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Invernizzi A, Zaffalon C, Manni P, Zicarelli F, Chisari D, Adani C, Mastrofilippo V, Bolletta E, Gozzi F, De Simone L, Staurenghi G, Cimino L. Anterior Vitreous Objective Assessment in Uveitis: An Anterior Segment Swept Source Optical Coherence Tomography Study. Ocul Immunol Inflamm 2024:1-9. [PMID: 38648627 DOI: 10.1080/09273948.2024.2339435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/30/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE To assess inflammatory changes in the anterior vitreous (AV) using a swept source anterior segment optical coherence tomography (SS-ASOCT) and to correlate them with uveitis features and clinical grading of intraocular inflammation. METHODS 140 eyes from 96 patients were included in this observational, cross-sectional study: 40 ACTIVE uveitis, 40 INACTIVE uveitis and 60 CONTROLS. All eyes underwent intraocular inflammation clinical grading (anterior chamber (AC) cells counting and vitreous haze evaluation) and AV imaging with SS-ASOCT. Cells seen in the AV on OCT were manually counted using imageJ. Vitreous reflectivity variation was indirectly measured by calculating the vitreous/iris pigment epithelium (VIT/IPE) relative intensity. These OCT-based parameters were compared across the groups and correlated with inflammation clinical grading. RESULTS The mean [SD] number of AV OCT cells was significantly higher (both p < 0.001) in ACTIVE uveitis (12[9.8]) compared to INACTIVE uveitis (4.5[3.5]) and CONTROLS (4[3.1]). In ACTIVE uveitis the number of AV OCT cells was significantly and positively correlated with the AC cells (p = 0.04), the VIT/IPE relative intensity (p = 0.0002), the uveitis anatomical classification (INTERMEDIATE UVEITIS, p = 0.02) and the vitreous haze clinical grading (p < 0.0001). The mean[SD] VIT/IPE relative intensity of the AV increased from CONTROLS (0.12[0.01]) to INACTIVE uveitis (0.15[0.01]) to ACTIVE uveitis (0.17[0.02]), but with no statistically significant differences. CONCLUSIONS We were able to visualize and objectively evaluate changes occurring in the AV in eyes with uveitis by means of a commercially available SS-ASOCT. OCT-cells in the AV could represent an adjunctive tool in the objective evaluation of intraocular inflammation.
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Affiliation(s)
- Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
- Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Chiara Zaffalon
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Priscilla Manni
- Department of Sense Organs, Ocular Immunovirology Service, Sapienza University of Rome, Rome, Italy
| | - Federico Zicarelli
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Domenico Chisari
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Chantal Adani
- Ocular Immunology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | | | - Elena Bolletta
- Ocular Immunology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Fabrizio Gozzi
- Ocular Immunology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Luca De Simone
- Ocular Immunology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Luca Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
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Romano F, Zaffalon C, Staurenghi G, Salvetti AP. Reply. Ophthalmology 2024; 131:e15-e16. [PMID: 38206214 DOI: 10.1016/j.ophtha.2023.11.029] [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: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 01/12/2024] Open
Affiliation(s)
- Francesco Romano
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Eye Clinic, Department of Biomedical and Clinical Sciences, Ospedale Luigi Sacco, University of Milan, Milan, Italy.
| | - Chiara Zaffalon
- Eye Clinic, Department of Biomedical and Clinical Sciences, Ospedale Luigi Sacco, University of Milan, Milan, Italy; Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Sciences, Ospedale Luigi Sacco, University of Milan, Milan, Italy
| | - Anna Paola Salvetti
- Eye Clinic, Department of Biomedical and Clinical Sciences, Ospedale Luigi Sacco, University of Milan, Milan, Italy
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Munoz-Solano J, Preziosa C, Staurenghi G, Pellegrini M. Resolution of epiretinal membrane after anti-VEGF and photodynamic therapy of retinal hemangioblastoma. Am J Ophthalmol Case Rep 2024; 33:101994. [PMID: 38303898 PMCID: PMC10831802 DOI: 10.1016/j.ajoc.2024.101994] [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: 07/16/2023] [Revised: 12/26/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024] Open
Abstract
Purpose To describe the clinical and multimodal imaging features in a case of resolution of pre-macular fibrosis after photodynamic therapy (PDT) of retinal hemangioblastoma (RH) not related to von-Hippel-Lindau (VHL). Observations A 25-year-old man presenting with blurred vision and central metamorphopsia in his left eye (LE) due to macular epiretinal membrane secondary to a peripheral RH. The patient had a comprehensive ophthalmic examination, including best corrected visual acuity (BCVA), wide-field fundus photography and autofluorescence (FAF), wide-field optical coherence tomography (OCT) and OCT angiography (OCTA), fluorescein angiography (FA) and indocyanine green angiography (ICGA) and ocular ultrasound. Baseline BCVA was 20/200 in his LE, and it improved to 20/40 nineteen months after anti-VEGF and photodynamic therapy were performed. The treatment led to a progressive shrinkage of the tumor and associated intraretinal exudation, and to a progressive resolution of the epiretinal membrane. Conclusions and importance Treatments performed on the peripheral retina may result in changes at the level of the vitreo-retinal interface in the macular region. In our patient, after an intravitreal anti-VEGF associated with PDT, a posterior vitreous detachment (PVD) was induced resulting in auto-peeling of the macular epiretinal membrane secondary to a peripheral RH. An accurate assessment of the macular area by OCT is highly recommended in the first days following treatments.
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Affiliation(s)
- Javier Munoz-Solano
- Department of Ophthalmology, Donostia University Hospital, San Sebastian, Spain
| | - Chiara Preziosa
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Marco Pellegrini
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco”, University of Milan, Luigi Sacco Hospital, Milan, Italy
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Romano F, Boon CJF, Invernizzi A, Bosello F, Casati S, Zaffalon C, Riva E, Bertoni AI, Agarwal A, Kalra G, Cozzi M, Staurenghi G, Salvetti AP. CORRELATION BETWEEN MICROPERIMETRY AND IMAGING IN EXTENSIVE MACULAR ATROPHY WITH PSEUDODRUSEN-LIKE APPEARANCE. Retina 2024; 44:246-254. [PMID: 37824814 DOI: 10.1097/iae.0000000000003951] [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] [Indexed: 10/14/2023]
Abstract
PURPOSE To determine the correlation between microperimetry and imaging findings in extensive macular atrophy with pseudodrusen-like appearance (EMAP). METHODS This cross-sectional, observational study included 44 consecutive patients with EMAP (88 eyes) and 30 healthy subjects (60 eyes). Both groups underwent visual acuity assessment, mesopic and scotopic microperimetry, fundus photography, autofluorescence, optical coherence tomography, and optical coherence tomography angiography. Retinal sensitivity was also subdivided in macular (0-4°) and paramacular areas (8-10°). Scotopic sensitivity loss was defined as the difference between scotopic and mesopic sensitivities for each tested point. Eyes with EMAP were further classified into the three stages described by Romano et al: 19 eyes in Stage 1, 31 in Stage 2, and 38 in Stage 3. RESULTS Mesopic and scotopic retinal sensitivity were significantly reduced in patients with EMAP compared with controls, particularly in the macular area (all P < 0.001). Mesopic retinal sensitivity progressively declined in more advanced EMAP stages (all P < 0.01), but no scotopic differences were observed between Stages 2 and 3 ( P = 0.08). Remarkably, scotopic sensitivity loss was significantly higher in Stage 1 ( P < 0.05).On multivariate analysis, mesopic dysfunction was associated with larger atrophic areas ( P < 0.01), foveal involvement ( P = 0.03), and fibrosis ( P = 0.02). Conversely, no independent variable was associated with a reduced scotopic retinal sensitivity (all P > 0.05). CONCLUSION The findings highlight that patients with EMAP suffer from a severe cone- and rod-mediated dysfunction on microperimetry. The predominant rod impairment in the early cases (Stage 1) emphasizes the importance of dark-adapted scotopic microperimetry as a clinical end point and suggests defective transportation across the RPE-Bruch membrane complex in its pathogenesis.
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Affiliation(s)
- Francesco Romano
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
- Harvard Retinal Imaging Laboratory, Mass Eye and Ear, Boston, Massachusetts
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Ophthalmology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Francesca Bosello
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Casati
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Chiara Zaffalon
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Ester Riva
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Alice Ingrid Bertoni
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Aniruddha Agarwal
- Eye Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates; and
| | - Gagan Kalra
- Cleveland Clinic, Cole Eye Institute, Cleveland, Ohio
| | - Mariano Cozzi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Anna Paola Salvetti
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
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Airaldi M, Monteduro D, Tondini G, Pichi F, De Simone L, Cornish E, Casalino G, Zicarelli F, Oldani M, Staurenghi G, McCluskey P, Cimino L, Invernizzi A. Immunomodulatory Treatment Versus Systemic Steroids in Inflammatory Choroidal Neovascularization Secondary to Idiopathic Multifocal Choroiditis. Am J Ophthalmol 2024; 262:62-72. [PMID: 38224927 DOI: 10.1016/j.ajo.2024.01.006] [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: 08/31/2023] [Revised: 12/24/2023] [Accepted: 01/01/2024] [Indexed: 01/17/2024]
Abstract
PURPOSE To evaluate the influence of immunomodulatory therapy (IMT) on visual and treatment outcomes of inflammatory choroidal neovascularization (iCNV) in patients affected by multifocal choroiditis (MFC), and to compare them to patients treated with steroids as needed. DESIGN Multicenter retrospective matched cohort study. METHODS Patients affected by MFC with iCNV were divided into a IMT group and a "steroids as needed" group and matched according to the time between diagnosis and beginning of systemic treatment. Visual acuity (VA), number of anti-vascular endothelial growth factor (VEGF) intravitreal injections, and number of iCNV reactivations during 2 years of follow-up after treatment initiation were compared between the 2 groups. RESULTS A total of 66 eyes of 58 patients were included, equally divided into the 2 groups. Patients in the IMT group had a lower relative risk (RR) of iCNV reactivation (0.64, P = .04) and of anti-VEGF intravitreal injection retreatment (0.59, P = .02). Relapses of MFC-related inflammation were independently associated with a higher RRs of iCNV reactivation (1.22, P = .003). Final VA was higher in the IMT compared to the steroids as needed group (mean [SD], 69.1 [15.1] vs 77.1 [8.9] letters, P = .01), and IMT was associated with greater VA gains over time (+2.5 letters per year, P = .04). CONCLUSIONS IMT was associated with better visual and treatment outcomes in MFC complicated by iCNV compared to steroids as needed. The better outcomes of the IMT group and the association between MFC-related inflammation and iCNV reactivations highlight the need for tighter control of inflammation to prevent iCNV relapses and visual loss.
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Affiliation(s)
- Matteo Airaldi
- From the Eye Clinic (M.A., D.M., G.T., F.Z., M.O., G.S., A.I.), Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy; Department of Molecular and Translational Medicine (M.A.), University of Brescia, Brescia, Italy
| | - Davide Monteduro
- From the Eye Clinic (M.A., D.M., G.T., F.Z., M.O., G.S., A.I.), Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Giovanni Tondini
- From the Eye Clinic (M.A., D.M., G.T., F.Z., M.O., G.S., A.I.), Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Francesco Pichi
- Eye Institute (F.P.), Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine (F.P.), Case Western Reserve University, Cleveland, Ohio, USA
| | - Luca De Simone
- Ocular Immunology Unit (L.D.S., L.C.), Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisa Cornish
- Save Sight Institute (E.C., P.M., A.I.), Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia
| | - Giuseppe Casalino
- Fondazione IRCCS Cà Granda (G.C.), Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Federico Zicarelli
- From the Eye Clinic (M.A., D.M., G.T., F.Z., M.O., G.S., A.I.), Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Marta Oldani
- From the Eye Clinic (M.A., D.M., G.T., F.Z., M.O., G.S., A.I.), Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Giovanni Staurenghi
- From the Eye Clinic (M.A., D.M., G.T., F.Z., M.O., G.S., A.I.), Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Peter McCluskey
- Save Sight Institute (E.C., P.M., A.I.), Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia
| | - Luca Cimino
- Ocular Immunology Unit (L.D.S., L.C.), Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Department of Surgery, Medicine, Dentistry and Morphological Sciences (L.C.), with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Invernizzi
- From the Eye Clinic (M.A., D.M., G.T., F.Z., M.O., G.S., A.I.), Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy; Save Sight Institute (E.C., P.M., A.I.), Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia.
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Cozzi M, Monteduro D, Esposito RA, Spooner KL, Fraser-Bell S, Staurenghi G, Romano F, Airaldi M, Chang AA, Invernizzi A. Lesion area progression in eyes with neovascular age-related macular degeneration treated using a proactive or a reactive regimen. Eye (Lond) 2024; 38:161-167. [PMID: 37393395 PMCID: PMC10764886 DOI: 10.1038/s41433-023-02652-3] [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: 02/17/2023] [Revised: 06/13/2023] [Accepted: 06/20/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND To compare the change in lesion area over 4 years of follow-up in eyes with neovascular age-related macular degeneration (nAMD) treated with anti-vascular endothelial growth factor (VEGF) agents using either a proactive or a reactive regimen in routine clinical practice. METHODS This was a multicentre, retrospective comparative study. Totally, 202 treatment-naïve nAMD eyes (183 patients) received anti-VEGF therapy according to a proactive (n = 105) or reactive (n = 97) regimen. Eyes were included if they had received anti-VEGF injections for a period of at least 4 years and had baseline fluorescein angiography and annual optical coherence tomography (OCT) imaging. Two masked graders independently delineated the lesion's margins from serial OCT images and growth rates were calculated. RESULTS At baseline, the mean [SD] lesion area was 7.24 [5.6] mm2 in the proactive group and 6.33 [4.8] mm2 in the reactive group respectively (p = 0.22). After four years of treatment, the mean [SD] lesion area in the proactive group was 5.16 [4.5] mm2 showing a significant reduction compared to the baseline (p < 0.001). By contrast, the mean [SD] lesion area kept expanding in the reactive group during the follow-up and was 9.24 [6.0] mm2 at four years (p < 0.001). The lesion area at 4 years was significantly influenced by treatment regimen, baseline lesion area, and proportion of visits with active lesions. CONCLUSIONS Eyes treated using a reactive strategy had an increased lesion area and worse visual outcomes at 4 years. By contrast, the proactive regimen was associated with fewer recurrences of active disease, shrinkage of the lesion area, and better vision at four years.
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Affiliation(s)
- Mariano Cozzi
- Eye Clinic, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Davide Monteduro
- Eye Clinic, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | | | | | - Samantha Fraser-Bell
- Sydney Retina Clinic, Sydney, Australia
- Faculty of Health and Medicine, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Francesco Romano
- Eye Clinic, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Matteo Airaldi
- Eye Clinic, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Andrew A Chang
- Sydney Retina Clinic, Sydney, Australia
- Faculty of Health and Medicine, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy.
- Faculty of Health and Medicine, Save Sight Institute, University of Sydney, Sydney, NSW, Australia.
