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Lees JS, Dobbin SJH, Elyan BMP, Gilmour DF, Tomlinson LP, Lang NN, Mark PB. A systematic review and meta-analysis of the effect of intravitreal VEGF inhibitors on cardiorenal outcomes. Nephrol Dial Transplant 2022:6786281. [PMID: 36318455 DOI: 10.1093/ndt/gfac305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Vascular endothelial growth factor inhibitors (VEGFi) have transformed the treatment of many retinal diseases, including diabetic maculopathy. Increasing evidence supports systemic absorption of intravitreal VEGFi and development of significant cardiorenal side effects. METHODS Systematic review and meta-analysis (PROSPERO: CRD42020189037) of randomised controlled trials of intravitreal VEGFi treatments (bevacizumab, ranibizumab and aflibercept) for any eye disease. Outcomes of interest were cardiorenal side effects (hypertension, proteinuria, kidney function decline and heart failure). Fixed-effects meta-analyses were conducted where possible. RESULTS There were 78 trials (81 comparisons; 13 175 participants) that met criteria for inclusion: 47% were trials in diabetic eye disease. Hypertension (29 trials; 8570 participants) was equally common in VEGFi and control groups (7.3 versus 5.4%; RR 1.08 [0.91; 1.28]). New or worsening heart failure (10 trials; 3384 participants) had similar incidence in VEGFi and control groups (RR 1.03 [0.70; 1.51]). Proteinuria (5 trials; 1902 participants) was detectable in some VEGFi-treated participants (0.2%) but not controls (0.0%; RR 4.43 [0.49; 40.0]). Kidney function decline (9 trials; 3471 participants) was similar in VEGFi and control groups. In participants with diabetic eye disease, risk of all-cause mortality was higher in VEGFi-treated participants (RR 1.62 [1.04; 2.46]). CONCLUSION In trials of intravitreal VEGFi, we did not identify an increased risk of cardiorenal outcomes, though these outcomes were reported in only a minority of cases. There was an increased risk of death in VEGFi-treated participants with diabetic eye disease. Additional scrutiny of post-licensing observational data may improve recognition of safety concerns in VEGFi-treated patients.
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Affiliation(s)
- Jennifer S Lees
- School of Cardiovascular and Metabolic Health, College of Medical and Veterinary Sciences, University of Glasgow, Glasgow, UK
| | - Stephen J H Dobbin
- School of Cardiovascular and Metabolic Health, College of Medical and Veterinary Sciences, University of Glasgow, Glasgow, UK
| | - Benjamin M P Elyan
- School of Cardiovascular and Metabolic Health, College of Medical and Veterinary Sciences, University of Glasgow, Glasgow, UK
| | | | | | - Ninian N Lang
- School of Cardiovascular and Metabolic Health, College of Medical and Veterinary Sciences, University of Glasgow, Glasgow, UK
| | - Patrick B Mark
- School of Cardiovascular and Metabolic Health, College of Medical and Veterinary Sciences, University of Glasgow, Glasgow, UK
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2
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Gao S, Zhang Y, Li X, Ge G, Duan J, Lei C, Zeng Y, Cai Z, Zhang M. Comparative Efficacy of Pharmacotherapy for Macular Edema Secondary to Retinal Vein Occlusion: A Network Meta-analysis. Front Pharmacol 2021; 12:752048. [PMID: 34955825 PMCID: PMC8692786 DOI: 10.3389/fphar.2021.752048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/17/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose: This network meta-analysis was conducted to obtain the relative effectiveness of different pharmacotherapy of macular edema secondary to retinal vein occlusion (RVO) by summarizing all available evidences. Methods: PubMed, Embase, and Cochrane Library databases were searched for all relevant randomized controlled trials. The outcomes were estimated through a network meta-analysis, including the mean change in best-corrected visual acuity (BCVA) from baseline, the proportion of patients who gained ≥15 letters in BCVA from baseline, the mean change in central retinal thickness (CRT). Results: We identified 15 randomized controlled trials (RCTs) involving 3,431 patients with RVO in our study. Different therapeutic regimens were compared including three anti-vascular endothelial growth factor (VEGF) agents (ranibizumab, bevacizumab, and aflibercept), ranibizumab with laser, dexamethasone intravitreal implant, and laser. For branch RVO, ranibizumab 0.5 mg monthly [weighted mean difference (WMD) = 11, 95% confidence intervals (CrI) 3.6 to 19], ranibizumab 0.5 mg 3 + pro re nata (WMD = 9.4, 95% CrI 0.43–18) is most effective in terms of changes of BCVA and 15 letters or more of BCVA improvement. For central RVO, three anti-VEGF regimens can improve visual acuity and there is no significant difference of efficacy among ranibizumab, bevacizumab and aflibercept (p > 0.05). Ranibizumab 0.5 mg monthly could achieve additional efficacy in CRT reduction in eyes with branch RVO or central RVO (WMD = -130, 95% CrI -400 to 140 or WMD = -280, 95% CrI -590 to 16)). Dexamethasone intravitreal implant (WMD = 1.7, 95% CrI -4.2 to 7.1 or WMD = 0.38, 95% CrI -9.8 to 8.8)) did not show a significant improvement in visual acuity at the end of 6 months follow-up in eyes with branch RVO or central RVO. Conclusion: In summary, this network meta-analysis demonstrated several anti-VEGF agents had equivalent effects on mean visual acuity changes and anatomical recovery in 6 months in eyes with branch or central RVO. Only one injection of dexamethasone intravitreal implant in 6 months could not maintain the visual benefit. Patients and clinicians could choose pharmacotherapies with further consideration toward personal factors.
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Affiliation(s)
- Sheng Gao
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Yun Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Xun Li
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Ge Ge
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Jianan Duan
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Chunyan Lei
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Yue Zeng
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Zhaolun Cai
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Meixia Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
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Reibaldi M, Fallico M, Avitabile T, Bonfiglio V, Russo A, Castellino N, Parisi G, Longo A, Pulvirenti A, Boscia F, Virgili G. Risk of Death Associated With Intravitreal Anti-Vascular Endothelial Growth Factor Therapy: A Systematic Review and Meta-analysis. JAMA Ophthalmol 2021; 138:50-57. [PMID: 31750861 DOI: 10.1001/jamaophthalmol.2019.4636] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Although intravitreal anti-vascular endothelial growth factor (VEGF) treatment represents the first-line therapy for many retinal diseases, the issue of their systemic safety is debatable. Objectives To assess whether intravitreal anti-VEGF therapy might be associated with increased risk of mortality and which variables are associated with the increase. Data Sources PubMed, MEDLINE, and Embase databases, the Cochrane Library, and ClinicalTrials.gov were systematically searched from inception to May 6, 2019. Study Selection Randomized clinical trials comparing intravitreal anti-VEGF treatment with control groups and with follow-up of at least 6 months were selected. Data Extraction and Synthesis Data were independently collected by 2 investigators. Meta-analyses were conducted using the frequentist and Bayesian methods. For the frequentist approach, random- and fixed-effects models were used, with random-effects models considered the primary technique. Odds ratios (ORs) with 95% CIs were computed. For the bayesian approach, uninformative and informative priors were used. Odds ratios with 95% credible intervals (CrIs) were computed. Meta-regression analyses were based on random-effects models. Main Outcomes and Measures The primary outcome measure was the all-cause death rate. Secondary outcomes included meta-regression analyses on the following variables: type of drug, number of injections, follow-up time, diagnosis, and cardiovascular risk. Results Of 2336 studies identified, 34 unique studies with 8887 unique participants were included in the present meta-analysis. For the frequentist analysis, fixed- and random-effects models yielded similar estimates (ORs, 1.34 [95% CI, 0.95-2.07; P = .09] and 1.34 [95% CI, 0.89-2.01; P = .17], respectively). For the Bayesian approach, noninformative and informative priors yielded similar results (ORs, 1.34 [95% CrI, 0.79-2.34; 0.13 probability of OR≤1.00] and 1.40 [95% CrI, 0.82-2.32; 0.11 probability of OR≤1.00], respectively). Meta-regression analyses showed the following risk for 1 injection more: frequentist OR of 1.12 (95% CI, 1.04-1.22; P = .005) and Bayesian OR of 1.06 (95% CrI, 0.98-1.15; 0.06 probability of OR≤1.00). Conclusions and Relevance In this study, no difference was found in the mortality rate between intravitreal anti-VEGF treatment and control groups. Additional data seem warranted to determine whether the mortality rate is increased in patients receiving a greater number of injections.
