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Zarbin MA, MacCumber MW, Karcher H, Adiguzel E, Mayhook A, LaPrise A, Bilano VL, Igwe F, Ip MS, Wykoff CC. Real-World Safety Outcomes with Brolucizumab in Neovascular Age-Related Macular Degeneration: Findings from the IRIS® Registry. Ophthalmol Ther 2024; 13:1357-1368. [PMID: 38520643 DOI: 10.1007/s40123-024-00920-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/27/2024] [Indexed: 03/25/2024] Open
Abstract
INTRODUCTION To assess real-world safety outcomes for adults with neovascular age-related macular degeneration (nAMD) treated with brolucizumab from the US-based IRIS® (Intelligent Research in Sight) Registry. METHODS In this retrospective study, 18,312 eyes (15,998 patients) treated with ≥ 1 intravitreal brolucizumab injections between 8 October 2019 (US launch date for brolucizumab) and 7 October 2021 were followed up for ≤ 2 years after first injection (index date). The study assessed the predefined incident ocular adverse events of intraocular inflammation (IOI), retinal vasculitis (RV), and retinal vascular occlusion (RO). RESULTS Overall, 614/18,312 eyes (3.4%) experienced any IOI, RV, and/or RO event. Median (interquartile range [IQR]) time to an event was 84 (42-167) days; 77.4% of events (475/614) occurred within 6 months after index date. Median (IQR) number of brolucizumab injections before an event was 2 (1-4). For eyes with an adverse event and visual acuity (VA) data (n = 406), median (IQR) change in Early Treatment of Diabetic Retinopathy Study (ETDRS) letters from pre-event VA was 0 (- 7 to + 5) at the 6-month follow-up; 50 eyes (12.3%) had a VA loss of 10 or more ETDRS letters. Risk of an event (hazard ratio [95% confidence interval]) was decreased in eyes from male patients (0.61 [0.53-0.71]), from older patients (0.83 [0.76-0.90]), from treatment-naive patients (0.51 [0.38-0.69]), and from patients who started brolucizumab in the second year after launch (0.68 [0.53-0.86] vs. first year). CONCLUSION In this large real-world brolucizumab safety study, 3.4% of eyes experienced an IOI, RV, and/or RO event. Among eyes that experienced an adverse event for which VA data were available, median ETDRS vision change was 0 letters (IQR - 7 to + 5).
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Affiliation(s)
- Marco A Zarbin
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Rutgers University, 90 Bergen Street, Room 6155, Newark, NJ, 07103, USA.
| | - Mathew W MacCumber
- Department of Ophthalmology, Rush University Medical Center, Chicago, IL, USA
- Illinois Retina Associates, Chicago, IL, USA
| | | | - Eser Adiguzel
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | | | | | - Michael S Ip
- Doheny Eye Institute, University of California, Los Angeles, CA, USA
| | - Charles C Wykoff
- Retina Consultants of Texas, Houston, TX, USA
- Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
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Sayanagi K, Hara C, Fukushima Y, Sato S, Kawasaki R, Nishida K. Three cases of macular retinal detachment exacerbated during follow-up with myopic foveoschisis around myopic choroidal neovascularization. Am J Ophthalmol Case Rep 2023; 32:101899. [PMID: 37564973 PMCID: PMC10410127 DOI: 10.1016/j.ajoc.2023.101899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/07/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023] Open
Abstract
Purpose Myopic choroidal neovascularization (CNV) and myopic traction maculopathy are major complications of pathologic myopia, and myopic foveoschisis (MF) is one of several symptoms that can be included under the general term "myopic traction maculopathy"; however, only a few cases will have MF around the myopic CNV. We report three cases with MF around myopic CNV that followed different clinical courses observed using swept-source optical coherence tomography. Observations Case 1 was a 69-year-old woman with an axial length of 29.71 mm, myopic CNV, and MF in the left eye. One month after intravitreal injection of ranibizumab (IVR), a macular retinal detachment (RD) expanded. Vitrectomy and gas tamponade were performed during month 2; the macular RD and MF resolved gradually thereafter. Case 2 was a 54-year-old man with an axial length of 30.59 mm, myopic CNV, and MF in the right eye; after IVR, a macular RD developed and gradually expanded until month 4; the RD and MF resolved spontaneously and resolved during month 8. Case 3 was a 66-year-old woman with an axial length of 28.63 mm, myopic CNV, and MF in the left eye. A macular RD expanded 1 month after a previous vitrectomy for MF; after intravitreal injection of aflibercept, the macular RD and MF resolved gradually in month 12. In all cases, the CNV was accompanied by subretinal fluid, and two of the three cases had outer lamellar holes. Conclusion and Importance The MF around the myopic CNV may lead to exacerbated MF and RD during follow-up, and the subretinal fluid caused by the CNV might facilitate MF progression. Since this condition is rare, further investigation of this entity is needed to determine appropriate management.
