Reduction In Central Retinal Thickness Research Articles

From pro-re-nata to fixed-interval regimen: evolving real-world treatment paradigms in anti-VEGF therapy for neovascular AMD.

To evaluate the impact of evolving treatment paradigms for neovascular age-related macular degeneration (nAMD) by comparing outcomes between two patient cohorts treated with different anti-vascular endothelial growth factor (anti-VEGF) regimens over a decade apart. This retrospective cohort study included 200 treatment-naive nAMD patients divided into two cohorts. Cohort 1 (2009-2010) was treated with a pro re nata (PRN) regimen, involving three initial monthly injections followed by as-needed treatments based on monthly monitoring. Cohort 2 (2019-2021) received a fixed-interval regimen, consisting of three initial monthly injections followed by bimonthly maintenance doses. Primary outcomes included changes in best corrected visual acuity (BCVA) and central retinal thickness (CRT) at 12 months. Secondary outcomes included the number of injections, follow-up visits, and adherence to treatment schedules. Cohort 2 demonstrated significantly greater improvement in BCVA (+5.5 vs -2.0 ETDRS letters, p < 0.001) and CRT reduction (-101.7 vs -26.5 μm, p < 0.001) compared to Cohort 1. Patients in Cohort 2 received more injections (7.7 vs 4.8, p < 0.001) but required fewer monitoring visits (3.2 vs 5.1, p < 0.001). Adherence to treatment schedules was markedly higher in Cohort 2 (78% vs 0%, p < 0.001). The transition from a PRN to a fixed-interval anti-VEGF regimen significantly improved visual and anatomical outcomes in nAMD patients. Fixed-interval regimens not only enhanced treatment efficacy but also optimized resource utilization, suggesting a superior approach for managing nAMD in a real-world clinical setting.

Short-term Outcomes of Ranibizumab Biosimilar CKD-701 Treatment in Macular Edema Secondary to Retinal Vein Occlusion

Purpose: To evaluate the short-term outcomes of intravitreal injection therapy using the ranibizumab biosimilar CKD-701 in macular edema due to retinal vein occlusion.Methods: We conducted a retrospective analysis of medical records from patients diagnosed with macular edema secondary to retinal vein occlusion who received intravitreal injections of CKD-701. The best-corrected visual acuity (BCVA) and central retinal thickness (CRT) before and after a single injection were compared. Additionally, differences in these indicators were assessed between central and branch retinal vein occlusion (CRVO/BRVO).Results: The study included 22 subjects, with 17 cases of BRVO and 5 cases of CRVO. The efficacy was evaluated at 6.0 ± 2.2 weeks after injection. CRT decreased significantly from 534.8 ± 224.9 µm before injection to 367.8 ± 162.7 µm after injection (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). The logarithm of the minimum angle of resolution BCVA improved significantly from 0.58 ± 0.41 to 0.48 ± 0.37 after injection (&lt;i&gt;p&lt;/i&gt; = 0.002). The CRVO group showed a greater reduction in CRT compared to the BRVO group (&lt;i&gt;p&lt;/i&gt; = 0.006).Conclusions: A single injection of CKD-701 significantly improved both functional and anatomical outcomes in patients with macular edema secondary to retinal vein occlusion. Additional long-term studies are needed.

Clinical Outcomes Following a Switch of Therapy to Faricimab in Patients Affected by Neovascular Age-Related Macular Degeneration.

Objectives: In this study, we evaluated clinical outcomes following a therapy switch to Faricimab, in a patient cohort affected by neovascular age-related macular degeneration (nAMD), having received prior intravitreal anti-VEGF therapy. Methods: A retrospective investigation, including 28 eyes of 23 patients, treated for nAMD at the University Medical Center Mainz, Germany was performed. A switch in therapy to Faricimab was conducted, due to an inadequate response to the previous anti-VEGF treatment. Visual acuity (VA), central retinal thickness (CRT), and axial pigment epithelial detachment (PED) height were analyzed, following the first (FU 1) and second (FU 2) Faricimab injection series. Further, a subgroup analysis was conducted to compare Faricimab responders and diminished responders, as well as an exploratory data analyses to evaluate potential influencing factors on VA and CRT changes. Results: The mean age of patients was 82 years, with an average prior anti-VEGF treatment duration of 4.4 years and an average of 33 prior injections. Following Faricimab, at FU 1, significant reductions in CRT (from 335.8 µm to 260.0 µm, p < 0.01) and axial PED height (from 177 µm to 116 µm, p < 0.01) were observed. At FU 2, anatomical improvements were stable. No significant improvements in VA were observed, with LogMAR remaining stable at FU 1 and FU 2. In the subgroup comparison, eight eyes fulfilled the responder criteria, exhibiting morphological and functional improvements following intravitreal Faricimab. Further, a bigger baseline CRT correlated with a bigger post-treatment CRT and a longer prior treatment duration, and a worse baseline VA correlated with a worse post-Faricimab VA. No adverse events were noted following the switch to Faricimab. Conclusions: Following a switch to Faricimab, significant anatomical improvements were observed, while VA remained stable. Baseline CRT, prior treatment duration, and baseline LogMAR were associated with clinical outcomes post the switch to Faricimab. Further investigations into long-term outcomes are necessary to evaluate the sustained efficacy of Faricimab.

