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Iglicki M, Khoury M, Donato L, Quispe DJ, Negri HP, Melamud JI. Comparison of subretinal aflibercept vs ranibizumab vs bevacizumab in the context of PPV, pneumatic displacement with subretinal air and subretinal tPA in naïve submacular haemorrhage secondary to nAMD. "The Submarine Study". Eye (Lond) 2024; 38:292-296. [PMID: 37537388 PMCID: PMC10810790 DOI: 10.1038/s41433-023-02676-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 06/29/2023] [Accepted: 07/17/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVE To compare efficacy and safety profile of subretinal aflibercept, ranibizumab, and bevacizumab in the context of pars plana vitrectomy, pneumatic displacement with subretinal air and subretinal tPA for subretinal macular haemorrhage (SMH) due to naïve neovascular age-related macular degeneration (nAMD). DESIGN Retrospective interventional cohort study. PARTICIPANTS 123 eyes of 123 patients treated with subretinal aflibercept (n = 41, 33%), ranibizumab (n = 41,33%), and bevacizumab (n = 41, 33%). METHODS Review of electronic medical records for best corrected visual acuity (BCVA), central subfoveal thickness (CST), and intraocular pressure (IOP) at baseline and 24 months after treatment. MAIN OUTCOME MEASURES BCVA, CST, and number of intravitreal anti VEGF over 24 months. RESULTS Mean age of patients was 80.5 ± 5.5 years, 43.9% were female. Mean time from symptom onset until surgery was 1.1 days (range 0-3 days). In all cases, the SMH did not reach the arcades. CST at baseline was 627 ± 140 µ, 739 ± 54 µ, and 793 ± 93 µ (p = 0.0001) for aflibercept, ranibizumab, or bevacizumab, respectively. Baseline BCVA (logMAR) was 0.65 ± 0.13, 0.69 ± 0.96, and 0.74 ± 0.81 (p = 0.0041) for aflibercept, ranibizumab, and bevacizumab, respectively. All three groups showed statistically significant improvement in BCVA and CST (for all groups: p < 0.001). There was no statistically significant difference at the final BCVA (p = 0.789). The mean number of anti VEGF given during follow-up period was 5.2 ± 0.81, 4.4 ± 0.63, and 5.5 ± 0.95 (p = 0.0001) for aflibercept, ranibizumab, and bevacizumab, respectively. CONCLUSION This study shows that aflibercept, ranibizumab, and bevacizumab in a subretinal manner in the context of PPV, pneumatic displacement with subretinal air and subretinal tPA for subretinal macular haemorrhage secondary to naïve nAMD work with the same efficacy and safety profile.
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Affiliation(s)
- Matias Iglicki
- Private Retina Office, University of Buenos Aires, Buenos Aires, Argentina.
| | - Marina Khoury
- Medical Investigation Institute "Alfredo Lanari", University of Buenos Aires, Buenos Aires, Argentina
| | - Lucas Donato
- Ophthalmologic Institute, Buenos Aires, Argentina
| | | | | | - Javier Ignacio Melamud
- Medical Investigation Institute "Alfredo Lanari", University of Buenos Aires, Buenos Aires, Argentina
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Iglicki M, Khoury M, Melamud JI, Donato L, Barak A, Quispe DJ, Zur D, Loewenstein A. Naïve subretinal haemorrhage due to neovascular age-related macular degeneration. pneumatic displacement, subretinal air, and tissue plasminogen activator: subretinal vs intravitreal aflibercept-the native study. Eye (Lond) 2023; 37:1659-1664. [PMID: 36038720 PMCID: PMC10220048 DOI: 10.1038/s41433-022-02222-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/09/2022] [Accepted: 08/17/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE We aimed to compare visual and anatomical outcome in subretinal aflibercept vs. intravitreal aflibercept in the context of Pars Plana Vitrectomy (PPV), pneumatic displacement with subretinal air and subretinal tPA in patients with naïve submacular haemorrhage (SMH) secondary to neovascular age-related macular degeneration (nAMD). DESIGN Retrospective interventional cohort study. PARTICIPANTS 80 patients treated with subretinal aflibercept vs. intravitreal aflibercept in the context of PPV, subretinal air and subretinal tPA in patients with SMH secondary to naïve nAMD. METHODS Records were reviewed. Best corrected visual acuity (BCVA), central subfoveal thickness (CST), and intraocular pressure (IOP) were recorded at baseline and 24 months after treatment. MAIN OUTCOME MEASURES BCVA, CST, and number of anti VEGF treatment over follow-up period. RESULTS The average duration from onset of symptoms to surgery was 1.26 days (range 0-3 days). Based on review of OCT images, SMH was subretinal in all 80 patients (100%), and sub-RPE in 29 patients (36.3%). Forty-one patients (51.25%) were treated with subretinal aflibercept ("subretinal group"), and 39 patients (48.75%) were treated with intravitreal aflibercept injections ("intravitreal group"). The groups were well balanced for age and gender p = 0.6588, and p = 0.263, respectively). Both groups showed statistically significant improvement in BCVA and CST (for all groups: p < 0.001). The mean number of anti VEGF given during follow-up period was statistically significantly lower in the "subretinal group" (p < 0.0001). CONCLUSION This study shows better management of the CNV, with a statistically significant lower need for anti-VEGF injections when treated with subretinal aflibercept compared to intravitreal application.
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Affiliation(s)
- Matias Iglicki
- Private Retina Office, University of Buenos Aires, Buenos Aires, Argentina.
| | - Marina Khoury
- Medical Investigation Institute "Alfredo Lanari", University of Buenos Aires, Buenos Aires, Argentina
| | - Javier Ignacio Melamud
- Medical Investigation Institute "Alfredo Lanari", University of Buenos Aires, Buenos Aires, Argentina
| | - Lucas Donato
- Ophthalmologic Institute, Buenos Aires, Argentina
| | - Adiel Barak
- Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Diego Jose Quispe
- Private Retina Office, University of Buenos Aires, Buenos Aires, Argentina
| | - Dinah Zur
- Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kikushima W, Sakurada Y, Fukuda Y, Matsubara M, Kotoda Y, Sugiyama A, Kashiwagi K. A Treat-and-Extend Regimen of Intravitreal Brolucizumab for Exudative Age-Related Macular Degeneration Refractory to Aflibercept: A 12-Month Result. Pharmaceuticals (Basel) 2023; 16:ph16040562. [PMID: 37111318 PMCID: PMC10141467 DOI: 10.3390/ph16040562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
We aimed to investigate whether a treat-and-extend regimen of intravitreal brolucizumab (6.0 mg/0.05 mL) is effective for eyes with exudative age-related macular degeneration (AMD) refractory to aflibercept for 12 months. Sixty eyes from 56 patients receiving brolucizumab for exudative AMD refractory to aflibercept were included. Patients received a mean of 30.1 aflibercept administrations for a mean 67.9-month follow-up. All patients exhibited exudation on optical coherence tomography (OCT) despite regular 4-8 weeks of aflibercept administration. Visit 1 was scheduled at the same interval from the last aflibercept injection to the baseline. The treatment interval was extended or shortened by 1-2 weeks depending on the presence or absence of exudation on OCT. After switching to brolucizumab, the follow-up interval significantly extended at 12 months (before switching: 7.6 ± 3.8 weeks vs. at 12 months: 12.1 ± 6.2 weeks, p = 1.3 × 10-7). Forty-three percent of the eyes achieved a dry macula at 12 months after switching. However, the best-corrected visual acuity did not improve at any visit. Morphologically, the central retinal thickness and subfoveal choroidal thickness significantly decreased from baseline at 12 months (p = 3.6 × 10-3 and 1.0 × 10-3, respectively). Switching to brolucizumab can be considered to extend the treatment interval in eyes with exudative AMD refractory to aflibercept.
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Affiliation(s)
- Wataru Kikushima
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Yoichi Sakurada
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Yoshiko Fukuda
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Mio Matsubara
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Yumi Kotoda
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Atsushi Sugiyama
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Kenji Kashiwagi
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
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Kawai K, Miyata M, Ooto S, Tamura H, Ueda-Arakawa N, Takahashi A, Uji A, Muraoka Y, Miyake M, Yamashiro K, Tsujikawa A. Macular atrophy at 5 years after photodynamic therapy for polypoidal choroidal vasculopathy. Eye (Lond) 2023; 37:1067-1072. [PMID: 35422494 PMCID: PMC10102034 DOI: 10.1038/s41433-022-02067-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 03/23/2022] [Accepted: 04/04/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To investigate predictors for macular atrophy (MA) involving the fovea after photodynamic therapy (PDT) followed by pro re nata (PRN) treatment for polypoidal choroidal vasculopathy (PCV). METHODS This prospective observational study analysed treatment-naïve eyes with symptomatic PCV without MA at baseline which were followed up for 5 years. All eyes were initially treated with PDT, followed by a PRN regimen of anti-vascular endothelial growth factor (VEGF) therapy and/or PDT. We assigned eyes with and eyes without development of MA involving the fovea 5 years after the initial treatment into MA and non-MA groups, respectively. Baseline parameters and the number of treatments were compared between the two groups. RESULTS Seventy-two eyes of 69 consecutive patients were included, and 29 eyes of 29 patients were analysed. Twelve (41%) and 17 (59%) eyes were assigned into the MA and non-MA groups, respectively. There were significant differences in subfoveal choroidal thickness (226.2 ± 47.8 μm vs. 278.8 ± 68.1 μm, P = 0.03) and number of anti-VEGF injections (13.7 ± 9.6 vs. 5.4 ± 5.6, P = 0.007) between the MA and non-MA groups, but not in the number of PDT sessions (P = 0.71). Best-corrected visual acuity at 5 years in the MA group was lower than in the non-MA group (P = 0.048). CONCLUSION Our long-term observation suggests that a thin subfoveal choroid at baseline and many followed anti-VEGF injections in a PRN regimen increase the risk for development of MA involving the fovea 5 years after PDT.
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Affiliation(s)
- Kentaro Kawai
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Manabu Miyata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Sotaro Ooto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroshi Tamura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naoko Ueda-Arakawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ayako Takahashi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihito Uji
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuki Muraoka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Yamashiro
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Ophthalmology, Otsu Red Cross Hospital, Otsu, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Sun T, Bai J, Wang M, Liu L, Peng Q. Cytokine profiling in patients with polypoidal choroidal vasculopathy before and after intravitreal injection of ranibizumab. Am J Transl Res 2022; 14:7147-7155. [PMID: 36398243 PMCID: PMC9641452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 08/10/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE This study aims to investigate the cytokines profiling in the aqueous humor of patients with polypoidal choroidal vasculopathy (PCV) before and after intravitreal ranibizumab injection (IVR). METHODS 14 patients clinically diagnosed with PCV and 15 cataract patients of similar age and gender (control group) were included. Throughout the cataract surgery and IVR, aqueous humor samples were collected from the PCV and control groups. RESULTS The levels of macrophage inflammatory protein 1β (MIP-1β) and normal T cell expressed and secreted (RANTES) in PCV patients were significantly lower than control subjects (P=0.045 and P=0.004, respectively). The concentration of vascular endothelial growth factor-A (VEGF-A) was significantly higher than the control group (P=0.003). The level of MIP-1β was greatly increased in PCV patients compared to prior to IVR (P=0.001). After IVR, the level of VEGF-A in PCV patients were considerably lower compared to before IVR (P=0.001). There was no link between the expression of several cytokines (MCP-1, MIP-1, Eotaxin, G-CSF, IL-8, IL-6, IL-5, IP-10 and IFN-γ) in the aqueous humor of PCV patients before and after intravitreal ranibizumab injection (IVR). The association between IL-5 expression and central macular thickness (CMT) was discovered before IVR (P=0.02), however, the correlation between several cytokines (MCP-1, MIP-1, Eotaxin, G-CSF, IL-8, IL-6, IL-5, IP-10 and IFN-γ) was discovered in PCV patients after IVR. CONCLUSION Based on our findings, we discovered that the production of neovascularization in PCV patients is driven by both angiogenic and inflammatory factors, with a correlation seen between several cytokines.
