Long-term effect of intravitreal injection of anti-VEGF agent for visual acuity and chorioretinal atrophy progression in myopic choroidal neovascularization

Purpose

To investigate the long-term visual prognosis and progression of chorioretinal atrophy in patients with myopic choroidal neovascularization (mCNV) treated with intravitreal injections of bevacizumab.

Methods

Hospital-based, retrospective, cross-sectional study. In total, 22 patients (22 eyes) with treatment-naïve mCNV who underwent intravitreal injection of bevacizumab and were followed up for more than 48 months were investigated. Visual acuity and fundus photographs before and 1, 2, 3, and 4 years after initial treatment in the clinics were compared and judged if chorioretinal atrophy (CRA) developed/enlarged or remained unchanged. The influence of clinical characteristics including age, sex, axial length, baseline visual acuity, CNV area, CNV location, and number of injections were investigated with logistic regression analysis.

Results

Mean logarithm of the minimum angle of resolution (logMAR) improved from 0.76 to 0.52 (P?<?.01), 0.48 (P?<?.01), and 0.54 (P?<?.05) after 1, 2, and 3 years, respectively. The effect slightly declined to marginally non-significant levels after 4 years (logMAR, 0.59; P?=?.07). CRA developed or enlarged in nine cases (41 %) in 1 year, reaching 16 cases (73 %) at the final visit. Those without CRA enlargement achieved better visual improvement. None of the aforementioned patient characteristics significantly affected CRA.

Conclusions

Anti-VEGF therapy for mCNV is effective for vision improvement in the long term. On the other hand, development or enlargement of CRA frequently occurred, and affected visual improvement. Strategies to manage atrophy should be the next step in achieving better visual outcome upon mCNV treatment.     

Summary of prognostic factors for choroidal neovascularization due to pathological myopia treated by intravitreal bevacizumab injection

Aim

This systematic review assesses the prognostic factors for intravitreal bevacizumab injection (IVB) in the treatment of choroidal neovascularization (CNV) due to pathological myopia.

Methods

The literature searches were performed in Ovid Medline, EMBASE and CENTRAL. Relevant studies with prognostic data on best corrected vision acuity (BCVA) after intravitreal bevacizumab injection were included for review. Two reviewers participated in the data retrieval and independently assessed each included study.

Results

A total 252 articles were retrieved, including 16 studies containing the most updated and complete data on prognostic factors for neovascularization due to pathological myopia treated by intravitreal bevacizumab injection. A great number of quantitative, clinical, and treatment-related factors were determined to have a positive influence on vision outcome after intravitreal bevacizumab.

Conclusion

A lower rate of development of chorioretinal atrophy, smaller pretreatment CNV size, and younger age were indentified as the most consistently significant prognostic factors affecting the efficacy of IVB in eyes of myopic CNV and were associated with improved BCVA. A worse BCVA after IVB in eyes with myopic CNV probably was associated with subfoveal CNV, lower baseline BCVA, longer duration of CNV, incomplete regression of CNV, subretinal hemorrhage, and previous PDT treatment. No apparent association were observed between the refraction error, axial length, lens status and change in BCVA after IVB. We indentified significant prognostic factors in this systematic review study that might allow for the selection of patients with myopic CNV which are most likely to benefit from IVB.     

Prognostic factors for visual outcomes 2-years after intravitreal bevacizumab for myopic choroidal neovascularization

Purpose

To determine the pre-treatment ocular factors significantly associated with the visual outcome 24 months after intravitreal bevacizumab (IVB) for myopic choroidal neovascularization (mCNV).

Methods

A total of 23 eyes of 23 patients with mCNV were treated with IVB followed by as needed therapy. The efficacy of IVB was evaluated by the best-corrected visual acuity (BCVA) at 24 months after the initial treatment. Forward stepwise multiple linear regression analyses were performed to evaluate the influence of pre-treatment factors on the BCVA and the improvement of the BCVA at 24 months.

