1
|
Cao J, Mongy M, Ferreira L, Brent MH. Ganglion cell complex changes in wet AMD patients treated with anti-VEGF intravitreal injections according to a treat-and-extend protocol. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:96-101. [PMID: 36535380 DOI: 10.1016/j.jcjo.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 11/15/2022] [Accepted: 11/26/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To analyze changes in ganglion cell complex (GCC) thickness in wet age-related macular degeneration (AMD) patients receiving intravitreal injections. DESIGN Retrospective cohort study involving 46 eyes at a single tertiary ophthalmology practice. PARTICIPANTS The injection group consisted of wet AMD patients who received intravitreal injections for at least 3 years following a treat-and-extend protocol. Twenty-two patients received ranibizumab, and 1 patient received aflibercept. The control group consisted of dry AMD patients who were observed only and did not receive medical treatment over the same period. GCC thickness and visual acuity were recorded at baseline and at 1-, 2-, and 3-year follow-up visits. RESULTS In the injection group, there was a nonsignificant trend toward reduction in GCC thickness over 3 years (-4.09 ± 8.47 µm; p = 0.09). Within the injection group, correlation analysis between the number of intravitreal injections and GCC thickness was nonsignificant but trended toward a direct relationship, with more injections correlated with a relatively thicker GCC at 3 years. There was no significant change in GCC thickness between baseline and year 3 for the control group. CONCLUSIONS Study results suggest that that there is no significant GCC thinning in wet AMD patients following a treat-and-extend regimen over 3 years.
Collapse
Affiliation(s)
- Jessica Cao
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Mohamed Mongy
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Lisia Ferreira
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Michael Henry Brent
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON..
| |
Collapse
|
2
|
Dammacco R, Lisch W, Kivelä TT, Terpos E, Kastritis E, Sisto D, Mavilio A, Ria R, Alessio G, Vacca A, Dammacco F. The Spectrum of Ocular Manifestations in Patients with Waldenström's Macroglobulinemia. Ocul Immunol Inflamm 2022; 30:1659-1668. [PMID: 34270382 DOI: 10.1080/09273948.2021.1933068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the ocular manifestations in 91 Waldenström's macroglobulinemia (WM) patients. METHODS Retrospective, cross-sectional, observational analysis. RESULTS Ocular impairments, detected in 19 patients, included flame-shaped hemorrhages, venous sausaging, papilledema, macular detachments, or central retinal vein occlusion in 16 patients; paraproteinemic keratopathy in 2; and a CANOMAD syndrome in 1. Best-corrected visual acuity was ≥0.5 logMAR units in 11 of 38 eyes. Intraocular pressure was increased in seven eyes. Genetic analysis in seven patients showed a mutation in the MYD88 gene in six patients and a nonsense mutation in the CXCR4 gene in five patients. Plasmapheresis followed by chemotherapy with or without the addition of rituximab resulted in improvement or normalization of the ophthalmological findings in 15 patients. CONCLUSION The ocular manifestations of WM are protean and potentially sight threatening. Recent advances in genomic profiling and chemotherapy have remarkably improved the hematological and ophthalmological outcomes of these patients.
