Long-term results of treatment of neovascular age-related macular degeneration using antiangiogenic drugs: A review of the literature.

Age-related macular degeneration (AMD) is one of the main causes of visual acuity (VA) loss in people over 50 years of age worldwide, with neovascular AMD (nAMD) accounting for 80% of cases of severe vision loss due to this disease. Anti-vascular endothelial growth factor (anti-VEGF) drugs have been used for the treatment of this disease for more than a decade, changing drastically the visual prognosis of these patients. However, initial studies reporting data on outcomes were short term. Currently, there are different series published on the long-term results of AMD after treatment with anti-VEGF, and the aim of this review is to synthesize these results. The mean follow-up of the included studies was 8.2 years (range 5-12 years). The mean initial VA was 55.3 letters in the Early Treatment Diabetic Retinopathy Study (ETDRS) (range 45.6-65) and the mean final VA was 50.1 letters (range 33.0-64.3), with a mean loss of 5.2 letters. At the end of follow-up, 29.4% of the patients maintained a VA > 70 letters. The 67.9% of patients remained stable at the end of follow-up (< 15 letter loss), with a severe loss (≥ 15 letters) of 30.1%. Fibrosis and atrophy were the main causes of long-term VA loss, occurring at the end of follow-up in 52.5% and 60.5%, respectively.

Brolucizumab tras fracaso de aflibercept con terapia fotodinámica en vasculopatía coroidea polipoidea: reporte de un caso / Brolucizumab after failure of aflibercept with photodynamic therapy in polypoidal choroidal vasculopathy: A case report

Describimos un caso de vasculopatía coroidea polipoidea con líquido subretiniano persistente a pesar de múltiples tratamientos intravítreos con bevacizumab, ranibizumab y aflibercept, así como aflibercept asociado a terapia fotodinámica. El paciente alcanzó la resolución completa después de la inyección intravítrea de brolucizumab, pero experimentó una recurrencia del líquido subretiniano 12 semanas después de la suspensión. Brolucizumab podría ser una opción para tratar el líquido subretiniano después del fracaso de otros agentes anti-VEGF asociados con la terapia fotodinámica. (AU)

We describe one case of polypoidal choroidal vasculopathy with persistent subretinal fluid despite multiple treatment with intravitreal bevacizumab, ranibizumab and aflibercept, as well as aflibercept associated with photodynamic therapy. The patient reached complete resolution after intravitreal brolucizumab injection, but experienced recurrence of subretinal fluid 12 weeks after discontinuation. Brolucizumab might be an option in treating subretinal fluid after failure of other anti-VEGF agents associated with photodynamic therapy. (AU)

Relación del tratamiento y coste con la ganancia de agudeza visual en la degeneración macular asociada a la edad / Relationship between treatment and cost with visual acuity improvement in age-related macular degeneration

Fundamento. Relacionar la ganancia de agudeza visual (AV) con el coste asistencial y de tratamiento con terapia anti-factor de cre-cimiento endotelial vascular (antiVEGF) en pacientes diagnostica-dos de degeneración macular asociada a la edad exudativa (DMAE exudativa).Pacientes y métodos. Estudio observacional, longitudinal, retros-pectivo, de pacientes ≥50 años diagnosticados de DMAE exudativa, con AV logMAR entre 0,6 y 0,06, en seguimiento y tratamiento en nuestro hospital de tercer nivel entre el 01/01/2014 y el 31/12/2018.Resultados. Se incluyeron 778 pacientes, 62,2% mujeres y media de edad 79,83±7,94 años, con 957 ojos con DMAE exudativa. La AV final global (0,65±0,45) aumentó un 3,2% respecto de la inicial. El 60,3% de los ojos recibieron antiVEGF con ranibizumab, el 10,2% con aflibercept y el 29,5% con ambos (mixto). El grupo mixto in-crementó significativamente la AV respecto de la inicial, sin dife-rencias entre grupos. Aunque el seguimiento/tratamiento fue más largo para el grupo mixto, este recibió menos inyecciones antiVE-GF y tomografías de coherencia óptica (OCT). El gasto total por año y ojo tratado fue de 1.972,7 €±824,5; los costes fueron mayores para visita, OCT y tratamiento en el grupo de aflibercept, y menores para angiografías con fluoresceína, tratamiento antiVEGF y costes totales en el grupo mixto. La ganancia decimal de AV tuvo un coste de 872 €±1.077,7 sin diferencias significativas entre grupos.Conclusiones. Los tratamientos antiVEGF con ranibizumab, afli-bercept y ambos mantuvieron la AV en pacientes con DMAE exu-dativa. En general, los costes asistenciales y de tratamiento fueron menores en el grupo que recibió ambos fármacos (AU)

