Decrease In Mean Central Macular Thickness Research Articles

Intravitreal Injections of Bevacizumab (Avastin); which Dose is Recommended?

This study was conducted to evaluate the fast improvement, effectiveness & safety of intravitreal injections bevacizumab (Avastin), in different doses, for treating diabetic macular edema (DME). Eyes of 80 patients with diabetic macular edema were randomized and planned to receive three consecutive monthly intravitreal injections of 1.25 mg or 2.5 mg bevacizumab (forty patients for each group). Patients were observed for 4 weeks after 1st injection and the changes in the best-corrected visual acuity (BCVA), central macular thickness (CMT) and adverse events were compared between both groups. CMT was significantly reduced in both groups (P < 0.013). Significant improvements between baseline and 2weeks to 4weeks in the 2.5 mg group, were mean decrease in CMT was 318 t0 182(P<.001), mean BCVA is 0.16 improve to 0.7 and P value 0.001. Intraocular pressure (IOP)measurements post intravitreal (IV) bevacizumab injection was not raised its statistically significant (P < 0.001). CMT improvement with a dose of intravitreal IV injection 2.5 mg is promising a rapid safe effective response for treating DME without any ocular or systemic side effects but Follow-up is still short to make any specific treatment recommendations.

Topical Dorzolamide as Adjunctive Treatment With Intravitreal Bevacizumab in Bilateral Diabetic Macular Edema.

Intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents is accepted as the gold standard treatment for center-involving diabetic macular edema (CI-DME). Adjunctive administration of topical dorzolamide may enhance the therapeutic effects of anti-VEGF agents. In this study, we compared the efficacy of topical dorzolamide plus intravitreal injection of bevacizumab (IVB) versus IVB alone in patients with bilateral DME. This prospective, randomized contralateral eye study was carried out in a tertiary referral ophthalmology center, Al-Zahra Eye Hospital, Zahedan, Iran, between April 2021 and April 2022. Thisstudy included 50 eyes of 25 patients with bilateral DME. All eyes received three consecutive monthly injections of IVB. For each patient, one eye was randomized to instill dorzolamide eye drops three times a day as an intervention, and the other received artificial tear drops as a placebo. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were evaluated before starting treatment and then monthly for the first three months. Among 25 included patients, the average age was 56.64 ± 7.97 years, and 48% were female. BCVA did not improve significantly in any groups (P > 0.05). No significant difference was observed in terms of BCVA between the intervention and control groups (P > 0.05). The present study showed a decrease in CMT in both study groups (P < 0.05). At month 3, the decrease in mean CMT from baseline was significantly higher in eyes receiving topical dorzolamide compared to the control group (-88.92 ± 82.90 vs. -37.64 ± 86.16 µM, respectively; P = 0.037). IOP decreased significantly only in eyes receiving dorzolamide (P < 0.001). The results of the present study indicate that adjunctive administration of topical dorzolamide has a beneficial effect on CMT reduction from baseline, but it did not have an additive effect on BCVA improvement compared to IVB monotherapy.

Safety and efficacy profile of intravitreal ranibizumab vs dexamethasone in treatment of naïve diabetic macular edema.

To compare the safety and efficacy parameters of intravitreal ranibizumab vs intravitreal dexamethasone (IVD) in the treatment of patients with naïve diabetic macular edema (DME) in terms of best-corrected visual acuity (BCVA), central macular thickness (CMT), and possible complications like intraocular pressure (IOP) rise and cataract progression. A hospital-based prospective and comparative study of naïve DME patients was conducted between November 2020 and October 2021 with a minimum follow-up (F/U) period of 6 months. Thirty phakic patients received one dose of IVD implant (Group A) and the other 30 (Group B) received three consecutive monthly doses of ranibizumab. The main exclusion criteria were steroid responders and the presence of ocular inflammation. The mean pre-injection CMT in Group A was 405µ and reduced to 297.07µ at 3 months and 278.35µ at 6 months. Mean increase in logMAR BCVA was 0.55. The mean pre-injection IOP was 16.28 and 17.64 mm of Hg at 6 months. In Group B, the mean pre-injection CMT was 401.07µ and reduced to 276.1µ at 3 months and 292.9µ at 6 months. Mean BCVA increased to 0.37. The mean pre-injection IOP was 17.28 mm Hg and 16.42 mm Hg at 6 months. There was no significant progression of cataract in both groups. The mean decrease in CMT was comparable in both the groups at 6 months F/U with an improvement of BCVA with no significant IOP fluctuation or cataract progression. Hence, IVD appears to be noninferior to ranibizumab in the treatment of naïve DME.

