Treatment results at 1 year of ranibizumab therapy for polypoidal choroidal vasculopathy in eyes with good visual acuity

Purpose

To evaluate the efficacy of intravitreal ranibizumab (IVR) for subfoveal polypoidal choroidal vasculopathy (PCV) in eyes with a best corrected visual acuity (BCVA) of 0.6 (logMAR 0.22) or better.

Methods

Fifty eyes with BCVA between 0.6 (logMAR 0.22) and 1.0 (logMAR 0) and subfoveal PCV were treated with IVR for 3 consecutive months. Additional IVR was given at subsequent monthly visits, if needed, up to 11 months after the initial injection. The patients were followed-up prospectively for 12 months, and changes in mean BCVA, central retinal thickness (CRT), serous retinal detachment (SRD), hemorrhage, and number of polypoidal lesions were evaluated.

Results

Mean BCVA improved significantly at the 3-, 6-, 9-, and 12-month follow-up visits and CRT decreased significantly at 1, 2, 3, 6, 9, and 12 months after the initial treatment as compared with the baseline. SRD was observed in 10 and 21 eyes at 3 and 12 months. Hemorrhage was observed in 6 eyes at 3 months and 3 eyes at 12 months. All polypoidal lesions had completely regressed in 19 % and the size of network vessels was either unchanged or enlarged in 98 % of the eyes at 12 months.

Conclusion

Based on the maintenance of vision improvement for at least 12 months, IVR for PCV proved useful for eyes with BCVAs of 0.6 (logMAR 0.22) to 1.0 (logMAR 0), despite a low regression rate of polypoidal lesions and minimal network size reduction.     

Retreatment of polypoidal choroidal vasculopathy after photodynamic therapy combined with intravitreal ranibizumab

Purpose

To investigate the incidence, risk factors and effect on visual improvement of retreatment within 60 months after initial photodynamic therapy (PDT) combined with intravitreal ranibizumab (IVR) in eyes with treatment-naïve polypoidal choroidal vasculopathy (PCV).

Methods

We retrospectively reviewed the medical records of 61 eyes from 60 patients with PCV, who were followed up for at least 12 months after undergoing combination therapy. Retreatment, including combination therapy or IVR alone, was administered if residual or recurrent exudative changes were present.

Results

During the follow-up period (mean 44 ± 13 months, median 48 months), 46 eyes (75.4 %) underwent retreatment. Survival analysis revealed that the proportions of eyes that were retreatment-free were 59 % at the 12-month visit, 41 % at the 24 month, 31 % at the 36 month, and 20 % at the 60-month visit. The median retreatment-free period was 15.0 [95 % confidence interval (CI) 7.4–22.7] months, and the mean period was 24.9 (95 % CI 19.3–30.6) months. Cox regression analysis revealed that older age (P = 0.010, hazard ratio 1.06, CI 1.02–1.11) and male gender (P = 0.043, hazard ratio 2.41, CI 1.03–5.62) were associated with retreatment. Visual improvement was significantly better in eyes without retreatment compared with those with retreatment at the 12-, 24- and 48-month visits.

Conclusions

About 80 % of eyes with PCV require retreatment within 5 years after combination therapy with PDT and IVR. Retreatment is associated with older age and male gender and is related to reduced improvement of visual acuity.

     

Long-term effects of ranibizumab treatment delay in neovascular age-related macular degeneration

Background

Intravitreal injections of ranibizumab are the standard of care for neovascular age-related macular degeneration (AMD). In clinical trials, comparable efficacy has been shown for either monthly injections or as needed injections upon monthly controls. Unlike in trial settings, treatment in clinical routine is often delayed by complex approval procedures of health insurance and limited short-term surgical capacities.

Methods

Eighty-nine patients with neovascular AMD were followed for 12 months. Early treatment diabetic retinopathy study (ETDRS) visual acuity (VA), Radner reading VA and spectral domain optical coherence tomography were performed monthly, with additional fluorescein angiography if needed. After an initial loading phase of three consecutive monthly intravitreal injections with ranibizumab, re-injections were performed when recurrent activity of choroidal neovascularization (CNV) was detected.