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Affiliation(s)
- Tingting Sun
- Department of Ophthalmology, Shanghai Tenth People’s Hospital, Tongji UniversityShanghai 200072, P. R. China
| | - Jianhao Bai
- Department of Ophthalmology, Shanghai Tenth People’s Hospital, Tongji UniversityShanghai 200072, P. R. China
| | - Minli Wang
- Department of Ophthalmology, Shanghai Tenth People’s Hospital, Tongji UniversityShanghai 200072, P. R. China
| | - Le Liu
- Institute of Materials Research, Shenzhen International Graduate School, Tsinghua UniversityShenzhen 518055, P. R. China
| | - Qing Peng
- Department of Ophthalmology, Shanghai Tenth People’s Hospital, Tongji UniversityShanghai 200072, P. R. China
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Park JY, Park YJ, Park SJ, Park KH, Yeo JH, Kim J, Yoon YH, Lee JY, Woo SJ. Comparison of visual outcomes of polypoidal choroidal vasculopathy and typical neovascular age-related macular degeneration-up to 10 years of follow-up. Acta Ophthalmol 2022; 100:e1579-e1588. [PMID: 35363434 DOI: 10.1111/aos.15149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/05/2022] [Accepted: 03/23/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate long-term visual outcomes of patients with polypoidal choroidal vasculopathy (PCV) and typical neovascular age-related macular degeneration (nAMD) in the real-world setting. METHODS Retrospective, multicenter, noninterventional consecutive cohort study. Two hundred eighty-five eyes of 261 patients with PCV and 902 eyes of 877 patients with typical nAMD, who could be followed up 1 year or longer from 2005 to 2018, were included. Mean changes in best-corrected visual acuity (BCVA) from baseline in the PCV and the typical nAMD groups were compared. RESULTS Mean follow-up period of total patients was 4.3 ± 2.8 (1-10) years. Baseline BCVA was better in the PCV group than that in the typical nAMD group (0.59 ± 0.52 versus 0.79 ± 0.63 logMAR, p < 0.001). The mean changes in BCVA from baseline in the PCV and nAMD group were +2.1 and -0.1 letters at 1 year, -0.2 and -3.7 letters at 3 years, -3.9 and -10.5 letters at 5 years and - 8.7 and - 12.1 letters at 7 years, respectively. Before 2006, the initial BCVA was sustained for approximately 1 year in eyes with PCV and for less than half year in eyes with typical nAMD. However, after 2007, when anti-VEGF agents were available, the initial BCVA was sustained for 4 years in eyes with PCV, while it was sustained for 1 year in eyes with typical nAMD. CONCLUSION In the real-world, long-term BCVA deteriorated in both PCV and typical nAMD groups, but the PCV group showed better visual outcomes than the typical nAMD group.
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Affiliation(s)
- Jun Young Park
- Department of Ophthalmology Seoul National University Bundang Hospital, Seoul National University College of Medicine Seongnam South Korea
- Department of Ophthalmology Uijeongbu Eulji Medical Center, Eulji University School of Medicine Uijeongbu South Korea
| | - Young Joo Park
- Department of Ophthalmology Seoul National University Bundang Hospital, Seoul National University College of Medicine Seongnam South Korea
- Department of Ophthalmology Kangwon National University Hospital, Kangwon National University Graduate School of Medicine Chuncheon South Korea
| | - Sang Jun Park
- Department of Ophthalmology Seoul National University Bundang Hospital, Seoul National University College of Medicine Seongnam South Korea
| | - Kyu Hyung Park
- Department of Ophthalmology Seoul National University Bundang Hospital, Seoul National University College of Medicine Seongnam South Korea
| | - Joon Hyung Yeo
- Department of Ophthalmology Chung‐Ang University Gwangmyeong Hospital, Chung‐Ang University College of Medicine Gwangmyeong South Korea
| | - June‐Gone Kim
- Department of Ophthalmology, Asan Medical Center University of Ulsan, College of Medicine Seoul South Korea
| | - Young Hee Yoon
- Department of Ophthalmology, Asan Medical Center University of Ulsan, College of Medicine Seoul South Korea
| | - Joo Yong Lee
- Department of Ophthalmology, Asan Medical Center University of Ulsan, College of Medicine Seoul South Korea
| | - Se Joon Woo
- Department of Ophthalmology Seoul National University Bundang Hospital, Seoul National University College of Medicine Seongnam South Korea
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Sun Z, Gong Y, Yang Y, Huang Y, Yu S, Pei J, Lin B, Zhou R, Li Y, Li Y, Zhang J, Liu X. Efficacy of Initial vs. Delayed Photodynamic Therapy in Combination With Conbercept for Polypoidal Choroidal Vasculopathy. Front Med (Lausanne) 2022; 8:791935. [PMID: 35223882 PMCID: PMC8864073 DOI: 10.3389/fmed.2021.791935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/10/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose To compare the efficacy of initial vs. delayed photodynamic therapy (PDT) in combination with intravitreal injection of conbercept (IVC) for polypoidal choroidal vasculopathy (PCV). Design Multicenter, randomized, non-inferiority clinical trial. Subjects Naïve PCV patients. Methods Patients were randomized 1:1 into two groups: initial PDT with IVC and delayed PDT with IVC. At baseline, patients in the initial combination group were treated with PDT and IVC within 1 week, while patients in the delayed combination group were treated with IVC alone. PDT and IVC was given PRN during the follow-up in each group. Main Outcome Measures Non-inferiority of delayed PDT with IVC to initial PDT with IVC for mean change in best-corrected visual acuity from baseline to month 12 (95% CI of the difference entirely above −5 letters). Results Eighty-six patients were enrolled, with 43 in each group. At month 12, the change of BCVA in initial combination group was equivalent to that in the delayed combination group, with gains of 6.42 ± 1.89 and 7.49 ± 2.14 (mean ± standard error) letters, respectively [delayed group minus initial group: 1.07 letters; 95% confidence interval (CI): −4.62 to 6.76; Pnon−inferiority = 0.0198]. The rates of complete polyp regression were 66.67 and 45.83% in the initial and delayed combination groups, respectively. The difference was not statistically significant (P = 0.386). The mean reductions of CRT were 204.77 ± 28.79 and 84.14 ± 30.62 μm in each group respectively. The difference was statistically significant (P = 0.005). In addition, the mean injection numbers were 3.47 ± 2.39 and 4.91 ± 2.65 in each group respectively. The differences were statistically significant (P = 0.010). Conclusions There was effective in both groups in patients with PCV. The initial combination group showed a more efficient decrease in CRT and polyp regression, along with fewer injections. However, the delayed combination group was non-inferior compared with the initial combination group in terms of the improvement of BCVA. Trial Registration https://ClinicalTrials.gov, Identifier: NCT02821520.
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Affiliation(s)
- Zuhua Sun
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yuanyuan Gong
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yating Yang
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Ying Huang
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Suqin Yu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junqing Pei
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Bing Lin
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Rong Zhou
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yingzi Li
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yumin Li
- Department of Ophthalmology, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China
| | - Junyan Zhang
- Bothwin Clinical Study Consultant, Shanghai, China
| | - Xiaoling Liu
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
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Sevik MO, Çam F, Aykut A, Dericioğlu V, Şahin Ö. Choroidal vascularity index changes during the Valsalva manoeuvre in healthy volunteers. Ophthalmic Physiol Opt 2021; 42:367-375. [PMID: 34913506 DOI: 10.1111/opo.12935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the effects of the Valsalva manoeuvre (VM) on the choroidal vascularity index (CVI) in healthy volunteers. METHODS This prospective, cross-sectional study included 60 eyes of 30 healthy volunteers. Enhanced depth imaging-optical coherence tomography scans of both eyes involving the fovea were taken, and a 1500 μm subfoveal choroidal area was selected for image binarization with open-access Fiji software. The binarized image was segmented into the stromal area (SA) and luminal area (LA), and CVI was calculated as the ratio (%) of LA to the total choroidal area (TCA). CVI, subfoveal choroidal thickness (SFCT), IOP, systolic and diastolic blood pressure were evaluated at rest and during the VM. RESULTS During the VM, a mean ± standard deviation increase in LA (0.02 ± 0.05 mm2 , p < 0.001) and CVI (1.72 ± 2.83%, p < 0.001) was observed, whereas SA (-0.02 ± 0.05 mm2 , p < 0.001) decreased. There was no significant change in TCA (0.00 ± 0.03 mm2 , p = 0.55) or SFCT (1.05 ± 10.92 μm, p = 0.46). There was a moderate positive correlation between the spherical equivalent refractive error (SE) and SFCT both at rest and during VM (r58 = 0.49, p < 0.0005 and r58 = 0.49, p < 0.0005, respectively). However, there was no significant correlation between SE and CVI either at rest or during VM (p = 0.11 and 0.06, respectively). In a multiple linear regression analysis, CVI was only associated with SFCT; however, SFCT was also associated with SE, both at rest and during VM (p < 0.001). CONCLUSION Valsalva manoeuvre increases CVI by choroidal vascular dilation as demonstrated by an increase in LA and a decrease in SA. Researchers should be careful about unintentional VM during examinations.
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Affiliation(s)
- Mehmet Orkun Sevik
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
| | - Furkan Çam
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
| | - Aslan Aykut
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
| | - Volkan Dericioğlu
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
| | - Özlem Şahin
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
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Chrząszcz M, Pociej-Marciak W, Żuber-Łaskawiec K, Romanowska-Dixon B, Sanak M, Michalska-Małecka K, Petrovič MG, Karska-Basta I. Changes in Plasma VEGF and PEDF Levels in Patients with Central Serous Chorioretinopathy. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57101063. [PMID: 34684100 PMCID: PMC8540423 DOI: 10.3390/medicina57101063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/27/2021] [Accepted: 09/30/2021] [Indexed: 12/05/2022]
Abstract
Background and Objectives: Retinal pigment epitheliopathy and hyperpermeability of choroidal vessels were postulated to be involved in the pathogenesis of central serous chorioretinopathy (CSC). Imbalanced levels of vascular endothelial growth factor (VEGF) and pigment-epithelium–derived factor (PEDF) were previously implicated in the development of chorioretinal diseases characterized by increased vascular permeability. We aimed to compare the plasma levels of proangiogenic VEGF and antiangiogenic PEDF for 26 patients with acute CSC, 26 patients with chronic CSC, and 19 controls. Materials and Methods: VEGF and PEDF levels were measured using a multiplex immunoassay or enzyme-linked immunosorbent assay. Correlations with disease duration were assessed. Results: VEGF levels differed between groups (p = 0.001). They were lower in patients with acute CSC (p = 0.042) and chronic CSC (p = 0.018) than in controls. PEDF levels were similar in all groups. The VEGF-to-PEDF ratio was lower in CSC patients than in controls (p = 0.04). A negative correlation with disease duration was noted only for PEDF levels in the group with chronic CSC (rho = −0.46, p = 0.017). Discussion: Our study confirmed that patients with CSC have imbalanced levels of VEGF and PEDF. This finding may have important implications for the pathogenesis of CSC. VEGF-independent arteriogenesis rather than angiogenesis may underlie vascular abnormalities in these patients.
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Affiliation(s)
- Michał Chrząszcz
- Clinic of Ophthalmology and Ocular Oncology, Department of Ophthalmology, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Kraków, Poland; (M.C.); (W.P.-M.); (K.Ż.-Ł.); (B.R.-D.)
| | - Weronika Pociej-Marciak
- Clinic of Ophthalmology and Ocular Oncology, Department of Ophthalmology, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Kraków, Poland; (M.C.); (W.P.-M.); (K.Ż.-Ł.); (B.R.-D.)
| | - Katarzyna Żuber-Łaskawiec
- Clinic of Ophthalmology and Ocular Oncology, Department of Ophthalmology, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Kraków, Poland; (M.C.); (W.P.-M.); (K.Ż.-Ł.); (B.R.-D.)
| | - Bożena Romanowska-Dixon
- Clinic of Ophthalmology and Ocular Oncology, Department of Ophthalmology, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Kraków, Poland; (M.C.); (W.P.-M.); (K.Ż.-Ł.); (B.R.-D.)
| | - Marek Sanak
- Molecular Biology and Clinical Genetics Unit, Department of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Kraków, Poland;
| | | | - Mojca Globočnik Petrovič
- Eye Hospital University Medical Centre, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Izabella Karska-Basta
- Clinic of Ophthalmology and Ocular Oncology, Department of Ophthalmology, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Kraków, Poland; (M.C.); (W.P.-M.); (K.Ż.-Ł.); (B.R.-D.)
- Correspondence:
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10
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Ghoshal R, Sharanjeet-Kaur S, Fadzil NM, Ghosh S, Ngah NF, Aziz RABA. Visual Parameters and Retinal Morphology for Polypoidal Choroidal Vasculopathy Pre- and Post-Intravitreal Ranibizumab with or without Photodynamic Therapy: A Short-Term Prospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052581. [PMID: 33806713 PMCID: PMC7967335 DOI: 10.3390/ijerph18052581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 11/30/2022]
Abstract
The objective of this study was to compare visual parameters and retinal layers’ morphology pre-treatment (baseline) and 6 months post-treatment in polypoidal choroidal vasculopathy (PCV) eyes. A single centre, longitudinal, prospective study was conducted at a public tertiary hospital of Malaysia. Visual parameters including distance and near visual acuity (DVA and NVA), contrast sensitivity (CS), reading speed (RS), and different qualitative and quantitative optical coherence tomography (OCT) parameters were evaluated pre- and 6 months post-treatment. Thirty-three naïve PCV eyes of 32 patients (mean age of 67.62 years) were evaluated pre- and post-treatment of intravitreal ranibizumab with and without photodynamic therapy. After treatment, sub retinal fluid decreased from 27 eyes (84.35%) at baseline to 7 eyes (21.88%) at 6 months while pigment epithelium detachment decreased from 32 eyes (100%) at base line to 15 eyes (46.87%) at 6 months. Mean pre-treatment quantitative morphological OCT retinal parameters including thickness and volume of central sub field, center thickness, center minimum, and maximum thickness reduced significantly. Similarly, all visual parameters including DVA, NVA, CS, and RS showed statistically significant improvement. While 89% of the eyes showed improvement in CS, 78%, 71%, and 65% of the eyes showed improvement in NVA, RS, and DVA, respectively. Thus, CS was the most treatment responsive visual parameter.
