Anti-vascular Endothelial Growth Factor Injections Research Articles

Association between the response of intravitreal antivascular endothelial growth factor injection and systemic factors of diabetic macular edema

BackgroundThis study investigated the effects of systemic factors in response to intravitreal injections in patients with macular edema due to non-proliferative diabetic retinopathy (NPDR).MethodsWe retrospectively reviewed the medical records of patients treated with intravitreal injections for macular edema secondary to NPDR between January 2018 and January 2021. The patients were divided into three groups according to the injection response. When patients with diabetic macular edema showed 20µ or more reduction in central retinal thickness compared to baseline, they were classified as responsive group, and if not, they were classified as refractory group. The responsive group was further divided into the complete and incomplete response groups. Patients with complete disappearance of edema at seven months were classified as the complete response group, whereas those in which edema did not disappear were classified as the incomplete response group. The clinical characteristics of each group, including medical history, ophthalmic examination results, and laboratory examination results at the time of diagnosis, were analyzed.ResultsOf the 112 eyes (91 patients) that satisfied the inclusion criteria, 89 (77 patients) in the responsive group and 23 (14 patients) in the refractory group were included in the analysis. The responsive group was further divided into the complete (51 eyes) and incomplete (38 eyes) response groups. The refractory group had significantly higher glycated hemoglobin levels and significantly lower estimated glomerular filtration rates than the responsive group (p = 0.026 and p = 0.012, respectively). In the multivariate logistic regression analysis, both factors were found to be significant in predicting the degree of response (all p < 0.05). No factor showed a significant difference between the incomplete and complete response groups(all p > 0.05).ConclusionsIn macular edema caused by NPDR, low glomerular filtration rates and high glycated hemoglobin levels may be used as predictors of poor response to intravitreal injection therapy. In addition to blood glucose control, education should be provided regarding the need for the continuous monitoring of renal function.

Central Retinal Vein Occlusion in COVID-19

Abstract Central retinal vein occlusion (CRVO) secondary to severe acute respiratory syndrome coronavirus 2–induced coagulation abnormalities is rare. A 32-year-old man presented with bilateral CRVO. He had a history of retinal migraine with occasional floaters and received 2 primary and a booster dose of the BNT162b2 vaccine 7 months prior. Four months before presentation, he developed acute blurring of vision in the left eye and was diagnosed with a nonischemic CRVO with dot-blot hemorrhages. He was managed conservatively with aspirin. Three weeks later, he contracted COVID-19 and received 5 days of nirmatrelvir/ritonavir. Four weeks after his COVID infection, repeat fundoscopic evaluation demonstrated resolving hemorrhages in the left eye but a new CRVO in the right eye. Antivascular endothelial growth factor injections were deferred because of normal visual acuity. He had a normal magnetic resonance imaging of the brain and a normal bilateral carotid duplex and was planned for close follow-up with ophthalmology. COVID-19 patients presenting with visual symptoms should be screened for CRVO.

CENTRAL BOUQUET HEMORRHAGE: Clinical and Multimodal Imaging Features.

To describe the clinical characteristics, multimodal imaging features, and anatomic basis of a distinctive pattern of deep retinal hemorrhages located in the central fovea, a presentation referred to as "central bouquet hemorrhage." Retrospective, observational, multicenter case series of eyes with central bouquet hemorrhage. Multimodal imaging features were reviewed and analyzed. Ten eyes from 10 patients (4 women and 6 men), with a mean age of 55.6 ± 21.7 years (range 25-84 years) were included. Underlying etiologies were neovascular age-related macular degeneration (40%), lacquer cracks in pathological myopia (30%), macular telangiectasia Type 2 (10%), proliferative diabetic retinopathy (10%), and ocular trauma associated with angioid streaks (10%). On ophthalmoscopy, all eyes with central bouquet hemorrhage displayed a deep retinal hemorrhage with round margins in the central fovea and associated with petaloid hemorrhages radiating in the surrounding Henle fiber layer. Cross-sectional optical coherence tomography showed a well-delineated round hyperreflective lesion involving the central foveal Henle fiber layer/outer nuclear layer in all cases. Accompanying hyperreflective hemorrhages tracking along the obliquely oriented Henle fiber layer were present in all eyes. Resolution occurred in all patients, either spontaneously (30%) or after treatment with intravitreal anti-vascular endothelial growth factor injections (70%), and was associated with partial visual acuity improvement (from 20/113 to 20/36). "Central bouquet hemorrhage" is a novel descriptive term describing a characteristic round pattern of intraretinal blood in the fovea associated with Henle fiber layer hemorrhage and encountered in a spectrum of macular disease.

