Nadim Rayess

Treatment Outcomes After 3 Years in Neovascular Age-Related Macular Degeneration Using a Treat-and-Extend Regimen

PURPOSE To determine 3-year treatment outcomes after 1 to 3 years of ranibizumab or bevacizumab therapy using a treat-and-extend regimen in patients with neovascular age-related macular degeneration (AMD). DESIGN Retrospective, interventional, consecutive case series. METHODS We treated 212 eyes from 196 patients diagnosed with treatment-naive neovascular AMD between January 2009 and March 2013; they were treated with either ranibizumab or bevacizumab for a minimum of 1 year, using a treat-and-extend regimen. The main outcome measures were change from baseline best-corrected Snellen visual acuity (BCVA), proportion of eyes losing <3 BCVA lines, proportion of eyes gaining ≥ 3 BCVA lines, change from baseline central retinal thickness, and mean number of injections at 1, 2 and 3 years of follow-up. RESULTS The mean follow-up period was 1.88 years (median, 2 years). At baseline, mean BCVA was 20/139; it improved to 20/79 (P < 0.001) after 1 year of treatment and was maintained at 20/69 and 20/64 at 2 and 3 years follow-up (P < 0.001), respectively. At baseline, mean central retinal thickness was 351 μm and significantly decreased to 285 μm, 275 μm and 276 μm at 1, 2 and 3 years of follow-up (P < 0.001), respectively. Patients received, on average, 7.6, 5.7 and 5.8 injections over years 1, 2 and 3 of treatment, respectively. At final follow-up, 94% of eyes had lost <3 lines BCVA, and 34.4% of eyes had gained ≥ 3 lines BCVA. CONCLUSIONS The treat-and-extend regimen is effective in achieving and maintaining visual and anatomic improvements in patients with neovascular AMD for up to 3 years of treatment.

Baseline Choroidal Thickness as a Predictor for Response to Anti–Vascular Endothelial Growth Factor Therapy in Diabetic Macular Edema

PURPOSE To determine the association between baseline subfoveal choroidal thickness and short-term response to intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in diabetic macular edema (DME). DESIGN Retrospective, consecutive case series. METHODS Fifty-three eyes from 42 patients diagnosed with treatment-naïve DME were treated with 3 monthly intravitreal injections of ranibizumab or bevacizumab. Serial enhanced depth imaging optical coherence tomography scans were used to measure subfoveal choroidal thickness and central macular thickness (CMT). Anatomic response (CMT decrease ≥ 50 μm) and functional response (best-corrected visual acuity gain ≥ 1 line) were assessed at 3 months follow-up using univariate and multivariate analyses. RESULTS After 3 monthly anti-VEGF treatments, subfoveal choroidal thickness decreased significantly (225 μm at baseline, 201 μm at 3 months, P < .0001). The anatomic responder group (32 eyes) had a greater baseline choroidal thickness (243 ± 15 μm) than the nonresponder group (21 eyes, 198 ± 13 μm, P = .03). Similarly, the functional responder group (28 eyes) tended to have a greater baseline subfoveal choroidal thickness (239 ± 12 μm) than the nonresponder group (25 eyes, 211 ± 16 μm, P = .08). Multivariate analyses revealed that a greater baseline subfoveal choroidal thickness was associated with a better anatomic (odds ratio = 1.12 for every 10 μm increase, P = .03) and functional response (odds ratio = 8.45 for >200 μm vs ≤ 200 μm, P = .008). CONCLUSION Baseline subfoveal choroidal thickness may help predict which patients with DME will respond more favorably in the short term to intravitreal anti-VEGF pharmacotherapy. In this study, eyes with a thicker baseline subfoveal choroidal thickness had better short-term anatomic and functional responses.

Influence Of Vitreomacular Interface On Anti-vascular Endothelial Growth Factor Therapy Using Treat And Extend Treatment Protocol For Age-related Macular Degeneration (vintrex)

