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Mammo DA, Wai K, Rahimy E, Pan CK, Srivastava SK, Mruthyunjaya P. Association of Cutaneous Keloids, Hypertrophic Scarring, and Fibrosis with Risk of Postoperative Proliferative Vitreoretinopathy. Ophthalmology 2024:S0161-6420(24)00093-9. [PMID: 38296203 DOI: 10.1016/j.ophtha.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/12/2024] [Accepted: 01/23/2024] [Indexed: 03/21/2024] Open
Abstract
PURPOSE To assess an association between cutaneous keloids, hypertrophic scarring, and fibrosis (KHF) and risk of postoperative proliferative vitreoretinopathy (PVR) after rhegmatogenous retinal detachment (RRD) repair. DESIGN Retrospective, population-based cohort study. PARTICIPANTS Patients aged ≥ 18 years who underwent initial retinal detachment (RD) repair with pars plana vitrectomy with or without scleral buckle (SB) (Current Procedural Terminology [CPT] 67108), pneumatic retinopexy (67110), and primary SB (67107) from January 1, 2003, to March 1, 2023. METHODS A de-identified electronic health record database through TriNetX, a global health research network, was used to analyze patients. Patients were queried for International Classification of Diseases, 10th Revision (ICD-10) codes L91.0 (hypertrophic scar) and L90.5 (scar conditions and fibrosis of skin). Frequency of subsequent diagnosis of PVR (H35.2) and CPT codes for secondary surgery including complex RD repair (67113) were determined. Patients with proliferative diabetic retinopathy (PDR) (ICD-10 H10.35/H11.35) were excluded. Descriptive statistics (Z-test) and propensity score matching (PSM) were used to match for age, sex, and race. MAIN OUTCOME MEASURES Prevalence of H35.2 and CPT 67113 within 180 days after RRD repair in the KHF cohort versus the non-KHF cohort. RESULTS Among patients with CPT 67108, 1061 in each cohort (KHF and non-KHF) were analyzed after PSM. The mean (standard deviation) age was 60.7 (15.2) years. Within 180 days, 10.1% of patients in the KHF cohort and 3.4% in the non-KHF cohort had a diagnosis of PVR (H35.2) (P < 0.001, odds ratio [OR], 3.2; 95% confidence interval [CI], 2.13-4.71). A total of 8.3% of patients in the KHF cohort and 5.4% of patients in the non-KHF cohort underwent complex RD repair (CPT 67113) (P = 0.008; OR, 3.2; 95% CI, 1.13-2.25). When including all RD repair types (CPT 67108, 67110, 67107), the rate of PVR diagnosis was still significantly greater in the KHF cohort than in the non-KHF cohort (9.0% vs 4.2%, P < 0.01; OR, 2.28; 95% CI, 1.64-3.16). CONCLUSIONS A dermatologic history of KHF may be a risk factor for PVR after RD repair. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Danny A Mammo
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Karen Wai
- Byers Eye Institute, Stanford Health Care, Palo Alto, California
| | - Ehsan Rahimy
- Byers Eye Institute, Stanford Health Care, Palo Alto, California
| | - Carolyn K Pan
- Byers Eye Institute, Stanford Health Care, Palo Alto, California
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Reeves MGR, Pasricha MV, Ludwig CA, Chandramohan A, Azad AD, Li AS, Rosenblatt TR, Sears CM, Kossler AL, Do DV, Pan CK. Trends in Leadership and Award Recognition Among Women in the American Society of Retina Specialists. J Vitreoretin Dis 2022; 6:374-380. [PMID: 37006904 PMCID: PMC9954927 DOI: 10.1177/24741264211021019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose This work evaluates trends in achievement of women in the retina field, through an analysis of gender representation in the American Society of Retina Specialists (ASRS). Methods This retrospective, longitudinal study spans 1983 to 2020. Historical data classified by male or female gender were collected from ASRS's overall membership, board of directors and officers, and recipients of the 4 society awards. The proportion of each benchmark held by women was compared with prior decades since the founding of ASRS using the Fisher's exact test. Results Women's representation increased from 11% of ASRS members in 2007 to 19.7% in 2020. From 2010 to 2019, women received a higher proportion of society awards (21.1%) compared with membership prior to the start of that decade. In 2020, women were proportionally well represented in board of director positions (21.9%) and held a significantly higher proportion of board positions than in the period 1983 to 1989 (P = .02). From 1983 to 2020, women held 4.3% (1 of 23) of presidencies. Conclusions Although the number of women in retina is increasing, women remain underrepresented in the leadership of ASRS. Interventions to increase exposure to female mentorship and improve childcare benefits are warranted to engage female ophthalmology trainees in retina and ultimately society leadership.
