scholarly journals Phacoemulsification Surgery in Eyes with Neovascular Age-Related Macular Degeneration

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Andre Grixti ◽  
Evangelia Papavasileiou ◽  
Dominic Cortis ◽  
Balakrishna Vineeth Kumar ◽  
Som Prasad
Keyword(s):  
Macular Degeneration ◽  
Case Series ◽  
Age Related Macular Degeneration ◽  
Final Visit ◽  
Neovascular Amd ◽  
Anti Vegf ◽  
Age Related ◽  
Before And After ◽  
Endothelial Growth Factor

Purpose. To evaluate the visual outcomes and effect of phacoemulsification surgery on the progression of neovascular age-related macular degeneration (AMD). Methods. Retrospective, noncomparative, and interventional case series. Thirty eyes from 29 subjects with neovascular AMD treated with intravitreal antivascular endothelial growth factor (VEGF) injections who underwent phacoemulsification and had a postsurgery follow-up of 6 months were included. LogMAR best corrected visual acuity (BCVA) was assessed preoperatively; 1 month, 3 months, and 6 months postoperatively; and finally at the last visit. The frequency of anti-VEGF therapy, calculated as the number of intravitreal injections per month, and central macular thickness (CMT) before and after cataract surgery were determined. Results. Median (range) logMAR BCVA was 0.69 (0.16 to 1.32) preoperatively; 0.55 (−0.04 to 1.32) at 1 month, 0.52 (−0.1 to 1.32) at 3 months, and 0.50 (0.0 to 1.32) at 6 months postoperatively; and 0.6 (0.0 to 1.4) at final visit (P=0.0011). There was no difference in the frequency of anti-VEGF injections between the immediate 6 months before and after phacoemulsification, which was equal to 0.1667 injections per month (P=0.6377). Median CMT measured 203 μm preoperatively, which temporarily increased to 238 μm at 1 month after surgery (P=0.0093) and then spontaneously returned to baseline, measuring 212.5 μm at 3 months postoperatively (P=0.3811). Conclusion. Phacoemulsification surgery significantly improved vision in patients with neovascular AMD, with no increased need for anti-VEGF injections to keep the macula dry postoperatively.

scholarly journals Antivascular Endothelial Growth Factor Treatment Might Be Continued Even After Vitrectomy for Endophthalmitis in Neovascular Age-Related Macular Degeneration

2019 ◽  
Vol 4 (1) ◽  
pp. 6-12
Author(s):  
Zofia Michalewska ◽  
Jerzy Nawrocki
Keyword(s):  
Growth Factor ◽  
Macular Degeneration ◽  
Visual Outcome ◽  
Age Related Macular Degeneration ◽  
Anti Vegf ◽  
Age Related ◽  
Antivascular Endothelial Growth Factor ◽  
Endothelial Growth Factor ◽  
Mean Time

Purpose: This article studies visual outcome and frequency of antivascular endothelial growth factor (anti-VEGF) injections continued in patients with neovascular age-related macular degeneration (AMD) who had an earlier vitrectomy for postinjection endophthalmitis. Methods: A retrospective interventional study was conducted reviewing our database for patients with a diagnosis of endophthalmitis in the course of anti-VEGF injections. Endophthalmitis diagnosis was made on clinical examination of pain, rapid decrease in visual acuity (VA), conjunctival hyperemia, hypopyon, and vitritis. In all eyes, core vitrectomy with intravitreal antibiotics was performed. Spectral-domain optical coherence tomography was performed monthly before and after surgery during follow-up. Anti-VEGF injections were continued after surgery in all cases. Results: Eight eyes with postinjection endophthalmitis were included. Mean VA immediately before endophthalmitis was 20/50 Snellen with a mean of 19 intravitreal anti-VEGF injections ( P = .45). At time of endophthalmitis diagnosis, mean VA was 20/1000 (range, 20/2000-20/200). Mean time from injection to when the patient noted first symptoms was 4.3 days (range, 1-8 days). Mean time from first symptoms to surgery was 12 hours (range, 2.5-26 hours). Final mean VA at the end of follow-up (range, 12-84 months) did not statistically differ from VA at the visit immediately before endophthalmitis diagnosis ( P = .69). Mean frequency of injections after vitrectomy did not significantly differ from the presurgical course of treatment ( P =.97). Conclusions: Anti-VEGF treatment might be continued after vitrectomy for endophthalmitis and results in satisfactory anatomical and visual outcome. Surgery did not influence the frequency of anti-VEGF injections for neovascular AMD.

