PRN Regimen Research Articles

Impact of anti-VEGF treatment-free interval during the first year on 5-year outcomes in eyes with branch retinal vein occlusion.

This study aims to analyze the impact of longest treatment-free interval (TFI) between anti-vascular endothelial growth factor (anti-VEGF) injections during the first year of treatment on 5-year best-corrected visual acuity (BCVA) and recurrence of macular edema (ME) in eyes with ME secondary to branch retinal vein occlusion (BRVO). A retrospective study including eyes with BRVO, minimum of 5-year follow-up, and available optical coherence topography (OCT) scans. Eyes underwent anti-VEGF loading dose therapy and were treated and monitored with an OCT-guided PRN regimen. Those with a history of ocular comorbidities were excluded. Total of 60 patient eyes, with 40 females and average age of 71.75 ± 11.07 years. TFI among eyes was 1 month (20%); > 1-2 months (23%); > 2-3 months (18%); > 3-4 months (17%), and >4 months (22%). Forty-three (72%) eyes experienced ME recurrence during the five-year period. Multivariate linear regression shows that TFI (-0.02 [-0.03-0.00], p = 0.021) and baseline BCVA (0.37 [0.08-0.66], p = 0.014) are significant predictors of 5-year BCVA. TFI (Cox Proportional Hazard Ratio 1.34 [1.04-1.72], p = 0.023) and number of injections in the first year (Cox Proportional Hazard Ratio 1.76 [1.01-3.06], p = 0.045) were significant predictors of ME recurrence. Gender, age, type of injection, BCVA, and CMT did not influence recurrence. For eyes receiving anti-VEGF injections to treat ME secondary to BRVO, TFI is a significant predictor of 5-year BCVA and ME recurrence according to regression models. This study suggests more ME recurrence may be due to increased TFI or indicate more injections needed to treat severe BRVO.

Cannabis use regimens in trauma-exposed individuals: Associations with cannabis use quantity and frequency

People with trauma histories have an increased odds of cannabis use. Little is known about the frequency or consequences of different cannabis use regimens in cannabis users with trauma histories. Individuals with anxiety disorders tend to administer benzodiazepines in a pro re nata (PRN; i.e., as needed) as opposed to regularly scheduled (RS, e.g., twice daily [BID], three times daily [TID]) manner. Although physicians tend to prescribe benzodiazepines on a PRN regimen to minimize use, this regimen is paradoxically associated with greater use levels. Indeed, PRN administration regimens may increase use via negative reinforcement processes. We extended this older benzodiazepine literature to cannabis by examining regimen of cannabis use among 94 trauma-exposed cannabis users (mean age = 35.1 years; 52.1 % male; 23.4 % with cannabis prescription). Participants reported their initial and current cannabis use regimen (PRN vs. RS vs. both [‘PRN+’]) and their past month cannabis use frequency (use occasions in last month) and quantity (grams/use occasion). Consistent with patterns in benzodiazepine research, PRN (47.1 % of sample) and PRN+ (43.5 % of sample) were more common than RS regimens (9.4 % of sample). Also consistent with patterns seen with benzodiazepines, our sample moved toward PRN regimens from initial to current use: e.g., 100 % of initial RS users switched to a regimen that included PRN use. Consistent with predictions emerging from learning theory, PRN and PRN+ cannabis users reported significantly higher cannabis use frequencies compared to RS users (p’s < 0.01). Unexpectedly, there were no significant differences between cannabis use regimen groups for quantity of cannabis/occasion. While limited by their cross-sectional nature, with longitudinal replication, result may have implications for identifying cannabis use regimens that minimize frequency of use and thereby reduce risk for negative health outcomes.

EFFICACY OF AS-NEEDED INTRAVITREAL INJECTION COMPARED TO 3-MONTHLY LOADING OF ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR AGENTS FOR BRANCH RETINAL VEIN OCCLUSION

