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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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Foveal structure during the induction phase of anti-vascular endothelial growth factor therapy for occult choroidal neovascularization in age-related macular degeneration
摘要： Purpose: To evaluate the efficacy of monthly injections of aflibercept and ranibizumab on foveal structure after three months, for the treatment of occult choroidal neovascularization (CNV) in age-related macular degeneration (AMD). Methods: We retrospectively studied 103 eyes with treatment-na?ve neovascular AMD with occult and no classic CNV. Seventy-four of 103 eyes were treated with ranibizumab (intravitreal ranibizumab injection [IVR] group); 29 eyes were treated with aflibercept (intravitreal aflibercept injection [IAI] group). The best-corrected visual acuity and the retinal and choroidal structure at the fovea were evaluated using optical coherence tomography. Results: The total foveal thickness, the height of serous retinal detachments, and subfoveal choroidal thickness were compared with baseline, and the incidence of retinal pigment epithelial elevation significantly decreased in the IAI group compared with the IVR group. In contrast, the thickness of the sensory retina at the fovea significantly decreased in the IVR group when compared with the IAI group. The logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity improved more significantly in the IVR group (?0.085±0.164) than in the IAI group (?0.020±0.125) at 3 months (P=0.017). Conclusion: After intravitreal injection, aflibercept more rapidly reduced subretinal fluid and subfoveal choroidal thickness. In contrast, ranibizumab decreased the sensory retinal thickness compared with aflibercept. The responses of the retinal and choroidal tissue to these anti-VEGF agents may be different during the induction phase for eyes with occult CNV secondary to neovascular AMD.
关键词： occult,neovascular age-related macular degeneration,outer nuclear layer,aflibercept,retinal thickness,ranibizumab
更新于2025-09-10 09:29:36
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Macular Atrophy Development and Subretinal Drusenoid Deposits in Anti-Vascular Endothelial Growth Factor Treated Age-Related Macular Degeneration
摘要： PURPOSE. To explore the association between presence of subretinal drusenoid deposits (SDD) at baseline in eyes with neovascular age-related macular degeneration (nAMD) with the development of macular atrophy (MA) during anti-vascular endothelial growth factor (VEGF) therapy. METHODS. There were 74 eyes without pre-existing MA receiving anti-VEGF therapy for nAMD for 2 years or longer analyzed. At least two image modalities that included spectral-domain optical coherence tomography, near-infrared re?ectance, ?uorescein angiography, and color fundus photos were used to assess for SDD presence, phenotype (dot and ribbon), and location, neovascularization type, and MA. Logistic regression models using generalized estimating equations assessed the association between SDD and the development of MA adjusting for age, neovascularization type, and choroidal thickness. RESULTS. SDD were present in 46 eyes (63%) at baseline. MA developed in 38 eyes (51%) during the mean of 4.7 6 1.2 years of follow-up. Compared with eyes without SDD, those with SDD at baseline were 3.0 times (95% con?dence interval [CI] 1.1–8.5, P ? 0.0343) more likely to develop MA. Eyes with SDD present in the inferior macula and inferior extramacular ?elds at baseline were 3.0 times and 6.5 times more likely to develop MA at follow-up than eyes without SDD in these locations (95% CI 1.0–8.9, P ? 0.0461 and 95% CI 1.3–32.4, P ? 0.0218, respectively). MA development was not associated with a speci?c SDD phenotype. CONCLUSIONS. MA frequently developed in eyes during anti-VEGF treatment. SDD were independently associated with MA development. The extension of SDD into the inferior fundus, particularly in the inferior extramacular ?eld, conferred higher odds of subsequent MA development.
