Incidence, clinical features, risk factors, and outcomes of Intraocular inflammation following Brolucizumab in Indian eyes – A multicentric study

Purpose: To report the incidence, clinical features, potential risk factors, and outcomes of intraocular inflammation (IOI) following brolucizumab in Indian eyes. Methods: All consecutive patients diagnosed with brolucizumab?induced IOI from 10 centers in eastern India between October 2020 and April 2022 were included. Results: Of 758 injections given during the study period across centers, 13 IOI events (1.7%) were recorded attributable to brolucizumab. The IOI occurred after the first dose in two eyes (15%) (median 45 days after brolucizumab), second dose in six eyes (46%) (median = 8.5 days), and third dose (39%) in the remaining five eyes (median 7 days). Reinjections of brolucizumab were administered at a median interval of 6 weeks (interquartile range = 4–10 weeks) in the 11 eyes, where IOI occurred after the second or third dose. Eyes that experienced IOI after the third dose had received a significantly greater number of previous antivascular endothelial growth factor injections (median = 8) compared to those who developed it after the first or second dose (median = 4) (P = 0.001). Anterior chamber cells were seen in almost all eyes (n = 11, 85%), while peripheral retinal hemorrhages were seen in two eyes, and one eye showed branch artery occlusion. Two?thirds of patients (n = 8, 62%) recovered with a combination of topical and oral steroids, while remaining recovered with topical steroids alone. Irreversible visual loss was not seen in any eye, and median vision recovered to pre?IOI levels by 3 months’ time point. Conclusion: Brolucizumab?induced IOI was relatively rare, occurring in 1.7% of eyes, was more common after the second or third injection, especially in those who required frequent reinjections every 6 weeks, and occurred earlier with increasing number of previous brolucizumab injections. Continued surveillance is necessary even after repeated doses of brolucizumab.

Afibercept treatment for macular edema with and without serous retinal detachment due to branch retinal vein occlusion / Tratamento com afibercepte para edema macular devido à oclusão da veia retiniana do ramo com e sem descolamento seroso da retina

ABSTRACT Purpose: To evaluate the effectiveness of intravitreal aflibercept treatment for macular edema with and without serous retinal detachment due to branch retinal vein occlusion. Methods: Thirty-seven eyes with branch retinal vein occlusion treated with intravitreal aflibercept injection for macular edema were evaluated retrospectively. The patients were divided into two groups according to whether they showed serous retinal detachment on spectral domain optical coherence tomography. Pro re nata regimen was applied after 1 dose of intravitreal aflibercept injection. After the initial injection, control treatments were administered at months 1, 2, 3, 6, and 12. The best-corrected visual acuity and central macular thickness were measured. Results: Fifteen patients had serous retinal detachment, and 22 with macular edema only (non-serous retinal detachment). The central macular thickness was significantly greater in the group with than in the group without serous retinal detachment (811.73 ± 220.68 µm and 667.90 ± 220.68 µm, respectively, p=0.04). The difference between the groups disappeared from the third month. The central macular thickness was similar between the two groups at the last control treatment (407.27 ± 99.08 µm and 376.66 ± 74.71 µm, p=0.66). The best-corrected visual acuity increased significantly in both groups. No significant difference was found between the two groups in terms of the best-corrected visual acuities at baseline and the final control. Conclusion: The intravitreal aflibercept treatment was highly effective in improving best-corrected visual acuity and central macular thickness in patients with branch retinal vein occlusion-induced macular edema independent of serous retinal detachment.

