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PARAFOVEAL INNER RETINAL THINNING AS THE BIOMARKER PREDICTING LESS RECURRENCE OF MACULAR EDEMA IN CENTRAL RETINAL VEIN OCCLUSION AFTER DISCONTINUING ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR. Retina 2022; 42:2336-2345. [DOI: 10.1097/iae.0000000000003616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Terao R, Fujino R, Ahmed T. Risk Factors and Treatment Strategy for Retinal Vascular Occlusive Diseases. J Clin Med 2022; 11:6340. [PMID: 36362567 PMCID: PMC9656338 DOI: 10.3390/jcm11216340] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 07/30/2023] Open
Abstract
Retinal occlusive diseases are common diseases that can lead to visual impairment. Retinal artery occlusion and retinal vein occlusion are included in the clinical entity, but they have quite different pathophysiologies. Retinal artery occlusion is an emergent eye disorder. Retinal artery occlusion is mainly caused by thromboembolism, which frequently occurs in conjunction with life-threatening stroke and cardiovascular diseases. Therefore, prompt examinations and interventions for systemic vascular diseases are often necessary for these patients. Retinal vein occlusion is characterized by retinal hemorrhage and ischemia, which may impair visual function via several complications such as macular edema, macular ischemia, vitreous hemorrhage, and neovascular glaucoma. Even though anti-vascular endothelial growth factor therapy is the current established first-line of treatment for retinal vein occlusion, several clinical studies have been performed to identify better treatment protocols and new therapeutic options. In this review, we summarize the current findings and advances in knowledge regarding retinal occlusive diseases, particularly focusing on recent studies, in order to provide an update for a better understanding of its pathogenesis.
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Affiliation(s)
- Ryo Terao
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8654, Japan
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Ryosuke Fujino
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8654, Japan
| | - Tazbir Ahmed
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8654, Japan
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Nanji K, Khan M, Khalid MF, Xie JS, Sarohia GS, Phillips M, Thabane L, Garg SJ, Kaiser P, Sivaprasad S, Wykoff CC, Chaudhary V. Treat-and-extend regimens of anti-vascular endothelial growth factor therapy for retinal vein occlusions: a systematic review and meta-analysis. Acta Ophthalmol 2021; 100:e1199-e1208. [PMID: 34845830 DOI: 10.1111/aos.15068] [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: 08/12/2021] [Revised: 10/12/2021] [Accepted: 11/19/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate treat-and-extend (T&E) regimens of anti-vascular endothelial growth factor (anti-VEGF) therapy for the treatment of macular oedema secondary to retinal vein occlusions (RVOs). METHODS Ovid MEDLINE, Ovid EMBASE and CENTRAL were searched on 25 February 2021. Randomized controlled trials, cohort studies, case-control studies and case series were included. The primary outcome was the change in Early Treatment Diabetic Retinopathy Score (ETDRS) letters from baseline. Conversions from Snellen to ETDRS letters were performed utilizing a published protocol. Secondary outcomes included improvement in retinal thickness from baseline, number of anti-VEGF injections and frequency of adverse events. Outcomes were examined at 12 and 24 months. Certainty of evidence was assessed utilizing GRADE (Grading of Recommendations Assessments, Development and Evaluations) guidelines. RESULTS Seven hundred eighty-six eyes from 16 studies were included. Meta-analysis demonstrated a mean improvement of 15.7 (95% CI: 13.3-18.0) ETDRS letters at 12 months. Central retinal thickness improved 269.7 μm (95% CI: 233.64-305.90) at 12 months. Injections were performed 8.1 (95% CI: 7.4-8.7) and 13.1 (95% CI: 9.4-16.8) times at 12 and 24 months respectively. Adverse events were infrequent across all studies. Grading of Recommendations Assessments, Development and Evaluations (GRADE) certainty of evidence was very low across all outcomes. CONCLUSIONS The results support the viability of T&E regimens for the treatment of macular oedema secondary to RVOs.