Results

The mean pre-IVB BCVA was 0.74±0.30 logarithm of the minimum angle of resolution (logMAR) units, and it improved to 0.43±0.31 logMAR units after 1 month (P<0.001, paired t-test). The improvement was maintained at 24 months (0.46±0.40, P<0.005). The mean number of IVB performed during the 24 months was 1.35±0.71. Forward stepwise regression analysis showed that the pre-IVB CNV size (standardized β=0.52, P<0.01) and BCVA (standardized β=−0.44, P<0.05) significantly affected the visual acuity change after 24 months. The CNV size was the only factor that significantly affected the BCVA after 24 months (standardized β=0.56, P<0.01).

Conclusions

IVB with as needed therapy for mCNV led to a rapid and sustained visual improvement. Smaller CNV size was a significant prognostic factor that predicts better visual acuity. Patients with lower pre-treatment BCVA had better visual recovery than those with better pre-treatment BCVA, however, this may be due to a ceiling/floor effect.     

Bromfenac alone or with single intravitreal injection of bevacizumab or triamcinolone acetonide for treatment of uveitic macular edema

Purpose

To evaluate the efficacy of bromfenac drops alone or with a single intravitreal injection of bevacizumab (IVB) or triamcinolone acetonide (IVTA) in the treatment of uveitic macular edema (UME).

Design

Comparative case series.

Study Participant

Sixty-seven eyes (of 55 patients) with UME that received either bromfenac drops alone (n?=?34), IVB plus bromfenac (n?=?21) or IVTA plus bromfenac (n?=?12).

Methods

Chart review of patients at the Massachusetts Eye Research and Surgery Institution (MERSI) was done. Eyes that received either bromfenac drops alone (Br), IVB plus bromfenac (IVB/Br) or IVTA plus bromfenac (IVTA/Br), with follow-up of up to 3 months, were included.

Main Outcome Measure

Visual acuity.

Results

There was no statistically significant effect seen in VA or CMT in the Br group, with 17 of 34 eyes (50 %) needing re-injection before 3 months of follow-up. Mean change in CMT at 4 weeks for the Br group was 5.06 µm. Compared to baseline, both the IVTA/Br and IVB/Br groups showed significant decrease in CMT and improvement in VA at 1 and 3 months follow-up. There was also a continuous decrease in CMT up to 3 months of follow-up with the IVTA/Br group, which was found to be significant in comparison with the IVB/Br group; this trend was not seen in the IVB/Br group at 3 months. The greatest mean change in CMT at 1 month was seen in the IVTA/Br group (154.33 ±178.22 µm), and this was statistically significant in comparison with the other groups (p?=?<0.0001). However, in terms of mean change in VA, there was no change in the Br group (0.01?±?0.11 VA logMAR), and only 0.12?±?0.19 and 0.15?±?0.20 in the IVB/Br and IVTA/Br groups, respectively.

Conclusion

IVB and IVTA are both effective in improving VA and decreasing CMT up to 3 months. Bromfenac is ineffective alone for UME treatment, but may have a synergistic effect with IVTA in reducing CMT up to 3 months of follow-up.     

Intravitreal bevacizumab versus low-fluence photodynamic therapy for treatment of chronic central serous chorioretinopathy

Purpose

To report the effectiveness and safety of intravitreal bevacizumab injection (IVB) compared with low-fluence photodynamic therapy (L-PDT) in eyes with chronic central serous chorioretinopathy (CSC).

Methods

This was a prospective comparative interventional study of 22 patients affected by chronic CSC. Patients were randomly assigned to group 1 (12 patients treated with 1.25?mg IVB) and group 2 (10 patients treated with L-PDT). In group 2, PDT with verteporfin was delivered at low fluence (300?mW/cm² for 83?s, 25?J/cm²). Follow-up visits were scheduled at 1, 3, 6, and 9?months.

Results

The improvement in visual acuity was greater in group 1 than in group 2, although the difference was not statistically significant (P?=?0.59). The mean change in central point thickness over 9?months from baseline was 127?μm (SD 36) in group 1 and 114?μm (SD 42) in group 2. After the first injection, retreatments were given if recurrence was noted, with an average of 3.0?±?1 injections in group 1 and 1.6?±?0.6 treatments with L-PDT in group 2. The difference between retreatment in the 2 groups was not statistically significant (P?=?0.45).

Conclusions

Based on the results obtained after 9?months of follow-up, our study provides evidence that IVB may be a treatment option for chronic CSC.     

