Improvement In Central Retinal Thickness Research Articles

The Impact of Switching Anti-Vascular Endothelial Growth Factor Therapy in the Management of Exudative Age-Related Macular Degeneration.

Switching of anti-vascular endothelial growth factor (VEGF) therapy in the management of poorly responsive exudative age-related macular degeneration (AMD) has had suggested benefits in individual reports that have yet to be consolidated. In this retrospective review, 24 studies published between 2009 and 2014 were identified. Reasons for switching included tachyphylaxis, health insurance coverage, cost issues, and nonresponse or inadequate response. Nine studies had data that could be used for comparison between studies. Median follow-up was 10.6 months (range: 4.2 months to 21.8 months). Mean baseline visual acuity (VA) ranged from 0.42 logMar to 0.94 logMar (standard deviation [SD] range: 0.05 logMar to 0.50 logMar) and mean VA on final follow-up ranged from 0.38 logMar to 0.78 logMar (SD range: 0.08 logMar to 0.50 logMar). Five of nine studies reported no statistically significant change in vision, and five of nine studies reported a statistically significant improvement in central retinal thickness. This review found that switching anti-VEGF did not confer significant improvement of VA, although it provided some anatomical improvement. Pertinent considerations for evaluating response following anti-VEGF therapy are also presented in this review. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:859-869.].

Dexamethasone Intravitreal Implant Therapy for Retinal Vein Occlusion Macular Oedema and Conversion to Ranibizumab in Clinical Practice

Purpose: Evaluation of outcomes in retinal vein occlusions (RVOs) for: (1) multiple repeat dexamethasone (DEX) injections and (2) conversion from DEX to ranibizumab. Methods: We conducted a retrospective study evaluating outcomes of multiple DEX injections and those requiring conversion to ranibizumab at Moorfields Eye Hospital, Bedford, UK. All patients had undergone a complete ophthalmic work-up. Results: Patients (n = 129) had a mean follow-up of 19.9 months. The mean improvement in central retinal thickness was 312 μm after final DEX (p = <0.0001). Mean peak best corrected visual acuity (BCVA) after final DEX was an improvement of 16 ETDRS letters (p < 0.0001). Forty-nine patients were converted and received a mean of 9.37 ranibizumab injections with a mean improvement in BCVA of 15 ETDRS letters (p < 0.0001) compared with final DEX. Conclusions: This study supports the use of ranibizumab in eyes previously treated with DEX and provides long-term efficacy and safety data for multiple DEX injection.

INTRAVITREAL DEXAMETHASONE IMPLANT AS ADJUVANT TREATMENT FOR BEVACIZUMAB- AND RANIBIZUMAB-RESISTANT NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: A Prospective Pilot Study.

To study the benefit of intravitreal dexamethasone implant in the management of neovascular age-related macular degeneration resistant to bevacizumab and ranibizumab. Patients with persistent macular fluid on optical coherence tomography despite monthly treatment with at least three consecutive bevacizumab injections followed by at least three ranibizumab injections were prospectively enrolled. A single dexamethasone implant was administered followed by intravitreal ranibizumab 1 week later. Ranibizumab was continued afterward on an as-needed basis. Main outcomes were improvement in central retinal thickness and best-corrected visual acuity. Nineteen patients (19 eyes) were enrolled. There was no significant change in best-corrected visual acuity over 6 months. Greatest reduction in mean central retinal thickness, from 295.2 μm to 236.2 μm, occurred 1 month after dexamethasone implant (P < 0.0001). By Month 6, mean central retinal thickness was 287.3 μm (P = 0.16). Eyes with only intraretinal fluid (13 eyes) achieved a fluid-free macula. Eyes with predominantly subretinal fluid (6 eyes) did not improve central retinal thickness and continued monthly ranibizumab. Mean baseline intraocular pressure was 13.2 mmHg, which peaked at 15.6 mmHg by Month 2 (P = 0.004). Intravitreal dexamethasone implant improved only macular intraretinal fluid in eyes with neovascular age-related macular degeneration resistant to bevacizumab and ranibizumab. However, this treatment had a limited duration.