Branch retinal vein occlusion (BRVO) is a prevalent retinal vascular disorder and a significant cause of vision impairment, particularly in individuals over the age of 50. Objective: The basic aim of the study is to find the efficacy of as-needed intravitreal injection compared to 3-monthly loading of anti-vascular endothelial growth factor agents for branch retinal vein occlusion. Methods: This prospective, comparative study was conducted at Al-Shifa Trust Eye Hospital, Rawalpindi from January 2024 to August 2024. A total of 55 patients diagnosed with BRVO were enrolled in the study. Results: Data were collected from 55 patients with a similar mean age of 53.45 ± 4.56 years and 52.4 ± 7.01 years, respectively. At baseline, the mean best-corrected visual acuity (BCVA) was comparable between the two groups (55.2 in Group A vs. 54.7 in Group B, p = 0.67), as was the mean central retinal thickness (CRT) (485.6 µm in Group A vs. 490.3 µm in Group B, p = 0.73). There were no statistically significant differences between the groups in these baseline characteristics. Conclusion: It is concluded that both the PRN-only and loading phase + PRN regimens are effective for treating BRVO, with the loading phase regimen providing slightly superior visual outcomes.

A Retrospective Study Evaluating Asthma Control in Patients on Fluticasone Propionate/Salmeterol Proactive Regular Dosing with a History of Uncontrolled Asthma.

The MERIT study in Malaysia is a real-world retrospective, observational, multicenter study that evaluated asthma control in patients with uncontrolled asthma who were switched from as-needed (pro re nata [PRN]) budesonide/formoterol or inhaled corticosteroid (ICS) whenever a short-acting beta-agonist (SABA) was taken, to proactive regular dosing of fluticasone propionate/salmeterol (FP/SAL PRD). Data from the medical records of patients who were stepped up to FP/SAL PRD were extracted retrospectively at baseline and follow-up (between 3 and 6months after stepping up to FP/SAL PRD). The primary endpoint was the percentage of patients with improvement in asthma control assessed via the Asthma Control Test (ACT). Secondary endpoints included safety and the percentage of patients with moderate and severe exacerbations. Additionally, patient-reported use of reliever medication, systemic corticosteroids, emergency department visits, or hospitalization was also analyzed. One hundred twenty patients with uncontrolled asthma who were stepped up to FP/SAL PRD were enrolled in the study. Of these, 76 (63.3%) patients were on prior budesonide/formoterol PRN, and 44 (36.7%) were on prior ICS with SABA PRN treatment. After stepping up to FP/SAL PRD with a mean follow-up of 5.8months, 110 (91.7%) patients achieved asthma control at the follow-up visit (p < 0.001). Similar improvements were observed regardless of prior PRN regimen. A statistically significant improvement was observed in the mean ACT score at the follow-up visit (p < 0.0001). The proportion of patients with moderate and severe exacerbations was also reduced after stepping up to FP/SAL PRD, with no adverse events reported. Over 80% of patients reported a decrease in the use of systemic corticosteroids, visits to the emergency department, or hospitalization. This study highlights the effectiveness of the FP/SAL PRD treatment approach in patients with uncontrolled asthma on a PRN treatment regimen.

Clinical Observation of Micropulse Laser Combined with Conbercept in the Treatment of Neovascular Age-related Macular Degeneration with Pigment Epithelial Detachment (PED)

The aim of this study is to observe the efficacy of micropulse laser combined with Conbercept in the treatment of neovascular age-related macular degeneration (nAMD) complicated with PED. Thirty patients (30 eyes) diagnosed with nAMD and PED at our hospital in 2023 were randomly divided into two groups: the Conbercept treatment (IVC) group with 15 cases (15 eyes) and the Conbercept combined with 577 nm threshold micropulse laser treatment (IVC+SMLP) group with 15 cases (15 eyes). Anti-VEGF treatment was administered according to the 3+PRN regimen, and the combined treatment group received 577 nm threshold micropulse laser treatment within 2 weeks after anti-VEGF injection. Follow-up observed the best-corrected visual acuity (BCVA), central macular thickness (CMT), PED height (PEDH), number of injections, and related complications at 1 month, 3 months, 6 months, and 12 months after Conbercept intravitreal injection. The average BCVA, CMT, and PEDH in both groups improved significantly from baseline at all time points (P &lt; 0.05). At 12 months of follow-up, PEDH in the IVC+SMLP group decreased significantly from baseline (293.57±82.59 vs 184.84±33.95) and was significantly lower than in the IVC group (P &lt; 0.05). The number of IVC injections in the IVC group was significantly higher than in the IVC+SMLP group (8.04±0.3 vs 5.29±1.26) with a significant difference (t=4.290, P=0.016). No treatment-related adverse events were observed during the study. The 577 nm threshold micropulse laser combined with Conbercept effectively improves or stabilizes visual function and anatomical morphology in nAMD with PED, reduces the number of intravitreal injections, and alleviates the patient's economic burden to some extent.

