scholarly journals Our experience in visual functions' improvement in patiens with “wet” age-related macular degeneration at switching from one anti-VEGF agent to another

2017 ◽  
Vol 10 (3) ◽  
pp. 67-73
Author(s):  
Sergey A Korotkikh ◽  
Evgeniy V Bobykin
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Choroidal Neovascularization ◽  
Retinal Thickness ◽  
Age Related Macular Degeneration ◽  
Central Retinal Thickness ◽  
Macular Volume ◽  
Anti Vegf ◽  
Age Related ◽  
Previously Treated

Purpose. To assess mean changes in visual acuity, central retinal thickness and macular volume as well as to determine the duration of clinical choroidal neovascularization inactivity after single aflibercept injection in neovascular age-related macular degeneration (nAMD) patients switched from ranibizumab (preliminary date). Methods. Open-label prospective study. The study enrolled 23 patients with nAMD previously treated with ranibizumab. Results. Mean age of patients was 70.5 years, 16 were women. Mean number of ranibizumab injections given prior to switching to aflibercept was 8.7. After single aflibercept inravitreal injection mean visual acuity has significantly improved from 0.40 to 0.47 Snellen chart. Mean central retinal thickness has significantly reduced from 323.1 to 246.9 μm and mean macular volume has significantly reduced from 7.71 to 6.74 mm3. Duration of choroidal neovascularization (CNV) inactivity was 2.91 months. Conclusion. Single aflibercept intravitreal injection has resulted in significant visual gain as well as in significant central retinal thickness (CRT) and macular volume reduction. This provides evidence of aflibecept efficacy in nAMD patients previously treated with anti-VEGF. Duration of CNV inactivity provides clinical data supporting aflibercept injection every 8 weeks in nAMD patients. (For citation: Korotkikh SA, Bobykin EV. Our experience in visual functions' improvement in patiens with “wet” age-related ­macular degeneration at switching from one anti-VEGF agent to another. Ophthalmology Journal. 2017;10(3):67-73. doi: 10.17816/OV10367-73).

scholarly journals Switching of an inhibitor of vascular endothelial growth factor in the treatment of resistant to ranibizumab neovascular form of age-related macular degeneration. Case study

2016 ◽  
Vol 9 (3) ◽  
pp. 69-76
Author(s):  
Nanuli V Ivanova ◽  
Oleg G Rasin ◽  
Aleksey V Savchenko ◽  
Olga A Litvinenko
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Choroidal Neovascularization ◽  
Retinal Thickness ◽  
Retinal Pigment ◽  
Age Related Macular Degeneration ◽  
Neovascular Amd ◽  
Membrane Area ◽  
Anti Vegf ◽  
Age Related

Aim: To analyze the spontaneous reattachment of retinal pigment epithelium (RPE) after replacing the anti-VEGF drug - ranibizumab, with aflibercept in the treatment of neovascular AMD based on the example given in our clinical study. Material and methods. We carried out a retrospective analysis of the patient’s history with exudative detachment of RPE due to choroidal neovascularization in age-related macular degeneration. This patient was treated with anti-angiogenic treatment in the form of monthly IVI ranibizumab. At the time of treatment, the visual acuity of the left eye was 0.3 with sph + 1,5D = 0,5, in the fundus of the eye there was a high exudative detachment of RPE in the macular region common to the vascular arcades. The edges were determined by the detachment of the neuroepithelium and abundance of hard drusen. Using optical coherence tomography, (OCT) we saw that the center of the macula of the left eye had a high detachment of RPE, local detachment of the neuroepithelium at the edge of the RPE detachment and an abundance of hard drusen. The foveola was flattened, and beneath it, the RPE was detached in the center - thickness of 247 microns (m). After the seventh injection of ranibizumab, we used OCT to assess the condition of the retina. The retinas condition was almost the same as before. The thickness in the central zone was 251 m, detachment of neuroepithelium was not seen, the dome of the RPE detachment circuit was unchanged and visual acuity improved to 0.7 with a maximum correction. We then replaced ranibizumab with another anti-angiogenic drug - aflibercept. Results and discussion. Two weeks on from our control examination, we noticed there was a smooth bubble detachment of the RPE and a retinal prominence over the choroidal neovascular membrane area (CNM). The OCT scan indicated minimal RPE detachment, resorption of the exudate, presence of subretinal spindle - shaped formation near the temporal side (CNM? Scar?). Retinal thickness was 178 m at the fixation point. Intravitreal injections were stopped. Visual acuity increased to 0.8 and remained stable for 5 months, but there were signs of renewed activity of choroidal neovascularization. According to OCT, the thickness in the central parts of the retina increased to 230 m, there were intraretinal cysts and increased spindle - shaped formation under the RPE. After 10 months of IVI aflibercept, acute vision decreased to 0.5, the thickness at the point of fixing increased to 250 m, subretinal formation increased and oozing of fluid was observed mainly parafoveal, which explains the high visual acuity. We then administered IVI ranibizumab. Two weeks later, the retinal thickness was 169 m, visual acuity improved to 0.8, but 1 month later we found that the retinal thickness had increased once more and decreased to 0.7. After 3 months after IVI ranibizumab, retinal thickness at the fixation point reached 286 m and visual acuity dropped to 0.5. Conclusion. In our practice, we face patients with neovascular AMD, who respond badly to ranibizumab. For such patients, it is important to replace ranibizumab with a better, more therapeutically effective anti-VEGF drug with anti-vaso proliferative properties. Aflibercept is an effective substitute for ranibizumab which was shown in this clinical case.

