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Yiallouridou C, Acton JH, Banerjee S, Waterman H, Wood A. Pain related to intravitreal injections for age-related macular degeneration: a qualitative study of the perspectives of patients and practitioners. BMJ Open 2023; 13:e069625. [PMID: 37586867 PMCID: PMC10432642 DOI: 10.1136/bmjopen-2022-069625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 08/01/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVES Ocular pain is a commonly reported finding in the intravitreal injection procedure, but post-injection experiences and patient adherence to treatment remain underexplored. We therefore aimed to identify key variations in the intravitreal injection procedure that may influence pain, and to gain insights into the post-injection experience and treatment adherence from the perspective of patients and practitioners. DESIGN Qualitative semistructured interview study using reflexive thematic analysis of transcripts. SETTING Hospital Eye Clinic in Wales, UK. Interviews were conducted between May and September 2019. PARTICIPANTS Purposive sample of patients aged ≥50 years with neovascular age-related macular degeneration and no other retinal pathology who had received at least six intravitreal injections, and practitioners including ophthalmologists, registered nurses and optometrists who performed intravitreal injections at the research site. RESULTS Data saturation was reached with 21 interviews: 14 patients and 7 practitioners. Three main themes were identified from the analysis: fear of losing eyesight and treatment anxiety influence patient adherence to treatment, variability in pain experience during treatment, and post-injection experience and impact on patient recovery. To reassure patients feeling apprehensive about the injections, practitioners promoted safety and trust, and used techniques to manage anxiety. Key variations that may influence pain identified were application of antiseptic or anaesthetic, injecting methods and communication. During injection, patients reported a dull-aching and sharp pain, contrary to practitioners' perspective of feeling a 'pressure'. Patients described prolonged soreness and irritation of up to 36 hours post-injection affecting their sleep and recovery. CONCLUSION Establishing rapport supported patients to recognise the necessity of ongoing treatment to prevent sight loss; however, inadequate pain management led to undesirable outcomes. Practitioners should use pain assessment tools during and immediately after injection and provide ongoing consistent information to help patients manage pain at home.
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Affiliation(s)
| | - Jennifer H Acton
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - Sanjiv Banerjee
- Ophthalmology, Cardiff and Vale University Health Board, Cardiff, UK
| | | | - Ashley Wood
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
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Huang X, Zhang L, Fu Y, Zhang M, Yang Q, Peng J. Rethinking the potential and necessity of drug delivery systems in neovascular age-related macular degeneration therapy. Front Bioeng Biotechnol 2023; 11:1199922. [PMID: 37288355 PMCID: PMC10242387 DOI: 10.3389/fbioe.2023.1199922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/09/2023] [Indexed: 06/09/2023] Open
Abstract
Age-related macular degeneration (AMD) is the predominant threat to human vision and ultimately results in blindness. With the increase in the aging population, it has become a more crucial issue to human health. AMD is a multifactorial disease with the unique feature of uncontrollable angiogenesis during initiation and progression. Although increasing evidence indicates that AMD is largely hereditary, the predominant efficient treatment is antiangiogenesis, which mainly involves VEGF and HIF-α as therapeutic targets. The repeated administration of this treatment over the long term, generally through intravitreal injection, has called for the introduction of long-term drug delivery systems, which are expected to be achieved by biomaterials. However, the clinical results of the port delivery system indicate that the optimization of medical devices toward prolonging the activities of therapeutic biologics in AMD therapy seems more promising. These results indicate that we should rethink the possibility and potential of biomaterials as drug delivery systems in achieving long-term, sustained inhibition of angiogenesis in AMD therapy. In this review, the etiology, categorization, risk factors, pathogenesis, and current clinical treatments of AMD are briefly introduced. Next, the development status of long-term drug delivery systems is discussed, and the drawbacks and shortages of these systems are emphasized. By comprehensively considering the pathological aspect and the recent application of drug delivery systems in AMD therapy, we hope to find a better solution for the further development of long-term therapeutic strategies for AMD.
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Affiliation(s)
- Xi Huang
- Department of Ophthalmology, Research Laboratory of Macular Disease, Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Zhang
- Department of Ophthalmology, Research Laboratory of Macular Disease, Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanyan Fu
- Department of Ophthalmology, Research Laboratory of Macular Disease, Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Meixia Zhang
- Department of Ophthalmology, Research Laboratory of Macular Disease, Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qian Yang
- Center of Scientific Research, Chengdu Medical College, Chengdu, Sichuan, China
| | - Jinrong Peng
- Department of Ophthalmology, Research Laboratory of Macular Disease, Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Baysal Z, Gobeka HH. Electrophysiological Evaluation of Macular Photoreceptor Functions in Patients with Choroidal Neovascular Membranes. Curr Eye Res 2022; 48:425-431. [PMID: 36524692 DOI: 10.1080/02713683.2022.2159982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate changes in cone functions using light-adapted (LA) 30 Hz flicker and LA 3.0 electroretinography (ERG) in intravitreal ranibizumab (IVR)-treated naïve neovascular age-related macular degeneration (nAMD) patients. MATERIALS AND METHODS This retrospective interventional study reviewed the medical records of 32 nAMD patients (32 eyes) who received monthly IVR between January 2019 and January 2021. A comprehensive ophthalmic examination, including best-corrected visual acuity (BCVA) testing and slit-lamp biomicroscopy, was performed as part of their clinical care, followed by LA 30 Hz flicker and LA 3.0 ERGs, optical coherence tomography, and fundus fluorescein angiography. All measurements were taken before IVR (baseline), as well as at months 6 and 12 later. Treatment was resumed for up to 12 months if recurrence occurred. RESULTS Compared to baseline, visual acuity improved significantly at months 6 and 12, respectively, coinciding with a significant decrease in central macular thickness (p < 0.05 for all). LA 30 Hz flicker ERG b-wave amplitude decreased significantly between baseline and months 6 and 12, respectively (p < 0.05 for both). There were no significant changes in LA 3.0 ERG a- and b-wave amplitudes between baseline and month 6 (p > 0.05 for both), but a significant decrease existed between baseline and month 12 (p < 0.05 for both). While LA 3.0 ERG a-wave implicit time increased significantly (p < 0.05 for both) between baseline and months 6 and 12, respectively, b-wave implicit time did not (p > 0.05 for both). Also, LA 30 Hz flicker ERG b-wave implicit times did not differ significantly between baseline and months 6 and 12, respectively (p > 0.05, for both). CONCLUSIONS IVR was associated with long-term electrophysiological changes in cone functions, as measured by LA 30 Hz flicker and LA 3.0 ERGs.
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Affiliation(s)
- Zeki Baysal
- Ophthalmology Clinic, Batman Educational and Research Hospital, Batman, Turkey
| | - Hamidu Hamisi Gobeka
- Department of Ophthalmology, Faculty of Medicine, Agri Ibrahim Cecen University, Agri, Turkey
- Department of Ophthalmology, Faculty of Medicine, Afronkarahisar Health Sciences University, Afyonkarahisar, Turkey
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Gani K, Chirmade T, Ughade S, Thulasiram H, Bhambure R. Understanding unfolding and refolding of the antibody fragment (Fab) III: Mapping covalent and non-covalent interactions during in-vitro refolding of light chain, heavy chain, and Fab. Biochem Eng J 2022. [DOI: 10.1016/j.bej.2022.108644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Vogt D, Deiters V, Herold TR, Guenther SR, Kortuem KU, Priglinger SG, Wolf A, Schumann RG. Optimal patient adherence and long-term treatment outcomes of neovascular age-related macular degeneration in real-life. Curr Eye Res 2022; 47:889-896. [PMID: 35179427 DOI: 10.1080/02713683.2022.2044056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To report on long-term real-life outcomes of anti-vascular endothelial growth factor (anti-VEGF) therapy in neovascular age-related macular degeneration (nAMD) with optimal patient adherence. METHODS For this retrospective monocenter study, we identified 3217 eyes of 2793 patients that received a minimum of three intravitreal anti-VEGF injections for nAMD therapy between 2006 and 2014 at the University Eye Hospital Munich. From those, we included eyes with treatment-naïve nAMD, follow-up (FU) of ≥60 months and continuous adherence during FU. Primary measures were corrected visual acuity (VA), number of injections and visits as well as treatment regimen. RESULTS We included 161 eyes of 125 patients with a mean FU of 8.0 ± 2.3 years. Mean VA at baseline was 60.1 letters (Snellen equivalent, 20/63). After the third year, mean VA declined constantly by 2-3 letters per year. After 5 and 8 years, 26.1% and 42.1% had lost at least 3 lines from baseline. Mean cumulative number of injections was 5.3 after the first year, and 23.9, 38.1, 48.5 after 5, 8, and 10 years. 'Treat and extent' regimen with higher injection frequency correlated with better function. At time of last FU, 69.8% of eyes were under active treatment. Eyes with ≥70 letters at baseline correlated with better VA at the end of FU. CONCLUSIONS Despite optimal patient adherence, visual function declined progressively in real-life nAMD therapy over long-term. The highest impact on treatment success is given by an early treatment start with individual but intensive anti-VEGF therapy.
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Affiliation(s)
- Denise Vogt
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Mathildenstr. 8, 80336 Munich, Germany
| | - Viktoria Deiters
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Mathildenstr. 8, 80336 Munich, Germany
| | - Tina R Herold
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Mathildenstr. 8, 80336 Munich, Germany
| | - Stefanie R Guenther
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Mathildenstr. 8, 80336 Munich, Germany
| | - Karsten U Kortuem
- Department of Ophthalmology, University Hospital Ulm, Priettwitzstr. 43, 89075 Ulm, Germany
| | - Siegfried G Priglinger
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Mathildenstr. 8, 80336 Munich, Germany
| | - Armin Wolf
- Department of Ophthalmology, University Hospital Ulm, Priettwitzstr. 43, 89075 Ulm, Germany
| | - Ricarda G Schumann
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Mathildenstr. 8, 80336 Munich, Germany.,Munich Eye Center Brienner Hof, Brienner Str. 12, 80333 Munich, Germany
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Stattin M, Haas AM, Ahmed D, Graf A, Krepler K, Ansari-Shahrezaei S. Evaluation of a calculation model to estimate the impact of the COVID-19 pandemic lockdown on visual acuity in neovascular AMD. Eur J Ophthalmol 2021; 32:2312-2318. [PMID: 34726553 PMCID: PMC9294617 DOI: 10.1177/11206721211052389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose A model was calculated during the first Austrian coronavirus disease-2019
(COVID-19) pandemic lockdown to estimate the effect of a short-term
treatment interruption due to healthcare restrictions on visual acuity (VA)
in neovascular age-related macular degeneration (nAMD). The model was
compared to the real-life outcomes before treatment re-started. Methods Retrospective data-collection of 142 eyes in 142 patients receiving repeated
intravitreal injections with anti-VEGF at a retina unit in Vienna in a
personalized pro-re-nata regimen prior to the COVID-19 associated lockdown,
when treatment was deferred between March 16 and May 4, 2020. During the
lockdown, the preliminary data was integrated into pre-existing formulae
based on the natural course of the disease in untreated eyes in the long
term. Patients were re-scheduled and treated after gradually opening
operating rooms. The calculation model was compared to the effective VA
change. Results The model calculated an overall VA loss of 3.5 ± 0.8 letters early treatment
diabetes retinopathy study (ETDRS) (p < 0.001 [95%
CI:3.3;3.6]) on average compared to 2.5 ± 6 letters ETDRS
(p < 0.001 [95% CI:1.5;3.5]) as measured with a mean
treatment delay of 61 ± 14 days after previously scheduled appointments. The
total difference between the model exercise and the real-life outcomes
accounted for 1 ± 5.9 letters ETDRS (p = 0.051 [95% CI:
0.1;1.9]). Conclusion The herein presented calculation model might not be suitable to estimate the
effective VA loss correctly over time, although untreated eyes and eyes
under therapy show similarities after short-term treatment interruption.
