[New aspects in the treatment of neovascular age-related macular degeneration: the criteria of re-treatment with the anti-VEGF therapy.]

ArticleinDer Ophthalmologe 108(1):85-90 · January 2011with12 Reads
DOI: 10.1007/s00347-010-2326-1 · Source: PubMed
    • "Monitoring visits are recommended at monthly intervals following the upload phase in Germany [10] and in Spain [9]. "
    [Show abstract] [Hide abstract] ABSTRACT: Purpose. To survey the management of patients with neovascular age-related macular degeneration (nvAMD) in Spain. Methods. An observational retrospective multicenter study was conducted. The variables analyzed were sociodemographic characteristics, foveal and macular thickness, visual acuity (VA), type of treatment, number of injections, and the initial administration of a loading dose of an antiangiogenic drug. Results. 208 patients were followed up during 23.4 months in average. During the first and second years, patients received a mean of 4.5 ± 1.8 and 1.6 ± 2.1 injections of antiangiogenic drugs, and 5.4 ± 2.8 and 3.6 ± 2.2 follow-up visits were performed, respectively. The highest improvement in VA was observed at 3 months of follow-up, followed by a decrease in the response that stabilized above baseline values until the end of the study. Patients who received an initial loading dose presented greater VA gains than those without. Conclusions. Our results suggest the need for a more standardized approach in the management and diagnosis of nvAMD receiving VEGF inhibitors. To achieve the visual outcomes reported in pivotal trials, an early diagnosis, proactive approach (more treating than follow-up visits), and a close monitoring might be the key to successfully manage nvAMD.
    Full-text · Article · Feb 2014
  • [Show abstract] [Hide abstract] ABSTRACT: The objectives of this study are to estimate the recent population-based incidences of all-cause and cause-specific blindness in Germany and compare them with results from a similar study conducted in 1994-1998. All blindness allowance recipients newly registered between January 2008 and December 2009 in a region in southern Germany (population, approximately 3.5 million) were assessed and their ophthalmological reports reviewed. The main causes of blindness were identified and their incidences estimated. There were 572 newly registered cases of blindness allowance. The all-cause incidence of blindness (per 100,000 person-years) in the general population was 8.4 (95 % confidence interval, 7.8-9.2), and the highest incidences were for macular degeneration (3.4; 3.0-3.9), diabetic retinopathy (0.8; 0.6-1.1) and glaucoma (0.7; 0.5-0.9). During the last two decades, blindness incidences decreased for all the main causes (standardised to the West German population 1991: 12.3; 11.9-12.7 in 1994-1998 vs. 7.3; 6.7-8.0 in 2008-2009). The highest absolute decrease was for macular degeneration and the highest relative decrease was for cataract. The most frequent main causes of blindness in Germany remained macular degeneration, diabetic retinopathy and glaucoma. Our findings suggest a remarkable decrease in the incidences of blindness, probably because of new diagnostic options and effective treatments.
    Article · Jun 2012
  • [Show abstract] [Hide abstract] ABSTRACT: Purpose: To evaluate effectiveness, tolerability and safety of repeated intravitreal injections of 0.5 mg ranibizumab for the treatment of neovascular age-related macular degeneration in routine medical practice in Germany. Methods: A noninterventional study with 3470 patients treated in 274 medical centres according to German guidelines, with monthly intravitreal injections of 0.5 mg ranibizumab during upload (3 months) followed by a maintenance phase (9 months) with reinjections if medically indicated. Results: Mean injection rate was 4.34 (SE = 0.05; median = 3.0). Best-corrected visual acuity (BCVA) remained stable (mean change 0.02 LogMAR, SE = 0.01, p = 0.0169) and central retinal thickness (CRT) decreased (by -78.9 μm, SE = 2.95 μm, p < 0.0001). The NEI-VFQ 25 summary score showed a positive stabilization with a mean change of 0.73 (SE = 0.37, p = 0.0501) compared with baseline. Adverse events were documented for 6.5% of the patients with 3.9% of these events being classified as serious. Conclusions: The number of administered intravitreal injections of ranibizumab over the first year of treatment was very low but still achieved a stabilization of BCVA, a reduction in CRT and maintained vision-related quality of life. The management of patients with neovascular AMD in Germany needs to be improved to achieve better treatment results.
    Article · Nov 2012
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