Cem KESİM, Ali DEMIRCAN, Gökhan DEMİR, Zeynep ALKIN, Mehmet Göksel ULAŞ

Tedaviye Dirençli Eksüdatif Yaşa Bağlı Makula Dejenerasyonunun İndosiyanin Yeşili Anjiyografisi ile Tekrar Değerlendirilmesi

Amaç: Eksüdatif yaşa bağlı makula dejenerasyonlu YBMD gözlerin ranibizumab tedavisinden aflibersept tedavisine geçiş öncesi indosiyanin yeşili anjiyografisi İSYA ile değerlendirilmesi ile bulguların görsel ve anatomik sonuçlar üzerindeki etkilerin incelenmesi.Gereç ve Yöntemler: Ranibizumab tedavisine dirençli olup aflibersept enjeksiyonuna değişiklik yapılan eksüdatif YBMD tanılı 44 hastanın 51 gözü bu retrospektif çalışmaya dahil edildi. Birincil sonuçlar değişiklik prosedürü sonrası 3. ay ve son vizitteki en iyi düzeltilmiş görme keskinliği EİDGK ve santral makula kalınlığı SMK değişiklikleri idi.Bulgular: Elli bir gözün 38ʼinde %74 polipoidal koroidal vaskülopati PKV , ve 10ʼunda %20 okült koroidal neovasküler membran KNV mevcuttu. Ortalama 0,73±0,45 logMAR olan bazal EİDGK 3. ayda 0,74±0,46ʼya, son vizitte 0,72±0,43ʼe değişti p=0,77, p=0,55 . EİDGK 29 gözde sabitken %56,9 , 12 gözde %23,5 görsel iyileşme görüldü ve tamamı PKV tanılı olan 10 göz %19,6 görmede azalma gösterdi. Son vizitte, okült KNV bulunan 10 gözün 5ʼinde görme düzelirken 5ʼinde görme düzeyi sabit kaldı. Ortalama SMK 3 ayda 390±103 µmʼden 326±72 µmʼye geriledi p

Anahtar Kelimeler:

İndosiyanin yaşili anjiyografisi, Yaşa bağlı makula dejenerasyonu, Aflibersept, Değişiklik prosedürü

Reassessment of Treatment-Resistant Exudative Age-Related Macular Degeneration with Indocyanine Green Angiography

Objective: To evaluate eyes with exudative age-related macular degeneration AMD with indocyanine green angiography ICGA prior switching from ranibizumab treatment to aflibercept treatment and investigate the effect of findings on visual and anatomic outcomes.Material and Methods: Fifty-one eyes of 44 patients with exudative AMD diagnosis that are resistant to ranibizumab and switched to aflibercept injections were included in this retrospective study. The primary outcomes were changes in best-corrected visual acuity BCVA and central macular thickness CMT at 3 months and at the last visit following the switch procedure.Results: Out of 51 eyes, 38 74% had polypoidal choroidal vasculopathy PCV , and 10 20% had occult choroidal neovascular membrane CNV . The mean baseline BCVA of 0.73±0.45 logMAR changed to 0.74±0.46 at 3 months and to 0.72±0.43 at the last visit p=0.77, p=0.55 . BCVA was stable in 29 eyes 56.9% , twelve eyes 23.5% experienced visual improvement while ten eyes 19.6% , all of which were diagnosed with PCV, showed visual loss. Of the 10 eyes with occult CNV, the vision improved in 5 eyes and remained stable in 5 eyes at the last visit. The mean CMT was reduced from 390±103 µm to 326±72 µm at 3 months p

Keywords:

Indocyanine green angiography, Age-related macular degeneration, Aflibercept, Switch procedure,