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Affiliation(s)
- Mary-Grace R. Reeves
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of
Medicine, Palo Alto, CA, USA
| | - Malini Veerappan Pasricha
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of
Medicine, Palo Alto, CA, USA
| | - Cassie A. Ludwig
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of
Medicine, Palo Alto, CA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and
Ear, Harvard Medical School, Boston, MA, USA
| | - Arthika Chandramohan
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of
Medicine, Palo Alto, CA, USA
- Division of Pediatric Ophthalmology, Department of Ophthalmology,
University of Washington School of Medicine, Seattle, WA, USA
| | - Amee D. Azad
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of
Medicine, Palo Alto, CA, USA
| | - Angela S. Li
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of
Medicine, Palo Alto, CA, USA
| | - Tatiana R. Rosenblatt
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of
Medicine, Palo Alto, CA, USA
| | - Connie Martin Sears
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of
Medicine, Palo Alto, CA, USA
| | - Andrea L. Kossler
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of
Medicine, Palo Alto, CA, USA
| | - Diana V. Do
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of
Medicine, Palo Alto, CA, USA
| | - Carolyn K. Pan
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of
Medicine, Palo Alto, CA, USA
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O'Fee JR, Rayess N, Pan CK, Toy BC. Factors Affecting Ophthalmology Trainees to Pursue Vitreoretinal Surgery Fellowship. Journal of Academic Ophthalmology 2022. [DOI: 10.1055/s-0041-1741461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Objective The aim of this study was to understand the factors that ophthalmology trainees consider in pursuing vitreoretinal surgery (VRS) fellowship training.
Methods This is a prospective observational survey study. Survey invitations were disseminated to postgraduate year 4 (PGY)-4 ophthalmology residents at Accreditation Council for Graduate Medical Education-accredited residency programs and surgical retina fellows at Association of University Professors of Ophthalmology Fellowship Compliance Committee-compliant fellowship programs in the United States. Survey questions on factors related to VRS were administered employing a 5-point Likert scale. Responses from ophthalmology residents pursuing surgical retina were combined with surgical retina fellows' responses and compared with responses from PGY-4 residents not pursuing vitreoretinal surgery.
Results Eighty-one resident surveys were completed. Forty-three fellow surveys were completed. Fifty-seven out of eighty-one (70.4%) residents were not pursuing surgical retina, and a total of 67 trainees (24 residents, 43 fellows) were pursuing surgical retina. The following factors were associated with pursuing VRS training: male gender (p = 0.031); having performed retina research during residency (p ≤ 0.001); enjoying surgical retina procedures (p ≤ 0.001), enjoying surgical retina patient outcomes (p ≤ 0.001), and working with vitreoretinal surgeons (p ≤ 0.001); finding surgical retina prestigious (p ≤ 0.001); perceiving their residency having a strong record of matching surgical retina (p = 0.039); liking the potential financial income from surgical retina (p ≤ 0.001); and having vitreoretinal mentors during residency (p = 0.014). A majority of trainees (31/57, 54.4%) not pursuing surgical retina disagreed or strongly disagreed with enjoying the patient outcomes in surgical retina. A third of female residents not pursuing surgical retina felt having a female surgical retina mentor would have made them more likely to pursue the field.
Conclusion Longer retina rotations, encouraging resident participation in retina research, and increasing mentorship opportunities of female trainees from female retina specialists may increase resident interest in pursuing surgical retina fellowship.