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Affiliation(s)
- Rituparna Ghoshal
- Optometry & Vision Science Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (R.G.); (N.M.F.)
| | - Sharanjeet Sharanjeet-Kaur
- Optometry & Vision Science Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (R.G.); (N.M.F.)
- Correspondence:
| | - Norliza Mohamad Fadzil
- Optometry & Vision Science Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (R.G.); (N.M.F.)
| | - Somnath Ghosh
- Department of Allied Health Sciences, Brainware University, Barasat, Kalkata, West Bengal 700125, India;
| | - Nor Fariza Ngah
- Department of Ophthalmology, Hospital Shah Alam, Persiaran Kayangan, Seksyen 7, Shah Alam 40000, Malaysia; (N.F.N.); (R.A.B.A.A.)
| | - Roslin Azni Binti Abd Aziz
- Department of Ophthalmology, Hospital Shah Alam, Persiaran Kayangan, Seksyen 7, Shah Alam 40000, Malaysia; (N.F.N.); (R.A.B.A.A.)
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11
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Kwon JM, Pak KY, Lee JJ, Sagong M, Kim HW. One-year Results of Aflibercept Treatment for Polypoidal Choroidal Vasculopathy with Good Visual Acuity. KOREAN JOURNAL OF OPHTHALMOLOGY 2021; 35:26-36. [PMID: 33307629 PMCID: PMC7904418 DOI: 10.3341/kjo.2020.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/06/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To evaluate the one-year efficacy of intravitreal aflibercept injection in polypoidal choroidal vasculopathy (PCV) with best-corrected visual acuity (BCVA) of 20 / 40 or better. METHODS This was a multicenter retrospective study. The medical records of patients diagnosed with treatment-naïve PCV were retrospectively reviewed. Patients with an initial BCVA of 20 / 40 or better and who had undergone intravitreal aflibercept injection were included. Patients were treated with three consecutive monthly injections, followed by pro re nata regimen according to the clinician's discretion at variable interval visits. The proportions of eyes for which BCVA was maintained (≤ 0.2 logarithm of the minimum angle of resolution change) or improved at 12 months were evaluated. The changes of BCVA, central subfield macular thickness (CSMT), pigment epithelial detachment, and subretinal fluid also were assessed. RESULTS A total of 86 eyes were included. The mean number of injections for 12 months of treatment was 5.4 ± 1.7. BCVA was maintained or improved in 94.2% (81 / 86) of cases. Mean BCVA (logarithm of the minimum angle of resolution) had changed from the baseline (0.23 ± 0.09) at 3 months (0.21 ± 0.14), 6 months (0.24 ± 0.22), and 12 months (0.20 ± 0.18), but with no statistical significance. CSMT had improved significantly from the baseline (336.1 ± 97.3 μm) at 3 months (223.6 ± 47.22 μm), 6 months (239.6 ± 64.2 μm), and 12 months (223.8 ± 47.9 μm). Pigment epithelial detachment was observed in 93% of cases at the baseline, 72.1% at 3 months, and 69.8% at 12 months, showing a significant decrease at all observation points. Subretinal fluid was observed in 91.9% of cases at the baseline, 20.9% at 3 months, and 29.1% at 12 months, showing a significant decrease at all observation points. CONCLUSIONS In cases of PCV with good visual acuity, intravitreal aflibercept injections decreased CSMT and were effective in maintaining visual acuity.
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Affiliation(s)
- Ji Min Kwon
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan,
Korea
| | - Kang Yeun Pak
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan,
Korea
| | - Jae Jung Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan,
Korea,Biomedical Research Institute, Pusan National University Hospital, Busan,
Korea
| | - Min Sagong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu,
Korea
| | - Hyun Woong Kim
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan,
Korea
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12
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Sahu Y, Chaudhary N, Joshi M, Gandhi A. Idiopathic polypoidal choroidal vasculopathy: a review of literature with clinical update on current management practices. Int Ophthalmol 2020; 41:753-765. [PMID: 33079309 DOI: 10.1007/s10792-020-01620-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/05/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE Polypoidal choroidal vasculopathy is a major cause of visual disability in a vast majority of Asian population due to exudative maculopathy. Although it is a distinctive disease entity with characteristic pathophysiology, genetics, immunology and clinical features, but it is still misdiagnosed as neovascular age related macular degeneration as both the diseases are a part of pachychoroid spectrum and have some similar features. Also, there are varied options for the management of this disease, but there are no clear recommendations. So, a detailed review of the literature has been done along with special attention to the recent therapeutic advances to help the readers get a better understanding of the disease and its current management practices. METHOD Detailed review of literature regarding polypoidal choroidal vasculopathy was done. The disease pathophysiology, genetics, risk factors, diagnostic modalities along with current treatment guidelines were extensively studied and compiled. RESULT A comprehensive clinical update on polypoidal choroidal vasculopathy was compiled with special emphasis on the recent diagnostic modalities and treatment guidelines. CONCLUSION Polypoidal choroidal vasculopathy is a distinct clinical entity which can be diagnosed based on indocyanine green angiography and optical coherence tomography. Treatment includes various options like photodynamic therapy, anti VEGF agents and thermal laser ablation. A review of literature has been done and recent diagnostic modalities with management practices have been compiled for the better understanding of the disease.
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Affiliation(s)
- Yamini Sahu
- Department of Ophthalmology, Vardhaman Mahavir Medical College and Safdarjung Hospital, Room No. 430 of Eye OPD, 4th Floor of OPD Building, Ansari Nagar, Ring Road, New Delhi, 110 029, India
| | - Niharika Chaudhary
- Department of Ophthalmology, Vardhaman Mahavir Medical College and Safdarjung Hospital, Room No. 430 of Eye OPD, 4th Floor of OPD Building, Ansari Nagar, Ring Road, New Delhi, 110 029, India.
| | - Mukesh Joshi
- Department of Ophthalmology, H.I.M.S.R and H.A.H. Centenary Hopsital, Nears GK.2, Alaknanda, New Delhi, India
| | - Aastha Gandhi
- Department of Ophthalmology, Vardhaman Mahavir Medical College and Safdarjung Hospital, Room No. 430 of Eye OPD, 4th Floor of OPD Building, Ansari Nagar, Ring Road, New Delhi, 110 029, India
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13
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García-Onrubia L, Valentín-Bravo FJ, Coco-Martin RM, González-Sarmiento R, Pastor JC, Usategui-Martín R, Pastor-Idoate S. Matrix Metalloproteinases in Age-Related Macular Degeneration (AMD). Int J Mol Sci 2020; 21:ijms21165934. [PMID: 32824762 PMCID: PMC7460693 DOI: 10.3390/ijms21165934] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 12/13/2022] Open
Abstract
Age-related macular degeneration (AMD) is a complex, multifactorial and progressive retinal disease affecting millions of people worldwide. In developed countries, it is the leading cause of vision loss and legal blindness among the elderly. Although the pathogenesis of AMD is still barely understood, recent studies have reported that disorders in the regulation of the extracellular matrix (ECM) play an important role in its etiopathogenesis. The dynamic metabolism of the ECM is closely regulated by matrix metalloproteinases (MMPs) and the tissue inhibitors of metalloproteinases (TIMPs). The present review focuses on the crucial processes that occur at the level of the Bruch’s membrane, with special emphasis on MMPs, TIMPs, and the polymorphisms associated with increased susceptibility to AMD development. A systematic literature search was performed, covering the years 1990–2020, using the following keywords: AMD, extracellular matrix, Bruch’s membrane, MMPs, TIMPs, and MMPs polymorphisms in AMD. In both early and advanced AMD, the pathological dynamic changes of ECM structural components are caused by the dysfunction of specific regulators and by the influence of other regulatory systems connected with both genetic and environmental factors. Better insight into the pathological role of MMP/TIMP complexes may lead to the development of new strategies for AMD treatment and prevention.
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Affiliation(s)
- Luis García-Onrubia
- Clinical University Hospital of Valladolid, Av. Ramón y Cajal, 3, 47003 Valladolid, Spain; (L.G.-O.); (F.J.V.-B.); (J.C.P.)
| | - Fco. Javier Valentín-Bravo
- Clinical University Hospital of Valladolid, Av. Ramón y Cajal, 3, 47003 Valladolid, Spain; (L.G.-O.); (F.J.V.-B.); (J.C.P.)
| | - Rosa M. Coco-Martin
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, 47011 Valladolid, Spain;
- Cooperative Health Network for Research in Ophthalmology (Oftared), National Institute of Health Carlos III, ISCIII, 28040 Madrid, Spain
| | - Rogelio González-Sarmiento
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain;
- Institute of Molecular and Cellular Biology of Cancer (IBMCC), University of Salamanca—CSIC, 37007 Salamanca, Spain
| | - J. Carlos Pastor
- Clinical University Hospital of Valladolid, Av. Ramón y Cajal, 3, 47003 Valladolid, Spain; (L.G.-O.); (F.J.V.-B.); (J.C.P.)
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, 47011 Valladolid, Spain;
- Cooperative Health Network for Research in Ophthalmology (Oftared), National Institute of Health Carlos III, ISCIII, 28040 Madrid, Spain
| | - Ricardo Usategui-Martín
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, 47011 Valladolid, Spain;
- Correspondence: (R.U.-M.); (S.P.-I.)
| | - Salvador Pastor-Idoate
- Clinical University Hospital of Valladolid, Av. Ramón y Cajal, 3, 47003 Valladolid, Spain; (L.G.-O.); (F.J.V.-B.); (J.C.P.)
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, 47011 Valladolid, Spain;
- Cooperative Health Network for Research in Ophthalmology (Oftared), National Institute of Health Carlos III, ISCIII, 28040 Madrid, Spain
- Correspondence: (R.U.-M.); (S.P.-I.)
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14
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Polypoidal choroidal vasculopathy in Canada. Can J Ophthalmol 2020; 55:199-211. [DOI: 10.1016/j.jcjo.2019.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/06/2019] [Accepted: 10/15/2019] [Indexed: 11/19/2022]
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15
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Pigment Epithelium-Derived Factor as a Possible Treatment Agent for Choroidal Neovascularization. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:8941057. [PMID: 32215180 PMCID: PMC7079215 DOI: 10.1155/2020/8941057] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/28/2020] [Indexed: 02/06/2023]
Abstract
Choroidal neovascularization (CNV) is a sight-threatening disease and is characterized by the formation of pathological neovascularization in the choroid which extends into the subretinal space. Exudative age-related macular degeneration (AMD) is the formation of CNV in the macular area which leads to irreversible blindness. Continuous leakage and hemorrhage of the CNV lesion may eventually result in scarring or later fibrosis, which could result in photoreceptor cell atrophy. The current strategy for treating CNV is the use of antivascular endothelial growth factor (VEGF) agents. Many studies have demonstrated the efficacy of intravitreal anti-VEGF therapy. Other studies have also reported the side effects of single anti-VEGF treatment. And long-term inhibition of a single system may result in collateral damage to other visual elements. Pigment epithelium-derived factor (PEDF) is a 50 kDa protein that was first isolated from the conditioned medium of human RPE cells. PEDF has both antiangiogenesis and neuroprotective functions for photoreceptor cells. It may be a potential ocular antiangiogenic agent. This review outlines the distribution of PEDF in the eye, the mechanism of antiangiogenesis, the protective effect on the retina, and the relationship between PEDF and VEGF.
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16
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Kokame GT, Liu K, Kokame KA, Kaneko KN, Omizo JN. Clinical Characteristics of Polypoidal Choroidal Vasculopathy and Anti-Vascular Endothelial Growth Factor Treatment Response in Caucasians. Ophthalmologica 2019; 243:178-186. [PMID: 31707394 DOI: 10.1159/000503834] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/01/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS To identify the clinical characteristics of polypoidal choroidal vasculopathy (PCV) in Caucasian patients and assess the prevalence of anti-vascular endothelial growth factor (anti-VEGF) resistance. METHODS This involved a retrospective chart review of Caucasian patients diagnosed with PCV and utilizing indocyanine green angiography with the scanning laser ophthalmoscope. Data collected included patients' demographics, disease characteristics, and treatment response. RESULTS There were 54 eyes of 49 patients with PCV; 51.0% were male and 49.0% were female with a mean age of 72.9 years. Forty-four patients (89.8%) had PCV unilaterally and 10.2% (5 patients) had PCV bilaterally. PCV was located in the macula in 79.6%, in the peripapillary region in 16.7%, and in both regions in 3.7%. PCV commonly presents with serous detachment (66.7%), retinal pigment epithelial detachment (RPED) (51.9%) and subretinal hemorrhage (37.0%). Twenty-nine eyes were included in the treatment response analysis, with 18 eyes (62.1%) showing persistent disease activity after 3 initial injections of anti-VEGF treatment. CONCLUSION PCV in Caucasian patients is more often unilateral and presents more commonly in the macular region than the peripapillary region. Serous detachment and RPED are the 2 most common findings. Resistance to current anti-VEGF treatment was noted frequently; it is thus extremely important to identify this subtype of type I subretinal neovascularization.