However, this study demonstrated the potentially negative impact of the
COVID-19 pandemic lockdown on patients compromised by nAMD.
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Affiliation(s)
- Martin Stattin
- Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria.,Department of Ophthalmology, Rudolf Foundation Hospital, Vienna, Austria.,Department of Ophthalmology and Optometry, Medical University Innsbruck, Innsbruck, Austria
| | - Anna-Maria Haas
- Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria.,Department of Ophthalmology, Rudolf Foundation Hospital, Vienna, Austria
| | - Daniel Ahmed
- Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria.,Department of Ophthalmology, Rudolf Foundation Hospital, Vienna, Austria
| | - Alexandra Graf
- Center for Medical Statistic, Informatics, and Intelligent Systems, 27271Medical University of Vienna, Vienna, Austria
| | - Katharina Krepler
- Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria.,Department of Ophthalmology, Rudolf Foundation Hospital, Vienna, Austria
| | - Siamak Ansari-Shahrezaei
- Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria.,Department of Ophthalmology, Rudolf Foundation Hospital, Vienna, Austria.,Medical School, Sigmund Freud University Vienna, Vienna, Austria.,Department of Ophthalmology, Medical University of Graz, Graz, Austria
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Topical Triamcinolone Acetonide-Loaded Liposome Formulation Used as an Adjuvant to Intravitreal Ranibizumab Therapy for Neovascular Age-Related Macular Degeneration. Pharmaceutics 2021; 13:pharmaceutics13091491. [PMID: 34575567 PMCID: PMC8471461 DOI: 10.3390/pharmaceutics13091491] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 01/01/2023] Open
Abstract
Novel strategies have been developed to reduce or avoid intravitreal injections (IVTs) of the antiangiogenic (ranibizumab (RBZ)) and anti-inflammatory (triamcinolone acetonide (TA)) agents used to treat vitreoretinal diseases. One of the strategies includes liposomes. This study evaluated the safety and efficacy of a topical triamcinolone-loaded liposome formulation (TALF) as an adjuvant to intravitreal RBZ therapy in treatment- naïve patients with neovascular age-related macular degeneration (nAMD). Subjects were randomly assigned to the RBZ-TALF or the RBZ-pro re nata (RBZ-PRN) groups. Patients from the RBZ-TALF group were instructed to apply TALF for 12 months after a single dose of RBZ. Patients from the RBZ-PRN group received three monthly RBZ-IVTs. Retreatment with RBZ was considered in the case of nAMD reactivation. Regarding safety, non-ocular abnormalities were observed during TALF therapy. Concerning efficacy, non-significant differences were identified in terms of visual acuity or central foveal thickness when the RBZ-PRN and RBZ-TALF groups were compared. It is worth noting that the average number of RBZ injections was significantly lower in the RBZ-TALF group (2.5 ± 1.4 vs. 6.1 ± 1.3 IVTs; p = 0.0004). Therefore, TALF used as an adjuvant to RBZ reduces the need for RBZ-IVT retreatment with optimal visual and anatomic results.
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Watson N, Al-Samkari H. Thrombotic and bleeding risk of angiogenesis inhibitors in patients with and without malignancy. J Thromb Haemost 2021; 19:1852-1863. [PMID: 33928747 DOI: 10.1111/jth.15354] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/13/2021] [Accepted: 04/26/2021] [Indexed: 01/06/2023]
Abstract
Over the past two decades, therapies targeting angiogenesis have developed into a major class of cancer therapeutics. The vascular endothelial growth factor (VEGF) family of signaling proteins, a group of potent angiogenic growth factors, and their receptors represent the main targets of this therapeutic class. To date, 16 antiangiogenic agents have been approved in the United States for the treatment of cancer and several more are in development. An important consideration with antiangiogenic therapy is toxicity, in particular thrombotic and bleeding risks. These complications have emerged as a major clinical concern that may affect the use of these agents in patients both with and without cancer who may already have an elevated risk of thrombosis and bleeding. Although these agents are frequently considered together as a class when contemplating their bleeding and thrombotic risks, in fact the risks for venous thromboembolism, arterial thrombosis, and bleeding vary significantly between different classes of antiangiogenic agents and even among different agents within a class. In this narrative review, we describe the literature investigating the venous and arterial thrombotic and bleeding risks associated with the currently available antiangiogenic drugs. In addition, we discuss these specific complications in the context of both cancer therapy as well as the management of nonmalignant disorders now managed with antiangiogenic agents, including hereditary hemorrhagic telangiectasia and neovascular age-related macular degeneration.
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Affiliation(s)
| | - Hanny Al-Samkari
- Harvard Medical School, Boston, MA, USA
- Division of Hematology, Massachusetts General Hospital, Boston, MA, USA
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Liefers B, Taylor P, Alsaedi A, Bailey C, Balaskas K, Dhingra N, Egan CA, Rodrigues FG, Gonzalo CG, Heeren TF, Lotery A, Müller PL, Olvera-Barrios A, Paul B, Schwartz R, Thomas DS, Warwick AN, Tufail A, Sánchez CI. Quantification of Key Retinal Features in Early and Late Age-Related Macular Degeneration Using Deep Learning. Am J Ophthalmol 2021; 226:1-12. [PMID: 33422464 DOI: 10.1016/j.ajo.2020.12.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 02/01/2023]
Abstract
PURPOSE We sought to develop and validate a deep learning model for segmentation of 13 features associated with neovascular and atrophic age-related macular degeneration (AMD). DESIGN Development and validation of a deep-learning model for feature segmentation. METHODS Data for model development were obtained from 307 optical coherence tomography volumes. Eight experienced graders manually delineated all abnormalities in 2712 B-scans. A deep neural network was trained with these data to perform voxel-level segmentation of the 13 most common abnormalities (features). For evaluation, 112 B-scans from 112 patients with a diagnosis of neovascular AMD were annotated by 4 independent observers. The main outcome measures were Dice score, intraclass correlation coefficient, and free-response receiver operating characteristic curve. RESULTS On 11 of 13 features, the model obtained a mean Dice score of 0.63 ± 0.15, compared with 0.61 ± 0.17 for the observers. The mean intraclass correlation coefficient for the model was 0.66 ± 0.22, compared with 0.62 ± 0.21 for the observers. Two features were not evaluated quantitatively because of a lack of data. Free-response receiver operating characteristic analysis demonstrated that the model scored similar or higher sensitivity per false positives compared with the observers. CONCLUSIONS The quality of the automatic segmentation matches that of experienced graders for most features, exceeding human performance for some features. The quantified parameters provided by the model can be used in the current clinical routine and open possibilities for further research into treatment response outside clinical trials.
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Zola M, D'Alessandro E, Sherif M, Nguyen A, De Azevedo D, Haeller C, Forestier E, Mantel I. Refractory neovascular age-related macular degeneration: time-dependent changes of central retinal thickness with anti-VEGF treatment. Graefes Arch Clin Exp Ophthalmol 2021; 259:1477-1486. [PMID: 33245426 PMCID: PMC8166689 DOI: 10.1007/s00417-020-05000-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/24/2020] [Accepted: 10/30/2020] [Indexed: 12/05/2022] Open
Abstract
PURPOSE To assess the influence of time interval since last injection and time from baseline on central retinal thickness (CRT) in neovascular age-related macular degeneration (nAMD) with fluid refractory to monthly anti-VEGF treatment. METHODS This retrospective study included nAMD eyes with incomplete response to anti-VEGF defined by the presence of intra- or subretinal fluid on optical coherence tomography despite maximal (monthly) anti-VEGF dosing. The outcome measure was CRT, and two time variables (time from last injection ant time from baseline) were the independent factors included in the individual correlation analyses. In addition, an association analysis was performed. RESULTS Sixty eyes of 56 patients (67.9% females, mean age: 78.7 ± 6.8 years) were included with a mean included time period of 35.6 months. A significant positive correlation between CRT and the time from last injection occurred in 24 (40%) and 25 (42%) eyes by univariate and multivariate analysis, respectively. Time from baseline was significantly correlated with CRT in 29 (48.3%) and 30 (50%) eyes by univariate and multivariate analysis, respectively. This correlation was positive in 12 (20%) and negative in 18 eyes (30%). No association with such correlation was found. CONCLUSION So-called refractory nAMD frequently shows a correlation of CRT with the interval in days from the preceding anti-VEGF injection, revealing that there is a subgroup of short-term responsiveness of the residual fluid. Moreover, slower CRT changes may occur over the years, either decrease or increase. In case of a slow CRT increase, this might require a diagnostic workup and therapeutic change.
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Affiliation(s)
- Marta Zola
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Foundation Asile des Aveugles, Lausanne, Switzerland
| | - Elisa D'Alessandro
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Foundation Asile des Aveugles, Lausanne, Switzerland
| | - Mohamed Sherif
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Foundation Asile des Aveugles, Lausanne, Switzerland
| | - Audrey Nguyen
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Foundation Asile des Aveugles, Lausanne, Switzerland
| | - Dominique De Azevedo
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Foundation Asile des Aveugles, Lausanne, Switzerland
| | - Céline Haeller
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Foundation Asile des Aveugles, Lausanne, Switzerland
| | - Edwige Forestier
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Foundation Asile des Aveugles, Lausanne, Switzerland
| | - Irmela Mantel
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Foundation Asile des Aveugles, Lausanne, Switzerland.
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Evaluation of Port Delivery System with ranibizumab for the treatment of neovascular age-related macular degeneration. Ther Deliv 2021; 12:191-200. [PMID: 33641347 DOI: 10.4155/tde-2020-0132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Current treatment of neovascular age-related macular degeneration involves periodic intravitreal injections of anti-VEGF medication, creating a burden to patients and physicians, resulting in nonadherence to recommended dosing schedules. The Port Delivery System with ranibizumab offers a long-term solution that involves implantation of a device into the pars plana and provides continuous release of anti-VEGF medication into the vitreous, thus requiring fewer office visits. The Port Delivery System has demonstrated comparable visual and anatomic outcomes to monthly injections and shows promise in alleviating the patient burden in the treatment of neovascular age-related macular degeneration, making possible better long-term real-world visual outcomes.
