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Hikichi T. Investigation of satisfaction with short-term outcomes after switching to faricimab to treat neovascular age-related macular degeneration. Jpn J Ophthalmol 2023; 67:652-656. [PMID: 37861941 DOI: 10.1007/s10384-023-01024-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/31/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE To investigate the outcomes and patient satisfaction at 6-months' follow-up after switching to faricimab to treat neovascular age-related macular degeneration (nAMD) with a treat-and-extend (TAE) regimen. STUDY DESIGN Retrospective observational study. METHODS Forty-eight consecutive eyes (48 patients) were switched to faricimab to treat nAMD and followed for 6 months on a TAE regimen. The Macular Disease Treatment Satisfaction Questionnaire (MacTSQ) was administered to patients 6 months after the switch. RESULTS Best-corrected visual acuity (BCVA) was maintained 6 months after the switch, while the mean (± standard error) central foveal thickness 6 months after the switch (272 ± 14 μm) decreased significantly compared to the time of the switch (372 ± 20 μm) (p < 0.001). The interval between injections 6 months after the switch was 10.45 ± 0.44 weeks, a significant extension from 6.72 ± 0.34 weeks at the switch (p = 0.002). The MacTSQ total score (58.8 ± 1.7) in eyes with a BCVA of 20/40 and better 6 months after the switch was significantly higher compared to that in eyes with a BCVA worse than 20/40 (48.2 ± 1.5) (p < 0.001). The MacTSQ total score (56.8 ± 1.8) in eyes in which a 4 weeks extension of the injection interval was achieved was significantly higher than (49.5 ± 1.9) in eyes without (p < 0.001). CONCLUSION Switching to faricimab with a TAE regimen seems to maintain the BCVA and extend the injection interval in patients with nAMD, resulting in enhanced satisfaction.
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Affiliation(s)
- Taiichi Hikichi
- Hikichi Eye Clinic, Kita-7 Nishi-5 7-1 Kita-Sky-Building, 14 Floor, Kita-ku, Sapporo, 060-0807, Japan.
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Wada I, Nakao S, Fukuda Y, Shiose S, Takeda A, Kannan R, Sonoda KH. Persistence of vascular empty sleeves in choroidal neovascularization after VEGF therapy in both animal models and humans. Graefes Arch Clin Exp Ophthalmol 2023; 261:2189-2197. [PMID: 36869890 DOI: 10.1007/s00417-023-06018-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 02/08/2023] [Accepted: 02/18/2023] [Indexed: 03/05/2023] Open
Abstract
PURPOSE Choroidal neovascularization (CNV) often recurs during anti-vascular endothelial growth factor (VEGF) therapy; however, little is known about the mechanism of vascular regrowth. Vascular regrowth along the empty sleeves of basement membranes was proposed as a mechanism for recurrence after the reversal of VEGF inhibition in tumors. This study investigated whether the proposed mechanism is involved in CNV during VEGF therapy. METHODS We made two observations using a mice model, as well as patients with CNV. Laser-induced CNV mice were used to examine the vascular empty sleeves of the basement membrane and CNV with the immunohistochemistry of type IV collagen and CD31, respectively. A retrospective cohort study included 17 eyes from 17 patients with CNV treated with anti-VEGF treatment. Vascular regrowth during anti-VEGF treatment was assessed using optical coherence tomography angiography (OCTA). RESULTS In the CNV mouse model, the CD31+ vascular endothelium area was decreased during anti-VEGF treatment compared with the IgG control (33516.7 ± 10864.7 vs. 10745.9 ± 5755.9 μm2, P < 0.05), whereas a significant difference was not observed in the area of type IV collagen+ vascular empty sleeve after the treatment compared with the control (29135.0 ± 7432.9 vs. 24592.0 ± 5935.3 μm2, P = 0.7). The proportions of CD31+ to type IV collagen+ areas were significantly decreased after the treatment (38.7 ± 7.4% vs. 17.1 ± 5.4%, P < 0.05). In the OCTA observations, the follow-up period in the retrospective cohort study was 58.2 ± 23.4 months. CNV regrowth was observed in 682 neovessels of the 17 eyes. In group 1, CNV regression and regrowth are in the same form (129 neovessels, 18.9%). In group 2, CNV regression and regrowth are in a different form (170 neovessels, 24.9%). In group 3, CNV regrowth is with a different form without the regression (383 neovessels, 56.2%). CONCLUSIONS Parts of CNV regrowth may occur along the vascular empty sleeve, which remain after anti-VEGF treatment.