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Affiliation(s)
- Keean Nanji
- Department of Surgery Division of Ophthalmology McMaster University Hamilton Ontario Canada
| | - Mohammad Khan
- Department of Surgery Division of Ophthalmology McMaster University Hamilton Ontario Canada
| | - Muhammad F. Khalid
- Department of Surgery Division of Ophthalmology McMaster University Hamilton Ontario Canada
| | - Jim S. Xie
- Department of Surgery Division of Ophthalmology McMaster University Hamilton Ontario Canada
| | - Gurkaran S. Sarohia
- Department of Ophthalmology and Visual Sciences 2319 Active Treatment Centre University of Alberta Edmonton Alberta Canada
| | - Mark Phillips
- Department of Health Research Methods, Evidence and Impact McMaster University Hamilton Ontario Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact McMaster University Hamilton Ontario Canada
- St. Joseph’s Healthcare‐Hamilton Biostatistics Unit Hamilton Ontario Canada
| | - Sunir J. Garg
- The Retina Service of Wills Eye Hospital MidAtlantic Retina Philadelphia PA USA
| | - Peter Kaiser
- Cleveland Clinic Cole Eye Institute Cleveland Ohio USA
| | - Sobha Sivaprasad
- Moorfields Eye Hospital NIHR Moorfields Biomedical Research Centre London UK
| | - Charles C. Wykoff
- Retina Consultants of Houston, Texas Blanton Eye Institute Houston Methodist Hospital and Weill Cornell Medical College Houston Texas USA
| | - Varun Chaudhary
- Department of Surgery Division of Ophthalmology McMaster University Hamilton Ontario Canada
- Department of Health Research Methods, Evidence and Impact McMaster University Hamilton Ontario Canada
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Modi YS, Goduni L, Moini H, Gibson A, Boucher N, Lucas G, Dhoot DS. Antivascular Endothelial Growth Factor Dosing Frequency and Visual Outcomes in Macular Edema Following Central Retinal Vein Occlusion. JOURNAL OF VITREORETINAL DISEASES 2021; 5:505-512. [PMID: 37007170 PMCID: PMC9976151 DOI: 10.1177/2474126421989225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: We evaluated the relationship between dosing frequency of intravitreal antivascular endothelial growth factor (anti-VEGF) agents and visual acuity (VA) outcomes over 2 years in eyes with macular edema (ME) secondary to central retinal vein occlusion (CRVO) in the US routine clinical practice setting. Methods: This retrospective analysis assessed electronic medical records of eyes with ME secondary to CRVO that received their first anti-VEGF injection January 1, 2012, to May 31, 2016, and were followed for 1 year or more in the US-based Vestrum Health Treatment and Outcomes database. Eyes were divided into 2 injection frequency subcohorts (≤6 or ≥7 injections/year). Results: Overall, 851 (34.6%) of 2458 eyes with ME secondary to CRVO received 6 or fewer injections, and 1607 (65.4%) received 7 or more injections through 1 year. The mean number of injections in patients receiving 6 or fewer injections and 7 or more injections was 4.7 and 8.8, respectively, and baseline mean VA was 35 and 37 letters, respectively. At year 1, mean letter gain from baseline was less in eyes receiving 6 or fewer injections vs in those receiving 7 or more injections (7.0 vs 12.2, P < .001). Mean VA at year 2 was 50 letters in eyes receiving 6 or fewer injections (n = 50) and 55 letters in eyes receiving 7 or more injections (n = 157). Conclusions: In routine clinical practice, more frequent dosing with anti-VEGF agents was associated with greater visual benefits in eyes with ME secondary to CRVO.
