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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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Iacono P, Saviano S, Parravano M, Varano M, Battaglia Parodi M. Eye-selfie to resolve the enigmatic diagnosis of transient “eye spot”. Eur J Ophthalmol 2022; 32:NP59-NP61. [DOI: 10.1177/1120672120950923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To describe two cases of Cobb’s tufts in apparently healthy subjects. Methods: Observational case series. Results: Two patients reporting sudden vision loss, with subsequent complete recovery, underwent a complete ophthalmological examination, including iris fluorescein angiography. Both patients took an “eye-selfie” using their smartphone to provide evidence of the iris bleeding. Iris fluorescein angiography confirmed the presence of iris neovascular tufts at the pupillary margin. Conclusion: Diagnosis of Cobb’s tufts can frequently be challenging. The two patients’ astute action in taking photographs of the eye enabled the condition to be promptly identified.
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Affiliation(s)
| | - Sandro Saviano
- Eye Clinic, Department of Medical, Surgical Sciences and Health, University of Trieste, Trieste, Italy
- TS Retina, Trieste, Italy
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Iacono P, Da Pozzo S, Bedendo A, Arrigo A, Parravano M, Varano M, Battaglia Parodi M. OCT retinal angiography features in patients with rheumatoid arthritis: A pilot study. Eur J Ophthalmol 2021; 32:2433-2439. [PMID: 34313159 DOI: 10.1177/11206721211035626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate the superficial (SCP) and deep retinal capillary plexus (DCP) by mean of optical coherence tomography angiography (OCTA) in treatment-naïve patients affected by rheumatoid arthritis (RA). METHODS Between March 2019 and January 2020, patients with recent diagnosis of "definite RA" based on 2010 Rheumatoid Arthritis Classification Criteria were included in a Prospective, observational single center case-control study carried out at G.B. Bietti Foundation. Data were compared with those of 16 healthy age- and sex-matched subjects. Values of the vessel density (VD) of SCP and DCP, central foveal thickness (CFT), foveal avascular zone (FAZ) were collected by mean of OCTA. Main outcome measure was the VD alteration of SCP and DCP in treatment-naïve RA-patients. RESULTS No difference in age, sex-distribution, best-corrected visual acuity, CFT was registered between the two groups. OCTA data analysis showed in RA-patients a statistically significant reduction in the VD in the mean global area, inner ring, especially in the superior quadrant of the SCP. A trend of VD reduction was also registered in temporal, nasal, and inferior quadrants, respectively, although it did not reach a statistically significant value. Assessment of VD of DCP and FAZ area did not evidence any difference among the groups. CONCLUSIONS OCTA allows to highlight the vascular remodeling of the retinal microcirculation in RA-patients, even in early stages of the disease, demonstrating a reduction of VD. Outcomes of the current investigation can provide new insight in the pathogenetic mechanism of RA and extend the potential applications of this diagnostic tool.
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Affiliation(s)
| | | | | | - Alessandro Arrigo
- Ophthalmology Department, San Raffaele University Hospital, Milan, Italy
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Battaglia Parodi M, Arrigo A, Iacono P, Falcomatà B, Bandello F. Central Serous Chorioretinopathy: Treatment with Laser. Pharmaceuticals (Basel) 2020; 13:ph13110359. [PMID: 33147718 PMCID: PMC7692124 DOI: 10.3390/ph13110359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/25/2020] [Accepted: 10/28/2020] [Indexed: 01/11/2023] Open
Abstract
Currently, no general consensus exists regarding the management of central serous chorioretinopathy (CSC). Laser treatments include three different therapeutic approaches: conventional laser, subthreshold laser and photodynamic therapy. Conventional focal laser, addressed to seal the leaking points, as evidenced on fluorescein angiography, was largely used in the past, but now, it is almost completely abandoned, owing to the potential complications. Several studies confirmed the positive effects achieved by subthreshold laser treatment in CSC, even though its improper application in the PLACE trial has questioned the effectiveness.
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Affiliation(s)
- Maurizio Battaglia Parodi
- Department of Ophthalmology, Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.B.P.); (A.A.); (F.B.)
- TSRetina, 34123 Trieste, Italy
| | - Alessandro Arrigo
- Department of Ophthalmology, Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.B.P.); (A.A.); (F.B.)
| | - Pierluigi Iacono
- IRCCS-Fondazione Bietti, Via Livenza 3, 00198 Rome, Italy
- Correspondence: ; Tel.: +39-06-77052834; Fax: +39-06-77052833
| | - Bruno Falcomatà
- Department of Ophthalmology, Ospedale Bianchi-Malacrino-Gabrielli, 89100 Reggio Calabria, Italy;
| | - Francesco Bandello
- Department of Ophthalmology, Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.B.P.); (A.A.); (F.B.)