Is Exudative Neovascular AMD a Chronic Disease? Analysis of Long-term Progression under Anti-VEGF Therapy.

Anti-VEGF therapy is the standard treatment for exudative neovascular age-related macular degeneration (nAMD) caused by the development of macular neovascularisation (MNV) with associated fluid exudation. The therapeutic strategies (T&E or PRN) assumed a scarring transformation of the MNV and exit strategies and were formulated accordingly. The present study investigates this hypothesis as a real-life long-term analysis. 150 eyes of 97 patients were continuously followed up over a mean period of 5.1 years (1 - 14 years) after initiation of anti-VEGF therapy between 2009 - 2017 until 2022. Treatment was based on the PRN regimen analogous to the IVAN study with ranibizumab, aflibercept or bevacizumab. The length and intensity of therapy were evaluated. Of these 150 eyes, 119 (79.3%) required ongoing anti-VEGF therapy, while in 18 eyes (12.0%) therapy could be discontinued due to stabilisation of the situation. In 13 eyes (8.7%), therapy was discontinued due to deterioration in visual acuity to < 0.05. With ongoing therapy, therapy was often protracted, with an indication for therapy at the last documented doctor's visit, while stabilisation was often achieved within the first 2 years of treatment. The treatment intensity increased to 7.7 - 8.0 injections/year, especially after 2013, with the introduction of OCT-based treatment criteria. Most eyes (74.8%) with ongoing therapy required 6 - 9 injections/year even in the last three years of treatment. The fact that in the present study there is a long-term and intensive need for therapy in the majority of patients (approx. 80%) with exudative nAMD, supports the assessment that nAMD should be regarded as a chronic disease. Therefore, a proactive treatment strategy with consistent therapy at any sign of lesion activity might be recommended. Particularly in view of the risk of irreversible loss of vision, long term adherence of patients is also crucial for the best possible long term therapeutic outcome.

Clinical Characteristics of Unilateral Macular Neovascularization Patients with Pachydrusen in the Fellow Eye.

Background/Objectives: To approach the clinical properties of pachydrusen that differ from conventional drusen, we investigated the incidence of macular neovascularization (MNV) in fellow eyes and the treatment outcomes of intravitreal aflibercept (IVA) in MNV eyes of unilateral MNV patients with pachydrusen in the fellow eye. Methods: We retrospectively studied 261 consecutive patients with treatment-naïve unilateral MNV. Patients were classified into four groups according to the type of drusen in the fellow eye: the pachydrusen group (n = 49), the soft drusen group (n = 63), the subretinal drusenoid deposit (SDD) group (n = 24), and the no drusen group (n = 125). The development of the MNV in the fellow eye was evaluated for five years, and the retreatment proportion after three monthly aflibercept injections was evaluated for one year. Results: The choroidal thickness in the fellow eyes and MNV eyes was the greatest in the pachydrusen group (all p < 0.001). The 5-year incidence of MNV in the pachydrusen group was similar to that in the soft drusen group and no drusen group. The pachydrusen group had a lower retreatment rate than the other groups did (pachydrusen group: 46.4%; soft drusen group: 78.1%; SDDs: 87.5%; no drusen group: 83.3%). Conclusions: Unilateral MNV patients with pachydrusen in the fellow eye had a lower retreatment rate (46.4%/1 year); therefore, aflibercept monotherapy using the PRN regimen is one of the preferred treatment methods for MNV patients with pachydrusen in the fellow eye.

Prognostic factors for intravitreal conbercept in the treatment of choroidal neovascularization secondary to pathological myopia.

