Retinal and choroidal changes after anti-VEGF therapy in neovascular-AMD patients: A systematic review and meta-analysis of SD-OCT studies.

BACKGROUND: In recent years, the progress made in the field of optical coherence tomography has helped to understand the changes in eye layers in patients with exudative age-related macular degeneration (nAMD). Early diagnosis of nAMD, a leading cause of irreversible vision impairment, is helpful. Therefore, we performed a meta-analysis on OCT measurement alterations before and after anti-VEGF therapy in patients with nAMD and controls. METHOD: We systematically searched Scopus, PubMed, Cochrane, and Web of Science to find articles that measured choroidal and retinal layer changes after anti-VEGF therapy in nAMD Patients. We chose either a fixed-effects or random-effects model based on the assessed heterogeneity level to perform a meta-analysis. In addition, we conducted meta-regression, subgroup analyses, publication bias, and quality assessment for included studies. RESULTS: Thirteen studies were included in the meta-analysis, with 733 total participants. Foveal thickness and subfoveal choroidal thickness (CT) decreased significantly in the first 3 years after injections, except for subfoveal CT in the third year after injection. It also showed that CT at 1500 µm temporal and nasal to the fovea did not significantly change. CONCLUSION: Our results showed anti-VEGF treatment for nAMD patients was associated with a significant reduction in foveal thickness and subfoveal CT in the first 2 years after treatment. Our analysis did not reveal any correlation between changes in foveal thickness and subfoveal CT with best-corrected visual acuity or other factors.

Un-explained visual loss following silicone oil removal: results of the Pan American Collaborative Retina Study (PACORES) Group.

PURPOSE: To report the incidence and clinical features of patients that experienced un-explained visual loss following silicone oil (SO) removal. METHODS: Multicenter retrospective study of patients that underwent SO removal during 2000-2012. Visual loss of ≥2 lines was considered significant. RESULTS: A total of 324 eyes of 324 patients underwent SO removal during the study period. Forty two (13%) eyes suffered a significant visual loss following SO removal. Twenty three (7.1%) of these eyes lost vision secondary to known causes. In the remaining 19 (5.9%) eyes, the loss of vision was not explained by any other pathology. Eleven of these 19 patients (57.9%) were male. The mean age of this group was 49.2 ± 16.4 years. Eyes that had an un-explained visual loss had a mean IOP while the eye was filled with SO of 19.6 ± 6.9 mm Hg. The length of time that the eye was filled with SO was 14.8 ± 4.4 months. In comparison, eyes that did not experience visual loss had a mean IOP of 14 ± 7.3 mm Hg (p < 0.0002) and a mean tamponade duration of 9.3 ± 10.9 months (p < 0.0001). CONCLUSIONS: An un-explained visual loss after SO removal was observed in 5.9% of eyes. Factors associated with this phenomenon included a higher IOP and longer SO tamponade duration.

Comparing outcomes in patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration treated with two different doses of primary intravitreal bevacizumab: results of the Pan-American Collaborative Retina Study Group (PACORES) at the 12-month follow-up.

PURPOSE: To compare the total number of injections and the anatomic and best-corrected visual acuity (VA) response after injecting 1.25 or 2.5 mg of bevacizumab as needed in patients with primary choroidal neovascularization secondary to age-related macular degeneration (AMD) at 12 months. METHODS: This was a retrospective, interventional, comparative multicenter study of 60 eyes treated with intravitreal bevacizumab (35 eyes, 1.25 mg; 25 eyes, 2.5 mg). RESULTS: The mean number of injections per eye was 3.8 in the 1.25-mg group and 3.2 in the 2.5-mg group (P = 0.2752). At 12 months, in the 1.25-mg group, 16 (46%) eyes gained > or =3 lines of Early Treatment Diabetic Retinopathy Study (ETDRS) VA and seven (20%) lost > or =3 lines of ETDRS VA. In the 2.5-mg group, 11 (44%) eyes improved by > or =3 lines, and four (16%) lost > or =3 lines (P = 1.000). At 12 months, in the 1.25-mg group, the mean central macular thickness decreased from 419 +/- 201 microm at baseline to 268 +/- 96 microm, compared with a decrease from 388 +/- 162 to 296 +/- 114 microm in the 2.5-mg group (P = 0.7896). CONCLUSION: There were no statistically significant differences between the two dose groups with regard to the number of injections, anatomic and VA outcomes.