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Salehi MA, Frounchi N, Zakavi SS, Mohammadi S, Harandi H, Shojaei S, Gouravani M, Fernando Arevalo J. Retinal and choroidal changes after anti-VEGF therapy in neovascular-AMD patients: A systematic review and meta-analysis of SD-OCT studies. Surv Ophthalmol 2024; 69:547-557. [PMID: 38641181 DOI: 10.1016/j.survophthal.2024.04.001] [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: 11/18/2023] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND In recent years, the progress made in the field of optical coherence tomography has helped to understand the changes in eye layers in patients with exudative age-related macular degeneration (nAMD). Early diagnosis of nAMD, a leading cause of irreversible vision impairment, is helpful. Therefore, we performed a meta-analysis on OCT measurement alterations before and after anti-VEGF therapy in patients with nAMD and controls. METHOD We systematically searched Scopus, PubMed, Cochrane, and Web of Science to find articles that measured choroidal and retinal layer changes after anti-VEGF therapy in nAMD Patients. We chose either a fixed-effects or random-effects model based on the assessed heterogeneity level to perform a meta-analysis. In addition, we conducted meta-regression, subgroup analyses, publication bias, and quality assessment for included studies. RESULTS Thirteen studies were included in the meta-analysis, with 733 total participants. Foveal thickness and subfoveal choroidal thickness (CT) decreased significantly in the first 3 years after injections, except for subfoveal CT in the third year after injection. It also showed that CT at 1500 µm temporal and nasal to the fovea did not significantly change. CONCLUSION Our results showed anti-VEGF treatment for nAMD patients was associated with a significant reduction in foveal thickness and subfoveal CT in the first 2 years after treatment. Our analysis did not reveal any correlation between changes in foveal thickness and subfoveal CT with best-corrected visual acuity or other factors.
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Affiliation(s)
| | - Negin Frounchi
- Kidney Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Sina Zakavi
- Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Soheil Mohammadi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Harandi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Shayan Shojaei
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Gouravani
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - J Fernando Arevalo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Ozawa Y, Ohgami K, Sasaki K, Hirano K, Sunaya T. Long-term surveillance provides real-world evidences of safety and effectiveness in intravitreal aflibercept treatment for age-related macular degeneration. Sci Rep 2023; 13:10597. [PMID: 37391547 PMCID: PMC10313657 DOI: 10.1038/s41598-023-37584-1] [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: 01/24/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023] Open
Abstract
This prospective, multicentre, postmarketing surveillance were conducted to report on the long-term safety and effectiveness of intravitreal aflibercept (IVT-AFL) treatment in clinical practice of Japanese patients with neovascular age-related macular degeneration (nAMD) who newly initiated IVT-AFL treatment. The primary outcomes were the incidence of adverse events (AEs) and of adverse drug reactions (ADRs) over 36 months. Number of injections, timing of ADR occurrence, and some effectiveness index were also summarised. A total of 3,872 patients received 7.2 ± 5.8 (mean ± standard deviation) injections, and AEs occurred in 5.73% of patients. ADRs were reported in 2.76% of patients, with ocular and nonocular ADRs in 2.07% and 0.72% of patients, respectively. Most vitreo-retinal events developed within 6 months of initial IVT-AFL treatment, and most instances of increased intraocular pressure and cerebral infarction developed after 6 months of follow-up. Mean best-corrected visual acuity and central retinal thickness were numerically better throughout the follow-up period compared with baseline. These results indicated acceptable tolerability and effectiveness of IVT-AFL treatment in patients with nAMD in clinical practice in Japan. Information regarding the risk and the timing of ADRs is valuable for safe and effective long-term treatment of patients with nAMD.Trial registration number: NCT01756248.
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Affiliation(s)
- Yoko Ozawa
- Department of Clinical Regenerative Medicine Eye Center, Fujita Medical Innovation Center Tokyo, Fujita Health University School of Medicine, Tokyo, Japan.
- Department of Ophthalmology, St. Luke's International Hospital, Tokyo, Japan.
- Department of Ophthalmology, St. Luke's International University, Tokyo, Japan.