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Affiliation(s)
- Yasha S. Modi
- New York University Langone Health, New York, NY, USA
| | | | - Hadi Moini
- Regeneron Pharmaceuticals Inc, Tarrytown, NY, USA
| | | | | | | | - Dilsher S. Dhoot
- California Retina Consultants/Retina Consultants of America, Santa Barbara, CA, USA
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Niyousha MR, Hassanpoor N, Jafari S. Bilateral Type 1 Idiopathic Macular Telangiectasia in a Female Patient: Multimodal Imaging of a Rare Presentation. Case Rep Ophthalmol 2021; 12:373-379. [PMID: 34054487 PMCID: PMC8136330 DOI: 10.1159/000513095] [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: 08/06/2020] [Accepted: 11/14/2020] [Indexed: 11/19/2022] Open
Abstract
We report a bilateral case of type 1 idiopathic macular telangiectasia (IMT) in a female patient. A 40-year-old otherwise healthy female with gradual vision loss since 2 years ago with best-corrected visual acuity of 20/400 in both eyes was referred. Her past medical history was negative for any systemic disease including diabetes and systemic hypertension. Color fundus photography showed bilateral loss of normal foveal reflex with macular edema. Fluorescein angiography demonstrated symmetric perifoveal telangiectasia mainly in the superior and nasal macula in both eyes with late staining and leakage. Spectral-domain optical coherence tomography revealed significant intraretinal fluid bilaterally and subretinal fluid in the left eye. Optical coherence tomography angiography (OCTA) revealed obvious saccular parafoveal capillary telangiectasia and capillary dropout as well as decreased vascular density in both superficial and deep capillary plexus. Deep capillary plexus involvement in OCTA was more evident than superficial plexus. Based on the patient's medical history and multimodal imaging, the diagnosis of bilateral IMT type 1 was made. The patient underwent 5 intravitreal monthly injection of bevacizumab in both eyes, which resulted in macular edema resolution. However, after 3 months of discontinuation of intravitreal bevacizumab, macular edema relapsed. In conclusion, type 1 IMT can occur bilaterally in an otherwise healthy female patient as a very rare presentation. To the best of our knowledge, this case is the 4th case of bilateral type 1 IMT reported in a female.
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Affiliation(s)
- Mohamad Reza Niyousha
- Retina & Vitreous Service, Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Narges Hassanpoor
- Retina & Vitreous Service, Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sasan Jafari
- Ophthalmology Resident, Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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Gallardo M, Munk MR, Kurmann T, De Zanet S, Mosinska A, Karagoz IK, Zinkernagel MS, Wolf S, Sznitman R. Machine learning can predict anti-VEGF treatment demand in a Treat-and-Extend regimen for patients with nAMD, DME and RVO associated ME. ACTA ACUST UNITED AC 2021; 5:604-624. [DOI: 10.1016/j.oret.2021.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 05/01/2021] [Accepted: 05/03/2021] [Indexed: 01/27/2023]
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[The modified treat and extend scheme with injection blocks in intravitreal injection treatment : Retrospective analysis from the routine clinical application]. Ophthalmologe 2020; 118:578-586. [PMID: 32894329 PMCID: PMC8187201 DOI: 10.1007/s00347-020-01218-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/29/2020] [Accepted: 08/06/2020] [Indexed: 01/04/2023]
Abstract
Hintergrund Die regelmäßige Therapie mittels intravitrealer operativer Medikamentenapplikation (IVOM) und die damit verbundenen Kontrolluntersuchungen stellen für viele Patienten eine große Herausforderung dar, die bis zum Behandlungsabbruch führen kann. Das modifizierte blockweise Treat-and-Extend(TAE)-Schema verfolgt das Ziel, mit möglichst wenigen Kontrollvisiten stabile Netzhaut- und Visusbefunde zu erreichen und dadurch die Belastung der Patienten zu minimieren. Methoden Diese monozentrische retrospektive Studie untersuchte Behandlungsverläufe von insgesamt 387 Patienten mit neovaskulärer altersbedingter Makuladegeneration (AMD), diabetischem Makulaödem (DMÖ), Venenastverschluss (VAV) und Zentralvenenverschluss (ZVV), bei denen das TAE-Regime jeweils in 3er-Blöcken angewendet wurde. Primärer Endpunkt war das Erreichen eines Injektionsintervalls von 12 Wochen. Ergebnisse Durch die blockweise applizierte IVOM konnte die Netzhautdicke signifikant reduziert und der Visus verbessert werden. Über die verschiedenen Indikationen konnte im Mittel ein Behandlungsintervall von 2 Monaten erreicht werden. Schlussfolgerung Ein in 3er-Blöcken angepasstes TAE-Schema im Rahmen der IVOM kann bei reduzierter Patientenbelastung zu stabilen Netzhaut- und Visusbefunden führen. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00347-020-01218-y) enthalten.
