Significant Reduction In Central Retinal Thickness Research Articles

Brolucizumab in recalcitrant neovascular age-related macular degeneration-real-world data in Chinese population.

This retrospective study aimed to determine the short-term efficacy and safety of brolucizumab treatment for recalcitrant neovascular age-related macular degeneration (nAMD) in a real-world setting in Taiwan. Recalcitrant nAMD patients who were treated with brolucizumab from November 2021 to August 2022 at Taipei Veterans General Hospital were included. Patients were followed for 3 months after switching to brolucizumab. The primary outcomes were changes in mean best-corrected visual acuity (BCVA) and central retinal thickness (CRT) from baseline to the third month. The secondary outcomes included the incidence of intraocular inflammation (IOI), proportion of patients with subretinal and intraretinal fluid (SRF and IRF), and change in pigment epithelial detachment (PED) height from baseline to the third month. The significance level was considered as p < .05 in all tests. A total of 38 patients (40 eyes) with a mean (±SD) age of 76.3 (±10.84) years were included. The baseline BCVA was 0.92±0.64 logMAR, and the CRT and PED height were 329.0±171.18 and 189.8±114.94 um, respectively. The patients had a significant reduction in CRT and resolution of IRF and SRF from baseline to the third month. There were numerical improvements in mean BCVA and PED height, but they were not significant. The percentages of achieving at least 0.1, 0.2, and 0.3 logMAR (equivalent to 5, 10, 15 ETDRS letters) visual gain were 50%, 37.5%, and 30%, respectively, during the first 3 months of follow-up. No IOI occurred in these patients. This study demonstrated that brolucizumab had good short-term structural and functional efficacy in recalcitrant nAMD patients.

Dexamethasone intravitreal implant (Ozurdex) in phakic patients with diabetic macular oedema resistant to anti‐VEGF therapy: Short‐term visual and anatomical outcomes in a real‐world study

Aims/Purpose: To prospectively study and analyse the clinical effectiveness of using intravitreal dexamethasone (IVO) implant in treatment resistant phakic patients with centre involving diabetic macular oedema (DMO).Methods: Prospective interventional case series of phakic patients with persistent centre‐involving diabetic macular oedema, who received an IVO implant between May 2022 and February 2023 were included. Primary outcome measures include best corrected visual acuity (BCVA) and central retinal thickness (CRT) at baseline, 2 months and 6 months. Secondary efficacy outcome measures include, change in level of cataract and change in intraocular pressure (IOP) control requiring topical treatment or interventional procedures.Results: Nine eyes from eight patients were included. Mean age at treatment was 61.87 ± 11.07 years with male preponderance (8:1). There was no statistically significant difference in BCVA at baseline compared to 2 months following IVO (0.291 ± 0.185 vs. 0.287 ± 0.208, respectively, p = 0.919) or comparing BCVA at baseline to BCVA 6 months following IVO (0.291 ± 0.185 vs. 0.347 ± 0.153, respectively, p = 0.063). Reduction in CRT from baseline to 2 months following IVO was highly significant (436.4 ± 65.1 vs. 305.9 ± 58.6, respectively, p = 0.006) and reduction in CRT comparing baseline and 6 months following IVO which remained significant (436.4 ± 65.1 vs. 363.2 ± 96.1, p = 0.041). Mean intraocular pressures was raised in 44.4% eyes with medical management required in 33.3%. Recurrence of maculopathy was noted in 88.9% eyes. Cataract requiring surgery was performed in one eye.Conclusions: This prospective series shows that phakic patients, with persistent DMO following anti‐VEGF therapy undergoing IVO, resulted in a highly statistically significant reduction in CRT at 2 months following IVO which was maintained at 6 months (p = 0.04) although there is high recurrence. BCVA remains stable over the 6‐month period with no statistically significant change.

Short-Term Treatment Outcomes of Brolucizumab in Patients with Neovascular Age-Related Macular Degeneration: A Multicentre Indian Real-World Evidence Study.