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
| | - Kazuhiro Ohgami
- Medical Affairs and Pharmacovigilance, Bayer Yakuhin, Ltd., Osaka, Japan
| | - Koji Sasaki
- Medical Affairs and Pharmacovigilance, Bayer Yakuhin, Ltd., Osaka, Japan
| | - Kazufumi Hirano
- Medical Affairs and Pharmacovigilance, Bayer Yakuhin, Ltd., Osaka, Japan
| | - Toshiyuki Sunaya
- Research and Development Japan, Bayer Yakuhin, Ltd., Osaka, Japan
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Shimizu Y, Miyata M, Ooto S, Miyake M, Mori Y, Tamura H, Ueda‐Arakawa N, Uji A, Muraoka Y, Takahashi A, Wakazono T, Yamashiro K, Hata M, Tsujikawa A. Pachychoroid-phenotype effects on 5-year visual outcomes of anti-VEGF monotherapy in polypoidal choroidal vasculopathy. Acta Ophthalmol 2022; 100:e943-e949. [PMID: 34533280 DOI: 10.1111/aos.15015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/31/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate whether the efficacy of anti-vascular endothelial growth factor (VEGF) monotherapy for polypoidal choroidal vasculopathy (PCV) differs between pachychoroid and non-pachychoroid phenotypes in the long term. METHODS This retrospective longitudinal study included 115 treatment-naïve eyes in 115 consecutive patients with symptomatic PCV who were treated with anti-VEGF monotherapy and were followed up for 5 years. Eligible eyes were assigned to either a pachy-PCV group, with a pachychoroid phenotype, or a non-pachy-PCV group, without a pachychoroid phenotype. Best-corrected visual acuity (BCVA) and other parameters over a 5-year period were compared between the groups. RESULTS Forty-eight eyes and 67 eyes were classified into the pachy-PCV and non-pachy-PCV groups respectively. Baseline and 5-year BCVA (logarithm of the minimum angle of resolution) were 0.19 ± 0.20 and 0.16 ± 0.28 in the pachy-PCV group, respectively, and 0.25 ± 0.26 and 0.26 ± 0.36 in the non-pachy-PCV group respectively. BCVA did not change significantly in either group (p = 0.18 and 0.08 respectively). BCVA did not differ between the groups at any observation time-point. Subfoveal choroidal thickness (SFCT) at baseline and at 5 years was significantly higher in the pachy-PCV group than in the non-pachy-PCV group (both p < 0.001); however, the mean rate of decrease in SFCT did not differ in either group over the 5-year period (22% vs. 23%, p = 0.81). CONCLUSION Our findings suggest that anti-VEGF monotherapy was similarly effective for pachychoroid- and non-pachychoroid-phenotype eyes with PCV, for at least 5 years, although further studies are required.
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Affiliation(s)
- Yuichiro Shimizu
- Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine Kyoto City Japan
| | - Manabu Miyata
- Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine Kyoto City Japan
| | - Sotaro Ooto
- Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine Kyoto City Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine Kyoto City Japan
| | - Yuki Mori
- Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine Kyoto City Japan
| | - Hiroshi Tamura
- Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine Kyoto City Japan
| | - Naoko Ueda‐Arakawa
- Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine Kyoto City Japan
| | - Akihito Uji
- Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine Kyoto City Japan
| | - Yuki Muraoka
- Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine Kyoto City Japan
| | - Ayako Takahashi
- Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine Kyoto City Japan
| | - Tomotaka Wakazono
- Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine Kyoto City Japan
| | - Kenji Yamashiro
- Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine Kyoto City Japan
- Department of Ophthalmology Red Cross Otsu Hospital Otsu City Japan
| | - Masayuki Hata
- Biochemistry and Molecular Medicine Maisonneuve‐Rosemont Hospital Research Centre University of Montreal Montreal QC Canada
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences Kyoto University Graduate School of Medicine Kyoto City Japan
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Minnella AM, Centini C, Gambini G, Savastano MC, Pagliei V, Falsini B, Rizzo S, Ciasca G, Maceroni M. Choroidal Thickness Changes After Intravitreal Aflibercept Injections in Treatment-Naïve Neovascular AMD. Adv Ther 2022; 39:3248-3261. [PMID: 35597837 PMCID: PMC9239952 DOI: 10.1007/s12325-022-02129-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
Abstract
Introduction Choroidal thickness (CT) plays an important role in the pathogenesis of various ocular diseases, including neovascular age-related macular degeneration (nAMD). Previous studies evaluated the CT variations after anti-vascular endothelial growth factor (VEGF) injections in patients with nAMD, but the results are still controversial. The present study aimed to evaluate the CT at different times (15, 30, 60, 90, and 365 days) after intravitreal aflibercept injections and its correlation with the baseline CT in treatment-naïve patients with nAMD. Secondly, the study evaluated the correlation between CT variation at 365 days and the number of intravitreal injections received. Methods This was a prospective, open-label, single-arm pilot study. Twenty-one treatment-naïve nAMD eyes were enrolled. The study population underwent three monthly aflibercept injections (loading phase) and additional injections as needed (pro re nata regimen). A complete ophthalmological examination, including optical coherence tomography (OCT) was performed at each visit. CT was measured manually by two independent observers. All patients were evaluated at baseline and at 15, 30, 60, 90, and 365 days after the first intravitreal injection. Results CT showed a statistically significant reduction at days 15, 90, and 365 in comparison to baseline. However, the major reduction of CT was observed at day 15 and in eyes with a thicker choroid at baseline. No significant correlation between CT variation and the number of injections performed was found. Conclusion Our findings contribute to clarifying the role of aflibercept injections in choroidal vasculature, confirming its effect after the first 2 weeks. Moreover, CT can be considered as a potential biomarker, as it reflects the pharmacological effect of anti-VEGF drugs.
