Efficacy of intravitreal aflibercept monotherapy in retinopathy of prematurity evaluated by periodic fluorescence angiography and optical coherence tomography

PURPOSE

To evaluate the efficacy of intravitreal aflibercept (IVA) in vascular and macular maturation in neonates with type 1 retinopathy of prematurity (ROP) and aggressive posterior retinopathy of prematurity (APROP).

MATERIALS AND METHODS

Thirty-six eyes of 18 patients with type 1 ROP or APROP in zone I or posterior zone II were enrolled in our study. At baseline, only fluorescein angiography (FA) was performed. After IVA injection, both FA and optical coherence tomography (OCT) were performed after 6.8 ± 0.8 (range 6-8) and 19 ± 0.9 (range 18-20) weeks to follow vascular and macular changes.

RESULTS

Both diffuse flat neovascularization with leakage and abnormal vascular branching at the small arteriolar level were detected in all eyes (100%) at baseline FA. Regression of the disease was observed in 34 eyes (94.4%) in the first week with binocular indirect ophthalmoscopy. Early unresponsiveness in remaining two eyes of an infant required an IVA re-treatment. Late reactivation was detected only in 19.4% of eyes, none of which required treatment during 12 months of follow-up. The most common feature after IVA injection was abnormal branching at capillary level, which was noted in 100% in the first post-injection FA and 50.0% of all eyes in the second FA. Meanwhile, the end limit of vascularization was observed in zone III in 83.3% of eyes. No vascular abnormality was also detected in 27.3% of eyes. The OCT examination at a mean postmenstrual age of 43.4 weeks revealed cystoid macular changes in four eyes of two infants (11.1%), normal foveal contour in 30 eyes of 15 infants (83.3%) and matured ellipsoid zone at the foveal center in 28 eyes of 14 infants (77.8%). Macular maturation was complete in all eyes in the last OCT analyses.

CONCLUSION

Intravitreal aflibercept monotherapy has been an effective treatment in type I ROP and APROP with much lower early and late re-treatment rates because of early unresponsiveness and late reactivation, respectively. In most of the eyes, rapid vascular outgrowth beyond zone III together with normal macular maturation was observed more precisely by periodic FA and OCT.

Selective Laser Trabeculoplasty vs. Fixed Combinations with Timolol in Practice: A Replacement Study in Primary Open Angle Glaucoma

OBJECTIVES

To evaluate the potential of selective laser trabeculoplasty (SLT) in two arms (360˚ vs. 180˚) as a replacement for fixed combinations (FCs) with timolol in primary open angle glaucoma over 6 months.

MATERIALS AND METHODS

Of 40 patients in a prospective, comparative, interventional case series, 18 eyes and 22 eyes were randomized to SLT 180º and SLT 360º groups, respectively, along with 40 fellow-control eyes. FC with timolol was discontinued on the day of treatment for the eye to be operated on, while ongoing therapy was not interrupted for the contralateral eye. Eyes were examined for intraocular pressure (IOP) elevation 1 hour and 1 day after SLT. The follow-up visits were then scheduled for 1 week, 1 month, 3 months, and 6 months after, during the which the IOP of both eyes and any possible complications were evaluated.

RESULTS

There were no statistically significant differences in mean IOPs through 6 months among the groups with exception of postlaser 1 hour and postlaser 1 day (p<0.001 and p=0.010, respectively). Multiple comparison analysis showed significantly higher IOP in both SLT 180º and SLT 360º subgroups compared to their controls at postlaser 1 hour (p=0.007, p<0.001) but significantly lower IOP only in SLT 360º subgroup compared to the controls at postlaser day 1 (p=0.013).

CONCLUSION

SLT offers promising potential as a substitute equivalent to efficacy of FCs with timolol. However, SLT 360˚ may not achieve additional IOP reduction.

Real-World Outcomes of Anti-VEGF Treatment for Neovascular Age-Related Macular Degeneration in Turkey: A Multicenter Retrospective Study, Bosphorus Retina Study Group Report No: 1

Objectives

To evaluate the real-world outcomes of intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment in neovascular age-related macular degeneration (nAMD) patients.