Collapse
Affiliation(s)
- Rosanna Dammacco
- Department of Ophthalmology and Neuroscience, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Walter Lisch
- Department of Ophthalmology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Tero T Kivelä
- Department of Ophthalmology, University of Helsinki, Helsinki, Finland
| | - Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian School of Medicine, University of Athens, Athens, Greece
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian School of Medicine, University of Athens, Athens, Greece
| | - Dario Sisto
- Department of Ophthalmology and Neuroscience, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Alberto Mavilio
- Social Health District, Glaucoma Center, Azienda Sanitaria Locale, Brindisi, Italy
| | - Roberto Ria
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Giovanni Alessio
- Department of Ophthalmology and Neuroscience, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Franco Dammacco
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Medical School, Bari, Italy
| |
Collapse
|
3
|
What the Silent Retina Tells You: Serous Retinal Detachment in Waldenström's Macroglobulinemia. Hemasphere 2021; 5:e527. [PMID: 33490879 PMCID: PMC7819681 DOI: 10.1097/hs9.0000000000000527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/09/2020] [Indexed: 12/05/2022] Open
|
4
|
Li J, Zhang R, Gu F, Liu ZL, Sun P. Optical coherence tomography angiography characteristics in Waldenström macroglobulinemia retinopathy: A case report. World J Clin Cases 2020; 8:6071-6079. [PMID: 33344607 PMCID: PMC7723702 DOI: 10.12998/wjcc.v8.i23.6071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/11/2020] [Accepted: 10/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Waldenström macroglobulinemia (WM) is a distinct clinicopathologic entity characterized by the infiltration of the bone marrow by clonal lymphoplasmacytic cells that produce monoclonal immunoglobulin M (IgM) in the blood, and patients may present with symptoms related to the infiltration of the hematopoietic tissues or the effects of monoclonal IgM in the blood. Funduscopic abnormalities were noted in some of the patients due to hyperviscosity or other retinal lesions. Optical coherence tomography angiography (OCTA) as a non-invasive imaging tool can give qualitative and quantitative information about the status of retinal and choroidal vessels, which might be useful for diagnosing patients with WM-associated retinopathy.
CASE SUMMARY The patient was a 67-year-old man who presented with sudden visual disturbance in both eyes. Ophthalmic tests showed that best corrected visual acuity (BCVA) for this patient was 20/100 in the right eye and 20/1000 in the left eye. Fundus examination, optical coherence tomography (OCT), and OCTA revealed substantial bilateral optic disc edema, dilated and tortuous retinal veins, and diffuse intraretinal blot hemorrhages and edema which were consistent with bilateral central retinal vein occlusion (CRVO). Meanwhile, remarkable bilateral serous macular detachments (SMD) were noticed on OCT. Systemic examinations showed that the patient had anemia and extremely high level of monoclonal IgM and infiltration of clonal lymphoplasmacytic cells in bone marrow. The diagnosis of WM with hyperviscosity and retinopathy was made based on the clinical manifestation and laboratory findings. He was subsequently treated with intravitreal ranibizumab injection, plasmapheresis, and bortezomib plus rituximab with dexamethasone. Six months after treatments, the central macular volume decreased by 16.1% in the right eye and 28.6% in the left eye on OCT, and the patient’s BCVA was improved to 20/60 in the right eye and 20/400 in the left eye. Very good partial response was obtained after systemic treatment.
CONCLUSION WM may affect visual function and present as bilateral CRVO. OCTA can show characteristic changes in both retina and choroid vasculatures, which might be of great value for diagnosing or following patients with WM retinopathy. Intravitreal anti-vascular endothelial growth factor treatment combined with systemic therapy might be beneficial for WM patients with retinopathy (SMD and CRVO).
Collapse
Affiliation(s)
- Jun Li
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Rui Zhang
- Department of Hematology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Feng Gu
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Zhe-Li Liu
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Peng Sun
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| |
Collapse
|
5
|
Li J, Zhang R, Gu F, Liu ZL, Sun P. Optical coherence tomography angiography characteristics in Waldenström macroglobulinemia retinopathy: A case report. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i23.6065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
|
6
|
Iovino C, Mastropasqua R, Lupidi M, Bacherini D, Pellegrini M, Bernabei F, Borrelli E, Sacconi R, Carnevali A, D’Aloisio R, Cerquaglia A, Finocchio L, Govetto A, Erba S, Triolo G, Di Zazzo A, Forlini M, Vagge A, Giannaccare G. Intravitreal Dexamethasone Implant as a Sustained Release Drug Delivery Device for the Treatment of Ocular Diseases: A Comprehensive Review of the Literature. Pharmaceutics 2020; 12:pharmaceutics12080703. [PMID: 32722556 PMCID: PMC7466091 DOI: 10.3390/pharmaceutics12080703] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 12/13/2022] Open
Abstract
Drug delivery into the vitreous chamber remains a great challenge in the pharmaceutical industry due to the complex anatomy and physiology of the eye. Intravitreal injection is the mainstream route of drug administration to the posterior segment of the eye. The purpose of this review is to assess the current literature about the widening use of the intravitreal 0.7 mg dexamethasone (Dex) implant, and to provide a comprehensive collection of all the ocular disorders that benefit from Dex administration. Although anti-vascular endothelial growth-factors (VEGFs) have been largely indicated as a first-choice level, the Dex implant represents an important treatment option, especially in selected cases, such as vitrectomized eyes or patients in whom anti-VEGF failed or are contraindicated. In this article, the safety profile as well as the list of the possible complications related to intravitreal Dex injection are also discussed.