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Affiliation(s)
- Angelo Maria Minnella
- Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Oftalmologia, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | | | - Gloria Gambini
- UOC Oftalmologia, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Maria Cristina Savastano
- Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Oftalmologia, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Valeria Pagliei
- Dipartimento di biotecnologie e scienze cliniche applicate, Università de L’Aquila, L’Aquila, Italy
| | - Benedetto Falsini
- Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Oftalmologia, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Stanislao Rizzo
- Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Oftalmologia, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Gabriele Ciasca
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo Agostino Gemelli, 8, 00168 Rome, RM Italy
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Veritti D, Sarao V, Soppelsa V, Danese C, Chhablani J, Lanzetta P. Managing Neovascular Age-Related Macular Degeneration in Clinical Practice: Systematic Review, Meta-Analysis, and Meta-Regression. J Clin Med 2022; 11:jcm11020325. [PMID: 35054021 PMCID: PMC8781865 DOI: 10.3390/jcm11020325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 12/23/2022] Open
Abstract
The use of anti-vascular endothelial growth factor (VEGF) agents has profoundly changed the prognosis of neovascular age-related macular degeneration (nAMD). As clinical experiences have accumulated, it has become mandatory to summarize data to give information that can be useful in everyday practice. We conducted a systematic review to identify randomized controlled trials (RCTs) and observational studies that reported 12-month changes in best-corrected visual acuity (BCVA) in patients with nAMD on anti-VEGF monotherapy. Data were analyzed in a random-effects meta-analysis with BCVA change as the primary outcome. Meta-regression was conducted to evaluate the impact of multiple covariates. Four hundred and twelve heterogeneous study populations (109,666 eyes) were included. Anti-VEGFs induced an overall improvement of +5.37 ETDRS letters at 12 months. Meta-regression showed that mean BCVA change was statistically greater for RCTs (p = 0.0032) in comparison with observational studies. Populations following a proactive regimen had better outcomes than those following a reactive treatment regimen. Mean BCVA change was greater in younger populations, with lower baseline BCVA and treated with a higher number of injections (p < 0.001). Our results confirm that anti-VEGFs may produce a significant functional improvement at 12 months in patients with nAMD.
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Affiliation(s)
- Daniele Veritti
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy; (D.V.); (V.S.); (V.S.); (C.D.)
| | - Valentina Sarao
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy; (D.V.); (V.S.); (V.S.); (C.D.)
- Istituto Europeo di Microchirurgia Oculare (IEMO), 33100 Udine, Italy
| | - Valentina Soppelsa
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy; (D.V.); (V.S.); (V.S.); (C.D.)
| | - Carla Danese
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy; (D.V.); (V.S.); (V.S.); (C.D.)
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, Pittsburg, PA 15261, USA;
| | - Paolo Lanzetta
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy; (D.V.); (V.S.); (V.S.); (C.D.)