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Affiliation(s)
- Iori Wada
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Doheny Eye Institute, Pasadena, CA, USA
- Stein Eye Institute, Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Shintaro Nakao
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
- Department of Ophthalmology, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan.
- Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan.
- Department of Ophthalmology, Juntendo University School of Medicine, Tokyo, Japan.
| | - Yosuke Fukuda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Ophthalmology, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
- Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Satomi Shiose
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Atsunobu Takeda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ram Kannan
- Doheny Eye Institute, Pasadena, CA, USA
- Stein Eye Institute, Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Charles J, Chau TRANTH. Five-year outcome of aflibercept intravitreal injection in naïve patients with neovascular age-related macular degeneration using a modified treat-and-extend regimen: Results from a prospective observational study. Taiwan J Ophthalmol 2023; 13:219-224. [PMID: 37484613 PMCID: PMC10361423 DOI: 10.4103/tjo.tjo-d-22-00135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/05/2023] [Indexed: 07/25/2023] Open
Abstract
PURPOSE The purpose is to study the 5-year results of aflibercept monotherapy using an individualized regimen in naïve patients with neovascular AMD (nAMD). MATERIALS AND METHODS This is a prospective observational study including naïve nAMD patients who underwent aflibercept injections with at least 5 years of follow-up. All of them received 3 monthly injections at the loading phase, followed by an observation period, then treated with an individualized treat-and-extend regimen. Visual acuity (VA) measurement and optical coherence tomography were performed at each visit. RESULTS Forty-eight eyes were included. Of these, 30 were followed up for 5 years. The mean follow-up was 61.7 ± 2.3 months. The mean age was 81 ± 8 years. The visual gain was 7.3 ± 12.7 letters at 1 year, 6.5 ± 12.5 letters at 2 years, 5.2 ± 17 letters at 3 years, 6.2 ± 18.6 letters at 4 years, and 5.6 ± 20 letters at 5 years. At the last observation, 53% of eyes had VA > 70 letters. A complete fluid resolution was obtained in 53% of the eyes. At the 5-year endpoint, the total number of injections was 21.6 ± 13.4. Macular atrophy was observed in 18 eyes (60%) and subretinal fibrosis in 14 eyes (46%). CONCLUSION Patients with exudative AMD can maintain their visual function at 5 years with aflibercept using an individualized treatment. The loss of visual gain beyond 2 years could be related to the natural progression of the disease than the direct effect of anti-vascular endothelial growth injections.
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Kim JG, Kim YC, Kang KT. Impact of Delayed Intravitreal Anti-Vascular Endothelial Growth Factor (VEGF) Therapy Due to the Coronavirus Disease Pandemic on the Prognosis of Patients with Neovascular Age-Related Macular Degeneration. J Clin Med 2022; 11:jcm11092321. [PMID: 35566445 PMCID: PMC9100166 DOI: 10.3390/jcm11092321] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/04/2022] [Accepted: 04/20/2022] [Indexed: 11/16/2022] Open
Abstract
This study estimated the outcome of delayed intravitreal anti-vascular endothelial growth factor (VEGF) therapy due to the coronavirus (COVID-19) disease pandemic on the prognosis of patients with neovascular age-related macular degeneration (nAMD). This study retrospectively enrolled 57 nAMD patients whose intravitreal anti-VEGF injections were delayed for >2 weeks between February and June 2020. Best-corrected visual acuity (BCVA), central subfield thickness (CST), and anatomical characteristics were evaluated before (baseline), on the day, and at 2, 4, and 6 months after the delayed injection, and risk factors were identified. The average injection interval before and after treatment delay was 3.05 ± 1.45 and 2.41 ± 1.46 months, respectively (p = 0.002). The CST at baseline and on the day of delayed injection was 227.82 ± 62.46 and 267.26 ± 77.74 µm, respectively (p < 0.001). The average BCVA decreased from 0.29 ± 0.29 logMAR (baseline) to 0.38 ± 0.31 logMAR (6 months) (p = 0.001). The maximum subretinal fluid (SRF) height increased from 84.32 ± 89.33 µm (baseline) to 121.38 ± 103.36 µm (6 months) (p = 0.027). A higher baseline maximum SRF height was associated with less SRF height deterioration 6 months later (p < 0.001). Delayed intravitreal anti-VEGF therapy caused by the COVID-19 pandemic has worsened BCVA and residual SRF in nAMD patients after a temporary recovery. The baseline SRF reduce the degree of SRF height deterioration.
