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Short-term response to anti-VEGF as indicator of visual prognosis in refractory age-related macular degeneration
Background Some patients with neovascular age-related macular degeneration (nAMD) respond insufficiently to anti-VEGF treatment despite maximal monthly intravitreal injections. Their short-term response between injections was investigated for extent and visual prognosis. Subjects/Methods Monocentric...
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| Published in: | Eye (London) 2024-05, Vol.38 (7), p.1342-1348 |
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| creator | Gigon, Anthony Iskandar, Antonio Kasser, Sophie Naso, Sacha Zola, Marta Mantel, Irmela |
| description | Background
Some patients with neovascular age-related macular degeneration (nAMD) respond insufficiently to anti-VEGF treatment despite maximal monthly intravitreal injections. Their short-term response between injections was investigated for extent and visual prognosis.
Subjects/Methods
Monocentric retrospective observational study. 45 eyes from 41 patients with refractory nAMD (who previously received at least 12 months of anti-VEGF treatment), evaluated by optical coherence tomography (OCT) in between monthly anti-VEGF injections. The fluid profile on OCT was evaluated before, 1 week after, and 1 month after an intravitreal injection, using central retinal thickness (CRT), manual measurements, and fluid specific volumetric measurements performed by an automated algorithm based on artificial intelligence.
Results
A significant improvement was found at week 1 in terms of CRT (
p
|
| doi_str_mv | 10.1038/s41433-023-02900-6 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11076480</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3051760054</sourcerecordid><originalsourceid>FETCH-LOGICAL-c426t-8c27653543f7efc979825a5277458444ae4656c1036724d72d85d7ebb4f000503</originalsourceid><addsrcrecordid>eNp9kc1u1TAQhS0EopfCC7BAltiwcXH8m6wQqtqCVKmLFsTO8nUmqavEDrZTqW-PL7eU0gULaxbnm-OZOQi9behRQ3n7MYtGcE4o272OUqKeoU0jtCJSSPEcbWgnKWGM_ThAr3K-obSKmr5EB7xluqsWG7RcXsdUSIE04wR5iSEDLhHbUDz5fnJ2im3GPvTe2RITjgO-9Xm1E15SHEPMfqfWziFZV4E7bEcgCSZboMezdetkE-5hhADJFh_Da_RisFOGN_f1EH07Pbk6_kLOL86-Hn8-J04wVUjrmFaSS8EHDYPrdNcyaSXTWshWCGFBKKlcvYPSTPSa9a3sNWy3YqCUSsoP0ae977JuZ-gdhJLsZJbkZ5vuTLTe_KsEf23GeGuahmol2p3Dh3uHFH-ukIuZfXYwTTZAXLNhXT26Uq3mFX3_BL2Jawp1P8OpbLSqI4lKsT3lUsy53uxhmoaaXaJmn6ipiZrfiRpVm9493uOh5U-EFeB7IFcpjJD-_v0f21_9tKx0</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3051760054</pqid></control><display><type>article</type><title>Short-term response to anti-VEGF as indicator of visual prognosis in refractory age-related macular degeneration</title><source>Springer Nature</source><creator>Gigon, Anthony ; Iskandar, Antonio ; Kasser, Sophie ; Naso, Sacha ; Zola, Marta ; Mantel, Irmela</creator><creatorcontrib>Gigon, Anthony ; Iskandar, Antonio ; Kasser, Sophie ; Naso, Sacha ; Zola, Marta ; Mantel, Irmela</creatorcontrib><description>Background
Some patients with neovascular age-related macular degeneration (nAMD) respond insufficiently to anti-VEGF treatment despite maximal monthly intravitreal injections. Their short-term response between injections was investigated for extent and visual prognosis.
Subjects/Methods
Monocentric retrospective observational study. 45 eyes from 41 patients with refractory nAMD (who previously received at least 12 months of anti-VEGF treatment), evaluated by optical coherence tomography (OCT) in between monthly anti-VEGF injections. The fluid profile on OCT was evaluated before, 1 week after, and 1 month after an intravitreal injection, using central retinal thickness (CRT), manual measurements, and fluid specific volumetric measurements performed by an automated algorithm based on artificial intelligence.
Results
A significant improvement was found at week 1 in terms of CRT (
p
< 0.0001), intraretinal (IRF) (
p
= 0.007), subretinal fluid (SRF) (
p
< 0.0001), and pigment epithelium detachment (PED) volume (
p
< 0.0001). Volumetric fluid measures revealed a >50% reduction at week 1 for both IRF and SRF for approximately two-thirds of eyes. Poorer short-term response was associated with larger exudative fluid amounts (IRF + SRF) (
p
= 0.003), larger PED (
p
= 0.007), lower visual acuity (
p
= 0.004) and less anatomic changes at treatment initiation (
p
< 0.0001). Univariate and multivariate analysis revealed that visual outcomes 4 and 5 years later was significantly worse with weaker short-term responsiveness (
p
= 0.005), with the presence of atrophy (
p
= 0.01) and larger PED volumes (
p
= 0.002).
