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Brolucizumab for Neovascular Age-Related Macular Degeneration in Real-World Setting Nadhira, Andi Marsa; Djatikusumo, Ari; Victor, Andi Arus
International Journal of Retina Vol 6 No 2 (2023): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2023.vol006.iss002.247

Introduction: The mainstay treatment for neovascular AMD (nAMD) is intravitreal injections of anti-vascular growth factor (anti-VEGF) agents. Based on clinical trials, a newly developed anti-VEGF named brolucizumab showed noninferiority in anatomical and functional outcomes with longer injection interval, when compared to previous anti-VEGF agents; however, severe post-injection inflammation has been observed. This review aims to evaluate the efficacy and safety of brolucizumab in real-world clinical setting. Methods: We conducted systematic searches in Pubmed, Science Direct, Clinicalkey, and Scopus. Observational studies, case series, and individual case studies enrolling naïve-treatment and switch-therapy nAMD patients who received intravitreal injection of brolucizumab were eligible for this review. Result: We included 12 studies, comprising 772 patients and 848 eyes, that reported the outcome of intravitreal injection of brolucizumab in real-world practice. The mean age of patients was 77 years old. Follow-up period ranged from 7,2 weeks to 52 weeks. Improvement in visual acuity was mostly observed in treatment-naïve groups, ranging from +4,5 to +11,9 Early Treatment Diabetic Retinopathy Study (ETDRS) letters. Improvement in retinal thickness and reduction in retinal fluids were reported in both groups, with mean central retinal thickness (CRT) change of 94,92 μm. Significant reductions of subretinal fluid (SRF) were observed in 4 studies, intraretinal fluid (IRF) in 2 studies, and pigment epithelial detachment (PED) in 3 studies. Eight studies reported injection interval, the longest of which extended to 12 weeks. Inflammatory events following brolucizumab injection were reported in 8,01% of eyes, ranging from mild to severe inflammation, with 34,2% of the intraocular inflammation occurring in the vitreous (22 eyes). Brolucizumab may help alleviate treatment burden in real-world clinical setting by reducing disease activity, mainly demonstrated as improvement in retinal thickness, reduction in retinal fluid, and prolongation of injection interval. Clinicians must be aware of the possible inflammatory events following brolucizumab injection.

Clinical Characteristics and Management of Wet Age-Related Macular Degeneration at Cipto Mangunkusumo Hospital Kirana, Jakarta, Indonesia Leonedine, Tengku Viona Zohra; Victor, Andi Arus; Djatikusumo, Ari; Adriono, Gitalisa Andayani; Yudanta, Anggun Rama; Hutapea, Mario Marbungaran; Suryoadji, Kemal Akbar
International Journal of Retina Vol 7 No 2 (2024): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2024.vol007.iss002.291

Introduction: Age-related macular degeneration (AMD) is a leading cause of blindness globally, with wet AMD being particularly debilitating. The prevalence of AMD is increasing, necessitating a deeper understanding of its clinical characteristics and management. This study aims to investigate the demographic and clinical features, management, and treatment outcomes of wet AMD at Cipto Mangunkusumo Hospital during January-December 2022. Methods: A retrospective descriptive study was conducted, analyzing medical records of wet AMD patients treated during the specified period. Data analysis included patient demographics, clinical characteristics, treatment modalities, and outcomes. Results: Of 129 eyes from 122 patients, 115 eyes met the inclusion criteria. The majority were female (55.7%) with an average age of 67 years. Most patients presented with blurry vision (93.9%) and received Patizra anti-VEGF injections (60.9%). Hypertension was the most common risk factor (28.7%). Anti-VEGF treatment significantly reduced central macular thickness (p < 0.05) but had no significant impact on visual acuity. Avastin and Patizra injections similarly influenced macular thickness but not visual acuity. There were no significant differences between loading and non-loading dose groups in terms of outcomes. Conclusion: Anti-VEGF treatment effectively reduces central macular thickness in wet AMD patients, regardless of the specific agent used. However, it does not significantly improve visual acuity. Further research is needed to explore differences between loading and non-loading dose protocols, compare treatment strategies, and investigate demographic risk factors. Consistency in visual acuity documentation using the ETDRS format is recommended for future studies.

