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Sepetis AE, Barbara R, Frisina R, Farag M, De Salvo G. Functional and structural characteristics in patients with type 3 macular neovascularisation treated with anti-VEGF. Three-year results in real world settings. Eye (Lond) 2024; 38:1438-1443. [PMID: 38184726 PMCID: PMC11126723 DOI: 10.1038/s41433-023-02918-w] [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: 05/14/2023] [Revised: 12/09/2023] [Accepted: 12/20/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND To evaluate the long-term anatomical and functional outcomes of anti-Vascular Endothelial Growth Factor intravitreal injections (anti-VEGF IVI) in patients with type 3 macular neovascularisation (MNV) in real-world settings. METHODS Retrospective review of patients with type 3 MNV who received anti-VEGF IVI between 2013 and 2020. Primary outcomes were best corrected visual acuity (BCVA) and central macular thickness (CMT). Secondary outcome was the development of new-onset of foveal-involving geographic atrophy (GA) and disciform scars. RESULTS We identified 59 eyes from 48 British patients that met the inclusion criteria. Treatment with anti- VEGF IVI resulted in a statistically significant reduction in median CMT, which was maintained throughout the study period. At 36 months, 24 eyes showed more than 50 μm reduction in CMT, 7 eyes remained stable and only 2 eyes showed an increase in CMT by more than 50μm compared to the baseline. At year three, deterioration was noticed in most eyes (52.78%) and vision remained stable or improved in 47.22% of the eyes. However, the median BCVA was not statistically significant different compared to baseline. During the study period new onset of macula-involving atrophy or scar was noted in 10.2% and 4.3% of the eyes, respectively. CONCLUSION In this real-world study, anatomic and functional improvement were recorded 12-months post anti-VEGF IVI in type 3 MNV. Despite sustained anatomical improvement, vision returned back to baseline levels at 36-months. The development of GA and macular scar was only partially responsible for this outcome suggesting a more severe nature of this form of nAMD.
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Affiliation(s)
- Anastasios E Sepetis
- Department of Ophthalmology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, Hampshire, United Kingdom
| | - Ramez Barbara
- Department of Ophthalmology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, Hampshire, United Kingdom
| | - Rino Frisina
- Ophthalmology - Surgery Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Mohamed Farag
- Department of Ophthalmology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, Hampshire, United Kingdom
| | - Gabriella De Salvo
- Department of Ophthalmology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, Hampshire, United Kingdom.
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Prenner V, Schmidt-Erfurth U, Fuchs P, Leingang O, Coulibaly LM, Bogunovic H, Barthelmes D, Reiter GS. Dynamics and patterns of recurrence in neovascular AMD during real-world management using automated fluid monitoring. Heliyon 2024; 10:e31567. [PMID: 38826751 PMCID: PMC11141345 DOI: 10.1016/j.heliyon.2024.e31567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 05/14/2024] [Accepted: 05/17/2024] [Indexed: 06/04/2024] Open
Abstract
In this retrospective longitudinal observational study, data from one site of the Fight Retinal Blindness! Registry (University of Zurich, Switzerland) was used to investigate the quantity and distribution of recurrent fluid in neovascular age-related macular degeneration (nAMD). Study eye eligibility required treatment-naïve nAMD, receiving at least three anti-vascular endothelial growth factor injections, followed by a treatment discontinuation of at least six months and subsequence fluid recurrence. To quantify fluid, a regulatory approved deep learning algorithm (Vienna Fluid Monitor, RetInSight, Vienna, Austria) was used. Fifty-six eyes of 56 patients with a mean age of 76.29 ± 6.58 years at baseline fulfilled the inclusion criteria. From baseline to the end of the first treatment-free interval, SRF volume had decreased significantly (58.0 nl (IQR 10-257 nl) to 8.73 nl (IQR 1-100 nl), p < 0.01). The quantitative increase in IRF volume from baseline to the end of the first treatment-free interval was not statistically significant (1.35 nl (IQR 0-107 nl) to 5.18 nl (IQR 0-24 nl), p = 0.13). PED also did not reach statistical significance (p = 0.71). At the end of the second treatment discontinuation there was quantitatively more IRF (17.3 nl) than SRF (3.74 nl). In conclusion, discontinuation of treatment with anti-VEGF therapy may change the fluid pattern in nAMD.
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Affiliation(s)
- Veronika Prenner
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Philipp Fuchs
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Oliver Leingang
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Leonard Mana Coulibaly
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Hrvoje Bogunovic
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
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Browning AC, Grinton ME, Quinn S, Jain T, Manikavasagar V, Aftab AM. Long term follow up of patients with MNV3 treated with intra-vitreal Aflibercept. Eur J Ophthalmol 2024:11206721241229912. [PMID: 38304945 DOI: 10.1177/11206721241229912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
PURPOSE MNV3 or Retinal angiomatous proliferation is a subtype of neovascular age-related macular degeneration (nAMD). We present the 5 year long term visual and anatomical outcomes of patients with MNV3 lesions treated with intravitreal Aflibercept. METHODS This is a prospective study of treatment naïve patients with reading centre graded MNV3 lesions. After the loading phase, the patients received intravitreal Aflibercept as per the View study up to year 3, thereafter it was given on a prn basis. At each visit, best corrected visual acuity (BCVA) and optical coherence tomography (OCT) central macular thickness (CMT) was measured. RESULTS Thirty one patients reached study completion. Mean BCVA of treated eyes had decreased by 0.6 ETDRS letters at the end of year 5 compared with baseline. At study completion, 81% of eyes had stable vision while 19% of eyes had gained 15 letters or more. At study end, 26% of eyes had BCVA of 6/12 or better, while 19% had lost 15 letters or more (all had central foveal photoreceptor loss). There was a maximal mean reduction in CMT of 164 microns (p = <0.0001) while 68% of maculae were fluid free at study completion. Eighty seven percent of treated eyes developed nascent GA, of which in 74% of eyes was involving the fovea. DISCUSSION Despite initial improvement in mean BCVA, the improvement in BCVA was not maintained despite good overall control of the MNV3 lesions. The loss of BCVA was most likely due to the majority of eyes developing centre involving macular atrophy.
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Affiliation(s)
- Andrew C Browning
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Michael E Grinton
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Stephanie Quinn
- Medical Physics Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Tania Jain
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | | - Akhunzada M Aftab
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Clemens CR, Eter N, Alten F. Current Perspectives on Type 3 Macular Neovascularization due to Age-Related Macular Degeneration. Ophthalmologica 2024; 247:73-84. [PMID: 38266500 PMCID: PMC11160428 DOI: 10.1159/000536278] [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: 02/20/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND The aim of this review was to systematically summarize the current knowledge on type 3 macular neovascularization (MNV3) in age-related macular degeneration (AMD). SUMMARY Recent histopathologic and multimodal imaging findings led to the consensus definition of the new term "type 3 macular neovascularization" in AMD. MNV3 originates in the deep vascular plexus as a neovascular process without connection with the retinal pigment epithelium in the initial stages. This type has numerous clinical and pathomorphologic features that separate it from the other two types of MNV in AMD. Besides, its frequency appears to be higher than previously thought. In optical coherence tomography (OCT), MNV3 can be classified into stages 1-3. Hyperreflective foci in the outer retina possibly represent a precursor lesion. In addition, MNV3 is characterized by a strong association with reticular pseudodrusen, a high rate of bilaterality, close associations with advanced age and arterial hypertension, decreased choroidal thickness, and decreased choriocapillaris flow signals. Data from latest anti-vascular endothelial growth factor studies in MNV3 suggest that the OCT biomarkers in intraretinal and subretinal fluids should be interpreted differently than in the other types. Additionally, data from MNV3 eyes should be analyzed separately, allowing optimal type-specific treatment strategies in the future. KEY MESSAGES This review highlights the need for accurate characterization of neovascular AMD lesions and an MNV type-specific approach, particularly for MNV3.
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Affiliation(s)
- Christoph R Clemens
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany
| | - Nicole Eter
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany
| | - Florian Alten
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany
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Lewis LLM, Dörschmann P, Seeba C, Thalenhorst T, Roider J, Iloki Assanga SB, Ruiz JCG, Del Castillo Castro T, Rosas-Burgos EC, Plascencia-Jatomea M, Ezquerra Brauer JM, Klettner A. Properties of Cephalopod Skin Ommochromes to Inhibit Free Radicals, and the Maillard Reaction and Retino-Protective Mechanisms in Cellular Models Concerning Oxidative Stress, Angiogenesis, and Inflammation. Antioxidants (Basel) 2022; 11:antiox11081574. [PMID: 36009293 PMCID: PMC9404994 DOI: 10.3390/antiox11081574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
Ommochromes are pigments of invertebrates that exhibit oxidative stress protection. The aim of this study was to investigate ommochromes extracted from cephalopod’s skin for their ability to inhibit age-related-macular degeneration (AMD)-related factors such as H2O2-induced and iron-dependent oxidative stress (ferroptosis and erastin), accumulation of advanced glycation end-products (AGEs), as well as vascular endothelial growth factor (VEGF), and inflammatory cytokines (interleukin 6 and interleukin 8) secretion. As cell systems, we used primary porcine retinal pigment epithelium (RPE), human retinal pigment epithelium cell line ARPE-19 and uveal melanoma cell line OMM-1. In vitro, ommochromes produced an antiglycation effect by the inhibition of fructosylation reaction. The ommochromes showed protective effects against erastin- induced cell death in ARPE-19. In addition, in long-term stimulation (7 days) ommochromes decreased constitutively secreted VEGF, as well as interleukin 6 and interleukin 8 induced by Poly I:C in primary RPE. No relevant effects were detected in OMM-1 cells. The effects are dependent on the cell system, time of exposition, and concentration. This substance is of interest for further research concerning age-related macular degeneration.
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Affiliation(s)
- Luján Lidianys María Lewis
- Departamento de Investigación y Posgrado en Alimentos, Universidad de Sonora, Blvd. Luis Encinas y Rosales S/N, Col. Centro, Hermosillo 83000, Sonora, Mexico
| | - Philipp Dörschmann
- Department of Ophthalmology, University of Kiel, University Medical Center, Arnold-Heller-Str. 3, Haus 25, 24105 Kiel, Germany
| | - Charlotte Seeba
- Department of Ophthalmology, University of Kiel, University Medical Center, Arnold-Heller-Str. 3, Haus 25, 24105 Kiel, Germany
| | - Tabea Thalenhorst
- Department of Ophthalmology, University of Kiel, University Medical Center, Arnold-Heller-Str. 3, Haus 25, 24105 Kiel, Germany
| | - Johann Roider
- Department of Ophthalmology, University of Kiel, University Medical Center, Arnold-Heller-Str. 3, Haus 25, 24105 Kiel, Germany
| | - Simon Bernard Iloki Assanga
- Department of Biological Chemical Sciences, Sonora University, Blvd. Luis Encinas y Rosales S/N, Col. Centro, Hermosillo 83000, Sonora, Mexico
| | - Juan Carlos Gálvez Ruiz
- Department of Biological Chemical Sciences, Sonora University, Blvd. Luis Encinas y Rosales S/N, Col. Centro, Hermosillo 83000, Sonora, Mexico
| | - Teresa Del Castillo Castro
- Department of Research on Polymers and Materials, Sonora University, Blvd. Luis Encinas y Rosales S/N, Col. Centro, Hermosillo 83000, Sonora, Mexico
| | - Ema Carina Rosas-Burgos
- Departamento de Investigación y Posgrado en Alimentos, Universidad de Sonora, Blvd. Luis Encinas y Rosales S/N, Col. Centro, Hermosillo 83000, Sonora, Mexico
| | - Maribel Plascencia-Jatomea
- Departamento de Investigación y Posgrado en Alimentos, Universidad de Sonora, Blvd. Luis Encinas y Rosales S/N, Col. Centro, Hermosillo 83000, Sonora, Mexico
| | - Josafat Marina Ezquerra Brauer
- Departamento de Investigación y Posgrado en Alimentos, Universidad de Sonora, Blvd. Luis Encinas y Rosales S/N, Col. Centro, Hermosillo 83000, Sonora, Mexico
| | - Alexa Klettner
- Department of Ophthalmology, University of Kiel, University Medical Center, Arnold-Heller-Str. 3, Haus 25, 24105 Kiel, Germany
- Correspondence: ; Tel.: +49-431-500-24283
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The Role of Medical Image Modalities and AI in the Early Detection, Diagnosis and Grading of Retinal Diseases: A Survey. Bioengineering (Basel) 2022; 9:bioengineering9080366. [PMID: 36004891 PMCID: PMC9405367 DOI: 10.3390/bioengineering9080366] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022] Open
Abstract
Traditional dilated ophthalmoscopy can reveal diseases, such as age-related macular degeneration (AMD), diabetic retinopathy (DR), diabetic macular edema (DME), retinal tear, epiretinal membrane, macular hole, retinal detachment, retinitis pigmentosa, retinal vein occlusion (RVO), and retinal artery occlusion (RAO). Among these diseases, AMD and DR are the major causes of progressive vision loss, while the latter is recognized as a world-wide epidemic. Advances in retinal imaging have improved the diagnosis and management of DR and AMD. In this review article, we focus on the variable imaging modalities for accurate diagnosis, early detection, and staging of both AMD and DR. In addition, the role of artificial intelligence (AI) in providing automated detection, diagnosis, and staging of these diseases will be surveyed. Furthermore, current works are summarized and discussed. Finally, projected future trends are outlined. The work done on this survey indicates the effective role of AI in the early detection, diagnosis, and staging of DR and/or AMD. In the future, more AI solutions will be presented that hold promise for clinical applications.