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Affiliation(s)
- John R. O'Fee
- USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Nadim Rayess
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
| | - Carolyn K. Pan
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
| | - Brian C. Toy
- USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California
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Azad AD, Davila JR, Rayess N, Cao M, Mruthyunjaya P, Pan CK. The Effect of Obstructive Sleep Apnea Treatment and Severity on Choroidal Thickness in Patients With Central Serous Chorioretinopathy. Journal of VitreoRetinal Diseases 2022; 6:22-30. [PMID: 37007726 PMCID: PMC9976222 DOI: 10.1177/24741264211009677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: This work aimed to analyze the association of obstructive sleep apnea (OSA) with choroidal thickness (CT) in patients with central serous chorioretinopathy (CSC). Methods: We identified patients in the Stanford Research Repository with a diagnosis of CSC and OSA. Age- and sex-matched controls with either CSC or OSA only were also identified. CT was measured at 5 points (subfoveal, and 1500 and 3000 µm nasal and temporal) by 2 graders. In addition to OSA treatment and severity, we also investigated the association of Oxygen Desaturation Index and nocturnal oxygen saturation nadir with subfoveal CT (SFCT). Results: A total of 57 patients and 72 eyes met the study inclusion criteria. The mean SFCT was significantly different across the 3 groups: OSA-only was the thinnest, followed by CSC with OSA, and CSC-only was the thickest (194.2 μm, 295.1 μm, and 357.8 μm, respectively, P < .001). SFCT was thicker in CSC with OSA compared with those with only OSA ( P < .05). OSA treatment status and OSA severity did not show a significant difference in SFCT in multivariable modeling. Nocturnal oxygen saturation nadir was positively associated with SFCT, but this did not reach significance.. Conclusions: SFCT is significantly different in patients with OSA alone, CSC with OSA, and CSC alone. While OSA treatment status did not demonstrate a significant difference in SFCT in this study, future studies should evaluate patients for OSA in patients known to have CSC and atypically thin CT to further investigate the novel metrics leveraged in this study.
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Affiliation(s)
- Amee D. Azad
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jose R. Davila
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Nadim Rayess
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Michelle Cao
- Stanford Sleep Medicine Clinic, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Prithvi Mruthyunjaya
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Carolyn K. Pan
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
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Pan CK, Vail D, Bhattacharya J, Cao M, Mruthyunjaya P. Reply to Comment on: The Effect of Obstructive Sleep Apnea on Absolute Risk of Central Serous Chorioretinopathy. Am J Ophthalmol 2021; 226:270-275. [PMID: 33567302 DOI: 10.1016/j.ajo.2021.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
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Pan CK, Vail D, Bhattacharya J, Cao M, Mruthyunjaya P. The Effect of Obstructive Sleep Apnea on Absolute Risk of Central Serous Chorioretinopathy. Am J Ophthalmol 2020; 218:148-155. [PMID: 32574769 PMCID: PMC10710904 DOI: 10.1016/j.ajo.2020.05.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE To determine the incidence of central serous chorioretinopathy (CSC) stratified by age, sex, and diagnosis with obstructive sleep apnea (OSA), and to determine whether some patients with newly diagnosed CSC may be candidates for OSA evaluation. DESIGN Retrospective cohort study. METHODS We used the IBM MarketScan database to select 59,016,145 commercially insured patients in the United States between 2007 and 2016. We identified patients' first diagnosis with CSC, and defined patients as having OSA if they had a diagnosis following a sleep study. We specified Cox proportional hazard models with interactions between age, sex, and OSA status to determine patients' risk of developing CSC. We estimated the positive predictive value (PPV) that a new diagnosis of CSC would have in predicting a subsequent diagnosis of OSA. RESULTS Risk of CSC increased with age in years (hazard ratio [HR] = 1.030, P < .001) and OSA diagnosis (HR = 1.081, P < .033), and was lower in women (HR = 0.284, P < .001). We estimated the annual incidence of CSC was 9.6 and 23.4 per 100,000 women and men, respectively. Incidence was higher in women and men with OSA (17.2 and 40.8 per 100,000). The PPV of CSC diagnosis as a predictor of OSA was highest in the fifth decade of life. CONCLUSION The incidence of CSC in our patient sample is higher than previously reported. Risk of CSC is higher in men than in women, and OSA increases risk of CSC in both men and women. Some patients, particularly older male patients, may be good candidates for OSA evaluation following a CSC diagnosis.
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Affiliation(s)
- Carolyn K Pan
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, California, USA
| | - Daniel Vail
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, California, USA
| | - Jayanta Bhattacharya
- Primary Care Outcomes Research, Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Michelle Cao
- Stanford Sleep Medicine Clinic, Stanford University, Palo Alto, California, USA
| | - Prithvi Mruthyunjaya
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, California, USA.
