Treatment Of Choroidal Neovascular Membrane Research Articles

Comparing the Outcomes of Anti-VEGF Treatment for Choroidal Neovascular Membrane

This quasi-experimental study was conducted in the Department of Ophthalmology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, and Bangladesh Eye Hospital, Dhaka, Bangladesh, from March 2020 to August 2021, to compare the efficacy of Bevacizumab and Ranibizumab on patients with choroidal neovascular membrane (CNVM) due to age-related macular degeneration (AMD). A total of 34 eyes of 34 participants with CNVM in AMD divided into Group A, received monthly intravitreal ranibizumab (0.5 mg in 0.05 ml) and Group B, bevacizumab (1.25 mg in 0.05 ml) for 3 consecutive months. Before treatment, mean BCVA was found 37.9412±16.68259 in group A and 35.2941±12.68249 in group B. After treatment, the mean best-corrected visual acuity (BCVA) was found 53.5294±14.97547 in group A and 48.8235±13.75334 in group B. The differences were not statistically significant (p>0.05) between two groups. The improvement in BCVA was highly significant (p<0.0001) in both groups before and after giving intravitreal bevacizumab and ranibizumab. Before treatment, mean central macular thickness (OCT) was found in 344.8824±82.51582 μm in group A and 360.1765±82.22016 μm in group B. After treatment, OCT was found 255.18±71.852 μm in group A and 241.76±42.405 μm in group B. The differences were not statistically significant (p>0.05) between two groups. However, the improvement by decreasing macular thickness was highly significant (p<0.0001) in both groups before and after giving intravitreal bevacizumab and ranibizumab. Treatment with intravitreal bevacizumab or ranibizumab was associated with a similar improvement in mean visual acuity and decreasing central macular thickness by 4 months. CBMJ 2024 July: vol. 13 no. 02 P: 265-273

Use of Adjunctive Corticosteroid With Antivascular Endothelial Growth Factor Agents in the Treatment of Choroidal Neovascular Membrane Associated With Presumed Ocular Histoplasmosis.

Purpose: To evaluate the impact of combination treatment of antivascular endothelial growth factor (anti-VEGF) intravitreal injections and corticosteroids in patients with choroidal neovascularization (CNV) secondary to presumed ocular histoplasmosis syndrome (POHS). Methods: A retrospective multicenter study was conducted in a cohort from Illinois and Missouri. Patients were identified over an 8-year period, and data were evaluated over a 1-year study window commencing with treatment initiation. Group 1 included patients treated with intravitreal injections of anti-VEGF, and group 2 included those who received intravitreal injections of anti-VEGF and adjuvant corticosteroids. Optical coherence tomography (OCT) measurements and increases in Early Treatment Diabetic Retinopathy Study (ETDRS) letter score were compared between each group. Results: Using the method of last visit carried forward, the visual acuity (VA) in group 2 was 6.42 ETDRS letters better than the VA in group 1 at the final assessment. Patients in group 2 had a mean ETDRS letter gain of 21.50 (P = .06) from the initial baseline vision. The average amount of decrease in OCT central subfield thickness compared with baseline was lower in group 1 (80.9 ± 129.8 µm) vs group 2 (102.8 ± 90.40 µm) at the 1-year follow-up visit (P = .25). Conclusions: Approved treatment of CNV secondary to POHS is limited. Adjuvant corticosteroid treatment in patients with CNV secondary to POHS may provide better long-term vision and OCT outcomes than anti-VEGF alone and may offer an additional therapy option for these patients.