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Huang YY, Lo WJ, Chang HY, Chou YB, Lin TC. Three-Year Outcomes of Intravitreal Aflibercept Injections for Retinal Angiomatous Proliferation According to Disease Stage. Ophthalmol Ther 2022; 11:1503-1516. [PMID: 35596037 PMCID: PMC9253227 DOI: 10.1007/s40123-022-00521-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/29/2022] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION To evaluate the outcomes of intravitreal aflibercept injections for retinal angiomatous proliferation (RAP) according to disease stage. METHODS This retrospective chart review included 68 eyes of 53 individuals diagnosed as having RAP and 109 neovascular age-related macular degeneration (nAMD) eyes of 109 patients as controls. All patients received intravitreal injections of aflibercept in a real-world setting. The main outcome measures were the changes in the mean of best-corrected visual acuity (BCVA) and central retinal thickness (CRT) as well as the total number of injections received during the 3-year follow-up period. RESULTS The average BCVA and CRT changes in eyes affected by RAP and the controls at 3 years were non-significant. Both populations received a similar number of injections. After 3 years of treatment, patients with RAP had visual decline despite stable anatomical outcomes. Approximately 50% of the eyes with stage II RAP exhibited significant BCVA decline at the end of the third year. Among those eyes that had deteriorated BCVA, persistently worsening BCVA and thinning CRT were observed from year 2 to year 3. CONCLUSION Similar to treating nAMD, intensive injections or aggressive treatment strategies are required to treat RAP to achieve optimal visual outcomes in a real-world setting. The response to aflibercept treatment at the second year is associated with the final visual outcome of eyes with stage II RAP lesions.
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Affiliation(s)
- Ya-Yun Huang
- Department of Medical Education and Research, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.,Department of Ophthalmology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan, Republic of China
| | - Wen-Jung Lo
- Department of Ophthalmology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan, Republic of China
| | - Hsin-Yi Chang
- Department of Ophthalmology, Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan, Republic of China
| | - Yu-Bai Chou
- Department of Ophthalmology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan, Republic of China.,Department of Ophthalmology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
| | - Tai-Chi Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan, Republic of China. .,Department of Ophthalmology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China.
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Kałużny JJ, Zabel P, Danek B, Jaworski D, Makowski J. Intraretinal Cysts as a Manifestation of Retinal Angiomatous Proliferation in Optical Coherence Tomography Angiography. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58050676. [PMID: 35630094 PMCID: PMC9145726 DOI: 10.3390/medicina58050676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/12/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Intraretinal cysts are common pathology observed inspectral domain optical coherence tomography (SDOCT) in patients with neovascular form of age-related macular degeneration (AMD). The aim of the study was to determine if the presence of intraretinal cysts is positively correlated with diagnosis of retinal angiomatous proliferation (RAP) in optical coherence tomography angiography (OCTA). Material and Methods: A total of 21 eyes with intraretinal cysts in SDOCT exam (Group1) and 21 eyes with subretinal fluid(Group 2) were enrolled into the study. In each eye, the presence of intraretinal neovascularization (IRN) and chorioretinal anastomosis (CRA) was evaluated in OCTA by two experienced graders. Results: IRN was observed in 20 eyes (95.2%) from Group 1 and 5 eyes (23.8%) from Group 2. Features of CRA were found in 18 eyes (80.95%) and 16 eyes (76.2%) respectively for Group 1 and 2. Patients with cysts are 50 (95% CI: 5.43−460.52) times more likely to have IRN (p < 0.001). Conclusions: The presence of intraretinal cysts on SDOCT retinal sections in eyes with neovascular AMD corresponds to the presence of IRN on OCTA examination. The results indicate that the absence of a cyst does not exclude the presence of IRN and CRA which can be identified on OCTA.
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Affiliation(s)
- Jakub J. Kałużny
- Department of Sensory Organ Studies, Collegium Medicum, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland; (J.J.K.); (P.Z.); (B.D.)
- Oftalmika Eye Hospital, 85-631 Bydgoszcz, Poland;
| | - Przemysław Zabel
- Department of Sensory Organ Studies, Collegium Medicum, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland; (J.J.K.); (P.Z.); (B.D.)
- Oftalmika Eye Hospital, 85-631 Bydgoszcz, Poland;
| | - Beata Danek
- Department of Sensory Organ Studies, Collegium Medicum, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland; (J.J.K.); (P.Z.); (B.D.)
- Oftalmika Eye Hospital, 85-631 Bydgoszcz, Poland;
| | - Damian Jaworski
- Oftalmika Eye Hospital, 85-631 Bydgoszcz, Poland;
- Division of Ophthalmology and Optometry, Department of Ophthalmology, Collegium Medicum, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland
- Correspondence:
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Gigon A, Iskandar A, Eandi CM, Mantel I. Fluid dynamics between injections in incomplete anti-VEGF responders within neovascular age-related macular degeneration: a prospective observational study. Int J Retina Vitreous 2022; 8:19. [PMID: 35260186 PMCID: PMC8902718 DOI: 10.1186/s40942-022-00363-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/14/2022] [Indexed: 12/01/2022] Open
Abstract
Background The purpose of the study was to investigate the short-term response profile after an intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF) in patients with neovascular age-related macular degeneration (nAMD) and incomplete response to anti-VEGF. Methods In this monocentric prospective observational study, we recruited patients with incomplete response to anti-VEGF, defined as presence of subretinal fluid (SRF) and/or intraretinal fluid (IRF) on optical coherence tomography (OCT) for at least 6 months despite monthly anti-VEGF treatment. Each patient underwent complete ophthalmic exam and imaging study (including OCT, fluorescein angiography, indocyanine green angiography, OCT-angiography) the day of their scheduled monthly IVI. Intermediate visits were performed weekly thereafter (comprising ophthalmic exam and OCT), until week 4. Fluid metrics were quantified using an artificial intelligence-based algorithm at baseline and at each subsequent weekly visit. Main outcomes were residual fluid volumes of SRF and IRF for each time point, and its relative change after treatment. Particular interest was given to each patients’ nadir point, which was used for association analysis with imaging parameters. Results A total of 28 eyes of 26 patients were included into the study. The maximal response was reached at 1.93 weeks on average. The relative fluid resolution at nadir point was 66 ± 36.7%, with quartile limits at 49.1%, 83%, and 96.1%, respectively. Mean residual fluid volume was 64.9 ± 128.8 µl at nadir point. Residual fluid was positively correlated with baseline SRF (r = 0.76, p < 0.0001) and larger pigment epithelium detachment (r = 0.65, p = 0.0001). Polypoidal choroidal vasculopathy was associated with larger residual fluid (p = 0.0013). Conclusions Incomplete anti-VEGF responders in nAMD showed significant mean fluid resolution between injections, typically after 2 weeks. However, complete resolution was the exception, and the amount of residual fluid varied greatly. To understand the role of the unresponsive fluid, further studies are needed.
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10
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Bridge arch-shaped subretinal fluid in neovascular age-related macular degeneration - evolution and outcomes. Retina 2022; 42:1012-1019. [PMID: 35152246 DOI: 10.1097/iae.0000000000003436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To study factors leading to bridge arch-shaped subretinal fluid (SRF) on optical coherence tomography (OCT) in wet age-related macular degeneration and evaluate its anatomical and functional outcomes. METHODS In this single-center, retrospective study, patients with bridge arch-shaped SRF and choroidal neovascular membrane (CNVM) were included. RESULTS We identified 623 eyes in 431 patients with chronic CNVM and 24 (4%) eyes in 21 patients showed bridge arch-shaped SRF. Mean age of patients was 69.19 ± 12.0 years. Type 1 CNVM was noted in 79% cases before development of bridge arch-shaped SRF. Mean ETDRS letters visual acuity was 53.93 ± 32.19. Time interval to develop bridge arch-shaped SRF was 21.9 ± 30.63 months. Mean number of intravitreal anti-VEGF injections given before developing bridge arch-shaped SRF was 6.5 ± 7.09. During development of bridge arch-shaped SRF, visual acuity reduced by -20.57 ± 31.13 letters (p=0.033) and fibrotic type 2 CNVM (n=18, 75%) was noted. RPE tear was noted in 8 (33%) eyes. At final visit, further reduction in visual acuity of -7.136 ± 13.73 ETDRS letters (p=0.011) after developing bridge arch-shaped SRF was seen. Mean number of injections given after developing bridge arch shaped SRF was 4.76 ± 3.76. CONCLUSION Bridge arch-shaped SRF is an uncommon finding seen in eyes with type 2 chronic CNVMs. Presence of RPE breach and tear and non-aggressive treatment regimen with intravitreal anti-VEGF injections could be responsible for its pathogenesis. It is a marker of fibrotic enlargement, leading to poor visual outcomes despite showing favourable therapeutic response.
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11
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Haj Najeeb B, Deak GG, Sacu S, Schmidt-Erfurth U, Gerendas BS. The RAP study, report 4: morphological and topographical characteristics of multifocal macular neovascularization type 3. Graefes Arch Clin Exp Ophthalmol 2022; 260:141-147. [PMID: 34436646 PMCID: PMC8763817 DOI: 10.1007/s00417-021-05332-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/23/2021] [Accepted: 07/16/2021] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To report on the morphological characteristics and regional distribution of multifocal macular neovascularization type 3 (mMNV3). METHODS Twenty-two consecutive eyes of 21 patients with mMNV3 were included using multimodal imaging. The count and stage of lesions of all MNV types and the existence of exudate and hemorrhage were determined. Also, we addressed the regional distribution of MNV3 lesions between the superior-inferior and the nasal-temporal halves of the macula, and the range of the distance of the lesions from the central fovea. Furthermore, we explored the number of feeding vessels including the cilioretinal artery. RESULTS We found 51 lesions in 22 eyes of 21 patients. They were bifocal in 16 (73%) eyes, trifocal in 5 (23%), and quadrifocal in one (4%). No lesion of MNV1 or 2 was found. Fifteen (68%), 2 (9%), and 16 (73%) eyes were associated with retinal hard exudate, subretinal pigment epithelium exudate, and intraretinal hemorrhage, respectively. Thirty (59%) lesions were located in the temporal half of the macula, whereas 21 (41%) were located nasally (p = 0.07). One (2%) lesion was closer than 500 µm, 49 (96%) between 500 and 1500 µm, and one (2%) between 1500 and 3000 µm. The lesions were supplied by one arteriole in one (4%) eye, two arterioles in 16 (73%) eyes, and 3 arterioles in 5 (23%) eyes. The CRA contributed as a feeding vessel in 5 (23%) eyes. CONCLUSION The multifocal variant of MNV3 has specific morphological and topographical characteristics. Multimodal imaging allows the understanding of the pathomorphological condition in more detail.
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Affiliation(s)
- Bilal Haj Najeeb
- Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gabor G Deak
- Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stefan Sacu
- Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Bianca S Gerendas
- Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Hildebrandt J, Käckenmeister T, Winkelmann K, Dörschmann P, Roider J, Klettner A. Pro-inflammatory activation changes intracellular transport of bevacizumab in the retinal pigment epithelium in vitro. Graefes Arch Clin Exp Ophthalmol 2021; 260:857-872. [PMID: 34643794 PMCID: PMC8850249 DOI: 10.1007/s00417-021-05443-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 10/01/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Bevacizumab is taken up and transported through the retinal pigment epithelium. Inflammatory signaling may influence this interaction. In the present study, we have investigated the effect of pro-inflammatory stimuli on the uptake, intracellular localization, and transepithelial transport of bevacizumab. Methods ARPE-19 cell line or primary porcine RPE cells were treated with clinical relevant concentrations of bevacizumab (250 µg/ml). Pro-inflammatory signaling was induced by TLR-3 agonist polyinosinic:polycytidylic acid (Poly I:C). Viability was investigated with MTT and trypan-blue exclusion assay, and cell number, uptake, and intracellular localization were investigated with immunofluorescence, investigating also actin filaments, the motor protein myosin 7a and lysosomes. Immunofluorescence signals were quantified. Intracellular bevacizumab was additionally detected in Western blot. Barrier function was investigated with transepithelial resistant measurements (TER). The transepithelial transport of bevacizumab and its influence on cytokine (IL-6, IL-8, IL-1β, TNFα) secretion was investigated with ELISA. Results Poly I:C in combination with bevacizumab reduced the viability of the cells. Treatment with Poly I:C reduced the uptake of bevacizumab, changed the intensity of the actin filaments, and reduced the colocalization with myosin 7a. In addition, Poly I:C reduced the capacity of RPE cells to transport bevacizumab over the barrier. In addition, bevacizumab reduced the secretion of IL-8 and TNFα after Poly I:C stimulation at selected time points. Conclusions Pro-inflammatory activation of RPE cells with TLR-3 agonist Poly I:C changes the interaction of RPE cells with the anti-VEGF compound bevacizumab, reducing its uptake and transport. On the other hand, bevacizumab might influence pro-inflammatory cytokine release. Our data indicate that inflammation may influence the pharmacokinetic of bevacizumab in the retina.
