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Martin S. Zinkernagel - One of the best experts on this subject based on the ideXlab platform.
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aflibercept for age related macular degeneration 4 year outcomes of a treat and extend regimen with Exit Strategy
British Journal of Ophthalmology, 2020Co-Authors: Damian Jaggi, Marion R. Munk, Andreas Ebneter, Sebastian Wolf, Thanoosha Nagamany, Martin S. ZinkernagelAbstract:Aim To report long-term outcomes on best-corrected visual acuity (BCVA) and treatment intervals with a treat-and-extend (T&E) regimen in patients with neovascular age-related macular degeneration (nAMD). Methods This observational study included treatment-naive patients with nAMD, treated with aflibercept. A specific T&E protocol without a loading phase and predefined Exit criteria was administered. After reaching predefined ‘Exit-criteria’, the treatment period was complete, and patients were observed three monthly. Results Eighty-two patients with a follow-up period of ≥2 years were included. BCVA (mean±SD, ETDRS letters) increased from 51.9±25.2 at baseline to 63.7±17.7 (p Conclusions After 4 years of treatment, initial vision gains were maintained with a reasonable treatment burden, even without an initial loading phase. Our results on functional outcomes are comparable with large controlled studies.
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Exit Strategy in a treat and extend regimen for exudative age related macular degeneration
Retina-the Journal of Retinal and Vitreous Diseases, 2017Co-Authors: Petra Arendt, Marion R. Munk, Andreas Ebneter, Sebastian Wolf, Martin S. ZinkernagelAbstract:Purpose:To evaluate the outcome of an Exit Strategy in a treat-and-extend regimen for neovascular age-related macular degeneration.Methods:Five hundred and ninety-eight eyes of 488 patients with neovascular age-related macular degeneration receiving intravitreal anti–vascular endothelial growth fact
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The Impact of the Vitreomacular Interface in Neovascular Age-Related Macular Degeneration in a Treat-and-Extend Regimen with Exit Strategy.
Ophthalmology Retina, 2017Co-Authors: Marion R. Munk, Petra Arendt, Lala Ceklic, Wolfgang Huf, Andreas Ebneter, Sebastian Wolf, Martin S. ZinkernagelAbstract:Purpose To evaluate the impact of the vitreomacular interface (VMI) in a treat-and-extend (TREX) regimen with Exit Strategy in patients with neovascular age-related macular degeneration (nAMD). Design Retrospective cohort study. Participants Five hundred ninety-three eyes of 498 patients with nAMD. Methods Eyes were treated according to a TREX regimen with an Exit criterion, which was defined as no signs of disease activity during 3 consecutive 16-week injection visits. The impact of the VMI and the presence of an epiretinal membrane (ERM) assessed by spectral-domain OCT were evaluated based on the parameters mentioned below. Main Outcome Measures Effect of vitreomacular adhesion (VMA) and ERM on mean treatment interval, number of injections, likelihood of fulfilling the Exit criterion, choroidal neovascularization recurrences, CRT decrease, and BCVA improvement. Results During the TREX period, posterior vitreous detachment (PVD) eyes needed significantly fewer injections (mean, 10.6 ± 5.9) than VMA eyes (mean, 12.6 ± 6.7; P = 0.0008), and the mean injection interval was shorter in VMA eyes (8.3 ± 3.1 weeks) than in PVD eyes (9.5 ± 3.5 weeks; P = 0.0008). Eyes with PVD at baseline and without an ERM were 9.2 and 11.4 times more likely to fulfill the Exit criterion than eyes with VMA and ERM, respectively ( P = 0.006 and P = 0.004, respectively, corrected). Although CRT decrease ( P = 0.16) and BCVA improvement ( P = 0.32) did not differ with respect to the VMI configuration, ERM had a significant impact on CRT decrease (ERM present, +11 ± 198 μm vs. ERM absent, −92 ± 136 μm; P = 0.041). Vitreomacular adhesion at treatment cessation was associated significantly with disease recurrence (likelihood ratio, 7.8; P = 0.013, corrected), whereas the presence of an ERM was not associated with choroidal neovascularization recurrence ( P = 0.18). Conclusions The configuration of the VMI and the presence of an ERM have a significant impact on the treatment frequency, the chance to meet the Exit criterion in this TREX regimen, and the recurrence risk after treatment cessation. This indicates that eyes with VMA should be monitored carefully for new disease activity after treatment cessation.