Background. We examined the relationship between visual acuity changes (VA) and the cost of care and treatment with anti-vascular endothelial growth factors (antiVEGF) in patients diagnosed with age-related exudative macular degeneration(exudative AMD).Methods. Observational, longitudinal, retrospective study of pa-tients ≥50 years of age diagnosed with exudative AMD, with a log-MAR VA between 0.6 and 0.06. and 0.06. Follow-up and treatment were done in our tertiary hospital between January 1, 2014 and December 31, 2018.Results. The study included 778 patients; 62.2% female and mean age 79.83±7.94 years; 957 eyes had exudative AMD. Mean of final VA (0.65±0.45) increasing 3.2% compared to initial values. Ranibi-zumab was administered to 60.3% of the eyes, aflibercept to 10.2% and ranibizumab + aflibercept (mixed group) to 29.5%. Significant increase in VA was seen in the group with the mixed treatment, with no inter-group differences. Although follow-up/treatment was longer for the mixed group, they received fewer anti-VEGF injections and optical coherence tomography (OCT). The total expenditure per year and treated eye was €1,972.7±824.5; costs were higher for visit, OCT, and treatment in the aflibercept group, and lower for fluorescein angiography, antiVEGF treatment, and total costs in the mixed group. Decimal VA gain had a cost of €872±1,077.7 with no significant inter-group differences.Conclusion. AntiVEGF treatments (ranibizumab, aflibercept, or both) maintained VA in patients with exudative AMD. Overall, care and treatment costs were lower in the group that received both drugs (AU)

Brolucizumab after failure of aflibercept with photodynamic therapy in polypoidal choroidal vasculopathy: A case report.

We describe one case of polypoidal choroidal vasculopathy with persistent subretinal fluid despite multiple treatment with intravitreal Bevacizumab, Ranibizumab and Aflibercept, as well as Aflibercept associated with photodynamic therapy. The patient reached complete resolution after intravitreal Brolucizumab injection, but experienced recurrence of subretinal fluid 12 weeks after discontinuation. Brolucizumab might be an option in treating subretinal fluid after failure of other anti-VEGF agents associated with photodynamic therapy.

Análisis comparativo de la calidad de vida en diferentes patologías de la retina / Comparative analysis of the quality of life among different retinal diseases

Objetivo Evaluar el impacto en la calidad de vida (CdV) entre diferentes enfermedades de la retina como el edema macular diabético (EMD), la oclusión venosa retiniana (OVR), la miopía patológica (MP), la degeneración macular asociada a la edad neovascular (DMAEn) y la coriorretinopatía serosa central (CSC). Métodos Se realizó un estudio transversal en 241 pacientes afectados de EMD (n=44), OVR (n=41), MP (n=34) y DMAEn (n=85) que recibieron inyecciones intravítreas por presencia de edema macular o neovascularización. Los pacientes con CSC incluidos (n=37) eran candidatos a tratamiento con láser. Los pacientes completaron el National Eye Visual Functioning Questioning-25 (NEIVFQ-25). Se registró la mejor agudeza visual corregida (MAVC). Resultados Existieron diferencias significativas entre subgrupos para todos los dominios, excepto para la visión general, en la que todas las puntuaciones entre enfermedades oscilaron entre 40,7 y 45,2 sobre 100 (p=0,436), a pesar de la diferencia en MAVC (CSC: 86,3±11,9; OVR: 78,5±15,5; EMD: 73,3±15,2; DMAEn: 72,9±12,6 y MP: 68,5±18,1 letras, respectivamente (p<0,001). La puntuación total más baja se observó en la MP (52,1±20,9), seguida de DMAEn (55,3±20,8), OVR (65,0±22,3), EMD (68,6±21,0) y CSC (70,9±16,2). El grupo con EMD tuvo la peor puntuación para la salud general (38,9±21,4). La salud mental y las dificultades de rol fueron más bajas en la MP (48,2±28,8 y 48,2±31,9, p<0,007). Conclusiones Este estudio revela las diferencias en la CdV entre EMD, OVR, DMAEn, MP y CSC, describiendo las diferentes repercusiones que pueden sufrir, observándose un mayor impacto en la MP y la DMAEn (AU)

Purpose To assess the impact on the quality of life (QoL) among different retinal diseases such as diabetic macular edema (DME), retinal vein occlusion (RVO), pathologic myopia (PM), neovascular age-related macular degeneration (nAMD) and central serous chorioretinopathy (CSC). Methods A cross-sectional study was carried out in 241 patients, affected by DME (n=44), RVO (n=41), PM (n=34) and nAMD (n=85) receiving intravitreal injections due to the presence of macular edema or choroidal neovascularization. The CSC patients included (n=37) were candidates for laser treatment. The patients included completed the National Eye Visual Functioning Questioning-25 (NEIVFQ-25). Best eye visual acuity (BEVA) was recorded using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. Results There were significant differences between subgroups for all the domains, except for the general vision in which all scores among diseases ranged from 40.7 to 45.2 out of 100 (P=.436), despite the difference in BEVA (CSC: 86.3±11.9; RVO: 78.5±15.5, DME: 73.3±15.2, nAMD: 72.9±12.6 and PM: 68.5±18.1 letters, respectively; P<.001). The lowest VFQ-25 total score was observed in the PM patients (52.1±20.9), followed by nAMD (55.3±20.8), RVO (65.0±22.3), DME (68.6±21.0) and CSC (70.9±16.2). The DME group reported the worst score for general health (38.9±21.4). Mental health and role difficulties were lowest for PM (48.2±28.8 and 48.2±31.9, P<.007). Conclusions This study reveals the differences in the QoL among DME, RVO, nAMD, PM and CSC, describing the different repercussions that they can suffer, observing a higher impact in PM and nAMD (AU)

Comparative analysis of the quality of life among different retinal diseases.