RESUMO Objetivo: Avaliar a eficácia do tratamento com aflibercepte intravítreo para edema macular devido à oclusão de um ramo da veia retiniana, com e sem descolamento seroso da retina. Métodos: Foram analisados retrospectivamente 37 olhos com oclusão de um ramo da veia retiniana, tratados com injeção intravítrea de aflibercepte para edema macular. Os pacientes foram divididos em dois grupos, de acordo com a presença ou ausência de um descolamento seroso de retina na tomografia de coerência óptica (SD-OCT). Um regime pro re nata foi seguido após 1 injeção intravítrea de aflibercepte. Após a injeção, foram realizadas consultas de acompanhamento nos meses 1, 2, 3, 6 e 12. Foram medidas a melhor acuidade visual corrigida e a espessura macular central. Resultados: Houve 15 pacientes com descolamento seroso de retina e 22 pacientes com apenas edema macular (descolamento não seroso de retina). A espessura macular central foi significativamente maior no grupo com descolamento seroso de retina do que no grupo com descolamento não seroso de retina (respectivamente, 811,73 ± 220,68 µm e 667,90 ± 220,68 µm; p=0,04). A diferença desapareceu a partir do terceiro mês. A espessura macular central foi semelhante nos dois grupos na última consulta (407,27 ± 99,08 µm e 376,66 ± 74,71 µm, p=0,66). A melhor acuidade visual corrigida aumentou significativamente em ambos os grupos. Não houve diferença entre os dois grupos quanto à melhor acuidade visual corrigida inicial e final. Conclusão: O tratamento com aflibercepte intravítreo foi altamente eficaz em melhorar a acuidade visual corrigida e a espessura macular central no edema macular induzido pela oclusão de um ramo da veia retiniana, independentemente da presença ou não de um descolamento seroso da retina.

Efficacy of Aflibercept and Ranibizumab in the treatment of diabetic macular edema / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the efficacy of aflibercept and ranibizumab in the treatment of diabetic macular edema(DME).METHODS: Prospective randomized controlled trial. A total of 35 patients(60 eyes)with non-proliferative diabetic retinopathy complicated with DME confirmed in our hospital from June 2020 to September 2021 were included. Intravitreal injection was performed using the 3+PRN protocol in all cases, of which 17 cases(30 eyes)received aflibercept treatment(aflibercept group)and 18 cases(30 eyes)received ranibizumab(ranibizumab group). The two groups were followed up for 12mo, observing the central macular thickness(CMT)and the best corrected visual acuity(BCVA)of the two groups, and recording the number of intravitreal injections and the occurrence of complications.RESULTS: After treatment, CMT and BCVA in the aflibercept group were significantly better than that in the ranibizumab group at 1, 3, 6 and 12 mo(all P<0.001). During the follow-up period, the number of intravitreal injections in the aflibercept group was lower than that in the ranibizumab group(4.23±0.86 vs. 6.40±0.97, P<0.05), there were no serious complications such as drug-related adverse reactions, intraocular infection, and vascular embolism in either group.CONCLUSION: Both aflibercept and ranibizumab have clear efficacy and safety in the treatment of DME, and aflibercept may be a more effective and convenient treatment option than ranibizumab for DME patients.

Triamcinolone Acetonide combined with Aflibercept in the treatment of wet age-related macular degeneration with poor response to Ranibizumab / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the efficacy and safety of intravitreal injection of aflibercept combined with posterior sub-fascial injection of triamcinolone acetonide in the treatment of wet age-related macular degeneration(ARMD)with poor response to anti-vascular endothelial growth factor drugs.METHODS: Retrospective cohort study. From June 2018 to May 2020, a total of 60 patients(60 eyes)with refractory ARMD who had poor response to the treatment of anti VEGF drug ranibizumab were randomly divided into the control group of aflibercept and the observation group of triamcinolone acetonide combined with aflibercept, with 30 patients(30 eyes)in each group. Once a month, the patients in the two groups received intravitreal injection of aflibercept alone or intravitreal injection of aflibercept combined with posterior sub-fascial injection of triamcinolone acetonide for three consecutive times. The changes of best corrected visual acuity(BCVA), central macular thickness(CMT)and intraocular pressure were reviewed before injection and 1, 3 and 6mo after the third injection.RESULTS: The BCVA and CMT of the two groups were significantly improved 1, 3 and 6mo after the injection of the drug(P<0.05). The mean intraocular pressure in the combined group was higher at 1mo after treatment than before, but it still within the normal range. There was a significant difference in intraocular pressure between the two groups(17.50±4.60 vs. 18.30±3.73mmHg, P<0.05).CONCLUSION: Triamcinolone acetonide injection under the posterior fascia of the eyeball combined with intravitreal injection of aflibercept in the treatment of wet ARMD can effectively reduce macular edema and improve vision, which is more safe and reliable.

