Anti-vascular Growth Factor Research Articles

A Review of Refractive Errors Post Anti-Vascular Endothelial Growth Factor Injection and Laser Photocoagulation Treatment for Retinopathy of Prematurity

Background/Objectives: The aim of this study was to examine the incidence and severity of refractive errors that occur following the treatment of retinopathy of prematurity (ROP) with anti-vascular growth factor (anti-VEGF) agents and laser photocoagulation. Methods: A review of the literature using three databases (PubMed, Embase, Medline) was performed using appropriate search terms, and the results of the relevant studies were compiled and extracted for descriptive analysis. Results: Sixty articles were identified. The cohorts in the studies were treated with either anti-VEGF monotherapy, laser photocoagulation, or a combination, with a high prevalence of myopia, ranging from 0 to 47.7%. Refractive errors of myopia, hypermetropia, astigmatism, and anisometropia were considered in infants who received ocular interventions for ROP. Conclusions: In comparison to laser photocoagulation, anti-VEGF monotherapy appears to yield lower levels of myopia and anisometropia; however, the incidence of hypermetropia and astigmatism is variable among cohort groups treated with different anti-VEGF agents.

Comparing macular thickness and visual acuity responses retinal vein occlusion versus diabetic macular edema following anti vascular endothelial growth factor therapy: A retrospective analysis

: Vascular growth factor associates Retinal vein occlusion (RVO) and Diabetic Macular Edema (DME). A retrospective analysis using database from a tertiary hospital.: The study aims to evaluate effects of anti-vascular growth factor therapy on patients Diabetic Macular Edema with and retinal vein occlusion,: This study conducted between December 2022 and June 2023 where 30 patients diagnosed with Diabetic macular edema (DME, n=15) or Retinal vein occlusion (RVO, n=15) receiving anti-VEGF were examined. This focused on changes in best corrected visual acuity, central macular thickness and predictors over a period of three months.: Retinal Vein Occlusion (RVO) patients exhibited a more significant improvement in Best Corrected Visual Acuity (BCVA) compared to Diabetic Macular Edema (DME) (25 vs. 10 letters, p = 0.006) after three months. The change in Central Macular Thickness (CMT) also favored RVO (100µm) over DME (40µm, p = 0.012). Final BCVA median was 70 for DME and 65 for RVO (p = 0.461). Considering initial BCVA and CMT, RVO predicted better visual enhancement than DME.: RVO exhibited major BCVA improvement at three months with Anti-Vascular Endothelial Growth Factor. Final vision was indistinguishable for DME and RVO. Anti VEGF stabilizes DME vision. Despite the improvement, early RVO diagnosis and treatment may enhance final vision.

Acquired vitelliform lesion: A lesser diagnosed entity

We report a case of 56-year-old female patient who came to our retina department with diminution of vision in both eyes (BE) for three years. She was treated with anti-vascular growth factor injections in BE for choroidal neovascular membrane (CNVM) at another medical facility three months back. Her best corrected visual acuity (BCVA) was 6/24, N18, and 6/9, N8 in the right and left eyes, respectively. Fundus showed vitelliform lesions and subretinal deposits in BE. We could not find any evidence of CNVM on optical coherence tomography (OCT) angiography. We made a provisional diagnosis of adult-onset foveomacular dystrophy (AOFVD). After the literature review and investigations, we made a clinical diagnosis of acquired vitelliform lesion (AVL). The lesion is usually located between the retinal pigment epithelium and photoreceptors, which may occur as an isolated entity or in conjunction with other comorbidities. Hence, it is very important to differentiate AVL from CNVM to avoid unnecessary treatment.

Perifoveal retinal thickness changes after intravitreal aflibercept injection for choroidal neovascularization in age-related macular degeneration