Central retinal thickness fluctuations in patients treated with anti-VEGF for neovascular age related macular degeneration

2021 ◽  
pp. 112067212110378
Author(s):  
Francesco Ciucci ◽  
Giuseppina Ioele ◽  
Antonio Bardocci ◽  
Giorgio Lofoco ◽  
Barbara Antonelli ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Retinal Thickness ◽  
Treatment Algorithm ◽  
Real Life ◽  
Principal Component ◽  
Age Related Macular Degeneration ◽  
Central Retinal Thickness ◽  
First Year ◽  
Anti Vegf ◽  
Age Related

Purpose: This is a retrospective, single-center, non randomized interventional real life study, investigating the correlation between variability of central retinal thickness (CRT) and functional outcomes during 2 years of anti-VEGF therapy in patients treated for neovascular age related macular degeneration (nAMD). Background: CRT fluctuations can depend on various factors such as the correct timing of injections, the therapeutic algorithm, and the number of injections (NI) performed; it is important to understand if CRT fluctuations are responsible for worse visual outcomes and consequently to identify the correct ways to avoid or reduce them. Methods: Forty-one patients were treated for nAMD with aflibercept: 0.5 mg intravitreal aflibercept was administered every 4 weeks during the first 3 months, then bimonthly over the first year, and after the first year adopting a PRN regimen. Standard deviation of CRT (CRT/SD), BCVA, and NI were recorded. Correlation studies were performed by Pearson’s test, Ancova, and Principal Component Analysis. Results: A negative correlation was found between CRT/SD and final BCVA. In patients who lost more than 15 letters, CRT/SD mean was significantly higher in comparison with patients who lost less than 15 letters. Patients with final BCVA >65 letters showed lower CRT/SD values compared to patients with final BCVA ⩽65 letters. Multivariate analysis confirmed that in patients with higher baseline BCVA, improvement of BCVA was correlated to NI, and lower values of CRT fluctuations were observed. Conclusions: CRT fluctuations, even after an appropriate NI given per year, significantly influence BCVA; a proactive treatment algorithm appears crucial when treating patients with nAMD.

Predicting visual outcomes in patients treated with aflibercept for neovascular age-related macular degeneration: Data from a real-world clinical setting

2019 ◽  
Vol 30 (3) ◽  
pp. 543-549 ◽  
Author(s):  
Corinne Fulcher ◽  
Charlotte A Hazel ◽  
Ian Pacey ◽  
Hasan Ali ◽  
Faruque D Ghanchi
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Predictive Factor ◽  
Retinal Thickness ◽  
Age Related Macular Degeneration ◽  
Central Retinal Thickness ◽  
Response To Treatment ◽  
Long Term Outcome ◽  
Age Related