- Istituto Europeo di Microchirurgia Oculare (IEMO), 33100 Udine, Italy
- Correspondence: ; Tel.: +39-04-3255-9907
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Quist SW, de Jong LA, van Asten F, Knoester P, Postma MJ, Freriks RD. Cost-minimisation analysis of a treat-and-extend regimen with anti-VEGFs in patients with neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2021; 260:1083-1095. [PMID: 34643793 PMCID: PMC8511619 DOI: 10.1007/s00417-021-05359-x] [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] [Received: 05/06/2021] [Revised: 07/16/2021] [Accepted: 07/27/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Although intraocular anti-vascular endothelial growth factors (anti-VEGFs) are effective as treatment of neovascular age-related macular degeneration (nAMD), the (economic) burden on the healthcare system is considerable. A treat-and-extend (T&E) regimen is associated with a lower number of injections without compromising the effectiveness and can therefore help optimise nAMD treatment. This study investigates the per-patient costs associated with nAMD treatment, when using aflibercept, bevacizumab, or ranibizumab with a T&E regimen. Methods In this cost-minimisation model, the per-patient costs in the Netherlands were modelled using a healthcare payers’ perspective over a 3-year time horizon with the assumption that efficacy of treatments is similar. Additionally, the break-even price of the different anti-VEGFs was calculated relative to the cheapest option and injection frequency. Results The injection frequency varied from 14.2 for aflibercept to 27.4 for bevacizumab in 3 years. Nonetheless, bevacizumab remains the cheapest treatment option (€14,215), followed by aflibercept (€18,202) and ranibizumab (€31,048). The medication covers the majority of the per-patient costs for aflibercept and ranibizumab, while administration covers the majority of the per-patient costs for bevacizumab. The break-even prices of aflibercept and ranibizumab are respectively €507 and €60.58 per injection. Brolucizumab was included in the scenario analysis and was more expensive than aflibercept (€20,446). Brolucizumab should reduce to 13.8 injections over 3 years to be as costly as aflibercept. Conclusion Bevacizumab is the cheapest anti-VEGF treatment. The list prices of all anti-VEGFs should reduce to be as costly as bevacizumab. Aflibercept is the second-choice treatment and so far brolucizumab is not.
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Affiliation(s)
- S W Quist
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, The Netherlands. .,Asc Academics, Professor Enno Dirk Wiersmastraat 5, Groningen, The Netherlands.
| | - L A de Jong
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, The Netherlands.,Asc Academics, Professor Enno Dirk Wiersmastraat 5, Groningen, The Netherlands
| | - F van Asten
- Department of Ophthalmology, Radboud University Medical Center, Philips Van Leydenlaan 15, Nijmegen, The Netherlands
| | - P Knoester
- Department of Pharmacy, Alrijne Hospital, Simon Smitweg 1, Leiderdorp, The Netherlands
| | - M J Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, The Netherlands.,Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Nettelbosje 2, Groningen, The Netherlands
| | - R D Freriks
- Asc Academics, Professor Enno Dirk Wiersmastraat 5, Groningen, The Netherlands.,Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Nettelbosje 2, Groningen, The Netherlands
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Long-term effect of intravitreal aflibercept treatment on choroidal vascularity index in neovascular age-related macular degeneration. Photodiagnosis Photodyn Ther 2021; 36:102582. [PMID: 34648995 DOI: 10.1016/j.pdpdt.2021.102582] [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: 08/09/2021] [Revised: 09/28/2021] [Accepted: 10/07/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Our aim is to examine the effect of intravitreal aflibercept treatment on the choroidal vascularity index in eyes with neovascular age-related macular degeneration (nARMD) using the binarization method. METHODS Included in the study were the 38 eyes of 38 patients diagnosed with nARMD and treated with intravitreal aflibercept at our clinic. The patients' 12-month records were reviewed retrospectively. Patients' choroidal thickness (CT) was measured at baseline, 3rd month, 6th month, and 12th month on EDI-OCT images. We calculated luminal area (LA), stromal area (SA), total choroidal area (TCA), and choroid vascular index (CVI) values using binarization. RESULTS The mean age of the patients was 70,1 ± 8 years. The mean of injections over 12 months was 5.6 ± 2. Baseline values were CT 224 µm, LA 0,214 mm2, SA 0,119mm2, TCA 0,333 mm2, and CVI 64% respectively. At the 3rd month, values were CT 223 µm, LA 0,212 mm2, SA 0,121 mm2, TCA 0,332 mm2, and CVI 64%, respectively. The 6th-month values were CT 221 µm, LA 0,204 mm2, SA 0,116 mm2, TCA 0,320 mm2, and CVI 64%, respectively, and 12-month values were CT 218 µm, LA 0,204 mm2, SA 0,112 mm2, TCA 0,318 mm2, and CVI 64%, respectively. According to LogMAR, BCVA was 0.59 at baseline, 0.56 at 3 months, 0.52 at 6 months, and 0.51 at 12 months. At the end of month 12, we observed a statistically significant decrease in CT. No significant changes were observed in other parameters. When the number of injections was correlated with CVI, CT, and BCVA, a significant negative correlation was observed with CVI CONCLUSIONS: Aflibercept treatment reduces CT by affecting not only luminal but also stromal areas of the choroid in the long term but does not change the CVI. However, as the number of injections increases, CVI decreases.
