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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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Śpiewak D, Witek K, Drzyzga Ł, Mrukwa-Kominek E. An Analysis of Optical Coherence Tomography Angiography (OCT-A) Perfusion Density Maps in Patients Treated for Retinal Vein Occlusion with Intravitreal Aflibercept. Diagnostics (Basel) 2023; 13:3100. [PMID: 37835843 PMCID: PMC10572925 DOI: 10.3390/diagnostics13193100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
AIM The primary goal of this study was to evaluate the reduction in non-perfusion area and improvement in blood flow as well as the reduction in retinal edema on optical coherence tomography angiography (OCT-A) in patients with retinal vein occlusion treated with 2 mg intravitreal injections of aflibercept. MATERIAL AND METHODS Fifty eyes of nine patients with central retinal vein occlusion (CRVO) and sixteen patients with branch retinal vein occlusion (BRVO), aged 50 to 75 years, were collectively analyzed as retinal vein occlusion (RVO). The following parameters were analyzed: superficial vessel density (VDSF), deep vessel density (VDD), flow area in the outer retina (FAOR), choriocapillaris flow area (FACC), non-flow area (NFA) and the foveal avascular zone (FAZ). RESULTS OCT-A revealed a reduction in macular edema. The most significant change in central retinal thickness (CRT) was observed between measurement timepoint "5" and the baseline (46%). The non-flow area was also reduced. Following a significant decrease in superficial vessel density 30 days after the first dose of aflibercept, a non-significant increase was noted at the subsequent timepoints. An increase was also found in deep vessel density and choriocapillaris flow area. Improvements in the above OCT-A parameters resulted in increased retinal blood flow and improved visual acuity. CONCLUSIONS Patients with retinal vein occlusion treated with 2 mg aflibercept exhibited reduced macular edema and FAZ, increased vessel density, improved blood flow, and better visual acuity.
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Affiliation(s)
- Dorota Śpiewak
- Department of Ophthalmology, Prof. K. Gibiński University Clinical Center, Medical University of Silesia, 40-514 Katowice, Poland
| | - Katarzyna Witek
- Department of Ophthalmology, Prof. K. Gibiński University Clinical Center, Medical University of Silesia, 40-514 Katowice, Poland
| | - Łukasz Drzyzga
- Department of Ophthalmology, Prof. K. Gibiński University Clinical Center, Medical University of Silesia, 40-514 Katowice, Poland
| | - Ewa Mrukwa-Kominek
- Department of Ophthalmology, Prof. K. Gibiński University Clinical Center, Medical University of Silesia, 40-514 Katowice, Poland
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
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Lin TY, Hsieh YT, Garg SJ, Chen LJ, Chen KJ, Wu WC, Lai CC, Hwang YS, Kang EYC. Systemic Outcomes of Intravitreal Injections of Dexamethasone and Anti-Vascular Endothelial Growth Factor. Ophthalmol Ther 2023; 12:1127-1140. [PMID: 36729247 PMCID: PMC10011242 DOI: 10.1007/s40123-023-00659-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/18/2023] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Intravitreal dexamethasone and anti-vascular endothelial growth factor (anti-VEGF) medications have revolutionized ocular disease management and favorable ocular safety profiles, but few studies have compared their systemic adverse events (SAEs). This study investigated the SAEs of intravitreal dexamethasone and anti-VEGFs by using real-world data. METHODS This retrospective cohort study sourced medical records from the largest multi-institutional database in Taiwan. Patients who received intravitreal dexamethasone (n = 137) or anti-VEGFs (n = 10,345) between 2014 and 2019 were enrolled. Propensity score matching was performed to achieve homogeneity between the two groups. Subdistribution hazard ratios (SHRs) and 95% confidence intervals (CIs) were calculated using the Fine-Gray model. Systemic as well as ocular clinical events and systemic biomarkers after 1-year follow-up were compared. RESULTS Both groups demonstrated comparable risks of major cardiac adverse events (SHR 1.57, 95% CI 0.29-8.55), heart failure (SHR 0.62, 95% CI 0.07-5.33), major bleeding (SHR 0.23, 95% CI 0.03-1.77), all-cause admission (SHR 0.73, 95% CI 0.41-1.30), and all-cause death (SHR 2.11, 95% CI 0.35-12.71). There were no significant differences in longitudinal changes in systolic and diastolic blood pressure, glycated hemoglobin, low-density lipoprotein, estimated glomerular filtration rate, or alanine aminotransferase between the groups. Both groups had a similar incidence of cataract surgery. Although the dexamethasone group exhibited a relatively high prevalence of antiglaucomatous medication use, there was not a significantly higher incidence of glaucoma surgery. CONCLUSION Intravitreal dexamethasone and anti-VEGF medications had comparable systemic safety profiles in our study. Both drugs represent efficacious and safe therapies for ocular diseases.