To evaluate the short-term effectiveness and safety outcomes following brolucizumab treatment in patients with neovascular age-related macular degeneration (nAMD) as a part of real-world clinical practice in India. This was a retrospective, observational, multicentre study including patients (≥50 years old) diagnosed with nAMD. Anonymized data of the patients receiving the first dose of brolucizumab intravitreal injection (IVI) who were either treatment-naïve or previously treated with a single or a combination of other anti-VEGF IVIs were included. The present study reported the change in retinal fluid levels from baseline to month 3, best-corrected visual acuity (BCVA), central retinal thickness (CRT), and the number of injections received. The adverse events in the three months after brolucizumab treatment initiation were also monitored. The study included 63 patients (65 eyes) from four study centres across India (mean age: 69.1 ± 9.7 years). A total of 82 brolucizumab injections were administered during the 3 months of study duration, with 52/65 (80.0%) eyes receiving only 1 injection. Resolution of IRF, SRF, and PED was observed in 76.9%, 64.6%, and 67.7% of eyes, respectively. Further, a significant reduction in CRT was observed (baseline: 403.5 ± 118.7 μm; month 3: 308.3 ± 73.8 μm; p < 0.001), and BCVA also improved notably from 0.7 ± 0.5 logMAR at baseline to 0.5 ± 0.4 logMAR at month 3 (p < 0.001). Adverse events (AEs) were reported in 3 eyes from 3 patients; retinal pigment epithelial rip (1) and subretinal hemorrhage (2) after the first injection of brolucizumab, however, none discontinued the treatment. The study reports on the short-term effectiveness and tolerability of brolucizumab therapy in the management of nAMD in both treatment-naïve and switch eyes. Brolucizumab was observed to have a favourable benefit-risk profile, and study results were within the known safety profile, with no instances of intraocular inflammation.

Angiographic biomarkers are significant predictors of treatment response to intravitreal aflibercept in diabetic macular edema

This prospective single-center study aims to identify biomarkers that predict improvement in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) at 6 months, in 76 eyes with diabetic macular edema (DME) treated monthly with intravitreal aflibercept. At baseline, all patients underwent standardized imaging with color photography, optical coherence tomography (OCT), fluorescein angiography (FA) and OCT angiography (OCTA). Glycosylated hemoglobin, renal function, dyslipidemia, hypertension, cardiovascular disease and smoking were recorded. Retinal images were graded in a masked fashion. Baseline imaging, systemic and demographic variables were investigated to detect associations to BCVA and CRT change post aflibercept. Predictors of BCVA improvement included greater macular vessel density quantified using OCTA (p = 0.001) and low-density lipoprotein (LDL) ≥ 2.6 mmol/L (p = 0.017). Lower macular vessel density eyes showed a significant reduction in CRT but no BCVA improvement. Predictors of CRT reduction included peripheral non-perfusion seen on ultrawide-field FA (p = 0.005) and LDL ≥ 2.6 mmol/L (p < 0.001). Retinal angiographic biomarkers derived from OCTA and ultrawide-field FA may help predict functional and anatomic response to anti-vascular endothelial growth factor (VEGF) therapy in patients with DME. Elevated LDL is associated with treatment response in DME. These results may be used to better-select patients who will benefit from intravitreal aflibercept for treatment of DME.

Role of intravitreal ranibizumab for rapid recovery of central serous chorioretinopathy

Background: Central serous chorioretinopathy (CSCR) is an idiopathic disorder in which there is leakage of fluid from hyper permeable choriocapillaris and the collection of fluid between neurosensory and neuropigmentry retina in the macular area that is responsible for decrease visual acuity. CSCR may be acute or chronic. Various treatment options include simple observation, argon laser photocoagulation of the leaking spot, photodynamic therapy (PDT), oral ketoconazole and oral rifampicin are available. Ranibizumab is a monoclonal antibody fragment that act as vascular endothelial growth factor inhibitor, stabilize blood retinal barrier and decrease leakage from choriocapillaris. This study aims to evaluate the role of intravitreal ranibizumab for rapid recovery in central serous chorioretinopathy.&#x0D; Patients and methods: This descriptive case series was carried out at Department of Ophthalmology, Nishtar Medical University Multan, Pakistan from 01-10-2019 till 30-04-2020. The study included twelve eyes of twelve patients suffering from acute CSCR. All patients were given a single injection of intravitreal ranibizumab (0.5mg/0.05ml) as a primary treatment and followed for two months after injection at one week, one month and two months interval to document efficacy of intravitreal ranibizumab. At each baseline and follow up visits, dilated fundus examination was carried out, ending up with patients’ best corrected visual acuity. Central retinal thickness (CRT) was also recorded and results were compared with prior visit results of patients. Major outcomes were the improvement in visual acuity and decrease in CRT. Baseline CRT values were also compared with post injection CRT values at one week, one month and two months intervals using paired sample t-test and best corrected visual acuity (BCVA) was compared using chi–square test.&#x0D; Results: Mean age of the patients was 39.6 years with a male to female ratio of 9:1. Best corrected visual acuity was 6/60 on Snellen chart at baseline. All patients exhibited mean improvement of best corrected visual acuity of three Snellen lines after one week. Eleven patients were back to best corrected visual acuity of 6/6 after one month. Remaining one patient gained best corrected visual acuity of 6/6 after two months of post injection. The mean CRT at presentation was 500 ± 80U (range; 386–580) which reduced significantly to 272 ± 52 U (range 220–338) from baseline after one month showing significant reduction (p&lt;0.001). At the last follow-up visit, the CRT was measured 230 ± 20 U (range 220—250) which shows complete resolution of sub-retinal fluid.&#x0D; Conclusion: Intravitreal ranibizumab can be used for rapid absorption of sub-retinal fluid in acute CSCR and significant reduction in CRT along with improvement in BCVA indicate that it may be safely employed in CSCR to achieve better clinical outcomes.

