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Initial Utilization of Aflibercept in Exudative Age-related Macular Degeneration
摘要： Purpose: Intravitreal aflibercept, a fusion protein with high affinity for vascular endothelial growth factor, offers an alternative treatment for exudative age-related macular degeneration. Preclinical studies and early and late phase clinical trials suggest that aflibercept’s high binding affinity may impart greater durability of activity and increased efficacy compared to ranibizumab or bevacizumab. Methods: A total of 266 eyes of 249 patients with exudative age-related macular degeneration who received aflibercept after treatment with bevacizumab and/or ranibizumab were included in a retrospective review. Mean central subfoveal thickness on spectral-domain optical coherence tomography and mean logarithm of the minimal angle of resolution (logMAR) visual acuity were calculated at 1, 3, 6, and 12 months after the first aflibercept injection. Subgroup analyses were performed in eyes receiving at least 5 bevacizumab and/or ranibizumab injections in the 6 months prior to aflibercept and in eyes receiving at least 10 injections in the 12 months prior to aflibercept. Results: Eyes received an average of 14.7 (range 1-43) ranibizumab and/or bevacizumab treatments prior to initiation of aflibercept therapy. The mean central subfoveal thickness decreased from 300 to 275 μm at 1 month (p<0.001) and was maintained at 6 months. Mean logMAR visual acuity improved from 0.60 (Snellen equivalent 20/80) to 0.54 (20/70, p = 0.01) at 1 month and was stable at 0.55 at 6 months (Snellen equivalent 20/70, p = 0.11, n = 251). In 82 eyes receiving at least 5 injections in the 6 months prior to aflibercept treatment (average of 18.1 injections total), the central subfoveal thickness improved from 296 to 279 μm at 1 month (p<0.0001) and was maintained at 6 months (p<0.0001). Visual acuity did not change (0.48 [20/61] at 1 month compared to baseline, 0.49 [20/62], p = 0.634, and at 6 months 0.51 [20/65], p = 0.601). In 50 eyes receiving at least 10 injections in the 12 months prior to aflibercept treatment (average of 21.8 injections total), the mean central subfoveal thickness decreased by 17 μm at 1 month (p = 0.0007) and was maintained at 6 months (p = 0.013). Again, visual acuity did not change (0.46 [20/56] at 1 month, baseline 0.44 [20/56], p = 0.547, and 0.50 [20/63] at 6 months, p = 0.2445). Conclusions: Aflibercept is a valuable treatment alternative in patients previously treated with bevacizumab and/or ranibizumab injections. Stability of visual acuity and anatomic improvement on spectral-domain optical coherence tomography were observed after initiation of aflibercept treatment in those previously treated with ranibizumab and/or bevacizumab injections every 4-6 weeks.
关键词： Ranibizumab,Age-related macular degeneration,Choroidal neovascularization,Aflibercept,Bevacizumab
更新于2025-09-10 09:29:36
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LONG-TERM VISUAL OUTCOMES AND CLINICAL FEATURES AFTER ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR INJECTION–RELATED ENDOPHTHALMITIS
摘要： Purpose: To determine long-term visual outcomes in patients who developed endophthalmitis after intravitreal anti–vascular endothelial growth factor injections and to correlate visual outcomes with clinical features. Methods: This is a retrospective, multicenter, consecutive case series of patients diagnosed with anti–vascular endothelial growth factor injection–related endophthalmitis who were treated at Mid Atlantic Retina, the Retina Service of Wills Eye Hospital, Philadelphia, PA, and the University of Southern California Roski Eye Institute, Los Angeles, CA. Patients were included if they had at least 1 year of follow-up. Primary outcome was to evaluate long-term visual outcomes up to 5 years of follow-up. The secondary outcome was to determine clinical features (e.g., culture results) that may predict long-term visual acuity outcomes. Results: A total of 56 cases of endophthalmitis from 168,247 anti–vascular endothelial growth factor injections were identi?ed (0.033%, 1/3,004 injections), from which 51 eyes met inclusion criteria. Mean follow-up period was 3.3 years (median 4 years; range 1–5 years). A total of 24 patients (47%) reached a maximum ?nal follow-up of 5 years. Mean Snellen visual acuity at the causative injection visit was 20/102 and decreased to counting ?ngers at diagnosis (P , 0.001). At 6-month follow-up, mean visual acuity improved to 20/644 (P , 0.001) and remained stable up to 5 years (20/480, P = 0.003) follow-up compared with diagnosis. At the ?nal follow-up, 20 eyes had visual acuity that returned to within one line of baseline visual acuity (visual recovery group), whereas 31 patients’ visual acuity was at least one line worse than initial visual acuity (visual deterioration group). The cultures for the visual recovery group were more likely to grow coagulase-negative Staphylococcus, whereas the visual deterioration group primarily grew Streptococcus species, Staphylococcus aureus, and Enterococcus faecalis (P = 0.002, comparing organisms isolated in the visual recovery and deterioration group). Conclusion: Visual outcomes after anti–vascular endothelial growth factor injection– related endophthalmitis seem to reach peak improvement by 6 months and remain stable up to a median of 4-year follow-up. Patients who develop culture-negative endophthalmitis or endophthalmitis secondary to coagulase-negative Staphylococcus are more likely to regain baseline visual acuity compared with cases secondary to Streptococcus species.