Quantifying Fluid and Function in Suboptimal Responders Switched From an Anti-vascular Endothelial Growth Factor (VEGF) to Faricimab.

Background Anti-vascular endothelial growth factor (VEGF) injections have been successful in reducing vision loss from neovascular age-related macular degeneration, a leading cause of blindness. Due to the high treatment burden and suboptimal responses, switching to bi-specific faricimab treatment may lead to improved outcomes. Methods This retrospective chart review evaluated if suboptimal responders to anti-VEGF injections had better outcomes when switched to faricimab. Suboptimal responders were defined as patients with a history of >3 months of injections and the presence of fluid after ≥3 injections. The primary endpoints were best-corrected visual acuity, treatment interval, and fluid levels. Visual acuity measurements and optical coherence tomography were performed before each injection. The total fluid area (TFA) was measured using MATLAB 2023a (MathWorks, Natick, MA, USA). Results Nineteen eyes were included in the analysis. After three faricimab injections, average letters increased from 54.5 to 59.0 (SD: 15.3; p<0.05), and the injection interval was extended from 7.6 to 9.3 weeks (SD: 3.9; p<0.01) after four injections. Patients also experienced anatomical retinal changes, with a reduction in the TFA to 47.3% (p<0.005) after the second injection and a reduction in pigment epithelial detachment height to 82.3% (p<0.005) after one injection. The central subfield thickness was significantly reduced after the second injection (90.6% (SD: 17.6%)p<0.05). Conclusion Switching to faricimab after a suboptimal anti-VEGF response results in improvements in visual acuity, reduced treatment burden, and reduced fluid levels.

Prediction of neovascular age-related macular degeneration recurrence using optical coherence tomography images with a deep neural network

Neovascular age-related macular degeneration (nAMD) can result in blindness if left untreated, and patients often require repeated anti-vascular endothelial growth factor injections. Although, the treat-and-extend method is becoming popular to reduce vision loss attributed to recurrence, it may pose a risk of overtreatment. This study aimed to develop a deep learning model based on DenseNet201 to predict nAMD recurrence within 3 months after confirming dry-up 1 month following three loading injections in treatment-naïve patients. A dataset of 1076 spectral domain optical coherence tomography (OCT) images from 269 patients diagnosed with nAMD was used. The performance of the model was compared with that of 6 ophthalmologists, using 100 randomly selected samples. The DenseNet201-based model achieved 53.0% accuracy in predicting nAMD recurrence using a single pre-injection image and 60.2% accuracy after viewing all the images immediately after the 1st, 2nd, and 3rd injections. The model outperformed experienced ophthalmologists, with an average accuracy of 52.17% using a single pre-injection image and 53.3% after examining four images before and after three loading injections. In conclusion, the artificial intelligence model demonstrated a promising ability to predict nAMD recurrence using OCT images and outperformed experienced ophthalmologists. These findings suggest that deep learning models can assist in nAMD recurrence prediction, thus improving patient outcomes and optimizing treatment strategies.

Real-world effects of anti-vascular endothelial growth factor injection frequency on visual outcomes in patients with diabetic macular oedema.

