Median Central Retinal Thickness Research Articles

PHOTODYNAMIC THERAPY-INDUCED ACUTE EXUDATIVE MACULOPATHY IN A CASE SERIES OF CIRCUMSCRIBED CHOROIDAL HEMANGIOMA.

To describe the incidence, features, and clinical outcomes of photodynamic therapy-induced acute exudative maculopathy (PAEM) in circumscribed choroidal hemangioma. Prospective series of 10 patients who underwent standard-fluence photodynamic therapy for circumscribed choroidal hemangioma. Best-corrected visual acuity in the Early Treatment Diabetic Retinopathy Score and swept-source optical coherence tomography were performed before PDT and 3 days and 1 month after PDT. Central retinal thickness, circumscribed choroidal hemangioma retinal thickness, and subretinal fluid were measured. Photodynamic therapy-induced acute exudative maculopathy was considered as an increase ≥50 µ m in subretinal fluid or intraretinal fluid or the appearance of fibrin 3 days after photodynamic therapy. Six men and four women were included; median age was 55 years (19-69 years). The incidence rate of PAEM was 7 of 10. Five PAEM patients showed an increase in intraretinal fluid, two in subretinal fluid, and one developed abundant fibrin. Median best-corrected visual acuity at baseline was 57.5 letters (5-76 letters) being stable at 1 month (64 letters; 5-80) ( P = 0.03). Median central retinal thickness increased from 516 µ m (262-1,265 µ m) to 664.5 µ m after 3 days and diminished to 245 µ m after 1 month (156-1,363) ( P ≤ 0.022). In 6 of 7 of PAEM, a complete resolution of the fluid was obtained. Photodynamic therapy-induced acute exudative maculopathy was frequent in circumscribed choroidal hemangioma, although a favorable prognosis was observed in most cases.

Navigated laser and aflibercept versus aflibercept monotherapy in treatment-naïve branch retinal vein occlusion: A 12-month randomized trial.

Angiostatic agents have proven effective in the treatment of macular oedema in patients with branch retinal vein occlusion (BRVO). However, treatment is inconvenient and expensive, and novel treatment regimens are warranted. We aimed to evaluate if combination treatment of navigated central retinal laser and aflibercept lowered the treatment burden in these patients. Treatment-naïve patients with BRVO and macular oedema were included at two centres and randomized 1:1 to three monthly injections of 2.0 mg aflibercept with (Group A) or without (Group B) navigated central laser, followed by aflibercept as needed from month 4 through 12. Re-treatment need was evaluated, and secondary endpoints included functional and anatomical outcomes and safety evaluated by retinal microperimetry. We evaluated 41 eyes of 41 patients with a mean age of 69.6 years. Baseline median best-corrected visual acuity (BCVA) was 70.0 letters, and median central retinal thickness (CRT) was 502 μm with no difference between Groups A (n = 21) and B (n = 20). Percentage of patients needing re-treatment after month three was 71% and 80% (p = 0.72). At month 12, groups did not differ in number of injections after loading (1 versus 2, p = 0.43), change in BCVA (+12.8 versus +15.1 letters, p = 0.48), CRT (-195 versus -181 μm, p = 0.82), or retinal sensitivity (+3.3 versus +4.1 dB, p = 0.67). In treatment-naïve BRVO patients, addition of navigated central laser to aflibercept did not lower treatment burden or affect functional or anatomical outcomes. A low number of intravitreal injections were needed for successful outcome in both treatment arms.

Mid-term safety and effectiveness of intravitreal dexamethasone implant to treat persistent cystoid macular edema in vitrectomized eyes for bacterial endophthalmitis.