Purpose: To determine the influence of vitreomacular adhesion (VMA) on treatment outcomes in patients with neovascular age-related macular degeneration who were treated with anti-vascular endothelial growth factor agents using a treat and extend treatment regimen. Methods: A retrospective consecutive case series of 204 eyes from 181 patients with a minimum of 1 year of follow-up at Wills Eye Hospital Retina Service. Vitreomacular interface characteristics were determined by spectral domain optical coherence tomography. One hundred and fifty-three eyes (75%) had no signs of VMA (non-VMA), and 51 (25%) had VMA. Results: Baseline mean visual acuity was 20/133 with a mean central retinal thickness of 350.5 &mgr;m in the non-VMA group and was 20/145 with 371.8 &mgr;m in the VMA group. Mean visual acuity in the non-VMA group was 20/83 and 20/64 at Years 1 and 2, respectively (P < 0.01 to baseline). Mean visual acuity in the VMA group was 20/81 and 20/85 at Years 1 and 2, respectively (P < 0.01 to baseline). The central retinal thickness was 289.71 &mgr;m and 267 &mgr;m at Years 1 and 2, respectively (P < 0.01 to baseline) in the non-VMA group and was 305.3 &mgr;m and 289.24 &mgr;m (P < 0.01 to baseline) in the VMA group. The mean total number of injections at Year 1 for non-VMA was 7.4 compared with 8.4 in VMA (P = 0.001) and 5.5 versus 6.7 for the 2 groups in Year 2 (P = 0.027). The mean longest extension at Year 1 was 11.8 weeks compared with 10.1 week (P = 0.005) and for Year 2 was 14.1 weeks compared with 12 weeks (P = 0.041). Conclusion: The vitreomacular interface seems to have a significant influence on anti-vascular endothelial growth factor treatment intervals but not visual acuity or exudative control outcomes. Eyes with VMA on spectral domain optical coherence tomography at baseline may require more intensive treatment with decreased ability to extend treatment intervals.

Radial Versus Raster Spectral-Domain Optical Coherence Tomography Scan Patterns for Detection of Macular Pathology

PURPOSE To compare the 6-line radial vs the 25-line raster spectral-domain optical coherence tomography (SD OCT) acquisition patterns at detecting intraretinal fluid, subretinal fluid, vitreomacular traction, and full-thickness macular hole (MH). DESIGN Retrospective cross-sectional analysis. METHODS Series of 365 eyes with neovascular age-related macular degeneration (AMD), diabetic macular edema (DME), central and branch retinal vein occlusion (CRVO/BRVO), central serous chorioretinopathy, vitreomacular traction, and full-thickness MH. Sequential 6-line radial and 25-line raster scans were evaluated for intraretinal/subretinal fluid and, when applicable, vitreomacular traction and MH. RESULTS For neovascular AMD (133 scans), 7 25-line raster scans confirmed subretinal/intraretinal fluid not identified by the 6-line radial (P=.02). For DME (140 scans) and central serous chorioretinopathy (91 scans), 25-line raster confirmed fluid in 4 scans (P=.13) and 1 scan (P=.32), respectively, that was not observed with the 6-line radial. For CRVO (123 scans) and BRVO (126 scans), 25-line raster confirmed fluid on 2 (P=.25) and 4 scans (P=.13), respectively, that was not detected by the 6-line radial. Conversely, for focal vitreomacular traction (70 scans) and full-thickness MH (82 scans), 25-line raster missed focal traction (<1500 μm) and MH in 5 scans (P=.07) and 7 scans (P=.02), respectively, that were identified using the 6-line radial. CONCLUSIONS The 6-line radial scan is statistically comparable to the 25-line raster at detecting fluid in DME, BRVO/CRVO, and central serous chorioretinopathy, but not neovascular AMD. Furthermore, it is superior to the 25-line raster pattern at detecting early MH formation, while demonstrating a positive trend in identifying focal vitreomacular traction.

Incidence and clinical features of post-injection endophthalmitis according to diagnosis

Purpose To compare the incidence and clinical features of endophthalmitis after intravitreal antivascular endothelial growth factor (VEGF) therapy for diabetic eye disease, neovascular age-related macular degeneration (AMD) and retinal vein occlusion (RVO). Methods Multicentre, retrospective, consecutive case–control study. All patients treated with intravitreal bevacizumab, ranibizumab or aflibercept for diabetic eye disease, neovascular AMD or RVO between 1 January 2009 and 30 September 2013 at three retina practices were included in this study. The total number of anti-VEGF injections administered for the three indications was calculated using billing records. Endophthalmitis cases were identified using both endophthalmitis log sheets and billing records. Patient charts were reviewed to confirm that endophthalmitis was directly related to anti-VEGF injection and to record clinical features and culture results. Results During the study period, a total of 353 978 intravitreal anti-VEGF injections were performed. Presumed infectious endophthalmitis occurred in 119 of 296 017 injections performed for neovascular AMD (1/2487, 0.040%), 12 of 24 541 for diabetic eye disease (1/2045, 0.049%) and 4 of 32 418 for RVO (1/8104, 0.012%). χ2 analysis found endophthalmitis rates to be higher in diabetic eye disease compared with RVO (p=0.010) and higher in neovascular AMD compared with RVO (p=0.014), while diabetic eye disease and neovascular AMD (p=0.517) had similar rates. The average age of the overall neovascular AMD patient population (81.9 years) was significantly older than the diabetic eye disease (64.7 years, p<0.001) and RVO (73.4 years, p<0.001) populations. Conclusions Endophthalmitis rates appear to be lower in eyes with RVO compared with diabetic eye disease and neovascular AMD, possibly due to impaired immunity in diabetics and waning immunity in the generally older AMD population.

