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Di Pierdomenico J, Gallego-Ortega A, Norte-Muñoz M, Vidal-Villegas B, Bravo I, Boluda-Ruiz M, Bernal-Garro JM, Fernandez-Bueno I, Pastor-Jimeno JC, Villegas-Pérez MP, Avilés-Trigueros M, de Los Ríos C, Vidal-Sanz M. Evaluation of the neuroprotective efficacy of the gramine derivative ITH12657 against NMDA-induced excitotoxicity in the rat retina. Front Neuroanat 2024; 18:1335176. [PMID: 38415017 PMCID: PMC10898249 DOI: 10.3389/fnana.2024.1335176] [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: 11/08/2023] [Accepted: 01/16/2024] [Indexed: 02/29/2024] Open
Abstract
Purpose The aim of this study was to investigate, the neuroprotective effects of a new Gramine derivative named: ITH12657, in a model of retinal excitotoxicity induced by intravitreal injection of NMDA. Methods Adult Sprague Dawley rats received an intravitreal injection of 100 mM NMDA in their left eye and were treated daily with subcutaneous injections of ITH12657 or vehicle. The best dose-response, therapeutic window study, and optimal treatment duration of ITH12657 were studied. Based on the best survival of Brn3a + RGCs obtained from the above-mentioned studies, the protective effects of ITH12657 were studied in vivo (retinal thickness and full-field Electroretinography), and ex vivo by quantifying the surviving population of Brn3a + RGCs, αRGCs and their subtypes α-ONsRGCs, α-ONtRGCs, and α-OFFRGCs. Results Administration of 10 mg/kg ITH12657, starting 12 h before NMDA injection and dispensed for 3 days, resulted in the best significant protection of Brn3a + RGCs against NMDA-induced excitotoxicity. In vivo, ITH12657-treated rats showed significant preservation of retinal thickness and functional protection against NMDA-induced retinal excitotoxicity. Ex vivo results showed that ITH12657 afforded a significant protection against NMDA-induced excitotoxicity for the populations of Brn3a + RGC, αRGC, and αONs-RGC, but not for the population of αOFF-RGC, while the population of α-ONtRGC was fully resistant to NMDA-induced excitotoxicity. Conclusion Subcutaneous administration of ITH12657 at 10 mg/kg, initiated 12 h before NMDA-induced retinal injury and continued for 3 days, resulted in the best protection of Brn3a + RGCs, αRGC, and αONs-RGC against excitotoxicity-induced RGC death. The population of αOFF-RGCs was extremely sensitive while α-ONtRGCs were fully resistant to NMDA-induced excitotoxicity.
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Affiliation(s)
| | | | - María Norte-Muñoz
- Departamento de Oftalmología, Universidad de Murcia e IMIB-Arrixaca, Murcia, Spain
| | | | - Isaac Bravo
- Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain
- Departamento de Ciencias Básicas de la Salud, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - María Boluda-Ruiz
- Departamento de Oftalmología, Universidad de Murcia e IMIB-Arrixaca, Murcia, Spain
| | | | - Iván Fernandez-Bueno
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Retina Group, Universidad de Valladolid, Valladolid, Spain
| | - Jose Carlos Pastor-Jimeno
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Retina Group, Universidad de Valladolid, Valladolid, Spain
| | | | | | - Cristobal de Los Ríos
- Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain
- Departamento de Ciencias Básicas de la Salud, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Manuel Vidal-Sanz
- Departamento de Oftalmología, Universidad de Murcia e IMIB-Arrixaca, Murcia, Spain
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Kumar A, Kumar A, Kumar J, Bai G, Jeewnani R, Dembra M, Kanwal K, Qadeer U, Khawar MH, Yaseen Khan I, Ram R, Varrassi G. Comparative Efficacy of Anti-vascular Endothelial Growth Factor (Anti-VEGF) Agents and Corticosteroids in Managing Diabetic Retinopathy-Associated Diabetic Macular Edema: A Meta-Analysis and Comprehensive Systematic Review. Cureus 2024; 16:e51910. [PMID: 38333510 PMCID: PMC10850611 DOI: 10.7759/cureus.51910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
