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Muñoz-Negrete FJ, Topouzis F, Oddone F, Nisslé S, Rokicki D, Januleviciene I, Harasymowycz P, Stalmans I. Preservative-free Bimatoprost 0.01% Ophthalmic Gel for Glaucoma Therapy. A Phase III Randomized Controlled Trial. J Glaucoma 2024:00061198-990000000-00345. [PMID: 38506750 DOI: 10.1097/ijg.0000000000002371] [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] [Received: 05/16/2023] [Accepted: 02/05/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE To evaluate the intraocular pressure (IOP)-lowering efficacy and safety of a preservative-free bimatoprost 0.01% ophthalmic gel (PFB 0.01% gel) compared with preserved bimatoprost 0.01% (PB 0.01%). DESIGN Phase III, international, multicenter, randomized, 2-parallel group, investigator-masked, 3-month treatment duration. METHODS Patients with glaucoma or ocular hypertension were randomized after a 7 week run-in/washout period to receive once-daily PFB 0.01% gel (n=236) or PB 0.01% (n=249) for 3 months. The primary efficacy measure was change from baseline in IOP at Week 12. Safety measures included adverse events (AEs) and assessment of conjunctival hyperemia. RESULTS Mean change from baseline in IOP at Week 12 in the PFB 0.01% gel and PB 0.01% were -9.72±2.97 mmHg and -9.47±3.06, respectively at 8 am, -9.41±3.03 and -9.19±3.12 mmHg at 10 am, and -8.99±3.36 and -8.54±3.44 mmHg at 4 pm. Noninferiority of PFB 0.01% gel to PB 0.01% was demonstrated at Week 12 based on predetermined criteria (upper 95% confidence interval margin of 1.5 mmHg at all timepoints). The most frequently reported AE was conjunctival hyperemia; 13 (5.5%) patients with PFB 0.01% gel and 17 (6.8%) patients with PB 0.01%. The percentage of patients experiencing a worsening from baseline in conjunctival hyperemia score was lower with PFB 0.01% gel compared to PB 0.01% at Week 6 (20.1% vs 29.3%, respectively) and Week 12 (18.3% vs 30.4%, respectively). CONCLUSIONS PFB 0.01% ophthalmic gel has the same efficacy in lowering IOP as PB 0.01% and demonstrated less aggravation of conjunctival hyperemia at Week 6 and Week 12.
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Affiliation(s)
- Francisco J Muñoz-Negrete
- Department of Ophthalmology, Hospital Universitario Ramón y Cajal, Madrid, Spain. Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, Spain
- Department of Ophthalmology, Aristotle University of Thessaloniki, School of Medicine, AHEPA Hospital, Thessaloniki, Greece
| | | | | | - Sylvie Nisslé
- Eye Clinic of Medical Academy of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dariusz Rokicki
- Eye Clinic of Medical Academy of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Paul Harasymowycz
- Bellevue Ophthalmology Clinics and Montreal Glaucoma Institute, Montreal, Canada
- Department of ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
| | - Ingeborg Stalmans
- Research Group of Ophthalmology, Catholic University KU Leuven, Leuven, Belgium
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Romano D, Oddone F, Montesano G, Fogagnolo P, Colizzi B, Tanga L, Giammaria S, Rui C, Rossetti LM. Comparison Between 24-2 ZEST and 24-2 ZEST FAST Strategies in Glaucoma and Ocular Hypertension Using a Fundus Perimeter. J Glaucoma 2024; 33:162-167. [PMID: 38245812 PMCID: PMC10901223 DOI: 10.1097/ijg.0000000000002358] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/27/2023] [Indexed: 01/22/2024]
Abstract
PRCIS Using a Compass (CMP) (CMP, Centervue, Padova, Italy) fundus perimeter, Zippy Estimation by Sequential Testing (ZEST) FAST strategy showed a significant reduction in examination time compared with ZEST, with good agreement in the quantification of perimetric damage. PURPOSE The aim of this study was to compare the test duration of ZEST strategy with ZEST FAST and to evaluate the test-retest variability of ZEST FAST strategy on patients with glaucoma and ocular hypertension. PATIENTS AND METHODS This was a multicenter retrospective study. We analyzed 1 eye of 60 subjects: 30 glaucoma patients and 30 patients with ocular hypertension. For each eye we analyzed, 3 visual field examinations were performed with Compass 24-2 grid: 1 test performed with ZEST strategy and 2 tests performed with ZEST FAST. Mean examination time and mean sensitivity between the 2 strategies were computed. ZEST FAST test-retest variability was examined. RESULTS In the ocular hypertension cohort, test time was 223±29 seconds with ZEST FAST and 362±48 seconds with ZEST (38% reduction, P <0.001). In glaucoma patients, it was respectively 265±62 and 386±78 seconds (31% reduction using ZEST FAST, P <0.001). The difference in mean sensitivity between the 2 strategies was -0.24±1.30 dB for ocular hypertension and -0.14±1.08 dB for glaucoma. The mean difference in mean sensitivity between the first and the second test with ZEST FAST strategy was 0.2±0.8 dB for patients with ocular hypertension and 0.24±0.96 dB for glaucoma patients. CONCLUSIONS ZEST FAST thresholding provides similar results to ZEST with a significantly reduced examination time.
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Affiliation(s)
- Dario Romano
- Eye Clinic, ASST Santi Paolo e Carlo – San Paolo Hospital, University of Milan, Milan
| | | | - Giovanni Montesano
- City, University of London–Optometry and Visual Sciences
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital, NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Paolo Fogagnolo
- Eye Clinic, ASST Santi Paolo e Carlo – San Paolo Hospital, University of Milan, Milan
| | - Benedetta Colizzi
- Eye Clinic, ASST Santi Paolo e Carlo – San Paolo Hospital, University of Milan, Milan
| | - Lucia Tanga
- Glaucoma Unit, IRCCS Fondazione Bietti, Rome
| | | | | | - Luca M. Rossetti
- Eye Clinic, ASST Santi Paolo e Carlo – San Paolo Hospital, University of Milan, Milan
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Cordeiro MF, Gandolfi S, Gugleta K, Normando EM, Oddone F. How latanoprost changed glaucoma management. Acta Ophthalmol 2024; 102:e140-e155. [PMID: 37350260 DOI: 10.1111/aos.15725] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023]
Abstract
Glaucoma is currently considered one of the leading causes of severe visual impairment and blindness worldwide. Topical medical therapy represents the treatment of choice for many glaucoma patients. Introduction of latanoprost, 25 years ago, with an entirely new mechanism of action from that of the antiglaucoma drugs used up to that time was a very important milestone. Since then, due mainly to their efficacy, limited systemic side effects and once daily dosing, prostaglandin analogues (PGAs) have become as the first-choice treatment for primary open-angle glaucoma. PGAs are in general terms well tolerated, although they are associated with several mild to moderate ocular and periocular adverse events. Among them, conjunctival hyperemia, eyelash changes, eyelid pigmentation, iris pigmentation and hypertrichosis around the eyes are the most prevalent. The objective of this paper is to review the role of PGAs in the treatment of glaucoma over the 25 years since the launch of Latanoprost and their impact on clinical practice outcomes.
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Affiliation(s)
- Maria Francesca Cordeiro
- Imperial College Healthcare NHS Trust, Western Eye Hospital, London, UK
- UCL Institute of Ophthalmology, London, UK
- Department of Surgery & Cancer, Irish Clinical Oncology Research Group, Imperial College London, London, UK
| | | | | | - Eduardo M Normando
- Department of Surgery & Cancer, Irish Clinical Oncology Research Group, Imperial College London, London, UK
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Sbardella D, Oddone F, Coletta M. Introductory remarks. Mol Aspects Med 2024; 95:101241. [PMID: 38171047 DOI: 10.1016/j.mam.2023.101241] [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] [Received: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
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Kellner RL, Harris A, Ciulla L, Guidoboni G, Verticchio Vercellin A, Oddone F, Carnevale C, Zaid M, Antman G, Kuvin JT, Siesky B. The Eye as the Window to the Heart: Optical Coherence Tomography Angiography Biomarkers as Indicators of Cardiovascular Disease. J Clin Med 2024; 13:829. [PMID: 38337522 PMCID: PMC10856197 DOI: 10.3390/jcm13030829] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Alterations in microvasculature represent some of the earliest pathological processes across a wide variety of human diseases. In many organs, however, inaccessibility and difficulty in directly imaging tissues prevent the assessment of microvascular changes, thereby significantly limiting their translation into improved patient care. The eye provides a unique solution by allowing for the non-invasive and direct visualization and quantification of many aspects of the human microvasculature, including biomarkers for structure, function, hemodynamics, and metabolism. Optical coherence tomography angiography (OCTA) studies have specifically identified reduced capillary densities at the level of the retina in several eye diseases including glaucoma. This narrative review examines the published data related to OCTA-assessed microvasculature biomarkers and major systemic cardiovascular disease. While loss of capillaries is being established in various ocular disease, pilot data suggest that changes in the retinal microvasculature, especially within the macula, may also reflect small vessel damage occurring in other organs resulting from cardiovascular disease. Current evidence suggests retinal microvascular biomarkers as potential indicators of major systemic cardiovascular diseases, including systemic arterial hypertension, atherosclerotic disease, and congestive heart failure.
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Affiliation(s)
- Rebecca L. Kellner
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (R.L.K.); (A.H.); (A.V.V.); (G.A.)
| | - Alon Harris
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (R.L.K.); (A.H.); (A.V.V.); (G.A.)
| | - Lauren Ciulla
- Department of Ophthalmology and Visual Science, The University of Chicago, Chicago, IL 60637, USA;
| | - Giovanna Guidoboni
- Maine College of Engineering and Computing, University of Maine, Orono, ME 04469, USA;
| | - Alice Verticchio Vercellin
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (R.L.K.); (A.H.); (A.V.V.); (G.A.)
| | - Francesco Oddone
- Glaucoma Unit, IRCCS—Fondazione Bietti, 00198 Rome, Italy; (F.O.); (C.C.)
| | - Carmela Carnevale
- Glaucoma Unit, IRCCS—Fondazione Bietti, 00198 Rome, Italy; (F.O.); (C.C.)
| | - Mohamed Zaid
- Graduate School of Biomedical Science and Engineering, University of Maine, Orono, ME 04469, USA;
| | - Gal Antman
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (R.L.K.); (A.H.); (A.V.V.); (G.A.)
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Jeffrey T. Kuvin
- Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, NY 11549, USA;
| | - Brent Siesky
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (R.L.K.); (A.H.); (A.V.V.); (G.A.)
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Mastropasqua L, Agnifili L, Brescia L, Figus M, Posarelli C, Oddone F, Giammaria S, Sacchi M, Pavan M, Innocenti DD, Olivotto V, Sensi SL, Mastropasqua R. A deep learning approach to investigate the filtration bleb functionality after glaucoma surgery: a preliminary study. Graefes Arch Clin Exp Ophthalmol 2024; 262:149-160. [PMID: 37530849 PMCID: PMC10805808 DOI: 10.1007/s00417-023-06170-6] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/30/2023] [Accepted: 07/10/2023] [Indexed: 08/03/2023] Open
Abstract
PURPOSE To distinguish functioning from failed filtration blebs (FBs) implementing a deep learning (DL) model on slit-lamp images. METHODS Retrospective, cross-sectional, multicenter study for development and validation of an artificial intelligence classification algorithm. The dataset consisted of 119 post-trabeculectomy FB images of whom we were aware of the surgical outcome. The ground truth labels were annotated and images splitted into three outcome classes: complete (C) or qualified success (Q), and failure (F). Images were prepared implementing various data cleaning and data transformations techniques. A set of DL models were trained using different ResNet architectures as the backbone. Transfer and ensemble learning were then applied to obtain a final combined model. Accuracy, sensitivity, specificity, area under the ROC curve, and area under the precision-recall curve were calculated to evaluate the final model. Kappa coefficient and P value on the accuracy measure were used to prove the statistical significance level. RESULTS The DL approach reached good results in unraveling FB functionality. Overall, the model accuracy reached a score of 74%, with a sensitivity of 74% and a specificity of 87%. The area under the ROC curve was 0.8, whereas the area under the precision-recall curve was 0.74. The P value was equal to 0.00307, and the Kappa coefficient was 0.58. CONCLUSIONS All considered metrics supported that the final DL model was able to discriminate functioning from failed FBs, with good accuracy. This approach could support clinicians in the patients' management after glaucoma surgery in absence of adjunctive clinical data.
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Affiliation(s)
- Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Ageing Science, University "G. D'Annunzio" of Chieti-Pescara, Via Dei Vestini Snc, 66100, Chieti, Italy
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Ageing Science, University "G. D'Annunzio" of Chieti-Pescara, Via Dei Vestini Snc, 66100, Chieti, Italy.
| | - Lorenza Brescia
- Ophthalmology Clinic, Department of Medicine and Ageing Science, University "G. D'Annunzio" of Chieti-Pescara, Via Dei Vestini Snc, 66100, Chieti, Italy
| | - Michele Figus
- Ophthalmology Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Chiara Posarelli
- Ophthalmology Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | | | - Sara Giammaria
- IRCCS Fondazione Bietti, Via Livenza, 3, 00198, Rome, Italy
| | - Matteo Sacchi
- University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy
| | - Marco Pavan
- Datamantix S.R.L. Artificial Intelligence Company, Via Paolo Sarpi, 14/15, 33100, Udine, Italy
| | - Dante Degli Innocenti
- Datamantix S.R.L. Artificial Intelligence Company, Via Paolo Sarpi, 14/15, 33100, Udine, Italy
| | - Valentina Olivotto
- Datamantix S.R.L. Artificial Intelligence Company, Via Paolo Sarpi, 14/15, 33100, Udine, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging and Clinical Sciences (DNISC), "G. d'Annunzio" University of Chieti-Pescara, Via Dei Vestini 31, 66100, Chieti, Italy
| | - Rodolfo Mastropasqua
- Department of Neuroscience, Imaging and Clinical Sciences (DNISC), "G. d'Annunzio" University of Chieti-Pescara, Via Dei Vestini 31, 66100, Chieti, Italy
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Stalmans I, Lim KS, Oddone F, Fichtl M, Belda JI, Hommer A, Laganovska G, Schweitzer C, Voykov B, Zarnowski T, Holló G. MERCURY-3: a randomized comparison of netarsudil/latanoprost and bimatoprost/timolol in open-angle glaucoma and ocular hypertension. Graefes Arch Clin Exp Ophthalmol 2024; 262:179-190. [PMID: 37615697 PMCID: PMC10806046 DOI: 10.1007/s00417-023-06192-0] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/22/2023] [Accepted: 07/23/2023] [Indexed: 08/25/2023] Open
Abstract
PURPOSE : To compare the efficacy and safety of the fixed-dose combination (FDC) of netarsudil 0.02%/latanoprost 0.005% ophthalmic solution (NET/LAT; Roclanda®) with bimatoprost 0.03%/timolol maleate 0.5% (BIM/TIM; Ganfort®) ophthalmic solution in the treatment of open-angle glaucoma (OAG) and ocular hypertension (OHT). METHODS MERCURY-3 was a 6-month prospective, double-masked, randomized, multicenter, active-controlled, parallel-group, non-inferiority study. Patients (≥ 18 years) with a diagnosis of OAG or OHT in both eyes that was insufficiently controlled with topical medication (IOP ≥ 17 mmHg in ≥ 1 eye and < 28 mmHg in both eyes) were included. Following washout, patients were randomized to once-daily NET/LAT or BIM/TIM for up to 6 months; efficacy was assessed at Week 2, Week 4, and Month 3; safety was evaluated for 6 months. Comparison of NET/LAT relative to BIM/TIM for mean IOP at 08:00, 10:00, and 16:00 h was assessed at Week 2, Week 6, and Month 3. Non-inferiority of NET/LAT to BIM/TIM was defined as a difference of ≤ 1.5 mmHg at all nine time points through Month 3 and ≤ 1.0 mmHg at five or more of nine time points through Month 3. RESULTS Overall, 430 patients were randomized (NET/LAT, n = 218; BIM/TIM, n = 212), and all received at least one dose of study medication. Efficacy analyses were performed at Month 3 on 388 patients (NET/LAT, n = 184; BIM/TIM, n = 204). NET/LAT demonstrated non-inferiority to BIM/TIM, with a between-treatment difference in IOP of ≤ 1.5 mmHg achieved at all time points and ≤ 1.0 mmHg at the majority of time points (six of nine) through Month 3. Mean diurnal IOP during the study ranged from 15.4 to 15.6 mmHg and 15.2 to 15.6 mmHg in the NET/LAT and BIM/TIM groups respectively, with no between-group statistically significant difference. No significant differences were observed in key secondary endpoints. No serious, treatment-related adverse events (AEs) were observed, and AEs were typically mild/moderate in severity. The most common treatment-related AEs were conjunctival hyperemia (NET/LAT, 30.7%; BIM/TIM, 9.0%) and cornea verticillata (NET/LAT, 11.0%; BIM/TIM, 0%). CONCLUSIONS Once-daily NET/LAT was non-inferior to BIM/TIM in IOP reduction in OAG and OHT, with AEs consistent with previous findings. NET/LAT offers a compelling alternative FDC treatment option for OAG and OHT.
