scholarly journals Compliance and Visual Outcome Of “Treat-And-Extend” Versus “Pro Re Nata”Dosing of Intravitreal Bevacizumab in Wet Age-Related Macular Degeneration – A Perspective From a Developing Country

2020 ◽  
Vol 5 (1) ◽  
pp. 921-926
Author(s):  
Kriti Joshi ◽  
Anadi Khatri KC ◽  
Roshija Khanal Rijal ◽  
Salma KC Rai ◽  
Gyanendra Lammichane ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Visual Outcome ◽  
Age Related Macular Degeneration ◽  
Average Hospital ◽  
Treat And Extend ◽  
Age Related ◽  
Group A ◽  
Pro Re Nata ◽  
Group B ◽  
Wet Amd

Introduction: Age- related Macular Degeneration (AMD) is the commonest cause of irreversible blindness and visual impairment in elderly, aged50 years or older contributing 8.7% of global blindness. Among the two types: “dry” and “wet”, the “wet” variant is treated using anti-VEGFs, mainly via two regimen – PRN or TREX. Objective: To study and compare the compliance, cost and visual outcome of “Treat-and- Extend (TREX)”versus “Pro Re Nata(PRN)” dosing of intravitrealbevacizumab in Wet AMD. Methodology: Sixty-four eyes of 64 patients with treatment naïve neovascular AMD were included and randomly divided into two groups, with each group comprising 32 eyes, by lottery system: “Group A [TREX]” and “Group B [PRN]”. Group A was treated with intravitrealbevacizumab [1.25mg/0.05ml] at presentation and at 1-month interval for 3 consecutive months [loading dose] and monthly till dry macula was obtained. Group B was treated with the same in “as needed” basis.Both Groups were followed up, for 1 year. Results Mean gain in visual acuity in the PRN group was 0.09 +/- 0.35 log MAR unit and in TREX, it was 0.14 +/- 0.3 log MAR unit within the period of 1 year.64% of the patients were compliant in TREX and 36% moderately complaint whereas in the PRN group, 24% were compliant, 60% moderately compliant and 16% noncompliant. Average hospital cost in PRN and TREX was NRs. 16, 170 (USD 149) and 23,785(USD 220) respectively. Conclusion: Compliance and visual outcome were better in TREX in comparison toPRN at 1 year of treatment with intravitrealbevacizumab for Wet AMD.

scholarly journals Outcomes when Switching from a pro re nata Regimen to a Treat and Extend Regimen Using Aflibercept in Neovascular Age-Related Macular Degeneration

2016 ◽  
Vol 236 (4) ◽  
pp. 201-206 ◽  
Author(s):  
Helena Giannakaki-Zimmermann ◽  
Andreas Ebneter ◽  
Marion R. Munk ◽  
Sebastian Wolf ◽  
Martin S. Zinkernagel
Keyword(s):  
Macular Degeneration ◽  
Age Related Macular Degeneration ◽  
Treat And Extend ◽  
Age Related ◽  
Pro Re Nata ◽  
Treat And Extend Regimen

scholarly journals To determine functional visual improvement after cataract surgery in eyes with age related macular degeneration

2022 ◽  
Vol 7 (4) ◽  
pp. 655-658
Author(s):  
Deepika Joshi ◽  
Sourav Shristi
Keyword(s):  
Cataract Surgery ◽  
Macular Degeneration ◽  
Age Related Macular Degeneration ◽  
Corrected Visual Acuity ◽  
Visual Improvement ◽  
Age Related ◽  
Retinal Pathology ◽  
Group A ◽  
Group B ◽  
A Prospective Study

To determine whether patients with Age related macular degeneration (ARMD) benefit from cataract surgery in terms of best corrected visual acuity (BCVA) and to assess impact of surgery on progression of ARMD.: A prospective study was carried out of patients with and without ARMD undergoing cataract surgery at our department. Patients were divided into two groups- Group A (cases) with ARMD and Group B (controls) without ARMD and other retinal pathology. BCVA of cases was recorded on day 1, day 14, 1 month and 1/month and compared to that of controls.: BCVA significantly improved but markedly less than that experienced by control eyes. No increased incidence in progression to wet form of ARMD. Cataract surgery is safe in ARMD patients with no evidence of increased complications or rates of disease advancement.

scholarly journals Long-Term Visual Outcome in Wet Age-Related Macular Degeneration Patients Depending on the Number of Ranibizumab Injections

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Pilar Calvo ◽  
Beatriz Abadia ◽  
Antonio Ferreras ◽  
Oscar Ruiz-Moreno ◽  
Jesús Leciñena ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Survival Rates ◽  
Visual Outcome ◽  
Age Related Macular Degeneration ◽  
Rank Test ◽  
Kaplan Meier ◽  
Age Related ◽  
Cirrus Oct ◽  
Wet Amd

