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Niegowski LJ, Cohen SY, Crincoli E, Mehanna CJ, Souied EH. Cognitive bias evaluation on the choice of treatment in common retinal disorders among retina specialists in 2023. J Fr Ophtalmol 2024; 47:104177. [PMID: 38603895 DOI: 10.1016/j.jfo.2024.104177] [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: 07/26/2023] [Revised: 10/01/2023] [Accepted: 10/22/2023] [Indexed: 04/13/2024]
Abstract
PURPOSE The study aimed to discern the intent to treat with the therapeutic agents prescribed first or second line in the following eye conditions: neovascular age-related macular Degeneration (nAMD), diabetic macular edema (DME), retinal vein occlusion (RVO), and myopic maculopathy with choroidal neovascularization (MMNV). The study also aimed to distinguish the ophthalmologists' intended treatment for their patients from those that they would prescribe for themselves if they were affected by the above macular conditions. METHODS The study utilized an online survey of 243 French ophthalmologists practicing medical retina, with males accounting for 54.3% of the participants. Data was obtained using a questionnaire that focused on the ophthalmologists' experience with various agents as well as their first and second line choices for nAMD, DME, RVO, and MMNV. RESULTS The vast majority of French ophthalmologists (99%) had experience with the most widely used anti-vascular endothelial growth factors (anti-VEGFs); ranibizumab, bevacizumab, and aflibercept. Fewer than 8% reported experience with anti-VEGF drug reservoirs, biosimilars, or faricimab. The study findings also showed ranibizumab and aflibercept as the commonly prescribed first line choices for the above-mentioned ocular conditions. For the second line choice, the study showed that aflibercept and dexamethasone intravitreal implants were the most common across the four retinal conditions studied. The only difference in intent to treat for "patients" versus "yourself" was for biosimilars (0% to 0.8%, P=0.001). CONCLUSION The findings regarding the first and second line choices for the mentioned ocular disorders were found to agree with the findings of published literature currently used in practice, with a tendency to prefer ranibizumab as first line therapy for neovascular disorders and aflibercept as first line therapy for macular edema. In addition, there were no differences between choices for first and second line therapy for patients vs. ophthalmologists.
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Affiliation(s)
- L-J Niegowski
- Department of Ophthalmology, University of Paris Est-Creteil, Créteil, France
| | - S Y Cohen
- Department of Ophthalmology, University of Paris Est-Creteil, Créteil, France; Ophthalmology Center for Imaging and Laser, Paris, France
| | - E Crincoli
- Department of Ophthalmology, University of Paris Est-Creteil, Créteil, France
| | - C J Mehanna
- Department of Ophthalmology, University of Paris Est-Creteil, Créteil, France
| | - E H Souied
- Department of Ophthalmology, University of Paris Est-Creteil, Créteil, France.
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Garay-Aramburu G, Hunt A, Arruabarrena C, Mehta H, Invernizzi A, Gabrielle PH, Guillaumie T, Wolff B, Gillies MC, Zarranz-Ventura J. Initial response and 12-month outcomes after commencing dexamethasone or vascular endothelial growth factor inhibitors for retinal vein occlusion in the FRB registry. Sci Rep 2024; 14:6122. [PMID: 38480837 PMCID: PMC10937938 DOI: 10.1038/s41598-024-56581-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/08/2024] [Indexed: 03/17/2024] Open
Abstract
To compare baseline characteristics, initial response and 12-month efficacy and safety outcomes in eyes with branch and central retinal vein occlusion (BRVO and CRVO) treated with dexamethasone implants (DEX) or anti-vascular endothelial growth factor (anti-VEGF) we performed a multi-centre, retrospective and observational study using Fight Retinal Blindness! Registry. Of 725 eligible eyes, 10% received DEX initially with very frequent adjunctive anti-VEGF (BRVO-DEX 49%, CRVO-DEX 60%). The primary outcome of mean adjusted change in VA at 12 months with DEX and anti-VEGF initiated groups were not statistically significantly different (BRVO: DEX + 6.7, anti-VEGF + 10.6 letters; CRVO: DEX + 2.8, anti-VEGF + 6.8 letters). DEX initiated eyes had fewer injections and visits than anti-VEGF initiated eyes. The BRVO-DEX eyes had greater initial mean changes in VA and central subfield thickness (CST) and achieved inactivity sooner than BRVO-anti-VEGF eyes. The mean CST after the first three months was above 350 μm in all but the BRVO-anti-VEGF group, suggesting undertreatment. In routine care DEX is uncommonly used when available as initial treatment of BRVO and CRVO requiring supplemental anti-VEGF within the first year. The 12-month outcomes were similar, but DEX initiated eyes had fewer injections and visits but more episodes of raised IOP Vs those starting anti-VEGF.
