Guidance for anti-VEGF intravitreal injections during the COVID-19 pandemic.

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Abstract

There is an urgent need to address how to best provide ophthalmic care for patients with retinal disease receiving intravitreal injections with anti-vascular endothelial growth factor agents during the ongoing global COVID-19 pandemic. This article provides guidance for ophthalmologists on how to deliver the best possible care for patients while minimizing the risk of infection.

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Three-year outcomes of individualized ranibizumab treatment in patients with diabetic macular edema: the RESTORE extension study.

Paolo Lanzetta, Emma Lang, Frank G. Holz … (2014)

To evaluate long-term efficacy and safety profiles during 3 years of individualized ranibizumab treatment in patients with visual impairment due to diabetic macular edema (DME). Phase IIIb, multicenter, 12-month, randomized core study and 24-month open-label extension study. Of the 303 patients who completed the randomized RESTORE 12-month core study, 240 entered the extension study. In the extension study, patients were eligible to receive individualized ranibizumab treatment as of month 12 guided by best-corrected visual acuity (BCVA) and disease progression criteria at the investigators' discretion. Concomitant laser treatment was allowed according to the Early Treatment Diabetic Retinopathy Study guidelines. Based on the treatments received in the core study, the extension study groups were referred to as prior ranibizumab, prior ranibizumab + laser, and laser. Change in BCVA and incidence of ocular and nonocular adverse events (AEs) over 3 years. Overall, 208 patients (86.7%) completed the extension study. In patients treated with ranibizumab during the core study, consecutive individualized ranibizumab treatment during the extension study led to an overall maintenance of BCVA and central retinal subfield thickness (CRST) observed at month 12 over the 2-year extension study (+8.0 letters, -142.1 μm [prior ranibizumab] and +6.7 letters, -145.9 μm [prior ranibizumab + laser] from baseline at month 36) with a median of 6.0 injections (mean, 6.8 injections; prior ranibizumab) and 4.0 (mean, 6.0 injections; prior ranibizumab + laser). In the prior laser group, a progressive BCVA improvement (+6.0 letters) and CRST reduction (-142.7 μm) at month 36 were observed after allowing ranibizumab during the extension study, with a median of 4.0 injections (mean, 6.5 injections) from months 12 to 35. Patients in all 3 treatment groups received a mean of <3 injections in the final year. No cases of endophthalmitis, retinal tear, or retinal detachment were reported. The most frequently reported ocular and nonocular adverse effects over 3 years were cataract (16.3%) and nasopharyngitis (23.3%). Eight deaths were reported during the extension study, but none were suspected to be related to the study drug/procedure. Ranibizumab was effective in improving and maintaining BCVA and CRST outcomes with a progressively declining number of injections over 3 years of individualized dosing. Ranibizumab was generally well tolerated with no new safety concerns over 3 years. Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

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Fundamental principles of an anti-VEGF treatment regimen: optimal application of intravitreal anti–vascular endothelial growth factor therapy of macular diseases

Paolo Lanzetta, Anat Loewenstein, (2017)

Background Intravitreal anti–vascular endothelial growth factor (VEGF) therapy is now considered the gold standard for the treatment of various retinal disorders. As therapy has evolved, so too have the treatment regimens employed by physicians in clinical practice; however, visual outcomes observed in the real world have typically not reflected those reported in clinical trials. Possible reasons for this include a lack of consensus on treatment regimens and a lack of clarity about what the aims of treatment should be. Methods The Vision Academy Steering Committee met to discuss the principles of an ideal treatment regimen, using evidence from the literature to substantiate each point. Literature searches were performed using the MEDLINE/PubMed database (cut-off date: March 2016) and restricted to English-language publications. Studies with fewer than ten patients were excluded from this review. Results The Steering Committee identified the following four key principles for the ideal treatment regimen for anti-VEGF management of retinal diseases: Maximize and maintain visual acuity (VA) benefits for all patients Decide when to treat next, rather than whether to treat now Titrate the treatment intervals to match patients’ needs Treat at each monitoring visit. Conclusions It is proposed that the adoption of a proactive and more personalized approach in the clinic such as a treat-and-extend regimen will lead to benefits for both the patient and the physician, through a reduction in the associated treatment burden and better utilization of clinic resources. Implementation of the four principles should also lead to better VA outcomes for each patient, with a minimized risk of vision loss.