ObjectiveThere has been some concern that anti-vascular growth factor treatment accelerates the development of macular atrophy in eyes with neovascular age-related macular degeneration. During the treatment with aflibercept, the thickness of choroid may decrease. This may lead to photoreceptor death. The rod cells are more susceptible to atrophic changes than cones during the disease. We aimed to find any thickness changes in the perifoveal outer nuclear layer, where the highest density of rods is found, during the aflibercept intravitreal injection therapy. Materials and MethodsRetrospectively, forty-two patients who were treated for age-related macular degeneration with choroidal neovascularization were included in the study. After the first three loading doses, intravitreal injections were repeated every two months. Outer nuclear layer thicknesses were measured 2000 µm away from the center of the fovea with OCT, at a total of 20 points, located at 180 and 90°. The mean of these measurements was obtained before the treatment and 1 year after the therapy. Results were compared by using the Wilcoxon Rank Test. ResultsThe mean visual acuity was 1,11±0,287 logMAR at the beginning and increased to 0,53±0,32 LogMAR after. Perifoveal thickness was significantly reduced when compared with the thickness before the treatment (p = 0.039, p < 0.05). This result was also significantly lower than the control group thicknesses (p = 0.035, p < 0.05). ConclusionAnti-VEGFs can cause loss of phagocytic functions of RPE. The mechanism of the observed thinning of the ONL may be described as follows: VEGF emitted by the RPE normally helps to maintain the choriocapillaris. Thus, injecting an anti-VEGF intravitreally causes RPE atrophy, which leads to a decrease in the choroidal vascular index. This in turn causes first the rods, and later the cones, that are part of the outer nuclear layer, to start to die and disappear, hence the thinning of this layer. As aflibercept consists of parts of the extracellular domain of both the VEGFR1 and VEGFR2 receptors, that are held together by a human IgG1 backbone, this makes the binding of aflibercept to VEGF-A and VEGF-B stronger as compared to the binding of the previously used ranibizumab or bevacizumab (by nearly a factor 100 in the case of the most abundant isoform VEGF-A 165). Besides, aflibercept also binds very well to placental growth factor (PIGF), which is also associated with several ocular diseases.

An Ayurvedic Management of Diabetic Retinopathy - A Case Report

Diabetic retinopathy (DR) is the most frequent micro vascular complication of Diabetes mellitus. It is an eye condition that can cause vision loss and blindness. Globally the prevalence of Diabetic retinopathy among diabetic patients is estimated to be 27.0% which leads to 0.4 million blindness in the world.[1] It affects blood vessels in the retina (the light-sensitive layer of tissue in the back of the eye). It commonly affects both eyes and can lead to vision loss if it left untreated. Currently available conventional treatments (Focal laser therapy, Anti-vascular growth factor drug) for DR have certain limitations, considering which options from alternative resources are being searched. Despite advances in science the treatment of DR is challenging. So, in this case Ayurveda treatment was done.

The Responses of Different Types of Diabetic Macular Edema after Three Loading Doses of Anti-vascular Growth Factor: Outcomes in Two Medical Centers

Abstract Background: Diabetic macular edema (DME) is currently treated by anti-vascular endothelial growth factor (anti-VEGF). Aim: The aim of this study was to evaluate the effect of intravitreal anti-VEGF in different types of DME classified by optical coherence tomography (OCT). Methods: This retrospective study included 161 treatment-naive eyes (116 patients) diagnosed with DME in two tertiary medical centers, which were classified into three groups according to initial OCT finding: diffuse retinal thickening (DRT), cystoid macular edema (CME), and serous retinal detachment (SRD). All eyes received three monthly loading doses of anti-VEGF. Primary and secondary outcomes were the improvement of best-corrected visual acuity (BCVA) and the decrease of central foveal thickness (CFT) on OCT, respectively. Results: Among the three groups, there was no significant difference in baseline BCVA (P = 0.137); however, the SRD group had the thickest baseline CFT (P &lt; 0.001). After three loading doses of anti-VEGF, the BCVA of all three groups improved from baseline (DRT vs. CME vs. SRD, P = 0.0002, P &lt; 0.0001, and P &lt; 0.0001, respectively), while the SRD group seemed to have relatively better improvement among three groups although not significant (P = 0.051). The CFTs of all three groups significantly decreased from baseline (P &lt; 0.0001 in all three groups). The CFT decreased the most in the SRD group, followed by the CME group, and the least in the DRT group (P &lt; 0.001). Conclusion: Anti-VEGF therapy improved the anatomical structure and function in all types of DME; SRD responded the best.

Automated large-scale prediction of exudative AMD progression using machine-read OCT biomarkers.