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Veerappan Pasricha M, So J, Myung D, Jelks A, Pan CK. Nonmydriatic Photographic Screening for Diabetic Retinopathy in Pregnant Patients with Pre-Existing Diabetes in a Safety Net Population: 1 Year Results from the Diabetic Retinopathy in Pregnant Patients Study. Womens Health Rep (New Rochelle) 2020; 1:436-443. [PMID: 33786508 PMCID: PMC7784768 DOI: 10.1089/whr.2020.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/03/2020] [Indexed: 06/12/2023]
Abstract
Background: Pregnant patients with pre-existing diabetes mellitus (DM) are at increased risk for development or progression of existing diabetic retinopathy (DR). A quality improvement project was initiated to improve DR screening during pregnancy at a safety net hospital. This article highlights the utility and generalizability of our telemedicine-based screening model. Materials and Methods: In April 2018, we implemented a photographic retinal screening system in the Maternal Fetal Medicine (MFM) clinic at Santa Clara Valley Medical Center in San Jose, CA. The system is intended to screen all pregnant patients with pre-existing diabetes (type 1 and 2). Retinal images are automatically uploaded to a secure server and interpreted by a retina specialist (C.K.P.). Results: A total of 71 pregnant patients with pre-existing DM were seen in the MFM clinic during the study period. Sixty-six of 71 patients (93.0%) were screened compared with 69.1% in the year prior. Of the 64 patients screened with readable images 11 (17.2%) had DR, whereas 53 did not. Forty-nine of the 64 (74.2%) patients screened underwent screening using the new nonmydriatic system in the MFM clinic. Only 7 out of 47 (14.9%) patients with readable images in the MFM clinic required referral to the ophthalmology clinic. Conclusion: Our model for DR screening in pregnant patients in safety net hospitals is effective in improving screening rates and expediting evaluation and treatment for those in need. This system can prevent irreversible vision loss in pregnant patients and provides an effective framework for ophthalmic care in a safety net hospital system.
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Affiliation(s)
- Malini Veerappan Pasricha
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Ophthalmology and Santa Clara Valley Medical Center, San Jose, California, USA
| | - Jodi So
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - David Myung
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Andrea Jelks
- Department of Obstetrics and Gynecology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Carolyn K. Pan
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Ophthalmology and Santa Clara Valley Medical Center, San Jose, California, USA
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Garcia GA, Tang PH, Pan CK, Mruthyunjaya P. Vitelliform Vitreoretinopathy: Clinical Implications of the Vitreomacular Interface. Oman J Ophthalmol 2020; 13:100-101. [PMID: 32792808 PMCID: PMC7394074 DOI: 10.4103/ojo.ojo_214_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/31/2020] [Accepted: 03/08/2020] [Indexed: 11/04/2022] Open
Abstract
Pathologies of the vitreomacular interface are implicated in a variety of sight-threatening clinical entities. The authors present a photo essay of a case of Terson syndrome with a striking premacular dehemoglobinized hemorrhage with ovoid morphology. This unique “vitelliform” finding highlights the distinct structure of the premacular vitreous space and its important implications in both health and disease.
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Affiliation(s)
- Giancarlo A Garcia
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | | | - Carolyn K Pan
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Prithvi Mruthyunjaya
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
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Vail D, Pan CK, Mruthyunjaya P. Questions on Rhegmatogenous Retinal Detachment and the Day of the Week of Repair or Diagnosis-Reply. JAMA Ophthalmol 2020; 138:803. [PMID: 32437496 DOI: 10.1001/jamaophthalmol.2020.1867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Daniel Vail
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
| | - Carolyn K Pan
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
| | - Prithvi Mruthyunjaya
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
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Nguyen QD, Das A, Do DV, Dugel PU, Gomes A, Holz FG, Koh A, Pan CK, Sepah YJ, Patel N, MacLeod H, Maurer P. Brolucizumab: Evolution through Preclinical and Clinical Studies and the Implications for the Management of Neovascular Age-Related Macular Degeneration. Ophthalmology 2020; 127:963-976. [PMID: 32107066 DOI: 10.1016/j.ophtha.2019.12.031] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/12/2019] [Accepted: 12/18/2019] [Indexed: 01/10/2023] Open