Results

After an initial increase to a value of +5.0?±?11.87 ETDRS letters from baseline, VA constantly decreased over 12 months to a value of ?0.66?±?16.82 ETDRS letters below baseline. Central retinal thickness (CRT) decreased from a value of 438.1?±?191.4 μm at baseline to a value of 289.9?±?138.6 μm after initial therapy and stabilized at a value of 322.4?±?199.5 μm. Loss of VA during latency between indication to treat and treatment was significantly greater than re-gain of VA after re-initiation of therapy (?2.2?±?5.0 versus 0.4?±?7.4 letters; p?=?0.046).

Conclusions

Latency between indication to treat and treatment is responsible for irreversible VA deterioration. A successful PRN treatment regimen for neovascular AMD requires immediate access to therapy after indication.     

Two-year results of reduced-fluence photodynamic therapy combined with intravitreal ranibizumab for typical age-related macular degeneration and polypoidal choroidal vasculopathy

Purpose

To report the 2-year results of reduced-fluence photodynamic therapy (RF-PDT) combined with intravitreal ranibizumab (IVR) for typical age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV).

Methods

Twenty-four previously untreated eyes of 23 AMD patients with decimal best-corrected visual acuity (BCVA) of less than 0.7 received the combined therapy, followed by retreatments as needed over the subsequent 2 years. When the BCVA was better than or equal to 0.7, only 3 monthly IVR injections were performed during the retreatment.

Results

The BCVAs were maintained in 7 of 10 typical AMD eyes and in 13 of 14 PCV eyes at month 24. The mean BCVA improved in the PCV group (P < 0.05) but not in the typical AMD group. The central foveal thickness decreased in both groups (P < 0.01, P < 0.001). The mean numbers of the total PDT and IVR injections were 1.8 and 7.2 in the typical AMD group and 1.8 and 6.4 in the PCV group.

Conclusion

After RF-PDT combined therapy with administration of retreatments as needed that consisted of either 3 IVR injections alone or combined therapy, the BCVA was maintained in typical AMD and improved in PCV during a 2-year follow-up period.     

Two-year outcome of an observe-and-plan regimen for neovascular age-related macular degeneration: how to alleviate the clinical burden with maintained functional results

Purpose

The purpose of this study was to report the 2-year outcome of an individually tailored ‘observe-and-plan'' treatment regimen for neovascular age-related macular degeneration (nAMD), and to investigate its clinical value in terms of functional outcome. This regimen aimed to reduce the clinical burden (visits) by employing individually fixed injection intervals, based on the predictability of an individual''s need for retreatment.

Methods

This prospective case series included 104 patients (115 eyes) with nAMD. Following three loading doses of ranibizumab, the disease recurrence interval was determined in monthly observation visits. Retreatment was applied in a series of three injections with individually fixed intervals (2 weeks shorter than the recurrence interval), combined with periodic adjustment of the intervals. The allowed injection intervals in treatment plans ranged from 1 to 3 months. If there was no recurrence at 3 months, the patient could change to monitoring alone.

Results

Mean visual acuity (VA) improved by 8.7, 9.7, and 9.2 letters at months 3, 12, and 24, respectively. The mean number of injections was 7.8 and 5.8 during years 1 and 2, respectively, whereas the mean number of ophthalmic examinations was 4.0 and 2.9, respectively. The mean treatment interval (after the loading doses) was 2.0 months during year 1, and 2.2 months during year 2.

Conclusion

The observe-and-plan regimen significantly improved and maintained VA over the course of 2 years. This favourable functional outcome was achieved with fewer clinic visits compared with other regimens. Therefore, this observe-and-plan regimen has the potential to alleviate the clinical burden of nAMD treatment.     

Prospective study evaluating the predictability of need for retreatment with intravitreal ranibizumab for age-related macular degeneration

Purpose

To investigate the rhythm and predictability of the need for retreatment with intravitreal injections of ranibizumab for neovascular age-related macular degeneration (nAMD).