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Papayannis A, Tsamis E, Stringa F, Iacono P, Battaglia Parodi M, Stanga PE. Swept-source optical coherence tomography angiography vitreo-retinal segmentation in proliferative diabetic retinopathy. Eur J Ophthalmol 2020; 31:1925-1932. [PMID: 32722940 DOI: 10.1177/1120672120944028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To identify a new cortical vitreous segmentation protocol for non invasive standardised investigation of Neovascularisation (NV) with detection of regression of NV activity in Proliferative Diabetic Retinopathy (PDR). DESIGN Retrospective study. PARTICIPANTS One hundred and eighty-six eyes of 93 consecutive diabetic patients (mean age: 52.6 ± 11.0 years) imaged using Topcon Triton® Swept-Source Optical Coherence Tomography Angiography (SS-OCTA) from June 2015 to January 2017. METHODS Scans were performed through the macula, optic disc and areas of possible NV in mid-peripheral retina using 6 × 6 mm and/or 9 × 9 mm raster-patterns in three segmentation protocols: Vitreo-Retinal (VRS), Outer-Vitreous (OVS) and Core-Vitreous Segmentation (CVS). Any suspicion of PDR was confirmed in all patients by Heidelberg® Widefield-Fundus-Fluorescein-Angiography (WF-FFA) and/or Optos® Ultra-WF-FFA (UWF-FFA). Inter-observer reproducibility of NV diagnosis and agreement between SS-OCTA and UWF-FFA were assessed. Primary outcome was the identification of an effective and reproducible segmentation protocol. Secondary outcome was the identification of NV regression after treatment. RESULTS Sensitivity-specificity reached, respectively, the value of 100 to 100 in detecting NVD, and 96.6 to 100 in detecting NVE in compared areas. SS-OCTA was able to confirm absence of blood flow within the residual NV plexus when using VRS protocol in 30 eyes in which regression of NV with absence of leakage was documented on FFA. CONCLUSION Three segmentation protocols (VRS, OVS and CVS) with different but complementary characteristics, allowed a reproducible and standardised investigation of NVD and NVE. The proposed new SS-OCTA cortical vitreous segmentation protocols may be of value when identifying and assessing NV-activity (VRS, OVS and CVS) or NV-regression (VRS) in PDR and therefore, response to therapy.
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Affiliation(s)
- Alessandro Papayannis
- Department of Ophthalmology, Monfalcone and Gorizia Hospitals, Monfalcone, GO, Italy
| | - Emmanouil Tsamis
- Hood Visual Sciences Lab, Department of Psychology, Columbia University, New York, USA
| | | | | | - Maurizio Battaglia Parodi
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milano, Italy
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Abstract
The therapeutic approach based on anti-vascular endothelial growth factor (anti-VEGF) molecules can be used to treat two important complications of retinal dystrophies: choroidal neovascularization and macular edema. The macular involvement in retinal dystrophies can lead to further visual deterioration in patients at a young age and already affected by functional limitations. The study reports the effect of anti-VEGF treatment in several subforms of retinal dystrophies, critically discussing advantages and limitations.
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Giorno P, Iacono P, Scarinci F, Di Renzo A, Varano M, Parravano M. Microvasculature Changes of Myopic Choroidal Neovascularization and the Predictive Value of Feeder Vessel Disappearance after Ranibizumab Treatment Revealed Using Optical Coherence Tomography Angiography. Ophthalmologica 2019; 243:263-270. [PMID: 31838464 DOI: 10.1159/000504755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 07/10/2019] [Accepted: 11/13/2019] [Indexed: 11/19/2022]
Abstract
AIM To investigate vascular changes of myopic choroidal neovascularization (mCNV) after ranibizumab treatment using optical coherence tomography-angiography (OCTA). METHODS Consecutive subjects with a diagnosis of mCNV were included. Patients underwent intravitreal injection of ranibizumab treatment with a 6-month follow-up. All patients underwent a complete ophthalmological examination and OCTA evaluation. The 3 × 3 OCTA en face images were analyzed for the absence/presence of mCNV, CNV area, and CNV network morphology. In particular, the morphology of the mCNV was analyzed in order to detect the presence/absence of feeder vessels. RESULTS Eleven subjects were evaluated. At baseline, the mCNV was identified in all cases on OCTA. At 6 months, the mean mCNV area was not statically significantly reduced in comparison with baseline values (p > 0.05), while the morphologic analysis revealed a complete disappearance of the feeder vessel in 6 eyes. The subgroup analysis of these latter showed that the CNV area was significantly reduced, visual acuity had improved, and only one intravitreal injection was administrated over the entire follow-up period. CONCLUSIONS OCTA allowed the detection of qualitative and quantitative vascular changes in mCNV. The disappearance of the feeder vessel was associated with better anatomical as well as functional outcomes at the last follow-up visit.
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Abstract
Purpose: To report the morphological and clinical features of a case of retinitis pigmentosa with large choroidal excavation. Methods: The patient underwent a complete ophthalmologic examination including best-corrected visual acuity assessment, anterior segment and dilated fundus examination and spectral-domain optical coherence tomography. Results: A 41-year-old woman affected by retinitis pigmentosa with genetic confirmation with mutation in RDH12 gene had a best-corrected visual acuity of 20/50 in both eyes. Dilated fundus examination revealed waxy pallor of the optic disc, diffuse narrowing of the retinal arterioles and a generalized retinal pigment epithelium mottling with bony spicule associated with diffuse retinal atrophy. At the posterior pole, an extended bilateral chorioretinal atrophy was evident with a partial sparing of the macular area. On spectral-domain optical coherence tomography, a bilateral large choroidal excavation could be clearly detected and it was associated with a diffuse retinal thinning at the posterior pole and a partial sparing of the fovea. Conclusion: Large choroidal excavation has been rarely reported. Although the pathogenetic mechanisms leading to the formation of large choroidal excavation are still a matter of debate, a combination of primary degenerative-inflammatory factors could be retained responsible for the large choroidal excavation development.
