Ranibizumab or Aflibercept Monotherapies in Treatment-Naive Eyes with Diabetic Macular Edema: A Head-to-Head Comparison in Real-Life Experience.

Objectives: To compare the functional and anatomical outcomes of ranibizumab and aflibercept monotherapies given according to a pro re nata (PRN) protocol in treatment-naive eyes with diabetic macular edema (DME) in a real-life clinical setting. Materials and Methods: The medical charts of treatment-naive patients with center-involved DME retrieved from our institutional database were reviewed in this retrospective cohort study. A total of 512 treatment-naive eyes with DME underwent either ranibizumab (Group I; 308 eyes) or aflibercept (Group II; 204 eyes) monotherapy and 462 patients were included. The primary outcome was visual gain over 12 months. Results: The mean number of intravitreal injections within the first year was 4.34±1.83 and 4.39±2.12 in Group I and II, respectively (p=0.260). The mean best corrected visual acuity (BCVA) improvement at 12 months was +5.7 and +6.5 ETDRS letters in Group I and II, respectively (p=0.321). However, among eyes with a BCVA score less than 69 ETDRS letters (54% of the study population), visual gain was more prominent in Group II (+15.2 vs. +12.1 ETDRS letters; p<0.001). Statistically significant decreases in central foveal thickness were observed with both ranibizumab and aflibercept monotherapy (p<0.001), with no significant difference between the groups. (p=0.148). Conclusions: No statistically significant difference was found in visual outcomes at 12-month follow-up between ranibizumab and aflibercept monotherapies using a PRN protocol, although there was a tendency toward slightly better functional and anatomic prognosis in the aflibercept arm.

Intravitreal Ranibizumab and Dexamethasone Implant Injections as Primary Treatment of Diabetic Macular Edema: The Month 24 Results from Simultaneously Double Protocol.

PURPOSE: To compare efficacy of simultaneously administered intravitreal dexamethasone implant (DEX implant) and ranibizumab (simultaneous double protocol) injections with ranibizumab monotherapy for diabetic macular edema (DME) at month 24. METHODS: This is a prospective, consecutive, clinical interventional study. Naïve eyes with DME were randomized into two groups: 34 eyes received simultaneous double-protocol therapy and 34 eyes received ranibizumab monotherapy. The primary efficacy endpoint was change in visual acuity in month 24. The secondary efficacy endpoints were to evaluate gain of ≥15 letters, morphological changes and central foveal thickness. Decreased vision from DME (study eye BCVA, 20/40 or worse Snellen equivalent using ETDRS testing), the presence of DME with ≥300 µm foveal intraretinal cystoid spaces (within 1000 µm of the centre of the fovea), subfoveal neuroretinal detachment (SND), intraretinal hyperreflective foci (HRF, within 500 µm of the centre of the fovea) or foveal lipid exudates and external limiting membrane (ELM) and ellipsoid zone (EZ) disruption (within 500 µm of the centre of the fovea) on SD-OCT were eligible to enrol. RESULTS: The mean baseline BCVA was 48 ± 23 letters in double protocol group and 52 ± 14 letters ranibizumab monotherapy group (p = 0.416). The mean number of ETDRS letters changed from baseline at 12 months versus change from baseline at month 24 in double protocol group and ranibizumab monotherapy group were +21.6 versus +20.2 and +9.6 versus +9.1, respectively. At the month 24 time point, 65.4% of patients in double protocol group and 26.2% of patients in ranibizumab monotherapy group had gained ≥15 ETDRS letters in BCVA from baseline (p < 0.001). The external limiting membrane (ELM) and ellipsoid zone (EZ) integrity were better in the double protocol group in comparison to ranibizumab monotherapy group at month 24. In addition, there was no statistically significant increase in the proportion of patients with epiretinal membrane in double protocol group at month 24, by the contrast with ranibizumab monotherapy group (p = 0.06 and p = 0.04 in the double protocol and ranibizumab monotherapy groups, respectively). From baseline to month 24, the mean central foveal thickness (CFT) was 672 ± 293 µm reduced to 278 ± 84 µm in double protocol group and was 631 ± 279 µm reduced to 356 ± 108 µm in ranibizumab monotherapy group (p < 0.001 and p < 0.001). From baseline to month 24, 38% (13/34) of eyes in double protocol group and 18% (6/34) of eyes in ranibizumab monotherapy group had at least 5 mmHg of IOP elevation (p = 0.012). Two grades or more increased cataract density were detected 27% (6/22) of eyes in the double protocol group and in 12.5% (3/24) of eyes in the ranibizumab monotherapy group from baseline to month 24 (p = 0.032). CONCLUSION: According to the improvements in visual acuity and morphological changes achieved at month 24, the simultaneous double protocol therapy can be an effective treatment option for DME with inflammatory biomarkers on OCT or/and decreased visual acuity.

Optociliary Shunt Vessels or Neovascularisation of the Optic Disc: Fluorescein Angiography Versus Optical Coherence Tomography Angiography.

A 56-year-old man with a history of gallbladder carcinoma, hypothyroidism and hypertension was examined by us after developing marked visual loss in his left eye. A left ischaemic type of central retinal vein occlusion (CRVO) with macular oedema was diagnosed. Three months later, a non-ischaemic type of CRVO with no macular oedema developed in his right eye. While the left eye received five intravitreal ranibizumab injections and panretinal photocoagulation, the right central retinal vein occlusion improved spontaneously without any treatment. Ten months after his first visit we noticed optociliary shunt vessel formation in the right eye and neovascularisation of the optic disc in the left eye. Fluorescein angiography and optical coherence tomography angiography were performed at the same visit. The place of fluorescein angiography and optical coherence tomography angiography in distinguishing the optociliary shunt vessel from neovascularisation of the optic disc is discussed.

