Treat-and-Extend Regimen for AMD
Rayess et al. evaluated a treat-and-extend regimen in patients with neovascular age-related macular degeneration (AMD) and found it to be an adequate treatment protocol for up to three years, as patients achieved and maintained significant visual and anatomic improvements.
For this consecutive case series, the researchers treated 212 eyes of 196 AMD patients with either intravitreal ranibizumab or bevacizumab for a minimum of one year using a treat-and-extend regimen. The mean follow-up period was 1.88 years. Patients received, on average, 7.6, 5.7, and 5.8 injections over years 1, 2, and 3 of treatment, respectively.
At baseline, mean best-corrected visual acuity (BCVA) was 20/139; it improved to 20/79 after one year of treatment and was maintained at 20/69 and 20/64 at two and three years, respectively. Mean central retinal thickness was 351 µm at baseline and significantly decreased to 285 µm, 275 µm, and 276 µm at one, two, and three years, respectively. At final follow-up, 94 percent of eyes had lost fewer than three lines of BCVA, and 34 percent of eyes had gained at least three lines.
Vitreomacular Adhesion Treated With Ocriplasmin
Warrow et al. evaluated treatment outcomes of intravitreal ocriplasmin in symptomatic vitreomacular adhesion (VMA). They found the VMA release rate was comparable to those reported by prior studies, despite inclusion of patients with macular comorbidities. In addition, spectral-domain optical coherence tomography (SD-OCT) identified a significant number of subjects with transient outer retinal attenuation.
For this retrospective interventional case series, the researchers included 35 patients (35 eyes) with symptomatic VMA who received intravitreal ocriplasmin injection.
Eleven patients (31 percent) had macular comorbidities. Average adhesion diameter was 571 µm, with a mean duration of symptoms of 7.9 months. Nine patients (26 percent) had epiretinal membrane, and six (17 percent) had macular hole (mean diameter, 186 µm)—one of which later closed. Mean preinjection logMAR visual acuity was 0.46 and improved to 0.33 at final follow-up. Fifteen eyes (43 percent) achieved adhesion release at a mean of 10 days after injection. Transient outer retinal attenuation occurred in 10 of 35 patients (29 percent), with eight of 10 (80 percent) achieving adhesion release. One patient (3 percent) developed a retinal detachment.
The researchers noted that VMA was more likely to resolve in younger patients without comorbidities and with small adhesion diameter, short adhesion duration, and transient outer retinal attenuation. They therefore recommend careful patient selection and postinjection SD-OCT monitoring.
Intravitreal Bevacizumab Every Two Weeks for Treatment of AMD
Barikian et al. evaluated the benefit of rapid induction with intravitreal bevacizumab for treatment of neovascular age-related macular degeneration (AMD). They found that biweekly induction did not increase the initial fluid-free interval or yield significant anatomic and functional benefits compared with monthly induction or an immediate pro re nata (PRN) regimen. Moreover, biweekly induction may be associated with development of subretinal fibrosis.
In this pilot study, patients with AMD were randomized 1:1:1 into one of three groups based on the initiation sequence: every two weeks for three consecutive injections, every four weeks for three consecutive injections, and immediate PRN after the first injection. Eyes with retinal angiomatous proliferation and polypoidal choroidal vasculopathy were excluded. Best-corrected visual acuity (BCVA) and central retinal thickness using optical coherence tomography (OCT) were measured at baseline and at each follow-up. After induction, bevacizumab was administered PRN based mainly on OCT findings. The main outcome measure was the mean initial fluid-free interval after induction. Secondary outcomes were mean improvement in BCVA and central retinal thickness.
Each group included 30 patients (30 eyes). The mean initial fluid-free interval was 2.4, 3.4, and 3.5 months for biweekly induction, monthly induction, and immediate PRN groups, respectively. These differences were not statistically significant when corrected for age and sex. Mean improvements in BCVA, central retinal thickness, and total number of injections were similar among the groups at 12 months. Six eyes in the biweekly induction group developed subretinal fibrosis compared with none of the eyes in the other two groups.
Progression Rates and Factors in Preperimetric Open-Angle Glaucoma
In this longitudinal, observational study, Kim et al. investigated the rate of progressive visual field (VF) loss and associated factors for progression in preperimetric open-angle glaucoma (OAG). They found that after at least five years of follow-up, a majority of medically treated, preperimetric OAG patients had structural or functional progression. In addition, optic disc hemorrhage and inadequate intraocular pressure (IOP) control were significantly associated with structural or functional deterioration.
The researchers included 127 eyes of 127 preperimetric OAG patients who were treated with topical medication and followed for more than five years. Progression was defined as a structural (glaucomatous change confirmed by stereo optic disc photography) or functional (new glaucomatous defect on standard automated perimetry) deterioration.
Glaucoma progression was detected in 72 of 127 eyes (57 percent). Mean rate of VF progression was –0.39 ± 0.64 dB per year in all patients, –0.66 ± 0.60 dB per year in progressors, and –0.03 ± 0.24 dB per year in nonprogressors. A multivariate Cox proportional hazard model revealed that optic disc hemorrhage and the percentage reduction in IOP were significantly associated with disease progression. Moreover, patients with disc hemorrhage had a greater cumulative probability of progression than those without disc hemorrhage.
American Journal of Ophthalmology summaries are edited by Thomas J. Liesegang, MD.
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