Effect of repeated intravitreal Ranibizumab and Aflibercept injections on the corneal nerves in patients with macular edema / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the effect of repeated intravitreal injection of ranibizumab and aflibercept on corneal nerve of patients with macular edema.METHODS: A total of 64 patients(64 eyes)enrolled in our hospital from June 2021 to June 2022 were treated with intravitreal injection of anti-vascular endothelial growth factor(VEGF). There were 20 cases(20 eyes)of diabetic macular edema, 19 cases(19 eyes)of wet age-related macular degeneration and 25 cases(25 eyes)of retinal vein occlusion. Corneal confocal microscope was used to collect images of corneal subbasal nerve plexus before injections and at 1mo after each intravitreal injection based on 3+pro re nata(PRN)treatment regimen. Furthermore, the length and density of corneal nerve were measured.RESULTS: There was no significant difference in corneal nerve density of patients injected with aflibercept between pre-injection and post-injection(P>0.05), while the corneal nerve length after 2nd and 3rd injections was lower than that of pre-injection(all P<0.01). There were no significant changes in corneal nerve density and length in patients with intravitreal injections of ranibizumab(all P>0.05), and there was no significant differences in corneal nerve density and length after 3 injections of the two drugs(all P>0.05).CONCLUSION: Repeated intravitreal anti-VEGF drug may affect corneal nerve to some extent. For patients who need repeated intravitreal injections of anti-VEGF, attention should be paid to the changes of corneal nerves.

Comparison of clinical efficacy of intravitreal injection of Conbercept and Aflibercept in the treatment of wet age-related macular degeneration / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the clinical efficacy of conbercept and aflibercept in the treatment of wet age-related macular degeneration(wARMD)based on 4 consecutive intravitreal injections.METHODS: The clinical data of 108 patients(108 eyes)who were diagnosed as wARMD and treated with intravitreal injection at our hospital from January 2019 to January 2021 were retrospectively analyzed. They were divided into conbercept group(54 cases, 54 eyes)and aflibercept group(54 cases, 54 eyes)according to the different injectable drugs. All patients received intravitreal injection once a month, with four consecutive injections. Follow up for 12mo to observe best corrected visual acuity(BCVA), central macular thickness(CMT), complications and recurrence before and after injection.RESULTS: BCVA and CMT of patients in the two groups at 1, 2, 5 and 8mo after injection had no between-group differences(P>0.05), but both were significantly improved compared with those before injection(P<0.05). By the end of follow-up, conjunctival hemorrhage occurred in 2 eyes of the conbercept group at the early stage, and increased intraocular pressure and conjunctival hemorrhage occurred respectively in 2 eyes of the aflibercept group. There were no serious complications related to drug injection such as retinal detachment, complicated cataract, endophthalmitis and retinal pigment epithelial tear in the two groups, and there was no difference in the recurrence rate between the two groups(7% vs. 6%, P=1.000).CONCLUSION: On the basis of continuous 4 times of intravitreal injection, both conbercept and aflibercept are safe and effective in the treatment of wARMD, and the efficacy is even.

Imágenes multimodales en desgarro del epitelio pigmentario de la retina. Reporte de caso / Multimodal imaging in retinal pigment epithelium tear. Case report

Los desgarros del epitelio pigmentario de la retina (EPR) pueden ocurrir espontáneamente o asociados al tratamiento con terapia antiangiogénica intravítrea (anti-VEGF) para la degeneración macular asociada a la edad neovascular (DMAEn). El objetivo de este estudio fue describir el caso de un desgarro del EPR en un paciente con neovascularización macular luego del tratamiento con terapia anti-VEGF. Paciente de sexo masculino, de 73 años, con diagnóstico de neovascularización macular mixta y desprendimiento fibrovascular del EPR en el ojo derecho; recibió tratamiento con terapia antiangiogénica, presentando un desgarro del EPR. Este puede desarrollarse como una complicación asociada al tratamiento con terapia anti-VEGF en pacientes con DMAEn. Describimos el uso de imágenes multimodales en el diagnóstico de esta patología.