关键词： bevacizumab,anti-vascular endothelial growth factor,diabetic macular edema,intravitreal injection,endophthalmitis,a?ibercept,long-term,ranibizumab,neovascular age-related macular degeneration,retinal vein occlusion
更新于2025-09-10 09:29:36
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Intravitreal Bevacizumab Injection for the Treatment of Choroidal Neovascularization Secondary to Candida Chorioretinitis
摘要： Purpose: To report a case of choroidal neovascularization (CNV) secondary to candida chorioretinitis initially treated with an intravitreal bevacizumab injection. Case summary: A 50-year-old female presented at our clinic with decreased vision and metamorphopsia in her left eye of 5 days duration. She received an anti-fungal treatment 2 months prior due to the presence of endogenous candida choroiditis in both eyes. Fluorescein angiography and optical coherence tomography (OCT) revealed juxtafoveal CNV in her left eye. Three monthly intravitreal injections of bevacizumab were administered as the initial loading dosage. Her visual symptoms improved and CNV regression was observed on OCT. No recurrence or complications were observed during the 6 month follow-up. Conclusions: Based on the present study results we suggest that intravitreal bevacizumab injection can be used to effectively treat CNV and improve visual symptoms during the treatment of juxtafoveal CNV associated with candida choroiditis.
关键词： Choroiditis,Intravitreal injection,Candida,Choroidal neovascularization,Bevacizumab
更新于2025-09-09 09:28:46
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A single-arm, investigator-initiated study of the efficacy, safety, and tolerability of intravitreal aflibercept injection in subjects with exudative age-related macular degeneration previously treated with ranibizumab or bevacizumab (ASSESS study): 12-month analysis
摘要： In subjects with active exudative age-related macular degeneration, treating with a fixed intravitreal aflibercept injection dosing regimen for 12 months demonstrated improved anatomic and vision endpoints from baseline. Purpose: Switching therapies in neovascular age-related macular degeneration (AMD) may offer an advantage for some patients. This study evaluates the efficacy of intravitreal aflibercept injection (IAI) in subjects previously treated with ranibizumab and/or bevacizumab. Methods: Subjects (n=26) were given monthly 2 mg of IAI for 3 months, followed by 2 mg once in every 2 months for up to 12 months. The mean absolute change from baseline in central subfield thickness (CST) measured by optical coherence tomography and the mean change from baseline in best-corrected visual acuity (BCVA) early treatment in diabetic retinopathy study (ETDRS) letter score were obtained. Additionally, the percentage of subjects who gained or lost $15 letters of vision and the percentage of subjects who are 20/40 or better or 20/200 or worse were evaluated. Results: There was a mean decrease in CST of ?50.3 μm (P,0.001) and a mean increase in ETDRS BCVA of +9.2 letters (P,0.001). Twenty-seven percent of subjects experienced a $15-letter improvement in visual acuity, and no subject lost $3 lines of vision from baseline. Fifty percent of subjects were 20/40 or better, and 11.5% of subjects were 20/200 or worse at month 12. Conclusion: Fixed IAI dosing regimen for 12 months demonstrated improved anatomic and vision endpoints in subjects with active exudative AMD.
关键词： bevacizumab,aflibercept,vascular endothelial growth factors,ranibizumab,age-related macular degeneration
更新于2025-09-09 09:28:46
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The outcomes of aflibercept therapy in patients with age-related macular degeneration resistant to bevacizumab or ranibizumab
摘要： Purpose: This study was designed to assess the functional and anatomic outcomes of intravitreal a?ibercept injection in patients with wet age-related macular degeneration (AMD) refractory to intravitreal bevacizumab or ranibizumab therapy. Methods: This retrospective study included 43 eyes of 43 patients resistant to treatment with at least 6 injections of bevacizumab or ranibizumab. Persistent intraretinal and subretinal ?uid (IRF and SRF) on optical coherence tomography (OCT), no improvement in best corrected visual acuity (BCVA), and a central macular thickness (CMT) increase of more than 100 mm due to SRF and/or IRF compared to baseline for at least 6 monthly intravitreal bevacizumab or ranibizumab injections were de?ned as resistant to bevacizumab/ranibizumab therapy. BCVA, intraocular pressure (IOP), CMT, maximum retinal thickness (MRT), and maximum pigment epithelial detachment (PED) height (MPEDH) were evaluated before and after a?ibercept injections. Result: After initiating a?ibercept treatment, the mean ?nal BCVA logarithm of the minimum angle of resolution or recognition (logMAR) improved to 0.84 ± 0.59 which was statistically signi?cant compared to baseline (1.14 ± 0.51), (P < 0.001). After a?ibercept injection, statistically signi?cant reduction was noted in mean CMT (402.6 ± 196.7 mm vs 264.2 ± 52.85 mm, P < 0.05), MRT (435.3 ± 195.2 mm vs 282.2 ± 31.8 mm, P < 0.05), and MPEDH (154.2 ± 86.0 mm vs 68.3 ± 70.6 mm, P < 0.05). There was no correlation between the total number of previous injections and the increase of BCVA (r ? (cid:2)0.10, P ? 0.265). The decrease of mean IOP was statistically signi?cant under a?ibercept treatment (P < 0.001). Conclusions: The present study showed the ef?cacy of a?ibercept treatment in eyes with persistent retinal or SRF under bevacizumab or ranibizumab therapy. A signi?cant anatomical and functional improvement was noted.
关键词： A?ibercept,Age related macular degeneration,Bevacizumab,Ranibizumab,Anti-vascular endothelial growth factor
更新于2025-09-04 15:30:14