scholarly journals Influence of vitreomacular interface score on treatment outcomes of anti-VEGF therapy for neovascular age-related macular degeneration

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Manabu Miyata ◽  
Sotaro Ooto ◽  
Kenji Yamashiro ◽  
Hiroshi Tamura ◽  
Akihito Uji ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Multivariable Analysis ◽  
Posterior Vitreous Detachment ◽  
Case Series ◽  
Poor Response ◽  
Resistance Rate ◽  
Age Related Macular Degeneration ◽  
Swept Source ◽  
Age Related ◽  
Vitreomacular Interface

Abstract Background To quantitatively evaluate the vitreomacular interface of eyes with neovascular age-related macular degeneration (AMD) and to investigate its association with the 1-year treatment outcome following intravitreal injections of aflibercept (IVA). Methods This prospective observational case series included 59 eyes of 59 consecutive patients with treatment-naïve neovascular AMD who were treated with three monthly IVA and subsequent four bi-monthly IVA and were followed up for 1 year. We estimated posterior vitreous detachment at 1, 9, and 25 macular points within an area of 6 × 6 mm2 at the center of the fovea using the built-in enhanced vitreous visualization mode of swept-source optical coherence tomography. One year after the initial IVA, we classified the eyes into either wet or dry groups. Results The wet and dry groups included 12 and 47 eyes, respectively. The resistance rate against IVA was 20.3%. The 25-point interface score was higher in the wet group than in the dry group (23.0 ± 4.3 vs. 18.6 ± 9.8, P = 0.03), whereas there were no significant between-group differences in the 9-point and 1-point scores (P = 0.21, and 0.47, respectively) or in the other studied parameters. Multivariable analysis revealed that the 25-point vitreomacular interface score was strongly correlated with subfoveal choroidal thickness (P = 0.02, β =  − 0.31). Conclusions Our findings suggest that wide-ranged separation of the posterior vitreous membrane from the retina induces poor response to IVA.

scholarly journals The Spectrum of Central Choriocapillaris Abnormalities on Swept-Source Optical Coherence Tomography Angiography in the Fellow Eye of Unilateral Exudative Age-Related Macular Degeneration Patients: From Flow Deficits to Subclinical Non-Exudative Neovascularization

2021 ◽  
Vol 10 (12) ◽  
pp. 2658
Author(s):  
Alexis Khorrami Kashi ◽  
Eric Souied ◽  
Selim Fares ◽  
Enrico Borrelli ◽  
Vittorio Capuano ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Degeneration ◽  
Optical Coherence Tomography Angiography ◽  
Clinical Findings ◽  
Age Related Macular Degeneration ◽  
Optical Coherence ◽  
Swept Source ◽  
Exudative Amd ◽  
Age Related ◽  
Fellow Eyes

We evaluated the spectrum of choriocapillaris (CC) abnormalities in the fellow eyes of unilateral exudative age-related macular degeneration (AMD) patients using swept-source optical coherence tomography angiography (SS-OCTA). Fellow eyes of unilateral exudative AMD patients were prospectively included between May 2018 and October 2018. Patients underwent a multimodal imaging including a SS-OCTA. Demographics and clinical findings were analyzed. The estimated prevalence of macular neovascularization (MNV) was computed. Number and size of flow deficits (FDs) and percentage of flow deficits (FD%) were computed on the compensated CC flow images with the Fiji software. We included 97 eyes of 97 patients (mean age was 80 ± 7.66 years, 39 males, 58 females). The prevalence of MNV in the studied eyes was 8.25% (8/97 eyes). In the 89 non-neovascular eyes, FD% averaged 45.84% ± 11.63%, with a corresponding total area of FDs of 4.19 ± 1.12 mm2. There was a higher prevalence of drusenoid pigment epithelial detachment in eyes with subclinical neovascularization (p = 0.021). Fellow eyes with unilateral exudative AMD encompassed a series of CC abnormalities, from FDs of the aging CC to subclinical non-exudative MNV.