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Affiliation(s)
- Michele Reibaldi
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Matteo Fallico
- Department of Ophthalmology, University of Catania, Catania, Italy.,Eye Unit, Southampton University Hospital, Southampton, United Kingdom
| | | | | | - Andrea Russo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | | | - Guglielmo Parisi
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Antonio Longo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Alfredo Pulvirenti
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Francesco Boscia
- Department of Ophthalmology, University of Sassari, Sassari, Italy
| | - Gianni Virgili
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Firenze and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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Balla S, Zold E, Potor L, Lukucz B, Vajas A, Ujhelyi B, Nagy V. Analysis of intravitreal bevacizumab treatment for macular oedema due to retinal vein occlusion. Eur J Ophthalmol 2020; 31:2528-2534. [PMID: 32993362 DOI: 10.1177/1120672120962051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE Our aim was to analyse the clinical effect of intravitreal bevacizumab treatment for macular oedema due to central/branch retinal vein occlusion (CRVO/BRVO). The end points were final best-corrected visual acuity (BCVA), BCVA improvement, final central 1-mm macular subfield thickness (CST) and change in CST. METHODS Our study included 34 CRVO and 25 BRVO patients. Patients received intravitreal bevacizumab (IVB) treatment at our department. Our control group consisted of 50 CRVO and 30 BRVO patients, who had not received this treatment because their disease developed before the anti-VEGF treatment became available. For statistical analysis, two-sample t-test, Pearson's correlation, and ANOVA were used. The level of significance was defined at p < 0.05. RESULTS With the two-sample t-test we found significant improvement of BCVA in the IVB-treated group (CRVO: 0.171 ± 0.270, p1 = 3.25×10-4; BRVO: 0.215 ± 0.282, p2 = 5.52×10-4). The difference in BCVA improvement was also significant compared to the control group (CRVO: p1 = 3.46×10-4; BRVO: p2 = 0.003). Significant decrease was observed in the CST in the treated group (CRVO: -345.114 ± 280.577, p1 = 6.94×10-9; BRVO: -151.875 ± 174.341, p2 = 1.67×10-4). In case of BRVO patients the final BCVA was significantly better in the treated group (0.617 ± 0.334) compared to the control group (0.406 ± 0.357), p = 0.016. CONCLUSION IVB treatment results in significantly better final visual acuity and leads to significantly increased BCVA improvement compared to patients with RVO-induced macular oedema receiving no treatment.
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Affiliation(s)
- Szabolcs Balla
- Department of Ophthalmology, University of Debrecen, Debrecen, Hungary
| | - Eszter Zold
- Department of Ophthalmology, University of Debrecen, Debrecen, Hungary
| | - Laszlo Potor
- Research Groups, MTA-DE Vascular Biology, Thrombosis and Haemostasis Research Group, University of Debrecen, Debrecen, Hungary
| | - Balazs Lukucz
- Department of Technology and Economics, University of Budapest, Budapest, Hungary
| | - Attila Vajas
- Department of Ophthalmology, University of Debrecen, Debrecen, Hungary
| | - Bernadett Ujhelyi
- Department of Ophthalmology, University of Debrecen, Debrecen, Hungary
| | - Valeria Nagy
- Department of Ophthalmology, University of Debrecen, Debrecen, Hungary
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5
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de Vries VA, Bassil FL, Ramdas WD. The effects of intravitreal injections on intraocular pressure and retinal nerve fiber layer: a systematic review and meta-analysis. Sci Rep 2020; 10:13248. [PMID: 32764619 PMCID: PMC7411061 DOI: 10.1038/s41598-020-70269-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 07/27/2020] [Indexed: 01/07/2023] Open
Abstract
The number of eye diseases treated with intravitreal injections is increasing. Obviously, an injection of fluid into the eye results in an increase of intraocular pressure (IOP), the main risk factor for glaucoma. However, the effect of these repeated IOP increases on the eye is unclear. Therefore, we performed a systematic review with meta-analyses. PubMed, Embase and Clinical Trials Registries were searched for articles investigating the relationship between intravitreal injections (anti-vascular endothelial growth factor [anti-VEGF] or steroids) and either IOP, retinal nerve fiber layer (RNFL)-thickness and glaucoma. Multiple meta-analyses were performed, combining data on intravitreal injection of anti-VEGF medication and dexamethasone implants. A total of 74 articles were eligible for meta-analyses. The short-term effect of an intravitreal injection of anti-VEGF showed a statistically significant increase in IOP. One day after injection of anti-VEGF, however, IOP was significantly lower than baseline. The long-term time-intervals showed no significant difference in IOP. After intravitreal injection of a dexamethasone implant, IOP was significantly higher than baseline 1 month post-injection. RNFL-thickness was significantly reduced 6 and 12 months post-injection of anti-VEGF, as well as at end of follow up. Caution is advised when using intravitreal medication, especially when treating patients with advanced glaucoma; in these cases, prophylactic IOP-lowering medication may be considered.