Age-related Macular Degeneration (AMD) is a major cause of irreversible vision loss in individuals over 55 years old in the United States. One of the late-stage manifestations of AMD, and a major cause of vision loss, is the development of exudative macular neovascularization (MNV). Optical Coherence Tomography (OCT) is the gold standard to identify fluid at different levels within the retina. The presence of fluid is considered the hallmark to define the presence of disease activity. Anti-vascular growth factor (anti-VEGF) injections can be used to treat exudative MNV. However, given the limitations of anti-VEGF treatment, as burdensome need for frequent visits and repeated injections to sustain efficacy, limited durability of the treatment, poor or no response, there is a great interest in detecting early biomarkers associated with a higher risk for AMD progression to exudative forms in order to optimize the design of early intervention clinical trials. The annotation of structural biomarkers on optical coherence tomography (OCT) B-scans is a laborious, complex and time-consuming process, and discrepancies between human graders can introduce variability into this assessment. To address this issue, a deep-learning model (SLIVER-net) was proposed, which could identify AMD biomarkers on structural OCT volumes with high precision and without human supervision. However, the validation was performed on a small dataset, and the true predictive power of these detected biomarkers in the context of a large cohort has not been evaluated. In this retrospective cohort study, we perform the largest-scale validation of these biomarkers to date. We also assess how these features combined with other EHR data (demographics, comorbidities, etc) affect and/or improve the prediction performance relative to known factors. Our hypothesis is that these biomarkers can be identified by a machine learning algorithm without human supervision, in a way that they preserve their predictive nature. The way we test this hypothesis is by building several machine learning models utilizing these machine-read biomarkers and assessing their added predictive power. We found that not only can we show that the machine-read OCT B-scan biomarkers are predictive of AMD progression, we also observe that our proposed combined OCT and EHR data-based algorithm outperforms the state-of-the-art solution in clinically relevant metrics and provides actionable information which has the potential to improve patient care. In addition, it provides a framework for automated large-scale processing of OCT volumes, making it possible to analyze vast archives without human supervision.

Chinese Herbal Medicine Combined with Intravitreal Antivascular Growth Factor Agents in Treatment of Macular Edema Secondary to Retinal Vein Occlusion: A Systematic Review and Meta-Analysis.

Retinal vein occlusion (RVO) is the second most common retinal vascular disease in the world after diabetic retinopathy. Moreover, macular edema (ME) is the main cause of visual impairment in RVO patients. Intravitreal injection of antivascular endothelial growth factor (VEGF) agents is recommended for RVO-ME. However, repeated injections severely limit their efficacy. Chinese herbal medicine (CHM) is widely used in RVO-ME as adjuvant therapy in China. The study aims to evaluate the efficacy and safety of anti-VEGF combined with CHM for RVO-ME and to provide reliable evidence for clinical application. Seven databases were searched without language or publication status restrictions. Randomized controlled trials (RCTs) comparing anti-VEGF combined with CHM (anti-VEGF + CHM) versus anti-VEGF in participants with RVO-ME were included in this study. The "risk of bias assessment tool" of the Cochrane Handbook was applied to assess the quality of included trials, and RevMan 5.3 software was used for data analysis. A total of 10 relevant trials with 743 patients were identified. The results showed that BCVA of the anti-VEGF + CHM group significantly improved at 3 months (P < 0.00001), 6 months (P=0.008), and 12 months (P=0.01), and CMT significantly reduced at 1 month (P=0.02), 2 months (P=0.0009), 3 months (P < 0.05), 6 months (P < 0.0001), and 12 months (P < 0.00001) compared with the anti-VEGF group alone. At the same time, the anti-VEGF + CHM group has a better performance in reducing the number of injections (P < 0.05) and improving the total effective rate (P < 0.0001). However, regarding adverse events, there was no statistical difference between the two groups (P=0.09). Our results provide promising evidence that anti-VEGF therapy combined with CHM may be more beneficial to patients than anti-VEGF therapy alone. However, because of the low quality and small sample size of the included studies, more rigorous and larger-scale trials were necessary to validate our results. Registration Number. CRD42021270262.

Evaluation of a revised care plan for babies with retinopathy of prematurity during SARS-CoV-2 pandemic in India.

