Vitreo-retinal disorders at high altitude in Nepal

Introduction: Nepal has many mountains including the highest one in the world. People living in high altitude are often involved in climbing mountains. Objective: To explore the pattern of vitreo-retinal disorders at high altitude in Nepal. Materials and methods: Consecutive patients aged 40 years and older who presented at the micro-surgical eye camp at Lukla of Solukhumbu district (2,860 metres) were included. Detailed ocular and systemic histories and ocular examination including dilated fundus evaluation were done. Results: There were a total 81 patients with the mean age of 56.7 years (S.D 11.15). Females (51.9 %) outnumbered males. Sherpa comprised of 76.5 % followed by Rai (9.8 %). The main occupation was agriculture (51.9 %) followed by mountain trekking (28.4 %). Smokers comprised of 13.5 %. Hypertension was the predominant systemic problem (28 %). The best corrected visual acuity of 6/18 and better was found in 86.4 % of cases and less than 3/ 60 in 3.6 % of cases. Age-related macular degeneration (AMD) was found in 19.6 % of cases with a predominant mild AMD (16 %), hypertensive retinopathy in 12.2 %, with grade I hypertensive change in 8.6 %, retinal vein occlusion (RVO) in 7.1 % of cases and with a branch RVO in 4.9 %. Dilated and tortuous retinal vessels were present in 25.9 % of cases; out of this, 9.8 % of the cases had concurrent AMD and/or hypertensive retinopathy. Other retinal problems were macular hole (2.46 %), solar retinopathy (2.46 %) and choroidal tear (1.2 %). Conclusion: AMD, hypertensive retinopathy, and RVO are the main vitreo-retinal disorders besides the dilated and tortuous retinal vessels in people living at high altitude in Nepal. Nepal J Ophthalmol 2013; 5(9):57-62 DOI: http://dx.doi.org/10.3126/nepjoph.v5i1.7823

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Intraocular Injection of Stivant® (A Biosimilar to Bevacizumab): A Case Series

Journal of Ophthalmic and Vision Research ◽

10.18502/jovr.v16i1.8248 ◽

2021 ◽

Author(s):

Ahmad Mirshahi ◽

Alireza Lashay ◽

Hamid Riazi-Esfahani ◽

Nazanin Ebrahimiadib ◽

Hassan Khojasteh ◽

...

Keyword(s):

Macular Edema ◽

Intravitreal Injection ◽

Case Series ◽

Age Related Macular Degeneration ◽

Intraocular Injection ◽

Vein Occlusion ◽

Corrected Visual Acuity ◽

Age Related ◽

Limited Experience ◽

The Mean

Purpose: To report the results of intravitreal injection of a bevacizumab biosimilar called Stivant®. Methods: This prospective interventional case series was conducted on eyes with neovascular age-related macular degeneration (nAMD), retinal vein occlusion (RVO), and diabetic macular edema (DME). Stivant® was injected in three consecutive months and changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measured at baseline and monthly up to one month after the third injection. Results: Three hundred and eighty-five eyes with DME (234 eyes, 61%), nAMD (87 eyes, 22%), and macular edema secondary to RVO (64 eyes, 17%) were enrolled. The mean ± standard deviation age of the patients was 61.7 ± 7.20 years. The mean BCVA and CMT changed from 0.63 ± 0.3 to 0.51 ± 0.3 LogMAR (P = 0.12 ) and from 420.4 ± 47.3μm at baseline to 316.7 ± 50.6 μm (P < 0.001) in the DME group; from 0.79 ± 0.3 to 0.68 ± 0.3 LogMAR (P = 0.19) and from 376.1 ± 31.7 μm to 303 ± 31.3 μm (P = 0.019) in the nAMD group; and from 0.81 ± 0.4 to 0.63 ± 0.4 LogMAR (P = 0.05) and from 424.21 ± 18 μm to 303.4 ± 18.8 μm (P < 0.001) in the RVO group, respectively. Conclusion: Our limited experience showed that the intravitreal injection of Stivant® was well tolerated. Although the results of this case series showed relative improvement in CMT one month after the last injection of Stivant®, BCVA improvement was statistically significant only in the RVO group. This would be essential to design a randomized clinical trial to evaluate the non-inferiority of Stivant® in comparison to bevacizumab.