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Affiliation(s)
- Victor A de Vries
- Department of Ophthalmology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Fabiana L Bassil
- Department of Ophthalmology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Wishal D Ramdas
- Department of Ophthalmology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
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6
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Shalchi Z, Mahroo O, Bunce C, Mitry D. Anti-vascular endothelial growth factor for macular oedema secondary to branch retinal vein occlusion. Cochrane Database Syst Rev 2020; 7:CD009510. [PMID: 32633861 PMCID: PMC7388176 DOI: 10.1002/14651858.cd009510.pub3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Branch retinal vein occlusion (BRVO) is one of the most commonly occurring retinal vascular abnormalities. The most common cause of visual loss in people with BRVO is macular oedema (MO). Grid or focal laser photocoagulation has been shown to reduce the risk of visual loss. Limitations to this treatment exist, however, and newer modalities may have equal or improved efficacy. Antiangiogenic therapy with anti-vascular endothelial growth factor (anti-VEGF) has recently been used successfully to treat MO resulting from a variety of causes. OBJECTIVES To investigate the efficacy and gather evidence from randomised controlled trials (RCTs) on the potential harms of anti-vascular endothelial growth factor (VEGF) agents for the treatment of macular oedema (MO) secondary to branch retinal vein occlusion (BRVO). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2019, Issue 6); MEDLINE Ovid; Embase Ovid; the ISRCTN registry; ClinicalTrials.gov; and the WHO ICTRP. The date of the last search was 12 June 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs) investigating BRVO. Eligible trials had to have at least six months' follow-up where anti-VEGF treatment was compared with another treatment, no treatment, or placebo. We excluded trials where combination treatments (anti-VEGF plus other treatments) were used; and trials that investigated the dose and duration of treatment without a comparison group (other treatment/no treatment/sham). DATA COLLECTION AND ANALYSIS Two review authors independently extracted the data using standard methodological procedures expected by Cochrane. The primary outcome was the proportion of participants with an improvement from baseline in best-corrected visual acuity of greater than or equal to 15 letters (3 lines) on the Early Treatment in Diabetic Retinopathy Study (ETDRS) Chart at six months and 12 months of follow-up. The secondary outcomes were the proportion of participants who lost greater than or equal to 15 ETDRS letters (3 lines) and the mean visual acuity (VA) change at six and 12 months, as well as the change in central retinal thickness (CRT) on optical coherence tomography from baseline at six and 12 months. We also collected data on adverse events and quality of life (QoL). MAIN RESULTS We found eight RCTs of 1631 participants that met the inclusion criteria after independent and duplicate review of the search results. These studies took place in Europe, North America, Eastern Mediterranean region and East Asia. Included participants were adults aged 18 or over with VA of 20/40 or worse. Studies varied by duration of disease but permitted previously treated eyes as long as there was sufficient treatment-free interval. All anti-VEGF agents (bevacizumab, ranibizumab and aflibercept) and steroids (triamcinolone and dexamethasone) were included. Overall, we judged the studies to be at moderate or unclear risk of bias. Four of the eight studies did not mask participants or outcome assessors, or both. One trial compared anti-VEGF to sham. At six months, eyes receiving anti-VEGF were significantly more likely to have a gain of 15 or more ETDRS letters (risk ratio (RR) 1.72, 95% confidence interval (CI) 1.19 to 2.49; 283 participants; moderate-certainty evidence). Mean VA was better in the anti-VEGF group at six months compared with control (mean difference (MD) 7.50 letters, 95% CI 5.29 to 9.71; 282 participants; moderate-certainty evidence). Anti-VEGF also proved more effective at reducing CRT at six months (MD -57.50 microns, 95% CI -108.63 to -6.37; 281 participants; lower CRT is better; moderate-certainty evidence). There was only very low-certainty evidence on adverse effects. There were no reports of endophthalmitis. Mean change in QoL (measured using the National Eye Institute Visual Functioning Questionnaire VFQ-25) was better in people treated with anti-VEGF compared with people treated with sham (MD 7.6 higher score, 95% CI 4.3 to 10.9; 281 participants; moderate-certainty evidence). Three RCTs compared anti-VEGF with macular laser (total participants = 473). The proportion of eyes gaining 15 or more letters was greater in the anti-VEGF group at six months (RR 2.09, 95% CI 1.44 to 3.05; 2 studies, 201 participants; moderate-certainty evidence). Mean VA in the anti-VEGF groups was better than the laser groups at six months (MD 9.63 letters, 95% CI 7.23 to 12.03; 3 studies, 473 participants; moderate-certainty evidence). There was a greater reduction in CRT in the anti-VEGF group compared with the laser group at six months (MD -147.47 microns, 95% CI -200.19 to -94.75; 2 studies, 201 participants; moderate-certainty evidence). There was only very low-certainty evidence on adverse events. There were no reports of endophthalmitis. QoL outcomes were not reported. Four studies compared anti-VEGF with intravitreal steroid (875 participants). The proportion of eyes gaining 15 or more ETDRS letters was greater in the anti-VEGF group at six months (RR 1.67, 95% CI 1.33 to 2.10; 2 studies, 330 participants; high-certainty evidence) and 12 months (RR 1.76, 95% CI 1.36 to 2.28; 1 study, 307 participants; high-certainty evidence). Mean VA was better in the anti-VEGF group at six months (MD 8.22 letters, 95% CI 5.69 to 10.76; 2 studies, 330 participants; high-certainty evidence) and 12 months (MD 9.15 letters, 95% CI 6.32 to 11.97; 2 studies, 343 participants; high-certainty evidence). Mean CRT also showed a greater reduction in the anti-VEGF arm at 12 months compared with intravitreal steroid (MD -26.92 microns, 95% CI -65.88 to 12.04; 2 studies, 343 participants; moderate-certainty evidence). People receiving anti-VEGF showed a greater improvement in QoL at 12 months compared to those receiving steroid (MD 3.10, 95% CI 0.22 to 5.98; 1 study, 307 participants; moderate-certainty evidence). Moderate-certainty evidence suggested increased risk of cataract and raised IOP with steroids. There was only very low-certainty evidence on APTC events. No cases of endophthalmitis were observed. AUTHORS' CONCLUSIONS The available RCT evidence suggests that treatment of MO secondary to BRVO with anti-VEGF improves visual and anatomical outcomes at six and 12 months.
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Affiliation(s)
- Zaid Shalchi
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Omar Mahroo
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Danny Mitry
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Royal Free Hospital, NHS Foundation Trust, London, UK
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Navarro-Partida J, Altamirano-Vallejo JC, Lopez-Naranjo EJ, Gonzalez-De la Rosa A, Manzano-Ramírez A, Apatiga-Castro LM, Armendáriz-Borunda J, Santos A. Topical Triamcinolone Acetonide-Loaded Liposomes as Primary Therapy for Macular Edema Secondary to Branch Retinal Vein Occlusion: A Pilot Study. J Ocul Pharmacol Ther 2020; 36:393-403. [PMID: 32564664 DOI: 10.1089/jop.2019.0143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purpose: To explore safety and therapeutic efficacy of a topical ophthalmic triamcinolone acetonide-loaded liposome formulation (TA-LF) as primary therapy in patients with macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Methods: Twelve eyes of 12 patients with ME secondary to BRVO were exposed to a topical instillation of 1 drop of TA-LF (TA 0.2%) 6 times a day for 12 weeks to evaluate safety and efficacy. Best corrected visual acuity (BCVA) intraocular pressure (IOP), slit lamp examination, and central foveal thickness (CFT) were analyzed at every visit. In addition, the morphology of TA-LF was analyzed using scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Results: Patients presented a significant improvement of BCVA and CFT without significant IOP modification (P = 0.94). Treated eyes showed BCVA improvement from 40 ± 12.05 to 64.83 ± 15.97 letters and CFT reduction from 682.91 ± 278.60 to 271.58 ± 57.66 μm after 12 weeks of TA-LF therapy (P < 0.001). No adverse events, including IOP rising, were registered. SEM analysis of liposomal formulations showed that liposome (LP) size depends on its concentration. As the concentration of TA increased, the average size of LPs and the number of larger particles increased as well. TEM study displayed that LP formulation efficiently solubilizes TA crystals in nanoparticles and encapsulates them. Conclusion: LPs can function as nanocarriers of TA and they could be used as topical ophthalmic primary therapy instead of intravitreal drugs in patients with ME secondary to BRVO.