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Abstract
PURPOSE To report the morphological and clinical features of a case of pachychoroid disease with focal choroidal excavation and large choroidal excavation complicated by choroidal neovascularization. METHODS The patient underwent a complete ophthalmologic examination including best-corrected visual acuity assessment, anterior segment and dilated fundus examination, fluorescein and indocyanine green angiography, and spectral-domain optical coherence tomography. RESULTS During the previous follow-up, the 57-year-old man received a diagnosis of central serous chorioretinopathy in the right eye with a late appearance of a choroidal neovascularization. The best-corrected visual acuity was 20/125 and 20/20 in the right and left eye, respectively. Dilated fundus examination, fluorescein angiography, and indocyanine green angiography confirmed a large subretinal fibrosis corresponding to the evolution of the choroidal neovascularization in the right eye. Spectral-domain optical coherence tomography clearly demonstrated in the right eye a large choroidal excavation below the fibrotic neovascular lesion with multiple hyperreflective foci inside the cavity, and in the left eye, a conforming focal choroidal excavation, bowl-shape type, associated with increased choroidal thickness with pachyvessels. CONCLUSION Large choroidal excavation has been rarely reported. Although the pathogenetic mechanisms leading to the formation of large choroidal excavation are still only hypotheses, a combination of primary degenerative inflammatory factors sustaining the focal choroidal excavation formation and disruptive process of the choroidal neovascularization could be retained responsible for the large choroidal excavation.
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Affiliation(s)
| | | | - Sandro Saviano
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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Iacono P, Toto L, Costanzo E, Varano M, Parravano MC. Pharmacotherapy of Central Serous Chorioretinopathy: A Review of the Current Treatments. Curr Pharm Des 2019; 24:4864-4873. [PMID: 30674250 DOI: 10.2174/1381612825666190123165914] [Citation(s) in RCA: 10] [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] [Received: 12/12/2018] [Accepted: 01/18/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Central serous chorioretinopathy (CSC) is the fourth most frequent retinal disorder in terms of prevalence. It typically occurs in young subjects and affects men more often than women. CSC is characterized by serous retinal detachment (SRD) involving mainly the macular area. The clinical course is usually selflimited, with spontaneous resolution within 3 months. The persistence of SRD or multiple relapse may result in a chronic form of CSC distinguished by permanent retinal pigment epithelium (RPE) and photoreceptor damage. As the pathogenetic mechanism of CSC primarily involves RPE and choroidal vascularization, the current therapeutic approaches aim to restore the normal functions of RPE and normal choroidal vascular permeability. In this review, the authors aim to summarize the current therapeutic approach to CSC. METHODS A comprehensive review of the literature was conducted in PubMed by searching for relevant studies on the current therapeutic options for CSC, including simple observation, conventional laser treatment, subthreshold laser treatment (SLT), photodynamic therapy (PDT) with verteporfin, treatment with mineralocorticoid receptor (MR) antagonists and treatment with anti-vascular endothelial growth factor drugs. RESULTS Since most cases resolve spontaneously, the most common initial CSC treatment is observation. Current evidence suggests that PDT and SLT are valuable in improving visual acuity, reducing subretinal fluid and maintaining long-term effectiveness. No clear evidence of efficacy has been achieved for anti-VEGF. MR antagonists might be a viable choice for the treatment of chronic CSC. CONCLUSION The pathophysiology of CSC remains poorly understood and as a consequence, the gold standard of care for CSC is yet to be defined. To date, PDT and SLT continue to offer good clinical outcomes. Positive preliminary results seem to emerge from the studies of MR antagonists.
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Affiliation(s)
| | - Lisa Toto
- Department of Medicine and Science of Ageing, Ophthalmology Clinic, University G. d'Annunzio Chieti-Pescara, Chieti, Italy
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Battaglia Parodi M, Iacono P, Papayannis A, Alto G, Buzzotta A, Arrigo A, Cicinelli MV, Bandello F. Near-infrared fundus autofluorescence in early age-related macular degeneration. Eur J Ophthalmol 2019; 30:1448-1453. [PMID: 31661979 DOI: 10.1177/1120672119885047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe the patterns on near-infrared fundus autofluorescence in eyes affected by early age-related macular degeneration. DESIGN Cross-sectional observational case series. PARTICIPANTS A total of 84 eyes of 84 patients suffering from early age-related macular degeneration (>63 μm but <125 μm drusen and no-to-mild retinal pigment epithelium abnormalities) were enrolled. METHODS Patients underwent best-corrected visual acuity, biomicroscopy, infrared reflectance, short-wavelength fundus autofluorescence, and near-infrared fundus autofluorescence. Eyes were classified according to different patterns of near-infrared fundus autofluorescence. Main outcome was definition of relative prevalence and features of each near-infrared fundus autofluorescence pattern; secondary outcomes were correlation between near-infrared fundus autofluorescence and short-wavelength fundus autofluorescence and between near-infrared fundus autofluorescence patterns and best-corrected visual acuity. RESULTS Four different patterns of near-infrared fundus autofluorescence identified: normal foveal signal (Pattern A, 7%); normal foveal signal with hyperautofluorescent/hypoautofluorescent spots not involving the fovea (Pattern B, 65.5%); hyperautofluorescent/hypoautofluorescent spots involving the fovea (Pattern C, 15.5%); patchy pattern (Pattern D, 12%). best-corrected visual acuity was lower in eyes with foveal signal alteration (Patterns C and D). CONCLUSION Near-infrared fundus autofluorescence pattern in early age-related macular degeneration might be suggestive of visual function deterioration when the fovea is involved. Longitudinal studies are warranted to confirm our preliminary results.