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Affiliation(s)
- Ingeborg Stalmans
- Department of Ophthalmology, University Hospitals UZ Leuven, Louvain, Belgium.
- Research Group of Ophthalmology, Department of Neurosciences, Catholic University KU Leuven, Louvain, Belgium.
| | - Kin Sheng Lim
- KCL Frost Eye Research Department, St Thomas' Hospital, London, UK
| | | | - Marek Fichtl
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
- Department of Ophthalmology for Children and Adults, Second Faculty of Medicine, Charles University and University Hospital Motol in Prague, Prague, Czech Republic
| | - Jose I Belda
- Department of Ophthalmology, Hospital Universitario de Torrevieja, Alicante, Spain
- Visionker Eye Clinic, Torrevieja, Spain
| | - Anton Hommer
- Private Office for Ophthalmology and Optometry, Albertgasse 39/10, 1080, Vienna, Austria
| | - Guna Laganovska
- Riga Stradins University, P.Stradins Clinical University Hospital, Riga, Latvia
| | - Cédric Schweitzer
- CHU Bordeaux, Department of Ophthalmology, 33000, Bordeaux, France
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team LEHA, UMR 1219, 33000, Bordeaux, France
| | - Bogomil Voykov
- Centre for Ophthalmology, University Hospital Tuebingen, Tuebingen, Germany
| | - Tomasz Zarnowski
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University, Lublin, Poland
| | - Gábor Holló
- Tutkimusz Ltd, Solymár, Hungary
- Eye Center, Prima Medica Health Centers, Budapest, Hungary
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Oddone F, Roberti G, Giammaria S, Posarelli C, Ghirelli G, Mastropasqua L, Agnifili L, Micelli Ferrari T, Pace V, Nucci P, Sacchi M, Monsellato G, Altafini R, Scuderi G, Perdicchi A, Uva M, Carnevale C, Covello G, Maglionico MN, Fea A, Figus M. Effectiveness and safety of XEN45 implant over 12 months of follow-up: data from the XEN-Glaucoma Treatment Registry. Eye (Lond) 2024; 38:103-111. [PMID: 37414935 PMCID: PMC10764778 DOI: 10.1038/s41433-023-02642-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 05/29/2023] [Accepted: 06/15/2023] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVES To evaluate the 1-year effectiveness and safety of the XEN45, either alone or in combination with phacoemulsification, in glaucoma patients. METHODS This multicentre, prospective, observational study included consecutive eyes of glaucoma patients from the Italian XEN-Glaucoma Treatment Registry (XEN-GTR) who underwent XEN45 alone or in combination with phacoemulsification, with at least 1 year of follow-up. Surgical success was defined as intraocular pressure (IOP) < 18 mmHg and ≥20% reduction from preoperative IOP, over 1 year of follow-up. RESULTS Two hundred thirty-nine eyes (239 patients) were analyzed, 144 (60.2%) eyes in the XEN-solo and 95 (39.8%) eyes in the XEN+Phaco groups. One hundred-sixty-eight (70.3%) eyes achieved overall success, without statistically significant differences between study groups (p = 0.07). Preoperative IOP dropped from a median (IQR) of 23.0 (20.0-26.0) mmHg to 14.0 (12.0-16.0) mmHg at month 12 (p < 0.001), with overall 39.9 ± 18.3% IOP reduction. The mean number of preoperative ocular hypotensive medications (OHM) was significantly reduced from 2.7 ± 0.9 to 0.5 ± 0.9 at month 12 (p < 0.001). Preoperative IOP < 15 mmHg (HR: 6.63; 95%CI: 2.61-16.84, p < 0.001) and temporal position of the surgeon (HR: 4.25; 95%CI: 2.62-6.88, p < 0.001) were significantly associated with surgery failure. One hundred-forty-six (61.1%) eyes had no intraoperative complications, whereas 91 (38.1%) and 56 (23.4%) eyes experienced at least one complication, respectively early (< month 1) and late (≥ month 1), all self-limiting or successfully treated without sequelae. Needling occurred in 55 (23.0%) eyes at least once during follow-up. CONCLUSION Over 1-year follow-up, XEN45 alone or in combination with phacoemulsification, had comparable success rates and effectively and safely lowered IOP and the need for OHM.
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Affiliation(s)
| | | | | | - Chiara Posarelli
- Department of Surgical, Medical, Molecular Pathology and of Critical Care Medicine, University of Pisa, Pisa, Italy
| | | | - Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | | | - Vincenzo Pace
- Regional General Hospital F. Miulli of Acquaviva delle Fonti, Bari, Italy
| | - Paolo Nucci
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy
| | - Matteo Sacchi
- Eye Clinic, San Giuseppe Hospital - IRCCS Multimedica, Milan, Italy
| | | | | | - Gianluca Scuderi
- Ophthalmology Unit, St. Andrea Hospital, NESMOS Department, University of Rome "Sapienza", Rome, Italy
| | - Andrea Perdicchi
- Ophthalmology Unit, St. Andrea Hospital, NESMOS Department, University of Rome "Sapienza", Rome, Italy
| | - Maurizio Uva
- University Hospital "Policlinico Vittorio Emanuele", Catania, Italy
| | | | - Giuseppe Covello
- Department of Surgical, Medical, Molecular Pathology and of Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Maria Novella Maglionico
- Department of Surgical, Medical, Molecular Pathology and of Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Antonio Fea
- Struttura Complessa Oculistica, Città Della Salute e Della Scienza di Torino, Dipartimento di Scienze Chirurgiche-Università Degli Studi di Torino, 10126, Torino, Italy
| | - Michele Figus
- Department of Surgical, Medical, Molecular Pathology and of Critical Care Medicine, University of Pisa, Pisa, Italy
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Pandino I, Giammaria S, Zingale GA, Roberti G, Michelessi M, Coletta M, Manni G, Agnifili L, Vercellin AV, Harris A, Oddone F, Sbardella D. Ubiquitin proteasome system and glaucoma: A survey of genetics and molecular biology studies supporting a link with pathogenic and therapeutic relevance. Mol Aspects Med 2023; 94:101226. [PMID: 37950974 DOI: 10.1016/j.mam.2023.101226] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/28/2023] [Accepted: 10/29/2023] [Indexed: 11/13/2023]
Abstract
Glaucoma represents a group of progressive neurodegenerative diseases characterized by the loss of retinal ganglion cells (RGCs) and their axons with subsequent visual field impairment. The disease develops through largely uncharacterized molecular mechanisms, that are likely to occur in different localized cell types, either in the anterior (e.g., trabecular meshwork cells) or posterior (e.g., Muller glia, retinal ganglion cells) segments of the eye. Genomic and preclinical studies suggest that glaucoma pathogenesis may develop through altered ubiquitin (Ub) signaling. Ubiquitin conjugation, referred to as ubiquitylation, is a major post-synthetic modification catalyzed by E1-E2-E3 enzymes, that profoundly regulates the turnover, trafficking and biological activity of the targeted protein. The development of new technologies, including proteomics workflows, allows the biology of ubiquitin signaling to be described in health and disease. This post-translational modification is emerging as a key role player in neurodegeneration, gaining relevance for novel therapeutic options, such as in the case of Proteolysis Targeting Chimeras technology. Although scientific evidence supports a link between Ub and glaucoma, their relationship is still not well-understood. Therefore, this review provides a detailed research-oriented discussion on current evidence of Ub signaling in glaucoma. A review of genomic and genetic data is provided followed by an in-depth discussion of experimental data on ASB10, parkin and optineurin, which are proteins that play a key role in Ub signaling and have been associated with glaucoma.
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Affiliation(s)
| | | | | | | | | | | | - Gianluca Manni
- IRCCS Fondazione Bietti, Rome, Italy; DSCMT University of Tor Vergata, Rome, Italy
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Aging Science, University "G. D'Annunzio" of Chieti-Pescara, Italy
| | | | - Alon Harris
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Montesano G, Redmond T, Mulholland PJ, Garway-Heath DF, Ometto G, Romano D, Antonacci F, Tanga L, Carnevale C, Rossetti LM, Crabb DP, Oddone F. Spatial Summation in the Glaucomatous Macula: A Link With Retinal Ganglion Cell Damage. Invest Ophthalmol Vis Sci 2023; 64:36. [PMID: 38010697 PMCID: PMC10683773 DOI: 10.1167/iovs.64.14.36] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/03/2023] [Indexed: 11/29/2023] Open
Abstract
Purpose The purpose of this study was to test whether functional loss in the glaucomatous macula is characterized by an enlargement of Ricco's area (RA) through the application of a computational model linking retinal ganglion cell (RGC) damage to perimetric sensitivity. Methods One eye from each of 29 visually healthy subjects <40 years old, 30 patients with glaucoma, and 20 age-similar controls was tested with a 10-2 grid with stimuli of 5 different area sizes. Structural estimates of point-wise RGC density were obtained from optical coherence tomography (OCT) scans. Structural and functional data from the young healthy cohort were used to estimate the parameters of a computational spatial summation model to generate a template. The template was fitted with a Bayesian hierarchical model to estimate the latent RGC density in patients with glaucoma and age-matched controls. We tested two alternative hypotheses: fitting the data by translating the template horizontally (H1: change in RA) or vertically (H2: loss of sensitivity without a change in RA). Root mean squared error (RMSE) of the model fits to perimetric sensitivity were compared. Ninety-five percent confidence intervals were bootstrapped. The dynamic range of the functional and structural RGC density estimates was denoted by their 1st and 99th percentiles. Results The RMSE was 2.09 (95% CI = 1.92-2.26) under H1 and 2.49 (95% CI = 2.24-2.72) under H2 (P < 0.001). The average dynamic range for the structural RGC density estimates was only 11% that of the functional estimates. Conclusions Macular sensitivity loss in glaucoma is better described by a model in which RA changes with RGC loss. Structural measurements have limited dynamic range.
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Affiliation(s)
- Giovanni Montesano
- City, University of London, Optometry and Visual Sciences, London, United Kingdom
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Tony Redmond
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Pádraig J. Mulholland
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
- Centre for Optometry and Vision Science, Biomedical Sciences Research Institute, Ulster University, Coleraine, United Kingdom
| | - David F. Garway-Heath
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Giovanni Ometto
- City, University of London, Optometry and Visual Sciences, London, United Kingdom
| | - Dario Romano
- ASST Santi Paolo e Carlo, Eye Clinic – University of Milan, Milan, Italy
| | - Federica Antonacci
- ASST Santi Paolo e Carlo, Eye Clinic – University of Milan, Milan, Italy
| | | | | | - Luca M. Rossetti
- ASST Santi Paolo e Carlo, Eye Clinic – University of Milan, Milan, Italy
| | - David P. Crabb
- City, University of London, Optometry and Visual Sciences, London, United Kingdom
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Verticchio Vercellin A, Siesky B, Antman G, Oddone F, Chang M, Eckert G, Arciero J, Kellner RL, Fry B, Coleman-Belin J, Carnevale C, Harris A. Regional Vessel Density Reduction in the Macula and Optic Nerve Head of Patients With Pre-Perimetric Primary Open Angle Glaucoma. J Glaucoma 2023; 32:930-941. [PMID: 37725789 PMCID: PMC10841039 DOI: 10.1097/ijg.0000000000002310] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
PRCIS Capillary and neuronal tissue loss occur both globally and with regional specificity in pre-perimetric glaucoma patients at the level of the optic nerve and macula, with perifovea regions affected earlier than parafovea areas. PURPOSE To investigate optic nerve head (ONH) and macular vessel densities (VD) and structural parameters assessed by optical coherence tomography angiography in pre-perimetric open angle glaucoma (ppOAG) patients and healthy controls. MATERIALS AND METHODS In all, 113 healthy and 79 ppOAG patients underwent global and regional (hemispheric/quadrants) assessments of retinal, ONH, and macular vascularity and structure, including ONH parameters, retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness. Comparisons between outcomes in ppOAG and controls were adjusted for age, sex, race, BMI, diabetes, and hypertension, with P <0.05 considered statistically significant. RESULTS In ppOAG compared with healthy controls: RNFL thicknesses were statistically significantly lower for all hemispheres, quadrants, and sectors ( P <0.001-0.041); whole image peripapillary all and small blood vessels VD were statistically significantly lower for all the quadrants ( P <0.001-0.002), except for the peripapillary small vessels in the temporal quadrant (ppOAG: 49.66 (8.40), healthy: 53.45 (4.04); P =0.843); GCC and inner and full macular thicknesses in the parafoveal and perifoveal regions were significantly lower in all the quadrants ( P =0.000- P =0.033); several macular VD were significantly lower ( P =0.006-0.034), with the exceptions of macular center, parafoveal superior and inferior quadrant, and perifoveal superior quadrant ( P >0.05). CONCLUSIONS In ppOAG patients, VD biomarkers in both the macula and ONH, alongside RNFL, GCC, and macular thickness, were significantly reduced before detectable visual field loss with regional specificity. The most significant VD reduction detected was in the peripheric (perifovea) regions. Macular and ONH decrease in VD may serve as early biomarkers of glaucomatous disease.