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Comparison of the Effectiveness and Prognostic Factors of Intravitreal Ranibizumab between Typical Neovascular Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy over 24 Months of Follow-Up

Ophthalmologica ◽

10.1159/000431000 ◽

2015 ◽

Vol 234 (1) ◽

pp. 33-39 ◽

Cited By ~ 9

Author(s):

Wataru Matsumiya ◽

Shigeru Honda ◽

Keiko Otsuka ◽

Akiko Miki ◽

Takayuki Nagai ◽

...

Keyword(s):

Macular Degeneration ◽

Polypoidal Choroidal Vasculopathy ◽

Age Related Macular Degeneration ◽

Morphological Parameters ◽

Intravitreal Ranibizumab ◽

Corrected Visual Acuity ◽

Age Related ◽

The Mean ◽

Choroidal Vasculopathy

Purpose: To compare the response to ranibizumab between patients with typical neovascular age-related macular degeneration (tAMD) and those with polypoidal choroidal vasculopathy (PCV), and to determine the predictors for the outcomes. Methods: Fifty-nine eyes from 59 consecutive patients (tAMD: 27 eyes, PCV: 32 eyes) were treated with three monthly ranibizumab injections followed by as-needed retreatment. Best-corrected visual acuity (BCVA) and morphological parameters were evaluated over 24 months of follow-up. Results: The mean BCVA in tAMD and PCV patients was significantly improved at 3 months (-0.22 and -0.09 logMAR units, respectively). The improvement in BCVA was sustained up to 24 months in tAMD (p = 0.01) but not in PCV patients. The significant predictor for good response to ranibizumab in tAMD patients was the improvement of BCVA at 3 months, whereas that in PCV patients was the anatomical resolution at 3 months. Conclusions: Ranibizumab is an effective therapy for tAMD and PCV over 24 months. The predictors for good outcome might be different between tAMD and PCV.

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Real-World Results of Aflibercept versus Ranibizumab for the Treatment of Exudative AMD Using a Fixed Regimen

BioMed Research International ◽

10.1155/2018/9276580 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Joana Providência ◽

Tiago M. Rodrigues ◽

Mariana Oliveira ◽

João Bernardes ◽

João Pedro Marques ◽

...

Keyword(s):

Real World ◽

Age Related Macular Degeneration ◽

Treatment Protocols ◽

Corrected Visual Acuity ◽

Age Related ◽

Significant Difference ◽

Clinical Practice Setting ◽

The Mean ◽

Endothelial Growth Factors

Intravitreal injections of antivascular endothelial growth factors have been considered a milestone in the treatment of neovascular age-related macular degeneration (nAMD). However, the increasing incidence of AMD and the burden of visits and injections overcharge both the patient and the healthcare systems. Real-world solutions depend on treatment protocols aimed at optimizing the number of clinical visits while guaranteeing good functional outcomes. We performed a retrospective analysis of 72 eyes from 63 naïve patients diagnosed with nAMD that underwent a fixed intravitreal protocol consisting of bimonthly injections after a three-month loading dose, with either Aflibercept or Ranibizumab (no predefined criteria for treatment selection). Best corrected visual acuity (BCVA) and optical coherence tomography were analyzed at baseline and during follow-up clinical visits (months 3, 6, 12, and 18). From the included participants, 42 followed a fixed regimen with Aflibercept and 30 with Ranibizumab. At the 12-month visit, there was not a statistically significant difference in the mean change of BCVA between the two groups (p=0.121); however, the mean difference in the central retinal thickness was significantly superior in the Aflibercept group (-142.2 versus -51.5, p=0.011). The described fixed regimen seems to be efficient in the treatment of nAMD in a clinical practice setting.