Anti-vascular endothelial growth factor (VEGF) injections are often administered less frequently in real-world treatment of diabetic macular oedema (DMO) than what was studied in clinical trials. This study aims to characterise real-world DMO treatment patterns and the effect of treatment intervals on patient outcomes. This was a retrospective study of 291 patients with DMO treated with anti-VEGF therapy. 12- and 24-month best visual acuity (BVA) and central subfield thickness (CST) were compared between injection interval groups, which were determined by averaging the two most recent injection intervals. Multiple linear regressions were performed to identify factors associated with injection interval, BVA, and CST. 48.8% of patients received injections less than or equal to every 8 weeks (≤ q8w), 27.5% between every 8 to 12 weeks (q8-12w), and 23.7% greater than every 12 weeks (> q12w). Baseline CST was similar (p = 0.32), but BVA differed significantly in q8-12w patients (p = 0.0095). BVA and CST at 12 months were similar, but q8-12w patients experienced greater 12-month BVA improvement (7.36 ± 12.4 letters) than > q12w patients (1.26 ± 12.3 letters; p = 0.0056). 24-month BVA and CST changes were similar between groups (p = 0.30 and 0.87). Baseline BVA, HbA1c, and sex were associated with 12-month BVA, and baseline BVA and CST were associated with 12-month CST. Many patients experienced improvements in BVA and CST over 12 months of treatment despite receiving less frequent anti-VEGF therapy than recommended in the pivotal trials. The present study showed that extended treatment intervals with bevacizumab were effective in preserving vision of many individuals with high baseline BVA.

Ixabepilone related angiographically silent macular edema

Ixabepilone related angiographically silent macular edema

Severe Recurrence and Retinal Inflammatory Infiltration After Cessation of Immunosuppression for Multifocal Choroiditis and Panuveitis.

To describe a severe recurrence of intraocular inflammation following the cessation of immunosuppression, previously administered for multifocal choroiditis and panuveitis (MCP). Retrospective chart review. A 27-year-old woman with MCP initially was treated with intravenous and oral corticosteroids and photodynamic therapy because of an active macular neovascularization in both eyes. Mycophenolate was soon started and the recurrences during tapering of the oral corticosteroids in the first months were treated with periocular corticosteroids and anti-vascular endothelial growth factor injections as they became available. After a decade of immunosuppression without recurrences, the patient, having relocated, discontinued mycophenolate upon the advice of a new ophthalmologist who diagnosed her with punctate inner choroidopathy. This led to a severe recurrence in both eyes, characterized by new inflammatory lesions, ellipsoid zone loss, and widespread inflammatory cell infiltration into the outer retina. Intravitreal triamcinolone injections resulted in the resolution of sub- and intraretinal inflammatory lesions and ellipsoid zone defects. The abrupt discontinuation of immunosuppression in a patient with MCP was associated with a rebound phenomenon, characterized by multi-level inflammatory activity in the posterior pole. This rebound phenomenon may offer clues as to the inflammatory targets in MCP.

Incidence of Blepharoptosis Following Intravitreal Anti-Vascular Endothelial Growth Factor Injections

PurposeWe aimed to determine the incidence of blepharoptosis following intravitreal anti-vascular endothelial growth factor (VEGF) injections and compare the rates of blepharoptosis between patients injected with an eyelid speculum and those injected without a speculum. DesignRetrospective cohort study MethodsInternational Classification of Diseases (ICD-10) was used to identify patients with exudative age-related macular degeneration (AMD) and those who developed ptosis following intravitreal injections. Patients with nonexudative AMD who did not receive intravitreal injections served as control. The outcomes were the incidence of ptosis in the injection group compared to the non-injection group and incidence of ptosis in patients whose injections were performed with an eyelid speculum as compared to those whose injections were performed without specula. ResultsWe recruited 1,100 exudative AMD patients who received at least one intravitreal anti-VEGF injection and 2,258 nonexudative AMD patients who had not received an injection. In the injection group, 18 out of 1100 patients (1.6%) developed ptosis, compared to 52 out of 2258 patients (2.3%) in the non-injection group (p=0.25). Within the injection group, ptosis was mostly bilateral, diagnosed on average 22.4 months following the initial injection, and following more than a one-year injection-free period. 11 out of 537 patients (2.0%) injected without a speculum developed ptosis, compared to 8 out of 444 patients (1.8%) injected with a speculum (p= 0.82). ConclusionsNo statistically significant differences in incidence rates of ptosis were observed. In this analysis, neither intravitreal anti-VEGF injections nor speculum use during injections appears to increase the risk of ptosis.

METHOD OF POVIDONE-IODINE APPLICATION AND ENDOPHTHALMITIS RISK.