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Affiliation(s)
- Kaori Sayanagi
- Department of Ophthalmology, Osaka University Medical School, Osaka, Japan
| | - Chikako Hara
- Department of Ophthalmology, Osaka University Medical School, Osaka, Japan
| | - Yoko Fukushima
- Department of Ophthalmology, Osaka University Medical School, Osaka, Japan
| | - Shigeru Sato
- Department of Ophthalmology, Osaka University Medical School, Osaka, Japan
| | - Ryo Kawasaki
- Department of Ophthalmology, Osaka University Medical School, Osaka, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Medical School, Osaka, Japan
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Martínez-Castillo R, González-Gallardo C, Muñoz-Ávila JI, Font P, Villalba-González M, Stoikow I, Fernández-Choquet de Isla I, Pugliese F, Anaya-Alaminos R, García-Serrano JL, Hermoso-Fernández F, Contieri F, Muñoz-de-Escalona-Rojas JE, Pérez-Fajardo L, Blanco-Blanco M, Jiménez-Gómez Y, González-Andrades M. Treatment of neovascular age-related macular degeneration within 48 h from diagnosis improves long-term functional outcome. Biomed Pharmacother 2023; 160:114368. [PMID: 36753959 DOI: 10.1016/j.biopha.2023.114368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To evaluate long-term visual and anatomical outcomes in neovascular age-related macular degeneration (nAMD) patients treated with anti-vascular endothelial growth factor (VEGF) agents depending on the time delay from confirmed diagnosis to treatment initiation. MATERIALS AND METHODS Seventy-three nAMD patients (73 eyes) treated with anti-VEGF agents for 12 months using the pro re nata regimen were included in this retrospective longitudinal study. Patients were split into 3 groups according to the time from diagnosis to first anti-VEGF injection: < 48 h (group 1); 48 h-7 days (group 2); > 7 days (group 3). Decimal best-corrected visual acuity (VA) and macular thickness (MT) were recorded at baseline and 1-2-, 3-4-, 6- and 12-month later. Furthermore, age, gender as well as the applied treatment and number of injections after 12 months of treatment were also registered and compared. RESULTS Long-term effect of the treatment demonstrated enhanced VA in group 1 patients compared with the rest of groups after 1-2-, 6-, and 12-month follow-up (P < 0.05). Positive effects of early treatment were additionally corroborated by the augmented percentage of patients with normal VA in the group 1 respect to the rest of groups over studied time points (P < 0.05). Moreover, the VA gain in nAMD at group 1 was obtained with a mean of 3.7 intravitreal injections over 1-year follow-up period. Regarding MT, non-significant difference was observed among groups. CONCLUSIONS An early initial treatment with VEGF inhibitors is critical to achieve the best functional benefits of this therapy in new-onset nAMD patients.
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Affiliation(s)
| | | | - José I Muñoz-Ávila
- Department of Ophthalmology, San Cecilio University Hospital, 18016 Granada, Spain
| | - Pilar Font
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain; Department of Medical and Surgical Sciences, School of Medicine, University of Cordoba, 14004 Cordoba, Spain
| | - Marta Villalba-González
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain; Department of Ophthalmology, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Indira Stoikow
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain; Department of Ophthalmology, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Ignacio Fernández-Choquet de Isla
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain; Department of Ophthalmology, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Francisco Pugliese
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain; Department of Ophthalmology, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | | | | | | | - Fabio Contieri
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain; Department of Ophthalmology, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | | | - Lorena Pérez-Fajardo
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain; Department of Ophthalmology, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Mario Blanco-Blanco
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain; Department of Ophthalmology, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Yolanda Jiménez-Gómez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain; Department of Ophthalmology, Reina Sofia University Hospital, 14004 Cordoba, Spain.
| | - Miguel González-Andrades
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain; Department of Medical and Surgical Sciences, School of Medicine, University of Cordoba, 14004 Cordoba, Spain; Department of Ophthalmology, Reina Sofia University Hospital, 14004 Cordoba, Spain.