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Affiliation(s)
| | - Brent Siesky
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gal Antman
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Rabin Medical Center, Petah Tikva, Israel
| | | | - Michael Chang
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George Eckert
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Julia Arciero
- Department of Mathematical Sciences, Indiana University Purdue University Indianapolis, Indianapolis, IN, United States
| | | | - Brendan Fry
- Department of Mathematics and Statistics, Metropolitan State University of Denver, Denver, CO, United States
| | | | | | - Alon Harris
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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12
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Verticchio Vercellin AC, Harris A, Oddone F, Siesky B, Eckert G, Belamkar A, Antman G, Segev F. Ocular blood flow biomarkers may predict long-term glaucoma progression. Br J Ophthalmol 2023:bjo-2022-322644. [PMID: 37852742 DOI: 10.1136/bjo-2022-322644] [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: 09/30/2022] [Accepted: 07/29/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND/AIM To examine the relationship between baseline blood flow biomarkers and long-term open-angle glaucoma (OAG) progression. METHODS 112 patients with early to moderate OAG (mean age 64.9±11.0 years; 68 female) were evaluated at baseline and every 6 months from 2008 to 2013. Biomarkers of retinal capillary blood flow were assessed by Heidelberg retinal flowmetry. Functional disease progression was monitored via Humphrey visual field examinations, defined as two consecutive visits with a mean deviation decrease ≥2 decibels and/or Advanced Glaucoma Intervention Study score increase ≥2 compared with baseline. Structural progression was monitored with optical coherence tomography and Heidelberg retinal tomograph, defined as two consecutive visits with retinal nerve fibre layer thickness decrease ≥8% and/or horizontal or vertical cup/disk ratio increase ≥0.2 compared with baseline. Mixed-model analysis of covariance was used to test for significant change from baseline to 5-year follow-up. Times to functional and structural progression were analysed using Cox proportional hazards models. RESULTS Lower HRF retinal capillary blood flow in the superior retina was significantly associated with structural progression (p=0.0009). CONCLUSION In our OAG sample, baseline lower retinal capillary perfusion in the superior retina was predictive of structural progression after 5 years. TRIAL REGISTRATION NUMBER NCT01145911.
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Affiliation(s)
| | - Alon Harris
- Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Brent Siesky
- Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - George Eckert
- Department of Biostatistics abd Health Data Science, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - Aditya Belamkar
- Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Gal Antman
- Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
| | - Fani Segev
- Ophthalmology, Assuta Ashdod Medical Center, Goldman Medical School, Ben-Gurion University, Be'er Sheva, Israel
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13
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Fea A, Sacchi M, Franco F, Laffi GL, Oddone F, Costa G, Serino F, Giansanti F. Effectiveness and Safety of XEN45 in Eyes With High Myopia and Open Angle Glaucoma. J Glaucoma 2023; 32:178-185. [PMID: 36730214 DOI: 10.1097/ijg.0000000000002151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/22/2022] [Accepted: 11/14/2022] [Indexed: 02/03/2023]
Abstract
PRCIS XEN45 implant was an effective and safe procedure in primary open angle glaucoma (OAG) eyes with high myopia. Although the hypotony incidence rate was relatively high, it resolved with medical therapy and was of short duration. PURPOSE The purpose of this study is to evaluate the effectiveness and safety of the XEN45 stent in eyes with OAG and high myopia. DESIGN Retrospective and multicenter study. METHODS Consecutive OAG patients who underwent a XEN45, either alone or in combination with cataract surgery, and had a refractive error higher than -6 D and an axial length ≥26 mm. The primary endpoint was the mean intraocular pressure (IOP) lowering at the last follow-up visit. RESULTS Thirty-one eyes were included (96.8% with a primary OAG diagnosis). The mean refraction was -13.2±5.6 (range: -6.75 to-23.0) D. In the overall study sample, preoperative mean IOP (95% CI) was significantly lowered from 23.5 (20.5-26.4) mm Hg to 13.0 (12.2-13.8) mm Hg at the last follow-up visit, P <0.0001. At the last follow-up visit, 16 (57.1%) eyes achieved an IOP ≤14 mm Hg, 11 (68.9%) of them without treatment. The number of ocular hypotensive medications was significantly reduced from 3.0±1.1 drugs at preoperatively to 0.6±1.0 drugs at the last follow-up visit, P <0.0001. Median (95% CI) follow-up was 24.0 (12.0-24.0) months. Linear regression analysis showed a significant correlation between the preoperative refraction and the IOP lowering ( r =0.43, P =0.0155). Needling procedure was performed in 11 eyes (39.3%) and hypotony (defined as an IOP <6 mm Hg) was observed in 8 eyes (28.6%) during the first postoperative day and remained for a week. CONCLUSION Although the Xen implant effectively lowered IOP in highly myopic eyes with glaucoma, the incidence of hypotony was high, and in most cases, resolved within the first month with medical management and monitoring.
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Affiliation(s)
- Antonio Fea
- Complex Ophthalmology Structure, City of Health and Science of Turin, Department of Surgical Sciences - University of Turin, Turin
| | - Matteo Sacchi
- Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan
| | - Fabrizio Franco
- Ophthalmology Department, SOD Ophthalmology, AOU Careggi Florence, Florence, Italy
| | | | | | - Giacomo Costa
- Ophthalmology Department, SOD Ophthalmology, AOU Careggi Florence, Florence, Italy
| | - Federica Serino
- Ophthalmology Department, SOD Ophthalmology, AOU Careggi Florence, Florence, Italy
| | - Fabrizio Giansanti
- Ophthalmology Department, SOD Ophthalmology, AOU Careggi Florence, Florence, Italy
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14
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Siesky B, Harris A, Verticchio Vercellin A, Arciero J, Fry B, Eckert G, Guidoboni G, Oddone F, Antman G. Heterogeneity of Ocular Hemodynamic Biomarkers among Open Angle Glaucoma Patients of African and European Descent. J Clin Med 2023; 12:1287. [PMID: 36835823 PMCID: PMC9967448 DOI: 10.3390/jcm12041287] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
This study investigated the heterogeneity of ocular hemodynamic biomarkers in early open angle glaucoma (OAG) patients and healthy controls of African (AD) and European descent (ED). Sixty OAG patients (38 ED, 22 AD) and 65 healthy controls (47 ED, 18 AD) participated in a prospective, cross-sectional study assessing: intraocular pressure (IOP), blood pressure (BP), ocular perfusion pressure (OPP), visual field (VF) and vascular densities (VD) via optical coherence tomography angiography (OCTA). Comparisons between outcomes were adjusted for age, diabetes status and BP. VF, IOP, BP and OPP were not significantly different between OAG subgroups or controls. Multiple VD biomarkers were significantly lower in OAG patients of ED (p < 0.05) while central macular VD was lower in OAG patients of AD vs. OAG patients of ED (p = 0.024). Macular and parafoveal thickness were significantly lower in AD OAG patients compared to those of ED (p = 0.006-0.049). OAG patients of AD had a negative correlation between IOP and VF index (r = -0.86) while ED patients had a slightly positive relationship (r = 0.26); difference between groups (p < 0.001). Age-adjusted OCTA biomarkers exhibit significant variation in early OAG patients of AD and ED.
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Affiliation(s)
- Brent Siesky
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Alon Harris
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | | | - Julia Arciero
- Department of Mathematical Sciences, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA
| | - Brendan Fry
- Department of Mathematics and Statistics, Metropolitan State University of Denver, Denver, CO 80217, USA
| | - George Eckert
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Giovanna Guidoboni
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO 65211, USA
| | | | - Gal Antman
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Ophthalmology, Rabin Medical Center, Petach Tikwa 4941492, Israel
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15
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Oddone F. ROCK
inhibitors in glaucoma medical treatment. Acta Ophthalmol 2022. [DOI: 10.1111/j.1755-3768.2022.15607] [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: 02/11/2023]
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16
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Belamkar A, Harris A, Zukerman R, Siesky B, Oddone F, Verticchio Vercellin A, Ciulla TA. Sustained release glaucoma therapies: Novel modalities for overcoming key treatment barriers associated with topical medications. Ann Med 2022; 54:343-358. [PMID: 35076329 PMCID: PMC8794062 DOI: 10.1080/07853890.2021.1955146] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Glaucoma is a progressive optic neuropathy and a leading cause of irreversible blindness. The disease has conventionally been characterized by an elevated intraocular pressure (IOP); however, recent research has built the consensus that glaucoma is not only dependent on IOP but rather represents a multifactorial optic neuropathy. Although many risk factors have been identified ranging from demographics to co-morbidities to ocular structural predispositions, IOP is currently the only modifiable risk factor, most often treated by topical IOP-lowering medications. However, topical hypotensive regimens are prone to non-adherence and are largely inefficient, leading to disease progression in spite of treatment. As a result, several companies are developing sustained release (SR) drug delivery systems as alternatives to topical delivery to potentially overcome these barriers. Currently, Bimatoprost SR (DurystaTM) from Allergan plc is the only FDA-approved SR therapy for POAG. Other SR therapies under investigation include: bimatoprost ocular ring (Allergan) (ClinicalTrials.gov identifier: NCT01915940), iDose® (Glaukos Corporation) (NCT03519386), ENV515 (Envisia Therapeutics) (NCT02371746), OTX-TP (Ocular Therapeutix) (NCT02914509), OTX-TIC (Ocular Therapeutix) (NCT04060144), and latanoprost free acid SR (PolyActiva) (NCT04060758). Additionally, a wide variety of technologies for SR therapeutics are under investigation including ocular surface drug delivery systems such as contact lenses and nanotechnology. While challenges remain for SR drug delivery technology in POAG management, this technology may shift treatment paradigms and dramatically improve outcomes.
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Affiliation(s)
- Aditya Belamkar
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alon Harris
- Department of Opthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ryan Zukerman
- Department of Opthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Opthalmology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Brent Siesky
- Department of Opthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Thomas A Ciulla
- Indiana University School of Medicine, Indianapolis, IN, USA.,Vitreoretinal Medicine and Surgery, Midwest Eye Institute, Indianapolis, IN, USA
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17
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Oddone F. Old is the new young: A paradox for glaucoma patients. Acta Ophthalmol 2022. [DOI: 10.1111/j.1755-3768.2022.15502] [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: 12/24/2022]
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Oddone F. Reviewing the evidence surrounding preservative-free tafluprost/timolol fixed-dose combination therapy in open angle glaucoma and ocular hypertension management: a focus on efficacy, safety and tolerability. Expert Opin Drug Saf 2022; 21:1259-1268. [PMID: 36250245 DOI: 10.1080/14740338.2022.2135701] [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] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Elevated intraocular pressure (IOP) is the most important modifiable risk factor for irreversible sight loss in open angle glaucoma (OAG). The topical fixed-dose combination (FC) of preservative-free (PF) tafluprost (0.0015%) and timolol (0.5%) (tafluprost/timolol) is among the second-line IOP-lowering options for OAG and ocular hypertension (OHT). AREAS COVERED PubMed searches identified publications reporting key evidence from randomized controlled trials (RCTs) and real-world studies examining the safety, tolerability and IOP-lowering efficacy of PF tafluprost/timolol FC therapy in OAG/OHT management. EXPERT OPINION Glaucoma patients are more likely to have ocular surface disease and treatment should be individualized so that target response may be achieved while considering tolerability and quality of life, according to European Glaucoma Society guidelines. PF FC therapies, such as PF tafluprost/timolol FC, avoid ocular surface exposure to toxic preservative agents and reduce the required number of treatment administrations. These properties may enhance treatment tolerability and adherence, resulting in improved IOP-lowering efficacy and disease control. Treatment outcomes from RCTs and real-world studies examining PF tafluprost/timolol FC therapy support this hypothesis, with significant IOP reductions and/or improvements in tolerability parameters demonstrated, regardless of the prior topical therapy used and even when switched directly to PF tafluprost/timolol FC treatment (without washout).
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19
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Guidoboni G, Nunez R, Keller J, Wikle C, Robinson EL, Verticchio Vercellin AC, Siesky B, Oddone F, Quaranta L, Wirostko B, Topouzis F, Cheng CY, Januleviciene I, Wegner A, Antman G, Jones C, Harris A. Precision medicine and glaucoma management: how mathematical modeling and artificial intelligence help in clinical practice. Expert Rev Ophthalmol 2022; 17:299-301. [PMID: 36545014 PMCID: PMC9762696 DOI: 10.1080/17469899.2022.2130249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/26/2022] [Indexed: 12/26/2022]
Affiliation(s)
- G Guidoboni
- Electrical Engineering Computer Science, University of Missouri, Columbia, MO, United States
| | - R Nunez
- Electrical Engineering Computer Science, University of Missouri, Columbia, MO, United States
| | - J Keller
- Electrical Engineering Computer Science, University of Missouri, Columbia, MO, United States
| | - C Wikle
- Statistics, University of Missouri, Columbia, MO, United States
| | - EL Robinson
- School of Social Work, University of Missouri System, Columbia, MO, United States
| | | | - B Siesky
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - F Oddone
- IRCCS Fondazione Bietti, Rome, Italy
| | - L Quaranta
- Centro Oculistico Italiano, Brescia, Italy
| | - B Wirostko
- Moran Eye Center, Salt Lake City, UT, United States
| | - F Topouzis
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - C-Y Cheng
- Singapore Eye Research Institute, Singapore, Singapore
| | | | - A Wegner
- Institute for Refractive and Ophthalmic Surgery, Zürich, Switzerland
| | - G Antman
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Rabin Medical Center, Petah Tikva, Israel
| | - C Jones
- Mathematics, University of Missouri, Columbia, MO, United States
| | - A Harris
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
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20
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Huang X, Sun J, Gupta K, Montesano G, Crabb DP, Garway-Heath DF, Brusini P, Lanzetta P, Oddone F, Turpin A, McKendrick AM, Johnson CA, Yousefi S. Detecting glaucoma from multi-modal data using probabilistic deep learning. Front Med (Lausanne) 2022; 9:923096. [PMID: 36250081 PMCID: PMC9556968 DOI: 10.3389/fmed.2022.923096] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To assess the accuracy of probabilistic deep learning models to discriminate normal eyes and eyes with glaucoma from fundus photographs and visual fields. Design Algorithm development for discriminating normal and glaucoma eyes using data from multicenter, cross-sectional, case-control study. Subjects and participants Fundus photograph and visual field data from 1,655 eyes of 929 normal and glaucoma subjects to develop and test deep learning models and an independent group of 196 eyes of 98 normal and glaucoma patients to validate deep learning models. Main outcome measures Accuracy and area under the receiver-operating characteristic curve (AUC). Methods Fundus photographs and OCT images were carefully examined by clinicians to identify glaucomatous optic neuropathy (GON). When GON was detected by the reader, the finding was further evaluated by another clinician. Three probabilistic deep convolutional neural network (CNN) models were developed using 1,655 fundus photographs, 1,655 visual fields, and 1,655 pairs of fundus photographs and visual fields collected from Compass instruments. Deep learning models were trained and tested using 80% of fundus photographs and visual fields for training set and 20% of the data for testing set. Models were further validated using an independent validation dataset. The performance of the probabilistic deep learning model was compared with that of the corresponding deterministic CNN model. Results The AUC of the deep learning model in detecting glaucoma from fundus photographs, visual fields, and combined modalities using development dataset were 0.90 (95% confidence interval: 0.89-0.92), 0.89 (0.88-0.91), and 0.94 (0.92-0.96), respectively. The AUC of the deep learning model in detecting glaucoma from fundus photographs, visual fields, and both modalities using the independent validation dataset were 0.94 (0.92-0.95), 0.98 (0.98-0.99), and 0.98 (0.98-0.99), respectively. The AUC of the deep learning model in detecting glaucoma from fundus photographs, visual fields, and both modalities using an early glaucoma subset were 0.90 (0.88,0.91), 0.74 (0.73,0.75), 0.91 (0.89,0.93), respectively. Eyes that were misclassified had significantly higher uncertainty in likelihood of diagnosis compared to eyes that were classified correctly. The uncertainty level of the correctly classified eyes is much lower in the combined model compared to the model based on visual fields only. The AUCs of the deterministic CNN model using fundus images, visual field, and combined modalities based on the development dataset were 0.87 (0.85,0.90), 0.88 (0.84,0.91), and 0.91 (0.89,0.94), and the AUCs based on the independent validation dataset were 0.91 (0.89,0.93), 0.97 (0.95,0.99), and 0.97 (0.96,0.99), respectively, while the AUCs based on an early glaucoma subset were 0.88 (0.86,0.91), 0.75 (0.73,0.77), and 0.92 (0.89,0.95), respectively. Conclusion and relevance Probabilistic deep learning models can detect glaucoma from multi-modal data with high accuracy. Our findings suggest that models based on combined visual field and fundus photograph modalities detects glaucoma with higher accuracy. While probabilistic and deterministic CNN models provided similar performance, probabilistic models generate certainty level of the outcome thus providing another level of confidence in decision making.
