Comparison of two different treatment regimens' efficacy in neovascular age-related macular degeneration in Turkish population-based on real life data-Bosphorus RWE Study Group.

AIM: To compare two different anti-vascular endothelial growth factor (anti-VEGF) treatment regimens'-a priori pro re nata (PRN) and PRN regimen following the loading phase-anatomical and functional results in neovascular age-related macular degeneration (nAMD) patients. METHODS: Totally 544 nAMD patients followed and treated with aflibercept (n=135) and ranibizumab (n=409) at 9 different centers between 2013 and 2015 were enrolled into this retrospective multicenter study. Patients with initial best corrected visual acuity (BCVA) interval of 1.3-0.3 (logMAR) and a minimum follow-up of 12mo were included. Patients under two different regimens-a priori pro re nata (1+PRN) or 3 consecutive intravitreal injections followed by a PRN regimen (3+PRN)-were compared in BCVA at 3th, 6th and 12th months, and in central macular thickness (CMT) at 6th and 12th months. The total study group, intravitreal ranibizumab (IVR) and intravitreal aflibercept (IVA) groups were evaluated separately. RESULTS: The mean CMT decreased in the 1+PRN (n=101) regimen from 407 to 358 and 340 µm and in the 3+PRN (n=443) group from 398 to 318 and finally to 310 µm at months 6 and 12, respectively. Anatomically, the CMT reduction at 6th month (48.5 vs 76.4; P<0.05) was statistically significant in favor of 3+PRN group. BCVA changed in 1+PRN group from 0.77 to 0.78, 0.75 and 0.75; in 3+PRN group from 0.81 to 0.69, 0.72, and 0.76 at months 3, 6, and 12, respectively. Visual gain was statistically better in 3+PRN group at 3th month (-0.01 vs 0.12; P<0.001). In IVR group, CMT reduction was in greater in 3+PRN at 6th (44 vs 72) and 12th month (61 vs 84), but statistically insignificant. The 3+PRN group revealed statistically better visual results at 3th month (-0.02 vs 0.11, P<0.05). In IVA group, although statistically insignificant, CMT reduction (61 vs 89, 6th month; 85 vs 97, 12th month) and visual gain (0.02 vs 0.16; 0.02 vs 0.14; 0.05 vs 0.11) was found in favor of 3+PRN group at all visits. CONCLUSION: The loading dose of anti-VEGF treatments in nAMD leads to significantly better anatomical and functional results, regardless of the agent, specially in early follow-up interval.

Real-World Outcomes of Anti-VEGF Treatment for Neovascular Age-Related Macular Degeneration in Turkey: A Multicenter Retrospective Study, Bosphorus Retina Study Group Report No: 1.

OBJECTIVES: To evaluate the real-world outcomes of intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment in neovascular age-related macular degeneration (nAMD) patients. MATERIALS AND METHODS: Multicenter, retrospective, interventional, non-comparative study. The records of nAMD patients treated with an anti-VEGF agent on a pro re nata treatment regimen basis between January 2013 and December 2015 were reviewed. The patients who completed a follow-up period of 12 months were included. Primary outcome measures of this study were the visit and injection numbers during the first year. RESULTS: Eight hundred eighty eyes of 783 patients met the inclusion criteria for the study. Mean number of visits at month 12 was 6.9±2.5 (range: 1-15). Mean number of injections at month 12 was 4.1±1.9 (range: 1-11). Mean visual acuity at baseline and months 3, 6, and 12 was 0.90±0.63 LogMAR (range: 0.0-3.0), 0.79±0.57 LogMAR (range: 0.0-3.0), 0.76±0.57 LogMAR (range: 0.0-3.0), and 0.79±0.59 LogMAR (range: 0.0-3.0), respectively. Mean central retinal thickness at baseline and months 6 and 12 was 395±153 µm (range: 91-1582), 330±115 µm (range: 99-975), and 332±114 µm (range: 106-1191), respectively. CONCLUSION: The numbers of visits and injections were much lower than ideal and were insufficient with the pro re nata treatment regimen.

Structural Changes in Pseudoexfoliation Syndrome Evaluated with Spectral Domain Optical Coherence Tomography.

