Humans ; Macular Degeneration ; complications ; drug therapy ; prevention & control ; Risk Factors ; Singapore

OBJECTIVE: To evaluate the effect of anti-vascular endothelial growth factor (VEGF) on juxtafoveal choroidal neovascularization (CNV) secondary to multifocal choroiditis (MFC) and wet age-related macular degeneration (AMD). METHODS: In this retrospective, comparative study, 20 unique eyes with CNV were divided into two groups: 10 patients affected by MFC and 10 patients diagnosed with wet AMD. They all received local intravitreal (IVT) injections of ranibizumab, with 6 months of follow-up. Retreatment injections were performed based on findings suggestive of active neovascularization. RESULTS: Significant improvements were observed in the juxtafoveal CNV lesions, and average central macular thickness decreased in both groups following the anti-VEGF therapy (P<0.05). The average number of injections used in MFC patients was 1.6, while three injections on average were used in wet AMD patients (Z=-2.844, P=0.009). Best-corrected visual acuity was significantly improved in MFC patients after anti-VEGF therapy (P<0.05), and there was no significant difference in wet AMD patients between before anti-VEGF therapy and 6 months later (P>0.05). CONCLUSIONS IVT ranibizumab resulted in good clinical outcomes for juxtafoveal CNV secondary to MFC and wet AMD, but the average number of injections used in MFC was fewer than that used in wet AMD over a 6-month observation period. Compared with the wet AMD group, visual acuity was obviously improved in the MFC group at 6 months.
Adult ; Aged ; Angiogenesis Inhibitors/therapeutic use* ; Choroidal Neovascularization/drug therapy* ; Female ; Humans ; Inflammation ; Intravitreal Injections ; Macular Degeneration/drug therapy* ; Male ; Middle Aged ; Ranibizumab/therapeutic use* ; Treatment Outcome ; Vascular Endothelial Growth Factor A/antagonists & inhibitors* ; Vision, Ocular ; Wet Macular Degeneration/drug therapy*

BACKGROUNDAge-related macular degeneration (AMD) is the leading cause of irreversible vision loss among the older population. In China, treatment of age-related ocular diseases is becoming a priority in eye care services. This study was to investigate the clinical characteristics and quality of life of Chinese patients with wet AMD and current treatment types, to evaluate short-term gains in different treatments, and to investigate associations between visual function and vision-related quality of life (VRQoL).

METHODSA prospective, observational, noninterventional study was conducted. Basic data were collected from patients with clinical diagnoses of wet AMD before clinical assessments at baseline. VRQoL was measured with the Chinese version of the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25). Correlations of the NEI VFQ-25 subscale scores with best-corrected visual acuity (BCVA) and between-group differences were analyzed.

RESULTSA total of 80 wet AMD patients were enrolled, with the mean age of 68.40 years. About one-quarter of wet AMD patients received intravitreal (IVT) ranibizumab treatment, and 67% of them were treated on a pro re nata basis. The visual acuity of patients treated with IVT ranibizumab at month 3 after treatment was significantly increased, whereas patients treated with traditional Chinese medicine achieved no significant improvement. Cronbach's α for the NEI VFQ-25 subscales ranged from 0.697 to 0.843. Eight subscale and overall composite scores were moderately correlated with the BCVA of the better-seeing eye. Significant differences in the overall NEI VFQ-25 scores and other subscales were observed between patients with BCVA in the better-seeing eye of less than 50 letters and the others.

CONCLUSIONSPatients treated with IVT ranibizumab experienced better vision improvement at short-term follow-up. The Chinese version of the NEI VFQ-25 is a valid and reliable tool for assessing the VRQoL of Chinese wet AMD patients.

Aged ; Angiogenesis Inhibitors ; administration & dosage ; therapeutic use ; Female ; Humans ; Intravitreal Injections ; Macular Degeneration ; drug therapy ; physiopathology ; Male ; Middle Aged ; Prospective Studies ; Quality of Life ; Ranibizumab ; administration & dosage ; therapeutic use ; Wet Macular Degeneration ; drug therapy ; physiopathology

Angiogenesis is a complex biological phenomenon that forms new blood vessels from the pre-existing vasculature. Aberrant angiogenesis has been implicated in a variety of diseases such as cancer, atherosclerosis, arthritis, obesity, pulmonary hypertension, diabetic retinopathy, and age-related macular degeneration. These conditions collectively affect nearly 10% of the global population. Much effort has focused on identifying new therapeutic agents that inhibit pathological angiogenesis since 1971, when Judah Folkman published the hypothesis that tumor growth is angiogenesis-dependent and that its inhibition may be therapeutic. In 2004, the U.S. Food and Drug Administration approved the first antiangiogenic drug for the treatment of metastatic colon cancer, bevacizumab (Avastin, Genentech). This drug is a humanized monoclonal antibody that neutralizes the vascular endothelial growth factor. It is used in combination with chemotherapy, and its use began the era of antiangiogenesis therapy. Several new therapeutic agents have been added to the list of approved drugs, and clinical trials of new therapeutic options and antiangiogenic agents are ongoing. This review describes the progress made in the first decade of antiangiogenesis therapy, and addresses both validated and possible targets for future drug development.
Angiogenesis Inhibitors/*therapeutic use ; Humans ; Macular Degeneration/drug therapy ; Molecular Targeted Therapy/*trends ; Neoplasms/drug therapy ; Neovascularization, Pathologic/metabolism ; Neovascularization, Physiologic