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CURRENT CONCEPTS AND MODALITIES FOR MONITORING THE FELLOW EYE IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION

Tien Wong, Paolo Lanzetta, Francesco Bandello … (2020)

Neovascular age-related macular degeneration in one eye is a major risk factor for developing neovascular age-related macular degeneration in the fellow eye; effective monitoring is therefore critical. This review summarizes existing and developing methods to monitor the fellow eye of patients with unilateral neovascular age-related macular degeneration and provides guidance for patients and clinicians.

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Author and article information

Journal

Journal ID (iso-abbrev): Graefes Arch Clin Exp Ophthalmol

Title: Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie

Publisher: Springer Science and Business Media LLC

ISSN (Electronic): 1435-702X

ISSN (Print): 0721-832X

Publication date (Electronic): Jun 2020

Volume: 258

Issue: 6

Affiliations

[1 ] Service d'ophtalmologie, CHU Bordeaux, Bordeaux, France. jean-francois.korobelnik@chu-bordeaux.fr.

[2 ] Inserm, Bordeaux Population Health Research Center, team LEHA, Université de Bordeaux, UMR 1219, F-33000, Bordeaux, France. jean-francois.korobelnik@chu-bordeaux.fr.

[3 ] Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

[4 ] Department of Ophthalmology, Hacettepe University, Ankara, Turkey.

[5 ] Charité - University Medicine Berlin, Berlin, Germany.

[6 ] Eye and Retina Surgeons, Camden Medical Centre, Singapore, Singapore.

[7 ] Global Medical Affairs Ophthalmology, Bayer, Basel, Switzerland.

[8 ] Department of Medicine - Ophthalmology, University of Udine, Udine, Italy.

[9 ] Department of Ophthalmology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Ospedale Santa Maria della Misericordia, Udine, Italy.

[10 ] Istituto Europeo di Microchirurgia Oculare, IEMO, Udine, Italy.

[11 ] Eye Center and Eye Institute, Peking University People's Hospital, Beijing, China.

[12 ] Department of Ophthalmology, Lund University Hospital, Lund, Sweden.

[13 ] Instituto Microcirugia Ocular, Barcelona, Spain.

[14 ] Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan.

[15 ] Royal Liverpool University Hospital, Liverpool, UK.

[16 ] Fundación Oftalmologia Nacional, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.

[17 ] Unity Health Toronto - St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.

[18 ] Macula, Vitreous and Retina Associates of Costa Rica, San José, Costa Rica.

Article

Publisher Item ID: 10.1007/s00417-020-04703-x

DOI: 10.1007/s00417-020-04703-x

PMC ID: 7179379

PubMed ID: 32328757

SO-VID: 0e1bd6fe-7ffd-4ed3-972e-2f0e167da3ae

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Keywords: COVID-19,Coronavirus,Ophthalmology,Recommendations,Retinal disease,Vision Academy

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Keywords: COVID-19, Coronavirus, Ophthalmology, Recommendations, Retinal disease, Vision Academy

Guidance for anti-VEGF intravitreal injections during the COVID-19 pandemic.

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Most cited references 3

Three-year outcomes of individualized ranibizumab treatment in patients with diabetic macular edema: the RESTORE extension study.

Fundamental principles of an anti-VEGF treatment regimen: optimal application of intravitreal anti–vascular endothelial growth factor therapy of macular diseases

CURRENT CONCEPTS AND MODALITIES FOR MONITORING THE FELLOW EYE IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION

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