INTRAVITREAL BEVACIZUMAB IN THE MANAGEMENT OF NEOVASCULAR AGE-RELATED MACULAR DEGENERATION

To study prospectively the safety and efficacy of intravitreal bevacizumab for eyes with neovascular age-related macular degeneration with baseline visual acuity better than 70 letters (Snellen equivalent better than 20/40). Patients with treatment-naive neovascular age-related macular degeneration were categorized prospectively into three groups according to baseline visual acuity: Group 1 (better than 70 letters), Group 2 (70 to 61 letters), and Group 3 (60 to 51 letters). Best-corrected visual acuity and central retinal thickness using optical coherence tomography were measured at baseline and at each follow-up visit. Intravitreal bevacizumab was administered according to an as-needed optical coherence tomography-guided regimen. Main outcome measure was mean best-corrected visual acuity for each group at 12 months. Each group included 30 patients (30 eyes). Improvement in central retinal thickness was similar among the 3 groups (P = 0.964). Mean letter gain in visual acuity at 12 months was +0.4, +3.8, and +4.2 for Groups 1, 2, and 3, respectively (P = 0.42). Mean best-corrected visual acuity at 12 months was 78.4 letters for Group 1, 70.0 letters for Group 2, and 61.1 letters for Group 3 (P < 0.001). All eyes in Group 1 (100%) avoided losing 15 letters of best-corrected visual acuity versus 83.3% in Group 2 and 80.0% in Group 3. This difference was significant only between Group 1 and Group 3 (P = 0.02). Intravitreal bevacizumab for eyes with neovascular age-related macular degeneration and baseline visual acuity better than 70 letters was safe and able to maintain this vision over 12 months.

Multifocal Pupillography Identifies Ranibizumab-Induced Changes in Retinal Function for Exudative Age-Related Macular Degeneration

To investigate the efficacy of multifocal pupillographic objective perimetry (mfPOP) to quantify the effects of intravitreal ranibizumab injection for choroidal neovascularization (CNV) secondary to exudative age-related macular degeneration (AMD). mfPOP visual fields from 20 patients with unilateral exudative AMD treated with intravitreal ranibizumab were measured before and after 3 months of treatment and were compared with that in 30 normal subjects. Two stimulus types consisting of ensembles of 24 or 44 independent stimuli per eye had a mean presentation interval at each region of 1 second. Pupil responses were recorded with video cameras under infrared illumination. Multiple linear models were fitted to contraction amplitudes and delay to peak responses, to determine the independent effects of exudative AMD before and after ranibizumab therapy. After 3 months of treatment, mean additional response delays compared to normal subjects for the 24-region stimulus improved significantly (P < 5 × 10⁻⁹) from a mean of 18.82 ± 3.0 ms at baseline to 7.45 ± 3.15 ms. The mean effect of exudative AMD at baseline decreased constriction amplitude by -1.11 ± 0.24 dB (P < 0.00001) with little improvement after ranibizumab therapy. Small pretreatment elevations of extrafoveal sensitivity correlated with improvements in central retinal thickness (CRT) after treatment (P < 0.0005). Improvements in mfPOP contraction amplitudes and time to peak responses were measured in eyes treated with intravitreal ranibizumab; however, response delays appeared to be the most indicative of functional improvement. Confirmation of hypersensitivity in the extrafoveal field in a larger group may support this finding as a prognostic marker for good treatment outcomes.