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Nakamura M, Funakoshi T, Kataoka S, Horimatsu T, Nishikawa Y, Matsubara T, Mizukami T, Goto T, Tsuchihashi K, Baba E, Tsumura T, Mihara Y, Hamaguchi T, Yanagita M, Muto M. Decision making for anti-VEGF inhibitor continuation: dip stick? or urine protein/creatinine ratio? (VERSiON UP study). BMC Cancer 2022; 22:515. [PMID: 35525917 PMCID: PMC9080145 DOI: 10.1186/s12885-022-09611-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/26/2022] [Indexed: 11/29/2022] Open
Abstract
Background Monitoring proteinuria is important for the management of patients with cancer treated with anti-vascular endothelial growth factor (VEGF) or anti-VEGF receptor (VEGFR) inhibitors (VEGF/Ri). Here we investigated the difference between the urine protein/creatinine ratio (UPCR) and a qualitative value test (QV) on the decision making of treatment continuation and the usefulness of UPCR testing in patients with gastrointestinal cancer treated with anti-VEGF/Ri. Methods From January 2017 to December 2018, a survey was conducted based on the medical records of patients with gastrointestinal cancer with a QV of ≥2+ during the use of anti-VEGF/Ri at seven Japanese institutions participating in the Onco-nephrology Consortium. The primary endpoint was the ratio of the worst UPCR < 2.0 (low UPCR) in cases with a QV2+ at the point of the first proteinuria onset. The secondary endpoints were a comparison of low UPCR and worst UPCR ≥2.0 (high UPCR), the concordance rate between UPCR and QV in the Common Terminology Criteria for Adverse Events (CTCAE) grading, and the differences in the decision making for anti-VEGF/Ri continuation. Results Among the 71 patients enrolled, the proportion of low UPCR in onset QV2+ (n = 53) was 66% (n = 35). In a comparison between low (n = 36) and high UPCR cases (n = 24), body weight (P = 0.036), onset QV status (P = 0.0134), and worst QV status (P < 0.0001) were significantly associated with UPCR levels. The concordance rate for CTCAE Grade 2 of both the QV and UPCR was 83%. Regarding the judgment of anti-VEGF/Ri continuation, treatment was continued in 42.4% of cases when the QV became 3+, whereas only 25% continued treatment when the UPCR value became high. Conclusion Urine dipstick test results may overestimate proteinuria, and the UPCR result tended to be more critical than the QV when deciding the treatment policy. Trial registration This study is a multiple institutional retrospectively registered observational trial. Clinical Trial number: University Hospital Medical Information Network (UMIN) Clinical Trials Registry (protocol ID UMIN000042545). Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09611-3.
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Affiliation(s)
- Michio Nakamura
- Department of Gastroenterology, Sapporo City General Hospital, 1-1, Kita 11-jo Nishi 13-chome, Chuo-ku, Sapporo, 060-8648, Japan.