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Romano F, Cozzi E, Boon CJF, Staurenghi G, Salvetti AP. MULTIMODAL RETINAL IMAGING REVEALS NEW PATHOGENIC INSIGHTS IN CENTRAL AREOLAR CHOROIDAL DYSTROPHY: A CASE SERIES. Retin Cases Brief Rep 2024; 18:32-38. [PMID: 36731070 DOI: 10.1097/icb.0000000000001325] [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] [Indexed: 02/04/2023]
Abstract
PURPOSE To describe novel imaging findings in a family affected by central areolar choroidal dystrophy. METHODS Case series with multimodal retinal imaging assessment. RESULTS A 19-year-old asymptomatic woman was referred for bilateral macular defects of the retinal pigment epithelium. Blue-light autofluorescence of her right eye revealed a speckled pattern in the macular area with a ring of decreased autofluorescence using near-infrared autofluorescence. Multimodal assessment of her left eye disclosed a single parafoveal spot of decreased pigmentation that was clearly visible as hyperautofluorescent using blue-light autofluorescence and as hypoautofluorescent using near-infrared autofluorescence. Optical coherence tomography angiography revealed several tiny areas of flow voids in correspondence of the retinal pigment epithelium alterations of both eyes. Three family members were recently diagnosed with presumed age-related macular degeneration and demonstrated well-demarcated areas of retinal pigment epithelium atrophy surrounded by yellowish deposits and a hypopigmented halo. Next-generation genetic analysis for inherited macular dystrophies was performed on the index case and the affected family members and revealed a p.Arg172Gln missense mutation in PRPH2 gene, leading to the diagnosis of central areolar choroidal dystrophy. CONCLUSION Multimodal imaging can reveal new pathogenic insights in central areolar choroidal dystrophy. Of notice, near-infrared autofluorescence and optical coherence tomography angiography are able to detect retinal pigment epithelium hypopigmentation and choriocapillaris rarefaction, respectively, since the earliest stages of the disease.
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Affiliation(s)
- Francesco Romano
- Eye Clinic, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Elisa Cozzi
- Eye Clinic, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; and
- Department of Ophthalmology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Anna Paola Salvetti
- Eye Clinic, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy
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Cozzi M, Monteduro D, Airaldi M, Parrulli S, Cinus F, Trinco A, Staurenghi G, Invernizzi A. Retromode Imaging Technology for Detecting Drusen-Like Deposits in Healthy Adults. Ophthalmol Retina 2023; 7:1051-1058. [PMID: 37479086 DOI: 10.1016/j.oret.2023.07.012] [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: 03/08/2023] [Revised: 06/17/2023] [Accepted: 07/13/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE To investigate the ability of retromode imaging technology to visualize drusen-like deposits (DLDs) in the macular region of healthy individuals without retinal diseases. Additionally, the correlation between subject age and the density of DLDs was assessed and their topographic distribution was evaluated. DESIGN Prospective, observational, cross-sectional study SUBJECTS: Healthy volunteers (aged ≥ 35 years) without macular diseases. METHODS This study evaluated macular images in healthy adults using color fundus photography (FP) and retromode imaging. Two masked graders counted the number of DLDs identifiable with each modality. The standardized ETDRS concentric rings were adopted to divide DLDs based on their topographic distribution. MAIN OUTCOME MEASURES Comparison of the number of DLDs detected with each imaging modality. The association between DLDs and age. The topographic distribution of macular DLDs with retromode imaging. RESULTS The study included 91 eyes of 52 healthy volunteers (mean ± standard deviation age, 57.9 ± 10.9 years; range, 36-82 years). Overall, at least 1 DLD was present in 63.74% of eyes on color FP and 96.71% on retromode. Retromode imaging allowed detection of significantly more DLDs compared with color FP within the ETDRS grid (median [interquartile range], 4 [1-14] vs. 0 [0-0] respectively; P < 0.001). The density of DLDs was higher in the outer and inner rings compared with the central subfield (relative risk [RR], 16.70; 95% confidence interval [CI], 10.3-27.3 vs. RR 17.1; 95% CI, 10.5-27.6, respectively). Age was significantly correlated with DLDs density in all 3 sectors (all P < 0.05). CONCLUSIONS Retromode technology allowed the detection of a significantly higher number of DLDs compared with FP in the macula of healthy individuals. This noninvasive imaging modality could be used to investigate the effect of the aging process on the macula, fostering a better understanding of the pathophysiology of age-related macular diseases. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Mariano Cozzi
- Eye Clinic, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Davide Monteduro
- Eye Clinic, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Matteo Airaldi
- Eye Clinic, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Salvatore Parrulli
- Eye Clinic, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Federico Cinus
- Eye Clinic, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Andrea Trinco
- Eye Clinic, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy; The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, NSW, Australia.
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9
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Ceccarini MR, Medori MC, Dhuli K, Tezzele S, Bonetti G, Micheletti C, Maltese PE, Cecchin S, Donato K, Colombo L, Rossetti L, Staurenghi G, Salvetti AP, Oldani M, Ziccardi L, Marangoni D, Iarossi G, Falsini B, Placidi G, D'Esposito F, Viola F, Nassisi M, Leone G, Cimino L, De Simone L, Mastrofilippo V, Beccari T, Bertelli M. Autoantibodies detection in patients affected by autoimmune retinopathies. Eur Rev Med Pharmacol Sci 2023; 27:57-63. [PMID: 38112948 DOI: 10.26355/eurrev_202312_34690] [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] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVE Autoimmune retinopathies (ARs) encompass a spectrum of immune diseases that are characterized by the presence of autoantibodies against retinal proteins in the bloodstream. These autoantibodies (AAbs) lead to a progressive and sometimes rapid loss of vision. ARs commonly affect subjects over 50 years of age, but also rare cases of kids under 3 years of age have been reported. PATIENTS AND METHODS In this study, 47 unrelated Caucasian patients were enrolled. All subjects showed negative cancer diagnoses and negative results in their genetic screenings. We studied 8 confirmed retinal antigens using Western blotting analysis, with α-enolase followed by carbonic anhydrase II being the two most frequently found in the patients' sera. RESULTS Nineteen patients were positive (40.4%), thirteen uncertain (27.7%), and fifteen were negative (31.9%). Their gender did not correlate with the presence of AAbs (p=0.409). CONCLUSIONS AAbs are responsible for retinal degeneration in some cases, while in others, they contribute to exacerbating the progression of the disease; however, their detection is crucial to reaching a better diagnosis and developing more effective treatments for these conditions. Moreover, finding good biomarkers is important not only for AR monitoring and prognosis, but also for helping with early cancer diagnosis.
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Affiliation(s)
- M R Ceccarini
- Department of Pharmaceutical Sciences, University of Perugia, Perugia, Italy.
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10
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Bonetti G, Cozza W, Bernini A, Kaftalli J, Mareso C, Cristofoli F, Medori MC, Colombo L, Martella S, Staurenghi G, Salvetti AP, Falsini B, Placidi G, Attanasio M, Pertile G, Bengala M, Bosello F, Petracca A, D’Esposito F, Toschi B, Lanzetta P, Ricci F, Viola F, Marceddu G, Bertelli M. Towards a Long-Read Sequencing Approach for the Molecular Diagnosis of RPGR ORF15 Genetic Variants. Int J Mol Sci 2023; 24:16881. [PMID: 38069202 PMCID: PMC10706286 DOI: 10.3390/ijms242316881] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/17/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
Sequencing of the low-complexity ORF15 exon of RPGR, a gene correlated with retinitis pigmentosa and cone dystrophy, is difficult to achieve with NGS and Sanger sequencing. False results could lead to the inaccurate annotation of genetic variants in dbSNP and ClinVar databases, tools on which HGMD and Ensembl rely, finally resulting in incorrect genetic variants interpretation. This paper aims to propose PacBio sequencing as a feasible method to correctly detect genetic variants in low-complexity regions, such as the ORF15 exon of RPGR, and interpret their pathogenicity by structural studies. Biological samples from 75 patients affected by retinitis pigmentosa or cone dystrophy were analyzed with NGS and repeated with PacBio. The results showed that NGS has a low coverage of the ORF15 region, while PacBio was able to sequence the region of interest and detect eight genetic variants, of which four are likely pathogenic. Furthermore, molecular modeling and dynamics of the RPGR Glu-Gly repeats binding to TTLL5 allowed for the structural evaluation of the variants, providing a way to predict their pathogenicity. Therefore, we propose PacBio sequencing as a standard procedure in diagnostic research for sequencing low-complexity regions such as RPGRORF15, aiding in the correct annotation of genetic variants in online databases.
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Affiliation(s)
- Gabriele Bonetti
- MAGI’s LAB, 38068 Rovereto, Italy; (M.C.M.); (M.B.)
- Department of Pharmaceutical Sciences, University of Perugia, 06123 Perugia, Italy
| | - William Cozza
- MAGI Euregio, 39100 Bolzano, Italy; (W.C.); (J.K.); (C.M.); (F.D.); (G.M.)
| | - Andrea Bernini
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, 53100 Siena, Italy;
| | - Jurgen Kaftalli
- MAGI Euregio, 39100 Bolzano, Italy; (W.C.); (J.K.); (C.M.); (F.D.); (G.M.)
| | - Chiara Mareso
- MAGI Euregio, 39100 Bolzano, Italy; (W.C.); (J.K.); (C.M.); (F.D.); (G.M.)
| | | | | | - Leonardo Colombo
- Department of Ophthalmology, ASST Santi Paolo e Carlo Hospital, University of Milan, 20142 Milan, Italy; (L.C.); (S.M.)
| | - Salvatore Martella
- Department of Ophthalmology, ASST Santi Paolo e Carlo Hospital, University of Milan, 20142 Milan, Italy; (L.C.); (S.M.)
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (G.S.); (A.P.S.)
| | - Anna Paola Salvetti
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (G.S.); (A.P.S.)
| | - Benedetto Falsini
- UOC Oculistica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo Gemelli 8, 00168 Rome, Italy (G.P.)
- Istituto di Oftalmologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giorgio Placidi
- UOC Oculistica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo Gemelli 8, 00168 Rome, Italy (G.P.)
| | - Marcella Attanasio
- Ospedale Sacrocuore Don Calabria, Viale Luigi Rizzardi, 4, 37024 Negrar di Valpolicella, Italy; (M.A.); (G.P.)
| | - Grazia Pertile
- Ospedale Sacrocuore Don Calabria, Viale Luigi Rizzardi, 4, 37024 Negrar di Valpolicella, Italy; (M.A.); (G.P.)
| | - Mario Bengala
- Medical Genetics Unit, Department of Oncohematology, Policlinico Tor Vergata, 00133 Rome, Italy;
| | - Francesca Bosello
- Department of Surgical Sciences, Dentistry, Paediatrics and Gynaecology, Section of Ophthalmology, University of Verona, 37134 Verona, Italy;
| | - Antonio Petracca
- Division of Medical Genetics, Fondazione IRCCS-Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy;
| | - Fabiana D’Esposito
- MAGI Euregio, 39100 Bolzano, Italy; (W.C.); (J.K.); (C.M.); (F.D.); (G.M.)
- Imperial College Ophthalmic Research Group (ICORG) Unit, Imperial College, London NW1 5QH, UK
- Eye Clinic, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, 80138 Naples, Italy
| | - Benedetta Toschi
- Section of Medical Genetics, Department of Medical and Oncological Area, University Hospital of Pisa, 56126 Pisa, Italy;
| | - Paolo Lanzetta
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy;
- Istituto Europeo di Microchirurgia Oculare (IEMO), 33100 Udine, Italy
| | - Federico Ricci
- Department of Experimental Medicine, Tor Vergata University of Rome, Viale Oxford, 00133 Rome, Italy;
| | - Francesco Viola
- Department of Ophthalmology, Fondazione IRCCS Cà Granda, Clinica Regina Elena, 20122 Milan, Italy;
| | - Giuseppe Marceddu
- MAGI Euregio, 39100 Bolzano, Italy; (W.C.); (J.K.); (C.M.); (F.D.); (G.M.)
| | - Matteo Bertelli
- MAGI’s LAB, 38068 Rovereto, Italy; (M.C.M.); (M.B.)
- MAGI Euregio, 39100 Bolzano, Italy; (W.C.); (J.K.); (C.M.); (F.D.); (G.M.)
- MAGISNAT, Atlanta Tech Park, 107 Technology Parkway, Peachtree Corners, GA 30092, USA
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11
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Romano F, Barbieri L, Staurenghi G, Salvetti AP. Hyperreflective Ganglion Cell Layer Band in Choroideremia. Retina 2023:00006982-990000000-00530. [PMID: 37972966 DOI: 10.1097/iae.0000000000004003] [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: 11/19/2023]
Affiliation(s)
- Francesco Romano
- Eye Clinic, Department of Biomedical and Clinical Sciences, Ospedale Luigi Sacco, University of Milan, Milan (Italy)
- Harvard Retinal Imaging Lab, Harvard Medical School, Massachusetts Eye and Ear, Boston (MA)
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston (MA)
| | - Lucrezia Barbieri
- Eye Clinic, Department of Biomedical and Clinical Sciences, Ospedale Luigi Sacco, University of Milan, Milan (Italy)
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Sciences, Ospedale Luigi Sacco, University of Milan, Milan (Italy)
| | - Anna Paola Salvetti
- Eye Clinic, Department of Biomedical and Clinical Sciences, Ospedale Luigi Sacco, University of Milan, Milan (Italy)
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12
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Romano F, Lamanna F, Boon CJF, Siligato A, Kalra G, Agarwal A, Medori C, Bertelli M, Pellegrini M, Invernizzi A, Staurenghi G, Salvetti AP. Clinical, Genotypic, and Imaging Characterization of the Spectrum of ABCA4 Retinopathies. Ophthalmol Retina 2023:S2468-6530(23)00574-2. [PMID: 37924945 DOI: 10.1016/j.oret.2023.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/14/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE To investigate the clinical and genotypic differences in the spectrum of ABCA4-associated retinopathies (ABCA4Rs). DESIGN Observational, cross sectional case series. PARTICIPANTS Sixty-six patients (132 eyes) carrying biallelic ABCA4 variants. METHODS Patients underwent visual acuity measurement and multimodal imaging. Clinical records were reviewed for age at onset, presenting symptoms, genetic variants, and electroretinogram (ERG). Each eye was assigned to a phenotype based on age at onset, imaging and ERG: cone dystrophy-bull's-eye maculopathy (CD-BEM, 40 eyes), cone-rod dystrophy (CRD, 12 eyes), Stargardt disease (SD, 28 eyes), late-onset SD (LO-SD, 38 eyes), and fundus flavimaculatus (14 eyes). Images were analyzed for: peripapillary sparing, retinal pigment epithelium (RPE) atrophy (definitely decreased autofluorescence, DDAF), flecks patterns using autofluorescence; type of atrophy according to Classification of Atrophy Meeting reports, macular and choroidal thickness on OCT; and choriocapillaris flow deficits on OCT angiography. MAIN OUTCOME MEASURES Primary outcome was to report the demographic, genotypic, and imaging characteristics of the different ABCA4R phenotypes. Secondary objectives included the assessment of imaging biomarkers as outcome measures for clinical trials. RESULTS Age at onset was lower in CRD (12 ± 8 years) and higher in patients with LO-SD (59 ± 9 years) (all P < 0.01). Central vision loss was a common presenting symptom in CD-BEM and SD, whereas patients with LO-SD primarily complained of difficult dark adaptation. Missense variants were more frequent in CD-BEM, and splice site in CRD and LO-SD (P < 0.05). Peripapillary sparing was absent in 3 eyes with LO-SD (8%). Cone dystrophy-bull's-eye maculopathy eyes typically had complete outer retinal atrophy alterations (98%), whereas CRD and SD eyes showed both complete outer retinal atrophy and complete RPE and outer retinal atrophy (cRORA) (71%-100%). Patients with LO-SD had larger areas of DDAF (100% cRORA) and of choriocapillaris flow deficits (all P < 0.01). Repeatability of DDAF measurements was low for some phenotypes (CD-BEM and CRD) and atrophic areas <7.5 mm2. Resorbed flecks were significantly associated with CRD and LO-SD (P < 0.01). CONCLUSIONS This research provides a thorough evaluation of the spectrum of ABCA4R. Our findings suggest that certain phenotypes show preferential photoreceptor degeneration (e.g., CD-BEM), whereas others have substantial RPE and choriocapillaris alterations (e.g., LO-SD). We recommend that clinical trial end points take into consideration these imaging features to improve the interpretation of their results. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Francesco Romano
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy; Harvard Retinal Imaging Lab, Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts.