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12
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Greenlee TE, Wang VY, Kang H, Ohlhausen ME, Chen AX, Hom GL, Conti TF, Briskin I, Babiuch AS, Singh RP. CONSEQUENCES OF LAPSES IN TREATMENT WITH VASCULAR ENDOTHELIAL GROWTH FACTOR INHIBITORS IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION IN ROUTINE CLINICAL PRACTICE. Retina 2021; 41:581-587. [PMID: 32658164 DOI: 10.1097/iae.0000000000002888] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Evaluating outcomes in patients receiving intravitreal antivascular endothelial growth factor (VEGF) inhibitors for neovascular age-related macular degeneration whom experience a lapse in treatment. METHODS A retrospective chart review evaluating 3,304 patients ≥18 years who experienced treatment lapses ≥3 months compared with control counterparts. Demographic information, macular thickness as measured by central subfield thickness, and visual acuity were collected at baseline, the first postlapse appointment, and at 3, 6, and 12 months after the lapse for the study group. RESULTS Lapse (n = 241) and control patients (n = 241) had similar baseline visual acuity and central subfield thickness (Early Treatment Diabetic Retinopathy Study: 58.9 ± 20.2 [20/63] vs. 59.2 ± 20.1 [20/63]; central subfield thickness: 252.4 ± 63.2 µm vs. 259.8 ± 66.2 µm, P = 0.21). Analysis revealed that lapse patients experienced a significant increase in central subfield thickness after lapse when compared with controls (279.4 ± 86.9 µm vs. 253.7 ± 65.9 µm, P < 0.01), which normalized on resumption of treatment (259.1 ± 79 µm vs. 246.8 ± 57.6 µm, P = 0.06). Study patients also experienced loss in the visual acuity after lapse when compared with controls (52.9 ± 23.6 Early Treatment Diabetic Retinopathy Study [20/100] vs. 59.9 ± 20.8 [20/63] Early Treatment Diabetic Retinopathy Study, P < 0.01) that did not recover through 12 months of follow-up. CONCLUSION Patients with neovascular age-related macular degeneration who have lapses in care are at risk for poorer outcomes. Although macular thickness normalizes on resumption of treatment, their decline in the visual acuity does not recover.
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Affiliation(s)
- Tyler E Greenlee
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Victoria Y Wang
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Hannah Kang
- Case Western Reserve University College of Arts and Sciences, Cleveland, Ohio; and
| | - Marc E Ohlhausen
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Andrew X Chen
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Grant L Hom
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Thais F Conti
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Isaac Briskin
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Amy S Babiuch
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
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Predictors of good visual outcomes in patients with neovascular age-related macular degeneration in daily practice. J Fr Ophtalmol 2020; 43:989-995. [DOI: 10.1016/j.jfo.2020.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/09/2020] [Accepted: 02/26/2020] [Indexed: 11/18/2022]
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15
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Bekmez S, Cakmak H, Kocaturk T, Cantas F, Dundar S. Biomechanical properties of the cornea following intravitreal ranibizumab injection. Graefes Arch Clin Exp Ophthalmol 2020; 259:691-696. [PMID: 33165643 DOI: 10.1007/s00417-020-05001-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/26/2020] [Accepted: 10/30/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate intraocular pressure (IOP) and corneal biomechanical properties changes after intravitreal ranibizumab injection (IVRI). METHODS One hundred twenty eyes of 120 patients who underwent IVRI between January and March 2018 in Adnan Menderes University Ophthalmology Clinic were included in study. Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated intraocular pressure (IOPcc) were measured by Ocular Response Analyzer (ORA) by the same specialist preoperatively (preop), postoperative 1st (postop-1st), postoperative 3rd (postop-3rd), and postoperative 24th hours (postop-24th) after single-dose IVRI. RESULTS Among the 120 wet age-related macular degeneration subjects, 58 (48.3%) were female and 62 (51.7%) were male. The mean age was 64.8 ± 10.4 years. Postop-1st hour IOP cc and IOPg measurements were statistically different from all other measurements (p < 0.001). Postop-1st hour CH measurements were statistically different from preop and postop-3rd (p = 0.022 and p = 0.008, respectively). CONCLUSION After intravitreal injection, IOP pressures significantly increased. But, CH and CRF values were significantly decreased. All these changes were temporary.
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Affiliation(s)
- Sinan Bekmez
- Department of Ophthalmology, University of Health Sciences Izmir Dr. Behcet Uz Children's Diseases and Surgery Training and Research Hospital, Izmir, Turkey.
| | - Harun Cakmak
- Department of Ophthalmology, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Tolga Kocaturk
- Department of Ophthalmology, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Fulden Cantas
- Department of Biostatistics, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Sema Dundar
- Department of Ophthalmology, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
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Barış ME, Menteş J, Afrashi F, Nalçaçı S, Akkın C. Subgroups and Features of Poor Responders to Anti-Vascular Endothelial Growth Factor Treatment in Eyes with Neovascular Age-Related Macular Degeneration. Turk J Ophthalmol 2020; 50:275-282. [PMID: 33342194 PMCID: PMC7610050 DOI: 10.4274/tjo.galenos.2020.38488] [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] [Indexed: 12/01/2022] Open
Abstract
Objectives: This study aimed to determine the incidence of poor response to intravitreal (IV) anti-VEGF treatment in neovascular age-related macular degeneration (nvAMD) and to define subgroups of poor responders. Materials and Methods: A total of 235 treatment-naive eyes of 202 patients completed this prospective study. Patients younger than 50 years of age and those with a contraindication for anti-VEGF therapy were excluded. All eyes were treated with IV ranibizumab. Poor response was defined as recurrence, persistence, or worsening despite treatment. Poor responders were classified into subgroups based on progression patterns. Results: Of the 235 eyes, 78 (33.2%) showed poor response. Pigment epithelial detachment (PED) and occult choroidal neovascularization (CNV) were more common among poor responders (p<0.001) and 5 subgroups were identified. Conclusion: Poor response to anti-VEGF treatment is not uncommon and occult CNV and PED are frequently seen in these eyes. Various subgroups can be defined based on clinical features.
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Affiliation(s)
- Mine Esen Barış
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Jale Menteş
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Filiz Afrashi
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Serhad Nalçaçı
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Cezmi Akkın
- Ege University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
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Avitabile T, Boscia F, Dell’Erba A, Introini U, Lanzetta P, Locatelli P, Ricci F, Staurenghi G, Varano M, Zotti F. Definition of indicators of appropriateness in the management of neovascular age-related macular degeneration: An expert opinion. Eur J Ophthalmol 2020; 30:795-804. [DOI: 10.1177/1120672120915685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Wet age-related macular degeneration is a chronic condition culminating, in most cases, in blindness. The introduction of anti-angiogenic agents in 2006 has represented a major breakthrough in the treatment of the disease, but timely and effective treatment with regular follow-up and monitoring is mandatory to stabilize and preserve visual acuity. In clinical practice, however, appropriate therapy provision is frequently challenged by economic and organizational issues that result in suboptimal visual outcomes and increased incidence of legal blindness. International Guidelines have defined a diagnostic and therapeutic pathway to ensure the best practice in wet age-related macular degeneration management, but reference parameters to evaluate and compare the performance of Retina Centers are lacking. To address the appropriateness of wet age-related macular degeneration management in Italy, a multidisciplinary panel of ten experts gathered in three meetings. They defined three sets of indicators and relative benchmark values that each Center should comply with to ensure patients optimal care already from the first access: (a) clinical intervention indicators, to determine the possible Center’s deviation from the diagnostic and therapeutic pathway; (b) outcome indicator, to evaluate the socioeconomic impact of the healthcare systems’ performance; (c) management indicators, to test the size of the gap between the Center’s supply and demand. Once the indicators have been analyzed, healthcare systems can plan actions to improve appropriateness and monitor their effects. However, to put this in practice, a concerted effort by all parts involved in healthcare provision is required, together with adequate systems to analyze clinical and administrative documentation.
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Affiliation(s)
| | - Francesco Boscia
- Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy
| | - Alessandro Dell’Erba
- Interdisciplinary Department of Medicine, Section of Legal Medicine, University of Bari, Bari, Italy
| | - Ugo Introini
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Paolo Lanzetta
- Department of Medicine—Ophthalmology, University of Udine, Udine, Italy
| | - Paolo Locatelli
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Federico Ricci
- UNIT Retinal Diseases, Policlinico Tor Vergata, University Tor Vergata, Rome, Italy
| | - Giovanni Staurenghi
- Ophthalmology Clinic, Department of Biomedical and Clinical Sciences “Luigi Sacco,” Luigi Sacco Hospital, University of Milan, Milan, Italy
| | | | - Fiorenza Zotti
- Interdisciplinary Department of Medicine, Section of Legal Medicine, University of Bari, Bari, Italy
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Avaylon J, Lee S, Gallemore RP. Case Series on Initial Responses to Intravitreal Brolucizumab in Patients with Recalcitrant Chronic Wet Age-Related Macular Degeneration. Int Med Case Rep J 2020; 13:145-152. [PMID: 32494207 PMCID: PMC7231770 DOI: 10.2147/imcrj.s252260] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/23/2020] [Indexed: 12/30/2022] Open
Abstract
Purpose To report a case series of initial responses to intravitreal brolucizumab in patients already undergoing anti-VEGF therapy for wet age-related macular degeneration. Case Series Six eyes (6 patients) with a history of wet age-related macular degeneration presented with either decline in vision or no improvement while undergoing treatment with anti-VEGF therapy – aflibercept or bevacizumab. Patients were switched to intravitreal brolucizumab. Four weeks post-injection, there was no significant change in visual acuity. Optical coherence tomography scans were taken and improved IRF/SRF, central macular thickness and average pericentral thickness were observed in all 6 patients. No serious adverse reactions were observed, including signs of vasculitis or increase in anterior chamber cell count at the 4-week follow-up for all 6 patients. Conclusion Intravitreal brolucizumab appears to be a safe and limitedly effective option for patients with recalcitrant CNV from wet AMD.
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Affiliation(s)
- Jaycob Avaylon
- California Northstate University, College of Medicine, Elk Grove, CA, USA
| | - Sol Lee
- Retina Macula Institute, Torrance, CA, USA
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Figueroa AG, McKay BS. A G-Protein Coupled Receptor and Macular Degeneration. Cells 2020; 9:cells9040910. [PMID: 32276449 PMCID: PMC7226737 DOI: 10.3390/cells9040910] [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: 03/01/2020] [Revised: 03/31/2020] [Accepted: 04/07/2020] [Indexed: 12/12/2022] Open
Abstract
Age-related macular degeneration (AMD) is a leading cause of irreversible blindness in the world. The risk of AMD increases with age and is most common among the white population. Here, we discuss the convergence of factors related to race, pigmentation, and susceptibility to AMD, where the primary defect occurs in retinal support cells, the retinal pigment epithelium (RPE). We explore whether the observed racial bias in AMD incidence is related to innate differences in the basal level of pigmentation between races, and whether the pigmentation pathway activity in the RPE might protect from retinal degeneration. More specifically, we explore whether the downstream signaling activity of GPR143, a G-protein coupled receptor in the pigmentation pathway, might underly the racial bias of AMD and be a target to prevent the disease. Lastly, we summarize the past findings of a large retrospective study that investigated the relationship between the stimulation of GPR143 with L-DOPA, the pigmentation pathway, and AMD, to potentially help develop new ways to prevent or treat AMD. The reader of this review will come to understand the racial bias of AMD, which is related to the function of the RPE.
