scholarly journals Impact of Baseline Central Retinal Thickness on Outcomes in the VIVID-DME and VISTA-DME Studies

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Edoardo Midena ◽  
Mark Gillies ◽  
Todd A. Katz ◽  
Carola Metzig ◽  
Chengxing Lu ◽  
...  
Keyword(s):  
Treatment Effect ◽  
Retinal Thickness ◽  
Continuous Variable ◽  
Central Retinal Thickness ◽  
Link Type ◽  
Intravitreal Aflibercept ◽  
Laser Control ◽  
Post Hoc ◽  
The Impact ◽  
Anatomical Outcomes

Purpose. To report the impact of baseline central retinal thickness (CRT) on outcomes in patients with diabetic macular edema (DME) in VIVID-DME and VISTA-DME. Methods. Post hoc analyses of two randomized controlled trials in which 862 DME patients were randomized 1 : 1 : 1 to treatment with intravitreal aflibercept 2.0 mg every 4 weeks (2q4), intravitreal aflibercept 2.0 mg every 8 weeks after five initial monthly doses (2q8), or macular laser photocoagulation at baseline and as needed. We compared visual and anatomical outcomes in subgroups of patients with baseline CRT < 400 μm and ≥400 μm. Results. At weeks 52 and 100, outcomes with intravitreal aflibercept 2q4 and 2q8 were superior to those in laser control-treated patients regardless of baseline CRT. When looked at in a binary fashion, the treatment effect of intravitreal aflibercept versus laser was not significantly better in the ≥400 μm than the <400 μm group; when looked at as a continuous variable, baseline CRT seemed to have an impact on the treatment effect of intravitreal aflibercept versus laser. Conclusions. Post hoc analyses of VIVID-DME and VISTA-DME demonstrated the benefits of intravitreal aflibercept treatment in DME patients with baseline CRT < 400 μm and ≥400 μm. This trial is registered with NCT01331681 and NCT01363440.

Stent retrievers with segmented design improve the efficacy of thrombectomy in tortuous vessels

2018 ◽  
Vol 11 (2) ◽  
pp. 119-122 ◽  
Author(s):  
Naoki Kaneko ◽  
Yutaro Komuro ◽  
Hajime Yokota ◽  
Satoshi Tateshima
Keyword(s):  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Vascular Anatomy ◽  
Success Rates ◽  
Link Type ◽  
Stent Retrievers ◽  
The Difference ◽  
Solitaire Fr ◽  
Post Hoc ◽  
The Impact

IntroductionTortuous vascular anatomy is one of the greatest challenges in mechanical thrombectomy. This study examines the impact of vascular tortuosity on the performance of stent retrievers and evaluates the efficacy of the newer generation stent retrievers with segmented design.Materials and methodsModels with mild, moderate, and severe tortuosity with an internal carotid artery (ICA) and a middle cerebral artery (MCA) were created. An elastic and cohesive clot was placed in the MCA lying from distal M1 and proximal M2. We assessed the revascularization rates of two commonly used stent retrievers (Trevo XP and Solitaire FR) and two newer stent retrievers with segmented design (Embotrap and Versi) in each vascular model.ResultsBoth the type of stent retriever and the severity of vessel tortuosity significantly affected the successful recanalization rate. Post-hoc tests showed that the rate of revascularization was significantly less in severe tortuosity than in mild or moderate tortuosity (P<0.001). The Versi resulted in higher success rates than the Solitaire (P<0.01) and the Trevo (P<0.05). The success rates of the Embotrap were higher than the Solitaire and Trevo stent retrievers, although the difference was not statistically significant.ConclusionsSevere tortuosity reduces the performance of mechanical thrombectomy. The segmented design in stent retrievers could improve the efficacy of mechanical thrombectomy in tortuous vessels.Trial registrationESCAPE NCT01778335;SWIFT PRIME >NCT01657461; REVASCAT >NCT01692379; All post-results.

scholarly journals Effects of Intravitreal Aflibercept in Patients with Central Serous Chorioretinopathy

2020 ◽  
Vol 36 (4) ◽  
Author(s):  
Ali Afzal Bodla ◽  
Muhammad Afzal Bodla ◽  
Syeda Minahil Kazmi ◽  
Ayema Moazzam
Keyword(s):  
Visual Acuity ◽  
Intravitreal Injection ◽  
Central Serous Chorioretinopathy ◽  
Retinal Thickness ◽  
Case Series ◽  
Central Retinal Thickness ◽  
Chronic Central Serous Chorioretinopathy ◽  
Intravitreal Aflibercept ◽  
The Mean