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Affiliation(s)
- Maurizio Battaglia Parodi
- Department of Ophthalmology, San Raffaele Vita-Salute University, Ospedale San Raffaele, Milano, Italy
| | | | | | - Giorgio Alto
- Department of Ophthalmology, San Raffaele Vita-Salute University, Ospedale San Raffaele, Milano, Italy
| | - Alessio Buzzotta
- Department of Ophthalmology, San Raffaele Vita-Salute University, Ospedale San Raffaele, Milano, Italy
| | - Alessandro Arrigo
- Department of Ophthalmology, San Raffaele Vita-Salute University, Ospedale San Raffaele, Milano, Italy
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, San Raffaele Vita-Salute University, Ospedale San Raffaele, Milano, Italy
| | - Francesco Bandello
- Department of Ophthalmology, San Raffaele Vita-Salute University, Ospedale San Raffaele, Milano, Italy
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Iacono P, Giorno P, Varano M, Parravano M. Structural and optical coherence tomography angiography in myopic choroidal neovascularization: Agreement with conventional fluorescein angiography. Eur J Ophthalmol 2019; 31:149-157. [PMID: 31619075 DOI: 10.1177/1120672119882333] [Citation(s) in RCA: 5] [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] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the agreement between fluorescein angiography and structural optical coherence tomography in diagnosing and monitoring the activity of myopic choroidal neovascularization and to provide a comparative analysis with optical coherence tomography angiography. METHODS Thirteen patients with active myopic choroidal neovascularization were prospectively enrolled. At the baseline, 2-month, and 6-month visits, each patient underwent a complete ophthalmological examination, including best-corrected visual acuity assessment, fundus examination, fluorescein angiography, and optical coherence tomography with structural and angiographic assessment. Sensitivity and specificity for all optical coherence tomography parameters were evaluated taking fluorescein angiography as the reference examination. RESULTS At the baseline, fluorescein angiography confirmed myopic choroidal neovascularization leakage in all patients. Structural optical coherence tomography demonstrated intraretinal or subretinal fluid in 61% of cases, fuzzy borders and absence of external limiting membrane visibility in 84% of cases, and subretinal hyperreflective exudation in 53% of cases. Sensitivity to the presence of retinal fluid and subretinal hyperreflective exudation was lower than sensitivity to fuzzy borders and external limiting membrane visibility, which reached 84%. During ranibizumab therapy, external limiting membrane visibility showed a higher sensitivity (100%) compared with fuzzy borders and subretinal hyperreflective exudation (66.6%) while displaying an equal specificity of 100%. At baseline and final visit, sensitivity increased to 100% when all structural optical coherence tomography parameters were pooled. Optical coherence tomography angiography detected myopic choroidal neovascularization at baseline, 2-month, and 6-month visits in 92%, 76%, and 76% of cases, respectively. CONCLUSION The study confirms that the new indicators of myopic choroidal neovascularization activity are more reliable than the presence or absence of retinal fluid. Optical coherence tomography angiography identified myopic choroidal neovascularization in most patients in the diagnostic phase and during treatment monitoring and could be considered as an alternative to fluorescein angiography in selected patients.
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Jung B, Iacono P, Schüle A, Wolf J, Nickolaus P. P274 Both BI 443651 and BI 1265162 show inhibition of ENaC-mediated in vitro water resorption. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30567-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sabater J, Jung B, Iacono P, Nickolaus P. ePS1.06 Both epithelial sodium channel (ENaC) inhibitors BI 443651 and BI 1265162 increase mucociliary clearance in sheep. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30245-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Khan N, Dean J, Singh D, Gupta A, Paterson J, Endriss V, Hobson D, Iacono P. P272 The inhaled ENaC inhibitor BI 443651 does not affect response to methacholine but induces post-inhalation airway obstruction and cough in mild asthmatics. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30565-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Jung B, Iacono P, Benediktus K, Hahn M, Göggerle G, Wolf J, Nickolaus P. P273 BI 443651 and BI 1265162 demonstrate in vitro inhibition of epithelial sodium channel (ENaC) in the Ussing chamber. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30566-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Nickolaus P, Iacono P, Constant S. ePS1.07 A single application of the epithelial sodium channel inhibitor BI 1265162 significantly improves water transport and mucociliary clearance of cystic fibrosis epithelial tissue, alone or combined with lumacaftor/ivacaftor or isoproterenol. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30246-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jung B, Iacono P, Hahn M, Borsch M, Hoffmann A, Nickolaus P. P275 Both BI 443651 and BI 1265162 demonstrate inhibition of the liquid absorption from the rat airway epithelium in vivo. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30568-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Battaglia Parodi M, Iacono P. Re: van Dijk et al.: Half-dose photodynamic therapy versus high-density subthreshold micropulse laser treatment in patients with chronic central serous chorioretinopathy: the PLACE trial (Ophthalmology. 2018;125:1547-1555). Ophthalmology 2019; 126:e29-e30. [PMID: 30910047 DOI: 10.1016/j.ophtha.2018.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/06/2018] [Indexed: 12/19/2022] Open