Randomized Controlled Trial of an Intravitreous Dexamethasone Drug Delivery System in Patients With Diabetic Macular Edema

To evaluate the safety and efficacy of a dexamethasone intravitreous drug delivery system (DDS) in eyes with diabetic macular edema (DME). Patients with persistent macular edema (> or = 90 days' duration) were randomized to treatment with 700 microg or 350 microg of dexamethasone DDS or observation. One eye from each patient was designated as the study eye. The analysis is of the eyes in this study with DME (n = 171). The primary outcome measure was the proportion of eyes that achieved an improvement in best-corrected visual acuity (BCVA) of 10 letters or more from baseline at day 90. Other outcome measures included fluorescein leakage, central retinal thickness, and safety parameters. At day 90, a BCVA improvement of 10 letters or more was seen in more eyes in the 700-microg group (33.3%) and 350-microg group (21.1%) than the observation group (12.3%; P = .007 vs 700-microg group). At day 180, a BCVA improvement of 10 letters or more was seen in 30% of eyes in the 700-microg group, 19% in the 350-microg group, and 23% in the observation group (P > or = .4 for treated vs observed eyes). There were also significantly greater improvements in central retinal thickness and fluorescein leakage in treated eyes than observed eyes (P = .03; day 90). Dexamethasone DDS was well tolerated. In eyes with persistent DME, treatment with 700 microg of intravitreal dexamethasone DDS is well tolerated and produces significant improvements in BCVA, central retinal thickness, and fluorescein leakage compared with observation (statistically significant at day 90). Dexamethasone DDS, 700 microg, may have potential as a treatment for persistent DME. clinicaltrials.gov Identifier: NCT00035906.

Early and Late Intravitreal Bevacizumab Injection in Macular Edema Due to Branch Retinal Vein Occlusion

Purpose: To compare the effects of early and late intravitreal injection of bevacizumab in patients with macular edema (ME) due to branch retinal vein occlusion (BRVO). Methods: The study sample included 56 eyes of 56 patients who received intravitreal bevacizumab injection for ME due to BRVO and were followed up with at least six months of observation. We retrospectively divided eyes into two classes that included 36 eyes with a disease duration of 3 months (early treatment group) and 20 eyes with a disease duration of > 3 months (late treatment group). We assessed the effects of injection on the best corrected visual acuity (BCVA), central retinal thickness and IOP at one, three, and six months after treatment. Results: There was no statistically significant differences in terms of sex, age, number of injections, ischemia, pre-injection visual acuity and central retinal thickness between the two treatment groups. Improvements in central retinal thickness were observed in both groups but were not significantly different between the groups. Visual acuity improved in both groups after treatment; the improvement was significantly better in the early treatment group observed three and six months after treatment. IOP did not change after treatment in either group. Conclusions: In cases of ME due to BRVO, early intravitreal bevacizumab injection is more effective than late injection for maintaining and improving visual acuity.

Electrophysiological and structural assessment of the central retina following intravitreal injection of bevacizumab for treatment of macular edema

To evaluate with electrophysiological responses and Optical Coherence Tomography (OCT), the short term functional and structural effects at the macula following intravitreal injection of bevacizumab for macular edema. Prospective, non-randomized, interventional case study. In total, 17 eyes of 17 patients with macular edema due to vein occlusions and diabetic retinopathy received intravitreal bevacizumab. All Patients underwent complete ophthalmic examination including Snellen visual acuity testing, Multifocal Electroretinography (mfERG) and Full Field Electroretinography (FERG), OCT scanning at baseline at 1 week and 2 months after intravitreal bevacizumab. FERG did not show any change in waveform parameters following intravitreal injection of bevacizumab. Average mfERG macular responses within central 20 degrees showed increased P(1) amplitude (P < 0.05) at 2 months after treatment as compared to the baseline recordings in all subjects. No changes were seen in the implicit time. There was 22% improvement in central retinal thickness (CRT) at 2 months compared to the baseline (P < 001). Intravitreal injection bevacizumab resulted in reduction in the central retinal thickness and mild to moderate improvement in the mfERG amplitudes in this short-term study. The visual acuity changes did not directly correlate with the reduced central retinal thickness or improvement in mfERG. The short-term results showed no serious ocular adverse effects. Therefore on short-term follow up the off label drug showed improvement of macular edema secondary to vein occlusion and diabetic retinopathy with no demonstrable toxic effects.