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Kiss S, Campbell J, Almony A, Shih V, Serbin M, LaPrise A, Wykoff CC. Management and Outcomes for Neovascular Age-Related Macular Degeneration. Ophthalmology 2020; 127:1179-1188. [DOI: 10.1016/j.ophtha.2020.02.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/14/2020] [Accepted: 02/19/2020] [Indexed: 10/24/2022] Open
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Li W, Zhang W, Zhang C, Zhu C, Yi X, Zhou Y, Lv Y. Soluble Tei2 fusion protein inhibits retinopathy of prematurity occurrence via regulation of the Ang/Tie2 pathway. Exp Ther Med 2019; 18:614-620. [PMID: 31258697 PMCID: PMC6566045 DOI: 10.3892/etm.2019.7608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 03/23/2019] [Indexed: 12/31/2022] Open
Abstract
The aim of the present study was to investigate the potential mechanism of retinopathy of prematurity (ROP) using an oxygen-induced retinopathy (OIR) mouse model. For experiments, mice were divided into either the OIR group or control group. Fluorescein isothiocyanate-dextran cardiac perfusion and stretched retina preparation were performed. The total retina area, area of instillation, density of microvascular network, area of new blood vessels, vein width and the tortuosity of arteries were measured. Next, mice were randomly assigned into the PBS, soluble TEK receptor tyrosine kinase (sTie2)-fusion protein (Fc), angiopoietin 1 (Ang1), ranibizumab, ranibizumab + sTie2-Fc and ranibizumab + Ang1 treatment groups. Following housing for 5 days, the body weight of each mouse was recorded. Mice in the OIR group presented smaller total retina area and larger area of instillation, larger area of new blood vessels, and higher microvascular network density compared with the control PBS group. Obvious retinal vein dilatation and arterial tortuosity were identified in the OIR group. The amount of endotheliocyte nuclei of new vessels beyond the inner limiting membrane was larger in the OIR group compared with the control group. Furthermore in the next set of experiments, a larger area of instillation, smaller area of new blood vessels and decreased amount of endotheliocyte nuclei of new vessels were observed in the sTie2-Fc group, Ang1 group, ranibizumab group, ranibizumab + sTie2-Fc group and ranibizumab + Ang1 group compared with the PBS group. Specifically, the ranibizumab + sTie2-Fc group and ranibizumab + Ang1 group demonstrated markedly reduced retina instillation area and microvascular network density in the instillation area. Total retina area and body weight following 10 days of the experiment for the ranibizumab group were significantly lower compared with other groups. In conclusion, the combined regulation of the Ang/Tie2 and the vascular endothelial growth factor (VEGF)/VEGF receptor pathways markedly increased the efficacy of treatment with retinal neovascularization (RNV). Regulation of these pathways has a potential for treating RNV, in particular ROP.
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Affiliation(s)
- Weijing Li
- Department of Ophthalmology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Weihua Zhang
- Department of Ophthalmology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Cuiying Zhang
- Department of Ophthalmology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Chunfang Zhu
- Department of Ophthalmology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Xiangling Yi
- Department of Ophthalmology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Yan Zhou
- Department of Ophthalmology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Yan Lv
- Department of Ophthalmology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
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Kumar JB, Wai KM, Ehlers JP, Singh RP, Rachitskaya AV. Subfoveal choroidal thickness as a prognostic factor in exudative age-related macular degeneration. Br J Ophthalmol 2018; 103:918-921. [PMID: 30150279 DOI: 10.1136/bjophthalmol-2018-312625] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/25/2018] [Accepted: 08/03/2018] [Indexed: 11/04/2022]
Abstract
