The frequency and costs of intravitreal therapy agents in retinal diseases

Background: The aim of this study is to analyze the numbers and the economic burden of intravitreal anti-VEGF agents and intravitreal dexamethasone (IVD) implants administered to patients with diabetic retinopathy (DR), age-related macular degeneration (AMD) and retinal vein occlusion (RVO). Material and methods: The retrospective case-control study included 1525 patients diagnosed with DME, neovascular AMD and RVO, and received intravitreal anti-VEGF and IVD between January 2016 and December 2018. Intravitreal anti-VEGF administration was performed within the framework of the Pro Re Nata (PRN) regimen. The prices of anti-VEGF agents and IVDs were calculated on the average of the prices in the relevant year. Results: The total number of intravitreal injections in 3 years was 5864. During the 3-year follow-up, on average,ranibizumab (Lucentis) was applied 3.56 ± 2.25 times, alfibercept (Eylea) was applied 3.31 ± 2.16 times, and IVD(Ozurdex) was applied 1.70 ± 0.83 times. The anti-VEGF numbers in 2016, 2017 and 2018 were 1997, 1801, 2066,respectively. In total, the 3-year drug cost was 3,587,812.44 USD. Conclusions: The economic burden of intravitreal anti-VEGF and IVD treatment for retinal diseases is so important to developing countries such as Turkey. The economic burden created by anti-VEGF agents and IVDs in Turkey will reduce in a serious sense, and the legal concerns of physicians will decrease thanks to the decision taken by the Turkish Medicines and Medical Devices Agency (TMMDA)

An Evaluation of Effects of Different Mydriatics on Choroidal Thickness by Examining Anterior Chamber Parameters: The Scheimpflug Imaging and Enhanced Depth Imaging-OCT Study

Aim. To assess the effects of mydriatics commonly used in clinical practice on choroidal thickness and anterior chamber change. Methods. This was a prospective, randomized, controlled, double-blinded study including a single eye of the participants. The subjects were assigned into 4 groups to receive tropicamide 1%, phenylephrine 2.5%, cyclopentolate 1%, and artificial tears. At the baseline, anterior chamber parameters were assessed using a Pentacam Scheimpflug camera system, and choroidal thickness (CT) was measured using a spectral-domain OCT with Enhanced Depth Imaging (EDI) modality. All measurements were repeated again after drug administration. Results. Increases in pupil diameter, volume, and depth of anterior chamber were found to be significant (p=0.000, p=0.000, and p=0.000, resp.), while decreases in the choroidal thickness were found to be significant in subjects receiving mydriatics (p<0.05). Conclusions. The study has shown that while cyclopentolate, tropicamide, and phenylephrine cause a decrease in choroidal thickness, they also lead to an increase in the volume and depth of anterior chamber. However, no correlation was detected between anterior chamber parameters and choroidal changes after drug administration. These findings suggest that the mydriatics may affect the choroidal thickness regardless of anterior chamber parameters. This study was registered with trial registration number 2014/357

Relationship between erythrocyte sedimentation rate and choroidal and retinal thickness in Behçet's disease