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Affiliation(s)
- Xiaoqin Huang
- Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Jian Sun
- Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, TN, United States
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Krati Gupta
- Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Giovanni Montesano
- ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
- Department of Optometry and Visual Sciences, City University of London, London, United Kingdom
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - David P. Crabb
- Department of Optometry and Visual Sciences, City University of London, London, United Kingdom
| | - David F. Garway-Heath
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Paolo Brusini
- Department of Ophthalmology, “Città di Udine” Health Center, Udine, Italy
| | - Paolo Lanzetta
- Ophthalmology Unit, Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | | | - Andrew Turpin
- School of Computing and Information System, University of Melbourne, Melbourne, VIC, Australia
| | - Allison M. McKendrick
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Chris A. Johnson
- Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Siamak Yousefi
- Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, TN, United States
- Department of Genetics, Genomics, and Informatics, University of Tennessee Health Science Center, Memphis, TN, United States
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21
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Roberti G, Michelessi M, Tanga L, Belfonte L, Del Grande LM, Bruno M, Oddone F. Glaucoma Progression Diagnosis: The Agreement between Clinical Judgment and Statistical Software. J Clin Med 2022; 11:jcm11195508. [PMID: 36233376 PMCID: PMC9573472 DOI: 10.3390/jcm11195508] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background: To explore the agreement between clinical judgment and Guided Progression Analysis II (GPAII) in the evaluation of visual fields (VF) progression in patients with glaucoma. Methods: Three glaucoma experts and three general ophthalmologists were asked to rate the VF series by classifying them as progressive through the observation of the overview report. The agreement between clinical judgment and GPAII event analysis (EA) and trend analysis (TA) was assessed by Cohen statistic. The sensitivity and specificity of clinical judgment in detecting the presence of progression was evaluated considering the results of GPAII as the reference standard. Results: 66 VF series were included in the study. Glaucoma experts, general ophthalmologists, GPAII EA, and GPAII TA found progression in 39%, 38%, 15%, and 21% of the VF series (p < 0.05). The clinical judgment of glaucoma experts and general ophthalmologists was discordant with GPAII EA in 27.2% and 28.7% (k = 0.35, 95% CI 0.15−0.56 and k = 0.30, 95% CI 0.09−0.52) and with GPAII TA in 21.2% and 25.7% of the VF series examined (k = 0.51, 95% CI 0.31−0.72 and k = 0.41, 95% CI 0.18−0.62). Considering the GPAII EA and TA as reference standard, glaucoma experts showed a sensitivity of 90% and 92.8% and a specificity of 69.6% and 75%, while general ophthalmologists showed a sensitivity of 80% and 78.5% and a specificity of 69.6% and 73%. Conclusions: The agreement between clinical judgment and GPAII ranges from fair to moderate. Glaucoma experts showed better ability than general ophthalmologists in detecting VF progression.
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22
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Posarelli C, Figus M, Roberti G, Giammaria S, Ghirelli G, Quercioli P, Micelli Ferrari T, Pace V, Mastropasqua L, Agnifili L, Sacchi M, Scuderi G, Perdicchi A, Altafini R, Uva M, D’Andrea D, Covello G, Maglionico MN, Fea AM, Carnevale C, Oddone F. Italian Candidates for the XEN Implant: An Overview from the Glaucoma Treatment Registry (XEN-GTR). J Clin Med 2022; 11:jcm11185320. [PMID: 36142967 PMCID: PMC9500791 DOI: 10.3390/jcm11185320] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background The Italian XEN Glaucoma Treatment Registry (XEN-GTR) was created to acquire a comprehensive prospective dataset that includes the patient characteristics, intraoperative variables, and postoperative management of glaucoma patients undergoing the XEN gel stent implantation. Methods This was a prospective observational, longitudinal clinical study involving 10 centres throughout Italy. The baseline examination included a comprehensive evaluation of demographic parameters (age, sex, ethnicity, and systemic condition), specific ophthalmological parameters, and quality of life questionnaire score collection. Results The baseline data of 273 patients were analysed. The median (IQR) age was 72 (65.0 to 78.0) years. Of the 273 patients, 123 (45%) were female and 150 (55%) were male. A total of 86% of the patients had open-angle glaucoma with a mean intraocular pressure of 24 ± 6 (range 12.0–60.0) mmHg. The mean number of medications was 2.7 ± 0.9 at baseline for the patients with a prevalence of prostaglandin analogues combined with a beta-blocker and anhydrase carbonic inhibitor (31.8%). The mean scores of the NEI-VFQ 25 and GSS questionnaires were 78 ± 18 (range 26.5–100) and 85 ± 14 (range 79–93), respectively. Combined XEN/cataract surgeries were scheduled in 73.7% of the patients. The preferred place for the XEN implant was the supero-nasal quadrant (91.6%). Conclusions Observing the baseline characteristics of the typical Italian candidates for the XEN gel implant shows that they are patients affected by POAG and cataracts, with moderate to severe glaucoma damage, all of which has an impact on their quality of life.
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Affiliation(s)
- Chiara Posarelli
- Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, 56124 Pisa, Italy
- Correspondence: ; Tel.: +39-050997675
| | - Michele Figus
- Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, 56124 Pisa, Italy
| | | | | | | | | | | | - Vincenzo Pace
- Ospedale Generale Regionale F. Miulli di Acquaviva delle Fonti, 70021 Bari, Italy
| | - Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D’Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D’Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Matteo Sacchi
- University Eye Clinic, San Giuseppe Hospital, University of Milan, 20162 Milan, Italy
| | - Gianluca Scuderi
- Ophthalmology Unit, NESMOS Department, S. Andrea Hospital, Faculty of Medicine and Psychology, University of Rome La Sapienza, 00189 Rome, Italy
| | - Andrea Perdicchi
- Ophthalmology Unit, NESMOS Department, S. Andrea Hospital, Faculty of Medicine and Psychology, University of Rome La Sapienza, 00189 Rome, Italy
| | | | - Maurizio Uva
- Azienda Ospedaliera Universitaria, “Policlinico Vittorio Emanuele”, P.O. Gaspare Rodolico, 95123 Catania, Italy
| | | | - Giuseppe Covello
- Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, 56124 Pisa, Italy
| | - Maria Novella Maglionico
- Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, 56124 Pisa, Italy
| | - Antonio Maria Fea
- Ophthalmic Eye Hospital, Department of Surgical Sciences, University of Turin, 10122 Turin, Italy
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23
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Holló G, Kirwan J, Lopez-Lopez F, Zimina M, Fassari C, Oddone F. A comparison of country-level data from the VISIONARY study examining treatment outcomes with preservative-free tafluprost/timolol fixed-dose combination therapy. Curr Med Res Opin 2022; 38:1189-1201. [PMID: 35621005 DOI: 10.1080/03007995.2022.2083324] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Analysis and comparison of country-level data from the VISIONARY study, examining treatment outcomes with the topical fixed-dose combination of preservative-free tafluprost (0.0015%) and timolol (0.5%) (PF tafluprost/timolol FC) in adults with open-angle glaucoma (OAG) and ocular hypertension (OHT) who were insufficiently treated with or unable to tolerate either beta-blocker or prostaglandin analogue (PGA) topical monotherapy. METHODS A European, prospective, observational study was conducted in 11 countries. Adults with OAG/OHT were switched to the PF tafluprost/timolol FC from either PGA or beta-blocker topical monotherapy. Statistical analysis examined changes in mean standard deviation (SD) intraocular pressure (IOP) from baseline at Week 4, Week 12 and Month 6. Data were documented for each eye separately at baseline and during follow up visits, with the eye reported to have the higher IOP (mmHg), as measured using Goldmann applanation tonometry, being selected for analysis (study eye). Country-level subanalysis examined outcomes by prior monotherapy, diagnosis and timing of dosing for those countries recruiting ≥20 patients (Country-level Subanalysis Population). Two-sided paired t-test was used to assess significance regarding mean IOP reduction from baseline and a compound symmetry covariance model was used in cross-country comparisons regarding variation in IOP change from baseline. Treatment-related adverse events (AEs) were evaluated. RESULTS Mean (SD) age among patients recruited to the VISIONARY study ranged between 63.9 (11.8) and 72.4 (10.6) years across all countries. The majority of participants (>50%) were female in each country. The Country-level Subanalysis Population included 551 eyes. Mean (SD) IOP was significantly reduced from baseline in each country at Week 4, Week 12 and Month 6 (p < .0001). Mean IOP reduction at Month 6 ranged from 5.0 mmHg (22.6%, Hungary) to 7.8 mmHg (31.8%, Latvia) and varied significantly between countries (p < .001). The greatest reductions were in Latvia and Russia, where baseline IOP was highest. Country-level IOP reductions were significant irrespective of prior monotherapy, diagnosis or dosing time (p < .0001). Most treatment-related AEs occurred in the UK (26 events, 73% mild). One serious AE was reported (Russia, status asthmaticus). Tolerability with PF tafluprost/timolol FC therapy was rated as good/very good by most patients (85.7-100%) in all countries. CONCLUSION Subanalysis of VISIONARY study data revealed significant IOP reductions following a switch to the PF tafluprost/timolol FC from either PGA or beta-blocker topical monotherapy. Cross-country variation was likely due to baseline IOP differences. Within country, outcomes were consistent regardless of diagnosis, dosing or prior monotherapy. Treatment was generally well tolerated.
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Affiliation(s)
- Gábor Holló
- Tutkimusz Ltd., Solymár, Hungary
- Eye Center, Prima Medica Health Centers, Budapest, Hungary
| | - James Kirwan
- Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Fernando Lopez-Lopez
- Department of Ophthalmology, Instituto Oftalmologico Gomez-Ulla, Santiago de Compostela, Galicia, Spain
| | - Marina Zimina
- Department of Ophthalmology, LLC Vzglyad, Leningradskaya, Chita, Russia
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Azzopardi M, Prokosch-Willing V, Michelessi M, Fea AM, Oddone F, Mercieca K. The current use of glaucoma virtual clinics in Europe. Eye (Lond) 2022; 37:1350-1356. [PMID: 35690678 PMCID: PMC9188015 DOI: 10.1038/s41433-022-02111-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 04/26/2022] [Accepted: 05/13/2022] [Indexed: 11/12/2022] Open
Abstract
Objectives To assess and describe current utilisation, characteristics and perspectives on virtual glaucoma clinics (VGCs) amongst European glaucoma specialists. Methods Cross-sectional, anonymized, online questionnaire distributed to all European Glaucoma Society-registered specialists. Questions were stratified into five domains: Demographics, Questions about VGC use, Questions for non-VGC users, COVID-19 effects, and VGC advantages/disadvantages. Results 30% of 169 participants currently use VGCs, with 53% based in the United Kingdom. Of those using VGCs, 85% reported higher patient acceptance compared to traditional care. The commonest virtual model was asynchronous remote monitoring (54%). Nurses (49%) and ophthalmic technicians (46%) were mostly responsible for data collection, with two-thirds using a mixture of professionals. Consultant ophthalmologists were the main decision-makers in 51% of VGCs. Preferred cohorts were: ocular hypertension (85%), glaucoma suspects (80%), early/moderate glaucoma in worse eye (68%), stable glaucoma irrespective of treatment (59%) and stable glaucoma on monotherapy (51%). Commonest investigations were: IOP (90%), BCVA (88%), visual field testing (85%) and OCT (78%), with 33 different combinations. Reasons for face-to-face referral included: visual field progression (80%), ‘above-target’ IOP (63%), and OCT progression (51%). Reasons for not using VGCs included: lack of experience (47%), adequate systems in place (42%), no appropriate staff (34%) and insufficient time/money (34%). 55% of non-VGC users are interested in their use with 38% currently considering future implementation. 83% stated VGC consultations have increased during the COVID-19 pandemic; 86% of all participants felt that the pandemic has highlighted the importance of VGCs. Conclusions A significant proportion of European glaucoma units are currently using VGCs, while others are considering implementation. Financial reimbursement and consensus guidelines are potentially crucial steps in VGC uptake.
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Affiliation(s)
| | | | | | - Antonio Maria Fea
- Dipartimento di Scienze Chirurgiche, Universita degli Studi di Torino, Torino, Italy
| | | | - Karl Mercieca
- University Hospital Bonn, Eye Clinic, Ernst Abbe Strasse 2, Bonn, Germany. .,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
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25
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Oddone F, Scorcia V, Iester M, Sisto D, De Cilla S, Bettin P, Cagini C, Figus M, Marchini G, Rossetti L, Rossi G, Salgarello T, Scuderi GL, Staurenghi G. Treatment of Open-Angle Glaucoma and Ocular Hypertension with the Fixed-Dose Combination of Preservative-Free Tafluprost/Timolol: Clinical Outcomes from Ophthalmology Clinics in Italy. Clin Ophthalmol 2022; 16:1707-1719. [PMID: 35677639 PMCID: PMC9167838 DOI: 10.2147/opth.s364880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/11/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction The VISIONARY study examined the intraocular pressure (IOP)-lowering efficacy and tolerability of the preservative-free fixed-dose combination of tafluprost (0.0015%) and timolol (0.5%) (PF tafluprost/timolol FC) in a real-world setting. The country-level data reported herein comprise the largest and first observational study of PF tafluprost/timolol FC therapy in Italy. Methods An observational, multicenter, prospective study included adult Italian patients with open-angle glaucoma (OAG) or ocular hypertension (OHT) demonstrating insufficient response or poor tolerability with topical prostaglandin analogue (PGA) or beta-blocker monotherapy. Treatment was switched to PF tafluprost/timolol FC therapy at baseline. Primary endpoint was the absolute mean IOP change from baseline at Month 6. Exploratory and safety endpoints included change in IOP at Weeks 4 and 12, ocular signs, symptom severity and reporting of adverse events (AEs). Results Overall, 160 OAG/OHT patients were included. Mean ± standard deviation IOP was reduced from 19.6 ± 3.6 mmHg at baseline to 14.5 ± 2.6 mmHg at Month 6 (reduction of 5.1 ± 3.7 mmHg; 24.1%; p < 0.0001). IOP reduction was also statistically significant at Week 4 (23.1%; p < 0.0001) and Week 12 (24.7%; p < 0.0001). Based on data cutoff values for mean IOP change of ≥20%, ≥25%, ≥30% and ≥35%, respective Month 6 responder rates were 68.1%, 48.7%, 36.2% and 26.9%. Most ocular signs and symptoms were significantly reduced in severity from baseline at Month 6. Two non-serious and mild AEs were reported during the study period, among which, one AE was treatment-related (eyelash growth). Conclusion Italian OAG and OHT patients demonstrated a significant IOP reduction from baseline at Week 4 that was maintained over a 6-month period following a switch from topical PGA or beta-blocker monotherapy to PF tafluprost/timolol FC therapy. Severity of most ocular signs and symptoms was significantly reduced during the study period, and PF tafluprost/timolol FC was generally well tolerated.