Treatment of Diabetic Macular Edema with Multiple Dexamethasone Intravitreal Implants: Evidence from Real-Life Experience

Objective: To gain information about multiple dexamethasone intravitreal implant (DEX-I) injections in diabetic macular edema (DME) eyes in real-life clinical settings. Methods: Patients with DME treated with multiple (≥5) DEX-I injections between January 1, 2014, and December 31, 2018, were retrospectively enrolled regardless of previous treatment with anti-VEGF agents. All patients were evaluated with best-corrected visual acuity (BCVA) in logMAR, ocular fundus, and spectral domain optical coherence tomography (SD-OCT) at baseline and at 3 months after the last DEX-I injection. Multiple DEX-I injections were administered when necessary in case of DME recurrence. Main efficacy measures were changes in BCVA and central retinal thickness (CRT) from baseline to 3 months after the last DEX-I injection; main secondary measures were an increase in intraocular pressure (IOP), the need for cataract surgery, endophthalmitis, and vitreous hemorrhage. Results: Seventeen patients (18 eyes) with DME and mean age (± SD) of 54.3 ± 8.16 years were treated with DEX-I injections between 2014 and 2018. The majority of eyes (77.8%) had been treated with a mean of 6.3 ± 3.2 anti-VEGF agents before switching to DEX-I. During a mean follow-up period of 37.6 months and after a mean number of 5.9 DEX-I injections, visual acuity improved or stabilized in 77.8% of all eyes, accompanied by a significant reduction in CRT. An increase in IOP was recorded in 38.8% of all patients, while a surgical procedure was needed for cataract in 73.3% of all phakic patients. Conclusions: In this real-life experience in Italy, multiple DEX-I treatments showed good efficacy with no new safety concerns. The follow-up duration of >3 years and a greater number of DEX-I intravitreal injections compared to other observations confirm the positive balance between risks and benefits of DEX-I in the long term.

Flare levels after intravitreal injection of ranibizumab, aflibercept, or triamcinolone acetonide for diabetic macular edema.

To evaluate anterior flare intensity (AFI) and central retinal thickness (CRT) values after intravitreal injection of aflibercept (IVA), ranibizumab (IVR), or triamcinolone acetonide (IVTA) in patients with diabetic macular edema (DME). This research was conducted as a prospective study for patients with DME. Patients with phakia received either IVA or IVR, whereas patients with pseudophakia received IVA, IVR, or IVTA. AFI and CRT were measured using a laser flare meter and spectral domain optical coherence tomography, respectively, at days 0, 1, 7, 30, and 90. Forty patients with phakia and 60 patients with pseudophakia were enrolled this study. In the IVTA group, AFI of pseudophakic eyes was significantly decreased at days 1 (p = 0.0487), 7 (p = 0.0201), and 30 (p = 0.0211). In the IVA group, AFI of phakic eyes was transiently increased at day 1 (p = 0.0078) and returned to baseline at day 7, whereas no significant change was observed in AFI of pseudophakic eyes. In the IVR group, there was no significant change in AFI regardless of phakic condition. All groups showed significant reduction in CRT at day 7 and later. DME improved after treatment by IVTA, IVR, or IVA, whereas AFI was reduced only in eyes treated with IVTA. The temporal profiles of AFI are likely related to differences in the pharmacological properties of the drugs.

