scholarly journals Preferred treatment regimen of aflibercept after treatment interruption in patients with neovascular age-related macular degeneration

2021 ◽  
Vol 14 (3) ◽  
pp. 17-24
Author(s):  
Aleksandr S. Kharakozov ◽  
Alexey N. Kulikov ◽  
Dmitrii S. Maltsev
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Degeneration ◽  
Treatment Interruption ◽  
Age Related Macular Degeneration ◽  
Optical Coherence ◽  
Dosing Regimen ◽  
Anti Vegf ◽  
Age Related ◽  
Second Year ◽  
Experienced Treatment

BACKGROUND: The efficacy of antiangiogenic therapy in neovascular age-related macular degeneration depends on adherence to the intravitreal injection regimen and regular follow-up. In 2020, the COVID-19 pandemic and associated epidemiological restrictions in ophthalmological care delivery led to a massive lack of appropriate control and management of this condition. AIM: To determine the preferred regimen of intravitreal anti-VEGF therapy in patients with neovascular age-related macular degeneration who experienced treatment interruption due to the COVID-19 pandemic. MATERIAL AND METHODS: Thirty eyes of 26 patients (20 males and 6 females, mean age 73.710.4 years) with neovascular age-related macular degeneration were included; all of them experienced treatment interruption due to the COVID-19 pandemic during the second year of aflibercept therapy. Re-starting therapy, all patients were divided in two groups and received treatment as per the fixed dosing (bimonthly), or as pro re nata (PRN) regimen. All patients underwent standard ophthalmological examination and optical coherence tomography before and after treatment interruption as well as six months after treatment re-start. RESULTS: At six months after treatment re-start, best corrected visual acuity and central retinal thickness did not show statistically significant difference similar between the fixed dosing group and that of PRN dosing regimen (p=0.34 and p=0.85, respectively). However, patients of the fixed dosing group received for one more injection than those of the PRN group (median value 2.0 injections, 95% confidence interval 2.0-2.4; p=0.0001). Preservation of the disease activity according to optical coherence tomography data, in the fixed regimen group was found in 10 eyes (71.4 %) versus 9 eyes (56.2 %) in the PRN group (p=0.63). CONCLUSIONS: For neovascular age-related macular degeneration patients at the second year of treatment, an adequate therapeutic strategy for re-starting anti-VEGF therapy after treatment interruption appears to be the PRN regimen. PRN regimen allows reducing one injection in comparison to fixed dosing regimen with comparable functional outcomes during first 6 month.

scholarly journals Subthreshold Exudative Choroidal Neovascularization Associated With Age-Related Macular Degeneration Identified by Optical Coherence Tomography Angiography

2020 ◽  
Vol 4 (5) ◽  
pp. 377-385
Author(s):  
Miin Roh ◽  
Joan W. Miller ◽  
Karen W. Jeng-Miller ◽  
Jay C. Wang ◽  
Inês Laíns ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Degeneration ◽  
Choroidal Neovascularization ◽  
Age Related Macular Degeneration ◽  
Fundus Photography ◽  
Pigment Epithelial Detachment ◽  
Optical Coherence ◽  
Pigment Epithelial ◽  
Anti Vegf ◽  
Age Related

Purpose: This article describes the clinical and multimodal imaging characteristics of subthreshold exudative choroidal neovascularization (CNV) associated with age-related macular degeneration (AMD). Methods: Among 3773 patients with AMD, 8 eyes (6 patients) were identified with the clinical phenotype of interest. Dilated fundus examinations, color fundus photography, fluorescein angiography (FA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), and OCT angiography (OCTA) were performed. Results: OCT typically showed a moderately reflective irregular pigment epithelial detachment with overlying subretinal fluid (SRF). Traditional FA did not show leakage and ICGA showed no definitive neovascular network or hot spots. However, OCTA clearly demonstrated a CNV within the pigment epithelial detachment. The majority of our cases (7 of 8) did not receive antivascular endothelial growth factor (anti-VEGF) injections, and visual acuity remained stable over the available follow-up period of 1 to 10 years. Conclusions: CNV is often associated with SRF and vision loss in AMD, usually requiring frequent anti-VEGF injections. OCTA allowed us to better identify CNV not readily detected on FA and ICGA. Although some have suggested early clinical intervention with anti-VEGF injections in any case with fluid and confirmed CNV on OCTA, we describe a subset of AMD patients with SRF who may be better managed by observation. These cases may represent a more indolent, mature, and stable vascular network.

scholarly journals Predictors of neovascular activity during neovascular age-related macular degeneration treatment based on optical coherence tomography angiography