AIMS To investigate the relationship between subfoveal choroidal thickness (SFCT), visual acuity (VA), optical coherence tomography (OCT) features and total anti-vascular endothelial growth factor (VEGF) treatments to determine whether SFCT serves as a prognostic factor in age-related macular degeneration (AMD). METHODS This is a retrospective case series of 62 consecutive treatment-naive patients with exudative AMD followed for 1 year and treated with treat-and-extend or pro re nata anti-VEGF protocols. SFCT was measured at three locations using Cirrus HD-OCT (the foveal centre and 500 um nasal and temporal to the fovea) at presentation, 3, 6 and 12 months. Demographic characteristics, OCT imaging biomarkers and VA were recorded. RESULTS Mean SFCT at baseline was 187 µm (range: 70-361 µm). There was a trend of decreasing SFCT at 1 year (173 µm) compared with 3 months (175 µm) and baseline (188 µm) (p=0.2). There was no correlation between baseline SFCT and presence of subretinal fluid (p=0.2), intraretinal fluid (p=0.6) or subretinal hyper-reflective material (p=0.4) at baseline. The mean number of injections at 1 year was 6.6 (range: 2-12). Increased SFCT at baseline showed statistically significant correlation with a higher number of intravitreal injections at 1 year (p=0.004). Eyes with SFCT>1 SD above the mean required 50% more injections compared with others. There was no association between SFCT on presentation with baseline and 1 year VA (p=0.7 and p=0.2). CONCLUSIONS SFCT in naïve patients with exudative AMD may be an important prognostic tool in determining treatment burden. Patients with thicker subfoveal choroid may require increased intravitreal injections.
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Affiliation(s)
- Jaya B Kumar
- Cleveland Clinic Department of Ophthalmology, Cole Eye Institute, Cleveland, Ohio, USA
| | - Karen M Wai
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Justin P Ehlers
- Cleveland Clinic Department of Ophthalmology, Cole Eye Institute, Cleveland, Ohio, USA
| | - Rishi P Singh
- Cleveland Clinic Department of Ophthalmology, Cole Eye Institute, Cleveland, Ohio, USA
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Silva FQ, Srivastava S, Ehlers JP, Li A, Bedi R, Schachat AP, Singh RP. A 24-Month Evaluation of Aflibercept for Wet Age-Related Macular Degeneration in Patients Previously Receiving Ranibizumab or Bevacizumab. Ophthalmol Retina 2017; 1:111-117. [PMID: 31047267 DOI: 10.1016/j.oret.2016.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/13/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE To report the 24-month results and predictive factors for outcomes in patients transitioned from other anti-vascular endothelial growth factor agents to aflibercept for the treatment of exudative age-related macular degeneration (AMD). DESIGN A prospective, single arm, investigator-initiated study. PARTICIPANTS A total of 24 patients participated in the study and 87.5% (n = 21) completed the 24 month assessments. Patients were included if they had an active exudative AMD confirmed by fluorescein angiography, presence of fluid on spectral-domain optical coherence tomography (OCT) or new hemorrhage on clinical examination, Electronic Early Treatment Diabetic Retinopathy Study vision of 25 to 80 letters (Snellen equivalent of approximately 20/25-20/320), prior bevacizumab or ranibizumab injections within 3 months of enrollment, and an initial response on OCT defined as a decrease of retinal edema and/or subretinal fluid to anti-vascular endothelial growth factor injections. METHODS Patients were treated the first 3 months with 2 mg of intravitreal aflibercept monthly, followed by a fixed bimonthly schedule for 24 months. At each study visit, visual acuity and a spectral-domain OCT scanning of both eyes were performed. MAIN OUTCOME AND MEASURES The mean absolute change from baseline in central subfield thickness at month 24, mean change from baseline in best-corrected visual acuity (BCVA) score, change from baseline in macular volume, and cube average thickness by spectral-domain OCT. Additionally, predictive factors associated with final visual and anatomic outcomes at month 24. RESULTS A mean decrease in central subfield thickness of -41 μm (P = 0.004) was observed with a mean increase in ETDRS BCVA of +10.4 letters (P < 0.001). At study entry, BCVA was a significant predictive factor for BCVA change at month 24 (rho = -0.59; P = 0.003). Also, the duration between AMD diagnosis and study entry was a significant factor for central subfield thickness change at month 24 (rho = -0.51; P = 0.011). CONCLUSIONS In nonnaïve patients with active exudative AMD, treatment with a fixed intravitreal aflibercept dosing regimen for 24 months demonstrated sustained improvements in anatomy and vision in patients transitioned from other anti-vascular endothelial growth factor agents and stability when compared with 12-month outcomes. Patients who benefited most were those with worse vision at entry and longer duration of disease.