Changes in reticular pseudodrusen area in eyes that progressed from early to late age-related macular degeneration

Objective

This retrospective cohort study utilized 3 imaging modalities to analyze quantitatively reticular pseudodrusen (RPD) area changes in eyes that progressed from early to late age-related macular degeneration (AMD).

Methods

Subjects with AMD, unilateral choroidal neovascularization (CNV), and early AMD with RPD in the fellow eye (the study eye) were included. The study eyes underwent indocyanine green angiography (ICGA), near-infrared reflectance (NIR-R), and short-wavelength autofluorescence (AF) imaging of the macula at baseline and at follow-up. Study eyes were analyzed for RPD and for the development of late AMD–CNV and/or geographic atrophy (GA). RPD area was measured at baseline and at follow-up as a percentage of the 30-degree field.

Results

During the study period (mean follow-up time 23.5 ± 5.0 months), 12/31 study eyes developed CNV and 4/31 developed GA. In the eyes that developed CNV, there was a statistically significant decrease in mean RPD area over the follow-up period as seen on AF (P < 0.01) and NIR-R (P = 0.01), and the decrease in mean RPD area approached statistical significance on ICGA (P = 0.08).

Conclusion

Using 3 en face imaging techniques, we demonstrate that RPD undergo dynamic spatiotemporal changes in eyes that progress from early AMD to CNV, namely a decrease in the area of lesions detected.

     

Choroidal Neovascularization in Highly Myopic Eyes After Cataract Surgery

Purpose

To determine the incidence and characteristics of choroidal neovascularization (CNV) in patients with high myopia (≥8 diopters) who underwent cataract surgery in the Department of Ophthalmology, Tokyo Medical and Dental University, or the Ohno Eye Clinic, Tokyo, between September 1991 and March 2000.

Methods

The medical records of 35 patients (48 eyes) who underwent cataract surgery with phacoemulsification and intraocular lens implantation were studied retrospectively. The development of CNV over a 4-year follow-up period, and its characteristics were determined. All of the eyes had received a comprehensive ophthalmological examination, including best-corrected visual acuity measurements, anterior segment biomicroscopy, and a dilated fundus examination by stereoscopic observation.

Results

CNV was found in six eyes (12.5%) of six patients. The mean interval between cataract surgery and the development of CNV was 34 ± 17 months (range, 12–48 months). The CNV was subfoveal in all cases. The mean logarithm of the minimum angle of resolution (logMAR) after cataract surgery and before the appearance of CNV was 0.23 ± 0.24, and 0.93 ± 0.41 after the CNV appeared. This decrease was statistically significant (P = 0.0008, paired Student t test). Subfoveal CNV developed more frequently in eyes when the fellow eye showed evidence of CNV preoperatively (40.0%) than in eyes when the fellow eye exhibited no evidence of CNV (9.3%).

Conclusions

CNV developed in 12.5% of patients with high myopia after cataract surgery. CNV tended to develop more frequently when the fellow eye had CNV.?Jpn J Ophthalmol 2006;50:345–348 © Japanese Ophthalmological Society 2006     

Correlation between optical coherence tomographic hyperreflective foci and visual outcomes after intravitreal bevacizumab for macular edema in branch retinal vein occlusion

Purpose

To investigate the correlation between hyperreflective foci (HF) on spectral-domain optical coherence tomography at baseline and visual outcomes after intravitreal bevacizumab injection (IVB) in branch retinal vein occlusion.

Methods

We retrospectively studied 97 eyes of 97 patients with macular edema secondary to BRVO, who were treated with IVB. The eyes were divided into three groups according to the location of HF on SD-OCT: HF in outer retinal layers, HF in inner retinal layers, and no HF. The baseline and final best-corrected visual acuity (BCVA), foveal thickness (FT), external limiting membrane (ELM) status, junction between photoreceptor inner and outer segments (IS/OS) status, and the number of HF were evaluated and compared among three groups.

