ABSTRACT
PURPOSE: To investigate the recurrence rate of active macular neovascularization in patients with neovascular age-related macular degeneration (nAMD) previously followed up in a treat-and-extend (TE) regimen in which treatment had been stopped because of disease stability. DESIGN: Prospective cohort study. PARTICIPANTS: One hundred five patients with nAMD previously followed up in a TE regimen treated with aflibercept injections. METHODS: All patients with a dry macula on 3 consecutive visits 12 weeks apart were eligible to participate in the study. Patients were examined at baseline and then monitored for disease recurrence 4, 6, 8, 10, and 12 months after the last injection. MAIN OUTCOME MEASURES: The proportion of patients with recurrent disease within 12 months after the last injection. Change in best-corrected visual acuity (BCVA) at the time of recurrence and after resumed therapy. RESULTS: Evidence of recurrent nAMD was seen in 54 of 102 patients (52.9%) after 12 months of follow-up. The mean time to recurrence after the last injection was 6.7 ± 2.2 months. The BCVA decreased from 71.7 ± 10.0 Early Treatment Diabetic Retinopathy Study (ETDRS) letters at baseline to 68.1 ± 11.1 ETDRS letters at the recurrence (P = 0.12). After treatment resumed, BCVA increased to 71.4 ± 10.0 ETDRS letters (P = not significant compared with baseline). Patients with a pigment epithelial detachment (PED) at baseline showed a 74% (14/19) recurrence rate compared with 48% (40/83) in patients without a PED (P < 0.05). Only 22 of 54 patients (40.7%) with recurrent disease showed symptoms of visual loss or metamorphopsia. CONCLUSIONS: Recurrent nAMD is common in previously stable patients for whom anti-VEGF injections have been suspended. It is difficult to predict which patients will experience a recurrence, and most of these patients do not show symptoms in the early stages of reactivation. Long-term follow-up is important, and early detection of recurrent disease can improve the chances for maintained visual function.
Subject(s)
Clinical Protocols , Disease Management , Macula Lutea/diagnostic imaging , Ranibizumab/administration & dosage , Receptors, Vascular Endothelial Growth Factor/administration & dosage , Recombinant Fusion Proteins/administration & dosage , Wet Macular Degeneration/diagnosis , Withholding Treatment , Aged , Angiogenesis Inhibitors/administration & dosage , Female , Follow-Up Studies , Humans , Intravitreal Injections , Male , Prospective Studies , Recurrence , Time Factors , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Visual Acuity , Wet Macular Degeneration/drug therapyABSTRACT
PURPOSE: To investigate the characteristics and treatment patterns of patients developing a neovascular event (NE) in the anterior chamber secondary to central retinal vein occlusion (CRVO) in an ordinary clinical setting. METHODS: In this retrospective real-life study, data from 243 eyes presenting with CRVO during 2012-2013 were collected. Maximum follow-up was 5 years. All patients that developed NE were included in the analysis. RESULTS: Of 243 eligible patients, 72 (30%) either presented with or developed NE during the follow-up. In these 72 patients, 23 (32%) eyes already had evidence of NE at baseline. Twenty-eight eyes (39%) developed NE after discontinuation of intravitreal therapy for macular oedema (ME). In this subgroup, the NE occurred 15.6 ± 13.8 months after the baseline visit and 4.1 ± 2.6 months after the last injection. Final best-corrected visual acuity was 8.6 Early Treatment Diabetic Retinopathy Study (ETDRS) letters in the group of patients presenting with NE compared to 8.1 ETDRS letters in the group that developed NE later on. Of the patients presenting with intraocular pressure (IOP) below 30 mmHg, 3/29 (10%) needed subsequent cyclodiode laser therapy compared to 35/43 (81%) patients with a baseline IOP above 30 mmHg (p < 0.001). CONCLUSIONS: In a clinical setting, many patients show evidence of NE already at the first visit. A substantial part of patients develops NE a long time after presentation, commonly a few months after discontinuation of intravitreal therapy for ME. The visual prognosis is similar for patients presenting with NE and patients developing NE during follow-up. A high baseline IOP predicts the need for subsequent pressure-lowering procedures.
Subject(s)
Bevacizumab/administration & dosage , Glaucoma, Neovascular/etiology , Intraocular Pressure/physiology , Retinal Vein Occlusion/complications , Visual Acuity , Aged , Aged, 80 and over , Angiogenesis Inhibitors/administration & dosage , Anterior Chamber/diagnostic imaging , Dexamethasone/administration & dosage , Female , Follow-Up Studies , Glaucoma, Neovascular/diagnosis , Glaucoma, Neovascular/physiopathology , Glucocorticoids/administration & dosage , Humans , Intravitreal Injections , Male , Prognosis , Retinal Vein Occlusion/diagnosis , Retinal Vein Occlusion/drug therapy , Retrospective Studies , Tomography, Optical Coherence/methods , Vascular Endothelial Growth Factor A/antagonists & inhibitorsABSTRACT
The Swedish Lucentis Quality Registry is a 12-month, open-label, observational, prospective, and retrospective study of ranibizumab administration for wet AMD. Visual acuity (VA) was measured with Snellen or ETDRS chart in 370 patients (66.8% women; age range 46-93 years). In total, a mean of 4.7 ± 1.6 injections per patient (range 1-10) was given to month 12. Mean VA score was 58.3 ± 12.2 letters before treatment, 63.3 ± 12.5 after 3 injections (Δ4.9 ± 10.1 letters from baseline), and 59.3 ± 16.2 at 12 months (Δ1.0 ± 13.6). VA score from baseline to month 12 was stable in 74.4% of patients, improved by 15 letters/3 lines or more in 14.7%, and decreased by ≥15 letters/3 lines in 10.9% of patients. With a mean of 4.7 ranibizumab injections per patient per year, mean VA was stabilised but not increased. To maintain the initial gain seen after the first three injections, an average of 1.8 ± 1.5 additional injections does not appear to be adequate.