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20
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COMPARISON AMONG DIFFERENT DIAGNOSTIC METHODS IN THE STUDY OF TYPE AND ACTIVITY OF CHOROIDAL NEOVASCULAR MEMBRANES IN AGE-RELATED MACULAR DEGENERATION. Retina 2020; 39:281-287. [PMID: 29232336 DOI: 10.1097/iae.0000000000001960] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To determine interobserver and intraobserver agreement in classifying the subtypes of choroidal neovascularization (CNV) and the decision of retreatment in patients affected by exudative age-related macular degeneration. Different imaging techniques were evaluated individually and compared with multiimaging. METHODS Fifty-two patients with naive CNV in age-related macular degeneration were evaluated after 3 monthly intravitreal injections of ranibizumab. Choroidal neovascularization subtype and activity were evaluated using spectral domain optical coherence tomography, infrared light, fundus autofluorescence, fluorescein angiography (FA), and indocyanine green angiography (ICGA). The evaluation was performed independently by 10 different retina specialists, 2 for each test. Other two operators analyzed all the information available together. RESULTS The interobserver k regarding the types of CNV was 0.69 for multiimaging, 0.63 for spectral domain optical coherence tomography, 0.43 for FA, and 0.46 for ICGA. The k values for interobserver for retreatment decision were 0.77 for multiimaging, 0.88 for spectral domain optical coherence tomography, 0.61 for infrared, 0.37 for fundus autofluorescence, 0.25 for FA, and 0.23 for ICGA. Fluorescein angiography, spectral domain optical coherence tomography, ICGA, and infrared showed good association with multiimaging on defining CNV activity (P = 0.0003, P < 0.0001, P = 0.01, and P = 0.05, respectively). CONCLUSION Optical coherence tomography and infrared evaluations of CNV activity were reproducible and strongly associated with multiimaging, whereas FA and ICGA evaluations showed poor reproducibility.
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21
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Balikova I, Postelmans L, Pasteels B, Coquelet P, Catherine J, Efendic A, Hosoda Y, Miyake M, Yamashiro K, Thienpont B, Lambrechts D. Genetic biomarkers in the VEGF pathway predicting response to anti-VEGF therapy in age-related macular degeneration. BMJ Open Ophthalmol 2020; 4:e000273. [PMID: 31909188 PMCID: PMC6936450 DOI: 10.1136/bmjophth-2019-000273] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 10/18/2019] [Accepted: 11/11/2019] [Indexed: 11/17/2022] Open
Abstract
Objective Age-related macular degeneration (ARMD) is a leading cause of visual impairment.
Intravitreal injections of anti-vascular endothelial growth factor (VEGF) are the
standard treatment for wet ARMD. There is however, variability in patient responses,
suggesting patient-specific factors influencing drug efficacy. We tested whether single
nucleotide polymorphisms (SNPs) in genes encoding VEGF pathway members contribute to
therapy response. Methods and analysis A retrospective cohort of 281 European wet ARMD patients treated with anti-VEGF was
genotyped for 138 tagging SNPs in the VEGF pathway. Per patient, we collected best
corrected visual acuity at baseline, after three loading injections and at 12 months. We
also registered the injection number and changes in retinal morphology after three
loading injections (central foveal thickness (CFT), intraretinal cysts and serous
neuroepithelium detachment). Changes in CFT after 3 months were our primary outcome
measure. Association of SNPs to response was assessed by binomial logistic regression.
Replication was attempted by associating visual acuity changes to genotypes in an
independent Japanese cohort. Results Association with treatment response was detected for seven SNPs, including in FLT4
(rs55667289: OR=0.746, 95% CI 0.63 to 0.88, p=0.0005) and KDR (rs7691507:
OR=1.056, 95% CI 1.02 to 1.10, p=0.005; and rs2305945: OR=0.963, 95% CI
0.93 to 1.00, p=0.0472). Only association with rs55667289 in FLT4 survived multiple
testing correction. This SNP was unavailable for testing in the replication cohort. Of
six SNPs tested for replication, one was significant although not after multiple testing
correction. Conclusion Identifying genetic variants that define treatment response can help to develop
individualised therapeutic approaches for wet ARMD patients and may point towards new
targets in non-responders.
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Affiliation(s)
- Irina Balikova
- Department of Ophthalmology, Ghent University Hospital, Ghent University, Ghent, Belgium.,Ophthalmology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Laurence Postelmans
- Ophthalmology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Brigitte Pasteels
- Ophthalmology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Pascale Coquelet
- Ophthalmology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Janet Catherine
- Ophthalmology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Azra Efendic
- Ophthalmology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Yoshikatsu Hosoda
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Yamashiro
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Ophthalmology, Otsu Red Cross Hospital, Otsu, Japan
| | | | - Bernard Thienpont
- Laboratory of Translational Genetics, Department of Human Genetics, KU Leuven, Leuven, Belgium.,Laboratory of Functional Epigenetics, Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Diether Lambrechts
- Laboratory of Translational Genetics, Department of Human Genetics, KU Leuven, Leuven, Belgium.,VIB Center for Cancer Biology, Leuven, Belgium
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22
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Short-term effects of anti-vascular endothelial growth factor on peripapillary choroid and choriocapillaris in eyes with neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2019; 257:2163-2172. [DOI: 10.1007/s00417-019-04432-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/16/2019] [Accepted: 07/23/2019] [Indexed: 12/25/2022] Open
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23
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Costagliola C, Morescalchi F, Duse S, Romano D, Mazza G, Parmeggiani F, Bartollino S, Semeraro F. Systemic thromboembolic adverse events in patients treated with intravitreal anti-VEGF drugs for neovascular age-related macular degeneration: an update. Expert Opin Drug Saf 2019; 18:803-815. [DOI: 10.1080/14740338.2019.1643838] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Ciro Costagliola
- Department of Medicine and Health Science “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Francesco Morescalchi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Sarah Duse
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Davide Romano
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giuseppina Mazza
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Parmeggiani
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Silvia Bartollino
- Department of Medicine and Health Science “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Francesco Semeraro
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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REDUCTION OF POSTINTRAVITREAL INJECTION PAIN USING ICE: An Open-Label Interventional Randomized Controlled Trial. Retina 2019; 40:1434-1438. [PMID: 31305506 DOI: 10.1097/iae.0000000000002608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Intravitreal injections of intraocular therapeutic agents are a common and effective treatment for various retinal pathologies. Patient discomfort related to injection is a potential barrier to treatment. Our aim in this study was to evaluate whether cooling the eye using topical ice compresses before intravitreal injection will reduce pain or bleeding. METHODS This randomized controlled open-label study included 42 patients. All patients received a standard topical anesthesia protocol and then were randomly assigned to either receive a placement of ice packs (intervention group) or a room-temperature pack (control group) on the eyelid, 2 minutes before the intravitreal injection. Patients' discomfort, itching, burning and pain (using visual analog scale), and bleeding size (using photographs) were measured 1 and 10 minutes after the injection. Tolerability was calculated by averaging patients' discomfort, itching, burning, and pain scores. RESULTS At 1 minute, pain (1.95 vs. 4.27, P = 0.01) and overall tolerability (1.66 vs. 2.98, P = 0.03) were significantly lower in patients receiving ice packs. At 10 minutes, pain (1.6 vs. 3.73, P = 0.02), burning (0.9 vs. 3.09, P = 0.007), discomfort (2.1 vs. 4.27, P = 0.008), and overall tolerability (1.23 vs. 2.87, P = 0.004) were all significantly lower in the ice group compared with the controls. Bleeding size (area or circumference) was not statistical different between groups. CONCLUSION Topical ice patch administered before intravitreal injection significantly decreased pain and overall tolerability. This simple and inexpensive method may be used to ameliorated pain and improve tolerability.
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25
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Batteux B, Gras V, Mahboud Y, Liabeuf S, Bennis Y, Masmoudi K. Ischaemic colitis associated with intravitreal administration of aflibercept: A first case report. Br J Clin Pharmacol 2019; 85:845-848. [PMID: 30610744 DOI: 10.1111/bcp.13853] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 11/06/2018] [Accepted: 12/09/2018] [Indexed: 12/12/2022] Open
Abstract
In patients with age-related macular degeneration (AMD), the intravitreal injection of antivascular endothelial growth factor (anti-VEGF) agents reduces disease progression and choroidal neovascularization. We report on a first case of ischaemic colitis associated with intravitreal injection of the anti-VEGF agent aflibercept in an 80-year-old female patient. Conservative treatment resulted in a favourable clinical outcome. The anti-VEGF agent was discontinued, and the symptoms did not recur. Although the intravitreal injection of anti-VEGF agents has not previously been linked to the occurrence of ischaemic colitis, consideration of aflibercept's pharmacological properties and the chronological relationship between the administration of this anti-VEGF agent and the occurrence of this systemic adverse event are strongly suggestive of a causal relationship in the present case. Although systemic complications have been rarely associated with intravitreal injections of anti-VEGF agents, physicians should be aware that novel adverse events can still occur in AMD patients treated with anti-VEGF agents.
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Affiliation(s)
- Benjamin Batteux
- Centre Régional de Pharmacovigilance, Service de Pharmacologie Clinique, CHU Amiens-Picardie, Amiens, France
| | - Valérie Gras
- Centre Régional de Pharmacovigilance, Service de Pharmacologie Clinique, CHU Amiens-Picardie, Amiens, France
| | - Yanis Mahboud
- Centre Régional de Pharmacovigilance, Service de Pharmacologie Clinique, CHU Amiens-Picardie, Amiens, France
| | - Sophie Liabeuf
- Centre Régional de Pharmacovigilance, Service de Pharmacologie Clinique, CHU Amiens-Picardie, Amiens, France.,INSERM U 1088, Université de Picardie Jules Verne, Amiens, France
| | - Youssef Bennis
- Laboratoire de Pharmacologie, Service de Pharmacologie Clinique, CHU Amiens-Picardie, Amiens, France.,INSERM U 1088, Université de Picardie Jules Verne, Amiens, France
| | - Kamel Masmoudi
- Centre Régional de Pharmacovigilance, Service de Pharmacologie Clinique, CHU Amiens-Picardie, Amiens, France
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Hwang DK, Hsu CC, Chang KJ, Chao D, Sun CH, Jheng YC, Yarmishyn AA, Wu JC, Tsai CY, Wang ML, Peng CH, Chien KH, Kao CL, Lin TC, Woung LC, Chen SJ, Chiou SH. Artificial intelligence-based decision-making for age-related macular degeneration. Am J Cancer Res 2019; 9:232-245. [PMID: 30662564 PMCID: PMC6332801 DOI: 10.7150/thno.28447] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/25/2018] [Indexed: 01/13/2023] Open
Abstract
Artificial intelligence (AI) based on convolutional neural networks (CNNs) has a great potential to enhance medical workflow and improve health care quality. Of particular interest is practical implementation of such AI-based software as a cloud-based tool aimed for telemedicine, the practice of providing medical care from a distance using electronic interfaces. Methods: In this study, we used a dataset of labeled 35,900 optical coherence tomography (OCT) images obtained from age-related macular degeneration (AMD) patients and used them to train three types of CNNs to perform AMD diagnosis. Results: Here, we present an AI- and cloud-based telemedicine interaction tool for diagnosis and proposed treatment of AMD. Through deep learning process based on the analysis of preprocessed optical coherence tomography (OCT) imaging data, our AI-based system achieved the same image discrimination rate as that of retinal specialists in our hospital. The AI platform's detection accuracy was generally higher than 90% and was significantly superior (p < 0.001) to that of medical students (69.4% and 68.9%) and equal (p = 0.99) to that of retinal specialists (92.73% and 91.90%). Furthermore, it provided appropriate treatment recommendations comparable to those of retinal specialists. Conclusions: We therefore developed a website for realistic cloud computing based on this AI platform, available at https://www.ym.edu.tw/~AI-OCT/. Patients can upload their OCT images to the website to verify whether they have AMD and require treatment. Using an AI-based cloud service represents a real solution for medical imaging diagnostics and telemedicine.