Comparison of intravitreal ranibizumab and aflibercept for the treatment of diabetic macular edema: a real-world study.

To compare the visual and anatomic outcomes of intravitreal ranibizumab versus aflibercept in patients with diabetic macular edema (DME) in a real-world study. This is a single-center retrospective comparative study of treatment-naïve patients who received intravitreal ranibizumab or aflibercept administration for DME for at least 12 months on an as needed regimen following three-monthly loading doses. The primary outcomes of the study were the mean change in best-corrected visual acuity (BCVA), central macular thickness (CMT), and central macular volume (CMV). Factors to potentially affect these parameters were also analyzed. A total of 100 eyes (66 patients) were included in the study. Fifty two eyes received ranibizumab and 48 eyes in aflibercept injections. At the end of follow-up, the improvement in mean BCVA was similar in both groups (p = 0.38). While the decrease in mean CMT at the 4th-month visit was significantly higher in the aflibercept-treated group than in the ranibizumab-treated group (p = 0.02), there was no difference between the two groups at the end of the 1-year follow-up (p = 0.25). There was no significant difference between the two groups in terms of change in mean CMV during the follow-up (p = 0.26, p = 0.27 at 4 and 12 months, respectively). The mean number of injections were also similar between groups (4.5 ± 1 vs. 4.6 ± 1.1 respectively, p = 0.63). In a real-world setting, ranibizumab and aflibercept were both found to be effective in the first-line treatment of DME. Patients with DME who received fewer injections in the real-world could achieve visual and anatomical results comparable to randomized controlled trials participants.

Aflibercept monotherapy versus aflibercept with targeted retinal laser to peripheral retinal ischemia for diabetic macular oedema (LADAMO)

ObjectiveWe tested the hypothesis that targeted retinal laser photocoagulation (TPRP) to peripheral retinal ischaemia reduces the overall burden of aflibercept injections when treating diabetic macular oedema (DMO) over a 24-month period.MethodsProspective, double-masked, multicentre, randomised controlled trial in Australia comparing aflibercept monotherapy, following a treat-and-extend protocol, or combination therapy of aflibercept and TPRP for DMO. The aflibercept monotherapy group received placebo laser. The primary outcome measure was the mean number of intravitreal aflibercept injections for each group at 24 months. Secondary outcome included: mean change in central macular thickness (CMT) and vision at trial completion, the proportion of eyes whose DMO resolved and the mean injection treatment interval. Ocular and systemic adverse events were recorded.ResultsWe enrolled 48 eyes of 47 patients; 27 eyes were randomised to combination therapy (aflibercept and TPRP) and 21 to aflibercept monotherapy. Thirty-two eyes (67%) completed the 2-year study. The number of intravitreal treatments given were similar for combination therapy (10.5 (SD 5.8) and monotherapy (11.8 (SD5.6)) (P = 0.44). The mean visual improvement (+4.0 (−1.8, 9.8) and +7.8 (2.6, 12.9) letters, P = 0.32), mean decrease in CMT (−154 (−222,−87) µm and −152 (−218,−86) µm, P = 0.96), proportion of eyes with CMT < 300 µm (48% and 67%; P = 0.50) and safety outcomes were similar in both the combination and monotherapy treatment groups (respectively).ConclusionsLaser to areas of ischaemic peripheral retina does not reduce the burden of intravitreal aflibercept injections when treating diabetic macular oedema.

Dexamethasone intravitreal implant (Ozurdex) in diabetic macular edema: real-world data versus clinical trials outcomes.