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Battaglia Parodi M, Iacono P, Romano F, Bandello F. Fluorescein Leakage and Optical Coherence Tomography Features of Choroidal Neovascularization Secondary to Pathologic Myopia. Invest Ophthalmol Vis Sci 2019; 59:3175-3180. [PMID: 30025121 DOI: 10.1167/iovs.17-23640] [Citation(s) in RCA: 10] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose We compare the fluorescein angiography (FA) patterns with morphologic alterations detectable on spectral-domain OCT (SD-OCT) in myopic choroidal neovascularization (mCNV) and evaluate whether they influence the effects of intravitreal ranibizumab (IVRI) in an as-needed (PRN) regimen. Methods The 49 patients enrolled in this prospective case series underwent a complete ophthalmologic examination, including best-corrected visual acuity (BCVA), FA, and SD-OCT assessment. The main outcome measure was correlation between FA patterns and SD-OCT features. Secondary outcomes were changes in BCVA and central macular thickness (CMT), and characterization of subretinal hyperreflective exudation (SHE). Results Three main patterns were identified on the FA: no (5%), minimal (35%), and profuse (59%) leakage CNV. Comparison between minimal versus profuse leakage CNV subtypes revealed no difference regarding baseline and final BCVA, CNV area, choroidal thickness, final CMT, and proportion of intraretinal cysts, subretinal fluid, and external limiting membrane (ELM) interruption; however, the minimal leakage CNV subgroup revealed a lower percentage of SHE (P = 0.0039), required fewer IVRI (P = 0.003), and showed a baseline smaller CMT (P = 0.004). Patients presenting with SHE showed a similar baseline BCVA to those without exudation, but displayed greater final BCVA improvement. CMT was greater at the baseline and the reduction also was more marked. CNV area achieved a significant reduction only in eyes with SHE. ELM interruption was present in all cases compared to 86.3% of eyes without SHE. Lastly, the eyes with SHE required more injections (P = 0.04). Conclusions Different patterns of mCNV may be identified in FA and they correlate with specific SD-OCT alterations. Moreover, the type of FA leakage may assist in identifying more active mCNV.
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Affiliation(s)
| | - Pierluigi Iacono
- Fondazione G. B. Bietti per l'Oftalmologia, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
| | - Francesco Romano
- Department of Ophthalmology, University Vita-Salute, Ospedale San Raffaele, Milano, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, Ospedale San Raffaele, Milano, Italy
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Parodi Battaglia M, Iacono P, Cascavilla M, Zucchiatti I, Bandello F. A Pathogenetic Classification of Diabetic Macular Edema. Ophthalmic Res 2018; 60:23-28. [DOI: 10.1159/000484350] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
<b><i>Purpose:</i></b> The aim of this study was to define a new pathogenetic classification of diabetic macular edema (DME) and to present the results of its application in common clinical practice. <b><i>Methods:</i></b> One hundred and seventy-seven consecutive patients with center-involving DME, central retinal thickness (CRT) ≥250 µm, were prospectively enrolled. A complete ophthalmological examination included best-corrected visual acuity (BCVA) assessment, fundus photography, and spectral-domain optical coherence tomography (OCT). The DME classification was broken down into 4 categories, combining the presence of retinal thickening with the presence/absence of visible vascular dilations and OCT-detectable macular traction. The OCT parameters included were as follows: CRT, subretinal fluid, intraretinal cysts, and hyper- reflective foci (HF). <b><i>Results:</i></b> Four subtypes of DME were identified: vasogenic (131 eyes, DME with vascular dilation), nonvasogenic (46 eyes, DME without vascular dilation), tractional (11 eyes), and mixed DME (13 eyes). Vasogenic DME was the pattern mainly represented in each subclass of CRT (< 300, 300–400, and > 400 µm), with tractional DME observed especially with CRT > 400 µm. Internal and external cysts and a greater presence of hard exudates were predominantly found in vasogenic DME, whereas HF was equally distributed in the 4 DME subgroups. <b><i>Conclusion:</i></b> The study offers a new pathogenetic classification able to detect significant differences among DME subtypes. A tailored therapeutic approach could take into consideration specific changes associated with the different DME subtypes.
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Parodi MB, Iacono P, Zucchiatti I, Bandello F. Regarding comments by Mathis T and Kodjikian L on “Choroidal Neovascularization Associated with Multiple Evanescent White Dot Syndrome Treated with Intravitreal Ranibizumab”. Ocul Immunol Inflamm 2017; 26:614. [DOI: 10.1080/09273948.2017.1312097] [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: 10/19/2022]
Affiliation(s)
| | - Pierluigi Iacono
- Fondazione G. B. Bietti per l’Oftalmologia, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
| | - Ilaria Zucchiatti
- Department of Ophthalmology, University Vita-Salute, San Raffaele Hospital, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, San Raffaele Hospital, Milan, Italy