To identify risk factors influencing visual outcomes in patients with pathological myopia-associated choroidal neovascularization (PM-CNV) following intravitreal injections of conbercept. A total of 86 eyes from 86 patients received intravitreal conbercept in a 1 + PRN regimen. After the initial injection, patients were followed for 12months. They were categorized into two groups based on their 12-month visual acuity change: those who achieved greater than a one-line improvement in BCVA (improved group; n = 65) and those who experienced a one-line or lesser improvement or a decrease in BCVA (non-improved group; n = 21). Over the 12-month period, the mean BCVA in the improved group significantly improved from 0.82 to 0.41 LogMAR. In the non-improved group, BCVA changed from 1.24 to 1.09 LogMAR. Similarly, the mean CRT decreased from 426.21μm at baseline to 251.56μm at 12months in the improved group, and from 452.47 to 382.45μm in the non-improved group. Multivariable logistic regression analyses revealed that older age (OR 1.287; 95% CI 1.019-1.625; P = 0.034), poorer baseline BCVA (OR 6.422; 95% CI 1.625-25.384; P = 0.008), the presence of subfoveal CNV (OR 4.817; 95% CI 1.242-18.681; P = 0.023), and organized interlacing patterns of CNV morphology (OR 5.593; 95% CI 1.397-22.392; P = 0.015) emerged as independent risk factors correlated with worsened visual prognosis following intravitreal conbercept injections. Conbercept demonstrates significant efficacy and safety in treating PM-CNV. Key factors influencing visual recovery post-treatment include older age, poorer baseline BCVA, the presence of subfoveal CNV, and organized interlacing patterns of CNV morphology.

Effect of Pro Re Nata Regimen with Anti-VEGF on Type 3 Macular Neovascularization: Long-Term Outcomes

Introduction: The purpose of this study was to investigate long-term outcomes of intravitreal injections (IVI) of antivascular endothelial growth factor (VEGF) in neovascular age-related macular degeneration (nAMD) with type 3 macular neovascularization (MNV). Methods: This retrospective study included 19 eyes of 17 patients with nAMD and type 3 MNV treated with anti-VEGF IVI with a loading dose and a PRN regimen. Best corrected visual acuity (BCVA), central macular thickness (CMT), presence of macular intraretinal fluid (IRF) and subretinal fluid (SRF), flow area (FA), subfoveal choroidal thickness (CT), and macular atrophy (MA) were assessed at baseline (T0) and during follow-up (T1, post-loading phase; T2, 1 year; T3, 2 years; T4 >2 years). The correlations between MA at the last follow-up and standard deviation (SD) values of CMT and CT during follow-up were assessed. The influence of the number of injections on the change in MA over time was also analyzed. MA differences at T4 were assessed for pseudodrusen presence. Results: BCVA improved significantly during follow-up (p = 0.013) particularly increasing from baseline to post-loading phase and then did not modify significantly thereafter. CMT significantly reduced from T0 to T1 and remained stable during follow-up (p = <0.001). MNV flow area showed a trend toward an increase in the post-loading phase that was not statistically significant (p = 0.082) and CT decreased significantly during follow-up (p < 0.001). MA changed significantly during follow-up (p < 0.001) with a significant increase from T0 to T3 and from T0 to T4 (p < 0.010). A Cochran-Armitage test for trend showed a significant reduction (p = 0.001) of macular IRF and SRF during follow-up. MA at T4 showed a significant positive correlation with SD (standard deviation) values of CMT (p = 0.040) and CT (p = 0.020). Indeed, the number of injections did not influence the change over time of MA (p = 0.709). MA at T4 was not statistically significantly different between patients with pseudodrusen at baseline (p = 0.497). Conclusions: Intravitreal anti-VEGF injections with PRN regimen in MNV type 3 showed functional and anatomical benefits. Variations of retinal thickness and choroidal thickness during treatment were related to MA modification over time.

Differences between young and elderly polypoidal choroidal vasculopathy patients with and without pachychoroid phenotypes.

To investigate the distinct characteristics between young and elderly polypoidal choroidal vasculopathy (PCV) patients based on the pachy- or non-pachychoroid phenotypes. PCV patients treated with intravitreal injections of Conbercept based on the 3 + PRN regimen from 27 centers of China PCV Research Alliance were included. Patients were categorized into the young and the elderly aged group based on the cut-off point determined using the Youden method according to the pachychoroid phenotypes. The characteristics of past medical history, lifestyle factors, fundus manifestations, and treatment response between the subgroups were analyzed. Three hundred eight eligible patients were included. Multivariate logistic regression showed a significant association between age and PCV subtype classification (OR = 0.921, P = 0.002). A cutoff age of 64.5 effectively distinguished between pachychoroid PCV and non-pachychoroid PCV (P < 0.001). Elderly PCV patients had a higher incidence of hypertension history (P = 0.044) but a lower incidence of diabetes history (P = 0.027). In terms of lifestyle, smoking history (P = 0.015) and staying up late (P = 0.004) were more significant in the young group of PCV patients. For clinical characteristics, the proportion of hemorrhagic PCV in the young group was significantly higher (P = 0.038), with a higher proportion of sharp-peaked PED (P = 0.049), thicker choroid (P < 0.001) but a lower portion of double-layer sign (P = 0.023) in OCT. Both groups showed significant anatomical changes compared to baseline in each follow-up period (P < 0.05), with the young group having a higher proportion of good anatomical response after the first injection (P = 0.009). PCV patients stratified by subtype exhibit distinct characteristics between the young and elderly groups.