| | - Francesca Lamanna
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands; Department of Ophthalmology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Alessandro Siligato
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Gagan Kalra
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | | | | | | | - Marco Pellegrini
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy; Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, Australia
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Anna Paola Salvetti
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
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13
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Romano F, Cozzi M, Casati S, Bosello F, Zaffalon C, Trinco A, Pellegrini M, Invernizzi A, Staurenghi G, Salvetti AP. Unveiling the Hidden: Early Manifestations of Extensive Macular Atrophy with Pseudodrusen-like appearance. Retin Cases Brief Rep 2023:01271216-990000000-00246. [PMID: 37910645 DOI: 10.1097/icb.0000000000001513] [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: 01/27/2023] [Accepted: 10/03/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE To describe novel microperimetry and imaging findings in two patients affected by extensive macular atrophy with pseudodrusen-like appearance (EMAP) without signs of retinal pigment epithelium (RPE) atrophy. METHODS Case series. Both patients underwent mesopic and dark-adapted two-color scotopic microperimetry, followed by multimodal imaging assessment including ultra-widefield photography, fundus autofluorescence (AF), high-resolution optical coherence tomography (Hi-Res OCT), OCT angiography and high-magnification module (HMM). RESULTS Albeit normal visual acuity, both patients had a significant reduction of retinal sensitivity - especially under scotopic cyan conditions. One patient had macular pigment abnormalities, while the combination of blue and near-infrared AF modalities highlighted different patterns of pseudodrusen-like lesions.Of notice, Hi-Res OCT revealed a marked separation between the RPE and Bruch's membrane, containing a hyperreflective material with two different reflectivities. OCT angiography excluded the presence of macular neovascularization and documented several choriocapillaris flow voids. HMM images showed severe alteration of photoreceptors' mosaic in the perifovea. CONCLUSIONS Our comprehensive assessment of two stage 1 EMAP patients revealed a predominant damage of perifoveal rods over areas of RPE-Bruch's membrane separation. These findings underscore the importance of basal laminar deposits in the initial stages of EMAP, contributing to a deeper understanding of its underlying mechanisms.
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Affiliation(s)
- Francesco Romano
- Eye Clinic, Luigi Sacco Hospital, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
- Harvard Retinal Imaging Lab, Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Mariano Cozzi
- Eye Clinic, Luigi Sacco Hospital, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Stefano Casati
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesca Bosello
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Chiara Zaffalon
- Eye Clinic, Luigi Sacco Hospital, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Trinco
- Eye Clinic, Luigi Sacco Hospital, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Marco Pellegrini
- Eye Clinic, Luigi Sacco Hospital, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Luigi Sacco Hospital, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Giovanni Staurenghi
- Eye Clinic, Luigi Sacco Hospital, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Anna Paola Salvetti
- Eye Clinic, Luigi Sacco Hospital, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
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14
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Khanani AM, Patel SS, Staurenghi G, Tadayoni R, Danzig CJ, Eichenbaum DA, Hsu J, Wykoff CC, Heier JS, Lally DR, Monés J, Nielsen JS, Sheth VS, Kaiser PK, Clark J, Zhu L, Patel H, Tang J, Desai D, Jaffe GJ. Efficacy and safety of avacincaptad pegol in patients with geographic atrophy (GATHER2): 12-month results from a randomised, double-masked, phase 3 trial. Lancet 2023; 402:1449-1458. [PMID: 37696275 DOI: 10.1016/s0140-6736(23)01583-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/25/2023] [Accepted: 07/28/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Geographic atrophy is an advanced form of dry age-related macular degeneration that can lead to irreversible vision loss and high burden of disease. We aimed to assess efficacy and safety of avacincaptad pegol 2 mg in reducing geographic atrophy lesion growth. METHODS GATHER2 is a randomised, double-masked, sham-controlled, 24-month, phase 3 trial across 205 retina clinics, research hospitals, and academic institutions globally. To be eligible, patients had to be aged 50 years or older with non-centrepoint-involving geographic atrophy and best corrected visual acuity between 20/25 and 20/320 in the study eye. Eligible patients were randomly assigned (1:1) to monthly avacincaptad pegol 2 mg administered as a 100 μL intravitreal injection or sham for the first 12 months. Randomisation was performed using an interactive response technology system with stratification by factors known to be of prognostic importance in age-related macular degeneration. Patients, investigators, study centre staff, sponsor personnel, and data analysts were masked to treatment allocation. The primary endpoint was geographic atrophy lesion size measured by fundus autofluorescence at baseline, month 6, and month 12. Efficacy and safety analyses were done in the modified intention-to-treat and safety populations, respectively. This trial is registered with ClinicalTrials.gov, NCT04435366. FINDINGS Between June 22, 2020, and July 23, 2021, 1422 patients were screened for eligibility, of whom 448 were enrolled and randomly assigned to avacincaptad pegol 2 mg (n=225) or sham (n=223). One patient in the sham group did not receive study treatment and was excluded from analyses. There were 154 (68%) female patients and 71 (32%) male patients in the avacincaptad pegol 2 mg group, and 156 (70%) female patients and 66 (30%) male patients in the sham group. From baseline to month 12, the mean rate of square-root-transformed geographic atrophy area growth was 0·336 mm/year (SE 0·032) with avacincaptad pegol 2 mg and 0·392 mm/year (0·033) with sham, a difference in growth of 0·056 mm/year (95% CI 0·016-0·096; p=0·0064), representing a 14% difference between the avacincaptad pegol 2 mg group and the sham group. Ocular treatment-emergent adverse events in the study eye occurred in 110 (49%) patients in the avacincaptad pegol 2 mg group and 83 (37%) in the sham group. There were no endophthalmitis, intraocular inflammation, or ischaemic optic neuropathy events over 12 months. To month 12, macular neovascularisation in the study eye occurred in 15 (7%) patients in the avacincaptad pegol 2 mg group and nine (4%) in the sham group, with exudative macular neovascularisation occurring in 11 (5%) in the avacincaptad pegol 2 mg group and seven (3%) in the sham group. INTERPRETATION Monthly avacincaptad pegol 2 mg was well tolerated and showed significantly slower geographic atrophy growth over 12 months than sham treatment, suggesting that avacincaptad pegol might slow disease progression and potentially change the trajectory of disease for patients with geographic atrophy. FUNDING Iveric Bio, An Astellas Company.
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Affiliation(s)
- Arshad M Khanani
- Sierra Eye Associates, Reno, NV, USA; University of Nevada, Reno School of Medicine, Reno, NV, USA.
| | | | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Ramin Tadayoni
- Université Paris Cité, Ophthalmology Department, AP-HP, Lariboisière, Saint Louis and Fondation Adolphe de Rothschild Hospitals, Paris, France
| | - Carl J Danzig
- Rand Eye Institute, Deerfield Beach, FL, USA; Florida Atlantic University, Charles E Schmidt School of Medicine, Boca Raton, FL, USA
| | - David A Eichenbaum
- Retina Vitreous Associates of Florida, Saint Petersburg, FL, USA; Morsani College of Medicine at the University of South Florida, Tampa, FL, USA
| | - Jason Hsu
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Charles C Wykoff
- Retina Consultants of Texas, Retina Consultants of America, Houston, TX, USA; Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
| | | | - David R Lally
- New England Retina Consultants, Springfield, MA, USA
| | - Jordi Monés
- Institut de la Màcula, Centro Médico Teknon, Barcelona, Spain
| | | | | | - Peter K Kaiser
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Julie Clark
- Iveric Bio, An Astellas Company, Parsippany, NJ, USA
| | - Liansheng Zhu
- Iveric Bio, An Astellas Company, Parsippany, NJ, USA
| | - Hersh Patel
- Iveric Bio, An Astellas Company, Parsippany, NJ, USA
| | - Justin Tang
- Iveric Bio, An Astellas Company, Parsippany, NJ, USA
| | - Dhaval Desai
- Iveric Bio, An Astellas Company, Parsippany, NJ, USA
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, NC, USA
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15
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Heier JS, Lad EM, Holz FG, Rosenfeld PJ, Guymer RH, Boyer D, Grossi F, Baumal CR, Korobelnik JF, Slakter JS, Waheed NK, Metlapally R, Pearce I, Steinle N, Francone AA, Hu A, Lally DR, Deschatelets P, Francois C, Bliss C, Staurenghi G, Monés J, Singh RP, Ribeiro R, Wykoff CC. Pegcetacoplan for the treatment of geographic atrophy secondary to age-related macular degeneration (OAKS and DERBY): two multicentre, randomised, double-masked, sham-controlled, phase 3 trials. Lancet 2023; 402:1434-1448. [PMID: 37865470 DOI: 10.1016/s0140-6736(23)01520-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Geographic atrophy is a leading cause of progressive, irreversible vision loss. The objectives of OAKS and DERBY were to assess the efficacy and safety of pegcetacoplan compared with sham treatment in patients with geographic atrophy. METHODS OAKS and DERBY were two 24-month, multicentre, randomised, double-masked, sham-controlled, phase 3 studies, in which patients aged 60 years and older with geographic atrophy secondary to age-related macular degeneration were enrolled at 110 clinical sites and 122 clinical sites worldwide, respectively. Patients were randomly assigned (2:2:1:1) by central web-based randomisation system to intravitreal 15 mg per 0·1 mL pegcetacoplan monthly or every other month, or sham monthly or every other month using stratified permuted block randomisation (stratified by geographic atrophy lesion area at screening, history or presence of active choroidal neovascularisation in the eye not under assessment, and block size of six). Study site staff, patients, reading centre personnel, evaluating physicians, and the funder were masked to group assignment. Sham groups were pooled for the analyses. The primary endpoint was the change from baseline to month 12 in the total area of geographic atrophy lesions in the study eye based on fundus autofluorescence imaging, in the modified intention-to-treat population (ie, all patients who received one or more injections of pegcetacoplan or sham and had a baseline and at least one post-baseline value of lesion area). Key secondary endpoints (measured at 24 months) were change in monocular maximum reading speed of the study eye, change from baseline in mean functional reading independence index score, change from baseline in normal luminance best-corrected visual acuity score, and change from baseline in the mean threshold sensitivity of all points in the study eye by mesopic microperimetry (OAKS only). Safety analyses included patients who were randomly assigned and received at least one injection of pegcetacoplan or sham. The now completed studies are registered with ClinicalTrials.gov, NCT03525613 (OAKS) and NCT03525600 (DERBY). FINDINGS Between Aug 30, 2018, and July 3, 2020, 1258 patients were enrolled in OAKS and DERBY. The modified intention-to-treat populations comprised 614 (96%) of 637 patients in OAKS (202 receiving pegcetacoplan monthly, 205 pegcetacoplan every other month, and 207 sham) and 597 (96%) of 621 patients in DERBY (201 receiving pegcetacoplan monthly, 201 pegcetacoplan every other month, and 195 sham). In OAKS, pegcetacoplan monthly and pegcetacoplan every other month significantly slowed geographic atrophy lesion growth by 21% (absolute difference in least-squares mean -0·41 mm2, 95% CI -0·64 to -0·18; p=0·0004) and 16% (-0·32 mm2, -0·54 to -0·09; p=0·0055), respectively, compared with sham at 12 months. In DERBY, pegcetacoplan monthly and pegcetacoplan every other month slowed geographic atrophy lesion growth, although it did not reach significance, by 12% (-0·23 mm2, -0·47 to 0·01; p=0·062) and 11% (-0·21 mm2, -0·44 to 0·03; p=0·085), respectively, compared with sham at 12 months. At 24 months, pegcetacoplan monthly and pegcetacoplan every other month slowed geographic atrophy lesion growth by 22% (-0·90 mm2, -1·30 to -0·50; p<0·0001) and 18% (-0·74 mm2, -1·13 to -0·36; p=0·0002) in OAKS, and by 19% (-0·75 mm2, -1·15 to -0·34; p=0·0004) and 16% (-0·63 mm2, -1·05 to -0·22; p=0·0030) in DERBY, respectively, compared with sham. There were no differences in key secondary visual function endpoints at 24 months. Serious ocular treatment-emergent adverse events were reported in five (2%) of 213, four (2%) of 212, and one (<1%) of 211 patients in OAKS, and in four (2%) of 206, two (1%) of 208, and two (1%) of 206 patients in DERBY receiving pegcetacoplan monthly, pegcetacoplan every other month, and sham, respectively, at 24 months. New-onset exudative age-related macular degeneration was reported in 24 (11%), 16 (8%), and four (2%) patients in OAKS, and in 27 (13%), 12 (6%), and nine (4%) patients in DERBY receiving pegcetacoplan monthly, pegcetacoplan every other month, and sham, respectively, at 24 months. INTERPRETATION Pegcetacoplan, the first treatment approved by the US Food and Drug Administration for geographic atrophy, slowed geographic atrophy lesion growth with an acceptable safety profile. FUNDING Apellis Pharmaceuticals.