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Changes in complement activation products after anti-VEGF injection for choroidal neovascularization in age-related macular degeneration and pachychoroid disease. Sci Rep 2021; 11:8464. [PMID: 33875685 PMCID: PMC8055893 DOI: 10.1038/s41598-021-87340-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/24/2021] [Indexed: 01/07/2023] Open
Abstract
We evaluated changes in the complement system resulting from anti-vascular endothelial growth factor (VEGF) in eyes with age-related choroidal neovascularization (CNV) including neovascular age-related macular degeneration, pachychoroid neovasculopathy, and polypoidal choroidal neovasculopathy. We measured the concentrations of the complement activation products (C3a, C4a), VEGF, and monocyte chemotactic protein-1 in the aqueous humor during intravitreal anti-VEGF injections for CNV. The VEGF level decreased significantly (P < 0.001), while the C3a and C4a levels increased significantly (P < 0.001 for both comparisons) 1 month after two monthly anti-VEGF injections. The VEGF level was correlated with the C3a (R = 0.328, P = 0.007) and C4a (R = − 0.237, P = 0.055) levels at baseline, but the correlation between the VEGF and C3a levels (R = − 0.148, P = 0.242) changed significantly (P = 0.028 by analysis of covariance) after anti-VEGF treatment. The C3a increase after anti-VEGF therapy did not change the visual outcomes in eyes with CNV for 1 year. Dysregulation of the complement system can be induced after anti-VEGF therapy.
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Jaggi D, Nagamany T, Ebneter A, Munk M, Wolf S, Zinkernagel M. Aflibercept for age-related macular degeneration: 4-year outcomes of a ‘treat-and-extend’ regimen with exit-strategy. Br J Ophthalmol 2020; 106:246-250. [PMID: 33127830 PMCID: PMC8788035 DOI: 10.1136/bjophthalmol-2020-316514] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 08/20/2020] [Accepted: 10/11/2020] [Indexed: 12/23/2022]
Abstract
AimTo report long-term outcomes on best-corrected visual acuity (BCVA) and treatment intervals with a treat-and-extend (T&E) regimen in patients with neovascular age-related macular degeneration (nAMD).MethodsThis observational study included treatment-naïve patients with nAMD, treated with aflibercept. A specific T&E protocol without a loading phase and predefined exit criteria was administered. After reaching predefined ‘exit-criteria’, the treatment period was complete, and patients were observed three monthly.ResultsEighty-two patients with a follow-up period of ≥2 years were included. BCVA (mean±SD, ETDRS letters) increased from 51.9±25.2 at baseline to 63.7±17.7 (p<0.0001) at 1 year, 61.7±18.5 (p<0.0001) at 2 years, 62.4±19.5 (p<0.0001, n=61) at 3 years and remained insignificantly higher than baseline at 4 years at 58.5±24.3 (p=0.22). Central subfield thickness (mean±SD, μm) decreased significantly from 387.5±107.6 (p<0.0001) at baseline to 291.9±65.5 (p<0.0001) at 1 year, and remained significantly lower until 4 years at 289.0±59.4 (p<0.0001). Treatment intervals (mean±SD, weeks) could be extended up to 9.3±3.1 weeks at 1 year and remained at 11.2±3.5 weeks at 4 years. Twenty-nine (35%) patients reached exit criteria and continued with three monthly observation only.ConclusionsAfter 4 years of treatment, initial vision gains were maintained with a reasonable treatment burden, even without an initial loading phase. Our results on functional outcomes are comparable with large controlled studies.
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Affiliation(s)
- Damian Jaggi
- Department of Ophthalmology, Inselspital, Bern University Hostpital, University of Bern, Bern, Switzerland
| | - Thanoosha Nagamany
- Department of Ophthalmology, Inselspital, Bern University Hostpital, University of Bern, Bern, Switzerland
| | - Andreas Ebneter
- Department of Ophthalmology, Inselspital, Bern University Hostpital, University of Bern, Bern, Switzerland
| | - Marion Munk
- Department of Ophthalmology, Inselspital, Bern University Hostpital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sebastian Wolf
- Department of Ophthalmology, Inselspital, Bern University Hostpital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Zinkernagel
- Department of Ophthalmology, Inselspital, Bern University Hostpital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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