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Background: Neovascular age-related macular degeneration (nAMD), also known as wet AMD, is a chronic eye disease that affects the macula, which is the central part of the retina responsible for sharp, central vision. Brolucizumab is a type of anti-vascular endothelial growth factor (VEGF) drug, which works by blocking the activity of a protein called VEGF that promotes the growth of abnormal blood vessels under the macula in neovascular AMD. The aim of this study was to evaluate the clinical outcome of brolucizumab in the treatment of neovascular age-related macular degeneration. Material & Methods: This prospective observational study was conducted in Department of Ophthalmology, Bangladesh Eye Hospital & Institute Ltd, Dhaka, Bangladesh, during the period from February 2022 to February 2023. Total 60 patients with neovascular AMD were included in this study who were treated with brolucizumab. Results: The mean age of the patients was 74.3 (SD±9.8) years. Majority of the study subjects were (51.7%) female patients in the study. In our study, majority (38.3%) of the patients had only their right eye affected. In optical coherence tomography (OCT) findings, we found that a high percentage of patients had subretinal fluid (85%), intraretinal fluid (61.7%), and sub-RPE fluid (83.3%). The BCVA showed a significant change after 12 weeks of treatment, as indicated by the P-value of 0.0007. Here improvement of vision was seen in patients with AMD with active Choroidal neovascularization (CNV). But in case of AMD with macular scar, no improvement of vision was seen. In addition, the SRT, FCP, and CMT parameters also showed a statistically significant (P<0.001) improvement after brolucizumab treatment. In our study, 4 patients (6.7%) experienced intraocular inflammation, which is inflammation within the eye, 2 patients (3.3%) reported cloudy vision, and 3 patients (5%) experienced eye redness as a complication of the treatment. The majority of the patients, 51 (85%) did not experience any complications from the treatment. After treatment, improved vision was seen in most of the study patients (70%) and 30% had no improvement. Conclusion: From the findings of our study, it can be concluded that brolucizumab may be an effective treatment for neovascular AMD, as it can improve the best-corrected visual acuity and structural outcomes of the retina such as subfoveal retinal thickness, foveal center point, and central macular thickness. There was also a tolerable complication rate after treatment.
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Fundus vascular diseases, including neovascular age-related macular degeneration(nAMD)and diabetic retinopathy(DR), are the leading causes of visual impairment worldwide. With the accelerated aging and increased incidence of diabetes, the prevalence of these two fundus diseases will continue to rise. Currently, intraocular injection of anti-vascular endothelial growth factor(anti-VEGF)remains the first-line treatment for fundus vascular diseases, but disadvantages exist, such as frequent intraocular injections, high cost and poor compliance, thus more durable and effective therapeutic strategies need to be explored. The successful application of gene therapy in inherited retinal diseases(IRDs)provides a new idea for the treatment of fundus vascular diseases. With the ongoing of several clinical trials, gene therapy for fundus vascular diseases is expected to be employed in the clinical setting. But there still remain some concerns, including the optimal therapeutic targets selection, administration route and safety issues. This review focuses on the application and prospect of gene augmentation and gene editing-mediated anti-VEGF therapy for the treatment of nAMD and DR.