Results

Baseline BCVA was correlated with baseline FT (R?=?0.366, p?R?=??0.008, p?=?0.942). Baseline BCVA was significantly better in eyes with intact ELM at baseline (p?=?0.006), and final BCVA was significantly better in eyes with intact ELM and IS/OS at final visit (p?p?=?0.003 respectively). At the final visit, 15 of 37 eyes (40.5 %) with HF in outer retinal layers had a disrupted ELM (p?=?0.001), while 28 of 37 eyes (75.7 %) with HF in outer retinal layers had a disrupted IS/OS (p?p?Conclusions HF on SD-OCT at baseline might predict the photoreceptor status and final VA after IVB in BRVO.     

One-year results of bevacizumab intravitreal and posterior sub-Tenon injection of triamcinolone acetonide with reduced laser fluence photodynamic therapy for retinal angiomatous proliferation

Purpose

Our aim was to study the efficacy of combined triple therapy with intravitreal bevacizumab injections (IVB), posterior sub-Tenon injection of triamcinolone acetonide (STTA), and reduced laser fluence photodynamic therapy (RFPDT) in Japanese patients with retinal angiomatous proliferation (RAP).

Design

This was a retrospective, observational, consecutive case series.

Methods

Fifteen consecutive RAP treatment-na?ve eyes were treated with triple therapy of IVB, STTA, and RFPDT (25?J/cm² of laser fluence). Whenever there was a recurrence of retinal–retinal anastomosis (RRA) or retinal–choroidal anastomosis (RCA) and marked leakage from subretinal neovascularization, the triple therapy was reapplied. When there were only intraretinal exudative and/or hemorrhagic changes without distinct RRA or RCA, IVB alone was applied.

Results

The mean logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) at baseline improved significantly (from 0.489 to 0.294 12 months) (paired t test, p?=?0.043). LogMAR BCVA at 12?months was stable or improved by ≥0.2 in 14 eyes (93.3?%). Mean number of triple therapy instituted during the 12-month study period was 1.2, and mean number of IVB treatments was 1.4.

Conclusion

Combined IVB, STTA, and RFPDT for RAP was effective in maintaining or improving VA at 1?year. In addition, the number of treatments could be markedly reduced.     

Panretinal photocoagulation with simultaneous cryoretinopexy or intravitreal bevacizumab for neovascular glaucoma

Background

To compare the therapeutic effects of panretinal photocoagulation (PRP) combined with intravitreal bevacizumab (IVB) and cryoretinopexy (CR-IVB) to that of PRP combined with IVB alone in eyes with neovascular glaucoma (NVG).

Design

Retrospective, consecutive, case-control study.

Methods

The medical records of 102 eyes of 96 patients with NVG due to proliferative diabetic retinopathy, central retinal vein occlusion, and ocular ischemic syndrome were reviewed. The mean age of the patients was 59.6?±?11.5 years, with a range of 34 to 84 years. Patients received either 1.25 mg/0.05 ml of IVB combined with 360° of cryotherapy of the peripheral retina (CR-IVB subgroup) or IVB alone (IVB alone subgroup) as adjunctive treatments to PRP. The patients were followed for at least 12 months. Fifty-four eyes of 49 patients had open-angle NVG; 30 of these eyes were treated by CR-IVB, and 24 eyes by IVB alone. Forty-eight eyes of 48 patients had angle-closure NVG; 22 of these eyes were treated by CR-IVB, and 26 eyes were by IVB alone. Failure was defined as a postoperative intraocular pressure (IOP) >21 mmHg for two consecutive follow-up visits, or the need of additional surgery such as trabeculectomy or diode laser cycloablation. The differences in the success rates between the CR-IVB and IVB alone subgroups for the eyes with open-angle and closed-angle NVG were compared.

Results

The success rate at 12 months in eyes with open-angle NVG was 80.0 % in the CR-IVB subgroup and 41.7 % in the IVB alone subgroup (P?=?0.0096). In eyes with angle-closure NVG, the success rate at 12 months was 22.7 % in the CR-IVB subgroup and 0 % in the IVB-alone subgroup (P?=?0.030).

Conclusion

The significantly better IOP control after PRP combined with cryotherapy and IVB than after PRP with IVB alone indicates that cryotherapy enhances the effectiveness of PRP for neovascular glaucoma for at least 1 year.     