Background/objectives: There is a significant variation in the way neovascular age-related macular degeneration patients respond to anti–vascular endothelial growth factor treatment. Both the financial and time cost of treatment are significant. As such, being able to predict patient response to treatment is valuable. Subjects/methods: 72 eyes treated with intravitreal aflibercept were retrospectively included in analysis. For each subject, visual acuity (letters) and central retinal thickness (µm) at baseline, second, third and fourth visits, as well as 12-month visits, were collated; a plot of visual acuity versus time was generated and a slope of the first three (slope3) and first four (slope4) visits was calculated. Differences in visual acuity at each visit compared to baseline were determined, as well as percentage differences in central retinal thickness at each visit compared to baseline. Lesion sub-type and the presence of fluid and haemorrhage were also recorded. Results: The average change in visual acuity over 12 months was +3.2 ± 13.4 letters with 91.2% of patients losing <15 letters. Slope4 was the only significant predictive factor for ‘visual acuity change over 12 months’ ( p < 0.001). Change in central retinal thickness, lesion sub-type, haemorrhage at baseline and the location of fluid at baseline were not useful predictive factors in long-term outcome. Conclusion: Aflibercept is an effective treatment option for neovascular age-related macular degeneration; however, the long-term response should not be predicted until at least three loading dose injections have been given. Visual acuity measures at each visit should be examined, as it is the trend in visual acuity across the first four visits (slope4) rather than the difference in visual acuity between two visits that is the predictive factor.

Association between central retinal thickness and low luminance visual acuity in early age-related macular degeneration

2020 ◽  
pp. 112067212096874
Author(s):  
María Cinta Puell ◽  
Francisco Javier Hurtado-Ceña ◽  
María Jesús Pérez-Carrasco ◽  
Inés Contreras
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Retinal Thickness ◽  
Central Area ◽  
Age Related Macular Degeneration ◽  
Central Retinal Thickness ◽  
Cross Sectional ◽  
Age Related ◽  
Low Luminance ◽  
Sd Oct

Purpose/Aim: To examine whether central retinal thickness (CRT) is related to mesopic visual acuity (VA) and low luminance deficit (LLD, difference between photopic and mesopic VA) in eyes with early and intermediate age-related macular degeneration (AMD). Materials and Methods: In a cross-sectional study, 50 pseudophakic subjects older than 63 years were divided into three groups (no AMD, early AMD and intermediate AMD). Spectral domain optical coherence tomography (SD-OCT) was used to measure CRT in the 1 mm-central-area. Best-corrected distance VA was measured under photopic or mesopic luminance conditions and LLD calculated. Subjects were stratified by VA impairment to compare CRTs across these groups. Relationships were examined by stepwise multiple linear regression. Results: No significant differences in mean CRT, photopic and mesopic VA or LLD were detected between the groups no AMD, early AMD and intermediate AMD. However, mean CRTs were 20 microns and 18 microns thicker in the eyes with impaired mesopic VA (> 0.3 logMAR) and impaired LLD (⩾ 0.3 logMAR) compared to the eyes with non-impaired VA or LLD respectively (both p < 0.01). CRT and mesopic pupil size were independent predictors of mesopic VA ( p  = 0.001). CRT emerged as the only independent predictor of LLD ( p  = 0.004). Conclusions: Increased CRT was linked to worse retinal function when measured under mesopic conditions in eyes without AMD and eyes with early to intermediate AMD. SD-OCT imaging combined with VA measurements under low luminance conditions could be a useful tool to detect early AMD.

scholarly journals A comparative analysis of the course of wet age-related macular degeneration in eyes with incipient cataract and in eyes after phacoemulsification

2014 ◽  
Vol 7 (4) ◽  
pp. 27-32
Author(s):  
Yuriy Sergeyevich Astakhov ◽  
Nikita Yur’yevich Dal’ ◽  
Natal’ya Viktorovna Chistyakova
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Retinal Thickness ◽  
Treated Group ◽  
Age Related Macular Degeneration ◽  
Central Retinal Thickness ◽  
Control Group ◽  
Age Related ◽  
Significant Difference ◽  
Wet Amd

