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Brinkmann M, Viggiano P, Boscia G, Müller T, Castellino N, Schweighofer J, Boscia F, Toro MD, El-Shabrawi Y. Analysis of Choriocapillaris Reperfusion Topography Following Faricimab Treatment for Neovascular Age-Related Macular Degeneration in Therapy-Naïve Patients. Ophthalmol Ther 2024:10.1007/s40123-024-00967-2. [PMID: 38801614 DOI: 10.1007/s40123-024-00967-2] [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: 03/04/2024] [Accepted: 05/03/2024] [Indexed: 05/29/2024] Open
Abstract
INTRODUCTION To assess changes in choriocapillaris (CC) vascular density surrounding macular neovascularization (MNV) in treatment-naïve age-related macular degeneration (AMD) after faricimab application using optical coherence tomography angiography (OCTA). METHODS Twenty-five eyes of 25 treatment-naïve individuals who underwent intravitreal faricimab injections for neovascular AMD (nAMD) with type 1 MNV were included. Spectral-domain optical coherence tomography (SD-OCT) images and en-face swept-source OCTA images were analyzed, and the percentage of CC flow deficit (FD%), FD average area (FDa) and FD number (FDn) in five progressive 20.0-μm-wide concentric rings (R1, R2, R3, R4 and R5) surrounding the dark halo around the MNV were calculated. Image acquisition was carried out prior to the first faricimab injection (T0) and 1 month after the injection (T1). RESULTS The topographical sub-analysis revealed noteworthy changes in all rings at T1 compared to T0. There was a notable progressive reduction in FD% at T1 compared to T0 values across all rings, indicating a gradual CC reperfusion following anti-VEGF treatment. Additionally, the average size of FD decreased after the loading phase. Although not reaching statistical significance, there was a progressive reduction in the FDa across all rings. CONCLUSION Our study highlights a CC FD reduction following the administration of three consecutive faricimab injections. This effect was detected in all rings surrounding the dark halo. These observations suggest a partial CC reperfusion surrounding the MNV, potentially serving as an indicator for disease regression.
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Affiliation(s)
- Max Brinkmann
- Department of Ophthalmology, Klinikum Klagenfurt, 9020, Klagenfurt, Austria.
- Department of Ophthalmology, Universitätsklinikum Schleswig-Holstein, 23564, Lübeck, Germany.
| | - Pasquale Viggiano
- Department of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro", Bari, Italy
| | - Giacomo Boscia
- Department of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro", Bari, Italy
| | - Tom Müller
- Department of Ophthalmology, Klinikum Klagenfurt, 9020, Klagenfurt, Austria
| | | | - Jakob Schweighofer
- Department of Ophthalmology and Optometry, Medical University of Vienna, 1090, Vienna, Austria
| | - Francesco Boscia
- Department of Translational Biomedicine Neuroscience, University of Bari "Aldo Moro", Bari, Italy
| | - Mario Damiano Toro
- Public Health Department, Eye Clinic, University of Naples Federico II, 80133, Naples, Italy.
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20079, Lublin, Poland.
| | - Yosuf El-Shabrawi
- Department of Ophthalmology, Klinikum Klagenfurt, 9020, Klagenfurt, Austria
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Brinkmann M, Viggiano P, Boscia G, Danckwardt M, Susantija E, Müller T, Castellino N, Schweighofer J, Boscia F, Toro MD, El-Shabrawi Y. Analysis of Choriocapillaris Reperfusion Topography following Faricimab Treatment for Neovascular Age-Related Macular Degeneration in Non-Treatment-Naïve Patients. Diagnostics (Basel) 2024; 14:901. [PMID: 38732315 PMCID: PMC11083352 DOI: 10.3390/diagnostics14090901] [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: 04/02/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
To assess changes in choriocapillaris (CC) vascular density surrounding macular neovascularization (MNV) in age-related macular degeneration (AMD) when transitioning from various anti-VEGF treatments to faricimab, using optical coherence tomography angiography (OCTA). 25 eyes of 22 individuals who underwent intravitreal faricimab injections for neovascular AMD with type 1 MNV were included. OCTA images were obtained prior to (T0), after one (T1), and after three faricimab injections (T2); Noteworthy changes occurred in the first ring at T2 in comparison to T0. The percentage of CC flow deficit (FD%), FD average area (FDa), and FD number (FDn) in 5 rings (R1-R5) surrounding the dark halo around the MNV were calculated. A reduction in FD% at T2 compared to T0 (50.5 ± 10.2% at T0, 46.4 ± 10.6% at T2; p = 0.020) was seen, indicating CC reperfusion. Additionally, we observed a reduction in the average FDa (140.2 ± 172.1% at T0, 93.7 ± 101.8% at T2; p = 0.029). Our study highlights an FD% after three consecutive faricimab injections. The most pronounced effect was observed in the first ring, directly adjacent to the dark halo, suggesting a partial CC reperfusion surrounding the MNV, potentially indicating disease regression.