scholarly journals Effects of Vitreomacular Adhesion on Age-Related Macular Degeneration

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Eui Chun Kang ◽  
Hyoung Jun Koh
Keyword(s):  
Macular Degeneration ◽  
Standard Treatment ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Neovascular Amd ◽  
Vitreomacular Adhesion ◽  
Anti Vegf ◽  
Age Related ◽  
Meta Analyses ◽  
Endothelial Growth Factor

Herein, we review the association between vitreomacular adhesion (VMA) and neovascular age-related macular degeneration (AMD). Meta-analyses have shown that eyes with neovascular AMD are twice as likely to have VMA as normal eyes. VMA in neovascular AMD may induce inflammation, macular traction, decrease in oxygenation, sequestering of vascular endothelial growth factor (VEGF), and other cytokines or may directly stimulate VEGF production. VMA may also interfere with the treatment effects of anti-VEGF therapy, which is the standard treatment for neovascular AMD, and releasing VMA can improve the treatment response to anti-VEGF treatment in neovascular AMD. We also reviewed currently available methods of relieving VMA.

scholarly journals Therapy of Age-related Exudative Macular Degeneration with Anti-vascular Endothelial Growth Factor Drugs: An Italian Real Life Study

2021 ◽  
Vol 15 (1) ◽  
pp. 130-136
Author(s):  
Settimio Rossi ◽  
Carlo Gesualdo ◽  
Antonio Tartaglione ◽  
Giovan Battista Scazzi ◽  
Anna Cristina D’Alessio ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Real Life ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Life Study ◽  
Anti Vegf ◽  
Age Related ◽  
Real Life Study ◽  
Endothelial Growth Factor

Aim: To evaluate the real utilization of ranibizumab and aflibercept in the daily management of patients with neovascular age-related macular degeneration (nAMD) treated at the Eye Clinic of Campania University L.Vanvitelli. Background: Therapy with anti-vascular endothelial growth factor represents the gold standard in wet age-related macular degeneration. There are nonreal life italian studies of this therapy in the literature. Objective: To analyze in our sample the post-therapy variations of best-corrected visual acuity (BCVA) and central retinal thickness (CRT) observed at the end of a 12-month follow-up period. Methods: This real-life study analyzes 109 patients that underwent monthly checks for the first 4 months and then every 2 months until the end of the 12-month follow-up. The sample was first analyzed in its entirety, subsequently subdivided into 3 groups based on baseline BCVA, age, and the number of intravitreal injections performed, in order to identify possible predictive elements of the anti-VEGF response. Results: On average, patients underwent 4.16 ± 1.58 intravitreal anti-VEGF injections in 1 year. At the end of the 12-month follow-up, the patients’ average BCVA increased from 33.01 letters to 33.75 letters (+0.74 ± 9,4 letters), while the average CRT decreased from 346.86 µm to 265.39 µm (-81.47 ± 121 µm). Conclusion: The study shows the efficacy of anti-VEGF therapy in the stabilization of BCVA in nAMD, confirming the differences in visual outcomes compared to clinical trials, mainly for economic-organizational reasons.

Quiescent Neovascular Age-Related Macular Degeneration After Endophthalmitis

2020 ◽  
Vol 4 (4) ◽  
pp. 300-305
Author(s):  
Cason B. Robbins ◽  
Henry L. Feng ◽  
Sharon Fekrat
Keyword(s):  
Macular Degeneration ◽  
Age Related Macular Degeneration ◽  
Glaucoma Drainage Device ◽  
Anti Vegf ◽  
Age Related ◽  
Intravitreal Aflibercept ◽  
Infectious Endophthalmitis ◽  
Endothelial Growth Factor ◽  
Reduced Activity

Purpose: This article describes eyes that achieved extended remission of neovascular age-related macular degeneration (NVAMD) following acute endophthalmitis. Methods: Adults who presented to the Duke Eye Center with acute endophthalmitis over a 9-year period and had at least 3 months of follow-up were identified. A retrospective review of medical records was performed to collect clinical data including demographic information, examination findings, etiology, treatment, and outcomes. Results: A total of 133 eyes of 130 patients with endophthalmitis were identified. Of these, 15 eyes of 14 patients (11.3%) were receiving intravitreal antivascular endothelial growth factor (anti-VEGF) injections for NVAMD. Six of these 15 eyes (40%) did not require an anti-VEGF injection after endophthalmitis for a mean of 36.2 months. Endophthalmitis was injection-related in 5 of 6 eyes (83%) and Baerveldt glaucoma drainage device–related in 1 of 6 eyes (17%). Two of the 6 (33%) had culture-proven infectious endophthalmitis, whereas 4 of 6 (67%) had culture-negative endophthalmitis. Five of 6 eyes have required no anti-VEGF therapy to date; the remaining eye restarted intravitreal aflibercept therapy 9.3 months after endophthalmitis. Conclusions: Acute endophthalmitis may be associated with reduced activity of choroidal neovascularization in a subset of eyes with NVAMD.