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Affiliation(s)
- Tzu-Yi Lin
- Department of Education, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Sunir J Garg
- MidAtlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lee-Jen Chen
- Department of Ophthalmology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Kuan-Jen Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Ophthalmology, Linkou Medical Center, Chang Gung Memorial Hospital, No. 5, Fu Shin St., Kuei-Shan, Taoyuan, 333, Taiwan
| | - Wei-Chi Wu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Ophthalmology, Linkou Medical Center, Chang Gung Memorial Hospital, No. 5, Fu Shin St., Kuei-Shan, Taoyuan, 333, Taiwan
| | - Chi-Chun Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yih-Shiou Hwang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Ophthalmology, Linkou Medical Center, Chang Gung Memorial Hospital, No. 5, Fu Shin St., Kuei-Shan, Taoyuan, 333, Taiwan. .,Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung, Taiwan. .,Department of Ophthalmology, Xiamen Chang Gung Memorial Hospital, Xiamen, China.
| | - Eugene Yu-Chuan Kang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Ophthalmology, Linkou Medical Center, Chang Gung Memorial Hospital, No. 5, Fu Shin St., Kuei-Shan, Taoyuan, 333, Taiwan. .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Xu S, Song Z, Li G, Zhang C. Antivascular endothelial growth factor for macular oedema secondary to retinal vein occlusion: a systematic review and meta-analysis. BMJ Open Ophthalmol 2022. [DOI: 10.1136/bmjophth-2022-001086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PurposeTo evaluate the efficacy and safety of antivascular endothelial growth factor (anti-VEGF) agents in treating macular oedema due to retinal vein occlusion (RVO-ME).MethodsStudies of randomised controlled trials were searched in PubMed, EMBASE, Cochrane databases and ClinicalTrials.gov registry. RevMan V.5.4 software and GRADE were used to synthesise the data and validate the evidence, respectively.ResultsSeventeen studies were included in this meta-analysis. The anti-VEGF agents showed significant better mean best-corrected visual acuity (BCVA) improvement, more patients with ≧15 Early Treatment in Diabetic Retinopathy Study (ETDRS) letters gained and fewer patients with ≧15 ETDRS letters lost, more effectiveness at reducing central retinal thickness (CRT) and improving the quality of life than sham and steroids both at 6 and 12 months. Compared with laser, the anti-VEGF agents showed significant BCVA improvement and more effectiveness at CRT both at 6 and 12 months. The proportion of eyes gaining ≧15 ETDRS letters was greater in the anti-VEGF group at 6 months. The anti-VEGF and other three groups reported similar levels of non-ocular serious adverse events (SAEs). The incidence of eye pain was significantly higher in the anti-VEGF group than in the sham group. There was a significant increase in the incidence of ocular AEs and conjunctival haemorrhage in the anti-VEGF group compared with the laser group. The incidence of elevated intraocular pressure and cataract was significantly higher in the steroid group than in the anti-VEGF group.ConclusionsThis meta-analysis suggested that treatment of ME secondary to RVO with anti-VEGF improves visual and anatomical outcomes compared with other treatments. Thus, anti-VEGF treatment is the first choice for treating patients with ME secondary to RVO.
