Clinical course of acute zonal occult outer retinopathy complicated by choroidal neovascularization

Purpose To report the clinical course and multimodal imaging features of acute zonal occult outer retinopathy (AZOOR) complicated by choroidal neovascularization (CNV) treated with anti-vascular endothelial growth factor (VEGF) treatment or photodynamic therapy (PDT). Methods Observational case series. Retrospective analysis of patients presenting to different institutions with evidence of AZOOR and neovascular lesions. Diagnosis of AZOOR was made on the basis of clinical presentation and multimodal imaging. All patients underwent a comprehensive ophthalmic evaluation and multimodal retinal imaging, including color fundus photos, fundus autofluorescence, fundus fluorescein angiography and spectral-domain optical coherence tomography. Results Four patients (three males, mean age 53.5 years) were included in the study. Mean follow-up was 5.1 years. Presentation of AZOOR was unilateral in two patients and bilateral in the remainder two patients. One of the patients presenting with unilateral AZOOR developed zonal lesions in the fellow eye during follow-up. All patients presented with unilateral type 2 (subretinal) CNV. Three patients underwent intravitreal anti-VEGF injections and one patient underwent a single PDT. Multimodal retinal imaging showed zonal or multizonal progression during treatment. After treatment, visual acuity and CNV stabilization was observed in all patients. Conclusions The presence of CNV expands the clinical spectrum of AZOOR. CNV complicating AZOOR may be effectively treated with intravitreal injections of anti-VEGF, despite progression of the zonal lesions. Further studies are required to define the role of treatment in the progression of the zonal lesions

Integrating Health Technology Assessment and Multi-Criteria Decision Analysis in Optimizing Diabetic Macular Edema Management: Results from an Italian Multi-Regional Study

Health Technology Assessment (HTA) is a widely implemented technical tool used to inform the decision-making process..

Different Outcomes of Anti-VEGF Treatment for Neovascular AMD according to Neovascular Sutypes and Baseline Features: 2-Year Real-Life Clinical Outcomes

Purpose. To evaluate the effects of anti-VEGF treatment of neovascular age-related macular degeneration (nAMD) in a real-life clinical setting. Methods. Study design is a retrospective case series. Naïve nAMD patients treated with intravitreal injection of aflibercept or ranibizumab were analyzed over a 24-month follow-up. Each patient received the loading dose, followed by a PRN regimen. Patients were further subdivided into subgroups according to macular neovascularization type, best corrected visual acuity (BCVA) at baseline (BCVA>0.3 LogMAR and BCVA≤0.3 LogMAR), and different anti-VEGF drugs. Primary outcome was the changes in BCVA and central macular thickness (CMT) over 24 months. Secondary outcomes included the influence of the selected drug and of the baseline BCVA on the final outcomes. Results. 439 patients (224 males; 51%) with naïve AMD-related macular neovascularization were included in the analyses. Mean age was 78±8 years old. Compared to baseline evaluations, not significant BCVA changes were found at 1-year and 2-year examinations. CMT was significantly reduced at both 1-year and 2-year follow-ups (p<0.01). Classic, polypoidal choroidal vasculopathy and mixed subtypes significantly correlated with worse visual outcome (p<0.01). Overall, baseline BCVA significantly correlated with both 1-year and 2-year follow-up changes (p<0.01). Moreover, BCVA at 1-year significantly correlated with BCVA changes at 2-year follow-up (p<0.01). Furthermore, CMT changes from baseline significantly correlated with both 1-year and 2-year follow-up measurements (p<0.01). Conclusion. Anti-VEGF approach is generally effective in stopping nAMD progression in our real-life analysis. No difference was found comparing patients treated with ranibizumab and aflibercept, nor in patients with drug switching

Long-Term Outcomes of Bacillary Layer Detachment in Neovascular Age-Related Macular Degeneration

Purpose: To evaluate the clinical characteristics, multimodal imaging features, and long-term treatment outcomes of eyes with neovascular age-related macular degeneration (nAMD) and bacillary layer detachment (BALAD) treated with intravitreal anti-VEGF therapy.Design: Retrospective, longitudinal, case series.Participants: Treatment-naive patients with nAMD (n = 30) showing BALAD on OCT and undergoing anti-VEGF therapy.Methods: Clinical records and multimodal imaging results of up to 4 years after diagnosis were reviewed.Main outcome measures: Best-corrected visual acuity (BCVA) values were compared over time. The cumulative risk of and risk factors for subretinal fibrosis were assessed using Cox regression analyses, and adjusted hazard ratio (aHR) was computed.Results: Thirty eyes of 30 patients were included. Macular neovascularization (MNV) subtypes were distributed as follows: type 1, 63%; type 2, 27%; mixed type 1 and 2, 3%; type 3, 3%; aneurysmal type 1, 3%. The BCVA significantly improved after anti-VEGF loading phase (Snellen equivalent, from 20 of 118 to 20 of 71, P = 0.03), but it returned to the baseline levels at 4 years (Snellen equivalent, 20 of 103, P = 0.6). The cumulative risk of subretinal fibrosis was 77% at 4 years. The risk factors associated with subretinal fibrosis included hemorrhagic BALAD (aHR, 2.02; 95% confidence interval [CI] 1.54-3.22; P Conclusions: BALAD was found in association with all types of MNV in patients with nAMD. Long-term observation revealed poor functional outcomes related to the high risk of subretinal fibrosis.</p

Treatment of Retinal Angiomatous Proliferation with Intravitreal Anti-VEGF Drugs in Real Life Practice

Purpose: To evaluate the outcomes of intravitreal anti-VEGF in the treatment of retinal angiomatous proliferation (RAP) in real life practice. Methods: The design of the study is a retrospective, interventional, multicentre, case series. All the charts of patients affected by RAP, regularly followed up and treated with anti-VEGF drugs over 12 months were examined. All the patients underwent, both at baseline and over the follow-up, a monthly complete ophthalmologic examination, including best corrected visual acuity (BCVA) on ETDRS charts, fluorescein angiography, indocyanine green angiography, and ocular coherence tomography. Both intravitreal injections of ranibizumab and bevacizumab were considered for the study. After an initial loading phase of three consecutive injections, further re-treatments were administered on the basis of the identification of persistence or recurrence of subretinal/intraretinal fluid. The main outcome measure was the change in the mean BCVA at the 12-month examination. Secondary outomes included the proportion of eyes gaining at least 3 ETDRS lines, the mean change in the central retinal thickness (CRT), and number of injections at the end of the follow-up. Results: Sixty-one eyes of 61 patients were considered for the study. Overall, the mean BCVA changed from 0.62, to 0.47 LogMAR (p: 0.004) at the 12-month examination. Seventeen eyes (28%) gained at least 3 ETDRS lines, whereas no eye lost more than 3 ETDRS lines, over the follow-up. Mean CRT passed from 333μm to 222μm (p < 0.001). Twenty-three eyes (37%) showed serous pigment epithelium detachment (PED) at baseline, which was still visible in 10 eyes (16%) at the end of the follow-up. No difference in BCVA gain was registered comparing ranibizumab and bevacizumab. Pigment epithelium detachment was detectable in 5% and 30% of the eyes, treated with ranibizumab and bevacizumab, respectively (p: 0.01). Mean number of injection was 4 and 4.6 in ranibizumab and bevacizumab subgroups, respectively. Conclusions: Intravitreal anti-VEGF therapy can ensure a visual function improvement in about one third of patients affected by RAP, who are treated in the common clinical practice. Ranibizumab treatment requires less injections and more frequently leads to a pigment epithelium detachment resolution