To investigate the safety and efficacy of intravitreal dexamethasone implants (Ozurdex®/DEX) in patients with diabetic macular edema (DME) either naïve or non-naïve to anti-VEGF therapies who switched to DEX implant independent of response to anti-vascular endothelial growth factors (anti-VEGFs). This was an audit retrospective review of medical records of patients with DME who switched to the DEX intravitreal implant. Patients were divided into 2 groups: patients naïve to antiangiogenic therapy and patients who were previously treated with anti-VEGFs. Data regarding demographics, changes in mean best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) was collected over 6mo. The demographic data mean changes in BCVA, CMT, and IOP were compared. Six-month follow-up data of 47 patients (57 eyes), who either switched to DEX implant irrespective of response to previous treatments or were treatment naïve before receiving DEX implant, was collected. Improvement in mean BCVA was observed from 1-4mo after injection with a decreased effect at month 6 as expected, with better outcomes in naïve compared to non-naïve patients. A statistically relevant decrease in mean CMT was observed during the follow-up period. An increase in mean IOP was observed in the first 2mo after DEX therapy. The mean number of injections of the overall population during the 6mo was 1.3. A subgroup analysis showed no relevant difference between phakic versus pseudophakic patients relative to measured outcomes. There was no cataract progression during the follow-up period and no adverse events reported. This real-life setting study shows that intravitreal DEX implant is effective and safe. The timings of greater therapeutic impact are concordant with previous studies and suggest that earlier treatment with corticosteroids may have an additional benefit in naïve patients.

Treatment of Eyes With Diabetic Macular Edema That Had a Suboptimal Response to Antivascular Endothelial Growth Factor Therapy: 2-mg Intravitreal Triamcinolone Acetonide vs 0.7-mg Dexamethasone Implant.

This article compares 2-mg intravitreal triamcinolone (IVT) and 0.7-mg dexamethasone (DEX) implant for the treatment of diabetic macular edema in eyes that had a suboptimal response to antivascular endothelial growth factor therapy. A single-center, retrospective review was conducted of patients receiving either IVT between January 1, 2013, and January 1, 2018, or patients receiving DEX between October 1, 2015, and January 1, 2018. Visual acuity and central macular thickness (CMT) were recorded at visit of first injection and all subsequent visits. Twenty-five eyes were included in the DEX group and 32 eyes were included in the IVT group. Change in vision from baseline was similar between DEX and IVT at 6-month follow-up (1.1 lines vs 2.3 lines, respectively; P = .24). Mean decrease in CMT from baseline was not different at 6-month follow-up (DEX: 120 µm vs IVT: 185 µm; P = .17). DEX and 2-mg IVT both achieved improvement in vision and CMT with no significant differences between treatment groups at 6-month follow-up.

Long-term results of a single injection of intravitreal dexamethasone as initial therapy in diabetic macular edema.

Purpose:To evaluate the long-term safety and efficacy of the intravitreal dexamethasone implant in the treatment of diabetic macular edema (DME) as initial therapy.Methods:A hospital-based prospective, non-comparative case study of recently detected DME patients was conducted between July 2016 and December 2017, in which30 eyes of 30 patients were studied. Presenting vision, age, gender, duration of diabetes, general and ocular examination, intraocular pressure, indirect ophthalmoscopy, fundus fluorescein angiography, optical coherence tomography (OCT), and blood sugar levels were noted. Patients with increased central macular thickness (CMT) received an intravitreal dexamethasone implant as initial therapy. All were followed up at 1 week, 1 month, 3 months, 6 months, and 1 year, and the findings were recorded and analyzed using SPSS software.Results:30 eyes of 30 patients were studied which included 22 males and 8 females. The mean age of presentation was 58.7 ± 4.45 years. The mean decrease in CMT following intravitreal dexamethasone was 269.27 ± 112.002, 253.5 ± 108.294, and 286.73 ± 143.395 μm at the end of 3, 6, and 12 months, respectively, and the mean improvement in visual acuity (VA) was 2.27 ± 1.70 lines at 3 months, 2.27 ± 1.83 lines at 6 months, and 1.17 ± 2.00 lines at 12 months. Out of 30 cases, 4 had persistent DME and 6 had recurrence of DME at completion of 1 year of follow-up.Conclusion:Intravitreal dexamethasone as initial therapy in the treatment of DME is both safe and efficacious in the reduction of CMT and improvement of vision and can be considered as primary therapy for DME.