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Affiliation(s)
- Gonzaga Garay-Aramburu
- Begiker-Ophthalmology Research Group, Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, OSI Bilbao Basurto, Facultad de Medicina, Campus de Basurto, University of the Basque Country, UPV/EHU, Avenida Montevideo 18, 48013, Bilbao, Spain.
| | - Adrian Hunt
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Department of Ophthalmology, Westmead Hospital, Westmead, NSW, Australia
| | | | - Hemal Mehta
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Ophthalmology, Royal Free London NHS Foundation Trust, London, UK
| | - Alessandro Invernizzi
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | | | - Tremeur Guillaumie
- Department of Ophthalmology, Saint Brieuc Hospital, 22000, Saint Brieuc, France
| | - Benjamin Wolff
- 55659 Ophthalmological Center Maison Rouge, Strasbourg, France
| | - Mark C Gillies
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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Sanders FWB, Dumont Jones R, Jones DR, Phillips SV, Williams GS. Treatment of Diabetic Macular Edema or Macular Edema Following Retinal Vein Occlusion Based on Repeated Injection of the Dexamethasone Intravitreal Implant: A Retrospective Real-World Analysis. Clin Ophthalmol 2023; 17:3177-3187. [PMID: 37901284 PMCID: PMC10612511 DOI: 10.2147/opth.s402142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 10/11/2023] [Indexed: 10/31/2023] Open
Abstract
Purpose To assess the "real world" utility of repeated injection with the dexamethasone intravitreal implant (DEX) in routine practice. Methods This was a retrospective, single-center analysis of consecutive patients with diabetic macular edema, or macular edema following retinal vein occlusion, treated with DEX. None had received prior intravitreal steroid treatment. DEX was implanted as per the manufacturer's instructions. Results Seventy-eight individuals (95 eyes) were included (50.0% female; mean age: 68.1 ± 12.4 years; mean duration of macular edema: 13.2 ± 12.9 months). Thirty-three eyes (34.7%) had received previous treatment with an anti-vascular endothelial growth factor (anti-VEGF) and/or laser. Thirty eyes (31.6%) underwent one round of DEX implantation; the remainder received 2-5 cycles (total: 225 cycles). Initial DEX treatment led to significant increases in visual acuity (VA) at 6 weeks (mean change: 4.6 letters; P=0.004). Greater VA improvements during the first treatment cycle were associated with inferior baseline VA (P=0.02), borderline associated with baseline central macular thickness (CMT; P=0.06), and independent of prior anti-VEGF treatment (P=0.39). In an analysis of all DEX injections, VA improvements were robust across cycles 1 and 2 but reduced in cycle 3 (P=0.03). CMT improvements did not differ based on injection number (P=0.20). Increases in intraocular pressure (IOP) were largest over the first 6 weeks (but rebounded towards baseline more rapidly) in cycle 1 versus cycles 2 and 3 (P<0.001). IOP rises were typically manageable with topical medications. Conclusion This analysis confirms the broad utility of DEX and may inform decision-making in routine practice.
