scholarly journals Visual Outcome and Treatment Frequency of Anti-VEGF Therapy Using the Treat-and-Extend and Treatment Cessation Regimen for Exudative Age-Related Macular Degeneration and Pachychoroid Neovasculopathy

2021 ◽  
Vol Volume 15 ◽  
pp. 4405-4418
Author(s):  
Takamasa Kinoshita ◽  
Junya Mori ◽  
Akira Hatanaka ◽  
Miho Shimizu ◽  
Hiroko Imaizumi
Keyword(s):  
Macular Degeneration ◽  
Visual Outcome ◽  
Age Related Macular Degeneration ◽  
Treatment Cessation ◽  
Treatment Frequency ◽  
Treat And Extend ◽  
Anti Vegf ◽  
Age Related ◽  
Pachychoroid Neovasculopathy

scholarly journals Visual Outcome and Treatment Frequency of Anti-VEGF Therapy using the Treat-and-extend and Treatment Cessation Regimen for Exudative Age-related Macular Degeneration and Pachychoroid Neovasculopathy

2021 ◽  
Author(s):  
Takamasa Kinoshita ◽  
Junya Mori ◽  
Akira Hatanaka ◽  
Kei Akaiwa ◽  
Miho Shimizu ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Successful Treatment ◽  
Visual Outcome ◽  
Age Related Macular Degeneration ◽  
Treatment Cessation ◽  
Treatment Frequency ◽  
Treat And Extend ◽  
Age Related ◽  
Long Term Treatment ◽  
Pachychoroid Neovasculopathy

Abstract Compared with fixed dosing regimens, anti-vascular endothelial growth factor therapy using treat-and-extend (TAE) and treatment cessation regimens for exudative age-related macular degeneration (AMD) and pachychoroid neovasculopathy (PN) may reduce the treatment burden on chronic patients. To confirm this, and to determine the factors related to the successful treatment cessation, we retrospectively examined the visual outcome and treatment frequency of 101 eyes with exudative AMD and PN that underwent treatment using TAE and treatment cessation regimen. We found that visual acuity was maintained at the last visit with a mean follow-up period of four years. At the last visit, nearly half of the eyes were being treated at an interval of ≥ 12 weeks, or were under treatment cessation. Further, more than a quarter of the eyes were under successful treatment cessation with a median treatment-free period of 126 weeks. There was a significant association of successful treatment cessation at the last visit with good early treatment response and a small recurrence number. Moreover, eyes with ≥ 2 recurrences were unlikely to achieve long-term treatment cessation. This information could help physicians predict the achievement of treatment cessation for a considerable period.

scholarly journals New Approach of Anti-VEGF Agents for Age-Related Macular Degeneration

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Young Gun Park ◽  
Hyun Wook Rhu ◽  
Seungbum Kang ◽  
Young Jung Roh
Keyword(s):  
Macular Degeneration ◽  
Visual Outcome ◽  
Standard Of Care ◽  
Age Related Macular Degeneration ◽  
Treatment Frequency ◽  
New Approach ◽  
Treatment Regimens ◽  
Anti Vegf ◽  
Age Related ◽  
The Many

Age-related macular degeneration (AMD) is the leading cause of visual loss in older population. Angiogenesis is an important factor associated with the development of CNV due to AMD. Treatment of CNV with intravitreal anti-VEGF monotherapy is currently the standard of care. However, not all patients respond to monotherapy, and modified anti-VEGF treatment regimen and combination therapy may target reducing treatment frequency or improving visual outcome. This paper reviews the many clinical trials that have been performed utilizing several treatment regimens. While many trials have shown that this variable therapy is justifiable, further study is required to determine correct regimens and dosage.

scholarly journals Pachychoroid Neovasculopathy Disguising as Age-Related Macular Degeneration Treated by Spironolactone and Anti-VEGF Combination Therapy