Materials and Methods

Multicenter, retrospective, interventional, non-comparative study. The records of nAMD patients treated with an anti-VEGF agent on a pro re nata treatment regimen basis between January 2013 and December 2015 were reviewed. The patients who completed a follow-up period of 12 months were included. Primary outcome measures of this study were the visit and injection numbers during the first year.

Results

Eight hundred eighty eyes of 783 patients met the inclusion criteria for the study. Mean number of visits at month 12 was 6.9±2.5 (range: 1-15). Mean number of injections at month 12 was 4.1±1.9 (range: 1-11). Mean visual acuity at baseline and months 3, 6, and 12 was 0.90±0.63 LogMAR (range: 0.0-3.0), 0.79±0.57 LogMAR (range: 0.0-3.0), 0.76±0.57 LogMAR (range: 0.0-3.0), and 0.79±0.59 LogMAR (range: 0.0-3.0), respectively. Mean central retinal thickness at baseline and months 6 and 12 was 395±153 μm (range: 91-1582), 330±115 μm (range: 99-975), and 332±114 μm (range: 106-1191), respectively.

Conclusion

The numbers of visits and injections were much lower than ideal and were insufficient with the pro re nata treatment regimen.

Comparison of two different treatment regimens' efficacy in neovascular age-related macular degeneration in Turkish population-based on real life data-Bosphorus RWE Study Group

AIM

To compare two different anti-vascular endothelial growth factor (anti-VEGF) treatment regimens'-a priori pro re nata (PRN) and PRN regimen following the loading phase-anatomical and functional results in neovascular age-related macular degeneration (nAMD) patients.

METHODS

Totally 544 nAMD patients followed and treated with aflibercept (n=135) and ranibizumab (n=409) at 9 different centers between 2013 and 2015 were enrolled into this retrospective multicenter study. Patients with initial best corrected visual acuity (BCVA) interval of 1.3-0.3 (logMAR) and a minimum follow-up of 12mo were included. Patients under two different regimens-a priori pro re nata (1+PRN) or 3 consecutive intravitreal injections followed by a PRN regimen (3+PRN)-were compared in BCVA at 3th, 6th and 12th months, and in central macular thickness (CMT) at 6th and 12th months. The total study group, intravitreal ranibizumab (IVR) and intravitreal aflibercept (IVA) groups were evaluated separately.

RESULTS

The mean CMT decreased in the 1+PRN (n=101) regimen from 407 to 358 and 340 µm and in the 3+PRN (n=443) group from 398 to 318 and finally to 310 µm at months 6 and 12, respectively. Anatomically, the CMT reduction at 6th month (48.5 vs 76.4; P<0.05) was statistically significant in favor of 3+PRN group. BCVA changed in 1+PRN group from 0.77 to 0.78, 0.75 and 0.75; in 3+PRN group from 0.81 to 0.69, 0.72, and 0.76 at months 3, 6, and 12, respectively. Visual gain was statistically better in 3+PRN group at 3th month (-0.01 vs 0.12; P<0.001). In IVR group, CMT reduction was in greater in 3+PRN at 6th (44 vs 72) and 12th month (61 vs 84), but statistically insignificant. The 3+PRN group revealed statistically better visual results at 3th month (-0.02 vs 0.11, P<0.05). In IVA group, although statistically insignificant, CMT reduction (61 vs 89, 6th month; 85 vs 97, 12th month) and visual gain (0.02 vs 0.16; 0.02 vs 0.14; 0.05 vs 0.11) was found in favor of 3+PRN group at all visits.

CONCLUSION

The loading dose of anti-VEGF treatments in nAMD leads to significantly better anatomical and functional results, regardless of the agent, specially in early follow-up interval.