Diabetic macular edema (DME) is a significant condition linked to diabetes that can result in visual loss. In recent times, there has been a notable change in the desire for treatment, with a shift toward anti-vascular endothelial growth factor (anti-VEGF) therapy and intravitreal steroids while moving away from conventional laser therapies. This comprehensive meta-analysis explicitly compares the efficacy of two therapies for DME: anti-VEGF therapy and corticosteroid. We conducted a thorough search using PubMed and Google Scholar to identify publications that compare the effects of anti-VEGF therapy and corticosteroid implants on DME. Using Review Manager 5.0 (RevMan), we incorporated data from nine research studies, which involved a total of 877 people. The group was split into two factions: 453 patients were administered corticosteroids, while 466 patients underwent treatment with anti-VEGF therapy. Our investigation demonstrated that both corticosteroid and anti-VEGF therapy positively improved the best-corrected visual acuity (BCVA) and reduced the central macular thickness (CMT). Nevertheless, comparing the mean BCVA on the logarithm of the minimum angle of resolution (logMAR) scale revealed no statistically significant changes between the two treatments. This indicates considerable inconsistency, as evidenced by the weighted mean difference (WMD) of -0.13 (-0.41, 0.16) with a P-value of 0.39 and an I2 value of 99%. In addition, both treatments improved BCVA compared to the initial measurement. However, there was no statistically significant benefit for corticosteroid over anti-VEGF therapy, as indicated by the WMD of 0.03 (-0.07, 0.13) with a P-value of 0.55 and an I2 value of 80%. The examination of the average CMT also yielded findings that lacked statistical significance, displaying a significant amount of variation (WMD -36.37, 95% confidence interval [-127.52, 54.78], P = 0.43, I2 = 98%). Remarkably, there were no significant alterations among the anti-VEGF therapy group despite a rise in CMT from the initial measurement. The main conclusion drawn from our research is that corticosteroid demonstrates encouraging immediate enhancements in BCVA and CMT. However, anti-VEGF therapy seems to provide more significant long-term advantages. Nevertheless, it is crucial to acknowledge that the corticosteroid group had a greater susceptibility to acquiring elevated intraocular pressure (IOP) and the possibility of glaucoma.
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Affiliation(s)
- Avesh Kumar
- Medicine, Bahria University Health Sciences Campus, Karachi, PAK
| | - Aman Kumar
- Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, PAK
| | - Jagdesh Kumar
- Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, PAK
| | - Guria Bai
- Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, PAK
| | - Rachna Jeewnani
- Medicine, Bahria University Health Sciences Campus, Karachi, PAK
| | - Mahek Dembra
- Medicine, Bahria University Health Sciences Campus, Karachi, PAK
| | - Kainat Kanwal
- Medicine and Surgery, Khawaja Muhammad Safdar Medical College, Sialkot, PAK
| | - Usama Qadeer
- Medicine, Allama Iqbal Medical College, Lahore, PAK
| | | | | | - Raja Ram
- Medicine, MedStar Washington Hospital Center, Washington, USA
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Patil NS, Dhoot AS, Nichani PAH, Popovic MM, Muni RH, Kertes PJ. Safety and Efficacy of a Treat-and-Extend Regimen of Anti-Vascular Endothelial Growth Factor Agents for Diabetic Macular Edema or Macular Edema Secondary to Retinal Vein Occlusion: A Systematic Review and Meta-Analysis. Ophthalmic Surg Lasers Imaging Retina 2023; 54:131-138. [PMID: 36944072 DOI: 10.3928/23258160-20230221-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
[Box: see text] Background and Objective: This meta-analysis evaluates treat-and-extend regimens relative to monthly and as-needed (prn) regimens using anti-vascular endothelial growth factor agents for diabetic macular edema and macular edema secondary to retinal vein occlusion. MATERIALS AND METHODS Comparative studies evaluating a treat-and-extend regimen relative to a monthly or prn regimen with anti-vascular endothelial growth factor therapy for diabetic macular edema or macular edema secondary to retinal vein occlusion were included following a systematic literature search. RESULTS Seven studies of 984 eyes were included. Relative to a monthly regimen, treat-and-extend was similar for change in best-corrected visual acuity at final follow-up (P = .59) and had a lower number of injections (P < .00001). Relative to a prn regimen, treat-and-extend was similar for change in best-corrected visual acuity at final follow-up (P = .84) and was associated with a higher number of injections (P = .02). CONCLUSION This meta-analysis found that a treat-and extend regimen was nonsignificantly different compared to monthly and prn regimens in efficacy and safety end points. [Ophthalmic Surg Lasers Imaging Retina 2023;54(3):131-138.].