Methods

This prospective study enrolled 39 patients with treatment-naïve nAMD. After three loading doses of intravitreal ranibizumab, patients underwent an intensified follow-up for 12 months (initially weekly, then with stepwise increases to every 2 weeks and to monthly after each injection). Patients were retreated on an as-needed basis if any fluid or increased central retinal thickness (CRT) (>50μm) was found on spectral domain optical coherence tomography (OCT). Statistical analysis included patients who received at least two retreatments (five injections).

Results

A mean of 7.5 injections (range 0–12) were given between months 3 and 15. The mean visual acuity increased by 13.1 and 12.6 ETDRS letters at months 12 and 15 respectively. Two or more injection–retreatment intervals were found in 31 patients. The variability of their intra-individual intervals up to 14 weeks was small (SD 0–2.13 weeks), revealing a high regularity of the retreatment rhythm. The SD was correlated with the mean interval duration (r?=?0.89, p?<?0.001). The first interval was a good predictor of the following intervals (regression coefficient =0.81). One retreatment criterion was stable in 97 % of patients (cysts or subretinal fluid).

Conclusion

The results of this study demonstrate a high intra-individual predictability of retreatment need with ranibizumab injections for nAMD. These findings may be helpful for developing individualized treatment plans for maintained suppression of disease activity with a minimum of injections and visits.     

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.     

Refractory subretinal fluid in patients with neovascular age-related macular degeneration treated with intravitreal ranibizumab: visual acuity outcome

Purpose

To investigate the functional outcome of eyes with neovascular AMD (nAMD) and subretinal fluid (SRF) refractory to treatment with ranibizumab.

Methods

Retrospective chart review of consecutive treatment-refractory SRF in nAMD despite monthly ranibizumab injections during 12 months or more. Data were evaluated for baseline characteristics, location of the refractory SRF, mean visual acuity (VA) change, number of injections, and timepoint of first complete disappearance of SRF.

Results

Forty-five eyes in 44 patients (mean age of 76 years) were included. The mean follow-up was 32.4 months (range 12–73 months). The mean number of injections was 11.6 in the first year and 27.5 over follow-up. The refractory SRF was located subfoveally in 66.7 %. In 12 eyes (26.7 %), complete absorption of SRF was found after a mean of 22.6 months (range, 13–41 months). Mean VA increased by 10.4, 8.2, and 8.6 letters by month 12, 24, and 36, respectively.

Conclusions

Neovascular AMD with SRF refractory to monthly retreatment with ranibizumab may still allow good and maintained visual improvement, even if the fluid is located subfoveally. SRF may progressively absorb under continuous monthly treatment. The necessity to treat refractory SRF with monthly injections could be questioned and would need future investigations.

     

Aqueous vascular endothelial growth factor and ranibizumab concentrations after monthly and bimonthly intravitreal injections of ranibizumab for age-related macular degeneration

Purpose

To evaluate vascular endothelial growth factor (VEGF) and ranibizumab concentrations in eyes with age-related macular degeneration (AMD) after monthly and bimonthly intravitreal ranibizumab (IVR) injections.

Methods

Aqueous humor samples were obtained from 26 eyes with AMD before and after IVR injections. Nine eyes received three monthly injections and 17 eyes received two bimonthly injections. The VEGF and ranibizumab concentrations were measured by enzyme-linked immunosorbent assay.

Results

The aqueous VEGF concentrations in the monthly injection group decreased below the lowest detectable limit in eight of nine eyes 1 month after the first injection and seven of nine eyes 1 month after the second injection (P?<?0.001, mean baseline value, 94.7 pg/ml); the aqueous VEGF concentrations in the bimonthly injection group decreased below the lowest detectable limit in two of 17 eyes 2 months after the first injection (P?<?0.001, mean baseline value, 152.4 pg/ml). The mean aqueous ranibizumab concentrations with monthly injections were 71.2 ng/ml 1 month after the first injection, and 96.3 ng/ml 1 month after the second injection. The mean aqueous ranibizumab concentrations in the bimonthly injection group were 2.5 ng/ml in 15 of 17 eyes, and below the lowest detectable limit in two of 17 eyes 2 months after the first injection.