Collapse
Affiliation(s)
- Claudio Iovino
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, 09124 Cagliari, Italy
- Correspondence: ; Tel.: +39-070-609-2319
| | - Rodolfo Mastropasqua
- Institute of Ophthalmology, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Marco Lupidi
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, 06129 Perugia, Italy; (M.L.); (A.C.)
- Fondazione per la Macula Onlus, DINOMGI., University Eye Clinic, 16132 Genova, Italy
- Centre de l’Odéon, 113 Boulevard St Germain, 75006 Paris, France
| | - Daniela Bacherini
- Department of Neurosciences, Psychology, Drug Research and Child Health, Eye Clinic, University of Florence, AOU Careggi, 50139 Florence, Italy; (D.B.); (L.F.)
| | - Marco Pellegrini
- Ophthalmology Unit, S. Orsola-Malpighi University Hospital, University of Bologna, 40138 Bologna, Italy; (M.P.); (F.B.)
| | - Federico Bernabei
- Ophthalmology Unit, S. Orsola-Malpighi University Hospital, University of Bologna, 40138 Bologna, Italy; (M.P.); (F.B.)
| | - Enrico Borrelli
- Department of Ophthalmology, Hospital San Raffaele, University Vita Salute San Raffaele, 20132 Milan, Italy; (E.B.); (R.S.)
| | - Riccardo Sacconi
- Department of Ophthalmology, Hospital San Raffaele, University Vita Salute San Raffaele, 20132 Milan, Italy; (E.B.); (R.S.)
| | - Adriano Carnevali
- Department of Ophthalmology, University “Magna Graecia,” 88100 Catanzaro, Italy; (A.C.); (G.G.)
| | - Rossella D’Aloisio
- Department of Medicine and Science of Ageing, Ophthalmology Clinic, University “G. d’Annunzio” Chieti-Pescara, 66100 Chieti, Italy;
| | - Alessio Cerquaglia
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, 06129 Perugia, Italy; (M.L.); (A.C.)
| | - Lucia Finocchio
- Department of Neurosciences, Psychology, Drug Research and Child Health, Eye Clinic, University of Florence, AOU Careggi, 50139 Florence, Italy; (D.B.); (L.F.)
- Moorfields Eye Hospital NHS Foundation Trust, London EC1V2PD, UK
| | - Andrea Govetto
- Fatebenefratelli-Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, 63631 Milan, Italy; (A.G.); (S.E.); (G.T.)
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol BS12LX, UK
| | - Stefano Erba
- Fatebenefratelli-Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, 63631 Milan, Italy; (A.G.); (S.E.); (G.T.)
| | - Giacinto Triolo
- Fatebenefratelli-Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, 63631 Milan, Italy; (A.G.); (S.E.); (G.T.)
| | - Antonio Di Zazzo
- Ophthalmology Complex Operative Unit, Campus Bio Medico University Hospital, 00128, Rome, Italy;
| | | | - Aldo Vagge
- University Eye Clinic, DINOGMI, Polyclinic Hospital San Martino IRCCS, 16132 Genoa, Italy;
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University “Magna Graecia,” 88100 Catanzaro, Italy; (A.C.); (G.G.)