To evaluate the proportion of patients developing endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents according to the mode of povidone-iodine (PI) antisepsis. A retrospective review of the anti-vascular endothelial growth factor injections given in a 7-year period at a community-based retinal practice. Endophthalmitis was diagnosed to have occurred if an eye developed intraocular inflammation and was given antibiotics with or without supportive culture identification of an organism. As part of their habitual clinical practice, component physicians used 5% PI as two drops, one drop, or just a dot of PI administered with a cotton-tipped applicator to the site before injection. There were 113,610 intravitreal injections administered and 23 cases were diagnosed with endophthalmitis over the 7-year period, for a rate of 1 case per 4,940 injections. The mode of PI antisepsis showed no significant relation to the rate of endophthalmitis ( P = 0.55, chi-square test). The proportion of endophthalmitis by physician demonstrated no significant difference ( P = 0.39, chi-square test). The use of PI has been associated with decreased incidence of endophthalmitis, but the mode of application has not been standardized. The results of this study suggest that "more is not better" in PI antisepsis in endophthalmitis. Moreover, the toxicity of PI on the ocular surface is known to be dose-related.

Widefield, Swept-Source Optical Coherence Tomography Angiography Metrics as Predictors of Anti-VEGF Treatment in Retinal Vein Occlusions.

Our objective was to assess baseline widefield swept-source optical coherence tomography angiography (WF SSOCTA) microvascular metrics as predictors for the number of anti-vascular endothelial growth factor (VEGF) injections and visual acuity (VA) at 12-months follow-up in patients with retinal vein occlusion (RVO). This was a prospective study including 49 RVO eyes from 49 patients who had not received an anti-VEGF injection for at least 3 months prior to imaging. Microvascular metrics from 6×6-mm and 12×12-mm angiograms were assessed using linear regression models, adjusting for age. Reductions in the vessel density (VD) and vessel skeletonized density (VSD) vascular metrics were associated both with a higher number of anti-VEGF injections at all follow-up time points and reduced VA 12 months after imaging in all RVO eyes. WF SS-OCTA VD and VSD micro-vascular metrics at baseline can prognosticate VA and number of anti-VEGF injections required at 3, 6, and 12 months in RVO eyes. [Ophthalmic Surg Lasers Imaging Retina 2024;55:xx-xx.].

Outcomes of intravitreal anti-VEGF injections and panretinal photocoagulation in preretinal hemorrhage secondary to proliferative diabetic retinopathy involving the fovea.

To evaluate the outcome of intravitreal anti-vascular endothelial growth factor (VEGF) injections and panretinal photocoagulation (PRP) in fovea involving preretinal hemorrhage (PRH) secondary to proliferative diabetic retinopathy (PDR). Retrospective non-comparative cross-sectional series of patients diagnosed with fovea involving PRH secondary to PDR at our institute from March 2019 to October 2021 who were treated with combination treatments of intravitreal anti-VEGF and PRP and have completed a minimum 6-month follow-up. The primary outcome measure was serial changes in the visual acuity (VA) and PRH regression from the fovea. Secondary outcome measures were the quantitative assessment of the size of PRH, its association with VA improvement and time to regression, and the proportion of patients who underwent surgery for poor response. In total, 22 eyes of 21 patients showed regression of PRH from the foveal center at 33.6 days, and complete regression was seen at 140.7 days. The average number of anti-VEGF injections required for clearance of PRH from the fovea was 1.6. Mean LogMAR visual acuity improved from 0.54 at baseline to 0.32 at 4 weeks and 0.18 at 6 months ( P < 0.01). Three eyes (13.6%) required vitrectomy surgery during follow-up. The mean area of PRH as measured by Image J analysis was 14.78 mm 2 at baseline, 8.97 mm 2 at 4 weeks, and 1.25 mm 2 at 3 months ( P < 0.01). No statistically significant difference was seen between the size of PRH and PRH clearance time and VA improvement. No systemic side effects were observed following the intravitreal injections during follow-up. Intravitreal anti-VEGF injections and PRP were found to be effective and safe treatment methods for fovea involving PRH secondary to PDR. Long-term studies are warranted to assess the long-term efficacy.