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Purpose: The present study compares the efficacy, safety, and immunogenicity of Lupin’s biosimilar ranibizumab with that of Lucentis® in patients with neovascular age-related macular degeneration. Methods: This prospective, double-blind, multi-centric phase-III study was conducted across 19 centers in India. A total of 202 patients with neovascular age-related macular degeneration were randomized (1:1) to receive either Lupin’s biosimilar ranibizumab or Lucentis®, 0.5 mg, as an intravitreous injection once every month for 3 months. The primary efficacy endpoint was the proportion of patients who lost fewer than 15 letters from baseline in best-corrected visual acuity. The safety profile included assessment of adverse events, ophthalmic examination, physical and systemic examination, and vital parameters. The immunogenicity assessment was based on evaluation of anti-drug antibodies. Results: Overall, 174 patients (87 [86.14%] in each group) completed the study. The demographics and baseline characteristics were comparable between the treatment groups. The proportion of patients losing fewer than 15 letters from baseline best corrected visual acuity score in the study eye was comparable between two groups. The difference between Lupin’s ranibizumab and Lucentis® for the proportion of patients who lost fewer than 15 letters was within the predefined equivalence margin (intention-to-treat population: 1.0%; 95% confidence interval [CI], ?3.3% to 5.4% and per protocol population: 1.2%; 95% CI, ?3.2% to 6.4%). The incidence of treatment-emergent adverse events was comparable, and 11 (10.89%) patients in Lupin’s ranibizumab and 19 (18.81%) patients in Lucentis® group had at least one treatment-emergent adverse event. The immunogenicity incidence as assessed by proportion of patients with positive anti-drug antibodies was numerically lower in Lupin’s ranibizumab (4.95%) than Lucentis® (12.87%). Conclusion: Lupin’s biosimilar ranibizumab demonstrated therapeutic equivalence, desirable safety, and favorable immunogenicity profile compared to Lucentis
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@#AIM: To compare the efficacy of conbercept and ranibizumab on neovascular age-related macular degeneration(nARMD)of type 1 macular neovascularization(MNV)with fibrovascular pigment epithelial detachment(fPED).<p>METHODS: Retrospective clinical study. From January 2019 to December 2020, 48 patients(48 eyes)of nARMD type 1 MNV patients with fPED diagnosed in our hospital were included and divided into conbercept group with 26 patients(26 eyes)and ranibizumab group with 22 patients(22 eyes)according to the drugs they received. All patients received treatment of 3+PRN. Followed up for 12mo, the best corrected visual acuity(BCVA)of the two groups was observed, and optical coherence tomography(OCT)was used to measure the macula foveal thickness(CFT)and the regression degree(height, area, volume)of retinal pigment epithelial detachment(PED).<p>RESULTS: There was no significant difference between two groups in BCVA, CFT and PED height, area and volume before treatment(<i>P</i> >0.05). The PED height of the two groups was significantly improved at 3, 6 and 12mo after the first intravitreal injection treatment compared with those before treatment(<i>P</i><0.05). But the PED area and volume were not significantly improved(<i>P</i>>0.05). There was no significant improvement in BCVA between the two groups after treatment compared with those before treatment(<i>P</i>>0.05). The CFT of the conbercept group was significantly improved at 3, 6 and 12mo after treatment compared with those before treatment(<i>P</i><0.05), and the ranibizumab group improved significantly only 3mo after treatment(<i>P</i><0.05). There were no significant differences in BCVA, CFT, and PED height, area and volume between the two groups at 3, 6 and 12mo after treatment(<i>P</i> >0.05).<p>CONCLUSION: The conbercept and ranibizumab have good effects on type 1 MNV with fPED in nARMD, which can reduce the PED height and CFT, and stabilize the visual acuity, PED area and volume. However, conbercept can achieve longer reduction of macular edema.
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@#Anti-vascular endothelial growth factor(anti-VEGF)drugs have become the first choice for the treatment of intraocular neovascularization, but the inconvenience and possible complications caused by frequent intravitreal injection cannot be ignored. Therefore, it is necessary to seek new drugs with long-lasting effects, so as to reduce the number of injections. Brolucizumab, a novel small molecule anti-VEGF drug, has the advantages of stronger tissue penetration, higher drug concentration, smaller injection dose, long-lasting efficacy and longer injection interval. Registered clinical studies and real-world evidence showed that Brolucizumab is non-inferior to aflibercept in efficacy, while its ability to improve intraretinal/subretinal fluid is more significant, and it can maintain a longer dosing interval. In addition, Brolucizumab is safe and has a low incidence of serious adverse events, such as retinal vasculitis reported. Brolucizumab provides a new treatment option for neovascular age-related macular degeneration(nARMD). This article reviews the latest progress of Brolucizumab in the treatment of nARMD.
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@#Age-related macular degeneration(ARMD)is an important cause of visual impairment in people over 65 years old in western countries. It is the third leading cause of blindness in China and mainly affects central visual acuity. Vascular endothelial growth factor(VEGF)plays an important role in the pathogenesis of ARMD. Currently, intravitreous injection of anti-VEGF agents has been considered as the first-line treatment for ARMD. However, some patients still need repeated injection, or response negatively to anti-VEGF agents. Therefore, it is necessary to explore novel therapy to improve clinical outcomes and provide insights for neovascular ARMD treatment.