Choroidal Neovascular Membrane (EYE) Treatment using Optical Fibre and LASER

At the point when the eye experiences choroidal neovascularization, scar, or both, at the hour of treatment, the pace of repeat was 65% versus 33% if the concerned eye had no choroidal neovascularization, scar, or both. Normally a visual sharpness of four lines is lost when individual eyes had choroidal neovascularization, scar, or both, versus one line when the individual eye had no choroidal neovascularization or mark. Photocoagulation of choroidal neovascularization using LASER in patients experiencing angioid streaks can cause the ending of the choroidal neovascularization and adjustment of visual keenness. Treatment of choroidal neovascular membranes (CNVM) can differ depending on the concerned disease. Treatment consists of thermal laser treatment, anti-VEGF drugs, photodynamic therapy (PDT). Contingent upon the advancement of the illness, the individual may get at least one of these therapeutic treatment. Laser treatment is generally done as an outpatient strategy. It happens in the eye specialist's office or at the hospital. The LASER beam utilized in this treatment is a focused light having high energy.[5] It obliterates the abnormal blood veins, anticipating further spillage, dying, and development. After the laser treatment, vision may turn out to be more obscured than previously. Be that as it may, frequently it will balance out inside half a month. The treatment brings about a perpetual scar, making a lasting vulnerable side. This came about vulnerable sides, may be perceptible in the field of vision. Generally in the LASER treatment anomalous veins are demolished. In any case, patients regularly need re-treatment inside three to five years.

Successful management of melanocytomaassociated choroidal neovascularization with photodynamic therapy.

To report the efficacy of photodynamic therapy in treatment of choroidal neovascular membrane (CNV) associated with melanocytoma of the optic disc. A middle-aged man with visual acuity of 20/200 in right eye was treated with photodynamic therapy for juxtafoveal classic CNV overlying the papillomacular bundle. CNV was secondary to ocular melanocytoma, a rare event. At the 6-month follow-up, a scarred CNV with final visual acuity of 20/30 was noted clinically and angiographically. Tomography revealed high reflective scar tissue with flat macula and microperimetry showed restoration of retinal sensitivity over the papillomacular bundle. Photodynamic therapy effectively resolved CNV that involved papillomacular bundle (secondary to melanocytoma) and restored retinal function in papillomacular bundle.

SHORT-TERM SAFETY OF 2 MG INTRAVITREAL ZIV-AFLIBERCEPT.

To evaluate the safety of single intravitreal 2 mg ziv-aflibercept (0.08 mL) injections for the treatment of choroidal neovascular membranes (CNVM). Eyes with choroidal neovascular membranes because of several conditions each received single intravitreal injections of 2 mg ziv-aflibercept (0.08 mL). Comprehensive ophthalmic examinations and detailed systemic evaluations were performed at baseline and Days 1, 7, and 30 after injections. Standard electroretinography was performed at baseline and Day 30. Primary outcome measures consisted of safety assessments (signs of clinical toxicity and electroretinographic abnormalities). Secondary outcome measures included changes in best-corrected visual acuity (BCVA) and central subfield thickness (CST) of the macula. Twenty-one eyes of 20 patients (12 males) received injections. Etiologies responsible for the choroidal neovascular membranes included age-related macular degeneration (14), polypoidal choroidal vasculopathy (PCV) (3), myopia (2), and idiopathic juxtafoveal telangiectasia (2). None of the patients complained of worsening vision or pain after the intravitreal injections and no intraocular inflammation was seen. No significant changes in the electroretinographic b/a ratio from baseline to 1 month were measured (scotopic: P = 0.89; photopic: P = 0.13) and mean intraocular pressures were unchanged (14.2 ± 3.6 vs. 13.7 ± 3.0 mmHg; P = 0.62). Mean best-corrected visual acuity did not change significantly from baseline to 1 month (0.66 ± 0.37 logMAR [Snellen equivalent: 20/100] vs. 0.61 ± 0.35 logMAR [Snellen equivalent: 20/80]; P = 0.72) but significant improvements in central subfield thickness were seen (343 ± 177 vs. 210 ± 133 μm; P = 0.01). Single intravitreal injections of 2 mg ziv-aflibercept (0.08 mL) appear to be safe through 1 month.

Verteporfin inhibits growth of human glioma in vitro without light activation

Verteporfin (VP), a light-activated drug used in photodynamic therapy for the treatment of choroidal neovascular membranes, has also been shown to be an effective inhibitor of malignant cells. Recently, studies have demonstrated that, even without photo-activation, VP may still inhibit certain tumor cell lines, including ovarian cancer, hepatocarcinoma and retinoblastoma, through the inhibition of the YAP-TEAD complex. In this study, we examined the effects of VP without light activation on human glioma cell lines (LN229 and SNB19). Through western blot analysis, we identified that human glioma cells that were exposed to VP without light activation demonstrated a downregulation of YAP-TEAD-associated downstream signaling molecules, including c-myc, axl, CTGF, cyr61 and survivin and upregulation of the tumor growth inhibitor molecule p38 MAPK. In addition, we observed that expression of VEGFA and the pluripotent marker Oct-4 were also decreased. Verteporfin did not alter the Akt survival pathway or the mTor pathway but there was a modest increase in LC3-IIB, a marker of autophagosome biogenesis. This study suggests that verteporfin should be further explored as an adjuvant therapy for the treatment of glioblastoma.