Intravitreal anti‐vegf agents and combination treatment in proliferative diabetic retinopathy

Proliferative diabetic retinopathy (PDR) poses as a significant threat to patient's vision if untreated or treated insufficiently. Panretinal photocoagulation (PRP) has long been a mainstay treatment for this condition. The advent of anti‐VEGF therapy provided an additional option for the management of this condition. The aim of the presentation is to present the effects of anti VEGF treatment in PDR with special emphasis on the combination: PRP with anti‐VEGF therapy. Results of treatment with these modalities, especially regression of neovascularization, together with the incidence of potential complications will be discussed. Additional aspects of such therapy, such as BCVA improvement and central retinal thickness reduction will also be presented. Potential indications for such treatment will be outlined as well as possible treatment schedules for such management.

Evaluating brolucizumab in neovascular AMD: Clinical outcomes from a tertiary care eye hospital

Aims/Purpose: To present real‐world clinical data on the effectiveness of brolucizumab in managing neovascular age‐related macular degeneration (nAMD), either as primary therapy or as switch therapy, in a tertiary care eye hospital in London.Methods: This research involved 37 eyes diagnosed with nAMD, all of which received intravitreal injections of brolucizumab. The main metrics assessed were changes in best corrected visual acuity (BCVA) and central retinal thickness (CRT) by optical coherence tomography (OCT), as well as the incidence of serious ocular adverse events. Additional evaluations included intraretinal fluid (IRF), subretinal fluid (SRF), subretinal hyperreflective material (SHRM), pigment epithelial detachments (PEDs), hyperreflective foci (HF), macular atrophy, and retinal pigment epithelial tears. The patients are classified into: patients not previously treated (Naïve) and patients treated with other anti‐VEGF agents.Results: The average BCVA for all patients after treatment was 0.47 ± 0.33 LogMAR, compared to a baseline of 0.50 ± 0.28 LogMAR (p = 0.372). Treatment‐naïve patients showed a non‐significant improvement in BCVA (p = 0.116). Both treatment‐naïve patients and the entire cohort exhibited a statistically significant reduction in mean CRT following the injections. Most patients showed enhancements in OCT findings, notably in the resolution of IRF, SRF, SHRM, and PEDs. Four eyes developed ocular adverse events, specifically intraocular inflammation.Conclusions: While brolucizumab did not lead to a significant improvement in BCVA, it effectively reduced CRT in both the overall study group and in treatment‐naïve nAMD patients. The study identified intraocular inflammation as a noteworthy adverse event related to brolucizumab. Therefore, careful patient selection, education, and diligent monitoring of inflammation are essential for those receiving this therapy.

Evaluating brolucizumab in neovascular AMD: Clinical outcomes from a tertiary care eye hospital