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Affiliation(s)
- Gregg T Kokame
- Division of Ophthalmology, Department of Surgery, University of Hawaii School of Medicine, Honolulu, Hawaii, USA, .,The Retina Center at Pali Momi, Aiea, Hawaii, USA, .,Retina Consultants of Hawaii, Aiea, Hawaii, USA, .,Hawaii Macula and Retina Institute, Aiea, Hawaii, USA, .,University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, USA,
| | - Keke Liu
- The Retina Center at Pali Momi, Aiea, Hawaii, USA.,Retina Consultants of Hawaii, Aiea, Hawaii, USA.,Hawaii Macula and Retina Institute, Aiea, Hawaii, USA.,University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Kelli A Kokame
- The Retina Center at Pali Momi, Aiea, Hawaii, USA.,Retina Consultants of Hawaii, Aiea, Hawaii, USA.,Hawaii Macula and Retina Institute, Aiea, Hawaii, USA
| | - Kyle N Kaneko
- The Retina Center at Pali Momi, Aiea, Hawaii, USA.,Retina Consultants of Hawaii, Aiea, Hawaii, USA.,Hawaii Macula and Retina Institute, Aiea, Hawaii, USA
| | - Jase N Omizo
- The Retina Center at Pali Momi, Aiea, Hawaii, USA.,Retina Consultants of Hawaii, Aiea, Hawaii, USA.,Hawaii Macula and Retina Institute, Aiea, Hawaii, USA
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17
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Gu X, Yu X, Dai H. Therapeutic effects of ranibizumab in patients with polypoidal choroidal vasculopathy. BMC Ophthalmol 2019; 19:153. [PMID: 31324161 PMCID: PMC6642544 DOI: 10.1186/s12886-019-1156-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/03/2019] [Indexed: 11/10/2022] Open
Abstract
Background There is no consensus on the optimal initial treatment for polypoidal choroidal vasculopathy (PCV). Our study aimed to report the efficacy of repeated injections of intravitreal ranibizumab with or without photodynamic therapy for the treatment of PCV and to determine the possible factors predictive of visual outcomes. Methods The results of the initial treatment of 40 patients with PCV with 3 monthly injections of ranibizumab were retrospectively reviewed. We compared the results in terms of the best corrected visual acuity (BCVA), the central retinal thickness (CRT), the number of injections, the regression rates of polyps and the rates of the reduction of subretinal fluid. Results At the 3-month follow-up, the mean BCVA was significantly increased by 7.3 ± 12.4 letters compared to baseline (p < 0.01). At the 12-month follow-up, the mean BCVA was increased by 3.4 ± 15.4 letters compared to baseline, and there was no significant difference (p > 0.05). The mean CRT at the 12-month follow-up was 593.58 ± 243.64 μm, with an average decrease of 101.55 ± 256.07 μm compared to baseline (p < 0.01). Fifteen eyes (18.8%) showed the complete regression of polyps, and 22 eyes (27.5%) showed a reduction in polyps. The baseline VA, the reduction in subretinal fluids and the greatest lesion diameter were significant independent factors that were predictive of improved VA at the final follow-up. Conclusions Three monthly injections of ranibizumab as an initial treatment could significantly improve VA in PCV patients in the short term. At 12 months postinjection, ranibizumab treatment could stabilize VA in most PCV patients. The baseline VA, the reduction in subretinal fluids and the greatest lesion diameter were predictive factors for the relative improvement of VA at the final follow-up.
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Affiliation(s)
- Xiaoya Gu
- Department of Ophthalmology, Beijing Hospital, National Center of Gerontology, No.1 Dahua Road, Dongdan, Dongcheng District, Beijing, China
| | - Xiaobing Yu
- Department of Ophthalmology, Beijing Hospital, National Center of Gerontology, No.1 Dahua Road, Dongdan, Dongcheng District, Beijing, China
| | - Hong Dai
- Department of Ophthalmology, Beijing Hospital, National Center of Gerontology, No.1 Dahua Road, Dongdan, Dongcheng District, Beijing, China.
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18
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Masuda N, Tsujinaka H, Hirai H, Yamashita M, Ueda T, Ogata N. Effects of concentration of amyloid β (Aβ) on viability of cultured retinal pigment epithelial cells. BMC Ophthalmol 2019; 19:70. [PMID: 30849957 PMCID: PMC6408759 DOI: 10.1186/s12886-019-1076-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 02/28/2019] [Indexed: 11/10/2022] Open
Abstract
Background Amyloid beta (Aβ) is a constituent of drusen that is a common sign of age-related macular degeneration (AMD). The purpose of this study was to investigate the effect of Aβ on human retinal pigment epithelial (RPE) cells in culture. Methods Cells from a human RPE cell line (ARPE-19) were exposed to 0 to 25 μM of Aβ 1–40 for 48 h, and the number of living cells was determined by WST-8 cleavage. Replicative DNA synthesis was measured by the incorporation of 5′-bromo-2′-deoxyuridine. The cell death pathway was investigated by the WST-8 cleavage assay after the addition of caspase-9 inhibitor, an anti-apoptotic factor. Real-time qRT-PCR was performed using Aβ-exposed cellular RNA to determine the level of vascular endothelial growth factor (VEGF)-A and pigment epithelium derived factor (PEDF). To determine the effect of receptor-for-advanced glycation end products (RAGE), the siRNA for RAGE was inserted into ARPE-19 treated with Aβ, and the levels of expression of VEGF-A and PEDF were determined. Results The number of living ARPE-19 cells was increased by exposure to 5 μM Aβ but was decreased by exposure to 25 μM of Aβ. Replicative DNA synthesis by ARPE-19 cells exposed to 25 μM of Aβ was significantly decreased indicating that 25 μM of Aβ inhibited cell proliferation. Real-time RT-PCR showed that the level of the mRNA of PEDF was increased by exposure to 5 μM Aβ, and the levels of the mRNAs of PEDF and VEGF-A were also increased by exposure to 25 μM Aβ. The addition of an inhibitor of caspase-9 blocked the decrease the number of ARPE-19 cells exposed to 25 μM Aβ. Exposure to si-RAGE attenuated the increase of VEGF-A and PEDF mRNA expression in ARPE-19 exposed to Aβ. Conclusions Exposure of ARPE-19 cells to low concentrations of Aβ increases the level of PEDF which then inhibits the apoptosis of ARPE-19 cells leading to RPE cell proliferation. Exposure to high concentrations of Aβ induces RPE cell death and enhances the expression of the mRNA of VEGF-A in RPE cells. The Aβ-RAGE pathway may lead to the expression VEGF-A and PEDF in RPE cells. These results suggest that Aβ is strongly related to the pathogenesis of choroidal neovascularization.
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Affiliation(s)
- Naonori Masuda
- Department of Ophthalmology, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan
| | - Hiroki Tsujinaka
- Department of Ophthalmology, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan
| | - Hiromasa Hirai
- Department of Ophthalmology, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan
| | - Mariko Yamashita
- Department of Ophthalmology, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan
| | - Tetsuo Ueda
- Department of Ophthalmology, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan
| | - Nahoko Ogata
- Department of Ophthalmology, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan.
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19
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Kumar A, Kumawat D, Sundar M D, Gagrani M, Gupta B, Roop P, Hasan N, Sharma A, Chawla R. Polypoidal choroidal vasculopathy: a comprehensive clinical update. Ther Adv Ophthalmol 2019; 11:2515841419831152. [PMID: 30834360 PMCID: PMC6393826 DOI: 10.1177/2515841419831152] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 01/22/2019] [Indexed: 12/16/2022] Open
Abstract
Polypoidal choroidal vasculopathy as a disease is yet to be comprehended completely. The clinical features consisting of huge serosanguineous retinal pigment epithelial and neurosensory layer detachments, although unique may closely mimick neovascular age-related macular degeneration and other counterparts. The investigative modalities starting from indocyanine angiography to optical coherence tomography angiography provide diagnostic challenges. The management strategies based on the available therapies are plenty and not vivid. A detailed review with clarifying images has been compiled with an aim to help the readers in getting a better understanding of the disease.
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Affiliation(s)
- Atul Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Devesh Kumawat
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Dheepak Sundar M
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Meghal Gagrani
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Barkha Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Prakhyat Roop
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Nasiq Hasan
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anu Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Li M, Dolz-Marco R, Messinger JD, Sloan KR, Ferrara D, Curcio CA, Freund KB. Clinicopathologic Correlation of Aneurysmal Type 1 Neovascularization in Age-Related Macular Degeneration. ACTA ACUST UNITED AC 2019; 3:99-111. [DOI: 10.1016/j.oret.2018.08.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 08/30/2018] [Accepted: 08/30/2018] [Indexed: 10/28/2022]
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Qi HJ, Jin EZ, Zhao MW. One-year outcomes of intravitreal conbercept combined rescue therapy for polypoidal choroidal vasculopathy in a Chinese population: a real-life clinical data. Int J Ophthalmol 2019; 12:51-57. [PMID: 30662840 DOI: 10.18240/ijo.2019.01.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 09/06/2018] [Indexed: 12/11/2022] Open
Abstract
AIM To evaluate the real-life clinical outcomes of intravitreal injection of conbercept combined rescue therapy for polypoidal choroidal vasculopathy (PCV). METHODS This was an open label, single center, and interventional study. All enrolled patients were treated initially with three consecutive monthly intravitreal conbercept injections (0.5 mg). Additional conbercept injections were administered upon substantial polyp regression with improved visual acuity (VA). Eyes with partial or no polyp regression and poor VA were rescue treated with photodynamic therapy (PDT) for subfoveal polyps or thermal laser photocoagulation for extrafoveal polyps. Best-corrected visual acuity (BCVA), central foveal thickness (CFT) and polyp regression were observed as primary outcomes. Side effects were also collected during the follow-up period. RESULTS A total of 56 eyes (56 patients) with PCV were included. BCVA increased significantly from the baseline of 43.52±24.21 letters to 55.88±21.94 letters (P<0.001) at 12mo, while CFT decreased significantly from 457.41±207.86 µm to 247.98±127.08 µm (P<0.001). All patients showed polyp regression. Twenty-three eyes achieved complete polyp regression after the three initial injections, which increased to 44 eyes at 12mo. Seventeen eyes underwent rescue therapy, among which 2 eyes treated with PDT and 15 eyes treated with laser photocoagulation. A mean of 4.30±1.43 injections were given per eye. No intraocular inflammation, retinal or vitreous hemorrhage, or systemic complication occurred. CONCLUSION Conbercept is an effective and safe option for the treatment of PCV in Chinese population. The treatment regimen of three initial conbercept injections followed by additional injections or rescue therapies is efficacious for treating PCV.
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Affiliation(s)
- Hui-Jun Qi
- Department of Ophthalmology, Ophthalmology & Optometry Center, Peking University People's Hospital, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China
| | - En-Zhong Jin
- Department of Ophthalmology, Ophthalmology & Optometry Center, Peking University People's Hospital, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China
| | - Ming-Wei Zhao
- Department of Ophthalmology, Ophthalmology & Optometry Center, Peking University People's Hospital, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China
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Palkar AH, Khetan V. Polypoidal choroidal vasculopathy: An update on current management and review of literature. Taiwan J Ophthalmol 2019; 9:72-92. [PMID: 31198666 PMCID: PMC6557071 DOI: 10.4103/tjo.tjo_35_18] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Polypoidal choroidal vasculopathy (PCV) is a subtype of neovascular age-related macular degeneration (nAMD), commonly seen in the Asian population. It is dissimilar in epidemiology, genetic heterogeneity, pathogenesis, natural history, and response to treatment in comparison to nAMD. Confocal scanning laser ophthalmoscopy-based simultaneous fluorescein angiography and indocyanine green angiography, spectral-domain optical coherence tomography (OCT) with enhanced depth imaging, swept-source OCT, and OCT angiography have improved the ability to detect PCV, understand its pathology, and monitor treatment response. A plethora of literature has discussed the efficacy of photodynamic therapy, anti-vascular endothelial growth factor (VEGF) monotherapy, and combination of both, but only a few studies with higher level of evidence and limited follow-up duration are available. This review discusses the understanding of PCV with respect to epidemiology, pathogenesis, clinical features, natural history, imaging techniques, and various treatment options. Recent clinical trials (EVEREST-II and PLANET study) have emphasized that either anti-VEGF monotherapy or combination treatment is equally capable to strike a balance between polyp regression and stabilization of visual acuity. The recurrent nature of the disease, the development of macular atrophy, and the long-term poor visual prognosis despite treatment are concerns that open avenues for further research.
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Affiliation(s)
- Amit Harishchandra Palkar
- Department of Vitreoretinal Services, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Vikas Khetan
- Department of Vitreoretinal Services, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Abstract
KIT is a receptor tyrosine kinase that after binding to its ligand stem cell factor activates signaling cascades linked to biological processes such as proliferation, differentiation, migration and cell survival. Based on studies performed on SCF and/or KIT mutant animals that presented anemia, sterility, and/or pigmentation disorders, KIT signaling was mainly considered to be involved in the regulation of hematopoiesis, gametogenesis, and melanogenesis. More recently, novel animal models and ameliorated cellular and molecular techniques have led to the discovery of a widen repertoire of tissue compartments and functions that are being modulated by KIT. This is the case for the lung, heart, nervous system, gastrointestinal tract, pancreas, kidney, liver, and bone. For this reason, the tyrosine kinase inhibitors that were originally developed for the treatment of hemato-oncological diseases are being currently investigated for the treatment of non-oncological disorders such as asthma, rheumatoid arthritis, and alzheimer's disease, among others. The beneficial effects of some of these tyrosine kinase inhibitors have been proven to depend on KIT inhibition. This review will focus on KIT expression and regulation in healthy and pathologic conditions other than cancer. Moreover, advances in the development of anti-KIT therapies, including tyrosine kinase inhibitors, and their application will be discussed.