To evaluate the mid-term safety and effectiveness of intravitreal dexamethasone implant (DEX-i) for treating unresponsive to medical therapy cystoid macular edema (CME) in vitrectomized eyes for endophthalmitis. Retrospective and interventional case series study conducted on vitrectomized eyes for endophthalmitis that developed a CME that did not adequately respond to medical therapy, who underwent 0.7-mg DEX-i. Main outcome measures were changes in central retinal thickness (CRT) and best corrected visual acuity (BCVA). Eleven eyes were included in the study. Microbiological findings of vitreous biopsies were 7 (63.6%) staphylococcus epidermidis; 3 (27.3%) Pseudomonas aeruginosa; and 1 (9.1%) Propionibacterium acnes. Median (interquartile range, IqR) duration of CME was 4.0 (3.0-4.0) months. Median (IqR) time between vitrectomy and DEX-i was 9.0 (9.0-11.0) months. Median CRT was significantly decreased from 548.0 (412.8-572.5) µm at baseline to 308.0 (281.3-365.5) µm at month 6 (p = 0.0009, Friedman test). Median BCVA significantly improved from 38.0 (30.5-44.8) letters at baseline to 50.0 (46.8-53.0) letters at month 6 (p < 0.0001, Friedman), with 9 (81.8%) eyes gaining ≥ 10 letters. Elevation of intraocular pressure was observed in one (9.1%) eye, which was successfully controlled with medical therapy. No recurrence of endophthalmitis or other complications was observed. Eight (72.7%) eyes required an additional DEX-i, while 3 (27.3%) were successfully controlled with only one DEX-i. CME recurrence occurred in 5 (62.5%) Gram-positive and 3 (100.0%) Gram-negative bacteria (p = 0.2357). In vitrectomized eyes for endophthalmitis affected by CME unresponsive to medical therapy, DEX-i had an acceptable safety profile and achieved favorable outcomes. The possibility of suppressing mechanisms for infection control should be taken into account, although correct management of endophthalmitis and long time without reactivation before DEX-i reduce the risk.

Dexamethasone implant improves anatomic response to anti-VEGF therapy in treatment-resistant polypoidal choroidal vasculopathy.

A significant proportion of eyes with polypoidal choroidal vasculopathy (PCV) can be resistant to anti-vascular endothelial growth factor (VEGF) injections. We evaluated the efficacy of a combination of dexamethasone intravitreal implant (DXI) and anti-VEGF therapy in eyes resistant to anti-VEGF monotherapy. In this retrospective study, patients with PCV resistant to anti-VEGF injections were additionally injected with a DXI along with an anti-VEGF agent. Best-corrected visual acuity (BCVA), slit-lamp examination, fundus evaluation, and optical coherence tomography (OCT) data were analyzed. Anatomical response on OCT was the primary outcome measure. Change in visual acuity and injection-free interval after DXI were evaluated as secondary outcome measures. Twelve eyes of 11 patients were included in the study. Mean age of patients at presentation was 64.7 ± 9.5years (range, 49-78.8years), and there were seven females (63.6%). Median number of anti-VEGF injections prior to DXI was 4 (interquartile range IQR, 3-7). Median follow-up duration after DXI was 32.2months (IQR, 6.6-41.6months). Median logMAR BCVA immediately prior to DXI was 0.41 (IQR, 0.30-0.88) and after injection was0.40 (IQR, 0.30-1.05), which was not significantly different (p = 0.85). Median Central Retinal Thickness (CRT) after DXI was 305.5µm (IQR, 249-409µm), which was significantly (p = 0.003) lesser than pre-injection thickness of 547µm (IQR, 431-771µm). Median injection-free interval in these eyes after DXI was 5months (IQR, 2.8-6.4months). Kaplan-Meier estimates of first injection after DXI were 27.3% at 3months, 67.3% at 6months, and 89.1% at 12months. Dexamethasone implant combined with anti-VEGF treatment can prolong the treatment-free interval in eyes with PCV resistant to anti-VEGF injection while maintaining visual acuity.

Comparing Effectiveness of Three Different Anti-VEGF Treatment Regimens for Neovascular Age-Related Macular Degeneration: Two Years' Real-World Clinical Outcomes.

PurposeTo compare and report the 2-year treatment outcomes from 3 different anti-VEGF treatment regimens in treating neovascular aged-related macular degeneration (nAMD): Ranibizumab pro re nata (Ranibizumab-PRN); Ranibizumab treat and extend (Ranibizumab-T&E); Aflibercept fixed first year dosing (7 injections) with treat and extend in subsequent year (Aflibercept-Fixed).MethodsAll treatment-naïve nAMD patients who completed 24 months of monitoring from a single treatment center were included. Patients received the initial loading dose of three injections (4-weekly interval), followed by one of the 3 treatment regimens. Primary outcomes were changes in visual acuity (VA) and central retinal thickness (CRT). Secondary outcome was number of injections required in each year. Data analysis included last observation carried forward (LOCF) for patients with incomplete year-2 follow-up.ResultsA total of 249 eyes (230 patients) were studied: 121 Ranibizumab-PRN; 65 Ranibizumab-T&E, and 63 Aflibercept-Fixed. Baseline median VA (ETDRS letters) for Ranibizumab-PRN, Ranibizumab-T&E, and Aflibercept-Fixed was 53.9, 61.1, and 54.9 letters, achieving final VA of 54.9, 65.1, and 65.1 letters, respectively. Hence, the number of letters increased at the end of 24 months for each group was +1.0 (Ranibizumab-PRN), +4.0 (Ranibizumab-T&E), highest +10.2 in Aflibercept-Fixed group. Median number of injections over 2 years (year-1/year-2) was 5/1 for Ranibizumab-PRN, 9/6 for Ranibizumab-T&E, and 7/5 for Aflibercept-Fixed. Both Ranibizumab-T&E and Aflibercept-Fixed also shared the same reduction of median CRT (115 µm), higher than Ranibizumab-PRN (83 µm).ConclusionWe report VA improvement from all three different treatment regimens with both Aflibercept-Fixed and Ranibizumab-T&E regimens achieving the same higher final VA. Aflibercept-Fixed dosing may have more favorable efficacy with the highest VA gain and comparatively lower dosing frequency whereas Ranibizumab-T&E may be more efficient than Ranibizumab-PRN regimen, according to our study.