Purpose:To analyze the impact of a revised care plan for retinopathy of prematurity (ROP) during SARS-CoV-2 pandemic in a tertiary eye care facility in eastern India.Methods: In a retrospective study, we analyzed the medical records of babies managed for ROP during the peak of the SARS-CoV-2 pandemic, with particular reference to the challenges, and the revised strategies addressing travel restrictions for five months, from April to August 2020. The strategy included selective referral (babies with higher treatment probability), longer follow-up intervals (babies with non-alarming findings), use of locally available workforce, and teleconsultation whenever feasible.Results: In the given period, 222 babies were examined versus 624 in the preceding year (P = 0.001). The average gestational age, birth weight, and postmenstrual age at presentation were 30.4 weeks, 1.31 kg, and 37.7 weeks, respectively. The first examination was on time in 40.1% of babies but was delayed by a median of 23 days in the remaining babies. In the cohort, 56.7% of babies had any ROP, and 27.9% required treatment (versus 8.8% in the previous year; P < 0.001). The intravitreal anti–vascular growth factor (anti-VEGF) injection was more often used than in the previous year (n = 72 vs 36; P < 0.0001). The treatment outcome was comparable before and after the SARS-CoV-2 lockdown period. There was no report of health issues among the care providers attributable to ROP care.Conclusion: The revised strategy resulted in a smaller pool of babies screened but a larger proportion of babies treated for ROP. This strategy could be used more profitably in future ROP care.

The Impact of Aflibercept on Diabetic Macular Edema Patients Refractory to Ranibizumab in a Tertiary Care Eye Specialist Hospital, Saudi Arabia

PTB Reports,2021,7,3,82-85.DOI:10.5530/PTB.2021.7.14Published:December 2021Type:Research ArticleAuthors:Abdullah AlHumaidan, Sitah AlZuman, Muhammad Haris Mazhar, Arwa A AlDahash, Wejdan AlMussalam, Hassan AlDhibi, Marco Mura, Loujain AlAbbasi, and Rajiv Khandekar Author(s) affiliations:Abdullah AlHumaidan*, Pharmacy Department, King Khaled Eye Specialist Hospital, Riyadh, SAUDI ARABIA. Sitah AlZuman, Pharmacy Department, King Khaled Eye Specialist Hospital, Riyadh, SAUDI ARABIA. Muhammad Haris Mazhar, Pharmacy Department, King Khaled Eye Specialist Hospital, Riyadh, SAUDI ARABIA. Arwa A AlDahash, Pharmacy Department, King Khaled Eye Specialist Hospital, Riyadh, SAUDI ARABIA. Wejdan AlMussalam, Pharmacy Department, King Khaled Eye Specialist Hospital, Riyadh, SAUDI ARABIA. Hassan AlDhibi, Vitreo-retina Department, King Khaled Eye Specialist Hospital, Riyadh, SAUDI ARABIA. Marco Mura, Vitreo-retina Department, King Khaled Eye Specialist Hospital, Riyadh, SAUDI ARABIA. Loujain AlAbbasi, Diagnostic Imaging Department, King Khaled Eye Specialist Hospital, Riyadh, SAUDI ARABIA. Rajiv Khandekar, Research Department, King Khaled Eye Specialist Hospital, Riyadh, SAUDI ARABIA. Abstract:Aim: The purpose of this study is to see if switching from intravitreal Ranibizumab, an anti–Vascular Endothelial Growth Factor (anti-VEGF), to Aflibercept is evidence-based in the diabetic Saudi population. We compared the efficacy of three injections of the Aflibercept treatment regimen in diabetic macular edema (DME) cases refractory to Ranibizumab. Methods: In 2018, a retrospective single-arm cohort study was carried out. Cases of refractory DME were evaluated before and after three injections of Ranibizumab, as well as three Aflibercept treatment regimens. Optical Coherence Tomography (OCT) was used to investigate changes in Central Macular Thickness (CMT) (anatomic outcome). In addition, changes in the CMT and Best Corrected Visual Acuity (BCVA) (functional outcome) were assessed. Results: The cohort consisted of 74 eyes from 74 DME patients. As an anatomical indicator, the mean CMT decreased from 482±153 μ to 385.6±134.6 μ after three injections of Ranibizumab. In contrast, with Aflibercept treatment, the mean CMT decreased to 370.2±116.9 μ. The decrease in CMT was statistically significant [94.6μ (95% confidence interval (CI): 54.8; 134.3] (P 0.001). In addition, BCVA improved by two or more lines in 17 (23%) of the eyes treated with Aflibercept, remained unchanged in 40 (54%) of the eyes, and decreased in 17 (23%) of the eyes. Conclusion: The anatomic successes of both anti-VEGF (Ranibizumab and Aflibercept) treatment regimens in Saudi patients with DME are promising. The Aflibercept treatment regimen improves success in refractory DME cases, but the visual improvement appears to be limited. Keywords:Aflibercept, Anti Vascular Endothelial Growth Factors (Anti-VEGF), Diabetes., Diabetic Macular Edema (DME), Diabetic retinopathy, RanibizumabView:PDF (242.06 KB) PDF PDF Images The Best-corrected distance visual acuity in eyes with diabetic macular edema before and after anti-vascular growth factor treatment regimen.