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Zhang Y, Li X, Chen X, Cai Z, Zhang Z, Tang Y, Chang T, Chen M, Zhang M. Combined therapy and antivascular endothelial growth factor monotherapies for polypoidal choroidal vasculopathy: A protocol for the systematic review and network meta-analysis of efficacy and safety. Medicine (Baltimore) 2018; 97:e13775. [PMID: 30572531 PMCID: PMC6319790 DOI: 10.1097/md.0000000000013775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Different antivascular endothelial growth factor (VEGF) monotherapy regimens and photodynamic therapy (PDT) combined with anti-VEGF therapy are available for patients with polypoidal choroidal vasculopathy (PCV). However, the comparative efficacy and safety of different anti-VEGF monotherapy regimens and combined therapy with PDT and anti-VEGF remains unknown. The aim of our study is to evaluate the efficacy and safety of anti-VEGF monotherapies and combined therapy in patients with PCV. METHODS We will systematically search PubMed, Embase, and the Cochrane library for eligible studies. The Cochrane Collaboration's tool for assessing the risk of bias in a randomized trial and the ROBINS-I tool will be used to assess the risk of bias in the included studies. The primary outcome is the mean change in best corrected visual acuity from baseline. The secondary outcomes are the mean change in central retinal thickness from baseline and the number of serious adverse events. RESULTS The result will generate a comprehensive suggestion for the treatment of PCV. CONCLUSION The results of the network meta-analysis will be submitted in a peer-reviewed journal for publication. ETHICS AND DISSEMINATION The study does not involve human subjects and requires no ethical approval or patient consent. The results of the network meta-analysis will be submitted in a peer-reviewed journal for publication and generate a comprehensive suggestion for the treatment of PCV.
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Affiliation(s)
- Yun Zhang
- Department of Ophthalmology, West China Hospital
| | - Xun Li
- Department of Ophthalmology, West China Hospital
| | | | - Zhaolun Cai
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Zirong Zhang
- Department of Ophthalmology, NO. 2 People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - You Tang
- Department of Ophthalmology, West China Hospital
| | | | - Misha Chen
- Department of West China Medicine Technology Transfer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Meixia Zhang
- Department of Ophthalmology, West China Hospital
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Human Vascular Endothelial Growth Factor A 165 Expression Induces the Mouse Model of Neovascular Age-Related Macular Degeneration. Genes (Basel) 2018; 9:genes9090438. [PMID: 30200369 PMCID: PMC6162490 DOI: 10.3390/genes9090438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/24/2018] [Accepted: 08/28/2018] [Indexed: 12/27/2022] Open
Abstract
Vascular endothelial growth factor (VEGF) expression induces age-related macular degeneration (AMD), which is a common vision-threatening disease due to choroidal neovascularization and a fibrovascular membrane. We describe a mouse model of neovascular AMD with the local expression of human VEGF-A165 in the eye. We use a transgenic mouse in which human VEGF-A165 has been silenced with the loxP-STOP fragment. The choroidal neovascularization and human VEGF-A165 expression in the mouse are induced by subretinal adenoviral Cre gene delivery. Cre gene transfer is compared with adenoviral LacZ gene transfer control. We characterize the AMD phenotype and changes in the vasculature by using fluorescein angiography, optical coherence tomography, and immunohistochemistry. At early time points, mice exhibit increases in retinal thickness (348 ± 114 µm vs. 231 ± 32 µm) and choroidal neovascularization area (12000 ± 15174 µm² vs. 2169 ± 3495 µm²) compared with the control. At later time points, choroidal neovascularization develops into subretinal fibrovascular membrane. Human VEGF-A165 expression lasts several weeks. In conclusion, the retinas display vascular abnormalities consistent with choroidal neovascularization. Together with immunohistochemical findings, these changes resemble clinical AMD-like ocular pathologies. We conclude that this mouse model of Cre-induced choroidal neovascularization is useful for mimicking the pathogenesis of AMD, studying the effects of human VEGF-A165 in the retina, and evaluating anti-VEGF treatments for choroidal neovascularization.
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Miyata M, Ooto S, Yamashiro K, Tamura H, Hata M, Ueda-Arakawa N, Yoshikawa M, Numa S, Tsujikawa A. Five-year visual outcomes after anti-VEGF therapy with or without photodynamic therapy for polypoidal choroidal vasculopathy. Br J Ophthalmol 2018; 103:617-622. [PMID: 29875231 DOI: 10.1136/bjophthalmol-2018-311963] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/06/2018] [Accepted: 05/22/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To evaluate the 5-year visual and anatomical outcomes after anti-vascular endothelial growth factor (VEGF) therapy alone or in combination with photodynamic therapy (PDT), followed by pro re nata (PRN) anti-VEGF therapy with or without PDT, for polypoidal choroidal vasculopathy (PCV). METHODS This retrospective, observational study included 61 consecutive patients with treatment-naïve symptomatic PCV who were followed for 5 years. Twenty eyes (20 patients) initially received PDT and intravitreal injection of ranibizumab (IVR), followed by a PRN regimen of anti-VEGF therapy with or without PDT (combination group), while 41 eyes (41 patients) initially received only IVR every 3 months, followed by a PRN regimen of anti-VEGF monotherapy (IVR group). Macular atrophy including the fovea was confirmed using colour fundus photography and spectral-domain optical coherence tomography. RESULTS In both groups, the visual acuity (VA) at 1 year was better than the baseline VA, whereas the 3-year, 4-year and 5-year VA values were similar to the baseline VA. There was no significant difference in the 5-year VA, 5-year central retinal thickness and incidence of macular atrophy between the two groups (p=0.63, 0.72 and 0.06, respectively). In the combination group, the 5-year VA was correlated with the 5-year incidence of macular atrophy (p=0.02, r=0.51). CONCLUSIONS A PRN regimen for PCV may have a limited effect for the long-term maintenance of improved VA. Macular atrophy may occur more frequently with combination therapy and is possibly associated with the 5-year VA. Thus, combination therapy should be carefully selected for patients susceptible to macular atrophy.
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Affiliation(s)
- Manabu Miyata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sotaro Ooto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Yamashiro
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroshi Tamura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masayuki Hata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naoko Ueda-Arakawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Munemitsu Yoshikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shogo Numa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Cheung CMG, Lai TY, Ruamviboonsuk P, Chen SJ, Chen Y, Freund KB, Gomi F, Koh AH, Lee WK, Wong TY. Polypoidal Choroidal Vasculopathy. Ophthalmology 2018; 125:708-724. [DOI: 10.1016/j.ophtha.2017.11.019] [Citation(s) in RCA: 211] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/09/2017] [Accepted: 11/09/2017] [Indexed: 12/28/2022] Open
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Kang HG, Kang H, Byeon SH, Kim SS, Koh HJ, Lee SC, Kim M. Long-term visual outcomes for treatment of submacular haemorrhage secondary to polypoidal choroidal vasculopathy. Clin Exp Ophthalmol 2018; 46:916-925. [PMID: 29652440 DOI: 10.1111/ceo.13198] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/01/2018] [Accepted: 04/03/2018] [Indexed: 11/30/2022]
Abstract
IMPORTANCE There is no consensus on the optimal management of submacular haemorrhage (SMH) secondary to polypoidal choroidal vasculopathy (PCV). BACKGROUND To compare the long-term outcome of three treatment strategies for PCV with SMH. DESIGN Retrospective case series at two tertiary hospitals. SAMPLES A total of 48 consecutive eyes treated between July 2006 and March 2016. METHODS Patients were grouped according to the treatment received: 22 eyes with intravitreal bevacizumab (IVB), 14 with a combination of IVB and pneumatic displacement (PD) and 12 with IVB and vitrectomy (TPPV). MAIN OUTCOME MEASURES Change in best-corrected visual acuity (BCVA) at onset and up to 24 months. Secondary measures included demographic data, imaging data and complications. RESULTS Comparing the mean BCVAs of the groups revealed significant differences only at month 1 (P = 0.005). Changes in the mean BCVA over time revealed no significance in the resulting final BCVA (P = 0.062), which was 20 out of 155 (logMAR 0.89 ± 0.64) for IVB monotherapy, 20 out of 174 (0.94 ± 1.04) for combined IVB + PD, and 20 out of 195 (0.99 ± 0.90) for combined IVB + TPPV eyes. Sustained long-term improvement of over three Snellen lines was found in seven (31.82%) IVB monotherapy, 10 (71.43%) combined IVB + PD, and seven (58.33%) combined IVB + TPPV eyes (P = 0.043). SMH recurrence was observed in two eyes after IVB monotherapy and one eye after combined IVB + PD (P = 0.786). CONCLUSIONS AND RELEVANCE IVB monotherapy appears to be as effective as combination therapies for treating SMH secondary to PCV with regards to BCVA at 24 months, and may be a cost-effective strategy for long-term management.
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Affiliation(s)
- Hyun Goo Kang
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyunseung Kang
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyoung Jun Koh
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Chul Lee
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Reche-Frutos J, Calvo-Gonzalez C, Donate-Lopez J, Garcia-Feijoo J, Leila M, Garcia-Sanchez J. Short-Term Anatomic Effect of Ranibizumab for Polypoidal Choroidal Vasculopathy. Eur J Ophthalmol 2018; 18:645-8. [DOI: 10.1177/112067210801800427] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | - M. Leila
- Hospital Clínico Universitario San Carlos, Madrid - Spain
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30
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Kumar S, Nakashizuka H, Jones A, Lambert A, Zhao X, Shen M, Parker M, Wang S, Berriochoa Z, Fnu A, VanBeuge S, Chévez-Barrios P, Tso M, Rainier J, Fu Y. Proteolytic Degradation and Inflammation Play Critical Roles in Polypoidal Choroidal Vasculopathy. THE AMERICAN JOURNAL OF PATHOLOGY 2017; 187:2841-2857. [PMID: 28941979 PMCID: PMC5718105 DOI: 10.1016/j.ajpath.2017.08.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/31/2017] [Accepted: 08/17/2017] [Indexed: 01/28/2023]
Abstract
Polypoidal choroidal vasculopathy (PCV) is a common subtype of wet age-related macular degeneration in Asian populations, whereas choroidal neovascularization is the typical subtype in Western populations. The cause of PCV is unknown. By comparing the phenotype of a PCV mouse model expressing protease high temperature requirement factor A1 (HTRA1) in retinal pigment epithelium with transgenic mice expressing the inactive HTRA1S328A, we showed that HTRA1-mediated degradation of elastin in choroidal vessels is critical for the development of PCV, which exhibited destructive extracellular matrix remodeling and vascular smooth muscle cell loss. Compared with weak PCV, severe PCV exhibited prominent immune complex deposition, complement activation, and infiltration of inflammatory cells, suggesting inflammation plays a key role in PCV progression. More important, we validated these findings in human PCV specimens. Intravitreal delivery of an HTRA1 inhibitor (DPMFKLboroV) was effective (36% lesion reduction; P = 0.009) in preventing PCV initiation but ineffective in treating existing lesions. Anti-inflammatory glucocorticoid was effective in preventing PCV progression but ineffective in preventing PCV initiation. These results suggest that PCV pathogenesis occurs through two stages. The initiation stage is mediated by proteolytic degradation of extracellular matrix proteins attributable to increased HTRA1 activity, whereas the progression stage is driven by inflammatory cascades. This study provides a basis for understanding the differences between PCV and choroidal neovascularization, and helps guide the design of effective therapies for PCV.
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Affiliation(s)
- Sandeep Kumar
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Hiroyuki Nakashizuka
- Department of Visual Sciences, Nihon University School of Medicine, Tokyo, Japan
| | - Alex Jones
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah
| | - Alyssia Lambert
- Department of Chemistry, University of Utah, Salt Lake City, Utah
| | - Xuchen Zhao
- Department of Chemistry, University of Utah, Salt Lake City, Utah
| | - Megan Shen
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Mackenzie Parker
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Shixian Wang
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah
| | - Zachary Berriochoa
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah
| | - Amrita Fnu
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Stephanie VanBeuge
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah
| | | | - Mark Tso
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jon Rainier
- Department of Chemistry, University of Utah, Salt Lake City, Utah
| | - Yingbin Fu
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas; Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah.