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Shoeibi N, Ansari-Astaneh MR, Sedaghat MR, Shokoohi Rad S. Effect of Intravitreal Bevacizumab Injection on Corneal in vivo Biomechanics: A Pilot Study. J Ophthalmic Vis Res 2019; 14:151-156. [PMID: 31114651 PMCID: PMC6504725 DOI: 10.4103/jovr.jovr_257_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To evaluate the effect of intravitreal bevacizumab (IVB) injection on corneal biomechanical parameters as measured by the ocular response analyzer (ORA) and Corneal Visualization Scheimpflug Technology (CorVis). Methods In this prospective pilot study, ORA and CorVis parameters were recorded before and after a three-month course of IVB injection therapy in 16 patients in the injected and the contralateral non-injected control eyes. The changes in the recorded parameters in each group and the differences between the two groups were evaluated and compared. Results None of the changes in ORA parameters were statistically significant in the injected and non-injected groups before and three months after injection, except for corneal resistance factor (CRF) in injected eyes (paired t-test, P = 0.039). The differences in corneal hysteresis (CH) and CRF were not statistically significant between the two groups (P = 0.441 and 0.236, respectively), but significant differences were noted between corneal compensated IOP (IOPcc) and Goldmann-correlated IOP (IOPg) (P = 0.045 and 0.047, respectively). None of the changes in CorVis parameters were statistically significant in the groups before and at the end of study, except for the time of first corneal applanation (TAp1 ms) in the injected group (P = 0.040, paired t-test). Differences in TAp1, length of the second corneal applanation (LAp2 mm), velocity of the second corneal applanation (VAp2 m/s), intraocular pressure (IOP), and central corneal thickness (CCT) also showed borderline significance between the two groups. Conclusion In this pilot study IVB injection could change CRF, IOPcc, IOPg, and TAP1 as measured by ORA and CorVis.
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Affiliation(s)
- Nasser Shoeibi
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Retina Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad-Reza Ansari-Astaneh
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Retina Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Sedaghat
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Cornea Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeed Shokoohi Rad
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Cornea Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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WRINKLED VASCULARIZED RETINAL PIGMENT EPITHELIUM DETACHMENT PROGNOSIS AFTER INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY. Retina 2018; 38:1100-1109. [PMID: 28520639 DOI: 10.1097/iae.0000000000001698] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE Neovascular age-related macular degeneration (nAMD) is frequently associated with vascularized pigment epithelial detachment (v-PED). We observed a peculiar characteristic of v-PED characterized by small lacy folds of the retinal pigment epithelium, appearing as a wrinkled PED (w-PED) on spectral domain optical coherence tomography (SD-OCT). Our purpose was to describe the visual prognosis and number of intravitreal injections in w-PED compared with non-w-PED. METHODS In this retrospective, case-control series, we reviewed retrospectively medical records of 52 eyes of 51 patients who were consecutively included between November 1 and 30, 2015 with a previous minimum 3-year follow-up. Inclusion criteria were: neovascular age-related macular degeneration, affected with w-PED. Baseline characteristics, best-corrected visual acuity (BVCA), number of intravitreal anti-vascular endothelial growth factor injections (anti-VEGF IVT) and maximal recurrence-free interval, that is, without intravitreal anti-vascular endothelial growth factor injection, were analyzed. A w-PED was defined as a v-PED ≥200 μm in height on SD-OCT imaging, presenting with at least 4 small lacy folds on the surface of the retinal pigment epithelium. Patients were compared with a control group, that is, patients harboring PED without wrinkle shape (non-w-PED). All patients had been treated by intravitreal anti-vascular endothelial growth factor injection of either ranibizumab (IVR) or aflibercept (IVA) using a pro re nata (PRN) protocol after three initial monthly treatments, with a minimum of follow-up of 3 years. RESULTS Two groups of patients were compared, w-PED (29 eyes, from 29 patients), and non-w-PED (23 eyes from 22 patients). In the w-PED group, mean BCVA evolved from 0.28 (±0.18) log MAR (20/40, range 20/25-20/63) at baseline, to 0.29 (±0.21) log MAR (20/40, range 20/25-20/63) at 1 year (P = 0.41), 0.34 (±0.26) log MAR (20/40, range 20/25-20/80) at 2 years (P = 0.49), 0.35 (±0.28) log MAR (20/40, range 20/25-20/80) at 3 years (P = 0.54). In the non-w-PED group, mean BCVA was 0.40 (±0.28) log MAR (20/50, range 20/25-20/100) at baseline and decreased to 0.48 (±0.46) log MAR (20/63, range 20/20-20/160) at 1 year (P = 0.19), 0.48 (±0.35) log MAR (20/63, range 20/25-20/125) at 2 years (P = 0.02), 0.60 (±0.38) log MAR (20/80, range 20/32-20/200) at 3 years (P = 0.002). In the w-PED group, the mean maximal documented recurrence-free interval was 7.87 (±2.94) months at Year 1, 13.5 (±7.52) at Year 2 and 14.78 (±10.70) at Year 3, versus 4.59 (±2.95) months at Year 1, 7.83 (±6.62) at Year 2, 8.57 (±11.18) at Year 3 in the non-w-PED group (P = 0.0004; 0.0101; 0.0168 respectively at Years 1, 2 and 3). DISCUSSION The evolution of v-PED after intravitreal anti-vascular endothelial growth factor injection is still difficult to predict despite intense clinical research in this topic. In our study, we noticed that w-PED might be a phenotypic prognosis factor for better visual acuity and longer maximal recurrence-free interval.
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Morphological Predictive Features on Spectral-Domain Optical Coherence Tomography for Visual Outcomes in Neovascular Age-Related Macular Degeneration Treated with Ranibizumab. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7438083. [PMID: 30046605 PMCID: PMC6038676 DOI: 10.1155/2018/7438083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 05/06/2018] [Indexed: 11/17/2022]
Abstract
Purpose To identify spectral-domain optical coherence tomography (SD-OCT) predictive morphological features for the outcome of Ranibizumab therapy for neovascular age-related macular degeneration (AMD). Methods This is a retrospective multicentric study that involved 64 eyes with naïve AMD. Patients who received three monthly intravitreal injections of Ranibizumab were stratified into (1) "responders" [≥ 5 letters gain on Early Treatment Diabetic Retinopathy Study (ETDRS) scale] and (2) "nonresponders" (< 5 letters gain). Best-corrected visual acuity (BCVA) and SD-OCT morphological features were compared at baseline and one month after three consecutive injections of Ranibizumab. Univariate and multivariate analyses were carried out to correlate these morphological features with the change in BCVA. Results Among the 64 patients enrolled, 40 (62.5%) were "responders" and 24 (37.5%) "nonresponders". Age, sex, and BCVA were comparable between both groups. A multivariate correlational analysis found that subfoveal choroidal thickness (SFCT) and the presence of pigment epithelial detachment (PED) > 250 μm at baseline were two independent prognostic indicators of final BCVA. No other SD-OCT morphological studied features seem to affect final BCVA after Ranibizumab treatment. Conclusion SFCT and the presence of PED > 250 μm are two significant biomarkers that may predict improvement after Ranibizumab therapy for AMD. These markers may guide ophthalmologists' treatment decision under financial constraints and limited time.
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Mori R, Tanaka K, Yuzawa M. Factors predicting 2-year treatment results of ranibizumab therapy for polypoidal choroidal vasculopathy in eyes with good baseline visual acuity. Medicine (Baltimore) 2018; 97:e11188. [PMID: 29924037 PMCID: PMC6024465 DOI: 10.1097/md.0000000000011188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aimed to explore predictors of long-term stabilization of polypoidal choroidal vasculopathy (PCV) lesions and vision in response to injection of intravitreal ranibizumab (IVR). The treated eyes had a baseline best corrected visual acuity (BCVA) of at least 0.6 (logarithm of the minimal angle of resolution (logMAR) 0.22).We treated 45 eyes showing BCVA between 0.6 (logMAR 0.22) and 1.0 (logMAR 0), with IVR for 3 consecutive months. All eyes were confirmed to have subfoveal PCV prior to starting this treatment regimen. Additional IVR was administered at the subsequent monthly visits, if necessitated by evidence of persistent PCV, for up to 23 months after the first ranibizumab injection. The subjects were then carefully followed-up for 24 months, allowing detailed retrospective evaluation of changes in mean BCVA, central retinal thickness (CRT), serous retinal detachment (SRD), hemorrhage, and polypoidal lesion numbers. The relationships between retreatment and each of the baseline characteristics and SRD development during follow-up were analyzed.The mean logMAR BCVAs were 0.111 ± 0.076, 0.068 ± 0.206 (P = .0033) and 0.115 ± 0.265 (P = .27) at baseline and at 12 and 24 months, respectively. At 24 months, 87% of eyes had BCVA of 20/40 or better. Not requiring retreatment between 12 and 23 months was found to be significantly associated with the absence of retinal pigment epithelial detachment (RPED) at baseline (odds ratio: 0.262 (95% confidence interval (CI): 0.073-0.946). The rates of retreatment from 12 to 23 months were significantly higher in eyes with SRD at 6 and 12 months than in those without SRD (P = .004 and P < .001).In conclusion, during 24 months of antivascular endothelial growth factor (VEGF) therapy using ranibizumab for PCV, BCVA was maintained in those with good visual acuity at baseline. Comprehensive analyses revealed RPED at baseline and SRD development during follow-up to correlate significantly with the need for retreatment between 12 and 23 months. Our observations might facilitate tailoring treatments to individual PCV patients.
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Combined VEGF/PDGF inhibition using axitinib induces αSMA expression and a pro-fibrotic phenotype in human pericytes. Graefes Arch Clin Exp Ophthalmol 2018; 256:1141-1149. [PMID: 29721663 DOI: 10.1007/s00417-018-3987-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 03/06/2018] [Accepted: 04/11/2018] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Large trials on anti-VEGF/PDGF (vascular endothelial/platelet-derived growth factor) combination therapy have been established to improve management of neovascular activity in age-related macular degeneration. Targeting pericytes, PDGF is thought to induce vessel regression and reduce fibrovascular scarring. The fate of pericytes exposed to anti-VEGF/PDGF combination therapy is not clear. Therefore, this study was designed to study the influence of anti-VEGF/PDGF on pericyte phenotype and cellular behavior. METHODS Human pericytes from placenta (hPC-PL) were treated with axitinib, a tyrosine kinase inhibitor targeting VEGFR1-3 and PDGFR. Toxic effects were excluded using live/dead staining. Phenotypic changes were evaluated using phalloidin staining for actin cytoskeleton and the expression of stress fibers. MRNA and protein expression levels of α-smooth muscle actin (αSMA) as a marker of proto-myofibroblastic transition were evaluated with real-time PCR and Western blotting. Influences of fibrotic cellular mechanisms were evaluated with a scratch wound migration and a collagen gel contraction assay. RESULTS Treatment with 0.5, 1, and 2.5 μg/ml axitinib strongly induced a proto-myofibroblast-like actin cytoskeleton with a marked increase in stress fibers. Quantitative real-time PCR and Western blotting revealed these changes to be linked to dose-dependent increases in αSMA mRNA and protein expression. However, fibrotic cellular mechanisms were significantly reduced in the presence of axitinib (scratch wound closure: up to - 78.4%, collagen gel contraction: up to - 37.4%). CONCLUSIONS Combined anti-VEGF/PDGF inhibition seems to induce a proto-myofibroblast-like phenotype in human pericytes in vitro, but reduce profibrotic cellular mechanisms due to prolonged anti-PDGF inhibition.
