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Toto L, Viggiano P, Quarta A, Grassi M, De Nicola C, Aloia R, D'Aloisio R, Boscia G, Boscia F, Porreca A, Di Nicola M, Savastano MC, Mastropasqua R. Effect of Pro Re Nata Regimen with Anti-VEGF on Type 3 Macular Neovascularization: Long-Term Outcomes. Ophthalmic Res 2024; 67:282-291. [PMID: 38621369 DOI: 10.1159/000538441] [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: 11/28/2023] [Accepted: 02/26/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION The purpose of this study was to investigate long-term outcomes of intravitreal injections (IVI) of antivascular endothelial growth factor (VEGF) in neovascular age-related macular degeneration (nAMD) with type 3 macular neovascularization (MNV). METHODS This retrospective study included 19 eyes of 17 patients with nAMD and type 3 MNV treated with anti-VEGF IVI with a loading dose and a PRN regimen. Best corrected visual acuity (BCVA), central macular thickness (CMT), presence of macular intraretinal fluid (IRF) and subretinal fluid (SRF), flow area (FA), subfoveal choroidal thickness (CT), and macular atrophy (MA) were assessed at baseline (T0) and during follow-up (T1, post-loading phase; T2, 1 year; T3, 2 years; T4 >2 years). The correlations between MA at the last follow-up and standard deviation (SD) values of CMT and CT during follow-up were assessed. The influence of the number of injections on the change in MA over time was also analyzed. MA differences at T4 were assessed for pseudodrusen presence. RESULTS BCVA improved significantly during follow-up (p = 0.013) particularly increasing from baseline to post-loading phase and then did not modify significantly thereafter. CMT significantly reduced from T0 to T1 and remained stable during follow-up (p = <0.001). MNV flow area showed a trend toward an increase in the post-loading phase that was not statistically significant (p = 0.082) and CT decreased significantly during follow-up (p < 0.001). MA changed significantly during follow-up (p < 0.001) with a significant increase from T0 to T3 and from T0 to T4 (p < 0.010). A Cochran-Armitage test for trend showed a significant reduction (p = 0.001) of macular IRF and SRF during follow-up. MA at T4 showed a significant positive correlation with SD (standard deviation) values of CMT (p = 0.040) and CT (p = 0.020). Indeed, the number of injections did not influence the change over time of MA (p = 0.709). MA at T4 was not statistically significantly different between patients with pseudodrusen at baseline (p = 0.497). CONCLUSIONS Intravitreal anti-VEGF injections with PRN regimen in MNV type 3 showed functional and anatomical benefits. Variations of retinal thickness and choroidal thickness during treatment were related to MA modification over time.
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Affiliation(s)
- Lisa Toto
- Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Ophthalmology Clinic, Chieti, Italy
| | - Pasquale Viggiano
- Department of Translational Biomedicine Neuroscience, University of Bari Aldo Moro, Bari, Italy
| | - Alberto Quarta
- Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Ophthalmology Clinic, Chieti, Italy
| | - Mariaoliva Grassi
- Department of Translational Biomedicine Neuroscience, University of Bari Aldo Moro, Bari, Italy
| | - Chiara De Nicola
- Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Ophthalmology Clinic, Chieti, Italy
| | - Raffaella Aloia
- Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Ophthalmology Clinic, Chieti, Italy
| | - Rossella D'Aloisio
- Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Ophthalmology Clinic, Chieti, Italy
| | - Giacomo Boscia
- Department of Translational Biomedicine Neuroscience, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Boscia
- Department of Translational Biomedicine Neuroscience, University of Bari Aldo Moro, Bari, Italy
| | - Annamaria Porreca
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Marta Di Nicola
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | | | - Rodolfo Mastropasqua
- Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Ophthalmology Clinic, Chieti, Italy
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Blazaki S, Blavakis E, Chlouverakis G, Bontzos G, Chatziralli I, Smoustopoulos G, Dimitriou E, Stavrakakis A, Kabanarou S, Xirou T, Vavvas DG, Tsilimbaris MK. Evolution of macular atrophy in eyes with neovascular age-related macular degeneration compared to fellow non-neovascular eyes. Graefes Arch Clin Exp Ophthalmol 2023; 261:3425-3436. [PMID: 37566302 PMCID: PMC10667153 DOI: 10.1007/s00417-023-06168-0] [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: 10/23/2022] [Revised: 06/28/2023] [Accepted: 07/07/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE Τo evaluate the evolution of macular atrophy (MA) in patients with neovascular AMD (nAMD), compared with their fellow eyes exhibiting dry AMD (dAMD). METHODS This retrospective study included 124 patients from three centers treated with anti-VEGF in their nAMD eye and having dAMD in the fellow eye. Patients without MA at baseline were analyzed to study the time to first MA development. Synchronous and unsynchronous time course of MA was also studied. MA was evaluated using near-infrared images, while all available optical coherence tomography (OCT) images were used to confirm the criteria proposed by the Classification of Atrophy Meetings group for complete MA. RESULTS MA first detection in nAMD eyes increased significantly from year 2 to 6 compared to dAMD eyes. Over the study's follow-up, 45.1% of nAMD-E developed MA, compared to 16.5% of fellow eyes (p < 0.001). When MA in the two eyes was compared in a synchronous paired manner over 4 years, nAMD eyes had an average MA progression rate of 0.275 mm/year versus 0.110 mm/year in their fellow dAMD eyes. Multivariate ANOVA revealed significant time (p < 0.001), eye (p = 0.003), and time-eye interaction (p < 0.001) effects. However, when MA did develop in dAMD eyes and was compared in an asynchronous manner to MA of nAMD eyes, it was found to progress faster in dAMD eyes (dAMD: 0.295 mm/year vs. nAMD: 0.176 mm/year) with a significant time-eye interaction (p = 0.015). CONCLUSIONS In this study, a significant difference in MA incidence and progression was documented in eyes with nAMD under treatment, compared to fellow eye exhibiting dAMD. Eyes with nAMD tended to develop more MA compared to fellow dAMD eyes. However, when atrophy did develop in the fellow dAMD eyes, it progressed faster over time compared to MA in nAMD eyes.