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Arai Y, Takahashi H, Inoda S, Sakamoto S, Tan X, Inoue Y, Tominaga S, Kawashima H, Yanagi Y. Efficacy of Modified Treat-and-Extend Aflibercept Regimen for Macular Edema Due to Branch Retinal Vein Occlusion: 1-Year Prospective Study. J Clin Med 2020; 9:jcm9082360. [PMID: 32718095 PMCID: PMC7464624 DOI: 10.3390/jcm9082360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/21/2020] [Accepted: 07/21/2020] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To assess the efficacy and safety of a modified treat-and-extend (mTAE) regimen of aflibercept for macular edema (ME) due to branch retinal vein occlusion (BRVO). METHODS This prospective multicentre intervention study evaluated 50 eyes of 50 patients enrolled from October 2016 to September 2017. The patients received intravitreal aflibercept (IVA) injections on an mTAE regimen for a total of 12 months. The main outcome measures were best-corrected visual acuity (BCVA) and central subfield thickness (CST) at 12 months. RESULTS The baseline BCVA and CST were 0.33 (0.27) and 488 (171) µm (mean (standard deviation)), respectively. The BCVA and CST were significantly improved at month 12 (0.067 (0.19) LogMAR and 295 (110) µm; both p < 0.0001, paired t-test). The mean number of clinic visits and IVA injections was 6.71 (1.41) and 4.26 (0.71), respectively. The time to first recurrence from the first injection was most frequently 3 months. CONCLUSION The mTAE regimen of IVA injections for ME due to BRVO effectively improved BCVA and reduced CST, and thus might be an effective therapy to reduce the number of injections and visits.
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Affiliation(s)
- Yusuke Arai
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi 329-0431, Japan; (Y.A.); (S.I.); (S.S.); (Y.I.); (S.T.); (H.K.)
| | - Hidenori Takahashi
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi 329-0431, Japan; (Y.A.); (S.I.); (S.S.); (Y.I.); (S.T.); (H.K.)
- Japan Community Health Care Organization Tokyo Shinjuku Medical Center, Tokyo 162-8543, Japan;
- Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
- Correspondence: ; Tel.: +81-285-58-7382; Fax: +81-285-44-8365
| | - Satoru Inoda
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi 329-0431, Japan; (Y.A.); (S.I.); (S.S.); (Y.I.); (S.T.); (H.K.)
| | - Shinichi Sakamoto
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi 329-0431, Japan; (Y.A.); (S.I.); (S.S.); (Y.I.); (S.T.); (H.K.)
| | - Xue Tan
- Japan Community Health Care Organization Tokyo Shinjuku Medical Center, Tokyo 162-8543, Japan;
- Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Yuji Inoue
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi 329-0431, Japan; (Y.A.); (S.I.); (S.S.); (Y.I.); (S.T.); (H.K.)
- Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Satoko Tominaga
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi 329-0431, Japan; (Y.A.); (S.I.); (S.S.); (Y.I.); (S.T.); (H.K.)
| | - Hidetoshi Kawashima
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi 329-0431, Japan; (Y.A.); (S.I.); (S.S.); (Y.I.); (S.T.); (H.K.)
| | - Yasuo Yanagi
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa 078-8802, Japan;
- Medical Retina, Singapore National Eye Centre, Singapore 168751, Singapore
- Medical Retina, Singapore Eye Research Institute, Singapore 168751, Singapore
- The Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
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Ang JL, Ah-Moye S, Kim LN, Nguyen V, Hunt A, Barthelmes D, Gillies MC, Mehta H. A systematic review of real-world evidence of the management of macular oedema secondary to branch retinal vein occlusion. Eye (Lond) 2020; 34:1770-1796. [PMID: 32313172 PMCID: PMC7608462 DOI: 10.1038/s41433-020-0861-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 02/19/2020] [Accepted: 03/24/2020] [Indexed: 01/10/2023] Open
Abstract
This review assessed the real-world evidence of the management of macular oedema secondary to branch retinal vein occlusion (BRVO). A meta-analysis of 2530 eyes from 48 real-world studies of therapies for macular oedema secondary to BRVO was conducted. Baseline characteristics, visual, anatomical and safety outcomes were recorded. The weighted mean and weighted estimates from random-effects models were calculated for visual acuity (VA) and central subfield thickness (CST) changes at 6, 12 and 24 months. Primary outcome was change in VA (logMAR letters) at 12 months. Study quality was assessed using the quality appraisal checklist for case series developed by Institute of Health Economics. The mean baseline VA for the pooled data was 54.0 (51.5, 56.5) letters and the mean baseline CST was 501.3 (483.5, 519.1) µm. The random-effects estimate for mean (95% CI) change in VA was 14.6 (12.5, 16.7) letters at 12 months (n = 1727). The random-effects estimate for mean (95% CI) change in CST was -181.7 (-230.7, -132.7) µm at 12 months (n = 1325). The quality of studies varied considerably. Ocular and systemic adverse events were discussed in 79% and 42% of treatment arms respectively, with possible under-reporting. Visual and anatomical gains achieved in the real-world for anti-VEGF therapy were not as impressive as seminal RCTs, possibly due to reduced injection frequency in the real world and differences in baseline characteristics. There is an urgent need for consensus on the minimum efficacy, treatment burden and safety data to collect to strengthen the real-world evidence base.
