Clin Exp Optom. 2019 Nov 6.
Comparison of pain during intravitreal dexamethasone, ranibizumab and aflibercept injection.
Ertan E, Duman R, Duman R.
Background: This study aimed to compare pain scores of patients during intravitreal aflibercept, ranibizumab or dexamethasone implant injection procedures.
Methods: This study included 162 eyes of 162 patients, who received intravitreal ranibizumab, aflibercept or dexamethasone implant injections at our clinic. Following the injection, patients were asked to rate their pain from 0 (no pain) to 10 (worst pain) using a visual analogue pain score survey (VAS). VAS was evaluated according to age, sex, indication for the injection, number of previous intravitreal injections, and lens status in the study eye.
Results: The mean VAS in the ranibizumab, aflibercept or dexamethasone implant groups was 3.38 ± 2.31, 3.82 ± 2.46, and 3.61 ± 2.94, respectively. Female patients reported a higher average pain score than male patients (p = 0.02). Also, phakic patients reported a higher average pain score than pseudophakic patients (p = 0.01). Pain did not significantly correlate with indication for the injection, number of injections, and injection drugs (p > 0.05).
Conclusion: Pain associated with intravitreal injection is generally mild and associated with sex, age, and lens status. There was no significant difference in pain between intravitreal injections of dexamethasone implant, ranibizumab or aflibercept.
PMID: 31691370 DOI: 10.1111/cxo.12974
Eur J Ophthalmol. 2019 Nov 5:1120672119883590.
Comparison of structural and functional outcome of aflibercept versus ranibizumab in patients with myopic choroidal neovascularization.
Howaidy A, Eldaly ZH.
Purpose: To compare visual functional improvement and retinal structural changes of aflibercept versus ranibizumab for the management of treatment-naïve choroidal neovascularization related to pathological myopia.
Patients and Methods: A prospective randomized study included patients suffering from myopic choroidal neovascularization. Patients received three intravitreal injections of aflibercept (2 mg) or ranibizumab (0.5 mg) in 1:1 ratio every 4 weeks. Ophthalmic evaluation and optical coherence tomography were performed at baseline, 1, 2, and 3 months after last injection. Primary outcome measure was the visual acuity change from baseline to month 3 after injection. Secondary outcome measures included change in retinal thickness and the relation of morphological and functional changes to baseline assessment parameters.
Results: A total of 48 myopic patients (48 eyes) suffering from myopic choroidal neovascularization were randomly assigned to receive either aflibercept (Group A) or ranibizumab (Group B). In Group A, best-corrected visual acuity significantly improved from 0.53 ± 0.10 logMAR to 0.38 ± 0.11 logMAR, at 3 months, and from 0.55 ± 0.11 logMAR to 0.39 ± 0.12 logMAR in Group B. Whereas, retinal thickness reduced from 317.7 ± 53.6 µm to 164.5 ± 81.9 µm in Group A, and from 321.1 ± 98.8 µm at baseline to 178.9 ± 64.5 µm in Group B at month 3. Changes in best-corrected visual acuity and central macular thickness were statistically insignificant between the two groups at final visit.
Conclusion: Both aflibercept and ranibizumab provided a significant improvement in visual acuity and retinal thickness in patients with myopic choroidal neovascularization. Comparable functional and architectural results were achieved by both treatment modalities.
PMID: 31690105 DOI: 10.1177/1120672119883590
J Ophthalmol. 2019 Oct 10;2019:7530458.
One-year outcomes of 1 dose versus 3 loading doses followed by pro re nata regimen using ranibizumab for neovascular age-related macular degeneration: The ARTIS Trial.
Wang F, Yuan Y, Wang L, Ye X, Zhao J, Shen M, Zhang Q, Xu D, Qin G, Zhang W, Yuan F, Chang Q, Zhao P, Wang F, Sun X.
Purpose: To compare the functional and anatomical outcomes of one dose and three loading doses followed by the pro re nata (PRN) regimen in Chinese neovascular age-related macular degeneration (nvAMD) (including polypoidal choroidal vasculopathy (PCV)) patients.
