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One-year outcome of intravitreal aflibercept injection for age-related macular degeneration resistant to ranibizumab: rapid morphologic recovery and subsequent visual improvement
摘要： Objective: To describe the 1-year efficacy of aflibercept in Japanese patients with age-related macular degeneration (AMD) who were resistant to ranibizumab treatment. Design: Retrospective case series. Participants: Fourteen consecutive eyes of 14 patients with AMD were enrolled who had no substantial response or developed resistance to intravitreal ranibizumab injections. Methods: All patients were subcategorized into one of two subtypes of AMD: seven patients with occult choroidal neovascularization (CNV) and seven with polypoidal choroidal vasculopathy (PCV). Serial intravitreal aflibercept (IVA) injections were administered. Comprehensive ophthalmic examinations, including optical coherence tomography, were conducted at baseline and at follow-up examinations at 1, 3, 6, and 12 months after the initial IVA injection. The best-corrected visual acuity converted to logarithm of the minimum angle of resolution (logMAR) and central macular thickness (CMT) at each follow-up visit were compared with the baseline values. The anatomic response was also assessed with absorption or reduction of fluid in the subretina or subretinal pigment epithelial space. Results: The logMAR best-corrected visual acuity improved significantly at 3, 6, and 12 months in the total cohort: at 3 and 6 months in patients with occult CNV and at 3 and 12 months in patients with PCV. The CMT decreased significantly at all follow-up visits in the total cohort as well as in both subtypes, except for the CMT at 6 months in PCV patients. The anatomic improvement was also demonstrated in all cases, and pigment epithelial detachments tended to be resolved more rapidly in patients with PCV than in patients with occult CNV. Conclusion: Conversion to IVA was effective in patients with AMD resistant to ranibizumab, showing rapid morphologic improvement. The logMAR visual acuity was raised significantly within 12 months, and the clinical course of visual acuity improvement may differ according to the AMD subtypes.
关键词： polypoidal choroidal vasculopathy,aflibercept,occult choroidal neovascularization,ranibizumab,resistance,age-related macular degeneration
更新于2025-09-04 15:30:14
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Progression Rate From Intermediate to Advanced Age-Related Macular Degeneration Is Correlated With the Number of Risk Alleles at the <i>CFH</i> Locus
摘要： PURPOSE. Progression rate of age-related macular degeneration (AMD) varies substantially, yet its association with genetic variation has not been widely examined. METHODS. We tested whether progression rate from intermediate AMD to geographic atrophy (GA) or choroidal neovascularization (CNV) was correlated with genotype at seven single nucleotide polymorphisms (SNPs) in the four genes most strongly associated with risk of advanced AMD. Cox proportional hazards survival models examined the association between progression time and SNP genotype while adjusting for age and sex and accounting for variable follow-up time, right censored data, and repeated measures (left and right eyes). RESULTS. Progression rate varied with the number of risk alleles at the CFH:rs10737680 but not the CFH:rs1061170 (Y402H) SNP; individuals with two risk alleles progressed faster than those with one allele (hazard ratio [HR] ? 1.61, 95% con?dence interval [CI] ? 1.08–2.40, P < 0.02, n ? 547 eyes), although this was not signi?cant after Bonferroni correction. This signal was likely driven by an association at the correlated protective variant, CFH:rs6677604, which tags the CFHR1-3 deletion; individuals with at least one protective allele progressed more slowly. Considering GA and CNV separately showed that the effect of CFH:rs10737680 was stronger for progression to CNV. CONCLUSIONS. Results support previous ?ndings that AMD progression rate is in?uenced by CFH, and suggest that variants within CFH may have different effects on risk versus progression. However, since CFH:rs10737680 was not signi?cant after Bonferroni correction and explained only a relatively small portion of variation in progression rate beyond that explained by age, we suggest that additional factors contribute to progression.
关键词： progression,age-related macular degeneration (AMD),genetics
更新于2025-09-04 15:30:14
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Longitudinal Changes in Retinotopic Rod Function in Intermediate Age-Related Macular Degeneration
摘要： PURPOSE. Although impairment of rod function in the early stages of age-related macular degeneration (AMD) has been well recognized, data on longitudinal changes in rod function at multiple retinal locations remain limited. This study investigated the longitudinal changes in retinotopic rod function in eyes with intermediate AMD (iAMD). METHODS. Complete ophthalmic examination, multimodal imaging, and scotopic perimetry were performed at baseline and at 12-month follow-up. Perimetric scotopic retinal sensitivities for the 505-nm stimulus were repeatedly measured for 20 minutes after exposing to a single photobleach (~30%). The rod intercept time (RIT) and retinal sensitivity at seven retinal loci within the central 128 were ascertained. Using the 95% limit of measurement variability derived from the control eyes as a reference, the proportion of test points with a significant change in retinal sensitivity or RIT at follow-up was determined. RESULTS. Twenty iAMD and 6 control eyes were included. Decline in rod function was detected at 12-month follow-up in eyes with iAMD, but not in control eyes. Approximately 25% of test points in iAMD eyes showed a significant increase in RIT compared to 6% of test points with a decrease in RIT over the 12-month period (P < 0.001). Similarly, 40% of test points demonstrated a reduction in retinal sensitivity compared to the 7% of test points with an increase in retinal sensitivity at follow-up (P < 0.001). CONCLUSIONS. There are detectable retinotopic changes in rod function over 12 months in iAMD eyes, indicating an ongoing disease progression in rod impairment or loss with time.
关键词： dark adaptation,age related macular degeneration,rod function
更新于2025-09-04 15:30:14
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Drusenoid retinal pigment epithelium detachments
摘要： The authors make a review of drusenoid retinal pigment epithelium detachments(DPDs), a form of retinal pigment epithelium detachment(PED) that evolves from confluent and large soft drusen.Drusenoidretinal pigment epithelial detachments are a recognized element of the “dry” AMD. Until now, no treatment is indicated in drusenoid PEDs. The authors describe the clinical characteristics of drusenoid retinal pigment epithelium detachments (DPEDs) and make a review of the DPEDs related in the international literature. We related in this revision paper the multimodal advanced image exams in two cases of dusenoid retinal pigment epithelium detachments (DPEDs) and the general characteristics of thisfinding associated with Dry Macular degeneration.Upon examination of the ocular fundusDPEDs emerge as well-circumscribed yellow or yellow–white elevations of the RPE that are usually found within the macula.They may show scalloped borders and a slightly irregular surface. When visualized using fluorescein angiography (FA),DPEDs are typically described as faint hyper-fluorescent in the early phase followed by a slow increase in fluorescence throughout the transit stage of the study without late leakage. With optical coherence tomography (OCT), drusenoid PEDs usually show a smooth contour of the detached hyperreflective RPE band that may have an undulating appearance.Drusenoid PEDs encompass far above the ground possibility type of “dry” AMD that develops in relationship with large confluent soft drusen.At this point no treatment is utilized in drusenoid retinal pigment epithelium detachment(DPEDs).
关键词： Macular degeneration,Aged,Fluorescein angiography,Age factors,fundus oculi,Retinal detachment,Retinal drusen
更新于2025-09-04 15:30:14