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Polypoidal choroidal vasculopathy (PCV) is a retinal disorder commonly found in Asians presenting as neovascular age-related macular degeneration and is characterized by serous macular detachment, serous or hemorrhagic pigment epithelial detachment, subretinal hemorrhage, and occasionally visible orange-red subretinal nodular lesions. PCV is diagnosed using indocyanine green angiography (ICGA), and the lesions appear as polypoidal aneurysmal vascular lesions with or without abnormal branching vascular network. Although ICGA remains the gold standard for the diagnosis of PCV, various imaging modalities have also facilitated the diagnosis and monitoring of PCV. Recent advances in imaging technology including the use of high resolution spectral domain optical coherence tomography (OCT) and OCT angiography have provided new insights on the pathogenesis of PCV, suggesting a link between PCV and pachychoroid spectrum of macular disorders. With the evolving understanding on the pathogenesis and clinical characteristics of PCV, different therapeutic options have been proposed. These include intravitreal anti-vascular endothelial growth factor (anti-VEGF) monotherapy, combination therapy with anti-VEGF and verteporfin photodynamic therapy, and thermal laser photocoagulation. In recent years, major multi-center randomized clinical trials such as EVEREST, EVEREST II, and PLANET studies have been conducted to compare the efficacy and safety of various treatment options for PCV. This review aims to summarize the results of recent literature, clinical trials and studies to provide an update on the management options of PCV. An overall management strategy for PCV will also be proposed.
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PURPOSE: To evaluate the effects of intravitreal aflibercept injection in the treatment of submacular hemorrhage secondary to neovascular age-related macular degeneration (nAMD). METHODS: This retrospective, observational study included patients diagnosed with nAMD with submacular hemorrhage treated with intravitreal aflibercept monotherapy. A total of 54 eyes of 54 patients were treated with an initial series of three monthly intravitreal aflibercept injections followed by as-needed injections. At the 6 month follow-up, changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and submacular hemorrhage area (SMH) were evaluated. RESULTS: The mean preoperative BCVA was 0.79 ± 0.59 logMAR, which improved significantly to 0.53 ± 0.46 logMAR at 3 months and 0.48 ± 0.50 logMAR at 6 months (p < 0.001, in both). The CMT significantly decreased in all eyes: preoperative, 454.4 ± 131.5 µm, to 242.6 ± 39.7 µm at 6 months. The SMH was also reduced in all eyes: preoperative, 6.4 ± 4.8 disc areas (DAs) to 0.8 ± 1.4 DAs at 6 months. Ten eyes were diagnosed with typical nAMD (18.5%) and 44 eyes were diagnosed polypoidal choroidal vasculopathy (81.5%). There was no significant difference at 6 months in the visual outcomes of the subgroups. CONCLUSIONS: Intravitreal aflibercept monotherapy is well-tolerated as a treatment in maintaining or improving vision in patients with SMH secondary to nAMD.
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Humans , Choroid , Follow-Up Studies , Hemorrhage , Macular Degeneration , Observational Study , Retrospective Studies , Visual AcuityABSTRACT
@#AIM: To investigate the correlations between aqueous concentrations of bone morphogenetic protein 6(BMP-6), interleukin 6(IL-6), and vascular endothelial growth factor(VEGF)and the parameters of macular edema acquired by optical coherence tomography(OCT)in patients with neovascular age-related macular degeneration(nARMD). <p>METHODS: Totally 35 eyes from 34 patients with nARMD were studied. Twenty eyes from 20 patients with no retinal pathology who underwent cataract surgery served as controls. The central subfield macular thickness(CSMT)of nARMD within 1 mm was measured with OCT. Aqueous humor samples were collected just before intravitreal ranibizumab injection in 35 eyes with nARMD and before cataract surgery in 20 control eyes. Concentration of BMP-6 were determined by ELISA. IL-6, VEGF were measured by cytometric bead array(CBA). <p>RESULTS: The level of BMP-6 in aqueous humor of patients with nARMD(35.29±4.27pg/mL)was significantly lower than that of control eyes(62.04±2.78pg/mL, <i>P</i><0.05), while VEGF level was 93.13±47.25pg/mL, significantly higher than that of the control group 69.21±13.40pg/mL(<i>P</i><0.05). The level of IL-6 was not significantly different between the two groups. BMP-6 was negatively correlated with CSMT(<i>r</i>=-0.409, <i>P</i>=0.015). <p>CONCLUSION: Aqueous humor concentrations of BMP-6 are decreased in eyes with nARMD. Aqueous humor concentrations of VEGF are elevated in eyes with nARMD. BMP-6 could be associated with the pathogenesis of nARMD.