The impact of epiretinal membrane on neovascular age‐related macular degeneration treatment: A spectral‐domain optical coherence tomography study

PurposeThe purpose of this prospective study was to evaluate the impact of epiretinal membrane (ERM) on anatomical and functional results in patients with wet age‐related macular degeneration (AMD) treated with intravitreal anti‐vascular endothelial growth (anti‐VEGF) injections.MethodsParticipants in the study were 48 patients with either wet AMD alone (n = 27) or AMD and ERM (n = 21). All patients received intravitreal anti‐VEGF injections (3 monthly injections and PRN thereafter) and were followed‐up for at least 12 months. All participants had best corrected visual acuity (BCVA) measurement and optical coherence tomography (OCT) at each visit, while fluorescein angiography was performed at baseline and then at the discretion of the physician. The main outcomes were the change in BCVA and central retinal thickness (CRT) along with the presence of fluid in the two groups.ResultsThere was a statistically significant improvement in BCVA in both groups, while the two groups did not differ significantly regarding BCVA at the end of the follow‐up. Accordingly, there was a statistically significant reduction in CRT in both groups, which did not have any difference in between. Patients with AMD alone presented subretinal fluid in a lower percentage than patients with AMD/ERM at the end of the follow‐up. In addition, patients with coexistence of AMD and ERM needed more injections than patients with AMD alone.ConclusionsPatients with AMD combined with ERM seemed to need more injections for the treatment of AMD, while they presented higher percentage of subretinal fluid at the 12‐month follow‐up, although there was no significant difference in BCVA and CRT in comparison with patients having AMD alone.

SWITCHING TREATMENT FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION FROM BEVACIZUMAB TO RANIBIZUMAB: Who is Likely to Benefit From the Switch?

To evaluate the safety and efficacy of switching from bevacizumab to ranibizumab in patients with neovascular age-related macular degeneration. Retrospective study of patients with neovascular age-related macular degeneration initially treated with bevacizumab and switched to ranibizumab. Visual acuity and central retinal thickness (CRT) were retrieved at four time points: before the last three bevacizumab injections, at the switch, after the first three ranibizumab injections, and at the end of follow-up. One hundred and fourteen eyes of 110 patients were included. Switching from bevacizumab to ranibizumab did not achieve a significant change in visual acuity, and a significant reduction in CRT was achieved after the first three injections but was not maintained by the end of follow-up. Eyes that lost ≥0.1 logMAR before the switch were more likely to improve in visual acuity (P = 0.013), and eyes with ≥10% increase in CRT before the switch were more likely to improve anatomically (P = 0.0003). In 47.3% of the eyes, the CRT was reduced by ≥10% after the first 3 ranibizumab injections, and the reduction was maintained with additional injections. Switching to ranibizumab should be considered in patients with visual acuity decrease or CRT increase, despite monthly bevacizumab injections. The response should be evaluated after the first three injections to guide future treatment.

Single injection of triamcinolone versus three repeated injections of bevacizumab for treatment of diabetic macular edema

To compare the effect of a single intravitreal injection of triamcinolone acetonide versus three consecutive monthly intravitreal injections of bevacizumab for the treatment of diabetic macular edema (DME). Forty patients treated with a single intravitreal injection of 4mg triamcinolone acetonide (triamcinolone group) were compared with 40 patients treated with three consecutive monthly intravitreal injections of 1.25mg bevacizumab (bevacizumab group). The triamcinolone group showed a significant decrease in mean central retinal thickness (CRT) from 472.5μm±120.35 to 374.0μm±152.31 after 3 months (p < 0.001). The bevacizumab group also showed a significant reduction in CRT from 464.5μm±115.3 to 370.0μm±142.31 (p<0.001). The triamcinolone group displayed an increase in best-corrected visual acuity (BCVA) following a single intravitreal triamcinolone acetonide injection from a mean of +0.70±0.17 logMAR to a mean of +0.54±0.38 logMAR after 3months (p<0.05). The bevacizumab group also showed an increase in BCVA following three injections of bevacizumab from a mean of +0.73±0.28 logMAR to a mean of +0.57±0.33 logMAR (p<0.05). Statistical analysis showed no significant difference between both groups at 3months. Our study showed that a single intravitreal injection of triamcinolone is as effective as three consecutive monthly intravitreal injections of bevacizumab for treatment of DME with regard to BCVA and CRT measured by optical coherence tomography. Despite the recent popularity of bevacizumab, three injections are no more effective than a single injection of triamcinolone for the treatment of DME.