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Affiliation(s)
- Francesco Oddone
- Glaucoma Unit, IRCSS-Fondazione Bietti, Roma, Italy
- Correspondence: Francesco Oddone, Glaucoma Unit, IRCSS-Fondazione Bietti, Roma, Italy, Tel + 39 06 85356727, Email
| | - Vincenzo Scorcia
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Michele Iester
- Eye Clinic of Genoa, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
| | - Dario Sisto
- Ophthalmology Department, University of Bari, Bari, Italy
| | - Stefano De Cilla
- Department of Health Sciences, Eye Clinic, University of Piemonte Orientale, Novara, Italy
| | - Paolo Bettin
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milano, Italy
| | - Carlo Cagini
- Department of Medicine and Surgery, Ophthalmology Section, University of Perugia, Perugia, Italy
| | - Michele Figus
- Ophthalmology, Department of Surgery, Medicine, Molecular and Emergency, University of Pisa, Pisa, Italy
| | - Giorgio Marchini
- Ophthalmology Unit, Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Luca Rossetti
- Eye Clinic, San Paolo Hospital, University of Milan, Milano, Italy
| | - Gemma Rossi
- University Eye Clinic, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Tommaso Salgarello
- Ophthalmology Unit, Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Institute of Ophthalmology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Gian Luca Scuderi
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, Università di Roma La Sapienza, Roma, Italy
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milano, Italy
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26
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Vercellin AV, Harris A, Belamkar A, Zukerman R, Carichino L, Szopos M, Siesky B, Quaranta L, Bruttini C, Oddone F, Riva I, Guidoboni G. Physiology-Enhanced Data Analytics to Evaluate the Effect of Altitude on Intraocular Pressure and Ocular Hemodynamics. Photonics 2022; 9:158. [PMID: 36777090 PMCID: PMC9912910 DOI: 10.3390/photonics9030158] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Altitude affects intraocular pressure (IOP); however, the underlying mechanisms involved and its relationship with ocular hemodynamics remain unknown. Herein, a validated mathematical modeling approach was used for a physiology-enhanced (pe-) analysis of the Mont Blanc study (MBS), estimating the effects of altitude on IOP, blood pressure (BP), and retinal hemodynamics. In the MBS, IOP and BP were measured in 33 healthy volunteers at 77 and 3466 m above sea level. Pe-retinal hemodynamics analysis predicted a statistically significant increase (p < 0.001) in the model predicted blood flow and pressure within the retinal vasculature following increases in systemic BP with altitude measured in the MBS. Decreased IOP with altitude led to a non-monotonic behavior of the model predicted retinal vascular resistances, with significant decreases in the resistance of the central retinal artery (p < 0.001) and retinal venules (p = 0.003) and a non-significant increase in the resistance in the central retinal vein (p = 0.253). Pe-aqueous humor analysis showed that a decrease in osmotic pressure difference (OPD) may underlie the difference in IOP measured at different altitudes in the MBS. Our analysis suggests that venules bear the significant portion of the IOP pressure load within the ocular vasculature, and that OPD plays an important role in regulating IOP with changes in altitude.
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Affiliation(s)
| | - Alon Harris
- Department of Ophthalmology, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, USA
| | - Aditya Belamkar
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Ryan Zukerman
- Department of Ophthalmology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Lucia Carichino
- School of Mathematical Sciences, Rochester Institute of Technology, Rochester, NY 14623, USA
| | - Marcela Szopos
- MAP5 UMR CNRS 8145, Université de Paris, 75006 Paris, France
| | - Brent Siesky
- Department of Ophthalmology, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, USA
| | - Luciano Quaranta
- Department of Ophthalmology, Centro Oculistico Italiano, 25122 Brescia, Italy
| | - Carlo Bruttini
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia—IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| | | | - Ivano Riva
- Department of Ophthalmology, Istituto Clinico Sant’Anna, 25127 Brescia, Italy
| | - Giovanna Guidoboni
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO 65211, USA
- Department of Mathematics, University of Missouri, Columbia, MO 65211, USA
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27
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Shin JD, Wolf AT, Harris A, Verticchio Vercellin A, Siesky B, Rowe LW, Packles M, Oddone F. Vascular biomarkers from optical coherence tomography angiography and glaucoma: where do we stand in 2021? Acta Ophthalmol 2022; 100:e377-e385. [PMID: 34363322 PMCID: PMC8920047 DOI: 10.1111/aos.14982] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 03/17/2021] [Revised: 05/28/2021] [Accepted: 07/01/2021] [Indexed: 12/16/2022]
Abstract
Biomarkers of ocular blood flow originating from a wide variety of imaging modalities have been associated with glaucoma onset and progression for many decades. Advancements in imaging platforms including optical coherence tomography angiography (OCTA) have provided the ability to quantify vascular changes in glaucoma patients, alongside traditional measures such as retinal nerve fibre layer thickness and optic nerve head structure. Current literature on vascular biomarkers, as measured by OCTA, indicates significant relationships between glaucoma and blood flow and capillary density in the retina and ONH. The data currently available, however, are highly diverse and lack robust longitudinal data on OCTA vascular outcomes and glaucoma progression. Herein we discuss and summarize the relevant current literature on OCTA vascular biomarkers and glaucoma reviewed through March 1, 2021. Associations between OCTA vascular biomarkers and clinical structural and functional glaucoma outcomes as well as differences between glaucoma patients and healthy controls are reviewed and summarized. The available data identify significantly decreased flow density, flow index and vessel density in the ONH, peripapillary vascular layer and macula of glaucoma patients compared with controls. Whole image vessel density is also significantly decreased in glaucoma patients compared with controls, and this outcome has been found to correspond to severity of visual field loss. OCTA vascular biomarkers alongside clinical structural outcomes may aid in assessing overall risk for glaucoma in patients.
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Affiliation(s)
- Joshua D. Shin
- School of Medicine, New York Medical College, Valhalla, NY
| | - Amber T. Wolf
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Alon Harris
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | | | - Brent Siesky
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Lucas W. Rowe
- Indiana University School of Medicine, Indianapolis, IN
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28
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Verticchio Vercellin A, Harris A, Stoner AM, Oddone F, Mendoza KA, Siesky B. Choroidal Thickness and Primary Open-Angle Glaucoma-A Narrative Review. J Clin Med 2022; 11:jcm11051209. [PMID: 35268300 PMCID: PMC8911149 DOI: 10.3390/jcm11051209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/09/2022] [Accepted: 02/18/2022] [Indexed: 02/01/2023] Open
Abstract
The choroid provides the majority of blood flow to the ocular tissues and structures that facilitate the processes of retinal metabolism responsible for vision. Specifically, the choriocapillaris provides a structural network of small blood vessels that supplies the retinal ganglion cells and deep ocular tissues. Similar to retinal nerve fiber layer thickness, choroidal thickness (CT) has been suggested to represent a quantifiable health biomarker for choroidal tissues. Glaucoma is a disease with vascular contributions in its onset and progression. Despite its importance in maintaining ocular structure and vascular functionality, clinical assessments of choroidal tissues have been historically challenged by the inaccessibility of CT biomarker targets. The development of optical coherence tomography angiography and enhanced depth imaging created a framework for assessing CT and investigating its relationship to glaucomatous optic neuropathy onset and progression. Pilot studies on CT in glaucoma are conflicting-with those both in support of, and against, its clinical utility. Complicating the data are highly customized analysis methods, small sample sizes, heterogeneous patient groups, and a lack of properly designed controlled studies with CT as a primary outcome. Herein, we review the available data on CT and critically discuss its potential relevance and limitations in glaucoma disease management.
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Affiliation(s)
- Alice Verticchio Vercellin
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (A.V.V.); (A.H.)
| | - Alon Harris
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (A.V.V.); (A.H.)
| | - Ari M. Stoner
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | | | | | - Brent Siesky
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (A.V.V.); (A.H.)
- Correspondence: ; Tel.: +1-212-241-2831
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29
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Agnifili L, Brescia L, Villani E, D'Onofrio G, Figus M, Oddone F, Nucci P, Mastropasqua R. In Vivo Confocal Microscopy of the Corneal Sub-Basal Nerve plexus in Medically Controlled Glaucoma. Microsc Microanal 2022; 28:1-8. [PMID: 34991750 DOI: 10.1017/s1431927621013969] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The present study investigated the corneal sub-basal nerve plexus (SNP) modifications in glaucoma. Ninety-five glaucomatous patients were enrolled and divided into Group 1 and 2, preserved and preservative-free mono-therapy (30 and 28 patients), and Group 3, multi-therapy (37). Thirty patients with dry eye disease (DED) and 32 healthy subjects (HC) served as controls. In vivo confocal microscopy evaluated the nerve fibers density (CNFD), length (CNFL), thickness (CNFT), branching density (CNBD), and dendritic cell density (DCD). CNFD, CNFL, and CNBD were reduced in Group 3 and DED compared to HC (p < 0.05). CNFL was reduced in Group 3 compared to Group 2 (p < 0.05), and in Group 1 compared to HC (p < 0.001). CNFD, CNBD, and CNFT did not differ between glaucomatous groups. DCD was higher in Group 3 and DED compared to HC and Group 2 (p < 0.01). Group 3 showed worse ocular surface disease index (OSDI) scores compared to Group 1, 2, and HC (p < 0.05). CNFL and DCD correlated with OSDI score in Group 3 (r = −0.658, p < 0.001; r = 0.699, p = 0.002). Medical therapy for glaucoma harms the corneal nerves, especially in multi-therapy regimens. Given the relations with the OSDI score, SNP changes seem features of glaucoma therapy-related OSD and negatively affects the patient's quality of life.
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Affiliation(s)
- Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Ageing Science, University "G. D'Annunzio" of Chieti-Pescara, Chieti66100, Italy
| | - Lorenza Brescia
- Ophthalmology Clinic, Department of Medicine and Ageing Science, University "G. D'Annunzio" of Chieti-Pescara, Chieti66100, Italy
| | - Edoardo Villani
- Department of Clinical Sciences and Community Health, University of Milan & Eye Clinic San Giuseppe Hospital, IRCCS Multimedica, Milan20123, Italy
| | - Giada D'Onofrio
- Ophthalmology Clinic, Department of Medicine and Ageing Science, University "G. D'Annunzio" of Chieti-Pescara, Chieti66100, Italy
| | - Michele Figus
- Ophthalmology Unit, Department of Surgery, Medicine, Molecular and Emergency, University of Pisa, Pisa56124, Italy
| | | | - Paolo Nucci
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Rodolfo Mastropasqua
- Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena41125, Italy
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Oddone F, Saborio G, Pavicic‐Astalos J, Scorcia V, Moreno‐Valladares A, Holló G. Treatment of open angle glaucoma or ocular hypertension with preservative‐free tafluprost/timolol fixed dose combination in a real‐world setting: analysis by diagnostic sub‐group at study entry. Acta Ophthalmol 2022. [DOI: 10.1111/j.1755-3768.2022.104] [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: 11/28/2022]
Affiliation(s)
| | | | | | | | | | - Gabor Holló
- Tutkimusz Ltd Solymár Hungary
- Eye Center Prime Medica Health Centers Budapest Hungary
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Oddone F, Fassari C, Iester M, Lopez‐Lopez F, Holló G. Treatment of open angle glaucoma or ocular hypertension with preservative‐free tafluprost/timolol fixed dose combination in a real‐world clinical practice setting: a cross‐country subanalysis. Acta Ophthalmol 2022. [DOI: 10.1111/j.1755-3768.2022.080] [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: 11/30/2022]
Affiliation(s)
| | | | - Michele Iester
- Eye Clinic DiNOGMI Università di Genova Ospedale Policlinico San Martino Genova Italy
| | | | - Gabor Holló
- Tutkimusz Ltd Solymár Hungary
- Eye Center Prime Medica Health Centers Budapest Hungary
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Oddone F, Kirwan J, Lopez-Lopez F, Zimina M, Fassari C, Holló G. Switching to Preservative-Free Tafluprost/Timolol Fixed-Dose Combination in the Treatment of Open-Angle Glaucoma or Ocular Hypertension: Subanalysis of Data from the VISIONARY Study According to Baseline Monotherapy Treatment. Adv Ther 2022; 39:3501-3521. [PMID: 35524840 PMCID: PMC9309126 DOI: 10.1007/s12325-022-02166-6] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/11/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The VISIONARY study demonstrated statistically significant intraocular pressure (IOP) reductions with the preservative-free fixed-dose combination of tafluprost 0.0015% and timolol 0.5% (PF tafluprost/timolol FC) in open-angle glaucoma (OAG) or ocular hypertension (OHT) patients, sub-optimally controlled with topical prostaglandin analogue (PGA) or beta-blocker monotherapy. Current subanalyses have examined these data according to the baseline monotherapy. METHODS A European, prospective, observational study included adults (aged ≥ 18 years) with OAG or OHT, who were switched to the PF tafluprost/timolol FC from PGA or beta-blocker monotherapy. Treatment outcomes were reported according to prior monotherapy subgroup: beta-blocker, preserved latanoprost, PF-latanoprost, bimatoprost, tafluprost, and travoprost. Endpoints included the mean change from baseline regarding IOP, conjunctival hyperemia, and corneal fluorescein staining (CFS) at Week 4 and Week 12, and at Month 6. RESULTS The subanalysis included 577 patients. All prior monotherapy subgroups demonstrated statistically significant IOP reductions from baseline at Week 4, that were maintained through Month 6 (p < 0.001). Mean (SD) IOP change at Month 6 was 6.6 (4.16), 6.3 (4.39), 5.6 (3.67), 4.9 (2.97), 4.6 (4.39), and 4.7 (3.64) mmHg for prior beta-blocker, preserved latanoprost, PF-latanoprost, tafluprost, bimatoprost, and travoprost subgroups, respectively. The largest IOP change was observed in the preserved latanoprost subgroup for each of the ≥ 20%, ≥ 25%, ≥ 30%, and ≥ 35% IOP reduction categories at Month 6, demonstrating respective reductions of 8.06, 9.20, 10.64, and 11.55 mmHg. CFS was significantly reduced at Month 6 in the prior bimatoprost subgroup (p = 0.0013). Conjunctival hyperemia severity was significantly reduced at each study visit for prior preserved latanoprost users (p < 0.001). CONCLUSION PF tafluprost/timolol FC therapy provided statistically and clinically significant IOP reductions from Week 4 over the total 6-month period, in patients with OAG/OHT, regardless of the type of prior PGA or beta-blocker monotherapy used. Conjunctival hyperemia severity and CFS decreased significantly in prior bimatoprost and preserved latanoprost users, respectively. CLINICAL STUDY NUMBER European Union electronic Register of Post-Authorization Studies (EU PAS) register number: EUPAS22204.