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Affiliation(s)
- Juan Lyn Ang
- Ophthalmology Department, Royal Free London NHS Foundation Trust, London, UK
| | - Sarah Ah-Moye
- Ophthalmology Department, Royal Free London NHS Foundation Trust, London, UK
| | - Leah N Kim
- Macular Research Group, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Vuong Nguyen
- Macular Research Group, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Adrian Hunt
- Macular Research Group, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Daniel Barthelmes
- Macular Research Group, Save Sight Institute, University of Sydney, Sydney, NSW, Australia.,Department of Ophthalmology, University Hospital Zurich & University of Zurich, Zurich, Switzerland
| | - Mark C Gillies
- Macular Research Group, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Hemal Mehta
- Ophthalmology Department, Royal Free London NHS Foundation Trust, London, UK. .,Macular Research Group, Save Sight Institute, University of Sydney, Sydney, NSW, Australia.
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Spooner K, Hong T, Fraser-Bell S, Chang AA. Current Outcomes of Anti-VEGF Therapy in the Treatment of Macular Oedema Secondary to Branch Retinal Vein Occlusions: A Meta-Analysis. Ophthalmologica 2019; 242:163-177. [PMID: 31158837 DOI: 10.1159/000497492] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/01/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE The current body of evidence on the efficacy and safety of anti-VEGFs for macular oedema secondary to branch retinal vein occlusion (BRVO) is steadily growing as large clinical trials and observational studies are continually completed. The aim of this meta-analysis is to analyse anatomical and functional outcomes in response to anti-VEGF therapy using evidence generated from a pooled analysis of current clinical trials and observational studies. METHODS The current meta-analysis includes treatment of BRVO with aflibercept, bevacizumab and ranibizumab from randomised controlled trials and observational studies. Inclusion criteria included peer-reviewed publications with at least a 12-month follow-up period. On literature review using multiple electronic databases (PubMed, Embase and Cochrane), 22 studies met the inclusion criteria. Baseline patient characteristics, study design, sample size and 12- and 24-month change in best corrected visual acuity (BCVA) and central foveal thickness (CFT) as measured on optical coherence tomography imaging were pooled in a meta-analysis. Data were then stratified by study design and anti-VEGF therapy in subgroup analyses. RESULTS A total of 1,236 eyes from 22 studies were included in this meta-analysis. Mean baseline BCVA ranged from 66 ETDRS letters (20/50 Snellen equivalent) to 35 letters (20/200 Snellen). Mean baseline CFT ranged from 406.0 to 681.0 µm. Anti-VEGF treatment demonstrated an overall mean improvement in BCVA at 12 months of 14 letters (95% CI 12.0 to 16.2, p < 0.001) and CFT reduction of 228 µm (95% CI -278.9 to -176.1, p < 0.001). The BCVA gains at 12 months were maintained to month 24 with a mean gain of 12.5 letters (95% CI 6.3 to 18.8, p < 0.001), as well as reduction of CFT of 238 µm (95% CI -336.0 to -140.2, p < 0.001). No cases of endophthalmitis or glaucoma were reported in any study. CONCLUSION This meta-analysis confirms the comparable safety and efficacy of anti-VEGF therapies for patients with cystoid macular oedema secondary to BRVO. There is a need for randomised prospective comparative trials of anti-VEGF agents for BRVO.