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Affiliation(s)
| | - Eleonora M Lad
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
| | - David Boyer
- Retina Vitreous Associates Medical Group, Los Angeles, CA, USA
| | | | | | - Jean-Francois Korobelnik
- Service d'Ophtalmologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Ophthalmology Department, University of Bordeaux, Bordeaux, France
| | - Jason S Slakter
- Department of Ophthalmology, New York University, New York, NY, USA
| | | | | | - Ian Pearce
- Department of Ophthalmology, Royal Liverpool University Hospital, Liverpool, UK
| | | | | | - Allen Hu
- Cumberland Valley Retina Consultants, Hagerstown, MD, USA
| | - David R Lally
- New England Retina Consultants, Springfield, MA, USA
| | | | | | | | - Giovanni Staurenghi
- Department of Biomedical and Clinical Science, Ospedale Luigi Sacco University of Milan, Milan, Italy
| | - Jordi Monés
- Institut de la Màcula, Centro Médico Teknon, Barcelona, Spain; Barcelona Macula Foundation: Research for Vision, Barcelona, Spain
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cleveland Clinic, Cleveland, OH, USA
| | | | - Charles C Wykoff
- Retina Consultants of Texas, Houston, TX, USA; Blanton Eye Institute, Houston, TX, USA; Houston Methodist Hospital, Houston, TX, USA.
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16
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Casalino G, Mambretti M, Govetto A, Grisolia A, Staurenghi G, Invernizzi A. Optical Coherence Tomography Features of Endogenous Aspergillus Endophthalmitis Secondary to HIV Infection. Ocul Immunol Inflamm 2023; 31:1541-1544. [PMID: 35914300 DOI: 10.1080/09273948.2022.2103716] [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: 02/20/2022] [Revised: 05/30/2022] [Accepted: 07/14/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE To report imaging findings, including optical coherence tomography (OCT), of a case of endogenous Aspergillus endophthalmitis in a patient with newly diagnosed acquired immunodeficiency syndrome. METHODS Observational case report. RESULTS A 38-year-old patient presented with acute painful vision loss in his right eye (RE). Examination of the RE revealed anterior inflammation, vitritis and a fluffy macular infiltrate; OCT showed preretinal hyperreflective aggregates extending into the vitreous cavity with no evidence of subretinal and/or choroidal involvement. Lab tests showed leukopenia with lymphocyte T CD4+ count of 13 cells/μL and positive HIV serology. Vitreous biopsy was positive for Aspergillus niger and diagnosis of endogenous Aspergillus endophthalmitis secondary to HIV infection was made. CONCLUSIONS OCT findings of this case show that ocular aspergillosis may present with disruption of the inner retinal layers and sparing of the outer retina and choroid, suggesting that Aspergillus may reach the eye through the retinal circulation.
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Affiliation(s)
| | | | - Andrea Govetto
- Oftalmico Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Antonella Grisolia
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Giovanni Staurenghi
- Oftalmico Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
- Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney, Australia
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17
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Corvi F, Bacci T, Corradetti G, Staurenghi G, Sarraf D, Freund KB, Sadda S. Characterisation of the vascular anterior surface of type 1 macular neovascularisation after anti-VEGF therapy. Br J Ophthalmol 2023; 107:1336-1343. [PMID: 35537801 DOI: 10.1136/bjophthalmol-2021-320047] [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: 07/13/2021] [Accepted: 04/25/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND To evaluate whether the status of vasculature at the top of type 1 macular neovascularisation (MNV) could function as mediator of the observed protective effect against the development of complete retinal pigment epithelial and outer retinal atrophy (cRORA). METHODS In consecutive treatment-naïve patients, the vasculature at the anterior surface of the MNV was isolated using a slab designed to extract the most superficial vascular portion of the MNV lesion showing a choriocapillaris (CC)-like structure which we termed the 'neo-CC'. The ratio between the neo-CC area (isolated using this custom slab) and the MNV area (isolated using the standard outer retina-CC slab) at baseline and at last follow-up was evaluated. RESULTS Forty-four eyes from 44 patients were included. 20 showed cRORA by the final follow-up (median 23 months), whereas 24 did not progress to atrophy (median 23.5 months). The proportion of MNV with neo-CC at the anterior surface was significantly lower in eyes which progressed to cRORA compared with those which did not. The multivariate regression showed that a lower proportion of neo-CC coverage over the MNV was associated with an increased odds for cRORA development. CONCLUSIONS More extensive coverage of neo-CC is associated with a lower likelihood of development of macular atrophy in eyes receiving antivascular endothelial growth factor therapy, suggesting the protective effect of a type 1 MNV may be mediated by the development of a neo-CC and may provide insights into the biological significance of MNV as a response mechanism in eyes with age-related macular degeneration.
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Affiliation(s)
- Federico Corvi
- Department of Ophthalmology, Doheny Eye Institute, Los Angeles, California, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Tommaso Bacci
- Dipartimento di Scienze Mediche Chirurgiche e Neuroscienze, Universita degli Studi di Siena, Siena, Italy
| | - Giulia Corradetti
- Department of Ophthalmology, Doheny Eye Institute, Los Angeles, California, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - David Sarraf
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Ophthalmology, Jules Stein Eye Institute, Los Angeles, California, USA
- Greater Los Angeles VA Healthcare Center, Los Angeles, California, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, USA
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York, USA
| | - SriniVas Sadda
- Department of Ophthalmology, Doheny Eye Institute, Los Angeles, California, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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18
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Romano F, Cozzi E, Airaldi M, Nassisi M, Viola F, Aretti A, Milella P, Giuffrida FP, Teo KCY, Cheung CMG, Staurenghi G, Invernizzi A. Ten-Year Incidence of Fibrosis and Risk Factors for Its Development in Neovascular Age-Related Macular Degeneration. Am J Ophthalmol 2023; 252:170-181. [PMID: 37030492 DOI: 10.1016/j.ajo.2023.03.033] [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: 08/10/2022] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/10/2023]
Abstract
PURPOSE To report the incidence and risk factors for fibrosis at 10 years in a large cohort of persons with neovascular age-related macular degeneration (nAMD). DESIGN Retrospective, multicenter, cohort study. METHODS We included 225 naive nAMD eyes that underwent intravitreal anti-vascular endothelial growth factor treatment over 10 years of follow-up at two Italian referral centers. Demographic and clinical data were reviewed at baseline and on an annual basis. Onset of fibrosis was defined by clinically assessing photographs, fundus descriptions, or fluorescein angiograms. Optical coherence tomography (OCT) scans of fibrosis were inspected by an external reading center and graded as subretinal pigment epithelium (RPE), mixed, or subretinal. RESULTS The mean age at baseline was of 72.1 ± 6.9 years. The incidence rate of fibrosis was estimated to be 8.9 per 100 person-years, with a cumulative incidence of 62.7% at 10 years. Fibrotic lesions were sub-RPE in 46.1%, mixed in 29.8%, and subretinal in 22.7%. Independent factors associated with fibrosis included the following: larger central subfield thickness variation (P < .001), submacular hemorrhages (P = .008), higher number of injections (P = .01), and worse baseline visual acuity (VA) (P = .03). Type 2 macular neovascularization was significantly associated with mixed and subretinal fibrosis. VA significantly declined over 10 years (-16.4 Early Treatment Diabetic Retinopathy Study [ETDRS] letters), particularly in eyes with mixed and subretinal fibrosis (P < .001). CONCLUSIONS We identified a 62.7% cumulative incidence of fibrosis in a large nAMD cohort at 10 years. Fibrosis was more common with frequent reactivations and lower baseline VA; its onset had a significant impact on final VA. This supports the hypothesis that nAMD patients should be promptly treated with proactive regimens.
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Affiliation(s)
- Francesco Romano
- From the Eye Clinic, Luigi Sacco Hospital (F.R., E.C., M.A., G.S., A.I.), Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Elisa Cozzi
- From the Eye Clinic, Luigi Sacco Hospital (F.R., E.C., M.A., G.S., A.I.), Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Matteo Airaldi
- From the Eye Clinic, Luigi Sacco Hospital (F.R., E.C., M.A., G.S., A.I.), Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Marco Nassisi
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico (M.N., F.V.), Milan, Italy
| | - Francesco Viola
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico (M.N., F.V.), Milan, Italy
| | - Andrea Aretti
- Department of Clinical Sciences and Community Health (A.A., P.M., F.P.G.), University of Milan, Milan, Italy
| | - Paolo Milella
- Department of Clinical Sciences and Community Health (A.A., P.M., F.P.G.), University of Milan, Milan, Italy
| | - Francesco Pozzo Giuffrida
- Department of Clinical Sciences and Community Health (A.A., P.M., F.P.G.), University of Milan, Milan, Italy
| | - Kelvin C Y Teo
- Singapore Eye Research Institution (K.C.Y.T., C.M.G.C.), Singapore National Eye Centre, Singapore; Duke-NUS Medical School (K.C.Y.T., C.M.G.C.), National University of Singapore, Singapore
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institution (K.C.Y.T., C.M.G.C.), Singapore National Eye Centre, Singapore; Duke-NUS Medical School (K.C.Y.T., C.M.G.C.), National University of Singapore, Singapore
| | - Giovanni Staurenghi
- From the Eye Clinic, Luigi Sacco Hospital (F.R., E.C., M.A., G.S., A.I.), Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Alessandro Invernizzi
- From the Eye Clinic, Luigi Sacco Hospital (F.R., E.C., M.A., G.S., A.I.), Department of Biomedical and Clinical Science, University of Milan, Milan, Italy; Faculty of Health and Medicine (A.I.), Save Sight Institute, University of Sydney, Sydney, NSW, Australia.
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Calabria S, Ronconi G, Dondi L, Piccinni C, Pedrini A, Dondi L, Dell'Anno I, Esposito I, Addesi A, Staurenghi G, Bandello F, Ricci F, Martini N. [The population affected by neovascular age-related macular degeneration and treated with anti-Vegf through Italian administrative healthcare data.]. Recenti Prog Med 2023; 114:447-461. [PMID: 37392108 DOI: 10.1701/4062.40464] [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] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
INTRODUCTION The neo-vascular age-related macular degeneration (nAmd) is a frequent cause of vision loss, although the intravitreal (Ivt) injections of anti-Vegf (vascular endothelial growth factor) have improved functional outcomes. This study has assessed the healthcare and economic burden on the Italian national health service (Inhs) for patients with nAmd and new users of anti-Vegf. METHODS From the database of Fondazione Ricerca e Salute (ReS), people aged ≥55 and with an in-hospital diagnosis of nAmd and/or an injection of anti-Vegf (aflibercept, ranibizumab, pegaptanib; index date) in 2018 are selected. Those with other conditions treated with anti-Vegf and with an Ivt injection before 2018 are excluded. New users of anti-Vegf are analyzed by sex, age, comorbidities, Ivt administrations, switch of anti-Vegf, local outpatient specialist services (with some focuses) and direct healthcare costs charged to the Inhs Results. In 2018, of 8125 inhabitants aged ≥55 with nAmd (4.6x1000 inhab.; mean age 76±9; F: 50%), 1513 (19%) are new users of Ivt anti-Vegf (mean age 74±9), whose incidence (0.9x1000) increased with age until 84 years old. A proportion of 60.7% had ≥2 comorbidities (mainly hypertension, dyslipidemia and diabetes). Within the 2nd follow-up year, only 598 patients are still treated (60% were lost). On average, 4.8 Ivt injections in the first and 3.1 in the second year are registered. On average, the total cost charged to the Inhs per new user of anti-Vegf was € 6726 (Ivt anti-Vegf accounted for the 76%) and € 3282 (hospitalizations for causes different from nAmd accounted for the 47%), during the first and the second year, respectively. CONCLUSIONS This analysis suggests that in Italy people with nAmd and new users of anti-Vegf are elderly, affected by many comorbidities, treated with Ivt anti-VEGF less than what is required and authorized to achieve a benefit, undergo very few follow-up outpatient specialist visits and tests and, within the 2nd year, their hospitalizations for causes different from nAmd mainly weighs on the total expenditure charged to the Inhs.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Federico Ricci
- Dipartimento Medicina sperimentale, Università Tor Vergata, Roma
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20
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Romano F, Preziosa C, Staurenghi G, Pellegrini M. Multimodal Imaging and Functional Assessment in a Young Patient Presenting With Concomitant Unilateral Retinal Capillary Hemangioma and Presumed Retinal Pigment Epithelium Dysgenesis. Retina 2023; 43:e37-e38. [PMID: 37027830 DOI: 10.1097/iae.0000000000003802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Affiliation(s)
- Francesco Romano
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
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21
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Muñoz-Solano J, Tondini G, Zicarelli F, Staurenghi G, Oldani M, Invernizzi A. Utility of Anterior Segment OCT in the Management of Uveitic Cataract Surgery: A Fibrinoid Syndrome Case Treated with rtPA. Ocul Immunol Inflamm 2023:1-4. [PMID: 37140351 DOI: 10.1080/09273948.2023.2203232] [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: 05/05/2023]
Abstract
PURPOSE To highlight the importance of swept-source anterior segment optical coherence tomography (SS-ASOCT) in the peri-surgical management of cataract in uveitis. To describe a case of fibrinoid syndrome in uveitis treated with recombinant tissue plasminogen activator (rtPA). METHODS SS-ASOCT was performed at each follow-up before and after cataract surgery to assess anterior chamber inflammation and assist the clinical management of the patient. RESULTS A patient with idiopathic autoimmune uveitis was scheduled for cataract surgery. SS-ASOCT allowed to correctly plan the surgery timing. The patient developed a severe fibrinoid syndrome. Postsurgical SS-ASOCT allowed to distinguish between anterior chamber cells and fibrin thus guiding the timing for rtPA intracameral injection. Visual acuity improved from 20/400 the day after the surgery to 20/40. CONCLUSION SS-ASOCT allowed a precise assessment of the inflammatory components (cellular vs fibrinoid) after cataract surgery. Intracameral rtPA was safe and effective in the treatment fibrinoid syndrome in uveitis.