Abstract
Improving or maintaining visual acuity is the main goal for the treatment of neovascular age-related macular degeneration (nAMD). Current nAMD standard of care dictates frequent intravitreal (IVT) anti-vascular endothelial growth factor (VEGF) injections, which places a substantial burden on patients, caregivers, and physicians. Brolucizumab, a newly developed anti-VEGF molecule for nAMD treatment, has demonstrated longer durability and improvement in visual and anatomic outcomes in clinical studies in a q12-week regimen, indicating its potential to reduce treatment burden as an important therapeutic tool in nAMD management. This review focuses on the development of brolucizumab and the preclinical and clinical studies evaluating its efficacy, tolerability, and safety. Brolucizumab (also known as "RTH258" and "ESBA1008") is a humanized, single-chain variable fragment (scFv) antibody with a molecular mass of approximately 26 kDa that inhibits VEGF-A. Preclinical studies show that brolucizumab readily penetrates the retina to reach the retinal pigment epithelium (RPE)/choroid with minimal subsequent systemic exposure. The safety, tolerability, and efficacy of a single IVT brolucizumab administration in patients with treatment-naïve nAMD were first demonstrated in the SEE Phase 1/2 study. The OSPREY Phase 2 study showed brolucizumab to be as efficacious as aflibercept in a q8-week regimen with regard to best-corrected visual acuity (BCVA) and brolucizumab achieving greater fluid resolution. Brolucizumab-treated patients in the OSPREY study were subsequently challenged with a q12-week dosing interval, and the outcomes provided key information for the study design and end points of the Phase 3 studies. In the HAWK and HARRIER Phase 3 studies, after 3 monthly loading injections, brolucizumab treatment regimen (q12-week or q8-week) was guided by individual disease activity assessment using functional and anatomic parameters (central subfield thickness [CST], intraretinal fluid [IRF], or subretinal fluid [SRF]) versus aflibercept (q8-week). Fewer brolucizumab 6-mg treated eyes had disease activity versus aflibercept, and anatomic outcome results at weeks 16 and 48 demonstrate brolucizumab as a potent drying agent. Moreover, of patients treated with 6 mg brolucizumab, 55.6% and 51.0% maintained a q12-week dosing interval immediately after the loading phase until week 48 in HAWK and HARRIER, respectively. These Phase 3 studies demonstrated that the brolucizumab q12-week regimen maintains efficacy and safety while reducing treatment burden associated with regular IVT injections for patients with nAMD.
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Affiliation(s)
- Quan Dong Nguyen
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California.
| | - Arup Das
- Department of Surgery, Division of Ophthalmology, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Diana V Do
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
| | - Pravin U Dugel
- USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Andre Gomes
- Department of Ophthalmology, University of Sao Paulo, Sao Paulo, Brazil
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Adrian Koh
- Eye and Retina Surgeons, Camden Medical Centre, Singapore, Singapore
| | - Carolyn K Pan
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
| | - Yasir J Sepah
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
| | - Nikhil Patel
- Novartis Pharmaceuticals, East Hanover, New Jersey
| | - Heather MacLeod
- Former Employee of Novartis Institutes for Biomedical Research, Novartis, Cambridge, Massachusetts
| | - Patrik Maurer
- Novartis Institutes for Biomedical Research, Novartis, Basel, Switzerland
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Lin W, Pan CK, Tsui I. Spontaneous resolution of clinically apparent submacular fluid after scleral buckling surgery. Ophthalmic Surg Lasers Imaging Retina 2014; 45:474-7. [PMID: 25197928 DOI: 10.3928/23258160-20140827-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 05/20/2014] [Indexed: 11/20/2022]
Abstract
A 37-year-old man presented with a chronic macula-involving rhegmatogenous retinal detachment. Despite scleral buckle surgery, the eye had clinically apparent submacular fluid for a prolonged period of time. By 1 year postoperatively, the patient had complete recovery of visual function, with residual ellipsoid layer changes on optical coherence tomography.
