main outcome measures were change in best corrected visual acuity (BCVA) and OCT parameters.ResultsA total of 77 eyes (74 patients; mean age: 61.9±21.8 years) with a mean disease duration of 9.2±14.1 months were included. BCVA improved significantly from 0.55±0.54 logMAR (20/70) at baseline to 0.29±0.39 logMAR (20/40) at 12 months (p<0.001) with a mean of 4.9±2.9 anti-VEGF injections. CMT, SFCT and retinal thickness at site of CNVM reduced significantly (p<0.001, <0.001 and 0.02, respectively) through 12 months. The most common disease aetiologies were neovascular age-related macular degeneration, and idiopathic, inflammatory and angioid streaks. Age (p=0.04) and baseline BCVA (p<0.001) were significant predictors of change in BCVA at 12 months.ConclusionPeripapillary CNVM, though uncommon, is associated with diverse aetiologies. Anti-VEGF agents lead to significant visual acuity and anatomical improvement in these eyes over long term irrespective of the aetiology.

scholarly journals Association between Retinal Thickness Variability and Visual Acuity Outcome during Maintenance Therapy Using Intravitreal Anti-Vascular Endothelial Growth Factor Agents for Neovascular Age-Related Macular Degeneration

2021 ◽  
Vol 11 (10) ◽  
pp. 1024
Author(s):  
Timothy Y. Y. Lai ◽  
Ricky Y. K. Lai
Keyword(s):  
Visual Acuity ◽  
Retinal Thickness ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Age Related ◽  
Thickness Variability ◽  
The Mean ◽  
Endothelial Growth Factor

Previous studies based on clinical trial data have demonstrated that greater fluctuations in retinal thickness during the course of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (nAMD) is associated with poorer visual acuity outcomes. However, it was unclear whether similar findings would be observed in real-world clinical settings. This study aimed to evaluate the association between retinal thickness variability and visual outcomes in eyes receiving anti-VEGF therapy for nAMD using pro re nata treatment regimen. A total of 64 eyes which received intravitreal anti-VEGF therapy (bevacizumab, ranibizumab or aflibercept) for the treatment of nAMD were evaluated. Variability in spectral-domain optical coherence tomography (OCT) central subfield thickness (CST) was calculated from the standard deviation (SD) values of all follow-up visits after three loading doses from month 3 to month 24. Eyes were divided into quartiles based on the OCT CST variability values and the mean best-corrected visual acuity values at 2 years were compared. At baseline, the mean ± SD logMAR visual acuity and CST were 0.59 ± 0.39 and 364 ± 113 µm, respectively. A significant correlation was found between CST variability and visual acuity at 2 years (Spearman’s ρ = 0.54, p < 0.0001), indicating that eyes with lower CST variability had better visual acuity at 2 years. Eyes with the least CST variability were associated with the highest mean visual acuity improvement at 2 years (quartile 1: +9.7 letters, quartile 2: +1.1 letters, quartile 3: −2.5 letters, quartile 4: −9.5 letters; p = 0.018). No significant difference in the number of anti-VEGF injections was found between the four CST variability quartile groups (p = 0.21). These findings showed that eyes undergoing anti-VEGF therapy for nAMD with more stable OCT CST variability during the follow-up period were associated with better visual outcomes. Clinicians should consider adopting treatment strategies to reduce CST variability during the treatment course for nAMD.

Visual Outcomes after Anti-VEGF Therapy for Exudative Age-Related Macular Degeneration in a Real-Life Setting

2021 ◽  
Vol 238 (04) ◽  
pp. 396-402
Author(s):  
Andrea R. Wenkstern ◽  
Christophe Valmaggia
Keyword(s):  
Macular Degeneration ◽  
Real Life ◽  
Case Series ◽  
Age Related Macular Degeneration ◽  
Serious Adverse Events ◽  
Visual Outcomes ◽  
Anti Vegf ◽  
Age Related ◽  
Real Life Setting