OAT mutations and clinical features in two Japanese brothers with gyrate atrophy of the choroid and retina

Background

Gyrate atrophy (GA) of the choroid and retina is an extremely rare inherited chorioretinal dystrophy. Ornithine aminotransferase (OAT) gene mutations are identified in patients with GA. The purpose of this study was to report a novel deletion mutation of the OAT gene and describe clinical features of two brothers with GA in a Japanese family.

Methods

We performed ophthalmic examinations, including best-corrected visual acuity, slit-lamp biomicroscopy, dilated funduscopy, fundus autofluorescence imaging, optical coherence tomography, visual field testing, and full-field electroretinography (ERG). Serum ornithine concentrations and OAT activities were analyzed. Mutation screening of the OAT gene was performed using Sanger sequencing.

Results

Both brothers had compound heterozygous mutations (p.K169DfsX10 and p.R426X), one of which was novel. Their unaffected parents carried one of the mutations heterozygously. An arginine-restricted diet was started in the younger brother at the age of 2 years, while the diet was not initiated in the older brother until the age of 6 years. After more than 15 years of follow-up, the dietary treatment seemed to slow the progression of the chorioretinal lesions in the younger brother. However, when compared at the same age, the younger brother had more reduced ERG amplitudes and constricted visual fields than his older brother.

Conclusions

We identified a novel frameshift mutation (p.K169DfsX10) in the OAT gene. While an early arginine-restricted dietary treatment suppressed the fundus changes of GA to some degree in the younger brother, the efficacy of suppressing the progression of visual function loss could not be clearly determined.     

Two-year results of combined intravitreal anti-VEGF agents and photodynamic therapy for retinal angiomatous proliferation

Purpose

To clarify the efficacy of a combination of intravitreal anti-vascular endothelial growth factor (VEGF) injections and photodynamic therapy (PDT), over 24 months, for patients with symptomatic retinal angiomatous proliferation (RAP).

Methods

We retrospectively reviewed 13 treatment-naïve eyes of 12 patients (7 men, 5 women; age range (mean), 63–92 (77) years) treated with intravitreal bevacizumab (IVB) plus PDT as initial treatment. Retreatment was performed with IVB plus PDT until February 2009 or intravitreal ranibizumab and PDT from March 2009.

Results

Mean best-corrected visual acuity (BCVA) significantly improved from 0.26 at baseline to 0.40 at 24 months (P = 0.013). The mean improvement in BCVA at 24 months from baseline was 1.79 lines. The central retinal thickness decreased significantly from 431 to 142 microns at 24 months (P < 0.0001). Complete occlusion of the retinal–retinal anastomosis was achieved in seven of the 10 eyes at 24 months. The mean number of PDT treatments during 24 months was 2.8 and the mean number of injections was 3.4. Geographic atrophy was seen in four eyes without significant decline of VA at 24 months.

Conclusion

Combined anti-VEGF and PDT for RAP patients effectively maintained or improved VA and reduced exudation, without severe adverse events, over 24 months.     

Extrafoveal changes following intravitreal bevacizumab injections for macular edema secondary to branch retinal vein occlusion: an mfERG and OCT study

Purpose

To evaluate the functional and structural changes of extrafoveal macula after intravitreal bevacizumab (IVB) injection in patients with macular edema due to branch retinal vein occlusion (BRVO) using multifocal electroretinogram (mfERG) and optical coherence tomography (OCT).

Methods

A total of 19 eyes of 19 patients with macular edema due to BRVO received three consecutive IVB injections with a 6-week interval. Spectral domain optical coherence tomography (SD-OCT), mfERG, and fluorescein angiography (FA) were performed at baseline. The macular area was divided into four quadrants (Q1–Q4) based on FA. The mean retinal thickness (MRT) and mfERG parameters in each of the four quadrants were measured at baseline and 4 weeks after the third injection.

Results

The MRT in the four quadrants improved significantly after IVB injections (p < 0.01 for Q1 and Q2, p < 0.05 for Q3 and Q4) compared to baseline. The significant improvements in mfERG responses were seen in Q1 and Q2. In Q1, there were 68 and 56 % improvement in N1 and P1 amplitude, respectively (p < 0.01). N1 and P1 amplitude in Q2 increased significantly by 43 and 46 %, respectively, compared to baseline (p < 0.05). The MRT and P1 amplitude were significantly correlated at baseline in Q1 and Q2, but no significant correlations were found after three IVB injections.