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Sen P, Bhende M, Sachidanandam R, Bansal N, Sharma T. Reduced-fluence photodynamic therapy and anti-vascular endothelial growth factor for polypoidal choroidal vasculopathy in an Indian population. Indian J Ophthalmol 2017; 64:908-913. [PMID: 28112132 PMCID: PMC5322706 DOI: 10.4103/0301-4738.198856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIMS The aim was to study the efficacy of combined therapy with reduced-fluence photodynamic therapy (RFPDT) and intravitreal bevacizumab/ranibizumab from the Indian subcontinent. SETTINGS AND DESIGN This was a single-center, retrospective interventional study. METHODS Thirty-five eyes of 34 patients diagnosed with polypoidal choroidal vasculopathy were included. All the patients underwent RFPDT, followed by intravitreal bevacizumab/ranibizumab. STATISTICAL ANALYSIS USED SPSS software, version 17.0 (SPSS Inc., Chicago, IL, USA) was used to compare the logarithm of the minimal angle of resolution visual acuity at presentation and final follow-up. P< 0.05 was considered statistically significant. RESULTS Regression of polyps after a single session of RFPDT was seen in five eyes; multiple sessions of treatment were required in thirty eyes. An average number of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections given were 4 ± 1.9 and average number of PDT sessions were 1.2 ± 0.5. Visual acuity improvement was seen in 21 (60%) eyes (P < 0.001), decrease in visual acuity was seen in 7 (20%) eyes (P = 0.016), and in 7 eyes (20%), vision remained stable. Regression of polypoidal lesions was seen in 80% of cases. No complications of massive subretinal hemorrhage or breakthrough vitreous hemorrhage were noted in our patients. The mean follow-up period was 18 months (range, 12-24 months). CONCLUSIONS RFPDT with anti-VEGF is safe and effective treatment with polyp regression and vision improvement in 80% of cases, without any complication of subretinal hemorrhage/vitreous hemorrhage.
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Affiliation(s)
- Parveen Sen
- Department of Vitreoretinal Services, Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Muna Bhende
- Department of Vitreoretinal Services, Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Ramya Sachidanandam
- Deaprtment of Optometry, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Nishat Bansal
- Department of Vitreoretinal Services, Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Tarun Sharma
- Department of Vitreoretinal Services, Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Farooq A, Frazier H, Marcus WB, Fechter C, Singh H, Marcus DM. Intravitreal Aflibercept for Neovascular Polypoidal Choroidal Vasculopathy in a Predominantly Non-Asian Population: RIVAL Results. Ophthalmic Surg Lasers Imaging Retina 2017; 48:34-52. [PMID: 28060392 DOI: 10.3928/23258160-20161219-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 11/02/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate safety and efficacy of intravitreal aflibercept (Eylea; Regeneron, Tarrytown, NY) injection (IAI) for the treatment of neovascular polypoidal choroidal vasculopathy (PCV) in a predominantly non-Asian population. PATIENTS AND METHODS This was an open-label, prospective, unmasked, nonrandomized clinical trial. Twenty eyes with neovascular PCV received monthly 2.0 mg IAI for 3 months followed by mandatory IAI every 2 months for 12 months. RESULTS The mean change in ETDRS best-corrected visual acuity from baseline to 1 year was +11 letters in the treatment-naïve group, +5 letters in the treatment non-naïve group, and +9 letters overall. There was an overall mean reduction of 70 µm from baseline central subfield thickness (CST) at 1 year. Patients received a mean of 6.2 mandatory and 0.7 additional IAI injections overall during the course of 1 year. No serious ocular adverse events were reported. CONCLUSION At 1 year, neovascular PCV in a predominantly non-Asian population treated with IAI demonstrated favorable visual, anatomic, and safety outcomes. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:34-44.].
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Sakai T, Kato N, Kubota M, Tsuneoka H. Effects of photodynamic therapy plus intravitreal aflibercept with subtenon triamcinolone injections for aflibercept-resistant polypoidal choroidal vasculopathy. Graefes Arch Clin Exp Ophthalmol 2017; 255:1565-1571. [PMID: 28601912 DOI: 10.1007/s00417-017-3700-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 05/14/2017] [Accepted: 05/30/2017] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To evaluate the outcome of triple therapy of photodynamic therapy combined with injections of intravitreal aflibercept (IVA) and subtenon triamcinolone acetonide for polypoidal choroidal vasculopathy (PCV) resistant to IVA. METHODS A retrospective chart review at a single institution was conducted to identify patients with PCV resistant to treatment with IVA who were switched to treatment with triple therapy. In total, 13 eyes from 13 patients were included in the study. Demographic data, visual acuities, central retinal thickness (CRT) and height of pigment epithelial detachment (PED) on optical coherence tomography (OCT), complications, and number of injections were reviewed. RESULTS The patients had a mean age of 68 years (range 53-83). The number of prior injections with IVA ranged from 5 to 10. At 12 months follow-up after triple therapy, there was a significant improvement in visual acuity (P = 0.0039), a significant decrease in CRT (P = 0.003), and a significant reduction of the height of PED (P = 0.015). Only one patient had retinal pigment epithelium tear. CONCLUSIONS Triple therapy improved visual and anatomical outcomes in patients with PCV with recurrent or resistant retinal fluid and PED after multiple injections with IVA.
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Affiliation(s)
- Tsutomu Sakai
- Department of Ophthalmology, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan. .,Jikei Daisan Hospital, Komae, Japan.
| | - Noriko Kato
- Department of Ophthalmology, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Masaomi Kubota
- Department of Ophthalmology, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiroshi Tsuneoka
- Department of Ophthalmology, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
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Abstract
PURPOSE OF REVIEW The goal of this paper is to review the recent literature of polypoidal choroidal vasculopathy (PCV) and provide an update on the epidemiology, pathophysiology, clinical findings, and management. RECENT FINDINGS Although indocyanine-green angiography (ICGA) is still the gold standard for diagnosis of PCV, the use of en face optical coherence tomography (OCT) and OCT angiography are useful tools in the diagnosis of PCV. Studies demonstrate superior treatment outcomes with combination photodynamic therapy (PDT) and anti-vascular endothelial growth factor (VEGF) therapy. SUMMARY PCV is a disease most commonly in Asians and African-Americans and presents with an orange-red nodule in the macula or the peripapillary region. While ICGA remains the most accurate method to diagnose PCV, newer non-invasive imaging modalities (eg. OCT-A and en face OCT) can be used to identify PCV lesions. The combination of PDT and anti-VEGF therapy is superior to either monotherapy. Future studies of OCT modalities and other anti-VEGF agents will be important in guiding PCV diagnosis and management, respectively.
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Affiliation(s)
- Joon-Bom Kim
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Rajinder S Nirwan
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Ajay E Kuriyan
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY, USA
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ANGIOGRAPHIC FINDINGS OF RANIBIZUMAB-RESISTANT POLYPOIDAL CHOROIDAL VASCULOPATHY AFTER SWITCHING TO A TREAT-AND-EXTEND REGIMEN WITH INTRAVITREAL AFLIBERCEPT. Retina 2017; 36:2158-2165. [PMID: 27258669 DOI: 10.1097/iae.0000000000001047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to study the angiopathic findings of ranibizumab-resistant polypoidal choroidal vasculopathy after switching to a treat-and-extend regimen with intravitreal aflibercept. METHODS The authors retrospectively reviewed 17 eyes of 17 Japanese patients with polypoidal choroidal vasculopathy (10 men and 7 women, age: 73.8 ± 7.4 years) who were treated with intravitreal aflibercept (2 mg/0.05 mL) injections from February 2013 to August 2014 at Tokyo University Hospital. All patients had switched to aflibercept because their polypoidal choroidal vasculopathy had been refractory to ranibizumab. RESULTS The mean logMAR best-corrected visual acuity at baseline and after 12 months of therapy was 0.30 ± 0.29 (Snellen equivalent: 20/40) and 0.17 ± 0.26 (20/30) (paired t-test P < 0.001). Visual acuity remained stable in 5 cases (29%), deteriorated in 3 (18%), and improved in 9 (53%). Branching vascular networks persisted in all 17 eyes but shrank in 15 (88%). The mean lesion diameter was 3329 ± 1261 μm at baseline and 3180 ± 1247 μm after 12 months (P = 0.0002). CONCLUSION A treat-and-extend regimen with intravitreal aflibercept for ranibizumab-resistant patients resulted in branching vascular network shrinkage over a 1-year period.
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Wong JG, Lai XJ, Sarafian RY, Wong HS, Smith JB. Photodynamic therapy for polypoidal choroidal vasculopathy secondary to choroidal nevus. Int Med Case Rep J 2017; 10:51-54. [PMID: 28243154 PMCID: PMC5317340 DOI: 10.2147/imcrj.s107648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
We report a case of a Caucasian female who developed active polypoidal choroidal vasculopathy (PCV) at the edge of a stable choroidal nevus and was successfully treated with verteporfin photodynamic therapy. No active polyp was detectable on indocyanine green angiography 2 years after treatment, and good vision was maintained. Indocyanine green angiography is a useful investigation to diagnose PCV and may be underutilized. Unlike treatment of choroidal neovascularization secondary to choroidal nevus, management of PCV secondary to nevus may not require intravitreal anti-vascular endothelial growth factor therapy. Photodynamic monotherapy may be an effective treatment of secondary PCV.
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Affiliation(s)
- James G Wong
- Strathfield Retina Clinic, Sydney, NSW, Australia; Medical Retina Unit, Sydney Eye Hospital, Sydney, NSW, Australia; Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Xin Jie Lai
- Strathfield Retina Clinic, Sydney, NSW, Australia
| | | | - Hon Seng Wong
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Jeremy B Smith
- Ophthalmology Clinic, Children's Hospital Westmead, Sydney, NSW, Australia
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EFFICACY OF INTRAVITREAL INJECTION OF CONBERCEPT IN POLYPOIDAL CHOROIDAL VASCULOPATHY: Subgroup Analysis of the Aurora Study. Retina 2016; 36:926-37. [PMID: 26595362 DOI: 10.1097/iae.0000000000000875] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate the efficacy of different doses of conbercept in patients with polypoidal choroidal vasculopathy in the AURORA study. METHODS Retrospective subgroup analyses of 12-month data from the AURORA study. Fifty-three patients (32 in 0.5-mg group and 21 in 2.0-mg group) diagnosed with polypoidal choroidal vasculopathy in AURORA study were retrospectively evaluated. Efficacy outcomes were compared between the two dosage groups. RESULTS At Month 12, mean changes in best-corrected visual acuity from baseline were 14.4 ± 14.1 letter scores for the 0.5-mg group and 14.2 ± 21.0 letter scores for the 2.0-mg group; mean central retinal thickness decreased by 104.5 ± 127.3 μm in the 0.5-mg group and 140.7 ± 127.9 μm in the 2.0-mg group; mean total macular volume decreased by 0.9 ± 2.3 mm and 1.0 ± 1.2 mm in the 0.5-mg and 2.0-mg groups, respectively. The mean subretinal fluid thickness decreased by 111.9 ± 122.5 μm and 76.3 ± 112.6 μm in the 0.5-mg and 2.0-mg groups, respectively. The mean pigment epithelial detachment height decreased by 79.3 ± 217.8 μm and 61.3 ± 161.5 μm in the 0.5-mg and 2.0-mg groups, respectively. The mean area of polyps decreased by 0.46 ± 0.76 mm and 0.55 ± 1.34 mm in the 0.5-mg and 2.0-mg groups, respectively. The mean total lesion area decreased by 2.51 ± 5.94 mm (P = 0.088) and 4.62 ± 5.51 mm in the 0.5-mg group and 2.0-mg groups, respectively. Complete regression of polyps was observed in 56.5% of patients in the 0.5-mg group and 52.9% of those in the 2.0-mg group, whereas partial regression was observed in 26.1% and 35.3% of patients in the 0.5-mg and 2.0-mg groups, respectively. CONCLUSION Intravitreal injection of conbercept appears to significantly improve visual acuity and anatomical outcomes in patients with polypoidal choroidal vasculopathy.
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Sakai T, Okano K, Kohno H, Tsuneoka H. Three-year visual outcomes of intravitreal ranibizumab with or without photodynamic therapy for polypoidal choroidal vasculopathy. Acta Ophthalmol 2016; 94:e765-e771. [PMID: 27237048 DOI: 10.1111/aos.13130] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 04/14/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE To compare 3-year visual outcomes after intravitreal ranibizumab (IVR) monotherapy and combination therapy of photodynamic therapy (PDT) with IVR for polypoidal choroidal vasculopathy (PCV). METHODS Medical records for 45 eyes in 45 patients (34 men, 11 women; mean age, 73.8 years old; range, 62-86 years old) with treatment-naïve PCV were reviewed retrospectively. Of the 45 eyes, 20 were treated with IVR monotherapy and 25 with combination therapy. Mean change in best-corrected visual acuity, numbers of injections of IVR and length of treatment-free period from baseline at month 36 were observed. Adverse events were monitored. RESULTS The change in visual acuity after combination therapy was significantly better than that after IVR monotherapy (p = 0.0399). At 36 months, improvement in visual acuity was seen in five eyes (25.0%) in the IVR monotherapy group and 13 eyes (52.0%) in the combination therapy group. The treatment-free period was significantly longer in the combination therapy group (p = 0.0008). Additional IVR therapy was required significantly more frequently in the IVR monotherapy group (p = 0.0026). Post-treatment subretinal haemorrhage or retinal pigment epithelium tear occurred only in the IVR monotherapy group, in one eye (5.0%) and one eye (5.0%), respectively. CONCLUSION Initial therapy consisting of a single session of PDT combined with IVR improves vision in treatment-naïve PCV. Compared with IVR monotherapy, this combination therapy may be more effective for PCV.