Many patients with wet age-related macular degeneration (AMD) also have a cataract in the same eye. Because there is a theoretical risk of progression of the degenerative processes in the macular area after surgical lens removal, this raises some ethical, clinical and economical questions for ophthalmologists. The purpose of the study was to compare the course of wet AMD in eyes with incipient cataract and the course in eyes after surgical cataract removal. Materials and methods: 135 eyes with wet AMD, 48 eyes - treated group - were subjects to phacoemulsification during the study, 87 eyes - control group - with incipient cataract without indications for surgery. Regular visits every 1.5 months during 2 years of follow-up with visual acuity testing, central retinal thickness analysis by optical coherence tomography (OCT). Anti-VEGF injections were performed according to a PRN regimen. Results: there was no statistically significant difference in visual acuity, central retinal thickness, intravitreal injection frequency between both groups during the study period. Conclusions: No influence of phacoemulsification on the wet AMD course was found.

scholarly journals One-year Outcomes of a Treat-and-extend of Ranibizumab for Naive Exudative Age-related Macular Degeneration: Retrospective Analysis

2021 ◽  
Vol 62 (7) ◽  
pp. 939-947
Author(s):  
Young-Je Choi ◽  
Woong-Sun Yoo ◽  
Yong-Wun Cho ◽  
Yu-Jin Choi ◽  
In Young Chung
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Retinal Thickness ◽  
Age Related Macular Degeneration ◽  
Central Retinal Thickness ◽  
Treat And Extend ◽  
Corrected Visual Acuity ◽  
Age Related ◽  
The Mean ◽  
Treat And Extend Regimen

Purpose: This study investigated the 1-year outcomes of a treat-and-extend regimen of ranibizumab for exudative age-related macular degeneration and examined the clinical results when drug treatment was changed within the same period. Methods: This retrospective analysis included 32 eyes first diagnosed with wet age-related macular degeneration and treated for more than 1 year with a treat-and-extend regimen of ranibizumab, as well as 24 eyes treated by changing from ranibizumab to aflibercept within the same period. The injection number, maximum injection interval, change in central retinal thickness, and best-corrected visual acuity were assessed in all eyes. Results: In 32 eyes that received a treat-and-extend regimen of ranibizumab, the mean best-corrected visual acuity improved from 59.46 ± 15.13 to 68.00 ± 12.48 at 12 months (p < 0.0001). The mean central retinal thickness decreased from 409 ± 141 μm to 273 ± 89 μm at 12 months (p < 0.0001). The average number of injections per year was 7.2 ± 0.85. One complication related to the 12 months of injections was a tear in the retinal pigment epithelium; no systemic complications were observed. Of 24 eyes that underwent a change in medication, the rate of maintenance or improvement in initial visual acuity was 83% (10 eyes). The central retinal thickness was initially 371.58 ± 109.96 μm, but improved to 290.33 ± 58.66 μm in 12 eyes that received three injections of aflibercept. Conclusions: At 1 year, good outcomes were obtained using treat-and-extend ranibizumab for exudative age-related macular degeneration. When the treatment was changed to aflibercept within the same period, vision was often maintained and short-term anatomical improvement was evident.

scholarly journals Intravitreal Aflibercept Outcomes in Patients with Persistent Macular Exudate Previously Treated with Bevacizumab and/or Ranibizumab for Neovascular Age-Related Macular Degeneration

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
David R. Griffin ◽  
Preston P. Richmond ◽  
John C. Olson
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Retinal Thickness ◽  
Group Analysis ◽  
Age Related Macular Degeneration ◽  
Central Retinal Thickness ◽  
Treatment Resistant ◽  
Appreciable Change ◽  
Age Related ◽  
Intravitreal Aflibercept

Purpose. To assess whether intravitreal aflibercept (2.0 mg) can effectively reduce persistent macular exudate and enhance visual acuity in ranibizumab (0.5 mg) and/or bevacizumab (1.25 mg) treatment resistant patients with neovascular age-related macular degeneration.Methods. This retrospective study included 47 treatment resistant eyes from 47 patients switched to intravitreal aflibercept injections after receiving a minimum of 3 injections with either ranibizumab or bevacizumab. Snellen visual acuity and optical coherence tomography were assessed just prior to the first injection (baseline) and prior to the fourth injection (final). Additionally, anatomical regions of persistent macular exudate were tracked to determine if these areas yielded varying responses to aflibercept.Results. At baseline, patients had received an average of 11.3 injections with any prior anti-VEGF drug (SD 5.96). For whole group analysis, baseline and final central retinal thickness were 370.57 µm and 295.7 µm (P≤.001), respectively. Baseline and final retinal fluid volumes were 4.81 mm3and 4.37 mm3(P≤.001), respectively. Baseline and final logMAR were 0.56 and 0.53 (P=0.301), respectively. Anatomic location of persistent exudate did not appreciably alter treatment outcome.Conclusion. Central retinal thickness and total retinal fluid volume were reduced in ranibizumab and/or bevacizumab treatment resistant patients following three aflibercept injections. No appreciable change in visual acuity was noted.