Aflibercept therapy in eyes with neovascular age‐related macular degeneration and its effect on choroidal thickness

BackgroundThe purpose of this study was to investigate changes in best‐corrected visual acuity (BCVA), central macular thickness (CMT) and subfoveal choroidal thickness (SCT) after intravitreal aflibercept injections for neovascular age‐related macular degeneration (NV‐AMD).MethodsEighty‐nine eyes (48 treatment naive, 41 resistant) were included in this prospective study. All patients were treated with three consecutive monthly injections then every two months as required. BCVA, CMT and SCT were recorded and compared within and between the two groups.ResultsThe mean increase in BCVA after injections was 0.18 ± 0.34 logMAR in the naive group (p = 0.01) and 0.092 ± 0.38 logMAR in the resistant group (p = 0.131). The mean decrease in CMT was 200.3 ± 216.1 μm in the naive group and 183.3 ± 203.4 μm in the resistant group (p < 0.001 for both). The mean decrease in SCT was 22.1 ± 62.0 μm in the naive group (p = 0.014). The mean change in SCT was 22.28 ± 74.05 μm in the resistant group; this was not statistically significant (p = 0.061).ConclusionBCVA, CMT and SCT decreased significantly after intravitreal aflibercept injections in naive patients with NV‐AMD. Despite anatomic success, functional improvement was not reached and SCT did not significantly decrease after intravitreal aflibercept injections in resistant patients.

Pars plana vitrectomy versus three intravitreal injections of bevacizumab for nontractional diabetic macular edema. A prospective, randomized comparative study.

Background:The aim of this study was to compare the effectiveness of pars plana vitrectomy (PPV) and removal of the internal limiting membrane (ILM) with three, monthly, intravitreal bevacizumab (IVB) injections for refractory diabetic macular edema.Materials and Methods:This was a prospective, randomized, comparative, interventional study. Forty-four patients were enrolled and randomized in two groups. Twenty-two eyes enrolled in Group I received three IVB injections at monthly interval. Twenty-two eyes were enrolled in Group II which underwent PPV with ILM removal. The primary outcomes measured were: (1) Best corrected logMAR visual acuity (BCVA) using Snellen's visual acuity chart. (2) Central macular thickness (CMT) on optical coherence tomography. The secondary outcome measures were: Complication rates like (1) progression of lens opacities, (2) high intraocular pressure needing further treatment/procedure, (3) development of vitreous hemorrhage related to the procedure employed, (4) retinal detachment and (5) severe inflammation/endophthalmitis.Results:In Group I (IVB): 3 (13.6%) eyes showed no change in BCVA; 3 (13.6%) eyes reported decrease in BCVA and 16 (72.8%) eyes showed improvement in BCVA; (P = 0.0181). In Group II (PPV): 4 (18.2%) eyes showed no change in BCVA; 5 (22.7%) eyes showed decrease and 13 (59.1%) eyes showed improvement in BCVA (P = 0.0281). Mean decrease in CMT in IVB group was 108.45 μ, whereas mean decrease in CMT in PPV group was 161.36 μ. No major complications were seen in either group.Conclusion:Posttreatment decrease in CMT was more in PPV group and vision improvement more in IVB group. However, no statistically significant difference between the two methods was found.