Conclusions

The injection of IVB improved functional and structural outcomes in the primarily affected half of the extrafoveal macula effectively. The measurements of structural and functional changes using mfERG and OCT may be appropriate for monitoring the effects of IVB injection in BRVO patients.     

Vascularized retinal pigment epithelial detachment in age-related macular degeneration: treatment and RPE tear incidence

Background

To review vascularized-pigment epithelial detachment (V-PED) treatment visual outcome, and to assess acute retinal pigment epithelium (RPE) tear incidence.

Methods

One hundred and thirty-two eyes of 125 consecutive patients with age-related macular degeneration and V-PED were included. Ninety-four eyes (71.2%) were associated with choroidal new vessels (CNV), 38 (28.8%) with retinal angiomatous proliferation (RAP). Patients, treated over a 10-year period with the time-current therapy, received: verteporfin photodynamic therapy (PDT) (group 1, 38 eyes), combined intravitreal triamcinolone acetonide (IVTA) and PDT (group 2, 44 eyes) or intravitreal anti-VEGF injection (bevacizumab or ranibizumab) (group 3, 50 eyes).

Results

Mean follow-up was 20.5?months. At month 12, all eyes treated with PDT or with IVTA and PDT showed a mean significant severe visual decrease. Eyes with CNV lost ?0.67 and ?0.37 logMAR (p?p?p?p?=?0.01 respectively). RPE tear occurred in 14 eyes (36.8%) and in six eyes (13.6%) in groups 1 and 2 respectively. Eyes treated with anti-VEGF therapy showed slight mean visual acuity decrease at month 12. Those with CNV had a mean baseline best-corrected visual acuity (BCVA) of 0.36 ±?0.24 logMAR, final of 0.44 ±?0.30 logMAR (?0.08 logMAR, n.s.). In eyes with RAP, mean baseline BCVA was 0.58 ±?0.39 logMAR, final was 0.78 ±?0.47 logMAR (?0.20 logMAR, n.s.). RPE tear occurred in 14 eyes (36.8%). Patients with either V-PED with CNV or a better baseline BCVA showed greater risk of acute RPE tear (p?=?0.01 and p?=?0.003 respectively).

Conclusions

Effective treatment for vascularized PED is still lacking. Until now, only stabilization of the disease has been achieved using anti-VEGF therapy, but the risk of RPE tear can further hamper our expectations. Baseline characteristics are helpful for prognosis, but patients must be informed of the uncertain response. New therapeutic strategies are needed.     

Comparison of observation, intravitreal bevacizumab, or pars plana vitrectomy for non-proliferative type 2 idiopathic macular telangiectasia

Purpose

To compare visual and anatomic outcomes in eyes with type 2 idiopathic macular telangiectasia (Mactel) treated with either intravitreal bevacizumab (IVB), observation, or pars plana vitrectomy (PPV) with internal limiting membrane removal.

Methods

Retrospective, consecutive, interventional case series of phakic patients with Mactel. Best-corrected Snellen visual acuity (BCVA) and complete ophthalmic exam was obtained prior to treatment and at subsequent 3-month intervals for a minimum of 6 months. Fluorescein angiographic and spectral-domain optical coherence tomography features were examined, and compared to BCVA at treatment initiation and follow-up.

Results

Fifty-six eyes of 28 patients were evaluated. Mean age was 65?±?12 years, and mean follow-up was 24?±?13 months. Patients were treated with either observation (n?=?33), IVB (n?=?15), or PPV (n?=?8). Mean number of treatments for the IVB group was 2.5?±?3.5 intravitreal injections. No significant differences in BCVA change were observed between treatment groups via one-way ANOVA (p?=?0.49). Presence of inner retinal cysts was not correlated to BCVA (p?>?0.05). Discontinuous outer nuclear layer was significantly related to worse initial and final vision, but not to BCVA change.

Conclusion

IVB and PPV with ILM removal appear ineffective in improving visual outcome in eyes with non-proliferative Mactel. SD-OCT evidence of disrupted foveal outer nuclear layer is related to decreased BCVA, but not related to BCVA change following treatment.     