Retinal pigment epithelium (RPE) tears can occur spontaneously or in association with intravitreal antiangiogenic therapy (anti-VEGF) treatment for neovascular age-related macular degeneration (AMD). The objective of this study was to describe the case of a RPE tear in a patient with macular neovascularization after treatment with anti-VEGF therapy. A 73-year-old male patient with a diagnosis of mixed macular neovascularization and fibrovascular detachment of the RPE in the right eye; he received treatment with antiangiogenic therapy, presenting a RPE tear. This can develop as a complication associated with treatment with anti-VEGF therapy in patients with AMD. We describe the use of multimodal imaging in the diagnosis of this pathology.

Aflibercept suppresses ovarian hyperstimulation syndrome: an experimental study in rats

SUMMARY OBJECTIVE: In this study, we aimed to determine the impact of the antiangiogenic medications, namely, aflibercept and cabergoline in the prevention and treatment of ovarian hyperstimulation syndrome in a rat model. METHODS: A total of 36 female Wistar rats were randomly allocated to one of the five groups, including disease-free and ovarian hyperstimulation syndrome controls: Group no OHSS (control, n=6) received saline only intraperitoneally (i.p.); group just OHSS (ovarian hyperstimulation syndrome only, n=6) received 10 IU pregnant mare serum gonadotropin and 30 IU human chorionic gonadotropin subcutaneously to produce ovarian hyperstimulation syndrome; group cabergoline+OHSS (cabergoline+ovarian hyperstimulation syndrome, n=8) received 100 μg/kg oral cabergoline; group aflibercept (12.5 mg/kg)+OHSS (aflibercept+ovarian hyperstimulation syndrome, n=8) received 12.5 mg/kg i.p. aflibercept; and group aflibercept (25 mg/kg)+OHSS (aflibercept+ovarian hyperstimulation syndrome, n=8) received 25 mg/kg i.p. aflibercept. The groups were compared for ovarian weight, immunohistochemical vascular endothelial growth factor expression, spectrophotometric vascular permeability evaluated with methylene blue solution in peritoneal lavage, and body weight growth. RESULTS: Vascular endothelial growth factor immunoexpression was substantially greater in the just OHSS group (22.00±10.20%) than in the aflibercept (12.5 mg/kg)+OHSS (7.87±6.13%) and aflibercept (25 mg/kg)+OHSS (5.63±4.53%) groups (p=0.008 and p=0.005, respectively). Post-hoc tests indicated that cabergoline, 12.5 mg/kg aflibercept, and 25 mg/kg aflibercept decreased vascular permeability compared to the untreated ovarian hyperstimulation syndrome group (p=0.003, p=0.003, and p=0.001, respectively). JOH group had the heaviest ovaries, whereas aflibercept (25 mg/kg)+OHSS group had the lightest. In terms of body weight gain, cabergoline+OHSS group was substantially greater than the aflibercept (12.5 mg/kg)+OHSS and aflibercept (25 mg/kg)+OHSS groups (p=0.006 and p=0.007, respectively). CONCLUSION: Aflibercept, an antiangiogenic medication, decreased ovarian hyperstimulation syndrome by lowering the vascular permeability and vascular endothelial growth factor expression.

Efficacy comparison of intravitreal injection of Conbercept versus Aflibercept in the treatment of pachychoroid neovasculopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To observe and compare the clinical efficacy and safety of intravitreal injection of conbercept or aflibercept in the treatment of pachychoroid neovasculopathy(PNV).METHODS:Retrospective case-control study. A total of 33 patients(35 eyes)diagnosed as PNV in our hospital from February 2018 to October 2022 were divided into 14 cases(14 eyes)in conbercept group and 19 cases(21 eyes)in aflibercept group according to the treatment methods. The best corrected visual acuity(BCVA), subfoveal choroidal thickness(SFCT)and central macular thickness(CMT), injection times and clinical complications of the two groups were compared before and 1, 3 and 6mo after treatment.RESULTS:BCVA, CMT and SFCT in both groups were significantly improved after 1, 3 and 6mo of treatment(all P<0.05). During the whole follow-up period, the number of intravitreal injections in the two groups were 2(2, 3)and 2(1.5, 2)respectively, and there was no significant difference(P=0.423). No serious complications occurred during the treatment of the two groups.CONCLUSION:Both intravitreal injections of conbercept and aflibercept can treat PNV with similar therapeutic effects. The desired clinical outcome is achieved by improving the anatomy while improving visual acuity.

