Dataset Information

Potential roles of MNREAD acuity charts and contrast/glare sensitivity in Ranibizumab treatment of branch retinal vein occlusion.

ABSTRACT: BACKGROUND/OBJECTIVES:To investigate the potential utility of MNREAD acuity charts and contrast/glare sensitivity (CGS) assessment for evaluating the efficacy of an initial treatment with ranibizumab (Lucentis®) for branch retinal vein occlusion (BRVO). METHODS:Intravitreal injections of ranibizumab were administered in 43 eyes of 43 treatment-naïve patients with BRVO. Efficacy was assessed 1 month later. Best-corrected far/near visual acuity (BCFVA/BCNVA), MNREAD parameters (reading acuity [RA], maximum reading speed [MRS], critical print size [CPS]), CGS (CS/GS), and central macular thickness (CMT) in optical coherence tomography (OCT) before and after treatment were evaluated. The area (superior/inferior) affected by BRVO was determined by fluorescein angiography. RESULTS:All parameters improved significantly following treatment (p < 0.05), and all MNREAD and CGS parameters were significantly correlated with BCVA in the treated eye before and after treatment (p < 0.01). The changes in BCFVA, BCNVA, MRS, and CS were significantly correlated with the amount of change in CMT (p < 0.007; r = 0.415, 0.528, -0.465, and -0.508, respectively). MRS exhibited a percentage change that was significantly correlated with that in CMT (p < 0.007; r = -0.511). Additionally, MRS exhibited the lowest threshold CMT (397 ?m) at which the most significant change in improvement was observed. CMT was less likely to improve if BRVO occurred at a superior site than if it occurred at an inferior site (0.05 < p = 0.07 < 0.1). CONCLUSIONS:MNREAD and CGS testing were useful for evaluating BRVO treatment efficacy. MRS might be a valuable index for evaluating treatment success and making treatment decisions.

SUBMITTER: Tanabe H

PROVIDER: S-EPMC7351188 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Potential roles of MNREAD acuity charts and contrast/glare sensitivity in Ranibizumab treatment of branch retinal vein occlusion.

Tanabe Hirotaka H Obana Akira A Yamamoto Sachiko S Ichikumi Kiyomi K Gohto Yuko Y Seto Takahiko T Moriyama Takanobu T

PloS one 20200710 7

<h4>Background/objectives</h4>To investigate the potential utility of MNREAD acuity charts and contrast/glare sensitivity (CGS) assessment for evaluating the efficacy of an initial treatment with ranibizumab (Lucentis®) for branch retinal vein occlusion (BRVO).<h4>Methods</h4>Intravitreal injections of ranibizumab were administered in 43 eyes of 43 treatment-naïve patients with BRVO. Efficacy was assessed 1 month later. Best-corrected far/near visual acuity (BCFVA/BCNVA), MNREAD parameters (read ...[more]

PMID: 32649680

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Project description:BACKGROUND:To identify baseline patient characteristics associated with early clinically significant visual acuity (VA) improvements within 3?months of treatment initiation in ranibizumab-treated patients with retinal vein occlusion (RVO) in the SHORE study. METHODS:Post hoc analysis of baseline patient characteristics in the randomized, open-label, vision examiner-masked SHORE phase 4 study that compared monthly versus pro re nata dosing of ranibizumab in patients with branch and central RVO. Patients who enrolled in SHORE fulfilled eligibility criteria per protocol (N =?202). SHORE data were retrospectively analyzed to identify baseline patient characteristics associated with early clinically significant improvements in VA, defined as improvement to a Snellen equivalent of 20/40 or better vision (? 69 Early Treatment Diabetic Retinopathy Study [ETDRS] letters) or an increase in best-corrected VA (BCVA) of 15 or more ETDRS letters from baseline within 3?months of treatment initiation. Main outcome measures were BCVA gain of 15 or more ETDRS letters from baseline, Snellen equivalent of 20/40 or better vision, and baseline factors associated with early clinically significant improvement in BCVA. RESULTS:The median time for patients to achieve a BCVA of 20/40 or better was 59?days and the median time for patients to gain 15 or more ETDRS letters was 63?days. Better baseline BCVA (>?50 ETDRS letters/Snellen equivalent ??20/100), greater baseline total macular volume (>?9.99?mm3), and presence of subretinal fluid at baseline were all associated with early improvement to 20/40 or better vision (ETDRS equivalent ??69 letters; P <?.0001, P =?.02, and P =?.03, respectively). CONCLUSIONS:This retrospective analysis found that better BCVA, greater total macular volume, and presence of subretinal fluid at baseline were associated with more rapid vision gains. Clinicians may find these helpful when considering the likelihood of achieving early clinically significant VA improvements with ranibizumab in patients with RVO. TRIAL REGISTRATION:ClinicalTrials.gov NCT01277302 .