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Affiliation(s)
- Javier Muñoz-Solano
- Department of Ophthalmology, Donostia University Hospital, San Sebastian, Spain
| | - Giovanni Tondini
- Eye Clinic, Department of Biomedical and Clinical Science, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Federico Zicarelli
- Eye Clinic, Department of Biomedical and Clinical Science, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Marta Oldani
- Eye Clinic, Department of Biomedical and Clinical Science, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science, University of Milan, Luigi Sacco Hospital, Milan, Italy
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, Australia
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22
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Freeman WR, Bandello F, Souied E, Guymer RH, Garg SJ, Chen FK, Rich R, Holz FG, Patel SS, Kim K, López FJ, Guymer R, Korobelnik JF, Souied E, Holz F, Ziemssen F, Bandello F, Campos E, Grignolo/Eandi C, Midena E, Peiretti E, Staurenghi G, Viola F, Bailey C, Esposti SD, Jackson T, Menon G, Pagliarini S, Quhill F, Antoszyk A, Brooks L, Callanan D, Csaky K, Edwards A, Eichenbaum D, Freeman W, Garg S, Ghuman AT, Gonzalez V, Gupta S, Hamilton R, Khurana R, Kunimoto D, Kuppermann B, Lauer A, Lee SY, Maturi R, Patel S, Reddy R, Rich R, Rivellese M, Rose S, Segal Z, Wong R. Randomized Phase 2b Study of Brimonidine Drug Delivery System Generation 2 for Geographic Atrophy in Age-related Macular Degeneration. Ophthalmol Retina 2023:S2468-6530(23)00097-0. [PMID: 36906177 DOI: 10.1016/j.oret.2023.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 10/24/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of repeat injections of Brimonidine Drug Delivery System (Brimo DDS) Generation 2 (Gen 2) containing 400 μg brimonidine in patients with geographic atrophy (GA) secondary to age-related macular degeneration (AMD). DESIGN Phase 2b, randomized, multicenter, double-masked, sham-controlled, 30-month study (BEACON). PARTICIPANTS Patients diagnosed with GA secondary to AMD and multifocal lesions with total area >1.25 mm2 and ≤18 mm2 in the study eye. METHODS Enrolled patients were randomized to treatment with intravitreal injections of 400-μg Brimo DDS (n=154) or sham procedure (n=156) in the study eye every 3 months from day 1 through month 21. MAIN OUTCOME MEASURES The primary efficacy endpoint was change from baseline in the GA lesion area in the study eye, assessed with fundus autofluorescence imaging, at month 24. Safety measures included treatment-emergent adverse events (AEs). RESULTS The study was terminated early, at the time of the planned interim analysis, because of a slow GA progression rate (∼1.6 mm2/year) in the enrolled population. Least-squares mean (standard error) GA area change from baseline at month 24 (primary endpoint) was 3.24 (0.13) mm2 with Brimo DDS (n=84) versus 3.48 (0.13) mm2 with sham (n=91); the reduction in GA area change from baseline in the Brimo DDS group compared with the sham group was 0.25 mm2 (7%) (P = 0.150). At month 30, the GA area change from baseline was 4.09 (0.15) mm2 with Brimo DDS (n=49) versus 4.52 (0.15) mm2 with sham (n=46), a reduction of 0.43 mm2 (10%) with Brimo DDS compared with sham (P=0.033). Exploratory analysis showed numerically smaller loss over time in retinal sensitivity assessed with scotopic microperimetry with Brimo DDS compared with sham (P=0.053 at month 24). Treatment-related AEs were usually related to the injection procedure. No implant accumulation was observed. CONCLUSIONS Multiple intravitreal administrations of Brimo DDS (Gen 2) were well tolerated. The primary efficacy endpoint at 24 months was not met, but there was a numerical trend for reduction in GA progression at 24 months compared with sham treatment. The study was terminated early because of the lower-than-expected GA progression rate in the sham/control group.
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Affiliation(s)
- William R Freeman
- Jacobs Retina Center, University of California San Diego, La Jolla, California, USA.
| | - Francesco Bandello
- University Vita-Salute Scientific Institute, Hospital San Raffaele, Milan, Italy
| | - Eric Souied
- Centre Hospitalier Creteil, Service Universitaire d'Ophthalmologie, Creteil, France
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, and Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Australia
| | - Sunir J Garg
- Mid Atlantic Retina, the Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Fred K Chen
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, and Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Australia; Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, Western Australia, Australia
| | - Ryan Rich
- Retina Consultants of Southern Colorado PC, Colorado Springs, Colorado, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Kimmie Kim
- Allergan, an AbbVie company, Irvine, California, USA
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Romano F, Lamanna F, Gabrielle PH, Teo KYC, Battaglia Parodi M, Iacono P, Fraser-Bell S, Cornish EE, Nassisi M, Viola F, Agarwal A, Samanta A, Chhablani J, Staurenghi G, Invernizzi A. Update on Retinal Vein Occlusion. Asia Pac J Ophthalmol (Phila) 2023; 12:196-210. [PMID: 36912792 DOI: 10.1097/apo.0000000000000598] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 09/08/2022] [Accepted: 12/11/2022] [Indexed: 03/14/2023] Open
Abstract
Retinal vein occlusion represents the second leading cause of retinal vascular disorders, with a uniform sex distribution worldwide. A thorough evaluation of cardiovascular risk factors is required to correct possible comorbidities. The diagnosis and management of retinal vein occlusion have changed tremendously in the last 30 years, but the assessment of retinal ischemia at baseline and during follow-up examinations remains crucial. New imaging techniques have shed light on the pathophysiology of the disease and laser treatment, once the only therapeutic option, is now only one of the possible approaches with antivascular endothelial growth factors and steroid injections being preferred in most cases. Nowadays long-term outcomes are better than those achievable 20 years ago and yet, many new therapeutic options are under development, including new intravitreal drugs and gene therapy. Despite this, some cases still develop sight-threatening complications deserving a more aggressive (sometimes surgical) approach. The purpose of this comprehensive review is to reappraise some old but still valid concepts and to integrate them with new research and clinical data. The work will provide an overview of the disease's pathophysiology, natural history, and clinical features along with a detailed discussion on the advantages of multimodal imaging and of the different treatment strategies with the aim of providing retina specialists with the most updated knowledge in the field.
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Affiliation(s)
- Francesco Romano
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Francesca Lamanna
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | | | - Kelvin Y C Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Maurizio Battaglia Parodi
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pierluigi Iacono
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Samantha Fraser-Bell
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Elisa E Cornish
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Marco Nassisi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Ophthalmological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Viola
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Ophthalmological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Aniruddha Agarwal
- Eye Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, US
- Department of Ophthalmology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Anindya Samanta
- Department of Ophthalmology and Visual Sciences, Texas Tech University Health Sciences Center, Lubbock, TX, US
| | - Jay Chhablani
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
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24
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Romano F, Cozzi M, Monteduro D, Oldani M, Boon CJF, Staurenghi G, Salvetti AP. NATURAL COURSE AND CLASSIFICATION OF EXTENSIVE MACULAR ATROPHY WITH PSEUDODRUSEN-LIKE APPEARANCE. Retina 2023; 43:402-411. [PMID: 36727827 DOI: 10.1097/iae.0000000000003683] [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] [Indexed: 02/03/2023]
Abstract
PURPOSE To describe the imaging characteristics and topographic expansion of retinal pigment epithelium (RPE) and outer retinal atrophy in extensive macular atrophy with pseudodrusen-like appearance. METHODS Three-year, prospective, observational study. Nine patients with extensive macular atrophy with pseudodrusen-like appearance (17 eyes; 6 women) with no other ocular conditions were annually examined; one eye was excluded because of macular neovascularization. Best-corrected visual acuity measurement, fundus photographs, blue-light autofluorescence, and optical coherence tomography were performed at each visit. Formation of atrophy was analyzed on optical coherence tomography at foveal and extrafoveal areas following the Classification of Atrophy Meeting recommendations. Spatial enlargement throughout four sectors was assessed on blue-light autofluorescence after placing an Early Treatment for Diabetic Retinopathy Study grid centered on the foveola. RESULTS Mean age was 53.0 ± 2.1 years at baseline with a follow-up of 36.6 ± 0.7 months. Thinning of the outer nuclear layer and disruption of the ellipsoid zone initially appeared above areas of RPE-Bruch membrane separation and preceded RPE atrophy. Subfoveal fibrosis was seen in 65% of the eyes. Superior sector involvement was found in all patients at baseline and was significantly larger than the other sectors at any time point ( P < 0.001). Best-corrected visual acuity declined from 68.0 ± 15.7 letters to 44.8 ± 14.9 letters during the follow-up and was significantly associated with subfoveal atrophy ( P < 0.001) and fibrosis ( P = 0.02). CONCLUSION Our findings suggest that primary alterations in patients with extensive macular atrophy with pseudodrusen-like appearance are present at the outer segment-RPE interface, with the superior Early Treatment for Diabetic Retinopathy Study sector being the most vulnerable, which progresses to extensive atrophy of the RPE and outer retinal layers. Accordingly, we propose a three-stage disease classification.
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Affiliation(s)
- Francesco Romano
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Mariano Cozzi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Davide Monteduro
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Marta Oldani
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Camiel J F Boon
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, the Netherlands; and
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Anna Paola Salvetti
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
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25
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Zicarelli F, Agarwal A, Rizzi C, Oldani M, Staurenghi G, Invernizzi A. Correlation Between Retinal Vessel Diameters and Uveitis Activity. Invest Ophthalmol Vis Sci 2023; 64:13. [PMID: 36877516 PMCID: PMC10007899 DOI: 10.1167/iovs.64.3.13] [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: 03/07/2023] Open
Abstract
Purpose To assess retinal vein and artery diameters during active and inactive intraocular inflammation in eyes with uveitis. Methods Color fundus photographs and clinical data of eyes with uveitis collected during two visits (active disease [i.e., T0] and inactive stage [i.e., T1]) were reviewed. The images were semi-automatically analyzed to obtain the central retina vein equivalent (CRVE) and central retina artery equivalent (CRAE). Changes of CRVE and CRAE from T0 to T1 were calculated, and their possible correlation with clinical data, including age, gender, ethnicity, uveitis etiology, and visual acuity, were investigated. Results Eighty-nine eyes were enrolled in the study. Both CRVE and CRAE reduced from T0 to T1 (P < 0.0001 and P = 0.01, respectively), with active inflammation being able to influence the CRVE and CRAE (P < 0.0001 and P = 0.0004, respectively) after accounting for all other variables. The degree of venular (∆V) and arteriolar (∆A) dilation was influenced only by time (P = 0.03 and P = 0.04, respectively). Best-corrected visual acuity was influenced by time and ethnicity (P = 0.003 and P = 0.0006). Conclusions CRVE and CRAE are increased in eyes with active intraocular inflammation regardless of the type of uveitis, and they decrease when the inflammation wears off.
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Affiliation(s)
- Federico Zicarelli
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, United States
| | - Chiara Rizzi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Marta Oldani
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy.,The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia
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26
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Oakley JD, Verdooner S, Russakoff DB, Brucker AJ, Seaman J, Sahni J, BIANCHI CD, Cozzi M, Rogers J, Staurenghi G. QUANTITATIVE ASSESSMENT OF AUTOMATED OPTICAL COHERENCE TOMOGRAPHY IMAGE ANALYSIS USING A HOME-BASED DEVICE FOR SELF-MONITORING NEOVASCULAR AGE-RELATED MACULAR DEGENERATION. Retina 2023; 43:433-443. [PMID: 36705991 PMCID: PMC9935585 DOI: 10.1097/iae.0000000000003677] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Indexed: 01/28/2023]
Abstract
PURPOSE To evaluate a prototype home optical coherence tomography device and automated analysis software for detection and quantification of retinal fluid relative to manual human grading in a cohort of patients with neovascular age-related macular degeneration. METHODS Patients undergoing anti-vascular endothelial growth factor therapy were enrolled in this prospective observational study. In 136 optical coherence tomography scans from 70 patients using the prototype home optical coherence tomography device, fluid segmentation was performed using automated analysis software and compared with manual gradings across all retinal fluid types using receiver-operating characteristic curves. The Dice similarity coefficient was used to assess the accuracy of segmentations, and correlation of fluid areas quantified end point agreement. RESULTS Fluid detection per B-scan had area under the receiver-operating characteristic curves of 0.95, 0.97, and 0.98 for intraretinal fluid, subretinal fluid, and subretinal pigment epithelium fluid, respectively. On a per volume basis, the values for intraretinal fluid, subretinal fluid, and subretinal pigment epithelium fluid were 0.997, 0.998, and 0.998, respectively. The average Dice similarity coefficient values across all B-scans were 0.64, 0.73, and 0.74, and the coefficients of determination were 0.81, 0.93, and 0.97 for intraretinal fluid, subretinal fluid, and subretinal pigment epithelium fluid, respectively. CONCLUSION Home optical coherence tomography device images assessed using the automated analysis software showed excellent agreement to manual human grading.
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Affiliation(s)
| | - Steven Verdooner
- OCTHealth LLC, Sacramento, California
- NeuroVision Imaging, Inc., Sacramento, California
| | | | - Alexander J. Brucker
- Perelman School of Medicine, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John Seaman
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | | | - Carlo D. BIANCHI
- Eye Clinic, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Mariano Cozzi
- Eye Clinic, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | | | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
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27
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Airaldi M, Zicarelli F, Forlani V, Casaluci M, Oldani M, Staurenghi G, Invernizzi A. CORRELATION BETWEEN INFLAMMATORY FOCI REACTIVATION AND ATROPHY GROWTH IN EYES WITH IDIOPATHIC MULTIFOCAL CHOROIDITIS. Retina 2023; 43:472-480. [PMID: 36730577 DOI: 10.1097/iae.0000000000003682] [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: 10/07/2022] [Accepted: 11/08/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To correlate the number of inflammatory reactivations in atrophic foci of multifocal choroiditis (MFC) with their growth rate over a 4-year span. METHODS Comparative case series. Optical coherence tomography scans of patients affected by MFC were reviewed to identify reactivations within or at the margin of atrophic MFC foci. The area of selected lesions was semiautomatically delineated on fundus autofluorescence images and recorded at yearly intervals for a total follow-up of 4 years. The main outcome was the difference in annual square-root transformed area growth rate between lesions that reactivated and lesions that did not. RESULTS Sixty-six foci of 30 eyes of 24 patients were included. All MFC foci enlarged over time, but the annual growth rate was more than double in lesions that reactivated compared with those that did not (mean [SD], 0.051 [0.035] vs. 0.021 [0.015] mm/year, P < 0.001), despite starting from comparable baseline areas. For each additional inflammatory reactivation, the annual growth rate increased by more than 20% (+0.009 mm/year, 95% CI [0.006, 0.012], P < 0.001). CONCLUSION Increasing number of reactivations of atrophic foci led to proportional increments in their growth rate, highlighting the need for a tight control of inflammatory relapses in patients affected by MFC.
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Affiliation(s)
- Matteo Airaldi
- Eye Clinic, Department of Biomedical and Clinical Science Luigi Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy; Department of Ophthalmology, Scientific Institute Capitanio Hospital, IRCCS Foundation, Istituto Auxologico Italiano, Milan, Italy; and The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, Australia
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Invernizzi A, Chhablani J, Viola F, Gabrielle PH, Zarranz-Ventura J, Staurenghi G. Diabetic retinopathy in the pediatric population: Pathophysiology, screening, current and future treatments. Pharmacol Res 2023; 188:106670. [PMID: 36681366 DOI: 10.1016/j.phrs.2023.106670] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023]
Abstract
Diabetic retinopathy (DR) is a sight threatening complication of diabetes mellitus (DM). The incidence of DR in the pediatric population has increased in the last two decades and it is expected to further rise in the future, following the increase in DM prevalence and obesity in youth. As early stages of the retinal disease are asymptomatic, screening programs are of extreme importance to guarantee a prompt diagnosis and avoid progression to more advanced, sight threatening stages. The management of DR comprises a wide range of actions starting from glycemic control, continuing with systemic and local medical treatments, up to para-surgical and surgical approaches to deal with the more aggressive complications. In this review we will describe the pathophysiology of DR trying to understand all the possible targets for currently available or future treatments. We will briefly consider the impact of screening techniques, screening strategies and their social and economic impact. Finally a large part of the review will be dedicated to medical and surgical treatments for DR including both currently available and under development therapies. Most of the available data in the literature on DR are focused on the adult population. The aim of our work is to provide clinicians and researchers with a comprehensive overview of the state of the art regarding DR in the pediatric population, considering the increasing numbers of this diseases in youth and the inevitable consequences that such a chronic disease could have if poorly managed in children.