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Affiliation(s)
- Tsutomu Sakai
- Department of Ophthalmology; Jikei University School of Medicine; Tokyo Japan
| | - Kiichiro Okano
- Department of Ophthalmology; Jikei University School of Medicine; Tokyo Japan
| | - Hideo Kohno
- Department of Ophthalmology; Jikei University School of Medicine; Tokyo Japan
| | - Hiroshi Tsuneoka
- Department of Ophthalmology; Jikei University School of Medicine; Tokyo Japan
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Sen P, Vinay Kumar S, Bhende M, Sharma T. Combined argon laser photocoagulation and antivascular endothelial growth factor for management of macular polypoidal choroidal vasculopathy. Oman J Ophthalmol 2016; 9:139-143. [PMID: 27843227 PMCID: PMC5084495 DOI: 10.4103/0974-620x.192263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aim: To evaluate the efficacy of combination therapy of argon laser photocoagulation and intravitreal antivascular endothelial growth factor (VEGF) injection in idiopathic polypoidal choroidal vasculopathy (PCV) involving macula. Materials and Methods: A retrospective interventional study involving 12 eyes of 11 patients diagnosed with PCV involving the macula on indocyanine green angiography (ICGA). Intravitreal anti-VEGF was given in eyes with significant subretinal/sub retinal pigment epithelium hemorrhage or exudation. ICGA-guided focal laser was done to extrafoveal leaking polyps. Mean change in best-corrected visual acuity (BCVA) and regression of polyp as seen on ICGA were evaluated at the final follow-up. Statistical Analysis: It was done using SPSS 17.0. – Mann-Whitney test. Results: 12 eyes of 11 patients underwent argon laser with intravitreal anti-VEGF injection. Ten patients were males and one female. Mean age was 65.75 ± 5.2 years. The mean number of injections given was 3.66 ± 1.5 (2–6) per eye. Mean number of laser sessions required was 1.33 ± 0.65 (1–3) per eye. BCVA improved in 25% (n = 3), remained stable in stable in 50% (n = 6) eyes, and decreased in 25% (n = 3) eyes. The regression of polypoidal lesions on ICGA was seen in 75% (n = 9) of eyes. Persistent subretinal fluid seen in 25% (n = 3) of eyes. The mean duration of follow-up was 15.41 ± 10.27 (3–36) months. Conclusion: Combined argon laser photocoagulation with intravitreal anti-VEGF injection helps in decreasing exudation and results in stabilization of the disease with visual improvement in eyes with PCV involving macula.
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Affiliation(s)
- Parveen Sen
- Department of Vitreoretina, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - S Vinay Kumar
- Department of Vitreoretina, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Muna Bhende
- Department of Vitreoretina, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Tarun Sharma
- Department of Vitreoretina, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Tan KA, Gupta P, Agarwal A, Chhablani J, Cheng CY, Keane PA, Agrawal R. State of science: Choroidal thickness and systemic health. Surv Ophthalmol 2016; 61:566-81. [DOI: 10.1016/j.survophthal.2016.02.007] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 02/28/2016] [Accepted: 02/29/2016] [Indexed: 12/12/2022]
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Phang WM, Tan AA, Gopinath SC, Hashim OH, Kiew LV, Chen Y. Secretion of N- and O-linked Glycoproteins from 4T1 Murine Mammary Carcinoma Cells. Int J Med Sci 2016; 13:330-9. [PMID: 27226773 PMCID: PMC4879765 DOI: 10.7150/ijms.14341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 03/31/2016] [Indexed: 02/06/2023] Open
Abstract
Breast cancer is one of the most common cancers that affect women globally and accounts for ~23% of all cancers diagnosed in women. Breast cancer is also one of the leading causes of death primarily due to late stage diagnoses and a lack of effective treatments. Therefore, discovering protein expression biomarkers is mandatory for early detection and thus, critical for successful therapy. Two-dimensional electrophoresis (2D-E) coupled with lectin-based analysis followed by mass spectrometry were applied to identify potential biomarkers in the secretions of a murine mammary carcinoma cell line. Comparisons of the protein profiles of the murine 4T1 mammary carcinoma cell line and a normal murine MM3MG mammary cell line indicated that cadherin-1 (CDH), collagenase 3 (MMP-13), Viral envelope protein G7e (VEP), Gag protein (GAG) and Hypothetical protein LOC433182 (LOC) were uniquely expressed by the 4T1 cells, and pigment epithelium-derived factor (PEDF) was exclusively secreted by the MM3MG cells. Further analysis by a lectin-based study revealed that aberrant O-glycosylated CDH, N-glycosylated MMP-13 and LOC were present in the 4T1 medium. These differentially expressed N- and O-linked glycoprotein candidates, which were identified by combining lectin-based analysis with 2D-E, could serve as potential diagnostic and prognostic markers for breast cancer.
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Affiliation(s)
- Wai-Mei Phang
- 1. Department of Oral Biology & Biomedical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Aik-Aun Tan
- 2. Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Penang 11800, Malaysia
| | - Subash C.B. Gopinath
- 3. Institute of Nano Electronic Engineering (INEE), Universiti Malaysia Perlis, 01000 Kangar, Perlis, Malaysia
- 4. School of Bioprocess Engineering, Universiti Malaysia Perlis, 02600 Arau, Perlis, Malaysia
| | - Onn H. Hashim
- 5. Department of Molecular Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Lik Voon Kiew
- 6. Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Yeng Chen
- 1. Department of Oral Biology & Biomedical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur 50603, Malaysia
- 7. Oral Cancer Research and Coordinating Centre, Faculty of Dentistry, University of Malaya, Kuala Lumpur 50603, Malaysia
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Brilliant MH, Vaziri K, Connor TB, Schwartz SG, Carroll JJ, McCarty CA, Schrodi SJ, Hebbring SJ, Kishor KS, Flynn HW, Moshfeghi AA, Moshfeghi DM, Fini ME, McKay BS. Mining Retrospective Data for Virtual Prospective Drug Repurposing: L-DOPA and Age-related Macular Degeneration. Am J Med 2016; 129:292-8. [PMID: 26524704 PMCID: PMC4841631 DOI: 10.1016/j.amjmed.2015.10.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 10/03/2015] [Accepted: 10/05/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Age-related macular degeneration (AMD) is a leading cause of visual loss among the elderly. A key cell type involved in AMD, the retinal pigment epithelium, expresses a G protein-coupled receptor that, in response to its ligand, L-DOPA, up-regulates pigment epithelia-derived factor, while down-regulating vascular endothelial growth factor. In this study we investigated the potential relationship between L-DOPA and AMD. METHODS We used retrospective analysis to compare the incidence of AMD between patients taking vs not taking L-DOPA. We analyzed 2 separate cohorts of patients with extensive medical records from the Marshfield Clinic (approximately 17,000 and approximately 20,000) and the Truven MarketScan outpatient and databases (approximately 87 million) patients. We used International Classification of Diseases, 9th Revision codes to identify AMD diagnoses and L-DOPA prescriptions to determine the relative risk of developing AMD and age of onset with or without an L-DOPA prescription. RESULTS In the retrospective analysis of patients without an L-DOPA prescription, AMD age of onset was 71.2, 71.3, and 71.3 in 3 independent retrospective cohorts. Age-related macular degeneration occurred significantly later in patients with an L-DOPA prescription, 79.4 in all cohorts. The odds ratio of developing AMD was also significantly negatively correlated by L-DOPA (odds ratio 0.78; confidence interval, 0.76-0.80; P <.001). Similar results were observed for neovascular AMD (P <.001). CONCLUSIONS Exogenous L-DOPA was protective against AMD. L-DOPA is normally produced in pigmented tissues, such as the retinal pigment epithelium, as a byproduct of melanin synthesis by tyrosinase. GPR143 is the only known L-DOPA receptor; it is therefore plausible that GPR143 may be a fruitful target to combat this devastating disease.
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Affiliation(s)
- Murray H Brilliant
- Center for Human Genetics, Marshfield Clinic Research Foundation, Marshfield, Wis
| | - Kamyar Vaziri
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Palm Beach Gardens, Fla
| | - Thomas B Connor
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee
| | - Stephen G Schwartz
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Palm Beach Gardens, Fla
| | - Joseph J Carroll
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee; Department of Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee
| | | | - Steven J Schrodi
- Center for Human Genetics, Marshfield Clinic Research Foundation, Marshfield, Wis
| | - Scott J Hebbring
- Center for Human Genetics, Marshfield Clinic Research Foundation, Marshfield, Wis
| | - Krishna S Kishor
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Palm Beach Gardens, Fla
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Palm Beach Gardens, Fla
| | - Andrew A Moshfeghi
- Department of Ophthalmology, USC Eye Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles
| | - Darius M Moshfeghi
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, Calif
| | - M Elizabeth Fini
- USC Institute for Genetic Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles; Department of Cell & Neurobiology, Keck School of Medicine of USC, University of Southern California, Los Angeles; Department of Ophthalmology, Keck School of Medicine of USC, University of Southern California, Los Angeles
| | - Brian S McKay
- Department of Ophthalmology and Vision Science, University of Arizona, Tucson; Department of Cellular and Molecular Medicine, University of Arizona, Tucson.
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The Features of Inflammation Factors Concentrations in Aqueous Humor of Polypoidal Choroidal Vasculopathy. PLoS One 2016; 11:e0147346. [PMID: 26799405 PMCID: PMC4723149 DOI: 10.1371/journal.pone.0147346] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/31/2015] [Indexed: 11/19/2022] Open
Abstract
Purpose To investigate the cytokine concentrations in the aqueous humor of patients with refractory polypoidal choroidal vasculopathy (PCV). Methods Three separate groups of patients were studied–refractory PCV (Group A, 41 eyes), stable PCV (Group B, 39 eyes) and senile cataract (Group C, 44 eyes). Aqueous humor samples were collected at two time points for Groups A and B–before the first intravitreal ranibizumab injection and before the last injection. Aqueous humor samples were collected prior to phacoemulsification in Group C. The cytokine concentrations of interleukin 2, 6, and 8 (IL-2, IL-6, and IL-8), tumor necrosis factor α (TNF-α), monocyte chemotactic protein 1 (MCP-1), and vascular endothelial growth factor (VEGF) were measured by cytometric bead array and flow cytometry. Results Before the first treatment, the MCP-1, VEGF, and TNF-α levels in Group A were significantly higher than those in Group C (P < 0.05), and the MCP-1 and VEGF levels in Group A were significantly higher than those in Group B (P < 0.05). Significantly higher MCP-1 and VEGF levels were seen in Group B compared to Group C (P < 0.05). Before the final treatment, the MCP-1, VEGF, and TNF-α concentrations in Group A were significantly higher than those in Group B (P < 0.05) and Group C (P < 0.05). IL-2 levels were significantly lower in Group A compared to Group B (P < 0.05) and Group C (P < 0.05). Conclusion Inflammatory cytokines such as MCP-1, VEGF, and TNF-α may be associated with the pathogenesis of both stable and refractory PCV.
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Tang K, Si JK, Guo DD, Cui Y, Du YX, Pan XM, Bi HS. Ranibizumab alone or in combination with photodynamic therapy vs photodynamic therapy for polypoidal choroidal vasculopathy: a systematic review and Meta-analysis. Int J Ophthalmol 2015; 8:1056-66. [PMID: 26558226 DOI: 10.3980/j.issn.2222-3959.2015.05.36] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 01/30/2015] [Indexed: 01/10/2023] Open
Abstract
AIM To compare the efficacy of intravitreal ranibizumab (IVR) alone or in combination with photodynamic therapy (PDT) vs PDT in patients with symptomatic polypoidal choroidal vasculopathy (PCV). METHODS A systematic search of a wide range of databases (including PubMed, EMBASE, Cochrane Library and Web of Science) was searched to identify relevant studies. Both randomized controlled trials (RCTs) and non-RCT studies were included. Methodological quality of included literatures was evaluated according to the Newcastle-Ottawa Scale. RevMan 5.2.7 software was used to do the Meta-analysis. RESULTS Three RCTs and 6 retrospective studies were included. The results showed that PDT monotherapy had a significantly higher proportion in patients who achieved complete regression of polyps than IVR monotherapy at months 3, 6, and 12 (All P≤0.01), respectively. However, IVR had a tendency to be more effective in improving vision on the basis of RCTs. The proportion of patients who gained complete regression of polyps revealed that there was no significant difference between the combination treatment and PDT monotherapy. The mean change of best-corrected visual acuity (BCVA) from baseline showed that the combination treatment had significant superiority in improving vision vs PDT monotherapy at months 3, 6 and 24 (All P<0.05), respectively. In the mean time, this comparison result was also significant at month 12 (P<0.01) after removal of a heterogeneous study. CONCLUSION IVR has non-inferiority compare with PDT either in stabilizing or in improving vision, although it can hardly promote the regression of polyps. The combination treatment of PDT and IVR can exert a synergistic effect on regressing polyps and on maintaining or improving visual acuity. Thus, it can be the first-line therapy for PCV.