Purpose. To analyse the visual outcome in wet age-related macular degeneration (AMD) patients depending on the number of ranibizumab injections.Methods. 51 naïve wet AMD patients were retrospectively recorded. Visual acuity (VA), central retinal thickness (CRT) measured with spectral domain (SD) optical coherence tomography (OCT), and number of intravitreal injections were compared at 6, 12, 18, 24, 30, and 36 months of follow-up. Kaplan-Meier survival rates (SRs) based on VA outcomes were calculated depending on the number of ranibizumab injections performed.Results. VA improved compared with baseline at 6 and 12 months (P<0.005). No differences were found at 18, 24, 30, and 36 months (P>0.05). CRT measured with Cirrus OCT decreased (P<0.001) at all time points analysed. The mean number of injections received was6.98±3.69. At 36 months, Kaplan-Meier SR was 76.5% (the proportion of patients without a decrease in vision of more than 0.3 logMAR units). VA remained stable (≤0.01 logMAR units) or improved in 62.7%. Within this group, SR was 92.9% in those who received 7 or more injections versus 51.4% receiving <7 treatments (P=0.008; log-rank test).Conclusion. Better VA outcomes were found in stable wet AMD patients after 3 years of follow-up if they received ≥7 ranibizumab injections.

scholarly journals Individualized Therapy with Ranibizumab in Wet Age-Related Macular Degeneration

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Alfredo García-Layana ◽  
Marta S. Figueroa ◽  
Luis Arias ◽  
Javier Araiz ◽  
José María Ruiz-Moreno ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Cost Savings ◽  
Visual Outcome ◽  
Current Data ◽  
Age Related Macular Degeneration ◽  
Office Visits ◽  
Treat And Extend ◽  
Outpatient Unit ◽  
Age Related ◽  
Study Results

Individualized treatment regimens may reduce patient burden with satisfactory patient outcomes in neovascular age-related macular degeneration. Intravitreal anti-VEGF drugs are the current gold standard. Fixed monthly injections offer the best visual outcome but this regimen is not commonly followed outside clinical trials. A PRN regimen requires monthly visits where the patient is treated in the presence of signs of lesion activity. Therefore, an early detection of reactivation of the disease with immediate retreatment is crucial to prevent visual acuity loss. Several trials suggest that “treat and extend” and other proactive regimens provide a reasonable approach. The rationale of the proactive regimens is to perform treatment anticipating relapses or recurrences and therefore avoid drops in vision while individualizing patient followup. Treat and extend study results in significant direct medical cost savings from fewer treatments and office visits compared to monthly treatment. Current data suggest that, for one year, PRN is less expensive, but treat and extend regimen would likely be less expensive for subsequent years. Once a patient is not a candidate to continue with treatment, he/she should be sent to an outpatient unit with adequate resources to follow nAMD patients in order to reduce the burden of specialized ophthalmologist services.

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.

Treatment approach to patients with combined retinal diseases: wet form of age-related macular degeneration and epiretinal membrane. Preliminary results

2021 ◽  
pp. 78-81
Author(s):  
S.V. Kolesnik ◽  
◽  
A.S. Zhuravlev ◽  
A.I. Kolesnik ◽  
S.A. Kakunina ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Treatment Approach ◽  
Optimal Treatment ◽  
Age Related Macular Degeneration ◽  
Loading Dose ◽  
Epiretinal Membranes ◽  
Anti Vegf ◽  
Age Related ◽  
Pro Re Nata ◽  
Wet Amd

Introduction. Age-related macular degeneration (AMD) is one of the leading causes of irreversible vision loss among older patients. Since the introduction of anti-VEGF therapy, retinal specialists have been able to maintain or improve vision in patients with AMD. However, anti-VEGF therapy is ineffective in a certain percentage of patients. In 25-35% of cases of wet AMD, secondary epiretinal membranes (ERM) in the macular region are found. Anti-VEGF therapy has been found to be less effective in the treatment of wet AMD with ERM. Optimal treatment tactics for this combined pathology remains a matter of debate. Purpose. To evaluate the efficacy of different combined treatment approaches to patients with wet AMD and ERM. Methods. Study was performed on 2 eyes of 2 patients with ERM and AMD, wet form. Patients were divided in two groups. First patient received one loading dose of anti-VEGF drug (ranibizumab) and after that underwent standart pars plana vitrectomy (PPV) with removal of epiretinal and inner limiting membrane (ILM). Anti-VEGF therapy than was continued according to pro re nata regimen. Second patient underwent standart PPV with removal of ERM and ILM first. After the surgery, loading dose of anti-VEGF drug was injected. Anti-VEGF therapy than was continued according to pro re nata regimen. Results. After treatment, there was a decrease in central retinal thickness in both patients, but an increase in maximum corrected visual acuity was observed only in first patient. Conclusions. Based on the results of the performed study, the most optimal treatment approach to patients with wet AMD and ERM consisted of a single loading dose of anti-VEGF drug injection followed by PPV with removal of ERM and ILM and further continuation of anti-VEGF therapy for wet AMD. However, further research is needed to form a final conclusion about the effectiveness of the chosen treatment tactic. Key words: epiretinal fibrosis, AMD, CNVM, anti-VEGF

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