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Affiliation(s)
- Julia Hildebrandt
- Department of Ophthalmology, University Medical Center, University of Kiel, Quincke Research Center, Rosalind-Franklin-Str. 9, 24105, Kiel, Germany
| | - Tom Käckenmeister
- Department of Ophthalmology, University Medical Center, University of Kiel, Quincke Research Center, Rosalind-Franklin-Str. 9, 24105, Kiel, Germany
| | - Katrin Winkelmann
- Department of Ophthalmology, University Medical Center, University of Kiel, Quincke Research Center, Rosalind-Franklin-Str. 9, 24105, Kiel, Germany
| | - Philipp Dörschmann
- Department of Ophthalmology, University Medical Center, University of Kiel, Quincke Research Center, Rosalind-Franklin-Str. 9, 24105, Kiel, Germany
| | - Johann Roider
- Department of Ophthalmology, University Medical Center, University of Kiel, Quincke Research Center, Rosalind-Franklin-Str. 9, 24105, Kiel, Germany
| | - Alexa Klettner
- Department of Ophthalmology, University Medical Center, University of Kiel, Quincke Research Center, Rosalind-Franklin-Str. 9, 24105, Kiel, Germany.
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THE RAP STUDY, REPORT TWO: The Regional Distribution of Macular Neovascularization Type 3, a Novel Insight Into Its Etiology. Retina 2021; 40:2255-2262. [PMID: 32032256 DOI: 10.1097/iae.0000000000002774] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore the regional distribution of macular neovascularization type 3 (MNV3). METHODS Seventy-eight eyes of 78 patients were reviewed. We defined the location of each lesion after applying a modified ETDRS grid and the incidence of simultaneous MNV1 or 2. Also, we investigated the distribution of MNV3 at the outline of the foveal avascular zone and when the diameter of foveal avascular zone was less than 325 µm. RESULTS The distribution of MNV3 was 4 lesions (5%) from the center to 500 µm, 72 (92%) from 500 µm to 1500 µm, and 2 (3%) from 1,500 µm to 3000 µm. The distribution in respect of the ETDRS fields was 7 (9%) nasal, 16 (20%) superior, 32 (40%) temporal, and 23 (31%) inferior. No additional MNV1 or 2 were found elsewhere. Most lesions tended to distribute along straight bands radiating from the perifoveal area, mainly in the temporal half (72%). None of the cases had MNV3 at the boundary of the foveal avascular zone. Only five cases had foveal avascular zone diameter of less than 325 µm, the closest lesion was 425 µm away from the center. CONCLUSION MNV3 lesions are most likely neither symmetrical nor uniformly distributed. They have a higher affinity to distribute radially in the temporal perifoveal area.
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Goker YS, Demir G. Comparison of optical coherence tomography angiography features in type 1 versus type 2 choroidal neovascular membranes secondary to age-related macular degeneration. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2021; 10:67-73. [PMID: 37641611 PMCID: PMC10460227 DOI: 10.51329/mehdiophthal1423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background Optical coherence tomography angiography (OCTA) is an advanced imaging modality that provides high resolution images at the level of different retinal layers. This study aime to evaluate choroidal neovascular membranes (CNVMs) secondary to age-related macular degeneration (AMD) quantitatively and qualitatively, according to their classification, morphological features, and flow areas, using OCTA. Methods In this descriptive, comparative, cross-sectional study, CNVMs were divided into 2 groups according to their classification as type 1 or type 2 neovascularization. Mied CNVMs were excluded from the study. The size (mm2) and the flow area (mm2) of the CNVMs were calculated via OCTA and the presence of the perivascular halo and loop anastomoses were analyzed. The morphological appearance of the CNVMs were classified as: medusa, sea-fan, lacy-wheel, glomerular, dead tree, and mature vascular networks. Results Of the 85 eyes assessed for eligibility, 45 eyes of 34 individuals with CNVM were enrolled in this retrospective study. Twenty-eight eyes had type 1 and 17 eyes had type 2 CNVMs. The mean size and flow area were greater in type 1 than in type 2 CNVMs (mean [standard deviation], 6.69 [4.54] and 3.61 [3.56] mm2 versus 3.04 [1.98] and 1.77 [1.62] mm2; P = 0.044 and 0.046, respectively). Among the 22 eyes with type 1 CNVMs and the 9 eyes with type 2 CNVMs, 31 eyes had exudative membranes. Among the eyes with exudative CNVMs, 22 eyes had a perivascular halo and 22 eyes had loop anastomoses; this was significantly more than in the non-exudative eyes (P = 0.042 and 0.041, respectively). The lacy-wheel (38.7%) and dead tree (71.4%) patterns were the most frequent morphological appearance of the CNVMs in the exudative and non-exudative membranes, respectively. Conclusions OCTA provides objective documantation about CNVMs. A perivascular dark halo around CNVMs could be a criterion to define exudative membranes activity.
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Affiliation(s)
- Yasin Sakir Goker
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Gokhan Demir
- Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
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Retinal Pigment Epithelium Expressed Toll-like Receptors and Their Potential Role in Age-Related Macular Degeneration. Int J Mol Sci 2021; 22:ijms22168387. [PMID: 34445096 PMCID: PMC8395065 DOI: 10.3390/ijms22168387] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 01/17/2023] Open
Abstract
(1) Background: Inflammation is a major pathomechanism in the development and progression of age-related macular degeneration (AMD). The retinal pigment epithelium (RPE) may contribute to retinal inflammation via activation of its Toll-like receptors (TLR). TLR are pattern recognition receptors that detect the pathogen- or danger-associated molecular pattern. The involvement of TLR activation in AMD is so far not understood. (2) Methods: We performed a systematic literature research, consulting the National Library of Medicine (PubMed). (3) Results: We identified 106 studies, of which 54 were included in this review. Based on these studies, the current status of TLR in AMD, the effects of TLR in RPE activation and of the interaction of TLR activated RPE with monocytic cells are given, and the potential of TLR activation in RPE as part of the AMD development is discussed. (4) Conclusion: The activation of TLR2, -3, and -4 induces a profound pro-inflammatory response in the RPE that may contribute to (long-term) inflammation by induction of pro-inflammatory cytokines, reducing RPE function and causing RPE cell degeneration, thereby potentially constantly providing new TLR ligands, which could perpetuate and, in the long run, exacerbate the inflammatory response, which may contribute to AMD development. Furthermore, the combined activation of RPE and microglia may exacerbate neurotoxic effects.
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Kwak JH, Park WK, Kim RY, Kim M, Park YG, Park YH. Unaffected fellow eye neovascularization in patients with type 3 neovascularization: Incidence and risk factors. PLoS One 2021; 16:e0254186. [PMID: 34280215 PMCID: PMC8289018 DOI: 10.1371/journal.pone.0254186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/21/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To evaluate the incidence and risk factors of neovascularization in unaffected fellow eyes of patients diagnosed with type 3 neovascularization in Korea. Methods This retrospective study included 93 unaffected fellow eyes of 93 patients diagnosed with type 3 neovascularization. For initial type 3 neovascularization diagnosis, optical coherence tomography and angiography were conducted. These baseline data were compared between patients with and without neovascularization in their fellow eyes during the follow-up period. Results The mean follow-up period was 66.1±31.1 months. Neovascularization developed in 49 (52.8%) fellow eyes after a mean period of 29.5±19.6 months. In the fellow eye neovascularization group, the incidence of soft drusen and reticular pseudodrusen was significantly higher than that in the non-neovascularization group (83.7% vs. 36.5%, p<0.001; 67.3% vs. 40.9%, p = 0.017, respectively), but the choroidal vascularity index (CVI) showed a significantly lower value (60.7±2.0% vs. 61.7±2.5%; p = 0.047). The presence of reticular pseudodrusen was related with the duration from baseline to development of fellow eye neovascularization (p = 0.038). Conclusion Neovascularization developed in 52.8% of unaffected fellow eyes. The presence of soft drusen, reticular pseudodrusen, and lower CVI values can be considered risk factors of neovascularization in unaffected fellow eyes of patients with type 3 neovascularization. The lower CVI values suggest that choroidal ischemic change may affect the development of choroidal neovascularization in these patients.
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Affiliation(s)
- Jae Hyuck Kwak
- Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woo Kyung Park
- Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Rae Young Kim
- Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mirinae Kim
- Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young-Gun Park
- Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young-Hoon Park
- Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
- * E-mail:
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Costanzo E, Parravano M, Giannini D, Borrelli E, Sacconi R, Querques G. Imaging Biomarkers of 1-Year Activity in Type 1 Macular Neovascularization. Transl Vis Sci Technol 2021; 10:18. [PMID: 34111264 PMCID: PMC8131998 DOI: 10.1167/tvst.10.6.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the predictive value of optical coherence tomography (OCT) and OCT angiography (OCTA) parameters at baseline on lesion's activity at the 1-year follow-up in type 1 macular neovascularizations (MNVs) treated with 1-year fixed regimen of intravitreal aflibercept injections (q8 IAIs). Methods All patients were imaged by structural OCT to evaluate central macular thickness (CMT), subretinal fluid (SRF), subretinal hyper-reflective material (SHRM), intraretinal fluid (IRF) and intraretinal hyper-reflective dots (HRDs), and by Swept-Source OCTA to measure baseline MNV area, perfusion density (PD), vessel length density (VLD), and vessel diameter index. At the end of q8 IAI, patients were classified in two groups: active-MNV (A-MNV) and inactive-MNV (I-MNV), considering the OCT signs of activity. Three binary logistic regression models were developed: (1) OCT-based, (2) OCTA-based, and (3) OCT/OCTA-based model. Results Thirty-one treatment-naïve type 1 MNVs were enrolled (13 A-MNV and 18 I-MNV). No differences were observed in baseline OCT and OCTA characteristics between A-MNV and I-MNV. Among the models developed, model 3 that combined OCT/OCTA parameters showed a performance of 87.5% and excellent sensitivity for A-MNV lesions (100%). By analyzing the model, the A-MNV group appears more likely to show at baseline SRF, greater CMT, wider MNV area, and lower PD and VLD compared to I-MNV. Conclusions Our study demonstrated that the combination of baseline OCT and OCTA parameters allowed to achieve a good models’ performance in the prediction of MNV activity permitting to correctly classifying the active lesions at the end of follow-up period, with excellent sensitivity. Translational Relevance OCT/OCTA could integrate statistical models potentially useful for artificial intelligence.
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Affiliation(s)
| | | | | | - Enrico Borrelli
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Riccardo Sacconi
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
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Schnabolk G, Obert E, Banda NK, Rohrer B. Systemic Inflammation by Collagen-Induced Arthritis Affects the Progression of Age-Related Macular Degeneration Differently in Two Mouse Models of the Disease. Invest Ophthalmol Vis Sci 2021; 61:11. [PMID: 33289791 PMCID: PMC7726584 DOI: 10.1167/iovs.61.14.11] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose Age-related macular degeneration (AMD) shares similar risk factors and inflammatory responses with rheumatoid arthritis (RA). Previously, we identified increased risk for dry AMD among patients with RA compared to control subjects, using retrospective data analysis. In this current study, we investigate the role of systemic inflammation triggered in a murine model of arthritis on choroidal neovascularization and retinal pigment epithelium (RPE) degeneration mouse models. Methods Collagen-induced arthritis (CIA) was induced in C57BL/6J mice prior to laser-induced choroidal neovascularization (CNV; wet AMD model) or sodium iodate-induced retinal degeneration (NaIO3; dry AMD model). CNV lesion size and retinal thickness were quantified by optical coherence photography (OCT), visual function was analyzed using optokinetic response and electroretinography, RPE morphology was examined by immunohistochemistry, and inflammatory gene expression was analyzed by quantitative PCR. Results CIA mice demonstrated decreased spatial acuity and contrast sensitivity, whereas no difference was observed in the RPE-generated c-wave. CNV lesion size was decreased in CIA mice. NaIO3 decreased c-wave amplitude, as well as retinal thickness, which was augmented by CIA. NaIO3 treatment resulted in loss of normal RPE hexagonal shape, which was further aggravated by CIA. Increased Cxcl9 expression was observed in the presence of CIA and CIA combined with AMD. Disease severity differences were observed between sexes. Conclusions Our data suggest systemic inflammation by CIA results in increased pathology in a dry AMD model, whereas it reduces lesions in a wet AMD model. These findings highlight the need for additional investigation into the role of secondary inflammation and sex-based differences on AMD.