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functional and anatomical outcome of eyes with neovascular age related macular degeneration treated with intravitreal ranibizumab following an Exit Strategy regimen
British Journal of Ophthalmology, 2014Co-Authors: Marcel N Menke, Andreas Ebneter, Martin S. Zinkernagel, Sebastian WolfAbstract:Aims To assess the functional and morphological outcome of eyes with neovascular AMD treated with intravitreal ranbizumab following an Exit Strategy treatment regime. Methods The Bern treatment regime for neovascular AMD has a fixed injection schedule, even in the non-active stage of the disease. The regimen has been adapted from the PIER study treatment protocol. Eyes with non-active AMD will receive 4 injections in the first year, and 2 injections in the second year of follow-up before treatment stops. Patients that received ranibizumab for treatment and reached the Exit criteria were identified, and charts were reviewed to assess functional and morphological outcome. Results Only 2.6% of all patients (15 out of 575 patients) reached the Exit criteria. Mean change in best corrected ETDRS visual acuity (VA) was 4.5±16.9 letters when comparing baseline VA to 4 weeks after the last injection (p=0.32). OCT mean foveal thickness was significantly thinner after last treatment (247.9±43.0 µm) compared to baseline (332.5±83.1 µm, p=0.002). The mean total number of ranibizumab injections was 15.6±8.0, and the mean total treatment period was 40.9±18.3 months. Twenty percent of eyes had geographic atrophy present at baseline versus 46.6% at the end of treatment. Conclusions Even with a fixed treatment regime and a defined treatment Exit Strategy, only a small percentage of patients reach Exit criteria. Retinal thickness has been significantly reduced by repeated intravitreal ranibizumab injections, and geographic atrophy became more frequent.
Sebastian Wolf - One of the best experts on this subject based on the ideXlab platform.
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aflibercept for age related macular degeneration 4 year outcomes of a treat and extend regimen with Exit Strategy
British Journal of Ophthalmology, 2020Co-Authors: Damian Jaggi, Marion R. Munk, Andreas Ebneter, Sebastian Wolf, Thanoosha Nagamany, Martin S. ZinkernagelAbstract:Aim To report long-term outcomes on best-corrected visual acuity (BCVA) and treatment intervals with a treat-and-extend (T&E) regimen in patients with neovascular age-related macular degeneration (nAMD). Methods This observational study included treatment-naive patients with nAMD, treated with aflibercept. A specific T&E protocol without a loading phase and predefined Exit criteria was administered. After reaching predefined ‘Exit-criteria’, the treatment period was complete, and patients were observed three monthly. Results Eighty-two patients with a follow-up period of ≥2 years were included. BCVA (mean±SD, ETDRS letters) increased from 51.9±25.2 at baseline to 63.7±17.7 (p Conclusions After 4 years of treatment, initial vision gains were maintained with a reasonable treatment burden, even without an initial loading phase. Our results on functional outcomes are comparable with large controlled studies.
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Exit Strategy in a treat and extend regimen for exudative age related macular degeneration
Retina-the Journal of Retinal and Vitreous Diseases, 2017Co-Authors: Petra Arendt, Marion R. Munk, Andreas Ebneter, Sebastian Wolf, Martin S. ZinkernagelAbstract:Purpose:To evaluate the outcome of an Exit Strategy in a treat-and-extend regimen for neovascular age-related macular degeneration.Methods:Five hundred and ninety-eight eyes of 488 patients with neovascular age-related macular degeneration receiving intravitreal anti–vascular endothelial growth fact
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The Impact of the Vitreomacular Interface in Neovascular Age-Related Macular Degeneration in a Treat-and-Extend Regimen with Exit Strategy.