Predictive factors for functional improvement after intravitreal bevacizumab therapy for macular edema due to branch retinal vein occlusion

BackgroundTo identify predictive factors for improvement of visual acuity and central retinal thickness by intravitreal bevacizumab for the treatment of macular edema (ME) due to branch retinal vein occlusion (BRVO).MethodsTwo hundred and five eyes from 204 patients with ME secondary to BRVO were retrospectively included at six sites. All eyes received intravitreal bevacizumab therapy (1.25 mg/0.05 ml). The mean follow-up was 36.8 ± 12.7 weeks (range, 18 to 54 weeks). Measurement of ETDRS best-corrected visual acuity (BCVA, in all eyes) and optical coherence tomography (OCT, in 87% of eyes) were performed at baseline and at follow-up examinations every 12 weeks. Using fluorescein angiography, the perfusion status of the macula at baseline could be assessed in 84% of the eyes. The main outcome measures were changes in BCVA and central retinal thickness (CRT). For analysis of predictive factors, the results at 24 weeks were used.ResultsThe median BCVA was 0.6 LogMAR at baseline and improved to 0.4 LogMAR at 24 and 48 weeks. This visual improvement was associated by a significant reduction in CRT, decreasing from a baseline of 454 μm to 267 μm and 248 μm after 24 and 48 weeks respectively. Eyes with ME and intact (perfused) or interrupted (ischemic) foveal capillary ring showed a 2-line increase of median BCVA [45 eyes (22%) and 128 eyes (62%) respectively]. However, the final median BCVA was significantly worse in eyes with ischemic ME (0.6 versus 0.3 logMAR in perfused ME). Other factors for visual improvement were absence of previous treatments of the ME, age younger than 60 years and low baseline BCVA (≥0.6 logMAR) (2, 3, and 2 median BCVA lines increase respectively). Furthermore, eyes with duration of the ME of less than 12 months responded with a 3-line increase of the median BCVA. Final CRT only showed minor differences between the subgroups. During the entire follow-up, retreatments were performed in 85% of the eyes, with a median number of injections of three (mean 3.2; range, 1 to 10) and a median time-interval between injections of 11.6 weeks (mean 14.6 weeks).ConclusionsIntravitreal injection of bevacizumab resulted in a significant improvement of BCVA and reduction of ME in BRVO. Baseline BCVA, patient’s age, and duration of BRVO were found to be of prognostic relevance for visual improvement. A less favorable outcome of the bevacizumab therapy in eyes with longstanding BRVO would advocate initiation of treatment within 12 months after onset.

Efficacy and safety of one intravitreal injection of bevacizumab in diabetic macular oedema

To assess the efficacy, duration of effect and safety of one intravitreal injection of bevacizumab in diabetic macular oedema (DMO). Bevacizumab (1 mg/0.04 ml) was injected intravitreally into eyes with DMO (29 with and nine without previous treatments). Best corrected visual acuity (BCVA), intraocular pressure and central retinal thickness (CRT) were measured; slit-lamp examination, macular biomicroscopy, optical coherence tomography and fluorescein angiography were performed before and at 2-4, 8 and 12 weeks post-injection. Best corrected VA and CRT were analysed in both groups. In the non-pretreated group, mean BCVA improved from 0.76 +/- 0.33 (baseline) to 0.57 +/- 0.30 and 0.54 +/- 0.27 at 2-4 weeks and 8 weeks post-injection, respectively (p = 0.02, p = 0.014, paired t-test). Mean CRT decreased from 632.4 +/- 196.0 microm (baseline) to 392.3 +/- 113.6 microm and 370.4 +/- 141.7 microm at the same time-points, respectively (p = 0.01, p = 0.01). There was no difference in BCVA or CRT at 12 weeks. In the pretreated group, mean BCVA improved from 0.62 +/- 0.30 (baseline) to 0.53 +/- 0.33 at 2-4 weeks post-injection (p = 0.01), and mean CRT decreased from 583.9 +/- 180.7 microm (baseline) to 404.1 +/- 197.9 microm at 2-4 weeks post-injection (p < 0.001). Mean BCVA was unchanged at 8 weeks and 12 weeks post-injection, although mean CRT remained lower at 8 weeks (p = 0.004). No ocular or systemic side-effects developed during follow-up. One intravitreal injection of bevacizumab for DMO seems to be effective and safe in both eyes that have been treated previously and eyes that have not. The therapeutic effect is temporary and repeat treatment may be needed.