| | - Taro Funakoshi
- Department of Clinical Oncology, Kyoto University Hospital, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shigeki Kataoka
- Department of Clinical Oncology, Kyoto University Hospital, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takahiro Horimatsu
- Department of Clinical Oncology, Kyoto University Hospital, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshitaka Nishikawa
- Department of Health Informatics, Kyoto University School of Public Health, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Takeshi Matsubara
- Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takuro Mizukami
- Department of Clinical Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan
| | - Tomoyuki Goto
- Department of Gastroenterology, Shiga General Hospital, 4-30, Moriyama-5-chome, Moriyama, 524-8524, Japan
| | - Kenji Tsuchihashi
- Department of Hematology, Oncology & Cardiovascular Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Eishi Baba
- Department of Oncology and Social Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takehiko Tsumura
- Department of Medical Oncology, Osaka Red Cross Hospital, 5-30 Fudegasakicho, Tennoji-ku, Osaka, 543-8555, Japan
| | - Yoshiaki Mihara
- Department of Medical Oncology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, 350-1298, Japan
| | - Tetsuya Hamaguchi
- Department of Medical Oncology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, 350-1298, Japan
| | - Motoko Yanagita
- Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Manabu Muto
- Department of Clinical Oncology, Kyoto University Hospital, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Hikichi T. Sub-Tenon's capsule triamcinolone acetonide injection to prevent brolucizumab-associated intraocular inflammation. Graefes Arch Clin Exp Ophthalmol 2022. [PMID: 35235038 DOI: 10.1007/s00417-022-05611-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 02/14/2022] [Accepted: 02/22/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To investigate the efficacy of sub-Tenon's capsule triamcinolone acetonide (STTA) injections for preventing development of intraocular inflammation (IOI) related to intravitreal injection (IVI) of brolucizumab for neovascular age-related macular degeneration (nAMD). METHODS Consecutive patients with nAMD treated with brolucizumab IVIs were studied retrospectively. All eyes treated with brolucizumab in the clinic were switched from another anti-vascular endothelial growth factor agent. After the fourth case of IOI related to brolucizumab IVI, all eyes treated with brolucizumab received a STTA injection. The patients were divided into two groups: brolucizumab alone and brolucizumab combined with a STTA injection. RESULTS Forty-four eyes (44 patients) treated with at least one brolucizumab IVI were studied: 14 eyes received brolucizumab IVI alone and 30 eyes received the combination therapy. IOI related to brolucizumab IVIs developed in four (28.6%) of 14 eyes in the brolucizumab group; IOI was severe in one eye, moderate in two eyes, and mild in one eye according to the HAWK and HARRIER trial definition; IOI did not develop in the 30 eyes that received combination therapy, the difference of which reached significance (p = 0.012). Regarding combination therapy, the intraocular pressure in three (10%) eyes increased to 22 to about 26 mmHg after the STTA injection and returned to normal range within 2 months without medication; no cataracts developed during this short mean follow-up period follow-up period of 7.1 ± 0.4 months. CONCLUSION The results indicated the possible preventative effect of a STTA injection on development of brolucizumab-associated IOI.
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Kato A, Yasukawa T, Sugita I, Yoshida M, Nozaki M, Hirano Y, Kondo J, Abe T, Sugita K, Okita T, Morita H, Takase N, Ogura Y. Mental Status and Feasibility of an Intravitreal Ranibizumab Treat-and-Extend Regimen in Patients with Neovascular Age-Related Macular Degeneration. Adv Ther 2022; 39:1403-1416. [PMID: 35112307 DOI: 10.1007/s12325-022-02052-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Anti-vascular endothelial growth factor (VEGF) therapy is the first-choice treatment for neovascular age-related macular degeneration (nvAMD); however, patients often are burdened physically, financially, and mentally. We investigated the relationship between mental status and feasibility of an intravitreal ranibizumab treat-and-extend (TAE) regimen for nvAMD. METHODS In this prospective, multicenter study, 75 patients with nvAMD received ranibizumab intravitreally in a TAE regimen. After two monthly injections, the injection intervals were extended step-by-step to 6, 8, 12, and 16 weeks in eyes with dry maculas on optical coherence tomography (OCT) and, if exudation persisted or relapsed, shortened by one step. The best corrected visual acuity (BCVA) measurement and OCT were performed at baseline and on the same days of the scheduled injections. At baseline, all patients completed a survey, the Hospital Anxiety and Depression Scale (HADS), regarding mental burden. At week 52, patients on the TAE regimen for 1 year completed the HADS and a questionnaire designated to assess treatment-associated mental status. RESULTS Fifty-one patients (68%) completed the 1-year TAE regimen; 24 eyes (32%) discontinued the TAE regimen because of the rescue treatment, difficulty in completing clinical visits, or financial burden. In 51 eyes on the TAE regimen for 1 year, the mean BCVAs improved from 64.3 letters at baseline to 71.6 letters at week 52. The mean anxiety and depression scores on HADS decreased significantly (p < 0.01) after the 1-year treatment. Women tended to have higher anxiety scores, possibly associated with fear of injection and recurrence, while some men had higher depression scores potentially associated with financial burden, difficulty in completing clinical visits, and subsequent interruption of the TAE regimen especially in eyes with low treatment efficacy. CONCLUSIONS A TAE regimen of intravitreal ranibizumab injections preserves vision in eyes with nvAMD and reduces mental burden associated with disease relapse. TRIAL REGISTRATION This clinical study was registered retrospectively on December 22, 2014 with the ClinicalTrials.gov identifier NCT02321839.