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4
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A Delphi study on the clinical management of age-related macular degeneration. Int Ophthalmol 2022; 42:1799-1809. [PMID: 35149923 DOI: 10.1007/s10792-021-02177-2] [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: 07/08/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Age-related macular degeneration (AMD) is one of the main causes of blindness and visual impairment worldwide. As achieving a dry macula is one of the main objectives in AMD management, the purpose of this work was to reach a consensus on the relevance of retinal fluid in function, disease activity control and treatment patterns. METHODS Forty-seven Portuguese ophthalmologists specialized in AMD participated in a DELPHI panel. Two rounds of presential meetings were conducted and a cut-off of 80% or more of votes was defined to consider answers consensual. RESULTS Consensus was reached for 11 out of 18 questions. These questions focused on the impact of anatomical results on visual acuity, standards exams and parameters to assess disease activity, frequency and factors which influence disease activity assessment, criteria to use non-fixed treatment regimens, usefulness of individualized regimens and conditions for treatment interruption. No consensus was obtained for relevance of the different fluid types in AMD prognosis, frequency of fluid presence assessment, factors commonly associated with progression to geographic atrophy, ideal conditions for a fixed treatment regimen, date of first disease activity assessment and parameters to monitor disease activity. CONCLUSIONS Consensus was achieved for over half of the questions assessed through this Delphi study. The questions for which no consensus was reached concerned either subjects that need further investigation or monitoring times which are influenced by resource availability. Raising awareness for these issues will allow the improvement of AMD management and treatment.
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Sharma TS, Sharma SM. Subretinal Neovascular Membrane in Wet Age-Related Macular Degeneration Managed With Intravitreal Ranibizumab. Cureus 2021; 13:e17642. [PMID: 34646690 PMCID: PMC8486362 DOI: 10.7759/cureus.17642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 11/09/2022] Open
Abstract
This case report depicts how a case of the subretinal neovascular membrane was managed with intravitreal ranibizumab injections. A 59-year-old female patient presented with complaints of diminution of vision in her right eye for one month. Various necessary examinations were carried out and the patient was diagnosed with both forms of age-related macular degeneration (ARMD) disorder - wet ARMD in the right eye and dry ARMD in the left eye. Pseudophakia was also seen in both eyes. Drusen deposits, characteristic of the disorder, were seen in the macular area of the oculus sinister (OS). The patient was treated for the wet ARMD with intravitreal injections of 0.5 mg ranibizumab administered one month apart in the right eye. The patient showed improvements in her visual acuity and a complete resolution of the subretinal fluid.