| |
Collapse
|
7
|
Diagnostic Criteria for Macular Edema Associated with Venous Occlusions. ACTA BIOMEDICA SCIENTIFICA 2020. [DOI: 10.29413/abs.2020-5.2.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
8
|
Bilateral simultaneous central retinal vein occlusion revealing Waldenström's macroglobulinemia. Presse Med 2019; 48:201-206. [DOI: 10.1016/j.lpm.2018.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 05/31/2018] [Accepted: 11/07/2018] [Indexed: 11/20/2022] Open
|
9
|
Lin AB, Sheyman AT, Jampol LM. UNUSUAL SEROUS RETINAL DETACHMENT IN A PATIENT WITH WALDENSTROM MACROGLOBULINEMIA: A CASE REPORT. Retin Cases Brief Rep 2019; 13:1-4. [PMID: 28106626 DOI: 10.1097/icb.0000000000000540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND/PURPOSE To report an unusual appearance of severe bilateral serous detachments in a patient with Waldenstrom macroglobulinemia. METHODS A case report of a Fifty-six-year-old female patient with Waldenstrom macroglobulinemia. RESULTS A patient with Waldenstrom macroglobulinemia presented with serous retinal detachments at the time of diagnosis with Waldenstrom. The patient's IgM levels remained abnormally elevated in the initial stages of her disease course, leading to dramatic ocular findings and images on optical coherence tomography. Chemotherapy was initiated and IgM levels slowly declined, with some improvement in macular fluid as IgM normalized. CONCLUSION Waldenstrom macroglobulinemia may lead to dramatic retinal pathology if IgM levels remain elevated. Prompt chemotherapy and reduction of immunoglobulin levels should be undertaken to preserve retinal architecture.
Collapse
Affiliation(s)
- Albert B Lin
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alan T Sheyman
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Lee M Jampol
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| |
Collapse
|
10
|
Georgakopoulos CD, Plotas P, Angelakis A, Kagkelaris K, Tzouvara E, Makri OE. Dexamethasone implant for immunogammopathy maculopathy associated with IgA multiple myeloma. Ther Adv Ophthalmol 2019; 11:2515841418820441. [PMID: 30671569 PMCID: PMC6329023 DOI: 10.1177/2515841418820441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 11/29/2018] [Indexed: 11/18/2022] Open
Abstract
Background: We describe a case where hyperviscosity retinopathy and immunogammopathy maculopathy were the presenting features of IgA multiple myeloma and report the response of maculopathy to intravitreal injection of dexamethasone implants. Case presentation: A 56-year-old man presented at the Department of Ophthalmology with the chief complain of reduced vision for the past 10 days in both eyes. Ophthalmic examination revealed central retinal vein occlusion resembling signs with severe macular edema in both eyes with prominent serous macular detachment. After comprehensive evaluation, an IgA type kappa multiple myeloma was diagnosed complicated with hyperviscosity-associated retinopathy and immunogammopathy maculopathy. Patient was treated with multiple sessions of plasmapheresis, systemic chemotherapy, and finally intravitreal implants of dexamethasone with complete restoration of macular edema and serous macular detachment in both eyes. The visual function and the hyperviscosity-associated retinopathy were partially restored. Conclusion: Ocular manifestation might be the only presenting sign of a life-threatening disease such as IgA multiple myeloma. A high level of suspicion is required to diagnose and treat such cases promptly and effectively.
Collapse
Affiliation(s)
| | - Panagiotis Plotas
- Department of Ophthalmology, Medical School, University of Patras, Patras, Greece
| | - Angelos Angelakis
- Department of Ophthalmology, Medical School, University of Patras, Patras, Greece
| | | | - Evangelia Tzouvara
- Department of Internal Medicine, Medical School, University of Patras, Patras, Greece
| | - Olga E Makri
- Department of Ophthalmology, Medical School, University of Patras, Patras, Greece
| |
Collapse
|
11
|
Krishnappa NC, Ganne P. Paraproteinemic Maculopathy in a 63-Year-Old Man. JAMA Ophthalmol 2018; 136:944-945. [DOI: 10.1001/jamaophthalmol.2017.6285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
12
|
Ratra D, Ratra V, Kishnani M. Localized retinal degeneration secondary to Waldenström's macroglobulinemia. Oman J Ophthalmol 2017; 10:244-246. [PMID: 29118506 PMCID: PMC5657173 DOI: 10.4103/ojo.ojo_126_2016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A 52-year-old man, treated for Waldenström's macroglobulinemia (WM), continued to experience decreased vision even after 24 months. He was evaluated using multimodal imaging and electroretinography. The retina did not show any hyperviscosity changes but revealed a yellow lesion at macula with atrophic changes causing a pattern on fluorescein angiography similar to a leopard's skin. Optical coherence tomographic imaging revealed uniformly reflective material deposited in the outer retina with degeneration of outer retinal layers. Full-field electroretinography was normal, but multifocal electroretinography revealed reduced foveal responses. This case highlights the degenerative effects of long-standing immunogammopathy maculopathy in WM.