Disease quiescence in endophthalmitis patients treated with anti-VEGF injections for retinal pathologies

BackgroundThe most feared complication of intravitreal injections is the development of endophthalmitis, which could lead to irreversible visual loss. The aim of this study was to characterize the clinical profiles, causative pathogens, and clinical outcome of patients post-endophthalmitis.MethodsRetrospective, single center case series study. Clinical records, causative pathogens and management of all cases of endophthalmitis post intravitreal anti-vascular endothelial growth factor (VEGF) injections recorded between January 1st, 2006 and May 30th, 2022; were retrieved. The visual and anatomic changes prior to the episode of endophthalmitis and up to 2 years post-treatment were compared.ResultsEleven post-injection endophthalmitis eyes of 10 patients (n = 3 females; 30%) were recruited at mean age of 64.5 ± 20.4 years. The median last recorded BCVA, up to 3 months prior to the episode of endophthalmitis was 60 (Interquartile range (IQR) 55–75) ETDRS letters. Then, it dropped to 30 (IQR 0-57.5), 35 (IQR 0-52.5) and 35 (IQR 0-57.5) ETDRS letters at presentation, 6- and 12-months follow-up; respectively (p = 0.027, p = 0.017 and p = 0.012). However, at 24 months, the median BCVA returned to similar baseline values prior to the episode of endophthalmitis; BCVA 50 (IQR 0–60) ETDRS letters, p = 0.062. Interestingly, two eyes with neovascular age-related macular degeneration (NVAMD), 1 with myopic choroidal neovascularization (CNV) and 1 with retinal vein occlusion (RVO), experienced disease quiescence and did not require additional anti-VEGF injections up to 2 years of follow-up.ConclusionThis study demonstrates long-term recovery of vision loss due to endophthalmitis post anti-VEGF injections, regained up to 2 years later. It also indicates that disease quiescence post endophthalmitis may not only occur in eyes treated for NVAMD, but also with myopic CNV and RVO.

Subjective Visual Floaters after Intravitreal Injection and Effect of the Inverse Tapping Technique

Purpose: To analyze the incidence of vitreous floaters after intravitreal antivascular endothelial growth factor injection and the effectiveness of the inverse tapping technique, which involves tapping the syringe with the needle downwards to prevent the entry of air bubbles during injection.Methods: The study enrolled patients undergoing their first intravitreal injection for exudative age-related macular degeneration or diabetic macular edema. The patients were divided into two groups: those who received an injection after inverse tapping (IT group) and controls who received the injection without tapping. Patients who consented to the study were randomly assigned to the IT group and the control group through block randomization. One week after injection, a questionnaire was used to assess the presence of vitreous floaters; those who reported them were examined via optical coherence tomography and wide fundus photography.Results: Of the 39 patients in the IT group, two (5.1%) reported floaters 1 week after injection. By contrast, eight (20.5%) of the 39 controls reported them, with a significant difference (&lt;i&gt;p&lt;/i&gt; = 0.042). Patients with floaters were significantly younger. Posterior vitreous detachment, as evaluated by pre-injection optical coherence tomography, was observed in 10.0% of those with floaters and 76.5% of those without them.Conclusions: The occurrence of vitreous floaters after intravitreal injection is related to age and the presence of posterior vitreous detachment. The use of the inverse tapping technique may help reduce these after intravitreal injection.

Injection Frequency and Differences in Visual Outcomes based on Diagnosis Year in Neovascular Age-related Macular Degeneration

Purpose: To evaluate the changes in injection frequency based on the diagnosis year in neovascular age-related macular degeneration (AMD) and the differences in visual outcomes associated with these changes.Methods: This retrospective study included 667 patients (667 eyes) diagnosed with treatment-naïve neovascular AMD and polypoidal choroidal vasculopathy in 2013, 2015, 2017, and 2019. The number of anti-vascular endothelial growth factor (VEGF) injections and degree of changes in visual acuity during the first 24 months after diagnosis were compared among the 4 years.Results: The 2013, 2015, 2017, and 2019 groups had a mean of 5.7 ± 2.7, 6.0 ± 2.8, 6.6 ± 3.0, and 6.9 ± 3.3 anti-VEGF injections, respectively. The number of injections was significantly higher in 2019 than in 2013 and 2015 (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). The mean degree of visual change during the 24-month follow-up period was 0.07 ± 0.55, 0.01 ± 0.51, 0.08 ± 0.50, and 0.04 ± 0.48 in 2013, 2015, 2017, and 2019, respectively. There was a significant difference in the degree of visual change among the four groups (&lt;i&gt;p&lt;/i&gt; = 0.020).Conclusions: Patients diagnosed more recently tend to receive more injections and have better visual outcomes. We speculate that more injections contributed to these results. This trend should be considered when predicting the future socioeconomic burden of neovascular AMD.