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Giralt-Peret L, Rodríguez-Urzay A, Pérez-Fernández S, Martínez-Alday N, Fonollosa-Calduch A. Real-life results in treating neovascular age-related macular degeneration with anti-VEGF therapy. Analysis of 122 patients from a single centre. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:191-197. [PMID: 35523465 DOI: 10.1016/j.oftale.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/09/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The prognosis of age-related macular degeneration (AMD) has improved significantly since the advent of antiangiogenic treatments. However, several «real life» studies have shown lower number of injections and a markedly worse visual prognosis than pivotal clinical trials. OBJECTIVE To assess the effectiveness and safety of the treatment of neovascular AMD and analyse clinical factors related to the functional and structural prognosis in routine clinical practice. MATERIAL AND METHODS Retrospective, observational, single-centre study that included 143 eyes of 122 patients diagnosed with neovascular AMD between the years 2015 and 2016, who received treatment with antiangiogenic drugs and were followed up for two or more years. RESULTS Visual acuity improved in 45% of patients after two years of treatment. The mean decrease in central macular thickness was 85 μm (p < 0.001) and the mean number of injections was 13. Retinal pigment epithelium rupture was present in 3.5%. Ranibizumab was the drug most used as a first option, although 79 patients (55.2%) required a change in treatment, most being switched to aflibercept. A greater number of visits (p < 0.001) and a lower number of injections (p < 0.01) were predictors of worse structural outcome. The number of visits was associated with better visual acuity (p < 0.001). CONCLUSIONS The treatment has demonstrated its efficacy by improving visual acuity and central macular thickness. However, the number of injections performed has generally been higher than in other real-life studies.
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Affiliation(s)
- L Giralt-Peret
- Servicio de Oftalmología, Hospital Universitario Cruces, Barakaldo, Vizcaya, Spain; Facultad de Medicina de la Universidad del País Vasco (UPV/EHU), Leioa, Vizcaya, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, Spain.
| | - A Rodríguez-Urzay
- Facultad de Medicina de la Universidad del País Vasco (UPV/EHU), Leioa, Vizcaya, Spain
| | - S Pérez-Fernández
- Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, Spain
| | - N Martínez-Alday
- Servicio de Oftalmología, Hospital Universitario Cruces, Barakaldo, Vizcaya, Spain; Facultad de Medicina de la Universidad del País Vasco (UPV/EHU), Leioa, Vizcaya, Spain
| | - A Fonollosa-Calduch
- Servicio de Oftalmología, Hospital Universitario Cruces, Barakaldo, Vizcaya, Spain; Facultad de Medicina de la Universidad del País Vasco (UPV/EHU), Leioa, Vizcaya, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, Spain
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Kim JH, Kim JW, Kim CG. Five-Year Reactivation After Ranibizumab or Aflibercept Treatment for Neovascular Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy. J Ocul Pharmacol Ther 2021; 37:525-533. [PMID: 34520251 DOI: 10.1089/jop.2021.0051] [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: 11/13/2022] Open
Abstract
Purpose: To evaluate 5-year reactivation after ranibizumab or aflibercept treatment for neovascular age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). Methods: This retrospective study included 192 patients (192 eyes) who had been diagnosed with neovascular AMD or PCV and treated with ranibizumab or aflibercept. The incidence and timing of lesion reactivation during the 5-year follow-up period were evaluated, and the factors associated with reactivation were also investigated. Results: During the follow-up period, lesion reactivation was noted in 156 patients (81.3%) at a mean of 9.5 ± 10.5 months after the third antivascular endothelial growth factor injection. The incidence of reactivation was 59.9% during the first 12 months, 33.7% during ≥12 and <24 months, 11.8% during >24 and ≤36 months, 15.5% during >36 and ≤48 months, and 5.3% during >48 and ≤60 months. There was a significant difference in the incidence among the 5 periods (P < 0.001). The proportion of PCV was significantly higher in patients experiencing reactivation (51.9%) than in those who did not (30.6%) (P = 0.021). Conclusions: During the 5-year follow-up, lesion reactivation was noted in approximately four-fifths of the patients. The incidence of lesion reactivation was highest during the first 12 months and decreased thereafter. The incidence was higher in patients with PCV than in those with neovascular AMD, especially after 12 months.