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@#AIM: To analyze the characteristics of choroidal neovascularization(CNV)in neovascular age-related macular degeneration(nARMD)patients and the outcome of intravitreal anti-vascular endothelial growth factor(VEGF)treatment by using optical coherence tomography angiography(OCTA). <p>METHODS: A prospective cohort study was carried out, which included 37 eyes of 29 patients with nARMD in West China Hospital during May to December 2017. OCTA scans was conducted to all patients before treatment, 1d, 1wk, 1mo and 3-6mo after treatment. The analysis was performed to evaluate the morphological characteristics, lesion area, parafoveal superficial vessel density and perfusion area of CNV before and after treatment. <p>RESULTS: Among all the subjects, immature structure, small branches, and capillaries responded well to anti-VEGF treatment. Compared with the mean lesion area in nARMD patients before treatment(1.27±1.88mm<sup>2</sup>), there was significant reduction(1.13±1.79 mm<sup>2</sup>)1d after treatment, which meant CNV lesion decreased 1d after treatment, and stabilized 1mo later(<i>P</i>=0.001). Obvious decrease was observed both in parafoveal superficial vessel density(<i>P</i>=0.003)and perfusion area(<i>P</i>=0.015)3mo after treatment in nARMD patients. <p>CONCLUSION: OCTA, a non-invasive diagnostic examination, clearly identified tiny structures of CNV, quantified the lesion area and displayed specific vasculature in nARMD patients. Furthermore, retinal microcirculation can be detected using OCTA, which provides an effective approach of monitoring the progression and treatment effect of nARMD.
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Objetivo: Exponer la experiencia local sobre el tratamiento de las enfermedades retinales con terapias anti factor de crecimiento endotelial vascular (anti-VEGF) y crear conciencia en relación con la atención centrada en el paciente reconociendo el papel de los médicos especialistas en la determinación del tratamiento más apropiado basado principalmente en la evidencia científica, pero también teniendo en cuenta la experiencia y práctica exitosas en el manejo de cada paciente, con base en sus características únicas e individuales. Método: Revisión y comparación de la literatura científica con la experiencia de los autores, en el diagnóstico y tratamiento de las enfermedades que involucran inyecciones intraoculares, haciendo especial énfasis en la degeneración macular relacionada con la edad neo vascular (DMRE-NV), el edema macular diabético (EMD), la retinopatía diabética (RD), edema macular por oclusión venosa de rama de vena central de la retina (ORVR), la oclusión de vena central de la retina (OVCR) y la neo vascularización sub retiniana asociada a miopía patológica (MP). Resultados: la revisión realizada reafirma que tanto cuando hablamos de clases de medicamentos, de algoritmos de tratamiento o de perfiles de paciente, los diferentes agentes de una misma clase terapéutica pueden tener eficacias o perfiles de seguridad variables. Se debe considerar la importancia clínica que representa la valoración adecuada de los resultados pos tratamiento, pero sobre todo, la selección cuidadosa para determinar el agente y esquema más apropiado en la intención de tratar a un paciente. Si bien existen recomendaciones y guías de tratamiento para las patologías, los protocolos en el manejo individualizado y la exposición de estas experiencias de vida real se hacen necesarios, ya que no todos los pacientes ni todas las enfermedades de la retina responden de igual forma a cada agente terapéutico. Conclusión: La efi cacia y seguridad en el uso de las terapias anti-VEGF son aspectos de suma importancia cuando se trata de proporcionar una atención verdaderamente centrada en el paciente. No hay ninguna solución, intervención o alternativa terapéutica que se ajuste a todas las enfermedades oculares complejas, por lo que es importante hacer un balance que considere la evidencia disponible, la experiencia, y las expectativas de los pacientes y tratantes. Esto permitirá acceder a las alternativas terapéuticas adecuadas, en el momento adecuado siempre teniendo en mente los perfiles de eficacia, seguridad, farmacovigilancia activa y los costos asociados a las alternativas terapéuticas utilizadas en el país.