PEDIATRIC BLEPHAROKERATOCONJUNCTIVITIS WITH DESCEMETOCELE AND CORNEAL NEOVASCULARIZATION : A CASE REPORT

Introduction : Blepharokeratoconjunctivitis is a chronic and recurrent inflammatory eyelid disorder that is commonly associated with secondary conjunctival and corneal involvement that is frequently underdiagnosed in children. The objective is to report a descemetocele and corneal neovascularization as severe complications of blepharokeratoconjunctivitis in children.&#x0D; Case Illustration : A five years old girl complained blackish lump in the right eye since a month ago. She also had a whitish spot in her eye since a year ago with redness, glare and watery. Three years ago she had a lump in the right eyelid and eye redness intermittently that was getting better with eye drop and history of allergy of house dust mites. Visual acuity (VA) in right eye was hand movement. Anterior segment of the right eye showed telangiectasis of palpebra, hyperemic conjunctiva, with neovascularization of entire surface of the cornea, descemetocele, leucoma and corneal thinning around descemetocele. We injected subconjunctival anti-vascular endothelial growth factor (VEGF) injection then we performed amniotic membrane transplantation. Follow-up 2 months post surgery we found VA was 2 m counting finger and the corneal neovascularization was reduced.&#x0D; Discussion : This case represents severe blepharokeratoconjunctivitis can cause some complications, from this patient we found corneal neovascularization and descemetocele. Anti-VEGF injection was to inhibit new blood formation in the patient’s cornea and the amniotic membrane transplantation was to manage the descemetocele.&#x0D; Conclusion : Pediatric blepharokeratoconjunctivitis and the complications associated with its treatment can be sight threatening. Early recognition of this disease entity and adequate management may arrest the disease process and may minimize visual morbidity.

Retinal vein occlusions before and during the COVID-19 pandemic. Visual outcomes and treatment patterns in a country with no mandatory lockdown.

To investigate the incidence, treatment patterns and visual outcomes in patients with branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO) before and during the COVID-19 pandemic in a country with no mandatory lockdown. This retrospective study included 788 patients presenting with a retinal vein occlusion (RVO) during 2019-2022 at St. Erik Eye Hospital. The control group and study groups consisted of patients presenting before and during the pandemic respectively. The incidence of diagnosed RVO cases decreased from 281 patients before the pandemic to 236 patients during the first year of the pandemic (p<0.05). In BRVO patients at the end of follow-up, the best-corrected visual acuity (BCVA) improved 10.3 letters (95% CI 7.6-12.9) in the control group compared to 14.3 letters (95% CI 12.6-16.0) in the study groups (p<0.05). In CRVO patients the BCVA improved 6.3 letters (95% CI 2.7-10.0) in the control group compared to 8.6 letters (95% CI 5.7-11.4) in the study groups (p=NS). Overall, the number of intravitreal anti-vascular endothelial growth factor (VEGF) injections increased from 7.0 (95% CI 6.6-7.3) in the control group to 7.6 (95% CI 7.4-7.8) in the study groups (p<0.05). Good visual and anatomical outcomes were sustained, and the number of intravitreal anti-VEGF injections increased significantly in RVO patients during the COVID-19 pandemic.

LONG-TERM USE OF ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.