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Affiliation(s)
- Max Brinkmann
- Department of Ophthalmology, Klinikum Klagenfurt, 9020 Klagenfurt, Austria; (T.M.)
- Department of Ophthalmology, Universitätsklinikum Schleswig-Holstein, 23564 Lübeck, Germany; (M.D.); (E.S.)
| | - Pasquale Viggiano
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, 70121 Bari, Italy; (P.V.); (G.B.); (F.B.)
| | - Giacomo Boscia
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, 70121 Bari, Italy; (P.V.); (G.B.); (F.B.)
| | - Mathis Danckwardt
- Department of Ophthalmology, Universitätsklinikum Schleswig-Holstein, 23564 Lübeck, Germany; (M.D.); (E.S.)
| | - Evelyn Susantija
- Department of Ophthalmology, Universitätsklinikum Schleswig-Holstein, 23564 Lübeck, Germany; (M.D.); (E.S.)
| | - Tom Müller
- Department of Ophthalmology, Klinikum Klagenfurt, 9020 Klagenfurt, Austria; (T.M.)
| | - Niccolò Castellino
- Department of Ophthalmology, University of Catania, 95123 Catania, Italy;
| | - Jakob Schweighofer
- Department of Ophthalmology and Optometry, Medical University of Vienna, 1090 Vienna, Austria;
| | - Francesco Boscia
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, 70121 Bari, Italy; (P.V.); (G.B.); (F.B.)
| | - Mario Damiano Toro
- Eye Clinic, Public Health Department, University of Naples Federico II, 80133 Naples, Italy
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20079 Lublin, Poland
| | - Yosuf El-Shabrawi
- Department of Ophthalmology, Klinikum Klagenfurt, 9020 Klagenfurt, Austria; (T.M.)
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Chadoulos N, Dastiridou A, Mitsios A, Tsinopoulos I, Kalogeropoulos C, Androudi S. Laser flare photometry in eyes receiving brolucizumab intravitreal injections for age related macular degeneration. Eur J Ophthalmol 2024:11206721241236917. [PMID: 38449080 DOI: 10.1177/11206721241236917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
PURPOSE To measure aqueous flare levels in treatment naïve eyes suffering from wet age- related macular degeneration (wAMD) treated with intravitreal brolucizumab. METHODS Patients with treatment naïve wAMD in one eye were prospectively enrolled. Flare levels were measured with laser flare photometry at baseline, 1 day and 1 month after each of the 3 monthly injections during the loading phase. RESULTS Twenty-two eyes from 22 patients aged 76.7 ± 6.0 years were enrolled. Flare values were 10.6 ± 3.7 photons/msec at baseline and 12.6 ± 5.8 photons/msec at the last follow up visit, 1 month after the third injection (p = 0.289, repeated measures ANOVA). The mean change in flare after the first injection was 4.2 ± 3.6. photons/msec, 6.6 ± 8.9 photons/msec after the 2nd and 8.6 ± 20.8 photons/msec after the 3rd injection (p = 0.640, repeated measures ANOVA). No patient had clinical signs of intraocular inflammation. CONCLUSIONS Eyes receiving brolucizumab injections for wAMD showed similar flare at baseline, during and 1 month after completion of three-monthly intravitreal injections. There was no evidence of subclinical inflammation during the loading phase of brolucizumab based on laser flare photometry measurements.
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Affiliation(s)
| | - Anna Dastiridou
- Ophthalmology Department, University of Thessaly, Larissa, Greece
| | - Andreas Mitsios
- Ophthalmology Department, University of Thessaly, Larissa, Greece
| | - Ioannis Tsinopoulos
- Ophthalmology Department, Papageorgiou Hospital, Aristotle University, Thessaloniki, Greece
| | | | - Sofia Androudi
- Ophthalmology Department, University of Thessaly, Larissa, Greece
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Design, construction and in vivo functional assessment of a hinge truncated sFLT01. Gene Ther 2022; 30:347-361. [PMID: 36114375 DOI: 10.1038/s41434-022-00362-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 08/05/2022] [Accepted: 08/26/2022] [Indexed: 11/08/2022]
Abstract
Gene therapy for the treatment of ocular neovascularization has reached clinical trial phases. The AAV2-sFLT01 construct was already evaluated in a phase 1 open-label trial administered intravitreally to patients with advanced neovascular age-related macular degeneration. SFLT01 protein functions by binding to VEGF and PlGF molecules and inhibiting their activities simultaneously. It consists of human VEGFR1/Flt-1 (hVEGFR1), a polyglycine linker, and the Fc region of human IgG1. The IgG1 upper hinge region of the sFLT01 molecule makes it vulnerable to radical attacks and prone to causing immune reactions. This study pursued two goals: (i) minimizing the immunogenicity and vulnerability of the molecule by designing a truncated molecule called htsFLT01 (hinge truncated sFLT01) that lacked the IgG1 upper hinge and lacked 2 amino acids from the core hinge region; and (ii) investigating the structural and functional properties of the aforesaid chimeric molecule at different levels (in silico, in vitro, and in vivo). Molecular dynamics simulations and molecular mechanics energies combined with Poisson-Boltzmann and surface area continuum solvation calculations revealed comparable free energy of binding and binding affinity for sFLT01 and htsFLT01 to their cognate ligands. Conditioned media from human retinal pigment epithelial (hRPE) cells that expressed htsFLT01 significantly reduced tube formation in HUVECs. The AAV2-htsFLT01 virus suppressed vascular development in the eyes of newborn mice. The htsFLT01 gene construct is a novel anti-angiogenic tool with promising improvements compared to existing treatments.