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Affiliation(s)
- Jose Navarro-Partida
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Campus Guadalajara, Zapopan, Mexico.,Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro, Zapopan, Mexico
| | - Juan Carlos Altamirano-Vallejo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Campus Guadalajara, Zapopan, Mexico.,Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro, Zapopan, Mexico
| | | | - Alejandro Gonzalez-De la Rosa
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Campus Guadalajara, Zapopan, Mexico.,Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro, Zapopan, Mexico
| | | | - Luis Miguel Apatiga-Castro
- Universidad Nacional Autonoma de Mexico (UNAM), Centro de Física Aplicada y Tecnología Avanzada, Querétaro, Mexico
| | - Juan Armendáriz-Borunda
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Campus Guadalajara, Zapopan, Mexico.,Instituto de Biología Molecular y Terapia Génica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Arturo Santos
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Campus Guadalajara, Zapopan, Mexico.,Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro, Zapopan, Mexico
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8
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IMPACT OF RETINAL ISCHEMIA ON FUNCTIONAL AND ANATOMICAL OUTCOMES AFTER ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY IN PATIENTS WITH RETINAL VEIN OCCLUSION. Retina 2019; 40:1098-1109. [PMID: 31157714 DOI: 10.1097/iae.0000000000002571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To compare the impact of the classification of retinal vein occlusion (RVO) into ischemic or nonischemic forms on outcomes after anti-vascular endothelial growth factor therapy. METHODS Retrospective review of consecutive patients with RVO evaluated at the Belfast Health and Social Care Trust between July 1, 2014, and December 31, 2015. Outcomes, including gain of ≥10 and ≥15 letters at 12 months, mean change in best-corrected visual acuity from baseline to 12 months, resolution of macular edema at 12 months, and development of neovascular complications and epiretinal membrane after anti-vascular endothelial growth factor therapy, were compared between ischemic and nonischemic eyes using regression models. RESULTS One hundred and seventeen eyes (115 patients), 58 with central RVO and 59 with branch RVO, were included. A greater proportion of eyes with ischemic branch RVO gained ≥10 and ≥15 letters at 12 months than those with nonischemic branch RVO (P = 0.005 and P = 0.016, respectively). No statistically significant differences in visual outcomes were observed between ischemic and nonischemic central RVO. Retinal vein occlusion classification was not associated with anatomical outcomes after treatment. CONCLUSION Findings support the use of anti-vascular endothelial growth factors in ischemic and nonischemic forms of RVO.
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9
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Venincasa MJ, Kuriyan AE, Sridhar J. Effect of funding source on reporting bias in studies of intravitreal anti-vascular endothelial growth factor therapy for retinal vein occlusion. Acta Ophthalmol 2019; 97:e296-e302. [PMID: 30232841 DOI: 10.1111/aos.13917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/14/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine the relationship between industry funding and outcome reporting bias in high-quality studies investigating the use of intravitreal anti-vascular endothelial growth factor (VEGF) agents for patients with macular oedema secondary to branch or central retinal vein occlusion (RVO). METHODS This systematic review in PubMed and Ovid MEDLINE examined all randomized clinical trials and meta-analyses published in journals with impact factor of ≥2 that investigated effectiveness of intravitreal anti-VEGF therapy in patients with RVO. The main outcome measure was correspondence between statistical outcome and abstract conclusion wording. RESULTS Forty-five studies met inclusion criteria; 38 (84%) showed correspondence between outcome and abstract conclusion without difference between industry-funded and nonindustry-funded publications (p = 0.39) or between publications in journals with impact factor ≥3 versus <3 (p = 0.96). CONCLUSION In high-quality studies of intravitreal anti-VEGF therapy for RVO, neither industry funding nor journal impact factor affected the rate of outcome reporting bias.
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Affiliation(s)
- Michael J Venincasa
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ajay E Kuriyan
- Department of Ophthalmology, Flaum Eye Institute, University of Rochester Medical Center, Rochester, New York, USA
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
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10
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Khayat M, Williams M, Lois N. Ischemic retinal vein occlusion: characterizing the more severe spectrum of retinal vein occlusion. Surv Ophthalmol 2018; 63:816-850. [DOI: 10.1016/j.survophthal.2018.04.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 04/14/2018] [Accepted: 04/20/2018] [Indexed: 12/15/2022]
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11
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Nikkhah H, Karimi S, Ahmadieh H, Azarmina M, Abrishami M, Ahoor H, Alizadeh Y, Behboudi H, Daftarian N, Dehghan MH, Entezari M, Farrahi F, Ghanbari H, Falavarjani KG, Javadi MA, Karkhaneh R, Moradian S, Manaviat MR, Mehryar M, Nourinia R, Parvaresh MM, Ramezani A, Haghi AR, Riazi-Esfahani M, Soheilian M, Shahsavari M, Shahriari HA, Rajavi Z, Safi S, Shirvani A, Rahmani S, Sabbaghi H, Pakbin M, Kheiri B, Ziaei H. Intravitreal Injection of Anti-vascular Endothelial Growth Factor Agents for Ocular Vascular Diseases: Clinical Practice Guideline. J Ophthalmic Vis Res 2018; 13:158-169. [PMID: 29719645 PMCID: PMC5905310 DOI: 10.4103/jovr.jovr_50_18] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 12/17/2017] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To provide the clinical recommendations for the administration of intravitreal anti-vascular endothelial growth factor (VEGF) drugs especially bavacizumab for ocular vascular diseases including diabetic macular edema, neovascular age-related macular degeneration, myopic choroidal neovascularization, retinal vein occlusion and central serous chorioretinopathy. METHODS Twenty clinical questions were developed by the guideline technical committee. Relevant websites and databases were searched to find out the pertinent clinical practice guidelines to answer the questions. The technical committee provided possible answers (scenarios) according to the available evidences for each question. All scenarios along with their levels of evidence and the supported articles were sent to the experts for external review. If the experts did not agree on any of the scenarios for one particular clinical question, the technical committee reviewed all scenarios and their pertinent evidences and made the necessary decision. After that, the experts were asked to score them again. All confirmed scenarios were gathered as the final recommendations. RESULTS All the experts agreed on at least one of the scenarios. The technical committee extracted the agreed scenario for each clinical question as the final recommendation. Finally, 56 recommendations were developed for the procedure of intravitreal anti-VEGF injection and their applications in the management of ocular vascular diseases. CONCLUSION The implementation of this guideline can standardize the management of the common ocular vascular diseases by intravitreal injection of anti-VEGF agents. It can lead to better policy-making and evidence-based clinical decision by ophthalmologists and optimal evidence based eye care for patients.