关键词： reticular pseudodrusen,anti-VEGF,neovascular age-related macular degeneration,geographic atrophy,subretinal drusenoid deposits
更新于2025-09-10 09:29:36
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Phenotype Characteristics of Fellow Eyes in Patients With Early Onset of Neovascular Age-Related Macular Degeneration
摘要： PURPOSE. To investigate phenotype characteristics of fellow eyes in patients with early onset of neovascular age-related macular degeneration (NVAMD). METHODS. Patients with new-onset unilateral NVAMD between 50 and 65 years (n ? 57, early-onset choroidal neovascularization [CNV] group) or >80 years (n ? 47, late-onset CNV group) or with nonneovascular AMD (n ? 98, no-CNV group) were included. Fellow eyes in both CNV groups and the eyes with the more severe AMD staging in the no-CNV group were used to evaluate number and size of macular drusen, extramacular drusen (EMD), pigmentary abnormalities, and retinal pigment epithelium (RPE) atrophy on color photographs and hyperre?ective dots (HRD) and reticular pseudodrusen (RPD) on spectral-domain optical coherence tomography (SDOCT) scans. Regression analysis was used to compare groups. RESULTS. Occurrence of >20 macular drusen was more frequent in the early-onset CNV group than the late-onset CNV group (odds ratio [OR] 2.93; P ? 0.01) or the no-CNV group (OR 2.17; P ? 0.02). Retinal pigment epithelium atrophy, RPD, and HRD appeared less frequently in the early-onset CNV group than in the late-onset CNV group (RPE atrophy: OR 0.11; P ? 0.005; RPD: OR 0.04; P ? 9.38 3 10(cid:2)10, HRD: OR 0.30; P ? 0.004) and no-CNV group (RPE atrophy: OR 0.12; P ? 0.005; RPD: OR 0.40, P ? 0.03, HRD: not signi?cant). No differences were detected regarding presence of large drusen, pigmentary abnormalities, and EMD. CONCLUSIONS. A large number of macular drusen in the fellow eye appeared to be characteristic for early onset of NVAMD, whereas RPE atrophy, HRD, and RPD were more frequently present in AMD patients > 80 years. Prospective trials with patients converting to NVAMD are required to further analyze morphologic characteristics for early versus late development of advanced AMD.
关键词： reticular pseudodrusen,fellow eye,spectral-domain optical coherence tomography,neovascular age-related macular degeneration
更新于2025-09-09 09:28:46
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Retinal metabolic and structural alterations in response to aflibercept treatment in neovascular age‐related macular degeneration
摘要： Purpose: Non-invasive retinal markers of disease activity could pave the way for individualized treatment in neovascular age-related macular degeneration (nAMD). We aimed to evaluate if retinal vascular oxygen saturation and calibres could predict the initial treatment response after a loading phase of intravitreal a?ibercept in nAMD. Method: A total of 149 eyes were included (nAMD, n = 76; dry AMD, n = 30; normal eyes n = 43). Of these, 57 treatment-na€?ve eyes with nAMD received three monthly injections with 2.0 mg a?ibercept and were subsequently strati?ed according to functional and structural response according to development in best-corrected visual acuity and macular retinal thickness. The retinal vascular oxygen saturation and calibres were measured prior to treatment and 1 month after the third injection. Results: Patients with nAMD and dry AMD had higher retinal arteriolar oxygen saturation as compared to normal eyes (94.3% versus 95.2% versus 92.6%, p = 0.04). Thirty-nine (68.4%) and 12 (21.1%) eyes with nAMD were functional and structural responders. After the loading phase, structural nonresponders developed a higher retinal arteriolar (95.3% versus 93.3%, p = 0.03) and venular (64.7% versus 59.4%, p = 0.02) oxygen saturation, and responders developed a lower retinal arteriolar calibre (118.0 versus 114.3 lm, p < 0.01). In a multiple logistic regression model, increasing retinal venular oxygen saturation associated with a negative structural treatment outcome (odds ratio 1.17 for each 1% increment after the loading phase, 95% con?dence interval 1.01–1.36, p = 0.03). Conclusion: Changes in the retinal venular oxygen saturation associate independently with initial treatment response in nAMD, but functional and structural retinal measurements prior to treatment could not predict the treatment response.
关键词： a?ibercept,retinal vascular calibre,disease activity,neovascular age-related macular degeneration,retinal oximetry,choroidal neovascularization
更新于2025-09-09 09:28:46