Project description:IntroductionRanibizumab and aflibercept are anti-vascular endothelial growth factor agents licensed for the treatment of visual impairment due to macular edema secondary to branch retinal vein occlusion (BRVO). The aim of this study was to estimate, from a UK healthcare payer's perspective, the cost-effectiveness of ranibizumab versus aflibercept in this indication.MethodsA Markov model was used to simulate the outcomes and costs of treating BRVO. Patient baseline characteristics and efficacy data for ranibizumab were obtained from the BRAVO trial. The relative efficacy of aflibercept was derived from a published network meta-analysis. Injection frequencies were derived from ranibizumab and aflibercept studies included in the network meta-analysis. Health states were defined by increments of 10 letters in best corrected visual acuity (BCVA). Patients could gain or lose a maximum of two health states between cycles. The first cycle was 6 months, followed by monthly cycles. Different utility values were assigned to the better-seeing and worse-seeing eyes based on BCVA. A 2-year treatment time frame and a lifetime time horizon were used. Future costs and health outcomes were discounted at 3.5% per annum. Sensitivity analyses were used to test the robustness of the model.ResultsThe lifetime cost per patient treated was £15,273 with ranibizumab and £17,347 with aflibercept. Ranibizumab was dominant over aflibercept, producing incremental health gains of 0.0120 quality-adjusted life-years (QALYs) and cost savings of £2074. Net monetary benefit for ranibizumab at a willingness-to-pay threshold of £20,000/QALY was £2314. Sensitivity analyses showed that the results were robust to variations in model parameters.ConclusionsRanibizumab provides greater health gains at a lower overall cost than aflibercept in the treatment of visual impairment due to macular edema secondary to BRVO. Ranibizumab is therefore cost-effective from a UK healthcare payer's perspective.FundingNovartis Pharma AG, Basel, Switzerland.

Project description:PURPOSE:To examine the relationship between optical coherence tomography (OCT) images and clinical course in eyes with branch retinal vein occlusion (BRVO) treated with intravitreal ranibizumab injection (IVR). DESIGN:Prospective cohort study. PARTICIPANTS:Thirty eyes of 30 patients with BRVO treated with IVR. METHODS:All patients received 1 initial IVR followed by repeated injections in the pro re nata (PRN) regimen. Correlations between logarithm of minimum angle of resolution best-corrected visual acuity (logMAR BCVA) or number of IVRs after 12 months and OCT parameters including the external limiting membrane (ELM), ellipsoid zone (EZ), interdigitation zone (IZ), and photoreceptor outer segment (PROS) length at first resolution of macular edema (ME) were assessed. Resolution of ME was defined as central foveal thickness <300 ?m and the absence of subretinal fluid. OCT parameters influencing BCVA and number of IVRs were evaluated using multivariate analysis. Correlations between nonperfusion areas (NPAs) and thinning areas and changes in retinal thickness of BRVO-affected areas were assessed. RESULTS:Of the 30 patients, 27 completed this study and were included in the statistical analyses. The mean logMAR BCVA at 3, 6, and 12 months was 0.16 ± 0.19, 0.09 ± 0.20, and 0.07 ± 0.20, respectively, which improved significantly from baseline at each visit (p < 0.0001, respectively), while the mean number of IVRs at 12 months was 3.9 ± 2.2. The mean number of IVRs for the first resolution of ME was 1.6 ± 0.8. Eyes with ELM and EZ defects at the points of first resolution of ME were correlated with a significantly lower BCVA at 12 months compared with eyes with preserved ELMs and EZs (p = 0.035, p = 0.002, respectively). However, eyes with IZ defects at the points of first resolution of ME were not correlated with a significantly lower BCVA at 12 months compared with eyes with preserved IZs (p = 0.160). Defects in the EZ at the points of first resolution of ME significantly affected the number of IVRs at 12 months (p = 0.042), although the ELM and IZ did not. PROS length at the points of first resolution of ME was significantly correlated with BCVA and number of IVRs at 12 months (p = 0.006, p = 0.0008, respectively). In multivariate analysis, PROS length at the points of first resolution of ME had the most significant effect on BCVA and number of IVRs (p = 0.013, p = 0.012, respectively). NPA size on fluorescein angiography and thinning area on OCT within the macular area showed a significant correlation (p = 0.003, r = 0.971). The retinal thickness of ischemic BRVO-affected areas was significantly less than that of control areas at 10, 11, and 12 months (p = 0.001, p = 0.005, p = 0.003, respectively). CONCLUSION:We showed that the 1+PRN regimen may be a useful therapy for ME due to BRVO. In addition, PROS length at points of first resolution of ME appears to be a good indicator of BCVA and number of IVRs in BRVO patients.

Dataset Information

Potential roles of MNREAD acuity charts and contrast/glare sensitivity in Ranibizumab treatment of branch retinal vein occlusion.

Publications

Potential roles of MNREAD acuity charts and contrast/glare sensitivity in Ranibizumab treatment of branch retinal vein occlusion.

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