ABSTRACT
BACKGROUND AND OBJECTIVE: We compared assistance burden between neovascular age-related macular degeneration (nAMD) and retinal angiomatous proliferation (RAP) under intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment on a treat-and-extend (T&E) regimen in a third-level hospital in a developed country. PATIENTS AND METHODS: This retrospective study using data from the Fight Retinal Blindness! Registry included patients treated between January 2016 and December 2020. Final event was established as best corrected visual acuity (BCVA) lower than 20 Early Treatment Diabetic Retinopathy Study letters. According to choroidal neovascularization (CNV), three different study groups were established: type 1, 2, and 3. RESULTS: A total of 285 eyes of 227 patients were included. Mean age was 80.1 ± 6.5, 79.1 ± 7.9, and 81.2 ± 7.2 years, for the three study groups, respectively. Mean injections were 16.0 ± 4.8, 16.5 ± 4.1, and 14.1 ± 5.7, respectively; and mean number of visits were 17.9 ± 4.3, 18.2 ± 3.1, and 16.8 ± 5.3, respectively. No differences were found (P > 0.05). Survival curves and log-rank analysis also showed no differences (P = 0.344). Cox proportional hazard models showed that a lower baseline BCVA, subfoveal geographic atrophy (GA), and subfoveal fibrosis (SF) were associated with a higher risk of reaching ≤ 20 letters. CONCLUSIONS: nAMD and RAP under a T&E regimen indicate a high assistance burden during the first three years. The presence of subfoveal GA or SF are associated with a BCVA lower than 20 letters. [Ophthalmic Surg Lasers Imaging Retina 2024;55:197-203.].
Subject(s)
Angiogenesis Inhibitors , Intravitreal Injections , Visual Acuity , Wet Macular Degeneration , Humans , Retrospective Studies , Male , Female , Follow-Up Studies , Aged , Angiogenesis Inhibitors/administration & dosage , Angiogenesis Inhibitors/therapeutic use , Aged, 80 and over , Wet Macular Degeneration/diagnosis , Wet Macular Degeneration/drug therapy , Tomography, Optical Coherence/methods , Retinal Neovascularization/diagnosis , Retinal Neovascularization/drug therapy , Ranibizumab/administration & dosage , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Fluorescein Angiography/methods , Time FactorsABSTRACT
PURPOSE: The aim of this report is to describe the resolution of refractory cystoid macular edema (CME) associated to retinitis pigmentosa (RP) with intravenous tocilizumab in three patients. METHODS: Retrospective study of a series of consecutive cases of patients treated with off-label intravenous tocilizumab (anti IL6) for CME refractory to acetazolamide 250 mg for 3 months. Patients were diagnosed with RP by fundus appearance, electrophysiology, visual fields, and genetic testing. A complete ophthalmic examination, including spectral domain optical coherence tomography (SD-OCT) was performed. PATIENTS: Three patients with RP and CME refractory to acetazolamide 250 mg for 3 months were treated with monthly intravenous tocilizumab for at least six months. RESULTS: All patients resolved CME and improved visual acuity after the third month of intravenous tocilizumab, resolving systemic and ocular adverse events related to previous treatments for CME. Tocilizumab was well tolerated with no other adverse events. DISCUSSION: CME causes visual impairment in RP, but current treatments are usually deficient. Tocilizumab has been successfully used as treatment for refractory CME in uveitis, retinal dystrophies, and autoimmune retinopathies. This article reports, for the first time, the long-term resolution of refractory CME in RP with intravenous tocilizumab.