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Affiliation(s)
- Kai Tang
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China ; Department of Ophthalmology, Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China
| | - Jun-Kang Si
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China ; Department of Ophthalmology, Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China
| | - Da-Dong Guo
- Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China
| | - Yan Cui
- Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China
| | - Yu-Xiang Du
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China ; Department of Ophthalmology, Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China
| | - Xue-Mei Pan
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China
| | - Hong-Sheng Bi
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China ; Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China
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Liu L, Ma J, Duan P, Liu Y, Yin ZQ. Practicability confirmation by meta-analysis of intravitreal ranibizumab compared to photodynamic therapy to treat polypoidal choroidal vasculopathy. Mol Vis 2015; 21:1130-41. [PMID: 26539025 PMCID: PMC4597912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 10/01/2015] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The literatures show that photodynamic therapy (PDT) and intravitreal ranibizumab (IVR) have their own specific advantages in treating polypoidal choroidal vasculopathy (PCV). Using a meta-analysis, we want to provide some suggestions for the clinical application of the two treatments to PCV patients through a comparison of the functional outcomes in a follow-up period after administration. METHODS A comprehensive literature search was performed using several databases to assemble the controlled trials of IVR and PDT. The program of RevMan version 5.0 was used to analyze the data. The effects of two treatments on PCV were evaluated by comparing weighted mean differences (WMDs) in the change of LogMar visual acuity, central retinal thickness (CRT), and the deterioration ratio for the proportions of patients with visual reductions from the baseline. Data with homogeneity among studies were analyzed using a fixed-effect meta-analysis model; otherwise, a random-effect model was applied to data with heterogeneity. RESULTS Five studies are included covering 260 cases in total in this study. The outcomes of IVR treatment compared to PDT appear to significantly improve vision, decrease the central retinal thickness (CRT), and reduce the invalidation rate. The LogMar visual acuity shifts from 0.6 to 0.3 in the following 24 months and the improvement rate of visual acuity ranges from 60-70% in IVR treated patients. However, the visual acuity improvement is moderate in the PDT group. These analyses indicate that IVR is an applicable treatment in PCV patients, although PDT is able to yield about a 35% visual acuity improvement in a short-term follow-up. Our 3-D mesh modal also confirms that IVR is able to yield better effects to treat PCV than PDT. CONCLUSIONS The analysis in this study suggests that IVR has a significant effect on the improvement of visual acuity when treating patients with PCV. Our findings clearly document that IVR can be used as a more effective therapy for long-term administration in PCV.
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Affiliation(s)
- Ling Liu
- Southwest Eye Hospital, Southwest Hospital, Key Laboratory of Visual Damage and Repair of Chongqing, Third Military Medical University, Chongqing, China
| | - Jie Ma
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA
| | - Ping Duan
- Southwest Eye Hospital, Southwest Hospital, Key Laboratory of Visual Damage and Repair of Chongqing, Third Military Medical University, Chongqing, China
| | - Yong Liu
- Southwest Eye Hospital, Southwest Hospital, Key Laboratory of Visual Damage and Repair of Chongqing, Third Military Medical University, Chongqing, China
| | - Zheng Qin Yin
- Southwest Eye Hospital, Southwest Hospital, Key Laboratory of Visual Damage and Repair of Chongqing, Third Military Medical University, Chongqing, China
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Saito M, Kano M, Itagaki K, Ise S, Imaizumi K, Sekiryu T. Subfoveal choroidal thickness in polypoidal choroidal vasculopathy after switching to intravitreal aflibercept injection. Jpn J Ophthalmol 2015; 60:35-41. [PMID: 26350229 DOI: 10.1007/s10384-015-0411-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 07/27/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the changes in subfoveal thickness after switching to intravitreal aflibercept injection for polypoidal choroidal vasculopathy (PCV). METHODS We retrospectively reviewed 66 eyes of 65 PCV patients (mean age 75.7 years) which were refractory to ranibizumab. The choroidal thickness was measured by optical coherence tomography (OCT) using an enhanced depth imaging technique. Intravitreal aflibercept (2 mg/0.05 ml) was administered with three consecutive monthly injections as a loading dose, followed by further injections bimonthly (every two months). RESULTS The mean subfoveal choroidal thickness significantly decreased from 203 μm at baseline to 171 μm at month 6 (P < 0.0001). The mean logMAR best-corrected visual acuity levels significantly improved from 0.40 at baseline to 0.33 at 6 months (P < 0.001). The central retinal thickness significantly decreased from 249 μm at baseline to 161 μm at 6 months (P < 0.0001). At month 6, 41 (62.1%) eyes had dry macula by OCT. Of 46 eyes with polypoidal lesions at baseline, complete regression of polypoidal lesions was achieved in 26 (56.5%) eyes at 3 months. CONCLUSIONS The choroidal thickness in PCV eyes significantly decreased after switching to intravitreal aflibercept injection. Aflibercept may help prevent choroidal neovascularization near or under the retinal pigment epithelium, which might help achieve greater occlusion of polypoidal lesions compared with ranibizumab.
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Affiliation(s)
- Masaaki Saito
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima, Japan.
- Department of Ophthalmology and Visual Sciences, Akita University Graduate School of Medicine, 1-1-1 Hondo Akita, Akita, 010-8543, Japan.
| | - Mariko Kano
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kanako Itagaki
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shigeyuki Ise
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kimihiro Imaizumi
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tetsuju Sekiryu
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima, Japan
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High-dose ranibizumab monotherapy for neovascular polypoidal choroidal vasculopathy in a predominantly non-Asian population. Eye (Lond) 2015; 29:1427-37. [PMID: 26337944 DOI: 10.1038/eye.2015.150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/06/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine safety and efficacy of intravitreal high-dose ranibizumab in the treatment of active neovascular polypoidal choroidal vasculopathy (PCV). METHODS In this Phase I/II, single-center, randomized, controlled, double-masked study, predominantly non-Asian, previously treated or treatment-naive, male and female adult patients were randomized to receive high-dose (1.0/0.1 ml or 2.0 mg/0.05 ml; n=15) or standard-dose (0.5 mg/0.05 ml; n=5) ranibizumab in 3 monthly loading doses, followed by 9 months of criteria-based, as-needed retreatment. Safety was evaluated by a descriptive analysis of all non-serious and serious adverse events, angiographic assessments, physical examinations, vital signs, ocular examinations, and visual acuity measurements. Visual acuity and anatomic outcomes are described for the high-dose group. RESULTS Twenty patients (aged 35-76 years; 8 Black, 11 White, 1 Asian) were enrolled. At baseline, in the high-dose group, mean best-corrected visual acuity (BCVA) was 63.5 letters (Snellen equivalent ~20/50), and mean baseline central foveal thickness (CFT) was 253.7 μm. High-dose ranibizumab was generally well tolerated without evidence of ocular or systemic severe adverse events, including arterial thromboembolic events. At month 12, in the high-dose group, the mean overall change from baseline in BCVA was +6.7 letters and in CFT was -49.7 μm. CONCLUSION High-dose ranibizumab monotherapy is safe and efficacious for treating patients with PCV.
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Anti-VEGF therapy in symptomatic peripheral exudative hemorrhagic chorioretinopathy (PEHCR) involving the macula. Graefes Arch Clin Exp Ophthalmol 2015; 254:653-9. [PMID: 26148802 DOI: 10.1007/s00417-015-3096-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 05/13/2015] [Accepted: 06/23/2015] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The purpose of this study was to describe the anatomical and functional outcome of vascular endothelial growth factor inhibitor (anti-VEGF) treatment in symptomatic peripheral exudative hemorrhagic chorioretinopathy (PEHCR) involving the macula. METHODS Clinical records from patients seen between 2012 and 2013 at a single academic center were reviewed to identify PEHCR patients receiving anti-VEGF therapy due to disease-associated changes involving the macula. Affected eyes were either treated with consecutive intravitreal injections of anti-VEGF or vitrectomy combined with anti-VEGF followed by pro re nata injections. RESULTS The mean age of the patients was 76 years (range 70-89 years). In all nine eyes, visual acuity was reduced due to central subretinal fluid. On average, three anti-VEGF injections (range 2-5 injections) were required initially to achieve complete resolution of macular subretinal fluid. In three eyes, subretinal fluid reappeared after an average of 10 months (range 5-16 months), and an average of 2.5 anti-VEGF injections (range 2-3 injections) were necessary to attain complete resolution of macular subretinal fluid a second time. Median visual acuity at the visit before the first injection was 1.0 logMAR (range 2.1-0.4 logMAR) and increased to 0.8 logMAR (range 2-0.1 logMAR) at the last visit. CONCLUSION Results of this study show that for cases in which PEHCR becomes symptomatic due to macular involvement, anti-VEGF treatment may have drying potential. Although vision was improved in some patients, it remained limited in cases with long-term macular involvement, precluding any definitive functional conclusion. However, we believe that the use of anti-VEGF agents should be recommended in PEHCR that threatens the macula. Due to its often self-limiting course, peripheral lesions should be closely observed. Larger studies are needed in order to provide clear evidence of the efficacy of anti-VEGF therapy in PEHCR.
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Tsujinaka H, Itaya-Hironaka A, Yamauchi A, Sakuramoto-Tsuchida S, Ota H, Takeda M, Fujimura T, Takasawa S, Ogata N. Human retinal pigment epithelial cell proliferation by the combined stimulation of hydroquinone and advanced glycation end-products via up-regulation of VEGF gene. Biochem Biophys Rep 2015; 2:123-131. [PMID: 29124153 PMCID: PMC5668646 DOI: 10.1016/j.bbrep.2015.05.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/12/2015] [Accepted: 05/18/2015] [Indexed: 01/26/2023] Open
Abstract
Although recent research showed that advanced glycation endproduct (AGE) and hydroquinone (HQ) are related to the pathogenesis of age-related macular degeneration (AMD), the mechanism how AGE and HQ induce or accelerate AMD remains elusive. In the present study, we examined the effects of AGE and HQ on changes of human retinal pigment epithelial (RPE) cell numbers and found that the viable cell numbers were markedly reduced by HQ by apoptosis and that AGE prevented the decreases of HQ-treated cell numbers by increased replicative DNA synthesis of RPE cells without changing apoptosis. Real-time RT-PCR revealed that vascular endothelial growth factor (VEGF)-A mRNA was increased by HQ treatment and the addition of HQ+AGE resulted in a further increment. The increase of VEGF secretion was confirmed by ELISA, and inhibition of VEGF signaling by chemical inhibitors and small interfering RNA decreased the HQ+AGE-induced increases in RPE cell numbers. The deletion analysis demonstrated that -102 to -43 region was essential for the VEGF-A promoter activation. Site-directed mutaions of specificity protein 1 (SP1) binding sequences in the VEGF-A promoter and RNA interference of SP1 revealed that SP1 is an essential transcription factor for VEGF-A expression. These results indicate that HQ induces RPE cell apoptosis, leading to dry AMD, and suggest that AGE stimulation in addition to HQ enhances VEGF-A transcription via the AGE-receptor for AGE pathway in HQ-damaged cells. As a result, the secreted VEGF acts as an autocrine/paracrine growth factor for RPE and/or adjacent vascular cells, causing wet AMD.
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Key Words
- AGE, advanced glycation endproduct
- AMD, age-related macular degeneration
- Advanced glycation endproduct(s)
- Age-related macular degeneration
- BSA, bovine serum albumin
- ELISA, enzyme-linked immunosorbent assay
- FCS, fetal calf serum
- HQ, hydroquinone
- Hydroquinone
- IdU, 5ʹ-Indo-2ʹ-deoxyuridine
- RAGE, receptor for advanced glycation endproduct
- RPE, retinal pigment epithelial
- RT-PCR, reverse transcription polymerase chain reaction;
- Retinal pigment epithelial cells
- SP1, specificity protein 1
- SR, scavenger receptor
- TUNEL, terminal deoxynucleotidyl transferase dUTP nick end labeling
- VEGF, vascular endothelial growth factor
- Vascular endothelial growth factor
- WST-8, 2-(2-methoxy-4-nitrophenyl)-3-(4-nitrophenyl)-5-(2,4-disulfophenyl)-2H-tetrazolium monosodium salt
- siRNA, small interfering RNA
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Affiliation(s)
- Hiroki Tsujinaka
- Department of Biochemistry, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8521 Nara, Japan
- Department of Ophthalmology, Nara Medical University, Kashihara, 634-8522 Nara, Japan
| | - Asako Itaya-Hironaka
- Department of Biochemistry, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8521 Nara, Japan
| | - Akiyo Yamauchi
- Department of Biochemistry, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8521 Nara, Japan
| | | | - Hiroyo Ota
- Department of Biochemistry, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8521 Nara, Japan
| | - Maiko Takeda
- Department of Biochemistry, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8521 Nara, Japan
| | - Takanori Fujimura
- Department of Biochemistry, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8521 Nara, Japan
| | - Shin Takasawa
- Department of Biochemistry, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8521 Nara, Japan
| | - Nahoko Ogata
- Department of Ophthalmology, Nara Medical University, Kashihara, 634-8522 Nara, Japan
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