Effect of intravitreal anti-VEGF injection on choroidal thickness in patients with diabetic macula edema / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate for any detectable change in sub-foveal choroidal thickness following intravitreal injections of Ranibizumab or Aflibercept in patients with central involving diabetic macula edema(DME), evidenced by optical coherence tomography(OCT).<p>METHODS: Totally 17 patients with central involving DME who required and agreed to intravitreal anti-VEGF injection were invited to be the subject of this study. These injection-naive subjects were undergone three loading doses of monthly intravitreal anti-VEGF(Ranibizumab 0.5 mg/0.05 mL for 9 patients or Aflibercept 2 mg/0.05 mL for 8 patients)injection, and a clinic review appointment 1mo after the third injection. The changes of foveal choroidal thickness, visual acuity and central retinal thickness at 1mo were observed before and after treatment in 2 groups by enhanced depth image-optical coherence tomography(EDI-OCT). <p>RESULTS: We recorded a significant sub-foveal choroidal thinning and vision improvement after three loading doses of anti-VEGF(all <i>P</i><0.05). The thinning effect between Ranibizumab and Aflibercept group was insignificant(all <i>P</i>>0.05). There was no significant correlation between pre-treatment sub-foveal choroidal thickness and vision improvement(<i>r_s</i>=-0.269, <i>P</i>=0.296). There was also no significant correlation between choroidal thickness changes with vision improvement, central retinal thickness change and age of subjects(all <i>P</i> >0.05).<p>CONCLUSION: Intravitreal Ranibizumab and Aflibercept injections both leads to significant sub-foveal choroidal thinning in DME subjects. It was accompanied with significant vision improvement with no evidence of immediate detrimental effect of choroidal thinning. Future research with a longer study duration would help in establishing the duration and long term effect of choroidal thinning.

Clinical therapeutic effects of Aflibercept or Ranibizumab combined with Ahmed glaucoma valve implantation on neovascular glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the clinical therapeutic efficacy of Ahmed glaucoma valve(AGV)implantation with intravitreal injection of aflibercept or ranibizumab in patients with neovascular glaucoma(NVG). <p>METHODS: A retrospective study. The clinical data of 33 cases(33 eyes)with NVG angle-closure glaucoma who were received intravitreal injection of aflibercept or ranibizumab with AGV implantation from January 2018 to August 2020 in our hospital were involved in this study. There were 18 eyes in the aflibercept group and 15 eyes in the ranibizumab group. All patients were followed-up for 6mo. The best-corrected visual acuity(BCVA), intraocular pressure, neovascularization, and postoperative complications were recorded and evaluated.<p>RESULTS: Before the first intravitreal injection and 1wk after intravitreal injection, the differences of intraocular pressure and BCVA in two groups were not statistically significant(<i>P</i>>0.05); The changes of intraocular pressure and BCVA before the first intravitreal injection and after AGV implant 1wk, 1, 3, 6mo were statistically significant in two groups(<i>P</i><0.01), but there were no statistically significant differences intraocular pressure and BCVA between the two groups at each follow-up time point(<i>P</i>>0.05). There were no significant differences in average number of injections between aflibercept group(1.61±0.98)and ranibizumab group(1.80±0.86)(<i>P</i>>0.05). The differences of neovascular recurrence rate, incidence of early and late complications and surgical success rates were not statistically significant(<i>P</i>>0.05).<p>CONCLUSION: Intravitreal aflibercept or ranibizumab injection combined with AGV implantation is an effective treatment for NVG. The clinical efficacy of aflibercept and ranibizumab were similar.

