scholarly journals Choroidal neovascularization activity and structure by optical coherence tomography angiography in age related macular degeneration

2021 ◽  
Vol 6 (6-1) ◽  
pp. 12-18
Author(s):  
M. A. Kovalevskaya ◽  
O. A. Pererva
Keyword(s):  
Macular Degeneration ◽  
Choroidal Neovascularization ◽  
Vascular System ◽  
Developed Countries ◽  
Age Related Macular Degeneration ◽  
Control Group ◽  
Type I ◽  
Neovascular Amd ◽  
Anti Vegf ◽  
Age Related

Background. In economically developed countries, age-related macular degeneration (AMD) is the leading cause of visual disability among the population of the older age group. The main criterion for the anti-VEGF treatment of neovascular AMD is the activity of choroidal neovascularization (CNV), which is determined by its confi guration. The search for optimal criteria for quantifying the state of the macular region in order to decide on the appointment of anti-VEGF therapy continues.Aim: improving the effi ciency of diagnosis and treatment of AMD based on the assessment of the configuration of vascular system on the “Key to Diagnosis II” platform.Material and methods. The study included 341 patients: 64 % (218 patients, 267 eyes) with non-neovascular AMD, 36 % (123 patients, 174 eyes) – with neovascular AMD. 56 patients (58 eyes) had active type I CNV. Group 1A – active CNV before treatment (9 patients, 9 eyes), group 1B – non-active CNV after treatment with antiVEGF (9 patients, 9 eyes); control group – 10 patients (10 eyes) without AMD. Analysis of OCT-angio images of choriocapillaries included the isolation of CNV, its area, fractal dimension (Df) and the complexity of the vascular system (CVS) counting.Results. Group 1A: Df – 1.5871 ± 0.05, CVS – 2.29 ± 0.29, area – 11734 ± 4866; group 1B: Df – 1.6462 ± 0.08, CVS – 1.65 ± 0.18, area – 6797 ± 3818; control: Df – 1.9167 ± 0.06, CVS – 1, area – 0. Significant differences were found for CVS (p = 0.0003). Df correlates with the CNV area (p = 0.7) and is probably an unreliable parameter due to incomplete visualization of active CNV.Conclusions. CVS is a quantitative biomarker for determining the activity of type 1 CNV in patients with AMD and can serve as a parameter for convolutional neural networks training for automated analysis of OCT angiography images based on the “Key to Diagnosis II” platform

Therapeutic effects of a novel siRNA-based anti-VEGF (siVEGF) nanoball for the treatment of choroidal neovascularization

Nanoscale ◽  
2017 ◽  
Vol 9 (40) ◽  
pp. 15461-15469 ◽  
Author(s):  
Na-Kyung Ryoo ◽  
Jihwang Lee ◽  
Hyunjoo Lee ◽  
Hye Kyoung Hong ◽  
Hyejin Kim ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Choroidal Neovascularization ◽  
Developed Countries ◽  
Age Related Macular Degeneration ◽  
Therapeutic Effects ◽  
Anti Vegf ◽  
Age Related

Age-related macular degeneration (AMD) is the leading cause of blindness in developed countries and is characterized by the development of choroidal neovascularization (CNV).

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.

scholarly journals Antivascular Endothelial Growth Factor Agents for Neovascular Age-Related Macular Degeneration

2012 ◽  
Vol 2012 ◽  
pp. 1-12 ◽  
Author(s):  
Ilias Zampros ◽  
Anna Praidou ◽  
Periklis Brazitikos ◽  
Panagiotis Ekonomidis ◽  
Sofia Androudi
Keyword(s):  
Monoclonal Antibody ◽  
Growth Factor ◽  
Macular Degeneration ◽  
Antibody Fragment ◽  
Developed Countries ◽  
Age Related Macular Degeneration ◽  
Neovascular Amd ◽  
Anti Vegf ◽  
Age Related ◽  
Endothelial Growth Factor

Age-related macular degeneration (AMD) is the leading cause of severe visual loss and blindness over the age of 50 in developed countries. Vascular endothelial growth factor (VEGF) is considered as a critical molecule in the pathogenesis of choroidal neovascularization (CNV), which characterizes the neovascular AMD. Anti-VEGF agents are considered the most promising way of effectively inhibition of the neovascular AMD process. VEGF is a heparin-binding glycoprotein with potent angiogenic, mitogenic and vascular permeability-enhancing activities specific for endothelial cells. Two anti-VEGF agents have been approved by the US Food and Drug Administration (FDA) for the treatment of neovascular AMD. Pegaptanib sodium, which is an aptamer and ranibizumab, which is a monoclonal antibody fragment. Another humanized monoclonal antibody is currently off-label used, bevacizumab. This paper aims to discuss in details the effectiveness, the efficacy and safety of these three anti-VEGF agents. New anti-VEGF compounds which are recently investigated for their clinical usage (VEGF-trap, small interfering RNA) are also discussed for their promising outcomes.