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Affiliation(s)
| | | | | | - Ang Li
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rumneek Bedi
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Rishi P Singh
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
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Kim JH, Chang YS, Kim JW, Lee DW, Han JI, Kim CG. Self‐recognition of recurrences among patients with exudative age‐related macular degeneration. Clin Exp Optom 2016; 99:56-60. [DOI: 10.1111/cxo.12315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 05/19/2015] [Accepted: 05/23/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea,
| | - Young Suk Chang
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, South Korea,
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea,
| | - Dong Won Lee
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea,
| | - Jung Il Han
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea,
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea,
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Charafeddin W, Nittala MG, Oregon A, Sadda SR. Relationship Between Subretinal Hyperreflective Material Reflectivity and Volume in Patients With Neovascular Age-Related Macular Degeneration Following Anti-Vascular Endothelial Growth Factor Treatment. Ophthalmic Surg Lasers Imaging Retina 2015; 46:523-30. [PMID: 26057755 DOI: 10.3928/23258160-20150521-03] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 03/18/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To assess the relationship between subretinal hyperreflective material (SRHM) reflectivity and volume in patients treated with anti-vascular endothelial growth factor (VEGF) therapy for choroidal neovascularization secondary to exudative age-related macular degeneration (AMD). PATIENTS AND METHODS Data from 17 eyes of 16 patients with neovascular AMD undergoing anti-VEGF therapy were collected retrospectively. Optical coherence tomography (OCT) data were obtained using the Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA) 512 × 128 macular cube protocol. Detailed manual segmentation was performed for each case using customized grading software. RESULTS The mean macular volume declined from 10.4 mm(3) at baseline to 9.6 mm(3) at 12 months. SRHM volume declined from 0.33 mm(3) to 0.12 mm(3), whereas reflectivity increased from 0.48 to 0.64 units (P = .012). SRHM reflectivity correlated positively with logarithm of the minimum angle of resolution (logMAR) acuity (r = .49, P = .04) but correlated with SRHM volume (r = -0.50, P = .04) only at baseline. CONCLUSION SRHM reflectivity, which correlated partially with SRHM volume, appears to carry independent information regarding disease activity. SRHM reflectivity may be useful for monitoring disease activity and response to therapy.
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Michalewski J, Nawrocki J, Izdebski B, Michalewska Z. Morphological changes in spectral domain optical coherence tomography guided bevacizumab injections in wet age-related macular degeneration, 12-months results. Indian J Ophthalmol 2015; 62:554-60. [PMID: 24881600 PMCID: PMC4065504 DOI: 10.4103/0301-4738.133485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose: To describe retinal changes during Spectral Domain Optical Coherence Tomography (SD-OCT) guided bevacizumab treatment for neovascular age- related macular degeneration (AMD). Settings and Design: Single center observational study. Materials and Methods: We confirmed wet AMD in 47 eyes of 45 patients by fluorescein angiography and SD-OCT. After bevacizumab injection, we examined the patients at 4-week intervals. During each follow-up control, we performed SD-OCT and a complete ophthalmic examination. Criteria for reinjection were visual acuity loss of more than five ETDRS letters, and/or increase of central retinal thickness, sub-retinal fluid, intra-retinal fluid, pigment epithelium detachment. If reinjection criteria were not met, we advised the patient to return in 4 weeks’ time for the next scheduled follow-up. We used 3-dimensional SD-OCT to measure photoreceptor defects and sub-retinal fibrosis. The main efficacy endpoints were the SD-OCT measurements of the size of photoreceptor defects, the size of external membrane defects and the central retinal thickness. Results: Over the 12 months study period, the percentage of scans in 3-D imaging mode showing visible defects of the junction between inner and outer segments of photoreceptors increased from 38.96 to 53.8%. The percentage of scans in 3-D imaging mode with visible sub-retinal fibrosis increased from 33 to 52% and mean central retinal thickness decreased from 333 μm (96-900 μm) to 272 μm (P = 0.011). Conclusion: In long-term anti- Vascular endothelial growth factor (VEGF) treatment for neovascular AMD, photoreceptor defects and fibrosis progress despite a decrease in central retinal thickness and improvements in visual acuity. We would encourage further discussion as to whether this is the natural course of the disease or a result of the treatment.
