Retinal layers measurements in healthy eyes and in eyes receiving silicone oil-based endotamponade.

PURPOSE: To characterize the concordance/symmetry of each retinal layers in individuals without macular pathology and to further characterize the localization of inner retinal thinning in eyes receiving silicone oil-based endotamponade. METHODS: Retinal layers of one hundred eyes of 50 individuals without macular pathology were imaged using spectral domain optical coherence tomography (SD-OCT) and manually segmented using ImageJ software (developed by Wayne Rasband, NIH, Bethesda, MD, USA). In the second part of the study, retrospective analysis of 3028 cases of pars plana vitrectomy in University Eye Hospital Cologne, Germany, was conducted, retrieving nine patients with silicone oil-based endotamponade with no macular condition interfering retinal layers measurements. These patients had retinal detachment not involving the macula due to various conditions. In these patients, retinal layer segmentation was performed and compared with the fellow eye. RESULTS: There is a moderate-to-high concordance for all retinal layers between the right and the left eye of the same individual. In eyes receiving silicone oil-based endotamponade, the inner retinal layers become subsequently thinner. Ganglion cell and inner plexiform layers contribute most to this thinning, that is, 0.537 ± 0.096 mm(3) compared with 0.742 ± 0.117 mm(3) ; p = 0.006. Outer retinal layers were not affected by silicone oil-based endotamponade (p = 0.439 for the differences of calculated outer retinal layers). CONCLUSION: Ganglion cell and inner retinal layers become subsequently thinner after the use of silicone oil-based endotamponade. This study advocates the use of spectral domain optical coherence tomography for patient management with silicone oil endotamponade to early detect subsequent retinal thinning.

Vascular endothelial growth factor suppression times in patients with diabetic macular oedema treated with ranibizumab.

BACKGROUND: To measure vascular endothelial growth factor (VEGF) levels in aqueous humour from patients with diabetic macular oedema (DME) treated with ranibizumab and to determine how long VEGF was suppressed. METHODS: In this nonrandomised, prospective clinical study, 17 eyes of 17 patients were included in the study. A total of 110 aqueous humour samples were taken before an intravitreal ranibizumab injection in patients with DME. VEGF-A was measured by Luminex multiplex bead analysis (Luminex Inc, USA). RESULTS: VEGF was completely suppressed in all patients after ranibizumab injections for a mean of 33.7 days (SD±5.1, range 27-42, median 34). VEGF suppression times were individually stable during the observation time of up to 16 months. There was no statistically significant difference of VEGF levels at baseline and before the beginning of a new injection series (123.6 pg/mL vs 125.1 pg/mL; p=1.0, Wilcoxon). CONCLUSIONS: Monthly ranibizumab injections lead to a complete VEGF suppression in patients with DME. The long-term stability and the range of suppression times among individuals suggest that some patients could benefit from individual injection intervals.

Patient preference of ranibizumab treatment regimen for neovascular age-related macular degeneration - monthly injections versus pro re nata.

PURPOSE: To identify preference of treatment regimen in patients with anti-VEGF therapy for neovascular age-related macular degeneration (AMD) in real life. METHODS: A cross-sectional study was conducted in 200 patients receiving ranibizumab therapy on a pro re nata regimen with monthly controls. One hundred and twenty-four patients were recruited in a tertiary health care clinic, and 76 patients were recruited in a private practice. Patients were asked to respond to a 14-item questionnaire covering items such as treatment burden and preference for treatment: either monthly injections or pro re nata. RESULTS: Mean time under anti-VEGF treatment was 33.7 months, and the mean number of intravitreal injections was 17.7. Despite a high treatment burden in 60.3 % of patients, there was an acceptance rate for monthly examinations or injections of 93 %. The proportion of patients who favoured a PRN regimen was 53.0 %, whereas 37.9 % of patients favoured continuous injections. Major concern was recurrent disease activity in 54.5 %. CONCLUSION: We identified two groups of patients of considerable size who would prefer either monthly injections or as-required. Overall, there was a high acceptance rate despite a high treatment burden. Nevertheless, efforts should be undertaken to improve examination and injection procedures and to consider the patient's preference for a treatment regimen.

Adherence to ranibizumab treatment for neovascular age-related macular degeneration in real life.

BACKGROUND: To identify factors and problems influencing treatment adherence in patients undergoing anti-VEGF therapy for neovascular age-related macular degeneration (AMD) under real-life conditions. METHODS: Cross-sectional study was conducted of 95 patients receiving ranibizumab therapy on a pro re nata (PRN) regimen with monthly controls in a tertiary health care clinic. Monthly controls included best corrected visual acuity, slit-lamp examination and spectral-domain optical coherence tomography. Adherence was measured using Kaplan-Meier time-to-discontinuation analysis. Patients were asked to respond to a 16-item questionnaire covering items such as anxiety, subjective benefit, and financial issues of therapy. RESULTS: Forty-two men and 53 women were included. After a mean follow-up time of 675 days (range 63-1008), adherence was 81.1% (77/95). The mean number of follow-up visits was 19 (3-30), the mean number of intravitreal injections was ten (3-23). Seven patients withdrew from treatment due to subjective dissatisfaction with benefit. Other reasons for loss to follow-up were death in one case, serious general disease in three patients, and treatment options closer to home in five cases. Two patients cancelled further follow-up after treatment cessation due to terminal fibrosis. 62.1% of patients were afraid of a negative examination result, whereas 19.0% were afraid of intravitreal injections. A major problem was travel to and from the hospital (46.3%), with 61.5% of patients requiring escort. CONCLUSION: Despite necessary monthly visits, patients showed a high adherence to therapy. The major problem was travel to and from the hospital. From the patients' point of view, anxiety of a negative examination result was more pronounced than fear of intraocular injections, which would be an argument for continuous injections rather than for a PRN regimen.