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Arslan J, Baird PN. Changing vision: a review of pharmacogenetic studies for treatment response in age-related macular degeneration patients. Pharmacogenomics 2018; 19:435-461. [DOI: 10.2217/pgs-2017-0183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Nonresponsiveness to age-related macular degeneration (AMD) treatments has become a growing concern in ophthalmology. Disparity among publications that have assessed pharmacogenetic (PGx) connections between AMD disease genes and treatments has delayed the implementation of PGx testing in AMD. We assessed all AMD PGx publications to identify the degree of agreement for publications within similar ethnic cohorts and worldwide, and the causes for differences in study outcomes. There are no accepted genotype–phenotype correlations, either within similar ethnic cohorts or worldwide. The diversity of measured outcomes, treatment protocols and statistical methods used may be causing this discrepancy. A universally accepted treatment protocol and the creation of agreed response group classification may bridge the gap between AMD PGx publications.
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Affiliation(s)
- Janan Arslan
- Department of Surgery (Ophthalmology), Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye & Ear Hospital, East Melbourne, Victoria, 3002, Australia
| | - Paul N Baird
- Department of Surgery (Ophthalmology), Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye & Ear Hospital, East Melbourne, Victoria, 3002, Australia
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One-Year Outcome of Ranibizumab for Neovascular Age-Related Macular Degeneration: A Thorough Analysis in a Real-World Clinical Setting. Eur J Ophthalmol 2018; 24:396-401. [DOI: 10.5301/ejo.5000385] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2013] [Indexed: 01/22/2023]
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Initial Utilization of Aflibercept in Exudative Age-related Macular Degeneration. Eur J Ophthalmol 2018; 24:576-81. [DOI: 10.5301/ejo.5000421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2013] [Indexed: 12/27/2022]
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35
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Farnoodian M, Sorenson CM, Sheibani N. Negative Regulators of Angiogenesis, Ocular Vascular Homeostasis, and Pathogenesis and Treatment of Exudative AMD. J Ophthalmic Vis Res 2018; 13:470-486. [PMID: 30479719 PMCID: PMC6210860 DOI: 10.4103/jovr.jovr_67_18] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Angiogenesis, the formation of new blood vessels from pre-existing capillaries, is very tightly regulated and normally does not occur except during developmental and reparative processes. This tight regulation is maintained by a balanced production of positive and negative regulators, and alterations under pathological conditions such as retinopathy of prematurity, diabetic retinopathy, and age-related macular degeneration can lead to growth of new and abnormal blood vessels. Although the role of proangiogenic factors such as vascular endothelial growth factor has been extensively studied, little is known about the roles of negative regulators of angiogenesis in the pathogenesis of these diseases. Here, we will discuss the role of thrombospondin-1 (TSP1), one of the first known endogenous inhibitors of angiogenesis, in ocular vascular homeostasis, and how its alterations may contribute to the pathogenesis of age-related macular degeneration and choroidal neovascularization. We will also discuss its potential utility as a therapeutic target for treatment of ocular diseases with a neovascular component.
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Affiliation(s)
- Mitra Farnoodian
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
| | - Christine M Sorenson
- Department of Pediatrics, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA.,McPherson Eye Research Institute, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
| | - Nader Sheibani
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA.,McPherson Eye Research Institute, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA.,Department of Biomedical Engineering, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA.,Department of Cell and Regenerative Biology, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
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Mohamad NA, Ramachandran V, Ismail P, Mohd Isa H, Chan YM, Ngah NF, Md Bakri N, Ching SM, Hoo FK, Wan Sulaiman WA. Prevalence and treatment patterns of ranibizumab and photodynamic therapy in a tertiary care setting in Malaysia. Int J Ophthalmol 2017; 10:1889-1897. [PMID: 29259909 PMCID: PMC5733518 DOI: 10.18240/ijo.2017.12.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 08/22/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To describe the prevalence and changes in treatment patterns of ranibizumab and photodynamic therapy (PDT) among retinal disease patients who attended the Ophthalmology Clinic in the tertiary care Hospital Selayang from 2010 to 2014. METHODS Study subjects were recruited retrospectively using the Electronic Medical Record (EMR) database software in Hospital Selayang. Demographic data, medical history, diagnostic procedure, treatments and diagnosis of patients were recorded. RESULTS The five-year analysis included 821 patients with a mean age of 65.9±11.73y. Overall, there were a higher number of males (63.1%) and a higher number of Chinese (47.4%) patients. Among the 821 patients, 62.9% received ranibizumab injection followed by 19.2% PDT therapy and 17.9% had ranibizumab combined with PDT therapy. Age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) were the most common retinal eye diseases reported, recording prevalence of 25.0% and 45.6%, respectively. The trend in ranibizumab treatment was reported to increase while PDT showed a decrease in trend from year 2010 to 2014. In terms of treatment, following multiple logistic regression, AMD was associated with the subjects being more likely to have received ranibizumab monotherapy (P<0.001) while PCV was associated with more likely to have received PDT (P<0.001) and PDT combined with ranibizumab therapy (P<0.001). CONCLUSION The tertiary care setting in Malaysia is consistent with management of patients from other countries whereby ranibizumab is the most common treatment given to patients with AMD, while PCV patients most commonly receive PDT and ranibizumab combined with PDT therapy.
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Affiliation(s)
- Nur Afiqah Mohamad
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Selangor DE 43400, Malaysia
| | - Vasudevan Ramachandran
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Selangor DE 43400, Malaysia
| | - Patimah Ismail
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor DE 43400, Malaysia
| | - Hazlita Mohd Isa
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur 56000, Malaysia
| | - Yoke Mun Chan
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Selangor DE 43400, Malaysia
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor DE 43400, Malaysia
| | - Nor Fariza Ngah
- Department of Ophthalmology, Hospital Selayang, Lebuhraya Selayang-Kepong, Batu Caves 68100, Malaysia
| | - Norshakimah Md Bakri
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Selangor DE 43400, Malaysia
| | - Siew Mooi Ching
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor DE 43400, Malaysia
| | - Fan Kee Hoo
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor DE 43400, Malaysia
| | - Wan Aliaa Wan Sulaiman
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor DE 43400, Malaysia
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Exploring factors predicting changes in patients' expectations and psychosocial issues during the course of treatment with intravitreal injections for wet age-related macular degeneration. Eye (Lond) 2017; 32:673-678. [PMID: 29219960 DOI: 10.1038/eye.2017.271] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 10/22/2017] [Indexed: 11/08/2022] Open
Abstract
PurposePatients with wet age-related macular degeneration (AMD) often require long courses of treatment. We investigate the psychosocial issues that could hinder compliance, including patient expectations of treatment. The aims of this study were to explore the factors related to changes in patient expectations, pain, and anxiety during treatment.Patients and methodsA structured interview was carried out among 50 patients selected from the list attending the AMD unit at the Princess Alexandra Eye Pavilion (PAEP). The interview was based on a questionnaire. Additionally, a visual analogue scale was created as a tool for measuring patient expectations, pain, and anxiety. Data were analysed using multinomial regression analysis.ResultsThere were significantly more patients who had a fall in expectations (P<0.05) during the course of treatment. A fall in expectations was found to be predicted by higher starting expectations (P=0.00001), greater decline in visual acuity (P=0.008), and perceived deterioration of vision after starting treatment (P=0.013). Of the patients, 32% planned to stop attending for further injections. Planning to stop attending was correlated with worse final visual acuity (P=0.026, 95% CI). Pain and anxiety with intravitreal therapy (IVT) was significantly reduced when patients were accompanied to the clinic by a friend or relative (P<0.01) using Pearson's correlation (r=0.597).ConclusionPatients require appropriate counselling at the start of a course of treatment to align expectations with perceived treatment outcomes in order to improve adherence. Additionally, a large minority of patients would consider stopping treatment. Patients' expectations should be assessed at relevant time points along a course of treatment.
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Garweg JG, Niderprim SA, Russ HM, Pfister IB. Comparison of Strategies of Treatment with Ranibizumab in Newly-Diagnosed Cases of Neovascular Age-Related Macular Degeneration. J Ocul Pharmacol Ther 2017; 33:773-778. [DOI: 10.1089/jop.2017.0006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Justus G. Garweg
- Swiss Eye Institute, Rotkreuz, Switzerland
- Berner Augenklinik am Lindenhofspital, Bern, Switzerland
- University of Bern, Bern, Switzerland
| | - Sophie A. Niderprim
- Swiss Eye Institute, Rotkreuz, Switzerland
- Berner Augenklinik am Lindenhofspital, Bern, Switzerland
- University of Bern, Bern, Switzerland
| | - Hanna Maria Russ
- University of Bern, Bern, Switzerland
- Clinic for Radiology and Nuclear Medicine, University Hospital Lübeck, Lübeck, Germany
- Department of Interventional Radiology, Lübeck, Germany
| | - Isabel B. Pfister
- Swiss Eye Institute, Rotkreuz, Switzerland
- Berner Augenklinik am Lindenhofspital, Bern, Switzerland
- University of Bern, Bern, Switzerland
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Kaya F. Change in choroidal thickness after intravitreal injection for treatment of neovascular age-related macular degeneration: Ranibizumab versus aflibercept. J Fr Ophtalmol 2017; 40:832-838. [PMID: 29113742 DOI: 10.1016/j.jfo.2017.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 04/10/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare the changes in subfoveal choroidal thickness after intravitreal ranibizumab or aflibercept injections for neovascular age-related macular degeneration (nAMD). METHODS In this retrospective study, 28 eyes with nAMD treated with 3 consecutive monthly injections of ranibizumab (IVR) and 24 eyes with nAMD treated with 3 consecutive monthly injections of aflibercept (IVA) between September 2012 and June 2016 were reviewed. The follow-up time was 6 months. Changes in two groups' best-corrected visual acuity (BCVA) and subfoveal choroidal thickness by using enhanced depth imaging optical coherence tomography at 1st, 3rd and 6th months were recorded and compared. RESULTS Choroidal thickness decreased significantly in eyes treated with IVR (P=0.015, 0.01 and 0.01, respectively) or IVA (P=0.001, 0.001 and ˂0.001, respectively) at 1, 3 and 6 months examination but IVA treated eyes presented a significantly further reduction in choroidal thickness when compared with ranibizumab (P=0.03, 0,04 and 0.03, respectively). There was no significant difference between aflibercept and ranibizumab group when change in BCVA from baseline compared at 1, 3 and 6th months (P=0.54, 0.06 and 0.37, respectively). There was no correlation between change in choroidal thickness and the BCVA outcomes in either group. CONCLUSIONS Subfoveal choroidal thickness decreased significantly after both of IVR and IVA injections in patients with nAMD. In conclusion, intravitreal injections of ranibizumab or aflibercept affect not only neovascular lesion but also the underlying choroid.
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Affiliation(s)
- F Kaya
- Service d'ophtalmologie, hôpital de Nisa, 34196 Istanbul, Turkey; Clinique universitaire d'ophtalmologie, faculté de médecine, université d'Istanbul Medipol, 34196 Istanbul, Turkey.