Surgical outcomes in patients with optic disc pit maculopathy: does peeling the ILM lead to better outcomes?

PurposeOptic disc pits (ODPs) are rare congenital anomalies. Several patients develop optic disc pit maculopathy (ODP-M): visual impairment caused by intra- and/or subretinal fluid. Treatment mode remains controversial. This study was designed to investigate the effectiveness of pars plana vitrectomy (PPV) and gas tamponade with or without internal limiting membrane (ILM)-peeling in improving visual acuity and reducing subretinal fluid in ODP-M patients.MethodsWe retrospectively reviewed the charts of 16 patients who underwent surgery for ODP-M from 2002–2015. Six patients underwent PPV with gas tamponade (group 1); ten patients additionally received ILM-peeling (group 2). Pre- and postoperative visual acuity and central retinal thickness (CRT) were compared between groups, as well as retinal morphology and the number of secondary vitrectomies and complications.ResultsMedian visual acuity improved by 2 ETDRS lines in both groups (p = 0.713, Mann–Whitney U test). Median CRT decreased by 426.5 µm and 460 µm (p = 0.931). One patient in group 1 underwent repeat vitrectomy for persistent retinoschisis. Three patients in group 2 required repeat vitrectomy: two to treat a macular hole, one for peripheral retinal holes with retinal detachment.ConclusionIn our cohort, PPV with gas tamponade proved to be an effective first-line treatment for ODP-M. Additional ILM-peeling did not give a significant benefit in this study.

One-year outcomes of the Polish treatment program for the wet form of age-related macular degeneration using intravitreal therapy.

To report 12-month outcomes of a Polish National Treatment Program using aflibercept and ranibizumab in eyes with wet, age-related macular degeneration in routine clinical practice. This was a non-randomized, retrospective, observational multicenter study. Anonymous data contained in the electronic Therapeutic Program Monitoring System were utilized in this study. The study population consisted of 2828 eyes from 2718 patients. The median age was 76.0 [70.0, 81.0] years; 61.7% were female. Best corrected visual acuity increased from 58.86 [50.05, 69.95] letters to 65.1 [50.1, 73.9] letters (p < 0.001). The median change in best corrected visual acuity was 0.0 [-4.0, 12.2] letters: 2.9 [-2.9, 15.1] letters for treatment-naïve eyes and 0.0 [-4.0, 8.8] letters for those continuing treatment (p < 0.001). The median central retinal thickness was significantly reduced from 341.0 [281.0, 422.0] to 275.0 [221.0, 344.0] μm (p < 0.001). The median number of visits was 9.0 [8.0, 9.0]. The median number of injections was 7.0 [6.0, 8.0]: 8.0 [7.0, 8.0] for treatment-naïve eyes and 6.0 [5.0, 7.0] for those continuing treatment (p < 0.001). Eyes treated as part of the Polish therapeutic program gained functional stability and morphological improvement. Treatment-naïve eyes showed the greatest functional benefit.

Combination Therapy for Macular Oedema in Retinal Vein Occlusions: 3-Year Results from a Real-World Clinical Practice.