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Questionnaire Survey on Driving among Patients with Age-Related Macular Degeneration in Japan

Journal of Clinical Medicine ◽

10.3390/jcm10214845 ◽

2021 ◽

Vol 10 (21) ◽

pp. 4845

Author(s):

Chikako Hara ◽

Miki Sawa ◽

Fumi Gomi ◽

Kohji Nishida

Keyword(s):

Macular Degeneration ◽

Age Related Macular Degeneration ◽

University Hospital ◽

Corrected Visual Acuity ◽

Age Related ◽

Paracentral Scotoma ◽

The Mean ◽

The Right ◽

The Relationship ◽

Car Driving

Purpose: This study aimed to assess driving capabilities in patients with exudative age-related macular degeneration (AMD) causing unilateral blindness or paracentral scotoma without vision deterioration. Methods: Of the 275 patients with AMD who responded to a questionnaire regarding car driving at Osaka University Hospital, we excluded 78 patients who answered that they had never driven. Finally, 197 patients were included (50 with bilateral and 142 with unilateral AMD). We investigated the relationship between the questionnaire findings and best-corrected visual acuity (BCVA). Results: The mean age was 74.8 ± 6.9 years, and the mean BCVA in the right and left eyes were 0.48 and 0.47, respectively. A negative correlation was observed between the proportion of patients who stopped driving due to AMD and the vision in the worse eye (p < 0.0001); however, 66% of participants were still driving. Regardless of the BCVA, 84% of them wished to continue driving. Concerning perceived dangerous situations, all patients reported an oversight of people or signals and night driving; further, patients with unilateral and bilateral vision deterioration reported vision narrowness and difficulty with discerning signal colours, respectively. Conclusion: Despite the associated danger, patients with AMD continued driving. Close attention should be paid to the driving activities among patients with AMD, even if they have passed the relevant driving tests.

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Three-Month Results of Brolucizumab Intravitreal Therapy in Patients with Wet Age-Related Macular Degeneration

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18168450 ◽

2021 ◽

Vol 18 (16) ◽

pp. 8450

Author(s):

Katarzyna Michalska-Małecka ◽

Dorota Śpiewak ◽

Dorota Luksa

Keyword(s):

Visual Acuity ◽

Retinal Thickness ◽

Age Related Macular Degeneration ◽

Central Retinal Thickness ◽

Membrane Flow ◽

Membrane Area ◽

Corrected Visual Acuity ◽

Age Related ◽

The Mean ◽

Best Corrected Visual Acuity

The purpose of the study was to evaluate changes in best corrected visual acuity, central retinal thickness, area and flow in the neovascular membrane and to compare therapeutic outcomes from baseline in patients who received three doses of Beovu (brolucizumab) at three-month follow-up. Material and methods: A prospective observational study conducted at the Prof. K. Gibiński University Clinical Center of the Medical University of Silesia in Katowice. Eight patients with exudative form of age-related macular degeneration (AMD) were observed. Results: The mean best corrected visual acuity (BCVA) outcome increased with each subsequent visit. The mean central retinal thickness (CRT) result also improved (decreased) with each subsequent visit, except for the last measurement. A statistically significant change in neovascular membrane area was observed after the first injection. In further treatment, the membrane area underwent changes that were not statistically significant. A statistically significant change in neovascular membrane flow was demonstrated after the first and second injections. Discussion: Our study confirmed the efficacy of brolucizumab in the treatment of patients with exudative AMD in terms of improvements in best corrected visual acuity (BCVA), central retinal thickness (CRT), neovascular membrane area, and neovascular membrane flow area.