Clinical outcomes of different regimens of intravitreal Conbercept for the treatment of choroidal neovascularization secondary to pathological myopia.

To assess the clinical outcomes of two intravitreal injection regimens of Conbercept used to treat choroidal neovascularization secondary to pathological myopia (PM-CNV). A total of 72 eyes of 72 patients were treated: 39 eyes received a single injection followed by treatment pro re nata (1 + PRN); 33 eyes first received 3 consecutive monthly injections (3 + PRN) then followed by PRN. After initial injection, patients were followed up for 12months. The mean age of 72 patients was 45.3 ± 5.1years, with the mean diopter of -10.62 ± 3.24D. The best corrected visual acuity (BCVA) was 0.86 ± 0.23 LogMAR with 1 + PRN and 0.90 ± 0.19 LogMAR with 3 + PRN at baseline (P = 0.422), 0.36 ± 0.07 and 0.33 ± 0.05 LogMAR at month 3 (P = 0.026); and 0.33 ± 0.03 and 0.32 ± 0.02 LogMAR at month 12 (P = 0.096). The central retinal thickness (CRT) was 333.5 ± 22.7μm with 1 + PRN and 341.2 ± 20.9μm with 3 + PRN at baseline (P = 0.139), 281.53 ± 10.28 and 273.15 ± 13.24μm at month 3 (P = 0.004); 266.83 ± 8.14 and 264.91 ± 9.27μm at month 12 (P = 0.350). The number of injections in the 1 + PRN group was significantly lower than that observed in the 3 + PRN group (2.15 ± 1.06 versus 3.36 ± 0.74; P < 0.001). During the follow-up, no serious ocular complications and adverse reactions related to Conbercept and injections occurred. Both injection regimens resulted in similar visual outcomes in PM-CNV patients. The 1 + PRN regimen had fewer injections and might be more suitable in this patient population.

Данные о распределении патологической ретинальной жидкости у пациентов с неоваскулярной возрастной макулярной дегенерацией, получавших антиангиогенную терапию в течение 5 лет в условиях реальной клинической практики

Purpose. To analyze the distribution of pathological retinal fluids according to optical coherence tomography (OCT) over time in patients with neovascular age-related macular degeneration (nAMD) who received anti-angiogenic therapy for 5 years. Material and methods. A retrospective analysis of OCT data of patients treated with anti-VEGF therapy (ranibizumab, aflibercept) in the 3+PRN regimen was performed. The study group consisted of 24 patients (79.2 % women, mean age 70.5 years). Results. Best corrected visual acuity increased from the initial 0.31 0.42 0.52 to 0.40 0.50 0.60 (p = 0.00028) by the 60th month. Central retinal thickness decreased from initial 304.0 343.4 382.7 µm to 190.6 209.8 229.1 µm (p &lt; 0.00001). Significant correlation indicators according to Spearman (p &lt; 0.05) were established in relation to an increase in the proportion of patients who had a «dry» retina and cases of subretinal fluid (SRF) resolution. Using the method of proportions, a significant (p &lt; 0.05) increase in the proportion of patients without pathological fluid was determined, as well as a decrease in the percentage of patients with SRF and sub-retinal pigment epithelium fluid, which were achieved in the first year of therapy and maintained until the end of the study, as well as a decrease in the proportion of patients with intraretinal fluid, which achieved a statistical significance (p &lt; 0.05) by the 60th month. Conclusion. One of the indicators confirming the high efficiency of long-term (60 months) anti-VEGF therapy for nAMD was a decrease in the proportion of patients with all compartments of the pathological retinal fluid. Keywords: age-related macular degeneration, anti-VEGF therapy, optical coherence tomography, retinal fluid, biomarkers

Safety and Efficacy of a Treat-and-Extend Regimen of Anti-Vascular Endothelial Growth Factor Agents for Diabetic Macular Edema or Macular Edema Secondary to Retinal Vein Occlusion: A Systematic Review and Meta-Analysis.