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Affiliation(s)
- Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea.,Kim's Eye Hospital Data Center, Seoul, South Korea
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
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Doi A, Miyata M, Ooto S, Tamura H, Ueda-Arakawa N, Uji A, Muraoka Y, Miyake M, Takahashi A, Wakazono T, Yamashiro K, Tsujikawa A. Long-Term Visual Outcome in Inferior Posterior Staphyloma and Efficacy of Treatment for Complicated Choroidal Neovascularization. Am J Ophthalmol 2021; 229:152-159. [PMID: 33838120 DOI: 10.1016/j.ajo.2021.02.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate long-term visual outcome in inferior posterior staphyloma (IPS) in each group classified based on macular complications and to examine the treatment effect for eyes with IPS with choroidal neovascularization (CNV). DESIGN Prospective clinical cohort study. PARTICIPANTS We analyzed 56 eyes of 43 consecutive patients with IPS who were followed for 4 years. METHODS We classified eligible eyes into 3 groups based on baseline findings: eyes without CNV or retinal exudate (no-exudate group), eyes without CNV and with retinal exudate (exudate group), and eyes with CNV (CNV group). We investigated the best-corrected visual acuity (BCVA) and associated parameters for 4 years. RESULTS BCVA declined during 4 years only in the exudate group (P = .002), whereas it was maintained for 4 years in the no-exudate and CNV groups (P = .53 and .20, respectively). Baseline BCVA was lower in the CNV group than in the exudate group (P = .004); however, the 4-year BCVA was not (P = .84). The 4-year BCVA was associated with baseline BCVA in all groups. Eyes in the CNV group required 9.0 ± 8.7 anti-vascular endothelial growth factor therapy in 4 years. CONCLUSIONS Better baseline BCVA in eyes with exudative IPS without CNV spontaneously declined in 4 years, whereas worse baseline BCVA in eyes with IPS with CNV did not, probably because of treatment for retinal exudate from CNV. Anti-vascular endothelial growth factor therapy would be effective for long-term maintenance of BCVA in eyes with IPS with CNV, similar to other diseases with CNV.
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Affiliation(s)
- Ayaka Doi
- From the Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City
| | - Manabu Miyata
- From the Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City.
| | - Sotaro Ooto
- From the Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City
| | - Hiroshi Tamura
- From the Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City
| | - Naoko Ueda-Arakawa
- From the Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City
| | - Akihito Uji
- From the Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City
| | - Yuki Muraoka
- From the Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City
| | - Masahiro Miyake
- From the Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City
| | - Ayako Takahashi
- From the Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City
| | - Tomotaka Wakazono
- From the Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City
| | - Kenji Yamashiro
- From the Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City; Department of Ophthalmology, Red Cross Otsu Hospital, Nagara, Otsu City, Shiga Prefecture, Japan
| | - Akitaka Tsujikawa
- From the Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto City
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Jin KW, Kim JH, Park JY, Park SJ, Park KH, Lee JY, Woo SJ. Long-term outcomes of ranibizumab vs. aflibercept for neovascular age-related macular degeneration and polypoidal choroidal vasculopathy. Sci Rep 2021; 11:14623. [PMID: 34272419 PMCID: PMC8285484 DOI: 10.1038/s41598-021-93899-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/15/2021] [Indexed: 12/27/2022] Open
Abstract
To evaluate the long-term outcomes of ranibizumab (RBZ) vs. aflibercept (AFL) in treatment-naïve eyes with typical neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV). This multicenter, retrospective, matched-cohort analysis was conducted on data up to 4 years of follow-ups. The primary outcome was the visual acuity (VA) change from baseline. The secondary outcomes included the number of injections, proportion of eyes without a yearly injection, and the number of eyes with treatment switching. Subgroup analyses were performed for typical nAMD and PCV. Typical nAMD was defined as nAMD other than PCV. We included VA-matched 215 eyes of 209 patients (131 and 84 eyes with RBZ and AFL, respectively). The crude mean VA changes from baseline were + 6.7 vs. + 2.6, + 2.1 vs. - 0.4, - 1.3 vs. - 1.8, and - 2.2 vs. - 5.0 letters in the RBZ and AFL groups, at 1, 2, 3, and 4 years, respectively (p > 0.05). The adjusted predicted VA by linear mixed model, proportion of eyes stratified by VA, and the survival curve for significant vision loss were comparable during the 4-year follow-up (p > 0.05). The mean number of injections were similar between the RBZ and AFL groups (2.9 vs. 3.0, respectively, p = 0.692). The subgroup analysis for typical nAMD and PCV showed similar results between the groups. The visual outcomes did not differ between RBZ and AFL during 4 years with comparable numbers of injections. Our study reflects the long-term, real-world clinical practice and treatment pattern of two treatments for typical nAMD and PCV.