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6
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Lai TYY, Lai RYK. Association between Retinal Thickness Variability and Visual Acuity Outcome during Maintenance Therapy Using Intravitreal Anti-Vascular Endothelial Growth Factor Agents for Neovascular Age-Related Macular Degeneration. J Pers Med 2021; 11:1024. [PMID: 34683165 PMCID: PMC8541068 DOI: 10.3390/jpm11101024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 01/04/2023] Open
Abstract
Previous studies based on clinical trial data have demonstrated that greater fluctuations in retinal thickness during the course of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (nAMD) is associated with poorer visual acuity outcomes. However, it was unclear whether similar findings would be observed in real-world clinical settings. This study aimed to evaluate the association between retinal thickness variability and visual outcomes in eyes receiving anti-VEGF therapy for nAMD using pro re nata treatment regimen. A total of 64 eyes which received intravitreal anti-VEGF therapy (bevacizumab, ranibizumab or aflibercept) for the treatment of nAMD were evaluated. Variability in spectral-domain optical coherence tomography (OCT) central subfield thickness (CST) was calculated from the standard deviation (SD) values of all follow-up visits after three loading doses from month 3 to month 24. Eyes were divided into quartiles based on the OCT CST variability values and the mean best-corrected visual acuity values at 2 years were compared. At baseline, the mean ± SD logMAR visual acuity and CST were 0.59 ± 0.39 and 364 ± 113 µm, respectively. A significant correlation was found between CST variability and visual acuity at 2 years (Spearman's ρ = 0.54, p < 0.0001), indicating that eyes with lower CST variability had better visual acuity at 2 years. Eyes with the least CST variability were associated with the highest mean visual acuity improvement at 2 years (quartile 1: +9.7 letters, quartile 2: +1.1 letters, quartile 3: -2.5 letters, quartile 4: -9.5 letters; p = 0.018). No significant difference in the number of anti-VEGF injections was found between the four CST variability quartile groups (p = 0.21). These findings showed that eyes undergoing anti-VEGF therapy for nAMD with more stable OCT CST variability during the follow-up period were associated with better visual outcomes. Clinicians should consider adopting treatment strategies to reduce CST variability during the treatment course for nAMD.
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Affiliation(s)
- Timothy Y. Y. Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Central Ave, Shatin, New Territories, Hong Kong, China
- 2010 Retina & Macula Centre, Tsim Sha Tsui, Kowloon, Hong Kong, China;
| | - Ricky Y. K. Lai
- 2010 Retina & Macula Centre, Tsim Sha Tsui, Kowloon, Hong Kong, China;
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7
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Nguyen V, Puzo M, Sanchez-Monroy J, Gabrielle PH, Garcher CC, Baudin F, Wolff B, Castelnovo L, Michel G, O'Toole L, Barthelmes D, Gillies MC. ASSOCIATION BETWEEN ANATOMICAL AND CLINICAL OUTCOMES OF NEOVASCULAR AGE-RELATED MACULAR DEGENERATION TREATED WITH ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR. Retina 2021; 41:1446-1454. [PMID: 33332811 PMCID: PMC8210784 DOI: 10.1097/iae.0000000000003061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE Assess the relationship between subretinal fluid (SRFL), intraretinal fluid, and visual outcomes of neovascular age-related degeneration in routine clinical practice. METHODS Treatment-naive eyes enrolled in the Fight Retinal Blindness! registry after January 2017 were identified. Lesion activity was graded at each visit as inactive, active not SRFL only (A-NSRFL only), or active SRFL only (A-SRFL only). Eyes were grouped based on initial activity as follows: 1) initially A-NSRFL only or 2) initially A-SRFL only, and their predominant activity status over 12 months was as follows: 1) mostly inactive, 2) mostly A-NSRFL only, or 3) mostly A-SRFL only. RESULTS Seven hundred and three eyes were eligible for analysis. Initially A-NSRFL only had a similar adjusted mean 12-month visual acuity change to initially A-SRFL eyes (5.7 vs. 6.9 letters; P = 0.165), but their final visual acuity was worse (62.5 vs. 67.5 letters at 12 months; P = 0.003). The adjusted mean 12-month visual acuity change between the predominant activity groups was significantly different (P = 0.005), with mostly inactive (7.6 letters) and mostly A-SRFL only (7.5 letters) eyes gaining more than mostly A-NSRFL only eyes (3.6 letters). CONCLUSION Eyes with SRFL only had similar outcomes at 1 year to eyes that were mostly inactive. Intraretinal fluid was associated with worse visual outcomes, highlighting the importance of distinguishing between intraretinal fluid and SRFL when managing neovascular age-related degeneration.