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Affiliation(s)
| | | | - David R Jones
- Department of Ophthalmology, Singleton Hospital, Swansea, UK
| | - Sean V Phillips
- Department of Ophthalmology, Singleton Hospital, Swansea, UK
| | - Gwyn S Williams
- Department of Ophthalmology, Singleton Hospital, Swansea, UK
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Bilton EJ, Guggenheim EJ, Baranyi B, Radovanovic C, Williams RL, Bradlow W, Denniston AK, Mollan SP. A Datasheet for the INSIGHT University Hospitals Birmingham Retinal Vein Occlusion Data Set. OPHTHALMOLOGY SCIENCE 2023; 3:100388. [PMID: 37720555 PMCID: PMC10500462 DOI: 10.1016/j.xops.2023.100388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/19/2023]
Abstract
Purpose Retinal vein occlusion (RVO) is the second leading cause of visual loss due to retinal disease. Retinal vein occlusion increases the risk of cardiovascular mortality and the risk of stroke. This article describes the data contained within the INSIGHT eye health data set for RVO and cardiovascular disease. Design Data set descriptor for routinely collected eye and systemic disease data. Participants All people who had suffered an RVO aged ≥ 18 years old, attending the Ophthalmology Clinic at Queen Elizabeth Hospital, University Hospitals Birmingham (UHB) National Health Service (NHS) Trust were included. Methods The INSIGHT Health Data Research Hub for Eye Health is an NHS-led ophthalmic bioresource. It provides researchers with safe access to anonymized routinely collected data from contributing NHS hospitals to advance research for patient benefit. This report describes the INSIGHT UHB RVO and major adverse cardiovascular events data set, a data set of ophthalmology and systemic data derived from the United Kingdom's largest acute care trust. Main Outcome Measures This data set consists of routinely collected data from the hospital's electronic patient records. The data set primarily includes structured data (relating to their hospital eye care and any cardiovascular data held for the individual) and OCT ocular images. Further details regarding the available data points are available in the supplementary information. Results At the time point of this analysis (September 30, 2022) the data set was composed of clinical data from 1521 patients, from Medisoft records inception. The data set includes 2196 occurrences of RVO affecting 2026 eyes, longitudinal eye follow-up clinical parameters, over 6217 eye-related procedures, and 982 encountered complications. The data set contains information on 2534 major adverse cardiovascular event occurrences, their subtype, number experienced per patient, and chronological relation to RVO event. Longitudinal follow-up data including laboratory results, regular medications, and all-cause mortality are also available within the data set. Conclusions This data set descriptor article summarizes the data set contents, the process of its curation, and potential uses. The data set is available through the structured application process that ensures research studies are for patient benefit. Further information regarding the data repository and contact details can be found at https://www.insight.hdrhub.org/. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Edward J. Bilton
- INSIGHT, Health Data Research Hub for Eye Health, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Emily J. Guggenheim
- INSIGHT, Health Data Research Hub for Eye Health, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Balazs Baranyi
- INSIGHT, Health Data Research Hub for Eye Health, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Charlotte Radovanovic
- INSIGHT, Health Data Research Hub for Eye Health, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Rowena L. Williams
- INSIGHT, Health Data Research Hub for Eye Health, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - William Bradlow
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, United Kingdom
- University Hospitals Birmingham, NHS Foundation Trust, United Kingdom
- MRC Health Data Research UK (HDR UK) Midlands, United Kingdom
| | - Alastair K. Denniston
- INSIGHT, Health Data Research Hub for Eye Health, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, United Kingdom
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Susan P. Mollan
