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Roubelat FP, Barioulet L, Varenne F, Escudier C, Meyer P, Gomane C, Butterworth J, Pagot-Mathis V, Fournié P, Gualino V, Soler V. The Reinforced Treat-and-Extend Protocol for Exudative Age-Related Macular Degeneration: Retrospective Assessment of 24-Month Real-World Outcomes in France. Ophthalmol Ther 2024; 13:1647-1667. [PMID: 38625500 PMCID: PMC11109064 DOI: 10.1007/s40123-024-00938-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/13/2024] [Indexed: 04/17/2024] Open
Abstract
INTRODUCTION The aim of this work is to evaluate the real-world outcomes of the reinforced treat-and-extend (RTE) protocol for the treatment of exudative age-related macular degeneration with intravitreal injections of aflibercept or ranibizumab (anti-vascular endothelial growth factor therapies). METHODS This was a retrospective review of patients from two tertiary ophthalmology centers in France initiating the RTE protocol between February 2018 and June 2021. The primary outcome was change in best-corrected visual acuity (BCVA) after 24 months. Secondary outcomes were change in central retinal thickness (CRT), recurrence, and management-related factors (injection interval, number of injections/consultations). Outcomes were additionally evaluated after protocol changes (strict versus modified RTE protocol groups). RESULTS Sixty-eight patients (72 eyes) were included (68% females; mean age 82.2 ± 7.8 years). After 24 months, mean BCVA significantly improved (65.22 ± 14 vs. 71.96 ± 13 Early Treatment Diabetic Retinopathy Study letters; p < 0.001) and CRT significantly decreased (388.6 ± 104 vs. 278.8 ± 51 μM; p < 0.001) with 21% of eyes showing signs of exudation. Over the 24 months, a mean total of 14.9 ± 4.0 injections and 8.6 ± 1.4 consultations were performed. Mean 24-month injection interval was 7.9 ± 2.3 weeks. Initial and 24-month ophthalmic outcomes for eyes in the strict (47%) versus modified (53%) groups were not significantly different, but mean time interval to first recurrence of disease activity was significantly shorter for the modified group (7.3 ± 2.4 vs. 9.9 ± 2.5 weeks; p < 0.001). Patients in the strict RTE group received significantly less injections (13.9 ± 3.6 vs. 16.5 ± 3.9; p = 0.006) and mean 24-month injection interval was significantly longer (9.5 ± 2.7 vs. 6.5 ± 2.1 weeks; p < 0.001). Consultation number was similar (8.5 ± 1.9 vs. 8.8 ± 1.6; p = 0.93). Treatment with aflibercept versus ranibizumab did not influence ophthalmic or management outcomes. CONCLUSIONS The RTE protocol, even when modified, reduced consultations but improved ophthalmic outcomes. The RTE protocol could reduce hospital visits and overall burden while also encouraging better patient compliance. Video Abstract available for this article. VIDEO ABSTRACT Vincent Soler and François-Philippe Roubelat summarize the Reinforced Treat-and-Extend Protocol and main results (MP4 225022 KB).
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Affiliation(s)
- François-Philippe Roubelat
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
| | - Lisa Barioulet
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
| | - Fanny Varenne
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
| | - Clément Escudier
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
| | - Pauline Meyer
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
| | - Clément Gomane
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
| | - Jacqueline Butterworth
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
| | - Véronique Pagot-Mathis
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
| | - Pierre Fournié
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
- Faculty of Medicine, University of Toulouse III, Toulouse, France
| | - Vincent Gualino
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France
- Ophthalmology Department, Clinique Honoré-Cave, Montauban, France
| | - Vincent Soler
- Retina Unit, Ophthalmology Department, Hôpital Pierre-Paul Riquet, CHU Toulouse, Place Baylac, 31059, Toulouse Cedex, France.
- Faculty of Medicine, University of Toulouse III, Toulouse, France.
