Hannah J Yu1, Dwain Fuller2, Rajiv Anand2, Timothy Fuller2, Jose Munoz1, Chelsey Moore1, Ryan S Kim1,3, Amy C Schefler4,5. 1. Retina Consultants of Texas, Retina Consultants of America, Houston, TX, USA. 2. Texas Retina Associates, Dalla, TX, USA. 3. McGovern Medical School, Houston, TX, USA. 4. Retina Consultants of Texas, Retina Consultants of America, Houston, TX, USA. acsmd@retinaconsultantstexas.com. 5. Blanton Eye Institute, Houston Methodist Hospital, 6560 Fannin Street, Ste. 750, Houston, TX, 77030, USA. acsmd@retinaconsultantstexas.com.
Abstract
PURPOSE: To assess the efficacy of a treat-and-extend strategy with intravitreal ranibizumab for radiation-related macular edema. METHODS: Forty eyes with radiation-induced macular edema and decreased visual acuity were enrolled in the phase IIb, prospective clinical trial and randomized into 3 cohorts: (A) monthly ranibizumab, (B) monthly ranibizumab with targeted retinal photocoagulation (TRP), or (C) as-needed ranibizumab and TRP. In year 2, all subjects entered a treat-and-extend protocol for ranibizumab. The primary outcome measure was mean change in early treatment diabetic retinopathy study (ETDRS) best-corrected visual acuity (BCVA) from baseline. RESULTS: Through year 1, the mean change in ETDRS BCVA was significantly different between the three cohorts (p < 0.001); cohort A saw the largest gain with + 4.0 letters. Significant anatomic improvements were also seen in all cohorts. Comparatively, through year 2, cohorts A, B, and C had a mean change in ETDRS BCVA of - 1.9, - 3.9, and + 1.3 letters, respectively; additionally, no significant differences were found in absolute ETDRS BCVA across time (ANOVA, p = 0.123). Overall, 90% of eyes maintained VA 20/200 or better and 33.3% of subjects gained at least one line of vision. There were no significant differences in mean central macular thickness for any cohort compared to baseline (p = 0.09). The presence of retinal hemorrhage and intraretinal exudates stayed consistent from year 1 to year 2 for all cohorts. CONCLUSIONS: Among eyes with radiation-related macular edema, a treat-and-extend regimen with ranibizumab may not result in as many visual and anatomic improvements as monthly injections. However, treat-and-extend still may prevent serious visual complications compared to historical controls. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02222610.
PURPOSE: To assess the efficacy of a treat-and-extend strategy with intravitreal ranibizumab for radiation-related macular edema. METHODS: Forty eyes with radiation-induced macular edema and decreased visual acuity were enrolled in the phase IIb, prospective clinical trial and randomized into 3 cohorts: (A) monthly ranibizumab, (B) monthly ranibizumab with targeted retinal photocoagulation (TRP), or (C) as-needed ranibizumab and TRP. In year 2, all subjects entered a treat-and-extend protocol for ranibizumab. The primary outcome measure was mean change in early treatment diabetic retinopathy study (ETDRS) best-corrected visual acuity (BCVA) from baseline. RESULTS: Through year 1, the mean change in ETDRS BCVA was significantly different between the three cohorts (p < 0.001); cohort A saw the largest gain with + 4.0 letters. Significant anatomic improvements were also seen in all cohorts. Comparatively, through year 2, cohorts A, B, and C had a mean change in ETDRS BCVA of - 1.9, - 3.9, and + 1.3 letters, respectively; additionally, no significant differences were found in absolute ETDRS BCVA across time (ANOVA, p = 0.123). Overall, 90% of eyes maintained VA 20/200 or better and 33.3% of subjects gained at least one line of vision. There were no significant differences in mean central macular thickness for any cohort compared to baseline (p = 0.09). The presence of retinal hemorrhage and intraretinal exudates stayed consistent from year 1 to year 2 for all cohorts. CONCLUSIONS: Among eyes with radiation-related macular edema, a treat-and-extend regimen with ranibizumab may not result in as many visual and anatomic improvements as monthly injections. However, treat-and-extend still may prevent serious visual complications compared to historical controls. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02222610.
Authors: B M Melia; D H Abramson; D M Albert; H C Boldt; J D Earle; W F Hanson; P Montague; C S Moy; A P Schachat; E R Simpson; B R Straatsma; A K Vine; T A Weingeist Journal: Ophthalmology Date: 2001-02 Impact factor: 12.079
Authors: Amy C Schefler; Dwain Fuller; Rajiv Anand; Timothy Fuller; Chelsey Moore; Jose Munoz; Ryan S Kim Journal: Am J Ophthalmol Date: 2020-04-09 Impact factor: 5.258
Authors: Anton Haas; Oliver Pinter; Georg Papaefthymiou; Martin Weger; Andrea Berghold; Oskar Schröttner; Klaus Müllner; Gerhard Pendl; Gerald Langmann Journal: Ophthalmology Date: 2002-05 Impact factor: 12.079
Authors: H Krema; S Somani; A Sahgal; W Xu; M Heydarian; D Payne; H McGowan; H Michaels; E R Simpson; N Laperriere Journal: Br J Ophthalmol Date: 2009-05-03 Impact factor: 4.638