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Affiliation(s)
- Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy; The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia.
| | - Jay Chhablani
- UPMC Eye Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Francesco Viola
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pierre Henry Gabrielle
- Department of Ophthalmology, University Hospital, 14 rue Paul Gaffarel, 21079 Dijon, France
| | - Javier Zarranz-Ventura
- Institut Clínic of Ophthalmology (ICOF), Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
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29
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Pellegrini M, Preziosa C, Yaghy A, Ruben M, Invernizzi A, Fung AT, Staurenghi G, Shields CL. Choroidal Lymphoma: Diagnostic Value of Combined Indocyanine Green Angiography and Optical Coherence Tomography. Ocul Immunol Inflamm 2023; 31:263-270. [PMID: 35050836 DOI: 10.1080/09273948.2022.2026407] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To compare multimodal imaging findings in patients with choroidal lymphoma (CL). METHODS Multicenter retrospective observational case series. Multimodal imaging features of patients with CL were reviewed with particular attention to the patterns of choroidal infiltration on indocyanine green angiography (ICGA) and optical coherence tomography (OCT). RESULTS Eighteen eyes of 15 patients were included in this study. Average tumor thickness on ultrasonography was 2.6 mm (range, 1.2-5.7 mm). Choroidal infiltration on ICGA was characterized by multifocal, round areas (300-500 microns diameter) of hypocyanescence in all cases, whereas OCT at the same region disclosed diffuse choroidal infiltration. By OCT, the tumor surface contour was primarily placid (22%), dome-shaped (11%), or undulating (67%). CONCLUSIONS In this analysis of eyes with CL, ICGA demonstrated multifocal sub-millimeter regions of choroidal hypocyanescence whereas OCT documented diffuse choroidal infiltration. This incongruence could be a distinctive diagnostic feature of choroidal lymphoma, assisting with differentiation from other pathological entities.
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Affiliation(s)
- Marco Pellegrini
- Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Chiara Preziosa
- Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Antonio Yaghy
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Megan Ruben
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alessandro Invernizzi
- Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy.,Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, Australia
| | - Adrian T Fung
- Westmead and Central (Save Sight Institute) Clinical Schools, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, Australia.,Department of Ophthalmology, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Giovanni Staurenghi
- Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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30
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Holz FG, Abreu-Gonzalez R, Bandello F, Duval R, O'Toole L, Pauleikhoff D, Staurenghi G, Wolf A, Lorand D, Clemens A, Gmeiner B. Does real-time artificial intelligence-based visual pathology enhancement of three-dimensional optical coherence tomography scans optimise treatment decision in patients with nAMD? Rationale and design of the RAZORBILL study. Br J Ophthalmol 2023; 107:96-101. [PMID: 34362776 PMCID: PMC9763175 DOI: 10.1136/bjophthalmol-2021-319211] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/23/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND/RATIONALE Artificial intelligence (AI)-based clinical decision support tools, being developed across multiple fields in medicine, need to be evaluated for their impact on the treatment and outcomes of patients as well as optimisation of the clinical workflow. The RAZORBILL study will investigate the impact of advanced AI segmentation algorithms on the disease activity assessment in patients with neovascular age-related macular degeneration (nAMD) by enriching three-dimensional (3D) retinal optical coherence tomography (OCT) scans with automated fluid and layer quantification measurements. METHODS RAZORBILL is an observational, multicentre, multinational, open-label study, comprising two phases: (a) clinical data collection (phase I): an observational study design, which enforces neither strict visit schedule nor mandated treatment regimen was chosen as an appropriate design to collect data in a real-world clinical setting to enable evaluation in phase II and (b) OCT enrichment analysis (phase II): de-identified 3D OCT scans will be evaluated for disease activity. Within this evaluation, investigators will review the scans once enriched with segmentation results (i.e., highlighted and quantified pathological fluid volumes) and once in its original (i.e., non-enriched) state. This review will be performed using an integrated crossover design, where investigators are used as their own controls allowing the analysis to account for differences in expertise and individual disease activity definitions. CONCLUSIONS In order to apply novel AI tools to routine clinical care, their benefit as well as operational feasibility need to be carefully investigated. RAZORBILL will inform on the value of AI-based clinical decision support tools. It will clarify if these can be implemented in clinical treatment of patients with nAMD and whether it allows for optimisation of individualised treatment in routine clinical care.
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Affiliation(s)
- Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Rodrigo Abreu-Gonzalez
- Department of Ophthalmology, University Hospital of La Candelaria, Santa Cruz de Tenerife, Spain
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, University Vita Salute Hospital San Raffaele, Milano, Italy
| | - Renaud Duval
- Department of Ophthalmology, Maisonneuve-Rosemont Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Louise O'Toole
- Department of Ophthalmology, Bon Secours Hospital Dublin, Dublin, Ireland
| | | | - Giovanni Staurenghi
- Dipartimento di Scienze Cliniche Luigi Sacco, Eye Clinic, University of Milan, Milan, Italy
| | - Armin Wolf
- Department of Ophthalmology, University of Ulm, Ulm, Germany
| | | | - Andreas Clemens
- Novartis Pharma AG, Basel, Switzerland,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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31
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Zicarelli F, Ometto G, Montesano G, Motta S, De Simone L, Cimino L, Staurenghi G, Agarwal A, Pichi F, Invernizzi A. Objective Quantification of Posterior Segment Inflammation: Measuring Vitreous Cells and Haze Using Optical Coherence Tomography. Am J Ophthalmol 2023; 245:134-144. [PMID: 36084686 DOI: 10.1016/j.ajo.2022.08.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/07/2022] [Accepted: 08/20/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To objectively grade posterior segment inflammation by measuring vitreous cells and haze on optical coherence tomography (OCT) scans and to compare OCT-based results with clinical grading. DESIGN Evaluation of a diagnostic test. METHODS OCT scans of patients with uveitis were collected at 3 timepoints: with active (T0), clinically improving (T1), and resolved (T2) inflammation. At each visit, visual acuity and clinical grading of the vitreous haze (National Eye Institute [NEI] scale) were assessed. The density of vitreous cells was calculated on each OCT scan manually and automatically through a bespoke algorithm. Vitreous haze was indirectly measured on OCT scans by calculating the vitreous/retinal pigmented epithelium (VIT/RPE)-relative intensity manually and automatically. The variation of OCT-derived measurements over time was assessed. OCT-derived measurements were compared with clinical grading. RESULTS A total of 222 scans from 74 eyes were analyzed. Both vitreous cell density and VIT/RPE-relative intensity significantly decreased over time. Cell density correlated with the clinical grading with a significant increase at each grade of the NEI scale. By contrast, the VIT/RPE-relative intensity was positively correlated with the clinical grade overall but there was no significant difference when comparing contiguous grades of the NEI scale. Infectious uveitis had a higher cell density. The intraclass correlation coefficient between manual and automatic assessment was 0.83 for cell density and 0.423 for the VIT/RPE-relative intensity. CONCLUSIONS Posterior segment inflammation could be objectively graded through OCT scans. Vitreous cell density was assessed manually and automatically with good agreement and correlated better with NEI clinical grading compared with VIT/RPE-relative intensity.
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Affiliation(s)
- Federico Zicarelli
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Giovanni Ometto
- 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
| | - 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
| | - Samuele Motta
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Luca De Simone
- Ocular Immunology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Luca Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy; Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Aniruddha Agarwal
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy; The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia.
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Staurenghi G, Cozzi M, Sadda S, Hill L, Gune S. Characteristics that Correlate with Macular Atrophy in Ranibizumab-Treated Patients with Neovascular Age-Related Macular Degeneration. Ophthalmol Retina 2022; 7:300-306. [PMID: 36372347 DOI: 10.1016/j.oret.2022.11.002] [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: 11/18/2021] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To use multimodal assessment (fluorescein angiography [FA], color fundus photography [CFP], and spectral-domain-OCT [SD-OCT]) to reevaluate macular atrophy (MA) and macular neovascularization (MNV) type in the HARBOR trial according to the consensus on neovascular age-related macular degeneration (nAMD) Nomenclature criteria; and to determine if there are any associations between baseline demographic factors, ocular characteristics, and treatment for nAMD and the development of MA by month 24. DESIGN Post hoc analysis of the phase III, randomized, multicenter, double-masked, controlled HARBOR trial (NCT00891735). SUBJECTS Nine-hundred and twenty-two study eyes and 919 fellow eyes from the HARBOR trial. METHODS This post hoc analysis included patients with multimodal assessments on FA, CFP, and SD-OCT at baseline. A risk analysis for the development of MA was performed by multimodal assessment and SD-OCT on study eyes without MA at baseline that had completed SD-OCT assessments for MA at month 24. MAIN OUTCOME MEASURES Development of MA in study eyes at month 24 and a risk analysis for developing MA at month 24 in study eyes that had no MA at baseline, as assessed by multimodal assessment. RESULTS Of 1097 patients in the HARBOR trial with nAMD and active subfoveal MNV, a total of 922 study eyes and 919 fellow eyes were included in the multimodal analysis of MNV. Macular atrophy assessment was performed on SD-OCT. Of these, 593 had no baseline MA and were included in the risk analysis for developing MA. In eyes with no detectable MA at baseline, a larger proportion of eyes with any MNV type 3 (including mixed type) at baseline developed new MA at month 24 (49.2%) than eyes with MNV type 1 (26.5%), type 2 (29.1%), or mixed type 1 and 2 (34.6%). Macular neovascularization type 3 and fellow eye MA were identified as risk factors for new MA development at month 24. CONCLUSIONS Macular neovascularization type 3 was a strong risk factor for new MA development at month 24, with fellow eye MA also being identified as a predictor. No other variables, including ranibizumab treatment, were identified as risk factors for new MA development. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Giovanni Staurenghi
- Eye Clinic, Luigi Sacco Hospital, Department of Biopmedical and Clinical Science, University of Milan, Milan, Italy.
| | - Mariano Cozzi
- Eye Clinic, Luigi Sacco Hospital, Department of Biopmedical and Clinical Science, University of Milan, Milan, Italy
| | - SriniVas Sadda
- Doheny Eye Institute, University of California Los Angeles, Los Angeles, California
| | - Lauren Hill
- Genentech, Inc., South San Francisco, California
| | - Shamika Gune
- Genentech, Inc., South San Francisco, California
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Preziosa C, Kashyap BP, Staurenghi G, Pellegrini M. CAVITARY CHOROIDAL NEVUS: A CASE REPORT. Retin Cases Brief Rep 2022; 16:674-677. [PMID: 33229913 DOI: 10.1097/icb.0000000000001096] [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] [Indexed: 06/11/2023]
Abstract
PURPOSE To describe a case of choroidal nevus with intralesional cavitations detected with enhanced depth imaging optical coherence tomography and to show its changes during an 8-year follow-up. METHODS A case report. RESULTS A 55-year-old male patient was found to have a pigmented lesion at the posterior pole of his right eye, just temporal to the fovea. A complete multiimaging examination was obtained and showed a lesion of about 4 mm of diameter with a small amount of subretinal fluid and chronic changes in the retina overlying the lesion. Based on clinical examination, a diagnosis of choroidal nevus was made, but interestingly the enhanced depth imaging optical coherence tomography revealed the presence of intralesional cavitations. Close follow-up with no intervention was planned, and over 8 years of observation, the lesion remained stable in size, with a gradual increase of the central necrosis. CONCLUSION Benign pigmented choroidal lesions can show internal cavitations likely secondary to internal necrosis. This feature does not represent a sign of malignancy of the lesion. Enhanced depth imaging optical coherence tomography is a feasible imaging tool for the visualization of the internal cavitations and to follow their evolution over time.
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Affiliation(s)
- Chiara Preziosa
- Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, Eye Clinic, University of Milan, Milan, Italy ; and
| | | | - Giovanni Staurenghi
- Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, Eye Clinic, University of Milan, Milan, Italy ; and
| | - Marco Pellegrini
- Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, Eye Clinic, University of Milan, Milan, Italy ; and
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Sadda SR, Holz FG, Staurenghi G, Invernizzi A, Arnold J, Tadayoni R. The Importance of Imaging to Identify Early Signs of Intraocular Inflammation Expert Opinion for Brolucizumab. Ophthalmologica 2022; 245:588-591. [PMID: 36130526 DOI: 10.1159/000526703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/18/2022] [Indexed: 02/02/2023]
Affiliation(s)
- SriniVas R Sadda
- Doheny Eye Institute, University of California, Los Angeles, California, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Giovanni Staurenghi
- Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Alessandro Invernizzi
- Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy.,Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Ramin Tadayoni
- Department of Ophthalmology, Hôpital Lariboisière, AP-HP, Hôpital Fondation Adolphe de Rothschild, Université de Paris, Paris, France
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Mathis T, Holz FG, Sivaprasad S, Yoon YH, Eter N, Chen LJ, Koh A, Cunha de Souza E, Staurenghi G. Characterisation of macular neovascularisation subtypes in age-related macular degeneration to optimise treatment outcomes. Eye (Lond) 2022:10.1038/s41433-022-02231-y. [DOI: 10.1038/s41433-022-02231-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/24/2022] [Accepted: 08/30/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractThe aim of this review is to identify the common characteristics and prognoses of different subtypes of neovascular age-related macular degeneration (nAMD). We also propose recommendations on how to tailor treatments to the subtype of neovessels to optimise patient outcomes. The authors, selected members of the Vision Academy, met to discuss treatment outcomes in nAMD according to macular neovascularisation (MNV) subtypes, using evidence from a literature search conducted on the PubMed database (cut-off date: March 2019). This review article summarises the recommendations of the Vision Academy on how the characterisation of MNV subtypes can optimise treatment outcomes in nAMD. The identification of MNV subtypes has been facilitated by the advent of multimodal imaging. Findings from fluorescein angiography, indocyanine green angiography and spectral-domain optical coherence tomography collectively help refine and standardise the determination of the MNV subtype. To date, three subtypes have been described in the literature and have specific characteristics, as identified by imaging. Type 1 MNV is associated with better long-term outcomes but usually requires more intense anti-vascular endothelial growth factor dosing. Type 2 MNV typically responds quickly to treatment but is more prone to the development of fibrotic scars, which may be associated with poorer outcomes. Type 3 MNV tends to be highly sensitive to anti-vascular endothelial growth factor treatment but may be associated with a higher incidence of outer retinal atrophy, compared with other subtypes. Accurately assessing the MNV subtype provides information on prognosis and helps to optimise the management of patients with nAMD.