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Lin Y, Ren X, Chen D. Steroid Treatment in Macular Edema: A Bibliometric Study and Visualization Analysis. Front Pharmacol 2022; 13:824790. [PMID: 35273502 PMCID: PMC8902303 DOI: 10.3389/fphar.2022.824790] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/17/2022] [Indexed: 02/05/2023] Open
Abstract
The use of steroids to treat macular edema (ME) is a research hotspot in ophthalmology. We utilized CiteSpace and VOSviewer software to evaluate the Web of Science Core Collection publications and to build visualizing maps to describe the research progress in this topic. There were 3,252 publications for three decades during 1988–2021. The number of studies was low during the first 14 years but has risen consistently in the following two decades. The average publications per year were only 4.8 during 1988–2002, which jumped to 113 per year during 2003–2012, and 227 per year during 2013–2021. These publications came from 83 countries/regions, with the United States, Germany, and Italy leading positions. Most studies were published in Investigative Ophthalmology Visual Science, and Ophthalmology was the most cited journal. We found 9,993 authors, with Bandello F having the most publications and Jonas JB being the most frequently co-cited. According to our research, the most popular keyword is triamcinolone acetonide (TA). Macular edema, diabetic macular edema (DME), retinal vein occlusion (RVO), dexamethasone (DEX), fluocinolone acetonide (FA), and some other keywords were commonly studied in this field. In conclusion, the bibliometric analysis provides a comprehensive overview of steroid hotspots and developmental tendencies in the macular edema study. While anti-VEGF therapy is the first-line treatment for DME and RVO-induced macular edema, steroids implant is a valid option for these DME patients not responding to anti-VEGF therapy and non-DME patients with macular edema. Combined therapy with anti-VEGF and steroid agents is vital for future research.
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Affiliation(s)
- Yu Lin
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.,Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiang Ren
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.,Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Danian Chen
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.,Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
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Gale R, Pikoula M, Lee AY, Denaxas S, Egan C, Tufail A, Taylor P. Real world evidence on 5661 patients treated for macular oedema secondary to branch retinal vein occlusion with intravitreal anti-vascular endothelial growth factor, intravitreal dexamethasone or macular laser. Br J Ophthalmol 2021; 105:549-554. [PMID: 32532760 PMCID: PMC8005793 DOI: 10.1136/bjophthalmol-2020-315836] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/27/2020] [Accepted: 05/14/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIMS Clinical trials suggest anti-vascular endothelial growth factor is more effective than intravitreal dexamethasone as treatment for macular oedema secondary to branch retinal vein occlusion. This study asks if 'real world' data from a larger and more diverse population, followed for a longer period, also support this conclusion. METHODS Data collected to support routine care at 27 NHS (National Health Service) Trusts between February 2002 and September 2017 contained 5661 treatment-naive patients with a single mode of treatment for macular oedema secondary to branch retinal vein occlusion and no history of cataract surgery either during or recently preceding the treatment. Number of treatment visits and change in visual acuity from baseline was plotted for three treatment groups (anti-vascular endothelial growth factor (anti-VEGF), intravitreal dexamethasone, macular laser) for up to 3 years. RESULTS Mean baseline visual acuity was 57.1/53.1/62.3 letters in the anti-VEGF/dexamethasone/macular laser groups, respectively. This changed to 66.72 (+9.6)/57.6 (+4.5)/63.2 (+0.9) at 12 months. Adequate numbers allowed analysis at 18 months for all groups (66.6 (+9.5)/56.1 (+3.0)/60.8 (-1.5)) and for anti-VEGF at 36 months (68.0, +10.9) Mean number of treatments were 5.1/1.5/1.2 at 12 months, 5.9/1.7/1.2 at 18 months for all three groups and 10.3 at 36 months for anti-VEGF. CONCLUSIONS Visual acuity improvements were higher and more sustained with anti-VEGF. Higher treatment burden occurred with anti-VEGF but this reduced over 36 months. Patients with better vision at baseline than those in the clinical trials maintained high levels of vision with both anti-VEGF and dexamethasone.