Conclusions
Incomplete responders to anti-VEGF showed a significant short-term response, identifiable at 1 week after injection, with rapid recurrence at 1 month. Weaker short-term responsiveness at 1 week was associated with poorer long term visual prognosis. These patients may need adjuvant treatment to improve their prognosis.</description><identifier>ISSN: 0950-222X</identifier><identifier>ISSN: 1476-5454</identifier><identifier>EISSN: 1476-5454</identifier><identifier>DOI: 10.1038/s41433-023-02900-6</identifier><identifier>PMID: 38279038</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>692/308/53/2422 ; 692/699/3161/1626 ; Acuity ; Age ; Aged ; Aged, 80 and over ; Angiogenesis Inhibitors - therapeutic use ; Artificial intelligence ; Atrophy ; Bevacizumab - therapeutic use ; Epithelium ; Female ; Humans ; Intravitreal Injections ; Laboratory Medicine ; Macular degeneration ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Multivariate analysis ; Ophthalmology ; Pharmaceutical Sciences/Technology ; Prognosis ; Ranibizumab - administration & dosage ; Ranibizumab - therapeutic use ; Receptors, Vascular Endothelial Growth Factor - therapeutic use ; Retrospective Studies ; Subretinal Fluid ; Surgery ; Surgical Oncology ; Tomography, Optical Coherence - methods ; Vascular endothelial growth factor ; Vascular Endothelial Growth Factor A - antagonists & inhibitors ; Visual Acuity - physiology ; Wet Macular Degeneration - diagnosis ; Wet Macular Degeneration - drug therapy ; Wet Macular Degeneration - physiopathology</subject><ispartof>Eye (London), 2024-05, Vol.38 (7), p.1342-1348</ispartof><rights>The Author(s) 2024</rights><rights>2024. The Author(s).</rights><rights>The Author(s) 2024. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c426t-8c27653543f7efc979825a5277458444ae4656c1036724d72d85d7ebb4f000503</cites><orcidid>0000-0003-1432-4201 ; 0000-0002-5457-7871 ; 0000-0002-8822-8194</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27915,27916</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38279038$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gigon, Anthony</creatorcontrib><creatorcontrib>Iskandar, Antonio</creatorcontrib><creatorcontrib>Kasser, Sophie</creatorcontrib><creatorcontrib>Naso, Sacha</creatorcontrib><creatorcontrib>Zola, Marta</creatorcontrib><creatorcontrib>Mantel, Irmela</creatorcontrib><title>Short-term response to anti-VEGF as indicator of visual prognosis in refractory age-related macular degeneration</title><title>Eye (London)</title><addtitle>Eye</addtitle><addtitle>Eye (Lond)</addtitle><description>Background
Some patients with neovascular age-related macular degeneration (nAMD) respond insufficiently to anti-VEGF treatment despite maximal monthly intravitreal injections. Their short-term response between injections was investigated for extent and visual prognosis.
Subjects/Methods
Monocentric retrospective observational study. 45 eyes from 41 patients with refractory nAMD (who previously received at least 12 months of anti-VEGF treatment), evaluated by optical coherence tomography (OCT) in between monthly anti-VEGF injections. The fluid profile on OCT was evaluated before, 1 week after, and 1 month after an intravitreal injection, using central retinal thickness (CRT), manual measurements, and fluid specific volumetric measurements performed by an automated algorithm based on artificial intelligence.
Results
A significant improvement was found at week 1 in terms of CRT (
p
< 0.0001), intraretinal (IRF) (
p
= 0.007), subretinal fluid (SRF) (
p
< 0.0001), and pigment epithelium detachment (PED) volume (
p
< 0.0001). Volumetric fluid measures revealed a >50% reduction at week 1 for both IRF and SRF for approximately two-thirds of eyes. Poorer short-term response was associated with larger exudative fluid amounts (IRF + SRF) (
p
= 0.003), larger PED (
p
= 0.007), lower visual acuity (
p
= 0.004) and less anatomic changes at treatment initiation (
p
< 0.0001). Univariate and multivariate analysis revealed that visual outcomes 4 and 5 years later was significantly worse with weaker short-term responsiveness (
p
= 0.005), with the presence of atrophy (
p
= 0.01) and larger PED volumes (
p
= 0.002).