Intravitreal Bevacizumab bei choroidaler Neovaskularisation infolge pathologischer Myopie

Purpose

The aim of this study was to evaluate the safety and efficacy of intravitreal bevacizumab as a treatment for choroidal neovascularization (mCNV) due to pathological myopia.

Methods

A consecutive series of 23 patients with mCNV treated with 1.25 mg intravitreal bevacizumab after being thoroughly informed about the off-label character of the treatment. Of the patients 6 received additional photodynamic therapy at the time of first injection. Reinjections were given every 6 weeks if intraretinal or subretinal fluid persisted.

Results

The pre-injection mean visual acuity (VA) was 0.25 (0.58 logMAR±0.36). During a follow up of 16.6±13.7 weeks 1.4±0.8 injections were given. Complete resorption of subretinal or intraretinal fluid was achieved in all patients. VA improved by 2.3±3.5 lines on average, 9 patients (39.1%) had an increase of ≥3 lines, none lost more than 1 line. Patients with bevacizumab monotherapy (n=17) had an improvement of 2.59±3.9 lines, 7 patients (41.2%) had an increase of ≥3 lines. No intraocular or systemic side effects were observed.

Conclusions

In this as yet largest series of patients with mCNV treated with intravitreal bevacizumab, the treatment seemed to be effective and safe.     

Response to anti-VEGF therapy in patients with subretinal fluid and pigment epithelial detachment on spectral-domain optical coherence tomography

Purpose

To analyse the long-term functional and morphological response of a specific choroidal neovascular membrane (CNV) phenotype to anti-vascular endothelial growth factor (VEGF) therapy.

Methods

Data from 30 eyes of 30 consecutive patients with subretinal fluid (SRF) and fibrovascular pigment epithelial detachment (PED) due to CNV on spectral-domain optical coherence tomography (SDOCT) with a follow-up of at least 20 months were retrospectively collected. Main outcome measures included change in visual acuity, quantitative and qualitative parameters on SDOCT [photoreceptor layer, outer nuclear layer (ONL), choroid, PED, SRF] and on fluorescein angiography (CNV activity). Subjects were divided into responders and non-responders based on morphological and functional aspects.

Results

An average number of 20.23?±?9.9 anti-VEGF injections were administered during a mean follow-up of 40.25?±?13.5 months. Fourteen eyes were categorized as morphological non-responders, 12 as functional non-responders and eight as complete non-responders. Complete non-responders were significantly younger than complete responders (68.5?±?4.5 vs 74.3?±?6.8 years; p?<?0.05) and presented thinner baseline ONL values (68.43?±?15.2 vs103.5?±?32.8 μm; p?<?0.05). Intermediate or large drusen as typical features for age-related macular degeneration (AMD) were less frequently present in complete non-responders; however, this was not statistically significant (62.5 % vs 91.7 %; p?=?0.25).

Conclusions

Our preliminary findings indicate that eyes with the specific SDOCT phenotype with isolated fibrovascular PED and SRF frequently demonstrate non-response to anti-VEGF therapy, and the underlying disease mechanism may be different from AMD. Larger prospective trials are required to validate those results, and to develop strategies to improve the morphological as well as functional outcome.     

VEGF gene polymorphism and response to intravitreal bevacizumab and triple therapy in age-related macular degeneration

Purpose

To investigate the association between the vascular endothelial growth factor (VEGF) gene and response to either intravitreal bevacizumab (IVB) or photodynamic therapy with intravitreal triamcinolone acetonide and IVB (triple therapy) for neovascular age-related macular degeneration (AMD).

Methods

The study consisted of 94 patients with neovascular AMD who underwent IVB and 79 patients with neovascular AMD who underwent triple therapy. Genotypes were determined for four selected tagging single-nucleotide polymorphism (SNP)s of the VEGF gene.

Results

Of the four SNPs studied, one SNP (rs699946) was associated significantly with visual acuity (VA) changes 12 months after treatment??irrespective of whether they received IVB alone (P = 0.044) or triple therapy 0.010). Baseline VA was not significantly different among the three genotypes of rs699946 in either treatment group. There were no significant differences in the number of treatments, incidence of recurrence, or the period until the recurrence according to VEGF rs699946 genetic variant.