PURPOSE: To assess the impact on the quality of life (QoL) among different retinal diseases such as diabetic macular edema (DME), retinal vein occlusion (RVO), pathologic myopia (PM), neovascular age-related macular degeneration (nAMD) and central serous chorioretinopathy (CSC). METHODS: A cross-sectional study was carried out in 241 patients, affected by DME (n=44), RVO (n=41), PM (n=34) and nAMD (n=85) receiving intravitreal injections due to the presence of macular edema or choroidal neovascularization. The CSC patients included (n=37) were candidates for laser treatment. The patients included completed the National Eye Visual Functioning Questioning-25 (NEI VFQ-25). Best eye visual acuity (BEVA) was recorded using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. RESULTS: There were significant differences between subgroups for all the domains, except for the general vision in which all scores among diseases ranged from 40.7 to 45.2 out of 100 (P=.436), despite the difference in BEVA (CSC: 86.3±11.9; RVO: 78.5±15.5, DME: 73.3±15.2, nAMD: 72.9±12.6 and PM: 68.5±18.1 letters respectively; P<.001). The lowest VFQ-25 total score was observed in the PM patients (52.1±20.9), followed by nAMD (55.3±20.8), RVO (65.0±22.3), DME (68.6±21.0) and CSC (70.9±16.2). The DME group reported the worst score for general health (38.9±21.4). Mental health and role difficulties were lowest for PM (48.2±28.8 and 48.2±31.9, P<.007). CONCLUSIONS: This study reveals the differences in the QoL among DME, RVO, nAMD, PM and CSC, describing the different repercussions that they can suffer, observing a higher impact in PM and nAMD.

Diagnóstico diferencial de las reacciones inflamatorias tras uso de medicación intravítrea en degeneración macular asociada a la edad: estéril vs. infeccioso / Differential diagnosis of endophthalmitis after intravitreal drug injection for age related macular degeneration: Sterile vs. infectious

El interés por las complicaciones inflamatorias tras la inyección intravítrea de fármacos antiangiogénicos ha aumentado tras la comercialización de brolucizumab y el desarrollo de nuevas moléculas como el abicipar pegol. Dichos fármacos se asocian a una tasa de complicaciones inflamatorias mayor a los antiangiogénicos clásicos. En este contexto resulta clave el diferenciar procesos infecciosos y estériles para realizar un tratamiento efectivo y precoz. El solapamiento del cuadro clínico entre procesos infecciosos y estériles, la baja tasa de positividad en los cultivos y la heterogeneidad en la terminología son barreras para el correcto diagnóstico y reporte de las complicaciones inflamatorias tras la inyección de medicación antiangiogénica intravítrea. Los cuadros estériles comienzan de forma precoz tras la inyección, dentro de las primeras 48 h, o alrededor de 20 días después en los casos de vasculitis asociada a brolucizumab. Los procesos infecciosos comienzan como promedio en el tercer día tras la inyección, y hasta una semana después de la misma. La disminución grave de la agudeza visual, el dolor severo, la hiperemia severa, el hipopion y un mayor grado de inflamación intraocular deben orientar hacia procesos infecciosos. En los casos en que exista duda sobre la etiología de la inflamación, debe procederse a un control muy estrecho del paciente o al tratamiento antimicrobiano empírico junto con la toma de muestra para evitar complicaciones derivadas de una endoftalmitis infecciosa. Por el contrario, los fenómenos estériles deben ser tratados con observación en los casos más leves o corticoterapia adaptada a la gravedad de inflamación en los casos más graves (AU)

The recent release of brolucizumab and the development of new antiangiogenic molecules as abicipar pegol has increased the interest towards inflammatory complications after intravitreal drug injection. Those drugs are associated to a higher rate of inflammatory adverse events compared to classic drugs. In this context it is essential to differentiate between sterile and infectious cases for a fast and effective treatment. The clinical similarities between infectious and sterile cases, the high rate of culture negative patients and the heterogeneity in the terminology used are obstacles for a correct diagnosis and report of these complications. Sterile cases appear early after the injection, before 48h; or 20 days after in brolucizumab-related vasculitis cases. Infectious cases show up around the third day after injection and up to a week after it. A severe visual impairment, severe pain, severe hyperemia, hypopyon and a more severe intraocular inflammatory process are signs of a likely infectious origin. If the cause of the inflammation is uncertain we must follow up the patient closely or “tap and inject” antimicrobial agents in order to prevent the eventual complications of an infectious endophthalmitis. On the other hand, sterile endophthalmitis might be observed in mild cases or treated with steroids according to the severity of the inflammation (AU)

Correlación entre la sensibilidad al contraste y las características morfológicas obtenidas por OCT en pacientes con degeneración macular relacionada con la edad avanzada tratados con dosis de carga de inhibidores del factor de crecimiento endotelial vascular / Correlation between contrast sensitivity and morphological features obtained by OCT in patients with age-related macular degeneration treated with a loading dose of vascular endothelial growth factor inhibitors