ABSTRACT Purpose: To compare retinal and choroidal thickness in patients with Behçet's disease with and without ocular involvement as well as to evaluate the correlation between erythrocyte sedimentation rate and choroidal thickness among patients with Behçet's disease. Methods: This was a prospective interventional study investigating erythrocyte sedimentation as well as choroidal and retinal thickness among patients with Behçet's disease. Patients who were diagnosed based on The International Criteria for Behçet's Disease with (Group A) or without (Group B) ocular involvement and a matched control group (Group C) participated in the study. Optical coherence tomography measurements and blood tests were performed on the same day. Retinal and choroidal thickness were measured using spectral-domain optical coherence tomography (Spectralis, Heidelberg Engineering, Heidelberg, Germany), and central macular thickness, central subfoveal choroidal thickness, and retinal nerve fiber layer thickness were measured using optical coherence tomography. Results: Average erythrocyte sedimentation values were 9.89 mm/h in Group A, 16.21 mm/h in Group B, and 3.89 mm/h in Group C; average central subfoveal choroidal thickness values were 350.66, 331.74, and 325.95 mm, respectively. Average central macular thickness and retinal nerve fiber layer thickness values of patients in Groups A, B and C were 226.39 and 225.97mm; 234.11 and 92.00 mm; and 97.58 and 99.84 mm, respectively. No significant difference was seen between Group A and B patients in central subfoveal choroidal thickness, central macular thickness, or retinal nerve fiber layer thickness values. Central macular thickness was statistically significantly thinner in Groups A and B than in Group C (p=0.016). Group A had thinning in the nasal quadrant of the retinal and general retinal nerve fiber layers when compared with those in Group C (p=0.010 and 0.041, respectively). A connection could not be established between the erythrocyte sedimentation, central subfoveal choroidal thickness, central macular thickness, and retinal nerve fiber layer thickness in the patients with Behçet's disease. Conclusion: The erythrocyte sedimentation rate is typically used to test for activation of Behçet's disease and assess treatment response. In our study, we could not establish a connection between the erythrocyte sedimentation rate and central subfoveal choroidal thickness, central macular thickness, and retinal nerve fiber layer thickness in patients with systematically active Behçet's disease without ocular involvement

Evaluation of the Macular, Peripapillary Nerve Fiber Layer and Choroid Thickness Changes in Behçet’s Disease with Spectral-Domain OCT

Purpose. To assess the macular, choroid, and peripapillary nerve fiber layer thickness (RNFL) in Behçet’s disease (BD) patients with and without ocular involvement by means of optical coherence tomography (OCT) and compare these findings with healthy controls. Design. Eighty patients with BD and 40 healthy controls who were followed up at the Uveitis and Retina Clinic of the Kayseri Research and Education Hospital in Turkey were enrolled in this prospective study. Subjects and Controls. The patients with BD were divided into two groups according to the presence of ocular involvement. Group 1 consisted of 40 eyes of 40 patients with ocular involvement and group 2 consisted of 40 eyes of 40 patients without ocular involvement. Methods. All of the patients and controls underwent macular, choroid, and peripapillary nerve fiber layer thickness analysis with Spectralis domain OCT (Spectralis OCT Heidelberg Engineering, Dossenheim, Germany). Main Outcome Measures. The differences in macular, choroid, and peripapillary nerve fiber layer thicknesses between groups were analyzed statistically. Results. Macular thickness was thinner in patients with BD than in the control group; this result was statistically significant (P = 0.05). There was no statistically significant difference in thickness between RNFL analysis of the patients with BD and control subjects. However, the BD patients with ocular involvement had statistically significant thinning in RNFL compared with BD patients without ocular involvement. Although the choroid was thicker in patients with BD than in the control group, it did not reach a statistically significant level (P = 0.382). Conclusions. BD with ocular involvement may be associated with decreased macular and RNFL thickness measured with spectral-domain OCT

The Impact of Migraine on Posterior Ocular Structures

Purpose. To investigate the thickness of the retinal nerve fiber layer (RNFL) and choroid in patients who have migraines in comparison to healthy controls. Methods. This study included 76 eyes and patients in the migraine group, 36 with aura (MWA group) and 40 without (MWoA group), and 38 eyes as control subjects. The RNFL and macular thicknesses were analysed with standard OCT protocol while choroidal thickness was analysed with EDI protocol in all subjects. Choroidal thickness was measured at the fovea, 1500 µm nasal and 1500 µm temporal to the fovea in a horizontal section. Results. The mean RNFL thickness for nasal and nasal inferior sectors was significantly thinner (P≤0.018) in the migraineurs’ eyes than in those of the controls, as was the mean choroid thickness at the fovea and measured points (P<0.0001). However, the mean macular thickness was not significantly different between the groups. Conclusions. This study suggests that migraine leads to a reduction in the peripapillary RNFL thickness and to thinning in choroidal structures. These findings can be explained by a chronic ischemic insult related to migraine pathogenic mechanisms and these findings are considered supportive of the relationship between glaucoma and migraine