Aims/Purpose: To present real‐world clinical data on the effectiveness of brolucizumab in managing neovascular age‐related macular degeneration (nAMD), either as primary therapy or as switch therapy, in a tertiary care eye hospital in London.Methods: This research involved 37 eyes diagnosed with nAMD, all of which received intravitreal injections of brolucizumab. The main metrics assessed were changes in best corrected visual acuity (BCVA) and central retinal thickness (CRT) by optical coherence tomography (OCT), as well as the incidence of serious ocular adverse events. Additional evaluations included intraretinal fluid (IRF), subretinal fluid (SRF), subretinal hyperreflective material (SHRM), pigment epithelial detachments (PEDs), hyperreflective foci (HF), macular atrophy, and retinal pigment epithelial tears.The patients are classified into: patients not previously treated (Naïve) and patients treated with other anti‐VEGF agents.Results: The average BCVA for all patients after treatment was 0.47 ± 0.33 LogMAR, compared to a baseline of 0.50 ± 0.28 LogMAR (p = 0.372). Treatment‐naïve patients showed a non‐significant improvement in BCVA (p = 0.116). Both treatment‐naïve patients and the entire cohort exhibited a statistically significant reduction in mean CRT following the injections. Most patients showed enhancements in OCT findings, notably in the resolution of IRF, SRF, SHRM, and PEDs. Four eyes developed ocular adverse events, specifically intraocular inflammation.Conclusions: While brolucizumab did not lead to a significant improvement in BCVA, it effectively reduced CRT in both the overall study group and in treatment‐naïve nAMD patients. The study identified intraocular inflammation as a noteworthy adverse event related to brolucizumab. Therefore, careful patient selection, education, and diligent monitoring of inflammation are essential for those receiving this therapy.

Idiopathic epiretinal membrane surgery with internal limiting membrane peeling: An optical coherence tomography angiography analysis of macular capillary plexus changes.

This study aims to assess retinal vascular changes following internal limiting membrane (ILM) peeling for idiopathic epiretinal membrane (ERM) treatment using optical coherence tomography angiography (OCT-A). A retrospective study was conducted. A cohort of thirty-nine patients was enlisted for this study. Each participant underwent comprehensive ophthalmological evaluation and OCT-A imaging at baseline, as well as at 1-month and 6-month intervals post-pars plana vitrectomy with ERM and ILM peeling. Post-surgery, remarkable improvements were observed in best-corrected visual acuity (BCVA) (from 0.335 ± 0.173 to 0.096 ± 0.126 at 6 months), coupled with a notable reduction in central retinal thickness (CRT) (from 460 ± 87 µm to 395 ± 53 µm at 6 months). Additionally, there was a noticeable expansion in the foveal avascular zone (FAZ) perimeter (from 0.099 ± 0.060 mm² to 0.125 ± 0.056 mm² at 6 months). However, there was a decline in vessel density (VD) in the superficial capillary plexus (SCP) (from 46.7 ± 4.4 to 43.8 ± 3.5% at 6 months), contrasted by an elevation in the deep capillary plexus (DCP) (from 45.2 ± 5.5% to 43.6 ± 5.3% at 6 months. Noteworthy correlations were detected between CRT and BCVA, as well as CRT and vascular parameters. ERM instigates a milieu of changes including SCP crowding and elevation, potentially leading to a falsely augmented density at OCT-A in affected patients. Subsequent surgery results in a release of ERM-induced forces, elucidating the observed decrease in SCP density. Conversely, the DCP appears to be less distorted by the ERM, facilitating gradual vessel reopening after its removal. OCTA provides valuable insights into optimal surgical timing.

Enhancing anti-vascular endothelial growth factor with photodynamic therapy for polypoidal choroidal vasculopathy: A meta-analysis.

Anti-vascular endothelial growth factor (VEGF) agents administered as either monotherapy or combination with verteporfin photodynamic therapy (PDT) are the 2 dominant treatment for polypoidal choroidal vasculopathy (PCV); However, controversies remain due to small sample sizes and inconsistency in prognosis from randomized controlled trials (RCTs). In accordance with the PRISMA statement, we investigated the efficacy of PDT plus anti-VEGF combination with anti-VEGF monotherapy. This study was accepted by the International Prospective Register of Systematic Reviews (CRD42023471362). Studies published up to July, 2024, were retrieved from PubMed, Embase, and Cochrane databases. A total of 7 RCTs with 926 eyes were reviewed. In 6 trials, combination therapy showed significantly higher rate of complete polyp regression (risk ratio [RR]: 1.56, 95% CI: 1.15-2.13, p = 0.005). In 5 trials, combination therapy also significantly reduced the number of anti-VEGF injections (SMD: -0.65, 95% CI: -0.95 to -0.35, p < 0.0001). For best corrected visual acuity improvement, central retinal thickness reduction, and rate of ocular adverse events, the performance of the 2 modalities were comparable. We conclude that PDT plus anti-VEGF combination therapy constitutes a safe and effective modality and should be considered the first-line treatment for PCV.

A Tertiary Centre's Experience With Using Ranibizumab Biosimilar Compared to Aflibercept for Neovascular Age-Related Macular Degeneration: A Retrospective Study.