Objetivo Determinar la correlación entre la sensibilidad al contraste y las características morfológicas obtenidas por tomografía de coherencia óptica en pacientes con degeneración macular relacionada con la edad avanzada tratados con dosis de carga de inhibidores del factor de crecimiento endotelial vascular (anti-VEGF). Diseño Se trata de un estudio ambispectivo (prospectivo+retrospectivo) observacional y analítico. Participantes Todos los pacientes de 55 años o más con degeneración macular relacionada con la edad que acudieron al departamento de Retina del servicio de Oftalmología y cumplieron con los criterios de inclusión entre marzo-mayo de 2022. Métodos Se recolectaron los datos por medio de la revisión de expedientes. Se analizaron los estudios de tomografía de coherencia óptica previa a la aplicación de inyecciones intravítreas de los pacientes que se encontraban en el mes posterior a la última dosis. Se incluyeron un total de 33 sujetos y un total de 30 continuaron seguimiento. Se realizaron pruebas de normalidad (Shapiro y Bartlett) entre los grupos de estudio, dando como resultado grupos no normales no homocedásticos. Los sujetos fueron sometidos a una nueva evaluación oftalmológica y nueva toma de mediciones retinianas. Resultados Se realizó un análisis de regresión lineal comparando los valores logarítmicos de la agudeza visual y la sensibilidad al contraste, obteniendo una relación significativa entre ambos valores posterior a la aplicación del tratamiento (p<0,0001). Asimismo, se demostró una correlación entre la disminución de los valores de la sensibilidad al contraste y todas las características evaluadas en el tomografía de coherencia óptica. Conclusiones Las estrategias de antiangiogénesis pueden conducir a mejores resultados en la función visual global, impactando positivamente en la sensibilidad al contraste (AU)

Objective To determine the correlation between contrast sensitivity and morphological characteristics obtained by optical coherence tomography in patients with age-related macular degeneration treated with a loading dose of vascular endothelial growth factor inhibitors (anti-VEGF). Design This is an ambispective (prospective+retrospective) observational, cross-sectional, and analytical study. Participants All patients over 55 years of age with age-related macular degeneration who attended the Retina service of the Ophthalmology department and met the inclusion criteria between March-May 2022. Methods Data collection was carried out by reviewing the records of patients.Optical coherence tomography studies prior to the application of intravitreal injections of patients who were currently in the first month after the last dose of anti-VEGF were analyzed. A total of 33 subjects were included, of which 30 continued follow-ups. Normality tests (Shapiro and Bartlett) were performed where a nonparametric data distribution was demonstrated. The subjects underwent a new ophthalmological evaluation and new retinal measurements of the affected eye. Results A linear regression analysis was performed comparing the logarithmic values of both visual acuity and contrast sensitivity, obtaining a significant relationship between both values after the application of treatment (P<.0001). Likewise, correlation was demonstrated between the decrease in contrast sensitivity values and all the characteristics evaluated in the patients’ optical coherence tomography. Conclusions Antiangiogenesis strategies can lead to better results in global visual function, positively impacting contrast sensitivity (AU)

Differential diagnosis of endophthalmitis after intravitreal drug injection for age related macular degeneration: sterile vs. infectious.

The recent release of brolucizumab and the development of new antiangiogenic molecules as abicipar pegol has increased the interest towards inflammatory complications after intravitreal drug injection. Those drugs are associated to a higher rate of inflammatory adverse events compared to classic drugs. In this context it is essential to differentiate between sterile and infectious cases for a fast and effective treatment. The clinical similarities between infectious and sterile cases, the high rate of culture negative patients and the heterogeneity in the terminology used are obstacles for a correct diagnosis and report of these complications. Sterile cases appear early after the injection, before 48 h; or 20 days after in brolucizumab-related vasculitis cases. Infectious cases show up around the third day after injection and up to a week after it. A severe visual impairment, severe pain, severe hyperemia, hypopyon and a more severe intraocular inflammatory process are signs of a likely infectious origin. If the cause of the inflammation is uncertain we must follow up the patient closely or "tap and inject" antimicrobial agents in order to prevent the eventual complications of an infectious endophthalmitis. On the other hand, sterile endophthalmitis might be observed in mild cases or treated with steroids according to the severity of the inflammation.

Desprendimiento de la capa bacilar de la retina asociado a enfermedad inflamatoria ocular

El desprendimiento de la capa bacilar de la retina es la separación de los segmentos internos de los fotorreceptores del resto de la retina neurosensorial, o separación entre la zona miode y elipsoide de la retina, que en un hallazgo reciente se puede identificar mediante la tomografía de coherencia óptica de dominio espectral. El objetivo es actualizar los conocimientos sobre el desprendimiento de la capa bacilar de la retina y el uso de la tomografía de coherencia óptica de dominio espectral en las enfermedades oculares que están asociadas con este signo. Se consultaron las fuentes bibliográficas como Google académico, SciELO LAC, Medline y MEDICARIBE. Se limitaron los resultados al idioma español e inglés y a los últimos cinco años. Se recuperaron 54 documentos, de ellos 18 resultaron relevantes a esta investigación. Los autores más mencionados fueron Ramtohul, Metha y Cicinelli. Ellos trabajaron el signo clínico en cuestión y reportaron la experiencia en la atención a los pacientes aquejados con esta enfermedad ocular. El desprendimiento de la capa bacilar de la retina es un signo presente en varias enfermedades asociadas a inflamación del segmento posterior ocular. La tomografía de coherencia óptica de dominio espectral es una técnica efectiva para determinarlo, aunque estos planteamientos aún son escasos en la literatura, lo cual reafirma la importancia científica de continuar los estudios a partir de hipótesis iniciales desde el punto de vista histológico y tomográfico.