Choroidal changes in intermediate age-related macular degeneration patients with drusen or pseudodrusen

2020 ◽  
pp. 112067212091453 ◽  
Author(s):  
Raffaella Rosa ◽  
Paolo Corazza ◽  
Maria Musolino ◽  
Chiara Mochi ◽  
Guido Maiello ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Degeneration ◽  
Choroidal Thickness ◽  
Age Related Macular Degeneration ◽  
Optical Coherence ◽  
Flow Area ◽  
Swept Source ◽  
Reticular Pseudodrusen ◽  
Vascular Flow ◽  
Age Related

Reticular pseudodrusen are associated with a thinner choroid. The aim of our study was to determine the differences in central choroidal thickness and choriocapillaris vascular flow area between eyes with and without reticular pseudodrusen using swept-source optical coherence tomography and swept-source optical coherence tomography angiography. We conducted a retrospective case control study which included 27 eyes from 27 consecutive patients with intermediate age-related macular degeneration and 17 eyes from 17 healthy participants. Complete ophthalmic examinations were carried out including axial length measurements; fundus color retinography; fundus autofluorescence; swept-source optical coherence tomography and swept-source optical coherence tomography angiography; central choroidal thickness and choriocapillaris vascular flow area. Patients were classified as no reticular pseudodrusen, mild reticular pseudodrusen, and severe reticular pseudodrusen. Mean central choroidal thickness in patients exhibiting severe reticular pseudodrusen (110 ± 56 μm) was significantly smaller than in patients with no reticular pseudodrusen (201 ± 76 μm, p < 0.01). Mean choriocapillaris vascular flow area in severe reticular pseudodrusen patients (45.2% ± 3.0%) was also significantly less than in patients with no (47.9% ± 1.6%, p < 0.001) and mild reticular pseudodrusen (47.7% ± 1.0%, p < 0.05). Stepwise multiple regression models confirmed the association of reticular pseudodrusen with central choroidal thickness (p < 0.001) and choriocapillaris vascular flow area (p < 0.01) even after accounting for age, axial length, and refractive error. Soft drusen were not associated with changes in either central choroidal thickness (p = 0.13) nor choriocapillaris vascular flow area (p = 0.29). A significant, positive relationship was found between central choroidal thickness and choriocapillaris vascular flow area (r = 0.44, p = 0.01). Therefore, both central choroidal thickness and choriocapillaris vascular flow area are decreased in eyes with reticular pseudodrusen, as compared to healthy eyes and intermediate age-related macular degeneration eyes not exhibiting reticular pseudodrusen. In addition, central choroidal thickness and choriocapillaris vascular flow area are related, and the reduction of either is directly associated to the severity of reticular pseudodrusen. Further studies are needed to assess the clinical significance of these findings.

scholarly journals Association of age-related macular degeneration on fracture risks among osteoporosis population: a nationwide population-based cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e037028
Author(s):  
Chi Chin Sun ◽  
Ting-Shuo Huang ◽  
Tsai-Sheng Fu ◽  
Chia-Yi Lee ◽  
Bing-Yu Chen ◽  
...  
Keyword(s):  
Visual Impairment ◽  
Macular Degeneration ◽  
Hip Fractures ◽  
Multivariable Analysis ◽  
Age Related Macular Degeneration ◽  
Control Group ◽  
Research Database ◽  
Risk Of Death ◽  
Age Related ◽  
Ulnar Fracture