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Affiliation(s)
| | | | | | - Zofia Michalewska
- Department of Ophthalmology, Ophthalmic Clinic, "Jasne Blonia"; Department of Ophthalmology, III Municipal Hospital, K. Jonscher, Lodz, Poland
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El-Ashry MF, Lascaratos G, Dhillon B. Evaluation of the effect of intravitreal ranibizumab injections in patients with neovascular age related macular degeneration on retinal nerve fiber layer thickness using optical coherence tomography. Clin Ophthalmol 2015. [PMID: 26203216 PMCID: PMC4508074 DOI: 10.2147/opth.s80704] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the effect of repeated intravitreal ranibizumab injections for neovascular age related macular degeneration (nAMD) on the retinal nerve fiber layer (RNFL) thickness using optical coherence tomography. Design A prospective observational cohort study of patients with nAMD. Methods Thirty eyes of 30 patients with nAMD were selected. All patients received three ranibizumab injections and underwent scans using the fast RNFL thickness protocol (Stratus optical coherence tomography) before starting the first injection and 1 month after the third injection. The RNFL thickness measurements prior to the injections and after the third injection were used for the analysis. We also evaluated the effect of the lens status as well as the type of choroidal neovascular membrane on RNFL thickness measurements pre- and post-injection. Pre- and post-injection average and individual quadrant RNFL thickness were measured and statistically analyzed. Results The mean (± standard deviation) pre-injection RNFL thickness was 90.8±18. The mean (± standard deviation) post-injection RNFL thickness was 91.03±15. The pre- and post-injection values of the mean RNFL thickness were not statistically significant. Likewise, the pre- and post-injection values for RNFL thickness in the different quadrants were not statistically significant. There was no statistical significance for the lens status or the type of choroidal neovascular membrane on the RNFL thickness. Conclusion Repeated ranibizumab injections in nAMD appear to have no harmful effect on the RNFL thickness in the short term, in spite of the proven neurotrophic effect of vascular endothelial growth factor. Nevertheless, the safety profile of ranibizumab injections in nAMD needs to be further evaluated in a large multicenter trial with special emphasis on the long-term effects on the retina and optic nerve.
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Affiliation(s)
- Mohamed F El-Ashry
- Princess Alexandra Eye Pavilion, Edinburgh, UK ; Ophthalmology Department, Tanta University Hospital, Tanta, Egypt ; North Cumbria University Hospital, Carlisle, UK
| | | | - Baljean Dhillon
- Princess Alexandra Eye Pavilion, Edinburgh, UK ; Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
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Chang YS, Han JI, Yoo SJ, Lew YJ, Kim JH. Intravitreal anti-vascular endothelial growth factor for typical exudative age-related macular degeneration in eyes with good baseline visual acuity. KOREAN JOURNAL OF OPHTHALMOLOGY 2014; 28:466-72. [PMID: 25435749 PMCID: PMC4239465 DOI: 10.3341/kjo.2014.28.6.466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 04/28/2014] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To investigate 12-month treatment outcomes of anti-vascular endothelial growth factor therapy in eyes with typical exudative age-related macular degeneration with good baseline visual acuity. METHODS This retrospective observational case series included 18 eyes (18 patients) with typical exudative age-related macular degeneration with a baseline best-corrected visual acuity of 20 / 25 or better. Patients were treated with anti-vascular endothelial growth factor monotherapy during the 12-month follow-up period. Baseline visual acuity and central foveal thickness were compared to the values at 12 months. RESULTS Patients received an average of 4.4 ± 1.3 intravitreal anti-vascular endothelial growth factor injections. The mean logarithm of minimum angle of resolution visual acuity was 0.08 ± 0.04, 0.08 ± 0.07, 0.12 ± 0.09, and 0.16 ± 0.11 at baseline, three months, six months, and 12 months, respectively. Visual acuity at 12 months was significantly worse than the baseline value at diagnosis (p = 0.017), and the mean central foveal thickness at the defined time points was 270.2 ± 55.6, 204.4 ± 25.4, 230.1 ± 56.3, and 216.8 ± 48.7 µm, respectively. The central foveal thickness at 12 months was significantly less than the baseline value at diagnosis (p = 0.042). CONCLUSIONS Deterioration in visual acuity was noted in eyes with typical exudative age-related macular degeneration with good baseline visual acuity, suggesting the need for close patient monitoring and prompt treatment even in patients with good baseline visual acuity.