- INSIGHT, Health Data Research Hub for Eye Health, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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Glacet-Bernard A, Girmens JF, Kodjikian L, Delcourt C, Fajnkuchen F, Creuzot-Garcher C, San Nicolas N, Massin P. Real-World Outcomes of Ranibizumab Treatment in French Patients with Visual Impairment due to Macular Edema Secondary to Retinal Vein Occlusion: 24-Month Results from the BOREAL-RVO Study. Ophthalmic Res 2023; 66:824-834. [PMID: 36972579 DOI: 10.1159/000530294] [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: 11/30/2022] [Accepted: 03/10/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Information about real-world ranibizumab use is needed to optimize treatment of macular edema secondary to retinal vein occlusion (RVO). The BOREAL-RVO study assessed treatment use, effectiveness, and safety of 24-month treatment with ranibizumab 0.5 mg in patients with visual impairment due to macular edema secondary to RVO in a real-world setting. METHODS This was a multicenter, post-authorization, observational study in France, including patients starting ranibizumab for RVO. Primary endpoint was mean change from baseline in best-corrected visual acuity (BCVA) at month 6. Secondary endpoints were mean changes from baseline in BCVA at month 24 and central retinal thickness (CRT) at months 6 and 24, and treatment use in real-world setting. RESULTS 226 branch RVO (BRVO) and 196 central RVO (CRVO) patients were enrolled; 71.7% and 70.9% completed the 24-month follow-up, respectively. In BRVO, mean (SD) baseline BCVA was 55.2 (18.7) letters, with gains of 14.3 (13.7), 14.1 (16.5), 13.0 (17.5), and 11.4 (20.1) letters at months 3, 6, 12, and 24, respectively. In CRVO, mean (SD) baseline BCVA was 40.4 (25.6) letters, with gains of 16.0 (21.2), 9.5 (25.4), 9.2 (27.7), and 8.3 (23.8) letters at months 3, 6, 12, and 24, respectively. At month 24, 52% of BRVO and 41% of CRVO patients had gains of 15 or more letters. In BRVO, mean (SD) CRT values at baseline and months 3, 6, 12, and 24 were 550 (175), 315 (104), 343 (122), 335 (137), and 340 (105) μm. In CRVO, mean (SD) CRT values at baseline and months 3, 6, 12, and 24 were 643 (217), 327 (152), 400 (203), 379 (175), and 348 (161) μm. On average, BRVO patients had 3.8 injections for 6.9 visits by month 6, and 7.2 injections for 19.7 visits by month 24. CRVO patients had 2.7 injections for 4.2 visits by month 6 and 7.1 injections for 21.1 visits by month 24. Factors predictive of better BCVA gain at month 6 were age under 60 at baseline, lower baseline BCVA and BCVA gain at month 3. There were no new safety findings. CONCLUSION Major improvements in BCVA and CRT were observed at month 3 after the induction phase and then were sustained up to month 24, with a slight decrease, probably due to under-treatment. This study demonstrated ranibizumab to be a safe and effective treatment for BRVO and CRVO in the real-world setting, although more regular or proactive treatment could further improve outcomes.
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Affiliation(s)
- Agnès Glacet-Bernard
- Department of Ophthalmology/Paris-Est Créteil University (UPEC, Paris XII University)/Intercommunal Hospital Center and Henri Mondor Hospital, Créteil, France
| | - Jean-François Girmens
- Department of Ophthalmology, INSERM-DGOS CIC 1423, Centre Hospitalier National d'Ophtalmologie (CHNO) des Quinze-Vingts, Paris, France
| | - Laurent Kodjikian
- Ophthalmology, Hopital de la Croix Rousse, Lyon University, UMR CNRS MATEIS 5510, Lyon, France
| | - Cécile Delcourt
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team LEHA, UMR 1219, F-33000, Bordeaux, France
| | - Franck Fajnkuchen
- Ophthalmology, Hôpital Avicenne, Bobigny, France
- Centre d'Imagerie et Laser, Paris, France
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Zhang M, Liu Y, Song M, Yu Y, Ruan S, Zheng K, Wang F, Sun X. Intravitreal Dexamethasone Implant Has Better Retinal Perfusion than Anti-Vascular Endothelial Growth Factor Treatment for Macular Edema Secondary to Retinal Vein Occlusion: A Five-Year Real-World Study. Ophthalmic Res 2022; 66:247-258. [PMID: 36215955 DOI: 10.1159/000527447] [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: 03/15/2022] [Accepted: 08/15/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of the study was to investigate the long-term effect of intravitreal dexamethasone (DEX) implant and anti-vascular endothelial growth factor (VEGF) injection on macular edema (ME) secondary to retinal vein occlusion (RVO) in a real-world setting. METHODS The medical records of RVO-ME cases, with intravitreal injections and followed up for at least 5 years, were retrospectively reviewed. Changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) were primary outcomes. Images of fluorescence angiography and swept-source optical coherence tomography angiography were analyzed. Foveal avascular zone (FAZ) metrics and perfusion density at the last visit were also compared between the two treatments. RESULTS A total of 16 patients were recruited, 8 in the anti-VEGF group and 8 in the DEX group. At the 5th year, the BCVA and the CMT in the DEX group were not different from those in the anti-VEGF group (0.69 ± 0.36 LogMAR vs. 0.57 ± 0.30 LogMAR, p = 0.574; 183.25 ± 97.31 µm vs. 195.38 ± 40.92 µm, p = 0.442). Compared with the anti-VEGF group, the DEX group had higher FAZ circularity index (0.57 ± 0.14 vs. 0.68 ± 0.14, p = 0.130) and higher retinal perfusion density (0.45 ± 0.02 vs. 0.39 ± 0.03, p = 0.001), especially in the deep capillary plexus. CONCLUSION DEX implant and anti-VEGF injection had comparative long-term effects on RVO-ME. Compared with the anti-VEGF treatment, the DEX treatment had advantages in maintaining retinal perfusion in patients with RVO.