Abstract Background To report visual outcomes of anti-vascular endothelial growth factor (anti-VEGF) therapy for exudative age-related macular degeneration (AMD) in a real-life setting. Patients and Methods Retrospective case series of consecutive patients treated with either ranibizumab and/or aflibercept for monolateral or bilateral exudative AMD. A physician established the indication for treatment and administered the injections. An independent physician confirmed the indication for primary treatment. A Pro Re Nata and a Treat and Extend regimen were used. Assessment of subretinal and/or intraretinal fluid, retinal hemorrhage and increase in pigment epithelial detachment served as criteria for further treatment decisions. Visual acuity (VA) was measured in ETDRS letters at each examination and then analyzed using a specialized software. Evolution of mean VA was considered for all study eyes and subgroups of eyes with an initial VA ≥ 70 ETDRS letters (subgroup 1) and ≤ 69 ETDRS letters (subgroup 2). Results A total of 102 eyes of 76 patients (30 men, mean age 75.9 years; 46 women, mean age 81.5 years) were included. Subgroup 1 consisted of 47 eyes, and subgroup 2 of 55 eyes. Mean follow-up was 55 months (range 6 to 150 months). For the entire collective as for subgroups 1 and 2, the mean VA was 64, 77, or 51 ETDRS letters at baseline. Mean VA improved at month 12 (68, 80, or 58 ETDRES letters) and then slowly decreased over time until month 150 (62, 72, or 54 ETDRS letters). Maximum improvement of + 5, + 3, or, + 9 ETDRS letters occurred after 9, 8, or 10 months of follow-up. Atrophy and fibrosis were mainly responsible for VA decrease. Ten serious adverse events were reported to Swissmedic: two cases of cardiovascular events and eight cases of intraocular inflammation. Conclusions Anti-VEGF therapy carried out in a real-life setting shows good VA outcomes with a favorable safety profile.

Visual acuity and progression of macular atrophy in patients receiving intravitreal anti-VEGF for age-related macular degeneration

2021 ◽  
pp. 112067212110017
Author(s):  
Marco H Ji ◽  
Natalia F Callaway ◽  
Cassie A Ludwig ◽  
Daniel Vail ◽  
Ahmad Al-Moujahed ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Case Series ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
Macular Atrophy ◽  
Anti Vegf ◽  
Age Related ◽  
Case Series Study ◽  
Retinal Atrophy

Purpose: Whether intravitreal anti-vascular endothelial growth factors (VEGFs) cause retinal atrophy is still a subject of debate. We reported 13 eyes that received several injections of anti-VEGF for wet age-related macular degeneration (AMD) with good visual acuity despite geographic atrophy on imaging. Methods: This is a case series study conducted at Byers Eye Institute at Stanford University. Patients of three retina specialists with wet AMD who received six or more intravitreal injection of anti-VEGFs with visual acuity of 20/60 or better and incomplete RPE and outer retina atrophy (iRORA) or complete RPE and outer retinal atrophy (cRORA) were enrolled in this case series. Different imaging modalities were reviewed by three retina specialists comparing the baseline with the most recent exam. Results: About 13 eyes of 10 patients met the selection criteria. Eleven eyes were classified as iRORA and 2 as cRORA. Despite the development of macular atrophy on imaging after an average of 38.1 injections, eyes maintained stable visual acuity. Conclusion: The discrepancy between structural and functional findings in this cohort suggests that patients treated by anti-VEGF drugs exhibit divergent clinical outcomes for currently unknown reasons. The authors propose anti-VEGF may affect melanosomes within RPE without disrupting RPE and photoreceptors function completely. This requires further investigation.

scholarly journals Effectiveness and tolerability of the combined use of anti-VEGF agents in clinical practice

2020 ◽  
Vol 20 (4) ◽  
pp. 209-215
Author(s):  
A.V. Kuroyedov ◽  
◽  
O.V. Gapon’ko ◽  
V.V. Gorodnichiy ◽  
I.V. Kondrakova ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Clinical Practice ◽  
Age Related Macular Degeneration ◽  
Anti Vegf ◽  
Age Related ◽  
Combined Use ◽  
Group 2 ◽  
Wet Amd ◽  
Group 1

Aim: to assess the effectiveness and tolerability of anti-VEGF agents, aflibercept (2.0 mg) and ranibizumab (0.5 mg), in the combined treat-ment for wet age-related macular degeneration (AMD) in routine clinical practice.Patients and Methods: 55 patients (65 eyes) with the late stage of wet AMD were divided into two groups. Group 1 included 32 eyes with classic choroidal neovascularization (CNV) and group 2 included 33 eyes with occult CNV. Best-corrected visual acuity (BCVA), intraocular pressure, and retinal nerve fiber layer (RNFL) thickness were measured. These parameters were compared at different time points during the treatment.Results: overall AMD duration (January 2019) was 36 (19; 47) months being 30 (12; 44) months in group 1 and 36 (23; 48) months in group 2 (р>0.05). The first intravitreal administration of an anti-VEGF drug was performed 7.5 (3.5; 9.5) months after AMD diagnosis in group 1 and 7 (3; 11) months after AMD diagnosis in group 2. Significant differences in intragroup intervals were revealed between various follow-up periods. More differences were identified for the intervals between intravitreal administrations in group 2. Baseline and final BCVA during the entire follow-up which was 29.5 (19.5; 38) months in group 1 and 28 (25; 44) months in group 2 demonstrated neither intragroup nor intergroup differences (р>0.05). Conclusion: our management strategy for wet AMD is somewhat different from conventional guidelines. However, it has no significant impact on visual acuity during the follow-up.Keywords: age-related macular degeneration, anti-VEGF drugs, intravitreal administration, IOP level, aflibercept, ranibizumab.For citation: Kuroyedov A.V., Gapon’ko O.V., Gorodnichiy V.V. et al. Effectiveness and tolerability of the combined use of anti-VEGF agents in clinical practice. Russian Journal of Clinical Ophthalmology. 2020;20(4):209–215. DOI: 10.32364/2311-7729-2020-20-4-209-215.

