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Kabunga RR, Onyango J, Ruvuma S, Arunga S. Outcome of intravitreal Avastin® injections in patients with macular oedema in Uganda: a cohort study. Eye (Lond) 2022; 36:45-50. [PMID: 35590055 PMCID: PMC9159050 DOI: 10.1038/s41433-022-02006-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background To determine the outcome of Intravitreal Avastin (IVA) injections in patients with Macular Oedema (MO) in Uganda. Methods We prospectively recruited patients presenting with MO at the Department of Ophthalmology of Mbarara University of Science and Technology in Southern Uganda from November 2018 to April 2019. We treated them with intravitreal injection of Bevacizumab (Avastin®) and followed them up for three consecutive months after the initial injection. We collected information on baseline clinical presentation and 3 month outcomes. We performed a Student’s t-test to compare central macular thickness (CMT) and best corrected visual acuity (BCVA) at baseline and at 3 months after IVA injections. We performed linear regression to test for predictors of change in CMT and BCVA at 3 months. Results We enroled 32 patients (35 eyes) of which 29 patients (32 eyes) completed the follow up. The mean age was 62.8 ± 11.8 years, and 53% were male. At 3 months after IVA, the mean CMT improved significantly from 426.90 ± 135.9 µm at baseline to 311.20 ± 134.80 µm (p = 0.0008). The mean BCVA improved from 0.70 ± 0.38 at baseline to 0.38 ± 0.36 logMAR units (p = 0.003). The improvement in CMT and BCVA were more marked in patients who had Diabetic ME compared to other causes. A high baseline CMT was a strong predictor of improvement in CMT at 3 months after IVA therapy. A worse baseline visual acuity was a predictor of improvement in vision at 3 months after IVA. Conclusions IVA therapy results in anatomical and visual improvement at 3 months especially in patients with Diabetic MO. Having a high baseline CMT was a predictor of good CMT outcome at 3 months while a worse vision at baseline was a predictor of better visual outcome at 3 months.
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Affiliation(s)
- Rachel R Kabunga
- Department of Ophthalmoogy, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - John Onyango
- Department of Ophthalmoogy, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Sam Ruvuma
- Department of Ophthalmoogy, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Simon Arunga
- Department of Ophthalmoogy, Mbarara University of Science and Technology, Mbarara, Uganda.,International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
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Zhou J, Ma H, Zhou X, Wang Q, Li W, Luo S, Cai C, Li Z, Liu D. Two-Week Central Macular Thickness Reduction Rate >37% Predicts the Long-Term Efficacy of Anti-vascular Endothelial Growth Factor Treatment for Macular Edema Secondary to Retinal Vein Occlusion. Front Med (Lausanne) 2022; 9:851238. [PMID: 35355596 PMCID: PMC8959117 DOI: 10.3389/fmed.2022.851238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo determine if the early response assessments can predict the long-term efficacy of anti-vascular endothelial growth factor (VEGF) treatment for macular edema secondary to retinal vein occlusion (RVO-ME).MethodsA retrospective study of patients with diagnosis of RVO-ME and intravitreal anti-VEGF treatment was conducted. Clinical characteristics including age, gender, disease subtype and disease duration were recorded at baseline. The best corrected visual acuity (BCVA and logMAR), intraocular pressure (IOP), and central macular thickness (CMT) were recorded at baseline, 2 weeks, and every month (months 1–6) after injection. Further, we compared the early response assessments between the cured group (6-month CMT ≤ 250 μm) and the uncured group (6-month CMT > 250 μm).ResultsA total of 164 eyes in 164 patients (77 male and 87 female) were included. At each post-injection time point, both BCVA and CMT are significantly decreased from baseline (all P < 0.001). Spearman’s test showed that 2-week CMT reduction rate after the first injection was negatively correlated with BCVA at 6 months (r = −0.359, P < 0.001). Compared with the uncured group (47 cases), the cured group (117 cases) was younger (59.53 ± 11.68 vs. 65.19 ± 13.10 years old, P < 0.01), had more BRVO patients (76.1% vs. 44.7%, P < 0.01), a shorter disease duration (1.92 ± 2.43 vs. 5.05 ± 4.32 months, P < 0.01), lower baseline CMT (527.09 ± 154.95 vs. 768.96 ± 287.75 μm, P < 0.01), and lower baseline BCVA (0.86 ± 0.44 vs. 1.31 ± 0.51, P < 0.01). At each post-injection time point, the cured group had lower CMT and BCVA values when compared to the uncured group (all P < 0.01), and the 2-week CMT reduction rate was identified as the earliest response time to predict the long-term treatment efficacy. Moreover, ROC curve analysis indicated that a 2-week CMT reduction rate >37% yielded the best cut-off point for predicting the long-term cure of anti-VEGF treatment at 6 months (P < 0.001). Multivariable logistic regression confirmed that the 2-week CMT reduction rate >37% was independently associated with the 6-month cured rate (OR = 9.639, 95% Cl = 1.030–90.227, P = 0.047).ConclusionAge, disease duration, baseline CMT, and baseline BCVA are associated with visual outcomes at 6-month of anti-VEGF treatment for RVO-ME. The “2-week CMT reduction rate >37%” after the first injection is an independent factor to predict better long-term outcomes.