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Affiliation(s)
- Min Zhang
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China,
| | - Yang Liu
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Minlu Song
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Yu
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Shang Ruan
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kairong Zheng
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
- Nursing Department, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fenghua Wang
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
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Niedzwiecki M, Hunt A, Nguyen V, Mehta H, Creuzot‐Garcher C, Gabrielle P, Guillemin M, Fraser‐Bell S, Arnold J, McAllister IL, Gillies M, Barthelmes D. 12-month outcomes of ranibizumab versus aflibercept for macular oedema in central retinal vein occlusion: data from the FRB! registry. Acta Ophthalmol 2022; 100:e920-e927. [PMID: 34519167 PMCID: PMC9292733 DOI: 10.1111/aos.15014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022]
Abstract
Purpose To compare 12‐month treatment outcomes of eyes receiving aflibercept or ranibizumab for macular oedema secondary to central retinal vein occlusion (CRVO) in routine clinical practice. Methods 296 treatment‐naïve eyes receiving either aflibercept (171 eyes, 2 mg) or ranibizumab (125 eyes, 0.5 mg) for macular oedema secondary to CRVO were recruited retrospectively from centres using the prospectively designed FRB! registry. The primary outcome measure was the mean change in LogMAR letter scores of visual acuity (VA). Secondary outcomes included change in central subfield thickness (CST), injections and visits, time to first grading of inactivity, switching and non‐completion from baseline to 12 months. Results Baseline VA (SD) was somewhat better in aflibercept‐ versus ranibizumab‐treated eyes (42.5 ± 25.5 letters versus 36.9 ± 26 letters; p = 0.07) with similar CST (614 (240) μm versus 616 (234) μm: p = 0.95). The 12‐month adjusted mean (95%CI) VA change was +16.6 (12.9, 20.4) letters for aflibercept versus +9.8 (5.5, 14.1) letters for ranibizumab (p = 0.001). The mean (95%CI) adjusted change in CST was significantly greater in aflibercept‐ versus ranibizumab‐treated eyes: −304 (−276, −333) µm versus −252 (−220, −282) µm (p < 0.001). Both groups had a median (Q1, Q3) of 7 (5, 9) injections and 10 (8,13) visits. Aflibercept‐treated eyes became inactive sooner than ranibizumab (p = 0.02). Switching occurred more commonly from ranibizumab (26 eyes, 21%) than from aflibercept (9 eyes, 5%) (p < 0.001). Conclusion Both aflibercept and ranibizumab improved VA and reduced CST in eyes with CRVO in routine clinical practice, with aflibercept showing significantly greater improvements in this comparative analysis.
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Affiliation(s)
- Mateusz Niedzwiecki
- Department of Ophthalmology University Hospital Zurich & University of Zurich Zurich Switzerland
| | - Adrian Hunt
- Department of Ophthalmology Westmead Hospital Westmead NSW Australia
- The Save Sight Institute Sydney Medical School The University of Sydney Sydney NSW Australia
| | - Vuong Nguyen
- The Save Sight Institute Sydney Medical School The University of Sydney Sydney NSW Australia
| | - Hemal Mehta
- The Save Sight Institute Sydney Medical School The University of Sydney Sydney NSW Australia
- Ophthalmology Department Royal Free London NHS Foundation Trust London UK
| | | | - Pierre‐Henry Gabrielle
- The Save Sight Institute Sydney Medical School The University of Sydney Sydney NSW Australia
- Department of Ophthalmology Dijon University Hospital Dijon France
| | - Martin Guillemin
- Department of Ophthalmology Dijon University Hospital Dijon France
| | - Samantha Fraser‐Bell
- The Save Sight Institute Sydney Medical School The University of Sydney Sydney NSW Australia
| | | | - Ian L. McAllister
- Centre for Ophthalmology and Visual Science Lions Eye Institute The University of Western Australia Perth WA Australia
| | - Mark Gillies
- The Save Sight Institute Sydney Medical School The University of Sydney Sydney NSW Australia
| | - Daniel Barthelmes
- Department of Ophthalmology University Hospital Zurich & University of Zurich Zurich Switzerland
- The Save Sight Institute Sydney Medical School The University of Sydney Sydney NSW Australia
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8
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Changes in 12-month outcomes over time for age-related macular degeneration, diabetic macular oedema and retinal vein occlusion. Eye (Lond) 2022; 37:1145-1154. [PMID: 35508721 PMCID: PMC9066999 DOI: 10.1038/s41433-022-02075-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/21/2022] [Accepted: 04/19/2022] [Indexed: 11/08/2022] Open
Abstract