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Affiliation(s)
- Ki Won Jin
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, South Korea
| | - Jun Young Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea
| | - Joo Yong Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea.
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Sun T, Wei Q, Gao P, Zhang Y, Peng Q. Cytokine and Chemokine Profile Changes in Patients with Neovascular Age-Related Macular Degeneration After Intravitreal Ranibizumab Injection for Choroidal Neovascularization. DRUG DESIGN DEVELOPMENT AND THERAPY 2021; 15:2457-2467. [PMID: 34140764 PMCID: PMC8203097 DOI: 10.2147/dddt.s307657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/28/2021] [Indexed: 01/28/2023]
Abstract
Objective To investigate the concentrations of cytokine and chemokines profiling in aqueous humor for choroidal neovascularization (CNV) due to neovascular age-related macular degeneration (nAMD) before and during Intravitreal injection of ranibizumab (IVR) and its relation with the disease’s active state. Methods The cytokine levels in aqueous humour were detected by the Bio-Plex® 200 System and the Bio-Plex™ Human Cytokine Standard 27-Plex, Group I. Aqueous humour samples of experimental group were collected from 19 patients diagnosed nAMD at baseline and at 1 month after IVR. Aqueous humour samples of control group were collected from 20 patients undergoing cataract surgery. Results Aqueous humor levels of basic fibroblast growth factor (basic FGF) and RANTES were significantly lower in nAMD patients than in the control group (P=0.044 and P<0.001, respectively). Vascular endothelial growth factor-A (VEGF-A) was significantly higher in nAMD patients than in the control group (P < 0.001). The average Eotaxin levels were significantly higher in nAMD patients after IVR than before (P=0.03). Contrarily, the average VEGF-A levels were significantly lower in AMD patients after IVR than before (P < 0.001). Conclusion Angiogenic, growth factors and inflammatory are involved in the formation of neovascularization of AMD patients. IVR did not cause significant differences in any growth factors or inflammatory cytokines in nAMD patients with the exception of VEGF.