Visual Outcomes after Anti-VEGF Therapy for Exudative Age-Related Macular Degeneration in a Real-Life Setting

2021 ◽  
Vol 238 (04) ◽  
pp. 396-402
Author(s):  
Andrea R. Wenkstern ◽  
Christophe Valmaggia
Keyword(s):  
Macular Degeneration ◽  
Real Life ◽  
Case Series ◽  
Age Related Macular Degeneration ◽  
Serious Adverse Events ◽  
Visual Outcomes ◽  
Anti Vegf ◽  
Age Related ◽  
Real Life Setting

Abstract Background To report visual outcomes of anti-vascular endothelial growth factor (anti-VEGF) therapy for exudative age-related macular degeneration (AMD) in a real-life setting. Patients and Methods Retrospective case series of consecutive patients treated with either ranibizumab and/or aflibercept for monolateral or bilateral exudative AMD. A physician established the indication for treatment and administered the injections. An independent physician confirmed the indication for primary treatment. A Pro Re Nata and a Treat and Extend regimen were used. Assessment of subretinal and/or intraretinal fluid, retinal hemorrhage and increase in pigment epithelial detachment served as criteria for further treatment decisions. Visual acuity (VA) was measured in ETDRS letters at each examination and then analyzed using a specialized software. Evolution of mean VA was considered for all study eyes and subgroups of eyes with an initial VA ≥ 70 ETDRS letters (subgroup 1) and ≤ 69 ETDRS letters (subgroup 2). Results A total of 102 eyes of 76 patients (30 men, mean age 75.9 years; 46 women, mean age 81.5 years) were included. Subgroup 1 consisted of 47 eyes, and subgroup 2 of 55 eyes. Mean follow-up was 55 months (range 6 to 150 months). For the entire collective as for subgroups 1 and 2, the mean VA was 64, 77, or 51 ETDRS letters at baseline. Mean VA improved at month 12 (68, 80, or 58 ETDRES letters) and then slowly decreased over time until month 150 (62, 72, or 54 ETDRS letters). Maximum improvement of + 5, + 3, or, + 9 ETDRS letters occurred after 9, 8, or 10 months of follow-up. Atrophy and fibrosis were mainly responsible for VA decrease. Ten serious adverse events were reported to Swissmedic: two cases of cardiovascular events and eight cases of intraocular inflammation. Conclusions Anti-VEGF therapy carried out in a real-life setting shows good VA outcomes with a favorable safety profile.

scholarly journals Long-term Outcomes of Treat and Extend Regimen of Anti-vascular Endothelial Growth Factor in Neovascular Age-related Macular Degeneration

2020 ◽  
Author(s):  
Andy Lee ◽  
Pooja G Garg ◽  
Alice T Lyon ◽  
Rukhsana Mirza ◽  
Manjot K Gill
Keyword(s):  
Visual Acuity ◽  
Growth Factor ◽  
Macular Degeneration ◽  
Age Related Macular Degeneration ◽  
Final Visit ◽  
Treat And Extend ◽  
Age Related ◽  
Endothelial Growth Factor

Purpose: This study describes the long-term visual and anatomic outcomes of antivascular endothelial growth factor (VEGF) treatment using a treat and extend dosing regimen. Methods: This cross-sectional cohort study consisted of 224 treatment-naïve eyes with neovascular age-related macular degeneration (NV-AMD) from 202 patients that were treated with anti-VEGF agents bevacizumab, ranibizumab, and aflibercept using a treat and extend (TAE) regimen by four physician investigators in a large urban referral center from 2008 to 2015. Subjects were evaluated for visual acuity, injection frequency, and optical coherence tomography (OCT). Results: Over a seven-year follow-up period (mean 3.4 years), an average 20.2 ± 14.7 injections were administered with 8.4 injections in the first year and 5.5 injections by the seventh year of remaining eyes undergoing treatment. Visual acuity was 0.70 logMAR (20/100 Snellen) at the first visit and 0.67 logMAR (20/93 Snellen) at the final visit, with 74% of eyes maintaining or gaining more than 2 lines of vision. Long-term, 45.1% of eyes achieved 20/50 or better, while 27.1% were 20/200 or worse. Of the treated patients, 61.2% received monotherapy with no difference in visual acuity outcomes or number of injections between the agents used. OCT analysis showed decreased fluid from initial to final follow-up visit: 70.1–15.6% with sub-retinal fluid (SRF) and 47.3–18.8% with intraretinal fluid (IRF) with no difference between the agents were used. Conclusion: This study demonstrates that most patients (74%) improve or maintain visual acuity long-term using a TAE model with a significant portion (45.1%) achieving 20/50 or better visual acuity with sustained treatment.