Intravitreal Bevacizumab Treatment in Wet-Form (Neovascular) Age-Related Macular Degeneration

Age-related macular dejeneration is one of the main causes of visual loss in the older population. In recent years, agents developed to aim the inhibition of the vascular endothelial growth factor are the main choice for the treatment of choroidal neovascular membranes often found in the wet type of this disease. This article mentions the standpoint of the off-label used anti-VEGF, bevacizumab, according to the literature.

Intravitreal Ziv-Aflibercept in Treatment of Naïve Chronic Central Serous Chorioretinopathy Related Choroidal Neovascular Membrane

Purpose. To study the effect and outcome of intravitreal Ziv-Aflibercept (IVZ) in treatment of Chronic Central Serous Chorioretinopathy (CSCR) related Choroidal Neovascular Membrane (CNVM). Methods. A case report of 48-year-old male patient treated with 1.25 mg/0.05 ml IVZ (total 3 doses at monthly intervals) in CSCR related CNVM. Pre- and posttreatment fundus fluorescein angiography (FFA) and Optical Coherence Tomography (OCT) were done to document response along with improvement in visual acuity. Patients. Single eye of a 48-year-old male patient. Results. Regression of CNVM was noted with improvement of macular contour and thickness on OCT and cessation of leakage on FFA. Visual acuity improved from 3/60, <N36 to 6/12, N12. Discussion. Anti-VEGF injections have shown benefit in treatment of CNVM. There is very little information about benefit of IVZ in CSCR related CNVM. Conclusion. IVZ is effective in regression of CSCR related CNVM and is associated with better macular anatomy and improved visual function.

Indocyanine Green Mediated Photothrombosis (IMP) with Intravitreal Bevacizumab (IVB) for Treatment of Choroidal Neovascular Membrane (CNV) due to ARMD

Purpose: Choroidal neovascular membrane (CNV) is one of the leading causes of blindness among elderly patients. Anti-Vascular endothelial growth factors (VEGF) and photodyanamic therapy (PDT) are the only treatment options available for subfoveal and juxtafoveal CNVM but are extremely costly. Indocyanine Green Mediated Photothrombosis (IMP) has been successfully used for subfoveal CNV due to ARMD and is much cheaper than PDT. Our study aims to evaluate IMP followed by intravitreal Bevacizumab in subfoveal and juxtafoveal CNV due to ARMD. Methods: This prospective interventional study consisted of 15 eyes with subfoveal and juxtafoveal CNV due to ARMD. IMP was performed with low power diode laser augmented with indocyanine green dye (ICG) and followed 24 hours later with intravitreal bevacizumab 1.25 mg/0.05ml. Subjects were followed up at 6 weeks, 12 weeks and 16 weeks for BCVA, IOP, lens status assessment on slit lamp, fundus examination, FFA and SD-OCT. Results: Mean visual acuity improved from 0.136 preoperatively to 0.177 at 6 weeks, to 0.183 at 12 weeks and 0.185 at 16 weeks. Mean pre-treatment mean macular thickness (MMT) varied from 284.1 µm to 261.2 µm at 4 weeks post-treatment, to 268.8 µm at 12 weeks and to 267 µm at 16 weeks post-treatment. 10 eyes showed stabilization of vision with treatment till 16 week post treatment. Five eyes showed improvement in vision which was sustained till 16th week post treatment. No eye showed decrease in vision by the end of follow up. The difference was statistically significant at all visits. Conclusion: IMP in combination with intravitreal Bevacizumab is an effective treatment modality for CNV in ARMD.