PurposeTo report long-term efficacy and treatment outcomes of the combination therapy for treating macular oedema (MO) in retinal vein occlusions (RVOs) from a real-world UK practice.MethodsThe initial reported 66 RVO patients with MO treated with combination therapy (initial Ranibizumab, later optional addition of Ozurdex and laser) were followed up to Year 3: visual acuity (VA) and central retinal thickness (CRT) were analysed against baseline and previous Year 1 results. Safety and adverse events were also recorded.ResultsBaseline LogMAR VA of 0.71 (Snellen 6/30) improved to 0.48 (Snellen 6/18) at Year 3 (p=0.006); 63% experienced VA improvement (40% improved ≥3 lines), 27% had worse vision. Stability of mean VA (6/18) was already achieved at first post-loading phase review and was maintained in each subsequent year. Statistically significant CRT improvement was noted in each year (Year 3 median CRT=264µm) compared to baseline (median CRT=531µm). There was a reduction in the mean number of total injections to 2.5 in Year 3 (vs 5.5 in Year 1). Comparing Year 3 against Year 1, mean Ranibizumab injection frequency was 2.1 vs 4.3; mean Ozurdex injection frequency was 0.2 vs 1.1. In Year 3, 39.6% of patients did not require any form of injections, laser frequency was also reduced to 22.9% (vs 81.8% in Year 1). There was no endophthalmitis in the cohort, one progressed to neovascular glaucoma in Year 2 and mortality rate was recorded as 6%.ConclusionOur real-world clinical practice for RVO patients using a combined therapy is associated with good long-term VA and anatomical outcomes with less intravitreal re-treatment rates.

Prospective Clinical Trial of Intravitreal Aflibercept Treat-and-extend Regimen for Diabetic Macular Edema: 1-Year Outcomes.

PurposeTo investigate the efficacy of aflibercept for the treatment of diabetic macular edema via a treat-and-extend regimen.MethodsThis prospective, single-center, open-label, interventional study involved 30 patients with a best-corrected visual acuity (BCVA) ≤0.6 and a central retinal thickness (CRT) ≥300 µm. The enrolled eyes each received a monthly intravitreal aflibercept injection until the CRT decreased below 300 µm, upon which the administration interval was extended for 1 month until the CRT once again increased to ≥300 µm. Main outcome measures were median BCVA and CRT at 6 and 12 months after initiation of treatment via last observation carried forward analysis, the median number of injections over the 12 months, and the effects on the diabetic retinopathy severity scale (DRSS) score of the patients who completed the 12-month follow-up period.ResultsOf the 30 enrolled patients, 29 and 25 respectively completed the 6- and 12-month follow-up examinations. From baseline to 6 and 12 months after treatment initiation, the median BCVA (logarithm of the minimum angle of resolution) significantly improved from 0.52 to 0.30 and 0.35, respectively, and the median CRT significantly decreased from 439.5 to 268.5 and 249.0 µm, respectively. The median number of injections over the 12-month follow-up period was 6.0. Compared to baseline, the DRSS score at 12 months was improved by 2 steps in 16% of patients; in no cases did the DRSS score worsen or improve by three steps or more.ConclusionsWhen administered in a treat-and-extend regimen, aflibercept is an effective treatment option for diabetic macular edema.

Real-World Visual And Clinical Outcomes For Patients With Neovascular Age-Related Macular Degeneration Treated With Intravitreal Ranibizumab: An 8-Year Observational Cohort (AMD8).

PurposeTo report the long-term clinical outcomes for patients with neovascular age-related macular degeneration (nAMD) who received anti-vascular endothelial growth factor (anti-VEGF) therapy as part of a standardised treatment protocol in a real-world setting.Patients and methodsThis is a retrospective audit of all treatment-naïve patients with nAMD who commenced a pro re nata (PRN) treatment regimen of intravitreal Ranibizumab from January to December 2009 and completed 8 years of follow-up in one single-treatment centre. Electronic medical notes were reviewed to evaluate the outcome measures. Outcome measures included progression of visual acuity (VA), central retinal thickness (CRT) and treatment frequency.Results95 eyes from 86 patients had complete data for 8 years of follow-up. Baseline median CRT was 295µm [IQR 254–349] and improved to 209µm [IQR 182–254] in year 8 (p<0.001); baseline median VA was 61 ETDRS letters which increased to 70 letters post-loading however was reduced to 55 letters by year 8 (mean VA change from baseline was −9.1 letters); 47.4% had stable or improved vision, 10.5% gained ≥15 letters and 33.7% had lost ≥15 letters. The highest visual gain was achieved after the initial loading-phase, with a subsequent steady decline, 26.3% (compared to baseline 33.4%) achieved driving vision standard. Median injection frequency was 6 (range 3–10) in year 1 and 3 injections (range 0–10) in year 8. 51.6% of eyes required at least one injection each year and only 34.7% required no injections in year 8.ConclusionOur real-world nAMD treatment cohort using Ranibizumab PRN regimen achieved an encouraging almost 50% stable or improved VA at year 8 and total injections of 31.6 injections per patient over an 8-year period.