Ophthalmology Retina, 2017Co-Authors: Marion R. Munk, Petra Arendt, Lala Ceklic, Wolfgang Huf, Andreas Ebneter, Sebastian Wolf, Martin S. ZinkernagelAbstract:Purpose To evaluate the impact of the vitreomacular interface (VMI) in a treat-and-extend (TREX) regimen with Exit Strategy in patients with neovascular age-related macular degeneration (nAMD). Design Retrospective cohort study. Participants Five hundred ninety-three eyes of 498 patients with nAMD. Methods Eyes were treated according to a TREX regimen with an Exit criterion, which was defined as no signs of disease activity during 3 consecutive 16-week injection visits. The impact of the VMI and the presence of an epiretinal membrane (ERM) assessed by spectral-domain OCT were evaluated based on the parameters mentioned below. Main Outcome Measures Effect of vitreomacular adhesion (VMA) and ERM on mean treatment interval, number of injections, likelihood of fulfilling the Exit criterion, choroidal neovascularization recurrences, CRT decrease, and BCVA improvement. Results During the TREX period, posterior vitreous detachment (PVD) eyes needed significantly fewer injections (mean, 10.6 ± 5.9) than VMA eyes (mean, 12.6 ± 6.7; P = 0.0008), and the mean injection interval was shorter in VMA eyes (8.3 ± 3.1 weeks) than in PVD eyes (9.5 ± 3.5 weeks; P = 0.0008). Eyes with PVD at baseline and without an ERM were 9.2 and 11.4 times more likely to fulfill the Exit criterion than eyes with VMA and ERM, respectively ( P = 0.006 and P = 0.004, respectively, corrected). Although CRT decrease ( P = 0.16) and BCVA improvement ( P = 0.32) did not differ with respect to the VMI configuration, ERM had a significant impact on CRT decrease (ERM present, +11 ± 198 μm vs. ERM absent, −92 ± 136 μm; P = 0.041). Vitreomacular adhesion at treatment cessation was associated significantly with disease recurrence (likelihood ratio, 7.8; P = 0.013, corrected), whereas the presence of an ERM was not associated with choroidal neovascularization recurrence ( P = 0.18). Conclusions The configuration of the VMI and the presence of an ERM have a significant impact on the treatment frequency, the chance to meet the Exit criterion in this TREX regimen, and the recurrence risk after treatment cessation. This indicates that eyes with VMA should be monitored carefully for new disease activity after treatment cessation.
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functional and anatomical outcome of eyes with neovascular age related macular degeneration treated with intravitreal ranibizumab following an Exit Strategy regimen
British Journal of Ophthalmology, 2014Co-Authors: Marcel N Menke, Andreas Ebneter, Martin S. Zinkernagel, Sebastian WolfAbstract:Aims To assess the functional and morphological outcome of eyes with neovascular AMD treated with intravitreal ranbizumab following an Exit Strategy treatment regime. Methods The Bern treatment regime for neovascular AMD has a fixed injection schedule, even in the non-active stage of the disease. The regimen has been adapted from the PIER study treatment protocol. Eyes with non-active AMD will receive 4 injections in the first year, and 2 injections in the second year of follow-up before treatment stops. Patients that received ranibizumab for treatment and reached the Exit criteria were identified, and charts were reviewed to assess functional and morphological outcome. Results Only 2.6% of all patients (15 out of 575 patients) reached the Exit criteria. Mean change in best corrected ETDRS visual acuity (VA) was 4.5±16.9 letters when comparing baseline VA to 4 weeks after the last injection (p=0.32). OCT mean foveal thickness was significantly thinner after last treatment (247.9±43.0 µm) compared to baseline (332.5±83.1 µm, p=0.002). The mean total number of ranibizumab injections was 15.6±8.0, and the mean total treatment period was 40.9±18.3 months. Twenty percent of eyes had geographic atrophy present at baseline versus 46.6% at the end of treatment. Conclusions Even with a fixed treatment regime and a defined treatment Exit Strategy, only a small percentage of patients reach Exit criteria. Retinal thickness has been significantly reduced by repeated intravitreal ranibizumab injections, and geographic atrophy became more frequent.