Objective This study aims to evaluate the real-world efficacy of ranibizumab biosimilar (Ongavia), compared to aflibercept (Eylea), in the treatment of treatment-naïve neovascular age-related macular degeneration (nAMD) at a busy tertiary eye care centre. Methods A retrospective analysis of medical records from August 2022 to August 2024 was conducted, comparing treatment outcomes in treatment-naive nAMD patients who received either Ongavia or Eylea intravitreal anti-VEGF (vascular endothelial growth factor) injections under a treat-and-extend protocol. Initial and 12-month outcome measures post-treatment initiation were collected, including best-corrected visual acuity (BCVA), central retinal thickness (CRT), prescribed treatment intervals, actual injection frequency, and the average total number of injections per eye over 12 months. Results A total of 62 eyes met the inclusion criteria. Over 12 months of follow-up, patients receiving Eylea (n = 36) showed a significantly greater improvement in BCVA (7.08 ± 4.12), p = 0.018, compared to Ongavia (n = 26) (-1.9 ± 3.31). CRT reductions were also more substantial for Eylea (-116.21 µm ± 35.61 µm) than for Ongavia (-51.14 µm ± 22.21 µm), p = 0.002. The average number of injections was 6.55 for Ongavia and 5.75 for Eylea over the 12-month follow-up. Excluding the initial three loading doses, observed injection intervals averaged 9.49 weeks for Eylea and 8.17 weeks for Ongavia. Notably, for the total study period, 164 out of 171 (96%) Ongavia injections were prescribed at four-week intervals, compared to 110 out of 207 (53%) for Eylea. However, capacity constraints impacted adherence to prescribed dosing schedules, affecting efficacy. Conclusion Our study indicates reduced visual and morphological outcomes with Ongavia compared to Eylea in treating nAMD when monthly injections cannot be provided as prescribed. Given clinical capacity constraints, Eylea's greater potency and durability prove advantageous, allowing extended intervals and reducing the reliance on strict monthly dosing. This highlights the need for additional resources to support frequent biosimilar administration and ensure effective ranibizumab treatment. A comprehensive cost-benefit analysis is warranted to assess whether increased clinic capacity offsets Ongavia's lower per-injection cost, compared to Eylea.

Efficacy of intravitreal faricimab therapy for polypoidal choroidal vasculopathy: A systematic review and meta-analysis.

Polypoidal choroidal vasculopathy (PCV) is an aneurismal type of macular neovascularization that show similarities with age-related macular degeneration and diseases that are part of the pachychoroid disease spectrum. Exudative changes in PCV can be treated with intravitreal anti-vascular endothelial growth factor monotherapy; however, a combination therapy with photodynamic therapy may be required. In this systematic review and meta-analysis, we evaluated the efficacy of faricimab for PCV. We searched 12 literature databases for eligible studies. All study evaluation and data extraction were made by two authors in duplicate. Studies eligible for analysis were included for a qualitative and quantitative review. We identified seven studies with data from 150 eyes with PCV, five studies were of treatment-naïve eyes who were commenced in faricimab monotherapy, and two studies were of switch-over to faricimab from other anti-VEGF drugs. After faricimab loading dose in treatment-naïve eyes, the best-corrected visual acuity (BCVA) remained stable at -0.09 (95% CI: -0.20-0.03) logMAR, central retinal thickness (CRT) decreased -169 (95% CI: -311--27) μm, and 48.7 (95% CI: 32.5-65.0) % of eyes obtained polyp closure. In switch-over eyes, 57%-67% experienced fluid reduction and 21% were able to extend their treatment interval. In conclusion, faricimab monotherapy for PCV leads to acceptable clinical outcomes in terms of stable BCVA, reduction of CRT, and high incidence of polyp closure. Some cases may benefit from a switch to faricimab. However, long-term efficacy studies and controlled comparative studies are warranted.

Dexamethasone implant for refractory macular edema secondary to diabetic retinopathy and retinal vein occlusion.