Purpose:  The purpose of this study is to assess the efficacy of intravitreal injection of Afliberceptin patients with chronic central serous chorioretinopathy (CSCR). Study Design:  Interventional case series. Place and Duration of Study: Multan Medical and Dental Centre and Bodla Eye Care from February 2019 to February 2020. Methods:  This study was conducted on fifteen eyes with sub-acute to chronic central serous chorioretinopathy. All patients who had undergone previous treatment with laser photocoagulation, intravitreal triamcinolone, or bevacizumab in past 3 months, history of glaucoma (intraocular pressure > 21 mmHg), patients who lost to follow-up, and those with previously vitrectomized eyes were excluded. Patients were treated with a single dose of intravitreal injection of Aflibercept (0.5 mg/0.05 ml). Visual acuity with Log MAR chart and central retinal thickness were studied before and after the injection. Results:  The mean age of the patients was 30.46 years ± 9 years. After one month of intravitreal Aflibercept injection, visual acuity improved from 0.32 Log MAR to 0.173 log MAR and at 3 months (the last follow-up) it was 0.206 Log MAR. Central retinal thickness (CRT) improved from 437 ± 82 µm (at the time of presentation) to 349 ± 67 µm at 1 month post injection. At the last follow-up the mean CRT decreased to 309 ± 121 µm. Except for two eyes, all eyes showed visual improvement. These two eyes had a higher CRT as compared to other participants. Conclusion:  Intravitreal injection of Afliberceptis effective in improving BCVA and decreasing the central retinal thickness in patients central serous chorioretinopathy. Key Words:  Central retinal thickness, Central Serous chorioretinopathy, Aflibercept.

scholarly journals Age, Initial Central Retinal Thickness, and OCT Biomarkers Have an Influence on the Outcome of Diabetic Macular Edema Treated With Ranibizumab– Tri-center 12-Month Treat-and-Extend Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Chun-Ting Lai ◽  
Yi-Ting Hsieh ◽  
Chun-Ju Lin ◽  
Jia-Kang Wang ◽  
Chih-Ying Lin ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Retinal Thickness ◽  
Central Retinal Thickness ◽  
Treat And Extend ◽  
Corrected Visual Acuity ◽  
Therapeutic Outcomes ◽  
Younger Age ◽  
To Receive ◽  
Anatomical Outcomes

Objective: We report the tri-center 1-year outcomes of a treat-and-extend (T&amp;E) regimen in four-week intervals with ranibizumab for diabetic macular edema (DME).Methods: In this retrospective study, all eyes received 3 monthly loading injections of 0.5 mg ranibizumab, followed by a T&amp;E regimen for DME. Regression models were used to evaluate the associating factors for visual and anatomical outcomes.Results: Ninety one eyes from 64 patients were enrolled. Mean LogMAR best-corrected visual acuity (BCVA) improved from 0.58 at baseline to 0.36 at month 12 and mean central retinal thickness (CRT) decreased from 411 μm at baseline to 290 μm at month 12. Younger age and eyes having thinner baseline CRT, with ellipsoid zone disruption (EZD), and without epiretinal membrane (ERM) were associated with better final CRT. Moreover, eyes with thicker baseline CRT tend to receive more injections. Among the parameters, only having ERM or EZD was associated with significant BCVA recovery.Conclusions: A T&amp;E regimen with ranibizumab by 4-week intervals is effective in improving BCVA and reducing CRT with efficacy notable starting from the third month. Clinical parameters including age, initial CRT, and presence of ERM or EZD significantly influenced therapeutic outcomes. Moreover, the presence of ERM should not preclude DME patients from receiving anti-VEGF therapy. Future studies with larger cohorts are warranted.

scholarly journals Intravitreal Aflibercept Outcomes in Patients with Persistent Macular Exudate Previously Treated with Bevacizumab and/or Ranibizumab for Neovascular Age-Related Macular Degeneration

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
David R. Griffin ◽  
Preston P. Richmond ◽  
John C. Olson
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Retinal Thickness ◽  
Group Analysis ◽  
Age Related Macular Degeneration ◽  
Central Retinal Thickness ◽  
Treatment Resistant ◽  
Appreciable Change ◽  
Age Related ◽  
Intravitreal Aflibercept