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Affiliation(s)
- Aki Kato
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
| | - Tsutomu Yasukawa
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | - Munenori Yoshida
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Miho Nozaki
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshio Hirano
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | | | | | | | - Hiroshi Morita
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Noriaki Takase
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuichiro Ogura
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Hikichi T. Three Japanese cases of intraocular inflammation after intravitreal brolucizumab injections in one clinic. Jpn J Ophthalmol 2021; 65:208-214. [PMID: 33543351 DOI: 10.1007/s10384-021-00819-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/07/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To report the development of intraocular inflammation (IOI) in three Japanese patients in the same clinic after intravitreal injections (IVI) of brolucizumab to treat neovascular age-related macular degeneration. CASES REPORTS The major findings were: (1) all three eyes had a history of treatment with multiple anti-vascular endothelial growth factor (VEGF) agents; (2) the time to the onset of IOI after the first IVI of brolucizumab varied, i.e., onset occurred after the first IVI in two cases and after the second IVI in one case; (3) the degree of vitreous opacities resulting from the IOI varied among the three cases and directly affected the degree of the decrease in the visual acuity (VA) and the timing of the VA recovery; (4) an injection of triamcinolone acetonide into the sub-Tenon's capsule (STTA) resulted in resolution of the IOI and improvement of the VA; and (5) the sheathed retinal vessels indicating vasculitis improved associated with reduction of the IOI after STTA. COMMENTS Although all three cases responded well to the injection of triamcinolone acetonide into the sub-Tenon's capsule, physicians should fully disclose to patients both the potential for this adverse effect, especially those patients with a history of anti-VEGF therapy, and the benefits of therapy with brolucizumab. Immediate steroid therapy is recommended to possibly reduce deterioration of the visual function caused by persistent IOI.
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Affiliation(s)
- Taiichi Hikichi
- Hikichi Eye Clinic, Kita-7 Nishi-5 7-1 Kita-Sky-Building, 14 Floor, Kita-ku, Sapporo, 060-0807, Japan.
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Yata N, Yasukawa T, Kawamura M, Hirano Y, Ogura Y. Macular hole and serous pigment epithelial detachment in bilateral acquired vitelliform lesions. Am J Ophthalmol Case Rep 2020; 18:100628. [PMID: 32140615 PMCID: PMC7049591 DOI: 10.1016/j.ajoc.2020.100628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/16/2019] [Accepted: 02/21/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose Acquired vitelliform lesions (AVLs) are associated with age-related macular degeneration and other variable macular disorders. AVLs often lead to outer retinal atrophy, sometimes accompanying a macular hole and choroidal neovascularization. The purpose of this study was to report a rare case with bilateral AVLs, in which one eye had accompanied a macular hole and the second eye a serous pigment epithelial detachment (sPED). Observations A 66-year-old woman complained of bilateral metamorphopsia. AVLs were observed in the right eye and a flat sPED in the left eye. The best-corrected visual acuity (BCVA) was 20/17 in both eyes. Fluorescein angiography revealed local leakage in the right eye and pattern dystrophy-like hypofluorescence in both eyes. The sPED progressed with AVLs in the left eye and was treated with a combination therapy of intravitreal aflibercept, a sub-Tenon's injection of triamcinolone acetonide, and photodynamic therapy (IVA/STTA/PDT), which successfully flattened the sPED and sustained good vision for 4 years. The right eye was treated with intravitreal ranibizumab and tissue plasminogen activator, which enhanced absorption of the vitelliform material. However, 14 months later, a macular hole with typical metamorphopsia formed above a subretinal fibrotic scar at the vitelliruptive stage. Although pars plana vitrectomy closed the macular hole, enlargement of the outer retinal atrophy worsened the BCVA to 20/100. Conclusions and importance We successfully treated one eye with a sPED with AVLs using the combination therapy of IVA/STTA/PDT, while the second eye with a macular hole secondary to AVLs ultimately developed outer retinal atrophy with visual loss.