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Curry B, Bylsma G, Hewitt AW, Verma N. The VEGF Treatment of AMD Switch Study (The vTAS Study). Asia Pac J Ophthalmol (Phila) 2017; 6:481-487. [PMID: 29204996 DOI: 10.22608/apo.2017364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 10/30/2017] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate the effect of aflibercept on anatomic and visual outcomes in patients with choroidal neovascularization (CNV) previously treated with intravitreal ranibizumab with persistent fluid on optical coherence tomography (OCT). DESIGN Prospective, open-label study. METHODS Eighteen patients (19 eyes) with CNV being treated with monthly ranibizumab, with persistent fluid on OCT, were switched to intravitreal aflibercept injections at intervals of up to 8 weeks. The primary outcome was the proportion of patients maintaining vision [<5 letter loss in visual acuity (VA)] at week 48. Secondary outcomes included the change in VA and central macular thickness (CMT) and the frequency of treatment necessary along with the safety of intravitreal aflibercept. RESULTS Forty-eight weeks after switching to aflibercept, 16/19 eyes had maintained VA. There was a median increase in vision of 5 letters [interquartile range (IQR): 0, 15; P = 0.06)] and median CMT was reduced from 313 µm (IQR: 214, 334) to 258 µm (IQR: 200, 299; P = 0.02). After stratification by fluid location the reduction in CMT was statistically significant for eyes with intraretinal fluid (IRF) at baseline [median change, -25 µm (IQR: -14, -64); P = 0.01]. Macular volume within 6 mm of the fovea (CMTVol) was significantly reduced in eyes with subretinal fluid (SRF) [-0.20 mm³ (IQR: -1.45, -0.05); P = 0.03]. CONCLUSIONS In this small cohort of eyes, switching to aflibercept seemed beneficial. The majority maintained or improved vision and eyes with IRF or SRF had significant reductions in macular edema. However, visual improvement was not always indicative of anatomical improvement.
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Affiliation(s)
| | | | - Alex W Hewitt
- Hobart Eye Surgeons, Hobart, Australia
- University of Tasmania, Hobart, Australia
| | - Nitin Verma
- Hobart Eye Surgeons, Hobart, Australia
- University of Tasmania, Hobart, Australia
- University of Sydney, Sydney, Australia
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Geng XY, Wu HQ, Jiang JH, Jiang K, Zhu J, Xu Y, Dong JC, Yan ZZ. Area and volume ratios for prediction of visual outcome in idiopathic macular hole. Int J Ophthalmol 2017; 10:1255-1260. [PMID: 28861352 DOI: 10.18240/ijo.2017.08.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 04/26/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To predict the visual outcome in patients undergoing macular hole surgery by two novel three-dimensional morphological parameters on optical coherence tomography (OCT): area ratio factor (ARF) and volume ratio factor (VRF). METHODS A clinical case series was conducted, including 54 eyes of 54 patients with an idiopathic macular hole (IMH). Each patient had an OCT examination before and after surgery. Morphological parameters of the macular hole, such as minimum diameter, base diameter, and height were measured. Then, the macular hole index (MHI), tractional hole index (THI), and hole form factor (HFF) were calculated. Meanwhile, novel postoperative macular hole (MH) factors, ARF and VRF were calculated by three-dimensional morphology. Bivariate correlations were performed to acquire asymptotic significance values between the steady best corrected visual acuity (BCVA) after surgery and 2D/3D arguments of MH by the Pearson method with two-tailed test. All significant factors were analyzed by the receiver operating characteristic (ROC) curve analysis of SPSS software which were responsible for vision recovery. ROC curves analyses were performed to further discuss the different parameters on the prediction of visual outcome. RESULTS The mean and standard deviation values of patients' age, symptoms duration, and follow-up time were 64.8±8.9y (range: 28-81), 18.6±11.5d (range: 2-60), and 11.4±0.4mo (range: 6-24), respectively. Steady-post-BCVA analyzed with bivariate correlations was found to be significantly correlated with base diameter (r=0.521, P<0.001), minimum diameter (r=0.514, P<0.001), MHI (r=-0.531, P<0.001), THI (r=-0.386, P=0.004), HFF (r=-0.508, P<0.001), and ARF (r=-0.532, P<0.001). Other characteristic parameters such as age, duration of surgery, height, diameter hole index, and VRF were not statistically significant with steady-post-BCVA. According to area under the curve (AUC) values, values of ARF, MHI, HFF, minimum diameter, THI, and base diameter are 0.806, 0.772, 0.750, 0.705, 0.690, and 0.686, respectively. However, Steady-post-BCVA analysis with bivariate correlations for VRF was no statistical significance. Results of ROC curve analysis indicated that the MHI value, HFF, and ARF was greater than 0.427, 1.027 and 1.558 respectively which could correlate with better visual acuity. CONCLUSION Compared with MHI and HFF, ARF could effectively express three-dimensional characteristics of macular hole and achieve better sensitivity and specificity. Thus, ARF could be the most effective parameter to predict the visual outcome in macular hole surgery.
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Affiliation(s)
- Xing-Yun Geng
- The Institute of Biomedical Engineering, School of Communication and Information Engineering, Shanghai University, Shanghai 200444, China.,Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Hui-Qun Wu
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Jie-Hui Jiang
- The Institute of Biomedical Engineering, School of Communication and Information Engineering, Shanghai University, Shanghai 200444, China
| | - Kui Jiang
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Jun Zhu
- Department of Ophthalmology, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Yi Xu
- Department of Ophthalmology, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Jian-Cheng Dong
- Department of Medical Informatics, Medical School of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Zhuang-Zhi Yan
- The Institute of Biomedical Engineering, School of Communication and Information Engineering, Shanghai University, Shanghai 200444, China
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Sawada T, Wang X, Sawada O, Saishin Y, Ohji M. Aqueous vascular endothelial growth factor and aflibercept concentrations after bimonthly intravitreal injections of aflibercept for age-related macular degeneration. Clin Exp Ophthalmol 2017. [DOI: 10.1111/ceo.13002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Tomoko Sawada
- Department of Ophthalmology; Shiga University of Medical Science; Otsu Shiga Japan
| | - Xiying Wang
- Key Laboratory of Harbin Medical University Eye Center, Eye Hospital; First Affiliated Hospital, Harbin Medical University; Harbin China
| | - Osamu Sawada
- Department of Ophthalmology; Shiga University of Medical Science; Otsu Shiga Japan
| | - Yoshitsugu Saishin
- Department of Ophthalmology; Shiga University of Medical Science; Otsu Shiga Japan
| | - Masahito Ohji
- Department of Ophthalmology; Shiga University of Medical Science; Otsu Shiga Japan
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ANGIOGRAPHIC FINDINGS OF RANIBIZUMAB-RESISTANT POLYPOIDAL CHOROIDAL VASCULOPATHY AFTER SWITCHING TO A TREAT-AND-EXTEND REGIMEN WITH INTRAVITREAL AFLIBERCEPT. Retina 2017; 36:2158-2165. [PMID: 27258669 DOI: 10.1097/iae.0000000000001047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to study the angiopathic findings of ranibizumab-resistant polypoidal choroidal vasculopathy after switching to a treat-and-extend regimen with intravitreal aflibercept. METHODS The authors retrospectively reviewed 17 eyes of 17 Japanese patients with polypoidal choroidal vasculopathy (10 men and 7 women, age: 73.8 ± 7.4 years) who were treated with intravitreal aflibercept (2 mg/0.05 mL) injections from February 2013 to August 2014 at Tokyo University Hospital. All patients had switched to aflibercept because their polypoidal choroidal vasculopathy had been refractory to ranibizumab. RESULTS The mean logMAR best-corrected visual acuity at baseline and after 12 months of therapy was 0.30 ± 0.29 (Snellen equivalent: 20/40) and 0.17 ± 0.26 (20/30) (paired t-test P < 0.001). Visual acuity remained stable in 5 cases (29%), deteriorated in 3 (18%), and improved in 9 (53%). Branching vascular networks persisted in all 17 eyes but shrank in 15 (88%). The mean lesion diameter was 3329 ± 1261 μm at baseline and 3180 ± 1247 μm after 12 months (P = 0.0002). CONCLUSION A treat-and-extend regimen with intravitreal aflibercept for ranibizumab-resistant patients resulted in branching vascular network shrinkage over a 1-year period.
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Reinsberg M, Hilgers RD, Lüdeke I, Nassar K, Grisanti S, Grisanti S, Lüke J, Lüke M. Testing the clinical value of multifocal electroretinography and microperimetry and the effects of intravitreal therapy with ranibizumab on macular function in the course of wet age-related macular degeneration: a 1-year prospective study. Clin Ophthalmol 2017; 11:621-629. [PMID: 28435212 PMCID: PMC5388268 DOI: 10.2147/opth.s123513] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Purpose To investigate the clinical value of multifocal electroretinography (mfERG) and microperimetry and the effects of intravitreal therapy with ranibizumab (Lucentis®) on macular function in the course of neovascular age-related macular degeneration (nAMD). Materials and methods We conducted a prospective single-arm interventional cohort study with 20 nAMD patients older than 50 years. Examinations were scheduled monthly for 1 year during intravitreal therapy with ranibizumab. The examinations included mfERG, microperimetry, spectral domain optical coherence tomography, and best-corrected visual acuity using ETDRS score. Results During the 12-month observation period, a significant positive linear correlation between the logarithm of minimum angle of resolution (logMAR) and scotoma area (r=0.28, 95% confidence interval [CI] 0.21–0.35), between logMAR and fovea thickness in optical coherence tomography (r=0.11, 95% CI 0.04–0.2), and a significant negative correlation between logMAR and mfERG (−0.37, 95% CI −0.43 to −0.31) were observed. A significant ranibizumab effect on logMAR was found (P=0.0065). From a total of 25 relapses, 14 were able to be predicted correctly by mfERG P1 decrease in the preceding month. However, there was no statistically significant relation between prediction and observed relapses (Fisher’s exact test, P=0.6726). Conclusion Our results indicate a possible role of mfERG and microperimetry in the monitoring of macular function and prediction of recurrence during intravitreal pharmacotherapy in wet AMD.
