OPHTHALMOLOGICA

VOL: 233 ISSUE: 3-4 MONTH: MARCH/APRIL 2015

AMD – a cardiovascular risk indicator

One out of three patients with exudative AMD with no history of coronary artery disease or stroke could nonetheless be at a high risk of acute atherothrombotic events, a new study suggests. Among 259 patients with exudative AMD evaluated, 28.2 per cent had a mean intima-media thickness of 1.0mm or greater and 8.9 per cent had severe carotid artery stenosis, 16.6 per cent had severe atherosclerosis with a plaque score greater than 10, 5.4 per cent had peripheral arterial disease, and 32 per cent had chronic kidney disease. Risk factors identified for abnormal carotid artery thickening were diabetes mellitus and AMD affecting eyes bilaterally, risk factors identified for CKD were age and body mass index. H Taniguchi et al, "Evaluation of Carotid Atherosclerosis, Peripheral Arterial Disease, and Chronic Kidney Disease in Patients with Exudative Age-Related Macular Degeneration without Coronary Artery Disease or Stroke", Ophthalmologica 2015; Volume 233, Issue 3-4 (DOI:10.1159/000371716).

Choroid grafts show some efficacy

Epithelium choroid grafts and anti-VEGF therapy can both provide visual improvements in eyes with exudative AMD, but with both treatments some patients will continue to lose vision postoperatively, according to the findings of a prospective randomised intervention study involving 20 patients. At a follow-up of one year, the mean change in visual acuity in the graft group was 15 ETDRS letters lower than it was preoperatively, and two patients had a gain of 10 or more lines. In the anti-VEGF group, there was a mean loss of eight ETDRS letters, but no patients had a gain of more than 10 letters. EJT Van Zeeburg et al, “Prospective, Randomized Intervention Study Comparing Retinal Pigment Epithelium-Choroid Graft Surgery and Anti-VEGF Therapy in Patients with Exudative Age-Related Macular Degeneration”, Ophthalmologica 2015; Volume 233, Issue 3-4 (DOI:10.1159/000380829).

Switching to aflibercept brings
anatomic improvements

The findings of a retrospective study indicate that aflibercept treatment can preserve the vision of AMD patients with poor responses to other anti-VEGF compounds, while also extending the interval between injections. The study involved 85 eyes of 69 patients who were either refractory to bevacizumab or were currently receiving ranibizumab. One year after switching to aflibercept there was an insignificant mean decrease of two letters in patients’ mean visual acuity and 90.6 per cent of eyes showed anatomic improvement with a reduction of fluid on OCT and a significant improvement in central retinal thickness. Moreover, the mean number of injections per month fell significantly after switching to the newer agent. J Pinheiro-Costa et al, “Switch to Aflibercept in the Treatment of Neovscular AMD: One-Year Results in Clinical Practice”, Ophthalmologica 2015; Volume 233, Issue 3-4 (DOI:10.1159/000381221).