The Variable Efficacy of Intravitreal Bevacizumab and Triamcinolone Acetonide for Cystoid Macular Edema Due to Radiation Retinopathy

Background: Both intravitreal bevacizumab and triamcinolone have been shown to be effective in treating macular edema secondary to VEGF-mediated disease. The purpose of this study is to describe the variable effects of intravitreal bevacizumab (IVB) and triamcinolone acetonide (IVTA) in the treatment of macular edema secondary to radiation retinopathy. Methods: Retrospective, nonrandomized, interventional case series. Charts of five patients with macular edema due to radiation retinopathy who received IVB with subsequent IVTA were reviewed. Clinical examination, Snellen visual acuity (VA), and central macular thickness (CMT) on optical coherence tomography (OCT) were examined. Main outcome measures included VA and CMT. Results: Of the five patients reviewed, patient 1 demonstrated complete resolution of macular edema both clinically and by OCT with IVB after the first two injections with a decrease in CMT to 243 and 284 µm from a baseline CMT of 340 µm. However, response diminished following successive injections and the patient was switched to IVTA with a complete response. Mean CMT was 249 µm following four injections of IVTA and vision improved 3 lines. Patients 2 and 3 demonstrated a partial response to IVB with a mean CMT of 362 and 451 µm from 436 and 596 µm, respectively. They similarly had a partial response to IVTA with a mean CMT of 363 and 433 µm from 460 and 429 µm. There was no improvement in vision. Patient 2 was then switched to a combination of IVB and IVTA with complete resolution of macular edema with a CMT of 299 and 289 µm following two treatments. Patients 4 and 5 failed to respond to IVB with a mean increase in CMT of 64.5 and 6 µm. Both responded well to IVTA with complete resolution of macular edema. Mean decrease in CMT was 146 and 183 µm with a mean CMT of 254 and 281 µm. Final vision was stable in patient 4 and improved 3 lines from 20/100 to 20/50 in patient 5. Conclusion: IVB and IVTA have variable effects on the reduction of macular edema due to radiation retinopathy. IVB appears to have an initial effect in reducing macular edema in some patients but after multiple injections there can be resistance to its effects. IVTA was effective in three of five patients with complete resolution of macular edema. The combination of IVB and IVTA completely resolved macular edema in one patient resistant to IVB or IVTA alone. The reason for this may be due to their different therapeutic mechanisms of action and consideration should therefore be given to their use in combination.

Correlation of macular thickness and posterior hyaloid change following bevacizumab and triamcinolone in diffuse diabetic macular edema in middle-aged patients

To compare changes in posterior vitreous detachment (PVD) following intravitreal injection of bevacizumab and triamcinolone in diffuse diabetic macular edema in middle-aged type 2 diabetes patients and to correlate this change with change in central macular thickness (CMT). cross sectional study. Fifteen consecutive patients treated by intravitreal bevacizumab (group A) and ten patients treated by intravitreal triamcinolone (group B). Institutional study carried out by retrospective analysis of patient registers including serial optical coherence tomography (OCT) images at baseline, and after 1 and 4months. A central macular thickness (CMT) and vitreomacular relationship was noted on OCT. PVD was graded on a linear scale (0-4). Change in grade of PVD was correlated with change in CMT at each follow-up. At month 4, the decrease in mean CMT from baseline was 51.2μ (P=0.000) and 45μ (P=0.022) in group A and group B, respectively, with no significant difference between the two groups (P=0.874). A change in grades of PVD from baseline to month 4 was significant in both group A (P=0.001) and group B (P=0.004) with no significant difference between the two groups (P=0.906). A significant correlation between change in PVD and reduction of CMT was observed in group A (P=0.011) but not in group B (P=0.315). Both bevacizumab and triamcinolone caused a significant reduction in macular thickness and a significant change in grade of PVD. Change in PVD played an influential role in the reduction of macular thickness following bevacizumab.