En face optical coherence tomography patterns in patients with angiographically documented uveitic macular edema: a cross-sectional retrospective study.

PURPOSE: To elucidate the en face optical coherence tomography (OCT) patterns of macular edema in eyes with angiographically documented uveitic macular edema (UME) and compare visual acuity (VA), OCT and OCT-angiography (OCT-A) parameters among the morphological subgroups. METHODS: Thirty-nine eyes of 29 patients with angiographically proven UME were enrolled into the study. All patients underwent comprehensive ophthalmological examination including structural OCT and OCT-A in addition to fluorescein angiography. Eyes with UME were divided into three subgroups (petaloid, sunflower and spoke-wheel pattern) with the help of en face OCT imaging. RESULTS: Posterior uveitis was the most common type of uveitis (17 patients; 58.7%), followed by panuveitis (11 patients; 37.9%) and then intermediate uveitis (1 patient; 3.4%). Underlying causes of uveitis were Behçet's disease (13 patients; 44.8%), idiopathic (11 patients; 37.9%), rheumatoid arthritis (2 patients; 6.9%), sarcoidosis (1 patient; 3.4%), inflammatory polyarthritis (1 patient; 3.4%) and psoriatic arthritis (1 patient; 3.4%). The most common en face OCT pattern was petaloid type (25 of 39 eyes; 64.1%). Eleven eyes (28.2%) had sunflower pattern and three (7.7%) spoke-wheel pattern. There were no statistically significant difference among the subgroups regarding the age, VA, central macular thickness and vessel density. CONCLUSION: This study reveals three morphological en face OCT patterns in eyes with UME and en face OCT may find a niche in the UME classification with the accumulation of experience among the uveitis experts.

Non-infectious Intraocular Inflammation Following Intravitreal Anti-Vascular Endothelial Growth Factor Injection.

Objectives: To evaluate the functional and anatomical results of patients with non-infectious intraocular inflammation (IOI) following intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection for the treatment of neovascular age-related macular degeneration (nAMD). Materials and Methods: The medical records of patients receiving anti-VEGF treatment for nAMD between January 2015 and March 2019 were retrospectively analyzed. Preoperative and postoperative routine ophthalmological examinations, central macular thickness, duration of inflammation, and follow-up time of the patients with non-infectious IOI following anti-VEGF injection were recorded. Results: Non-infectious IOI was determined in 13 eyes (11 eyes with aflibercept, 2 eyes with ranibizumab) of 1,966 patients who received a total of 12,652 anti-VEGF (4,796 aflibercept and 7,856 ranibizumab) injections. IOI was detected after a mean of 7 injections (2-12 injections). All eyes had both anterior chamber reaction (Tyndall +1/+3) and vitritis (grade 1-3). None of the patients had pain, hypopyon, or fibrin reaction. Visual acuity progressed to baseline levels within 28.3 days. Vitritis continued with a mean of 40 days. All patients recovered with topical steroid therapy. In 11 eyes, injection of the same anti-VEGF agent was continued. No recurrence of IOI was observed in any patients. Conclusion: Non-infectious IOI following intravitreal anti-VEGF injection typically occurs without pain, conjunctival injection, hypopyon, or fibrin and responds well to topical steroid therapy. Visual acuity returns to baseline levels within weeks according to the severity of inflammation.

A cross-sectional optical coherence tomography study in patients on taxane-based therapy and a case report with the literature review.

PURPOSE: To evaluate the characteristics of macular retinal and subfoveal choroidal changes in patients already on taxane-based therapy by the help of spectral domain optical coherence tomograpy (SD-OCT) and determine the incidence of taxane- related cystoid macular edema (CME). MATERIALS AND METHODS: In this cross-sectional case-control study, 202 patients who received taxane-based therapy due to treatment of various cancer and age and sex-matched 200 healthy control subjects were examined. Only patients who received at least 4 cycles of taxane-based therapy were taken into consideration for the taxane group. Taxane-based therapy was further divided into two subgroups; paclitaxel group (149 patients) and docetaxel group (53 patients). Central macular thickness (CMT) and central subfoveal choroidal thickness (CCT) were measured just once during their ongoing chemotherapy using SD-OCT and enhanced-depth imaging (EDI) OCT by Heidelberg OCT by a single examiner. RESULTS: Patients received a median of 7 cycles (range, 4-26) of paclitaxel or docetaxel and received a total cumulative dose of 852.81 ± 368.82 mg/m2 (range, 300-2310 mg/m2). Though the mean CMT was significantly thicker in the taxane group (224.9 ± 28.4 µm) than the healthy control group (215.9 ± 19.7 µm), there was no statistically significant difference between the paclitaxel (225.3 ± 28.2 µm) and docetaxel (224.2 ± 20.1 µm) groups. On the other hand, the CCT was not statistically significant different between the taxane versus control eyes and paclitaxel versus docetaxel patients. Taxane-related CME was detected only in one patient on paclitaxel. Overall, incidence of taxane-related maculopathy was 0.5% (1/202) of all patients in the taxane group. CONCLUSION: In our group of taxane receiving patients, incidence of taxane-related CME was 0.5%. In light of our study, we believe that clinicians should be alert on the occurence of taxane-related CME and carefully scrutinize the patients whenever any suspicion is arisen.