Methods: In this multicenter, prospective, open-label, controlled, 12-month study (ClinicalTrials.gov: NCT02810808), patients were randomized (1 : 1) to 1 dose + PRN (PRN group) or 3 loading doses + PRN (LD group) using intravitreal ranibizumab treatment. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were evaluated. The main outcome was the change in BCVA. The noninferiority limit was 5 letters.
Results: Forty-five patients in the PRN group and 49 patients in the LD group finished 12-month follow-up. Each group included 4 PCV patients. The mean change in BCVA from baseline was 7.8 letters in the PRN group, compared with 10.9 letters in the LD group (P=0.344). There were no significant differences between two groups in the mean change of CRT (-159.3 μm vs. -120.5 μm) at month 12. The mean number of injections during the 12-month follow-up was 6.0 in the PRN group and 6.8 in the LD group. The proportion of patients who gained an improvement in visual acuity by 15 or more letters was 28.9% in the PRN group and 44.9% in the LD group (P=0.066).
Conclusion: One dose + PRN showed noninferior visual gains than 3 loading doses + PRN regimen using ranibizumab in Chinese nvAMD and PCV patients. Number of injections in the PRN group was similar as that in the LD group but remained a potential risk of vision instability during one-year follow-up using OCT-guided retreatment criteria. This trial is registered with NCT02810808.
PMID: 31687203 PMCID: PMC6811781 DOI: 10.1155/2019/7530458
DIAGNOSIS & IMAGING
Graefes Arch Clin Exp Ophthalmol. 2019 Nov 4.
Utility of a public-available artificial intelligence in diagnosis of polypoidal choroidal vasculopathy.
Yang J, Zhang C, Wang E, Chen Y, Yu W.
Purpose: To investigate the feasibility of training an artificial intelligence (AI) on a public-available AI platform to diagnose polypoidal choroidal vasculopathy (PCV) using indocyanine green angiography (ICGA).
Methods: Two methods using AI models were trained by a data set including 430 ICGA images of normal, neovascular age-related macular degeneration (nvAMD), and PCV eyes on a public-available AI platform. The one-step method distinguished normal, nvAMD, and PCV images simultaneously. The two-step method identifies normal and abnormal ICGA images at the first step and diagnoses PCV from the abnormal ICGA images at the second step. The method with higher performance was used to compare with retinal specialists and ophthalmologic residents on the performance of diagnosing PCV.
Results: The two-step method had better performance, in which the precision was 0.911 and the recall was 0.911 at the first step, and the precision was 0.783, and the recall was 0.783 at the second step. For the test data set, the two-step method distinguished normal and abnormal images with an accuracy of 1 and diagnosed PCV with an accuracy of 0.83, which was comparable to retinal specialists and superior to ophthalmologic residents.
Conclusion: In this evaluation of ICGA images from normal, nvAMD, and PCV eyes, the models trained on a public-available AI platform had comparable performance to retinal specialists for diagnosing PCV. The utility of public-available AI platform might help everyone including ophthalmologists who had no AI-related resources, especially those in less developed areas, for future studies.
PMID: 31686211 DOI: 10.1007/s00417-019-04493-x
J Ophthalmol. 2019 Oct 7;2019:4962363.
Focal choroidal elevations: localized pigment epithelial contour alterations due to isolated choroidal vessels.
Chu RL, Pannullo NA, Sigler EJ.
Purpose: The objective of this case series was to describe the clinical and imaging features of focal choroidal elevations (FCE), which are chorioretinal contour changes induced by individual choroidal vessels within an overall thin-appearing choroid.
Methods: A total of 787 enhanced depth imaging (EDI) spectral domain optical coherence tomography (SD-OCT) patient images were initially screened for the presence of FCE. Prospective imaging analysis of 38 patients with FCE was done. Mean central macular choroidal thickness (CMCT), FCE location, FCE vessel lumen diameter, patient demographics, cycloplegic autorefraction, ophthalmoscopic findings, and presence of choroidal neovascularization (CNV) in the fellow eye were recorded.