Retinal bacillary layer detachment is the separation of the inner segments of the photoreceptors from the rest of the neurosensory retina, or separation between the myode and ellipsoid zone of the retina, which in a recent finding can be identified by spectral-domain optical coherence tomography. The objective is to update the knowledge about the detachment of the bacillary layer of the retina and the use of spectral-domain optical coherence tomography in ocular diseases that are associated with this sign. Bibliographic sources such as academic Google, SciELO LAC, MEDLINE and MEDICARIBE were consulted. Fifty-four documents were retrieved, of which 18 were relevant to this research. The results were limited to the Spanish and English language and to the last five years. The most mentioned authors were Ramtohul, Metha and Cicinelli. They worked on the clinical sign in question and reported the experience in caring for patients afflicted with this ocular disease. Detachment of the bacillary layer of the retina is a sign present in several diseases associated with ocular posterior segment inflammation. Spectral-domain optical coherence tomography is an effective technique to determine it, although it is still scarce in the literature, which reaffirms the scientific validity of continuing studies from initial hypotheses from the histological and tomographic point of view.

[Management optimization of neovascular age-related macular degeneration in Spain: Evolution towards proactive treatment models]. / Optimización del manejo de la degeneración macular asociada a la edad neovascular en España: evolución hacia modelos proactivos de tratamiento.

INTRODUCTION AND OBJECTIVE: Healthcare resources optimization is crucial to assume the growing demand of neovascular age-related macular degeneration (nAMD). This work provides guidelines and support so that each hospital can lead its change management. METHODS: The OPTIMUS project (n=10 hospitals) was based on face-to-face interviews with the key staff of the ophthalmology services, and alignment with the main responsible for each centre (nominal group) to identify potential needs for improving nAMD. The OPTIMUS nominal group was expanded to 12 centres (eVOLUTION). Through different remote work sessions, different guides and tools were defined and developed to implement proactive treatment strategies, one-step treatment administration and potential for remote visits (eConsult) in nAMD. RESULTS: The information collected from the OPTIMUS interviews and working groups (n=10 centres) defined roadmaps to promote the development of protocols and proactive treatment strategies, including healthcare workload optimization and one-stop treatment administration in nAMD. With eVOLUTION, processes and tools were developed to promote eConsult: (i) healthcare burden calculator; (ii) definition of potential patients for telematic management; (iii) definition of nAMD management archetypes; (iv) definition of processes for implementation of eConsult by archetype; and (v) key performance indicators for changing evaluation. CONCLUSIONS: Managing change is an internal task that requires an adequate diagnosis of processes and feasible implementation roadmaps. OPTIMUS and eVOLUTION provide the basic tools for an autonomous advance of hospitals in the optimization of AMD management, with the available resources.

Evaluación de signos tomográficos no exudativos en casos de degeneración macular asociada a la edad de tipo exudativo / Evaluation of non-exudative tomographic signs in cases of exudative age-related macular degeneration

Objetivo Analizar la prevalencia de signos tomográficos no exudativos (signo de cebolla, seudoedema, tubulación de la retina externa, seudoquistes, hendiduras subretinianas y atrofia macular) en pacientes con degeneración macular asociada a la edad neovascular. Material y métodos Un total de 174 ojos de pacientes con degeneración macular asociada a la edad neovascular que no habían recibido tratamiento previo fueron incluidos en el estudio. Se valoró la agudeza visual, la actividad de la neovascularización y la aparición o no de los distintos signos objeto de estudio en los tiempos 0 (visita inicial), 4 meses, un año, año y medio y a los 2 y 3 años de seguimiento. Se evaluaron también: la edad, el sexo, el ojo afecto y el tipo de neovascularización (1, 2, 3, polipoidea o mixta). Los análisis se han realizado mediante el software estadístico R (versión 3.3.2) y el paquete glmmADMB (versión 0.8.3.3). Resultados La presencia de seudoquistes y tubulación de la retina externa va en aumento a lo largo del seguimiento. El signo de cebolla comienza con una frecuencia ascendente hasta los 12 meses, posteriormente desciende a los 18 meses y vuelve a incrementarse a los 24 meses. En cuanto al seudoedema, mantiene un incremento hasta los 18 meses para finalmente descender. Las hendiduras subretinianas son el signo más raro, presentándose en el 1,1% en la primera visita. Finalmente, la atrofia macular, presente en el 12,6% de los ojos inicialmente, se encuentra en el 25% a los 2 años. Conclusión Los seudoquistes, la tubulación de la retina externa y la atrofia macular fueron los signos más prevalentes, mientras que las hendiduras subretinianas fueron los más infrecuentes (AU)

Objective To analyze the prevalence of non-exudative tomographic signs (onion sign, pseudoswelling, external retinal tubulation, pseudocysts, subretinal clefts and macular atrophy) in patients with neovascular age-related macular degeneration. Material and methods A total of 174 eyes of patients with neovascular age-related macular degeneration who had not received previous treatment were included in the study. Visual acuity, neovascularization activity, and the appearance or not of the different signs under study were assessed at times 0 (initial visit), 4 months, one year, year and a half, and at 2 and 3 years of follow-up. The following were also evaluated: age, sex, affected eye and type of neovascularization (1, 2, 3, polypoid or mixed). The analysis were performed using the statistical software R (version 3.3.2) and the glmmADMB package (version 0.8.3.3). Results The presence of pseudocysts and external retinal tubulation increases throughout the follow-up. The onion sign begins with an ascending frequency up to 12 months, then decreases at 18 months and increases again at 24 months. Regarding pseudowelling, it maintains an increase until 18 months to finally decrease. Subretinal clefts is the rarest sign, presenting in 1.1% on the first visit. Finally, macular atrophy, present in 12.6% of the eyes initially, is found in 25% after 2 years. Conclusion Pseudocysts, external retinal tubulation and macular atrophy were the most prevalent signs, while subretinal clefts were the most infrequent (AU)

Evaluation of non-exudative tomographic signs in cases of exudative age-related macular degeneration.