Evaluation of vitreous cellular activity following per-operative Povidone-iodine alone and combined per-operative Povidone-iodine with topical antibiotic after Intravitreal injection of anti-vascular endothelial growth factor Bevacizumab for retinal pathologies

Abstract: Purpose: To assess the efficacy of per-operative 5% Povidone-iodine alone or in combination with post injection topical antibiotics for reducing vitreous activity in patients undergoing Intravitreal injection of anti-vascular endothelial growth factors Bevacizumab. Methods: Total of 114 enrolled patients with retinal medical pathologies requiring Intravitreal anti vascular growth factors were randomized to study group A (5% Povidone-iodine per operative on conjunctiva for 3 minutes) and group B (5% Povidone-iodine per-operative on conjunctiva for 3 minutes and post injection topical antibiotics fluroquinolone four times a day for a week) with 57 patients in each group. All Intravitreal injections were performed in operating room in a sterile manner. Vitreous activity assessed using Sun’s classification on slit lamp on first day and day 7 post Intravitreal injection of 1.25mg/0.05ml anti VEGF Bevacizumab. Collected data of group A and B was analyzed. Result: Out of 114 patients, 75 were males and 39 were females. Vitreous activity seen at day one post injection was same in both study groups while at day seven group A had increased vitreous cellular activity as compared to study group B. Both day one and day seven activity within the study groups were insignificant with p=0.244 and p=0.498 respectively. Conclusions: In both groups A and B, 5% Povidone-iodine (PI) solution shows effective prophylaxis against Endophthalmitis in Intravitreal anti VEGF injections. Post injection topical antibiotics should be avoided following Intravitreal injections of anti VEGF as it can increase microorganism resistance, virulence and add additional cost for the patients.

Inflammatory Choroidal Neovascularisation

Inflammatory choroidal neovascularization is uncommon severe sight threatening complication of uveitis, more frequent in posterior uveitis. Hypoxia, release of vascular endothelial growth factor and other mediators seem to be involved in its pathogenesis. Multimodal imaging including the recent optical coherence tomography angiography greatly aid in diagnosis and management. Management of these neovascular membranes consists of anti-vascular growth factor agents, with or without concomitant anti-inflammatory and/or corticosteroid therapy. Besides effective eradication of inflammation in uveitis, the ideal therapeutic goal should include timely detection and treatment of inflammatory CNVM, as the ultimate visual outcome would depend on the control of both

Early Visual Functional Outcomes and Morphological Responses to Anti-Vascular Growth Factor Therapy in Diabetic Macular Oedema Using Optical Coherence Tomography Angiography

PurposeDiabetic macular oedema (DME) is a vision-threatening complication of diabetic retinopathy. Spectral domain optical coherence tomography angiography (OCTA) is useful for assessing DME. We performed serial OCTA measurements before and after 3 monthly intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections to understand its relationship with best corrected visual acuity (BCVA), central macular thickness (CMT) and vascular indices.MethodsOCTA assessment consisting of 6 × 6 mm scans centred on fovea and en-face retinal angiograms were obtained. Scans were done at baseline and at 1 month following each of the 3 intravitreal injections of anti-VEGF (ranibizumab, Lucentis®).ResultsOur prospective study included 24 eyes of 24 subjects, aged 63.0 ± 5.0 years. There was a mean gain of 0.07 LogMAR (3 letters) and reduction of CMT, vessel density (VD) and perfusion density (PD) by end of 3rd month. CMT was independently associated with improvement in BCVA. There were significant reductions in FAZ area, VD and PD over 3 months from baseline.ConclusionAt three months, intravitreal anti-VEGF therapy is associated with visual function recovery in DME, with reduction in CMT being the most reliable predictor of response. OCTA shows a reduction in VD and PD respectively suggestive of reduced macular perfusion in the short term. Simultaneous reduction in FAZ size can be due to reversal of manual displacement of the retinal capillaries resulting from resolution of intraretinal oedema.

Effect of Intravitreal Anti-Vascular Growth Factor Agents With or Without Macular Photocoagulation on Diabetic Macular Edema: A Systematic Review and Meta-Analysis.