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Parodi MB, Iacono P, Zucchiatti I, Bandello F. Choroidal Neovascularization Associated with Multiple Evanescent White Dot Syndrome Treated with Intravitreal Ranibizumab. Ocul Immunol Inflamm 2016; 26:608-611. [DOI: 10.1080/09273948.2016.1247175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Pierluigi Iacono
- Fondazione G. B. Bietti per l’Oftalmologia, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
| | - Ilaria Zucchiatti
- Department of Ophthalmology, University Vita-Salute, San Raffaele Hospital, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, San Raffaele Hospital, Milan, Italy
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Iacono P, Battaglia Parodi M, Bandello F. Non-Responders to Intravitreal Ranibizumab in Subfoveal Choroidal Neovascularization Secondary to Age-Related Macular Degeneration. Ophthalmic Res 2016; 57:42-47. [DOI: 10.1159/000448955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 08/08/2016] [Indexed: 11/19/2022]
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Iacono P, Parodi MB, Scaramuzzi M, Bandello F. Morphological and functional changes in recalcitrant diabetic macular oedema after intravitreal dexamethasone implant. Br J Ophthalmol 2016; 101:791-795. [DOI: 10.1136/bjophthalmol-2016-308726] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 08/22/2016] [Accepted: 08/28/2016] [Indexed: 01/04/2023]
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Iacono P, Battaglia Parodi M, La Spina C, Bandello F. Intravitreal Bevacizumab for Nonsubfoveal Choroidal Neovascularization Associated With Angioid Streaks: 3-Year Follow-up Study. Am J Ophthalmol 2016; 165:174-8. [PMID: 27013066 DOI: 10.1016/j.ajo.2016.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 09/19/2015] [Revised: 03/07/2016] [Accepted: 03/10/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the effects of intravitreal bevacizumab injections in the treatment of nonsubfoveal choroidal neovascularization (CNV) associated with angioid streaks (AS) in a 3-year follow-up study. DESIGN Noncomparative, interventional, prospective case series. METHODS Eighteen patients (18 eyes) with juxtafoveal/extrafoveal CNV secondary to AS were recruited. All patients underwent a complete ophthalmologic examination, including best-corrected visual acuity (BCVA) measurement on ETDRS chart, optical coherence tomography (OCT), and fluorescein angiography (FA). The protocol treatment included a first injection, followed by repeated injections on the basis of detection of new hemorrhage, any type of fluid on OCT, and/or presence of FA leakage. Primary outcome measures were final mean changes in BCVA and proportion of eyes with 10 ETDRS letters improvement. Secondary outcomes were mean changes of central macular thickness (CMT) and foveal involvement. RESULTS After a mean BCVA stabilization over the first year, a statistically significant BCVA worsening was registered at the 24-month (72.8 ± 10.0 ETDRS letters, P = .03) and 36-month examinations (65.8 ± 15.0 ETDRS letters, P = .02) in comparison with the 1-year visual outcomes (80.1 ± 5.4 ETDRS letters); lastly, a substantial stabilization in the BCVA was observed at 36 months in comparison with the baseline value (77.9 ± 10.0 ETDRS letters, P = .22). Two eyes (25%) with juxtafoveal CNV and no eye with extrafoveal CNV experienced a 10-letter improvement at the 3-year examination. Mean CMT at baseline was 220 ± 15 μm and 235 ± 66 μm at 36 months (P = 1.00). During the first and second years of follow-up, 5 juxtafoveal CNVs and 3 extrafoveal CNVs showed foveal involvement. CONCLUSIONS Intravitreal bevacizumab can be effective in the management of nonsubfoveal CNV secondary to AS, although monthly monitoring is required to control CNV recurrence or progression.
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Affiliation(s)
- Pierluigi Iacono
- Fondazione G. B. Bietti per l'Oftalmologia, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy.
| | - Maurizio Battaglia Parodi
- Department of Ophthalmology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
| | - Carlo La Spina
- Department of Ophthalmology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
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Iacono P, Battaglia Parodi M, Falcomatà B, Bandello F. Central Serous Chorioretinopathy Treatments: A Mini Review. Ophthalmic Res 2015; 55:76-83. [PMID: 26619293 DOI: 10.1159/000441502] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 10/06/2015] [Indexed: 11/19/2022]
Abstract
Central serous chorioretinopathy (CSC) is a retinal disorder that primarily affects young (20- to 50-year-old) white men, although it is seen occasionally in older patients and females. CSC is characterized by avascular focal leakage through the retinal pigment epithelium (RPE), resulting in serous detachment of the neurosensory retina. The course is usually self-limiting and in most cases resolves spontaneously within a 3-month period, with visual acuity usually recovering to 20/30 or better. However, chronic CSC may develop as a consequence of recurrences or persistent neurosensory detachment, and can result in progressive RPE atrophy and permanent visual loss. A primary involvement of the RPE and choroidal vascularization play a significant role in the pathogenesis of CSC and the current treatment options attempt to restore the functions of the RPE and the normal choroidal vasculature. The aim of the current review is to provide an overview of the current therapeutical approaches to CSC, including observation, laser treatment, photodynamic therapy with verteporfin, intravitreal anti-vascular endothelial growth factor therapy and the mineralocorticoid receptor antagonists.