Purpose: To display local experience on treatment for retinal diseases with anti-Vascular Endothelial Growth Factor (anti-VEGF) therapies and to raise awareness regarding patient-centered care, recognizing the role of medical specialists in determining the most appropriate treatment mainly based on scientific evidence, but also considering the successful experience and practice handling each patient, based on their unique and individual characteristics. Method: Review and comparison of scientific literature according to the authors experience to diagnose and treat diseases involving intraocular injections, focusing on Neovascular Age-related Macular Degeneration (NV-AMD), Diabetic Macular Edema (DME), Diabetic Retinopathy (DR), Macular Edema due to Branch Retinal Vein Occlusion (BRVO), Central Retinal Vein Occlusion (CRVO) and Sub-retinal Neovascularization associated with Pathological Myopia (PM). Results: the review confi rms that, when speaking of drug classes, treatment algorithms or patient profi les, diff erent agents of the same therapeutic class can result in variable efficacies or safety profiles. The clinical relevance represented by the adequate assessment of post-treatment results must be considered, but specially, the careful screening to determine the most appropriate agent and regimen in the intention-to-treat a patient. Th ough recommendations and treatment guidelines for pathologies exist, protocols in individualized management and exposure of these real-life experiences are necessary, since not all patients or all retinal diseases respond in the same way to each therapeutic agent. Conclusion: Efficacy and safety using anti-VEGF therapies are extremely important when it comes to providing truly patient-centered care. There is no therapeutic solution, intervention or alternative that fi ts all complex ocular diseases, so it is important to weigh the available evidence, the experience and the expectations of both patients and prescribers. Th is will allow to get access to the appropriate therapeutic alternatives, in a timely manner, always considering the efficacy and safety profiles, active pharmacovigilance and the costs associated with the therapeutic alternatives used locally.
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Retinal Diseases/therapy , Education of Visually Disabled , Eye Diseases/therapy , Injections, Intraocular , Vascular Endothelial Growth Factor A/therapeutic useABSTRACT
AIM: To evaluate visual acuity outcomes after phacoemulsification and intraocular lens implantation in patients with wet age-related macular degeneration (wAMD).METHODS: We reviewed the medical documents of the patients who underwent phacoemulsification and intraocular lens implantation surgery during June 2013 and January 2016.Totally 61 eyes of 48 patients with wAMD in the stable stage were recruited.The pre-and post-operative vision of selected cases were recorded and compared.RESULTS: After phacoemulsification and intralocular lens implantation, visual acuity changes were as follows: 49 eyes improved, 11 eyes retained, and 1 eye deteriorated.Visual acuity improvement after cataract surger were statistically significant (P<0.001).Visual acuity improvement was not related to age.CONCLUSION: Visual acuity improved in patients with wet AMD after phacoemulcification and intraocular lens implantation.
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PURPOSE: To investigate the correlation between hyperreflective foci (HF) on spectral domain optical coherence tomography (SD-OCT) at baseline and visual outcomes after intravitreal ranibizumab injection in neovascular age-related macular degeneration (nAMD). METHODS: We retrospectively reviewed the medical records of 44 eyes of 44 nAMD patients. The number of HF was counted according to the location of HF on SD-OCT: neurosensory retinal layer, outer retinal layer, and subretinal layer. Statistical correlations among final visual acuity (VA) and pretreatment OCT parameters including number of HF, foveal thickness (FT), thickness of choroidal neovascularization (CNV), the status of external limiting membrane, and photoreceptor inner and outer segments (IS/OS) were evaluated. RESULTS: The number of HF was reduced in all retinal layers in nAMD patients after treatment. In multivariate regression analysis, final VA was associated with baseline VA, number of subretinal HF, and IS/OS disruption length (p = 0.028, p = 0.046 and p = 0.009, respectively) in nAMD patients. The baseline number of subretinal HF was correlated with final FT and CNV thickness (p = 0.002 and p = 0.009, respectively). CONCLUSIONS: The baseline number of subretinal HF on SD-OCT might predict the final VA after intravitreal ranibizumab treatment in nAMD patients.