2021 ◽  
pp. 116-123
Author(s):  
Leonie F. Keidel ◽  
Benedikt Schworm ◽  
Siegfried G. Priglinger ◽  
Jakob Siedlecki
Keyword(s):  
Combination Therapy ◽  
Macular Degeneration ◽  
Pigment Epithelium ◽  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Chronic Central Serous Chorioretinopathy ◽  
Anti Vegf ◽  
Age Related ◽  
Therapeutic Concepts ◽  
Pachychoroid Neovasculopathy

Nonresponse of neovascular age-related macular degeneration (nAMD) to anti-vascular endothelial growth factor (anti-VEGF) therapy can often be attributed to misdiagnosis, and pathologies mimicking AMD might require different therapeutic concepts. In the following, we want to outline a case of presumed nAMD which revealed to be pachychoroid neovasculopathy (PNV) and was successfully treated by the addition of spironolactone. A 67-year-old female patient was referred for nonresponse of nAMD on her left eye after 29 intravitreal injections of aflibercept with no complete resolution of subretinal fluid. On fundoscopy, both maculae presented with pigment epithelium alterations, while the left eye showed subretinal fluid on optical coherence tomography (OCT) with an associated pigment epithelium detachment, which revealed to contain a neovascular network on OCT angiography. There was faint leakage on fluorescence (FAG) and indocyanine green angiography (ICGA) and some focal vascular dilation of the neovascular network on ICGA. Due to the absence of Drusen on any eye, a thick choroid, and the presence of a gravitational tract on blue autofluorescence (BAF), chronic central serous chorioretinopathy with a choroidal neovascularization, defined as PNV in the pachychoroid disease was diagnosed. Upon the addition of spironolactone to anti-VEGF treatment, choroidal thickness significantly decreased, and subretinal fluid resolution was observed and maintained for the first time. In conclusion, PNV should be ruled out in cases of presumed nAMD nonresponding to anti-VEGF. In these cases, a combination therapy of anti-VEGF and mineralocorticoid antagonists can facilitate fluid resorption.

scholarly journals PSS5 COMPARING TWO TREAT-AND-EXTEND ANTI-VEGF REGIMENS FOR MANAGING WET AGE-RELATED MACULAR DEGENERATION - IMPLICATIONS FOR THE NATIONAL HEALTH SYSTEM IN FRANCE

2019 ◽  
Vol 22 ◽  
pp. S886
Author(s):  
M. Pochopien ◽  
M. Palarcyzk ◽  
E. Clay ◽  
C. Koerber ◽  
M. Boitte ◽  
...  
Keyword(s):  
Health System ◽  
Macular Degeneration ◽  
National Health ◽  
National Health System ◽  
Age Related Macular Degeneration ◽  
Treat And Extend ◽  
Anti Vegf ◽  
Age Related

scholarly journals Antivascular Endothelial Growth Factor Treatment Might Be Continued Even After Vitrectomy for Endophthalmitis in Neovascular Age-Related Macular Degeneration

2019 ◽  
Vol 4 (1) ◽  
pp. 6-12
Author(s):  
Zofia Michalewska ◽  
Jerzy Nawrocki
Keyword(s):  
Growth Factor ◽  
Macular Degeneration ◽  
Visual Outcome ◽  
Age Related Macular Degeneration ◽  
Anti Vegf ◽  
Age Related ◽  
Antivascular Endothelial Growth Factor ◽  
Endothelial Growth Factor ◽  
Mean Time