Conclusions

In this pilot study with limited follow-up, intravitreal injection of ranibizumab can suppress aqueous VEGF completely for 1 month in most cases. Its effect does not last for 2 months enough to suppress VEGF completely in most cases, although aqueous VEGF at 2 months after intravitreal injection of ranibizumab is less than that before injection in most cases.     

A 10-year review of assault-related open-globe injuries at an urban hospital

Background

To describe the demographics and outcomes of assault-related open-globe injuries (OGI) at University Hospital (UH), Newark, New Jersey over a ten-year period.

Methods

The medical records of all subjects presenting to a single university referral center with an OGI were retrospectively analyzed to identify prognostic factors for enucleation and final visual acuity (VA) of no light perception (NLP).

Results

One hundred and forty-eight eyes of 147 patients presented to UH with assault-related OGI. Eighty-two percent of patients were male, and the mean age was 35.9 years. The anatomic site of the wound was zone 3 in the majority (54.1 %) of eyes. Most common type of injury noted was rupture (57.4 %), followed by penetrating injury (35.1 %). Mean initial presenting and final VA in LogMAR were 2.38?±?0.12 and 2.18?±?0.16 respectively. Initial Snellen VA was no light perception (NLP) in 57 eyes (38.5 %); four eyes had an initial VA of ≥20/40 (2.7 %). Final VA was NLP in 68 eyes (45.9 %) of which 46 were enucleated (31.1 %); 18 eyes (12.2 %) had a final VA of ≥20/40. Fifty eyes (33.8 %) underwent pars plana vitrectomy (PPV). Significant risk factors of final VA of NLP or enucleation included initial VA of NLP, perforating or rupture type of OGI, and zone 3 injury. Eyes that sustained penetrating injuries were less likely to have final VA of NLP or require enucleation.

Conclusions

Assault-related OGIs carry an extremely poor visual prognosis and a high rate of enucleations. Only eighteen eyes (12.2 %) recovered VA ≥20/40. We found initial VA of NLP and zone 3 injury to be significant predictors of final VA of NLP or undergoing enucleation. Penetrating injuries were less likely to have a final VA of NLP or an enucleation.     

Treat-and-extend therapy using intravitreal aflibercept for neovascular age-related macular degeneration: 2-year real-world practice data from Slovenia

Background

To assess visual outcomes over 24?months in patients with neovascular age-related macular degeneration (nAMD) who initiated intravitreal aflibercept therapy under a treat-and-extend (TE) regimen in real-world settings.

Methods

In this retrospective, observational, multicentre study in Slovenia, medical records of all treatment-naïve patients with nAMD who started intravitreal aflibercept therapy between October 2013 and April 2015 were reviewed. The primary outcome measure was change in mean visual acuity (VA) from baseline to 24?months in patients who received the TE regimen for 2?years, assessed by standardised Early Treatment Diabetic Retinopathy Study charts and calculated as least-squares means. Other outcome measures included the numbers of injections and visits at 12?months and 24?months.

Results

The primary analysis included 115 eyes of 105 patients who received TE treatment for 2?years (Group A). The mean VA improved from 57.9?±?14.9 letters at baseline to 64.6?±?15.8 letters (+?6.5 letters, p?<?0.0001) at 12?months and 64.8?±?15.6 letters (+?7.0 letters, p?<?0.0001) at 24?months. The mean number of injections per eye was 8.4?±?1.9 and the mean number of visits was 8.8?±?1.7 at 12?months; these numbers decreased to 6.1?±?2.0 and 6.4?±?1.9, respectively, at 24?months. The additional analysis included 33 eyes of 33 patients who received TE treatment in Year 1, followed by pro re nata treatment in Year 2 (Group B). Compared with Group A whose vision improvement was maintained at 24?months, the VA gain in Group B eyes seen at 12?months (change in mean VA vs baseline: +?6.9 letters, p?=?0.0008) was no longer present at 24?months (change in mean VA vs baseline: +?1.2 letters, p?=?0.5733).

