Optical Coherence Tomography Central Retinal Thickness Research Articles

Treat and extend versus fixed regimen in neovascular age related macular degeneration: A systematic review and meta-analysis.

To compare efficacy of treat and extend (T&E) versus fixed regimen treatment protocols in neovascular age-related macular degeneration (nAMD). Randomized clinical trials (RCTs) comparing T&E versus fixed regimen protocols for nAMD were systematically searched. Primary outcome was to compare the mean best corrected visual acuity (BCVA) change in T&E regimen versus fixed regimen. Secondary outcomes were change in the mean optical coherence tomography (OCT) central retinal thickness (CRT) and mean number of injections. Standardized mean difference (SMD) along with 95% confidence intervals (CIs) were calculated. Random-effect models were used for meta-analyses. Four RCTs were included, with a total of 649 and 621 eyes in the T&E and fixed regimen cohort at 12 months, and 267 and 249 eyes at 24 months. Pooled analysis of mean BCVA change included all four RCTs at 12 months and two RCTs at 24 months, showing no difference between the two groups (12-month: SMD = 0.08, 95% CI: -0.20 to 0.35, p = 0.55; 24-month: SMD = 0.04, 95% CI: -0.13 to 0.21, p = 0.64). Pooled analysis of OCT CRT change at 12 months included three studies, showing no difference between the two groups (SMD = 0.03, 95% CI: -0.46 to 0.51, p = 0.91). Pooled analysis of mean injection number included all four RCTs at 12 months and two RCTs at 24 months, showing significant difference between the two groups (12-month: SMD = -1.11, 95% CI: -1.67 to -0.56, p < 0.001; 24-month: SMD = -1.34, 95% CI: -1.54 to -1.15, p < 0.001). A T&E regimen proved as effective as a fixed dosage regimen throughout a 24-month follow-up and with a lower number of injections.

Clinical experience of switching anti-VEGF therapy from ranibizumab to aflibercept in age-related choroidal neovascularization.

To report the response of participants switching from ranibizumab to aflibercept treatment for neovascular age-related macular degeneration (nAMD) requiring further anti-vascular endothelial growth factor treatment. In this retrospective case review of 68 participants treated in a single hospital, all participants, prior to switching, received ranibizumab injections only. Best-corrected visual acuity (BCVA), clinical examination, and optical coherence tomography (OCT) were performed at each visit. Active nAMD was defined as persistent intraretinal or subretinal fluid on OCT. Participants had their first aflibercept injection at baseline and 2 more injections at 2 monthly intervals. Afterwards, they were followed up every 6-8 weeks and given injections as needed. The main outcome measures were visual acuity and the OCT central retinal thickness (CRT), average thickness (AT), and total macular volume (TMV). The BCVA at baseline visit was 0.57 ± 0.33 log MAR and the final BCVA was 0.54 ± 0.37 log MAR (p = 0.215). The CRT mean change was -75.6 ± 85.6 (p = 0.001), the AT mean change was -24.2 ± 27.2 (p = 0.001), and TMV mean change was -0.69 ± 0.78 (p = 0.001). There were no significant ophthalmic complications related to treatments. Intravitreal aflibercept improved anatomic outcomes (as measured by OCT) in eyes with nAMD that were previously treated with intravitreal ranibizumab and were still active. There was no statistically significant difference in logMAR visual acuity in participants who switched to aflibercept with a follow-up of at least 6 months.