scholarly journals Antivascular Endothelial Growth Factor Agents for Neovascular Age-Related Macular Degeneration

2012 ◽  
Vol 2012 ◽  
pp. 1-12 ◽  
Author(s):  
Ilias Zampros ◽  
Anna Praidou ◽  
Periklis Brazitikos ◽  
Panagiotis Ekonomidis ◽  
Sofia Androudi
Keyword(s):  
Monoclonal Antibody ◽  
Growth Factor ◽  
Macular Degeneration ◽  
Antibody Fragment ◽  
Developed Countries ◽  
Age Related Macular Degeneration ◽  
Neovascular Amd ◽  
Anti Vegf ◽  
Age Related ◽  
Endothelial Growth Factor

Age-related macular degeneration (AMD) is the leading cause of severe visual loss and blindness over the age of 50 in developed countries. Vascular endothelial growth factor (VEGF) is considered as a critical molecule in the pathogenesis of choroidal neovascularization (CNV), which characterizes the neovascular AMD. Anti-VEGF agents are considered the most promising way of effectively inhibition of the neovascular AMD process. VEGF is a heparin-binding glycoprotein with potent angiogenic, mitogenic and vascular permeability-enhancing activities specific for endothelial cells. Two anti-VEGF agents have been approved by the US Food and Drug Administration (FDA) for the treatment of neovascular AMD. Pegaptanib sodium, which is an aptamer and ranibizumab, which is a monoclonal antibody fragment. Another humanized monoclonal antibody is currently off-label used, bevacizumab. This paper aims to discuss in details the effectiveness, the efficacy and safety of these three anti-VEGF agents. New anti-VEGF compounds which are recently investigated for their clinical usage (VEGF-trap, small interfering RNA) are also discussed for their promising outcomes.

Progression of macular atrophy in patients receiving long-term anti-VEGF therapy for age-related macular degeneration; Real Life Data

2021 ◽  
Author(s):  
Styliani Blazaki ◽  
Emmanouil Blavakis ◽  
Georgios Smoustopoulos ◽  
Georgios Bontzos ◽  
Anastasios Stavrakakis ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Real Life ◽  
Age Related Macular Degeneration ◽  
Final Visit ◽  
Neovascular Amd ◽  
Near Infrared Reflectance ◽  
Macular Atrophy ◽  
Anti Vegf ◽  
Age Related ◽  
Number Of Injections

Purpose To evaluate the progression of macular atrophy (MA) based on near-infrared reflectance (NIR) and optical coherence tomography (OCT) images, in patients with age-related macular degeneration (AMD), receiving anti-vascular endothelial growth factor (anti-VEGF) treatment for at least a 6-year period. Materials and Methods This retrospective study included 53 naïve patients (53 eyes) with neovascular AMD from two centers, who were treated with anti-VEGF intravitreal injections and had no MA at baseline. MA was evaluated in an annual basis using NIR images, while all available OCT images were used to confirm that the atrophic area fulfilled the criteria proposed by the Classification of Atrophy Meetings (CAM) group for complete retinal pigment epithelium RPE and outer retinal atrophy (cRORA). Incidence and progression of MA were evaluated. Associations with best-corrected visual acuity (BCVA) and total number of injections were also studied. Results Treatment duration of our patients was 7.34 ± 1.54 years. The mean number of anti-VEGF injections was 24.4 ± 13.6. BCVA at baseline was 0.38 ± 0.27 logMAR while at final visit it was 0.60 ± 0.35 logMAR (p=0.731). The cumulative incidence of new MA at years 1, 2, 3, 4, 5, and 6 was 1.89%, 18.87% 32.08%, 39.62%, 49.06% and 50.94% respectively. In patients who developed MA, mean MA area increased from zero at baseline to 5.66 ± 7.18 mm2 at final visit. The estimated annual enlargement of MA was 0.45 mm/year based on square root transformation (1.12 mm2/year, untransformed data). MA progression does not appear to be significantly associated with age (R=0.055; p=0.784), gender (R=0.113; p=0.576), BCVA (R=0.168; p=0.404) and total number of injections (R=0.133; p=0.255). Conclusion In this real-life setting, half of neovascular AMD patients under anti-VEGF treatment, without MA at therapy initiation, developed MA over a period of at least 6 years. In this work, the number of injections did not seem to have a significant association with MA progression.

