Quantitative Analysis of Pigment Epithelial Detachment Response to Different Anti–vascular Endothelial Growth Factor Agents in Wet Age-Related Macular Degeneration

Balaskas, Konstantinos; Karampelas, Michael; Horani, Mania; Hotu, Oana; Keane, Pearse A.; Aslam, Tariq

doi:10.1097/iae.0000000000001342

Cited by 21 publications

(19 citation statements)

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“…The response to treatment is different than in treatment naïve patients who have new active disease and usually show good outcome with early initiation of anti-VEGF treatment. For treatment naive patients with nAMD related PED, most studies have reported anatomical improvement in terms of reduction in PED height with Bevacizumab [ 10 – 13 ] Ranibizumab [ 10 , 11 , 13 – 22 ] and Aflibercept [ 10 , 20 – 22 ]. With Bevacizumab (1.25 mg) treatment, Freeman WR et al showed no statistically significant change in SRF and IRF resorption or visual acuity improvement in PED and non-PED groups.…”

Section: Discussionmentioning

confidence: 99%

“…A post hoc subgroup analysis in the HARBOR study of patients presenting with PED at baseline reported PED height reduction and BCVA gain with Ranibizumab across PEDs of all heights but a decrease in vision in eyes with extra-large PEDs treated with higher dose of Ranibizumab [ 19 ]. With aflibercept treatment H J Cho and Balaskas K have reported greater reduction in PED height compared to ranibizumab [ 20 , 22 ] at 1 year. They also noticed improved BCVA at 1 year in both groups but variable correlations to baseline parameters.…”

Section: Discussionmentioning

confidence: 99%

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Clinical response of pigment epithelial detachment associated with neovascular age-related macular degeneration in switching treatment from Ranibizumab to Aflibercept

Tyagi¹,

Juma²,

Hor³

et al. 2018

BMC Ophthalmol

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BackgroundTo study the clinical outcomes of pigment epithelial detachment (PED) associated with neovascular age-related macular degeneration (nAMD) in patients switched from Ranibizumab to Aflibercept.MethodsRetrospective non-comparative case series. 50 eyes with active nAMD and fovea involving PED of ≥100 μm measured manually using the caliper on the OCT, initially treated with intravitreal Ranibizumab (0.5 mg/0.05 ml) and later switched to Aflibercept (2.0 mg/0.05 ml). The outcome measures of best corrected visual acuity (BCVA), PED height, PED width and number of injections were measured at baseline and at time point of switch, 4 months, 1 year and at last follow up visit post-switch. Three paired t-tests and Pearson’s correlations were calculated to analyze variables at switch and change in variables at 1 year.ResultsAfter switch to Aflibercept, the improvement of BCVA was 1.84 (p = 0.11), 1.74 (p = 0.21) and 1.16 (p = 0.45) letters, the change in PED height was − 65.6μm (p < 0.001), − 50.64μm (p = 0.007) and − 68.48μm (p < 0.001) and the change in PED width was − 36.6μm (p = 0.514), + 29.7μm (p = 0.922) and + 118.4μm (p = 0.210) at 4 months, 1 year and the last visit respectively. There was a moderate negative correlation between reduction in PED height at 1 year after switch and PED height at the time of switch to Aflibercept (r = − 0.474, p < 0.05).ConclusionThe improvement in BCVA and change in PED width was not statistically significant however the reduction in PED height was significant after switching treatment to Aflibercept. The change in BCVA at 1 year after switch was not correlated with any of the analyzed anatomical characteristics of PED.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical response of pigment epithelial detachment associated with neovascular age-related macular degeneration in switching treatment from Ranibizumab to Aflibercept

Tyagi¹,

Juma²,

Hor³

et al. 2018

BMC Ophthalmol

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“…They also observed in 6-months follow-up, the mean number of injections and visits were similar in 2 drug groups [23]. On the contrary, Balaskas et al, found a libercept is more effective than ranibizumab according to anatomic and functional results of 3 rd and 12 th months [24].…”

Section: Current Treatment Of Vascularized Pigment Epithelial Detachmentmentioning

confidence: 81%

“…PED height decrement is positively associated with higher baseline PED height, the higher the baseline PED height the more reduction was observed [27]. According to Balascas et al, study, all of baseline values including BCVA, subretinal luid, central macular thickness, PED volume, PED's vertical dimension have prognostic importance [24]. In contrary, there are many studies argued that baseline characteristics of PED have not any in luence on the functional outcomes [23].…”