Conclusions

The VEGF gene SNP rs699946 was associated with response to IVB alone and to triple therapy in this study. The G allele in SNP rs699946 can thus be applied as a marker for better visual prognosis in patients with neovascular AMD who receive either IVB or triple therapy.     

Vision-related quality of life and visual function following intravitreal bevacizumab injection for persistent diabetic macular edema after vitrectomy

Purpose

To investigate the vision-related quality of life (VR-QOL) and visual function in patients undergoing intravitreal injection of bevacizumab (IVB) for persistent diabetic macular edema (DME) after vitrectomy.

Methods

This institutional study enrolled 20 consecutive patients (20 eyes) who had received 1.25 mg IVB for persistent macular edema after vitrectomy for DME at least 3 months previously. Visual function and VR-QOL were measured before, and 1 and 3 months after IVB. Measurements included the logarithm of the minimum angle of resolution (logMAR), best corrected visual acuity (BCVA), letter contrast sensitivity, severity of metamorphopsia using M-CHARTS, central retinal thickness using optical coherence tomography, and VR-QOL with the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25).

Results

One month after IVB, statistically significant improvements were observed in central retinal thickness, letter contrast sensitivity, and the VFQ-25 “mental health” subscale score (P < 0.05, Dunnett test). LogMAR BCVA, metamorphopsia, and the VFQ-25 composite score did not improve significantly. Three months after IVB, there were no significant improvements in any parameters examined.

Conclusions

Intravitreal bevacizumab injection for persistent DME after vitrectomy temporarily improved central retinal thickness, contrast sensitivity, and the psychometric aspect of the VR-QOL, but these effects did not last for over 3 months.     

Ranibizumab for exudative AMD in a clinical setting: differences between 2007 and 2010

Background/purpose

Visual results of ranibizumab given pro re nata in clinical settings depend greatly from the achievement of the monthly follow-up. In 2007, a previous study performed in our tertiary care showed a mean visual gain of only?+?0.7 ETDRS chart letters, probably because of insufficient number of follow-up visits and injections. We report a second retrospective study of patients whose eyes were treated in the same setting, and whose first injection was performed after April 1 2010. The aim was to check if the changes in the management of AMD patients between 2010 and 2007 achieved better visual results.

Method

One hundred and twenty-two patients (125 eyes) with exudative age-related macular degeneration (AMD) were included. Age, gender, side, type of CNV, VA measured on an ETDRS chart at baseline and at 52 ± 6 weeks, the number of IVT performed, and follow-up visits were recorded. The series was compared to our former series of the year 2007. Results are expressed as means?±?standard deviation. Mann–Whitney’s non-parametric test was used to compare the statistical distribution of the parameters measured. Fisher’s exact test was used for 2?×?2 categorical variables, and the chi-square test for others.

Results

In the 2010 series, the mean visual gain was +6.0?±?11.0 l (?35 to?+?34). During this period, the eyes had 5.0?±?1.8 IVT and 7.8?±?1.4 follow-up visits. No correlation was found between the change in VA and gender, type of CNV, age, or the numbers of IVT and visits. There was a reverse correlation between baseline VA and VA changes (r?=??0.413, p?<?0.0001): i.e., the higher the VA at presentation, the smaller the gain. Comparison between 2010 and 2007 showed that in 2010, patients were older (82.2?±?7.0 vs 78.3?±?7.0 y, p?<?0.0001), had a better baseline VA (60.6?±?12.7 vs 56.1?±?14.6 l, p?=?0.0191) and, despite the reverse correlation between change in VA and VA at presentation, visual results were better: +6.0?±?11.0 vs +0.7?±?11.99 l, p?=?0.0003. In 2010, eyes received more injections: 5.0?±?1.8 vs 3.8?±?1.4 in 2007, p?<?0.0001. However, the series did not differ for the number of visits, gender, side or type of CNV.

Conclusions

In 2010, monotherapy with ranibizumab for exudative AMD achieved better visual results than in 2007 in our clinical setting, despite the treatment of older patients with better baseline VA. This is probably due to the greater number of IVT performed. Alternate strategies, such as “inject and extend” or maintenance therapy, may also account for the better visual results.