Conclusions

Using the TE regimen in clinical practice, intravitreal aflibercept significantly improved visual outcomes in treatment-naïve patients with nAMD, which were maintained over time. TE therapy with intravitreal aflibercept is a rational long-term strategy that can produce favourable outcomes in clinical practice.

     

Optimising assessment intervals improves visual outcomes in ranibizumab-treated age-related neovascular degeneration: using the stability phase as a benchmark

Background

To observe visual acuity change in the stability phase when follow-up intervals are decreased in ranibizumab-treated neovascular age-related macular degeneration (nvAMD).

Methods

Selection of patients was based on a review of a cohort of 189 eyes of 154 patients with nvAMD treated with intravitreal ranibizumab in routine clinical practice. Patients were transferred from a base hospital with a 8-week follow-up interval to a community eye clinic, enabling a new follow-up interval of 4 weeks. Staff, assessment, and treatment protocols were equivalent in the two centres. Patients were included when they were in the stability phase of treatment defined 1 month after having completed their three initiation treatments with ranibizumab. Each patient was required to have attended at least a further 12 visits; this means a follow-up time for a year or longer, consisting of six visits at the base hospital followed by six visits at the new eye clinic. The best-corrected visual acuity (BCVA), follow-up intervals and injection numbers were collected.

Results

Seventy-two eyes of 62 patients were included. The mean follow-up interval for the six visits in the base hospital was 56.81 days, and in the new eye centre 31.81 days. The BCVA loss in the base hospital was ?1.13 letters, compared to a gain of +4.61 letters in the community eye clinic over the six visits. The number of ranibizumab injections was 3.67 in the base hospital, compared with 3.91 in the other centre over the respective periods.

Conclusion

Visual acuity improves and severe visual loss decreases when follow-up intervals reduce from approximately 8 weeks to 4 weeks. Furthermore, using the stability phase to evaluate the outcome and effectiveness of our treatments for age-related macular degeneration appeared to be an efficient tool.     

Macular edema and visual outcome following cataract surgery in patients with diabetic retinopathy and controls

Background

Cystoid macular edema (CME) is a well-known complication after cataract surgery, and diabetic retinopathy is reported to be an important risk factor for impaired visual recovery. In this prospective study, we compared visual outcome 6?months after surgery in eyes with moderate retinopathy and no previous ME with a control group, and observed the incidence of ME seen on fluorescein angiography (FA) and optical coherence tomography (OCT).

Methods

Thirty-four patients with type-2 diabetes and 35 controls were enrolled. Best-corrected visual acuity (VA) letters ETDRS was measured pre-op, at day 7, week 6 and month 6. FA performed pre-op and at week 6 was divided into three leakage patterns. OCT performed pre-op, at week 6 and month 6 was qualitatively divided into three types. Macular thickness was measured in three circular fields (central subfield, inner and outer circle) from the macular maps.

Results

There was no statistically significant difference in VA before surgery, at day 7 or at 6?months, but at 6?weeks there was a significant difference with lower VA in the diabetic group. Six percent of control and 12% of diabetic eyes developed a clinical CME defined as a loss of >5 letters between day 7 and week 6. Incidence of FA leakage was 23% in control and 76% in diabetic eyes. At 6?weeks, 20% of control and 44% of the diabetic eyes had qualitative changes on OCT. A statistically significant increase in thickness was observed for all three macular areas in both groups, part of it remaining at 6?months. There were, however, no differences in central macular thickness between the groups at any visit. Retinal thickening had poor correlation with VA.

Conclusion

The final visual outcome in eyes with mild to moderate retinopathy, without previous ME, is as good as in normal eyes, but an increased frequency of macular changes may protract recovery of full vision. Changes on OCT or FA are often seen without any obvious effect on VA. OCT is as good as FA at detecting a clinical CME, and is the technique recommended for follow-up before FA is considered.     

Prevalence, causes and associations of amblyopia in year 1 students in Central China

Background

Earlier diagnosis and treatment of amblyopia are associated with improved visual outcomes. This study reports the prevalence of amblyopia and associated factors in year 1 primary school students in central China.