Andreas Ebneter - One of the best experts on this subject based on the ideXlab platform.
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aflibercept for age related macular degeneration 4 year outcomes of a treat and extend regimen with Exit Strategy
British Journal of Ophthalmology, 2020Co-Authors: Damian Jaggi, Marion R. Munk, Andreas Ebneter, Sebastian Wolf, Thanoosha Nagamany, Martin S. ZinkernagelAbstract:Aim To report long-term outcomes on best-corrected visual acuity (BCVA) and treatment intervals with a treat-and-extend (T&E) regimen in patients with neovascular age-related macular degeneration (nAMD). Methods This observational study included treatment-naive patients with nAMD, treated with aflibercept. A specific T&E protocol without a loading phase and predefined Exit criteria was administered. After reaching predefined ‘Exit-criteria’, the treatment period was complete, and patients were observed three monthly. Results Eighty-two patients with a follow-up period of ≥2 years were included. BCVA (mean±SD, ETDRS letters) increased from 51.9±25.2 at baseline to 63.7±17.7 (p Conclusions After 4 years of treatment, initial vision gains were maintained with a reasonable treatment burden, even without an initial loading phase. Our results on functional outcomes are comparable with large controlled studies.
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Exit Strategy in a treat and extend regimen for exudative age related macular degeneration
Retina-the Journal of Retinal and Vitreous Diseases, 2017Co-Authors: Petra Arendt, Marion R. Munk, Andreas Ebneter, Sebastian Wolf, Martin S. ZinkernagelAbstract:Purpose:To evaluate the outcome of an Exit Strategy in a treat-and-extend regimen for neovascular age-related macular degeneration.Methods:Five hundred and ninety-eight eyes of 488 patients with neovascular age-related macular degeneration receiving intravitreal anti–vascular endothelial growth fact
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The Impact of the Vitreomacular Interface in Neovascular Age-Related Macular Degeneration in a Treat-and-Extend Regimen with Exit Strategy.
Ophthalmology Retina, 2017Co-Authors: Marion R. Munk, Petra Arendt, Lala Ceklic, Wolfgang Huf, Andreas Ebneter, Sebastian Wolf, Martin S. ZinkernagelAbstract:Purpose To evaluate the impact of the vitreomacular interface (VMI) in a treat-and-extend (TREX) regimen with Exit Strategy in patients with neovascular age-related macular degeneration (nAMD). Design Retrospective cohort study. Participants Five hundred ninety-three eyes of 498 patients with nAMD. Methods Eyes were treated according to a TREX regimen with an Exit criterion, which was defined as no signs of disease activity during 3 consecutive 16-week injection visits. The impact of the VMI and the presence of an epiretinal membrane (ERM) assessed by spectral-domain OCT were evaluated based on the parameters mentioned below. Main Outcome Measures Effect of vitreomacular adhesion (VMA) and ERM on mean treatment interval, number of injections, likelihood of fulfilling the Exit criterion, choroidal neovascularization recurrences, CRT decrease, and BCVA improvement. Results During the TREX period, posterior vitreous detachment (PVD) eyes needed significantly fewer injections (mean, 10.6 ± 5.9) than VMA eyes (mean, 12.6 ± 6.7; P = 0.0008), and the mean injection interval was shorter in VMA eyes (8.3 ± 3.1 weeks) than in PVD eyes (9.5 ± 3.5 weeks; P = 0.0008). Eyes with PVD at baseline and without an ERM were 9.2 and 11.4 times more likely to fulfill the Exit criterion than eyes with VMA and ERM, respectively ( P = 0.006 and P = 0.004, respectively, corrected). Although CRT decrease ( P = 0.16) and BCVA improvement ( P = 0.32) did not differ with respect to the VMI configuration, ERM had a significant impact on CRT decrease (ERM present, +11 ± 198 μm vs. ERM absent, −92 ± 136 μm; P = 0.041). Vitreomacular adhesion at treatment cessation was associated significantly with disease recurrence (likelihood ratio, 7.8; P = 0.013, corrected), whereas the presence of an ERM was not associated with choroidal neovascularization recurrence ( P = 0.18). Conclusions The configuration of the VMI and the presence of an ERM have a significant impact on the treatment frequency, the chance to meet the Exit criterion in this TREX regimen, and the recurrence risk after treatment cessation. This indicates that eyes with VMA should be monitored carefully for new disease activity after treatment cessation.