Macula halo syndrome

INTRODUCTION

Niemann-Pick disease (NPD) is a hereditary lysosomal storage disorder in which mutations in the sphingomyelin phosphodiesterase gene leads to partial or complete deficiency of the sphingomyelinase enzyme. Niemann-Pick Type B is the intermediate form associated with hepatosplenomegaly, foam cells in the bone marrow, hyperlipidemia and diffuse pulmonary infiltrates, which is generally diagnosed in late adolescence. Central nervous system is not affected, and some cases may display macular halo.

CASE

A 45-year-old female seen in ophthalmology clinic for the examination of the eyes. Extraocular motility was normal bilaterally, and the visual acuity was 20/25 for both eyes. Biomicroscopic examination revealed faint corneal haze bilaterally, Circular pale granular depositions were detected in the parafoveal retina on both eyes. Optical coherence tomography (OCT) revealed thin hyperreflective band corresponding to depositions located in the parafoveolar inner retina. Microperimeter showed slight depression in retinal sensitivity, which was more pronounced particularly on perifovea rather than parafovea.

CONCLUSIONS

Challenge to identify the NPD subtype of this case is associated with phenotypic characteristics on a wider spectrum that overlap the currently described subtypes.

Can optical coherence tomography findings be related with suicide attempt in bipolar disorder?

BACKGROUND

The aim was to investigate the relationship between OCT findings and suicidal behavior (SB) in patients with Bipolar Disorder type 1 (BPD1) in comparison to healthy controls.

METHODS

Forty five euthymic BPD1 patients with previous suicide attempts (BPD1+), 46 euthymic BPD1 patients without previous suicide attempts (BPD1-) and 63 healthy controls were included. The subjects were evaluated with Sociodemographic Data Form, SCID, Suicide Behaviors Questionnaire, Beck Depression Inventory, Young Mania Rating Scale and OCT.

RESULTS

All OCT measures were lower in patients with BPD1 than healthy controls (p<0.001). While no significant differences were found between (BPD1+) and (BPD1-) in all GCC levels and inferior RNFL values (p>0.05), the superior RNFL and global RNFL values were found to be lower in the (BPD1+) than in the (BPD1-) (p = 0.037, p = 0.028, respectively). Global RNFL was found to significantly predict suicide risk in a multivariate logistic regression model (p = 0.024 Exp(B):0.930).

CONCLUSIONS

Neurodegeneration might occur during the course of BPD1 and SB. Decreased RNFL may be important for neurodegeneration related to SB.

Results of anti-VEGF treatment for neovascular AMD in eyes with different baseline visual acuity in Turkish population-based on real life data-Bosphorus Retina Study Group

BACKGROUND

To investigate the anatomical and visual outcomes of the patients with neovascular age-related macular degeneration (nAMD) treated with anti-vascular endothelial growth factor (anti-VEGF), according to the baseline best-corrected visual acuity (BCVA) based on the multicenter real-life data.

METHODS

Five-hundred-ninety patients who had taken the Pro Re Nata (PRN) treatment regimen with three loading doses and at least one year of follow-up were included. The patients were divided into three groups according to the baseline BCVA: Group 1 (BCVA ≥1.3 Logmar), Group 2 (1.3 Logmar > BCVA ≥0.3 Logmar), and Group 3 (BCVA ≤0.2 Logmar). BCVA, central macular thickness (CMT), and the number of injections and visits were evaluated.

RESULTS

There were 175, 322, and 93 patients in Group 1, Group 2, and Group 3, respectively. The number of visits and injections in the 1st year was not different between the groups (p = 0.58 and p = 0.08) and was 7.09 and 4.41 (Group 1), 6.59 and 5.58 (Group 2), 6.77 and 4.08 (Group 3). There was a significant difference in CMT between the baseline and 12^th month in Group 1 and Group 2 (p<0.001, p<0.001, respectively) but not in Group 3 (p = 0.84). BCVA was significantly better in the 12th month in Group 1 (p<0.001), slightly worse in Group 2 (p = 0.79), and significantly worse in Group 3 (p<0.001).

CONCLUSION

This study provides evidence that an inadequate number of injections cannot protect vision. Moreover, it can cause vision loss, especially in the eyes with good vision.