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Humans , Choroidal Neovascularization , Macular Degeneration , Medical Records , Membranes , Retinaldehyde , Retrospective Studies , Tomography, Optical Coherence , Visual Acuity , RanibizumabABSTRACT
PURPOSE: To evaluate outcomes of intravitreal aflibercept in cases resistant to bevacizumab and ranibizumab in neovascular age-related macular degeneration. METHODS: Twenty patients with neovascular age-related macular generation who were resistant to treatment with bevacizumab and ranibizumab were evaluated. After switching to aflibercept the best corrected visual acuity (BCVA) and central retinal thickness (CRT) were compared at baseline and at 1 month after injection. Additionally, changes in the intraretinal fluid, subretinal fluid and pigment epithelial detachment were evaluated. RESULTS: The mean BCVA was 0.83 +/- 0.56 log MAR and the mean CRT was 294.20 +/- 12.99 microm before aflibercept treatment. After switching to aflibercept the mean BCVA was 0.86 +/- 0.61 log MAR with no statistical difference (p = 0.406) and the mean CRT was decreased to 232.45 +/- 12.05 microm (p = 0.011). After 1 month of aflibercept injections, a reduction of intraretinal fluid in 4 eyes (80%), reduction of subretinal fluid in 11 eyes (78.6%) and reduction of pigment epithelial detachment in 5 eyes (50%) were observed. Increases in fluid or new lesions were not observed. CONCLUSIONS: Aflibercept injection appears beneficial in patients with neovascular age-related macular generation who are resistant to bavacizumab and ranibizumab treatment.
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Humans , Macular Degeneration , Retinaldehyde , Subretinal Fluid , Visual Acuity , Bevacizumab , RanibizumabABSTRACT
PURPOSE: To investigate the effects of vitreomacular traction (VMT) on ranibizumab treatment response for neovascular age-related macular degeneration (AMD). METHODS: A retrospective review of 85 eyes of 85 patients newly diagnosed with neovascular AMD was conducted. Patients were eligible if they had received more than three consecutive monthly ranibizumab (0.50 mg) treatments and ophthalmic evaluations. Patients were classified into a VMT (+) group or VMT (-) group according to optical coherence tomography imaging. Best corrected visual acuity and central retinal thickness (CRT) measurements were obtained at three and six months after initial injection. RESULTS: One month after the third injection, mean visual acuity (VA) increases of 6.36 and 9.87 letters were observed in the VMT (+) and VMT (-) groups, respectively. The corresponding mean CRT values decreased by 70.29 microm and 121.68 microm, respectively. A total 41 eyes were identified as eligible for a subsequent fourth injection; 71.1% of patients (27 eyes) in the VMT (+) group but only 29.8% of patients in the VMT (-) group needed a subsequent fourth injection. Follow-up was extended to six months for 42 of the 85 enrolled patients (49.4%). The trends in VA and optical coherence tomography were found to be maintained at six-month follow-up. CONCLUSIONS: VA and CRT appeared to be more improved after ranibizumab treatment in the VMT (-) group compared to the VMT (+) group. VMT might antagonize the effect of ranibizumab treatment in a subpopulation of AMD patients.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Angiogenesis Inhibitors/therapeutic use , Follow-Up Studies , Intravitreal Injections , Ranibizumab/therapeutic use , Retina/pathology , Retinal Diseases/physiopathology , Retrospective Studies , Tissue Adhesions , Tomography, Optical Coherence , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Visual Acuity/drug effects , Vitreous Body/pathology , Wet Macular Degeneration/drug therapyABSTRACT