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Affiliation(s)
- Kimberly Spooner
- Sydney Institute of Vision Science, Sydney Retina, Sydney, New South Wales, Australia.,Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Thomas Hong
- Sydney Institute of Vision Science, Sydney Retina, Sydney, New South Wales, Australia
| | - Samantha Fraser-Bell
- Sydney Institute of Vision Science, Sydney Retina, Sydney, New South Wales, Australia.,Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew A Chang
- Sydney Institute of Vision Science, Sydney Retina, Sydney, New South Wales, Australia, .,Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia,
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Guichard MM, Xavier AR, Türksever C, Pruente C, Hatz K. Spectral-Domain Optical Coherence Tomography-Driven Treat-and-Extend and Pro Re Nata Regimen in Patients with Macular Oedema due to Retinal Vein Occlusion: 24-Month Evaluation and Outcome Predictors. Ophthalmic Res 2018; 60:29-37. [PMID: 29566387 DOI: 10.1159/000487489] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/07/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE To analyse the efficacy and outcome predictors of ranibizumab using a spectral-domain optical coherence tomography (SD-OCT)-driven treat-and-extend regimen (TER) versus SD-OCT-driven pro re nata regimen (PRN) in patients with cystoid macular oedema (CME) due to branch or central retinal vein occlusion (BRVO, CRVO). METHODS Retrospective, consecutive case series. Evaluation included best corrected visual acuity (BCVA), morphological parameters on SD-OCT, and treatment frequency. RESULTS From baseline to months 12, 18, and 24, BCVA improved by 16.6 ± 13.1, 15.5 ± 14.4, and 16.6 ± 15.8 letters, respectively, in TER (n = 45), compared to 11.3 ± 17.0, 11.0 ± 15.0, and 10 ± 20.5 letters in PRN (n = 31) (p = 0.152, p = 0.237, p = 0.172). The mean reduction in central retinal thickness was -261 ± 189, -272 ± 188, and -264 ± 158 μm, respectively, in TER, compared to -130 ± 196, -140 ± 210, and -166 ± 207 μm in PRN (p = 0.006, p = 0.017, p = 0.064). 59% (53%) of TER and 22% (17%) of PRN patients showed no intra- or subretinal fluid on SD-OCT at 12 (24) months. Using TER, the maximum recurrence-free treatment interval increased from 8.9 ± 2.3 weeks at 12 months to 9.8 ± 2.3 and 10.5 ± 2.7 weeks at 18 and 24 months, respectively. The number of injections was significantly higher in the TER than in the PRN group. CONCLUSIONS In CME, due to BRVO/CRVO, TER provides better morphological outcome using more injections than PRN.
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Affiliation(s)
| | | | | | - Christian Pruente
- Department of Ophthalmology, University of Basel, Basel, Switzerland.,Department of Ophthalmology, Kantonsspital Liestal, Liestal, Switzerland
| | - Katja Hatz
- Vista Klinik, Binningen, Switzerland.,Department of Ophthalmology, University of Basel, Basel, Switzerland
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Tilgner E, Dalcegio Favretto M, Tuisl M, Wiedemann P, Rehak M. Macular cystic changes as predictive factor for the recurrence of macular oedema in branch retinal vein occlusion. Acta Ophthalmol 2017; 95:e592-e596. [PMID: 28266152 DOI: 10.1111/aos.13396] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 12/17/2016] [Indexed: 01/14/2023]
Abstract
AIM To evaluate the role of small cystic macular changes as a prognostic factor for the recurrence of macular oedema (ME) in patients with branch retinal vein occlusion (BRVO) treated with anti-VEGF drugs. METHODS We performed retrospective chart analysis of 116 patients treated with intravitreal injection of ranibizumab (IVR) or bevacizumab (IVB) for ME secondary to BRVO. At the baseline and monthly follow-up visits over a period of 12 months, a comprehensive ophthalmologic examination including best-corrected visual acuity (BCVA) and volume scan of macula using Spectral domain optical coherence tomography (SD-OCT) were performed. Patients without ME (CRT <250 μm) were screened for the presence of intraretinal cysts. In these patients, the changes in BCVA and CRT were evaluated over a period of 12 months and compared with the baseline. RESULTS In the IVR group (41 patients), 91 events of macular cysts, without a worsening of BCVA, were detected by OCT. In 89 of 91 events (97%), BCVA and CRT deteriorated significantly (p < 0.0001) within the next 4-11 (in mean 7.1 ± 2.0) weeks. BCVA decreased from 0.38 ± 0.25 to 0.49 ± 0.27 logMAR and CRT increased significantly from 223 ± 43 to 605 ± 244 μm. In the IVB group (19 patients), 54 events of cystic changes were detected. All of these patients showed significant worsening of BCVA from 0.40 ± 0.19 to 0.57 ± 0.22 logMAR and CRT from 251 ± 17 to 490 ± 147 μm within 4-10 (in mean 7.8 ± 2.8) weeks after the first presence of small macular cysts. CONCLUSION In BRVO patients treated with anti-VEGF drugs, the macular cystic changes may be used as an early indicator for impending recurrence of ME, with the decrease in BCVA in the following weeks. These patients should be scheduled for a next visit within 6-8 weeks.