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Affiliation(s)
- Pierluigi Iacono
- Fondazione G.B. Bietti per l'Oftalmologia, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
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Iacono P, Parodi MB, Papayannis A, La Spina C, Varano M, Bandello F. A new treatment algorithm for the management of myopic choroidal neovascularization using intravitreal ranibizumab. Acta Ophthalmol 2015; 93:e519-20. [PMID: 25828793 DOI: 10.1111/aos.12677] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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)
- Pierluigi Iacono
- G. B. Bietti Foundation for study and research in ophthalmology; IRCCS; Rome Italy
| | - Maurizio Battaglia Parodi
- Department of Ophthalmology; University Vita-Salute; Scientific Institute San Raffaele; Milano Italy
| | | | - Carlo La Spina
- Department of Ophthalmology; University Vita-Salute; Scientific Institute San Raffaele; Milano Italy
| | - Monica Varano
- G. B. Bietti Foundation for study and research in ophthalmology; IRCCS; Rome Italy
| | - Francesco Bandello
- Department of Ophthalmology; University Vita-Salute; Scientific Institute San Raffaele; Milano Italy
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Parodi MB, Iacono P, Sacconi R, Iuliano L, Bandello F. Fundus Autofluorescence Changes After Ranibizumab Treatment for Subfoveal Choroidal Neovascularization Secondary to Pathologic Myopia. Am J Ophthalmol 2015; 160:322-327.e2. [PMID: 25935099 DOI: 10.1016/j.ajo.2015.04.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 04/21/2015] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe fundus autofluorescence (FAF) patterns of myopic choroidal neovascularization (CNV) treated with intravitreal ranibizumab and their correlation with visual acuity. DESIGN Prospective interventional case series. METHODS Twenty-seven eyes (27 patients) affected by myopic CNV were enrolled from January 2011 to January 2013. All patients underwent a complete ophthalmologic examination, including best-corrected visual acuity (BCVA) determination and fundus autofluorescence (FAF). The patients underwent ranibizumab injections following a pro re nata treatment regimen. The main outcome measure was the identification of the FAF patterns of myopic CNV over a 12-month follow-up. The secondary outcome was the correlation of the FAF patterns with the BCVA. RESULTS At baseline 17 eyes (63%) showed a hyperautofluorescent pattern and 10 eyes (37%) a patchy pattern. BCVA changed from 0.48 ± 0.23 (logMAR) to 0.30 ± 0.32 at the 12-month examination (P = .027) in the hyper-FAF subgroup. In the subgroup showing the patchy pattern, the BCVA declined slightly from 0.51 ± 0.27 to 0.56 ± 0.37 (P = .53). The 14 eyes preserving the hyper-FAF pattern during the follow-up had a final BCVA of 0.20 ± 0.17, whereas the 9 eyes maintaining the patchy pattern showed a final BCVA of 0.60 ± 0.37 (P = .002). The atrophic area of the retinal pigment epithelium assessed on the basis of FAF increased from 1.27 ± 2.80 mm(2) to 1.83 ± 3.74 mm(2) at the 12-month examination (P = .016). The mean atrophic area increased by 0.37 mm(2) in the hyper-FAF subgroup and by 0.90 mm(2) in the patchy FAF subgroup. CONCLUSIONS Two main patterns were identified on FAF in myopic CNV and were related to the prognostic evolution, the hyperautofluorescent CNV being associated with a greater visual gain and fewer atrophic changes over a 12-month follow-up.
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Battaglia Parodi M, Iacono P, Panico D, Cascavilla M, Bandello F. Microperimetric assessment of the two optical coherence tomography subtypes of acute macular neuroretinopathy. Clin Exp Ophthalmol 2015; 43:637-42. [DOI: 10.1111/ceo.12519] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 02/26/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | - Pierluigi Iacono
- Fondazione G. B. Bietti per l'Oftalmologia; IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico); Rome Italy
| | - Daniele Panico
- Department of Ophthalmology; Scientific Institute San Raffaele; University Vita-Salute; Milan Italy
| | - Marialucia Cascavilla
- Department of Ophthalmology; Scientific Institute San Raffaele; University Vita-Salute; Milan Italy
| | - Francesco Bandello
- Department of Ophthalmology; Scientific Institute San Raffaele; University Vita-Salute; Milan Italy
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Iacono P, Battaglia Parodi M, Bandello F. One-year outcomes of aflibercept in recurrent or persistent neovascular age-related macular degeneration. Am J Ophthalmol 2015; 159:996-7. [PMID: 25867595 DOI: 10.1016/j.ajo.2015.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 01/26/2015] [Accepted: 02/19/2015] [Indexed: 11/19/2022]
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Parodi MB, Iacono P, Triolo G, La Spina C, Zucchiatti I, Cicinelli MV, Borrelli E, Manitto MP, Martina E, Bandello F. Morpho-functional correlation of fundus autofluorescence in Stargardt disease. Br J Ophthalmol 2015; 99:1354-9. [DOI: 10.1136/bjophthalmol-2014-306237] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 03/21/2015] [Indexed: 11/03/2022]
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Iacono P, Battaglia PM, Papayannis A, La Spina C, Varano M, Bandello F. Acute central serous chorioretinopathy: a correlation study between fundus autofluorescence and spectral-domain OCT. Graefes Arch Clin Exp Ophthalmol 2015; 253:1889-97. [PMID: 25563727 DOI: 10.1007/s00417-014-2899-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 11/24/2014] [Accepted: 12/15/2014] [Indexed: 10/24/2022] Open
Affiliation(s)
- Pierluigi Iacono
- Fondazione G. B. Bietti per l'Oftalmologia, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Via Livenza 3, Rome, Italy.