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Affiliation(s)
- Vuong Nguyen
- Discipline of Ophthalmology, Save Sight Institute, the University of Sydney, Sydney Medical School, Sydney, Australia
| | - Martin Puzo
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain
| | | | - Pierre-Henry Gabrielle
- Discipline of Ophthalmology, Save Sight Institute, the University of Sydney, Sydney Medical School, Sydney, Australia
- Department of Ophthalmology, Dijon University Hospital, Dijon, France
| | | | - Florian Baudin
- Department of Ophthalmology, Dijon University Hospital, Dijon, France
| | | | | | | | - Louise O'Toole
- Eye Centre, Mater Private Hospital, Dublin, Ireland; and
| | - Daniel Barthelmes
- Discipline of Ophthalmology, Save Sight Institute, the University of Sydney, Sydney Medical School, Sydney, Australia
- Department of Ophthalmology Zurich, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Mark C. Gillies
- Discipline of Ophthalmology, Save Sight Institute, the University of Sydney, Sydney Medical School, Sydney, Australia
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8
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[Biomarkers in full-thickness and lamellar defects of the macula]. Ophthalmologe 2021; 118:321-336. [PMID: 33646383 DOI: 10.1007/s00347-021-01340-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Biomarkers are characteristic biological measurable signs and objective parameters to detect the state of health. Besides functional and temporal factors, imaging biomarkers play an increasingly important role. In full-thickness and lamellar defects of the macula numerous imaging parameters have been described. This knowledge resulted in new classifications for both clinical pictures, which are based on important biomarkers of these clinical pictures and characteristic features of described subtypes. METHODS Imaging biomarkers for full-thickness and lamellar macular defects are described with respect to the classification and their functional prognostic importance. The importance of these biomarkers is presented. RESULTS The current classification of full-thickness and lamellar macular defects is based on structural biomarkers. Biomarkers are important for prognostic and therapeutic evaluation and they have an impact on the surgical strategy. There are various surgical strategies for treatment of full-thickness macular holes depending on the size of the foramen and other biomarkers. The inverted ILM flap technique improves the closure rate of large macular holes. In lamellar macular holes showing signs of progression an early surgical intervention results in a good anatomical and functional prognosis. CONCLUSION Multimodal diagnostics provide important preoperative, intraoperative, and postoperative features for macular holes and lamellar macular holes, which are essential biomarkers for the exact classification, the therapeutic strategy and for assessment of the prognosis.
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9
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Trivizki O, Karp MR, Chawla A, Yamanuha J, Gregori G, Rosenfeld PJ. Eliminating Visual Acuity and Dilated Fundus Examinations Improves Cost Efficiency of Performing Optical Coherence Tomogrpahy-Guided Intravitreal Injections. Am J Ophthalmol 2020; 219:222-230. [PMID: 32621894 PMCID: PMC7329678 DOI: 10.1016/j.ajo.2020.06.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 01/22/2023]
Abstract
Purpose The clinic efficiency and cost savings achieved by eliminating formal visual acuity (VA) and dilated fundus examinations (DFEs) were assessed for established patients receiving optical coherence tomography (OCT)–guided intravitreal injections. Design Comparative cost analysis. Methods Two different treatment models were evaluated. The first model included patients undergoing routine VA assessment, DFEs, OCT imaging, and intravitreal injections. The second model eliminated the routine VA assessment and DFE while using OCT imaging through an undilated pupil followed by the intravitreal injection. The 2 models incorporated both bevacizumab and aflibercept. The number of patients per clinic day, the cost per visit, and the daily revenues were compared between the 2 models. Results Optimized schedules with and without VA assessments and DFEs allowed for 48 and 96 patients to be injected per day, respectively. Excluding drug costs, the cost per encounter for the visits with and without a DFE were $39.33 and $22.63, respectively. Including the drug costs, the costs per encounter for the visits with and without a DFE were $85.55 and $68.85 for bevacizumab and $1787.58 and $17770.88 for aflibercept, respectively. Once the reimbursements for each visit type were included, the clinics that eliminated the VA and DFEs were more cost efficient. Conclusion Eliminating both VA assessments and DFEs for patients undergoing OCT-guided retreatment with intravitreal injections resulted in decreased exposure times between patients and clinic staff, decreased cost per encounter, and increased patient volumes per clinic day, resulting in improved clinic efficiency and safety while seeing more patients in a clinic day.