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Affiliation(s)
| | | | - Inger Lüdeke
- University Eye Hospital, University of Lübeck, Lübeck
| | - Khaled Nassar
- University Eye Hospital, University of Lübeck, Lübeck
| | | | | | - Julia Lüke
- University Eye Hospital, University of Lübeck, Lübeck
| | - Matthias Lüke
- University Eye Hospital, University of Lübeck, Lübeck
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Bhattacharya M, Sarkhel S, Peltoniemi J, Broadbridge R, Tuomainen M, Auriola S, Urtti A. Differentially cleaving peptides as a strategy for controlled drug release in human retinal pigment epithelial cells. J Control Release 2017; 251:37-48. [DOI: 10.1016/j.jconrel.2017.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/10/2017] [Accepted: 02/13/2017] [Indexed: 12/21/2022]
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Hatz K, Prünte C. Treat and Extend versus Pro Re Nata regimens of ranibizumab in neovascular age-related macular degeneration: a comparative 12 Month study. Acta Ophthalmol 2017; 95:e67-e72. [PMID: 27009503 DOI: 10.1111/aos.13031] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 01/22/2016] [Indexed: 01/17/2023]
Abstract
PURPOSE To compare outcomes in patients with treatment-naïve neovascular age-related macular degeneration (nAMD) receiving ranibizumab treat and extend (TE) with those receiving ranibizumab pro re nata (PRN) in a clinical setting. METHODS During this 12-month retrospective, consecutive, comparative case series, patients received ranibizumab 0.5 mg according to a TE or PRN regimen. Monthly optical coherence tomography (OCT) evaluation was performed during the PRN regimen; retreatment criteria included recurrence of intra-/subretinal fluid, or haemorrhages. During the TE regimen, initial treatment with 4-week intervals was sequentially lengthened by 2 weeks until signs of choroidal neovascularization (CNV) activity recurred. Study end-points included mean change in best corrected visual acuity (BCVA) and central retinal thickness (CRT), mean injection frequency and number of follow-up visits attended. RESULTS Baseline characteristics were similar between the TE (n = 70) and PRN (n = 70) groups. Mean change in BCVA from baseline to Month 12 was significantly greater in the TE group than the PRN group (+0.18 ± 0.17 versus +0.07 ± 0.20, p < 0.001). Mean change in CRT from baseline to Month 12 was greater in the TE group than the PRN group (-116 ± 132 versus -58 ± 157 μm, p = 0.019). The number of follow-up visits attended was significantly higher in the PRN group than the TE group (11.9 ± 1.1 versus 8.6 ± 1.9, p < 0.001), while patients in the TE group received more injections during the study than those in the PRN group (8.6 ± 1.9 versus 6.0 ± 1.9, p < 0.001). CONCLUSION Ranibizumab administered using a TE regimen in treatment-naïve patients with nAMD provided better visual outcomes with fewer clinic visits, compared with a PRN regimen.
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Affiliation(s)
- Katja Hatz
- Vista Klinik; Binningen Switzerland
- Department of Ophthalmology; Kantonsspital Liestal Switzerland
- University of Basel; Basel Switzerland
| | - Christian Prünte
- Vista Klinik; Binningen Switzerland
- Department of Ophthalmology; Kantonsspital Liestal Switzerland
- University of Basel; Basel Switzerland
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Feltgen N, Bertelmann T, Bretag M, Pfeiffer S, Hilgers R, Callizo J, Goldammer L, Bemme S, Hoerauf H. Efficacy and safety of a fixed bimonthly ranibizumab treatment regimen in eyes with neovascular age-related macular degeneration: results from the RABIMO trial. Graefes Arch Clin Exp Ophthalmol 2017; 255:923-934. [PMID: 28102456 DOI: 10.1007/s00417-017-3589-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/05/2017] [Accepted: 01/11/2017] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To evaluate prospectively the efficacy and safety of a fixed bimonthly ranibizumab treatment regimen (RABIMO) in eyes with neovascular age-related macular degeneration (nAMD) and to compare these results with a pro re nata (PRN) treatment scheme. METHODS This was a 12-month, phase IV, single center, randomised, non-inferiority study. Following three initial monthly injections, patients were randomised to receive either ranibizumab bimonthly (RABIMO group) or ranibizumab PRN (PRN group) (n = 20 each). Main outcome measures were best-corrected visual acuity (BCVA), central retinal thickness (CRT), number of injections, and adverse events (AEs). RESULTS BCVA [median (interquartile range, IQR)] increased significantly in both groups after 12 months [RABIMO group +8.5 (14); PRN group +6.5 (16) ETDRS letters] when compared to baseline (p < 0.0001; p = 0.0085). At month 12, the RABIMO treatment regimen was non-inferior to the PRN scheme (∆BCVA = 3.5 ETDRS letters; p < 0.0001). CRT was significantly reduced in both groups after the 12-month study period (p < 0.0001 each), with no significant difference between groups (p = 0.6772). Number of overall injections [median (IQR)] was 8 (0) in the RABIMO versus 4 (5) in the PRN group (p = 0.0037). Three patients in the RABIMO group received one additional unscheduled injection. We observed no significant differences between groups in the number of patients with reported SAEs/AEs (RABIMO group n = 6/15; PRN group n = 7/13) (p = 0.7357/p = 0.4902). CONCLUSIONS We found no evidence of significant functional or anatomical differences between the RABIMO and PRN treatment regimens. However, the RABIMO group's number of injections was twice as high as the PRN group's (protocol-driven). In light of potential side effects, the fixed bimonthly treatment regimen might not be advisable for routine clinical care, but it might be a worthwhile treatment option if monthly monitoring is not possible. Eudra-CT number: 2009-017324-11.
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Affiliation(s)
- Nicolas Feltgen
- Department of Ophthalmology, University Medical Centre, Robert-Koch-Straße 40, 37075, Goettingen, Germany.
| | - Thomas Bertelmann
- Department of Ophthalmology, University Medical Centre, Robert-Koch-Straße 40, 37075, Goettingen, Germany
| | - Mirko Bretag
- Department of Ophthalmology, Carl-Thiem-Klinikum gGmbH, Cottbus, Germany
| | - Sebastian Pfeiffer
- Institute for Clinical Research GmbH, Georg-August-University, Goettingen, Germany
| | - Reinhard Hilgers
- Institute for Medical Statistics, Georg-August-University, Goettingen, Germany
| | - Josep Callizo
- Department of Ophthalmology, University Medical Centre, Robert-Koch-Straße 40, 37075, Goettingen, Germany
| | | | - Sebastian Bemme
- Department of Ophthalmology, University Medical Centre, Robert-Koch-Straße 40, 37075, Goettingen, Germany
| | - Hans Hoerauf
- Department of Ophthalmology, University Medical Centre, Robert-Koch-Straße 40, 37075, Goettingen, Germany
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Chung WH, van Dijk EHC, Mohabati D, Dijkman G, Yzer S, de Jong EK, Fauser S, Schlingemann RO, Hoyng CB, Boon CJF. Neovascular age-related macular degeneration without drusen in the fellow eye: clinical spectrum and therapeutic outcome. Clin Ophthalmol 2017; 11:63-70. [PMID: 28053502 PMCID: PMC5189970 DOI: 10.2147/opth.s122568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose To investigate the clinical characteristics and therapeutic outcome of patients with neovascular age-related macular degeneration (nAMD) in 1 eye, without drusen in the fellow eye. Patients and methods Medical records of 381 patients were analyzed to identify the cases. The main outcomes included Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) and change in central retinal thickness (CRT). These parameters were reviewed at baseline, first follow-up visit, and after 6, 12, and 24 months. Results Out of 381 patients, 29 cases (8%) were included (of whom 3 had polypoidal choroidal vasculopathy [PCV]) who were treated with anti-vascular endothelial growth factor (anti-VEGF) therapy which was supplemented by photodynamic therapy (PDT) in the PCV patients. Overall, no statistically significant change in mean BCVA was observed during follow-up. BCVA improved or remained stable (defined as a gain in BCVA, a stable BCVA, or a loss of <5 ETDRS letters) in 22 patients (76%), and 7 patients (23%) had lost ≥5 ETDRS letters at final follow-up. A gain of ≥15 ETDRS letters at final follow-up was seen in 5 patients (17%). Mean CRT had decreased significantly with 99 µm (P<0.001) at 24 months after the initial visit. Conclusion There is a clinical spectrum of nAMD that is not associated with drusen in the fellow eye. Patients with nAMD without drusen in the fellow eye respond to anti-VEGF treatment and, in cases of PCV, to supplemental PDT. The pathophysiology of this spectrum of nAMD may be different from drusen-associated age-related macular degeneration.
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Affiliation(s)
- Wing H Chung
- Department of Ophthalmology, Leiden University Medical Center, Leiden
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden
| | - Danial Mohabati
- Department of Ophthalmology, Leiden University Medical Center, Leiden
| | - Greet Dijkman
- Department of Ophthalmology, Leiden University Medical Center, Leiden
| | | | - Eiko K de Jong
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sascha Fauser
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | - Reinier O Schlingemann
- Department of Ophthalmology; Ocular Angiogenesis Group, Departments of Ophthalmology and Cell Biology and Histology, Academic Medical Center; Netherlands Institute for Neuroscience, Amsterdam, the Netherlands
| | - Carel B Hoyng
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden; Department of Ophthalmology
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Pennington KL, DeAngelis MM. Epidemiology of age-related macular degeneration (AMD): associations with cardiovascular disease phenotypes and lipid factors. EYE AND VISION 2016; 3:34. [PMID: 28032115 PMCID: PMC5178091 DOI: 10.1186/s40662-016-0063-5] [Citation(s) in RCA: 294] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 11/24/2016] [Indexed: 12/13/2022]
Abstract
Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in adults over 50 years old. Genetic, epidemiological, and molecular studies are beginning to unravel the intricate mechanisms underlying this complex disease, which implicate the lipid-cholesterol pathway in the pathophysiology of disease development and progression. Many of the genetic and environmental risk factors associated with AMD are also associated with other complex degenerative diseases of advanced age, including cardiovascular disease (CVD). In this review, we present epidemiological findings associating AMD with a variety of lipid pathway genes, cardiovascular phenotypes, and relevant environmental exposures. Despite a number of studies showing significant associations between AMD and these lipid/cardiovascular factors, results have been mixed and as such the relationships among these factors and AMD remain controversial. It is imperative that researchers not only tease out the various contributions of such factors to AMD development but also the connections between AMD and CVD to develop optimal precision medical care for aging adults.
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Affiliation(s)
- Katie L Pennington
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, UT USA
| | - Margaret M DeAngelis
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, UT USA
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TOPICAL APRACLONIDINE REDUCES PAIN AFTER INTRAVITREAL INJECTIONS: A Double-Blind Randomized Controlled Trial. Retina 2016; 37:1575-1580. [PMID: 27841849 DOI: 10.1097/iae.0000000000001397] [Citation(s) in RCA: 5] [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 evaluate the efficacy of topical apraclonidine in reducing pain and subconjunctival hemorrhage (SCH) after intravitreal injections (IViT). METHODS A prospective, randomized, double-blinded study. Thirty-nine patients were examined twice, at each monthly IViT of 1.25 mg/0.05 mL bevacizumab. Patients were randomly assigned to receive either topical apraclonidine 0.5% or placebo to the treated eye, 30 minutes before the first IViT. At their second IViT, the intervention was switched. Thirty minutes after the injection, SCH size was measured by a slit lamp, and pain was assessed by the numerical rating scale (NRS-11). RESULTS Mean pain score was 1.69 (SD ±1.44) in the apraclonidine group and 3.28 (SD ±2.27) in the control group (P < 0.001). Phakic patients had a greater pain reduction after topical apraclonidine (P < 0.001). Subconjunctival hemorrhage incidence was 41% in the apraclonidine group and 51.3% in the control group (P = 0.503). Mean SCH size was 1.71 mm (SD ±5.83) in the apraclonidine group and 3.25 mm (SD ±6.41) in the control group (P = 0.253). After topical apraclonidine, there was a smaller reduction in SCH size in patients with choroidal neovascularization or hypertension (P = 0.003 and 0.044, respectively), and a greater reduction in phakic patients (P = 0.048). CONCLUSION Topical apraclonidine 0.5%, administered 30 minutes before IViT, significantly decreased pain by a factor of 1.94. It did not decrease the incidence or size of SCH in the entire cohort, but only in several subpopulations.
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