scholarly journals Different Outcomes of Anti-VEGF Treatment for Neovascular AMD according to Neovascular Sutypes and Baseline Features: 2-Year Real-Life Clinical Outcomes

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Alessandro Arrigo ◽  
Andrea Saladino ◽  
Emanuela Aragona ◽  
Stefano Mercuri ◽  
Ugo Introini ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Real Life ◽  
Case Series ◽  
Visual Outcome ◽  
Age Related Macular Degeneration ◽  
Retrospective Case ◽  
Anti Vegf ◽  
Age Related ◽  
Life Analysis

Purpose. To evaluate the effects of anti-VEGF treatment of neovascular age-related macular degeneration (nAMD) in a real-life clinical setting. Methods. Study design is a retrospective case series. Naïve nAMD patients treated with intravitreal injection of aflibercept or ranibizumab were analyzed over a 24-month follow-up. Each patient received the loading dose, followed by a PRN regimen. Patients were further subdivided into subgroups according to macular neovascularization type, best corrected visual acuity (BCVA) at baseline ( BCVA > 0.3   LogMAR and BCVA ≤ 0.3   LogMAR ), and different anti-VEGF drugs. Primary outcome was the changes in BCVA and central macular thickness (CMT) over 24 months. Secondary outcomes included the influence of the selected drug and of the baseline BCVA on the final outcomes. Results. 439 patients (224 males; 51%) with naïve AMD-related macular neovascularization were included in the analyses. Mean age was 78 ± 8 years old. Compared to baseline evaluations, not significant BCVA changes were found at 1-year and 2-year examinations. CMT was significantly reduced at both 1-year and 2-year follow-ups ( p < 0.01 ). Classic, polypoidal choroidal vasculopathy and mixed subtypes significantly correlated with worse visual outcome ( p < 0.01 ). Overall, baseline BCVA significantly correlated with both 1-year and 2-year follow-up changes ( p < 0.01 ). Moreover, BCVA at 1-year significantly correlated with BCVA changes at 2-year follow-up ( p < 0.01 ). Furthermore, CMT changes from baseline significantly correlated with both 1-year and 2-year follow-up measurements ( p < 0.01 ). Conclusion. Anti-VEGF approach is generally effective in stopping nAMD progression in our real-life analysis. No difference was found comparing patients treated with ranibizumab and aflibercept, nor in patients with drug switching.

scholarly journals Phacoemulsification Surgery in Eyes with Neovascular Age-Related Macular Degeneration

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Andre Grixti ◽  
Evangelia Papavasileiou ◽  
Dominic Cortis ◽  
Balakrishna Vineeth Kumar ◽  
Som Prasad
Keyword(s):  
Macular Degeneration ◽  
Case Series ◽  
Age Related Macular Degeneration ◽  
Final Visit ◽  
Neovascular Amd ◽  
Anti Vegf ◽  
Age Related ◽  
Before And After ◽  
Endothelial Growth Factor

Purpose. To evaluate the visual outcomes and effect of phacoemulsification surgery on the progression of neovascular age-related macular degeneration (AMD). Methods. Retrospective, noncomparative, and interventional case series. Thirty eyes from 29 subjects with neovascular AMD treated with intravitreal antivascular endothelial growth factor (VEGF) injections who underwent phacoemulsification and had a postsurgery follow-up of 6 months were included. LogMAR best corrected visual acuity (BCVA) was assessed preoperatively; 1 month, 3 months, and 6 months postoperatively; and finally at the last visit. The frequency of anti-VEGF therapy, calculated as the number of intravitreal injections per month, and central macular thickness (CMT) before and after cataract surgery were determined. Results. Median (range) logMAR BCVA was 0.69 (0.16 to 1.32) preoperatively; 0.55 (−0.04 to 1.32) at 1 month, 0.52 (−0.1 to 1.32) at 3 months, and 0.50 (0.0 to 1.32) at 6 months postoperatively; and 0.6 (0.0 to 1.4) at final visit (P=0.0011). There was no difference in the frequency of anti-VEGF injections between the immediate 6 months before and after phacoemulsification, which was equal to 0.1667 injections per month (P=0.6377). Median CMT measured 203 μm preoperatively, which temporarily increased to 238 μm at 1 month after surgery (P=0.0093) and then spontaneously returned to baseline, measuring 212.5 μm at 3 months postoperatively (P=0.3811). Conclusion. Phacoemulsification surgery significantly improved vision in patients with neovascular AMD, with no increased need for anti-VEGF injections to keep the macula dry postoperatively.