Efficacy of Aflibercept versus Ranibizumab in the treatment of diabetic macular edema / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the efficacy of aflibercept and ranibizumab in the treatment of diabetic macular edema(DME).<p>METHODS: Patients with DME who visited the ophthalmology department of Xingtai People's Hospital for the first time from November 2019 to February 2020 were included in the study. They were randomly divided into the aflibercept group and the ranibizumab group. 3+PRN(pro re nata)was used, and the interval time between two injections was at least 4wk. All patients were given three injections first. During follow-up, the patient's best corrected visual acuity(BCVA)and central foveal thickness(CFT)were used to determine whether to inject again. All patients were followed-up for 12mo. The changes of BCVA, CFT, intraocular pressure and injection times were recorded in two groups before and after treatment.<p>RESULTS: During preoperative and postoperative follow-up, there were statistical differences in LogMAR BCVA and CFT of the two groups respectively(<i>P</i><0.05). The comparison between the two groups showed no statistical significance during the BCVA and the CFT follow-up(<i>P</i>>0.05). At the end of follow-up, there was a statistical difference in the number of injections between the two groups(<i>t</i>= -6.403, <i>P</i><0.05). The average number of injections was 6.094±0.689 in the aflibercept group and 7.231±0.652 in the ranibizumab group. No ocular complications or systemic adverse reactions occurred in all patients.<p>CONCLUSION: Compared with intravitreal injection of ranibizumab and aflibercept for the treatment of DME can achieve similar treatment effect, but the number of injections is less in the aflibercept.

Progress of Aflibercept of clinical application for neovascular age-related macular degeneration / 国际眼科杂志(Guoji Yanke Zazhi)

@#Aflibercept is a recombinant human fusion protein that acts as a soluble decoy receptor for vascular endothelial growth factor(VEGF)family members. VEGF-A, VEGF-B and placental growth factor(PLGF)were included in VEGF family that could inhibit downstream signalling mediated by these ligands. Aflibercept binds to all isoforms of VEGF-A with high affinity, and presented a markedly higher affinity compared with ranibizumab or bevacizumab. Intravitreal injection aflibercept has been approved for the treatment of patients with age-related macular degeneration(ARMD). Numerous studies showed it could improve best corrected visual acuity(BCVA), reduce macular edema and with fewer complications that has been another choice for ARMD patients. However, studies of participation time with large sample are lacking, and relevant studies are limited in China. Contribution in clinical efficacy, advancement in selection and use of medicines, safety and limitations with aflibercept will be here summarized.

Short-term effects of anti-VEGF drugs on macular perfusion in patients with diabetic macular edema / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the effect of Conbercept or Aflibercept on macular perfusion status in patients with diabetic macular edema(DME), and the changes in foveal avascular zone(FAZ)areas and capillary density in macular regions were measured quantitatively by optical coherence tomography angiography(OCTA).<p>METHODS: Twenty-six patients with DME received intravitreal injections of Conbercept or Alfibercept. The changes of FAZ areas, PERIM, AI, and macular vessel density in fovea of 300μm width(FD-300)were measured by OCTA in baseline 1, 7, and 30d after injection, and the effect of anti-VEGF drugs on blood circulation in macular area was analyzed. The best-corrected visual acuity(BCVA), central foveal thickness(CFT)were observed, the BCVA was converted to LogMAR. The changes of BCVA, CFT, FAZ, FD-300, PERIM, AI treated with anti-VEGF by methods repetitive measure analysis of variance on 1, 7, 30d after treatment were compared. Bonferroni was used to analyze the differences at different time points in pairwise comparison. Pearson correlation analysis was used to evaluate the correlation between changes in BCVA(LogMAR)and FAZ, CFT.<p>RESULTS: The FAZ area was 0.296±0.022mm² in baseline. After 1d drug injection, the FAZ increased to 0.339±0.024mm²(<i>P</i>=0.015). There was no significant difference in FAZ on the 7 and 30d after surgery(<i>P</i>=0.084, <i>P</i>=0.224). Compared with before treatment, BCVA and CFT decreased significantly, the anti-VEGF therapy was effective. The changes in PERIM, AI, and FD-300 did not reach significant level(<i>F</i>=2.598, <i>P</i>=0.059; <i>F</i>=0.438, <i>P</i>=0.726; <i>F</i>=0.594, <i>P</i>=0.621). The results of correlation analysis showed that BCVA(LogMAR)was positively correlated with FAZ and CFT(<i>r</i>=0.273, <i>P</i>=0.005; <i>r</i>=0.200, <i>P</i>=0.042)which had influence on BCVA.<p>CONCLUSION: With an increase in the avascular area of macular fovea was detected within 1d after intravitreal injection of anti-VEGF drug in patients with DME, and decrease in the area of avascular area in macular fovea after 1wk, accompanied by improved visual acuity. The selected appropriate index of OCTA can provide a reliable means to measure retinal circulation.