Real-World Evaluation of the Effectiveness of Intravitreal Bevacizumab Injection for Neovascular Age-Related Macular Degeneration at Cipto Mangunkusumo National Referral Hospital Adriono, Gitalisa Andayani; Pambudy, Indra Maharddhika; Victor, Andi Arus; Djatikusumo, Ari; Yudhanta, Anggun Rama; Hutapea, Mario Marbungaran; Triyoga, Ichsan Fauzi
International Journal of Retina Vol 8 No 2 (2025): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2025.vol008.iss002.319

Introduction: Neovascular age-related macular degeneration (nAMD) is a leading cause of visual impairment globally. While intravitreal anti-VEGF therapy is the standard treatment, real-world data on bevacizumab (IVB), the most accessible agent in Indonesian public hospitals despite being off-label, remains limited. This study aims to evaluate the effectiveness of IVB in patients with nAMD at a tertiary referral center in Indonesia. Methods: This retrospective study included patients diagnosed with nAMD who received IVB injections at Cipto Mangunkusumo National Referral Hospital between January and December 2017. Inclusion criteria encompassed patients with confirmed nAMD and available clinical data pre- and post-injection. Data on demographics, best-corrected visual acuity (BCVA), central macular thickness (CMT) measured by OCT, and IVB injection regimen were extracted from electronic medical records. Statistical analysis was performed using Wilcoxon signed-rank and Mann–Whitney U tests, with p < 0.05 considered statistically significant. Result: A total of 138 eyes from 131 patients (mean age: 66.7 years; 51% male) were analyzed. The median number of injections was three (range: 1–6). Mean BCVA showed a non-significant improvement from 1.19 to 1.14 logMAR (mean change: 0.05 logMAR; p = 0.770). Subgroup analysis indicated significant improvement in eyes with baseline VA worse than 1.32 logMAR (mean gain: 0.54 logMAR; p < 0.01) and a significant decline in eyes with baseline VA between 0.48 and 1.00 logMAR (mean loss: 0.21 logMAR; p = 0.02). CMT significantly decreased by an average of 108.33 µm (p < 0.01). Conclusion: IVB treatment for nAMD resulted in significant anatomical improvement and was particularly effective in patients with poor baseline visual acuity. These findings highlight the role of IVB in real-world clinical practice within resource-limited settings.

Clinical Characteristics of Patients with Retinal Vein Occlusion and Macular Edema at Cipto Mangunkusumo Hospital Kirana in Indonesia Isfyanto, Isfyanto; Djatikusumo, Ari; Andayani, Gitalisa; Yudantha, Anggun Rama; Hutapea, Mario Marbungaran; Suryoadji, Kemal Akbar; Victor, Andi Arus
International Journal of Retina Vol 7 No 1 (2024): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2024.vol007.iss001.271

Introduction: Retinal vein occlusion (RVO) is a significant retinal vascular disease, often resulting in macular edema and vision impairment. This study aims to investigate the clinical characteristics, management, and outcomes of RVO patients with macular edema at Cipto Mangunkusumo Hospital Kirana from January 2020 to December 2021. Methods: This retrospective descriptive study analyzed medical records of 85 RVO patients with macular edema. Demographic data, clinical characteristics, management approaches, and treatment outcomes were examined. Data were analyzed using SPSS. Results: Most patients were over 50 years old, predominantly male, and affected in one eye. Hypertension and diabetes mellitus were common comorbidities. Central RVO cases had worse initial visual acuity and macular thickness than branch RVO cases. Anti-VEGF injections were the primary therapy, and patients received an average of two injections in the first year. Macular thickness reduced after anti-VEGF injections, but visual acuity improvement was minimal. Conclusion: Patients with RVO and macular edema are often older males with systemic risk factors. Anti-VEGF injections are the primary treatment, with improvements in macular thickness but limited visual acuity gain. Patient education, comprehensive management, and public awareness are recommended to enhance RVO care. Further research to analyze parameter relationships is needed.

CLINICAL CHARACTERISTICS OF PROLIFERATIVE DIABETIC RETINOPATHY (PDR) PATIENTS WITH VITREOUS HEMORRHAGE AT CIPTO MANGUNKUSUMO HOSPITAL Ali, Reyno Satria; Victor, Andi Arus; Djatikusumo, Ari; Andayani, Gitalisa; Yudanta, Anggun Rama; Hutapea, Mario Marbungaran
International Journal of Retina Vol 6 No 1 (2023): International Journal of Retina (IJRetina) - INAVRS
Publisher : Indonesian Vitreoretinal Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35479/ijretina.2023.vol006.iss001.227

