Seven-year outcomes following intensive anti-vascular endothelial growth factor therapy in patients with exudative age-related macular degeneration.

BACKGROUND: Anti-vascular endothelial growth factor (VEGF) therapy is currently the most effective therapy of exudative age-related macular degeneration (AMD). The aim of this study was to assess long-term benefits of intensive aflibercept and ranibizumab anti-VEGF therapy in patients with exudative AMD. METHODS: Two clinical trial sites recruited their original subjects for a re-evaluation 7 years after the baseline visit of the phase-3 Vascular Endothelial Growth Factor (VEGF) Trap-Eye: Investigation of Efficacy and Safety in Wet Age-Related Macular Degeneration (VIEW 2) trial. Forty-seven eyes of 47 patients with AMD originally treated with ranibizumab (14 eyes) or aflibercept (33 eyes) were included. RESULTS: Mean number of injections was 17.8 ± 3.0 during participation in the VIEW 2 trial. Fourteen of 47 (30%) eyes were given additional injections with a mean number of 5.7 ± 4.5 after the trial. At a mean follow-up time of 82 ± 5 months best corrected visual acuity (BCVA) remained stable or improved (≤ 10 letters lost) in 55% of patients in the entire study population, in 43% in the ranibizumab group and in 60% in the aflibercept group. In both groups combined mean BCVA was 54 ± 13 letters at baseline, 65 ± 17 letters at the end of the intensive phase and 45 ± 25 letters at the end of follow-up. There was no statistically significant difference in BCVA between the two groups at baseline (p = 0.88) and at the end of follow-up (p = 0.40). Macular atrophy was observed in 96% of eyes, average area was 7.22 ± 6.31 mm2 with no statistically significant difference between groups (p = 0.47). Correlation between BCVA at end-of-follow-up and the area of atrophy was significant (p < 0.001). At the end of follow-up, fluid was detected in 7 of 47 eyes (15%) indicating disease activity. CONCLUSION: Long-term efficacy of aflibercept and ranibizumab was largely consistent. Following a two-year intensive therapy with as-needed regimen, BCVA was maintained or improved in almost half of the patients and in the ranibizumab group and more than half of the patients in the aflibercept group with very few injections. In a remarkable proportion of eyes, BCVA declined severely which underlines the need for long-term follow-ups and may indicate a more prolonged intensive therapy. TRIAL REGISTRATIONS: VIEW 2 study: ClinicalTrials.gov ID: NCT00637377, date of registration: March 18, 2008. Long-term follow-up: IRB nr.: SE RKEB 168/2022, ClinicalTrials.gov ID: NCT05678517, date of registration: December 28, 2022, retrospectively registered.

[Intravitreal ranibizumab therapy for choroidal neovascularization secondary to pathological myopia]. / Patológiás myopia talaján kialakult érújdonképzodés intravitrealis ranibizumabkezelése.

INTRODUCTION: Pathological myopia is one of the leading causes of vision loss worldwide, especially among young people of working age. Choroidal neovascularization is one of the most important cause of visual impairment in pathological myopia. AIM: To evaluate the efficacy of intravitreal ranibizumab for the treatment of myopic choroidal neovascularization. METHOD: In this retrospective analysis 14 eyes of 14 patients (mean age: 61 ± 17 years) with myopic choroidal neovascularization were treated with intravitreal ranibizumab as needed. Best-corrected visual acuity, thickness of choroidal neovascularization lesion and the number of injections were assessed. RESULTS: The mean visual acuity changed from 55.8 ± 19.3 letters to 64.8 + 15.5 at 12 months (p = 0.0414), and 62.6 ± 16.3 during follow-up time (p = 0.2896). Mean follow-up time was 19.7 ± 23.9 months, average number of injections was 2.8 ± 2.1. Visual acuity declined in four patients despite the treatment. CONCLUSIONS: Intravitreal ranibizumab is an effective therapy in pathological myopia. Some patients experience deterioration of visual acuity despite of treatment. Orv. Hetil., 2017, 158(15), 579-586.

[Angiography of the ocular fundus without dye: Optical coherence tomography based angiography in exsudative age-related macular degeneration]. / Szemfenéki érfestés festék nélkül: Az optikai koherencia tomográfia alapú angiográfia exsudativ típusú idoskori maculadegenerációban.