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Affiliation(s)
- Gloriane Schnabolk
- Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Elisabeth Obert
- Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Nirmal K Banda
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Bärbel Rohrer
- Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina, United States.,Ralph H. Johnson VA Medical Center, Division of Research, Charleston, South Carolina, United States
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Merkle CW, Augustin M, Harper DJ, Gesperger J, Lichtenegger A, Eugui P, Garhöfer G, Glösmann M, Baumann B. High-resolution, depth-resolved vascular leakage measurements using contrast-enhanced, correlation-gated optical coherence tomography in mice. BIOMEDICAL OPTICS EXPRESS 2021; 12:1774-1791. [PMID: 33996197 PMCID: PMC8086440 DOI: 10.1364/boe.415227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/22/2021] [Accepted: 01/24/2021] [Indexed: 06/09/2023]
Abstract
Vascular leakage plays a key role in vision-threatening retinal diseases such as diabetic retinopathy and age-related macular degeneration. Fluorescence angiography is the current gold standard for identification of leaky vasculature in vivo, however it lacks depth resolution, providing only 2D images that complicate precise identification and localization of pathological vessels. Optical coherence tomography (OCT) has been widely adopted for clinical ophthalmology due to its high, micron-scale resolution and rapid volumetric scanning capabilities. Nevertheless, OCT cannot currently identify leaky blood vessels. To address this need, we have developed a new method called exogenous contrast-enhanced leakage OCT (ExCEL-OCT) which identifies the diffusion of tracer particles around leaky vasculature following injection of a contrast agent. We apply this method to a mouse model of retinal neovascularization and demonstrate high-resolution 3D vascular leakage measurements in vivo for the first time.
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Affiliation(s)
- Conrad W. Merkle
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Marco Augustin
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Danielle J. Harper
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Johanna Gesperger
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Antonia Lichtenegger
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Pablo Eugui
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Martin Glösmann
- Core Facility for Research and Technology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Bernhard Baumann
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
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Progression from Type 2 Macular Neovascularization to Fibrovascular Pigment Epithelial Detachment. Vision (Basel) 2021; 5:vision5020016. [PMID: 33805868 PMCID: PMC8103250 DOI: 10.3390/vision5020016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 01/18/2023] Open
Abstract
The aim of this study was to report unusual progression of type 2 macular neovascularization (MNV) associated with age-related macular degeneration (AMD), high myopia or angioid streaks. Retrospective multicentric observational case series data were used. Eyes that progressed from type 2 MNV secondary to AMD, high myopia or angioid streaks to fibrovascular pigment epithelial detachment (PED) were included. A total of 29 treatment-naive eyes from 29 patients with type 2 MNV secondary to AMD (n = 14), high myopia (n = 10) or angioid streaks (n = 5) that progressed to a fibrovascular PED on Spectral Domain-Optical Coherence Tomography were used. This progression occurred within 3 months after anti-VEGF therapy initiation. Logarithm of minimum angle of resolution (LogMAR) visual acuity improved significantly after anti-VEGF therapy, from 0.55 (SD ± 0.30) (20/63–20/80) at baseline to 0.30 (20/40) at 3 months, and 0.33 (20/40) at the final follow-up (mean follow up: 3.68 years). Mean number of intravitreal injections per year for patients with a total follow-up ≥ 12 months (n = 24) was 4.3 ± 2.1 per year. Progression from type 2 MNV to a fibrovascular PED may occur in patients suffering from AMD, high myopia or angioid streaks. This progression appears early after initiation of anti-VEGF therapy and is associated with a favorable visual and anatomical outcome, at least on a short follow up basis.
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Lee JH, Kim JH, Kim JW, Kim CG, Lee DW. Difference in treatment burden of neovascular age-related macular degeneration among different types of neovascularization. Graefes Arch Clin Exp Ophthalmol 2021; 259:1821-1830. [PMID: 33404679 DOI: 10.1007/s00417-020-05028-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/14/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To evaluate the difference in the treatment burden among different types of neovascular age-related macular degeneration (AMD). METHODS This retrospective, observational study included 431 patients who were diagnosed with neovascular AMD. Patients were divided into three groups: type 1 or 2 neovascularization group (n = 167), type 3 neovascularization group (n = 50), and polypoidal choroidal vasculopathy (PCV) group (n = 214). The number of hospital visits per year and the number of anti-vascular endothelial growth factor (VEGF) injections per year were compared among these groups. Furthermore, the incidence of bilateral involvement during the follow-up period was compared among the groups. RESULTS The mean follow-up period was 50.6 ± 11.3 months. The number of hospital visits per year was significantly higher in the type 1 or 2 neovascularization group (mean: 6.1 ± 1.5) and type 3 neovascularization (6.6 ± 1.6) than in the PCV group (6.0 ± 1.5) (P < 0.001). The number of anti-VEGF injections per year was significantly higher in type 3 neovascularization group (3.1 ± 1.7) than in the type 1 or 2 neovascularization group (2.3 ± 1.5) or the PCV group (2.3 ± 1.2) (P = 0.042). There was a significant difference in the incidence of bilateral involvement among patients in type 1 or 2 neovascularization group (20.4%), type 3 neovascularization group (46.0%), and the PCV group (15.4%) (P < 0.001). CONCLUSIONS The high frequency of hospital visits and that of anti-VEGF injections in patients with type 3 neovascularization suggests high treatment burden in these patients. The high incidence of bilateral involvement could be one of the primary reasons for high treatment burden in patients with type 3 neovascularization.
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Affiliation(s)
- Ji Hyun Lee
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea.
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
| | - Dong Won Lee
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
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Chen L, Messinger JD, Kar D, Duncan JL, Curcio CA. Biometrics, Impact, and Significance of Basal Linear Deposit and Subretinal Drusenoid Deposit in Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2021; 62:33. [PMID: 33512402 PMCID: PMC7846955 DOI: 10.1167/iovs.62.1.33] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/04/2021] [Indexed: 02/07/2023] Open
Abstract
Purpose Basal linear deposit (BLinD) is a thin layer of soft drusen material. To elucidate the biology of extracellular deposits conferring age-related macular degeneration (AMD) progression risk and inform multimodal clinical imaging based on optical coherence tomography (OCT), we examined lipid content and regional prevalence of BLinD, soft drusen, pre-BLinD, and subretinal drusenoid deposit (SDD) in AMD and non-AMD aged eyes. We estimated BLinD volume and illustrated its relation to type 1 macular neovascularization (MNV). Methods Donor eyes were classified as early to intermediate AMD (n = 25) and age-matched controls (n = 54). In high-resolution histology, we assessed BLinD/soft drusen thickness at 836 and 1716 locations in AMD and control eyes, respectively. BLinD volume was estimated using solid geometry in donor eyes, one clinically characterized. Results BLinD, drusen, type 1 MNV, and fluid occupy the sub-RPE-basal laminar space. BLinD volume in a 3-mm diameter circle may be as much as 0.0315 mm3. Osmophilic lipid was more concentrated in BLinD/drusen than SDD. In the fovea, BLinD/drusen was prevalent in AMD eyes; pre-BLinD was prevalent in control eyes. SDD was low in the fovea and high in perifovea, especially in AMD eyes. Conclusions Although invisible, BLinD may presage type 1 MNV. BLinD volume approaches the criterion OCT drusen volume of 0.03 mm3 for AMD progression risk. BLinD culminates years of subfoveal lipid accumulation. SDD is detected relatively late in life, with currently unknown precursors. Deposit topography suggests one outer retinal lipid recycling system serving specialized cone and rod physiology, and its dysregulation in AMD is due to impaired transfer to the circulation.
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Affiliation(s)
- Ling Chen
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute, Chongqing, China
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Jeffrey D. Messinger
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Deepayan Kar
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Jacque L. Duncan
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, United States
| | - Christine A. Curcio
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
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Dörschmann P, Klettner A. Fucoidans as Potential Therapeutics for Age-Related Macular Degeneration-Current Evidence from In Vitro Research. Int J Mol Sci 2020; 21:E9272. [PMID: 33291752 PMCID: PMC7729934 DOI: 10.3390/ijms21239272] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023] Open
Abstract
Age-related macular degeneration (AMD) is the major reason for blindness in the industrialized world with limited treatment options. Important pathogenic pathways in AMD include oxidative stress and vascular endothelial growth factor (VEGF) secretion. Due to their bioactivities, fucoidans have recently been suggested as potential therapeutics. This review gives an overview of the recent developments in this field. Recent studies have characterized several fucoidans from different species, with different molecular characteristics and different extraction methods, in regard to their ability to reduce oxidative stress and inhibit VEGF in AMD-relevant in vitro systems. As shown in these studies, fucoidans exhibit a species dependency in their bioactivity. Additionally, molecular properties such as molecular weight and fucose content are important issues. Fucoidans from Saccharina latissima and Laminaria hyperborea were identified as the most promising candidates for further development. Further research is warranted to establish fucoidans as potential therapeutics for AMD.
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Affiliation(s)
| | - Alexa Klettner
- Department of Ophthalmology, Campus Kiel, University Medical Center Schleswig-Holstein UKSH, 24105 Kiel, Germany;
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Clinical characteristics and visual outcomes of non-resolving subretinal fluid in neovascular AMD despite continuous monthly anti-VEGF injections: a long-term follow-up. Graefes Arch Clin Exp Ophthalmol 2020; 259:1153-1160. [PMID: 33245430 DOI: 10.1007/s00417-020-05024-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/01/2020] [Accepted: 11/20/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To describe the clinical characteristics and visual outcomes of neovascular age-related macular degeneration (NV-AMD) patients with irregular pigment epithelium detachment (PED) and non-resolving subretinal fluid (SRF) despite continuous monthly injections of anti-vascular endothelial growth factor (VEGF). METHODS This is a retrospective case series, including NV-AMD patients treated in a tertiary academic practice. Inclusion criteria were NV-AMD diagnosis, with irregular PED, and non-resolving SRF treated with continuous monthly anti-VEGF intravitreal injections. Data collection included best corrected visual acuity (BCVA), central macular thickness (CMT), sub-foveal choroidal thickness (SFCT), and type and location of PED as seen on optical coherence tomography (OCT). RESULTS A total of 738 patients with NV-AMD underwent anti-VEGF injections during the follow-up period and 20 eyes of 19 patients (14 females and 5 males) met the inclusion criteria. Average age was 81.7 ± 6.6 years, mean follow-up time was 32.1 ± 23.5 months, and mean number of injections was 31.3 ± 24.2. Mean VA was 0.26 ± 0.21 logMAR (Snellen 20/36) at baseline versus 0.20 ± 0.23 logMAR (Snellen 20/32) at the end of the follow-up (P = 0.28). All eyes presented with sub-foveal, type 1 macular neovascularization (MNV). Average sub-foveal choroidal thickness changed from 189.70 ± 68.46 μm at baseline to 169.00 ± 63.06 μm (P < 0.001) at last follow-up. CONCLUSION Patients with type 1 NV-AMD, irregular PED, and non-resolving SRF and under continuous treatment of monthly anti-VEGF injections may maintain good visual acuity after long period of time.
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Stepanov A, Nemcansky J, Veith M, Manethova K, Stredova M, Pencak M, Tarkova A, Studnicka J. Two-year results of a combined regimen of aflibercept treatment in three types of choroidal neovascular membrane in the wet form of age-related macular degeneration: Real-life evidence in the Czech Republic. Eur J Ophthalmol 2020; 31:2488-2495. [PMID: 33198503 DOI: 10.1177/1120672120971190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
AIM To present the results of a 2-year therapy with aflibercept in real-life practice in a mixed regimen in patients with a neovascular form of age-related macular degeneration (nAMD) and to evaluate the treatment response of various types of choroidal neovascular membranes (CNV) - occult (Type 1), classic (Type 2) and minimally classic (Type 4). METHODS This was a multicentric, prospective, observational study of a series of cases. Patients diagnosed with the wet form of AMD were treated in a fixed regimen (3 injections at intervals of 1 month and then injections at 8-week intervals) in the first year, and in a pro re nata regimen (PRN) in the second year. The period of investigation was 24 months. The development of the best corrected visual acuity (BCVA) was evaluated by means of ETDRS optotypes (Early Treatment Diabetic Retinopathy Study) and the central retinal thickness (CRT). Measurements were performed prior to the commencement of therapy and then after 4, 8, 12, 16, 20 and 24 months. RESULTS The therapeutically naïve group consisted of 135 eyes of 135 patients. Sixty-one eyes suffered from CNV of the 1st type, 50 eyes from CNV of the 2nd type and 24 eyes from CNV of the 4th type. The average baseline of BCVA ± SD in Type 1 CNV was 56.1 ± 10.8 letters of ETDRS, and then, respectively, 62.2 ± 12.9 letters, 62.8 ± 15.1 letters and 59.4 ± 13.2 letters after 4, 12 and 24 months. The average baseline value of CRT ± SD for Type 1 CNV was 442.4 ± 194.9 µm, and then 302.5 ± 144.4 µm, 277.7 ± 106.5 µm and 327.6 ± 138.6 µm at months 4, 12 and 24. The average baseline value of BCVA ± SD in Type 2 CNV was 55.6 ± 9.9 letters of ETDRS, and then 62.5 ± 11.1 letters, 62.5 ± 14.2 letters and 60.6 ± 15.1 letters after 4, 12 and 24 months. The average baseline value of CRT ± SD in Type 2 CNV was 446.8 ± 159.1 µm, and then 327.4 ± 127.0 µm, 316.7 ± 139.1 µm and 352.5 ± 132.4 µm at 4, 12 and 24 months. In Type 4 CNV, the average baseline value of BCVA ± SD was 56.7 ± 9.0 letters of ETDRS, and then 59.1 ± 10.6 letters, 59.2 ± 12.6 letters and 58 ± 8.8 letters after 4, 12 and 24 months. The average baseline value of CRT ± SD in Type 4 CNV was 492.1 ± 187.0 µm, and then 333.3 ± 137.5 µm, 326.7 ± 122.4 µm and 328.4 ± 132 µm at months 4, 12 and 24. All these changes were statistically significant (p < 0.05). CONCLUSION Therapy with aflibercept in a mixed regimen in patients with the wet form of AMD during the investigation resulted in a statistically significant improvement in BCVA and decrease in CRT in both the occult and classic type of CNV. Both the functional and anatomical response to therapy was worse in the minimally classic type (Type 4) of CNV. SUMMARY DECLARATION Patients suffering from the neovascular form of age-related macular degeneration were treated with aflibercept in a mixed regimen (fixed in the first year and PRN in the second year). After 24 months of examination, a significant improvement of both morphological and functional results was observed in three types of choroidal neovascular membrane.