Purpose: This article studies visual outcome and frequency of antivascular endothelial growth factor (anti-VEGF) injections continued in patients with neovascular age-related macular degeneration (AMD) who had an earlier vitrectomy for postinjection endophthalmitis. Methods: A retrospective interventional study was conducted reviewing our database for patients with a diagnosis of endophthalmitis in the course of anti-VEGF injections. Endophthalmitis diagnosis was made on clinical examination of pain, rapid decrease in visual acuity (VA), conjunctival hyperemia, hypopyon, and vitritis. In all eyes, core vitrectomy with intravitreal antibiotics was performed. Spectral-domain optical coherence tomography was performed monthly before and after surgery during follow-up. Anti-VEGF injections were continued after surgery in all cases. Results: Eight eyes with postinjection endophthalmitis were included. Mean VA immediately before endophthalmitis was 20/50 Snellen with a mean of 19 intravitreal anti-VEGF injections ( P = .45). At time of endophthalmitis diagnosis, mean VA was 20/1000 (range, 20/2000-20/200). Mean time from injection to when the patient noted first symptoms was 4.3 days (range, 1-8 days). Mean time from first symptoms to surgery was 12 hours (range, 2.5-26 hours). Final mean VA at the end of follow-up (range, 12-84 months) did not statistically differ from VA at the visit immediately before endophthalmitis diagnosis ( P = .69). Mean frequency of injections after vitrectomy did not significantly differ from the presurgical course of treatment ( P =.97). Conclusions: Anti-VEGF treatment might be continued after vitrectomy for endophthalmitis and results in satisfactory anatomical and visual outcome. Surgery did not influence the frequency of anti-VEGF injections for neovascular AMD.

scholarly journals Treatment for neovascular age-related macular degeneration: reasonable expectations of physicians and patients

2021 ◽  
Vol 21 (3) ◽  
pp. 169-174
Author(s):  
A.B. Durasov ◽  
◽  
◽  
◽  
◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Treatment Outcomes ◽  
Randomized Clinical Trials ◽  
Patient Characteristics ◽  
Age Related Macular Degeneration ◽  
Strict Adherence ◽  
Treat And Extend ◽  
Anti Vegf ◽  
Age Related

Neovascular age-related macular degeneration (nAMD) is a progressive chronic multifactorial disease requiring long-term, lifelong anti- VEGF therapy. Treatment outcomes are not always in line with the results of randomized clinical trials and do not meet the expectations for therapy whose success is assessed differently by patients and physicians. Good functional and anatomical results are expected from antivasoproliferative therapy under certain conditions, e.g., accurate evaluation of some patient characteristics (baseline visual acuity, type of choroidal neovascularization, comorbidities, status of retinal fluid and its differentiation), timely (as early as possible) treatment initiation after verifying diagnosis, and strict adherence to a proactive personalized "Treat-and-Extend" (T&E) regimen that implies a required number of injections with individual intervals. Poor adherence to treatment (non-compliance or nonpersistence of anti-VEGF therapy) significantly affects treatment outcomes in real-world clinical practice. This paper reviews criteria which predict the response to antivasoproliferative therapy and improving treatment adherence. The authors describe four fundamental principles to be met by an ideal regimen of anti-VEGF therapy for nAMD. Keywords: neovascular age-related macular degeneration, nAMD, "Treat-and-Extend", T&E, adherence, nonpersistence, anti-VEGF. For citation: Durasov A.B. Treatment for neovascular age-related macular degeneration: reasonable expectations of physicians and patients. Russian Journal of Clinical Ophthalmology. 2021;21(3):169–174 (in Russ.). DOI: 10.32364/2311-7729-2021-21-3-169-174.

scholarly journals Patient satisfaction following a switch from treat-and-extend to observe-and-plan regimen in age-related macular degeneration

2022 ◽  
Vol 7 (1) ◽  
pp. e000930
Author(s):  
Tora Sund Morken ◽  
Christina Knutsen ◽  
Margrete Sætre Hanssen ◽  
Dordi Austeng
Keyword(s):  
Patient Satisfaction ◽  
Macular Degeneration ◽  
Standard Treatment ◽  
Age Related Macular Degeneration ◽  
Treat And Extend ◽  
Corrected Visual Acuity ◽  
Anti Vegf ◽  
Age Related ◽  
Treatment Naïve ◽  
Endothelial Growth Factor