Comparative studies evaluating a treat-and-extend regimen relative to a monthly or prn regimen with anti-vascular endothelial growth factor therapy for diabetic macular edema or macular edema secondary to retinal vein occlusion were included following a systematic literature search. Seven studies of 984 eyes were included. Relative to a monthly regimen, treat-and-extend was similar for change in best-corrected visual acuity at final follow-up (P = .59) and had a lower number of injections (P < .00001). Relative to a prn regimen, treat-and-extend was similar for change in best-corrected visual acuity at final follow-up (P = .84) and was associated with a higher number of injections (P = .02). This meta-analysis found that a treat-and extend regimen was nonsignificantly different compared to monthly and prn regimens in efficacy and safety end points. [Ophthalmic Surg Lasers Imaging Retina 2023;54(3):131-138.].

STRICT PRO RE NATA VERSUS TREAT-AND-EXTEND REGIMENS IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: A SYSTEMATIC REVIEW AND META-ANALYSIS.

To compare the visual and anatomical outcomes between strict pro re nata (strict PRN) and treat-and-extend (T&E) anti-vascular endothelial growth factor (anti-VEGF) regimens for neovascular age-related macular degeneration (nAMD). A meta-analysis of 1-year and 2-year changes between strict PRN and T&E anti-VEGF regimens were conducted in both randomized controlled trials (RCTs) and real-world studies (RWSs). The best-corrected visual acuity (BCVA), central retinal thickness (CRT), and weighted mean numbers of visits and injections were evaluated. A total of 19 RCTs and 23 RWSs (2,530 eyes in strict PRN and 4,399 eyes in T&E) were included. Mean BCVA change in strict PRN group in both 1-year and 2-year (5.95 and 5.78, respectively) was noninferior to the T&E group (7.85 and 5.96, respectively). Mean CRT changes were also similar in both strict PRN and T&E groups. Mean number of visits were significantly more in the strict PRN group, whereas mean number of injections was significantly more in the T&E group. The strict PRN regimen demonstrates a noninferior BCVA improvement to the T&E regimen, achieving fewer injections, and may be both economically and medically beneficial. Both selections should be provided to patients with an overall consideration.

Seven-year outcome after 1-year fixed regimen of intravitreal aflibercept injections followed by pro re nata treatment for neovascular age-related macular degeneration.

The study aims to investigate the 7-year best-corrected visual acuity (BCVA) course after 1-year fixed regimen of intravitreal aflibercept injection (IVA) for neovascular age-related macular degeneration (nAMD) and to identify factors affecting this BCVA. This longitudinal, observational study included 63 treatment-naïve eyes (61 patients) with nAMD, treated with 1-year fixed regimen of IVA-3 monthly injections and 4 subsequent bimonthly injections-essentially followed by PRN regimen of IVA but sometimes followed by agent switching, photodynamic therapy (PDT), or vitrectomy, as needed. We assessed BCVA changes over a 7-year period. Morphologically, we assessed central retinal thickness (CRT), central choroidal thickness (CCT), subfoveal pigment epithelial detachment (PED) height, vitreomacular traction/adhesion (VMT/VMA), epiretinal membrane (ERM), and macular atrophy involving the fovea. Logarithm of the minimum angle of resolution (logMAR) BCVA changed from 0.20 ± 0.24 to 0.29 ± 0.45 over 7years. BCVA improved significantly after years 1 and 2 (P = 0.002 and 0.001, respectively) and then slowly decreased. BCVA after years 3-7 did not significantly differ from baseline. CRT and CCT decreased significantly during follow-up, while PED height did not. VMT/VMA decreased significantly, whereas ERM and macular atrophy increased significantly. Seven-year and baseline BCVA positively correlated (P = 0.007, β = 0.35). BCVA was maintained for 7years in nAMD eyes after 1-year fixed regimen of IVA, essentially followed by PRN regimen, but sometimes followed by agent switching, PDT, or vitrectomy, without severe drug-induced complications. Thus, early diagnosis and treatment of nAMD are essential for maintaining good long-term BCVA, even in eyes with relatively poor baseline vision.