Objectives To identify whether the outcomes of neovascular age-related macular degeneration (nAMD), diabetic macular oedema (DMO) and retinal vein occlusion (RVO) in routine clinical practice have changed over time. Methods We analysed 12-month outcomes in treatment-naïve eyes that started aflibercept or ranibizumab for nAMD (3802 eyes), DMO (975 eyes), Branch RVO (BRVO, 357 eyes), Central RVO (CRVO, 371 eyes) and Hemi-RVO (HRVO, 54 eyes) from 2015 and 2019 tracked in the prospectively designed observational Fight Retinal Blindness! Registry. Results The mean VA change at 12-month for each year between 2015 and 2019 remained stable or otherwise showed no discernible trends over time in eyes with nAMD (+3.3 to +6 letters), DMO (+3.6 to +6.7 letters) and RVO (+10.3 to +11.7 letters for BRVO, +5.9 to +17.7 letters for CRVO and 10.2 to 20.7 letters for HRVO). The median number of VEGF-inhibitor injections in eyes that completed 12-month follow-up also remained stable at 8–9 for nAMD, 6–7 for DMO, 7–9 for RVO. Fewer eyes (<one-fourth) that started treatment between 2015 and 2018 and more eyes starting in 2019 did not complete 12-month’s follow-up visit. The mean VA in non-completers at their last visit was higher than that of their baseline visit. Conclusions Treatment patterns and outcomes for nAMD, DMO and RVO in routine clinical practice have stabilised over the past 5 years at levels inferior to those reported by the pivotal phase 3 studies. A conscious effort to treat these conditions more intensively, or with longer lasting agents, would likely improve outcomes further in our patients.
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9
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Paracentral Acute Middle Maculopathy and Central Retinal Venous Occlusion following Electrical Injury. Case Rep Ophthalmol Med 2022; 2022:3699667. [PMID: 35469175 PMCID: PMC9034943 DOI: 10.1155/2022/3699667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/07/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose To report a case of central retinal vein occlusion (CRVO) and paracentral acute middle maculopathy (PAMM) following electric shock injury. Case Description. A 45-year-old male presented with a significant painless decreased vision in the right eye following an electrical injury of the right hand in his workplace. The best-corrected visual acuity (BCVA) of the right eye was 20/40. Funduscopic examination of the right eye revealed diffuse superficial and deep intraretinal hemorrhages, mild venous tortuosity, and an area of the pale retina. Optical coherence tomography (OCT) demonstrated hyperreflective band-like lesions in the middle retinal layers. Patchy areas of vascular flow void in deep capillary plexus seen in OCT angiography of the right eye were compatible with PAMM. Fluorescein angiography of the right eye was indicative of delayed venous filling suggestive of CRVO. The left eye was completely normal on exam and imaging. Conclusion This report illustrates the occurrence of CRVO associated with PAMM following electric shock injury. Electrical injury leads to a wide range of retinal manifestations. Clinicians need to pay attention to any hyperreflectivity and thinning of middle retinal layers in OCT in cases with the presentation of sudden visual loss following electrical injuries.
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Kishore K, Bhat PV, Venkatesh P, Canizela CC. Dexamethasone Intravitreal Implant for the Treatment of Macular Edema and Uveitis: A Comprehensive Narrative Review. Clin Ophthalmol 2022; 16:1019-1045. [PMID: 35418744 PMCID: PMC8995179 DOI: 10.2147/opth.s209395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/10/2022] [Indexed: 01/09/2023] Open
Abstract
Purpose The purpose of this review article is to provide a comprehensive review of the current applications of intravitreal DEX implant (Ozurdex®, Allergan Inc, Irvine, CA) for a variety of ophthalmic conditions – ranging from FDA approved indications to off-label uses. We have attempted to provide relevant evidence from the literature to help a reader develop an understanding of the biological and pharmacokinetic properties of DEX implant, its uses, and potential side effects. Methods PubMed searches were performed using the terms “Ozurdex”, or “intravitreal DEX implant”, AND “retinal vein occlusion”, or “diabetic macular edema”, or “uveitis”. The search was performed in July of 2021, with an additional search in October 2021. All original English language articles were considered for this review. Results DEX implant has evidence of efficacy in a variety of clinical situations including macular edema associated with retinal vein occlusion, diabetes, uveitis, and others. Safety concerns include cataract formation and progression, intraocular pressure elevation, complications related to intravitreal injection, and opportunistic infections secondary to steroid-induced immune suppression. Conclusion DEX implant is a useful tool in the management of several retinal disorders. Further studies are needed for head-to-head comparison with other treatment modalities and to determine its precise place in clinical practice.