Introduction: Optical coherence tomography (OCT) is a commonly used imaging modality that provides detailed cross‑sectional retinal images. This has revolutionised management of neovascular age‑related macular degeneration. The need for repeated anti‑vascular endothelial growth factor injections has led to therapy being delivered using OCT‑guided retreatment strategies with both qualitative OCT features of disease activity (e.g. macular fluid) and changes in retinal thickness as triggers for retreatment The purpose of this study is to determine the intra‑session repeatability of retinal thickness and volume measurements using the Topcon 3DOCT‑1000 spectral‑domain optical coherence tomography (SDOCT) device in patients with neovascular age‑related macular degeneration (nAMD). This is the largest study to date looking specifically at the Topcon 3DOCT‑1000. Materials and Methods: Two SDOCT raster scans were performed by the same blinded observer in the same sitting in consecutive patients attending for nAMD treatment as part of standard validation of a new device. Retrospective analysis was undertaken, with retinal thickness and volume measurements automatically calculated by the onboard software for each Early Treatment of Diabetic Retinopathy Study subfield for each scan. Bland‑Altman methods of analysis were used to assess repeatability. Results: Data from the 73 patients were analyzed with a mean age of 78 years (standard deviation 8). The 95% coefficient of repeatability (CR) was 64 μm and 0.050 mm3 for retinal thickness and volume respectively in the central 1 mm macular subfield. The CR did not exceed 85 μm (0.30 mm3) in any subfield. The revised CR for retinal thickness and volume for the subgroup of 37 patients with no segmentation error in the central 1 mm subfield was 53 μm and 0.050 mm3 respectively. Discussion: We report relatively modest intra‑sessional repeatability of SDOCT retinal thickness and volume metrics in patients with nAMD in a clinical setting. Though useful in detecting clinical change from measurement variability in clinical practice, these results suggest the precision of macular thickness measurement does not approach the theoretical resolution of SDOCT.
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Objective: To systematically collate and evaluate the evidence from recent SRs of bevacizumab for neo‑vascular age related macular degeneration. Materials and Methods: Literature searches were carried out in Medline, Embase, Cochrane databases for all systematic reviews (SRs) on the effectiveness of bevacizumab for neo‑vascular age related macular degeneration, published between 2000 and 2013. Titles and abstracts were assessed against the inclusion/exclusion criteria using Joanna Briggs Institute (JBI) study eligibility form. Data was extracted using the JBI data extraction form. The quality of the SRs was assessed using JBI critical appraisal checklist for SRs. Decisions on study eligibility and quality were made by two reviewers; any disagreements were resolved by discussion. Results: Nine relevant reviews were identified from 30 citations, of which 5 reviews fulfilled the review’s inclusion criteria. All 5 reviews showed bevacizumab to be effective for neovascular AMD in the short‑term when used alone or in combination with PDT or Pegaptanib. The average quality score of the reviews was 7; 95% confidence interval 6.2 to 7.8 (maximum possible quality score is 10). The selection and publication bias were not addressed in all included reviews. Three‑fifth of the reviews had a quality score of 7 or lower, these reviews had some methodological limitations, search strategies were only identified in 2 (40%) reviews, independent study selection and quality assessment of included studies (4 (80%)) were infrequently performed. Conclusion: Overall, the reviews on the effectiveness of intravitreal/systemic bevacizumab for neovascular age‑related macular generation (AMD) received good JBI quality scores (mean score = 7.0 points), with a few exceptions. The study also highlights the suboptimal reporting of SRs on this topic. Reviews with poor methodology may limit the validity of the reported results; hence efforts should be made to improve the design, reporting and publication of SRs across all journals.