New Treatments for Age Related Macular Degeneration: The Role of AntiAngiogenic Agents in the Treatment of Choroidal Neovascular Membrane - A Case of Recurrent Membrane

New Treatments for Age Related Macular Degeneration: The Role of AntiAngiogenic Agents in the Treatment of Choroidal Neovascular Membrane - A Case of Recurrent Membrane

Evaluation of effect of intravitreal injection bevacizumab in treatment of choroidal neovascualr membrane of the eye

Background: Age-related macular degeneration (ARMD) is the leading cause of irreversible blindness in individuals over 50 years in developed countries. The objective was to study the effect of intravitreal bevacizumab in patients of choroidal neovascular membrane of eye by visual acuity and fluorescence angiography photograph. Methods: Non-randomized, open label, prospective analysis of 30 eyes in 30 patients with choroidal neovascualr diagnosed by direct ophthalmoscope and slit lamp 90D biomicroscopy. Visual acuity of the clinically diagnosed patient was taken by ETDRS (early treatment diabetic retinopathy system) visual acuity chart. Fundus fluorescence angiography was done by topcon retinal camera. Now all patients regardless of type were given 3 injections of 0.05 ml of injection bevacizumab intravitreally at infratemporal site 3.5 mm and 4 mm away from the limbus in pseudophakic and phakic eye repectively at interval of 1 month. After 1 month of last dose, patient was assessed with ETDRS chart for visual acuity, FFA for anatomical changes. FFA was done before and after giving 3 injection of bevacizumab at monthly interval. Patients were asked for regular follow-up and patients were examined after 6 hours, 48 hours and 7 days for any early and late complications. Results: There was significant improvement of visual acuity after intravitreal bevacizumab treatment (before 1.196 log MAR and after 0.95067 log MAR with p value is 0.0001, paired t-test with t=6.333 with 29 degree of freedom) in cases of choroidal neovascular membrane. Gain in visual acuity was accompanied by a significant decrease in leakage in fluorescein angiography (FFA) Conclusions: We present evidence that intravitreal bevacizumab is an effective treatment for choroidal neovascular membrane.

RECURRENT SUBRETINAL HEMORRHAGE ASSOCIATED WITH RIVAROXABAN ANTICOAGULATION.

To report a case of spontaneous recurrent significant subretinal hemorrhage in a patient on rivaroxaban (Xarelto). A case report of a 63-year-old man on rivaroxaban with peripapillary choroidal neovascular membrane and macula involving subretinal hemorrhage. Improvement in visual acuity from 20/200 to 20/30 and restoration of foveal contour after pneumatic displacement of hemorrhage with C3F8 gas and subsequent treatment with ranibizumab. The authors report a case of recurrent subretinal hemorrhage associated with rivaroxaban use. Pneumatic displacement and subsequent treatment of choroidal neovascular membrane with intravitreal ranibizumab improved visual acuity.

Dramatic Regression of Amelanotic Choroidal Melanoma With PDT Following Poor Response to Brachytherapy

Photodynamic therapy (PDT) has been used for treatment of choroidal neovascular membrane from exudative macular degeneration. Other applications include treatment of some intraocular tumors, such as choroidal hemangioma, vasoproliferative tumor, and choroidal osteoma. The authors report the effect of PDT for amelanotic choroidal melanoma. A 40-year-old woman with an amelanotic choroidal melanoma of 6.5 mm thickness showed poor response to iodine brachytherapy (80 Gy apical dose) with no reduction in thickness at 16 months of follow-up. There was prominent residual tumor. The amelanotic tumor was treated with verteporfin PDT using three overlapping spots (8,600 microns), with avoidance of the optic disc using standard treatment parameters. Dramatic tumor regression over 2 months to a completely flat scar (1.3 mm thickness) was documented and remained stable at 50 months of follow-up. Amelanotic choroidal melanoma with incomplete response following conventional plaque radiotherapy can be treated with verteporfin PDT for consolidation.