Aged ; Aged, 80 and over ; Aging ; physiology ; Antibodies, Monoclonal, Humanized ; therapeutic use ; Humans ; Macular Degeneration ; drug therapy ; prevention & control ; Ranibizumab ; Visual Acuity ; drug effects

AIMTo review the outcomes of eyes with neovascular age-related macular degeneration (AMD) treated with photodynamic therapy (PDT) with verteporfin and intravitreal triamcinolone acetonide injection.

MATERIALS AND METHODSWe retrospectively reviewed the outcomes of consecutive eyes with neovascular AMD that received an intravitreal triamcinolone injection within 1 week of their first PDT and had at least 6 months of follow-up. Eyes were retreated with PDT at 3-month intervals if angiographic leakage was present.

RESULTSTwenty-six eyes from 24 patients were identified. The mean visual acuity at baseline was 20/118 (median 20/112). The mean visual acuity decreased to 20/138 at 9 months (P = 0.24, n = 15) and to 20/174 at 12 months (P = 0.23, n = 8). The change in visual acuity from baseline was not statistically significant at any time point. The mean central foveal thickness by OCT measured 342 microm at baseline and decreased to 296 microm at 12 months (P = 0.31). Sixty-two per cent of eyes required no additional PDT at 12 months. Nineteen per cent of 26 eyes had a rise in intraocular pressure that was controlled with topical medication alone.

CONCLUSIONPhotodynamic therapy with verteporfin combined with intravitreal triamcinolone injection in the treatment of neovascular AMD may be superior to PDT alone by decreasing visual loss and reducing the number or retreatments.

Age Factors ; Aged ; Choroidal Neovascularization ; Female ; Humans ; Macular Degeneration ; drug therapy ; therapy ; Male ; Photochemotherapy ; Photosensitizing Agents ; therapeutic use ; Porphyrins ; therapeutic use ; Retrospective Studies ; Treatment Outcome ; Triamcinolone ; therapeutic use

PURPOSE: To evaluate the diode laser photodynamic therapy efficacy on choroidal neovascularization (CNV) in the treatment of three patients with age-related macular degeneration (ARMD). METHODS: The authors selected three patients with ARMD whose vision has decreased due to CNV, and applied diode laser treatment after injecting an indocyanine green (ICG) solution. The patients were followed for at least three months after treatment, and examinations included evaluating vision changes and possible leakage on fluorescein angiography (FAG). RESULTS: The final vision of two patients improved by more than one line on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart after at least three months of follow-up. However, the final vision of the third patient decreased by one line on ETDRS chart. FAG was done in all patients, and in two of the patients, there was no evidence of leakage at the laser-applied site. In the other patient, there was evidence of minimal leakage, with the area of leakage decreasing by more than fifty percent. Side effects of ICG were not found during or after the photodynamic therapy sessions. CONCLUSIONS: The photodynamic usage of ICG treatment of CNV in patients with ARMD, was effective in preventing or improving the visual outcome. Compared to the widely used verteporfin, ICG is more stable and is more cost effective. The authors therefore came to a conclusion that ICG can be very useful in the treatment of CNV. However, further studies are necessary.
Treatment Outcome ; *Photochemotherapy ; Middle Aged ; Male ; Macular Degeneration/*drug therapy ; Lasers/*therapeutic use ; Indocyanine Green/*therapeutic use ; Humans ; Female ; Coloring Agents/*therapeutic use ; Aged

PURPOSE: To determine and compare the clinical characteristics, visual prognosis and treatment of hemorrhagic polypoidal choroidal vasculopathy (HPCV) with those of hemorrhagic choroidal neovascularization (HCNV) due to age-related macular degeneration (ARMD). MATERIALS AND METHODS: Retrospective analysis of 44 consecutive eyes with a submacular hemorrhage comprising more than 50% of the neovascular lesion. Patients were diagnosed as having HPCV or HCNV on the basis of indocyanine green angiography. RESUTLS: Of the 44 eyes with submacular hemorrhage, 26 were classified as HPCV and 18 as HCNV. The baseline patient characteristics were similar for both groups. At the final follow-up the HPCV group had 17 eyes showing visual improvement, four showing maintained vision, and five showing visual deterioration. In contrast, the HCNV group had four eyes showing visual improvement, one showing maintained vision, and 13 showing visual deterioration. Visual acuity of < 0.1 at follow-up was found in 7 (27%) of HPCV eyes and 10 (56%) of HCNV eyes. PDT was performed in 15 HPCV eyes, of which 13 (87%) showed improvement or no change in visual acuity, while only 2 (22%) of the 9 HCNV eyes responded similarly after PDT. Eyes treated with PDT did not have better outcomes compared to eyes that underwent other types of treatment (Fisher's exact test, p > 0.05). CONCLUSION: PCV accounts for the largest proportion of submacular hemorrhage in Koreans. PCV showed a better visual prognosis than CNV.
Vision Disorders/etiology ; Treatment Outcome ; Tissue Plasminogen Activator/therapeutic use ; Retinal Hemorrhage/drug therapy/*epidemiology ; Photochemotherapy ; Middle Aged ; Male ; Macular Degeneration/drug therapy/epidemiology ; Korea/epidemiology ; Humans ; Follow-Up Studies ; Female ; Choroidal Neovascularization/drug therapy/*epidemiology