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Affiliation(s)
- Alexandr Stepanov
- Department of Ophthalmology, Faculty Hospital in Hradec Kralove and Charles University Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jan Nemcansky
- Department of Ophthalmology, Faculty Hospital in Ostrava and Ostrava University Faculty of Medicine, Ostrava, Czech Republic
| | - Miroslav Veith
- Department of Ophthalmology, Faculty Hospital Kralovske Vinohrady and Charles University Third Faculty of Medicine, Prague, Czech Republic
| | | | - Marketa Stredova
- Department of Ophthalmology, Faculty Hospital in Hradec Kralove and Charles University Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Martin Pencak
- Department of Ophthalmology, Faculty Hospital Kralovske Vinohrady and Charles University Third Faculty of Medicine, Prague, Czech Republic
| | - Anna Tarkova
- Department of Ophthalmology, Faculty Hospital in Hradec Kralove and Charles University Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jan Studnicka
- Department of Ophthalmology, Faculty Hospital in Hradec Kralove and Charles University Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
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Deep phenotype unsupervised machine learning revealed the significance of pachychoroid features in etiology and visual prognosis of age-related macular degeneration. Sci Rep 2020; 10:18423. [PMID: 33116208 PMCID: PMC7595218 DOI: 10.1038/s41598-020-75451-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022] Open
Abstract
Unsupervised machine learning has received increased attention in clinical research because it allows researchers to identify novel and objective viewpoints for diseases with complex clinical characteristics. In this study, we applied a deep phenotyping method to classify Japanese patients with age-related macular degeneration (AMD), the leading cause of blindness in developed countries, showing high phenotypic heterogeneity. By applying unsupervised deep phenotype clustering, patients with AMD were classified into two groups. One of the groups had typical AMD features, whereas the other one showed the pachychoroid-related features that were recently identified as a potentially important factor in AMD pathogenesis. Based on these results, a scoring system for classification was established; a higher score was significantly associated with a rapid improvement in visual acuity after specific treatment. This needs to be validated in other datasets in the future. In conclusion, the current study demonstrates the usefulness of unsupervised classification and provides important knowledge for future AMD studies.
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Michl M, Fabianska M, Seeböck P, Sadeghipour A, Haj Najeeb B, Bogunovic H, Schmidt-Erfurth UM, Gerendas BS. Automated quantification of macular fluid in retinal diseases and their response to anti-VEGF therapy. Br J Ophthalmol 2020; 106:113-120. [PMID: 33087314 DOI: 10.1136/bjophthalmol-2020-317416] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/15/2020] [Accepted: 09/27/2020] [Indexed: 12/15/2022]
Abstract
AIM To objectively assess disease activity and treatment response in patients with retinal vein occlusion (RVO), neovascular age-related macular degeneration (nAMD) and centre-involved diabetic macular oedema (DME), using artificial intelligence-based fluid quantification. METHODS Posthoc analysis of 2311 patients (11 151 spectral-domain optical coherence tomography volumes) from five clinical, multicentre trials, who received a flexible antivascular endothelial growth factor (anti-VEGF) therapy over a 12-month period. Fluid volumes were measured with a deep learning algorithm at baseline/months 1, 2, 3 and 12, for three concentric circles with diameters of 1, 3 and 6 mm (fovea, paracentral ring and pericentral ring), as well as four sectors surrounding the fovea (superior, nasal, inferior and temporal). RESULTS In each disease, at every timepoint, most intraretinal fluid (IRF) per square millimetre was present at the fovea, followed by the paracentral ring and pericentral ring (p<0.0001). While this was also the case for subretinal fluid (SRF) in RVO/DME (p<0.0001), patients with nAMD showed more SRF in the paracentral ring than at the fovea up to month 3 (p<0.0001). Between sectors, patients with RVO/DME showed the highest IRF volumes temporally (p<0.001/p<0.0001). In each disease, more SRF was consistently found inferiorly than superiorly (p<0.02). At month 1/12, we measured the following median reductions of initial fluid volumes. For IRF: RVO, 95.9%/97.7%; nAMD, 91.3%/92.8%; DME, 37.3%/69.9%. For SRF: RVO, 94.7%/97.5%; nAMD, 98.4%/99.8%; DME, 86.3%/97.5%. CONCLUSION Fully automated localisation and quantification of IRF/SRF over time shed light on the fluid dynamics in each disease. There is a specific anatomical response of IRF/SRF to anti-VEGF therapy in all diseases studied.
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Affiliation(s)
- Martin Michl
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Maria Fabianska
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Philipp Seeböck
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Amir Sadeghipour
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Bilal Haj Najeeb
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Hrvoje Bogunovic
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | | | - Bianca S Gerendas
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
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Borchers L, Roider J, Klettner A. Differences in Uptake and Intracellular Fate between Bevacizumab and Aflibercept after Repetitive Long-Term Treatment in the Retinal Pigment Epithelium. Ophthalmic Res 2020; 64:369-388. [PMID: 33011724 DOI: 10.1159/000511960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/22/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Anti-VEGF therapy is repeatedly given for an extended period of time to patients when treated for age-related macular degeneration. While short-term effects of anti-VEGF agents on retinal pigment epithelial cells have been investigated, the effects of long-term and repeated treatment on these cells are scarce. In this study, we have investigated the effects of anti-VEGF treatment (bevacizumab and aflibercept) after long-term, repeated treatment on uptake, storage, and subcellular localization. METHODS Experiments were conducted in primary porcine retinal pigment epithelium (RPE) cells in first passage and in ARPE-19 cell line. Cells were treated with 250 µg/mL bevacizumab, aflibercept, or, as a non-VEGF inhibiting antibody, rituximab once a week for 1 day, 7 days, 4, and 12 weeks. Cell survival was evaluated with methyl thiazolyl tetrazolium assay. Uptake and localization of compounds were investigated with immunofluorescence microscopy. Selective intracellular proteins were stained with specific respective primary antibodies; actin cytoskeleton was stained with phalloidin. For quantitative analysis, intracellular signals were normalized to light intensity and exposure time. Intracellular association with lysosomes (Lamp2) and exosomes (CD63) was also quantified. In addition, subcellular fractions (nucleus, plasma, membrane, and cytoskeleton) were generated and analyzed in Western blot. RESULTS Weekly treatment up to 12 weeks displayed no toxic effects on RPE cells in any substance tested. Intracellular signal of bevacizumab and aflibercept was strongest after 1 day, decreased after 1 and 4 weeks but increased again after 12 weeks. The signal of intracellular bevacizumab was significantly stronger than of aflibercept. In addition, in primary RPE, aflibercept was significantly more associated with Lamp2, indicating degradation of aflibercept. At all time points, the respective therapeutics could be detected at the cytoskeleton. In primary RPE cells, co-localization with exosome marker CD63 showed a maximum after 1 day for bevacizumab and after 12 weeks for aflibercept. Actin-encapsulated therapeutics can be found at any time point tested. CONCLUSION Both bevacizumab and aflibercept display a distinctive time-dependent uptake in the RPE cells and are stored in actin-covered accumulations for extended periods of time. When normalized and quantified, less aflibercept can be found in RPE cells, while more aflibercept is co-localized with Lamp2. Our data suggest that bevacizumab is differently processed by RPE cells than aflibercept.
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Affiliation(s)
- Laura Borchers
- Department of Ophthalmology, University of Kiel, University Medical Center, Kiel, Germany
| | - Johann Roider
- Department of Ophthalmology, University of Kiel, University Medical Center, Kiel, Germany
| | - Alexa Klettner
- Department of Ophthalmology, University of Kiel, University Medical Center, Kiel, Germany,
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Ahmed D, Stattin M, Haas AM, Graf A, Krepler K, Ansari-Shahrezaei S. Drusen characteristics of type 2 macular neovascularization in age-related macular degeneration. BMC Ophthalmol 2020; 20:381. [PMID: 32977799 PMCID: PMC7519492 DOI: 10.1186/s12886-020-01651-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background Type 2 macular neovascularization (MNV) is supposed to be a rare condition in age-related macular degeneration (AMD). The main purpose of this study was to assess accompanying factors of type 2 MNV in AMD. Methods Retrospective data analysis of eyes previously diagnosed with neovascular AMD in a tertiary eye care center (Medical Retina Unit, Rudolf Foundation Hospital, Vienna, Austria) between June 2008 and December 2017. Drusen subtypes, fibrosis, atrophy and subfoveal choroidal thickness (SFCT) of both eyes in patients with type 2 MNV lesions were categorized based on multimodal imaging. Results Type 2 MNV was diagnosed in 27 (3.2%) of 835 eyes (749 patients). Drusen characteristics in type 2 MNV were observed as followed: drusen < 63 μm in 2 eyes (7.4%), drusen ≥63 μm in 10 eyes (37%), subretinal drusenoid deposits (SDD) in 8 eyes (29.6%), cuticular drusen in 2 eye (7.4%) and no drusen were evident in 10 eyes (37%). Drusen distribution in 23 fellow eyes was detected as followed: drusen < 63 μm in 2 eyes (8.7%), drusen ≥63 μm in 9 eyes (39.1%), SDD in 5 eyes (21.7%), cuticular drusen in 1 eye (4.3%) and no drusen were evident in 9 eyes (39.1%). Mean SFCT was 140 ± 49 μm in affected eyes and 152 ± 41 μm in the fellow eyes. Patients with drusen or SDD were significantly younger (mean 70.88 ± 6.85, p = 0.04) than patients without deposits (mean 77.40 ± 5.74). Conclusions Type 2 MNV remains a rare entity in AMD. It was frequently seen in the absence of drusen, a hallmark of AMD. These findings contribute to the heterogeneity of phenotypes related to pure type 2 lesions.
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Affiliation(s)
- Daniel Ahmed
- Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria.,Department of Ophthalmology, Rudolf Foundation Hospital, Juchgasse 25, 1030, Vienna, Austria
| | - Martin Stattin
- Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria.,Department of Ophthalmology, Rudolf Foundation Hospital, Juchgasse 25, 1030, Vienna, Austria
| | - Anna-Maria Haas
- Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria.,Department of Ophthalmology, Rudolf Foundation Hospital, Juchgasse 25, 1030, Vienna, Austria
| | - Alexandra Graf
- Center for Medical Statistic, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Katharina Krepler
- Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria.,Department of Ophthalmology, Rudolf Foundation Hospital, Juchgasse 25, 1030, Vienna, Austria
| | - Siamak Ansari-Shahrezaei
- Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria. .,Department of Ophthalmology, Rudolf Foundation Hospital, Juchgasse 25, 1030, Vienna, Austria. .,Department of Ophthalmology, Medical University of Graz, Auenbruggerplatz 1, 8036, Graz, Austria.