Collapse
Affiliation(s)
- Dhanashree Ratra
- Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Vineet Ratra
- Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Mansi Kishnani
- Sewa Sadan Eye Hospital Trust, Behind Civil Hospital, Bhopal, Madhya Pradesh, India
| |
Collapse
|
13
|
Lee SE, Shin YU, Lim HW, Seong MC, Cho HY, Kang MH. Bilateral Simultaneous Central Retinal Vein Occlusion in a Patient with Waldenstrom's Macroglobulinemia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.6.1012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Sang Eon Lee
- Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Yong Un Shin
- Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Han Woong Lim
- Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Min Chul Seong
- Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Hee Yoon Cho
- Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Min Ho Kang
- Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| |
Collapse
|
14
|
Kamath S, Patil M, Mendonca N, Nazareth N, Bhat S, Rodrigues FEA, Cestari DM, Randhawa S. Diagnostic and Therapeutic Challenges. Retina 2016; 36:216-20. [DOI: 10.1097/iae.0000000000000510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
15
|
Rajagopal R, Apte RS. Seeing through thick and through thin: Retinal manifestations of thrombophilic and hyperviscosity syndromes. Surv Ophthalmol 2015; 61:236-47. [PMID: 26519860 DOI: 10.1016/j.survophthal.2015.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/21/2015] [Accepted: 10/23/2015] [Indexed: 01/23/2023]
Abstract
The presence of retinal vasculopathy in the absence of typical predisposing factors should suggest a possible underlying hematologic abnormality. In such cases, a systemic investigation may reveal a potentially fatal hypercoagulability or hyperviscosity syndrome. Retinal vein occlusion is the most commonly encountered ophthalmic finding in such syndromes; however, abnormalities of the arterial system, the choroid, and the macula are also possible. Visual symptoms may be the only manifestation of the underlying process, making timely diagnosis by the ophthalmologist critical for both treatment and thrombotic prophylaxis. Moreover, as newer ophthalmic diagnostic technologies arise, there is an increasingly important role for eye physicians in the management of such syndromes.
Collapse
Affiliation(s)
- Rithwick Rajagopal
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Saint Louis, Missouri, USA.
| | - Rajendra S Apte
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Saint Louis, Missouri, USA.
| |
Collapse
|
16
|
Xu LT, Courtney RJ, Ehlers JP. Bevacizumab therapy and multimodal ultrawide-field imaging in immunogammopathy maculopathy secondary to Waldenström's macroglobulinemia. Ophthalmic Surg Lasers Imaging Retina 2015; 46:262-5. [PMID: 25707055 DOI: 10.3928/23258160-20150213-06] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 09/05/2014] [Indexed: 12/18/2022]
Abstract
Waldenström's macroglobulinemia (WM) is associated with retinal findings of hyperviscosity, such as venous dilation, and findings of immunogammopathy maculopathy, such as serous macular detachment. This report describes a case of bilateral serous macular detachment with intraretinal schisis-like fluid in a patient with WM. Enhanced depth imaging optical coherence tomography revealed a thickened choroid with hyperreflective accumulations in the retinal pigment epithelium layer. Ultrawide-field fundus autofluorescence demonstrated a central area of hyperautofluorescence corresponding to the area of serous macular detachment. Ultrawide-field fluorescein angiography was characteristically silent. Intravitreal bevacizumab therapy resulted in significant reduction in intraretinal fluid but minimal change in subretinal fluid. Long-term follow-up demonstrated alterations in retinal architecture and improved serous detachments.