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Affiliation(s)
- Omer Trivizki
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael R Karp
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Anuj Chawla
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Justin Yamanuha
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Philip J Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
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10
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Gil-Martínez M, Santos-Ramos P, Fernández-Rodríguez M, Abraldes MJ, Rodríguez-Cid MJ, Santiago-Varela M, Fernández-Ferreiro A, Gómez-Ulla F. Pharmacological Advances in the Treatment of Age-related Macular Degeneration. Curr Med Chem 2020; 27:583-598. [PMID: 31362645 DOI: 10.2174/0929867326666190726121711] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 07/05/2019] [Accepted: 07/19/2019] [Indexed: 12/16/2022]
Abstract
Age-related macular degeneration is an acquired degenerative disease that is responsible for severe loss of vision in elderly people. There are two types: dry age-related macular degeneration and wet age-related macular degeneration. Its treatment has been improved and tries to be tailored in the future. The aim of this review is to summarize the pharmacological advances in the treatment of age-related macular degeneration. Regarding dry AMD, there is no effective treatment to reduce its progression. However, some molecules such as lampalizumab and eculizumab were under investigation, although they have shown low efficacy. Herein, in an attempt to prevent dry AMD progression, the most important studies suggested increasing the antioxidants intake and quitting the smoke habit. On the other hand, wet AMD has more developed treatment. Nowadays, the gold standard treatment is anti-VEGF injections. However, more effective molecules are currently under investigation. There are different molecules under research for dry AMD and wet AMD. This fact could help us treat our patients with more effective and lasting drugs but more clinical trials and safety studies are required in order to achieve an optimal treatment.
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Affiliation(s)
- María Gil-Martínez
- Department of Ophthalmology, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain.,Instituto Oftalmológico Gómez-Ulla, Santiago de Compostela, Spain
| | - Paz Santos-Ramos
- Department of Ophthalmology, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Maribel Fernández-Rodríguez
- Department of Ophthalmology, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain.,Instituto Oftalmológico Gómez-Ulla, Santiago de Compostela, Spain.,Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Maximino J Abraldes
- Department of Ophthalmology, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain.,Instituto Oftalmológico Gómez-Ulla, Santiago de Compostela, Spain.,Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Maria José Rodríguez-Cid
- Department of Ophthalmology, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain.,Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - María Santiago-Varela
- Department of Ophthalmology, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Anxo Fernández-Ferreiro
- Pharmacy Department and Pharmacology Group, Univ Hospital of Santiago de Compostela (SERGAS) and Health Research Intitute (IDIS), Santiago de Compostela, Spain
| | - Francisco Gómez-Ulla
- Instituto Oftalmológico Gómez-Ulla, Santiago de Compostela, Spain.,Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain
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11
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Ong EL, Spooner K, Hong T, Chang A. Brolucizumab: an evolution in treatment for neovascular age-related macular degeneration. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1735363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Ee Lin Ong
- Sydney Retina Clinic & Day Surgery, Sydney, Australia
- Sydney Institute of Vision Science, Sydney, Australia
| | - Kimberly Spooner
- Sydney Retina Clinic & Day Surgery, Sydney, Australia
- Sydney Institute of Vision Science, Sydney, Australia
| | - Thomas Hong
- Sydney Retina Clinic & Day Surgery, Sydney, Australia
- Sydney Institute of Vision Science, Sydney, Australia
| | - Andrew Chang
- Sydney Retina Clinic & Day Surgery, Sydney, Australia
- Sydney Institute of Vision Science, Sydney, Australia
- Retinal Unit, Sydney Eye Hospital, Sydney, Australia
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12
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García-Quintanilla L, Luaces-Rodríguez A, Gil-Martínez M, Mondelo-García C, Maroñas O, Mangas-Sanjuan V, González-Barcia M, Zarra-Ferro I, Aguiar P, Otero-Espinar FJ, Fernández-Ferreiro A. Pharmacokinetics of Intravitreal Anti-VEGF Drugs in Age-Related Macular Degeneration. Pharmaceutics 2019; 11:pharmaceutics11080365. [PMID: 31370346 PMCID: PMC6723750 DOI: 10.3390/pharmaceutics11080365] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 07/20/2019] [Accepted: 07/22/2019] [Indexed: 12/27/2022] Open