Clinical Study of “Lingqi Huangban Granule” in Treating Choroidal Neovascularisation in Pathologic Myopia

Objectives: To study the therapeutic effects of “Lingqi Huangban Granule” (LQHB) combined with intravitreal ranibizumab injection (IVR) for choroidal neovascularisation (CNV) in pathologic myopia (PM). Methods: This was a prospective, comparative, interventional study. Eighty eyes of eighty consecutive patients with myopic CNV were randomized into control group (IVR, 40 eyes) and integrative therapy group (IVR + LQHB, 40 eyes), each with a follow-up period of 12 months. IVR was given with an “on demand” regimen (Pro re nata, PRN). Final best corrected visual acuity (BCVA) and its change from baseline were the main outcome measures. Changes in optical coherence tomography (OCT) and central retinal thickness (CRT) were the secondary outcome measures. Results: BCVA of patients in the integrative group improved significantly (from 47.10 ± 13.51 letters to 90.72 ± 12.98 letter, P < 0.05), more than in the control group (from 42.90 ± 13.18 letters to 69.18±13.21 letters, P < 0.05) since the third month after the initial treatment to the end of the follow-up. Mean OCT CRT reduced from 364.75 ± 69.31 to 278.93 ± 33.05 um (P < 0.05) in the control group and from 370.73 ± 65.31 to 271.73 ± 46.44 um (P < 0.05) in the integrative group, respectively. The mean number of intravitreal injections in the 1-year follow-up was also reduced. No ocular or systemic side effects were observed. Conclusion: LQHB combined with IVR therapy was an effective treatment for stabilizing and improving vision with fewer intravitreal injections. It appears to be an interesting option for this type of patient.

The Effects of Cataract Surgery on Patients With Wet Macular Degeneration

To explore whether cataract surgery contributes to the progression of wet age-related macular degeneration (wet AMD). Retrospective cohort study. Retrospective review was performed of consecutive patients with wet AMD who underwent cataract surgery at the midpoint of a 1-year study window. A control arm included wet AMD eyes treated with anti-vascular endothelial growth factor (VEGF) injections that did not undergo cataract surgery for a 1-year period. Best-corrected visual acuity (BCVA), number of anti-VEGF injections, and optical coherence tomography (OCT) features were compared between the 2 arms. Forty eyes in the surgical group and 42 in the nonsurgical group were included. BCVA was equivalent in the first half of the study, and became significantly better in the surgical group vs the nonsurgical group (0.23 ± 0.65 vs 0.11 ± 0.59 logMAR improvement, P= .049). There was no change in the number of injections given 6months before vs after the midpoint in the surgical group (P= .921). The mean OCT central retinal thickness became greater in postsurgical eyes compared to nonsurgical eyes (265.4 ± 98.4μm vs 216.4 ± 58.3μm, P= .011). Surgical eyes were more likely to develop new or worse cystoid changes after the study midpoint (13 surgical eyes [54.2%] vs 9 nonsurgical eyes [28.1%], P= .048). Cataract surgery leads to vision improvement and does not appear to contribute to worsening of wet AMD. However, anatomic changes based on OCT analysis suggest a subclinical susceptibility to postoperative cystoid macular edema or exacerbation of choroidal neovascularization.

Ozurdex in the management of the macular edema following retinal vein occlusion in clinical practice