Choroidal neovascular membranes secondary to intraocular tuberculosis misdiagnosed as neovascular age-related macular degeneration

2017 ◽  
Vol 28 (2) ◽  
pp. 216-224 ◽  
Author(s):  
Alessandro Invernizzi ◽  
Aniruddha Agarwal ◽  
Maura Di Nicola ◽  
Fabio Franzetti ◽  
Giovanni Staurenghi ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Choroidal Neovascularization ◽  
Multimodal Imaging ◽  
Age Related Macular Degeneration ◽  
Enhanced Depth Imaging ◽  
Fundus Photography ◽  
Imaging Features ◽  
Neovascular Amd ◽  
Age Related ◽  
Intraocular Tuberculosis

Purpose: Intraocular tuberculosis (IOTB) can be complicated by choroidal neovascularization (CNV). However, when the CNV development is not accompanied by clear signs of inflammation, the etiology can be missed, especially in countries nonendemic for tuberculosis. We describe the clinical and imaging features of CNVs presenting as the first sign of IOTB initially misdiagnosed as exudative age-related macular degeneration (AMD). Methods: A retrospective review of clinical and imaging data of patients initially misdiagnosed with neovascular AMD later diagnosed with inflammatory CNV secondary to IOTB at tertiary referral centers was conducted. Features of fundus photography, fluorescein angiography, indocyanine green angiography, and enhanced depth imaging optical coherence tomography were analyzed. Distinguishing features between neovascular AMD and IOTB-associated CNV were evaluated. Results: Five patients over 55 years of age, erroneously diagnosed with exudative AMD, were included in the study. Multimodal imaging analysis allowed identification of peculiar choroidal alterations such as choroidal granulomas or choroiditis suggestive for posterior uveitis. Systemic workup for granulomatous uveitis including immunologic investigations such as tuberculin skin test or QuantiFERON TB Gold® and radiologic investigations revealed tubercular etiology in all the cases, allowing correct diagnosis and management of the uveitis and related CNV. Conclusions: Choroidal neovascularization represents a rare and unusual presenting sign of IOTB that can be misleading especially when it occurs in the elderly living in countries with low prevalence of the disease. Multimodal imaging can be helpful and should be employed, especially in atypical cases of CNV, in order to avoid misdiagnosis and/or diagnostic delays.

scholarly journals Emerging Therapies for Wet-Form (Neovascular) Age-Related Macular Degeneration

2017 ◽  
pp. 235-240
Keyword(s):  
Macular Degeneration ◽  
Viral Vectors ◽  
Developed Countries ◽  
Age Related Macular Degeneration ◽  
Vegf Inhibitors ◽  
Anti Vegf ◽  
Age Related ◽  
Emerging Therapies ◽  
Endothelial Growth Factor ◽  
Wet Amd

Age-related macular degeneration (AMD) is the most common cause of permanent visual loss in persons over 65 years of age in developed countries. Currently, intravitreal vascular endothelial growth factor (VEGF) inhibitors are the mainstay of the treatment for patients with wet AMD. Despite significant improvements in visual acuity since the beginning of these therapies, challenges in the treatment of wet AMD are still present. Therefore, there are ongoing researches such as sustained-release anti-VEGF therapy, novel generation anti-VEGF agents, viral vectors to modify genetic transcription, and combination therapies. In this review, it is aimed to discuss these emerging therapies.

Ganglion Cell Layer Thickness Change in Neovascular Age-Related Macular Degeneration Treated With Anti-VEGF Injections

2021 ◽  
pp. 247412642110403
Author(s):  
Dimosthenis Mantopoulos ◽  
Hetal Ray ◽  
George Sanchez ◽  
Russell Pokroy ◽  
Daniel B. Roth
Keyword(s):  
Ganglion Cell ◽  
Macular Degeneration ◽  
Ganglion Cell Layer ◽  
Cell Layer ◽  
Treated Group ◽  
Age Related Macular Degeneration ◽  
Control Group ◽  
Fellow Eye ◽  
Anti Vegf ◽  
Age Related