IntroductionDiabetes is a common cause of new sight loss in populations world-wide, and diabetic macular edema (DME) is a major cause of visual deficits in the diabetic populations of developed countries. We have performed a meta-analysis to evaluate whether combined treatment with anti-vascular endothelial growth factor (VEGF) injections and macular photocoagulation (MPC) is more efficacious than primary monotherapy with anti-VEGF injections in patients with DME.MethodsWe systematically searched the PubMed and Web of Science databases for studies providing sufficient information for a comparison of pre- and post-treatment of central macular thickness (CMT) and best-corrected visual acuity (BCVA) between two groups of patients with DME given interventional therapies (monotherapy with an anti-VEGF agent vs. combination therapy with an anti-VEGF agent and MPC) before January 2019. A meta-analysis was performed to summarize the results of the studies included in the systematic review.ResultsThe results of our meta-analysis indicated that post-treatment CMT was significantly lower at 3 months in DME patients receiving combination therapy with bevacizumab, a humanized anti-VEGF antibody, and MPC than in those receiving monotherapy with bevacizumab. The results also showed that post-treatment CMT was lower in DME patients given ranibizumab, an anti-VEGF agent, in combination with MPC at 6, 9 and 12 months than in those treated with ranibizumab alone. However, no significant differences were found in post-treatment BCVA at 1, 3, 6, 9 and 12 months between DME patients receiving combination therapy with an anti-VEGF agent (bevacizumab or ranibizumab) and MPC and those receiving monotherapy with an anti-VEGF agent.ConclusionIn conclusion, the results of our meta-analysis demonstrate a transiently synergistic effect of MPC on CMT when this treatment is combined with anti-VEGF agents, whereas no similar synergistic effect could be detected on the BCVA. A relatively longer follow-up was essential to be able to evaluate the long-term existence of this synergistic effect.Electronic Supplementary MaterialThe online version of this article (10.1007/s13300-019-0631-5) contains supplementary material, which is available to authorized users.

Intravitreal Ranibizumab Treatment in Macular Edema Secondary to Central Retinal Vein Occlusion

The two main complications of central retinal vein occlusion are macular edema and neovascularizations. Intravitreal anti-vascular growth factor and corticosteroid injections are the mainstays of the current treatment of central retinal vein occlusion. In this review, we aimed to summarize the clinical studies of intravitreal ranibizumab in macular edema secondary to central retinal vein occlusion.

Intravitreal Ranibizumab Treatment in Macular Edema Secondary to Central Retinal Vein Occlusion

The two main complications of central retinal vein occlusion are macular edema and neovascularizations. Intravitreal anti-vascular growth factor and corticosteroid injections are the mainstays of the current treatment of central retinal vein occlusion. In this review, we aimed to summarize the clinical studies of intravitreal ranibizumab in macular edema secondary to central retinal vein occlusion.

Intravitreal Ranibizumab Treatment in Macular Edema Secondary to Central Retinal Vein Occlusion

The two main complications of central retinal vein occlusion are macular edema and neovascularizations. Intravitreal anti-vascular growth factor and corticosteroid injections are the mainstays of the current treatment of central retinal vein occlusion. In this review, we aimed to summarize the clinical studies of intravitreal ranibizumab in macular edema secondary to central retinal vein occlusion.

An efficacy comparison of anti-vascular growth factor agents and laser photocoagulation in diabetic macular edema: a network meta-analysis incorporating individual patient-level data