Editor, This study aims to evaluate the safety and the efficacy of the dexamethasone drug delivery system (Ozurdex®) in eyes with macular oedema (ME) secondary to retinal vein occlusion (RVO). Figure 1A summarizes the demographic and diagnostic information for our group compared with the characteristics of the GENEVA study (Haller et al. 2011). (A) Summary of the demographics and diagnostics information for our group compared with the characteristics of the GENEVA study. (B) Visual acuity gain up to 15 letters according subtype of retinal vein occlusion. (C) Maximal foveal thickness according subtype of retinal vein occlusion. (D) Percentage of patient with intraocular pressure (IOP) ≥ 25 mmHg during the follow-up. (E) Percentage of patient with IOP ≥ 25 mmHg during the follow-up, according the IOP status at the diagnosis. Complete examination was performed on 220 eyes monthly from baseline to 6 months (M6) including best-corrected visual acuity (BCVA), biomicroscopy, intraocular pressure (IOP), fundus examination; and central retinal thickness (CRT) by optical coherence tomography (OCT) and fluorescein angiography (Spectralis/HRA, Heidelberg, Germany) at M0-1-3-6. Mean BCVA was 41.43 letters ± 20.7 SD and for subgroups 36.3 letters ± 21.3 SD and 44.8 letters ± 19.6 SD (p = 0.018), respectively, for central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). Mean OCT CRT was 641.86 μm ± 221.6 SD with 686 μm ± 247.1 SD and 612.4 μm ± 198.8 SD, respectively, for CRVO and BRVO (p = 0.09). Mean IOP was 15.2 mmHg ± 3.2 SD and follow-up was 10.16 months. Best-corrected visual acuity improves to 54.62 letters ± 19.8 SD at M1, 54.17 letters ± 20.9 SD at M3 and 49.12 ± 22.6 SD letters at M6. The proportion of eyes achieving at least a 15-letter improvement from baseline BCVA was 50.8% M3 and 33.9% M6. In general, the response to treatment in both subgroups (BRVO/CRVO) was qualitatively similar to the responses seen in the overall population. But improvement was greater in CRVO subgroup and was particularly marked in the analysis of mean change from baseline BCVA at M6 due to the worse BCVA at baseline in this subgroup (0.97 LogMAR ± 0.43 SD and 0.80 LogMAR ± 0.39 SD; p = 0.018, respectively, for CRVO and BRVO). The mean CRT was 326.8 μm ± 126.9 SD, 362.5 μm ± 184.8 SD and 481.7 μm ± 265.3 SD, respectively, at M1, M3 and M6. For subgroups, the patterns of response differed (Fig. 1C) with better improvement in BRVO compared with the CRVO subgroup at M6, which present an earlier recurrence of ME (p = 0.05). The principal ocular adverse event was subconjunctivals haemorrhages (14.1%). Cataracts developed for 6.8% patients, but no surgery was necessary. No severe adverse effects were reported. The increase in IOP was transient with maximum at M1 (Fig. 1D) followed by a progressive decrease. It was less frequent and lower compared with triamcinolone (Ip et al. 2009) and was more frequent in patients with glaucoma but still transient (Fig. 1E) and proportional to initial IOP. Thirty per cent of patients were re-injected at M6 and 49% were re-injected during the overall follow-up. The mean time for reinjection was 5.3 months. So, treatment by Ozurdex produced a significant improvement in both structure and function in eyes with vision loss due to ME associated with BRVO or CRVO. The greater improvements in visual acuity were accompanied by greater decreases in CRT, but it was not strictly proportional. The percentage of patients with a gain of VA > 15 letters was better than observed in GENEVA (Haller et al. 2011), probably due to the initial differences between the included patient populations enrolled in the studies (Fig. 1A). The incidence of cataract surgery in our study was very low, but the incidence increases with time. So, this rate should be higher after a longer follow-up. In general, our study found a better prognosis in BRVO compared with CRVO both in anatomical and in functional results, proving that these two diseases which are close in terms of clinical aspect are two different diseases in terms of pathophysiology and so progression (Moisseiev et al. 2013). In summary, Ozurdex provides an efficient treatment option with an acceptable risk benefit ratio for the treatment of RVO patients with ME. The response seems to be better on larger ME, low VA and in early RVO patients (<3 months; Yeh et al. 2012). It is important not to neglect IOP increase, so in a high-risk situation, it is preferable to discuss anti-VEGF treatment or to introduce a preventive IOP lowering treatment.

Macular Epiretinal Brachytherapy in Treated Age-related Macular Degeneration: MERITAGE Study: Twelve-Month Safety and Efficacy Results