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Affiliation(s)
| | - James Kirwan
- Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Fernando Lopez-Lopez
- Instituto Oftalmologico Gomez-Ulla, Calle Maruxa Mallo 3 Santiago de Compostela, Galicia, Spain
| | | | | | - Gábor Holló
- Tutkimusz Ltd, Solymár, Hungary
- Eye Center, Prima Medica Health Centers, Budapest, Hungary
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Wolf AT, Harris A, Oddone F, Siesky B, Vercellin AV, Ciulla TA. Disease progression pathways of wet AMD: opportunities for new target discovery. Expert Opin Ther Targets 2022; 26:5-12. [PMID: 35060431 PMCID: PMC8915198 DOI: 10.1080/14728222.2022.2030706] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Age-related macular degeneration (AMD) is the leading cause of irreversible blindness among people age 60 years or older in developed countries. Current standard-of-care anti-vascular endothelial growth factor (VEGF) therapy, which inhibits angiogenesis and vascular permeability, has been shown to stabilize choroidal neovascularization and increase visual acuity in neovascular AMD. However, therapeutic limitations of anti-VEGF therapy include limited durability with consequent need for frequent intravitreal injections, and a ceiling of efficacy. Current strategies under investigation include targeting VEGF-C and VEGF-D, integrins, tyrosine kinase receptors, and the Tie2/angiopoietin-2 pathway. A literature search was conducted through November 30, 2021 on PubMed, Medline, Google Scholar, and associated digital platforms with the following keywords: wet macular degeneration, age-related macular degeneration, therapy, VEGF-A, VEGF-C, VEGF-D, integrins, Tie2/Ang2, and tyrosine kinase inhibitors. AREAS COVERED The authors provide a comprehensive review of AMD disease pathways and mechanisms involved in wet AMD as well as novel targets for future therapies. EXPERT OPINION With novel targets and advancements in drug delivery, there is potential to address treatment burden and to improve outcomes for patients afflicted with neovascular AMD.
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Affiliation(s)
- Amber T. Wolf
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Alon Harris
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | | | - Brent Siesky
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | | | - Thomas A. Ciulla
- Vitreoretinal Medicine and Surgery, Midwest Eye Institute, Indianapolis, IN, USA
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De Simone G, Sbardella D, Oddone F, Pesce A, Coletta M, Ascenzi P. Structural and (Pseudo-)Enzymatic Properties of Neuroglobin: Its Possible Role in Neuroprotection. Cells 2021; 10:cells10123366. [PMID: 34943874 PMCID: PMC8699588 DOI: 10.3390/cells10123366] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/20/2021] [Accepted: 11/23/2021] [Indexed: 12/17/2022] Open
Abstract
Neuroglobin (Ngb), the third member of the globin family, was discovered in human and murine brains in 2000. This monomeric globin is structurally similar to myoglobin (Mb) and hemoglobin (Hb) α and β subunits, but it hosts a bis-histidyl six-coordinated heme-Fe atom. Therefore, the heme-based reactivity of Ngb is modulated by the dissociation of the distal HisE7-heme-Fe bond, which reflects in turn the redox state of the cell. The high Ngb levels (~100–200 μM) present in the retinal ganglion cell layer and in the optic nerve facilitate the O2 buffer and delivery. In contrast, the very low levels of Ngb (~1 μM) in most tissues and organs support (pseudo-)enzymatic properties including NO/O2 metabolism, peroxynitrite and free radical scavenging, nitrite, hydroxylamine, hydrogen sulfide reduction, and the nitration of aromatic compounds. Here, structural and (pseudo-)enzymatic properties of Ngb, which are at the root of tissue and organ protection, are reviewed, envisaging a possible role in the protection from neuronal degeneration of the retina and the optic nerve.
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Affiliation(s)
- Giovanna De Simone
- Dipartimento di Scienze, Università Roma Tre, Viale Marconi 446, 00146 Roma, Italy;
| | | | | | - Alessandra Pesce
- Dipartimento di Fisica, Università di Genova, Via Dodecaneso 33, 16100 Genova, Italy;
| | - Massimo Coletta
- IRCCS Fondazione Bietti, 00198 Roma, Italy; (D.S.); (F.O.)
- Dipartmento di Scienze Cliniche e Medicina Traslazionale, Università di Roma “Tor Vergata”, Via Montpellier 1, 00133 Roma, Italy
- Correspondence: (M.C.); (P.A.); Tel.: +39-06-72596365 (M.C.); +39-06-57336321 (P.A.)
| | - Paolo Ascenzi
- Dipartimento di Scienze, Università Roma Tre, Viale Marconi 446, 00146 Roma, Italy;
- Accademia Nazionale dei Lincei, Via della Lungara 10, 00165 Roma, Italy
- Unità di Neuroendocrinologia, Metabolismo e Neurofarmacologia, IRCSS Fondazione Santa Lucia, 00179 Roma, Italy
- Correspondence: (M.C.); (P.A.); Tel.: +39-06-72596365 (M.C.); +39-06-57336321 (P.A.)
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Vernazza S, Tirendi S, Passalacqua M, Piacente F, Scarfì S, Oddone F, Bassi AM. An Innovative In Vitro Open-Angle Glaucoma Model (IVOM) Shows Changes Induced by Increased Ocular Pressure and Oxidative Stress. Int J Mol Sci 2021; 22:ijms222212129. [PMID: 34830007 PMCID: PMC8622817 DOI: 10.3390/ijms222212129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/26/2021] [Accepted: 11/08/2021] [Indexed: 02/07/2023] Open
Abstract
Primary Open-Angle Glaucoma (POAG) is a neurodegenerative disease, and its clinical outcomes lead to visual field constriction and blindness. POAG's etiology is very complex and its pathogenesis is mainly explained through both mechanical and vascular theories. The trabecular meshwork (TM), the most sensitive tissue of the eye anterior segment to oxidative stress (OS), is the main tissue involved in early-stage POAG, characterized by an increase in pressure. Preclinical assessments of neuroprotective drugs on animal models have not always shown correspondence with human clinical studies. In addition, intra-ocular pressure management after a glaucoma diagnosis does not always prevent blindness. Recently, we have been developing an innovative in vitro 3Dadvanced human trabecular cell model on a millifluidicplatform as a tool to improve glaucoma studies. Herein, we analyze the effects of prolonged increased pressure alone and, in association with OS, on such in vitro platform. Moreover, we verify whethersuch damaged TM triggers apoptosis on neuron-like cells. The preliminary results show that TM cells are less sensitive to pressure elevation than OS, and OS-damaging effects were worsened by the pressure increase. The stressed TM releases harmful signals, which increase apoptosis stimuli on neuron-like cells, suggesting its pivotal role in the glaucoma cascade.
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Affiliation(s)
- Stefania Vernazza
- Department of Experimental Medicine (DIMES), University of Genoa, 16132 Genoa, Italy; (S.V.); (S.T.); (F.P.); (A.M.B.)
| | - Sara Tirendi
- Department of Experimental Medicine (DIMES), University of Genoa, 16132 Genoa, Italy; (S.V.); (S.T.); (F.P.); (A.M.B.)
- Inter-University Center for the Promotion of the 3Rs Principles in Teaching & Research (Centro 3R), 56122 Pisa, Italy;
| | - Mario Passalacqua
- Department of Experimental Medicine (DIMES), University of Genoa, 16132 Genoa, Italy; (S.V.); (S.T.); (F.P.); (A.M.B.)
- Inter-University Center for the Promotion of the 3Rs Principles in Teaching & Research (Centro 3R), 56122 Pisa, Italy;
- Correspondence:
| | - Francesco Piacente
- Department of Experimental Medicine (DIMES), University of Genoa, 16132 Genoa, Italy; (S.V.); (S.T.); (F.P.); (A.M.B.)
| | - Sonia Scarfì
- Inter-University Center for the Promotion of the 3Rs Principles in Teaching & Research (Centro 3R), 56122 Pisa, Italy;
- Department of Earth, Environmental and Life Sciences (DISTAV), University of Genoa, 16132 Genoa, Italy
| | | | - Anna Maria Bassi
- Department of Experimental Medicine (DIMES), University of Genoa, 16132 Genoa, Italy; (S.V.); (S.T.); (F.P.); (A.M.B.)
- Inter-University Center for the Promotion of the 3Rs Principles in Teaching & Research (Centro 3R), 56122 Pisa, Italy;
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Katsanos A, Riva I, Bozkurt B, Holló G, Quaranta L, Oddone F, Irkec M, Dutton GN, Konstas AG. A new look at the safety and tolerability of prostaglandin analogue eyedrops in glaucoma and ocular hypertension. Expert Opin Drug Saf 2021; 21:525-539. [PMID: 34666576 DOI: 10.1080/14740338.2022.1996560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION In the last 25 years, topical prostaglandin analogues (PGAs) have emerged to become first line and first choice therapeutic options in the management of glaucoma and ocular hypertension (OHT). Although the short-term efficacy and safety of PGAs has been extensively investigated, less is known about their long term safety and tolerability. This gap in current knowledge is clinically relevant, because treatment-related adverse events and long-term tolerability issues are key determinants of the overall success of long-term therapy and the final outcome of a lifelong, symptomless disease like glaucoma. AREAS COVERED We include selected evidence pertaining to the safety and tolerability of available and emerging PGA formulations. We also outline PGA formulations with different concentrations of the active ingredient, different preservatives, and preservative-free (PF) options. EXPERT OPINION Undoubtedly PGAs will continue to play a major role in the medical therapy of glaucoma and OHT. Despite extensive literature and prolonged clinical experience with these agents worldwide, a number of areas that warrant further research have been identified in the present review. Recently launched novel PGAs, or those still in development offer new opportunities and future challenges.
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Affiliation(s)
- Andreas Katsanos
- Ophthalmology Department, University of Ioannina, Ioannina, Greece
| | - Ivano Riva
- Istituto Clinico Sant'Anna, Brescia, Italy
| | - Banu Bozkurt
- Department of Ophthalmology, Selcuk University School of Medicine, Konya, Turkey
| | - Gábor Holló
- Tutkimusz Ltd, Solymar, Hungary.,Eye Center, Prima Medica Health Centers, Budapest, Hungary
| | - Luciano Quaranta
- Department of Surgical and Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia, Irccs Fondazione Policlinico San Matteo, Pavia, Italy
| | | | - Murat Irkec
- Faculty of Medicine, Department of Ophthalmology, Hacettepe University, Ankara, Turkey
| | - Gordon N Dutton
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Anastasios G Konstas
- 1st and 3rd University Departments of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Vercellin AV, Harris A, Siesky B, Zukerman R, Tanga L, Carnevale C, Scarinci F, Oddone F. Agreement of rebound and applanation tonometry intraocular pressure measurements during atmospheric pressure change. PLoS One 2021; 16:e0259143. [PMID: 34710167 PMCID: PMC8553080 DOI: 10.1371/journal.pone.0259143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/14/2021] [Indexed: 11/25/2022] Open
Abstract
This study investigated the agreement of intraocular pressure measurements using rebound tonometry and applanation tonometry in response to atmospheric changes in a hyperbaric chamber. Twelve eyes of 12 healthy subjects were included in this prospective, comparative, single-masked study. Intraocular pressure measurements were performed by rebound tonometry followed by applanation tonometry in a multiplace hyperbaric chamber at 1 Bar, followed by 2, 3 and 4 Bar during compression and again at 3 and 2 Bar during decompression. Mean differences between rebound and applanation intraocular pressure measurements were 1.6, 1.7, and 2.1 mmHg at 2, 3, and 4 Bar respectively during compression and 2.6 and 2.2 mmHg at 3 and 2 Bar during decompression. Lower limits of agreement ranged from -3.7 to -5.9 mmHg and upper limits ranged from -0.3 to 1.9 mmHg. Multivariate analysis showed that the differences between rebound and applanation intraocular pressure measurements were independent of atmospheric pressure changes (p = 0.79). Intraocular pressure measured by rebound tonometry shows a systematic difference compared to intraocular measured by applanation tonometry, but this difference is not influenced by changes of atmospheric pressure up to 4 Bar in a hyperbaric chamber. Agreement in magnitude of change between devices suggests rebound tonometry is viable for assessing intraocular pressure during atmospheric changes. Future studies should be designed in consideration of expected differences in IOP values provided by the two devices.
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Affiliation(s)
- Alice Verticchio Vercellin
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Alon Harris
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- * E-mail:
| | - Brent Siesky
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Ryan Zukerman
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Lucia Tanga
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G.B. Bietti per lo Studio e la Ricerca in Oftalmologia ONLUS, Rome, Italy
| | - Carmela Carnevale
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G.B. Bietti per lo Studio e la Ricerca in Oftalmologia ONLUS, Rome, Italy
| | - Fabio Scarinci
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G.B. Bietti per lo Studio e la Ricerca in Oftalmologia ONLUS, Rome, Italy
| | - Francesco Oddone
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G.B. Bietti per lo Studio e la Ricerca in Oftalmologia ONLUS, Rome, Italy
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Torabi R, Harris A, Siesky B, Zukerman R, Oddone F, Mathew S, Januleviciene I, Vercellin ACV. Prevalence Rates and Risk Factors for Primary Open Angle Glaucoma in the Middle East. J Ophthalmic Vis Res 2021; 16:644-656. [PMID: 34840687 PMCID: PMC8593541 DOI: 10.18502/jovr.v16i4.9755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/09/2021] [Indexed: 12/16/2022] Open
Abstract
Glaucoma is a multifactorial disease and a leading cause of irreversible blindness worldwide. Current data has demonstrated the approximate distribution of primary open-angle glaucoma (POAG) in patients of European, African, Hispanic, and Eastern Asian descent. However, a significant gap in the literature exists regarding the prevalence of POAG in Middle Eastern (ME) populations. Current studies estimate ME POAG prevalence based on a European model. Herein we screened 65 total publications on ME prevalence of POAG and specific risk factors using keywords: "glaucoma", "prevalence", "incidence", "risk factor", "Middle East", "Mideast", "Persian", "Far East", as well as searching by individual ME countries through PubMed, Embase, Ovid, Scopus, and Trip searches with additional reference list searches from relevant articles published up to and including March 1, 2021. Fifty qualifying records were included after 15 studies identified with low statistical power, confounding co-morbid ophthalmic diseases, and funding bias were excluded. Studies of ME glaucoma risk factors that identify chromosomes, familial trend, age/gender, socioeconomic status, lifestyle, intraocular pressure, vascular influences, optic disc hemorrhage, cup-to-disc ratio, blood pressure, obstructive sleep apnea, and diabetes mellitus were included in this systematic review. We conclude that the prevalence of POAG in the ME is likely higher than the prevalence rate that European models suggest, with ME specific risk factors likely playing a role. However, these findings are severely limited by the paucity of population-level data in the ME. Well-designed, longitudinal population-based studies with rigorous inclusion and exclusion criteria are ultimately needed to accurately assess the epidemiology and specific mechanistic risk factors of glaucoma in ME populations.