OBJECTIVE: To analyse the prevalence of non-exudative tomographic signs (onion sign, pseudoswelling, external retinal tubulation, pseudocysts, subretinal clefts and macular atrophy) in patients with neovascular age-related macular degeneration. MATERIAL AND METHODS: A total of 174 eyes of patients with neovascular age-related macular degeneration who had not received previous treatment were included in the study. Visual acuity, neovascularization activity, and the appearance or not of the different signs under study were assessed at times 0 (initial visit), 4 months, one year, year and a half, and at 2 and 3 years of follow-up. The following were also evaluated: age, sex, affected eye and type of neovascularization (1, 2, 3, polypoid or mixed). The analysis were performed using the statistical software R (version 3.3.2) and the glmmADMB package (version 0.8.3.3). RESULTS: The presence of pseudocysts and external retinal tubulation increases throughout the follow-up. The onion sign begins with an ascending frequency up to 12 months, then decreases at 18 months and increases again at 24 months. Regarding pseudowelling, it maintains an increase until 18 months to finally decrease. Subretinal clefts is the rarest sign, presenting in 1.1% on the first visit. Finally, macular atrophy, present in 12.6% of the eyes initially, is found in 25% after 2 years. CONCLUSION: Pseudocysts, external retinal tubulation and macular atrophy were the most prevalent signs, while subretinal clefts were the most infrequent.

Correlation between contrast sensitivity and morphological features obtained by OCT in patients with age-related macular degeneration treated with a loading dose of vascular endothelial growth factor inhibitors.

OBJECTIVE: To determine the correlation between contrast sensitivity and morphological characteristics obtained by Optical Coherence Tomography (OCT) in patients with Age-Related Macular Degeneration treated with a loading dose of vascular endothelial growth factor inhibitors (anti-VEGF). DESIGN: This is an ambispective (prospective + retrospective) observational, cross-sectional, and analytical study. PARTICIPANTS: All patients over 55 years of age with Age-Related Macular Degeneration who attended the Retina service of the Ophthalmology department and met the inclusion criteria between March-May 2022. METHODS: Data collection was carried out by reviewing the records of patients diagnosed with Age-Related Macular Degeneration of the neovascular variety treated with the loading dose of anti-VEGF. OCT studies obtained by Optovue® iVue80 prior to the application of intravitreal injections of patients who met the inclusion criteria and were currently in the first month after the last dose of anti-VEGF were analyzed. A total of 33 subjects were included, of which 30 continued follow-ups. The subjects underwent a new ophthalmological evaluation and new retinal measurements of the affected eye. Normality tests (Shapiro‒Wilk) were performed where a nonparametric data distribution was demonstrated. RESULTS: A linear regression analysis was performed comparing the logarithmic values of both visual acuity and contrast sensitivity, obtaining a significant relationship between both values after the application of treatment (P = <.0001***). Likewise, correlation was demonstrated between the decrease in contrast sensitivity values and all the characteristics evaluated in the patients' OCT. CONCLUSIONS: Antiangiogenesis strategies can lead to better results in global visual function, positively impacting contrast sensitivity.

Análisis de minimización de costes de brolucizumab en el tratamiento de la degeneración macular asociada a la edad neovascular / Cost minimization analysis of brolucizumab in the treatment of neovascular age-related macular degeneration

Introducción Brolucizumab es un nuevo fármaco antifactor de crecimiento endotelial vascular (anti-VEGF) administrado con una pauta fija de ocho o 12 semanas que en los estudios HAWK y HARRIER demostró ser no inferior a aflibercept con respecto a la mejor agudeza visual corregida, bajo una menor carga de administración. El objetivo del análisis fue comparar los costes directos sanitarios de ambos anti-VEGF como tratamiento en pacientes con degeneración macular asociada a la edad neovascular. Material y métodos Se realizó un análisis de minimización de costes bajo un horizonte temporal de 25 años y considerando el coste farmacológico, de administración, de pruebas de seguimiento y del manejo de eventos adversos. El uso de recursos fue obtenido de literatura relacionada y validada por expertos clínicos. Se llevaron a cabo diversos análisis de escenarios para comprobar la robustez de los resultados. Resultados Brolucizumab resultó con un menor coste por paciente en comparación con aflibercept, considerando el número de inyecciones derivadas de los estudios HAWK y HARRIER. Este resultado se mantuvo en los diferentes escenarios analizados, excepto frente al número de inyecciones de la pauta flexible de aflibercept del estudio ARIES, ya que la menor discontinuación de tratamiento con brolucizumab conlleva mantener el tratamiento de más pacientes. Al considerar la misma discontinuación, brolucizumab mantuvo los resultados observados en el caso base del análisis. Conclusiones El presente estudio muestra como la pauta de administración fija de brolucizumab puede ayudar a disminuir la carga asistencial para los centros sanitarios y los pacientes (AU)