Interferon Alpha for Refractory Pseudophakic Cystoid Macular Edema (Irvine-Gass Syndrome)

ABSTRACTPurpose: To assess the efficacy and safety of systemic interferon alpha-2a (IFN) for refractory pseudophakic cystoid macular edema (PCME).Methods: Retrospective observational study. The primary outcome was the decrease of central retinal thickness (CRT). Secondary endpoints were the improvement of best-corrected visual acuity (BCVA) and the assessment of IFN-related side effects.Results: Twenty-four eyes of 20 patients were included. The median CRT was 513 µm (range 220–980 µm) at baseline and decreased to 190 µm (range 140–520 µm) at the last follow-up visit (p < 0.001). Reduction of CRT greater than 100 µm was observed in 22 eyes (92%). The median BCVA (logMAR) increased statistically significant from 0.5 (range 0.2–1.5) at baseline to 0.3 (0–0.8) at the last follow-up (p < 0.001). The BCVA improved in 18 eyes (75%) and remained stable in five eyes (21%). No severe treatment-related side effects occurred.Conclusion: IFN is a very effective agent for treatment of refractory PCME.

Effect of Aflibercept on Cystoid Macular Edema Associated with Central Retinal Vein Occlusion. Results from a District Hospital in the United Kingdom.

The purpose of this study was to report the efficiency and safety of intravitreal aflibercept for the treatment of cystoid macular edema (CME) secondary to central retinal vein occlusion (CRVO). This is a retrospective cohort study. Ten naive eyes of ten patients with CME secondary to CRVO were included. All eyes received a loading dose of 3 monthly aflibercept injections followed by as-needed injections at monthly follow-up visits. Best corrected visual acuity (BCVA) and central retinal thickness (CRT) were evaluated at baseline and at the end of the follow-up period. The median follow-up period was 6 months (range: 6 - 9). The median number of injections was 4 (range: 3 - 5). Median BCVA improved from 1.05 LogMAR units (range: 0.7 - 1.6) at baseline to 0.65 (range: 0.4 - 1.6) at the end of the follow-up period (p = 0.02). Median CRT improved from 690 µm (range: 561 - 1235) at baseline to 243 µm (range: 207 - 531) at the end of the follow-up period (p = 0.002). The power of all statistical tests was greater than 0.8. No adverse effects or complications were documented. Intravitreal aflibercept treatment for CME secondary to CRVO significantly improved both macular anatomy and visual acuity without adverse effects.

Effectiveness and Safety of Intravitreal Dexamethasone Implant (Ozurdex) in Patients with Diabetic Macular Edema: A Real-World Experience

Introduction: There are few real-life studies on the intravitreal 0.7-mg dexamethasone implant for the treatment of diabetic macular edema (DME) conducted in Latin America. We aimed to assess the effectiveness and safety of this implant in clinical practice. Methods: Twenty-seven centers from Brazil and one from Argentina provided information on patients with DME treated with Ozurdex. The efficacy outcome variables were best-corrected visual acuity (BCVA) in Snellen and central retinal thickness (CRT). Safety was assessed by the elevation in intraocular pressure (IOP), occurrence of cataracts, and adverse events. Results: A total of 329 eyes (both treated cases and naïve eyes) from 282 patients underwent treatment. The time since diagnosis of DME ranged from 1 to 156 months. The median BCVA was 0.7 logMAR/50 letters at baseline and 0.3 logMAR/70 letters after treatment (both p < 0.001). Median CRT values decreased from 425 µm at baseline to 270 µm after treatment (p < 0.001). Increases in IOP of at least 10 mm Hg were observed in 7.4% of eyes, and 4% of eyes had cataract evolution. No cases of endophthalmitis were reported. Conclusion: These real-life results suggest that the intravitreal dexamethasone implant is effective and safe for eyes with DME.

The role of posterior vitreous detachment on the efficacy of anti-vascular endothelial growth factor intravitreal injection for treatment of neovascular age-related macular degeneration.

Purpose:A prospective cohort study investigating the effect of posterior vitreous detachment (PVD) on the efficacy of intravitreal bevacizumab for exudative age-related macular degeneration (AMD), in view of evidence that the vitreoretinal interface impacts the severity of the disease.Methods:Treatment-naïve AMD eyes with (+) complete PVD and without (−) PVD on ultrasonography received three monthly and then pro re nata bevacizumab injections. Best-corrected visual acuity (BCVA) on Snellen charts and optical coherence tomography (OCT) findings were recorded for 12 months. Secondary analysis included PVD definition and group allocation according to OCT baseline scan.Results:Forty-one eyes of 34 patients met the inclusion criteria. At 12 months, median BCVA improved by 0.12 logMAR in the PVD+ group [interquartile range (IQR) −0.52, 0.03, P = 0.140] and remained the same in the PVD− group (IQR −0.12, 0.15, P = 0.643). Median central retinal thickness improved by 43.5 μm and 43 μm in the PVD+ (IQR −143, 3, P = 0.016) and PVD− group (IQR −90, −14, P = 0.008), respectively. All parameters were similar in the two groups at final follow up (P > 0.05). The secondary analysis included 32 eyes of 26 patients and showed no significant differences between the groups at the 12 months endpoint (P > 0.05).Conclusion:Our findings show no significant impact of PVD as assessed by ultrasound or by OCT on visual and anatomical outcomes in exudative AMD treated with bevacizumab.