To evaluate the efficacy, timing of retreatment and safety of dexamethasone (DEX) implant on macular edema (ME) secondary to diabetic retinopathy (DME) and retinal vein occlusion (RVO-ME) patients who were refractory to anti-vascular endothelial growth factor (VEGF) treatment. This retrospective study included 37 eyes received at least one DEX implant treatment for DME or RVO-ME between January 1, 2019, and January 1, 2023. These refractory DME and RVO-ME cases received at least 5 anti-VEGF injections and failure to gain more than 5 letters or a significant reduction in central retinal thickness (CRT). The best corrected visual acuity (BCVA) and CRT were measured at baseline, and at 1, 3, 4 and 6mo post-DEX implant injection. Adverse events such as elevated intraocular pressure (IOP) and cataract were recorded. For RVO cases (n=22), there was a significant increase in BCVA from 0.27±0.19 to 0.35±0.20 at 6mo post-DEX injection (P<0.05) and CRT decreased from 472.1±90.6 to 240.5±39.0 µm at 6mo (P<0.0001). DME cases (n=15) experienced an improvement in BCVA from 0.26±0.15 to 0.43±0.20 at 6mo post-DEX implant injection (P=0.0098), with CRT reducing from 445.7±55.7 to 271.7±34.1 µm at 6mo (P<0.0001). Elevated IOP occurred in 45.9% of patients but was well-controlled with topical medications. No cases of cataract or other adverse events were reported. DEX implants effectively improve BCVA and reduce CRT in refractory DME and RVO-ME. Further research with larger cohorts and longer follow-up periods is needed to confirm these findings and assess long-term outcomes.

Crossover to 689 nm laser therapy after poor responsiveness to subthreshold micropulse laser for chronic central serous chorioretinopathy

PurposeTo compare the visual and anatomical outcomes of 689 nm laser therapy (689-LT) and continued subthreshold micropulse laser (SML) therapy, for chronic central serous chorioretinopathy (cCSC) eyes after poor responsiveness to initial SML treatment. MethodsThe retrospective study included 32 cCSC patients, of which 15 patients received continued SML, and 17 patients received 689-LT. Best corrected visual acuity (BCVA), central retinal thickness (CRT), the maximum height of subretinal fluid (mSRF), subfoveal choroidal thickness (SFCT), three-dimensional choroidal vascularity index (CVI), and the vascular density of choriocapillaris (CCVD) of two groups were evaluated and compared at baseline, one-month and three-month follow-up after treatment. ResultsThirty-two cCSC eyes of 32 patients (7 female, 25 male) were included in our study, with a mean age of 46.69 ± 6.56 years. Three months after treatment, complete resolution of SRF was achieved in four eyes in the 689-LT group, whereas no eyes displayed complete resolution in the SML group. There were no significant improvements in BCVA and CCVD at the three-month follow-up in both groups. In the 689-LT group, at one-month and three-month follow-ups, there was a significant reduction in CRT, mSRF, SFCT and CVI, compared to the baseline (p < 0.001 in all analyses). There were no statistically significant changes in CRT, mSRF, SFCT and CVI in the SML group (p > 0.05 in all analyses). The ANOVA test for repeated measures showed the changes in the measurements over time were significantly different between the two groups (P value using Greenhouse–Geisser test < 0.05). Conclusion689 nm laser therapy provides the opportunity for cCSC eyes with poor responsiveness to SML treatment, especially when verteporfin is unavailable. There was also a notable recovery in the abnormal dilatation of choroidal vessels in the 689-LT group. Further studies are warranted to investigate the long-term efficacy and safety of 689 nm laser therapy in the management of cCSC.

Aflibercept in the clinical routine: the AURIGA study : The 24-month results of the German cohort of treatment-naïve patients with diabetic macular edema receiving intravitreal aflibercept

AURIGA is the largest prospective real-world study to evaluate intravitreal aflibercept (IVT-AFL) treatment of diabetic macular edema (DME) and macular edema secondary to retinal vein occlusion. This article presents 24-month data from the German cohort of treatment-naïve patients with DME. Treatment-naïve patients (≥ 18years) with DME were treated with IVT-AFL at the discretion of the physician in clinical practice. The primary endpoint was mean change in visual acuity (early treatment diabetic retinopathy, ETDRS, letters) at month12 compared to baseline. Statistical analyses were descriptive. The analysis included data from 150 DME patients (54.7% male). At months6, 12 and24, mean (95% confidence interval) visual acuity gains of4.6 (2.6; 6.5), 4.0 (2.1; 6.5) and 5.0 (3.0; 6.9) letters from baseline (mean ±SD: 65.0 ± 15.3 letters) and reductions in retinal thickness of 86µm (109; 64µm), 70µm (94; 43µm) and 75µm (103; 47µm) from baseline (mean ±SD: 391 ± 132 µm), respectively, were achieved. At month24, 54% of patients gained ≥ 5 letters and 22% ≥ 15 letters. Patients received amean number of 5.0 ± 1.6injections until month6, 7.1 ± 3.2 until month12 and9.0 ± 5.3 until month24, 68% of patients received ≥ 5injections until month6 and 56% ≥ 7injections within the first year. The safety profile was consistent with previous studies. In the German AURIGA cohort, treatment-naïve DME patients achieved aclinically relevant gain in visual acuity as well as reduction in central retinal thickness following IVT-AFL treatment in clinical practice. From month6 onwards, improvements were maintained despite alow injection frequency over 24months. In comparison with previous real-world studies, care of DME patients in clinical practice seems to have improved; however, there is still room for further improvement.