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Affiliation(s)
- Jialin Zhou
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huafeng Ma
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiyuan Zhou
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiuyu Wang
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weihou Li
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shuai Luo
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chang Cai
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zefeng Li
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Danning Liu
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Michl M, Liu X, Kaider A, Sadeghipour A, Gerendas BS, Schmidt‐Erfurth U. The impact of structural optical coherence tomography changes on visual function in retinal vein occlusion. Acta Ophthalmol 2021; 99:418-426. [PMID: 32996711 PMCID: PMC8359321 DOI: 10.1111/aos.14621] [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: 11/19/2019] [Accepted: 08/18/2020] [Indexed: 11/30/2022]
Abstract
Purpose We aimed to determine the correlation between optical coherence tomography (OCT)‐ and demographic features and baseline best corrected visual acuity (BCVA) in treatment‐naïve patients with retinal vein occlusion (RVO). Methods This was a cross‐sectional posthoc analysis of OCT images that included RVO patients from two prospective, open‐label, multicentre studies. The morphological grading was done manually, in the standardized setting of a reading centre. Main outcome measure was the estimated difference in Early Treatment Diabetic Retinopathy Study letters associated with each individual biomarker. Results Included were 381/301 treatment‐naïve patients with BRVO/CRVO. For BRVO, statistically significant correlations with BCVA were seen for a 100 µm increase in central subfield thickness (CST; −3.1 letters), intraretinal cysts at centre point (CP; +4.1), subretinal fluid (SRF) at CP (+3.0) and hyperreflective foci (HRF) at the central B‐scan (−2.2). In CRVO, a 100 µm increase in CST was associated with a loss of −3.4 letters. In the total cohort, 100 µm increase in CST, SRF at CP and HRF at the central B‐scan correlated with a difference of −3.2,+3.2 and −2.0 letters. A 10‐year increase in age and female gender yielded a −2.0 and −2.5 letter decrease in the total cohort. Adjusted multiple R2 for the respective group was 18.3%/26.3%/23.5%. Conclusions Of all parameters studied, only CST and age were consistently associated with worse BCVA in treatment‐naïve RVO patients. Morphology on OCT explained only a modest part of functional loss in this patient cohort.
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Affiliation(s)
- Martin Michl
- Department of Ophthalmology Vienna Reading Center and OPTIMA Study Group Medical University of Vienna Vienna Austria
| | - Xuhui Liu
- Department of Ophthalmology Vienna Reading Center and OPTIMA Study Group Medical University of Vienna Vienna Austria
- Department of Ophthalmology The First Affiliated Hospital of Zhengzhou University Zhengzhou City China
| | - Alexandra Kaider
- Center for Medical Statistics Informatics and Intelligent Systems Medical University of Vienna Vienna Austria
| | - Amir Sadeghipour
- Department of Ophthalmology Vienna Reading Center and OPTIMA Study Group Medical University of Vienna Vienna Austria
| | - Bianca S. Gerendas
- Department of Ophthalmology Vienna Reading Center and OPTIMA Study Group Medical University of Vienna Vienna Austria
| | - Ursula Schmidt‐Erfurth
- Department of Ophthalmology Vienna Reading Center and OPTIMA Study Group Medical University of Vienna Vienna Austria
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Rodrigues MW, Cardillo JA, Messias A, Siqueira RC, Scott IU, Jorge R. Bevacizumab versus triamcinolone for persistent diabetic macular edema: a randomized clinical trial. Graefes Arch Clin Exp Ophthalmol 2019; 258:479-490. [PMID: 31873786 DOI: 10.1007/s00417-019-04564-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/25/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To evaluate 24-week visual acuity and anatomic outcomes of two "pro re nata" (prn) treatment strategies (intravitreal bevacizumab [IVB] prn versus intravitreal triamcinolone acetonide [IVT] prn) in patients with persistent diabetic macular edema (pDME) after 24 weeks of prn-IVB. METHODS One hundred eyes with center-involving DME were enrolled and treated with prn-IVB for 24 weeks; at week 24, eyes with pDME (central subfield thickness [CST] on spectral domain optical coherence tomography > 300 μm) were randomized to IVB monthly prn (group I; prn-IVB) or IVT every 3 months prn (group II; prn-IVT) and eyes in which the CST was ≤ 300 μm were assigned to continue prn-IVB (group III). RESULTS Seventy-four eyes completed a 48-week study period. At week 24, 65 (79.3%) eyes still had DME with CST > 300 μm and, therefore, were randomized to prn-IVB (group I, n = 33) or prn-IVT (group II, n = 32); the remaining 17 (20.7%) eyes had CST ≤ 300 μm and were assigned to continued