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Abdin AD, Aljundi W, El Jawhari K, Suffo S, Weinstein I, Seitz B. First Year Real Life Experience With Intravitreal Brolucizumab for Treatment of Refractory Neovascular Age-Related Macular Degeneration. Front Pharmacol 2022; 13:860784. [PMID: 35721125 PMCID: PMC9197757 DOI: 10.3389/fphar.2022.860784] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 05/03/2022] [Indexed: 12/25/2022] Open
Abstract
Purpose: To assess the morphological and functional outcomes within the first year of treatment with intravitreal brolucizumab for refractory neovascular age-related macular degeneration (nAMD). Methods: This retrospective study included 21 eyes from 19 patients with refractory nAMD followed for 12 months. All patients were switched to brolucizumab after treatment with at least two other anti-vascular endothelial growth factors (VEGF). All eyes received 3x brolucizumab 6 mg/0.05 ml intravitreal injections (IVI) monthly as an upload phase. Then eyes received an IVI every 8 weeks with interval adjustment to every 12 weeks if disease activity was not present. Main outcome measures: best corrected visual acuity (BCVA), central macular thickness (CMT) and retinal fluid distribution. In addition, we reported the adverse event rate. Results: The number of previous anti-VEGF IVIs/eye was 36 ± 22 before switching to brolucizumab. BCVA (ETDRS) was 51 ± 16 before treatment and 50 ± 19 at week 52 (p = 0.6). CMT was 374 ± 158 μm before treatment and 298 ± 92 μm at week 52 (p = 0.01). The number of IVIs/eye decreased from 9.6 ± 1.9 IVIs in the last year before switching to 6.4 ± 0.9 IVIs in the first year after switching to brolucizumab (p < 0.001). The rate of eyes with subretinal fluid and pigment epithelial detachment decreased at week 52. Finally, two cases of intraocular inflammation were observed as adverse events. Conclusion: In the first year of treatment, intravitreal brolucizumab was able to stabilize visual acuity with significantly less IVIs in patients with refractory nAMD. It also improved anatomic outcomes in these patients, particularly reducing subretinal fluid and pigment epithelial detachment and subsequently central macular thickness. However, two cases of intraocular inflammation were observed as adverse events.
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Affiliation(s)
- Alaa Din Abdin
- Department of Ophthalmology, Saarland University Medical Center UKS, Homburg, Germany
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Friesacher A, Varde MA, Valmaggia C, Todorova M. An Off-Label Application of Anti-VEGF in Refractory Posttraumatic Irvine-Gass Syndrome: A Case Report. Klin Monbl Augenheilkd 2022; 239:534-536. [PMID: 35472800 DOI: 10.1055/a-1785-5287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Anna Friesacher
- Department of Ophthalmology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Meghana Anika Varde
- Department of Ophthalmology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Christophe Valmaggia
- Department of Ophthalmology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Margarita Todorova
- Department of Ophthalmology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.,Department of Ophthalmology, University of Basel, Basel, Switzerland.,Department of Ophthalmology, University of Zürich, Zürich, Switzerland
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Yan R, Zhao J, Zhang X, Wang W, Jiang Z. Association Between Aspirin Usage and Age-Related Macular Degeneration: An Updated Systematic Review and Meta-analysis. Front Pharmacol 2022; 13:824745. [PMID: 35401184 PMCID: PMC8990128 DOI: 10.3389/fphar.2022.824745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: To investigate the association between long-term use of aspirin and age-related macular degeneration (AMD).Methods: An updated systematic literature search was conducted in PubMed, Medline, Cochrane Library, and embase from conception to February 26, 2021, without any language restriction. All studies that evaluated the relationship between long-term aspirin use and AMD were included.Results: In the current study, 16 articles were pooled. Overall, no significant association was observed (estimate ratio = 1.108, 95% confidence interval (CI): 0.886–1.385). When the subgroups were evaluated according to various standards, aspirin use was significantly correlated with AMD in studies with volunteer participants (estimate ratio = 0.899, 95% CI: 0.830–0.974, p < 0.01), studies followed up for >10 years (estimate ratio = 2.206, 95% CI: 2.124–2.292, p < 0.01), duration of aspirin use >10 years (estimate ratio = 2.323, 95% CI: 2.234–2.416, p < 0.01), and cohort studies (estimate ratio = 1.961, 95% CI: 1.893–2.032, p < 0.01).Conclusion: Therefore, the association of aspirin and AMD can be demonstrated with a long-term follow-up or aspirin use, appropriate study design and participant source. The findings in our study might provide practical information on intervention strategies.