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Affiliation(s)
- Styliani Blazaki
- Department of Ophthalmology, The University of Crete Medical School, 71110, Voutes, Greece
| | - Emmanouil Blavakis
- Department of Ophthalmology, The University of Crete Medical School, 71110, Voutes, Greece
| | - Gregory Chlouverakis
- Laboratory of Biostatistics, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Georgios Bontzos
- Department of Ophthalmology, Korgialenio-Benakio General Hospital, Athens, Greece
| | - Irini Chatziralli
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Eleni Dimitriou
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios Stavrakakis
- Department of Ophthalmology, The University of Crete Medical School, 71110, Voutes, Greece
| | - Stamatina Kabanarou
- Department of Ophthalmology, Korgialenio-Benakio General Hospital, Athens, Greece
| | - Tina Xirou
- Department of Ophthalmology, Korgialenio-Benakio General Hospital, Athens, Greece
| | - Demetrios G Vavvas
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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Core JQ, Pistilli M, Hua P, Daniel E, Grunwald JE, Toth CA, Jaffe GJ, Martin DF, Maguire MG, Ying GS. Predominantly Persistent Intraretinal Fluid in the Comparison of Age-related Macular Degeneration Treatments Trials. Ophthalmol Retina 2022; 6:771-785. [PMID: 35405352 PMCID: PMC10282893 DOI: 10.1016/j.oret.2022.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/26/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To describe predominantly persistent intraretinal fluid (PP-IRF) and its association with visual acuity (VA) and retinal anatomic findings at long-term follow-up in eyes treated with pro re nata (PRN) ranibizumab or bevacizumab for neovascular age-related macular degeneration. DESIGN Cohort within a randomized clinical trial. PARTICIPANTS Participants in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT) assigned to PRN treatment. METHODS The presence of intraretinal fluid (IRF) on OCT scans was assessed at baseline and monthly follow-up visits by Duke OCT Reading Center. Predominantly persistent intraretinal fluid through week 12, year 1, and year 2 was defined as the presence of IRF at the baseline and in ≥ 80% of follow-up visits. Among eyes with baseline IRF, the mean VA scores (letters) and changes from the baseline were compared between eyes with and those without PP-IRF. Adjusted mean VA scores and changes from the baseline were also calculated using the linear regression analysis to account for baseline patient features identified as predictors of VA in previous CATT studies. Furthermore, outcomes were adjusted for concomitant predominantly persistent subretinal fluid. MAIN OUTCOME MEASURES Predominantly persistent intraretinal fluid through week 12, year 1, and year 2; VA score and VA change; and scar development at year 2. RESULTS Among 363 eyes with baseline IRF, 108 (29.8%) had PP-IRF through year 1 and 95 (26.1%) had PP-IRF through year 2. When eyes with PP-IRF through year 1 were compared with those without PP-IRF, the mean 1-year VA score was 62.4 and 68.5, respectively (P = 0.002), and was 65.0 and 67.4, respectively (P = 0.13), after adjustment. Predominantly persistent intraretinal fluid through year 2 was associated with worse adjusted 1-year mean VA scores (64.8 vs. 69.2; P = 0.006) and change (4.3 vs. 8.1; P = 0.01) as well as worse adjusted 2-year mean VA scores (63.0 vs. 68.3; P = 0.004) and changes (2.4 vs. 7.1; P = 0.009). Predominantly persistent intraretinal fluid through year 2 was associated with a higher 2-year risk of scar development (adjusted hazard ratio = 1.49; P = 0.03). CONCLUSIONS Approximately one quarter of eyes had PP-IRF through year 2. Predominantly persistent intraretinal fluid through year 1 was associated with worse long-term VA, but the relationship disappeared after adjustment for baseline predictors of VA. Predominantly persistent intraretinal fluid through year 2 was independently associated with worse long-term VA and scar development.
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Affiliation(s)
- Jason Q Core
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Maxwell Pistilli
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peiying Hua
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ebenezer Daniel
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Juan E Grunwald
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cynthia A Toth
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | | | - Maureen G Maguire
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gui-Shuang Ying
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Spooner KL, Fraser-Bell S, Cozzi M, Staurenghi G, Invernizzi A, Monteduro D, Munk MR, Hong T, Chang AA. Macular Atrophy Incidence and Progression in Eyes with Neovascular Age-Related Macular Degeneration Treated with Vascular Endothelial Growth Factor Inhibitors Using a Treat-and-Extend or a Pro Re Nata Regimen. Ophthalmology 2020; 127:1663-1673. [DOI: 10.1016/j.ophtha.2020.06.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 01/12/2023] Open
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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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