ObjectiveStandard treatment of neovascular age-related macular degeneration (nAMD) is intravitreal injections (IVI) of antivascular endothelial growth factor (anti-VEGF) according to treat-and-extend (TnE). Observe-and-plan (OnP), a new regimen based on each individual’s relapse interval lead to fewer clinical visits and has so far shown to be safe in treatment-naïve patients. In this study, we explore patient satisfaction and safety in nAMD when switching from TnE to OnP.Methods and analysis38 participants treated acording to TnE for ≥12 months were included and switched from TnE to OnP with their last stable interval. Main outcome was patient satisfaction (Leeds Satisfaction Questionnaire). Secondary outcomes were best-corrected visual acuity (BCVA), central retinal thickness (CRT) before and 12 months after switch and number of monitoring visits and injections of anti-VEGF 12 months prior to and following switch.ResultsMean patient satisfaction was higher (3.7±0.5 SD) at 12 months after switch from TnE to OnP than before (3.6±0.5 SD, p=0.009, response rate 76%). BCVA and CRT were unchanged. Number of monitoring visits and injections were lower in the 12 months following than prior to switch (p<0.001).ConclusionA switch from TnE to OnP in a non-treatment-naïve population resulted in higher patient satisfaction, while maintaining stable BCVA. This indicates that OnP may be applicable in the large group of nAMD patients that have received IVI for several years. OnP may alleviate the treatment burden on both individual and society of frequent clinical visits while increasing patient satisfaction.

scholarly journals Analyses of the effects of persistent subretinal fluid on visual/anatomic outcomes according to the type of macular neovascularization during the relaxed treat-and-extend protocol in age-related macular degeneration patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kyung Tae Kim ◽  
Ju Byung Chae ◽  
Seungheon Lee ◽  
Eoi Jong Seo ◽  
Dong Yoon Kim
Keyword(s):  
Macular Degeneration ◽  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Long Term Effects ◽  
Treat And Extend ◽  
Anti Vegf ◽  
Age Related ◽  
Treat And Extend Regimen

Abstract Background To analyze the long-term effects of persistent subretinal fluid (SRF) on visual/anatomic outcomes according to the type of macular neovascularization (MNV) during relaxed treat-and-extend regimen with anti-vascular endothelial growth factor (anti-VEGF) agents in age-related macular degeneration (AMD) patients. Methods Patients with fovea-involving type 1 or type 2 MNV, treated with a relaxed treat-and-extend regimen for 2 years were retrospectively reviewed. Eyes with SRF observed more than three times per year were defined as the ‘persistent SRF (+) group’. To exclude the effects of IRF as much as possible, the eyes with persistent IRF were excluded. The effects of persistent SRF on the best-corrected visual acuity (BCVA), central subfield retinal thickness (CST), and changes in the photoreceptor layer (PRL) thickness and outer retinal bands (external limiting membrane, ellipsoid zone, and cone outer segment tip line) after anti-VEGF injection were analyzed for each MNV type. Results Seventy-seven eyes with type 1 MNV (44 eyes with persistent SRF) and 53 eyes with type 2 MNV (18 eyes with persistent SRF) were enrolled. Following a relaxed treat-and-extend regimen with anti-VEGF agents, BCVA and CST improved for each MNV type. In comparison between persistent SRF (+) and persistent SRF (−) group, there were no differences in the amount of change in BCVA and CST between the two groups for each MNV type during 2-year follow-up periods. In addition, there were no differences in the amount of reduction in PRL thickness and state of the outer retinal bands between the two groups for each MNV type. Conclusions Using a relaxed treat-and-extend regimen with anti-VEGF agents, persistent SRF did not have additional effects on visual and anatomic outcomes by 2 years, regardless of the MNV type.

Efficacy of treat-and-extend regimen with aflibercept for pachychoroid neovasculopathy and Type 1 neovascular age-related macular degeneration

2018 ◽  
Vol 62 (2) ◽  
pp. 144-150 ◽  
Author(s):  
Hidetaka Matsumoto ◽  
Takashi Hiroe ◽  
Masahiro Morimoto ◽  
Kensuke Mimura ◽  
Arisa Ito ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Age Related Macular Degeneration ◽  
Treat And Extend ◽  
Age Related ◽  
Pachychoroid Neovasculopathy ◽  
Treat And Extend Regimen
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