Introduction: Proliferative Diabetic retinopathy is the most common cause of blindness in adults. In the management of vitreous hemorrhage, vitrectomy is the main choice and also laser photocoagulation with or without anti-VEGF administration as additional therapy. This study aims to determine the number of patients, demographic characteristics, clinics, risk factors, distribution of treatment, and treatment outcomes for PDR patients with vitreous hemorrhage at Cipto Mangunkusumo Hospital. Methods: This study was retrospective descriptive study conducted from January 2020 to October 2022 who met the inclusion criteria. Population in this study were patients at Cipto Mangunkusumo Hospital with PDR accompanied by vitreous hemorrhage. Data shown in the table were mean (standard deviation) and number (percentage) based on the type of the data. Result: A total of 146 patients with the diagnosis of Proliferative Diabetic Retinopathy (PDR) with vitreous hemorrhage. Majority of subjects were men (60,9%), diagnosed with DM more than 10 years (63,0%) with another systemic risk factor. The most common clinical characteristics found visual acuity at the initial visit <3/60 (80,8%), diagnosed phakia (78,9%), retinal detachment (85,3%), grade 2 vitreous hemorrhage (80,8%). The majority of eyes underwent vitrectomy (90,44%), Anti-VEGF injections (22,92%), Laser PRP (11,46 %), Phacoemulsification pre and post- vitrectomy as adjuvant treatment. The condition of the vitreous was clear after vitrectomy (99,1%). Mean visual acuity before vitrectomy is 2.10 (1.80 – 2.50), while mean visual acuity after vitctomy was 1.00 (1.30 – 2.40), with a difference in initial and final visual acuity of -0.10 (-0.50 – 0.60). Conclusion: Majority of study subjects were men with an age range of 25-77 years. Vitrectomy as the main treatment combined with intravitreal injection of anti-VEGF, laser PRP as adjuvant treatment. In nearly all cases, vitreous hemorrhage was clear after vitrectomy treatment. Visual acuity after vitrectomy shows progress even though in some cases there was no improvement.

DIAGNOSIS DAN TATALAKSANA EALES DISEASE : A LITERATURE REVIEW Victor, Andi Arus; Suryoadji, Kemal Akbar; Adishabri, Ananda Kukuh; Abdullah, Muhammad Raoul Taufiq
Jurnal Ilmiah Kesehatan Vol 23 No 02 (2024): Jurnal Ilmiah Kesehatan terbitan Agustus Volume 23 Nomor 02 Tahun 2024
Publisher : UIMA Press

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33221/jikes.v23i02.2657

Penyakit Eales adalah vaskulopati retina oklusif idiopatik yang utamanya memengaruhi retina perifer. Penyakit Eales ditandai oleh vaskulitis retina dan perdarahan vitreus berulang, iskemia retina, dan neovaskularisasi yang disertai nyeri kepala, konstipasi, dan epistaksis. Penyebab pasti belum sepenuhnya dipahami namun diduga terkait reaksi imunologis terhadap agen eksogen seperti tuberkulosis. Patofisiologi melibatkan periflebitis retina, iskemia retina, dan neovaskularisasi. Tinjauan pustaka menggunakan sumber data dari NCBI atau PubMed dengan kata kunci "Eales disease" dan kriteria inklusi berupa naskah lengkap dan berbahasa Inggris. Studi ini bertujuan untuk meninjau pustaka mengenai diagnosis dan tatalaksana penyakit Eales, serta menyajikan informasi berbagai pilihan pengobatan berdasarkan tahap penyakit guna meningkatkan prognosis visual. Diagnosis penyakit Eales didasarkan pada anamnesis dan pemeriksaan oftalmologis meliputi tajam penglihatan, pemeriksaan segmen anterior, vitreus, saraf optik, dan retina. Pemeriksaan penunjang seperti fundus fluorescein angiography (FFA), B-scan ultrasonography, dan tomografi koherensi optik (OCT) membantu memastikan diagnosis. Pemeriksaan laboratorium diperlukan untuk menyingkirkan penyakit lain penyebab vasculitis. Tatalaksana penyakit Eales melibatkan terapi medis dengan steroid (oral atau periokular) pada tahap inflamasi, fotokoagulasi laser pada tahap proliferasi untuk mengatasi neovaskularisasi, dan pembedahan vitreoretinal (vitrektomi) pada kasus dengan perdarahan vitreus persisten atau retinal detachment. Komplikasi termasuk perdarahan vitreus berulang, neovaskularisasi iris, katarak, dan glaukoma neovaskular. Penyakit Eales adalah vaskulopati retina dengan gejala vaskulitis dan perdarahan vitreus berulang. Diagnosis didukung oleh pemeriksaan seperti FFA, B-scan ultrasonography, dan OCT. Tatalaksana melibatkan penggunaan steroid, fotokoagulasi laser, dan pembedahan vitreoretinal.

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