ObjectivesVisual impairment is an important risk factor for fracture in the elderly population. Age-related macular degeneration (AMD) is the leading cause of irreversible visual impairment in elderly people. This study was conducted to explore the relationship between AMD and incident fractures in patients with osteoporosis (OS).DesignRetrospective analysis of Taiwan’s National Health Insurance Research Database (NHIRD).SettingA multicenter study conducted in Taiwan.Participants and controlsThe current study used the NHIRD in Taiwan between 1996 and 2011. A total of 13 584 and 54 336 patients with OS were enrolled in the AMD group and the non-AMD group, respectively.InterventionPatients with OS were included from the Taiwan’s NHIRD after exclusion, and each patient with AMD was matched for age, sex and comorbidities to four patients with non-AMD OS, who served as the control group. A Cox proportional hazard model was used for the multivariable analysis.Primary outcome measuresTransitions for OS to spine fracture, OS to hip fracture, OS to humero-radio-ulnar fracture and OS to death.ResultsThe risks of spine and hip fractures were significantly higher in the AMD group (HR=1.09, 95% CI=1.04 to 1.15, p<0.001; HR=1.18; 95% CI=1.08 to 1.30, p=0.001, respectively) than in the non-AMD group. The incidence of humero-radio-ulnar fracture between AMD and non-AMD individuals was similar (HR=0.98; 95% CI=0.90 to 1.06; p=0.599). However, the risk of death was higher in patients with OS with older age, male sex and all types of comorbidity (p<0.05), except for hyperthyroidism (p=0.200).ConclusionPatients with OS with AMD had a greater risk of spine and hip fractures than did patients without AMD.

scholarly journals Simultaneous Dexamethasone Intravitreal Implant and Anti-VEGF Therapy for Neovascular Age-Related Macular Degeneration Resistant to Anti-VEGF Monotherapy

2017 ◽  
Vol 1 (1) ◽  
pp. 65-74 ◽  
Author(s):  
Bozho Todorich ◽  
Aristomenis Thanos ◽  
Yoshihiro Yonekawa ◽  
Gerta Mane ◽  
Madeleine Hasbrook ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Combined Treatment ◽  
Case Series ◽  
Dual Therapy ◽  
Age Related Macular Degeneration ◽  
Treatment Resistant ◽  
Dexamethasone Intravitreal Implant ◽  
Anti Vegf ◽  
Age Related ◽  
Intravitreal Implant

Purpose: To evaluate the efficacy of a dexamethasone intravitreal implant in combination with intravitreal anti-vascular endothelial growth factor (VEGF) agents for treatment-resistant neovascular age-related macular degeneration (nvAMD). Methods: This study was designed as a single-center, retrospective interventional case series. Consecutive patients with treatment-resistant nvAMD underwent simultaneous combined injection of anti-VEGF agent and dexamethasone intravitreal implant. Eighteen patients with mean age of 81.5 years were included. Patients received an average of 26.3 anti-VEGF injections before dual therapy, with a mean follow-up of 8.2 months after dual therapy. Results: Dual therapy produced a significant mean decrease in central foveal thickness (126.3 μm), compared to a mean increase in 29.9 μm when treated with anti-VEGF monotherapy ( P = .0017). Patients also had a mean decrease in macular cube volume of −0.85 mm3 with dual therapy compared to anti-VEGF monotherapy ( P = .0014). There was a moderate correlation between the number of prior anti-VEGF injections and the magnitude of anatomic response, suggesting that shorter disease duration may positively influence response to combined treatment. Although there was a slight trend toward improved mean visual acuity after dual therapy, these differences did not reach statistical significance. Nevertheless, with combination treatment, 33% of patients gained 1 or more lines of vision. Dual therapy resulted in a significantly lower number of required anti-VEGF injections (4.25 vs 5.33) and an increase in the anti-VEGF injection-free interval to 1.41 months from 1.12 months during the 6 months following dual therapy compared to the same interval before dual therapy. Dual therapy was well tolerated; 2 eyes developed mild intraocular pressure elevation effectively managed with topical therapy and 1 patient developed worsening cataract. Conclusions: Combined treatment of anti-VEGF with dexamethasone intravitreal implant is a viable alternative for treatment-resistant nvAMD and may reduce treatment burden. Earlier treatment with dual therapy may be beneficial to maximize anatomic and visual outcomes in these patients.

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