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Affiliation(s)
- Nana Yata
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tsutomu Yasukawa
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Mihoko Kawamura
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshio Hirano
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuichiro Ogura
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Yang J, Yuan M, Wang E, Xia S, Chen Y. Five-year real-world outcomes of anti-vascular endothelial growth factor monotherapy versus combination therapy for polypoidal choroidal vasculopathy in a Chinese population: a retrospective study. BMC Ophthalmol 2019; 19:237. [PMID: 31752769 PMCID: PMC6873695 DOI: 10.1186/s12886-019-1245-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/07/2019] [Indexed: 01/05/2023] Open
Abstract
Background To evaluate 5-year outcomes of anti-vascular endothelial growth factor (VEGF) monotherapy and combination therapy of anti-VEGF agents and photodynamic therapy (PDT) for polypoidal choroidal vasculopathy (PCV) in a real-world Chinese population. Methods Retrospective study. Fifty-three eyes of 46 patients with subtype 1 and 2 PCV followed up for at least 60 months were grouped into three regimens: anti-VEGF monotherapy, PDT combining with anti-VEGF therapy initially, and PDT combining with deferred anti-VEGF therapy. Main outcome measure was best-corrected visual acuity (BCVA) using logarithm of minimal angle of resolution (logMAR). Results The mean BCVA of eyes with subtype 1 PCV (n = 28) deteriorated from 0.69 logMAR at baseline to 1.25 logMAR at months 60 (P = 0.001), while the mean BCVA of eyes with subtype 2 PCV (n = 25) sustained stable from 0.62 logMAR at baseline to 0.57 at months 60 (P = 0.654). No significant differences of visual outcomes were found between the 3 treatment regimens for subtype 1 PCV. Anti-VEGF monotherapy and initial combination treatment had better visual outcomes in eyes with subtype 2 PCV than deferred combination group during part of follow-up significantly. Initial combination group needed a less number of PDT than deferred combination group (P < 0.001). Conclusions Compared with subtype 1 PCV, subtype 2 PCV has a more favorable visual outcome in real world. All the regimens presented unfavorable visual outcomes for subtype 1 PCV. Anti-VEGF monotherapy and initial combination therapy should be superior to deferred combination therapy in the long-term management of subtype 2 PCV. Prospective randomized studies of larger size are needed to determine the long-term efficacy and safety of various treatment for PCV in real world.
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Affiliation(s)
- Jingyuan Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingzhen Yuan
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Erqian Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Song Xia
- Department of Ophthalmology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China. .,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China.
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10
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Lee EK, Yu HG. Outcomes of Anti-vascular Endothelial Growth Factor Treatment for Foveal Serous Retinal Detachment Associated with Inferior Staphyloma. Korean J Ophthalmol 2019; 33:228-237. [PMID: 31179654 PMCID: PMC6557795 DOI: 10.3341/kjo.2018.0125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/04/2019] [Accepted: 01/12/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the efficacy of anti-vascular endothelial growth factor (VEGF) treatment of eyes with foveal serous retinal detachment (SRD) associated with inferior staphyloma and to investigate choroidal thickness changes following anti-VEGF therapy. METHODS In this observational case series, eyes with inferior staphyloma accompanied by foveal SRD were treated with a single intravitreal anti-VEGF injection, followed by further injections as needed. Changes in height and width of subretinal fluid (SRF) and visual acuity after treatment were assessed. Choroidal thickness was measured at the subfovea, 1.5 mm superior and inferior to the fovea using enhanced depth imaging optical coherence tomography at baseline and 1 month after initial anti-VEGF therapy. RESULTS Six eyes from six patients were included. One month after the initial injection, the mean SRF height and width had decreased significantly from 112.5 ± 40.1 to 44.5 ± 48.7 μm (p = 0.046) and from 1,401.8 ± 627.3 to 690.7 ± 634.7 μm (p = 0.028), respectively. Mean choroidal thickness at the superior point decreased from 218.7 ± 59.3 to 200.5 ± 61.0 μm (p = 0.046). SRF resolved completely in three of the six eyes (50%) with a mean of 6.8 ± 5.9 injections (range, 1 to 15). All eyes experienced at least one recurrence of exudation, at a mean interval of 4.8 months. Mean visual acuity improvement was 0.17 logarithm of the minimum angle of resolution units at a mean of 28.7 months follow-up. CONCLUSIONS Anti-VEGF therapy resulted in an SRF decrease and modest visual improvement in eyes with foveal SRD associated with inferior staphyloma. Reduction in superior choroidal thickness appeared to contribute to the clinical improvements that were observed.