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Purpose: To describe retinal changes during Spectral Domain Optical Coherence Tomography (SD-OCT) guided bevacizumab treatment for neovascular age- related macular degeneration (AMD). Se ings and Design: Single center observational study. Materials and Methods: We confi rmed wet AMD in 47 eyes of 45 patients by fl uorescein angiography and SD-OCT. After bevacizumab injection, we examined the patients at 4-week intervals. During each follow-up control, we performed SD-OCT and a complete ophthalmic examination. Criteria for reinjection were visual acuity loss of more than fi ve ETDRS le ers, and/or increase of central retinal thickness, sub-retinal fl uid, intra-retinal fl uid, pigment epithelium detachment. If reinjection criteria were not met, we advised the patient to return in 4 weeks’ time for the next scheduled follow-up. We used 3-dimensional SD-OCT to measure photoreceptor defects and sub-retinal fi brosis. The main effi cacy endpoints were the SD-OCT measurements of the size of photoreceptor defects, the size of external membrane defects and the central retinal thickness. Results: Over the 12 months study period, the percentage of scans in 3-D imaging mode showing visible defects of the junction between inner and outer segments of photoreceptors increased from 38.96 to 53.8%. The percentage of scans in 3-D imaging mode with visible sub-retinal fi brosis increased from 33 to 52% and mean central retinal thickness decreased from 333 μm (96-900 μm) to 272 μm (P = 0.011). Conclusion: In long-term anti- Vascular endothelial growth factor (VEGF) treatment for neovascular AMD, photoreceptor defects and fi brosis progress despite a decrease in central retinal thickness and improvements in visual acuity. We would encourage further discussion as to whether this is the natural course of the disease or a result of the treatment.
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PURPOSE: In neovascular age-related macular degeneration (AMD), it is reported that retinal nerve fiber layer (RNFL) thickness becomes gradually thinner due to degeneration of the outer retinal layer. To our knowledge, there is no previous report regarding RNFL thickness in patients with non-neovascular AMD. Therefore, in this study, we compared RNFL thickness in patients with non-neovascular AMD and normal controls. METHODS: Thirty-one eyes with AMD category 3a (AREDS research group), 11 eyes suffering foveal geographic atrophy AMD category 4a, and 31 age-matched normal eyes were evaluated. In every group, regional RNFL thickness (General, Temporal, Superotemporal, Superonasal, Superior, Nasal, Inferonasal, Inferotemporal, and Inferior) was measured using spectral domain optical coherence tomography (SD-OCT). RESULTS: There were no significant differences in age or intraocular pressure among the 3 groups. The mean best corrected visual acuity (BCVA) (log MAR) of the category 4a group was significantly decreased compared to those of the other 2 groups. The mean RNFL thickness in total area in the category 3a group, category 4a group, and normal control group was 99.5 +/- 14.0 microm, 99.3 +/- 9.4 microm, and 99.4 +/- 9.6 microm, respectively. The difference was not statistically significant. No other regional mean values of RNFL thickness in the three groups were significantly different. CONCLUSIONS: There was no significant difference in RNFL thickness between non-neovascular patients and the control group.
Subject(s)
Humans , Geographic Atrophy , Intraocular Pressure , Macular Degeneration , Nerve Fibers , Retinaldehyde , Tomography, Optical Coherence , Visual AcuityABSTRACT
Background: Recent reports indicated that the slope of the foveal depression influences the macular pigment (MP) spatial profile. MP has been shown to confer possible protection against age‑related macular degeneration (ARMD) because of its antioxidant properties. Aims: To study the configuration of foveal slope and the foveal thickness in fellow eyes of subjects with unilateral neovascular ARMD. Settings and design: Case‑control series. Materials and Methods: The study population consisted of 30 cases aged >50, who had unilateral choroidal neovascular membrane (CNVM) or disciform scar in the fellow eye and 29 controls aged >50, who had no sign of ARMD in the either eye. Using spectral‑domain optical coherence tomography, foveal thickness at different locations including the central subfield foveal thickness (CSFT) was noted. The foveal slopes were calculated in the six radial scans (between 0.25° and 1° retinal eccentricity) as well as the 3D scan. Results: Cases had a significantly higher CSFT when compared to controls (215.1 ± 36.19 μ vs. 193.0 ± 17.38 μ, P = 0.004). On the 3D scan, the cases had shallower superior (cases 1.32 ± 0.32 vs. controls 1.45 ± 0.13, P = 0.04) and temporal slopes (cases 1.27 ± 0.21 vs. controls 1.39 ± 0.12, P = 0.01) in comparison to the controls. Conclusions: We noted a shallower superior and temporal foveal slope and a higher CSFT in the fellow eyes of subjects with a unilateral neovascular ARMD. Prospective studies observing the development of CNVM in subjects with altered foveal slope might provide more information on this optical coherence tomography finding.