To evaluate the safety and efficacy of epimacular brachytherapy (EMB) for the treatment of chronic, active, neovascular age-related macular degeneration (AMD). Prospective, multicenter, interventional, noncontrolled clinical trial. Fifty-three eyes of 53 participants with neovascular AMD requiring frequent anti-vascular endothelial growth factor (VEGF) retreatment. Participants underwent pars plana vitrectomy with a single 24-Gy dose of EMB delivered using an intraocular, handheld cannula containing a strontium 90/yttrium 90 source positioned over the active lesion. Participants were retreated with ranibizumab administered monthly as needed, using predefined retreatment criteria. Optical coherence tomography (OCT) was undertaken monthly, with images assessed by an independent reading center. Coprimary outcomes at 12 months were proportion of participants with stable vision (losing <15 Early Treatment Diabetic Retinopathy Study [ETDRS] letters) and mean number of anti-VEGF retreatments. Before enrollment, participants had received an average of 12.5 anti-VEGF injections. After a single treatment with EMB, 81% maintained stable vision, with a mean of 3.49 anti-VEGF retreatments in 12 months. Mean ± standard deviation change in visual acuity was -4.0±15.1 ETDRS letters. Mean ± standard deviation OCT central retinal thickness increased by 50±179 μm. Common adverse events included conjunctival hemorrhage (n = 38), cataract (n = 16), resolving vitreous hemorrhage (n = 6), and eye pain (n = 5). Epimacular brachytherapy produces stable visual acuity in most participants with previously treated, active disease. Epimacular brachytherapy may reduce the need for frequent anti-VEGF retreatment.

Is ranibizumab effective in stopping the loss of vision for choroidal neovascularisation in pathologic myopia? A long-term follow-up study

AimTo assess the efficacy and safety of ranibizumab in the treatment of choroidal neovascularisation (CNV) caused by pathologic myopia (PM).DesignProspective, multicentre, interventional case series.Methods40 eyes of 39 consecutive patients with...

An Optical Coherence Tomography-Guided, Variable Dosing Regimen with Intravitreal Ranibizumab (Lucentis) for Neovascular Age-related Macular Degeneration

To evaluate an optical coherence tomography (OCT)-guided, variable-dosing regimen with intravitreal ranibizumab for the treatment of patients with neovascular age-related macular degeneration (AMD). Open-label, prospective, single-center, nonrandomized, investigator-sponsored clinical study. In this two-year study, neovascular AMD patients with subfoveal choroidal neovascularization (CNV) (n = 40) and a central retinal thickness of at least 300 microm as measured by OCT were enrolled to receive three consecutive monthly intravitreal injections of ranibizumab (0.5 mg). Thereafter, retreatment with ranibizumab was performed if one of the following changes was observed between visits: a loss of five letters in conjunction with fluid in the macula as detected by OCT, an increase in OCT central retinal thickness of at least 100 microm, new-onset classic CNV, new macular hemorrhage, or persistent macular fluid detected by OCT at least one month after the previous injection of ranibizumab. At month 12, the mean visual acuity improved by 9.3 letters (P < .001) and the mean OCT central retinal thickness decreased by 178 microm (P < .001). Visual acuity improved 15 or more letters in 35% of patients. These visual acuity and OCT outcomes were achieved with an average of 5.6 injections over 12 months. After a fluid-free macula was achieved, the mean injection-free interval was 4.5 months before another reinjection was necessary. This OCT-guided, variable-dosing regimen with ranibizumab resulted in visual acuity outcomes similar to the Phase III clinical studies, but required fewer intravitreal injections. OCT appears useful for determining when retreatment with ranibizumab is necessary.

Intravitreal Bevacizumab (Avastin) for Neovascular Age-related Macular Degeneration: A Short-term Study

To report the short-term study of intravitreal bevacizumab (Avastin) in the treatment of neovascular age-related macular degeneration (AMD). Interventional, consecutive, prospective case series. One hundred and two eyes of 102 patients with neovascular AMD received monthly intravitreal bevacizumab (Avastin) (1.25 mg) until resolution of macular edema, subretinal fluid, and/or pigment epithelial detachment. Outcome measures included visual acuity (VA) and central retinal thickness as defined from optical coherence tomography (OCT). Mean VA was 20/80 and OCT central retinal thickness was 251.0 +/- 74.6 microm before injection and improved to 20/63 and 214.9 +/- 41.7 microm at six weeks (P < .001), 20/50 and 204.8 +/- 33.6 microm at 10 weeks (P < .001), and remained stable at 20/50 and 210 microm after 14 weeks (P < .05). No significant ocular or systemic side effects were observed. Intravitreal bevacizumab (Avastin) appears to be beneficial and well tolerated in the treatment of neovascular AMD in the short term. Further comparative evaluation against other antivascular endothelial growth factor (VEGF) agents and dosing schedule is warranted.