INTRODUCTION: Vascular endothelial growth factor antibody therapy is an established treatment of exsudative age-related macular degeneration. AIM: The morphologic characterisation of the macular microvasculature after longstanding treatment. METHOD: Forty-eight patients (34 women and 14 men; age, 74.4 ± 8.0 years) were enrolled in the study. During follow-up time (53.8 ± 31.0 months), 7.6 ± 4.9 injections were administered in 56 eyes. Optical coherence tomography angiographic examination was performed with AngioVue (Optovue Inc. Fremont, CA, USA). RESULTS: Distortion of the superficial retinal plexus and foveal avascular zone enlargement were noted in 5/56 eyes, deep retinal plexus defect was detected in 9/56 cases. Destruction of the choriocapillaries and the former neovascularisation could be found in 4 different patterns: 1. pigment epithelium and choriocapillary atrophy, 2. submacular scar, 3. active leaking choroidal neovascularisation, 4. intraretinal cysts. CONCLUSION: Optical coherence tomography angiography is a novel non-invasive method, which enables the follow up of macular degeneration. Orv. Hetil., 2016, 157(42), 1683-1690.

Very high frequency ultrasound biometry of the anterior and posterior chamber diameter.

PURPOSE: To measure the largest diameter of the anterior chamber (AC) and posterior chamber (PC) dimension and its orientation and determine the relationship with the principal keratometric meridians. METHODS: Twenty-eight eyes of 14 subjects were scanned with high frequency (50 MHz) ultrasound in sequential meridional scan planes at 30 degrees increments. Observer identified angle and ciliary sulcus recess boundaries in each patient scan set were fit with an elliptical model to obtain the ellipse semi-major axis corresponding to the largest diameter and its meridional orientation. Anterior and posterior chamber diameters from raw data and model fit were compared using linear statistics. Circular statistics were used to compare the orientation of the largest diameter for raw ultrasound measurements, model estimations of largest diameter, and autorefractor determined keratometric axes. RESULTS: The mean model diameters were anterior chamber OD 12.07 mm (0.32 SD); anterior chamber OS 12.06 mm (0.36 SD); posterior chamber OD 12.35 mm (0.42 SD); posterior chamber OS 12.33 mm (0.43 SD). The general trend for orientation of the meridian of largest diameter was in the horizontal meridian. In over 35% of eyes the difference between AC or PC meridian and the flat keratometric axis was greater than 20 degrees. CONCLUSIONS: Accurate and reproducible anterior segment biometry depends on visualization of structures and minimization of eye and head movement error. The range and standard deviation of the diameter and orientation measures suggests anatomic variation is sufficient to require biometry for proper sizing and placement of intraocular devices that use angle or sulcus fixation.

The diameters of the human retinal branch vessels do not change in darkness.

PURPOSE: To examine whether the diameters of retinal branch vessels of the human eye change during dark and light adaptation. METHODS: Images (S-VHS recordings) were obtained of the peripapillary region in 11 eyes of 11 healthy young adults (seven women, four men; mean age, 26.4 years). The images were made under a sequence of different illumination conditions (light, 30 minutes of darkness, light) with a scanning laser ophthalmoscope (SLO), using near-infrared illumination (785 nm). The recordings were then analyzed with a retinal vessel analyzer (RVA), and the caliber changes of one branch artery and one vein were measured in each eye. RESULTS: For arteries, the changes of diameter under different illumination conditions showed no clear trend, and comparisons between the different time sections revealed no statistically significant changes (P = 0.933; repeated measures ANOVA). There was a slight dilation (average, 0.9%; range, -3.9% to +5.1%) in darkness, and a return to baseline (range, -2.9% to + 2.9%) on restoring normal illumination. Veins during darkness showed a small but fairly consistent constriction (average, 1.5%; range -5.4% to +3.9%; significant P = 0.05), again returning to baseline (range, -2.1% to +2.6%) in normal light. CONCLUSIONS: The small changes of retinal branch vessel diameters under different light conditions probably have little influence on the possible changes of retinal blood flow in healthy subjects.