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Affiliation(s)
- Homayoun Nikkhah
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Karimi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Azarmina
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Abrishami
- Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Ahoor
- Department of Ophthalmology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yousef Alizadeh
- Department of Ophthalmology, Guilan University of Medical Sciences, Rasht, Iran
| | - Hasan Behboudi
- Department of Ophthalmology, Guilan University of Medical Sciences, Rasht, Iran
| | - Narsis Daftarian
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Dehghan
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Entezari
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereydoun Farrahi
- Department of Ophthalmology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | | | - Mohammad Ali Javadi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Karkhaneh
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Siamak Moradian
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Reza Manaviat
- Department of Ophthalmology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Morsal Mehryar
- Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Nourinia
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehdi Parvaresh
- Department of Ophthalmology, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Ramezani
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Riazi-Esfahani
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Soheilian
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Shahsavari
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein-Ali Shahriari
- Department of Ophthalmology, Al-Zahra Eye Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Zhale Rajavi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sare Safi
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Shirvani
- Standardization and CPG Development Office, Deputy of Curative Affairs, Ministry of Health and Medical Education, Tehran, Iran
| | - Saeed Rahmani
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamideh Sabbaghi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojgan Pakbin
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Kheiri
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Ziaei
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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New Developments in the Classification, Pathogenesis, Risk Factors, Natural History, and Treatment of Branch Retinal Vein Occlusion. J Ophthalmol 2017; 2017:4936924. [PMID: 28386476 PMCID: PMC5366235 DOI: 10.1155/2017/4936924] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/07/2017] [Indexed: 12/15/2022] Open
Abstract
For years, branch retinal vein occlusion is still a controversial disease in many aspects. An increasing amount of data is available regarding classification, pathogenesis, risk factors, natural history, and therapy of branch retinal vein occlusion. Some of the conclusions may even change our impression of branch retinal vein occlusion. It will be beneficial for our doctors to get a deeper understanding of this disease and improve the treatment skills. The aims of this review is to collect the information above and report new ideas especially from the past a few years.
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Zhao ZX, Li X, Liu WD, Liu XZ, Wu SJ, Hu XH. Inhibition of Growth and Metastasis of Tumor in Nude Mice after Intraperitoneal Injection of Bevacizumab. Orthop Surg 2017; 8:234-40. [PMID: 27384733 PMCID: PMC6593177 DOI: 10.1111/os.12236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/19/2016] [Indexed: 01/16/2023] Open
Abstract
Objective To explore the inhibitory effect of bevacizumab, a vascular endothelial growth factor antibody, on angiogenesis in human osteosarcoma of nude mice. Methods Twenty‐one nude mice were inoculated with red fluorescent protein (RFP)‐labeled human osteosarcoma cell line 143B‐RFP, that is, clones that expressed RFP in the cytoplasm, and randomly assigned to one of three groups: G1 (Control group, injected with saline solution); G2 (intraperitoneal bevacizumab 2 mg/kg twice per week) and G3 (intraperitoneal bevacizumab 5 mg/kg, twice per week). The tumor‐bearing mice were examined in a fluorescence light box that was illuminated periodically. The primary tumors were measured by fluorescence imaging weekly and their volumes calculated. Results The mean tumor volumes were significantly smaller in the G3 (186.4 ± 100.8 mm3) than the control group (587.0 ± 406.8 mm3) (P < 0.05) on Day 31, and again significantly smaller in the G3 (677.3 ± 461.9 mm3) than the control group (3162.6 ± 1529.2 mm3) on Day 38 (P < 0.01). The average tumor volume in the G2 group was 493.5 ± 425.4 mm3 on Day 31 and 1870.1 ± 1524.8 mm3 on Day 38. The effect on tumor volume was greater in the G3 than the G2 group. Three mice in the G2 group, four in the G3 group and four in the control group developed lung metastases that were confirmed by pathological examination; these differences were not statistically significant (P < 0.05). Conclusions Bevacizumab exhibits strong antiangiogenesis activity in experimental osteosarcoma in a nude mouse model but does not influence the incidence of lung metastasis. Our findings may have considerable potential for the treatment of osteosarcoma.
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Affiliation(s)
- Ze-Xue Zhao
- Department of Orthopaedics, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Orthopaedics, Huaian First People's Hospital, Nanjing Medical University, Huaian, China
| | - Xiang Li
- Department of Orthopaedics, Huaian First People's Hospital, Nanjing Medical University, Huaian, China
| | - Wei-Dong Liu
- Department of Orthopaedics, Huaian First People's Hospital, Nanjing Medical University, Huaian, China
| | - Xiao-Zhou Liu
- Department of Orthopaedics, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Su-Jia Wu
- Department of Orthopaedics, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiao-Hui Hu
- Department of Orthopaedics, Huaian First People's Hospital, Nanjing Medical University, Huaian, China
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Yoo SG, Kim JH, Lee TG, Kim CG, Kim JW. Short-term efficacy of intravitreal triamcinolone acetonide for macular edema secondary to retinal vein occlusion that is refractory to intravitreal bevacizumab. Indian J Ophthalmol 2016; 63:25-9. [PMID: 25686058 PMCID: PMC4363952 DOI: 10.4103/0301-4738.151460] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
AIMS To evaluate the 1-month efficacy of intravitreal triamcinolone acetonide (TA) in treating macular edema secondary to retinal vein occlusion (RVO) that was refractory to intravitreal bevacizumab. MATERIALS AND METHODS This retrospective, observational study included 23 eyes from 23 patients with macular edema secondary to RVO. Macular edema that did not respond to two or more consecutive intravitreal bevacizumab injections was treated with intravitreal TA. Central foveal thickness (CFT) and best-corrected visual acuity (BCVA) were compared before and one month after TA injection. RESULTS Fifteen eyes were diagnosed with central RVO, and eight eyes were diagnosed with branch RVO. All patients were previously treated with 2.4 ± 0.6 intravitreal bevacizumab injections. The TA injection was performed, on average, 5.8 ± 1.4 weeks after the last bevacizumab injection. The CFT before TA injection was 516.6 ± 112.4 μm and significantly decreased to 402.3 ± 159.7 μm after TA therapy (P < 0.001). The logarithm of the minimal angle of resolution BCVA was 0.72 ± 0.34 before TA therapy and was not significantly improved by the treatment (0.67 ± 0.35, P = 0.119), despite a decrease in CFT. However, seven eyes (30.4%) had a BCVA gain of one or more lines. CONCLUSIONS Intravitreal TA therapy was beneficial in some patients with macular edema secondary to RVO that was refractory to intravitreal bevacizumab therapy. This study suggests that intravitreal TA should be considered as a treatment option for refractory macular edema.
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Affiliation(s)
| | - Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
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Thorell MR, Goldhardt R. Update in the Management of Macular Edema Following Retinal Vein Occlusions. CURRENT OPHTHALMOLOGY REPORTS 2016; 4:38-47. [PMID: 30345164 PMCID: PMC6195357 DOI: 10.1007/s40135-016-0091-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Retinal vein occlusion (RVO) is a common retinal vascular disease classified according to the anatomical location of the occlusion in central (CRVO) or branch (BRVO) retinal vein occlusion. RVO is an important cause of visual loss worldwide and frequently results in visual impairment and ocular complications. Major causes of vision loss in BRVO and CRVO include macular edema (ME), capillary non-perfusion, and neovascularization, causing glaucoma, vitreous hemorrhage and/or tractional retinal detachment.[1-4] Macular edema is the leading cause of decreased central visual acuity in RVO.[5] Recently, there was a paradigm shift in the treatment of ME due to RVO with the advent of new pharmacotherapy treatment strategies and combination therapies. This paper reviews the current thinking and discusses the evidence behind the emerging treatment options for ME following RVO, including laser photocoagulation, intravitreal anti-vascular endothelial growth factor (VEGF), intravitreal corticosteroid-based pharmacotherapies, and surgical management.