A customized regimen of intravitreal aflibercept for the treatment of choroidal neovascularization secondary to different chorioretinal diseases

BackgroundTo assess the response of CNV secondary to chorioretinal diseases to IVA and to explore the adequate dosing regimen and the long-term results.MethodsA retrospective study including patients with treatment-naïve active CNV secondary to chorioretinal diseases. All patients received an initial IVA injection followed by a PRN regimen. The main outcome measures were improvement of BCVA, improvement of anatomical morphology and vascularity of the CNV on SS-OCT, and SS-OCTA, respectively, and ocular or systemic complications attributed to IVA.ResultsThe study included 17 eyes of 15 patients. Nine patients (60%) were females. The median age was 20 years. The main primary chorioretinal disease was vitelliform macular dystrophy (29%). The mean baseline BCVA was 0.16. The mean follow-up period was 15 months. Final BCVA improved by a mean of 6 lines. The CNV regressed or became inactive in all eyes. The median number of IVA injections was 2. There were no ocular or systemic complications attributed to IVA.ConclusionThe customized IVA regimen is effective in inducing long-term regression of secondary CNV and in improving BCVA. Multimodal imaging is fundamental in establishing the diagnosis of CNV, and in monitoring its response to IVA.

Long-term clinical effects of intravitreal injections of conbercept for the treatment of choroidal neovascularization in patients with pathological myopia.

To observe the long-term clinical efficacy of intravitreal injections of conbercept, a novel vascular growth factor inhibitor, for the treatment of pathological myopia choroidal neovascularization (PM-CNV). A total of 67 eyes (from 67 patients; mean age, 54.90±12.7y) with PM-CNV were retrospectively researched. Based on the different schemes used for the administration of the drug, the patients were divided into two groups: group A (n=35; average age, 53.31±13.6y; average diopter, 9.25±1.72 D), which received only one injection of pro re nata (PRN; 1+PRN regimen), and group B (n=32; average age, 56.49±11.8y; average diopter, 9.63±2.24 D), which received one injection per month for 3mo (3+PRN regimen). Best-corrected visual acuity (BCVA) analysis, intraocular pressure (IOP) examination, slit-lamp microscopy, fundus examination and optical coherence tomography were performed at each follow-up. The recurrence and treatment times of CNV were recorded. The patients were followed up for at least 12mo. The BCVA was increased in 29 eyes (82.9%) in group A and 30 eyes (93.75%) in group B; no increase or decrease was observed in 6 (17.1%) and 2 (6.25%) eyes in groups A and B, respectively. The BCVA (logMAR) values before treatment (0.67±0.48 and 0.71±0.56) were significantly higher than those 12mo after treatment (0.31±0.26 and 0.33±0.17) in groups A and B, respectively (P<0.05). The mean central macular thickness (CMT) values had significantly decreased from 346.49±65.99 and 360.10±82.31 µm at baseline to 257.29±40.47 and 251.97±48.26 µm in groups A and B, respectively, after 12mo of treatment. A total of 21 eyes in group A needed reinjection (60%; average number of injections, 2.51±0.98); the corresponding values in group B were 6 eyes (18.75%; average number of injections, 3.74±1.22). There were no adverse ocular and systemic complications during the treatment and follow-up. Intravitreal injection of conbercept with 1+PRN or 3+PRN improve the visual acuity, reduce macular edema and reduce the level of CMT in patients with PM-CNV. The 3+PRN regimen demonstrates a lower recurrence rate of CNV than the 1+PRN regimen, but requires more treatment. However, both treatment regimens demonstrate long-term safety and efficacy for the treatment of PM-CNV.