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Affiliation(s)
- Young Suk Chang
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea
| | - Jung Il Han
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Su Jin Yoo
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Young Ju Lew
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
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Kiss S, Liu Y, Brown J, Holekamp NM, Almony A, Campbell J, Kowalski JW. Clinical Monitoring of Patients With Age-Related Macular Degeneration Treated With Intravitreal Bevacizumab or Ranibizumab. Ophthalmic Surg Lasers Imaging Retina 2014; 45:285-91. [DOI: 10.3928/23258160-20140709-04] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 04/17/2014] [Indexed: 11/20/2022]
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Holekamp NM, Liu Y, Yeh WS, Chia Y, Kiss S, Almony A, Kowalski JW. Clinical utilization of anti-VEGF agents and disease monitoring in neovascular age-related macular degeneration. Am J Ophthalmol 2014; 157:825-833.e1. [PMID: 24388973 DOI: 10.1016/j.ajo.2013.12.018] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 12/20/2013] [Accepted: 12/23/2013] [Indexed: 11/15/2022]
Abstract
PURPOSE To examine bevacizumab and ranibizumab utilization and disease monitoring patterns in patients with neovascular age-related macular degeneration (neovascular AMD) in clinical practice. DESIGN Retrospective medical claims analysis. METHODS Patients receiving ≥1 ranibizumab or bevacizumab injection during the 12 months after initial neovascular AMD diagnosis were included. Annual bevacizumab and/or ranibizumab injection utilization was assessed by year of first injection cohorts: 2006 and 2007 (received either agent because of billing code overlap), 2008, 2009, and January-June 2010 (received each agent). Outcome measures were time to first injection relative to neovascular AMD diagnosis and mean numbers of intravitreal injections, ophthalmologist visits, and optical coherence tomography (OCT) and fluorescein angiography (FA) examinations in 12 months. RESULTS In the 2006 and 2007 cohorts (n = 8767), mean annual numbers of bevacizumab or ranibizumab injections were 4.7 and 5.0, respectively. Over 92% of patients in all cohorts received first treatment within 3 months of neovascular AMD diagnosis. In the 2008-2010 cohorts (n = 10 259), mean annual number of injections remained low (bevacizumab: 4.6, 5.1, and 5.5; ranibizumab: 6.1, 6.6, and 6.9), as did mean numbers of ophthalmologist visits (bevacizumab only) and OCT examinations (both agents), but there was no such trend in FA examinations. CONCLUSIONS Compared with treatment paradigms validated by clinical trials published at the time, in clinical practice, patients with neovascular AMD received fewer bevacizumab or ranibizumab injections and less-frequent monitoring from 2006 to mid-2011. Factors contributing to this lower injection frequency and visual outcomes associated with reduced utilization need to be researched.
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Affiliation(s)
- Nancy M Holekamp
- Pepose Vision Institute and Washington University School of Medicine, St Louis, Missouri.
| | - Ying Liu
- Allergan, Inc., Irvine, California
| | | | | | - Szilárd Kiss
- Weill Cornell Medical College, New York, New York
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