Remission and Dropout Rate of Anti-VEGF Therapy for Age-Related Macular Degeneration

2011 ◽  
Vol 21 (6) ◽  
pp. 777-782 ◽  
Author(s):  
Akio Oishi ◽  
Michiko Mandai ◽  
Akihiro Nishida ◽  
Masayuki Hata ◽  
Takaaki Matsuki ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Remission Rate ◽  
Dropout Rate ◽  
Initial Therapy ◽  
Age Related Macular Degeneration ◽  
Anti Vegf ◽  
Age Related ◽  
Final Observation ◽  
Endothelial Growth Factor

Purpose. Anti-vascular endothelial growth factor (VEGF) therapy is a first-line treatment for age-related macular degeneration (AMD) but frequent visits and injections can be a burden for patients. The purpose of this study is to estimate the remission rate and tolerability of anti-VEGF therapy for AMD in a clinical setting. Methods. We investigated 90 eyes of 87 patients with AMD who underwent anti-VEGF therapy and were followed for more than 6 months. Ranibizumab and pegaptanib were used as anti-VEGF agents. Initial therapy was any of the following: a single injection, 3 consecutive monthly injections, or combination therapy with verteporfin. Additional injections were given as-needed during follow-up. An injection-free period greater than 6 months at the final observation was regarded as cessation; the reason for cessation was studied for each patient. Clinical characteristics were compared between patents with and without cessation. Results. The mean follow-up period was 12.8 months. Mean logMAR before and 6 months after the treatment was 0.89 and 0.83, respectively. Cessation was noted in 32 eyes of 31 patients (35.6%). Remission was achieved in 13 (40.6%) of these eyes. The other cases either did not wish to undergo further treatment or dropped out. Poor baseline visual acuity (VA) was associated with cessation. Conclusions. With current anti-VEGF therapy, remission was achieved in a limited number of AMD cases. The high frequency of voluntary cessation warrants consideration of an alternative treatment and/or supportive care for those with poor baseline VA.

scholarly journals Continued anti-VEGF treatment does not prevent recurrences in eyes with stable neovascular age-related macular degeneration using a treat-and-extend regimen: a retrospective case series

Eye ◽  
2021 ◽  
Author(s):  
Justus G. Garweg ◽  
Peter G. Traine ◽  
Richard A. Garweg ◽  
Juliana Wons ◽  
Christin Gerhardt ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Stable Disease ◽  
Case Series ◽  
Age Related Macular Degeneration ◽  
Retrospective Case ◽  
Anti Vegf ◽  
Age Related ◽  
Group 2 ◽  
Group 1

Abstract Background The continuation of anti-vascular endothelial growth factor (anti-VEGF) treatment after achieving stability in patients with neovascular age-related macular degeneration has generally been advocated. In our own patients, we thought to assess whether continued anti-VEGF treatment is capable of preventing recurrences. Methods In this retrospective observational case series, patients with stable disease either opted to continue treatment every 12–14 weeks (Group 1) or stopped treatment with subsequent follow-up visits every 8–12 weeks (Group 2). Results Of the 103 eyes of 103 patients achieving stability, 49 eyes continued treatment (Group 1), whereas treatment was stopped in 54 eyes undergoing regular follow-up (Group 2). Recurrent disease was observed in 21 (42.9%) and 33 (61.1%) cases in Group 1 and Group 2, respectively (p = 0.08). Time between achieving stable disease and recurrence was comparable between Group 1 and Group 2 (11.1 ± 8.2 months vs. 9.2 ± 6.7 months; p = 0.43). The number of visits between achieving stability and disease recurrence was similar, but not the number of injections (3.5 ± 2.0 vs. 0.2 ± 0.4; p < 0.001). Conclusions Continuing anti-VEGF therapy after achieving functional and morphological stability every 12–14 weeks does not prevent recurrences. Patients deserve to be informed of a potential lifetime risk of recurrences, even under continued therapy.

Sign in / Sign up

Export Citation Format

Share Document