TREATMENT OUTCOMES FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION PATIENTS WITH INITIAL VISION BETTER THAN 20/40 USING A TREAT-AND-EXTEND REGIMEN.

Purpose: To determine treatment outcomes in eyes with neovascular age-related macular degeneration having visual acuity better than 20/40 after 1 years to 2 years of ranibizumab or bevacizumab therapy using a treat-and-extend regimen. Methods: Retrospective observational case series. Clinical records were reviewed from patients with treatment-naive neovascular age-related macular degeneration and baseline best-corrected Snellen visual acuity >20/40 treated with intravitreal ranibizumab or bevacizumab for a minimum of 1 year using a treat-and-extend regimen. The primary outcome measures were change from initial visual acuity, proportion of eyes losing <3 best-corrected visual acuity lines, proportion of eyes maintaining visual acuity ≥20/40, change from baseline central retinal thickness, and mean number of injections after 1 years and 2 years of follow-up. Results: A total of 42 eyes from 40 patients were included. The mean follow-up period was 1.44 years. The mean initial logMAR visual acuity was 0.226, and remained stable at 0.257 and 0.267 after 1 years and 2 years of follow-up, respectively. At baseline, mean central retinal thickness was 305.8 &mgr;m, improved to 272.6 &mgr;m after 1 year of treatment (P < 0.001), and remained stable at 266.2 &mgr;m (P = 0.015) after 2 years. At 1-year follow-up period, 94.4% of eyes had lost less than 3 Snellen lines, and 94.1% of eyes lost less than 3 Snellen lines after 2 years. The percentage of eyes maintaining visual acuity ≥20/40 was 81% and 75% after each year. Eyes received on average 7.8 injections during the first year of treatment and 6.1 injections over the second year. Conclusion: Eyes with neovascular age-related macular degeneration presenting with initial visual acuity better than 20/40 on average maintained vision, lost less than 3 lines of acuity, and achieved anatomical improvements using a treat-and-extend regimen over a 2-year period.

Economic Evaluation of a Home-Based Age-Related Macular Degeneration Monitoring System

Background Medicare recently approved coverage of home telemonitoring for early detection of incident choroidal neovascularization (CNV) among patients with age-related macular degeneration (AMD), but no economic evaluation has yet assessed its cost-effectiveness and budgetary impact. Objectives To evaluate a home-based daily visual-field monitoring system using simulation methods and to apply the findings of the Home Monitoring of the Eye study to the US population at high risk for wet-form AMD. Design, Setting, and Participants In this economic analysis, an evaluation of the potential cost, cost-effectiveness, and government budgetary impact of adoption of a home-based daily visual-field monitoring system among eligible Medicare patients was performed. Effectiveness and visual outcomes data from the Age-Related Eye Disease Study 2 Home Monitoring of the Eye study, treatment data from the Wills Eye Hospital Treat & Extend study, and AMD progression data from the Age-Related Eye Disease Study 1 were used to simulate the long-term effects of telemonitoring patients with CNV in one eye or large drusen and/or pigment abnormalities in both eyes. Univariate and probabilistic sensitivity analysis and an alternative scenario using the Treat & Extend study control group outcomes were used to examine uncertainty in these data and assumptions. Interventions Home telemonitoring of patients with AMD for early detection of CNV vs usual care. Main Outcomes and Measures Incremental cost-effectiveness ratio, net present value of lifetime societal costs, and 10-year nominal government expenditures. Result Telemonitoring of patients with existing unilateral CNV or multiple bilateral risk factors for CNV (large drusen and retinal pigment abnormalities) incurs

Radial versus raster spectral-domain optical coherence tomography scan patterns for detection of macular fluid in neovascular age-related macular degeneration

907 (95% CI, −

MICROBIOLOGIC SPECTRUM AND VISUAL OUTCOMES OF ACUTE-ONSET ENDOPHTHALMITIS UNDERGOING THERAPEUTIC PARS PLANA VITRECTOMY.

6302 to

OUTCOMES OF RETINAL DETACHMENT REPAIR AFTER POSTERIOR OPEN GLOBE INJURY.

2809) in net lifetime societal costs, costs