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Affiliation(s)
- Wonchon Lin
- Jules Stein Eye Institute, University of California Los Angeles, 100 Stein Plaza, Los Angeles, CA 90095, USA
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Schwartz SD, Hubschman JP, Heilwell G, Franco-Cardenas V, Pan CK, Ostrick RM, Mickunas E, Gay R, Klimanskaya I, Lanza R. Embryonic stem cell trials for macular degeneration: a preliminary report. Lancet 2012; 379:713-20. [PMID: 22281388 DOI: 10.1016/s0140-6736(12)60028-2] [Citation(s) in RCA: 927] [Impact Index Per Article: 77.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND It has been 13 years since the discovery of human embryonic stem cells (hESCs). Our report provides the first description of hESC-derived cells transplanted into human patients. METHODS We started two prospective clinical studies to establish the safety and tolerability of subretinal transplantation of hESC-derived retinal pigment epithelium (RPE) in patients with Stargardt's macular dystrophy and dry age-related macular degeneration--the leading cause of blindness in the developed world. Preoperative and postoperative ophthalmic examinations included visual acuity, fluorescein angiography, optical coherence tomography, and visual field testing. These studies are registered with ClinicalTrials.gov, numbers NCT01345006 and NCT01344993. FINDINGS Controlled hESC differentiation resulted in greater than 99% pure RPE. The cells displayed typical RPE behaviour and integrated into the host RPE layer forming mature quiescent monolayers after transplantation in animals. The stage of differentiation substantially affected attachment and survival of the cells in vitro after clinical formulation. Lightly pigmented cells attached and spread in a substantially greater proportion (>90%) than more darkly pigmented cells after culture. After surgery, structural evidence confirmed cells had attached and continued to persist during our study. We did not identify signs of hyperproliferation, abnormal growth, or immune mediated transplant rejection in either patient during the first 4 months. Although there is little agreement between investigators on visual endpoints in patients with low vision, it is encouraging that during the observation period neither patient lost vision. Best corrected visual acuity improved from hand motions to 20/800 (and improved from 0 to 5 letters on the Early Treatment Diabetic Retinopathy Study [ETDRS] visual acuity chart) in the study eye of the patient with Stargardt's macular dystrophy, and vision also seemed to improve in the patient with dry age-related macular degeneration (from 21 ETDRS letters to 28). INTERPRETATION The hESC-derived RPE cells showed no signs of hyperproliferation, tumorigenicity, ectopic tissue formation, or apparent rejection after 4 months. The future therapeutic goal will be to treat patients earlier in the disease processes, potentially increasing the likelihood of photoreceptor and central visual rescue. FUNDING Advanced Cell Technology.
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Affiliation(s)
- Steven D Schwartz
- Jules Stein Eye Institute Retina Division, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
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Pan CK, Durairaj C, Kompella UB, Agwu O, Oliver SCN, Quiroz-Mercado H, Mandava N, Olson JL. Comparison of long-acting bevacizumab formulations in the treatment of choroidal neovascularization in a rat model. J Ocul Pharmacol Ther 2011; 27:219-24. [PMID: 21574814 DOI: 10.1089/jop.2010.0158] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The objective of this study was to compare the reduction in size of experimentally induced choroidal neovascularization (CNV) in rat eyes treated with bevacizumab, poly(ethylene-glycol) (PEG)-bevacizumab conjugate (b-PEG), and poly(lactic-co-glycolic acid) (PLGA)-encapsulated bevacizumab (b-PLGA). METHODS Forty-eight eyes from 24 rats were divided into 4 groups of 12 eyes. In each group, 3 eyes were assigned to a treatment subgroup, each receiving a different injection-control, bevacizumab, b-PEG, and b-PLGA. In all eyes, laser photocoagulation was used to rupture Bruch's membrane. In group 1, laser was followed by injection, which was then followed by harvesting the rats to assess the CNV area. All 3 steps were separated by a 2-week interval. In groups 2, 3, and 4, injection preceded laser photocoagulation by a variable interval and all rats were harvested 2 weeks postlaser treatment. In group 2, laser and injection were separated by 2 weeks. In group 3, laser followed injection by 4 weeks. In group 4, laser followed injection by 6 weeks. The CNV area was measured for each subgroup and compared against its control. Pairwise comparisons were conducted to assess for statistically significant differences between subgroups. RESULTS All subgroups in groups 1, 2, and 4 showed statistically significant reduction of CNV area (P<0.05). In group 3, the b-PEG and b-PLGA subgroups showed a 9.0% (P=0.384) and 20.3% (P=0.077) reduction in CNV area versus control, whereas there was no reduction in CNV area in the bevacizumab subgroup. However, this was not found to be statistically significant. In group 4, b-PEG was more effective than bevacizumab and b-PLGA. CONCLUSION The reduction in CNV area in all treatment subgroups, with the exception of those in group 3, suggests successful creation of the 2 bevacizumab formulations while retaining its active antiangiogenic properties. Further studies varying in dosages and timing of injection and laser are needed to evaluate the formulations' long-acting efficacy.
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Affiliation(s)
- Carolyn K Pan
- Department of Ophthalmology, University of Colorado, Aurora, Colorado, USA
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Yuan TK, Yuan CC, Yuan CY, Pan CK, Chen DY. Hemobilia secondary to liver abscess: report of a case. Taiwan Yi Xue Hui Za Zhi 1987; 86:553-5. [PMID: 3625160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Pan CK, Zheng DC, Finstad TG, Chu WK, Speriosu VS, Nicolet MA, Barrett JH. Structural study of GaSb/AlSb strained-layer superlattice. Phys Rev B Condens Matter 1985; 31:1270-1277. [PMID: 9935901 DOI: 10.1103/physrevb.31.1270] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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