CHANGES OF DRUSEN NUMBER AND CENTRAL RETINAL THICKNESS IN AGE-RELATED MACULAR DEGENERATION PATIENTS OVER TWO YEARS

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.

Download Full-text

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

European Journal of Ophthalmology ◽

10.1177/1120672119839299 ◽

2019 ◽

Vol 30 (3) ◽

pp. 543-549 ◽

Cited By ~ 2

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.

Download Full-text

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

European Journal of Ophthalmology ◽

10.1177/1120672120968740 ◽

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.

Download Full-text

Three-Year Outcomes of Wet Age-Related Macular Degeneration Treatment in Polish Therapeutic Programs

Medicina ◽

10.3390/medicina58010042 ◽

2021 ◽

Vol 58 (1) ◽

pp. 42

Author(s):

Małgorzata Figurska ◽

Marek Rękas

Keyword(s):

Macular Degeneration ◽

Treatment Program ◽

Retinal Thickness ◽

Age Related Macular Degeneration ◽

Central Retinal Thickness ◽

First Year ◽

Regular Treatment ◽

Age Related ◽

Significant Difference ◽

Treatment Naïve

Background and Objectives: Wet age-related macular degeneration (wAMD) is a chronic, progressive disease of the central part of the retina. Standard treatment for wAMD consists of multiple intravitreal injections of anti-vascular endothelial growth factor drugs. The study goal was to evaluate the three-year effectiveness of wAMD treatment with aflibercept and ranibizumab as part of the therapeutic program in routine clinical practice. Materials and Methods: 1430 patients (possessing 1430 wAMD eyes) with median age of 78.0 years (71.0, 83.0) were enrolled in a non-randomized, retrospective, observational, multicenter study; 804 (56.2%) eyes were treatment-naïve. Therapy was carried out in accordance with the guidelines of the treatment program (the fixed or pro re nata regimen). Results: After the first year of treatment, there was a gain of 2.03 (12.15) letters; after the second, 0.94 (13.72) (p ˂ 0.001); and after the third, 0.17 (14.05) (p ˂ 0.001). There was a significant reduction in the central retinal thickness. In the first year, the patients received 7.00 (5.00, 8.00) injections. In the following years, a significantly lower number of injections (4.00 (2.00, 5.00)) was administered. After the first year, there was a significant difference in the distribution of the best corrected visual acuity according to the Early Treatment Diabetic Retinopathy Study protocol, with more frequent values in the ranges > 35 ≤ 70 for this parameter and > 70 letters in the treatment naïve eye subgroup. After the first year, central retinal thickness in treatment-naïve eyes was significantly reduced. Conclusions: Regular treatment of wet age-related macular degeneration as part of the treatment program achieves functional stabilization and significant morphological improvement over a long-term, three-year follow-up, with significantly fewer injections needed after the first year of treatment.

Download Full-text

Long term intravitreal ranibizumab treatment for exsudative age-related macular degeneration

Orvosi Hetilap ◽

10.1556/oh.2013.29729 ◽

2013 ◽

Vol 154 (45) ◽

pp. 1790-1797 ◽

Cited By ~ 1

Author(s):

Regina Lukács ◽

Miklós Resch ◽

András Papp ◽

Antal Szabó ◽

Ágnes Borbándy ◽

...

Keyword(s):

Macular Degeneration ◽

Retinal Thickness ◽

Age Related Macular Degeneration ◽

Central Retinal Thickness ◽

First Year ◽

Intravitreal Ranibizumab ◽

Age Related ◽

Pro Re Nata ◽

Ranibizumab Treatment

Introduction: The results of intravitreal ranibizumab treatment for exsudative age-related macular degeneration have been favourable until this time. Aim: To evaluate the two-year functional and anatomic results of intravitreal ranibizumab treatment. Method: 46 patients (age: 75±9.1 years) were included in a prospective single center study. Treatment regimen was the following: monthly 0.5 mg ranibizumab was administered in the first 3 months, and later as required (pro re nata). The change of best corrected visual acuity and central retinal thickness was followed. Results: The visus change at the end of the follow-up time was not statistically significant compared to baseline (p = 0.760) and the at the end of the first year (p = 0.154). Central retinal thickness decreased significantly compared to baseline (p = 0.000001), but the change was not statistically significant compared to the end of the first year (p = 0.875). Conclusions: Patients with neovascular macular degeneration treated with intravitreal ranibizumab using pro re nata regimen have stable visus for long term, and the exsudation could be reduced efficiently. Orv. Hetil., 154(45), 1790–1797.

Download Full-text

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

Ophthalmology journal ◽

10.17816/ov2014427-32 ◽

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.

Download Full-text

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

Journal of the Korean Ophthalmological Society ◽

10.3341/jkos.2021.62.7.939 ◽

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.

Download Full-text

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

Journal of Ophthalmology ◽

10.1155/2014/497178 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 8

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.

Download Full-text