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functional and anatomical outcome of eyes with neovascular age related macular degeneration treated with intravitreal ranibizumab following an Exit Strategy regimen
British Journal of Ophthalmology, 2014Co-Authors: Marcel N Menke, Andreas Ebneter, Martin S. Zinkernagel, Sebastian WolfAbstract:Aims To assess the functional and morphological outcome of eyes with neovascular AMD treated with intravitreal ranbizumab following an Exit Strategy treatment regime. Methods The Bern treatment regime for neovascular AMD has a fixed injection schedule, even in the non-active stage of the disease. The regimen has been adapted from the PIER study treatment protocol. Eyes with non-active AMD will receive 4 injections in the first year, and 2 injections in the second year of follow-up before treatment stops. Patients that received ranibizumab for treatment and reached the Exit criteria were identified, and charts were reviewed to assess functional and morphological outcome. Results Only 2.6% of all patients (15 out of 575 patients) reached the Exit criteria. Mean change in best corrected ETDRS visual acuity (VA) was 4.5±16.9 letters when comparing baseline VA to 4 weeks after the last injection (p=0.32). OCT mean foveal thickness was significantly thinner after last treatment (247.9±43.0 µm) compared to baseline (332.5±83.1 µm, p=0.002). The mean total number of ranibizumab injections was 15.6±8.0, and the mean total treatment period was 40.9±18.3 months. Twenty percent of eyes had geographic atrophy present at baseline versus 46.6% at the end of treatment. Conclusions Even with a fixed treatment regime and a defined treatment Exit Strategy, only a small percentage of patients reach Exit criteria. Retinal thickness has been significantly reduced by repeated intravitreal ranibizumab injections, and geographic atrophy became more frequent.
V V Chari - One of the best experts on this subject based on the ideXlab platform.
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thoughts on the federal reserve system s Exit Strategy
Social Science Research Network, 2010Co-Authors: V V ChariAbstract:Now that global financial markets are beginning to stabilize, the Federal Reserve is considering how best to reabsorb liquidity so as not to create inflation as the economy revives. Three broad strategies for managing monetary reserves in the United States include: (1) paying interest on excess reserves, (2) managing interest rates on short-term deposits, and (3) selling back financial assets such as mortgage-backed securities. From a theoretical standpoint, these strategies are identical; which approach is employed is not of fundamental macroeconomic importance. Nevertheless, this note argues that several potentially large dangers associated with the first two strategies have been overlooked, whereas a frequently cited weakness of asset sales has been exaggerated. The best course is a careful blend of all three approaches, with strong emphasis on a preannounced program of gradual sales of financial assets. Such a joint Strategy is likely to have the highest probability of success in draining reserves, with minimal risk.
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thoughts on the federal reserve system s Exit Strategy
Economic Policy Paper, 2010Co-Authors: V V ChariAbstract:How can banks and similar institutions design optimal compensation systems? Would such systems conflict with the goals of society? This paper considers a theoretical framework of how banks structure job contracts with their employees to explore three points: the structure of a socially optimal compensation system; the structure of a compensation system that is privately optimal, given the reality of government-guaranteed bank debt; and policy interventions that can lead from the second structure to the first. Analysis reveals a potential policy option: providing proper incentives to banks by charging debt default insurance premiums that depend on the compensation structure banks choose. If policymakers consider this unwise or impractical, then it may be useful for government to regulate bank compensation more directly.
Marion R. Munk - One of the best experts on this subject based on the ideXlab platform.