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D'Addio F, Pastore I, Loretelli C, Valderrama-Vasquez A, Usuelli V, Assi E, Mameli C, Macedoni M, Maestroni A, Rossi A, Lunati ME, Morpurgo PS, Gandolfi A, Montefusco L, Bolla AM, Ben Nasr M, Di Maggio S, Melzi L, Staurenghi G, Secchi A, Bianchi Marzoli S, Zuccotti G, Fiorina P. Abnormalities of the oculomotor function in type 1 diabetes and diabetic neuropathy. Acta Diabetol 2022; 59:1157-1167. [PMID: 35729357 PMCID: PMC9329167 DOI: 10.1007/s00592-022-01911-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/23/2022] [Indexed: 11/21/2022]
Abstract
AIMS Abnormalities in the oculomotor system may represent an early sign of diabetic neuropathy and are currently poorly studied. We designed an eye-tracking-based test to evaluate oculomotor function in patients with type 1 diabetes. METHODS We used the SRLab-Tobii TX300 Eye tracker®, an eye-tracking device, coupled with software that we developed to test abnormalities in the oculomotor system. The software consists of a series of eye-tracking tasks divided into 4 classes of parameters (Resistance, Wideness, Pursuit and Velocity) to evaluate both smooth and saccadic movement in different directions. We analyzed the oculomotor system in 34 healthy volunteers and in 34 patients with long-standing type 1 diabetes. RESULTS Among the 474 parameters analyzed with the eye-tracking-based system, 11% were significantly altered in patients with type 1 diabetes (p < 0.05), with a higher proportion of abnormalities observed in the Wideness (24%) and Resistance (10%) parameters. Patients with type 1 diabetes without diabetic neuropathy showed more frequently anomalous measurements in the Resistance class (p = 0.02). The classes of Velocity and Pursuit were less frequently altered in patients with type 1 diabetes as compared to healthy subjects, with anomalous measurements mainly observed in patients with diabetic neuropathy. CONCLUSIONS Abnormalities in oculomotor system function can be detected in patients with type 1 diabetes using a novel eye-tracking-based test. A larger cohort study may further determine thresholds of normality and validate whether eye-tracking can be used to non-invasively characterize early signs of diabetic neuropathy. TRIAL NCT04608890.
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Affiliation(s)
- Francesca D'Addio
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, DIBIC, Università di Milano, Milan, Italy
| | - Ida Pastore
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Cristian Loretelli
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, DIBIC, Università di Milano, Milan, Italy
| | - Alessandro Valderrama-Vasquez
- Nephrology Division, Boston Children's Hospital and Transplantation Research Center, Brigham and Women's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA
| | - Vera Usuelli
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, DIBIC, Università di Milano, Milan, Italy
| | - Emma Assi
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, DIBIC, Università di Milano, Milan, Italy
| | - Chiara Mameli
- Department of Pediatrics, Buzzi Children's Hospital, Milan, Italy
| | | | - Anna Maestroni
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, DIBIC, Università di Milano, Milan, Italy
| | - Antonio Rossi
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | | | | | - Laura Montefusco
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | - Moufida Ben Nasr
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, DIBIC, Università di Milano, Milan, Italy
- Nephrology Division, Boston Children's Hospital and Transplantation Research Center, Brigham and Women's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA
| | - Stefania Di Maggio
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, DIBIC, Università di Milano, Milan, Italy
| | - Lisa Melzi
- Neuro-Ophthalmology Center and Ocular Electrophysiology Laboratory, IRCCS Istituto Auxologico Italiano, Capitanio Hospital, Milan, Italy
| | - Giovanni Staurenghi
- Clinica Oculistica, ASST Fatebenefratelli-Sacco, Università di Milano, Milan, Italy
| | - Antonio Secchi
- Transplant Medicine, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Stefania Bianchi Marzoli
- Neuro-Ophthalmology Center and Ocular Electrophysiology Laboratory, IRCCS Istituto Auxologico Italiano, Capitanio Hospital, Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Clinical Research Center Romeo Ed Enrica Invernizzi, DIBIC, Università di Milano and Department of Pediatrics, Buzzi Children's Hospital, Milan, Italy
| | - Paolo Fiorina
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, DIBIC, Università di Milano, Milan, Italy.
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy.
- Nephrology Division, Boston Children's Hospital and Transplantation Research Center, Brigham and Women's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA.
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Parrulli S, Cozzi M, Airaldi M, Romano F, Viola F, Sarzi‐Puttini P, Staurenghi G, Invernizzi A. Quantitative autofluorescence findings in patients undergoing hydroxychloroquine treatment. Clin Exp Ophthalmol 2022; 50:500-509. [PMID: 35503294 PMCID: PMC9545387 DOI: 10.1111/ceo.14090] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 11/28/2022]
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Salvatore Parrulli
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco”, Sacco Hospital University of Milan Milan Italy
| | - Mariano Cozzi
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco”, Sacco Hospital University of Milan Milan Italy
| | - Matteo Airaldi
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco”, Sacco Hospital University of Milan Milan Italy
| | - Francesco Romano
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco”, Sacco Hospital University of Milan Milan Italy
| | - Francesco Viola
- Ophthalmological Unit Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milan Italy
- Department of Clinical Sciences and Community Health University of Milan Milan Italy
| | | | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco”, Sacco Hospital University of Milan Milan Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco”, Sacco Hospital University of Milan Milan Italy
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology Sydney Medical School Sydney New South Wales Australia
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Yaghy A, Lee AY, Keane PA, Keenan TDL, Mendonca LSM, Lee CS, Cairns AM, Carroll J, Chen H, Clark J, Cukras CA, de Sisternes L, Domalpally A, Durbin MK, Goetz KE, Grassmann F, Haines JL, Honda N, Hu ZJ, Mody C, Orozco LD, Owsley C, Poor S, Reisman C, Ribeiro R, Sadda SR, Sivaprasad S, Staurenghi G, Ting DS, Tumminia SJ, Zalunardo L, Waheed NK. Artificial intelligence-based strategies to identify patient populations and advance analysis in age-related macular degeneration clinical trials. Exp Eye Res 2022; 220:109092. [PMID: 35525297 PMCID: PMC9405680 DOI: 10.1016/j.exer.2022.109092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/18/2022] [Accepted: 04/20/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Antonio Yaghy
- New England Eye Center, Tufts University Medical Center, Boston, MA, USA
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA; Karalis Johnson Retina Center, Seattle, WA, USA
| | - Pearse A Keane
- Moorfields Eye Hospital & UCL Institute of Ophthalmology, London, UK
| | - Tiarnan D L Keenan
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA; Karalis Johnson Retina Center, Seattle, WA, USA
| | | | - Joseph Carroll
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, 925 N 87th Street, Milwaukee, WI, 53226, USA
| | - Hao Chen
- Genentech, South San Francisco, CA, USA
| | | | - Catherine A Cukras
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Amitha Domalpally
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI, USA
| | | | - Kerry E Goetz
- Office of the Director, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Jonathan L Haines
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Cleveland Institute of Computational Biology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Zhihong Jewel Hu
- Doheny Eye Institute, University of California, Los Angeles, CA, USA
| | | | - Luz D Orozco
- Department of Bioinformatics, Genentech, South San Francisco, CA, 94080, USA
| | - Cynthia Owsley
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephen Poor
- Department of Ophthalmology, Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | | | | | - Srinivas R Sadda
- Doheny Eye Institute, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Giovanni Staurenghi
- Department of Biomedical and Clinical Sciences Luigi Sacco, Luigi Sacco Hospital, University of Milan, Italy
| | - Daniel Sw Ting
- Singapore Eye Research Institute, Singapore National Eye Center, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Santa J Tumminia
- Office of the Director, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Nadia K Waheed
- New England Eye Center, Tufts University Medical Center, Boston, MA, USA.
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Zicarelli F, Staurenghi G, Invernizzi A. Anterior Segment Optical Coherence Tomography (AS-OCT) Visualization of Anterior Vitritis. Ocul Immunol Inflamm 2022:1-2. [PMID: 35708306 DOI: 10.1080/09273948.2022.2079535] [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: 10/18/2022]
Abstract
The clinical grading of vitreous haze presents some limitations such as subjectivity and intra-grader variability. On the other hand the proposed OCT-based methods only explore the posterior part of the vitreous. Here we describe the inflammatory changes affecting the anterior vitreous imaged by Anterior Segment Optical Coherence, Tomography (AS-OCT) from patients affected by uveitis. The AS-OCT (Anterion, Heidelberg Engineering, Heidelberg, Germany) detected vitreous sheets, vitreous lacunae, and formations resembling inflammatory cells, providing an objective characterization of the inflammatory changes in the anterior vitreous as well as their relationships with the other ocular structures.
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Affiliation(s)
- Federico Zicarelli
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy.,The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, Australia
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy.,The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, Australia
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy.,The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, Australia
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Pellegrini M, Staurenghi G, Preziosa C. Clinical Applications of Optical Coherence Tomography Angiography in Ocular Oncology: Pearls and Pitfalls. Ocul Oncol Pathol 2022; 8:79-87. [PMID: 35959157 PMCID: PMC9218615 DOI: 10.1159/000520951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 08/03/2021] [Accepted: 11/15/2021] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Optical coherence tomography angiography (OCTA) is a valuable imaging tool for the diagnosis of several retinal and choroidal diseases. Its role in ocular oncology is clinically promising but still controversial. In this review, we report the main applications and limits of the use of OCTA for the study of intraocular tumors. SUMMARY OCTA allows a rapid, safe, low-cost, and high-resolution visualization of the retinal and choroidal vasculature. Attempts have been made to use this technology in ocular oncology to differentiate benign and malignant lesions and to assist physicians in the evaluation and monitoring of post-treatment complications. Main limitations include failure in correct segmentation due to the tumor inner profile or thickness, poor penetration of the laser into the lesion, masking effect from overlying fluid, media opacities and poor fixation. KEY MESSAGES The main applications of OCTA in ocular oncology consist of the documentation of tumor-associated choroidal neovascularizations and the study of vascular changes following tumor treatments. In particular, the diffusion of wide-field protocols makes OCTA suitable for the diagnosis and follow-up of radiation chorio-retinopathy, allowing a detailed visualization of both macular and peripheral ischemic changes. Optimistically, future innovations in OCTA technology may offer new perspectives in the diagnosis and follow-up of intraocular tumors.
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Affiliation(s)
- Marco Pellegrini
- Department of Biomedical and Clinical Science “Luigi Sacco,” Eye Clinic, Luigi Sacco Hospital, University of Milan, Milan, Italy
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41
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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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Romano F, Cozzi M, Staurenghi G, Salvetti AP. Multimodal retinal imaging of m.3243A>G associated retinopathy. Am J Ophthalmol Case Rep 2022; 26:101411. [PMID: 35282600 PMCID: PMC8904216 DOI: 10.1016/j.ajoc.2022.101411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 01/29/2022] [Accepted: 02/07/2022] [Indexed: 11/01/2022] Open
Abstract
Retro-mode illumination imaging can provide good visualization of chorio-retinal atrophy and of the retinal pigment epithelial alterations occurring in m.3243A > G associated retinopathy.
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Airaldi M, Corvi F, Cozzi M, Nittala MG, Staurenghi G, Sadda SR. Differences in long-term progression of atrophy between neovascular and non-neovascular age-related macular degeneration. Ophthalmol Retina 2022; 6:914-921. [PMID: 35460930 DOI: 10.1016/j.oret.2022.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/24/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare enlargement rates over 5 years of follow-up in geographic atrophy (GA) versus macular atrophy (MA) associated with macular neovascularization (MNV). DESIGN Retrospective, longitudinal comparative case series. PARTICIPANTS Consecutive series of age-related macular degeneration (AMD) patients with GA (dry) or MA with MNV. METHODS Atrophic regions on serial registered fundus autofluorescence (FAF) images were semiautomatically delineated and area measurements were recorded every 6±3 months for the first 2 years of follow-up and at yearly intervals up to 5 years. MAIN OUTCOME MEASURES Annual raw and square root transformed atrophy growth rates. RESULTS 117 eyes of 95 patients were included (61 in the GA and 56 in the MA cohort); 100% and 38.5% of eyes completed 2 and 5 years of follow-up, respectively. Mean baseline lesion size was similar between the two groups (raw: 1.74 vs. 1.53 mmˆ2, p = 0.56; sqrt transformed: 1.17 vs. 1.02 mm, p = 0.26). Overall enlargement rates were greater for the GA cohort (raw: 1.72 vs. 1.32 mmˆ2/year, p = 0.002; sqrt transformed: 0.41 vs. 0.33 mm/year; p = 0.03), as well as the area of atrophy growth at 5 years (raw: +8.06 vs. +4.55 mmˆ2, p = 0.001; sqrt transformed: +1.93 vs. +1.38 mm, p = 0.02). Estimated sqrt transformed area was also significantly greater for the GA cohort at 2 years (1.84 vs. 1.67 mm, p = 0.01). CONCLUSIONS Presence of MNV was associated with a slower rate of expansion resulting in overall smaller areas of atrophy over time. These findings support the hypothesis that MNV may protect against the progression of atrophy.
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Affiliation(s)
- Matteo Airaldi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Sacco Hospital, University of Milan, Milan, Italy
| | - Federico Corvi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Sacco Hospital, University of Milan, Milan, Italy; Doheny Eye Institute, University of California at Los Angeles, Los Angeles, California, USA; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Mariano Cozzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Sacco Hospital, University of Milan, Milan, Italy
| | | | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Sacco Hospital, University of Milan, Milan, Italy
| | - SriniVas R Sadda
- Doheny Eye Institute, University of California at Los Angeles, Los Angeles, California, USA; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States.
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Abstract
PURPOSE To evaluate the efficacy and safety of double-fluence photodynamic therapy for the treatment of circumscribed choroidal hemangioma. METHODS Retrospective observational study including patients affected by circumscribed choroidal hemangioma and treated with double-fluence photodynamic therapy. The photodynamic therapy was performed with verteporfin infusion intravenously (dose of 6 mg/m2 body surface area over 10 minutes), followed by the application of two consecutive spots of 50 J/cm2 light at 689 nm for 83 seconds. RESULTS Twenty-three eyes of 23 patients were included. The mean best-corrected visual acuity increased from 20/45 to 20/28, the mean tumor thickness decreased from 2,758 ± 530 µm to 722 ± 314 µm (P < 0.05), and the mean central retinal thickness decreased from 404 ± 209 µm to 188 ± 56 µm (P < 0.05) in 12 months, respectively. A total reabsorption of macular subretinal fluid, cystoid macular edema, and SRF associated with the tumor was obtained within 6 months in all cases, with persistence of tumor-associated intraretinal fluid up to 12 months only in two patients. No cases of side effects or need for retreatment were reported during the follow-up (average time of 25 months). CONCLUSION Double-fluence photodynamic therapy is a safe and effective treatment for circumscribed choroidal hemangiomas and should be considered as the first line of treatment for these lesions.