Efficacy and timing of adjunctive therapy in the anti-VEGF treatment regimen for macular oedema in retinal vein occlusion: 12-month real-world result

PurposeVarious combination treatment regimens have been tried to improve the short-term efficacy of intravitreal monotherapy for the treatment of macular oedema (MO) secondary to retinal vein occlusion (RVO). Our study introduces the RandOL protocol (Ranibizumab and Ozurdex with Laser photocoagulation) of initial anti-VEGF therapy, controlling recurrent non-ischaemic MO with an intravitreal steroid and applying laser therapy to non-perfused retina. We describe our 12-month follow-up experience on timing for adjunctive therapy and real-world effectiveness and safety data.MethodsA retrospective analysis was carried out on 66 consecutive treatment-naive RVO patients with MO who received our RandOL treatment regimen. Baseline visual acuity (VA) and central retinal thickness (CRT) were compared with 12-month result.ResultsAt 12 months, 77% had significant VA improvement, 52% had ≥3-line improvement, and 15% were worse. Significant improvements in CRT were observed in 97% (baseline median CRT=531 μm (IQR 435–622) reduced to 245 μm (IQR 221–351, P<0.001) at 12 months); 76% achieved a dry fovea at 1 year. Mean number of total injections required was 5.5 (range 2–11) and 6% required ≥9 injections in 1 year. Although 70% received additional Ozurdex, 82% received ≥1 sessions of laser therapy. The BRVO subgroup achieved better VA and CRT improvement at 1 year, but small numbers limit definitive statistical conclusions.ConclusionsOur real-world results using a combination treatment protocol for RVO-related MO achieved similar desirable anatomical and visual outcomes as with a single-agent therapy with less intravitreal re-treatment rates at first year. Randomised controlled studies are needed to evaluate the role of laser and the ideal timing of combination therapy.

Aflibercept in persistent neovascular AMD: comparison of different treatment strategies in switching therapy

PurposeTo evaluate the effects of aflibercept administered according to a pro re nata (PRN) or Fixed Regimen to patients with neovascular AMD and persistent intraretinal/subretinal fluid (IRF/SRF) despite three consecutive ranibizumab injections.MethodsPatients were switched to aflibercept injection (IVA) administered according to a PRN or to a fixed regimen for 1 year in two different retina centers. At baseline each patient underwent a complete ophthalmologic evaluation, including best-corrected visual acuity assessment (BCVA ETDRS chart), fluorescein, and indocyanine green angiography and OCT.ResultsEach group included 36 eyes. After 1 year the PRN group showed BCVA stabilization (63 vs 60 letters, P=0.33), whereas fixed regimen group showed significant BCVA improvement (68 vs 71, P=0.008). The median central retinal thickness decreased by 94 μm in the PRN (P=0.002) and by 148 μm in the fixed regimen group (P≤0.001). Complete IRF/SRF reabsorption was found in 58% of eyes in the PRN and in 42% of eyes in the fixed regimen group. At 1-year visit, the percentage of eyes with pigment epithelium detachment did not significantly decrease, but a height reduction was recorded in both groups. The median number of IVA was 3.5 in the PRN and 7 in the fixed regimen group.ConclusionThe switch to aflibercept with both treatment strategies enabled improvement in morphological parameters and stabilization of visual acuity. BCVA improvement and reduction in vision loss with reduction in retinal thickness, fluid and PED height was achieved with the fixed regimen in previously treated nAMD after 1 year.

Epiretinal membrane as a source of errors during the measurement of peripapillary nerve fibre thickness using spectral-domain optical coherence tomography (SD-OCT).