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Affiliation(s)
- Mariana R Thorell
- Department of Ophthalmology, Hospital Banco de Olhos de Porto Alegre, Porto Alegre, Brazil.
| | - Raquel Goldhardt
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, USA.
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Zhang S, An N, Ha W, Zhang S, Hu X, Ma A, Zhao B. Factors correlated with the resolution of macular oedema after one dose injection of intravitreal triamcinolone acetonide treatment in branch retinal vein occlusion. J Int Med Res 2016; 44:685-97. [PMID: 26936966 PMCID: PMC5536696 DOI: 10.1177/0300060515617386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/19/2015] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate the predictive baseline factors for a successful outcome following one dose of intravitreal triamcinolone acetonide (IVTA) in patients with macular oedema (ME) caused by branch retinal vein occlusion (BRVO). Methods This retrospective study enrolled patients with ME (macular retinal thickness [MRT] ≥ 300 µm) due to BRVO who still had ME 3 months after grid laser photocoagulation. Patients were divided according to treatment into an IVTA group and a laser-only group. The resolution of ME was documented at months 3 and 6. Results A total of 154 eyes with ME were investigated: IVTA group (90 eyes) and laser-only group (64 eyes). Predictive factors for successful IVTA treatment were younger age, shorter duration of ME, initial onset ME, accompanied by serous retinal detachment, few concomitant systemic diseases and nonischaemic BRVO. A broken foveal capillary ring was related to a poor treatment outcome. Eyes with cystoid spaces in the outer plexiform layer were more likely to have a good treatment response. Conclusion IVTA is effective for resolving ME due to BRVO after grid laser photocoagulation treatment.
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Affiliation(s)
- Shuang Zhang
- Department of Ophthalmology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong Province, China Department of Ophthalmology, Ningxia Eye Hospital, Ningxia People's Hospital, Yinchuan, Ningxia, China
| | - Ningyu An
- Department of Ophthalmology, Ningxia Eye Hospital, Ningxia People's Hospital, Yinchuan, Ningxia, China
| | - Wenjing Ha
- Department of Ophthalmology, Ningxia Eye Hospital, Ningxia People's Hospital, Yinchuan, Ningxia, China
| | - Shaochi Zhang
- Department of Ophthalmology, Ningxia Eye Hospital, Ningxia People's Hospital, Yinchuan, Ningxia, China
| | - Xiaowen Hu
- Department of Ophthalmology, Ningxia Eye Hospital, Ningxia People's Hospital, Yinchuan, Ningxia, China
| | - Aihua Ma
- Department of Paediatrics, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong Province, China
| | - Bojun Zhao
- Department of Ophthalmology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong Province, China
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Sun Y, Qu Y. Comparison of intravitreal bevacizumab with intravitreal triamcinolone acetonide for treatment of cystoid macular edema secondary to retinal vein occlusion: a Meta-analysis. Int J Ophthalmol 2015; 8:1234-9. [PMID: 26682180 DOI: 10.3980/j.issn.2222-3959.2015.06.29] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 03/23/2015] [Indexed: 11/02/2022] Open
Abstract
AIM To compare the effects of intravitreal injection of bevacizumab (IVB) with intravitreal triamcinolone acetonide (IVTA) on the treatment of cystoid macular edema (CME) secondary to retinal vein occlusion (RVO). METHODS A literature search was conducted using PubMed, the Cochrane Central Register of Controlled Trials, Web of Science and the Chinese Biomedical Database. The comparison was divided into two groups, group 1 conducted comparison in branch RVO (BRVO) or central RVO (CRVO), group 2 conducted comparison in ischemic-RVO or nonischemic-RVO. Pooled mean differences (MDs) for changes in visual acuity (VA), central macular thickness (CMT) and intraocular pressure (IOP) were calculated in groups at 4, 12 and 24wk after treatment respectively. RESULTS Eight studies comparing the efficacy of IVB with IVTA were included in the Meta-analysis. In group 1, in BRVO, significant difference was shown on the comparison of CMT at 24wk (MD, -45.66; 95% CI, -76.03 to -15.28; P=0.003), IVB was effective on BRVO for at least 24wk; no significant differences were found in the comparison of VA at each time points (P>0.05 respectively). In CRVO, no significant differences were found in the comparison of VA or CMT between IVB and IVTA at each time points (P>0.05, respectively). In group 2, in ischemic-RVO, significant differences were shown in the comparison of VA (MD, -0.28; 95% CI, -0.42 to -0.14; P<0.0001) and CMT (MD, -86.50; 95% CI, -151.18 to -22.43; P=0.008) at 24wk; In nonischemic-RVO, no significant differences were demonstrated in the comparison of VA or CMT between IVB and IVTA at each time points (P>0.05, respectively). The occurrence of high IOP was much lower in IVB group. CONCLUSION This Meta-analysis suggested that IVB was effective in decreasing CMT in BRVO for at least 24wk, IVB is more effective on improving VA and reducing CMT in ischemic-RVO. IVB is more promising on RVO than IVTA.
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Affiliation(s)
- Yan Sun
- Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China ; Affiliated Hospital of Weifang Medical University, Weifang 261000, Shandong Province, China
| | - Yi Qu
- Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
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Berger AR, Cruess AF, Altomare F, Chaudhary V, Colleaux K, Greve M, Kherani A, Mandelcorn ED, Parsons H, Rhéaume MA, Tourville E. Optimal Treatment of Retinal Vein Occlusion: Canadian Expert Consensus. Ophthalmologica 2015; 234:6-25. [DOI: 10.1159/000381357] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 02/25/2015] [Indexed: 11/19/2022]
Abstract
Background: The availability of new therapeutic approaches, particularly intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapies, has prompted significant changes to the established treatment paradigms for retinal vein occlusion (RVO). Better visual outcomes and significantly lower rates of adverse events have been noted in multiple large randomized clinical trials and have led to a new standard of care for this sight-threatening condition. Objective: To develop an expert consensus for the management of RVO and associated complications in the context of recent clinical evidence. Methods: The development of a Canadian expert consensus for optimal treatment began with a review of clinical evidence, daily practice, and existing treatment guidelines and algorithms. The expert clinicians (11 Canadian retina specialists) met on February 1, 2014, in Toronto to discuss their findings and to propose strategies for consensus. Results: The result of this expert panel is a consensus proposal for Canadian ophthalmologists and retina specialists treating patients presenting with RVO. Treatment algorithms specific to branch and central RVO (BRVO and CRVO) were also developed. Conclusions: The consensus provides guidelines to aid clinicians in managing RVO and associated complications in their daily practice. In summary, laser remains the therapy of choice when neovascularization secondary to RVO is detected. Adjunctive anti-VEGF could be considered in managing neovascularization secondary to RVO in cases of vitreous hemorrhage. Intravitreal anti-VEGF should be considered for symptomatic visual loss associated with center-involving macular edema on optical coherence tomography. Patients with BRVO and a suboptimal response to anti-VEGF could be treated with grid laser, and those with CRVO and an inadequate response to anti-VEGF may be candidates for intravitreal steroids.