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Affiliation(s)
- Marco Pellegrini
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy; and
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy; and
| | - Manuela Mambretti
- Department of Ophthalmology, Oftalmico Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Chiara Preziosa
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy; and
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Freund KB, Staurenghi G, Jung JJ, Zweifel SA, Cozzi M, Hill L, Blotner S, Tsuboi M, Gune S. Macular neovascularization lesion type and vision outcomes in neovascular age-related macular degeneration: post hoc analysis of HARBOR. Graefes Arch Clin Exp Ophthalmol 2022; 260:2437-2447. [PMID: 35239009 PMCID: PMC8891431 DOI: 10.1007/s00417-022-05586-w] [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: 09/23/2021] [Revised: 01/20/2022] [Accepted: 02/03/2022] [Indexed: 11/27/2022] Open
Abstract
Purpose To characterize relationships between Consensus on Neovascular Age-Related Macular Degeneration Nomenclature (CONAN) Study Group classifications of macular neovascularization (MNV) and visual responses to ranibizumab in patients with neovascular age-related macular degeneration (nAMD). Methods This was a post hoc analysis of the phase 3 HARBOR trial of ranibizumab in nAMD. Analyses included ranibizumab-treated eyes with baseline multimodal imaging data; baseline MNV; subretinal and/or intraretinal fluid at screening, baseline, or week 1; and spectral-domain optical coherence tomography images through month 24 (n = 700). Mean best-corrected visual acuity (BCVA) over time and mean BCVA change at months 12 and 24 were compared between eyes with type 1, type 2/mixed type 1 and 2 (type 2/M), and any type 3 MNV at baseline. Results At baseline, 263 (37.6%), 287 (41.0%), and 150 (21.4%) eyes had type 1, type 2/M, and any type 3 lesions, respectively. Type 1 eyes had the best mean BCVA at baseline (59.0 [95% CI: 57.7–60.3] letters) and month 24 (67.7 [65.8–69.6] letters), whereas type 2/M eyes had the worst (50.0 [48.6–51.4] letters and 60.8 [58.7–62.9] letters, respectively). Mean BCVA gains at month 24 were most pronounced for type 2/M eyes (10.8 [8.9–12.7] letters) and similar for type 1 (8.7 [6.9–10.5] letters) and any type 3 eyes (8.3 [6.3–10.3] letters). Conclusion Differences in BCVA outcomes between CONAN lesion type subgroups support the use of an anatomic classification system to characterize MNV and prognosticate visual responses to anti-vascular endothelial growth factor therapy for nAMD. Trial registration ClinicalTrials.gov identifier: NCT00891735. Date of registration: April 29, 2009.
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Affiliation(s)
- K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA. .,Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA.
| | - Giovanni Staurenghi
- Department of Biomedical and Clinical Science Luigi Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Jesse J Jung
- East Bay Retina Consultants, Inc., Oakland, CA, USA.,Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Sandrine A Zweifel
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Mariano Cozzi
- Department of Biomedical and Clinical Science Luigi Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Lauren Hill
- Genentech, Inc., South San Francisco, CA, USA
| | | | - Min Tsuboi
- Genentech, Inc., South San Francisco, CA, USA
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Nittala MG, Metlapally R, Ip M, Chakravarthy U, Holz FG, Staurenghi G, Waheed N, Velaga SB, Lindenberg S, Karamat A, Koester J, Ribeiro R, Sadda S. Association of Pegcetacoplan With Progression of Incomplete Retinal Pigment Epithelium and Outer Retinal Atrophy in Age-Related Macular Degeneration: A Post Hoc Analysis of the FILLY Randomized Clinical Trial. JAMA Ophthalmol 2022; 140:243-249. [PMID: 35113137 PMCID: PMC8814977 DOI: 10.1001/jamaophthalmol.2021.6067] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
IMPORTANCE Change in areas of incomplete retinal pigment epithelium (RPE) and outer retinal atrophy (iRORA) within eyes with geographic atrophy (GA) might reflect similar changes among eyes with drusen but no GA. OBJECTIVE To evaluate the potential association of pegcetacoplan with progression of iRORA in eyes with GA secondary to AMD. DESIGN, SETTING, AND PARTICIPANTS This post hoc analysis of the phase 2 multicenter, randomized, single-masked, sham-controlled FILLY trial of intravitreal pegcetacoplan for 12 months took place from February 2 to July 7, 2020. Participants comprised 167 patients with GA secondary to AMD who received pegcetacoplan monthly (n = 41) or every other month (n = 56) or a sham injection (n = 70) in the FILLY trial, completed the month 12 study visit, and did not develop exudative AMD. INTERVENTIONS Intravitreal pegcetacoplan, 15 mg, or sham injection, monthly or every other month for 12 months. MAIN OUTCOMES AND MEASURES Masked readers analyzed spectral-domain optical coherence tomography scans in regions beyond a perimeter of 500 μm from the GA border according to the Classification of Atrophy Meetings criteria. Primary outcome measures were progression from iRORA to complete RPE and outer retina atrophy (cRORA) from baseline to 6 and 12 months. RESULTS Among the 167 patients in the study, at baseline, iRORA was present in 45.0% of study eyes (18 of 40) in the pegcetacoplan monthly group, 61.8% of study eyes (34 of 55) in the pegcetacoplan every other month group, and 50.7% of study eyes (34 of 67) in the sham group. At 12 months, progression from iRORA to cRORA occurred in 50.0% of study eyes (9 of 18) in the pegcetacoplan monthly group (P = .02 vs sham), 60.6% of study eyes (20 of 33) in the pegcetacoplan every other month group (P = .06 vs sham), and 81.8% of study eyes (27 of 33) in the sham group. Compared with sham treatment, the relative risk of progression at 12 months from iRORA to cRORA was 0.61 (95% CI, 0.37-1.00) for eyes in the pegcetacoplan monthly group and 0.74 (95% CI, 0.54-1.02) for eyes in the pegcetacoplan every other month group. CONCLUSIONS AND RELEVANCE Eyes receiving intravitreal pegcetacoplan had lower rates of progression from iRORA to cRORA compared with controls, suggesting a potential role for pegcetacoplan therapy earlier in the progression of AMD prior to the development of GA. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02503332.
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Affiliation(s)
| | - Ravi Metlapally
- Department of Clinical Development, Apellis Pharmaceuticals, Waltham, Massachusetts
| | - Michael Ip
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles
| | - Usha Chakravarthy
- Department of Ophthalmology and Vision Sciences, Queen’s University of Belfast Royal Victoria Hospital, Belfast, United Kingdom
| | - Frank G. Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Giovanni Staurenghi
- University Eye Clinical Department of Biomedical and Clinical Science, Luigi Sacco Hospital, Milan, Italy
| | - Nadia Waheed
- New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Swetha Bindu Velaga
- Doheny Image Reading Research Lab, Doheny Eye Institute, Los Angeles, California
| | - Sophiana Lindenberg
- Doheny Image Reading Research Lab, Doheny Eye Institute, Los Angeles, California
| | - Ayesha Karamat
- Doheny Image Reading Research Lab, Doheny Eye Institute, Los Angeles, California
| | | | - Ramiro Ribeiro
- Department of Clinical Development, Apellis Pharmaceuticals, Waltham, Massachusetts
| | - SriniVas Sadda
- Doheny Image Reading Research Lab, Doheny Eye Institute, Los Angeles, California,Department of Ophthalmology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles
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Invernizzi A, Staurenghi G, Cheung CMG, Teo KYC. Reply to Comment on: "Outer Retinal Layer Thickening Predicts the Onset of Exudative Neovascular Age-Related Macular Degeneration". Am J Ophthalmol 2022; 235:330-331. [PMID: 34655529 DOI: 10.1016/j.ajo.2021.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 11/26/2022]
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Teo KYC, Invernizzi A, Staurenghi G, Cheung CMG. COVID-19-Related Retinal Micro-vasculopathy - A Review of Current Evidence. Am J Ophthalmol 2022; 235:98-110. [PMID: 34587494 PMCID: PMC8465265 DOI: 10.1016/j.ajo.2021.09.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate the occurrence of retinal microvasculopathy in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and who developed coronavirus disease (COVID-19). DESIGN Systematic review and meta-analysis. METHODS The Pubmed and Embase databases were comprehensively searched to identify studies that reported retina vascular changes in eyes with COVID-19. Two independent reviewers selected papers and extracted data for analysis. Data of interest were extracted and analyzed in RevMan Web versions 3.3. Quality of evidence was assessed using the National Institute of Health quality assessment tool for a case-control study. RESULTS Thirty-one studies reporting on 1373 subjects (972 COVID-19 and 401 controls) were included. Only case-control studies were included in the pooled analysis. There was a significantly higher likelihood of retinal microvasculopathy in subjects with COVID-19 compared to controls (odds ratio [95% confidence interval], 8.86 [2.54-27.53], P < .01). Optical coherence tomography angiography (OCTA) revealed reduced vessel density and enlarged foveal avascular zone in subjects with COVID-19 compared to controls. CONCLUSIONS The results suggested that COVID-19-related retinal microvasculopathy is a significant ocular manifestation of COVID-19 and may herald future retinal complications. These microvascular impairments might have occurred antecedent to clinically visible changes and could be detected earlier by OCTA. These findings are significant, due to the large numbers with COVID-19, and need to be recognized by ophthalmologists as a potential long-term sequalae of the disease.
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Affiliation(s)
- Kelvin YC Teo
- From the Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore (K.Y.C.T, C.M.G.C),Duke-NUS Medical School, National University of Singapore, Singapore (K.Y.C.T, C.M.G.C),Save Sight Institute, The University of Sydney, Faculty of Health and Medicine, Sydney, New South Wales, Australia (K.Y.C.T, A.I)
| | - Alessandro Invernizzi
- Save Sight Institute, The University of Sydney, Faculty of Health and Medicine, Sydney, New South Wales, Australia (K.Y.C.T, A.I),Eye Clinic, Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Italy (A.I, G.S)
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Italy (A.I, G.S)
| | - Chui Ming Gemmy Cheung
- From the Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore (K.Y.C.T, C.M.G.C); Duke-NUS Medical School, National University of Singapore, Singapore (K.Y.C.T, C.M.G.C).
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Erba S, Cozzi M, Xhepa A, Cereda M, Staurenghi G, Invernizzi A. Distribution and Progression of Inflammatory Chorioretinal Lesions Related to Multifocal Choroiditis and Their Correlations with Clinical Outcomes at 24 Months. Ocul Immunol Inflamm 2022; 30:409-416. [DOI: 10.1080/09273948.2020.1800048] [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: 10/23/2022]
Affiliation(s)
- Stefano Erba
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco” Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Mariano Cozzi
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco” Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Alba Xhepa
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco” Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Matteo Cereda
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco” Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco” Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco” Luigi Sacco Hospital, University of Milan, Milan, Italy
- Faculty of Health and Medicine, Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
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50
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Testa F, Murro V, Signorini S, Colombo L, Iarossi G, Parmeggiani F, Falsini B, Salvetti AP, Brunetti-Pierri R, Aprile G, Bertone C, Suppiej A, Romano F, Karali M, Donati S, Melillo P, Sodi A, Quaranta L, Rossetti L, Buzzonetti L, Chizzolini M, Rizzo S, Staurenghi G, Banfi S, Azzolini C, Simonelli F. RPE65-Associated Retinopathies in the Italian Population: A Longitudinal Natural History Study. Invest Ophthalmol Vis Sci 2022; 63:13. [PMID: 35129589 PMCID: PMC8822366 DOI: 10.1167/iovs.63.2.13] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose To investigate the course of inherited retinal degenerations (IRD) due to mutations in the RPE65 gene. Methods This longitudinal multicentric retrospective chart-review study was designed to collect best corrected visual acuity (BCVA), Goldman visual field, optical coherence tomography (OCT), and electroretinography (ERG) measurements. The data, including imaging, were collected using an electronic clinical research form and were reviewed at a single center to improve consistency. Results From an overall cohort of 60 Italian patients with RPE65-associated IRD, 43 patients (mean age, 27.8 ± 19.7 years) were included and showed a mean BCVA of 2.0 ± 1.0 logMAR. Time-to-event analysis revealed a median age of 33.8 years and 41.4 years to reach low vision and blindness based on BCVA, respectively. ERG (available for 34 patients) showed undetectable responses in most patients (26; 76.5%). OCT (available for 31 patients) revealed epiretinal membranes in five patients (16.1%). Central foveal thickness significantly decreased with age at a mean annual rate of −0.6%/y (P = 0.044). We identified 43 different variants in the RPE65 gene in the entire cohort. Nine variants were novel. Finally, to assess genotype-phenotype correlations, patients were stratified according to the number of RPE65 loss-of-function (LoF) alleles. Patients without LoF variants showed significantly (P < 0.05) better BCVA compared to patients with one or two LoF alleles. Conclusions We described the natural course of RPE65-associated IRD in an Italian cohort showing for the first time a specific genotype-phenotype association. Our findings can contribute to a better management of RPE65-associated IRD patients.
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Affiliation(s)
- Francesco Testa
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Vittoria Murro
- Eye Clinic, Neuromuscolar and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Sabrina Signorini
- Developmental Neuro-ophthalmology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Leonardo Colombo
- Eye Clinic, ASST Santi Paolo e Carlo Hospital, University of Milan, Milan, Italy
| | - Giancarlo Iarossi
- Department of Ophthalmology, Bambino Gesù IRCCS Children's Hospital, Rome, Italy
| | - Francesco Parmeggiani
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy.,ERN-EYE Network-Center for Retinitis Pigmentosa of Veneto Region, Camposampiero Hospital, Padova, Italy
| | - Benedetto Falsini
- Institute of Ophthalmology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Paola Salvetti
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Raffaella Brunetti-Pierri
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giorgia Aprile
- Developmental Neuro-ophthalmology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Chiara Bertone
- Department of Surgical and Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Agnese Suppiej
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Francesco Romano
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Marianthi Karali
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy.,Telethon Institute of Genetics and Medicine, Pozzuoli, Italy
| | - Simone Donati
- Unit of Ophthalmology, Azienda Socio-Sanitaria Territoriale (ASST) Dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Paolo Melillo
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Andrea Sodi
- Eye Clinic, Neuromuscolar and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Luciano Quaranta
- Department of Surgical and Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Luca Rossetti
- Eye Clinic, ASST Santi Paolo e Carlo Hospital, University of Milan, Milan, Italy
| | - Luca Buzzonetti
- Department of Ophthalmology, Bambino Gesù IRCCS Children's Hospital, Rome, Italy
| | - Marzio Chizzolini
- ERN-EYE Network-Center for Retinitis Pigmentosa of Veneto Region, Camposampiero Hospital, Padova, Italy
| | - Stanislao Rizzo
- Institute of Ophthalmology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Sandro Banfi
- Telethon Institute of Genetics and Medicine, Pozzuoli, Italy.,Medical Genetics, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Claudio Azzolini
- Unit of Ophthalmology, Azienda Socio-Sanitaria Territoriale (ASST) Dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Francesca Simonelli
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
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