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Affiliation(s)
- Rana Torabi
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana, University School of Medicine, Indianapolis, IN, USA
| | - Alon Harris
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brent Siesky
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ryan Zukerman
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Sunu Mathew
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana, University School of Medicine, Indianapolis, IN, USA
| | - Ingrida Januleviciene
- Eye Clinic of Medical Academy of Lithuanian University of Health Sciences, Kaunas, Lithuania
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Tundo GR, Sbardella D, Oddone F, Kudriaeva AA, Lacal PM, Belogurov AA, Graziani G, Marini S. At the Cutting Edge against Cancer: A Perspective on Immunoproteasome and Immune Checkpoints Modulation as a Potential Therapeutic Intervention. Cancers (Basel) 2021; 13:4852. [PMID: 34638337 PMCID: PMC8507813 DOI: 10.3390/cancers13194852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 01/22/2023] Open
Abstract
Immunoproteasome is a noncanonical form of proteasome with enzymological properties optimized for the generation of antigenic peptides presented in complex with class I MHC molecules. This enzymatic property makes the modulation of its activity a promising area of research. Nevertheless, immunotherapy has emerged as a front-line treatment of advanced/metastatic tumors providing outstanding improvement of life expectancy, even though not all patients achieve a long-lasting clinical benefit. To enhance the efficacy of the currently available immunotherapies and enable the development of new strategies, a broader knowledge of the dynamics of antigen repertoire processing by cancer cells is needed. Therefore, a better understanding of the role of immunoproteasome in antigen processing and of the therapeutic implication of its modulation is mandatory. Studies on the potential crosstalk between proteasome modulators and immune checkpoint inhibitors could provide novel perspectives and an unexplored treatment option for a variety of cancers.
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Affiliation(s)
| | | | | | - Anna A. Kudriaeva
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry of the Russian Academy of Sciences, Miklukho-Maklaya 16/10, 117997 Moscow, Russia; (A.A.K.)
| | - Pedro M. Lacal
- Laboratory of Molecular Oncology, IDI-IRCCS, 00167 Rome, Italy;
| | - Alexey A. Belogurov
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry of the Russian Academy of Sciences, Miklukho-Maklaya 16/10, 117997 Moscow, Russia; (A.A.K.)
- Lomonosov Moscow State University, Leninskie Gory, 119991 Moscow, Russia
| | - Grazia Graziani
- Laboratory of Molecular Oncology, IDI-IRCCS, 00167 Rome, Italy;
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Stefano Marini
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
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Stoner A, Harris A, Oddone F, Belamkar A, Verticchio Vercellin AC, Shin J, Januleviciene I, Siesky B. Topical carbonic anhydrase inhibitors and glaucoma in 2021: where do we stand? Br J Ophthalmol 2021; 106:1332-1337. [PMID: 34433550 DOI: 10.1136/bjophthalmol-2021-319530] [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: 04/23/2021] [Accepted: 08/16/2021] [Indexed: 11/04/2022]
Abstract
Carbonic anhydrase inhibitors (CAIs) have been used for many decades in the treatment of glaucoma. Systemic CAIs were an early treatment option to lower intraocular pressure by reducing aqueous humour production; however, frequent side effects including polyuria and paresthesia contributed to the eventual development of topical CAIs. As topical drug development evolved over time, prostaglandin analogues and beta-blockers have become the gold standard of glaucoma therapies. Although prescribed less often than other classes of topical glaucoma therapies, topical CAIs continue to be used in combination therapies with beta-blockers and alpha agonists. Topical CAIs have also been demonstrated to alter biomarkers of ocular haemodynamics, which have relevance in glaucoma. The purpose of this review is to review and summarise the current state of topical CAI prescribing trends, known efficacy and suggested mechanisms and potential influence on ocular haemodynamics for the future of glaucoma management.
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Affiliation(s)
- Ari Stoner
- Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alon Harris
- Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Aditya Belamkar
- Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Joshua Shin
- New York Medical College, Valhalla, New York, USA
| | | | - Brent Siesky
- Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Parisi V, Ziccardi L, Tanga L, Roberti G, Barbano L, Carnevale C, Manni G, Oddone F. Neural Conduction Along Postretinal Visual Pathways in Glaucoma. Front Aging Neurosci 2021; 13:697425. [PMID: 34408643 PMCID: PMC8365149 DOI: 10.3389/fnagi.2021.697425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: This study was conducted in order to evaluate retinal ganglion cell (RCG) function and the neural conduction along the postretinal large and small axons and its correlation with retinal nerve fiber layer thickness (RNFL-T) in open-angle glaucoma (OAG) eyes. Methods: Thirty-seven OAG patients (mean age: 51.68 ± 9.83 years) with 24-2 Humphrey mean deviation (MD) between -2.5 and -20 dB and IOP <21 mmHg on pharmacological treatment (OAG group) and 20 age-matched controls (control group) were enrolled. In both groups, simultaneous pattern electroretinograms (PERG) and visual evoked potentials (VEP), in response to checks stimulating macular or extramacular areas (the check edge subtended 15' and 60' of visual arc, respectively), and RNFL-T (measured in superior, inferior, nasal, and temporal quadrants) were assessed. Results: In the OAG group, a significant (ANOVA, p < 0.01) reduction of 60' and 15' PERG P50-N95 and VEP N75-P100 amplitudes and of RNFL-T [overall (average of all quadrants) or temporal] with respect to controls was found; the values of 60' and 15' PERG P50 and VEP P100 implicit times and of retinocortical time (RCT; difference between VEP P100 and PERG P50 implicit times) were significantly (p < 0.01) increased with respect to control ones. The observed increased RCTs were significantly linearly correlated (Pearson's test, p < 0.01) with the reduced PERG amplitude and MD values, whereas no significant linear correlation (p < 0.01) with RNFL-T (overall or temporal) values was detected. Conclusions: In OAG, there is an impaired postretinal neural conduction along both large and small axons (increased 60' and 15' RCTs) that is related to RGC dysfunction, but independent from the RNFL morphology. This implies that, in OAG, the impairment of postretinal neural structures can be electrophysiologically identified and may contribute to the visual field defects, as suggested by the linear correlation between the increase of RCT and MD reduction.
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Affiliation(s)
| | | | | | | | | | | | - Gianluca Manni
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
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Rui C, Montesano G, Crabb DP, Brusini P, Chauhan BC, Rossetti LM, Fogagnolo P, Giraud JM, Fenolland JR, Oddone F. Improving event-based progression analysis in glaucomatous visual fields. Sci Rep 2021; 11:16353. [PMID: 34381121 PMCID: PMC8357820 DOI: 10.1038/s41598-021-95877-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/30/2021] [Indexed: 12/03/2022] Open
Abstract
Glaucoma is a progressive optic neuropathy with characteristic changes to the optic nerve head and the visual field (VF). Detecting progression of VF damage with Standard Automated Perimetry (SAP) is of paramount importance for clinical care. One common approach to detecting progression is to compare each new VF test to a baseline SAP test (event analysis). This comparison is made difficult by the test–retest variability of SAP, which increases with the level of VF damage, and the limited range of measurement, meaning that damage cannot be assessed below a certain level. We performed a prospective international multi-centre data collection of SAP data on 90 eyes from 90 people with glaucoma and different levels of VF damage over a short period of time (6 tests in 60 days). Data were collected using a fundus tracked perimeter (Compass, CenterVue). We used these data (minus the first test) to develop an improved event analysis that accounts for both the change in variability with damage and the lower bound on the measurement imposed by SAP. Using simulations, we show that our approach is more sensitive compared to previously developed methods, especially in the case of advanced glaucoma, while retaining similar specificity.
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Affiliation(s)
| | - Giovanni Montesano
- Optometry and Visual Science, City, University of London, Northampton Square, London, EC1V 0HB, UK. .,NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
| | - David P Crabb
- Optometry and Visual Science, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Paolo Brusini
- Department of Ophthalmology, "Città di Udine" Health Center, Udine, Italy
| | - Balwantray C Chauhan
- Department of Ophthalmology and Visual Sciences, Dalhousie University and Nova Scotia Health Authority, Halifax, Canada
| | - Luca M Rossetti
- University of Milan e ASST Santi Paolo e Carlo, Milan, Italy
| | - Paolo Fogagnolo
- University of Milan e ASST Santi Paolo e Carlo, Milan, Italy
| | - Jean-Marie Giraud
- Bégin Military Hospital, Glaucoma Center, Saint Mandé, France.,Val-de-Grâce Army Medical School, Paris, France
| | - Jean-Rémi Fenolland
- Bégin Military Hospital, Glaucoma Center, Saint Mandé, France.,Val-de-Grâce Army Medical School, Paris, France
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Barkana Y, Leshno A, Stern O, Singer R, Russ H, Oddone F, Lanzetta P, Perdicchi A, Johnson CA, Garway-Heath DF, Rossetti LM, Skaat A. Visual Field Endpoints Based on Subgroups of Points May Be Useful in Glaucoma Clinical Trials: A Study With the Humphrey Field Analyzer and Compass Perimeter. J Glaucoma 2021; 30:661-665. [PMID: 33899809 DOI: 10.1097/ijg.0000000000001856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/23/2020] [Accepted: 04/02/2021] [Indexed: 11/26/2022]
Abstract
PRECIS Visual field (VF) endpoints based on average deviation of specific subsets of points rather than all points may offer a more homogeneous data set without necessarily worsening test-retest variability and so may be useful in clinical trials. PURPOSE The purpose of this study was to characterize the outcome measures encompassing particular subsets of VF points and compare them as obtained with Humphrey [Humphrey visual field analyser (HVF)] and Compass perimeters. METHODS Thirty patients with imaging-based glaucomatous neuropathy performed a pair of 24-2 tests with each of 2 perimeters. Nonweighted mean deviation (MD) was calculated for the whole field and separate vertical hemifields, and again after censoring of points with low sensitivity (MDc) and subsequently including only "abnormal" points with a total deviation probability of <5% (MDc5%) or <2% (MDc2%). Test-retest variability was assessed using Bland-Altman 95% limits of agreement (95%LoA). RESULTS For the whole field, using HVF, MD was -7.5±6.9 dB, MDc -3.6±2.8 dB, MDc5% -6.4±1.7 dB, and MDc2% -7.3±1.5 dB. With Compass the MD was -7.5±6.6, MDc -2.9±1.7 dB, MDc5% -6.3±1.5, and MDC2% -7.9±1.6. The respective 95%LoA were 5.5, 5.3, 4.6, and 5.6 with HVF, and 4.8, 3.7, 7.1, and 7.1 with Compass. The respective number of eligible points were 52, 42±12, 20±11, and 15±9 with HVF, and 52, 41.2±12.6, 10±7, and 7±5 with Compass. With both machines, SD and 95%LoA increased in hemifields compared with the total field, but this increase was mitigated after censoring. CONCLUSION Restricting analysis to particular subsets of points of interest in the VF after censoring points with low sensitivity, as compared with using the familiar total field MD, can provide outcome measures with a broader range of MD, a markedly reduced SD and therefore more homogeneous data set, without necessarily worsening test-retest variability.
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Affiliation(s)
- Yaniv Barkana
- Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Galimedix Therapeutics, Kensington, MD
| | - Ari Leshno
- Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Stern
- Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Reut Singer
- Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Paolo Lanzetta
- Ophthalmology Unit, Department of Medical and Biological Sciences, University of Udine, Udine
| | - Andrea Perdicchi
- Ophthalmology Unit, St. Andrea Hospital, NESMOS Department, University of Rome "Sapienza," Rome
| | - Chris A Johnson
- Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - David F Garway-Heath
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Luca M Rossetti
- University of Milan e ASST Santi Paolo e Carlo, Milan, Italy
| | - Alon Skaat
- Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Zukerman R, Harris A, Oddone F, Siesky B, Verticchio Vercellin A, Ciulla TA. Glaucoma Heritability: Molecular Mechanisms of Disease. Genes (Basel) 2021; 12:genes12081135. [PMID: 34440309 PMCID: PMC8391305 DOI: 10.3390/genes12081135] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 02/06/2023] Open
Abstract
Glaucoma is one of the world’s leading causes of irreversible blindness. A complex, multifactorial disease, the underlying pathogenesis and reasons for disease progression are not fully understood. The most common form of glaucoma, primary open-angle glaucoma (POAG), was traditionally understood to be the result of elevated intraocular pressure (IOP), leading to optic nerve damage and functional vision loss. Recently, researchers have suggested that POAG may have an underlying genetic component. In fact, studies of genetic association and heritability have yielded encouraging results showing that glaucoma may be influenced by genetic factors, and estimates for the heritability of POAG and disease-related endophenotypes show encouraging results. However, the vast majority of the underlying genetic variants and their molecular mechanisms have not been elucidated. Several genes have been suggested to have molecular mechanisms contributing to alterations in key endophenotypes such as IOP (LMX1B, MADD, NR1H3, and SEPT9), and VCDR (ABCA1, ELN, ASAP1, and ATOH7). Still, genetic studies about glaucoma and its molecular mechanisms are limited by the multifactorial nature of the disease and the large number of genes that have been identified to have an association with glaucoma. Therefore, further study into the molecular mechanisms of the disease itself are required for the future development of therapies targeted at genes leading to POAG endophenotypes and, therefore, increased risk of disease.
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Affiliation(s)
- Ryan Zukerman
- Department of Ophthalmology, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, USA; (R.Z.); (A.H.); (B.S.); (A.V.V.)
- Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Alon Harris
- Department of Ophthalmology, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, USA; (R.Z.); (A.H.); (B.S.); (A.V.V.)
| | | | - Brent Siesky
- Department of Ophthalmology, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, USA; (R.Z.); (A.H.); (B.S.); (A.V.V.)
| | - Alice Verticchio Vercellin
- Department of Ophthalmology, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, USA; (R.Z.); (A.H.); (B.S.); (A.V.V.)
| | - Thomas A. Ciulla
- Midwest Eye Institute, Indianapolis, IN 46290, USA
- Correspondence: ; Tel.: +1-(317)-506-0334 or +1-(317)-817-1822; Fax: +1-(317)-817-1898
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Oddone F, Roberti G, Posarelli C, Agnifili L, Mastropasqua L, Carnevale C, Micelli Ferrari T, Pace V, Sacchi M, Cremonesi E, Uva M, Menchini M, Brescia L, Figus M. Endothelial Cell Density After XEN Implant Surgery: Short-term Data From the Italian XEN Glaucoma Treatment Registry (XEN-GTR). J Glaucoma 2021; 30:559-565. [PMID: 33813558 DOI: 10.1097/ijg.0000000000001840] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 08/29/2020] [Accepted: 03/13/2021] [Indexed: 12/13/2022]
Abstract
PRECIS XEN implant was associated with low endothelial cell density (ECD) reduction. In fact, when combined with phacoemulsification, the reduction in ECD was similar to that expected after phacoemulsification alone. PURPOSE The purpose of this study was to assess the impact of XEN implant, either alone or in combination with phacoemulsification, on ECD. METHODS Multicenter, prospective, observational study conducted on consecutive open-angle glaucoma patients, who were enrolled in the Italian XEN Glaucoma Treatment Registry and have complete endothelial cell count data at baseline and at 6 months after implantation. The primary endpoint was the mean percentage change in ECD between baseline and month 6. RESULTS The study included 108 open-angle glaucoma eyes (68 in the XEN-solo and 40 eyes in the XEN+phaco groups) and 60 control eyes (phaco-solo group). As compared with baseline, mean (95% confidence interval, CI) ECD reduction was -5.6% (-7.0% to -4.9%), -11.3% (-13.8% to -10.9%), and -13.0% (14.8% to -11.8%) in the XEN-solo, XEN+phaco, and phaco-solo groups, respectively (P=0.0004, <0.0001, and <0.0001, respectively). As compared with the XEN-solo group, the ECD reduction was significantly greater in the XEN+phaco group (mean difference=5.7%; 95% CI: 4.1%-7.3%, P<0.0001) and in the phaco-solo group (mean difference=7.4%; 95% CI: 5.7%-9.1%, P<0.0001). ECD reduction was similar in XEN+phaco and phaco-solo groups (P=0.9). In absolute terms, ECD reduction was significantly greater in the XEN+phaco (mean difference=169±306, P=0.021) and in the phaco-solo (mean difference=192±302, P=0.0022) groups than in the XEN-solo group. CONCLUSIONS The mean ECD reduction 6 months after XEN implantation was low. The ECD reduction in the XEN+phaco group was larger than in the XEN-solo group but was similar to that observed in the phaco-solo group.