Electrophysiologic changes after intravitreal ranibizumab injection for the treatment of choroidal neovascular membrane (CNVM)

Purpose:To determine the pattern of electroretinographic change after an intravitreal ranibizumab (Lucentis®) injection for the treatment of choroidal neovascular membrane (CNVM).Patients and methods:A prospective interventional case series of patients treated by intravitreal ranibizumab injection. Best corrected visual acuity, optical coherence tomography (OCT), and multifocal electroretinography (mfERG) were assessed prior to treatment, and 2 weeks, 1 and 3 months after treatment. Primary outcome was the functional change in amplitude and implicit time by mfERG and secondary outcome was the structural change in macular thickness by optical coherence tomography (OCT).Results:Twenty-six eyes from 25 consecutive patients were enrolled. At 3 months after treatment, the mean visual acuity (VA) improved from 1.06 to 0.84 logMAR (P = 0.034) and the mean macular thickness decreased from 389.7 to 264.4 microns (P = 0.003). The mean implicit time of the central zone showed an improvement at 3 months after treatment when compared with the response at baseline (P = 0.024) and at 1 month (P = 0.013) but the mean amplitude showed no significant change. In subgroup analysis, the eyes with initial visual acuity (VA) ≥ 20/200 had a significant improvement in mean implicit time of the peripheral zone at 2 weeks after treatment (P = 0.028). The OCT revealed a significant decrease (P < 0.003) in macular thickness at 1 and 3 months postoperatively.Conclusion:The mean implicit time of the central zone improved significantly at 3 months after treatment, whereas the mean amplitude showed no significant change. The macular thickness decreased significantly after the treatment, while VA improved to a lesser extent.

Redefining tissue engineering for nanomedicine in ophthalmology

Working at the nanoscale means to completely rethink how to approach engineering in the body in general and in the eye in particular. In nanomedicine, tissue engineering is the ability to influence an environment either by adding, subtracting or manipulating that environment to allow it to be more conducive for its purpose. The goal is to function at the optimum state, or to return to that optimum state. Additive tissue engineering replaces cells or tissue, or tries to get something to grow that is no longer there. Arrestive tissue engineering tries to stop aberrant growth which, if left uncontrolled, would result in a decrease in function. Nano delivery of therapeutics can perform both additive and arrestive functions influencing the environment either way, depending on the targeting. By manipulating the environment at the nanoscale, the rate and distribution of healing can be controlled. It infers that potential applications of nanomedicine in ophthalmology include procedures, such as corneal endothelial cell transplantation, single retinal ganglion cell repair, check of retinal ganglion cell viability, building of nanofibre scaffolds, such as self-assembling peptides, to create a scaffold-like tissue-bridging structure to provide a framework for axonal regeneration in the case of optic nerve reconnection or eye transplantation, and ocular drug delivery. Examples of potential arrestive therapies include gene-related treatment modalities to inhibit intraocular neovascularization and to block retinal cell apoptosis. Looking towards the future, this review focuses on how nanoscale tissue engineering can be and is being used to influence that local environment.

Successful treatment of choroidal neovascular membrane in retinitis pigmentosa with intravitreal bevacizumab

We report a rare association of choroidal neovascularization (CNV) with retinitis pigmentosa and note its resolution by intravitreal injection of the anti-vascular endothelial growth factor (VEGF), bevacizumab. A classic choroidal neovascular membrane was seen in the right eye (RE) of a patient with sector retinitis pigmentosa. Bevacizumab 1.25 mg in 0.05 ml was injected intravitreally. The choroidal neovascular membrane was seen to regress following this single intravitreal bevacizumab injection with formation of a scar. CNV has very rarely been seen in association with retinitis pigmentosa. Anti-VEGF drugs have been shown to have a beneficial role in CNV with other causes; in this case their effectiveness in CNV associated with retinal dystrophies, for example retinitis pigmentosa, has been demonstrated.

Photodynamic therapy for bilateral subfoveal choroidal neovascularization complicating stargardt macular dystrophy.

To report the outcome of repeated photodynamic therapy (PDT) for a patient with choroidal neovascularization complicating Stargardt disease. Interventional case report. A 41-year-old patient with Stargardt disease developed unilateral choroidal neovascularization treated multiple times with PDT over 2.5 years. At that time, she developed choroidal neovascularization in the fellow eye also treated with PDT. Despite poor interim vision, after >4 years of follow-up, final visual outcome was excellent. Our case provides further evidence that repeated PDT may be used for the treatment of choroidal neovascular membrane complicating Stargardt disease without deleterious effects up to 4 years after treatment.