Methods

The school-based, cross-sectional study involved 3,112 year 1 primary school students . All the participants underwent a comprehensive eye examinations including cycloplegic refraction, cover test and ocular movement examinations. The unaided and best corrected visual acuity (BCVA) was recorded. Unilateral amblyopia was defined as a 2-line interocular difference with BCVA?≤?20/32 (≥ logMar 0.2) in the worse eye and with coexisting anisometropia (≥ 1.00 D SE for hyperopia, ≥ 3.00 D SE for myopia, or?≥?1.50 D for astigmatism), strabismus or past or present visual axis obstruction. Bilateral amblyopia was defined as BCVA in both eyes<20/40 (> logMar 0.3), with coexisting hyperopia?≥?4 D SE, myopia?≤??6 D SE, or astigmatism?≥?2.5 D, or past or present visual axis obstruction.

Results

Out of the 3,112 eligible students, 2,893 (93.0 %) students completed the examinations. The average age of the students was 7.1?±?0.4 (mean?±?standard deviation SD) years old. The prevalence of amblyopia was 1.0 % (95 % confidence interval [CI], 0.6 %–1.3 %) with no difference between the sexes (P?=?0.88). Of the 27 amblyopic students, unilateral amblyopia was found in 18 (66.7 %) students, and bilateral amblyopia in 9 (33.3 %) students. Of 18 unilateral amblyopia, 13 were anisometropic amblyopia, 4 were strabismus amblyopia, 1 was mixed amblyopia. Of 9 bilateral amblyopia, 7 were isoametropic amblyopia, 2 were stimulus deprivation. The mean corrected VA of the amblyopic eyes was 30.50 logMAR letters (Snellen VA equivalent 4/12.6), and the range was 5 to 45 logMAR letters (Snellen VA equivalent 4/40-4/6.3). Most amblyopic eyes (38.9 %) were significantly hyperopic (spherical equivalent?≥?+3.00 D); 25.0 % were myopic. In addition, 58 (2.1 %) students had a previous amblyopia history of amblyopia that was not corroborated in this study.

Conclusions

The study shows a relatively low prevalence of amblyopia (1.0 %) in year 1 students in central China. Amblyopia is usually caused by abnormal refractive error.     

Effekt von Bevacizumab auf die Abhebung des retinalen Pigmentepithels bei okkulter choroidaler Neovaskularisation

Purpose

This study aimed to investigate the effect of bevacizumab on pigment epithelial detachment (PED) in occult choroidal neovascularization (CNV) in patients with age-related macular degeneration (AMD) and to determine predictive factors.

Methods

73 eyes of patients with AMD and PED due to CNV with subretinal and/or intraretinal fluid were assessed. Patients were treated with 1.25 mg of intravitreal bevacizumab.

Results

After 30.6 weeks, the mean visual acuity (VA) increased from 0.53 to 0.49 logMAR (p=0.170). The mean PED height decreased from 354.4 μm to 277.4 μm (p=0.004). Although 53.4% of the eyes showed a reduction in PED, this did not correlate with a significant change in VA. Predictive factors were a high baseline PED and VA <0.32.

Conclusion

Half of the patients showed PED flattening. Especially in patients with distinctive PED, a response to intravitreal bevacizumab may be expected. This therapy can stabilize VA, but PED flattening does not essentially correlate with an increase in VA.     

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.     

Pars plana vitrectomy for treatment of advanced Coats’ disease—presentation of a modified surgical technique and long-term follow-up

Background

To present a modified surgical technique in the treatment of retinal detachment secondary to advanced Coats’ disease in children, and report on long-term anatomical and functional outcome.

Methods

We analysed an interventional case series of 13 patients (13 eyes) with advanced Coats’ disease characterised by retinal detachment in addition to massive subretinal exudates and vascular malformation. The presented patients underwent pars plana vitrectomy (PPV), including a modified technique of exocryotherapy applied after fluid–air exchange in order to achieve complete treatment of the vascular changes, to reduce associated side-effects, and to avoid retinectomy and silicone oil tamponade.