We aimed to examine the extent to which measurement errors in the determination of retinal nerve fibre layer (RNFL) using spectral-domain optical coherence tomography (SD-OCT) occur in cases of epiretinal membrane and whether systematic deviations are found in the values obtained. A macular scan and a circumpapillary scan were performed on 97 eyes of 97 patients using SD-OCT. Group 1 comprised 53 patients with epiretinal membrane at an age of 70 ± 4.8years (median ± average absolute deviation). Group 2 consisted of 44 patients without any macular pathologies (median age 70 ± 5.8years). Differences in the thickness of the RNFL and segmentation errors in the detection of the RNFL were recorded quantitatively in both groups and checked for statistical significance using non-parametric tests. The median central retinal thickness in Group 1 was 357 ± 79μm (median ± average absolute deviation), and in Group 2 it was 270 ± 11μm (p < 0.001). The result of the quadrant-by-quadrant measurement of the average RNFL in Group 1 and Group 2, respectively, was: temporal 88 ± 17 and 73 ± 9μm, inferior 121 ± 17 and 118 ± 15μm, nasal 87 ± 15 and 89 ± 14μm and superior 115 ± 15 and 114 ± 9μm. Temporally, the difference was statistically significant (p < 0.001). Segmentation errors of the RNFL were found in 19 of 53 eyes (35.8%) in Group 1 and in no eyes (p < 0.001) in Group 2. In eyes with epiretinal membrane, measuring errors in the SD-OCT occur significantly more frequently than in eyes without any retinal pathologies. If epiretinal membrane and glaucoma are present simultaneously, the results of the automated RNFL measurement using SD-OCT should be critically scrutinised, even if no papillary changes are visible clinically.

One-year outcome of bevacizumab therapy for chronic macular edema in central and branch retinal vein occlusions in real-world clinical practice in the UK.

BackgroundThe purpose of this study was to investigate the 12-month outcome of macular edema secondary to both chronic and new central and branch retinal vein occlusions treated with intravitreal bevacizumab in the real-life clinical setting in the UK.MethodsRetrospective case notes analysis of consecutive patients with retinal vein occlusions treated with bevacizumab in 2010 to 2012. Outcome measures were visual acuity (measured with Snellen, converted into logMAR [logarithm of the minimum angle of resolution] for statistical calculation) and central retinal thickness at baseline, 4 weeks post-loading phase, and at 1 year.ResultsThere were 56 and 100 patients with central and branch retinal vein occlusions, respectively, of whom 62% had chronic edema and received prior therapies and another 32% required additional laser treatments post-baseline bevacizumab. Baseline median visual acuity was 0.78 (interquartile range [IQR] 0.48–1.22) in the central group and 0.6 (IQR 0.3–0.78) in the branch group. In both groups, visual improvement was statistically significant from baseline compared to post-loading (P<0.001 and P=0.03, respectively), but was not significant by month 12 (P=0.058 and P=0.166, respectively); 30% improved by at least three lines and 44% improved by at least one line by month 12. Baseline median central retinal thickness was 449 μm (IQR 388–553) in the central group and 441 μm (IQR 357–501) in the branch group. However, the mean reduction in thickness was statistically significant at post-loading (P<0.001) and at the 12-month time point (P<0.001) for both groups. The average number of injections in 1 year was 4.2 in the central group and 3.3 in the branch group.ConclusionOur large real-world cohort results indicate that bevacizumab introduced to patients with either new or chronic edema due to retinal vein occlusion can result in resolution of edema and stabilization of vision in the first year.

Optical coherence tomography (OCT) for detection of macular oedema in patients with diabetic retinopathy.