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Affiliation(s)
- Tingting Sun
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, People's Republic of China
| | - Qingquan Wei
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, People's Republic of China
| | - Peng Gao
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, People's Republic of China
| | - Yongjie Zhang
- Department of Human Anatomy, Nanjing Medical University, Nanjing, Jiangsu Province, 211166, People's Republic of China
| | - Qing Peng
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, People's Republic of China
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Oshima Y, Ishibashi Y, Umeda N, Nagata T, Yoshida S, Uchio E, Kondo H, Sonoda KH, Ishibashi T. Correlation between improvement in visual acuity and QOL after Ranibizumab treatment for age-related macular degeneration patients: QUATRO study. BMC Ophthalmol 2021; 21:58. [PMID: 33485320 PMCID: PMC7825175 DOI: 10.1186/s12886-021-01816-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/12/2021] [Indexed: 12/27/2022] Open
Abstract
Background To evaluate the correlation between visual acuity improvement and vision-related QOL after ranibizumab treatment in Japanese patients with AMD. Methods In this one-year prospective, interventional, open-label, multicenter study involving four sites, patients with neovascular AMD were enrolled and observed for 12 months. Treatment-naïve patients received 0.5 mg ranibizumab as needed after three initial monthly doses. The best corrected visual acuity (BCVA) and central macular thickness (CMT) were measured at every visit. Evaluations with the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and patient satisfaction questionnaire were performed at baseline and 3 and 12 months after initial treatment. The primary endpoint was change in BCVA and QOL 3 months after ranibizumab treatment. QOL outcomes were also assessed in the better and poor BVCA subgroups. Results The study enrolled 100 patients. The mean logMAR BCVA after treatment improved significantly from 0.43 to 0.30 at 3 months (p< 0.0001), and 0.28 at 12 months (p< 0.0001). The mean NEI-VFQ-25 composite scores improved from 79.48 to 84.13 at 3 months (p< 0.0001), and 86.0 at 12 months (p< 0.0001). The 3 and 12-month changes in NEI-VFQ-25 score and BCVA showed significant correlation. In the poor baseline visual acuity group (decimal BCVA ≤0.5), there was a significant correlation between the changes in the NEI-VFQ-25 score and BCVA (p=0.02) but not in the better baseline visual acuity group (decimal BCVA > 0.6, p=0.1) at 3 months. There were no significant differences in the satisfaction questionnaire score from baseline to at 3 months (p=0.54) and 12 months (p=0.23). The average CMT improved significantly from 340 to 264 μm at 3 months (p< 0.0001) and to 268 μm at 12 months (p< 0.0001). Conclusions Intravitreal ranibizumab treatment resulted in improvement in visual acuity, anatomical change, and visual function change in Japanese AMD patients. Significant improvement was seen in patient visual function, and this was correlated with changes in VA, except immediately after loading dose treatment in patients with higher baseline VA. The patients’ satisfaction with the treatment remained unchanged during the study period. Trial registration This study is registered at UMIN Clinical Trials Registry (UMIN000012013). Registered October 10, 2013, as prospective study.
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Affiliation(s)
- Yuji Oshima
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Yumi Ishibashi
- Department of Ophthalmology, Kurume University School of Medicine, Fukuoka, Japan
| | - Naoyasu Umeda
- Department of Ophthalmology, School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Tatsuo Nagata
- Department of Ophthalmology, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Shigeo Yoshida
- Department of Ophthalmology, Kurume University School of Medicine, Fukuoka, Japan
| | - Eiichi Uchio
- Department of Ophthalmology, School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hiroyuki Kondo
- Department of Ophthalmology, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tatsuro Ishibashi
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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11
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Itagaki K, Sekiryu T, Kasai A, Sugano Y, Ogasawara M, Saito M. Three-year outcome of aflibercept treatment for Japanese patients with neovascular age-related macular degeneration. BMC Ophthalmol 2020; 20:276. [PMID: 32650757 PMCID: PMC7350732 DOI: 10.1186/s12886-020-01542-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 07/02/2020] [Indexed: 12/27/2022] Open
Abstract
Background To evaluate the three-year outcome after intravitreal aflibercept injection (IAI) for neovascular age-related macular degeneration (nAMD). Methods Forty-nine treatment-naïve nAMD patients (50 eyes) were enrolled in this prospective study. The eyes received IAI at two-month intervals in the first year. The treatment regimen was changed to IAI based on a treat-and-extend approach in the second and third years. Results Twenty-nine eyes of 28 patients were successfully followed up over 36 months. The nAMD subtypes included 15 eyes with typical AMD and 14 eyes with polypoidal choroidal vasculopathy. The number of IAIs performed over the 3 years was 17.2 ± 3.1 (mean ± standard deviation). The mean logMAR, which was 0.42 at baseline, improved to 0.19 (P = 0.001) at 12 months, and 0.26 (P = 0.049) at 36 months. The central retinal thickness (CRT) was 329 ± 120 μm at baseline, 151 ± 38 μm (P < 0.001) at 12 months, and 143 ± 61 μm (P < 0.001) at 36 months. The mean subfoveal choroidal thickness (SFCT) was 288 ± 97 μm at baseline, 243 ± 82 μm (P < 0.001) at 12 months, and 208 ± 63 μm (P < 0.01) at 36 months. The changes in logMAR, CRT, and SFCT over the study period did not differ between typical AMD and PCV. Conclusion Long-term aflibercept injection can achieve visual improvement and reduce the thickness of the retina and choroid in nAMD. Morphological improvement of these tissues may not be sufficient to sustain earlier visual improvement over the long-term.