PURPOSE: To detect early structural changes of macular ganglion cell complex (GCC), peripapillary nerve fiber layer (pNFL), and optic nerve head (ONH) topography in subjects with pseudoexfoliation (PEX) using 3-D spectral domain optical coherence tomography (SD-OCT, Topcon 3D-2000). MATERIALS AND METHODS: Thirty-five participants with PEX and 29 healthy control subjects were included in the study. All study participants underwent SD-OCT imaging. Macular NFL, ganglion cell layer and inner plexiform layer (GCL + IPL), pNFL, and ONH parameters were measured in each participant. The results were compared within the two groups. RESULTS: In eyes with PEX, the superior and total mNFL thickness; superior, and total GCL + IPL thickness; superior, inferior, and total GCC thickness; and inferior, temporal, nasal, and total pNFL thickness were significantly thinner than the control subjects. In the topographic evaluation of ONH, there was no significant difference in optic disc area (ODA), cup area, rim area, cup to disc ratio (CDR), cup volume, rim volume, linear CDR and vertical CDR between the two groups. CONCLUSIONS: In PEX syndrome, similar decreases of the GCC and NFL occurred, and a high correlation existed between the two. Therefore, GCC can potentially be used to detect the early stages of PEX glaucoma.

Choroidal thickness in patients with diabetic retinopathy.

PURPOSE: The aim of the study reported here was to assess choroidal thickness (CT) and central macular thickness (CMT) in patients with diabetic retinopathy. MATERIALS AND METHODS: A total of 151 eyes from 80 patients from the retina department of Istanbul Training and Research Hospital who had type 2 diabetes mellitus with diabetic retinopathy were studied retrospectively in this cross-sectional research. Patients were divided into three groups: mild-moderate nonproliferative diabetic retinopathy without macular edema (NPDR), mild-moderate nonproliferative diabetic retinopathy with macular edema (DME), and proliferative diabetic retinopathy (PDR). In addition, 40 eyes of 20 healthy individuals comprised a control group. Choroidal thickness was measured from the posterior edge of the retinal pigment epithelium to the choroid/sclera junction at 500-µm intervals up to 1,500 µm temporal and nasal to the fovea. The CMT measurement was obtained for each eye. Serum hemoglobin A1c (HbA1c) levels were measured. RESULTS: The study included 191 eyes, comprising 151 eyes of 80 patients and 40 eyes of 20 healthy individuals. Of the 151 patient eyes, 61 had NPDR, 62 had PDR, and 28 eyes had DME. There was no statistically significant difference in age between the groups (P>0.05). In both the PDR and DME groups, the CT was statistically significantly decreased compared with the control group (P<0.001, P<0.001 for the PDR and DME groups, respectively). The mean CMT in the DME group was increased significantly compared with both the NPDR and PDR groups (P<0.001, P<0.001, respectively). In all three groups, serum HbA1c levels were found to be increased significantly compared with the control group (P=0.000). We found a statistically weak-moderate negative correlation between central macular and foveal CT (r=-289, P=0.000). There was a statistically strong correlation between CMT and HbA1c levels (r=0.577, P=0.483) and a statistically weak-moderate negative correlation between the central CT and HbA1c levels (r=-0.331, P<0.001). CONCLUSION: Diabetes changes the CT. CT was found to be significantly decreased in the DME and PDR groups.

Quantitative analysis of subfoveal choroidal thickness using enhanced depth imaging optical coherence tomography in normal eyes.

To evaluate subfoveal choroidal thickness of normal eyes with the use of the enhanced depth imaging technique of optical coherence tomography (EDI-OCT) and correlation of choroidal thickness with patient age. A retrospective analysis of 123 healthy eyes was performed. Age, gender, refractive state and spheric equivalencies were noted. Subfoveal choroidal thickness was measured and noted manually by two independent observers. A total of 72 patients (123 eyes) were included in this study. The mean age of the patients was 47.47 (15-84). The mean spheric equivalent of the refractive error was -0.24 D. According to LogMAR, the mean visual acuity was -0.006. The mean subfoveal choroidal thickness was 280.23 µm (SD ± 81.15, range 124-527 µm). The choroidal thickness showed a negative correlation with age for the subfoveal location (p = 0.000(a)). Regression analysis showed that subfoveal choroidal thickness decreased 3.14 µm for each year of age. The regression formulation was choroidal thickness = 429 - 3.14 × age. When we compared eyes according to their spheric equivalencies, there was no statistically significant correlation between spheric equivalency and subfoveal choroidal thickness. (p = 0.14). In this study, we report choroidal thickness measurement among healthy eyes within the Turkish population to demonstrate that EDI-OCT imaging can give cross-sectional information regarding the choroid, thereby facilitating quantitative imaging.