Diabetic macular oedema (DMO) is a thickening of the central retina, or the macula, and is associated with long-term visual loss in people with diabetic retinopathy (DR). Clinically significant macular oedema (CSMO) is the most severe form of DMO. Almost 30 years ago, the Early Treatment Diabetic Retinopathy Study (ETDRS) found that CSMO, diagnosed by means of stereoscopic fundus photography, leads to moderate visual loss in one of four people within three years. It also showed that grid or focal laser photocoagulation to the macula halves this risk. Recently, intravitreal injection of antiangiogenic drugs has been investigated to try to improve vision in people with macular oedema due to DR.Optical coherence tomography (OCT) is based on optical reflectivity and is able to image retinal thickness and structure producing cross-sectional and three-dimensional images of the central retina. It is already widely used because it provides objective and quantitative assessment of macular oedema unlike the subjectivity of fundus biomicroscopic assessment, which is routinely used by ophthalmologists instead of photography. Optical coherence tomography is also used for quantitative follow up of the effects of treatment of CSMO. Disadvantages of using OCT are the cost to purchase it and the need for trained personnel to perform the examinations.To determine the diagnostic accuracy of OCT for detecting macular oedema in people with DR. A secondary objective is to compare the diagnostic accuracy by study-specific characteristics, such as factors related to methodology, patients or OCT.We searched the Cochrane Database of Systematic Reviews (CDSR), the Database of Abstracts of Reviews of Effects (DARE), the Health Technology Assessment Database (HTA) and the NHS Economic Evaluation Database (NHSEED) (The Cochrane Library 2011, Issue 5), MEDLINE (January 1950 to May 2011), EMBASE (January 1950 to May 2011), ISI Web of Science (January 1970 to May 2011), BIOSIS Previews (January 1969 to May 2011), MEDION and the Aggressive Research Intelligence Facility database (ARIF). There were no date or language restrictions in the electronic search for trials. The electronic databases were last searched on 16 May 2011. We checked bibliographies of relevant studies for additional references.We selected studies that assessed the diagnostic accuracy of any OCT model for detecting DMO or CSMO in patients with DR who were referred to eye clinics. Diabetic macular oedema and CSMO were diagnosed by means of fundus biomicroscopy by ophthalmologists or stereophotography by ophthalmologists or other trained personnel.Three authors independently extracted data on study characteristics and measures of accuracy. We assessed data using random-effects hierarchical sROC meta-analysis models.Nine studies (768 participants, 1325 eyes) were included. Prevalence of CSMO was 19% to 65% (median 50%). Study quality was good for half the QUADAS items, whereas unclear or inadequate quality was found in some studies regarding selection criteria, index and reference test masking (blinding), availability of clinical information, uninterpretable results and withdrawals. There was a specific 'unit of analysis' issue because both eyes of the majority of participants were included in the analyses as if they were independent.Central CSMO was the target condition in all but one study and thus our results cannot be applied to non-central CSMO. In eight studies providing data on CSMO (697 participants, 1241 eyes), pooled sensitivity was 0.78 (95% confidence interval (CI) 0.72 to 0.83) and specificity was 0.86 (95% CI 0.76 to 0.93). The median central retinal thickness cut-off we selected for data extraction was 250 µm (range 230 µm to 300 µm).Data from three studies reporting accuracy for detection of DMO (180 participants, 343 eyes) were not pooled. Sensitivities and specificities were about 0.80 in two studies and were both 1.00 in the third study.Central retinal thickness measured with OCT cannot be used as a stand-alone test to diagnose the central type of CSMO and decide on the use of laser photocoagulation in patients who are referred to retina clinics. In fact, there is a substantial disagreement of OCT with the ETDRS definition of CSMO based on clinical examination. Some researchers have observed that OCT can detect macular thickening earlier than clinical examination, but also found that such cases did not necessarily progress to CSMO and need photocoagulation.Care should be taken in applying the conclusions of this review to other test-treatment pathways. In fact, OCT will become an essential tool to manage antiangiogenic therapy, an expanding therapeutic option for patients with macular oedema due to DR, because OCT is a component of the diagnostic algorithms of studies on this new treatment.

Incidence of macular edema following single versus 4 session pattern scanning laser panretinal photocoagulation in diabetic retinopathy

AbstractPurpose The purpose of this study was to investigate a change in macular thickness 9 months after single versus 4 sessions of panretinal photocoagulation (PRP) performed with Pattern Scanning Laser (PSL) in diabetic patients and to make a medico‐economic assessment.Methods This prospective, multicenter, randomized trial enrolled patients in 2 arms: single session PRP (group A) and 4 session PRP (group B) between October 2011 and October 2013. Patients had non proliferative severe diabetic retinopathy or proliferative non complicated diabetic retinopathy. The primary endpoint was the difference in macular central retinal thickness (CRT) using spectral domain optical coherence tomography (SD‐OCT) at 9 months. CRT with SD‐OCT, ETDRS visual acuity (VA), pain with Visual Analogic Scale (VAS), were recorded at baseline, 7 days, 1, 3, 6, and 9 months. A medico‐economic assessment was also performed.Results 26 eyes of 26 patients were included. On inclusion, the median CRT was 258 [240‐294] µm in group A and 282 [261‐292] µm in group B (p=0.06), the median VA was 84 [76‐88] letters in group A and 83 [75‐90] letters in group B (p=0.94). At M9, the median CRT was 281 [245‐322] µm in group A and 301[278‐313] µm in group B (p=0.34). At M9, the median VA was 84 [70‐91] letters in group A and 85 [74‐85] letters in group B (0.58). The median VAS value was 3.5 [2.0‐5.0] in in group A and 3.5 [1.0‐7.0] for all sessions in group B. The medico‐economic assessment was in favor of the single session protocol.Conclusion Single session PSL‐PRP seems to be a possible, well tolerated protocol for the treatment of diabetic retinopathy.