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Affiliation(s)
- Kanako Itagaki
- Department of Ophthalmology, Fukushima Medical University, Fukushima-Shi, Fukushima Pref., Japan
| | - Tetsuju Sekiryu
- Department of Ophthalmology, Fukushima Medical University, Fukushima-Shi, Fukushima Pref., Japan.
| | - Akihito Kasai
- Department of Ophthalmology, Fukushima Medical University, Fukushima-Shi, Fukushima Pref., Japan
| | - Yukinori Sugano
- Department of Ophthalmology, Fukushima Medical University, Fukushima-Shi, Fukushima Pref., Japan
| | - Masashi Ogasawara
- Department of Ophthalmology, Fukushima Medical University, Fukushima-Shi, Fukushima Pref., Japan
| | - Masaaki Saito
- Department of Ophthalmology, Hirosaki University, Hirosaki-Shi, Aomori Pref., Japan
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12
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Kung FF, Starr MR, Bui YT, Mejia CA, Bakri SJ. Long-Term Follow-up of Patients with Exudative Age-Related Macular Degeneration Treated with Intravitreal Anti-Vascular Endothelial Growth Factor Injections. Ophthalmol Retina 2020; 4:1047-1053. [PMID: 32439455 DOI: 10.1016/j.oret.2020.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To determine the long-term visual outcomes and intravitreal injection burden of patients with exudative age-related macular degeneration (AMD) treated with intravitreal anti-vascular endothelial growth factor (VEGF) injections. DESIGN Retrospective cohort study. PARTICIPANTS Patients with exudative AMD treated with intravitreal anti-VEGF injections with annual office visits for at least 7 years. METHODS Snellen visual acuity was measured at baseline and then annually until the last year of follow-up. The number of injections was recorded on an annual basis during each year of follow-up. MAIN OUTCOME MEASURES The change in the frequency of injections over time along with the change in visual acuity each year from the baseline visit through 7 years. RESULTS During this period, 533 eyes of 429 patients were treated for exudative AMD. Of these, 391 eyes (73%) met the inclusion criteria of annual office visits and received a mean of 5.8 ± 2.5 intravitreal injections per year. The baseline mean visual acuity was 0.6 ± 0.5 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/80), and the 7-year visual acuity was 0.8 ± 0.6 logMAR (Snellen equivalent, 20/126; P < 0.0001). When compared with the 142 eyes that did not undergo an office visit for a continuous 12-month period, eyes with annual office visits showed similar baseline mean visual acuity (0.7 logMAR vs. 0.6 logMAR; P = 0.2102), but more injections per year (P < 0.0001). Of the 533 total eyes, 124 eyes (23%) maintained better than 20/40 visual acuity at 7 years. These eyes received more injections overall per year (6.5 vs. 5.5 injections per year; P = 0.0007). CONCLUSIONS In a real-world setting, eyes that maintained consistent, long-term follow-up received significantly more intravitreal injections per year than eyes with inconsistent follow-up. Eyes with 20/40 or better vision at study conclusion received more injections per year than eyes with worse than 20/40 vision.