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Uzzan J, Haddad M, Salamé N. [Quality of life survey of 3,738 patients treated with intravitreal injections for age-related macular degeneration]. J Fr Ophtalmol 2024; 47:104075. [PMID: 38368762 DOI: 10.1016/j.jfo.2024.104075] [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: 05/01/2023] [Accepted: 07/03/2023] [Indexed: 02/20/2024]
Abstract
PURPOSE To evaluate the peri- and post-intravitreal injection (IVI) symptoms reported by patients who have been repeatedly injected for age-related macular degeneration (AMD) and to analyze these according to the protocols of the injector. MATERIALS AND METHODS Multi-center, cross-sectional, consecutive, analytical survey. RESULTS The IVI protocols of 106 injectors differed in terms of the number of instillations of povidone-iodine, its contact time, and rinsing of the ocular surface post-injection. In total, 3,738 patients responded to the survey, 60.1% of whom were women; 36.4% had received more than 20 IVIs; 50.7% of patients reported irritation upon application of povidone-iodine. Post-IVI, depending on the symptom in question, between 44.8% and 57.4% of patients reported symptoms of ocular surface change. The number of instillations of povidone-iodine, its contact time with the ocular surface, and abundant rinsing post-IVI increased the immediate symptoms. Patients who received more IVIs were more prone to experiencing gritty eyes, and the incidence of acute pain increased in patients who had previously received over 20 IVIs. Women and patients previously treated for dry eye or glaucoma were at greater risk of worse symptoms. CONCLUSION Comparing injecting centers' practices with patients' self-assessments showed an aggravation of symptoms of ocular surface changes related to povidone-iodine. This survey contributes to providing data for the implementation of a protocol to improve the quality of life of patients injected repeatedly for AMD.
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Affiliation(s)
- J Uzzan
- Clinique Mathilde Gpe Vivalto, 4, rue de Lessard, 76100 Rouen, France
| | - M Haddad
- Hôpital privé de la Baie, avenue du Quesnoy, 50300 Avranches, France
| | - N Salamé
- CHP Saint-Martin, 18, rue des Roquemonts, 14000 Caen, France.
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Veritti D, Sarao V, Chhablani J, Loewenstein A, Lanzetta P. The ideal intravitreal injection setting: office, ambulatory surgery room or operating theatre? A narrative review and international survey. Graefes Arch Clin Exp Ophthalmol 2023; 261:3299-3306. [PMID: 37199802 PMCID: PMC10587024 DOI: 10.1007/s00417-023-06108-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/02/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023] Open
Abstract
PURPOSE This study reviews evidence and provides recommendations for the ideal setting of intravitreal injection (IVI) administration of vascular endothelial growth factor (VEGF) inhibitors. METHODS A multi-step approach was employed, including content analysis of regulations and guidelines, a systematic literature review, and an international survey assessing perioperative complications and endophthalmitis incidence in relation to injection settings. The literature review searched PubMed and Cochrane databases from 2006 to 2022, focusing on studies reporting correlations between complications and treatment settings. The survey utilized a web-based questionnaire distributed to clinical sites and the international ophthalmic community, with data managed using electronic capture tools. RESULTS We reviewed regulations and guidelines from 23 countries across five continents, finding significant variation in IVI administration settings. In most countries, IVI is primarily administered in outpatient clean rooms (96%) or offices (39%), while in others, it is restricted to ambulatory surgery rooms or hospital-based operating theatres (4%). The literature review found that endophthalmitis risk after IVI is generally low (0.01% to 0.26% per procedure), with no significant difference between office-based and operating room settings. The international survey (20 centers, 96,624 anti-VEGF injections) found low overall incidences of severe perioperative systemic adverse events and endophthalmitis, independent of injection settings. CONCLUSION No significant differences in perioperative complications were observed among various settings, including operating theatres, ambulatory surgery rooms, offices, hospitals, or extra-hospital environments. Choosing the appropriate clinical setting can optimize patient management, potentially increasing effectiveness, quality, productivity, and capacity.