scholarly journals Continued anti-VEGF treatment does not prevent recurrences in eyes with stable neovascular age-related macular degeneration using a treat-and-extend regimen: a retrospective case series

Eye ◽  
2021 ◽  
Author(s):  
Justus G. Garweg ◽  
Peter G. Traine ◽  
Richard A. Garweg ◽  
Juliana Wons ◽  
Christin Gerhardt ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Stable Disease ◽  
Case Series ◽  
Age Related Macular Degeneration ◽  
Retrospective Case ◽  
Anti Vegf ◽  
Age Related ◽  
Group 2 ◽  
Group 1

Abstract Background The continuation of anti-vascular endothelial growth factor (anti-VEGF) treatment after achieving stability in patients with neovascular age-related macular degeneration has generally been advocated. In our own patients, we thought to assess whether continued anti-VEGF treatment is capable of preventing recurrences. Methods In this retrospective observational case series, patients with stable disease either opted to continue treatment every 12–14 weeks (Group 1) or stopped treatment with subsequent follow-up visits every 8–12 weeks (Group 2). Results Of the 103 eyes of 103 patients achieving stability, 49 eyes continued treatment (Group 1), whereas treatment was stopped in 54 eyes undergoing regular follow-up (Group 2). Recurrent disease was observed in 21 (42.9%) and 33 (61.1%) cases in Group 1 and Group 2, respectively (p = 0.08). Time between achieving stable disease and recurrence was comparable between Group 1 and Group 2 (11.1 ± 8.2 months vs. 9.2 ± 6.7 months; p = 0.43). The number of visits between achieving stability and disease recurrence was similar, but not the number of injections (3.5 ± 2.0 vs. 0.2 ± 0.4; p < 0.001). Conclusions Continuing anti-VEGF therapy after achieving functional and morphological stability every 12–14 weeks does not prevent recurrences. Patients deserve to be informed of a potential lifetime risk of recurrences, even under continued therapy.

scholarly journals Genetic biomarkers in the VEGF pathway predicting response to anti-VEGF therapy in age-related macular degeneration

2019 ◽  
Vol 4 (1) ◽  
pp. e000273
Author(s):  
Irina Balikova ◽  
Laurence Postelmans ◽  
Brigitte Pasteels ◽  
Pascale Coquelet ◽  
Janet Catherine ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Treatment Response ◽  
Multiple Testing ◽  
Age Related Macular Degeneration ◽  
Patient Specific ◽  
Multiple Testing Correction ◽  
Anti Vegf ◽  
Age Related ◽  
Vegf Pathway

ObjectiveAge-related macular degeneration (ARMD) is a leading cause of visual impairment. Intravitreal injections of anti-vascular endothelial growth factor (VEGF) are the standard treatment for wet ARMD. There is however, variability in patient responses, suggesting patient-specific factors influencing drug efficacy. We tested whether single nucleotide polymorphisms (SNPs) in genes encoding VEGF pathway members contribute to therapy response.Methods and analysisA retrospective cohort of 281 European wet ARMD patients treated with anti-VEGF was genotyped for 138 tagging SNPs in the VEGF pathway. Per patient, we collected best corrected visual acuity at baseline, after three loading injections and at 12 months. We also registered the injection number and changes in retinal morphology after three loading injections (central foveal thickness (CFT), intraretinal cysts and serous neuroepithelium detachment). Changes in CFT after 3 months were our primary outcome measure. Association of SNPs to response was assessed by binomial logistic regression. Replication was attempted by associating visual acuity changes to genotypes in an independent Japanese cohort.ResultsAssociation with treatment response was detected for seven SNPs, including in FLT4 (rs55667289: OR=0.746, 95% CI 0.63 to 0.88, p=0.0005) and KDR (rs7691507: OR=1.056, 95% CI 1.02 to 1.10, p=0.005; and rs2305945: OR=0.963, 95% CI 0.93 to 1.00, p=0.0472). Only association with rs55667289 in FLT4 survived multiple testing correction. This SNP was unavailable for testing in the replication cohort. Of six SNPs tested for replication, one was significant although not after multiple testing correction.ConclusionIdentifying genetic variants that define treatment response can help to develop individualised therapeutic approaches for wet ARMD patients and may point towards new targets in non-responders.

Sign in / Sign up

Export Citation Format

Share Document