Fluorescein angiography patterns associated with the effect of intravitreal bevacizumab injection for diabetic macular edema

Abstract Purpose To analyze the fluorescein angiography (FAG) findings associated with the effect of intravitreal bevacizumab injection (IVB) for treatment of diabetic macular edema (DME). Methods Seventy eyes of 65 patients with DME were included in this prospective, non‐randomized pilot study. The changes in best‐corrected visual acuity (BCVA) and central macular thickness (CMT) on optical coherence tomography were evaluated considering the FAG pattern at baseline and 3 month after IVB. Results On baseline FAG, 20 eyes (28.6%) showed honeycomb type hyperfluorescence; 9 eyes (12.9%), petaloid type; and 41 eyes (58.6%), diffuse type. Three months after IVB, the mean decrease in CMT was 250.5 (198.78) μm in the case of the honeycomb and petaloid type, which was significantly larger than that in the case of the diffuse type 102.5 (147.72) μm (p = 0.03). The improvement in BCVA was 0.27 (0.30) logMAR in the case of the honeycomb and petaloid type and 0.11 (0.27) logMAR in the case of the diffuse type; this difference was statistically significant (p &lt; 0.02). There was no statistical relationship between the leakage starting time and CMT or BCVA. Conclusion The effect of IVB for treatment of DME was better in eyes showing honeycomb and petaloid type hyperfluorescence on baseline FAG than those exhibiting diffuse type hyperfluorescence.

Comparison of Bevacizumab and Triamcinolone for Treatment of Macular Edema Secondary to Central Retinal Vein Occlusion – A Matched-Pairs Analysis

Purpose: Our aim was to evaluate differences in the outcome of bevacizumab or triamcinolone acetate (TA) treatment in patients with macular edema (ME) after central retinal vein occlusion (CRVO). Procedures: In a retrospective assessment 9 bevacizumab-treated patients and 9 TA-treated ones with ME after CRVO were pair-matched according to initial best-corrected visual acuity (BCVA) and central macular thickness (CMT) as measured by Stratus optical coherence tomography. BCVA and CMT were the main endpoints. Results: The initial BCVA of 0.15 ± 0.1 increased not significantly by 1.0 ± 3.1 lines in the bevacizumab-treated patients after a mean of 10 months. The initial BCVA of 0.17 ± 0.1 decreased by –1.0 ± 5.2 lines after a mean of 13 months following initial TA injection. The only significant decrease in mean CMT by 239 ± 209 µm occurred 8 weeks after initial bevacizumab injection. Conclusions: Both substances are able to stabilize CMT and BCVA in ME after CRVO, but only bevacizumab was devoid of unfavorable intraocular pressure elevation.

VITREOMACULAR TRACTION SYNDROME

To evaluate the relationship between preoperative structure and surgical outcome in eyes with macular edema caused by vitreomacular traction (VMT).A retrospective review of 24 eyes of 24 patients with macular edema due to VMT who underwent vitrectomy to relieve macular traction is presented. The diagnosis of VMT was based on findings of clinical examination and optical coherence tomography (OCT). Preoperative and postoperative best-corrected visual acuity was converted to logarithm of the minimal angle of resolution visual acuity for analysis. Patients with a minimum of 6 months of follow-up were included.Eyes were categorized into one of the three groups based on the relationship of the posterior hyaloid to the retina: Group 1 (11 eyes) had focal vitreofoveal hyaloidal attachment with perifoveal separation; Group 2 (6 eyes) had vitreoretinal hyaloidal attachment to the macula and papillomacular bundle; and Group 3 (7 eyes) had broad vitreofoveal attachment with a fine epiretinal membrane over the posterior pole. Mean postoperative follow-up was 9.8 months (range, 6-15 months). Twenty-one eyes (87.5%) had at least 1 line of improvement in visual acuity (logMAR). Improvement in vision was significantly greater in the eyes in Group 1 (2.82 +/- 1.47 lines) than in those in Group 2 (0.83 +/- 1.17 lines; P = 0.004) or Group 3 (1.29 +/- 0.49 lines; P = 0.036). Visual outcome correlated with symptom duration (P = 0.024), VMT category (Group 1, 2, or 3; P = 0.013), and preoperative central macular thickness (CMT) by OCT (P = 0.007). A decrease in mean CMT was also significantly correlated with VMT configuration (Group 1, 2, or 3; P = 0.041).Visual outcome after vitrectomy for VMT is correlated with preoperative vitreomacular structure, duration of symptoms, and preoperative CMT.