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Kim JH, Kim JW, Kim CG, Lee DW. Long-Term Treatment Outcomes in Type 3 Neovascularization: Focus on the Difference in Outcomes between Geographic Atrophy and Fibrotic Scarring. J Clin Med 2020; 9:jcm9041145. [PMID: 32316276 PMCID: PMC7230588 DOI: 10.3390/jcm9041145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/03/2020] [Accepted: 04/14/2020] [Indexed: 11/29/2022] Open
Abstract
Background: To evaluate the difference in the long-term treatment outcomes of type 3 neovascularization between eyes with geographic atrophy and those with fibrotic scars. Methods: This retrospective study included 195 eyes diagnosed with type 3 neovascularization and treated with anti-vascular endothelial growth factor (VEGF) agents. The included eyes were divided into three groups according to the fundus findings at the final visit: patients with fovea-involving geographic atrophy (GA group), patients with fovea-involving fibrotic scars (scar group), and patients with no fovea-involving geographic atrophy or fibrotic scars (non-GA/scar group). The best-corrected visual acuities (BCVA) of the three groups at the final visits were compared. Results: The mean follow-up period was 47.5 ± 20.7 months. The mean logMAR BCVA at the final visit was 1.18 ± 0.58 in the GA group (n = 58), 1.67 ± 0.58 in the scar group (n = 62), and 0.69 ± 0.64 in the non-GA/scar group (n = 75). The BCVA was significantly worse in the scar group than in the GA (p < 0.001) and the non-GA/scar groups (p < 0.001). Conclusion: Eyes with fibrotic scars showed the poorest visual outcomes in type 3 neovascularization among the studied groups. Preventing the development of fibrotic scars should be considered an important treatment goal.
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Affiliation(s)
- Jae Hui Kim
- Correspondence: ; Tel.: +82-2-2639-7664; Fax: +82-2-2639-7824
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Singh SR, Parameswarappa DC, Govindahari V, Lupidi M, Chhablani J. Clinical and angiographic characterization of choroidal neovascularization in diabetic retinopathy. Eur J Ophthalmol 2020; 31:584-591. [PMID: 31984769 DOI: 10.1177/1120672120902027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND To report the clinical and angiographic characteristics of choroidal neovascularization in patients with diabetic retinopathy. METHODS Patients of type 2 diabetes mellitus with presence of choroidal neovascularization in at least one eye were retrospectively analyzed. The study eyes were divided into three groups based on presence (active or scarred) or absence of choroidal neovascularization (fellow eyes). Imaging characteristics of active choroidal neovascularization were recorded using optical coherence tomography, fluorescein, and indocyanine angiography. Central macular thickness, subfoveal choroidal thickness, and large choroidal vessel layer thickness were compared at baseline and final visit. RESULTS Our study reports the prevalence rate of choroidal neovascularization in eyes with diabetic retinopathy (0.27%; 36 out of 13,382 eyes). A total of 64 eyes of 32 patients (age, mean ± standard deviation: 68.5 ± 9.3 years) with baseline visual acuity of 0.69 ± 0.69 logarithm of minimum angle of resolution (Snellen equivalent 20/100) were included. Nonproliferative diabetic retinopathy (57 eyes) comprised the majority followed by proliferative diabetic retinopathy (7 eyes). Eyes with choroidal neovascularization (36, 56.25%) included both active (25) and scarred (11) choroidal neovascularization, with bilateral choroidal neovascularization in 4 patients. Type 1 choroidal neovascularization was the most common subtype of choroidal neovascularization on optical coherence tomography. Common etiologies for active choroidal neovascularization included age-related macular degeneration (3; 12%), myopia (1; 4%), and inflammatory choroidal neovascularization secondary to chorioretinitis (1; 4%). In the remaining 20 eyes, choroidal neovascularization formation was primarily due to diabetic choroidopathy. CONCLUSION The prevalence of choroidal neovascularization in eyes with diabetic retinopathy is very low, with a lower prevalence of age-related macular degeneration. Diabetic choroidopathy plays a significant role in formation of choroidal neovascularization in eyes with diabetic retinopathy.
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Affiliation(s)
- Sumit Randhir Singh
- Smt. Kanuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India.,Retina and Uveitis Department, L V Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, India
| | - Deepika C Parameswarappa
- Smt. Kanuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India.,Academy for Eye Care Education, L V Prasad Eye Institute, Hyderabad, India
| | - Vishal Govindahari
- Smt. Kanuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India.,Retina and Uveitis Service, L V Prasad Eye Institute, MTC Campus, Bhubaneswar, India
| | - Marco Lupidi
- Department of Biochemical and Surgical Sciences, Section of Ophthalmology, University of Perugia, Perugia, Italy
| | - Jay Chhablani
- Smt. Kanuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
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A Multicenter, Retrospective Study (RE-ENACT 2) on the Use of Razumab™ (World's First Biosimilar Ranibizumab) in Wet Age-Related Macular Degeneration. Ophthalmol Ther 2019; 9:103-114. [PMID: 31883056 PMCID: PMC7054591 DOI: 10.1007/s40123-019-00228-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION The REal life assessmENt of safety And effeCTiveness of Razumab (RE-ENACT) and long-term RE-ENACT 2 retrospective studies have evaluated the use of Razumab™ (world's first biosimilar ranibizumab) in retinal disorders in Indian patients. This report presents the subgroup analysis from the RE-ENACT 2 study in patients with wet age-related macular degeneration (wet AMD). METHODS Medical charts of patients administered biosimilar ranibizumab injections as PRN treatment regimen between September 2015 and June 2018, at 17 centers across India, were reviewed. Changes from baseline in best-corrected visual acuity (BCVA, based on Snellen's or logMAR chart), central subfield thickness (CSFT), intraocular pressure (IOP), and proportions of patients having intraretinal fluid (IRF) and subretinal fluid (SRF) at weeks 4, 8, 12, 16, 20, 24, 30, 36, and 48 were evaluated. RESULTS Of 103 patients with wet AMD, 62.1% were men and the majority (74.8%) were treatment naïve. The majority (57.9%) of the patients had received 3 (range 1-5) injections. Significant improvements were observed from baseline to all timepoints for BCVA (baseline, 0.92 ± 0.6 [n = 94]; week 48, 0.51 ± 0.4 [n = 14]; P = 0.0014) and CSFT (baseline, 430.83 ± 14.4 [n = 85]; week 48, 301.26 ± 11.6 [n = 15]; P < 0.0001). Changes in IOP from baseline to 48 weeks were minimal and not significant (14.92 ± 3.2 [n = 94] vs. 14.50 ± 2.1 [n = 18]; P = 0.9068). A decrease in proportions of patients having IRF (baseline, 63.6% [n = 99] vs. week 48, 15% [n = 20]) and SRF (baseline, 82.3% [n = 96] vs. week 48, 5% [n = 20]) were also observed. Similar results were observed for occult and classic subgroups. There were no new safety concerns. CONCLUSION Razumab (biosimilar ranibizumab) demonstrated improvements in visual acuity and disease outcomes in patients with wet age-related macular degeneration without new safety issues.
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Au A, Hou K, Dávila JP, Gunnemann F, Fragiotta S, Arya M, Sacconi R, Pauleikhoff D, Querques G, Waheed N, Freund KB, Sadda S, Sarraf D. Volumetric Analysis of Vascularized Serous Pigment Epithelial Detachment Progression in Neovascular Age-Related Macular Degeneration Using Optical Coherence Tomography Angiography. ACTA ACUST UNITED AC 2019; 60:3310-3319. [DOI: 10.1167/iovs.18-26478] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Adrian Au
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
| | - Kirk Hou
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
| | - Juan Pablo Dávila
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
| | | | - Serena Fragiotta
- Vitreous Retina Macula Consultants of New York, New York, New York, United States
| | - Malvika Arya
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - Riccardo Sacconi
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | | | - Giuseppe Querques
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Nadia Waheed
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - K. Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, United States
| | - SriniVas Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, United States
| | - David Sarraf
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
- Greater Los Angeles VA Healthcare Center, Los Angeles, California, United States
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Response to Aflibercept Therapy in Three Types of Choroidal Neovascular Membrane in Neovascular Age-Related Macular Degeneration: Real-Life Evidence in the Czech Republic. J Ophthalmol 2019; 2019:2635689. [PMID: 31316822 PMCID: PMC6604339 DOI: 10.1155/2019/2635689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/20/2019] [Accepted: 05/27/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To present a cohort of treatment-naive patients with the neovascular form of age-related macular degeneration (nAMD) treated with aflibercept in a fixed regimen and evaluate the treatment response of three types of choroidal neovascular membrane (CNV)—occult (Type 1), classic (Type 2), and minimally classic (Type 4). Methods This was a multicentre, prospective, observational consecutive case series study. Patients diagnosed with three types of CNV of nAMD were treated in a fixed regimen (3 injections every 4 weeks, and then injections at 8 week intervals). The follow-up period was 48 weeks. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were measured using Early Treatment Diabetic Retinopathy Study (ETDRS) charts and spectral-domain optical coherence tomography (OCT). The measurements were taken at the baseline and then at 16, 32, and 48 weeks. Results The treatment-naive group was composed of 135 eyes of 135 patients in the study. 61 eyes had Type 1 lesions of CNV, 50 eyes had Type 2 lesions, and 24 eyes had Type 4 lesions. Mean baseline BCVA ± SD for Type 1 lesions was 56.1 ± 10.8 ETDRS letters, and then 62.2 ± 12.9 letters, 61.2 ± 13.7 letters, and 62.8 ± 15.1 letters at 16, 32, and 48 weeks, respectively. Mean baseline CRT ± SD for Type 1 lesions was 442.4 ± 194.9 μm, and then 302.5 ± 144.4 μm, 299.7 ± 128.5 μm, and 277.7 ± 106.5 μm at 16, 32, and 48 weeks, respectively. Mean baseline BCVA ± SD for Type 2 lesions was 55.6 ± 9.9 ETDRS letters, and then 62.5 ± 11.1 letters, 60.7 ± 13.0 letters, and 62.5 ± 14.2 letters at 16, 32, and 48 weeks, respectively. Mean baseline CRT ± SD. For Type 4 lesions mean baseline BCVA ± SD was 56.7 ± 9.0 ETDRS letters, and then 59.1 ± 10.6 letters, 59.5 ± 11.4 letters, and 59.2 ± 12.6 letters at 16, 32, and 48 weeks respectively. Mean baseline CRT ± SD for Type 4 lesions was 492.1 ± 187.0 μm, and then 333.3 ± 137.5 μm, 354.4 ± 175.0 μm, and 326.7 ± 122.4 μm at 16, 32, and 48 weeks respectively. All these changes were statistically significant (p < 0.005). Conclusions The primary outcome of our study is that the treatment with aflibercept in nAMD patients led to statistically significant improvement in BCVA and to a decrease in CRT throughout the follow-up period in both occult and classic types of CNV. The minimally classic type of CNV demonstrated a poorer functional and anatomical response to treatment.
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Invernizzi A, Benatti E, Cozzi M, Erba S, Vaishnavi S, Vupparaboina KK, Staurenghi G, Chhablani J, Gillies M, Viola F. Choroidal Structural Changes Correlate With Neovascular Activity in Neovascular Age Related Macular Degeneration. Invest Ophthalmol Vis Sci 2019; 59:3836-3841. [PMID: 30073357 DOI: 10.1167/iovs.18-23960] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To correlate changes in choroidal thickness and vascularity index with disease activity in patients with neovascular age-related macular degeneration (nAMD). Methods Eyes diagnosed with AMD that had two sequential visits within 12 months and that had no choroidal neovascularization (CNV) or had inactive CNV at the first visit were included. Those that had active CNV at follow-up were enrolled as cases. Eyes that did not developed a CNV or that were still inactive at the second visit were enrolled as controls. Disease activity was based on optical coherence tomography (OCT) and fluorescein angiography findings. Subfoveal choroidal thickness (SCT), mean choroidal thickness (MCT), and choroidal vascularity index (CVI) were assessed on enhanced depth imaging OCT and compared between the baseline and follow-up visit. Subgroup analysis accounting for lesion type and previous treatment, if any, were performed. Results Sixty-five eyes from 60 patients (35 females) and 50 age- and sex-matched controls were included. At the active visit, cases had an increase from 164 ± 67 μm to 175 ± 70 μm in mean ± SD SCT and from 144 ± 45 μm to 152 ± 45 μm in MCT (both P < 0.0001). The mean CVI also increased at from 54.5% ± 3.3% to 55.4% ± 3.8% (P = 0.04). Controls did not show significant changes in choroidal measurements between the two visits. Mean SCT, MCT, and CVI values were similar for previously treated and treatment-naive eyes. Conclusions Choroidal thickness and CVI significantly increased with active disease in nAMD eyes. Changes in choroidal thickness may predict CNV development or recurrence before they are otherwise evident clinically.
