Anti-VEGF injection frequency correlates with visual acuity outcomes in pro re nata neovascular AMD treatment

Wecker, Thomas; Grundel, Bastian; Reichl, Sabine; Stech, Milena; Lange, Clemens; Agostini, Hansjürgen; Böhringer, Daniel; Stahl, Andreas

doi:10.1038/s41598-019-38934-8

Cited by 43 publications

(32 citation statements)

References 13 publications

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“…All experiments were performed in accordance with relevant guidelines and regulations. The methods of clinical data acquisition have been described previously 6 , 7 and are briefly summarized here: all analyses reported in this study are per eye; VA was acquired on decimal charts and converted to ETDRS-equivalents for analysis. In contrast to controlled trials this is a real-life cohort, implying that a number of different operators collected VA as well as other measurements and that operators changed over the years.…”

Section: Methodsmentioning

confidence: 99%

Real-life medium term follow-up data for intravitreal dexamethasone implant in retinal vein occlusion

Wecker

Grundel

et al. 2021

Sci Rep

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Macular edema (ME) is the most frequent vision threatening consequence after retinal vein occlusion (RVO). In this study, we evaluate the effect of dexamethasone intravitreal implants (DII, Ozurdex) in a real-life cohort of 99 patients with ME due to RVO. All patients who received DII for ME following RVO between 2011 and 2016 at the University Eye Hospital Freiburg, Germany and who had fully accessible electronic medical records were eligible for this study. Most of the patients included in this study were not treatment-naïve: 61 eyes had received prior anti-VEGF drugs, 6 eyes had received intravitreal corticosteroids (triamcinolone) and 15 had been treated with both; 17 eyes were treatment-naïve. Mean follow-up was 312 ± 310 days. Mean visual acuity (VA) was maintained throughout the observation period (mean VA at baseline: 66.7 ± 23.5 letters; at last observation 64.9 ± 28.3). Central retinal thickness (CRT) decreased from 526 ± 179 µm at baseline to 431 ± 199 µm. Mean intraocular pressure (IOP) increased from 14.4 ± 3.1 mmHg at baseline to 17.1 ± 6.3 mmHg. Cataract surgery was performed in 22% of phakic eyes. DII was used as second-line treatment in the majority of cases in this cohort. The fact that mean VA remained unchanged while mean CRT decreased illustrates that morphologic improvement does not always translate into functional gain. Mean IOP was maintained within normal limits and cataract formation was as expected in this age group.

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Section: Methodsmentioning

confidence: 99%

Real-life medium term follow-up data for intravitreal dexamethasone implant in retinal vein occlusion

Wecker

Grundel

et al. 2021

Sci Rep

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“…There are different anti-VEGF IVI protocols in the management of nAMD, including application in regular (monthly and bi-monthly) intervals or irregular (“pro-re-nata” [PRN, as needed] and “treat-and-extend” [TAE]) intervals after three consecutive monthly loading doses [ 5 – 8 ]. While the regular fixed-interval protocols adopt a strategy of applying IVI regardless of whether any sign of disease activity present, in the PRN treatment protocol, the IVI decision is made according to any sign of disease activity in monthly visits [ 5 – 7 ]. However, TAE is an individualized, proactive dosing regimen, in which, after three consecutive loading IVI doses, in-person visits and at-the-same-day IVI treatment intervals are extended (1 week to 4 weeks, to a maximum of 12 weeks) or shortened (1 week to 4 weeks, to a minimum of 4 weeks) according to predefined disease activity criteria [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

The effect of COVID-19 pandemic restrictions on neovascular AMD patients treated with treat-and-extend protocol