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Ramezani A, Esfandiari H, Entezari M, Moradian S, Soheilian M, Dehsarvi B, Yaseri M. Three intravitreal bevacizumab versus two intravitreal triamcinolone injections in recent onset central retinal vein occlusion. Acta Ophthalmol 2014; 92:e530-9. [PMID: 24373344 DOI: 10.1111/aos.12317] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 10/26/2013] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate the effects of repeated intravitreal injections of bevacizumab (IVB) versus triamcinolone acetonide (IVT) in the treatment of acute central retinal vein occlusion (CRVO). METHODS In this randomized clinical trial, 86 eyes with recent onset (<12 weeks) CRVO were assigned to two groups: IVB group (43 eyes) that received three monthly injections of 1.25 mg of IVB, and IVT group (43 eyes) that received two injections of 2 mg IVT 2 months apart. Outcomes were best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) changes. RESULTS Mean BCVA improved significantly at 6 months in both groups; from 0.87 ± 0.49 to 0.41 ± 0.35 logMAR in IVB group, and from 0.81 ± 0.45 to 0.62 ± 0.48 logMAR in IVT group (p < 0.001). However, between-group differences reach a significant level at months 4 (p = 0.003) and 6 (p < 0.001) in favour of the IVB group. In terms of CMT reduction, the difference between the groups was statistically significant (p = 0.002) at month 6. Significant differences were noted more in the ischaemic cases in favour of the IVB group. Mean IOP rise was significantly higher in the IVT group at all visits. CONCLUSIONS Both 3-times monthly IVB injections and 2-times IVT injections could be effective in cases with recent onset CRVO up to 6 months. However, considering the better outcomes after IVB injections and the potential complications of IVT injections, we would recommend prescheduled repeated IVB injections for such cases. The observed favourable responses were more pronounced in the ischaemic types; nevertheless, this should be confirmed in larger studies.
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Affiliation(s)
- Alireza Ramezani
- Department of Ophthalmology; Ophthalmic Research Center; School of Medicine; Labbafinejad and Imam Hossein Medical Centers; Shahid Beheshti University of Medical Sciences; Tehran Iran
- School of Medicine; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Hamed Esfandiari
- Department of Ophthalmology; Ophthalmic Research Center; School of Medicine; Labbafinejad and Imam Hossein Medical Centers; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Morteza Entezari
- Department of Ophthalmology; Ophthalmic Research Center; School of Medicine; Labbafinejad and Imam Hossein Medical Centers; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Siamak Moradian
- Department of Ophthalmology; Ophthalmic Research Center; School of Medicine; Labbafinejad and Imam Hossein Medical Centers; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Masoud Soheilian
- Department of Ophthalmology; Ophthalmic Research Center; School of Medicine; Labbafinejad and Imam Hossein Medical Centers; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Babak Dehsarvi
- Department of Ophthalmology; Ophthalmic Research Center; School of Medicine; Labbafinejad and Imam Hossein Medical Centers; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Mehdi Yaseri
- Department of Ophthalmology; Ophthalmic Research Center; School of Medicine; Labbafinejad and Imam Hossein Medical Centers; Shahid Beheshti University of Medical Sciences; Tehran Iran
- Department of Biostatistics and Epidemiology; Tehran University of Medical Sciences; Tehran Iran
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Rehak M, Tilgner E, Franke A, Rauscher FG, Brosteanu O, Wiedemann P. Early peripheral laser photocoagulation of nonperfused retina improves vision in patients with central retinal vein occlusion (Results of a proof of concept study). Graefes Arch Clin Exp Ophthalmol 2013; 252:745-52. [PMID: 24346235 DOI: 10.1007/s00417-013-2528-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 10/24/2013] [Accepted: 11/07/2013] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND To evaluate the effect of combination of ranibizumab and laser photocoagulation to peripheral retinal areas of nonperfusion in patients with non-ischemic central retinal vein occlusion (CRVO) without neovascularizations. METHODS This prospective, proof of concept study randomized 22 CRVO patients into two arms. The RL group (ranibizumab + laser; n = 10) received ranibizumab with additive laser photocoagulation; the control R group (n = 12) was treated with ranibizumab only. All patients received three initial monthly ranibizumab injections followed by PRN regimen. Changes in best corrected visual acuity (BCVA) and in central retinal thickness (CRT) were documented over 6 months. RESULTS Median of BCVA improved in the RL group from 65 ETDRS letters (interquartile range IQR = 10 letters) at baseline to 70 (IQR = 23.2) letters at month 6. In the control group BCVA remained stable [baseline: 61 (IQR = 19.5) and month 6: 61 (IQR = 22) letters]. CRT decreased between baseline and final visit in the RL group from 547 (IQR = 513) μm to 246.5 (IQR = 346.3) μm, and in the control group from 637.5 (IQR = 344) μm to 423 (IQR = 737) μm. More pronounced improvements in BCVA were seen in the RL group (medians = 14 vs. 6.5 letters) although the observed group differences were not statistically significant due to small samples. CONCLUSIONS The selective laser photocoagulation of peripheral areas of nonperfusion seems to lead to additional visual improvement in patients with CRVO. A larger replication trial is necessary to confirm the results of this proof of concept study.
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Affiliation(s)
- Matus Rehak
- Department of Ophthalmology, University of Leipzig, Liebigstrasse 10-14, 04103, Leipzig, Germany
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Effects of arteriolar constriction on retinal gene expression and Müller cell responses in a rat model of branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 2013; 252:257-65. [PMID: 24292703 DOI: 10.1007/s00417-013-2532-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 10/31/2013] [Accepted: 11/13/2013] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND To investigate the effect of induced arteriolar constriction (AC) on alterations in gene expression of factors implicated in the development of edema in branch retinal vein occlusion (BRVO). METHODS In Brown-Norway rats, BRVO was induced by laser photocoagulation of the veins in one half of the retina. AC of the afferent arterioles was performed 30 min later. We then determined the expression of Vegfa, Vegfb, Pedf, Kir4.1, Aqp4, Aqp1, Il1ß, and Il6 with real-time polymerase chain reaction (RT-PCR) in the neuroretina and retinal pigment epithelium (RPE) after 1, 3, and 7 days. Immunostaining against GFAP, aquaporin (AQP)-4, and Kir4.1 was performed on days 1 and 3. RESULTS BRVO resulted in transient upregulation of Vegfa in the neuroretina on day 1. The expressions of Kir4.1, AQP4, and AQP1 were downregulated, and Il1ß and Il6 were strongly upregulated, on days 1 and 3. The retinal distribution of GFAP and AQP4 proteins remained unaltered, while the Kir4.1 protein displayed redistribution from polarized to uniform retinal distribution. AC accelerated the restoration of downregulated Kir4.1, Aqp4, and Aqp1 in the RPE, of Kir4.1 in the neuroretina, and of upregulated Il6 in the neuroretina. AC did not influence the gliotic alterations of Müller cells and the redistribution of the Kir4.1 protein. CONCLUSION Constriction of the afferent artery in the BRVO region accelerated the restoration of potassium channels and Il6. These alterations may contribute to faster resorption of retinal edema, and may decrease the level of inflammation.