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Affiliation(s)
- Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy.,Save Sight Institute, Sydney Eye Hospital, University of Sydney, Sydney, Australia
| | - Eleonora Benatti
- Department of Clinical Sciences and Community Health, University of Milan, Ophthalmological Unit, IRCCS-Cà Granda Foundation - Ospedale Maggiore Policlinico, Milan, Italy
| | - Mariano Cozzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Stefano Erba
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | | | | | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | | | - Mark Gillies
- Save Sight Institute, Sydney Eye Hospital, University of Sydney, Sydney, Australia
| | - Francesco Viola
- Department of Clinical Sciences and Community Health, University of Milan, Ophthalmological Unit, IRCCS-Cà Granda Foundation - Ospedale Maggiore Policlinico, Milan, Italy
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Tan CS, Ngo WK, Lim LW, Tan NW, Lim TH. EVEREST study report 4: Fluorescein angiography features predictive of polypoidal choroidal vasculopathy. Clin Exp Ophthalmol 2019; 47:614-620. [PMID: 30652395 PMCID: PMC6767036 DOI: 10.1111/ceo.13464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/18/2018] [Accepted: 12/12/2018] [Indexed: 12/01/2022]
Abstract
Importance It is important to identify features of polypoidal choroidal vasculopathy (PCV) that differentiate it from typical neovascular age‐related macular degeneration (nAMD) on various imaging modalities, including fluorescein angiography (FA). Background PCV was thought to be indistinguishable from nAMD using FA alone. In real‐world practice, indocyanine‐green angiography may often be unavailable or contraindicated. Design Analysis of FA images from a prospective, multicentre study. Participants Study images of both PCV and nAMD patients from the EVEREST study. Methods FA features at baseline were independently graded by masked graders (fellowship‐trained ophthalmologists) using standardized diagnostic algorithms. Main Outcome Measures Predictive indicators (sensitivity, specificity, positive and negative predictive values) for PCV. Results Of the 95 patients screened, 61 had PCV. Of the 34 screening failures, 15 were diagnosed as nAMD. Hyperfluorescent nodules on FA were observed in 80% of patients with PCV vs 20% with nAMD (P < 0.001). Blocked fluorescence on FA, which corresponded to the presence of subretinal haemorrhage, occurred more frequently among patients with PCV vs nAMD (61.7% vs 13.3%, P = 0.001). Similarly, the leakage characteristic of occult choroidal neovascularization occurred more frequently among patients with PCV vs nAMD (95.0% vs 73.3%, P = 0.026). The positive predictive value for PCV was 94.1% for hyperfluorescent nodules, 94.9% for blocked fluorescence, 83.8% for occult choroidal neovascularization and 82.0% for pigment epithelial detachment. Conclusions and Relevance This study demonstrated that certain FA features can be predictive of PCV and may be considered as an indication for retina specialists to perform indocyanine green angiography as confirmatory test.
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Affiliation(s)
- Colin S Tan
- Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore, Singapore.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wei K Ngo
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Louis W Lim
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Nikolle W Tan
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Tock H Lim
- Fundus Image Reading Centre, National Healthcare Group Eye Institute, Singapore, Singapore.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
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Invernizzi A, Teo K, Nguyen V, Daniell M, Squirrell D, Barthelmes D, Gillies MC. Type 3 neovascularisation (retinal angiomatous proliferation) treated with antivascular endothelial growth factor: real-world outcomes at 24 months. Br J Ophthalmol 2018; 103:1337-1341. [DOI: 10.1136/bjophthalmol-2018-312944] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/17/2018] [Accepted: 11/05/2018] [Indexed: 12/20/2022]
Abstract
AimsTo compare 24 months outcomes of eyes with retinal angiomatous proliferations (RAPs) treated with antivascular endothelial growth factor (anti-VEGF) with a group of controls diagnosed with other neovascular age-related macular degeneration (nAMD) subtypes in a real-world setting.MethodsTreatment-naïve nAMD eyes that commenced anti-VEGF between January 2006 and November 2015 were identified from a registry of nAMD treatment outcomes. Cases were defined as eyes diagnosed with RAP. Three controls per case were selected among nAMD eyes with non-RAP lesions and matched on baseline visual acuity (VA), year of treatment initiation, anti-VEGF agent first injected and follow-up. Baseline VA was compared with 12 and 24 months VA. Change in VA, number of injections received, proportion of visits with active nAMD and time to first inactivation were compared between RAPs and controls.Results157 RAPs and 469 controls were included. Baseline VA (mean (SD)) increased at 12 months (61.4 (15.5) vs 68.7 (14.7) letters, p<0.001) and remained higher (66.6 (17.3) letters) at 24 months (p<0.001) in RAPs. The change from baseline VA (mean(95% CI)) was significantly higher in RAPs than in controls at 12 months (7.3 (5.4 to 9.1) vs 4.1 (2.8 to 5.4) letters, p=0.01) and at 24 months (5.1 (2.8 to 7.3) vs 2.5 (1 to 4) letters, p=0.056). Both groups received a median of 13 injections. RAPs inactivated earlier and were less active than controls (both p<0.001).ConclusionsRAPs responded well to anti-VEGF, with a significant improvement in VA persisting at 24 months. RAPs had better visual outcomes than controls at 12 and 24 months, tended to inactivate earlier and were less active throughout 2 years follow-up.
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ANGIOPOIETIN-LIKE 4 CORRELATES WITH RESPONSE TO INTRAVITREAL RANIBIZUMAB INJECTIONS IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION. Retina 2018; 38:523-530. [PMID: 28151839 DOI: 10.1097/iae.0000000000001554] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To investigate whether the aqueous angiopoietin-like 4 (ANGPTL4) level correlates with clinical features in neovascular age-related macular degeneration (AMD). METHODS The control and study groups consisted of all consecutive patients who received senile cataract surgery or intravitreal ranibizumab injection for treatment-naïve neovascular AMD, respectively. The AMD group received 3 monthly ranibizumab injections followed by monthly pro re nata for at least 12 months. Aqueous ANGPTL4 and vascular endothelial growth factor (VEGF) were measured at baseline and 4 weeks after the first injection. In the AMD group, best-corrected visual acuity, lesion area by fluorescein angiography, and central subfield thickness were measured at baseline and at 12 months. RESULTS The AMD group (30 eyes) had higher baseline aqueous ANGPTL4 and VEGF levels than those of the control group (32 eyes) (both P < 0.001). Four weeks after the first injection, VEGF in the patients with AMD had dropped significantly (P < 0.001). Baseline ANGPTL4 correlated with the lesion area at baseline and at 12 months (P < 0.05, respectively), and also correlated with the frequency of anti-VEGF injections during 12 months (P = 0.008). CONCLUSION Aqueous ANGPTL4 levels correlated with the lesion area and anti-VEGF treatment frequency. Angiopoietin-like 4 may be a potential diagnostic and/or therapeutic biomarker in the neovascular AMD.
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RISK FACTORS AND CLINICAL SIGNIFICANCE OF PRECHOROIDAL CLEFT IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION. Retina 2018; 37:2047-2055. [PMID: 28114175 DOI: 10.1097/iae.0000000000001435] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To investigate the risk factors associated with prechoroidal cleft occurrence after treatment for neovascular age-related macular degeneration (nAMD) and to elucidate its clinical significance. METHODS Two hundred thirty-four subjects who were treated for neovascular age-related macular degeneration were assessed to identify prechoroidal cleft on optical coherence tomography. Clinical variables were compared between patients manifesting a cleft (cleft group) and patients who did not (control group). RESULTS Prechoroidal cleft was detected in 29 of 234 patients (8.1%). Although the baseline visual acuity was not different between the 2 groups, logMAR visual acuity at final visit was 0.89 ± 0.74 (with approximate Snellen equivalent of 20/160) in the cleft group and 0.65 ± 0.69 (with approximate Snellen equivalent of 20/100) in controls (P < 0.05). Within cleft group, the early-onset (<6 months) subgroup had even worse visual outcomes than the late-onset subgroup (P < 0.05). Multiple logistic regression analyses revealed that the incidence of prechoroidal cleft was positively correlated with having received intravitreal gas injection to displace a submacular hemorrhage and a diagnosis of retinal angiomatous proliferation and typical neovascular age-related macular degeneration (P < 0.05). CONCLUSION Diagnosis of retinal angiomatous proliferation and typical neovascular age-related macular degeneration, and a submacular hemorrhage treated by pneumatic displacement were the independent risk factors for development of prechoroidal cleft. Eyes with a cleft, especially clefts that develop early, generally had worse prognoses than eyes without clefts.
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Barben M, Samardzija M, Grimm C. The Role of Hypoxia, Hypoxia-Inducible Factor (HIF), and VEGF in Retinal Angiomatous Proliferation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1074:177-183. [PMID: 29721942 DOI: 10.1007/978-3-319-75402-4_22] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In industrialized countries, age-related macular degeneration (AMD) is the leading cause of blindness in elderly people. Hallmarks of the non-neovascular (dry) form of AMD are the formation of drusen and geographic atrophy, whereas the exudative (wet) form of the disease is characterized by invading blood vessels. In retinal angiomatous proliferation (RAP), a special form of wet AMD, intraretinal vessels grow from the deep plexus into the subretinal space. Little is known about the mechanisms leading to intraretinal neovascularization, but age-related changes such as reduction of choroidal blood flow, accumulation of drusen, and thickening of the Bruch's membrane may lead to reduced oxygen availability in photoreceptors. Such a chronic hypoxic situation may induce several cellular response pathways including the stabilization of hypoxia-inducible factors (HIFs) and the production of angiogenic factors, such as vascular endothelial growth factor (VEGF). Here, we discuss the potential contribution of hypoxia and HIFs in RAP disease pathology and in some mouse models for subretinal neovascularization.
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Affiliation(s)
- Maya Barben
- Lab for Retinal Cell Biology, Department of Ophthalmology, University Hospital Zurich, University of Zurich, Wagistr. 14, 8952, Schlieren, Switzerland
- Neuroscience Center Zurich (ZNZ), University of Zurich, Zurich, Switzerland
| | - Marijana Samardzija
- Lab for Retinal Cell Biology, Department of Ophthalmology, University Hospital Zurich, University of Zurich, Wagistr. 14, 8952, Schlieren, Switzerland
| | - Christian Grimm
- Lab for Retinal Cell Biology, Department of Ophthalmology, University Hospital Zurich, University of Zurich, Wagistr. 14, 8952, Schlieren, Switzerland.
- Neuroscience Center Zurich (ZNZ), University of Zurich, Zurich, Switzerland.
- Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland.
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Dolz-Marco R, Phasukkijwatana N, Sarraf D, Freund KB. REGRESSION OF TYPE 2 NEOVASCULARIZATION INTO A TYPE 1 PATTERN AFTER INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION. Retina 2017; 37:222-233. [PMID: 27627752 DOI: 10.1097/iae.0000000000001279] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To study eyes with Type 2 (subretinal) neovascularization (NV) secondary to neovascular age-related macular degeneration (nAMD) that shows lesion regression into a Type 1 (subretinal pigment epithelium) pattern after treatment with intravitreal anti-vascular endothelial growth factor (VEGF) therapy. METHODS Retrospective consecutive case series. Patients showing regression of Type 2 neovascularization into a Type 1 pattern after envelopment by retinal pigment epithelium were included in this analysis. A review of the clinical records and multimodal imaging of these cases was performed at baseline, 1, 3, 6, and 12 months. Demographic data, best-corrected visual acuity (BCVA), color fundus photography, fundus autofluorescence (FAF), fluorescein angiography, near-infrared reflectance (NIR), and structural spectral-domain optical coherence tomography (SD-OCT) were reviewed and analyzed. When available, optical coherence tomography angiography images were analyzed as well. RESULTS Ten eyes of 9 patients (6 males) diagnosed with treatment-naive pure Type 2 neovascularization secondary to nAMD were included. The mean age was 80.7 years (SD ± 4.30). Mean best-corrected visual acuity expressed in logMAR (Snellen) was 0.45 ± 0.20 (20/55) at baseline and significantly improved to 0.22 ± 0.13 (20/32) at 3-month follow-up (P-value: 0.007). At baseline, color photographs and fundus autofluorescence showed a pigment ring around the neovascular lesion in 6 eyes. A hyperreflective ring was visible on NIR in all eyes at 3-month follow-up. Color photographs showed a tessellated fundus appearance in 9 of the 10 eyes. Serial structural spectral-domain optical coherence tomography scans showed the gradual regression of the Type 2 lesions into a Type 1 pattern with envelopment by the retinal pigment epithelium. En face and cross-sectional optical coherence tomography angiography showed baseline subretinal flow patterns which, after treatment, exhibited reduced flow beneath an intact hyperreflective retinal pigment epithelium (RPE) band. CONCLUSION Pure Type 2 lesions are infrequent in nAMD, often leading to poor visual outcomes related to subretinal fibrosis. We describe an alternate regression pattern occurring in eyes with early Type 2 lesions treated with intravitreal anti-vascular endothelial growth factor therapy in which the neovascular tissue is enveloped by retinal pigment epithelium producing a Type 1 pattern. These eyes appear to have better visual outcomes than typically seen with Type 2 lesions related to reduced outer retinal damage.