Evaluating the Efficacy of Conbercept and Dexamethasone Implants Sequentially in the Treatment of Refractory Macular Edema Secondary to Central Retinal Vein Occlusion (CRVO): A One-Year Follow-Up Study.

The objective of this research was to assess the effectiveness and safety of using Conbercept injection and dexamethasone implant (DEX I) in sequence for treating refractory macular edema (ME) caused by central retinal vein occlusion (CRVO) in patients. A study was conducted on 34 patients with persistent macular edema caused by central retinal vein occlusion, reviewing their medical history and interventions performed. Sequential implantation of DEX I was performed 1week after the Conbercept injection. OCTA images were used to measure central retinal thickness (CRT), best-corrected visual acuity (BCVA), intraocular pressure (IOP), and pre- and post-treatment vessel density of the superficial capillary plexus (SCP) and deep capillary plexus (DCP), with a 1-year follow-up period. At the 12-month follow-up, participants demonstrated notable improvements in central retinal thickness and intraocular pressure (p < 0.05). Throughout the monitoring period, no significant differences were found in BCVA improvement or vessel density reduction (p > 0.05). Two patients required topical treatment to lower their intraocular pressure during the study period. In conclusion, patients experiencing persistent ME due to secondary CRVO may benefit from transitioning to a treatment regimen involving Conbercept and DEX I, potentially resulting in a reduction in CRT. However, no significant improvement was observed in BCVA or deep and superficial capillary plexus vessel density.

Short-Term Clinical Outcomes of Patients with Diabetic Macular Edema Following a Therapy Switch to Faricimab.

Background: With this study, we investigate the short-term clinical outcomes of patients affected by diabetic macular edema (DME) after switching to intravitreal Faricimab (IVF) in a real-world setting. Methods: We conducted a retrospective chart review on all patients treated for DME with IVF who showed insufficient responses to prior anti-VEGF therapy. Data collected included baseline patient demographics, medical history, best-corrected visual acuity (BCVA), central retinal thickness (CRT) and central retinal volume (CRV). We analyzed functional and structural measures before and after IVF, compared baseline demographics and treatment factors between Faricimab-responders and reduced-responders and assessed influencing factors of the follow-up BCVA and CRT. Results: This study included 25 eyes from 16 patients. After switching to IVF, the mean BCVA showed no significant improvement, changing from 59.4 ± 13.4 Early Treatment of Diabetic Retinopathy Study (ETDRS) letters at baseline to 61.4 ± 12.8 ETDRS letters at follow-up (p = 0.26). CRT significantly reduced from 414.4 ± 126.3 µm to 353.3 ± 131.1 µm (p < 0.011), and the 3 mm CRV significantly decreased from 2.8 ± 0.5 mm3 to 2.6 ± 0.6 mm3 (p < 0.012). Seven patients met the responder criteria, exhibiting an improvement of at least 5 ETDRS letters and a simultaneous CRT reduction of at least 30 µm. Further analysis showed that higher BCVA at baseline (p < 0.001) was associated with better BCVA following IVF, while higher baseline CRT (p < 0.003), a higher number of prior anti-VEGF agents (p < 0.034) and prior corticosteroid injections (p < 0.019) were associated with greater CRT at follow-up. Conclusions: Following the initial IVF injection series, we observed a clear improvement of anatomical measures. No functional improvement was observed, although visual acuity remained stable. Higher baseline BCVA was associated with better post-IVF BCVA, while higher baseline CRT, a greater number of prior anti-VEGF agents and prior corticosteroid injections were linked to higher CRT post-IVF.

Comparing ranibizumab, dexamethasone implant, and combined therapy for macular edema secondary to branch retinal vein occlusion: a clinical trial.