Introduction Brolucizumab is a novel anti-vascular endothelial growth factor (anti-VEGF) drug administered in a fixed regimen of 8 or 12 weeks which, in the HAWK and HARRIER studies, was shown not to be inferior to aflibercept with respect to the best corrected visual acuity, with a less burdensome treatment regimen. The aim of the analysis was to compare the direct healthcare costs of both anti-VEGF as a treatment in patients with neovascular age-related macular degeneration.Material and methods A cost minimization analysis was performed under a 25-year time horizon and considering the drug costs, administration, follow-up tests, and management of adverse events. Resource use was obtained from the related literature and validated by clinical experts. Various scenario analysis were carried out to check the robustness of the results. Results Brolucizumab resulted in a lower cost per patient compared with aflibercept, considering the number of injections derived from the HAWK and HARRIER studies. This result was maintained in the different scenarios analysed, except for the number of injections of the flexible aflibercept regimen of the ARIES study, since the lower discontinuation of treatment with brolucizumab implies maintaining the treatment of more patients. Considering the same discontinuation, brolucizumab maintained the results observed in the base case of the analysis. Conclusions This study shows how the fixed administration regimen of brolucizumab can help reduce both healthcare and patients’ burden (AU)

Cost minimization analysis of brolucizumab in the treatment of neovascular age-related macular degeneration.

INTRODUCTION: Brolucizumab is a novel anti-vascular endothelial growth factor (anti-VEGF) drug administered in a fixed regimen of 8 or 12 weeks which, in the HAWK and HARRIER studies, was shown not to be inferior to aflibercept with respect to the best corrected visual acuity, with a less burdensome treatment regimen. The aim of the analysis was to compare the direct healthcare costs of both anti-VEGF as a treatment in patients with neovascular age-related macular degeneration. MATERIAL AND METHODS: A cost minimization analysis was performed under a 25-year time horizon and considering the drug costs, administration, follow-up tests, and management of adverse events. Resource use was obtained from the related literature and validated by clinical experts. Various scenario analysis were carried out to check the robustness of the results. RESULTS: Brolucizumab resulted in a lower cost per patient compared with aflibercept, considering the number of injections derived from the HAWK and HARRIER studies. This result was maintained in the different scenarios analysed, except for the number of injections of the flexible aflibercept regimen of the ARIES study, since the lower discontinuation of treatment with brolucizumab implies maintaining the treatment of more patients. Considering the same discontinuation, brolucizumab maintained the results observed in the base case of the analysis. CONCLUSIONS: This study shows how the fixed administration regimen of brolucizumab can help reduce both healthcare and patients' burden.

Carga económica de la degeneración macular neovascular y el edema macular diabético en Colombia / Economic burden of neovascular macular degeneration and diabetic macular edema in Colombia

Antecedentes: La pérdida de visión tiene consecuencias tanto en la salud como en la estabilidad económica, ya que promueve retrasos en el desarrollo emocional, social, además de reducciones en la productividad laboral. Objetivo: Estimar la carga económica de la degeneración macular asociada a la edad neovascular (DMAEn) y el edema macular diabético (EMD) en Colombia para el año 2022. Método: Para una perspectiva social se incluyeron costos directos utilizando la aproximación de Bottom-up y costos indirectos relacionados con la pérdida de productividad. Resultados: El costo directo de un paciente con DMAEn fue 5.974 USD$ desde una base teórica. A nivel nacional, la DMAEn costaría 179,9 millones USD$. Los costos indirectos de DMAEn se estimaron en 13,9 millones USD$. Los costos directos teóricos en EMD fueron 741,6 millones USD$. El costo nacional sería de 132,04 millones USD$. Para los costos indirectos de EMD, se estimó un costo de 93,3 millones USD$. Conclusiones: La DMAEn y el EMD tienen un alto impacto para el sistema de salud y la sociedad.

Background: The vision loss has consequences for both health and economic stability, since it promotes delays in emotional and social development, as well as reductions in labor productivity. Objective: To estimate the economic burden of age-related macular degeneration (AMD) and diabetic macular edema (DME) in Colombia for 2022. Method: For a social perspective, direct costs were included using the bottom-up approach, and indirect costs related to lost productivity. Results: The direct costs of treating a patient with AMD were USD $5,974 from a theoretical background. At national level, the AMD would cost USD $179.9 million. The AMD indirect cost in Colombia was estimated in USD $13.9 million. Patients theoretical direct cost of DME was USD $741.6 million. The cost at national level is USD $132.04 million. Regarding the indirect costs result for DME, a cost of USD $93.31 million was estimated. Conclusions: The AMD and the DME have a considerable impact on the health system and society.

Análisis de minimización de costos de brolucizumab para la DMAEh en Colombia / Cost minimization analysis of brolucizumab for wAMD in Colombia

Introducción: La degeneración macular asociada a la edad húmeda (DMAEh) tiene un impacto negativo en la calidad de vida. Brolucizumab es una alternativa efectiva y segura. Objetivo: Evaluar la diferencia en costos anuales de tratamiento entre brolucizumab 6 mg (esquema 6 LP → q12/q8), ranibizumab 0.5 mg (esquema Treat and Extend [TREX]) y aflibercept 2 mg (esquema TREX) para pacientes con DMAEh en Colombia. Materiales y métodos: Se realizó un análisis de minimización de costos con un horizonte temporal de cinco años y una tasa de descuento del 5%. Se consideraron costos médicos directos mediante fuentes locales. Se realizó un análisis de sensibilidad univariante. Resultados: El uso de brolucizumab implica un ahorro anual del 7.63% vs. aflibercept y del 12.8% vs. ranibizumab. Estos resultados fueron consistentes con los análisis de sensibilidad. Conclusiones: En un horizonte temporal de cinco años, brolucizumab es una tecnología costo-ahorradora para el tratamiento de la DMAEh en Colombia.