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Affiliation(s)
- Eric Tilgner
- Department of Ophthalmology; University of Leipzig; Leipzig Germany
| | - Maiara Dalcegio Favretto
- Department of Ophthalmology; São José Hospital - Dr Homero de Miranda Gomes Hospital; Santa Catarina Brazil
| | - Maria Tuisl
- Department of Ophthalmology; University of Leipzig; Leipzig Germany
| | - Peter Wiedemann
- Department of Ophthalmology; University of Leipzig; Leipzig Germany
| | - Matus Rehak
- Department of Ophthalmology; University of Leipzig; Leipzig Germany
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Bertelmann T, Frank HU, Fuchs HA, Feltgen N. Branch Retinal Vein Occlusion, Macular Ischemia, and Intravitreal Anti-VEGF Therapy. Case Rep Ophthalmol 2017; 8:271-278. [PMID: 28559839 PMCID: PMC5437432 DOI: 10.1159/000475520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/06/2017] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To report a case with ischemic macular edema (ME) due to an acute branch retinal vein occlusion (BRVO) which was treated with repeated intravitreal anti-VEGF injections. METHODS Retrospective case presentation. RESULTS A 66-year-old female patient was treated with repeated intravitreal anti-VEGF injections due to ischemic ME following an acute BRVO. Over a period of 2.5 years best corrected visual acuity increased from 0.06 to 0.6 (decimal notation) accompanied by a reduction in central retinal thickness from 546 to 292 µm. Overall 17 anti-VEGF injections were administered to treat repeated recurrence of ME. Macular ischemia did not worsen during this profound intravitreal anti-VEGF therapy. CONCLUSION Intravitreal anti-VEGF therapy can be a beneficial treatment strategy even in ischemic ME following an acute BRVO.
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Affiliation(s)
- Thomas Bertelmann
- aDepartment of Ophthalmology, Belenus Eye Center Siegen, Siegen, Germany.,bDepartment of Ophthalmology, University Medical Center Goettingen, Goettingen, Germany
| | - Hans Ulrich Frank
- aDepartment of Ophthalmology, Belenus Eye Center Siegen, Siegen, Germany
| | | | - Nicolas Feltgen
- bDepartment of Ophthalmology, University Medical Center Goettingen, Goettingen, Germany
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Sugimoto M, Ichio A, Nunome T, Kondo M. Two year result of intravitreal bevacizumab for diabetic macular edema using treat and extend protocol. Medicine (Baltimore) 2017; 96:e6406. [PMID: 28422832 PMCID: PMC5406048 DOI: 10.1097/md.0000000000006406] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
To determine the efficacy of the treat and extend (TAE) protocol with intravitreal bevacizumab (IVB) for managing diabetic macular edema (DME).Retrospective, single-center study.For this retrospective study, 42 eyes of 42 patients were initially treated with 3 consecutive monthly IVB injections (loading phase), after which they were selected for different additional therapies. For the TAE protocol, the baseline treatment interval was selected to be 8 weeks and was sequentially lengthened by 2 weeks if the central macular thickness (CMT) was <300 μm at 2 consecutive examinations.Among the 42 eyes, 8 eyes (19.0%) received the TAE treatment for 2 years. The BCVA was improved significantly from 0.37 ± 0.04 before treatment to 0.19 ± 0.04 logMAR units at 2 years after the TAE determined IVB injections (P < .05). The ratio of eyes with a gain of the BCVA by more than 2 lines was 37.5%. The CMT was significantly reduced from 515.4 ± 75.5 to 303.6 ± 45.0 μm after 2 years (P < .01). The mean number of TAE injection was 8.8 and the mean injection interval was 11.0 weeks.After the loading phase, 19.0% of patients can be treated with the TAE protocol. Although significant visual improvements were obtained after the TAE protocol, it does not apply to every DME case.