Abstract
Intravitreal administration of anti-vascular endothelial growth factor (VEGF) antibodies has become the standard treatment for Age-Related Macular Degeneration; however, the knowledge of their pharmacokinetics is limited. A comprehensive review of the preclinical and clinical pharmacokinetic data that were obtained in different studies with intravitreal bevacizumab, ranibizumab, and aflibercept has been conducted. Moreover, the factors that can influence the vitreous pharmacokinetics of these drugs, as well as the methods that were used in the studies for analytical determination, have been exposed. These anti-VEGF drugs present different charge and molecular weights, which play an important role in vitreous distribution and elimination. The pharmacokinetic parameters that were collected differ depending on the species that were involved in the studies and on physiological and pathological conditions, such as vitrectomy and lensectomy. Knowledge of the intravitreal pharmacokinetics of the anti-VEGF drugs that were used in clinical practice is of vital importance.
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Affiliation(s)
- Laura García-Quintanilla
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
- Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), 15706 Santiago de Compostela, Spain
| | - Andrea Luaces-Rodríguez
- Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), 15706 Santiago de Compostela, Spain
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain
| | - María Gil-Martínez
- Ophthalmology Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - Cristina Mondelo-García
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
- Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), 15706 Santiago de Compostela, Spain
| | - Olalla Maroñas
- Genomic Medicine Group, Galician Public Foundation of Genomic Medicine, Health Research Institute of Santiago de Compostela (FIDIS), 15706 Santiago de Compostela, Spain
| | - Víctor Mangas-Sanjuan
- Department of Pharmacy and Pharmaceutical Technology and Parasitology, University of Valencia, 46100 Valencia, Spain
- Interuniversity Research Institute for Molecular Recognition and Technological Development, Polytechnic University of Valencia, 46100 Valencia, Spain
| | - Miguel González-Barcia
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
- Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), 15706 Santiago de Compostela, Spain
| | - Irene Zarra-Ferro
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
- Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), 15706 Santiago de Compostela, Spain
| | - Pablo Aguiar
- Nuclear Medicine Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
- Molecular Imaging Group, Health Research Institute of Santiago de Compostela (FIDIS), 15706 Santiago de Compostela, Spain
| | - Francisco J Otero-Espinar
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain.
| | - Anxo Fernández-Ferreiro
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain.
- Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), 15706 Santiago de Compostela, Spain.
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain.
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Real-world use of ranibizumab for neovascular age-related macular degeneration in Taiwan. Sci Rep 2018; 8:7486. [PMID: 29748599 PMCID: PMC5945845 DOI: 10.1038/s41598-018-25864-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 05/01/2018] [Indexed: 11/08/2022] Open
Abstract
This study investigated the “real-world” use of ranibizumab for neovascular age-related macular degeneration (nAMD) in Taiwan and assessed the visual outcome. We reviewed the medical records at National Cheng Kung University Hospital, Taiwan, during 2012–2014 for 264 consecutive eyes of 229 patients with nAMD, who applied for ranibizumab covered by national health insurance. A total of 194 eyes (73.5%) in 179 patients (65.5% men; mean ± standard deviation age 69.4 ± 10.7 years) were pre-approved for treatment. Applications for treatment increased year by year, but approval rates decreased during this time. The major causes of rejection for funding were diseases mimicking nAMD, including macular pucker/epiretinal membrane, macular scarring, dry-type AMD, and possible polypoidal choroidal vasculopathy. After completion of three injections in 147 eyes, visual acuity significantly improved, gaining ≥1 line in 51.8% of eyes and stabilising in 38.3% of 141 eyes in which visual acuity was measured. The 114 eyes approved with only one application had a better visual outcome than the 27 eyes approved after the second or third applications. In conclusion, ranibizumab is effective for nAMD; however, approval after the second or third application for national health insurance cover is a less favourable predictor of visual outcome.
