Optical Coherence Tomography Angiography to Distinguish Changes of Choroidal Neovascularization after Anti-VEGF Therapy: Monthly Loading Dose versus Pro Re Nata Regimen

Purpose. To compare the qualitative and quantitative choroidal neovascularization (CNV) changes after antivascular endothelial growth factor (anti-VEGF) therapy in treatment-naïve and treated eyes with age-related macular degeneration (AMD) using optical coherence tomography angiography (OCTA). Methods. Consecutive patients with neovascular AMD underwent multimodal imaging, including OCTA (AngioPlex, CIRRUS HD-OCT model 5000; Carl Zeiss Meditec, Inc., Dublin, OH) at baseline and at three monthly follow-up visits. Treatment-naive AMD patients undergoing anti-VEGF loading phase were included in group A, while treated patients were included in group B. Qualitative and quantitative OCTA analyses were performed on outer retina to choriocapillaris (ORCC) slab. CNV size was measured using a free image analysis software (ImageJ, open-source imaging processing software, 2.0.0). Results. Twenty-five eyes of 25 patients were enrolled in our study (mean age 78.32 ± 6.8 years): 13 treatment-naïve eyes in group A and 12 treated eyes in group B. While qualitative analysis revealed no significant differences from baseline to follow-up in the two groups, quantitative analysis showed in group A a significant decrease in lesion area (P=0.023); in group B, no significant change in the lesion area was observed during anti-VEGF therapy (P=0.93). Conclusion. Treatment-naïve and treated eyes with CNV secondary to neovascular AMD respond differently to anti-VEGF therapy. This should be taken into account when using OCTA for CNV follow-up or planning therapeutic strategies

Weekly Sequential Antibioprophylaxis for Recurrent Urinary Tract Infections Among Patients With Neurogenic Bladder: A Randomized Controlled Trial

International audienceBACKGROUND:Recurrent urinary tract infections (R-UTIs) are the main cause of morbidity and hospitalisations in subjects with neurogenic bladder (NB) due to spinal cord injury (SCI). We evaluated the efficacy of weekly oral cyclic antibiotic (WOCA) prophylaxis, i.e. the alternate weekly administration of two antibiotics, in preventing R-UTI.METHODS:Randomized (1:1), open-label, superiority controlled trial, comparing WOCA prophylaxis to no prophylaxis (control) for six months in patients with NB due to SCI, using clean intermittent self-catheterization, and suffering from R-UTIs. Primary outcome: incidence of symptomatic antibiotic-treated UTIs. Secondary outcomes: number of febrile UTIs, number of hospitalisations, WOCA tolerance, antibiotic consumption, number of negative urine cultures, and emergence of bacterial resistance in urinary, intestinal and nasal microbiota.RESULTS:A total of 45 patients were either allocated to the WOCA group (n=23) or the control group (n=22). Median incidence of symptomatic antibiotic-treated UTIs was 1.0 [IQR 0.5; 2.5] in the WOCA group vs. 2.5 [IQR 1.2; 4.0] (p=0.0241) in the control group. No febrile UTI were recorded in the WOCA group vs. 9 (45.0%) (p<0.001) in the control group. Median number of additional antibiotic treatment was 0.0 [IQR 0.0; 2.0] vs. 3.0 [2.0; 5.0] (p=0.004) in the WOCA and control groups, respectively. Only few adverse events were reported. No impact on emergence of bacterial resistance was observed.CONCLUSIONS:WOCA is efficient and well-tolerated in preventing R-UTI in SCI patients. In our study, we did not observe any emergence of antibiotic resistance in digestive and nasal microbiological cultures