Optical coherence tomographic and visual results at six months after transitioning to aflibercept for patients on prior ranibizumab or bevacizumab treatment for exudative age-related macular degeneration (an American Ophthalmological Society thesis).

PURPOSE: To study optical coherence tomographic (OCT) results and vision at 6 months after transition (post-Tx) from intravitreal bevacizumab and/or ranibizumab to aflibercept for treatment of neovascular age-related macular degeneration (nAMD). The null hypothesis was the lack of improvements in OCT metrics and vision outcome in study eyes at 6 months after transitioning from bevacizumab or ranibizumab to aflibercept. METHODS: This retrospective study assessed 6 monthly OCT (Cirrus) data after transitioning to aflibercept for eyes on prior Legacy-ranibizumab, Legacy-bevacizumab, or mixed treatment for nAMD. Outcome measures were subretinal fluid (SRF), cystoid macular edema (CME), pigment epithelial detachment (PED) heights and volumes, central 1- and 3-mm subfield, Macular Volume, and best spectacle and pinhole visual acuity (VA). A single masked investigator performed all OCT measurements. RESULTS: One hundred eighty-nine eyes in 172 patients in Legacy-bevacizumab (95 eyes), Legacy-ranibizumab (84 eyes), or Mixed Group(10 eyes) were switched to aflibercept and followed for 6 months. Significant post-Tx reductions were noted in SRF/CME heights and volumes (all P<.001). Similar findings were noted for PED heights (122.8 µm vs 79.4 µm) and PED volumes (all P<.001). Post-Tx VA was better (20/43 vs 20/51, P<.001). There were no differences between Legacy-bevacizumab and Legacy-ranibizumab groups in OCT and VA changes. Post-Tx VA, SRF/CME, and PED heights and volumes were improved for Nonresponders (suboptimal response to bevacizumab/ranibizumab) (P=.001 to <.001), but not Responders (good responses to same). The only adverse event was a retinal pigment epithelial tear in one eye. CONCLUSIONS: Significant improvements in vision and OCT metrics developed in Nonresponders but not in Responders. Post-Tx VA and OCT measures were similar for eyes on prior bevacizumab or ranibizumab. Post-Tx adverse events were uncommon.

The evolving treatment options for diabetic macular edema.

Diabetic retinopathy (DR) is the leading cause of vision loss in working-age adults, and diabetic macular edema (DME) is the most common cause of visual impairment in individuals with DR. This review focuses on the pathophysiology, previous treatment paradigms, and emerging treatment options in the management of DME.

Anti-VEGF response in macular hemorrhage and incidence of retinal pigment epithelial tears.

OBJECTIVE: To study the visual and anatomic outcomes of serial anti-vascular endothelial growth factor (anti-VEGF) therapy for severe macular hemorrhage in eyes with exudative age-related macular degeneration (AMD). DESIGN: Consecutive retrospective analysis. PARTICIPANTS: Twenty eyes from 20 patients with severe macular hemorrhage (greater than 50% blockage with formal fluorescein angiography [FA]) secondary to wet AMD were studied. METHODS: We performed a chart review of patients at a single centre from May 2006 to September 2009. Presenting visual acuity and diameter of hemorrhage were recorded as well as number of injections, time by which no hemorrhage was remaining, and final anatomic outcome. Cardiovascular risk factors and use of antiplatelet medication or anticoagulation were noted. RESULTS: Average presenting visual acuity was 1.55 (20/710), and number of injections needed for resolution of hemorrhage was 4. Visual acuity significantly improved from 1.55 (20/710) to 0.70 (20/100) after injections. Thirty-five percent of eyes were found to have an associated retinal pigment epithelial (RPE) tear, and these eyes were found to have received more injections. Final visual acuity was not significantly different in eyes with RPE tears compared with nontear eyes. Eighty-one percent of patients had associated cardiovascular risk factors; antiplatelet therapy and anticoagulation were not found to play a role in hemorrhage size. CONCLUSIONS: RPE tears are found in a significant number of individuals with large macular hemorrhages secondary to exudative macular degeneration, but with continued treatment with anti-VEGF therapy, visual acuity can significantly improve even in the presence of these tears. Eyes with severe macular hemorrhage thus should be considered candidates for anti-VEGF therapy.

Sonoporation enhances chemotherapeutic efficacy in retinoblastoma cells in vitro.

PURPOSE: To study the ability of ultrasound (US) and microbubbles (MB) to enhance chemotherapeutic efficacy against retinoblastoma Y79 cells in vitro. METHODS: The experiment was performed in three stages. The authors first compared cell viability of Y79 cells exposed to doxorubicin versus cells exposed to doxorubicin combined with low-intensity, low-frequency US + MB. They then evaluated enhanced cell permeability by studying the intensity of intracellular fluorescence in cells exposed to doxorubicin versus those exposed to doxorubicin with US + MB. Lastly they evaluated the morphologic characteristics of the cells by scanning electron microscopy (SEM) to identify the presence of pores. RESULTS: The Y79 cells exposed to doxorubicin with US + MB showed a significant decrease in cell viability at 72 hours compared with those exposed to doxorubicin alone (P = 0.02). Cells also showed immediate increased permeability to doxorubicin with the addition of US + MB compared with doxorubicin alone, which continued to increase over 60 minutes. SEM did not demonstrate physical pores at the lowest US + MB intensity shown to enhance intracellular doxorubicin fluorescence. CONCLUSIONS: US + MB facilitates the uptake of chemotherapy in retinoblastoma Y79 cells in vitro. This occurs in the absence of visible pores, suggesting a possible secondary mechanism for increased drug delivery. This experiment is the first step toward enhancing chemotherapy with sonoporation in the treatment of intraocular tumors. This technique may lead to more effective chemotherapy treatments with less collateral damage to ocular tissues and may allow reduced systemic dosage and systemic side effects.