Purpose. To assess whether intravitreal aflibercept (2.0 mg) can effectively reduce persistent macular exudate and enhance visual acuity in ranibizumab (0.5 mg) and/or bevacizumab (1.25 mg) treatment resistant patients with neovascular age-related macular degeneration.Methods. This retrospective study included 47 treatment resistant eyes from 47 patients switched to intravitreal aflibercept injections after receiving a minimum of 3 injections with either ranibizumab or bevacizumab. Snellen visual acuity and optical coherence tomography were assessed just prior to the first injection (baseline) and prior to the fourth injection (final). Additionally, anatomical regions of persistent macular exudate were tracked to determine if these areas yielded varying responses to aflibercept.Results. At baseline, patients had received an average of 11.3 injections with any prior anti-VEGF drug (SD 5.96). For whole group analysis, baseline and final central retinal thickness were 370.57 µm and 295.7 µm (P≤.001), respectively. Baseline and final retinal fluid volumes were 4.81 mm3and 4.37 mm3(P≤.001), respectively. Baseline and final logMAR were 0.56 and 0.53 (P=0.301), respectively. Anatomic location of persistent exudate did not appreciably alter treatment outcome.Conclusion. Central retinal thickness and total retinal fluid volume were reduced in ranibizumab and/or bevacizumab treatment resistant patients following three aflibercept injections. No appreciable change in visual acuity was noted.

scholarly journals Association between Vortex Vein Engorgement and Treatment Outcomes of Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy

2021 ◽  
Vol 62 (10) ◽  
pp. 1370-1380
Author(s):  
Areum Jeong ◽  
Min Sagong
Keyword(s):  
Treatment Outcomes ◽  
Polypoidal Choroidal Vasculopathy ◽  
Retinal Thickness ◽  
Central Retinal Thickness ◽  
Intravitreal Aflibercept ◽  
Treatment Naïve ◽  
Vortex Vein ◽  
Choroidal Vessels ◽  
Choroidal Vasculopathy ◽  
Number Of Injections

Purpose: To investigate the influence of the number of engorged vortex veins on treatment outcomes in eyes with treatment-naïve polypoidal choroidal vasculopathy (PCV) undergoing intravitreal aflibercept monotherapy.Methods: The medical charts of 65 patients with PCV who underwent intravitreal aflibercept injection were reviewed retrospectively. The number of quadrants of vortex vein engorgement was evaluated in the middle phase of ultra-widefield indocyanine green angiography, which was classified as extended engorgement if the dilated choroidal vessels expanded the macula. Associations between treatment outcomes with age, subfoveal choroidal thickness (SFCT), central retinal thickness, and vortex vein engorgement were investigated using univariate and multivariate analyses.Results: There were no significant differences in best-corrected visual acuity (BCVA), SFCT, and central retinal thickness at baseline and 12 months, according to the number of vortex vein engorgement. However, an increase in the number of vortex vein engorgement extending to the macula was associated with a thick SFCT (p = 0.038), a greater number of injections (p = 0.041), low BCVA at 12 months (p = 0.038), and a less dry macula at 12 months (p = 0.026). In the multivariate analysis, the number of quadrants with vortex vein engorgement extending to the macula was significantly associated with BCVA changes at 12 months, total number of injections, and a dry macula at 12 months (p = 0.030, p = 0.030, p = 0.020, respectively).Conclusions: More quadrants with vortex vein engorgement extending to the macula in PCV was associated with unfavorable visual outcomes, a less dry macula at 12 months, and a greater number of injections at 1 year after intravitreal aflibercept injection. Clinicians should keep in mind that vortex vein engorgement extending to the macula may be a new biomarker in predicting treatment outcomes in PCV.

Abstract 13814: Semaglutide Reduces Mace Consistently Across Baseline Triglyceride Levels in Patients With Type 2 Diabetes: A Post Hoc Analysis of the Sustain 6 and Pioneer 6 Trials

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Subodh Verma ◽  
Lawrence A Leiter ◽  
Marie M Michelsen ◽  
David Orsted ◽  
Soren Rasmussen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cox Regression ◽  
Density Lipoprotein ◽  
Statin Treatment ◽  
Continuous Variable ◽  
Post Hoc Analysis ◽  
Glucagon Like Peptide 1 ◽  
Post Hoc ◽  
The Impact