Оценка эффективности комбинированной терапии постокклюзионных изменений сетчатки

Purpose. To evaluate the volume of therapeutic measures necessary for the relief of macular edema in patients with Branch Retinal Vein Occlusion (BRVO) depending on the initial macular ischemia. Material and methods. 142 patients with macular edema on the background of BRVO were included in the study. All patients received intravitreal injection of ranibizumab in 1+PRN regimen, laser coagulation if necessary. All patients underwent examination, including visometry, electroretinography, optical coherence tomography (OCT) and OCT angiography. The number of injections and laser manipulations over the entire follow up period was taken into account. The comparative analysis of the obtained results was carried out in 3 groups formed depending on the area of the initial macular ischemia. The significance level was p&lt;0.0125. Results. It was found that in group 1 patients with an initial area of macular ischemia from 0.3 to 1.5 mm² , 1.5±0.7 injections of ranibizumab were required to resorb macular edema and increase visual acuity by more than 2 times. In group 2 patients with an area of macular ischemia from 1.5 to 1.8 mm² , an average of 7.2±2.2 injections of ranibizumab were required to relieve macular edema, in 62% of cases, sectoral laser coagulation, in 15% – panretinal laser coagulation of the retina, while visual acuity improved unreliably (p&gt;0.05). In group 3 patients with an initial area of macular ischemia more than 1.8 mm² , despite an average of 3.6±1.4 injections of ranibizumab and in 58% of cases of panretinal laser coagulation, visual acuity did not significantly change (p&gt;0.05), and the area of capillary nonperfusion increased in the perifoveal zone and on the periphery of the retina. Conclusion. The volume of therapeutic measures in patients with macular edema on the background of BRVO and the possibility of improving visual functions depends not only on the degree of ischemia of the peripheral retina, but also on the initial area of ischemia of the macular zone according to OCT angiography, the amplitude of the b-wave ERG and oscillatory potentials, which can be considered as markers that allow predicting the effectiveness of combined therapy of post-occlusive retinal changes. Key words: central retinal vein branch occlusion, retinal ischemia, macular ischemia, anti-VEGF therapy, OCT, OCT angiography.

One-year outcome of neovascular age-related macular degeneration patients followed-up using different optical coherence tomography modalities.

The aim of this study is to compare the one year outcome of neovascular age-related macular degeneration (nAMD) patients treated by a PRN regimen of Anti-vascular endothelial growth factor (VEGF) intravitreal injections (IVTs), using optical coherence tomography B-scan (OCT-B) or OCT Angiography (OCT-A) imaging modalities during follow-up. Patients older than 50 years with nAMD currently treated by PRN regimen of Anti-VEGF IVTs were recruited from Rothschild Foundation Hospital - Paris and Centre Ophtalmologique Maison Rouge - Strasbourg and followed-up for a year. Patients were randomized in two groups: one group was followed by OCT-B while the other was followed by OCT-A. Thirty-three patients were followed by OCT-A and 31 patients were followed by OCT-B. Twenty-nine patients in the OCT-A group and 27 patients in the OCT-B group attended the last visit. No statistically significant difference was found between the two groups at 1 year concerning: improvement or stabilization of the best corrected distance visual acuity (BCVA) (p > 0.9), exudative signs (p > 0.9), number of injections (p = 0.8) and the delay until the first reinjection was performed (p = 0.5). The use of OCT-A or OCT-B as imaging modalities in nAMD treated by a PRN regimen of Anti-VEGF IVTs seem to be comparable at one year.

The Structural and Comparative Analysis of Intravitreal Dexamethasone Implant (Ozurdex) and Anti-VEGF Injection in Branched Retinal Vein Occlusion Patients by Optical Coherence Tomography Angiography Images Quantitation

ABSTRACT Background and Objective: To evaluate and compare the structural changes of retinal vasculature after intravitreal dexamethasone implant (Ozurdex) insertion and antivascular endothelial growth factor (anti-VEGF) injection in patients with branched retinal vein occlusion (BRVO) using optical coherence tomography angiography (OCTA). Study Design/Materials and Methods: We retrospectively analyzed 39 patients with unilateral BRVO. Subjects were divided into two groups according to treatment agent: Ozurdex (n = 18) and anti-VEGF (n = 21). Swept Source (SS) OCT and OCTA were performed and images were analyzed quantitatively using ImageJ (National Institutes of Health) software. Intravitreal implant and anti-VEGF injections were performed following a prn regimen. The specific anti-VEGF agent used was chosen among bevacizumab, ranibizumab and aflibercept. Results: Of the 39 patients (mean ± SD age, 70.0 ± 8.9 years [range, 48–89 years]; 20 men [51.0%]) with unilateral BRVO, in an independent two-sample t test, there was greater vascular reperfusion of the choriocapillaris slab in the intravitreal Ozurdex implant group than in the anti-VEGF group using the angiography mode (P = .013). Increased number of particles was more prominent in intravitreal anti-VEGF injection group than intravitreal Ozurdex implant group in outer retina slab of En-face mode (P = .039). There was no statistically significant difference between the 2 treatment groups in relation to the Early Treatment Diabetic Retinopathy Study (ETDRS) density map and other angiography slabs; and the superficial, deep, and outer retina. Conclusions: Results of a quantitative analysis of OCTA images using ImageJ software suggest that the intravitreal Ozurdex implant induced increased retinal vascular perfusion compared with anti-VEGF injection for the treatment of BRVO.