Macular edema (ME) is a common complication following branch retinal vein occlusion (BRVO) and is also the main reason for visual impairment. This study aimed to compare the efficacy and safety of intravitreal ranibizumab (IVR) or dexamethasone implant (IDI) monotherapy, as well as the combination of IVR and IDI injections, in patients with ME secondary to branch retinal vein occlusion (BRVO). This multicenter, prospective, and comparative study included 292 patients with unilateral ME involvement (total of 292 eyes) secondary to BRVO. The patients were randomly assigned to three groups and followed up for 12months. Patients in group 1 (n = 96) were treated with 3-dose loading IVR injections followed by a pro re nata (PRN) regimen. Patients in group 2 (n = 98) received IVR combined with IDI injection, followed by IVR PRN regimen. Patients in group 3 (n = 98) were treated with IDI injection, followed by repeated IDI injection based on clinical necessity. Best corrected visual acuity (BCVA), central retinal thickness (CRT), complications, and frequency of injections were recorded and compared between the three groups. At baseline, the three groups did not differ in age, gender, duration of ME, BCVA, IOP, and CRT (P > 0.05). Mean number of total injections per eye within 12months were 7.1 ± 2.3 (range 4-9) in group 1, 3.7 ± 1.5 (range 2-6) in group 2, and 1.8 ± 0.4 (range 1-3) in group 3. There was a statistical difference in the number of injections between group 1 and group 2 (P = 0.037). Eyes in group 3 received fewer injections than those in group 2, but the difference was not statistically significant (P = 0.052). BCVA improvement and CRT reduction were achieved in all groups and there was no significant difference between the three groups at the end of the 12th month. However, IOP elevation and cataract progression were more frequent in group 3, especially in those patients who received repeated IDI injections. Three therapeutic regimens had comparable efficacy in treating ME secondary to BRVO. Combination therapy had an advantage in maintaining good effect with fewer re-injections and complications. The study complied with the principles of the Declaration of Helsinki and was approved by Xi'an Aier Ancient City Eye Hospital, Xi'an Aier Eye Hospital, and Xianyang Aier Eye Hospital ethics committees (2022SF-367).

Real-life study on dexamethasone intravitreal implant (Ozurdex) for macular edema at a Colombian reference center

ABSTRACT Purpose To evaluate the real-life safety, morphological, and visual outcomes of the dexamethasone intravitreal implant (Ozurdex) in patients with macular edema (ME) within a low-middle-income country (LMIC) setting. Methods Patients with ME who received Ozurdex injections between 2012 and 2018 were included. Central retinal thickness (CRT), best-corrected visual acuity (BCVA), lens status, and intraocular pressure (IOP) at baseline and last follow-up were compared. Univariate and multivariate analyses identified factors associated with visual improvement. Results 154 patients were enrolled. Diabetic ME was the most common etiology (32.4%), followed by central retinal vein occlusion (18.8%), branch retinal vein occlusion (14.2%), and uveitis (9.99%). CRT was significantly reduced in all patients except those with uveitis but did not correlate with BCVA improvement. Lower baseline visual acuity (OR=1.67), younger age (OR=1.87), and ME secondary to branch retinal vein occlusion (OR=1.34) were associated with BCVA improvement (p < 0.05). During follow-up, 11 patients (7.14%) developed cataracts, and 22 (14.2%) showed increased IOP; these complications resolved without affecting final BCVA improvement. Conclusion In an LMIC setting, Ozurdex effectively reduces CRT in diabetic and retinal vein occlusion-related ME but not in uveitis. BCVA improvement depends on factors beyond CRT reduction. Cataracts and elevated IOP are manageable complications.

Intravitreal Injection of Conbercept Combined with Dexamethasone for Macular Edema Following Central Retinal Vein Occlusion.