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Affiliation(s)
- Eun Kyoung Lee
- Department of Ophthalmology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea.,Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeong Gon Yu
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
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11
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Farinha C, Martins A, Neves A, Soares R, Ruão M, Ornelas M, Neves P, Gomes Rodrigues F, Coelho C, Silva R. Ranibizumab for the Treatment of Diabetic Macular Oedema in the Real-World Clinical Setting in Portugal: A Multicentre Study. Ophthalmologica 2018; 241:1-8. [PMID: 29886497 DOI: 10.1159/000489046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/09/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the 2-year outcome of ranibizumab for diabetic macular oedema (DME) in the real-life clinical practice of five ophthalmology departments of the National Health Service (NHS) in Portugal. METHODS This is a retrospective multicentre study. The clinical records on consecutive patients with DME from clinical practice treated with 0.5 mg intravitreal ranibizumab and followed up for 24 months were reviewed. Efficacy outcomes comprised the change in best corrected visual acuity (BCVA) and central macular thickness (CMT) evaluated by SD-OCT. Multivariate regression analysis was performed to explore predictors of BCVA. RESULTS A total of 122 eyes of 93 patients were included. The median BCVA change by 24 months was +5.0 letters (IQR 12.0) (p < 0.001) and the CMT change was -89.0 µm (IQR 165.0) (p < 0.001). By 24 months, 21.4% of the eyes had gained ≥15 letters and 8.6% had lost ≥15 letters. The median number of injections given during follow-up was 5.0 (IQR 4.0). A greater baseline CMT and a more disrupted status of the external limiting membrane were predictive of worse BCVA at 24 months (p ≤ 0.015). CONCLUSION DME treatment with ranibizumab in the Portuguese NHS is associated with anatomic and functional improvement by 2 years; however, our results are below those reported in major clinical trials, and undertreatment is probably the cause.
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Affiliation(s)
- Cláudia Farinha
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, .,Association for Innovation and Biomedical Research on Light and Image, Coimbra, .,Faculty of Medicine, University of Coimbra, Coimbra,
| | - Amélia Martins
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - Arminda Neves
- Serviço de Oftalmologia, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Raquel Soares
- Serviço de Oftalmologia, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Miguel Ruão
- Serviço de Oftalmologia, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Mário Ornelas
- Serviço de Oftalmologia, Centro Hospitalar de Setúbal, EPE, Setúbal, Portugal
| | - Pedro Neves
- Serviço de Oftalmologia, Centro Hospitalar de Setúbal, EPE, Setúbal, Portugal
| | | | - Constança Coelho
- Laboratório de Genética/Instituto de Saúde Ambiental, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Rufino Silva
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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12
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García-Layana A, Figueroa MS, Arias L, Adán A, Cabrera F, Abraldes M, Fernández-Vega Á, Navarro R, Cervera E, Silva R, Armadá F, Donate J, Ruiz-Moreno JM. Clinical Decision-Making when Treating Diabetic Macular Edema Patients with Dexamethasone Intravitreal Implants. Ophthalmologica 2018; 240:61-72. [PMID: 29617689 DOI: 10.1159/000486800] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/10/2018] [Indexed: 12/17/2022]
Abstract
Diabetes mellitus (DM) is a metabolic disease frequently associated with comorbidities that include diabetic macular edema (DME). The current medical approach to treating DME involves intravitreal injections with either anti-vascular endothelial growth factors or steroids. However, the burden associated with intravitreal injections and DM-derived complications is high, underlining the need to find optimal treatment regimens. In this article we describe the considerations we apply when treating DME patients with dexamethasone intravitreal implants (Ozurdex®), particularly those that influence the clinical decision-making process during the follow-up period. These considerations are based both on the available medical literature and on our clinical experience following the use of these implants in this type of patient, the goal being to optimize the number of injections and the clinical outcome of this therapy. We also provide a general overview of the pathophysiology of DME, highlighting the inflammatory component as a rationale to use steroids in these patients.