Systemic Bevacizumab (Avastin) Therapy for Neovascular Age-Related Macular Degeneration: Twenty-Four–Week Results of an Uncontrolled Open-Label Clinical Study

To evaluate the safety, efficacy, and durability of bevacizumab for the treatment of subfoveal choroidal neovascularization (CNV) in patients with neovascular age-related macular degeneration (AMD). Open-label, single-center, uncontrolled clinical study. Age-related macular degeneration patients with subfoveal CNV (n = 18) and best-corrected visual acuity (VA) letter scores of 70 to 20 (approximate Snellen equivalent, 20/40-20/400). Patients were treated at baseline with an intravenous infusion of bevacizumab (5 mg/kg) followed by 1 or 2 additional doses given at 2-week intervals. Safety assessments were performed at all visits. Ophthalmologic evaluations included protocol VA measurements, ocular examinations, and optical coherence tomography (OCT) imaging at each visit. Retreatment with bevacizumab was performed if there was evidence of recurrent CNV. Assessments of safety and changes from baseline in VA scores and OCT measurements were performed through 24 weeks. No serious ocular or systemic adverse events were identified through 24 weeks. The only adverse event identified was a mild elevation of mean systolic and diastolic blood pressure measurements (+11 mmHg, P = 0.004; +8 mmHg, P<0.001) evident by 3 weeks and easily controlled with antihypertensive medications. By 24 weeks, the systolic and diastolic mean blood pressures were at or below baseline measurements. Visual acuity in the study eyes improved within the first 2 weeks, and by 24 weeks, the mean VA letter score increased by 14 letters in the study eyes (P<0.001), and the mean OCT central retinal thickness measurement decreased by 112 microm (P<0.001). By 24 weeks, retreatment was needed for only 6 of the 18 study eyes, and after retreatment, the recurrent leakage was eliminated, with restoration of any lost VA. Systemic bevacizumab therapy for neovascular AMD was well tolerated and effective for all 18 patients through 24 weeks. By 6 months, most patients did not require any additional treatment beyond the initial 2 or 3 infusions. Despite these impressive results, it is unlikely that systemic bevacizumab will be studied in a large clinical trial because of the potential risks associated with systemic anti-VEGF therapy and the perception that intravitreal therapy is safer.

SHORT-TERM SAFETY AND EFFICACY OF INTRAVITREAL BEVACIZUMAB (AVASTIN) FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION

To evaluate the safety and efficacy of intravitreal bevacizumab (Avastin, Genentech Inc.) for the treatment of neovascular age-related macular degeneration (ARMD). A retrospective review was performed on consented patients with neovascular ARMD receiving intravitreal bevacizumab therapy. All patients received intravitreal bevacizumab at baseline with additional monthly injections given at the discretion of the treating physician. At each visit, a routine Snellen visual acuity assessment was performed followed by an ophthalmic examination and optical coherence tomography (OCT) imaging. Fifty-three eyes of 50 patients received an intravitreal bevacizumab injection between May and August 2005. Including the month 3 visit, the average number of injections was 2.3 out of a maximum of 4 injections. No serious drug-related ocular or systemic adverse events were identified. Improvements in visual acuity and central retinal thickness measurements were evident by week 1 and continued through month 3. At month 3, the mean visual acuity improved from 20/160 to 20/125 (P < 0.001) and the mean central retinal thickness decreased by 99.6 microm (P < 0.001). Off-label intravitreal bevacizumab therapy for neovascular ARMD was well tolerated over 3 months with improvements in visual acuity and OCT central retinal thickness measurements. While the long-term safety and efficacy of intravitreal bevacizumab remain unknown, these short-term results suggest that intravitreal bevacizumab may be the most cost effective therapy for the treatment of neovascular ARMD.