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Neovaskulinės amžinės geltonosios dėmės degeneracijos gydymo ranibizumabu 24 mėnesių morfologiniai ir funkciniai pokyčiai

Medicinos teorija ir praktika ◽

10.15591/mtp.2015.065 ◽

2015 ◽

Vol 21 (3.2) ◽

pp. 413-416

Author(s):

Vilma Jūratė Balčiūnienė ◽

Rosita Lažaunykaitė

Keyword(s):

Visual Acuity ◽

Macular Thickness ◽

Age Related Macular Degeneration ◽

Central Macular Thickness ◽

Corrected Visual Acuity ◽

Age Related ◽

Before And After ◽

The Mean ◽

The Difference ◽

Best Corrected Visual Acuity

Key words: ranibizumab, age-related macular degeneration, central macular thickness. Research objective. To evaluate influence of treatment with vascular endothelial growth factor inhibitor, ranibizumab, for best corrected visual acuity and central macular thickness in patients with neovascular age-related macular degeneration. Materials and methods. In this retrospective study were included treatment – naive patients. Intravitreal injections were performed at Lithuanian University of Health Sciences Kaunas Clinics Eye clinic. In this study were analysed the 24-month morphological and functional outcomes of intravitreal ranibizumab injections. Best corrected visual acuity was meassured using the Snellen chart (Landolt’s rings C optotypes). Optical coherence tomography images were obtained using the spectral – domain OCT (NIDEK RS – 3000 Advance (NIDEK CO LTD, Japan). The central thickness measurements were obtained from macular thickness maps using the digital caliper tool. Results. In this study were included 88 patients. Best corrected visual acuity before treatment was 0.36 ± 0.22. The difference between visual acuity before and after first injection was 0.04 ± 0.22 (p = 0.03). Before fifth injection visual acuity was 0.41 ± 0.21, after – 0.46 ± 0.22 (p = 0.05). Central macular thickness before treatment was 297.81 ± 106.04 μm. The difference between central macular thickness before and after first injection was 85.21 ± 113.37 μm (p < 0.001). Before second injection central macular thickness was 273.57 ± 87.49 μm, after – 234.51 ± 58.96 μm (p = 0.002). Before fourth injection central macular thickness was 237.20 ± 40.87 μm, after – 219.10 ± 42.26 μm (p = 0.04). The mean central macular thickness significantly decreased from 298.15 ± 104.78 to 229.08 ± 56.57 (p < 0.001). In 24 month of treatment the average number of ranibizumab injections was 3.61 ± 1.55. Conclusions. Our study’s results showed that over 24 month best corrected visual acuity improvement was statistically significant after first and fifth injection. Baseline compared with last injection, there was not statistically significant difference. Central macular thickness improvement statistically significant was after first, second and fourth injection. There was statistically significant decreased baseline compared with the last injection. The mean number of ranibizumab injections was 3.61 ± 1.55 in 24 month.

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Early Responses to Intravitreal Ranibizumab in Typical Neovascular Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy

Journal of Ophthalmology ◽

10.1155/2011/742020 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 10

Author(s):

Wataru Matsumiya ◽

Shigeru Honda ◽

Hiroaki Bessho ◽

Sentaro Kusuhara ◽

Yasutomo Tsukahara ◽

...

Keyword(s):

Polypoidal Choroidal Vasculopathy ◽

Retinal Thickness ◽

Early Response ◽

Age Related Macular Degeneration ◽

Neovascular Amd ◽

Intravitreal Ranibizumab ◽

Corrected Visual Acuity ◽

Age Related ◽

The Mean ◽

Choroidal Vasculopathy

Purpose. To evaluate the early response to intravitreal ranibizumab (IVR) in two different phenotypes of age-related macular degenerations (AMD): typical neovascular AMD (tAMD) and polypoidal choroidal vasculopathy (PCV).Methods. Sixty eyes from 60 patients (tAMD 28, PCV 32 eyes) were recruited. Three consecutive IVR treatments (0.5 mg) were performed every month. Change in the best-corrected visual acuity (BCVA) and central retinal thickness (CRT) was then compared between the tAMD and PCV groups.Results. The mean BCVA logMAR was significantly improved at month 1 and month 3 after the initial IVR in the tAMD group, but there was no change in the PCV group. Both phenotypes showed significant improvements in the CRT during the 3 months after the initial IVR. There were no significant differences in the improvements of the CRT in the tAMD versus the PCV group. In the stepwise analysis, a worse pretreatment BCVA and tAMD lesions were significantly beneficial for a greater improvement of BCVA at 3 months after the initial IVR.Conclusions. The phenotype of tAMD showed a significantly better early response to IVR than PCV in terms of BCVA improvement.