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Affiliation(s)
- Daniele Veritti
- Department of Medicine - Ophthalmology, University of Udine, Piazzale Santa Maria Della Misericordia, 33100, Udine, Italy
| | - Valentina Sarao
- Department of Medicine - Ophthalmology, University of Udine, Piazzale Santa Maria Della Misericordia, 33100, Udine, Italy
- Istituto Europeo Di Microchirurgia Oculare - IEMO, Udine, Italy
| | - Jay Chhablani
- Department of Ophthalmology, UPMC Eye Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Medical, Tel Aviv University, Tel Aviv, Israel
| | - Paolo Lanzetta
- Department of Medicine - Ophthalmology, University of Udine, Piazzale Santa Maria Della Misericordia, 33100, Udine, Italy.
- Istituto Europeo Di Microchirurgia Oculare - IEMO, Udine, Italy.
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Billant J, Douma I, Agard E, Levron A, Bouvarel H, Leroux P, Badri Y, Dot C. [Late steroid-induced ocular hypertension after intravitreal dexamethasone implants: A series of 20 cases]. J Fr Ophtalmol 2023; 46:1039-1046. [PMID: 37758545 DOI: 10.1016/j.jfo.2023.03.041] [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: 02/27/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Steroid-induced ocular hypertension (OHT) occurs in approximately one third of cases after dexamethasone implant (DEXi) injection. Among these, more than one fifth occur after the third DEXi intravitreal injection (IVI). Our goal was to analyze the clinical profiles of these late responders. MATERIAL AND METHODS A real-life, retrospective, observational study was conducted to assess demographic characteristics and intraocular pressure (IOP) responses in late responders (IOP ≥ 21mmHg, n DEXi ≥ 4). The following parameters were analyzed: IOP 2 months after IVI and number of glaucoma medications needed. The IOP response compared to baseline was defined as low (< +6mmHg), moderate (≤ +15mmHg) or high (> 15mmHg). RESULTS Late steroid-induced OHT occurred in 20.8% of cases. Twenty eyes (18 patients) were included. The mean duration of follow-up was 3.8±1.9 years. They received a mean number of 9.5±4.2 IVI. The first OHT peak, measured at 25.3±3.2mmHg (21-31), occurred after 6.8±2.3 IVI. Approximately 65% of OHT spikes occurred between the fourth and sixth IVI; 35% occurred later. At maximum, 1.7±1.0 glaucoma medications and 0.75±0.79 SLT procedures were required to control the OHT, with no filtering surgery required. The ratio of "low," "moderate," and "high" responders was 5%, 85% and 10% respectively. CONCLUSION Late steroid-induced OHT occurs after at least 3 DEXi in one fifth of multi-injected patients, requiring long-term IOP monitoring. This case series identifies mostly moderate responder profiles, whose IOP rise often remains well-controlled with medical management or laser treatment (SLT).
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Affiliation(s)
- J Billant
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, Lyon, France.
| | - I Douma
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, Lyon, France
| | - E Agard
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, Lyon, France
| | - A Levron
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, Lyon, France
| | - H Bouvarel
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, Lyon, France
| | - P Leroux
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, Lyon, France
| | - Y Badri
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, Lyon, France
| | - C Dot
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, Lyon, France; École du Val-de-Grâce, Paris, France; Service d'ophtalmologie, hôpital Édouard-Herriot, hospices civils de Lyon, Lyon, France
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Ducloyer JB, Deltour JB, Le Meur G, Weber M. [Intravitreal injections: Guidelines, methods and medicolegal issues]. J Fr Ophtalmol 2023; 46:1079-1086. [PMID: 37838497 DOI: 10.1016/j.jfo.2023.04.012] [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: 03/21/2023] [Accepted: 04/21/2023] [Indexed: 10/16/2023]
Abstract
Intravitreal injection (IVI) of a drug allows for immediate intraocular concentrations of active ingredients higher than those obtained by intravenous injection while reducing the risk of systemic side effects. Today, IVI's play a central role in the treatment of many vitreoretinal diseases. With the aging of the population and the advent of vascular endothelial growth factor (VEGF) antagonists, their indications have increased exponentially, creating structural, organizational and economic difficulties. IVI is now one of the most widely performed medical procedures in industrialized countries, and its indications are expected to expand further in the near future with the development of new molecules. Although the overall safety of this practice is proven, an IVI exposes the patient to a 0.05 % risk of endophthalmitis, the consequences of which are often dramatic. This article details the current recommendations, in particular regarding asepsis and antisepsis, and proposes a typical sequence for performing an IVI.