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Affiliation(s)
- Richard Gale
- Ophthalmology, Hightown Surgery, York, UK.,York Teaching Hospital NHS Foundation Trust, York, North Yorkshire, UK
| | - Maria Pikoula
- Institute of Health Informatics, University College London, London, London, UK
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, London, UK
| | - Catherine Egan
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Adnan Tufail
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Paul Taylor
- Institute of Health Informatics, University College London, London, London, UK
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Jang M, Lee H, Kim HC, Chung H. Two-dimensional Quantitative Effects of Anti-vascular Endothelial Growth Factor and Dexamethasone Implants on Retinal Vein Occlusion. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.11.1279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Chhablani J, Wong K, Tan GS, Sudhalkar A, Laude A, Cheung CMG, Zhao P, Uy H, Lim J, Valero S, Ngah NF, Koh A. Diabetic Macular Edema Management in Asian Population: Expert Panel Consensus Guidelines. Asia Pac J Ophthalmol (Phila) 2020; 9:426-434. [PMID: 32956188 DOI: 10.1097/apo.0000000000000312] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of this consensus article was to provide comprehensive recommendations in the management of diabetic macular edema (DME) by reviewing recent clinical evidence. DESIGN A questionnaire containing 47 questions was developed which encompassed clinical scenarios such as treatment response to anti-vascular endothelial growth factor and steroid, treatment side effects, as well as cost and compliance/reimbursement in the management of DME using a Dephi questionnaire as guide. METHODS An expert panel of 12 retinal specialists from Singapore, Malaysia, Philippines, India and Vietnam responded to this questionnaire on two separate occasions. The first round responses were compiled, analyzed and discussed in a round table discussion where a consensus was sought through voting. Consensus was considered achieved, when 9 of the 12 panellists (75%) agreed on a recommendation. RESULTS The DME patients were initially profiled based on their response to treatment, and the terms target response, adequate response, nonresponse, and inadequate response were defined. The panellists arrived at a consensus on various aspects of DME treatment such as need for classification of patients before treatment, first-line treatment options, appropriate time to switch between treatment modalities, and steroid-related side effects based on which recommendations were derived, and a treatment algorithm was developed. CONCLUSIONS This consensus article provides comprehensive, evidence-based treatment guidelines in the management of DME in Asian population. In addition, it also provides recommendations on other aspects of DME management such as steroid treatment for stable glaucoma patients, management of intraocular pressure rise, and recommendations for cataract development.
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Affiliation(s)
- Jay Chhablani
- University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | | | - Gavin S Tan
- Surgical Retinal Department of the Singapore National Eye Centre; Clinician scientist, Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Aditya Sudhalkar
- Alphavision Augenzentrum Bremerhaven, Germany
- Sudhalkar Eye Hospital and Retina Centre in Baroda, India and Raghudeep Eye Hospital, Ahmedabad, India
| | - Augustinus Laude
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital; Adjunct associate professor, Lee Kong Chian School of Medicine Nanyang Technological University, Singapore
| | | | - Paul Zhao
- Department of Ophthalmology, National University Hospital; Chief, Alexandria Hospital Eye Surgery Center, Singapore
| | - Harvey Uy
- University of the Philippines and Medical Director, Peregrine Eye and Laser Institute in Makati, Philippines
| | - Jeffrey Lim
- Chong Hua Hospital, Cebu; Head, Retina section, Vicente Sotto Memorial Medical Center, Philippines
| | | | - Nor Fariza Ngah
- National Head, Ophthalmology Service, Ministry of Health Malaysia; Ophthalmology Service, Ministry of Health Malaysia; Head of Department, Ophthalmology Unit, Hospital Shah Alam, Malaysia
| | - Adrian Koh
- The Eye and Retina Surgeons, Camden Medical Center, Singapore
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Evidence-based practice versus economics in treatment of macular edema secondary to central retinal vein occlusion in India. Eye (Lond) 2019; 34:217-218. [PMID: 31767969 DOI: 10.1038/s41433-019-0709-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 01/23/2023] Open
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