Results: FCE were observed in 25 patients with age-related macular degeneration (ARMD), in 5 patients with high myopia, and in 8 patients with age-related choroidal atrophy (ARCA). Mean patient age was 80 ± 9.4 years. Mean CMCT was 86 ± 40 μm. Mean lumen diameter of the vessels inducing FCE was 131 ± 33 μm.
Conclusion: FCE are relatively frequently encountered morphologic features of elderly patients with ARMD, high myopia, and ARCA, and have a distinct clinical and imaging morphology which differs from classically described chorioretinal folds. The lesions may commonly be mistaken for pigment epithelial detachments on ophthalmoscopy, may be associated with CNV in fellow eyes, and have a characteristic SD-OCT appearance.
PMID: 31687198 PMCID: PMC6800952 DOI: 10.1155/2019/4962363
Br J Ophthalmol. 2019 Nov 6. pii: bjophthalmol-2019-314765.
Association of macular disease with long-term use of pentosan polysulfate sodium: findings from a US cohort.
Jain N, Li AL, Yu Y, VanderBeek BL.
Background/Aims: A series at a single clinical centre recently demonstrated an association between the interstitial cystitis drug pentosan polysulfate sodium (PPS) and a vision-threatening pigmentary maculopathy. The aim of this study was to determine if an association exists between PPS use and macular disease in a large national cohort.
Methods: A retrospective, matched cohort study using data from a large US medical claims database from 2002 to 2016 was performed. A total of 3012 and 1604 PPS users were compared with 15 060 and 8017 matched controls at 5 and 7 years, respectively. The primary outcome measures included (1) any new diagnosis of a hereditary or secondary pigmentary maculopathy (atypical maculopathy outcome), and (2) any new diagnosis of dry age-related macular degeneration (AMD) or drusen in addition to the aforementioned diagnoses (atypical maculopathy+AMD outcome).
Results: At the 5-year and 7-year follow-up, 9 (0.3%) and 10 (0.6%) PPS patients progressed to the atypical maculopathy outcome compared with 32 (0.2%) and 25 (0.3%) control patients, respectively. 103 (3.4%) and 87 (5.4%) PPS patients developed the atypical maculopathy+AMD outcome compared with 440 (2.9%) and 328 (4.1%) control patients at 5 and 7 years, respectively. At 5 years, multivariate analysis showed no significant association (p>0.13). At 7 years, PPS users had significantly increased odds of having the atypical maculopathy+AMD outcome (OR=1.41, 95% CI 1.09 to 1.83, p=0.009).
Conclusion: PPS exposure was associated with a new diagnosis of macular disease at the 7-year follow-up in a large national cohort.
PMID: 31694837 DOI: 10.1136/bjophthalmol-2019-314765
Clin Exp Optom. 2019 Nov 7.
Object search in neovascular age-related macular degeneration: the crowding effect.
Thibaut M, Boucart M, Tran THC.
Background: Visual search, an activity that relies on central vision, is frequent in daily life. This study investigates the effect of spacing between items in an object search task in participants with central vision loss.
Methods: Patients with neovascular age-related macular degeneration (AMD), age-matched controls, and young controls were included. The stimuli were displays of four, six and nine objects randomly presented in a 'crowded' (spacing 1.5°) or 'uncrowded' (spacing 6°) condition. For each of 96 trials, participants were asked to search for a predefined target that remained on the screen until the response was recorded. Accuracy, search time, and eye movements (number of fixations and scan path ratio) were recorded.
Results: Compared to older controls, accuracy decreased by 31 per cent and search time increased by 61 per cent in AMD participants. Ageing also affected performance with a lower accuracy by 13.5 per cent and longer search times by 46 per cent in older compared to younger controls. Increasing the spacing between elements increased accuracy by 21 per cent in AMD participants but it had no effect in older and younger controls. Performance was not related to visual acuity or to duration of neovascular AMD, but search time was correlated to the lesion size in the 'crowded' condition.
Conclusions: Object search is ubiquitous in daily life activities. When visual acuity is irrevocably reduced, increasing the spacing between elements can reliably improve object search performance in patients.
PMID: 31698519 DOI: 10.1111/cxo.12982