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Affiliation(s)
- J-B Ducloyer
- Service d'ophtalmologie, CHU de Nantes, Nantes université, 1, place Alexis-Ricordeau, 44093 Nantes, France.
| | - J-B Deltour
- Service d'ophtalmologie, CHU de Nantes, Nantes université, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - G Le Meur
- Service d'ophtalmologie, CHU de Nantes, Nantes université, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - M Weber
- Service d'ophtalmologie, CHU de Nantes, Nantes université, 1, place Alexis-Ricordeau, 44093 Nantes, France
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Mehanna CJ, Souied E, Coscas F, Razavi S, Cohen SY. [Update on practice of intravitreal injections. Recommendations of the Fédération France Macula, the Société française de la rétine, and the Club francophone des spécialistes de la rétine]. J Fr Ophtalmol 2023; 46:956-960. [PMID: 37120345 DOI: 10.1016/j.jfo.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/16/2023] [Indexed: 05/01/2023]
Affiliation(s)
- C-J Mehanna
- Centre hospitalier intercommunal de Créteil, 94000 Créteil, France
| | - E Souied
- Centre hospitalier intercommunal de Créteil, 94000 Créteil, France; Fédération France Macula, CHIC, 94000 Créteil, France
| | - F Coscas
- Société française de la rétine, 113, boulevard Saint-Germain, 75006 Paris, France
| | - S Razavi
- Club francophone des spécialistes de la rétine, 2, rue Ambroise-Paré, 75010 Paris, France
| | - S-Y Cohen
- Centre hospitalier intercommunal de Créteil, 94000 Créteil, France; Centre ophtalmologique d'imagerie et de laser, 11, rue Antoine-Bourdelle, 75015 Paris, France.
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Use of selective laser trabeculoplasty as an alternative in patients who developed ocular hypertension after intravitreal dexamethasone implants: a series of 35 eyes. Graefes Arch Clin Exp Ophthalmol 2022; 260:3665-3673. [PMID: 35665853 DOI: 10.1007/s00417-022-05725-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/22/2022] [Accepted: 05/27/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Steroid-induced ocular hypertension (OHT) occurs in about a third of cases after dexamethasone implant (DEXi) intravitreal injection (IVI), for which treatment discontinuation may be required. The aim of this study was to assess the benefit of selective laser trabeculoplasty (SLT) in patients who developed transient OHT after DEXi injection to prevent subsequent steroid-induced OHT peaks during reinjections. METHODS A real-life, retrospective, and observational study was conducted to assess the intraocular pressure (IOP) after SLT in steroid responders after DEXi injection (IOP > 21 mmHg). Were analyzed: IOP 1 and 2 months after SLT, maximum IOP (IOPmax) after each new DEXi IVI, and the number of prophylactic hypotensive treatments needed at the time of DEXi reinjections. RESULTS Thirty-five eyes of 29 patients were included. The mean macular edema follow-up duration was 38.4 ± 28.4 months. SLT was performed after a mean number of 6.3 ± 4.7 DEXi IVIs. After SLT, the IOPmax measured after the first reinjection was lowered by 36.6 ± 14.7% (p < 0.0001). The mean number of hypotensive treatments was 2.1 ± 0.9 before versus 1.5 ± 0.8 after SLT. The post-reinjection lowering in OHT peak was maintained during the subsequent 3 DEXi IVIs: - 29.1 ± 25.5% (p = 0.0009), - 35.8 ± 13.1% (p = 0.0078), and - 45.4 ± 8.6% (p = 0.0312) after the second, third, and fourth DEXi reinjections. SLT allowed continuing injections in 88.6% of patients. CONCLUSION The use of 180° SLT in this indication could be an effective therapeutic alternative to control steroid-induced OHT and safely continue DEXi injections.