Purpose: This work assesses bilateral ganglion cell layer–inner plexiform layer (GCL-IPL) thickness changes in patients with unilateral neovascular age-related macular degeneration (nAMD) treated with antivascular endothelial growth factor (anti-VEGF). Methods: In this single-center, retrospective, cohort study, the medical records of patients with unilateral nAMD treated with anti-VEGF were reviewed. The treated group included eyes with newly diagnosed nAMD that subsequently underwent treatment with intravitreal anti-VEGF injections. The control group was the fellow eye with dry AMD. Eyes receiving at least 10 intravitreal injections were included. Measurement of GCL-IPL thickness was performed at different time points using spectral domain–optical coherence tomography. Results: A total of 216 eyes of 108 patients met the inclusion criteria. The mean age ± SD was 80.1 ± 10.7 years. Eyes in the treated group underwent a mean ± SD of 20.2 ± 7.2 injections in 21.3 ± 6.8 months. At baseline, average mean ± SD of GCL-IPL thickness was 73.71 ± 8.81 µm and 73.84 ± 8.26 µm in the treated and fellow eye, respectively ( P = .795). After 10 injections the average thickness was 65.41 ± 14.08 µm and 68.77 ± 13.24 µm in the treated and fellow eye, respectively ( P = .007). The absolute decrease in thickness was significantly greater in the treated eye than the fellow eye (mean ± SD, 8.31 ± 11.19 µm vs 5.07 ± 10.83 µm, respectively; P = .002). Conclusions: GCL-IPL thickness decreased significantly in the treated group more than in the control group after 10 anti-VEGF injections. The mechanism and clinical significance of this observation warrants further study.

Morphological characteristics of eyes with neovascular age-related macular degeneration and good long-term visual outcomes after anti-VEGF therapy

2021 ◽  
pp. bjophthalmol-2021-319602
Author(s):  
Mengyuan Fang ◽  
Karntida Chanwimol ◽  
Jyotsna Maram ◽  
Ghazala A Datoo O'Keefe ◽  
Charles C Wykoff ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Retinal Pigment ◽  
Morphological Characteristics ◽  
Age Related Macular Degeneration ◽  
Neovascular Amd ◽  
Poor Vision ◽  
Anti Vegf ◽  
Age Related ◽  
Good Vision

PurposeTo analyse the morphological characteristics of eyes with neovascular age-related macular degeneration (AMD) with good long-term visual acuity after anti-VEGF (vascular endothelial growth factor) therapy.MethodsRetrospective, observational study of 175 patients with neovascular AMD with >5 years of follow-up after initiating anti-VEGF therapy. Spectral-domain optical coherence tomography images were assessed for thickness of pigment epithelial detachment (PED), subretinal hyper-reflective material (SHRM), subretinal fluid and subfoveal choroidal, as well as the integrity of the outer retinal bands.ResultsThe final analysis cohort included 203 eyes (175 patients) followed for a mean of 7.84±1.70 years (range: 5–11). The maximum PED thickness in the foveal central subfield (FCS) was significantly lower (p<0.001) in the poor vision group (13.11 μm) compared with the intermediate (86.25 μm) or good (97.92 μm) vision groups, respectively. In contrast, the maximum thickness of SHRM in the FCS was significantly thicker (p<0.001) in eyes with poor vision (149.46 μm) compared with eyes with intermediate vision (64.37 μm) which in turn were significantly thicker (p<0.001) than eyes with good vision (9.35 μm). The good vision group also had better continuity of all outer retinal bands (external limiting membrane, ellipsoid zone, and retinal pigment epithelium) compared with the other two groups (all p<0.001).ConclusionA thicker PED and thinner SHRM were correlated with better vision in eyes with neovascular AMD following long-term anti-VEGF therapy. If replicated in future prospective studies, these findings may have implications for design of optimal anatomic endpoints for neovascular AMD treatment.

scholarly journals Today and Future of Age-Related Macular Degeneration

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Kang Liu ◽  
Bolin Xie
Keyword(s):  
Risk Factors ◽  
Macular Degeneration ◽  
Effective Treatment ◽  
Treatment Options ◽  
Developed Countries ◽  
Age Related Macular Degeneration ◽  
Neovascular Amd ◽  
Age Related ◽  
New Directions ◽  
Genetic Mechanisms

Age-related macular degeneration (AMD) is the leading cause of blindness in people over 50 in developed countries. Understanding of the pathologic process, genetic mechanisms, and risk factors of this disease has the benefit of seeking newer and more effective treatment options. Current clinical therapy for AMD shows a dramatic change from a decade ago. Anti-VEGF drug therapy is regarded as the more effective treatment for neovascular AMD now, especially combining PDT therapy. In the future, the genetic and biochemical therapies may be the promising treatments for AMD. This paper will focus on the progress of pathology, candidate genes of AMD, risk factors, and the existing drugs or surgical therapies available, in order to present some new directions of care with the prospect of improved vision in many patients suffered from AMD.

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.

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