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Kunho Bae ◽  
Hyo Jung Kim ◽  
Yong Kyun Shin ◽  
Se Woong Kang
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Degeneration ◽  
Optical Coherence Tomography Angiography ◽  
Multivariate Regression Analysis ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Optical Coherence ◽  
Anti Vegf ◽  
Age Related ◽  
Endothelial Growth Factor

AbstractThe advent of anti-vascular endothelial growth factor (VEGF) therapies has remarkably improved the functional outcomes of neovascular age-related macular degeneration (nAMD) patients. However, there are guidelines on how to start treatment, the guidelines for discontinuing treatment are not yet clear. In this respect, the treat-extend-stop (TES) protocol have showed us the possibility of discontinuing treatment. In this study, we tried to investigate optical coherence tomography angiography (OCTA) biomarkers related to recurrence of neovascular activity in eyes with nAMD undergoing treatment using TES protocol. A total of 134 eyes with nAMD were divided into two groups (stop, non-stop) depending on whether they met criteria for stopping anti-VEGF treatment. Quantitative and qualitative OCTA parameters including the morphologic pattern of choroidal neovascularization (CNV) were compared between groups. Of these, 44 eyes (32.8%) were in the stop group and 90 eyes (67.2%) were in the non-stop group. In multivariate regression analysis, closed-circuit pattern of CNV and the presence of peripheral loop were associated with the non-stop group (all p < 0.001). Our results imply that the morphologic appearance of CNV on OCTA after anti-VEGF treatment may be a useful biomarker to predict weaning from treatment.

Analysis of the Vascular Morphology of the Fibrotic Choroidal Neovascularization in Neovascular Age-Related Macular Degeneration Using Optical Coherence Tomography Angiography

2020 ◽  
Vol 237 (11) ◽  
pp. 1312-1319 ◽  
Author(s):  
Marius Book ◽  
Martin Ziegler ◽  
Kai Rothaus ◽  
Henrik Faatz ◽  
Marie-Louise Gunnemann ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Degeneration ◽  
Choroidal Neovascularization ◽  
Optical Coherence Tomography Angiography ◽  
Age Related Macular Degeneration ◽  
Optical Coherence ◽  
Vascular Morphology ◽  
Anti Vegf ◽  
Age Related ◽  
Number Of Segments

Abstract Purpose Choroidal neovascularization (CNV) in neovascular age-related macular degeneration (nAMD) undergoing anti-VEGF therapy transforms into a fibrotic lesion. This fibrovascular transformation is associated with a great variety of functional and morphological effects. The aim of this study was to investigate the vascular morphology of fibrotic CNV, to compare it with its surrounding tissue and to identify phenotypes using optical coherence tomography angiography (OCTA). Methods In 18 eyes with fibrotic CNV in nAMD spectral domain OCT (SD-OCT) and OCTA were performed. The automated segmentation lines were manually adjusted. A slab from 60 µm beneath Bruchʼs membrane to the inner edge of the subretinal hyperreflective material was applied. Quantitative analysis of the vascular morphology was performed using skeletonized OCTA images. Results Compared to the perilesional rim, the number of segments per area was significantly lower (234.75 ± 25.68 vs. 255.30 ± 20.34 1/mm2, p = 0.0003) within the fibrovascular lesion. Two phenotypes could be identified within the lesion. The phenotypic traits of cluster 1 were few, long and thick vascular segments; Cluster 2 was characterized by many, short and thin vascular segments (number of segments per area: 219.4 ± 18.8 vs. 258.8 ± 13.2 1/mm2, p = 0.00009, segment length: 49.6 ± 2.7 vs. 45.0 ± 1.3 µm, p = 0.0002, vascular caliber: 26.6 ± 1.2 vs. 23.5 ± 1.8 µm, p = 0.003). The clusters did not differ significantly regarding visual acuity (0.52 ± 0.44 vs. 0.54 ± 0.18 logMAR, p = 0.25), differentiability of subretinal (OR = 3.43, CI = [0.30, 39.64], p = 0.6) and intraretinal fluid (OR = 5.34, CI = [0.48, 89.85], p = 0.14). Less normalized ellipsoid zone (EZ) loss could be observed in cluster 1 (131.0 ± 161.3 vs. 892.4 ± 955.6 1/m, p = 0.006). Conclusion In this study the vascular morphology of fibrotic CNV was analyzed using OCTA. Differences between the lesion and a perilesional rim could be detected. Two phenotypes within the fibrovascular lesion were identified. These morphological clusters could indicate different patterns of fibrovascular transformation of the CNV under long-term anti-VEGF therapy and be useful identifying possible predictive biomarkers in future studies.