Section: Current Treatment Of Vascularized Pigment Epithelial Detachmentmentioning

confidence: 98%

Treatment of Retinal Pigment Epithelial Detachment

Altintas¹

2018

Int J Clin Exp Ophthalmol

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Anatomical separation of the retinal pigment epithelium from the Bruch membrane is defi ned as retinal pigment epithelial detachment (PED) andit is classifi ed as drusenoid, serous, and vascularized. Vascularized PED is mostly associated with choroidal neovascularmembrane due to age-related macular degeneration and the risk of vision loss is high in this situation. Studies show that all of baseline values including BCVA, PED height, subretinal fl uid, central macular thickness, PED volume, vertical dimension, presence of coincident macular pathology, refl ectivity and morphology on optical coherence tomography have prognostic importance. Current treatment protocols mainly based on intravitreal injection of anti-vascular endothelial growth factor (VEGF). Even the bevacizumab was the fi rst anti-VEGF that was used for treatment in PED, there are several reports show the insuffi ciency of bevacizumab. In treatment-naïve eyes, both of ranibizumab and afl ibercepthave similar effect in vascularized PED. In treatment-resistant eyes, high dose bevacizumab or switching therapy of anti-VEGF procedures can be effective when considering of all cases, afl ibercept seems more effective than other options.We aimed in this manuscript, to give a general information about different characteristics of PEDs and to investigate the treatment strategies in the light of current literature.

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“…Optical coherence tomography (OCT) is one particularly crucial technology that has allowed for more accurate characterisation of retinal conditions such as neovascular age-related macular degeneration (AMD). [1][2][3] In AMD structural OCT measures such as macular thickness have been instrumental in confirming response to anti-vegf agents 1 and further research has explored the clinical importance and relevance of other OCT features, such as pigment epithelial detachments, 2 subretinal fluid 3,4 and subretinal fibrosis. 5 Studies that specifically assess the relationship between such structural imaging findings and visual function [6][7][8] provide particularly important information for both research and clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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Aslam¹,

Mahmood²,

Ali³

et al. 2018

American Journal of Ophthalmology

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To develop a neural network for the estimation of visual acuity from optical coherence tomography (OCT) images of patients with neovascular age related macular degeneration and to demonstrate its use to model the impact of specific controlled OCT changes on vision. Design: Artificial Intelligence (neural network) study. Methods: We assessed 1400 OCT scans of patients with neovascular age related macular degeneration (AMD). 15 physical features for each eligible OCT as well as patient age were used as input data and corresponding recorded visual acuity as the target data to train, validate and test a supervised neural network. We then applied this network to model the impact on acuity of defined OCT changes in subretinal fluid, subretinal hyperreflective material and loss of external limiting membrane integrity. Results: 1,210 eligible OCT scans were analysed resulting in 1210 data points which were each 16 dimensional. A ten layer feed-forward neural network with one hidden layer of 10 neurons was trained to predict acuity and demonstrated a root mean square error of 8.2 letters for predicted compared to actual visual acuity and a mean regression coefficient of 0.85. A virtual model using this network demonstrated the relationship of visual acuity to specific, programmed changes in OCT characteristics. When external limiting membrane (ELM) is intact, there is a shallow decline in acuity with increasing sub-retinal fluid but a much steeper decline with equivalent increasing sub-retinal hyperreflective material. When ELM is not intact, all visual acuities are reduced. Increasing subretinal hyperreflective material or subretinal fluid in this circumstance reduces vision further still, but with a smaller gradient than when ELM is intact. Conclusions: The supervised machine learning neural network developed is able to generate an estimated visual acuity value from OCT images in a population of patients with AMD. These findings should be of clinical and research interest in macular degeneration, for example in estimating visual prognosis or highlighting the importance of developing treatments targeting more visually destructive pathologies.

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Quantitative Analysis of Pigment Epithelial Detachment Response to Different Anti–vascular Endothelial Growth Factor Agents in Wet Age-Related Macular Degeneration

Cited by 21 publications

References 20 publications

Clinical response of pigment epithelial detachment associated with neovascular age-related macular degeneration in switching treatment from Ranibizumab to Aflibercept

Clinical response of pigment epithelial detachment associated with neovascular age-related macular degeneration in switching treatment from Ranibizumab to Aflibercept

Treatment of Retinal Pigment Epithelial Detachment

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