scholarly journals Neovascular AMD: Where do we go from here?

2016 ◽  
Vol 7 (2) ◽  
pp. 97-102
Author(s):  
Mark R Barakat ◽  
Pravin U Dugel
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Visual Acuity ◽  
Growth Factor ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Neovascular Amd ◽  
Age Related ◽  
Monthly Injection ◽  
Injection Regimen ◽  
Endothelial Growth Factor

In the age of anti-vascular endothelial growth factor (VEGF) therapy, we are fortunate as clinicians to have three great options in the treatment of neovascular age-related macular degeneration (AMD). Yet we still face a dilemma, in that we lack a truly sustainable treatment strategy. For various reasons, as a group we cannot maintain a monthly injection regimen for patients and are giving far less, approximately half of that, be it bevacizumab, ranibizumab, or aflibercept (Holekamp et al, 2014). Unfortunately, this comes at a cost: changing from monthly to as-needed injections has been associated with a decline in visual acuity almost back down to baseline (Singer et al, 2012; Silva et al, 2013). 

scholarly journals Long-Term Outcome of Anti-Vascular Endothelial Growth Factor Therapy Following Vitrectomy for Submacular and/or Vitreous Hemorrhage in Neovascular Age-Related Macular Degeneration

2021 ◽  
Author(s):  
Setsuko Kawakami ◽  
Yoshihiro Wakabayashi ◽  
Kazuhiko Umazume ◽  
Yoshihiko Usui ◽  
Daisuke Muramatsu ◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Visual Acuity ◽  
Growth Factor ◽  
Vitreous Hemorrhage ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Age Related ◽  
Endothelial Growth Factor

Abstract Purpose: To study long-term clinical outcomes in patients with submacular hemorrhage (SMH) and/or vitreous hemorrhage (VH) associated with neovascular age-related macular degeneration (nAMD), who received pars plana vitrectomy (PPV) followed by anti-vascular endothelial growth factor (VEGF) therapy.Methods: In this retrospective case series, 25 eyes with SMH and/or VH associated with nAMD were treated by PPV and followed for at least 24 months. When exudative changes were unresolved or recurred after PPV, additional intravitreal anti-VEGF therapy was given. Results:Mean best-corrected visual acuity (BCVA) of all patients improved significantly at 1, 3, 6, 12, 18 and 24 months (P<0.01) post-PPV and at the final visit (P<0.05). Mean BCVA of 13 eyes with anti-VEGF therapy improved significantly at 1 (P<0.05), 3, 6, 12 (P<0.01), 18 and 24 months (P<0.05), while 12 eyes without anti-VEGF therapy improved at 1, 3 and 6 months (P<0.05) only. Average duration from initial PPV to anti-VEGF therapy initiation was 7.54±9.9 months. Five of 13 eyes (38.5%) with anti-VEGF therapy maintained dry macula for more than 1 year after the last injection. Conclusions:　In patients with SMH and VH caused by nAMD, administering intravitreal anti-VEGF therapy when exudative changes are unresolved or recur after PPV maintains improved visual acuity long term.

scholarly journals Long-Term Outcomes of Treat and Extend Regimen of Anti-Vascular Endothelial Growth Factor in Neovascular Age-Related Macular Degeneration

2019 ◽  
Vol 3 (2) ◽  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Visual Acuity ◽  
Growth Factor ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Age Related ◽  
Injection Frequency ◽  
Endothelial Growth Factor

This retrospective cross-sectional cohort study describes the long-term visual and anatomic outcomes of anti-vascular endothelial growth factor (VEGF) treatment using a treat and extend (TAE) regimen. The cohort consisted of 224 treatment-naïve eyes with age related macular degeneration (NV-AMD) from 202 patients that were treated with anti-VEGF agents bevacizumab, ranibizumab, and aflibercept using a TAE regimen by four physician investigators in a large urban referral center from 2008-2015. Subjects were evaluated for visual acuity, injection frequency and optical coherence tomography (OCT). Over a seven-year follow-up period (mean 3.4 years), an average 20.2 ± 14.7 injections were administered per patient. Visual acuity was 0.70 logMAR (20/100 Snellen) at the first visit and 0.67 logMAR (20/93 Snellen) at the final visit, with 74% of eyes maintaining or gaining more than 2 lines of vision. Longterm, 45.1% of eyes achieved 20/50 or better, while 27.1% were 20/200 or worse. 61.2% received monotherapy with no difference in visual acuity outcomes or injection frequency between the agent used. OCT analysis showed decreased fluid from initial to final follow-up visit: 70.1% to 15.6% with sub-retinal fluid (SRF) and 47.3% to 18.8% with intraretinal fluid (IRF) with no difference between the agent used. This study demonstrates that most patients (74%) improve or maintain visual acuity gains long-term using a TAE model with a significant portion (45.1%) achieving 20/50 or better with sustained treatment.

scholarly journals Safety and Effectiveness of Cataract Surgery with Simultaneous Intravitreal Anti-VEGF in Patients with Previously Treated Exudative Age-Related Macular Degeneration

2017 ◽  
Vol 30 (2) ◽  
pp. 127 ◽  
Author(s):  
Manuel Sousa Falcão ◽  
Paulo Freitas-Costa ◽  
João Nuno Beato ◽  
João Pinheiro-Costa ◽  
Amândio Rocha-Sousa ◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Visual Acuity ◽  
Growth Factor ◽  
Cataract Surgery ◽  
Macular Degeneration ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Age Related ◽  
Previously Treated ◽  
Endothelial Growth Factor

Introduction: To evaluate the safety and impact on visual acuity, retinal and choroidal morphology of simultaneous cataract surgery and intravitreal anti-vascular endothelial growth factor on patients with visually significant cataracts and previously treated exudative age-related macular degeneration.Material and Methods: Prospective study, which included 21 eyes of 20 patients with exudative age-related macular degeneration submitted to simultaneous phacoemulsification and intravitreal ranibizumab or bevacizumab. The patients were followed for 12 months after surgery using a pro re nata strategy. Visual acuity, foveal and choroidal thickness changes were evaluated 1, 6 and 12 months post-operatively.Results: There was a statistically significant increase in mean visual acuity at one (13.4 letters, p < 0.05), six (11.5 letters, p < 0.05) and twelve months (11.3 letters, p < 0.05) without significant changes in retinal or choroidal morphology. At 12 months, 86% of eyes were able to maintain visual acuity improvement. There were no significant differences between the two anti-vascular endothelial growth factor drugs and no complications developed during follow-up.Discussion: Simultaneous phacoemulsification and intravitreal anti- vascular endothelial growth factor is safe and allows improvement in visual acuity in patients with visually significant cataracts and exudative age-related macular degeneration. Visual acuity gains were maintained with a pro re nata strategy showing that in this subset of patients, phacoemulsification may be beneficial.Conclusion: Cataract surgery and simultaneous anti-vascular endothelial growth factor therapy improves visual acuity in patients with exudative age-related macular degeneration.

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