Although pivotal trials have demonstrated efficacy of anti-vascular endothelial growth factor therapy in neovascular age-related macular degeneration, there is a paucity of clinical data about the long-term (>5 years) treatment. Retrospective analysis of all patients with neovascular age-related macular degeneration who were actively treated, had received >40 anti-vascular endothelial growth factor injections, and were followed for ≥5 years. Snellen-corrected visual acuity, initial drug choice, and times elapsed between treatments were collected. Rates of endophthalmitis and outcomes of submacular hemorrhage were also evaluated. A total of 88 patients (162 eyes) met the inclusion criteria: the average patient age was 86.3 years with an average follow-up period of 7.6 years. The average total number of injections per eye was 69 (18.0 SD); a total of 11,208 injections were given throughout the study period, and 6 cases (0.05%) of endophthalmitis were observed. Overall, there was a clinical and statistical difference in average Snellen-corrected visual acuity at Injections #2,#3, #4, #5, #6, #10, and #20, as compared with baseline ( P = 0.03, P < 0.01, P = 0.02, P < 0.01, P = 0.01, P = 0.01, P < 0.01, respectively). Patients in the Snellen-corrected visual acuity subgroup 20/20 to 20/40 maintained vision until injection #30. Seven eyes experienced a visually significant submacular hemorrhage. This neovascular age-related macular degeneration cohort received on average eight anti-vascular endothelial growth factor injections per year for approximately 8 years; eyes with good (≥20/40) initial baseline vision maintained their visual acuity, whereas those with worse Snellen-corrected visual acuity (≤20/50) had a robust initial improvement that diminished with time. Most patients were maintained on the same initial drug of choice and the rate of endophthalmitis was low.

AGE-RELATED MACULAR DEGENERATION INJECTION FREQUENCY: Effects of Distance Traveled and Travel Support.

Although efficacious, intravitreal anti-vascular endothelial growth factor therapy regimens for neovascular age-related macular degeneration can prove difficult for patients to adhere to because of high cost and burden of transportation. Analysis of electronic health record data from the San Francisco Veterans Administration Medical Center eye clinic (January 1, 2010 to December 31, 2019) was performed, extracting demographic data, anti-vascular endothelial growth factor injection history, and enrollment in the SFVA travel benefit program. Two-tailed P -values were calculated for Poisson regression examining average number of injections per year as the outcome and distance traveled as the primary predictor. Travel benefit was evaluated as a modifying effect on the distance-injection relationship. Three hundred and eighteen patients who received intravitreal injection for treatment of neovascular age-related macular degeneration were included in the analysis. Median (interquartile range) distance to clinic was 31.5 miles (7.4-69.4 miles). Driving distance in miles was inversely associated with average number of injections per year. Among all 318 patients, for every additional 100 miles a patient lived from our clinic, the patient received on average 2.5 fewer injections per year ( distance = -0.0025, P < 0.001), but this was not the case for patients with travel benefits ( distance = -0.0011, P = 0.362). The greater the distance from a patient's eye clinic, the lower the average number of injections per year. However, travel benefits mitigated this relationship, highlighting opportunities for improving patient's adherence through assistance programs.

Do intravitreal anti-VEGF injections have an effect on corneal endothelial remodeling in children with premature retinopathy?

This study was carried out to investigate the effects of retinopathy of prematurity (ROP) and intravitreal antivascular endothelial growth factor (VEGF) injections on the corneal endothelium in the childhood period of patients who have had ROP. The material of comparative case-control clinical study consisted of patients followed up with ROP between February 2013 and February 2023. The eyes in the study group were divided into two subgroups consisting of those who received intravitreal anti-VEGF injections (subgroup 1) and those who were followed up only (subgroup 2). Central corneal endothelial cell density (ECD), coefficient of variation (CV), central corneal thickness (CCT), and pleomorphism parameters in the childhood period were evaluated by corneal specular microscopy and compared with age-matched healthy control subjects. There were 84 eyes of 42 patients with ROP in the study group and 80 eyes of 40 healthy children in the control group. Mean CCT was significantly higher in subgroup 1 and the control group than in subgroup 2 (p = 0.037), and mean ECD was significantly higher in subgroup 2 than in subgroup 1 and the control group (p < 0.001). There was no significant difference between subgroup 1 and the control group in mean ECD and CCT values (p = 1.000 for both cases). Considering that ROP patients who received intravitreal anti-VEGF injections had more advanced-stage ROP than ROP patients who were followed up only, these findings suggest that intravitreal anti-VEGF applications in ROP cases may lead to corneal endothelial parameters similar to those of healthy eyes.