Anti-VEGF and Retinal Dystrophies

2020 ◽  
Vol 21 (12) ◽  
pp. 1201-1207
Author(s):  
Maurizio Battaglia Parodi ◽  
Pierluigi Iacono ◽  
Stefano Da Pozzo
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Macular Edema ◽  
Choroidal Neovascularization ◽  
Therapeutic Approach ◽  
Functional Limitations ◽  
Vascular Endothelial ◽  
Retinal Dystrophies ◽  
Anti Vegf ◽  
Endothelial Growth Factor

The therapeutic approach based on anti-vascular endothelial growth factor (anti-VEGF) molecules can be used to treat two important complications of retinal dystrophies: choroidal neovascularization and macular edema. The macular involvement in retinal dystrophies can lead to further visual deterioration in patients at a young age and already affected by functional limitations. The study reports the effect of anti-VEGF treatment in several subforms of retinal dystrophies, critically discussing advantages and limitations.

scholarly journals Combination Treatment of Diabetic Macular Edema with Anti-Vascular Endothelial Growth Factor and Steroids: Analysis of DRCR.net Protocol U

2018 ◽  
Vol 1 ◽  
pp. 2
Author(s):  
Cindy Ung ◽  
Kareem Moussa ◽  
Yoshihiro Yonekawa
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Diabetic Patients ◽  
Vascular Endothelial ◽  
First Line ◽  
Second Line Therapy ◽  
Anti Vegf ◽  
Endothelial Growth Factor

Diabetic macular edema (DME) is the main cause of visual impairment in diabetic patients. Intravitreal anti-vascular endothelial growth factor (VEGF) therapy is considered the first-line treatment option in the management of DME with corticosteroids used as second-line therapy. The DRCR.net Protocol U study was a Phase II trial that sought to compare the combination of a steroid and anti-VEGF therapy to anti-VEGF monotherapy regarding visual acuity and anatomic outcomes. This review highlights the strengths, weaknesses, and clinical implications of this study.

scholarly journals Short term visual and structural outcomes of anti-vascular endothelial growth factor (anti-VEGF) treatment delay during the first COVID-19 wave: A pilot study

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247161
Author(s):  
Ameay V. Naravane ◽  
Rusdeep Mundae ◽  
Yujia Zhou ◽  
Christopher Santilli ◽  
Frederik J. G. M. van Kuijk ◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Diabetic Retinopathy ◽  
Pilot Study ◽  
Growth Factor ◽  
Macular Edema ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Delayed Group ◽  
Endothelial Growth Factor

Regularly scheduled intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections are essential to maintaining and/or improving many ocular conditions including: neovascular age-related macular degeneration (nAMD), diabetic retinopathy, and retinal vein occlusions with macular edema (RVO). This study aims to assess the effect of unintended delays in anti-VEGF treatment during the first wave of the COVID-19 pandemic. This retrospective case series identified patients receiving regularly scheduled anti-VEGF intravitreal injections based on current procedural terminology (CPT) code at two practices in Minnesota. Diagnoses were limited to nAMD, diabetic macular edema (DME), proliferative diabetic retinopathy, and RVO. Patients were divided into two groups based on whether they maintained or delayed their follow-up visit by more than two weeks beyond the recommended treatment interval during the COVID-19 lockdown. The ‘COVID-19 lockdown’ was defined as the period after March, 28th, 2020, when a lockdown was declared in Minnesota. We then compared the visual acuity and structural changes to the retina using ocular coherence tomography (OCT) to assess whether delayed treatment resulted in worse visual outcomes. A total of 167 eyes from 117 patients met criteria for inclusion in this study. In the delayed group, the average BCVA at the pre- and post-lockdown visits were 0.614 and 0.715 (logMAR) respectively (p = 0.007). Central subfield thickness (CST) increased from 341 to 447 in the DME delayed group (p = 0.03) while the CST increased from 301 to 314 (p = 0.4) in the nAMD delayed group. The results of this pilot study suggests that treatment delays may have a negative impact on the visual and anatomic outcomes of patients with nAMD and DME. Future studies with larger sample sizes are required for further investigation.

scholarly journals Anti-vascular Endothelial Growth Factor Pharmacotherapy in the Treatment of Subretinal Choroidal Neovascularization

2012 ◽  
Vol 05 (02) ◽  
pp. 107
Author(s):  
Yoreh Barak ◽  
Mark A Ihnen ◽  
Shlomit Schaal ◽  
◽  
◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Choroidal Neovascularization ◽  
San Francisco ◽  
Age Related Macular Degeneration ◽  
Effective Dosage ◽  
Treatment Modalities ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Endothelial Growth Factor