et al. 2021

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Purpose To investigate the adherence rate of neovascular age-related macular degeneration (nAMD) patients in treat-and-extend (TAE) protocol to their anti-vascular endothelial growth factor (anti-VEGF) intravitreal injection (IVI) appointments and to evaluate the functional and anatomical outcomes of the patients who attended and did not attend their IVI appointments during the coronavirus disease 2019 (COVID-19) restriction period (RP). Methods The patients with nAMD having IVI appointments between March 16 and June 1, 2020 (RP in Turkey) were included in this retrospective study. For adherence analysis, the patients who attended (Group 1, n = 44) and who did not attend (Group 2, n = 60) their IVI appointment visits during the RP ( V RP ) were evaluated according to their last visit before the RP ( V 0 ). For outcome analysis, the patients who attend V RP and have follow-up (Group 1a, 46 eyes) and who did not attend V RP but later attended for follow-up (Group 2a, 33 eyes) were evaluated for functional (best-corrected visual acuity, BCVA [logMAR]) and anatomical (optical coherence tomography [OCT] disease activity) outcomes at the first visit after RP ( V 1 ) and last visit within six months after RP ( V 2 ). Patients received a complete ophthalmologic evaluation with anti-VEGF (Aflibercept) IVI administration at all visits. Results The adherence rate of the patients to V RP was 42.3% (44/104). The patients in Group 1 were significantly younger (mean ± SD years, 71.0 ± 8.1 vs. 74.7 ± 8.0, p = 0.024), had better median [IQR] BCVA at their first presentation (0.30 [0.54] vs. 0.61 [1.08], p = 0.023) and V 0 (0.40 [0.48] vs. 0.52 [0.70], p = 0.031), and had less hypertension (36.4% vs. 58.3%, p = 0.044) than Group 2. The mean ± SD delay of planned IVI at V RP in Group 2a was 13.9 ± 6.2 weeks. Disease activity in OCT was significantly higher in Group 2a than Group 1a at V 1 (60.6% vs. 32.6%, p = 0.025). In Group 2a, the median (IQR) BCVA was significantly worse at V 1 (0.70 [0.58]) and V 2 (0.70 [0.59]) than V 0 (0.52 [0.40], p = 0.047 and p = 0.035, respectively). Conclusions More than half of the scheduled nAMD patients in TAE protocol mi...

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“…Although these fixed-interval regimens represent on-label standards for anti-VEGF therapy, discontinuous regimens are mostly used in clinical practice in order to reduce treatment burden. The "pro-re-nata" (PRN -"as needed") protocol is based on re-treatment on evidence of exudative disease activity [13]. Conversely, the "treat and extend" (TREX) regimen is characterized by a progressive extension of treatment and visit intervals up to 12 weeks depending on the clinical findings [14].…”

Section: Introductionmentioning

confidence: 99%

Short-term outcomes of patients with neovascular exudative AMD: the effect of COVID-19 pandemic

Borrelli

Grosso

Vella

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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Purpose To estimate the impact of delayed care during the coronavirus disease 2019 (COVID-19) pandemic on the outcomes of patients with neovascular age-related macular degeneration (AMD). Methods Consecutive patients with diagnosis of neovascular AMD were consecutively enrolled between March 9, 2020, and June 12, 2020, (during and immediately after the Italian COVID-19 quarantine). During the inclusion (or pandemic) visit (V 0), patients received a complete ophthalmologic evaluation, including optical coherence tomography (OCT). Best-corrected visual acuity (BCVA) and OCT findings from the two preceding visits (V −1 and V −2) were compared with data at V 0. Results One-hundred patients (112 eyes) were enrolled in this study. The time interval between following visits was 110.7 ± 37.5 days within V 0 and V −1 and 80.8 ± 39.7 days within V −1 and V −2 , respectively (P < 0.0001). BCVA was statistically worse at the V 0 visit as compared with the immediately preceding (V −1) visit (0.50 ± 0.43 LogMAR and 0.45 ± 0.38 LogMAR at the V 0 and V −1 visits, respectively; P = 0.046). On structural OCT, 91 out of 112 (81.2%) neovascular AMD eyes displayed the evidence of exudative disease activity at the V 0 visit, while 77 (68.7%) eyes exhibited signs of exudation at the V −1 visit (P = 0.022). No differences in terms of BCVA and OCT findings were detected between the V −1 and V −2 visits. In multiple regression analysis, the difference in BCVA between V 0 and V −1 visits was significantly associated with the interval time within these two visits (P = 0.026). Conclusion The COVID-19 pandemic-related postponement in patient care proved to be significantly associated with worse short-term outcomes in these patients. Keywords COVID-19. Retina. Neovascular AMD. Outcome This is part of a topical collection on Perspectives on COVID-19

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Anti-VEGF injection frequency correlates with visual acuity outcomes in pro re nata neovascular AMD treatment

Cited by 43 publications

References 13 publications

Real-life medium term follow-up data for intravitreal dexamethasone implant in retinal vein occlusion

Real-life medium term follow-up data for intravitreal dexamethasone implant in retinal vein occlusion

The effect of COVID-19 pandemic restrictions on neovascular AMD patients treated with treat-and-extend protocol

Short-term outcomes of patients with neovascular exudative AMD: the effect of COVID-19 pandemic

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