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Wong WL, Su X, Li X, Cheung CM, Klein R, Cheng CY, Wong TY. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: A systematic review and meta-analysis. Lancet Glob Health 2014; 2:106-16.
Brown DM, Kaiser PK, Michels M, Soubrane G, Heier JS, Kim RY, Sy JP, Schneider S. ANCHOR Study Group. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med 2006; 355(14):1432-44.
Heier JS, Brown DM, Chong V, Korobelnik JF, Kaiser PK, Nguyen QD, Kirchhof B, Ho A, Ogura Y, Yancopoulos GD, Stahl N, Vitti R, Berliner AJ, Soo Y, Anderesi M, Groetzbach G, Sommerauer B, Sandbrink R, Simader C, Schmidt-Erfurth U; VIEW 1 and VIEW 2 Study Groups. Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration. Ophthalmology 2012; 119(12): 2537-48.
Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, Kim RY. MARINA Study Group. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med 2006; 355(14):1419-31.
CATT Research Group, Martin DF, Maguire MG, Ying GS, Grunwald JE, Fine SL, Jaffe GJ. Ranibizumab and bevacizumab for neovascular age-related macular degeneration. N Engl J Med 2011; 364(20):1897-908.
Amoaku WM, Chakravarthy U, Gale R, Gavin M, Ghanchi F, Gibson J, Harding S, Johnston RL, Kelly SP, Lotery A, Mahmood S, Menon G, Sivaprasad S, Talks J, Tufail A, Yang Y. Defining response to anti- VEGF therapies in neovascular AMD. Eye (Lond) 2015; 29(6):721-31.
Yang S, Zhao J, Sun X. Resistance to anti-VEGF therapy in neovascular age-related macular degeneration: A comprehensive review. Drug Des Devel Ther 2016; 10:1857-67.
Ehlken C, Jungmann S, Böhringer D, Agostini HT, Junker B, Pielen A. Switch of anti-VEGF agents is an option for nonresponders in the treatment of AMD. Eye (Lond). 2014; 28(5):538-45.
Almony A, Mansouri A, Shah GK, Blinder KJ. Efficacy of intravitreal bevacizumab after unresponsive treatment with intravitreal ranibizumab. Can J Ophthalmol 2011; 46(2):182-5.
Gasperini JL, Fawzi AA, Khondkaryan A, Lam L, Chong LP, Eliott D, Walsh AC, Hwang J, Sadda SR. Bevacizumab and ranibizumab tachyphylaxis in the treatment of choroidal neovascularisation. Br J Ophthalmol 2012; 96(1):14-20.
Kumar N, Marsiglia M, Mrejen S, Fung AT, Slakter J, Sorenson J, Freund KB. Visual and anatomical outcomes of intravitreal aflibercept in eyes with persistent subfoveal fluid despite previous treatments with ranibizumab in patients with neovascular age-related macular degeneration. Retina 2013; 33(8):1605-12.
Cho H, Shah CP, Weber M, Heier JS. Aflibercept for exudative AMD with persistent fluid on ranibizumab and/or bevacizumab. Br J Ophthalmol 2013; 97(8):1032- 5.
Ricci F, Parravano M, Regine F, Sciamanna M, Tedeschi M, Missiroli F, Varano M. Aflibercept in persistent neovascular AMD: Comparison of different treatment strategies in switching therapy. Eye (Lond) 2016; 30(8):1077-83.
Yannuzzi LA, Ciardella A, Spaide RF, Rabb M, Freund KB, Orlock DA. The expanding clinical spectrum of idiopathic polypoidal choroidal vasculopathy. Arch Ophthalmol 1997; 115:478-85.
Yannuzzi LA, Negrao S, Iida T, Carvalho C, Rodriguez- Coleman H, Slakter J, Freund KB, Sorenson J, Orlock D, Borodoker N. Retinal angiomatous proliferation in age- related macular degeneration. Retina 2001; 21:416-34.
Ozkaya A, Alagoz C, Garip R, Alkin Z, Perente I, Yazici AT, Taskapili M. The role of indocyanine green angiography imaging in further differential diagnosis of patients with nAMD who are morphologically poor responders to ranibizumab in a real-life setting. Eye (Lond) 2016; 30(7):958-65.
Stangos AN, Gandhi JS, Nair-Sahni J, Heimann H, Pournaras CJ, Harding SP. Polypoidal choroidal vasculopathy masquerading as neovascular age-related macular degeneration refractory to ranibizumab. Am J Ophthalmol 2010; 150:666-73.
Ilginis T, Ottosen S, Harbo Bundsgaard K, Uggerhİj Andersen C, Vorum H. Polypoidal choroidal vasculopathy in patients diagnosed with neovascular age-related macular degeneration in Denmark. Acta Ophthalmol 2012; 90:487-8.
Curry B, Bylsma G, Hewitt AW, Verma N. The VEGF treatment of AMD Switch study (The vTAS Study). Asia Pac J Ophthalmol (Phila) 2017; 6(6):481-7.
Waizel M, Todorova MG, Masyk M, Wolf K, Rickmann A, Helaiwa K, Blanke BR, Szurman P. Switch to aflibercept or ranibizumab after initial treatment with bevacizumab in eyes with neovascular AMD. BMC Ophthalmol 2017; 17(1):79.
Massamba N, Dirani A, Butel N, Fardeau C, Bodaghi B, Ingram A, Lehoang P. Evaluation of outer retinal tubulations in eyes switched from intravitreal ranibizumab to aflibercept for treatment of exudative age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2017; 255(1):61-7.
Ho VY, Yeh S, Olsen TW, Bergstrom CS, Yan J, Cribbs BE, Hubbard GB. Short-term outcomes of aflibercept for neovascular age-related macular degeneration in eyes previously treated with other vascular endothelial growth factor inhibitors. Am J Ophthalmol 2013; 156(1):23-8.
Spooner K, Hong T, Wijeyakumar W, Chang AA. Switching to aflibercept among patients with treatment- resistant neovascular age-related macular degeneration: A systematic review with meta-analysis. Clin Ophthalmol 2017; 11:161-77.
Seguin Greenstein S, Lightman S, Tomkins Netzer O. A meta-analysis of studies evaluating visual and anatomical outcomes in patients with treatment resistant neovascular age-related macular degeneration following switching to treatment with aflibercept. J Ophthalmol 2016; 2016:4095852.
Zuber-Laskawiec K, Kubicka-Trzaska A, Karska- Basta I, Pociej-Marciak W, Romanowska-Dixon B. Non-responsiveness and tachyphylaxis to anti-vascular endothelial growth factor treatment in naive patients with exudative age-related macular degeneration. J Physiol Pharmacol 2019; 70(5):779-85.
Dirani A, Mantel I. Ranibizumab treatment history as predictor of the switch-response to aflibercept: Evidence for drug tolerance. Clin Ophthalmol 2018; 12:593-600.
Eghoj MS, Sorenson TL. Tachyphylaxis during treatment of exudative age-related macular degeneration with ranibizumab. Br J Ophthalmol 2012; 96(1):21-3.
Koike N, Otsuji T, Tsumura A, Miki K, Sakai Y, Nishimura T, Takahashi K. Results of switchback from ranibizumab to aflibercept in patients with exudative age-related macular degeneration. Clin Ophthalmol 2019; 13:1247- 51.
Saito M, Kano M, Itagaki K, Oguchi Y, Sekiryu T. Switching to intravitreal aflibercept injection for polypoidal choroidal vasculopathy refractory to ranibizumab. Jpn J Ophthalmol 2016; 60(1):35-41.
Arakawa A, Inoue M, Sato S, Yamane S, Kadonosono K. Efficacy of intravitreal aflibercept injections for Japanese patients with polypoidal choroidal vasculopathy. Clin Ophthalmol 2017; 11:797-802.