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New Developments in the Classification, Pathogenesis, Risk Factors, Natural History, and Treatment of Branch Retinal Vein Occlusion. J Ophthalmol 2017; 2017:4936924. [PMID: 28386476 PMCID: PMC5366235 DOI: 10.1155/2017/4936924] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/07/2017] [Indexed: 12/15/2022] Open
Abstract
For years, branch retinal vein occlusion is still a controversial disease in many aspects. An increasing amount of data is available regarding classification, pathogenesis, risk factors, natural history, and therapy of branch retinal vein occlusion. Some of the conclusions may even change our impression of branch retinal vein occlusion. It will be beneficial for our doctors to get a deeper understanding of this disease and improve the treatment skills. The aims of this review is to collect the information above and report new ideas especially from the past a few years.
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Rahimy E, Rayess N, Brady CJ, Regillo CD. Treat-and-Extend Regimen for Macular Edema Secondary to Central Retinal Vein Occlusion: 12-Month Results. ACTA ACUST UNITED AC 2017; 1:118-123. [DOI: 10.1016/j.oret.2016.10.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 10/26/2016] [Accepted: 10/26/2016] [Indexed: 11/26/2022]
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Reply. Retina 2016; 36:e113-e115. [DOI: 10.1097/iae.0000000000001353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Panakanti TK, Chhablani J. Clinical Trials in Branch Retinal Vein Occlusion. Middle East Afr J Ophthalmol 2016; 23:38-43. [PMID: 26957837 PMCID: PMC4759902 DOI: 10.4103/0974-9233.172294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Branch retinal vein occlusion (BRVO) is the second most common retinal vascular disorder. The management of macular edema has changed considerably over time. The laser is considered the gold standard treatment for over two decades. However, visual recovery with laser is usually slow and incomplete. The advent of intravitreal agents, specifically anti-vascular endothelial growth factors (VEGF) have heralded a new era which promises rapid recovery of vision and quality of vision. Randomized clinical trials have reported optimal results with anti-VEGF agents (ranibizumab, bevacizumab, and aflibercept) compared to laser therapy or steroids. However, nearly 50% of the patients require repeat intravitreal anti-VEGF therapy up to 4 years after initiating therapy to sustain the visual gains. The adverse events (systemic and ocular) of these agents are minimal. Monotherapy with anti-VEGF agents have been found to provide better results than any combination with laser. This review article summarizes evidence from randomized controlled trials evaluating treatment options for the treatment of macular edema secondary to BRVO with a special focus on anti-VEGF therapy.
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Affiliation(s)
| | - Jay Chhablani
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
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Oellers P, Grewal DS, Fekrat S. Role of aflibercept for macular edema following branch retinal vein occlusion: comparison of clinical trials. Clin Ophthalmol 2016; 10:411-8. [PMID: 27022238 PMCID: PMC4789836 DOI: 10.2147/opth.s98853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
For years, the standard of care for branch-retinal-vein-occlusion-associated macular edema was initial observation followed by grid-pattern laser photocoagulation for persistent edema. Newer pharmacologic options have revolutionized the management of branch-retinal-vein-occlusion-associated macular edema, and the visual outcomes of these eyes are better than ever. However, a variety of available treatment options including intravitreal corticosteroids and intravitreal anti-vascular endothelial growth factor agents have established novel challenges with regard to appropriate drug selection. This review summarizes the available clinical studies with special emphasis on the comparison of intravitreal aflibercept with ranibizumab, bevacizumab, and steroid agents.
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Affiliation(s)
- Patrick Oellers
- Duke Eye Center, Duke University Medical Center, Durham, NC, USA; Surgical Service, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Dilraj S Grewal
- Duke Eye Center, Duke University Medical Center, Durham, NC, USA; Surgical Service, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Sharon Fekrat
- Duke Eye Center, Duke University Medical Center, Durham, NC, USA; Surgical Service, Durham Veterans Affairs Medical Center, Durham, NC, USA
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21
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Călugăru D, Călugăru M. Letter to the Editor: Treat-and-Extend Intravitreal Bevacizumab for Branch Retinal Vein Occlusion. Ophthalmic Surg Lasers Imaging Retina 2015; 46:994. [DOI: 10.3928/23258160-20151027-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | - Mihai Călugăru
- Department of Ophthalmology, University of Medicine Cluj-Napoca/Romania
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