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Affiliation(s)
- Kamal Kishore
- Illinois Retina and Eye Associates, Peoria, IL, USA
- Department of Surgery, University of Illinois College of Medicine, Peoria, IL, USA
- Correspondence: Kamal Kishore, Illinois Retina and Eye Associates, 4505 N Rockwood Drive, Suite 1, Peoria, IL, 61615, USA, Tel +1 3095891880, Fax +1 3095891885, Email
| | - Pooja V Bhat
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Pradeep Venkatesh
- Department of Ophthalmology, Dr. Rajendra Prasad Center for Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi, 110029, India
| | - Cecilia C Canizela
- Department of Surgery, University of Illinois College of Medicine, Peoria, IL, USA
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Wu L, Acon D, Berrocal MH, Gallego-Pinazo R, Dolz-Marco R, Roca JA, Maia M, Rojas S, Zas M, Arevalo JF, Chhablani J. Five-year outcomes after intravitreal bevacizumab of treatment-naive eyes with macular edema secondary to CRVO in routine clinical practice: Results of the Pan-American Collaborative Retina Study (PACORES) group. Int Ophthalmol 2021; 42:951-958. [PMID: 34628544 DOI: 10.1007/s10792-021-02077-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 09/29/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to report the 5-year outcomes of treatment-naive eyes with cystoid macular edema secondary to central retinal vein occlusion treated with intravitreal bevacizumab in routine clinical practice. METHODS We conducted multicenter retrospective non-comparative case series of 102 eyes. The main outcome measured was the change in best-corrected visual acuity (BCVA) at 5 years. Secondary outcomes included the number of injections and the change in CMT at 5 years. RESULTS At 5 years, the mean BCVA improved from 1.22 ± 0.58 (Snellen 20/428) at baseline to 1.00 ± 0.68 logMAR (Snellen 20/200; p < 0.0001). At 5 years, 48 (47%) eyes had a gain of ≥ 3 lines, 41 (40.2%) eyes remained within 3 lines and 13 (12.7%) eyes had a loss of ≥ 3 lines of BCVA. The CMT improved from 740 ± 243 to 322 ± 179 µm (p < 0.0001). At 5 years, 59 (57.8%) eyes had a completely dry SD-OCT. Patients received a total of 10.6 ± 6.1 (range 6-27) injections. Baseline BCVA (p < 0.0001) and the duration of symptoms prior to initial anti-VEGF injection (p = 0.0274) were the only predictive factors for BCVA at 5 years. CONCLUSIONS After 5 years with an average of 10.6 injections, there was a mean gain of 0.22 logMAR. In addition, more eyes achieved a BCVA of ≥ 20/40, gained ≥ 3 lines and less patients had a BCVA ≤ 20/200. Eyes with a better baseline BCVA and a shorter duration of symptoms were more likely to achieve better BCVA at 5 years.
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Affiliation(s)
- Lihteh Wu
- Asociados de Macula Vitreo y Retina de Costa Rica, Primer Piso, Torre Mercedes, Paseo Colón, San José, Costa Rica. .,Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois Chicago School of Medicine, Chicago, IL, USA.
| | - Dhariana Acon
- Asociados de Macula Vitreo y Retina de Costa Rica, Primer Piso, Torre Mercedes, Paseo Colón, San José, Costa Rica
| | - Maria H Berrocal
- Department of Ophthalmology, University of Puerto Rico, San Juan, Puerto Rico
| | | | | | | | - Mauricio Maia
- Department of Ophthalmology, Vision Institute, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Sergio Rojas
- Fundación Hospital Nuestra Señora de la Luz, Mexico City, Mexico
| | - Marcelo Zas
- Department of Ophthalmology, University of Buenos Aires, Buenos Aires, Argentina
| | - J F Arevalo
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Jay Chhablani
- L.V.Prasad Eye Institute, Hyderabad, India.,Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
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