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Chatziralli IP, Jaulim A, Peponis VG, Mitropoulos PG, Moschos MM. Branch retinal vein occlusion: treatment modalities: an update of the literature. Semin Ophthalmol 2013; 29:85-107. [PMID: 24171809 DOI: 10.3109/08820538.2013.833271] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Retinal vein occlusion is the second most common retinal vascular disorder after diabetic retinopathy and is considered to be an important cause of visual loss. In this review, our purpose is to update the literature about the treatment alternatives for branch retinal vein occlusion. METHODS Eligible papers were identified by a comprehensive literature search of PubMed, using the terms "branch retinal vein occlusion," "therapy," "intervention," "treatment," "vitrectomy," "sheathotomy," "laser," "anti-VEGF," "pegaptanib," "bevacizumab," "ranibizumab," "triamcinolone," "dexamethasone," "corticosteroids," "non-steroids," "diclofenac," "hemodilution," "fibrinolysis," "tPA," and "BRVO." Additional papers were also selected from reference lists of papers identified by the electronic database search. RESULTS Treatment modalities were analyzed. CONCLUSIONS There are several treatment modalities for branch retinal vein occlusion and specifically for its complications, such as macular edema, vitreous hemorrhage, retinal neovascularization, and retinal detachment, including anti-aggregative therapy and fibrinolysis, isovolemic hemodilution, vitrectomy with or without sheathotomy, peripheral scatter and macular grid retinal laser therapy, non-steroid agents, intravitreal steroids, and intravitreal anti-vascular endothelial growth factors (anti-VEGFs).
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Jin ZY, Zhu D, Tao Y, Wong IY, Jonas JB. Meta-analysis of the effect of intravitreal bevacizumab versus intravitreal triamcinolone acetonide in central retinal vein occlusion. J Ocul Pharmacol Ther 2013; 29:826-31. [PMID: 23971622 DOI: 10.1089/jop.2013.0061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To further evaluate the effect of intravitreal bevacizumab (IVB) for the treatment of central retinal vein occlusion (CRVO) by meta-analysis. METHODS Pertinent publications were identified through PubMed, EMBASE, and the Cochrane Controlled Trials Register up to January 30, 2013. Changes in central macular thickness (CMT) and best-corrected visual acuity (BCVA) were extracted at 4, 12, and 24 weeks after treatment, and a meta-analysis was carried out to compare results between groups receiving IVB and intravitreal triamcinolone acetonide (IVTA). RESULTS One randomized controlled trial and 4 comparative studies were identified and included. All of the funnel plots, the Egger's method and Begg method did not show publication bias. Our meta-analysis revealed that BCVA and CMT at 4, 12, and 24 weeks after treatment did not vary significantly between the IVB groups and IVTA groups (BCVA: at 4 weeks, P=0.27; at 12 weeks, P=0.51; at 24 weeks, P=0.64; CMT at 4 weeks, P=0.88; at 12 weeks, P=0.57; at 24 weeks, P=0.64). However, the rate of intraocular pressure rise after intravitreal injection varied significantly between the IVB groups and IVTA groups (P<0.001). CONCLUSIONS Our results showed a similar improvement in BCVA and CMT among CRVO patients was obtained after intravitreal injections of both IVB, or IVTA, while the rate of IOP rise was significantly higher in the latter.
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Affiliation(s)
- Zi Ye Jin
- 1 The Affiliated Hospital of Inner Mongolia Medical University , Hohhot, Inner Mongolia, China
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Freund KB, Mrejen S, Gallego-Pinazo R. An update on the pharmacotherapy of neovascular age-related macular degeneration. Expert Opin Pharmacother 2013; 14:1017-28. [PMID: 23560774 DOI: 10.1517/14656566.2013.787410] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Neovascular age-related macular degeneration (AMD) is currently the most common cause of legal blindness in industrialized countries. The advent of pharmacotherapy with intravitreal VEGF inhibitors has greatly improved outcomes for the treatment of this disease. AREAS COVERED The present review is divided into two major sections: the period prior to the use of anti-VEGF agents (triamcinolone acetonide, verteporfin photodynamic therapy) and the period following their introduction (pegaptanib sodium, bevacizumab, ranibizumab, aflibercept). The main pharmacological and clinical characteristics of each therapy are summarized. EXPERT OPINION Monotherapy with anti-VEGF agents is currently the 'gold standard' for treating neovascular AMD, but, with several drug choices and various different dosing regimens available, there is still wide variability in how individual clinicians manage their patients. Despite improved visual outcomes, there remains a significant unmet need for better treatments as the frequent office visits and injections associated with anti-VEGF therapy are costly and place a significant burden on patients, their family members and physicians.
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Affiliation(s)
- K Bailey Freund
- Vitreous Retina Macula Consultants of New York, 460 Park Avenue, 5th Floor, New York, NY 10022, USA.
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Zhu D, Jin ZY, Tao Y, Jonas JB. Meta-analysis of the effect of intravitreal bevacizumab in branch retinal vein occlusion. J Ocul Pharmacol Ther 2013; 29:523-9. [PMID: 23537150 DOI: 10.1089/jop.2012.0278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND To further evaluate the effect of intravitreal bevacizumab (IVB) for the treatment of branch retinal vein occlusion in a meta-analysis of previous studies. METHODS Pertinent publications were identified through systemic searches of PubMed, EMBASE, and the Cochrane Controlled Trials Register up to July 2012. Data on central macular thickness and best-corrected visual acuity obtained at 4 and 12 weeks after treatment were extracted. Groups of patients receiving IVB were compared with control groups. RESULTS Four randomized controlled and 3 comparative studies were included. A publication bias was not detected by funnel plots, the Egger method, or the Begg method. Best corrected visual acuity measured at 4 and 12 weeks after baseline increased significantly in the IVB groups as compared with the control groups [4 weeks: weighted mean deviation (WMD)=-0.09; 95% confidence interval (CI): -0.12, -0.05; P<0.001; at 12 weeks: WMD=-0.21; 95% CI: -0.30, -0.12; P<0.001]. Similarly, reduction in central macular thickness at 12 weeks after baseline was significantly higher in the IVB groups than in the control groups (WMD=-29.02; 95% CI: -50.56, -7.49; P=0.008). The change in central macular thickness at 4 weeks after baseline did not vary significantly between the IVB groups and control groups (WMD=-20.48; 95% CI: -67.30, 26.34; P=0.39). All included studies taken separately reported on a significant increase in visual acuity in the IVB groups. CONCLUSIONS Patients with branch retinal vein occlusion experienced a significant benefit in terms of visual improvement and reduction in central macular thickness after the intravitreal injection of bevacizumab.
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Affiliation(s)
- Dan Zhu
- The Affiliated Hospital of Inner Mongolia Medical College, Hohhot, Inner Mongolia, China
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