Conclusions
Incomplete responders to anti-VEGF showed a significant short-term response, identifiable at 1 week after injection, with rapid recurrence at 1 month. Weaker short-term responsiveness at 1 week was associated with poorer long term visual prognosis. These patients may need adjuvant treatment to improve their prognosis.</description><subject>692/308/53/2422</subject><subject>692/699/3161/1626</subject><subject>Acuity</subject><subject>Age</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Angiogenesis Inhibitors - therapeutic use</subject><subject>Artificial intelligence</subject><subject>Atrophy</subject><subject>Bevacizumab - therapeutic use</subject><subject>Epithelium</subject><subject>Female</subject><subject>Humans</subject><subject>Intravitreal Injections</subject><subject>Laboratory Medicine</subject><subject>Macular degeneration</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Multivariate analysis</subject><subject>Ophthalmology</subject><subject>Pharmaceutical Sciences/Technology</subject><subject>Prognosis</subject><subject>Ranibizumab - administration & dosage</subject><subject>Ranibizumab - therapeutic use</subject><subject>Receptors, Vascular Endothelial Growth Factor - therapeutic use</subject><subject>Retrospective Studies</subject><subject>Subretinal Fluid</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Tomography, Optical Coherence - methods</subject><subject>Vascular endothelial growth factor</subject><subject>Vascular Endothelial Growth Factor A - antagonists & inhibitors</subject><subject>Visual Acuity - physiology</subject><subject>Wet Macular Degeneration - diagnosis</subject><subject>Wet Macular Degeneration - drug therapy</subject><subject>Wet Macular Degeneration - physiopathology</subject><issn>0950-222X</issn><issn>1476-5454</issn><issn>1476-5454</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kc1u1TAQhS0EopfCC7BAltiwcXH8m6wQqtqCVKmLFsTO8nUmqavEDrZTqW-PL7eU0gULaxbnm-OZOQi9behRQ3n7MYtGcE4o272OUqKeoU0jtCJSSPEcbWgnKWGM_ThAr3K-obSKmr5EB7xluqsWG7RcXsdUSIE04wR5iSEDLhHbUDz5fnJ2im3GPvTe2RITjgO-9Xm1E15SHEPMfqfWziFZV4E7bEcgCSZboMezdetkE-5hhADJFh_Da_RisFOGN_f1EH07Pbk6_kLOL86-Hn8-J04wVUjrmFaSS8EHDYPrdNcyaSXTWshWCGFBKKlcvYPSTPSa9a3sNWy3YqCUSsoP0ae977JuZ-gdhJLsZJbkZ5vuTLTe_KsEf23GeGuahmol2p3Dh3uHFH-ukIuZfXYwTTZAXLNhXT26Uq3mFX3_BL2Jawp1P8OpbLSqI4lKsT3lUsy53uxhmoaaXaJmn6ipiZrfiRpVm9493uOh5U-EFeB7IFcpjJD-_v0f21_9tKx0</recordid><startdate>20240501</startdate><enddate>20240501</enddate><creator>Gigon, Anthony</creator><creator>Iskandar, Antonio</creator><creator>Kasser, Sophie</creator><creator>Naso, Sacha</creator><creator>Zola, Marta</creator><creator>Mantel, Irmela</creator><general>Nature Publishing Group UK</general><general>Nature Publishing Group</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-1432-4201</orcidid><orcidid>https://orcid.org/0000-0002-5457-7871</orcidid><orcidid>https://orcid.org/0000-0002-8822-8194</orcidid></search><sort><creationdate>20240501</creationdate><title>Short-term response to anti-VEGF as indicator of visual prognosis in refractory age-related macular degeneration</title><author>Gigon, Anthony ; Iskandar, Antonio ; Kasser, Sophie ; Naso, Sacha ; Zola, Marta ; Mantel, Irmela</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c426t-8c27653543f7efc979825a5277458444ae4656c1036724d72d85d7ebb4f000503</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>692/308/53/2422</topic><topic>692/699/3161/1626</topic><topic>Acuity</topic><topic>Age</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Angiogenesis Inhibitors - therapeutic use</topic><topic>Artificial intelligence</topic><topic>Atrophy</topic><topic>Bevacizumab - therapeutic use</topic><topic>Epithelium</topic><topic>Female</topic><topic>Humans</topic><topic>Intravitreal Injections</topic><topic>Laboratory Medicine</topic><topic>Macular degeneration</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Multivariate analysis</topic><topic>Ophthalmology</topic><topic>Pharmaceutical Sciences/Technology</topic><topic>Prognosis</topic><topic>Ranibizumab - administration & dosage</topic><topic>Ranibizumab - therapeutic use</topic><topic>Receptors, Vascular Endothelial Growth Factor - therapeutic use</topic><topic>Retrospective Studies</topic><topic>Subretinal Fluid</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Tomography, Optical Coherence - methods</topic><topic>Vascular endothelial growth factor</topic><topic>Vascular Endothelial Growth Factor A - antagonists & inhibitors</topic><topic>Visual Acuity - physiology</topic><topic>Wet Macular Degeneration - diagnosis</topic><topic>Wet Macular Degeneration - drug therapy</topic><topic>Wet Macular Degeneration - physiopathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gigon, Anthony</creatorcontrib><creatorcontrib>Iskandar, Antonio</creatorcontrib><creatorcontrib>Kasser, Sophie</creatorcontrib><creatorcontrib>Naso, Sacha</creatorcontrib><creatorcontrib>Zola, Marta</creatorcontrib><creatorcontrib>Mantel, Irmela</creatorcontrib><collection>SpringerOpen</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Eye (London)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gigon, Anthony</au><au>Iskandar, Antonio</au><au>Kasser, Sophie</au><au>Naso, Sacha</au><au>Zola, Marta</au><au>Mantel, Irmela</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Short-term response to anti-VEGF as indicator of visual prognosis in refractory age-related macular degeneration</atitle><jtitle>Eye (London)</jtitle><stitle>Eye</stitle><addtitle>Eye (Lond)</addtitle><date>2024-05-01</date><risdate>2024</risdate><volume>38</volume><issue>7</issue><spage>1342</spage><epage>1348</epage><pages>1342-1348</pages><issn>0950-222X</issn><issn>1476-5454</issn><eissn>1476-5454</eissn><abstract>Background
Some patients with neovascular age-related macular degeneration (nAMD) respond insufficiently to anti-VEGF treatment despite maximal monthly intravitreal injections. Their short-term response between injections was investigated for extent and visual prognosis.
Subjects/Methods
Monocentric retrospective observational study. 45 eyes from 41 patients with refractory nAMD (who previously received at least 12 months of anti-VEGF treatment), evaluated by optical coherence tomography (OCT) in between monthly anti-VEGF injections. The fluid profile on OCT was evaluated before, 1 week after, and 1 month after an intravitreal injection, using central retinal thickness (CRT), manual measurements, and fluid specific volumetric measurements performed by an automated algorithm based on artificial intelligence.
Results
A significant improvement was found at week 1 in terms of CRT (
p
< 0.0001), intraretinal (IRF) (
p
= 0.007), subretinal fluid (SRF) (
p
< 0.0001), and pigment epithelium detachment (PED) volume (
p
< 0.0001). Volumetric fluid measures revealed a >50% reduction at week 1 for both IRF and SRF for approximately two-thirds of eyes. Poorer short-term response was associated with larger exudative fluid amounts (IRF + SRF) (
p
= 0.003), larger PED (
p
= 0.007), lower visual acuity (
p
= 0.004) and less anatomic changes at treatment initiation (
p
< 0.0001). Univariate and multivariate analysis revealed that visual outcomes 4 and 5 years later was significantly worse with weaker short-term responsiveness (
p
= 0.005), with the presence of atrophy (
p
= 0.01) and larger PED volumes (
p
= 0.002).
Conclusions
Incomplete responders to anti-VEGF showed a significant short-term response, identifiable at 1 week after injection, with rapid recurrence at 1 month. Weaker short-term responsiveness at 1 week was associated with poorer long term visual prognosis. These patients may need adjuvant treatment to improve their prognosis.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>38279038</pmid><doi>10.1038/s41433-023-02900-6</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-1432-4201</orcidid><orcidid>https://orcid.org/0000-0002-5457-7871</orcidid><orcidid>https://orcid.org/0000-0002-8822-8194</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Eye (London), 2024-05, Vol.38 (7), p.1342-1348 |
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| source | Springer Nature |
| subjects | 692/308/53/2422 692/699/3161/1626 Acuity Age Aged Aged, 80 and over Angiogenesis Inhibitors - therapeutic use Artificial intelligence Atrophy Bevacizumab - therapeutic use Epithelium Female Humans Intravitreal Injections Laboratory Medicine Macular degeneration Male Medicine Medicine & Public Health Middle Aged Multivariate analysis Ophthalmology Pharmaceutical Sciences/Technology Prognosis Ranibizumab - administration & dosage Ranibizumab - therapeutic use Receptors, Vascular Endothelial Growth Factor - therapeutic use Retrospective Studies Subretinal Fluid Surgery Surgical Oncology Tomography, Optical Coherence - methods Vascular endothelial growth factor Vascular Endothelial Growth Factor A - antagonists & inhibitors Visual Acuity - physiology Wet Macular Degeneration - diagnosis Wet Macular Degeneration - drug therapy Wet Macular Degeneration - physiopathology |
| title | Short-term response to anti-VEGF as indicator of visual prognosis in refractory age-related macular degeneration |
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