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Affiliation(s)
- Rosa Dolz-Marco
- *Vitreous Retina Macula Consultants of New York, New York, New York; †LuEsther T Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York; ‡Retinal Disorders and Ophthalmic Genetics Division, Jules Stein Eye Institute, University of California, Los Angeles, California; §Greater Los Angeles VA Healthcare Center, Los Angeles, California; ‖Department of Ophthalmology, Edward S Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York; and ¶Department of Ophthalmology, New York University School of Medicine, New York, New York
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Tsai AS, Cheung N, Gan AT, Jaffe GJ, Sivaprasad S, Wong TY, Cheung CMG. Retinal angiomatous proliferation. Surv Ophthalmol 2017; 62:462-492. [DOI: 10.1016/j.survophthal.2017.01.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 01/24/2017] [Accepted: 01/27/2017] [Indexed: 01/06/2023]
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Chou HD, Wu WC, Wang NK, Chuang LH, Chen KJ, Lai CC. Short-term efficacy of intravitreal Aflibercept injections for retinal angiomatous proliferation. BMC Ophthalmol 2017; 17:104. [PMID: 28655307 PMCID: PMC5488380 DOI: 10.1186/s12886-017-0497-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the short-term efficacy of intravitreal injections of aflibercept (IVA) to treat retinal angiomatous proliferation (RAP) and identify factors related to functional outcomes. METHODS This retrospective case series consisted of 19 eyes in 19 patients with RAP. All 19 eyes received 3 monthly consecutive IVA. The primary outcome measures were best-corrected visual acuity (BCVA) and central retinal thickness (CRT) after the last IVA. RESULTS Of the 19 treated eyes, 8 (42%) were pre-treated with 1 dose of bevacizumab one month prior to the initiation of treatment with aflibercept. BCVA was significantly improved and CRT was significantly reduced after 3 consecutive IVAs (P = 0.014 and P = 0.0002, respectively). Stabilization or improvement in BCVA was observed in 17 eyes (90%) treated with IVA. Eyes with baseline fibrovascular pigment epithelial detachment (PED) showed no significant gain in BCVA, and fibrovascular PED was negatively correlated with final BCVA (Spearman's correlation coefficient = - 0.481, P = 0.037). The mean follow-up was 3.5 ± 0.5 months. CONCLUSIONS In this short-term study, three consecutive IVAs showed efficacy for improving vision and reducing retinal edema in RAP patients. Eyes with fibrovascular PED showed poorer responses, and the presence of fibrovascular PED at baseline was negatively correlated with visual outcomes.
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Affiliation(s)
- Hung-Da Chou
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, Republic of China
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, Republic of China.,School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 333, Taiwan, Republic of China
| | - Nan-Kai Wang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, Republic of China.,School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 333, Taiwan, Republic of China
| | - Lan-Hsin Chuang
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 333, Taiwan, Republic of China.,Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, No. 222, Maijin Rd., Anle Dist., Keelung City, 204, Taiwan, Republic of China
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, Republic of China.,School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 333, Taiwan, Republic of China
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, Republic of China. .,School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 333, Taiwan, Republic of China.
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Ozkok A, Sigford DK, Tezel TH. PATTERNS OF FUNDUS AUTOFLUORESCENCE DEFECTS IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION SUBTYPES. Retina 2017; 36:2191-2196. [PMID: 27078800 DOI: 10.1097/iae.0000000000001034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To test define characteristic fundus autofluorescence patterns of different exudative age-related macular degeneration subtypes. METHODS Cross-sectional study. Fifty-two patients with choroidal neovascularization because of three different neovascular age-related macular degeneration subtypes were included in the study. Macular and peripheral fundus autofluorescence patterns of study subjects were compared in a masked fashion. RESULTS Fundus autofluorescence patterns of all three neovascular age-related macular degeneration subtypes revealed similar patterns. However, peripapillary hypo-autofluorescence was more common among patients with polypoidal choroidal vasculopathy (88.2%) compared with patients with retinal angiomatous proliferation (12.5%) and patients without retinal angiomatous proliferation and polypoidal choroidal vasculopathy (21.1%) (P < 0.0001). CONCLUSION Presence of peripapillary fundus autofluorescence defects in neovascular age-related macular degeneration maybe suggestive of polypoidal choroidal vasculopathy as a variant of neovascular age-related macular degeneration.
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Affiliation(s)
- Ahmet Ozkok
- *Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky; and †Department of Ophthalmology, Columbia University, New York, New York
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Jabbarpoor Bonyadi MH, Yaseri M, Bonyadi M, Soheilian M. Association of ARMS2/LOC387715 A69S, CFH Y402H, and CFH I62V polymorphisms with retinal angiomatous proliferation compared with typical age-related macular degeneration: a meta-analysis. Int Ophthalmol 2016; 37:1397-1409. [PMID: 28005184 DOI: 10.1007/s10792-016-0413-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 12/07/2016] [Indexed: 01/01/2023]
Abstract
PURPOSE To compare the published results of studies on the genotype association of ARMS2/LOC387715 A69S, CFH Y402H, and CFH I62V in cases diagnosed as retinal angiomatous proliferation (RAP) versus neovascular age-related macular degeneration (AMD) or healthy controls. METHODS Heterogeneity of studies was evaluated using Cochran's Q test and I-square index. To modify the heterogeneity in the variables, we used random effects model. Meta-analysis was performed using STATA. RESULTS Four studies were included with 1076 neovascular AMD patients, 222 RAP cases, and 2276 control subjects. Pooled overall odds ratios for RAP/AMD were 1.15 (95% CI 0.60-2.18) for GT versus GG, 3.52 (95% CI 1.25-9.91) for TT versus GG ARMS2, 0.98 (95% CI 0.22-4.29) for GA versus AA, 1.00 (95% CI 0.25-4.02) for GG versus AA CFHI62V, 0.57 (95% CI 0.35-0.93) for CT versus TT CFH Y402H, and 0.40 (95% CI 0.22-0.74) for CC versus TT CFH Y402H. Regression analysis showed that ARMS2 TT genotype has a statistically significant effect on RAP versus AMD compared to CFH genotypes (P < 0.001). CONCLUSION This meta-analysis disclosed a stronger effect of ARMS2 genotypes in RAP cases compared with CFH Y402H and I62V genotypes.
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Affiliation(s)
- Mohammad Hossein Jabbarpoor Bonyadi
- Ocular Tissue Engineering Research Center, Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Pasdaran Ave, Boustan 9th street, Tehran, Iran.
| | - Mehdi Yaseri
- Department of Biostatistics and Epidemiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Mortaza Bonyadi
- Center of Excellence for Biodiversity, Faculty of Natural Sciences, University of Tabriz, Tabriz, Iran
| | - Masoud Soheilian
- Ocular Tissue Engineering Research Center, Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Pasdaran Ave, Boustan 9th street, Tehran, Iran
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CHOROIDAL THICKNESS CHANGE AFTER INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENT IN RETINAL ANGIOMATOUS PROLIFERATION AND ITS RECURRENCE. Retina 2016; 36:1516-26. [DOI: 10.1097/iae.0000000000000952] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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TYPE 2 NEOVASCULARIZATION SECONDARY TO AGE-RELATED MACULAR DEGENERATION IMAGED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina 2016; 35:2212-8. [PMID: 26441269 DOI: 10.1097/iae.0000000000000773] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Optical coherence tomography angiography is a novel and noninvasive technique for imaging retinal microvasculature by detecting changes in reflectivity that is related to blood flow. The purpose of this study was to describe Type 2 neovascularization characteristics in age-related macular degeneration using optical coherence tomography angiography. METHODS Fourteen eyes of 14 consecutive patients with Type 2 neovascularization were prospectively included. All patients underwent a complete ophthalmological examination, including color and infrared fundus photography, fluorescein and indocyanine green angiography, spectral domain optical coherence tomography angiography, and optical coherence tomography angiography. RESULTS In all cases, Type 2 lesions could be detected by optical coherence tomography angiography, presenting as a hyperflow lesion in the outer retina, with a glomerulus (4/14) or medusa shape (10/14), surrounded by a dark halo. The superficial layer and the deep retina showed no abnormal flow. Surprisingly, the Type 2 lesions could also be observed in the presumed choriocapillaris layer. These glomerulus- or medusa-shaped lesions were connected, in 10/14 eyes, to a thicker main branch, which seemed to continue deep into the choroidal layers. CONCLUSION Optical coherence tomography angiography may be a new imaging method for the diagnosis of Type 2 neovascularization in clinical routine. However, the specificity of the features needs to be investigated in further studies.
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Arias L, Gómez-Ulla F, Ruiz-Moreno JM. Ranibizumab in monotherapy and combined with photodynamic therapy for retinal angiomatous proliferation. Clin Ophthalmol 2016; 10:861-9. [PMID: 27274190 PMCID: PMC4876105 DOI: 10.2147/opth.s106092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare the effects of intravitreal ranibizumab in monotherapy (group A) and combined with photodynamic therapy (PDT) with verteporfin (group B) in retinal angiomatous proliferation (RAP) treatment. Methods This was a multicentric, prospective, randomized clinical study conducted with parallel groups. The study eye in both groups received ranibizumab on days 1, 30, and 60 (loading dose); group B received PDT additionally on day 1. Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) testing and optical coherence tomography were performed monthly, and fluorescein angiography and indocyanine green angiography were performed quarterly. Retreatment criteria were leakage in fluorescein angiography or indocyanine green angiography, mean foveal thickness increase ≥100 µm, or VA decrease ≥5 letters. Results Twenty patients were recruited (ten patients in each group). Six eyes had previous treatment (three eyes in group A and three eyes in group B), so only 14 eyes were naïve. At 12-month follow-up, mean VA improved +1.5 letters in group A and +5.6 letters in group B (analysis of variance test; P>0.05). Two patients (20%) in both groups gained ≥15 letters (chi-square test; P>0.05). Mean changes in greatest linear dimension and in foveal thickness were not statistically significant between groups of treatment (analysis of variance test; P>0.05). Mean retreatments per patient were 1.8 (group A) and 0.9 (group B) (Mann–Whitney U-test; P>0.05). One patient died due to underlying disease not related to study medication. Conclusion Intravitreal ranibizumab administered in monotherapy or combined with PDT was efficacious in terms of VA stabilization in patients with RAP.
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Affiliation(s)
- Luis Arias
- Ophthalmology Department, Bellvitge University Hospital, C/Feixa Llarga, L'Hospitalet de Llobregat, Barcelona, Spain; Spanish Vitreoretinal Society (SERV), C/Xosé Chao Rego, Santiago de Compostela, Spain; RETICS OFTARED, Institute of Health Carlos III, C/Sinesio Delgado, Madrid, Spain
| | - Francisco Gómez-Ulla
- Spanish Vitreoretinal Society (SERV), C/Xosé Chao Rego, Santiago de Compostela, Spain; RETICS OFTARED, Institute of Health Carlos III, C/Sinesio Delgado, Madrid, Spain; Gómez-Ulla Eye Institute, Santiago de Compostela, Spain
| | - José M Ruiz-Moreno
- Spanish Vitreoretinal Society (SERV), C/Xosé Chao Rego, Santiago de Compostela, Spain; RETICS OFTARED, Institute of Health Carlos III, C/Sinesio Delgado, Madrid, Spain; Department of Ophthalmology, Albacete University Hospital, Avenida de Almansa s/n, Albacete, Spain
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50
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Wong CW, Yanagi Y, Lee WK, Ogura Y, Yeo I, Wong TY, Cheung CMG. Age-related macular degeneration and polypoidal choroidal vasculopathy in Asians. Prog Retin Eye Res 2016; 53:107-139. [PMID: 27094371 DOI: 10.1016/j.preteyeres.2016.04.002] [Citation(s) in RCA: 245] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 03/31/2016] [Accepted: 04/11/2016] [Indexed: 12/12/2022]
Abstract
Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in elderly people globally. It is estimated that there will be more Asians with AMD than the rest of the world combined by 2050. In Asian populations, polypoidal choroidal vasculopathy (PCV) is a common subtype of exudative AMD, while choroidal neovascularization secondary to AMD (CNV-AMD) is the typical subtype in Western populations. The two subtypes share many common clinical features and risk factors, but also have different epidemiological and clinical characteristics, natural history and treatment outcomes that point to distinct pathophysiological processes. Recent research in the fields of genetics, proteomics and imaging has provided further clarification of differences between PCV and CNV-AMD. Importantly, these differences have manifested as disparity in response to intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) treatment between PCV and CNV-AMD, emphasizing the need for accurate diagnosis of PCV and in distinguishing PCV from CNV-AMD, particularly in Asian patients. Current clinical trials of intravitreal anti-VEGF therapy and photodynamic therapy will provide clearer perspectives of evidence-based management of PCV and may lead to paradigm shifts in therapeutic strategies away from those currently employed in the treatment of CNV-AMD. Further research is needed to clarify the relative contribution of specific pathways in inflammation, complement activation, extracellular matrix dysregulation, lipid metabolism and angiogenesis to the pathogenesis of PCV. Findings from this research, together with improved diagnostic technology and new therapeutics, will facilitate more optimal management of Asian AMD.
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Affiliation(s)
- Chee Wai Wong
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Yasuo Yanagi
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Won-Ki Lee
- Department of Ophthalmology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Yuichiro Ogura
- Department of Ophthalmology, Nagoya City University, Nagoya, Japan
| | - Ian Yeo
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore.
| | - Chui Ming Gemmy Cheung
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
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