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aflibercept for age related macular degeneration 4 year outcomes of a treat and extend regimen with Exit Strategy
British Journal of Ophthalmology, 2020Co-Authors: Damian Jaggi, Marion R. Munk, Andreas Ebneter, Sebastian Wolf, Thanoosha Nagamany, Martin S. ZinkernagelAbstract:Aim To report long-term outcomes on best-corrected visual acuity (BCVA) and treatment intervals with a treat-and-extend (T&E) regimen in patients with neovascular age-related macular degeneration (nAMD). Methods This observational study included treatment-naive patients with nAMD, treated with aflibercept. A specific T&E protocol without a loading phase and predefined Exit criteria was administered. After reaching predefined ‘Exit-criteria’, the treatment period was complete, and patients were observed three monthly. Results Eighty-two patients with a follow-up period of ≥2 years were included. BCVA (mean±SD, ETDRS letters) increased from 51.9±25.2 at baseline to 63.7±17.7 (p Conclusions After 4 years of treatment, initial vision gains were maintained with a reasonable treatment burden, even without an initial loading phase. Our results on functional outcomes are comparable with large controlled studies.
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Exit Strategy in a treat and extend regimen for exudative age related macular degeneration
Retina-the Journal of Retinal and Vitreous Diseases, 2017Co-Authors: Petra Arendt, Marion R. Munk, Andreas Ebneter, Sebastian Wolf, Martin S. ZinkernagelAbstract:Purpose:To evaluate the outcome of an Exit Strategy in a treat-and-extend regimen for neovascular age-related macular degeneration.Methods:Five hundred and ninety-eight eyes of 488 patients with neovascular age-related macular degeneration receiving intravitreal anti–vascular endothelial growth fact
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The Impact of the Vitreomacular Interface in Neovascular Age-Related Macular Degeneration in a Treat-and-Extend Regimen with Exit Strategy.
Ophthalmology Retina, 2017Co-Authors: Marion R. Munk, Petra Arendt, Lala Ceklic, Wolfgang Huf, Andreas Ebneter, Sebastian Wolf, Martin S. ZinkernagelAbstract:Purpose To evaluate the impact of the vitreomacular interface (VMI) in a treat-and-extend (TREX) regimen with Exit Strategy in patients with neovascular age-related macular degeneration (nAMD). Design Retrospective cohort study. Participants Five hundred ninety-three eyes of 498 patients with nAMD. Methods Eyes were treated according to a TREX regimen with an Exit criterion, which was defined as no signs of disease activity during 3 consecutive 16-week injection visits. The impact of the VMI and the presence of an epiretinal membrane (ERM) assessed by spectral-domain OCT were evaluated based on the parameters mentioned below. Main Outcome Measures Effect of vitreomacular adhesion (VMA) and ERM on mean treatment interval, number of injections, likelihood of fulfilling the Exit criterion, choroidal neovascularization recurrences, CRT decrease, and BCVA improvement. Results During the TREX period, posterior vitreous detachment (PVD) eyes needed significantly fewer injections (mean, 10.6 ± 5.9) than VMA eyes (mean, 12.6 ± 6.7; P = 0.0008), and the mean injection interval was shorter in VMA eyes (8.3 ± 3.1 weeks) than in PVD eyes (9.5 ± 3.5 weeks; P = 0.0008). Eyes with PVD at baseline and without an ERM were 9.2 and 11.4 times more likely to fulfill the Exit criterion than eyes with VMA and ERM, respectively ( P = 0.006 and P = 0.004, respectively, corrected). Although CRT decrease ( P = 0.16) and BCVA improvement ( P = 0.32) did not differ with respect to the VMI configuration, ERM had a significant impact on CRT decrease (ERM present, +11 ± 198 μm vs. ERM absent, −92 ± 136 μm; P = 0.041). Vitreomacular adhesion at treatment cessation was associated significantly with disease recurrence (likelihood ratio, 7.8; P = 0.013, corrected), whereas the presence of an ERM was not associated with choroidal neovascularization recurrence ( P = 0.18). Conclusions The configuration of the VMI and the presence of an ERM have a significant impact on the treatment frequency, the chance to meet the Exit criterion in this TREX regimen, and the recurrence risk after treatment cessation. This indicates that eyes with VMA should be monitored carefully for new disease activity after treatment cessation.