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Verrecchia S, Chiambaretta F, Kodjikian L, Nakouri Y, El Chehab H, Mathis T, Badri Y, Chudzinski R, Levron A, Chaperon M, Agard E, Pradat P, Dot C. A prospective multicentre study of intravitreal injections and ocular surface in 219 patients: IVIS study. Acta Ophthalmol 2021; 99:877-884. [PMID: 33733603 DOI: 10.1111/aos.14797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE To assess the impact of intravitreal injections (IVTI) on ocular surface of patients treated with multiple injections. METHODS Prospective, tricentric study conducted in patients treated with unilateral IVTI. An asepsis protocol with povidone-iodine was used for all patients during IVTI. The primary endpoint was the difference between the pre-IVTI Ocular Surface Disease Index (OSDI 1) score and that measured on day one (D1) post-IVTI (OSDI 2). Secondary endpoints were the evaluation of predictive factors for OSDI scores, pain assessment on D1, and the Lacrydiag® analysis of tears from the injected eye versus contralateral eye before IVTI. RESULTS Two hundred and nineteen patients with a mean age of 75.9 ± 10 years were included. The mean OSDI2-OSDI1 difference was 19.2 ± 20.6 (p < 0.001). The mean noninvasive tear break-up time was 6.41 ± 4.59 seconds in the injected eye versus 7.36 ± 4.36 seconds in the contralateral eye (p < 0.001). In the multivariate analysis, the factors significantly associated with the OSDI 2 score were the OSDI 1 score (p < 0.001), the pain score on D1 (p < 0.001) the number of instilled glaucoma eye drop (p = 0.01) and a centre effect (centres 2 and 3 versus centre 1, p < 0.001). CONCLUSION Our results confirm the impairment of the ocular surface and quality of life immediately after an IVTI. These results suggest 3 levels of action to improve the immediate tolerance: improving the basal status of the ocular surface, reducing the contact time with povidone-iodine that might be toxic to the surface, and improving immediate post-IVTI treatment.
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Affiliation(s)
- Sarah Verrecchia
- Department of Ophthalmology Desgenettes Military Hospital Lyon France
- Department of Ophthalmology Croix‐Rousse University Hospital Hospices Civils de Lyon Lyon France
| | | | - Laurent Kodjikian
- Department of Ophthalmology Croix‐Rousse University Hospital Hospices Civils de Lyon Lyon France
- UMR‐CNRS 5510 Matéis Villeurbanne Université Claude Bernard Lyon 1 University of Lyon Lyon France
| | - Yasemin Nakouri
- Gabriel‐Montpied University Hospital Center Clermont Ferrand France
| | - Hussam El Chehab
- Department of Ophthalmology Desgenettes Military Hospital Lyon France
| | - Thibaud Mathis
- Department of Ophthalmology Croix‐Rousse University Hospital Hospices Civils de Lyon Lyon France
| | - Yannis Badri
- Department of Ophthalmology Desgenettes Military Hospital Lyon France
| | - Roman Chudzinski
- Department of Ophthalmology Desgenettes Military Hospital Lyon France
| | - Antoine Levron
- Department of Ophthalmology Desgenettes Military Hospital Lyon France
| | - Mayeul Chaperon
- Department of Ophthalmology Desgenettes Military Hospital Lyon France
| | - Emilie Agard
- Department of Ophthalmology Desgenettes Military Hospital Lyon France
| | - Pierre Pradat
- Department of Ophthalmology Croix‐Rousse University Hospital Hospices Civils de Lyon Lyon France
| | - Corinne Dot
- Department of Ophthalmology Desgenettes Military Hospital Lyon France
- French Military Health Service Academy Val de Grâce Paris France
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Couturier A, Kodjikian L, Baillif S, Conart JB, Dot C, Delyfer MN, Matonti F, Caillaux V, Bousquet E, Robinet A, Massé H, Uzzan J, Mrejen S, Semoun O. [Treatment of exudative age-related macular degeneration: Consensus of French experts for first-line treatment selection and the importance of long-term risk/benefit ratio]. J Fr Ophtalmol 2021; 44:937-946. [PMID: 34147276 DOI: 10.1016/j.jfo.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/28/2021] [Indexed: 11/27/2022]