Efficacy of intravitreal injection of Aflibercept <i>vs</i> Ranibizumab in the treatment of diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To systematically assess the effect of intravitreal injection of Aflibercept or Ranibizumab in the treatment of diabetic retinopathy(DR)by using Meta-analysis.<p>METHODS: PubMed, MEDLINE, Web of Science, Cochrane, Nature Series, ScienceDirect, and ESI Databases were searched until May 2019. Ten studies included a total of 1 240 participants with DR had been administered in the Meta-analysis. Aflibercept or Ranibizumab <i>via</i> intravitreal injection. After selecting useful information, we used RevMan 5.3 to further analysis. Systematic review and Meta-analysis were used to design.<p>RESULTS: The pooled results showed that central macular thickness(CMT)was significantly reduced(<i>P</i><0.00001)in the intravitreous Aflibercept group(IVA); compared with the intravitreous Ranibizumab group(IVR), which did not greatly improve best corrected visual acuity(BCVA)and visual acuity(VA).<p>CONCLUSION:This Meta-analysis suggests that both IVA and IVR are effective in the treatment of DR patients. Specifically, Aflibercept shows better improvements in CMT, while Ranibizumab is beneficial in increasing BCVA or VA.

Changes in the Ganglion Cell-inner Plexiform Layer after Consecutive Intravitreal Injections of Anti-vascular Endothelial Growth Factor in Age-related Macular Degeneration Patients

Short-term efficacy of intravitreal Aflibercept injection on macular edema secondary to retinal vein occlusion / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the short-term efficacy of intravitreal injection of aflibercept on macular edema secondary to retinal vein occlusion(RVO). <p>METHODS: Totally 24 patients(24 eyes)with macular edema secondary to RVO confirmed by ophthalmic clinical examination received intravitreal injection of aflibercept from May to October in 2019 in hospital. Before and after the 1wk, 1mo treatment, all the eyes of the sick were examined with best corrected visual acuity(BCVA), optical coherence tomography angiography(3x3mm scanning range model)BCVA, central macular thickness(CMT), vascular density of superficial capillary plexus(SCP), vascular density of deep capillary plexus(DCP), and the area, perimeter and the roundness index in foveal avascular zone(FAZ)were observed. <p>RESULTS: Intravitreal injection of aflibercept for 1wk and 1mo, BCVA improved with the difference were statistically significant(<i>P</i><0.05); The treatment for 1wk and 1mo, CMT decreased with the difference were statistically significant(<i>P</i><0.001); There were no statistical difference for the vascular density of SCP,DCP and FD-300 before and after treatment 1wk, 1mo(<i>P</i>>0.05), and it revealed there was no obvious change for vascular density of SCP,DCP and FD-300(All <i>P</i>>0.05); The area and perimeter of FAZ after treatment increased obviously, and the roundness index of FAZ decreased than before with the difference were statistically significant(<i>P</i><0.05).<p>CONCLUSION: For macular edema secondary to RVO, eyesight improved and edema absorbed obviously with the intravitreal injection of aflibercept in short-term clinical observation. At the same time, FAZ become regular and macular ischemia wasn't aggravated after treatment.