treatment with prn-IVB (group III). At baseline, mean CST (μm) ± standard error of the mean (SEM) was 447.2 ± 24.4, 478.0 ± 19.7, and 386.0 ± 21.0 in groups I, II, and III, respectively (p > 0.05). At week 48, there was no significant difference in mean CST between groups I and II (369.9 ± 23.3 and 426.0 ± 26.1, respectively; p = 0.9995). A significant reduction in mean CST, compared with baseline, was noted at weeks 28 (p = 0.0002) and 44 (p = 0.0002) in group II. Group I did not show a significant reduction in mean CST compared with baseline at any study visit. There were no significant differences in mean CST between groups I and II at any study visit. At baseline, mean ± SEM best-corrected visual acuity (BCVA) (logMAR) was 0.50 ± 0.00, 0.60 ± 0.10, and 0.50 ± 0.10 in groups I, II, and III, respectively (p > 0.05). At week 48, there was no statistically significant difference in mean BCVA between groups I and II (0.50 ± 0.10 and 0.80 ± 0.10, respectively; p = 0.4473). There was no significant improvement in mean BCVA, as compared with baseline, at any study follow-up visit in any of the groups. Group II demonstrated significantly lower BCVA after 24 weeks of IVT (at week 48) compared with baseline (p = 0.0435). There was no significant difference in mean BCVA between groups I and II at any time-point. CONCLUSION In eyes with pDME after 24 weeks of treatment with prn-IVB, there was no difference between continued treatment with prn-IVB versus a treatment switch to prn-IVT with respect to mean BCVA or mean CST at week 48. However, BCVA was stable in the prn-IVB group, while prn-IVT was associated with BCVA reduction from baseline and a higher risk of IOP elevation.
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Affiliation(s)
- Murilo W Rodrigues
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Brazil, 3900, Bandeirantes av., Campus, 12fl., Ribeirão Preto, São Paulo, 14048-900, Brazil.
| | - José A Cardillo
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Brazil, 3900, Bandeirantes av., Campus, 12fl., Ribeirão Preto, São Paulo, 14048-900, Brazil
| | - André Messias
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Brazil, 3900, Bandeirantes av., Campus, 12fl., Ribeirão Preto, São Paulo, 14048-900, Brazil
| | - Rubens C Siqueira
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Brazil, 3900, Bandeirantes av., Campus, 12fl., Ribeirão Preto, São Paulo, 14048-900, Brazil
| | - Ingrid U Scott
- Departments of Ophthalmology and Public Health Sciences, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA, 17033, USA
| | - Rodrigo Jorge
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Brazil, 3900, Bandeirantes av., Campus, 12fl., Ribeirão Preto, São Paulo, 14048-900, Brazil
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Chen SC, Chiu HW, Chen CC, Woung LC, Lo CM. A Novel Machine Learning Algorithm to Automatically Predict Visual Outcomes in Intravitreal Ranibizumab-Treated Patients with Diabetic Macular Edema. J Clin Med 2018; 7:jcm7120475. [PMID: 30477203 PMCID: PMC6306861 DOI: 10.3390/jcm7120475] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 12/13/2022] Open
Abstract
Purpose: Artificial neural networks (ANNs) are one type of artificial intelligence. Here, we use an ANN-based machine learning algorithm to automatically predict visual outcomes after ranibizumab treatment in diabetic macular edema. Methods: Patient data were used to optimize ANNs for regression calculation. The target was established as the final visual acuity at 52, 78, or 104 weeks. The input baseline variables were sex, age, diabetes type or condition, systemic diseases, eye status and treatment time tables. Three groups were randomly devised to build, test and demonstrate the accuracy of the algorithms. Results: At 52, 78 and 104 weeks, 512, 483 and 464 eyes were included, respectively. For the training group, testing group and validation group, the respective correlation coefficients were 0.75, 0.77 and 0.70 (52 weeks); 0.79, 0.80 and 0.55 (78 weeks); and 0.83, 0.47 and 0.81 (104 weeks), while the mean standard errors of final visual acuity were 6.50, 6.11 and 6.40 (52 weeks); 5.91, 5.83 and 7.59; (78 weeks); and 5.39, 8.70 and 6.81 (104 weeks). Conclusions: Machine learning had good correlation coefficients for predicating prognosis with ranibizumab with just baseline characteristics. These models could be the useful clinical tools for prediction of success of the treatments.
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Affiliation(s)
- Shao-Chun Chen
- Department of Ophthalmology, Taipei City Hospital, Taipei 10632, Taiwan.
| | - Hung-Wen Chiu
- Department of Ophthalmology, Taipei City Hospital, Taipei 10632, Taiwan.
| | - Chun-Chen Chen
- Department of Ophthalmology, Taipei City Hospital, Taipei 10632, Taiwan.
| | - Lin-Chung Woung
- Department of Ophthalmology, Taipei City Hospital, Taipei 10632, Taiwan.
| | - Chung-Ming Lo
- Department of Ophthalmology, Taipei City Hospital, Taipei 10632, Taiwan.
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