Vascular endothelial growth factor (VEGF) plays a pivotal role in stimulating the growth of pathologic subretinal choroidal neovascularization (CNV). The increased production of VEGF and subsequent CNV formation can occur in degenerative, inflammatory, and vascular diseases of the retina and choroid, often leading to severe visual impairment. Anti-VEGF agents which are readily available today are much better, more potent, and longer acting in comparison with previous treatment modalities, and therefore have dramatically improved the prognosis of patients with CNV. There are four intravitreal anti-VEGF pharmacotherapies proven by large prospective, multicenter, randomized trials to be effective in the treatment of age-related macular degeneration (AMD)-related CNV: pegaptanib (Macugen®, Eyetech Pharmaceuticals, Palm Beach Gardens, FL), ranibizumab (Lucentis®, Genentech, Inc., South San Francisco, CA), bevacizumab (Avastin®, Genentech, Inc., South San Francisco, CA), and VEGF Trap-Eye (Eylea® Regeneron, Tarrytown, NY). However, there are still many challenges and unanswered questions regarding the optimal anti-VEGF pharmacotherapy agent, the best clinical treatment regimen, the most effective dosage, the optimal injection frequency, and the duration of treatment. The heavy burden of frequent injections on the elderly patient population and physicians begs for a simpler way of drug administration or development of more potent compounds.

scholarly journals Intravitreal Therapy for Diabetic Macular Edema: An Update

2021 ◽  
Vol 2021 ◽  
pp. 1-23
Author(s):  
Claudio Furino ◽  
Francesco Boscia ◽  
Michele Reibaldi ◽  
Giovanni Alessio
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Sustained Release ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Functional Outcomes ◽  
Surgical Removal ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Endothelial Growth Factor

Diabetic macular edema (DME) represents a prevalent and disabling eye condition. Despite that DME represents a sight-threatening condition, it is also among the most accessible to treatment. Many different treatment options including photocoagulation, intravitreal medical treatment (either vascular endothelial growth factor inhibitors or corticosteroids therapies), and surgical removal are currently available. Although laser has been considered as the gold standard for many years, over the past several years vascular endothelial growth factor inhibitors (anti-VEGFs) have become first-line therapy. However, many patients do not adequately respond to them. With the development of sustained-release corticosteroid devices, steroids have gained a presence in the management of the DME. We review and update the role of anti-VEGF and intravitreal sustained-release corticosteroid management of DME. According to the currently available scientific evidence, the choice of one anti-VEGF over another critically depends on the baseline best-corrected visual acuity (BCVA). While aflibercept may be the drug of choice in low baseline BCVA, the three anti-VEGFs (bevacizumab, ranibizumab, and aflibercept) provided similar functional outcomes when the baseline BCVA was higher. DEX implants are a valuable option for treating DME, although they are usually seen as a second choice, particularly in those eyes that have an insufficient response to anti-VEGF. The new evidence suggested that, in eyes that did not adequately respond to anti-VEGF, switching to a DEX implant at the time to 3 monthly anti-VEGF injections provided better functional outcomes.

scholarly journals Concomitant Bilateral Intravitreal Injection of Anti-Vascular Endothelial Growth Factor: Experience in Covid-19 Pandemic

2021 ◽  
Author(s):  
SERKAN ÖZEN ◽  
Hakan Koc ◽  
Hasan Burhanettin Kaptı ◽  
Murat Atabey Ozer
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Adverse Events ◽  
Macular Edema ◽  
Intravitreal Injection ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Before And After ◽  
The Mean ◽  
Endothelial Growth Factor

Abstract Purpose: To report the concomitant bilateral intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection preference rates of patients before and after the Covid-19 outbreak and to evaluate whether this practice is safe when compared to unilateral injection. Materials and Methods: This is a single-center, retrospective study including consecutive series of 198 eyes of 112 patients received bilateral same-day (concomitant) or unilateral anti-VEGF injections of bevacizumab, ranibizumab, and aflibercept in the operating-room between January 2020 and January 2021. One-year medical record data including preference of bilateral over unilateral injection and adverse events were reviewed with 3-month intervals as before and after Covid-19 pandemic due to the labile Covid-19 outbreak course.Results: A total of 504 injections with 234 concomitant bilateral (%46) were administered to 112 patients. The study group consisted of 58 neovascular age-related macular degeneration (nAMD- 63.7% had bilateral nAMD), 46 diabetic macular edema (DME- 67.3% had bilateral DME) and 8 macular edema complicating retinal vein occlusion (RVO- 25% had bilateral RVO) patients. Of the injections, 156 (31%) were bevacizumab, 144 (29%) were aflibercept, and 204 (40%) were ranibizumab. The mean follow-up time per patient was 7.4 ± 4.3 months (range 4-11 months) and the mean number of injections was 3.6 ± 2.1 (range 2-10). None of the patients experienced serious vision-threatening complications or non-ocular adverse events. 85% of patients whose both eyes involved strongly preferred concomitant bilateral injection during Covid-19 pandemic while it was %35 before Covid-19 (P<0.001). The ratio of the number of concomitant bilateral injections to a total of injections increased from 30% to 57% after Covid-19 (P=0.03). Only 3 patients (2.6%) requested alternating unilateral injections after receiving the second concomitant bilateral injections.Conclusion: Concomitant bilateral injection approach was preferred by the majority of patients and did not increase the adverse event rate when applied under meticulous precautions; This intravitreal injection option may be preferred during still ongoing pandemic to reduce the clinical visits of patients at risk of Covid-19 related mortality due to their comorbidities and age.