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Affiliation(s)
- Felix F Kung
- Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Matthew R Starr
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Yvonne T Bui
- Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Camilo A Mejia
- Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sophie J Bakri
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
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13
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Chandra S, Arpa C, Menon D, Khalid H, Hamilton R, Nicholson L, Pal B, Fasolo S, Hykin P, Keane PA, Sivaprasad S. Ten-year outcomes of antivascular endothelial growth factor therapy in neovascular age-related macular degeneration. Eye (Lond) 2020; 34:1888-1896. [PMID: 31980748 PMCID: PMC7608465 DOI: 10.1038/s41433-020-0764-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/06/2020] [Accepted: 01/09/2020] [Indexed: 11/09/2022] Open
Abstract
Purpose Single center, noninterventional cohort study to assess 10-year visual and anatomical outcomes following initiation of treatment with antivascular endothelial growth factor (anti-VEGF) agents in neovascular age-related macular degeneration (AMD) patients. Neovascular AMD patients initiated on intravitreal anti-VEGF injections in 2008–2009 and continued to be followed up for at least 10 years were included in this study. Methods The Moorfields OpenEyes database was searched for all patients who were initiated on anti-VEGF therapy for neovascular AMD in 2008–2009 and the visual acuity (VA) in Early Diabetic Retinopathy Study (ETDRS) letters and injection records were analyzed for those who have had at least 10-year follow-up. The spectral-domain optical coherence tomography (SD-OCT) scans, color fundus photos, and fundus fluorescein angiography (FA) were graded by two retinal physicians. The outcomes were also compared between those with good and poor VA outcomes based on pre-defined criteria. The primary end point was change in VA at 10 years; secondary outcomes included percentage with VA of 20/40 or better, 20/70 or better, VA gains and losses, anatomic outcomes and number of injections. Results After a mean of 10.04 years after initiation of anti-VEGF therapy, the mean decline in VA from baseline was −2.1 ETDRS letters (SD 19.9, p = 0.65). One hundred eyes (67.1%) achieved a VA threshold of 20/70 or better, 33.5% achieved a VA of 20/40 or better, and 76.5% eyes maintained VA defined as a loss of less than 15 letters. Fourteen percent of study eyes had VA of 20/200 or worse and 23.5% declined by 15 letters or more. 87.5% of eyes were switched from ranibizumab to aflibercept during the course of 10 years and the eyes received a mean of 52.2 (SD 18.1) injections over 10 years. From this cohort, 87 (58.3%) eyes are having on-going treatment. On OCT, 34.9% had persistent fluid at the last visit, 6.7% patients showed new onset atrophy compared to baseline, and 43.7% had increased area of macular atrophy. The mean area of atrophy at the final visit was 4.15 mm2. Comparison between the good and worse visual outcome groups showed lower baseline VA, fovea-involving atrophy and final area of atrophy had a statistically significant negative effect on the final visual outcome (p < 0.05). Conclusions Regular monitoring and anti-VEGF treatment over 10 years reduce the risk of visual loss of 15 letters or more in patients with neovascular AMD. The most common cause of substantial visual decline was macular atrophy.
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Affiliation(s)
- Shruti Chandra
- National Institute of Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK.
| | - Cristina Arpa
- National Institute of Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Deepthy Menon
- National Institute of Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Hagar Khalid
- National Institute of Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Robin Hamilton
- National Institute of Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Luke Nicholson
- National Institute of Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Bishwanath Pal
- National Institute of Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Sandro Fasolo
- National Institute of Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Philip Hykin
- National Institute of Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Pearse A Keane
- National Institute of Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Sobha Sivaprasad
- National Institute of Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
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14
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Horani M, Mahmood S, Aslam TM. A Review of Macular Atrophy of the Retinal Pigment Epithelium in Patients with Neovascular Age-Related Macular Degeneration: What is the Link? Part II. Ophthalmol Ther 2020; 9:35-75. [PMID: 31907843 PMCID: PMC7054566 DOI: 10.1007/s40123-019-00227-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction To explore the potential link between macular atrophy (MA) of the retinal pigment epithelium (RPE) in patients with neovascular age-related macular degeneration (nAMD) and anti-vascular endothelial growth factor (anti-VEGF) treatment. Methods Through a balanced overview of the field from a largely clinical perspective, we looked at available evidence on the topic of MA correlation with anti-VEGF therapy and examined possible risk factors for MA development in the context of nAMD treatment with anti-VEGF. Results Links have been reported to connect both MA incidence and progression to treatment frequency and to the anti-VEGF drug type. Conclusions All reports agree on the fact that de novo development of MA in anti-VEGF-treated eyes is frequent and multifactorial. Research data shows an expansion of atrophy during anti-VEGF treatment. There are mixed conclusions about the correlation of MA incidence or progression with treatment-related risk factors. It mostly appears that there is no straightforward link. More clinical research is still needed to further understand this association.
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Affiliation(s)
- Mania Horani
- Manchester Royal Eye Hospital, Manchester University Foundation NHS Trust, Manchester, UK.
| | - Sajjad Mahmood
- Manchester Royal Eye Hospital, Manchester University Foundation NHS Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Tariq M Aslam
- Manchester Royal Eye Hospital, Manchester University Foundation NHS Trust, Manchester Academic Health Science Centre, Manchester, UK.,Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, UK
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