Background: Wet age-related macular degeneration (wAMD) has a negative impact on quality of life. Brolucizumab is an effective and safe alternative. Objective: To assess the difference in annual treatment costs between brolucizumab 6 mg (6 LP → q12/q8 schedule), ranibizumab 0.5 mg (Treat and Extend [TREX schedule]), and aflibercept 2 mg (TREX schedule), for patients with AMD in Colombia. Materials and methods: A cost minimization analysis was performed with a time horizon of five years and a discount rate of 5%. Direct medical costs were considered through local sources. A univariate sensitivity analysis was performed. Results: The use of brolucizumab implies an annual saving of 7.63% vs. aflibercept and 12.8% vs. ranibizumab. These results were consistent with the sensitivity analyses. Conclusions: In a time horizon of 5 years, brolucizumab is a cost-saving technology for the treatment of AMD in Colombia

Imágenes multimodales en desgarro del epitelio pigmentario de la retina. Reporte de caso / Multimodal imaging in retinal pigment epithelium tear. Case report

Los desgarros del epitelio pigmentario de la retina (EPR) pueden ocurrir espontáneamente o asociados al tratamiento con terapia antiangiogénica intravítrea (anti-VEGF) para la degeneración macular asociada a la edad neovascular (DMAEn). El objetivo de este estudio fue describir el caso de un desgarro del EPR en un paciente con neovascularización macular luego del tratamiento con terapia anti-VEGF. Paciente de sexo masculino, de 73 años, con diagnóstico de neovascularización macular mixta y desprendimiento fibrovascular del EPR en el ojo derecho; recibió tratamiento con terapia antiangiogénica, presentando un desgarro del EPR. Este puede desarrollarse como una complicación asociada al tratamiento con terapia anti-VEGF en pacientes con DMAEn. Describimos el uso de imágenes multimodales en el diagnóstico de esta patología.

Retinal pigment epithelium (RPE) tears can occur spontaneously or in association with intravitreal antiangiogenic therapy (anti-VEGF) treatment for neovascular age-related macular degeneration (AMD). The objective of this study was to describe the case of a RPE tear in a patient with macular neovascularization after treatment with anti-VEGF therapy. A 73-year-old male patient with a diagnosis of mixed macular neovascularization and fibrovascular detachment of the RPE in the right eye; he received treatment with antiangiogenic therapy, presenting a RPE tear. This can develop as a complication associated with treatment with anti-VEGF therapy in patients with AMD. We describe the use of multimodal imaging in the diagnosis of this pathology.

Calidad de vida según función visual en degeneración macular húmeda asociada a la edad tratada con Bevacizumab / Quality of Life According to Visual Function in Age-related Wet Macular Degeneration Treated with Bevacizumab

Introducción: La degeneración macular asociada a la edad, es causa frecuente de ceguera o baja visión en el adulto mayor. La valoración de la calidad de vida relativa a la función visual, es fundamental en estos pacientes tratados con Bevacizumab. Objetivo: Evaluar la calidad de vida en relación con la función visual en pacientes con degeneración macular tratada con Bevacizumab asociada a la edad. Métodos: Estudio descriptivo longitudinal prospectivo realizado en el ICO "Ramón Pando Ferrer", desde enero de 2019 hasta mayo de 2021. La muestra fue de 52 pacientes. El cuestionario NEI VFQ-25 fue aplicado antes y después de la administración de las tres dosis del medicamento intravítreo. Resultados: Predominó el sexo femenino, el grupo etario de mayor representación fue el de 60 a 79 años, la enfermedad sistémica más frecuente fue la hipertensión y ocular, la catarata. Casi todos los pacientes ganaron más de dos líneas en la cartilla de Snellen, el 42,3 por ciento presentó una ganancia de 3 líneas o más. El resultado de la mayoría de los elementos que explora el test, así como la función visual total es significativo desde el punto de vista estadístico. Conclusiones: Hubo una mejoría en la calidad de vida relativa a la función visual en los pacientes después de ser tratados con Bevacizumab. No existió una relación directamente proporcional entre la mejor agudeza visual post tratamiento y la mejora de la función visual total(AU)

Introduction: Age-related macular degeneration constitutes a frequent cause of blindness or low vision in the older adult. The assessment of quality of life related to visual function is essential in these patients treated with Bevacizumab. Objective: To assess the quality of life in relation to visual function in patients with age-related macular degeneration treated with Bevacizumab, at the ICO "Ramón Pando Ferrer", from January 2019 to May 2021. Methods: Prospective longitudinal descriptive study. The sample was 52 patients and the NEI VFQ-25 questionnaire was applied before and after three doses of the intravitreal drug. Results: Female gender predominated, the most represented age group was 60 to 79 years, the most frequent systemic disease was hypertension and the most frequent ocular disease was cataract. Almost all patients gained more than two lines in the Snellen chart, 42.3 percent presented a gain of 3 lines or more. The result of most of the items explored by the test, as well as the total visual function is statistically significant. Conclusions: There was an improvement in quality of life relative to visual function in patients after being treated with Bevacizumab. There was no directly proportional relationship between improved post-treatment visual acuity and improvement in total visual function(AU)