Successful Management of Melanocytoma-Associated Choroidal Neovascularization with Photodynamic Therapy

To report the efficacy of photodynamic therapy in treatment of choroidal neovascular membrane (CNV) associated with melanocytoma of the optic disc. A middle-aged man with visual acuity of 20/200 in right eye was treated with photodynamic therapy for juxtafoveal classic CNV overlying the papillomacular bundle. CNV was secondary to ocular melanocytoma, a rare event. At the 6-month follow-up, a scarred CNV with final visual acuity of 20/30 was noted clinically and angiographically. Tomography revealed high reflective scar tissue with flat macula and microperimetry showed restoration of retinal sensitivity over the papillomacular bundle. Photodynamic therapy effectively resolved CNV that involved papillomacular bundle (secondary to melanocytoma) and restored retinal function in papillomacular bundle.

Long-term results after surgical extraction of subfoveal choroidal neovascular membranes with and without haemorrhage in age-related macular degeneration.

Surgical extraction has been suggested as a treatment of choroidal neovascular membranes. We demonstrate the long-term results of our patients regarding complications, risk of recurrence and development of visual acuity. We have retrospectively evaluated the charts and re-examined the patients who underwent surgical extraction of choroidal neovascular membranes (CNV) because of age-related macular degeneration (AMD) between March 1994 and December 2000 in the Department of Ophthalmology of the Benjamin Franklin Clinic, Berlin. Fifty-two eyes of 49 patients with a minimum follow-up of 12 months after pars plana vitrectomy with CNV extraction and SF6-endotamponade were included. Initially, in 15% of all eyes the lesions were obscured by intravitreal haemorrhage. All visible lesions were located subfoveally. In 40% of all eyes the lesion was predominantly classic; 21% of the lesions were predominantly occult and 23% of the lesions were comprised of more than 50% haemorrhage. The maximum follow-up was 80 months, the mean 46 months. The median initial visual acuity was 0.08 (range: hand movements to 0.4) and the median final visual acuity was not significantly different at 0.067 (range: non lux to 0.4). A loss of less than three lines of visual acuity occurred in 65.4% of our patients. During follow-up, 25% of eyes developed a rhegmatogenous retinal detachment and 19.2% of all eyes suffered from recurrence of CNV. At the end of the follow-up, three eyes (5.8%) suffered from non-treated retinal detachment and three eyes (5.8%) had recurrent CNV lesions. All eyes showed a retinal pigment epithelium defect at the site of former CNV. A stabilisation of visual acuity in individual patients with CNV because of AMD can be achieved by surgical extraction, yet the defect of the RPE and the risk of complications limit the benefit. We consider the surgical extraction of CNV from AMD in patients with low initial visual acuity who are not amenable to PDT.

Intravitreal triamcinolone acetonide inhibits choroidal neovascularization in a laser-treated rat model.

To determine if intravitreal triamcinolone acetonide (TAAC) inhibits experimental choroidal neovascular membranes induced by laser trauma in a rat model. Nineteen anesthetized male Brown Norway rats received a series of 8 krypton red laser lesions per eye (647 nm, 0.05 seconds, 50 microm, and 150 mW in 17 rats, and 200 mW in 2 rats). One eye received an intravitreal injection of triamcinolone acetonide (20 microL, 0.8 mg) and the other eye received an injection of isotonic sodium chloride solution. Fundus and fluorescein angiography examinations occurred just before euthanasia and tissue processing for histopathology on day(s) 0, 1, 3, 7, 14, 21, 28, and 35. From the control eyes that underwent photocoagulation at 150 mW, 57 discrete lesions with definitive fibrovascular proliferations were observed at 21, 28, and 35 days, arising from a total of 72 spots placed (79% yield). From the control eyes that underwent photocoagulation at 200 mW, 11 discrete lesions with definitive fibrovascular proliferations were observed at 28 days, arising from a total of 16 spots placed (69% yield). In the TAAC-treated group, no fibrovascular proliferations were observed in the 72 lesions and in the 16 lesions created with 150 mW and 200 mW, respectively. Intravitreal TAAC is a potent inhibitor of fibrovascular proliferations in a rat model of choroidal neovascular membranes induced by laser trauma. This study corroborates previous investigations that propose TAAC as a potential treatment for choroidal neovascular membranes in humans.