To compare the efficacy of intravitreal injections of Conbercept combined with dexamethasone (DEX) for macular edema (ME) following central retinal vein occlusion (CRVO). This was a prospective, single-masked, randomised, controlled clinical trial. Patients with ME following CRVO were randomised into groups to receive intravitreal injections of 0.5 mg Conbercept plus 0.2 mg DEX or 0.5 mg Conbercept alone on day 0 followed by repeat injections as indicated. The primary outcome measure was the change in best-corrected visual acuity (BCVA) from baseline to month 12. Secondary outcome measures included decrease in central retinal thickness (CRT), injection frequency and interval and percentage of patients who gained more than 15 ETDRS letters or achieved a CRT of < 250 μm at month 12. 33 males (51%) and 32 females (49%) were initially recruited with an average age of 56.64 ± 13.88 years. Patients in the Conbercept and Conbercept + DEX groups gained an average of 14.55 ± 19.19 and 14.88 ± 17.68 ETDRS letters, respectively, at months 12 (t = 4.221, P = 0.000; and t = 4.834, P = 0.000) with no significant difference between the two groups (t = 0.071, P = 0.943). In the Conbercept group, the mean reduction in CRT from baseline to month 12 was 435.26 ± 293.37 μm (t = 8.261, P = 0.000) compared to 431.36 ± 294.55 (t = 8.413, P = 0.000) in the Conbercept + DEX group. There was no significant difference between the two groups (t = 0.053, P = 0.958). The Conbercept + DEX group received fewer intravitreal injections. No major complications occurred. Conbercept, alone or with DEX, can improve BCVA and reduce CRT in ME following CRVO without serious adverse events. The treatment interval was longer in the Conbercept + DEX group. The study was registered with the Chinese Clinical Trial Registry at 5 July 2017. (http://www.chictr.org.cn, 05/07/2017 Registration Number: ChiCTR-INR-17011877).

Comparative study on the efficacy of Conbercept and Aflibercept in the treatment of neovascular age-related macular degeneration

This study compares the effectiveness of Conbercept and Aflibercept in treating neovascular age-related macular degeneration (nAMD). Conducted at the First Affiliated Hospital of Chongqing Medical University's Ophthalmology Department (May 2020–May 2023), this prospective study enrolled 159 nAMD patients. Participants were randomly divided into two groups: one receiving 0.5 mg Conbercept and the other 2 mg Aflibercept intravitreal injections. Over 12 months, the study, employing a Treat-and-Extend (T&E) regimen, assessed Best-Corrected Visual Acuity (BCVA), Central Retinal Thickness (CRT) changes and injection frequency. Of the 159 patients, 137 (149 eyes) completed the study. No significant age difference was found between the groups (P = 0.331). After 12 months, BCVA improved similarly in both groups (Conbercept: 52.8 ± 18.9, Aflibercept: 52.0 ± 19.7 letters; P = 0.820). CRT reduction was also comparable (Conbercept: 246.3 ± 82.8 µm, Aflibercept: 275.9 ± 114.3 µm; P = 0.079). Injection frequencies averaged 6.9 ± 0.7 (Conbercept) and 6.7 ± 0.7 (Aflibercept; P = 0.255). Subtype analysis revealed Type 1 MNV had higher baseline BCVA and lower CRT, with more frequent injections compared to other types. Both Conbercept and Aflibercept are clinically similar in efficacy for nAMD, with the T&E regimen proving therapeutically effective and potentially reducing patient costs. Anti-VEGF treatment efficacy varies across nAMD subtypes, indicating a potential benefit in tailored treatments for specific subtypes.Clinical trial registration number NCT05539235 (Protocol Registration and Results System).

Immediate response to intravitreal treatment for macular edema due to diabetes and retinal vein occlusion.

To objectively assess the immediate response to intravitreal treatment for macular edema and compare it across different agents. This retrospective, comparative study included patients with macular edema due to diabetic retinopathy (DME) or vein occlusion who were treated with intravitreal injections of either steroids (triamcinolone acetonide or dexamethasone sustained release implant) or anti-vascular endothelial growth factor antibodies (VEGF). The central retinal thickness (CRT) and the best corrected visual acuity (BCVA) were measured 1 day after the injection and compared with immediate pre-injection values. There were 79 eyes (57 patients) including 51 eyes with DME, 18 with branch retinal vein occlusion edema (BRVO-ME), and 10 eyes with central retinal vein occlusion edema (CRVO-ME). The intravitreal agents were triamcinolone acetonide (TA)(n = 15), dexamethasone sustained release implant (DEX)(n = 22), ranibizumab (n = 19), and bevacizumab (n = 23). Statistically significant improvement in CRT was seen in all injection groups (p < 0.05) while improvement in mean BCVA was significant only in the TA group (p = 0.009). The mean change in CRT was maximum with steroids than with anti-VEGFs; viz. 159.47 µ in TA, 115.45 µ in DEX, 86.10 µ in ranibizumab, and 78.78 µ in bevacizumab group. Least amount of change was noted in the spongy type of macular edema (18.73 µ) while improvement in mean BCVA was statistically significant only in the cystoid group (p = 0.01). Comparatively, steroid agents showed better immediate response to therapy than anti-VEGFs. Maximum reduction in central retinal thickness was seen following triamcinolone acetonide injection. Cystoid edema showed better immediate response than spongy retinal thickening.