scholarly journals Effects of treatment interruption on anatomical and functional status of eyes with neovascular age-related macular degeneration receiving anti-VEGF therapy

2021 ◽  
Vol 14 (1) ◽  
pp. 35-42
Author(s):  
Alexandr S. Kharakozov ◽  
Alexey N. Kulikov ◽  
Dmitrii S. Maltsev
Keyword(s):  
Treatment Group ◽  
Macular Degeneration ◽  
Treatment Interruption ◽  
Age Related Macular Degeneration ◽  
First Year ◽  
Anti Vegf ◽  
Age Related ◽  
End Of Treatment ◽  
Intraretinal Fluid ◽  
Second Year

AIM: To study anatomical and functional changes in eyes with neovascular age-related macular degeneration (AMD) receiving anti-VEGF therapy and experienced treatment interruption during COVID pandemic. MATERIAL AND METHODS: This retrospective study included 58 eyes (49 patients, 34 males and 15 females with a mean age of 73.2 9.4 years) with nAMD. Eyes in the first-year treatment group (18 eyes) received up to 7 intravitreal aflibercept injections, eyes in the second-year treatment group (21 eyes) were treated with pro re nata regimen. The treatment interruption period in the first and second-year treatment group was 5.5 0.7 and 5.5 1.0 months, respectively. RESULTS: Over the treatment interruption period, the first-year treatment group showed no statistically significant differences in best-corrected visual acuity (BCVA) and central retinal thickness (CRT), p = 0.25 and p = 0.09, respectively. At the same time, the second-year treatment group showed a statistically significant decrease in BCVA (p = 0.0004) and an increase in CRT (p = 0.002). Baseline BCVA was positively associated with BCVA at the end of treatment interruption (r = 0.82; p 0.0001). Presence of sub- and intraretinal fluid (p = 0.015 and p = 0.007, respectively), low BCVA (p 0.0001), high CRT (p = 0.019), alteration of the ellipsoid zone (p 0.001) were negatively associated with BCVA at the end of treatment interruption. Age (p = 0.8), gender (p = 0.41), and the number of intravitreal injections (p = 0.5) showed no association with changes in BCVA. CONCLUSIONS: NAMD patients of the second year of anti-VEGF therapy appear to have a higher risk of functional loss during treatment interruption. Higher CRT and lower BCVA, as well as sub- and intraretinal fluid before treatment interruption, are associated with poorer functional status at the end of the interruption period.

scholarly journals Relationship between Neovascular Density in Swept Source-Optical Coherence Tomography Angiography and Signs of Activity in Exudative Age-Related Macular Degeneration

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Martin Stattin ◽  
Julia Forster ◽  
Ahmed Daniel ◽  
Alexandra Graf ◽  
Katharina Krepler ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Degeneration ◽  
Choroidal Neovascularization ◽  
Optical Coherence Tomography Angiography ◽  
Age Related Macular Degeneration ◽  
Optical Coherence ◽  
Swept Source ◽  
Anti Vegf ◽  
Age Related ◽  
Active Disease

Purpose. To assess the relationship between signs of activity in exudative neovascular age-related macular degeneration (nAMD) following anti-vascular endothelial growth factor (anti-VEGF) treatment and morphology of choroidal neovascularization (CNV) based on neovascular density as imaged using swept source-optical coherence tomography angiography (SS-OCTA) in a qualitative manner. Methods. A single-cohort retrospective data analysis from one tertiary eye care center. Seventy-seven eyes of 72 patients were included and their charts reviewed which had been started on intravitreal injections with anti-VEGF for nAMD at least one year prior to enrollment. Clinically active disease was evaluated by slit-lamp fundus examination and spectral domain-OCT B-scans. Morphological appearance in SS-OCTA was characterized based on 5 different criteria and subsequently divided into 3 groups: predominantly hyperdense, minimally hyperdense, and hypodense lesions. Results. Fifty-eight eyes (75%) were considered clinically active and 19 eyes (25%) clinically inactive. CNV was depicted in 71 eyes (92%) by SS-OCTA and separated accordingly into predominantly hyperdense (32%), minimally hyperdense (34%), and hypodense lesions (34%). A borderline significant difference in the probability of neovascular activity for predominantly hyperdense lesions compared to hypodense lesions was detected (p=0.05). Conclusions. Hyperdense choroidal neovascularization based on qualitative assessment of flow density showed a significant relation to active disease. Inactivity could not be matched adequately. This study demonstrated the potential usefulness of SS-OCTA for guidance of treatment in age-related macular degeneration.

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