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Mundo L, Tosi GM, Lazzi S, Pertile G, Parolini B, Neri G, Posarelli M, De Benedetto E, Bacci T, Silvestri E, Siciliano MC, Barbera S, Orlandini M, Greenwood J, Moss SE, Galvagni F. LRG1 Expression Is Elevated in the Eyes of Patients with Neovascular Age-Related Macular Degeneration. Int J Mol Sci 2021; 22:8879. [PMID: 34445590 PMCID: PMC8396268 DOI: 10.3390/ijms22168879] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 12/14/2022] Open
Abstract
Leucine-rich a-2-glycoprotein 1 (LRG1) is a candidate therapeutic target for treating the neovascular form of age-related macular degeneration (nvAMD). In this study we examined the expression of LRG1 in eyes of nvAMD patients. Choroidal neovascular membranes (CNVMs) from patients who underwent submacular surgery for retinal pigment epithelium-choroid graft transplantation were collected from 5 nvAMD patients without any prior intravitreal anti-VEGF injection, and from six patients who received intravitreal anti-VEGF injections before surgery. As controls free of nvAMD, retina sections were obtained from the eyes resected from a patient with lacrimal sac tumor and from a patient with neuroblastoma. CNVMs were immunostained for CD34, LRG1, and α-smooth muscle actin (α-SMA). Aqueous humor samples were collected from 58 untreated-naïve nvAMD patients prior to the intravitreal injection of anti-VEGF and 51 age-matched cataract control patients, and LRG1 concentration was measured by ELISA. The level of LRG1 immunostaining is frequently high in both the endothelial cells of the blood vessels, and myofibroblasts in the surrounding tissue of CNVMs of treatment-naïve nvAMD patients. Furthermore, the average concentration of LRG1 was significantly higher in the aqueous humor of nvAMD patients than in controls. These observations provide a strong experimental basis and scientific rationale for the progression of a therapeutic anti-LRG1 monoclonal antibody into clinical trials with patients with nvAMD.
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Affiliation(s)
- Lucia Mundo
- Section of Pathology, Department of Medical Biotechnology, University of Siena, 53100 Siena, Italy; (L.M.); (S.L.); (M.C.S.)
- Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | - Gian Marco Tosi
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (G.M.T.); (G.N.); (M.P.); (E.D.B.); (T.B.)
| | - Stefano Lazzi
- Section of Pathology, Department of Medical Biotechnology, University of Siena, 53100 Siena, Italy; (L.M.); (S.L.); (M.C.S.)
| | - Grazia Pertile
- IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Italy;
| | | | - Giovanni Neri
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (G.M.T.); (G.N.); (M.P.); (E.D.B.); (T.B.)
| | - Matteo Posarelli
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (G.M.T.); (G.N.); (M.P.); (E.D.B.); (T.B.)
| | - Elena De Benedetto
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (G.M.T.); (G.N.); (M.P.); (E.D.B.); (T.B.)
| | - Tommaso Bacci
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (G.M.T.); (G.N.); (M.P.); (E.D.B.); (T.B.)
| | - Ennio Silvestri
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Via A. Moro, 2, 53100 Siena, Italy; (E.S.); (S.B.); (M.O.)
| | - Maria Chiara Siciliano
- Section of Pathology, Department of Medical Biotechnology, University of Siena, 53100 Siena, Italy; (L.M.); (S.L.); (M.C.S.)
| | - Stefano Barbera
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Via A. Moro, 2, 53100 Siena, Italy; (E.S.); (S.B.); (M.O.)
| | - Maurizio Orlandini
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Via A. Moro, 2, 53100 Siena, Italy; (E.S.); (S.B.); (M.O.)
| | - John Greenwood
- UCL Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK;
| | - Stephen E. Moss
- UCL Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK;
| | - Federico Galvagni
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Via A. Moro, 2, 53100 Siena, Italy; (E.S.); (S.B.); (M.O.)
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