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Affiliation(s)
| | - Marta S Figueroa
- Hospital Universitario Ramón y Cajal, Vissum Corp., Madrid, Spain
| | | | | | - Francisco Cabrera
- Complejo Hospitalario Universitario Insular Materno-lnfantil de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Maximino Abraldes
- Complexo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Instituto Oftalmológico Gómez-Ulla, Santiago de Compostela, Spain
| | | | | | - Enrique Cervera
- Hospital General de Valencia, Universidad de Valencia, Valencia, Spain
| | - Rufino Silva
- Department of Ophthalmology, Centro Hospitalar e Universitario de Coimbra (CHUC), Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Institute for Biomedical Imaging and Life Sciences (FMUC-IBILI), Coimbra, Portugal.,Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | | | | | - José Maria Ruiz-Moreno
- Universidad de Castilla La Mancha, Albacete, Spain.,Hospital Universitario Puerta de Hierro-Majadahonda, Vissum Corp., Madrid, Spain
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13
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Kang HM, Koh HJ, Lee SC. Baseline polyp size as a potential predictive factor for recurrence of polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol 2015; 254:1519-1527. [PMID: 26686373 DOI: 10.1007/s00417-015-3241-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 11/17/2015] [Accepted: 12/01/2015] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To investigate the predictive factors for recurrence of polypoidal choroidal vasculopathy (PCV). METHODS The medical records of 78 consecutive patients (78 eyes) with treatment-naïve PCV who responded to first-line treatment and completed at least a 3-year follow-up after the first remission were retrospectively analyzed. In this comparative cohort study, baseline characteristics were compared between the patients who had at least one recurrence (the recurrence group) and those without recurrence (the non-recurrence group) during at least 3-year follow-up periods. In addition, possible predictive factors for recurrence of PCV were investigated by using Cox regression analysis. RESULTS Within 3 years of the first remission, 50 eyes (64 %) showed at least one recurrence (mean 1.5; 1 to ∼2 times). There were no significant differences in the baseline characteristics between the recurrence group and the non-recurrence group. However, the largest polyp diameter was significantly different: the mean largest polyp diameter (524 ± 340 μm) was significantly larger in the recurrence group compared to that of the non-recurrence group (352 ± 173 μm; P = 0.038). Cox regression analysis showed that the largest polyp diameter at baseline significantly correlated with recurrence of PCV (B = 1.470, P = 0.015). CONCLUSIONS The largest polyp diameter at baseline may be predictive for PCV recurrence, as it was significantly larger in patients who had at least one recurrence.
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Affiliation(s)
- Hae Min Kang
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, 120-752, Republic of Korea.,Department of Ophthalmology, Catholic Kwandong Universtiy College of Medicine, International St. Mary's Hospital, Incheon, Republic of Korea
| | - Hyoung Jun Koh
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, 120-752, Republic of Korea
| | - Sung Chul Lee
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, 120-752, Republic of Korea.
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Nishimura T, Furihata M, Kubo H, Tani M, Agawa S, Setoyama R, Toyoda T. Intracranial hemorrhage in patients treated with bevacizumab: Report of two cases. World J Gastroenterol 2011; 17:4440-4. [PMID: 22110272 PMCID: PMC3218160 DOI: 10.3748/wjg.v17.i39.4440] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 03/29/2011] [Accepted: 04/05/2011] [Indexed: 02/06/2023] Open
Abstract
Treatment with bevacizumab, an antiangiogenic agent, in patients with metastatic or unresectable colorectal cancer was approved less than 4 years ago in Japan. Bevacizumab improves the survival of patients with metastatic colorectal cancer; however, it may lead to complications such as bleeding, which are sometimes fatal. Bevacizumab should be administered only after careful consideration because the potential risks of therapy outweigh its benefits. Therefore, pharmaceutical companies do not recommend bevacizumab therapy for patients with brain metastases. While some reports support the cautious use of bevacizumab, others report that it is not always necessary to prohibit its use in patients with metastases to the central nervous system (CNS), including the brain. Thus, bevacizumab therapy in colorectal cancer patients with brain metastases is controversial, and it is unclear whether brain metastases are a risk factor for intracranial hemorrhage during anti-vascular endothelial growth factor (VEGF) therapy. We report a 64-year-old man and a 65-year-old man with recurrent colorectal cancer without brain metastases; these patients developed multifocal and solitary intracranial hemorrhage, respectively, after the administration of bevacizumab. Our findings suggest that intracranial hemorrhage can occur even if the patient does not have brain metastases prior to bevacizumab treatment and also suggest that brain metastases are not a risk factor for intracranial hemorrhage with bevacizumab treatment. These findings also question the necessity of excluding patients with brain metastases from clinical trials on anti-VEGF therapy.
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