scholarly journals Intravitreal Anti-Vascular Endothelial Growth Factor for Macular Edema due to Complex Retinal Arterial Macroaneurysms

2017 ◽  
Vol 8 (1) ◽  
pp. 141-147 ◽  
Author(s):  
Caroline Bormann ◽  
Jens Heichel ◽  
Ute Hammer ◽  
Anke Habermann ◽  
Thomas Hammer
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Macular Edema ◽  
Laser Photocoagulation ◽  
Fundus Photography ◽  
Complete Regression ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
First Case ◽  
Endothelial Growth Factor

Introduction: Complex retinal arterial macroaneurysms (RAM) are often accompanied by hemorrhage and/or affect the macula. We evaluated the effect of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy using ranibizumab or aflibercept with or without laser photocoagulation in the treatment of macular edema due to RAM. Methods: A case report of two patients with secondary macular edema caused by RAM is presented. The first case was a 76-year-old female treated with two 0.5-mg injections of ranibizumab and additional focal laser photocoagulation. This patient presented a solely intraretinal exudation. The second patient was a 96-year-old female, who received one 2.0-mg injection of aflibercept. She showed sub- and intraretinal edema. We documented the clinical courses of these patients based on fundus photography, fluorescein angiography, and spectral-domain optical coherence tomography. Patients were followed-up for 12 months. Results: Patients were treated successfully using anti-VEGF therapy (ranibizumab or aflibercept) with or without laser photocoagulation. In both cases, we observed a complete regression of the macular edema and an increase in visual acuity. Conclusion: RAM can manifest with heterogeneous findings. Intravitreal anti-VEGF therapy with or without laser photocoagulation may be an effective treatment option in cases of macular edema due to RAM. Aflibercept and ranibizumab seem to be a potent anti-VEGF therapy for RAM. Individualized patient care is needed.

COMPARATIVE EFFECTIVENESS OF ANTI-VEGF AGENTS FOR DIABETIC MACULAR EDEMA

2013 ◽  
Vol 29 (4) ◽  
pp. 392-401 ◽  
Author(s):  
Daniel A. Ollendorf ◽  
Jennifer A. Colby ◽  
Steven D. Pearson
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Visual Acuity ◽  
Growth Factor ◽  
Macular Edema ◽  
Comparative Effectiveness ◽  
Laser Photocoagulation ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Meta Analyses ◽  
Endothelial Growth Factor

Objectives: The aim of this study was to evaluate the comparative effectiveness of anti-vascular endothelial growth factor therapy in the treatment of diabetic macular edema (DME).Methods: Searches focused on reports concerning treatment of DME with aflibercept, bevacizumab, pegaptanib, or ranibizumab published between January 2000 and June 30, 2012, with comparisons to laser photocoagulation, sham injection, or other control (e.g., triamcinolone). Effectiveness was based on best-corrected visual acuity (BCVA), in terms of letters gained. Direct meta-analyses were conducted on BCVA for each anti-vascular endothelial growth factor (VEGF) agent; indirect comparisons also were performed for each anti-VEGF pair.Results: A total of fifteen randomized controlled trials (eleven fair- or good-quality) and eight observational studies were included. No direct comparative studies were identified. Improvement in visual acuity versus control was seen with all agents (range: 4–9 letters); outcomes were consistent across multiple timepoints. Meta-analyses showed no statistically significant and/or consistent differences between agents in BCVA changes or the percentage of patients gaining more than ten letters. No discernible differences in the potential harms of anti-VEGFs, including ocular events, MI, stroke, and other cardiovascular events, as well as death, were noted between aflibercept, pegaptanib, and ranibizumab. Data on harms for bevacizumab were underreported.Conclusions: All anti-VEGF agents are effective in improving visual acuity in comparison to laser photocoagulation. Evidence is insufficient to distinguish the performance of any single anti-VEGF agent over others. The safety of bevacizumab remains the greatest element of uncertainty.

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