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Feltgen N, Bertelmann T, Bretag M, Pfeiffer S, Hilgers R, Callizo J, Goldammer L, Bemme S, Hoerauf H. Efficacy and safety of a fixed bimonthly ranibizumab treatment regimen in eyes with neovascular age-related macular degeneration: results from the RABIMO trial. Graefes Arch Clin Exp Ophthalmol 2017; 255:923-934. [PMID: 28102456 DOI: 10.1007/s00417-017-3589-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/05/2017] [Accepted: 01/11/2017] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To evaluate prospectively the efficacy and safety of a fixed bimonthly ranibizumab treatment regimen (RABIMO) in eyes with neovascular age-related macular degeneration (nAMD) and to compare these results with a pro re nata (PRN) treatment scheme. METHODS This was a 12-month, phase IV, single center, randomised, non-inferiority study. Following three initial monthly injections, patients were randomised to receive either ranibizumab bimonthly (RABIMO group) or ranibizumab PRN (PRN group) (n = 20 each). Main outcome measures were best-corrected visual acuity (BCVA), central retinal thickness (CRT), number of injections, and adverse events (AEs). RESULTS BCVA [median (interquartile range, IQR)] increased significantly in both groups after 12 months [RABIMO group +8.5 (14); PRN group +6.5 (16) ETDRS letters] when compared to baseline (p < 0.0001; p = 0.0085). At month 12, the RABIMO treatment regimen was non-inferior to the PRN scheme (∆BCVA = 3.5 ETDRS letters; p < 0.0001). CRT was significantly reduced in both groups after the 12-month study period (p < 0.0001 each), with no significant difference between groups (p = 0.6772). Number of overall injections [median (IQR)] was 8 (0) in the RABIMO versus 4 (5) in the PRN group (p = 0.0037). Three patients in the RABIMO group received one additional unscheduled injection. We observed no significant differences between groups in the number of patients with reported SAEs/AEs (RABIMO group n = 6/15; PRN group n = 7/13) (p = 0.7357/p = 0.4902). CONCLUSIONS We found no evidence of significant functional or anatomical differences between the RABIMO and PRN treatment regimens. However, the RABIMO group's number of injections was twice as high as the PRN group's (protocol-driven). In light of potential side effects, the fixed bimonthly treatment regimen might not be advisable for routine clinical care, but it might be a worthwhile treatment option if monthly monitoring is not possible. Eudra-CT number: 2009-017324-11.
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Affiliation(s)
- Nicolas Feltgen
- Department of Ophthalmology, University Medical Centre, Robert-Koch-Straße 40, 37075, Goettingen, Germany.
| | - Thomas Bertelmann
- Department of Ophthalmology, University Medical Centre, Robert-Koch-Straße 40, 37075, Goettingen, Germany
| | - Mirko Bretag
- Department of Ophthalmology, Carl-Thiem-Klinikum gGmbH, Cottbus, Germany
| | - Sebastian Pfeiffer
- Institute for Clinical Research GmbH, Georg-August-University, Goettingen, Germany
| | - Reinhard Hilgers
- Institute for Medical Statistics, Georg-August-University, Goettingen, Germany
| | - Josep Callizo
- Department of Ophthalmology, University Medical Centre, Robert-Koch-Straße 40, 37075, Goettingen, Germany
| | | | - Sebastian Bemme
- Department of Ophthalmology, University Medical Centre, Robert-Koch-Straße 40, 37075, Goettingen, Germany
| | - Hans Hoerauf
- Department of Ophthalmology, University Medical Centre, Robert-Koch-Straße 40, 37075, Goettingen, Germany
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