BackgroundThis was an updated network meta-analysis (NMA) of anti-vascular endothelial growth factor (VEGF) agents and laser photocoagulation in patients with diabetic macular edema (DME). Unlike previous NMA that used meta-regression to account for potential confounding by systematic variation in treatment effect modifiers across studies, this update incorporated individual patient-level data (IPD) regression to provide more robust adjustment.MethodsAn updated review was conducted to identify randomised controlled trials for inclusion in a Bayesian NMA. The network included intravitreal aflibercept (IVT-AFL) 2 mg bimonthly (2q8) after 5 initial doses, ranibizumab 0.5 mg as-needed (PRN), ranibizumab 0.5 mg treat-and-extend (T&E), and laser photocoagulation. Outcomes included in the analysis were change in best-corrected visual acuity (BCVA), measured using an Early Treatment Diabetic Retinopathy Study (ETDRS) chart, and patients with ≥10 and ≥ 15 ETDRS letter gains/losses at 12 months. Analyses were performed using networks restricted to IPD-only and IPD and aggregate data with (i) no covariable adjustment, (ii) covariable adjustment for baseline BVCA assuming common interaction effects (against reference treatment), and (iii) covariable adjustments specific to each treatment comparison (restricted to IPD-only network).ResultsThirteen trials were included in the analysis. IVT-AFL 2q8 was superior to laser in all analyses. IVT-AFL 2q8 showed strong evidence of superiority (95% credible interval [CrI] did not cross null) versus ranibizumab 0.5 mg PRN for mean change in BCVA (mean difference 5.20, 95% CrI 1.90–8.52 ETDRS letters), ≥15 ETDRS letter gain (odds ratio [OR] 2.30, 95% CrI 1.12–4.20), and ≥10 ETDRS letter loss (OR 0.25, 95% CrI 0.05–0.74) (IPD and aggregate random-effects model with baseline BCVA adjustment). IVT-AFL 2q8 was not superior to ranibizumab 0.5 mg T&E for mean change in BCVA (mean difference 5.15, 95% CrI -0.26–10.61 ETDRS letters) (IPD and aggregate random-effects model).ConclusionsThis NMA, which incorporated IPD to improve analytic robustness, showed evidence of superiority of IVT-AFL 2q8 to laser and ranibizumab 0.5 mg PRN. These results were irrespective of adjustment for baseline BCVA.

Association of Acute Endophthalmitis With Intravitreal Injections of Corticosteroids or Anti–Vascular Growth Factor Agents in a Nationwide Study in France

The number of patients affected by retinal diseases treated with intravitreal injections (IVTs) has resulted in a rapidly growing number of procedures. One of the worst complications after these injections is endophthalmitis. To evaluate the incidence of acute endophthalmitis after IVTs of corticosteroids or anti-vascular endothelial growth factor (anti-VEGF) agents. This population-based cohort study included patients undergoing IVTs from January 1, 2012, through December 31, 2015, in France. Data were acquired from the French medical-administrative database (Système National d'Information Inter-Régime de l'Assurance Maladie), which collects hospitalization discharge abstracts and out-of-hospital care information for the whole country. Data were analyzed from March through July 2017. Intravitreal injections of corticosteroid or anti-VEGF agents. Incidence of acute endophthalmitis within 6 weeks after IVT by means of billing codes from a national database. During the study period, 1 811 977 IVTs of corticosteroids or anti-VEGF agents performed on 254 927 patients (60.4% female; median age, 79 years [interquartile range, 70-85 years]) were analyzed. A total of 444 acute endophthalmitis cases (crude incidence, 0.0245%) were recorded. In multivariable analysis, which did not include adjustment for when the endophthalmitis occurred during the study period, the risk of endophthalmitis was lower in male patients (incidence rate ratio [IRR], 0.78; 95% CI, 0.63-0.96; P = .02), higher for corticosteroids than for anti-VEGF agents (IRR, 3.21; 95% CI, 2.33-4.44; P < .001), and higher for nonprefilled syringes of anti-VEGF medications than prefilled syringes for ranibizumab (IRR, 1.63; 95% CI, 1.15-2.30) and aflibercept (IRR, 1.82; 95% CI, 1.25-2.66; P < .001). The findings from this study of a nationwide database appear to have confirmed the low incidence rate of acute endophthalmitis after IVTs of corticosteroids or anti-VEGF agents. Although an association may not necessarily indicate a cause and effect, the risk for acute endophthalmitis after IVTs appeared to be higher for corticosteroids compared with anti-VEGF agents, while a lower risk of endophthalmitis appeared to be found with prefilled syringes of anti-VEGF medications.

English

Introduction Many recent researches have contributed immensely in the management of retinal diseases. In this critical review, we discuss the management of retinal diseases. Conclusion Currently, age-related macular degeneration is managed primarily by anti-vascular growth factor agents. Newer reports on combination therapy may help in managing this visually debilitating condition in a better way. There are many new reports regarding the use of aflibercept and Ozurdex® (Allergan Inc., Irvine, California, USA) in the management of diabetic macular oedema and macular oedema associated with retinal vein occlusions. In the light of recent reports, retinopathy of prematurity may be often managed with bevacizumab. Introduction of ocriplasmin and Argus-II Retinal Prosthesis System (Second Sight Medical Products, Inc., Sylmar, California, USA) may offer ophthalmologists newer ways to treat some important vitreoretinal conditions.