OBJECTIVETo investigate the efficacy of Chinese medicine Huangban Bianxing Recipe (HBR) for treatment of choroidal neovascularization (CNV).

METHODSEighty patients (97 eyes) suffered from CNV were assigned to two groups, the treated group treated by HBR orally taken one dose every day and the control group treated with ginkgo leaf tablet 1 tablet (19.2 mg) thrice a day, all for 3 months. The best corrected visual acuity (BCVA), fundus hemorrhagic area were measured; the neo-genetic vascular leakage area determined by fluorescent fundus angiography (FFA); and the out-layer high reflective band thickness (OHRBT) estimated by optical coherent tomography (OCT) were recorded before and after treatment.

RESULTSAfter treatment, in the treated group, BCVA was improved, with an effective rate of 67.12%, while in the control group, it was 33.33%, the former was better than the latter significantly (P < 0.05). The effective rate in reducing fundus hemorrhagic area in the two groups (85.11% vs 47.62%) and that in the CNV closure showed by FFA (67.50% vs 37.50%) were also superior in the treated group (P < 0.05). Besides, OCT showed that the OHRBT reduced significantly after treatment in the treated group (P < 0.01).

CONCLUSIONHBR can improve the vision, reduce the CNV leakage in the macular region, and advance the absorption of fundus hemorrhage in CNV patients.

Adult ; Aged ; Aged, 80 and over ; Choroidal Neovascularization ; drug therapy ; etiology ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Macular Degeneration ; complications ; drug therapy ; Male ; Middle Aged ; Phytotherapy ; Visual Acuity ; drug effects ; Young Adult

PURPOSE: To compare pain scores of patients during intravitreal 27-gauge bevacizumab and 30-gauge ranibizumab injection procedures. METHODS: Seventy eyes of 70 patients who had not previously undergone intravitreal anti-vascular endothelial growth factor therapy were included in this study. Thirty-five patients received ranibizumab and 35 patients received bevacizumab. The diagnoses of the patients were: 27 age related macular degeneration, 15 diabetic macular edema, 9 diabetic vitreous hemorrhage, 6 central retinal vein occlusion, 11 branch retinal vein occlusion and 2 central serous chorioretinopathy. Bevacizumab (1.25 mg/0.05 mL) was injected into the vitreous cavity using a 27-gauge needle, and ranibizumab (0.5 mg/0.05 mL) was injected with 30-gauge needle. Patients were asked just after the injection to rate their perceived pain during the injection using the visual analogue scale (VAS) of 0 (no pain) to 10 (unbearable/worst pain). The average of these scores was used as the primary outcome. RESULTS: The VAS pain scores in the ranibizumab and bevacizumab groups were 1.06 +/- 0.91 (range, 0 to 3) and 1.94 +/- 1.55 (range, 0 to 7), respectively, a significant difference (p = 0.005). Patients <65 and > or =65 years of age in both the ranibizumab and bevacizumab groups were then compared. For patients <65, there was a significant difference in the average VAS pain scores between groups (p = 0.003). However, for patients > or =65 years, there was not a significant difference in the average VAS pain scores between groups (p = 0.238). Female and male patients in both ranibizumab and bevacizumab groups were also compared. For female patients, there was a significant difference in the average VAS pain scores between groups (p = 0.016), although not for male patients (p = 0.078). CONCLUSIONS: Thirty-gauge intravitreal injection is more comfortable than 27-gauge injection. Injection of bevacizumab with 30-gauge needle syringes may be more tolerable for patients.
Aged ; Aged, 80 and over ; Angiogenesis Inhibitors/*administration & dosage ; Antibodies, Monoclonal, Humanized/*administration & dosage ; Bevacizumab/*administration & dosage ; Diabetic Retinopathy/drug therapy/physiopathology ; Female ; Humans ; *Intravitreal Injections ; Macular Degeneration/drug therapy/physiopathology ; Macular Edema/drug therapy/physiopathology ; Male ; Middle Aged ; Pain Measurement ; Ranibizumab/*administration & dosage ; Retinal Vein Occlusion/drug therapy/physiopathology