Collapse
|
17
|
Ganglion Cell Complex Evaluation in Exudative Age-Related Macular Degeneration after Repeated Intravitreal Injections of Ranibizumab. BIOMED RESEARCH INTERNATIONAL 2015; 2015:268796. [PMID: 26167478 PMCID: PMC4475747 DOI: 10.1155/2015/268796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 10/17/2014] [Accepted: 10/26/2014] [Indexed: 12/01/2022]
Abstract
Purpose. To detect the effects of intravitreal ranibizumab injections on GCC in patients with wet AMD. Methods. 32 wet AMD eyes were selected and submitted at three ranibizumab injections. RTVue-OCT GCC and MM5 protocol were performed before treatment and twenty days after each injection. Results. At baseline mean GCC thickness was 93.9 ± 18.5 μm. Twenty days after each intravitreal injection it was, respectively, 85.8 ± 10.1, 86.5 ± 9.3, and 91.1 ± 11.5 μm, without statistical significance. A significant improvement in visual acuity (P = 0.031) and a reduction of mean foveal (P = 0.001) and macular thickness (P = 0.001) were observed. Conclusion. The clinical results confirm therapeutic efficacy of intravitreal injections of ranibizumab in wet AMD. A contemporary not statistically significant reduction of GCC thickness suggests that the loading phase of ranibizumab does not have any toxic effects on ganglion cell complex.
Collapse
|
18
|
Kapoor KG, Wagner MS. Bevacizumab in macular serous detachments associated with Waldenstrom's macroglobulinemia. Ophthalmic Surg Lasers Imaging Retina 2015; 46:95-7. [PMID: 25559519 DOI: 10.3928/23258160-20150101-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 08/15/2014] [Indexed: 12/22/2022]
Abstract
Waldenström's macroglobulinemia (WM) is a lymphoproliferative B-cell disorder characterized by monoclonal proliferation of immunoglobulin M. WM can be associated with impressive hyperviscosity retinopathy and a unique tendency to develop serous macular detachments. These have been described as immunogammopathy maculopathy and portend a poor visual prognosis, often persisting despite multiple plasmapheresis treatments. In this case report, the authors demonstrate the accelerated resolution of hyperviscosity retinopathy and associated macular detachments in a patient with WM with marked visual improvement. This case report serves to raise awareness of the potential role of anti-vascular endothelial growth factor modulation in the treatment of patients with hyperviscosity retinopathy associated with WM.
Collapse
|
19
|
Ratanam M, Ngim YS, Khalidin N, Subrayan V. Intravitreal bevacizumab: a viable treatment for bilateral central retinal vein occlusion with serous macular detachment secondary to Waldenström macroglobulinaemia. Br J Haematol 2015; 170:431-4. [PMID: 25640801 DOI: 10.1111/bjh.13307] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Mohanarasan Ratanam
- Department of Ophthalmology, University of Malaya Medical Centre, Jalan University, Kuala Lumpur, Malaysia.
| | - You Siang Ngim
- Department of Ophthalmology, Sultanah Fatimah Hospital, Muar, Johor, Malaysia
| | - Nurliza Khalidin
- Department of Ophthalmology, University of Malaya Medical Centre, Jalan University, Kuala Lumpur, Malaysia
| | - Visvaraja Subrayan
- Department of Ophthalmology, University of Malaya Medical Centre, Jalan University, Kuala Lumpur, Malaysia
| |
Collapse
|
20
|
Mansour AM, Arevalo JF, Badal J, Moorthy RS, Shah GK, Zegarra H, Pulido JS, Charbaji A, Amselem L, Lavaque AJ, Casella A, Ahmad B, Paschall JG, Caimi A, Staurenghi G. Paraproteinemic maculopathy. Ophthalmology 2014; 121:1925-32. [PMID: 24950591 DOI: 10.1016/j.ophtha.2014.04.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/06/2014] [Accepted: 04/09/2014] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Paraproteinemia relates to monoclonal gammopathy-producing pathologic antibodies with serous macular detachment being an uncommon ocular manifestation. We ascertained the clinical course of maculopathy in paraproteinemia and investigated the effect of various therapeutic methods on the resolution of subretinal deposits. DESIGN Multicenter, retrospective, observational case series. PARTICIPANTS The records of patients with paraproteinemia with optical coherence tomography (OCT) documentation of serous macular detachment were reviewed. METHODS Data collection included coexisting morbidity, rheology data (immunoglobulin level, hematocrit, and blood viscosity), clinical examination results, and OCT findings. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA), height and basal area of the serous macular detachment, and systemic versus local therapies. RESULTS A total of 33 cases were collected: 10 new and 23 previously reported in the literature. Diabetes was present in 7 patients, systemic hypertension in 9 patients, and anemia in 18. Mean initial immunoglobulin level was 6497 mg/dl, and mean serum viscosity was 5.5 centipoise (cP). Mean logarithm of the minimum angle of resolution initial vs. final BCVA was 0.55 (Snellen equivalent, 20/71) vs. 0.45 (20/56) in the right eye and 0.38 (20/48) vs. 0.50 (20/63) in the left eye. After mean follow-up of 7 months (range, 0-51 months). Systemic therapies included plasmapheresis (18), chemotherapy (30), blood transfusions (2), transplantation of progenitor hematopoietic cells (2), and oral rituximab (10). Immunoglobulin levels normalized in 8 patients and were unchanged in 1 after plasmapheresis, chemotherapy, or both. Ocular therapy in 8 patients included vitrectomy (1), laser photocoagulation (4), intravitreal bevacizumab (5), intravitreal triamcinolone (2), intravitreal dexamethasone implant (1), intravitreal rituximab (1), and sub-Tenon corticosteroid (1). The maculopathy resolved partially or completely in 17 patients and worsened or remained unchanged in 14 patients over median follow-up of 7 months. Maculopathy was unilateral in 9 cases and occurred at a lower initial immunoglobulin level in diabetics. There was a positive correlation between area of the detachment and serum viscosity. CONCLUSIONS Paraproteinemic maculopathy can be unilateral. Decreasing the blood immunoglobulin level is the primary goal of therapy for paraproteinemic maculopathy, and this can be achieved by a systemic route. Coexisting diabetes facilitates leakage of immunoglobulins at lower levels than in nondiabetics.
Collapse
Affiliation(s)
- Ahmad M Mansour
- Departments of Ophthalmology, American University of Beirut and Rafic Hariri University Hospital, Beirut, Lebanon.
| | - J Fernando Arevalo
- Retina Departments, The King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia, and Wilmer Eye Institute, The Johns Hopkins University, Baltimore, Maryland
| | - Josep Badal
- Department of Ophthalmology, Hospital Moises Broggi Sant Joan Despi, Barcelona, Spain
| | - Ramana S Moorthy
- Associated Vitreoretinal and Uveitis Consultants, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | - Jose S Pulido
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Abdulrazzak Charbaji
- Department of Statistics and Research Methodology, Lebanese American University and Lebanese University, Beirut, Lebanon
| | - Luis Amselem
- Department of Ophthalmology, Hospital Moises Broggi Sant Joan Despi, Barcelona, Spain
| | | | - Antonio Casella
- Department of Ophthalmology, Universidade Estadual de Londrina, Parana, Brazil
| | | | - Joshua G Paschall
- Associated Vitreoretinal and Uveitis Consultants, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Antonio Caimi
- Department of Clinical Science "Luigi Sacco," Sacco Hospital, University of Milan, Milan, Italy
| | - Giovanni Staurenghi
- Department of Clinical Science "Luigi Sacco," Sacco Hospital, University of Milan, Milan, Italy
| |
Collapse
|
21
|
Ganglion Cell Complex Evaluation in Exudative Age-Related Macular Degeneration after Repeated Intravitreal Injections of Ranibizumab. BIOMED RESEARCH INTERNATIONAL 2014. [DOI: 10.1155/2014/268796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To detect the effects of intravitreal ranibizumab injections on GCC in patients with wet AMD.Methods. 32 wet AMD eyes were selected and submitted at three ranibizumab injections. RTVue-OCT GCC and MM5 protocol were performed before treatment and twenty days after each injection.Results. At baseline mean GCC thickness was 93.9 ± 18.5 μm. Twenty days after each intravitreal injection it was, respectively, 85.8 ± 10.1, 86.5 ± 9.3, and 91.1 ± 11.5 μm, without statistical significance. A significant improvement in visual acuity (P= 0.031) and a reduction of mean foveal (P= 0.001) and macular thickness (P= 0.001) were observed.Conclusion. The clinical results confirm therapeutic efficacy of intravitreal injections of ranibizumab in wet AMD. A contemporary not statistically significant reduction of GCC thickness suggests that the loading phase of ranibizumab does not have any toxic effects on ganglion cell complex.
Collapse
|