Pharmacoeconomic Evaluation of Anti-VEGF Drugs and Laser Photocoagulation for The Treatment of DME in China / 中国药学杂志

OBJECTIVE: To evaluate the cost-effectiveness of ranibizumab and aflibercept compared with laser photocoagulation for the treatment of diabetic macular edema (DME) from Chinese societal perspective. METHODS: A Markov model was constructed to simulate the long-term outcomes and costs of treating DME. Transition probabilities were calculated from the raw data of randomized controlled trial and published network Meta-analysis. Health state utilities were estimated through literature, and costs were estimated from experts consultation of 6 hospitals in China and published literature. The primary outcomes of the model were costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Uncertainty was addressed via univariate and probabilistic sensitivity analyses. RESULTS: The ICER comparing ranibizumab with laser photocoagulation was 61 174•QALY-1, comparing aflibercept with laser photocoagulation was 138 232•QALY-1. Based on the generally accepted ICER threshold of 3 times per-capita GDP (59 660, 2017 China), ranibizumab and aflibercept were found to be cost-effective compared with laser photocoagulation. Comparing ranibizumab with aflibercept, ranibizumab was the dominant therapy, with an incremental gain of 0.03 QALYs and cost savings of 22 053. Univariate and probabilistic sensitivity analysis demonstrated the robustness of the results. CONCLUSION: Compared with laser photocoagulation, ranibizumab and aflibercept are the cost-effective treatment for DME; compared with aflibercept, ranibizumab is the dominant treatment for DME.

Comparison of intravitreal ziv-aflibercept and bevacizumab monotherapy in treatment-naive polypoidal choroidal vasculopathy

Purpose: To report the visual and anatomical outcomes of intravitreal ziv-aflibercept (IVZ) and bevacizumab (BVZ) monotherapy in treatment-naive polypoidal choroidal vasculopathy (PCV). Methods: This was a retrospective case series of 16 eyes (8 eyes each in IVZ and BVZ groups). The study period was from January 2016 to March 2018. The inclusion criteria were treatment-naive PCV patients who were treated with either IVZ or BVZ monotherapy on pro re nata protocol and followed up monthly for 6 months. The change in best-corrected visual acuity (BCVA), central macular thickness (CMT), and pigment epithelial detachment (PED) height was measured at baseline and 6 months. Results: A total of 16 eyes were studied. IVZ group had an improvement in BCVA by 0.15 logarithm of minimum angle of resolution (logMAR; approximately 1.5 lines) at 6 months, whereas BVZ group had a reduction in BCVA by 0.21 logMAR (approximately 2 lines) (P = 0.027). Five patients and one patient in IVZ and BVZ groups, respectively, had ?5 letters gain of BCVA. IVZ group had significant reduction in PED height (P = 0.048), whereas the change in CMT was not significant at 6 months (P = 0.681). The mean number of injections (2.87 ± 0.83 in IVZ and 2.25 ± 0.89 BVZ group; P = 0.168) and longest treatment-free interval (3.00 ± 2.20 months in IVZ and 2.12 ± 1.96 months in BVZ group; P = 0.41) were not significantly different. Conclusion: The visual and anatomical outcomes in terms of PED reduction in treatment-naive PCV patients were better in IVZ group compared with BVZ. IVZ monotherapy is a viable, cost-effective alternative in these patients with good safety profile.

Bevacizumab versus ziv-aflibercept in branch retinal vein occlusion

Purpose: To compare the effectiveness of treatment with intravitreal bevacizumab (IVB) and ziv-aflibercept (IVZ) in patients with macular edema (ME) post-branch retinal vein occlusion (BRVO). Methods: Patients with treatment naïve ME post-BRVO were included retrospectively if they received either IVB (0.05 ml/1.25 mg) or IVZ (0.05 ml/1.25 mg) monotherapy with a follow up of 12 months. Results: Thirty-two and 17 eyes received IVB and IVZ, respectively. The mean improvement in best corrected visual acuity (BCVA) was 0.36 ± 0.3 logarithm of minimum angle of resolution (logMAR) in the IVB group and 0.27 ± 0.3 in the IVZ group (P = 0.35). The mean change in central macular thickness was 178.9 ± 180.9 and 173.5 ± 344.4 ?m in IVB and IVZ groups, respectively (P = 0.94). The mean number of injections was higher in the IVB group (4.0 ± 1.8) compared with 1.82 ± 0.8 in the IVZ group (P < 0.0001). The IVZ group had significantly fewer number of visits (P < 0.0001) and longer maximum treatment-free intervals (P = 0.0081). Conclusion: IVZ appears to be cost-effective with the similar visual outcome and less number of visits in comparison to IVB.