Results

Within a median follow-up period of 37 months (range: 18–66 months), no enucleation was necessary. Four eyes (31 %) did not need any further therapy, and in nine eyes (69 %) additional treatments were performed. Six patients (46 %) required revisional surgery with silicone oil tamponade. In ten eyes (77 %), the pathologic vessels and exudates finally regressed and the retina reattached. Visual acuity (VA) could be stabilized in the majority of patients: in three eyes (27 %) VA improved, in four eyes (36 %) VA remained stable, in four eyes (36 %) visual acuity (VA) deteriorated, and in two eyes VA could not be evaluated.

Conclusions

The presented modified technique allows for sufficient cryotherapy of vascular malformations, even in the presence of massive exudation, in a subset of patients with advanced Coats’ disease, and thus may reduce surgery-related complications and improve the rehabilitation process of these young patients.     

Intravitreal bevacizumab (Avastin) for neovascular age‐related macular degeneration using a variable frequency regimen in eyes with no previous treatment

Purpose: To evaluate a variable frequency regimen with intravitreal bevacizumab for treatment of neovascular age‐related macular degeneration (AMD) in eyes that have not received any previous treatment. Methods: Retrospective review of patients with neovascular AMD who were treated with three consecutive monthly intravitreal injections of bevacizumab (1.25 mg) and retreated based on the PrONTO study criteria. Outcome measures included visual acuity (VA) and central retinal thickness. Subgroup analysis was conducted to identify pretreatment characteristics that could determine visual outcome with treatment. Results: A total of 109 eyes of 109 patients were treated. The mean age was 82 years, and the mean follow‐up period was 9.4 months (range 6–12 months). At baseline, the mean VA was 45.6 letters (6/37.5) and mean central retinal thickness 343 µm. This improved to 51 letters (6/30) (P < 0.001)) and 231 µm (P < 0.001) at 6 months. At 6 months, VA was improved by at least five letters in 50%, remained stable in 30% and worsened by at least five letters in 20% of patients. Patients with large intraretinal cysts on optical coherence tomography before treatment had an increased risk of worse vision (odds ratio 10.5, 95% confidence interval 1.69–64.99; P = 0.018). Conclusions: The majority of patients had improvement or stability of VA regardless of the angiographic type of choroidal neovascularization. Intravitreal bevacizumab with this tailored regimen is beneficial in the treatment of neovascular AMD in the short term. The presence of large intraretinal cysts on optical coherence tomography is a poor prognostic factor for visual improvement with this treatment.     

Maintenance therapy with pegaptanib sodium for neovascular age-related macular degeneration: an exploratory study in Japanese patients (LEVEL-J study)

Purpose

To explore the efficacy and safety of pegaptanib sodium as maintenance therapy in Japanese patients with neovascular, age-related macular degeneration (AMD) after induction therapy (LEVEL-J study).

Methods

A multi-center, prospective study was conducted at 21 medical institutions between 2009 and 2011. Of Japanese neovascular AMD patients with choroidal neovascularization who showed improvement in visual acuity (VA) with induction therapy, those who were scheduled for intravitreal injections of pegaptanib as maintenance therapy were recruited. LogMAR VA was assessed. Booster treatment (unscheduled treatment with other agents) was allowed during the study period if symptoms were judged to have worsened. Safety was assessed by monitoring adverse events and intraocular pressure (IOP).

Results

Of 75 patients included in the analysis, 80 % completed the 54-week study period. Their mean age was 74.7 ± 6.9 years, and 54 patients (72.0 %) were men. The mean number of pegaptanib injections was 5.7 ± 2.6. Booster treatment was not required in 40 eyes (53.3 %). Mean logMAR VA was 0.61 ± 0.31 before induction therapy, 0.26 ± 0.24 before maintenance therapy, and 0.29 ± 0.28 at 54 weeks. No notable change in VA was observed during maintenance therapy. Adverse events were reported in 4 patients (5.3 %), including increased intraocular pressure, cancer, gallstones and recurrence of breast cancer, but mean IOP remained stable during maintenance therapy.

Conclusions

The results of this exploratory study suggest that maintenance therapy with pegaptanib is potentially an effective and well-tolerated option in Japanese patients with neovascular AMD in whom induction therapy has been successful.