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Correlation between visual acuity, external limiting membrane and photoreceptor status in patients with neovascular age-related macular degeneration treated with bevacizumab

Vojnosanitetski pregled ◽

10.2298/vsp150709149r ◽

2017 ◽

Vol 74 (9) ◽

pp. 849-853

Author(s):

Dragana Ristic ◽

Miroslav Vukosavljevic ◽

Marko Kontic ◽

Petar Ristic ◽

Dubravko Bokonjic ◽

...

Keyword(s):

Visual Acuity ◽

Age Related Macular Degeneration ◽

Type I ◽

Type Ii ◽

External Limiting Membrane ◽

Corrected Visual Acuity ◽

Age Related ◽

Number Of Patients ◽

The Mean ◽

Best Corrected Visual Acuity

Background/Aim. The integrity of outer retinal structures, primarily the photoreceptor layer, is important because of its direct correlation with visual acuity. The aim of this study was to investigate the correlation between best-corrected visual acuity (BCVA), the foveal photoreceptorinner segment/outer segment (IS/OS) junction and external limiting membrane (ELM) in patients with neovascular age-related macular degeneration (NVAMD) after the treatment with bevacizumab, as well as the correlation between the above-mentioned parameters and different types of neovascular membrane, classified by fluorescein angiography (FA). Methods. The study included 82 patients with NVAMD, treated with intravitreal bevacizumab. All patients underwent a basic ophthalmological examination, FA and optical coherence tomography (OCT). Based on the results of FA, all the patients were divided into two main groups ? type I (the occult and minimally classic) and type II (classic and predominantly classic) of the choroidal neovascular membrane (CNV). The OCT images revealed either the presence or the absence of IS/OS and ELM. Results. After the treatment, the mean best corrected visual acuity improved significantly in both groups (p < 0.01). Preserved IS/OS and ELM were registered in a smaller number of patients as compared to the condition before the treatment (p < 0.01). After the treatment, the mean BCVA was significantly better in patients with preserved IS/OS and ELM (p < 0.01). In addition, we registered a higher number of patients with preserved ELM in the first group than in the second group (p < 0.01), whereas there was no significant difference in the integrity of IS/OS between the groups (p > 0.05). Conclusion. The patients with preserved IS/OS and ELM achieved better final visual acuity as compared to the patients without preserved IS/OS and ELM. In our patients, the absence of IS/OS and ELM were more frequent in type II (classic and predominantly classic) CNV than in type I (the occult and minimally classic) CNV.

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Medical retina

10.1093/med/9780199672516.003.0006 ◽

2016 ◽

Author(s):

Venki Sundaram ◽

Michel Michaelides

Keyword(s):

Fluorescein Angiography ◽

Fundus Autofluorescence ◽

Age Related Macular Degeneration ◽

Hypertensive Retinopathy ◽

Autofluorescence Imaging ◽

Fundus Fluorescein Angiography ◽

Vein Occlusion ◽

Age Related ◽

Retinal Artery ◽

Endothelial Growth Factor

This chapter starts off with a discussion of fundus fluorescein angiography and the causes of abnormal fluorescein angiography. It then discusses indocyanine green angiography, including the main indications for this technique. It goes on to cover fundus autofluorescence imaging and electrophysiology. It also includes clinical knowledge areas of diabetic retinopathy, hypertensive retinopathy, retinal vein occlusion, retinal artery occlusions, age-related macular degeneration, central serous chorioretinopathy, retinal vascular anomalies, inherited retinal disorders, macular dystrophies, and choroidal dystrophies. It also discusses a number of important clinical trial studies and contains a section on the use of intravitreal injections of agents against vascular endothelial growth factor (known as VEGF).

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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.

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