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Affiliation(s)
| | | | - Chiara Posarelli
- Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D'Annunzio of Chieti-Pescara, Chieti
| | - Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D'Annunzio of Chieti-Pescara, Chieti
| | | | | | - Vincenzo Pace
- Regional General Hospital F. Miulli of Acquaviva delle Fonti, Bari
| | - Matteo Sacchi
- University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan
| | - Elena Cremonesi
- University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan
| | - Maurizio Uva
- University Hospital "Policlinico Vittorio Emanuele," Catania, Italy
| | - Martina Menchini
- Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa
| | - Lorenza Brescia
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D'Annunzio of Chieti-Pescara, Chieti
| | - Michele Figus
- Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa
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Montesano G, McKendrick AM, Turpin A, Brusini P, Oddone F, Fogagnolo P, Perdicchi A, Johnson CA, Lanzetta P, Rossetti LM, Garway-Heath DF, Crabb DP. Do Additional Testing Locations Improve the Detection of Macular Perimetric Defects in Glaucoma? Ophthalmology 2021; 128:1722-1735. [PMID: 34153384 DOI: 10.1016/j.ophtha.2021.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/21/2021] [Revised: 06/06/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To evaluate the ability of additional central testing locations to improve detection of macular visual field (VF) defects in glaucoma. DESIGN Prospective cross-sectional study. PARTICIPANTS Four hundred forty healthy people and 499 patients with glaucomatous optic neuropathy (GON) were tested with a fundus tracked perimeter (CMP; CenterVue) using a 24-2 grid with 12 additional macular locations (24-2+). METHODS Glaucomatous optic neuropathy was identified based on expert evaluation of optic nerve head photographs and OCT scans, independently of the VF. We defined macular defects as locations with measurements outside the 5% and 2% normative limits on total deviation (TD) and pattern deviation (PD) maps within the VF central 10°. Classification was based on the total number of affected macular locations (overall detection) or the largest number of affected macular locations connected in a contiguous cluster (cluster detection). Criteria based on the number of locations and cluster size were used to obtain equivalent specificity between the 24-2 grid and the 24-2+ grids, calculated using false detections in the healthy cohort. Partial areas under the receiver operating characteristic curve (pAUCs) were also compared at specificities of 95% or more. MAIN OUTCOME MEASURES Matched specificity comparison of the ability to detect glaucomatous macular defects between the 24-2 and 24-2+ grids. RESULTS At matched specificity, cluster detection identified more macular defects with the 24-2+ grid compared with the 24-2 grid. For example, the mean increase in percentage of detection was 8% (95% confidence interval, 5%-11%) and 10% (95% confidence interval [CI], 7%-13%) for 5% TD and PD maps, respectively, and 5% (95% CI, 2%-7%) and 6% (95% CI, 4%-8%) for the 2% TD and PD maps, respectively. Good agreement was found between the 2 grids. The improvement measured by pAUCs was also significant but generally small. The percentage of eyes with macular defects ranged from about 30% to 50%. Test time for the 24-2+ grid was longer (21% increase) for both cohorts. Between 74% and 98% of defects missed by the 24-2 grid had at least 1 location with sensitivity of < 20 dB. CONCLUSIONS Visual field examinations with additional macular locations can improve the detection of macular defects in GON modestly without loss of specificity when appropriate criteria are selected.
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Affiliation(s)
- Giovanni Montesano
- Optometry and Visual Sciences, City, University of London, London, United Kingdom; NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Allison M McKendrick
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Australia
| | - Andrew Turpin
- School of Computing and Information System, University of Melbourne, Melbourne, Australia
| | - Paolo Brusini
- Department of Ophthalmology, "Città di Udine" Health Center, Udine, Italy
| | | | | | - Andrea Perdicchi
- Ophthalmology Unit, St. Andrea Hospital, NESMOS Department, University of Rome "Sapienza," Rome, Italy
| | - Chris A Johnson
- Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Paolo Lanzetta
- Ophthalmology Unit, Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | | | - David F Garway-Heath
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - David P Crabb
- Optometry and Visual Sciences, City, University of London, London, United Kingdom.
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Carnevale C, Riva I, Roberti G, Michelessi M, Tanga L, Verticchio Vercellin AC, Agnifili L, Manni G, Harris A, Quaranta L, Oddone F. Confocal Microscopy and Anterior Segment Optical Coherence Tomography Imaging of the Ocular Surface and Bleb Morphology in Medically and Surgically Treated Glaucoma Patients: A Review. Pharmaceuticals (Basel) 2021; 14:581. [PMID: 34207162 PMCID: PMC8234834 DOI: 10.3390/ph14060581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 01/21/2023] Open
Abstract
Glaucoma patients often suffer from ocular surface disease (OSD) caused by the chronic administration of topical anti-glaucoma medications, especially in cases of long-term therapy with preserved or multiple drugs. Additionally, glaucoma surgery may determine ocular surface changes related to the formation and location of the filtering bleb, the application of anti-mitotic agents, and the post-operative wound-healing processes within the conjunctiva. Recently, several studies have evaluated the role of advanced diagnostic imaging technologies such as in vivo confocal microscopy (IVCM) and anterior segment-optical coherence tomography (AS-OCT) in detecting microscopic and macroscopic features of glaucoma therapy-related OSD. Their clinical applications are still being explored, with recent particular attention paid to analyzing the effects of new drug formulations and of minimally invasive surgical procedures on the ocular surface status. In this review, we summarize the current knowledge about the main changes of the ocular surface identified at IVCM and AS-OCT in glaucoma patients under medical therapy, or after surgical treatment.
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Affiliation(s)
- Carmela Carnevale
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
| | - Ivano Riva
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia—IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy; (I.R.); (L.Q.)
| | - Gloria Roberti
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
| | - Manuele Michelessi
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
| | - Lucia Tanga
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
| | - Alice C. Verticchio Vercellin
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA; (A.C.V.V.); (A.H.)
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. d’Annunzio of Chieti—Pescara, 66100 Chieti, Italy;
| | - Gianluca Manni
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Alon Harris
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA; (A.C.V.V.); (A.H.)
| | - Luciano Quaranta
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia—IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy; (I.R.); (L.Q.)
| | - Francesco Oddone
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
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Sbardella D, Tundo GR, Coletta M, Manni G, Oddone F. Dexamethasone Downregulates Autophagy through Accelerated Turn-Over of the Ulk-1 Complex in a Trabecular Meshwork Cells Strain: Insights on Steroid-Induced Glaucoma Pathogenesis. Int J Mol Sci 2021; 22:ijms22115891. [PMID: 34072647 PMCID: PMC8198647 DOI: 10.3390/ijms22115891] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 12/16/2022] Open
Abstract
Steroid-induced glaucoma is a severe pathological condition, sustained by a rapidly progressive increase in intraocular pressure (IOP), which is diagnosed in a subset of subjects who adhere to a glucocorticoid (GC)-based therapy. Molecular and clinical studies suggest that either natural or synthetic GCs induce a severe metabolic dysregulation of Trabecular Meshwork Cells (TMCs), an endothelial-derived histotype with phagocytic and secretive functions which lay at the iridocorneal angle in the anterior segment of the eye. Since TMCs physiologically regulate the composition and architecture of trabecular meshwork (TM), which is the main outflow pathway of aqueous humor, a fluid which shapes the eye globe and nourishes the lining cell types, GCs are supposed to trigger a pathological remodeling of the TM, inducing an IOP increase and retina mechanical compression. The metabolic dysregulation of TMCs induced by GCs exposure has never been characterized at the molecular detail. Herein, we report that, upon dexamethasone exposure, a TMCs strain develops a marked inhibition of the autophagosome biogenesis pathway through an enhanced turnover of two members of the Ulk-1 complex, the main platform for autophagy induction, through the Ubiquitin Proteasome System (UPS).
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Affiliation(s)
- Diego Sbardella
- IRCCS-Fondazione Bietti, 00198 Rome, Italy;
- Correspondence: (D.S.); (F.O.)
| | | | - Massimo Coletta
- Department of Clinical Sciences and Translational Medicine, University of Tor Vergata, 00133 Rome, Italy; (M.C.); (G.M.)
| | - Gianluca Manni
- Department of Clinical Sciences and Translational Medicine, University of Tor Vergata, 00133 Rome, Italy; (M.C.); (G.M.)
| | - Francesco Oddone
- IRCCS-Fondazione Bietti, 00198 Rome, Italy;
- Correspondence: (D.S.); (F.O.)
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Lemmens S, Rossetti L, Oddone F, Sunaric-Mégevand G, Hommer A, Vandewalle E, Francesca Cordeiro M, McNaught A, Montesano G, Stalmans I. Comparison of preserved bimatoprost 0.01% with preservative-free tafluprost: A randomised, investigator-masked, 3-month crossover, multicentre trial, SPORT II. Eur J Ophthalmol 2021; 32:11206721211006573. [PMID: 33818170 DOI: 10.1177/11206721211006573] [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] [Indexed: 11/15/2022]
Abstract
IMPORTANCE This study compares the efficacy and tolerability of a preservative-free prostaglandin analogue (tafluprost 15 mg/ml) to a prostaglandin analogue that uses 0.02% of benzalkonium chloride (bimatoprost 0.1 mg/ml). BACKGROUND Different prostaglandin analogues have been commercially approved, with differences in tolerability. DESIGN Prospective, randomised, investigator-masked, 3-month crossover, multicentre trial. PARTICIPANTS Sixty-four patients with ocular hypertension or open-angle glaucoma were randomised to two groups, after a 4-week washout period from their current topical drop regimen. METHODS Participants were randomised to tafluprost (Group 1; n = 33) or bimatoprost (Group 2; n = 31). At month 3, each group switched to the opposite treatment. IOP was evaluated at multiple timepoints. MAIN OUTCOME MEASURES The primary outcome was difference in mean IOP between the two groups at the final visit. Secondary outcomes included change from baseline IOP at month 3 and month 6, difference in mean IOP at month 3 and difference in IOP at all timepoints. Safety outcomes included best-corrected visual acuity (BCVA), adverse events, ocular tolerability, optic nerve assessment and slit lamp biomicroscopy. RESULTS Both medications significantly lowered IOP at month 6 compared to baseline: 5.4 mmHg (27%) for tafluprost and 6.8 mmHg (33%) for bimatoprost (p < 0.0001). No significant differences in any of the safety measures (including conjunctival hypearemia) were detected. CONCLUSIONS AND RELEVANCE Bimatoprost produced a statistically significant greater IOP reduction compared to tafluprost with minimal to no difference in side effects. This should be borne in mind when weighing up the pros and cons of preserved versus preservative-free prostaglandin analogue therapy. CLINICALTRIALS.GOV IDENTIFIER NCT02471105.
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Affiliation(s)
- Sophie Lemmens
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
- Department of Neurosciences, Laboratory of Ophthalmology, KU Leuven, Leuven, Belgium
| | - Luca Rossetti
- Clinica Oculista, San Paolo Hospital, University of Milan, Milan, Italy
| | | | | | | | - Evelien Vandewalle
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
- Department of Neurosciences, Laboratory of Ophthalmology, KU Leuven, Leuven, Belgium
| | | | - Andrew McNaught
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham General Hospital, Gloucestershire, UK
| | | | - Ingeborg Stalmans
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
- Department of Neurosciences, Laboratory of Ophthalmology, KU Leuven, Leuven, Belgium
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Oddone F, Rossetti L, Parravano M, Sbardella D, Coletta M, Ziccardi L, Roberti G, Carnevale C, Romano D, Manni G, Parisi V. Citicoline in Ophthalmological Neurodegenerative Disease: A Comprehensive Review. Pharmaceuticals (Basel) 2021; 14:ph14030281. [PMID: 33804675 PMCID: PMC8003774 DOI: 10.3390/ph14030281] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 12/12/2022] Open
Abstract
Cytidine 5'-diphosphocholine has been widely studied in systemic neurodegenerative diseases, like Alzheimer's disease, Parkinson's disease, and brain ischemia. The rationale for the use of citicoline in ophthalmological neurodegenerative diseases, including glaucoma, anterior ischemic optic neuropathy, and diabetic retinopathy, is founded on its multifactorial mechanism of action and the involvement in several metabolic pathways, including phospholipid homeostasis, mitochondrial dynamics, as well as cholinergic and dopaminergic transmission, all being involved in the complexity of the visual transmission. This narrative review is aimed at reporting both pre-clinical data regarding the involvement of citicoline in such metabolic pathways (including new insights about its role in the intracellular proteostasis through an interaction with the proteasome) and its effects on clinical psychophysical, electrophysiological, and morphological outcomes following its use in ophthalmological neurodegenerative diseases (including the results of the most recent prospective randomized clinical trials).
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Affiliation(s)
- Francesco Oddone
- IRCCS-Fondazione Bietti, Via Livenza, 3, 00198 Rome, Italy; (F.O.); (D.S.); (L.Z.); (G.R.); (C.C.); (V.P.)
| | - Luca Rossetti
- Eye Clinic, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Via Antonio di Rudinì, 8, 20142 Milan, Italy; (L.R.); (D.R.)
| | - Mariacristina Parravano
- IRCCS-Fondazione Bietti, Via Livenza, 3, 00198 Rome, Italy; (F.O.); (D.S.); (L.Z.); (G.R.); (C.C.); (V.P.)
- Correspondence: ; Tel.: +39-6-8535-6727
| | - Diego Sbardella
- IRCCS-Fondazione Bietti, Via Livenza, 3, 00198 Rome, Italy; (F.O.); (D.S.); (L.Z.); (G.R.); (C.C.); (V.P.)
| | - Massimo Coletta
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (M.C.); (G.M.)
| | - Lucia Ziccardi
- IRCCS-Fondazione Bietti, Via Livenza, 3, 00198 Rome, Italy; (F.O.); (D.S.); (L.Z.); (G.R.); (C.C.); (V.P.)
| | - Gloria Roberti
- IRCCS-Fondazione Bietti, Via Livenza, 3, 00198 Rome, Italy; (F.O.); (D.S.); (L.Z.); (G.R.); (C.C.); (V.P.)
| | - Carmela Carnevale
- IRCCS-Fondazione Bietti, Via Livenza, 3, 00198 Rome, Italy; (F.O.); (D.S.); (L.Z.); (G.R.); (C.C.); (V.P.)
| | - Dario Romano
- Eye Clinic, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Via Antonio di Rudinì, 8, 20142 Milan, Italy; (L.R.); (D.R.)
| | - Gianluca Manni
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (M.C.); (G.M.)
| | - Vincenzo Parisi
- IRCCS-Fondazione Bietti, Via Livenza, 3, 00198 Rome, Italy; (F.O.); (D.S.); (L.Z.); (G.R.); (C.C.); (V.P.)
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