Abstract
Choosing a first-line treatment to optimize long-term outcomes is a major challenge for treating patients with neovascular age-related macular degeneration (AMD). The development of several new molecules makes it critical to identify the relevant factors to consider so as to provide an optimal risk-benefit ratio when initiating a treatment in naïve patients with neovascular AMD. This paper proposes a consensus established with the Delphi method (which includes a gradation in a consensus based on an analysis of the convergence rate of answers) to provide criteria that guide the ophthalmologist's decision for treatment initiation and follow-up in neovascular AMD patients. Fourteen questions were submitted to 93 French retina experts. Thirteen (93%) of the questions reached a consensus (≥50% of answers consensual). The criteria recommended to take into account were both efficacy and onset of action of the molecules, their safety, and the ability to decrease injection frequency. The primary criterion of expected efficacy of a molecule is a combination of the gain in visual acuity and resorption of retinal fluid. With regard to safety, experts recommend tighter follow-up for molecules currently in development, and at every scheduled visit, patients should be screened to identify early any potential adverse effects such as intraocular inflammation, retinal vasculitis or vascular occlusion. Experts also emphasize the importance of the packaging of the biological, with a preference toward prefilled syringes. Injection frequency is a key factor, and the authors recommended aiming for a maximal injection interval of 12 to 16 weeks. The stability of that maximum interval is also an important factor to consider in treatment selection.
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Affiliation(s)
- A Couturier
- Université de Paris, service d'ophtalmologie, assistance publique hôpitaux de Paris, hôpital Lariboisière, Paris, France
| | - L Kodjikian
- Service d'ophtalmologie, hôpital universitaire Croix-Rousse, hospices Civils de Lyon, université Lyon I, Lyon, France; CNRS UMR 5510 Mateis, Villeurbanne, France
| | - S Baillif
- Service d'ophtalmologie, hôpital universitaire Pasteur 2, université Côte d'Azur, Nice, France
| | - J-B Conart
- Service d'ophtalmologie, CHRU Nancy, Vandoeuvre-lès-Nancy, France; Institut de la Vision, Inserm, UMR_S 968, CNRS, Sorbonne Université, Paris, France
| | - C Dot
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, 69003 Lyon, France; École du Val de Grâce, Paris, France
| | - M-N Delyfer
- Service d'ophtalmologie, centre hospitalier universitaire de Bordeaux, université de Bordeaux, Inserm, Bordeaux population health research centre, team LEHA, UMR 1219, 33000 Bordeaux, France
| | - F Matonti
- Centre Monticelli Paradis, Aix Marseille Univ, CNRS, INT, Inst Neurosci Timone, 433, bis rue Paradis, 13008 Marseille, France
| | - V Caillaux
- Centre explore vision Paris, Rueil Malmaison, France; Service d'ophtalmologie, assistance publique hôpitaux de Paris, hôpital Lariboisière, Paris, France
| | - E Bousquet
- OphtalmoPôle de Paris, hôpital Cochin, assistance publique hôpitaux de Paris, université de Paris, Paris, France
| | - A Robinet
- Centre ophtalmologique ophtasiam, clinique Pasteur-Lanrose, Brest, France
| | - H Massé
- Service d'ophtalmologie, centre hospitalier universitaire de Nantes, Nantes, France
| | - J Uzzan
- Clinique Mathilde, Rouen, France
| | - S Mrejen
- Centre d'Imagerie et de Laser, Paris, France
| | - O Semoun
- Service d'ophtalmologie, centre hospitalier intercommunal de Créteil, université Paris Est Créteil, 40, avenue de Verdun, 94000 Créteil, France; Centre ophtalmologique du Panthéon, Paris, France.
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