EXPERIENCE OF AFLIBERCEPT APPLICATION IN PATIENTS WITH EXUDATIVE AGE-RELATED MACULAR DEGENERATION

2020 ◽  
pp. 90-96
Author(s):  
Darina Aleksandrovna Konovalova
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Macular Degeneration ◽  
Retinal Thickness ◽  
Age Related Macular Degeneration ◽  
Intravitreal Injections ◽  
Central Retinal Thickness ◽  
Optical Coherence ◽  
Treatment Results ◽  
Age Related

Age−related macular degeneration is a threatening pathology, gradually leading to a complete loss of central vision, which adversely affects an individual physically and emotionally as well as socially, reducing the life quality of such patients. To analyze the anatomical and functional results of intravitreal injections of aflibercept in the patients with exudative age−related macular degeneration, 47 patients a were prospectively studied. Intravitreal injections of aflibercept were performed by the same surgeon under aseptic operating conditions at a dosage of 2 mg, which was 0.05 ml of the drug. All patients underwent a comprehensive ophthalmic examination, which included visometry, autoceratorefractometry, tonometry, biomicroscopy, and ophthalmoscopy under medical mydriasis, as well as optical coherence tomography. The study took place before the intravitreal administration of aflibercept, one month after each of the three loading injections, 4, 8, and 12 weeks, respectively, after the start of treatment, and 4 weeks after the fourth injection, which was performed 8 weeks after the third loading. The total follow−up period was 24 weeks. For assessing the anatomical and functional efficiency of the treatment the changes in visual acuity, which were adjusted as well as those in the central retinal thickness according to optical coherence tomography were accepted as the criteria. The treatment results showed a significant increase in visual acuity of patients with the most significant increase in the index at week 12 from the beginning of therapy, as well as to a statistically significant decrease in the central retinal thickness within six months of observation. It is obvious that a consistent use of this drug is necessary to achieve stable treatment results. Key words: exudative age−related macular degeneration, visual acuity, central retinal thickness, intravitreal antiangiogenic therapy.

scholarly journals Switching Between Aflibercept and Ranibizumab in the Treatment of Refractory Exudative Age-related Macular Degeneration

2021 ◽  
Vol 8 (3) ◽  
pp. 167-173
Author(s):  
Małgorzata Wichrowska ◽  
Jarosław Kocięcki ◽  
Wojciech Suda
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Retinal Thickness ◽  
Age Related Macular Degeneration ◽  
Central Retinal Thickness ◽  
Primary Therapy ◽  
Corrected Visual Acuity ◽  
Age Related ◽  
Treatment Naïve ◽  
Best Corrected Visual Acuity

Introduction: Aflibercept and ranibizumab have become the most used drugs in the treatment of wet age-related macular degeneration. Some patients; however, do not respond to aflibercept and ranibizumab treatment. Our aim was to determine whether the switch from aflibercept to ranibizumab, and then switchback, is effective in a group of patients poorly responding to aflibercept. We assessed best corrected visual acuity, central retinal thickness, and the presence of intra- and subretinal fluid (respectively). Material and methods: We conducted a retrospective comparative case series study. Twenty eyes of 20 patients, who had no inhibition of disease activity after at least one year of treatment with aflibercept, were included in the study. If after switch to ranibizumab the response to the drug was again inadequate, we returned to aflibercept. We divided the study population into two groups: treatment- naïve and patients who had received injections before entering the Drug Program for the Treatment of Age-Related Exudative Macular Degeneration. Results: We observed an improvement in both best corrected visual acuity and central retinal thickness parameters, but only in the treatment-naïve group. We did not observe any statistically credible effects for sub- and intraretinal fluid in the studied groups. Conclusions: Drug conversion may be beneficial for patients poorly responding to primary therapy. Greater improvement is seen in previously untreated patients.

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