Introduction: Elevated triglyceride (TG) levels may predict CV events, although this has not been evaluated in large contemporary trials. The effects of glucagon-like peptide-1 receptor agonists on major adverse CV events (MACE) across TG levels are not fully characterized. SUSTAIN 6 (NCT01720446) and PIONEER 6 (NCT02692716) were randomized, CV outcomes trials investigating once-weekly and oral semaglutide vs placebo, respectively, in patients with type 2 diabetes at high CV risk. We performed a post hoc analysis to assess the effect of semaglutide vs placebo on the primary endpoints, MACE (CV death, nonfatal myocardial infarction, or nonfatal stroke), and its components in these two trials pooled, across baseline TG levels. Methods: The risk of first MACE with semaglutide vs placebo was evaluated across three baseline TG groups (≤151, >151-≤205, and >205 mg/dL). The effect of semaglutide vs placebo on MACE was estimated with Cox regression by TG level categorically, and continuously when adjusting for baseline TG and high-density lipoprotein-cholesterol (HDL-C) levels. The impact of statin treatment was also assessed. Results: In total, 6,417 patients had baseline TG measurements: 3,191 (49.7%) ≤151, 1,459 (22.7%) >151-≤205, and 1,767 (27.5%) >205 mg/dL; mean (±SD) TGs were 107.3 (26.0), 176.6 (15.6), and 326.5 (197.1) mg/dL, respectively. Overall, semaglutide reduced TGs vs placebo by 5% in SUSTAIN 6 and 6% in PIONEER 6 (p<0.01). The incidence of MACE with placebo increased across increasing TG levels (Figure) . Semaglutide generally reduced the risk of MACE and its components vs placebo across TG groups. Results were consistent when evaluating TGs as a continuous variable (adjusting for baseline TG and HDL-C levels), and regardless of statin treatment. Conclusions: In this post hoc analysis of SUSTAIN 6 and PIONEER 6, over half of patients had elevated TG levels (>151 mg/dL). Semaglutide consistently reduced the risk of MACE vs placebo across baseline TG levels.

Characteristics of patients with neovascular age-related macular degeneration who are non-responders to intravitreal aflibercept

2018 ◽  
Vol 103 (5) ◽  
pp. 623-629 ◽  
Author(s):  
Chikako Hara ◽  
Taku Wakabayashi ◽  
Hiroshi Toyama ◽  
Yoko Fukushima ◽  
Kaori Sayanagi ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Retinal Thickness ◽  
Statistical Significance ◽  
Case Series ◽  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Central Retinal Thickness ◽  
Age Related ◽  
Intravitreal Aflibercept ◽  
Choroidal Vascular Hyperpermeability

PurposeTo investigate the frequency and patient characteristics that influence anatomic response of intravitreal aflibercept in treatment-naïve neovascular age-related macular degeneration (AMD).DesignRetrospective, interventional, consecutive case series.MethodsThree hundred and sixty-five eyes of 365 patients with AMD who underwent 3 monthly intravitreal aflibercept treatments with follow-up for at least 12 months were investigated. Treatment response was evaluated as follows. Responders were defined as those with complete resolution of exudation, including intraretinal oedema, subretinal fluid and pigment epithelial detachment, or more than a 100 µm decrease of central retinal thickness at 3 months compared with baseline. Non-responders were defined as patients exhibiting an increase in exudation or a decreased central retinal thickness of less than 100 µm.ResultsNineteen (5.2%) of 365 eyes were identified as non-responders. The remaining were responders to intravitreal aflibercept. The non-responders group was significantly associated with choroidal vascular hyperpermeability on indocyanine green angiography and lower frequency of subretinal hyper-reflective materials on optical coherence tomography. The central choroidal thickness at baseline and after 3 monthly injections tended to be thicker in the non-responder group than the responder group, although the differences did not meet statistical significance (p=0.066 and p=0.051, respectively). Additional treatments with either intravitreal ranibizumab or PDT in combination with aflibercept were effective in 15 (79%) of 19 non-responders.ConclusionIntravitreal aflibercept is effective for treating eye pathology in most naïve AMD cases. However, non-responsiveness may occur in small subgroup of patients with choroidal vascular hyperpermeability.

The Impact of Smoking on Cardiovascular Outcomes and Comorbidities in Statin-treated Patients with Coronary Artery Disease: A Post hoc Analysis of the GREACE Study

2013 ◽  
Vol 11 (5) ◽  
pp. 779-784 ◽  
Author(s):  
Vasilios G. Athyros ◽  
Konstantinos Tziomalos ◽  
Niki Katsiki ◽  
Thomas D. Gossios ◽  
Olga Giouleme ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiovascular Outcomes ◽  
Post Hoc Analysis ◽  
Artery Disease ◽  
Post Hoc ◽  
The Impact
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