| | - Parodi Maurizio Battaglia
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | | | - Carlo La Spina
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Monica Varano
- Fondazione G. B. Bietti per l'Oftalmologia, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Via Livenza 3, Rome, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
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Parodi MB, Iacono P, Del Turco C, Bandello F. Near-infrared fundus autofluorescence in subclinical best vitelliform macular dystrophy. Am J Ophthalmol 2014; 158:1247-1252.e2. [PMID: 25174897 DOI: 10.1016/j.ajo.2014.08.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 06/25/2014] [Revised: 08/25/2014] [Accepted: 08/25/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE To describe fundus autofluorescence (FAF) on short-wavelength FAF and near-infrared FAF in the subclinical form of Best vitelliform macular dystrophy. DESIGN Cross-sectional prospective study. METHODS Patients affected by the subclinical form of Best vitelliform macular dystrophy (positive testing for BEST1 gene mutation, fully preserved best-corrected visual acuity, normal fundus appearance) were recruited. Each patient underwent a complete ophthalmologic examination, including electro-oculogram (EOG), short-wavelength FAF, near-infrared FAF, spectral-domain OCT (SD OCT), and microperimetry. Main outcome measure was the identification of abnormal FAF patterns. RESULTS Forty-six patients showing mutations in the BEST1 gene were examined. Forty patients presented a bilateral Best vitelliform macular dystrophy, 2 patients showed a unilateral Best vitelliform macular dystrophy, and 4 patients had a bilateral subclinical form. Patients with the unilateral form (2 eyes) and patients with the subclinical form (8 eyes) were analyzed. Three BEST1 sequence variants were identified: c.73C>T (p.Arg25Trp), c.28G>A (p.Ala10Thr), and c.652C>G (p.Arg218Gly). Short-wavelength FAF was normal in all eyes. Near-infrared FAF detected a pattern consisting of a central hypo-autofluorescence surrounded by a round area of hyper-autofluorescence. A bilateral reduced EOG response was detected in 1 patient. SD OCT revealed a thicker, well-defined, and more reflective interdigitation zone in 2 patients (4 eyes, 40%). Microperimetry of the central 10 degrees revealed a slight, diffuse reduction of retinal sensitivity. Mean retinal sensitivity within the central 2 and 4 degrees was lower and matched the hypo-autofluorescent area detected on near-infrared FAF. Additional relative scotomata were detected within the 10-degree area. No change in clinical, functional, or FAF pattern was found over the follow-up. CONCLUSIONS Subclinical Best vitelliform macular dystrophy is characterized by the absence of biomicroscopic fundus abnormality and fully preserved visual acuity, but shows an abnormal near-infrared FAF pattern, with central hypo-autofluorescence.
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Affiliation(s)
- Maurizio Battaglia Parodi
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Pierluigi Iacono
- Fondazione G. B. Bietti per l'Oftalmologia, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy.
| | - Claudia Del Turco
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
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Parodi MB, Iacono P, Bandello F. Subthreshold grid laser versus intravitreal bevacizumab as second-line therapy for macular edema in branch retinal vein occlusion recurring after conventional grid laser treatment. Graefes Arch Clin Exp Ophthalmol 2014; 253:1647-51. [PMID: 25382074 DOI: 10.1007/s00417-014-2845-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 07/02/2014] [Revised: 10/22/2014] [Accepted: 10/24/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To compare the effects of subthreshold grid laser treatment (SGLT) and intravitreal bevacizumab injection (IVBI) for the treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO) recurring after conventional grid laser photocoagulation. METHODS Thirty-five eyes were considered in this prospective, randomised, interventional study and treated with micropulse diode laser (SGLT subgroup) or IVBI (IVBI subgroup). SGLT was administered once, whereas IVBI (1.25 mg) was given at baseline and then on a pro re nata regimen according to ME presence on optical coherence tomography (OCT), performed at monthly examinations over a 12-month follow-up. Primary outcome measures were the mean BCVA changes over the follow-up and the decrease in mean central foveal thickness (CFT) on optical coherence tomography (OCT). Secondary outcomes included the proportion of eyes that gained at least 15 letters (approximately three lines) at the 12-month examination. RESULTS Eighteen and 17 patients were assigned to SGLT and IVBI subgroups, respectively. At baseline, the subgroups were similar with regard to mean ME duration, BCVA, and CFT. At month 12, mean CFT significantly improved from 484 μm to 271 μm in the IVBI subgroup, whereas it was unchanged in the SGLT subgroup. Mean BCVA changed from 0.92 ± 0.3 (LogMAR) to 0.99 ± 0.2 in the SGLT subgroup; in the IVBI subgroup, mean BCVA showed a statistically significant improvement from 0.94 ± 0.3 to 0.72 ± 0.2. Ten patients in the IVBI subgroup (58 %) and no patient in the SGLT subgroup gained at least three lines. CONCLUSION At the 1-year follow-up, IVBI provided a significant functional and anatomical improvement, whereas SGLT failed to demonstrate any beneficial effects. IVBI might be a useful approach in the treatment of recurrent ME secondary to BRVO already treated with conventional grid laser photocoagulation. UMIN registry, number UMIN000005014, URL: http://www.umin.ac.jp/ctr/index.htm.
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Affiliation(s)
- M Battaglia Parodi
- Department of Ophthalmology, University Vita-Salute, San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milano, Italy.
| | - P Iacono
- Fondazione G. B. Bietti per l'Oftalmologia, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Roma, Italy
| | - F Bandello
- Department of Ophthalmology, University Vita-Salute, San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milano, Italy
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Parodi MB, Iacono P, Campa C, Del Turco C, Bandello F. Fundus autofluorescence patterns in Best vitelliform macular dystrophy. Am J Ophthalmol 2014; 158:1086-92. [PMID: 25068640 DOI: 10.1016/j.ajo.2014.07.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 07/15/2014] [Accepted: 07/17/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To provide a systematic classification of fundus autofluorescence (FAF) patterns in patients affected by Best vitelliform macular dystrophy. DESIGN Cross-sectional prospective study. METHODS Patients affected by Best vitelliform macular dystrophy at different stages of the disease were prospectively enrolled from January 2012 to July 2013. Eighty eyes of 40 patients were included in the study. All patients underwent a complete ophthalmologic examination, including genetic characterization, short-wavelength FAF, and near-infrared FAF. Main outcome measures were the recognition of the FAF patterns in the different stages and the identification of a relationship between FAF patterns and best-corrected visual acuity (BCVA). RESULTS Six FAF patterns for both short-wavelength and near-infrared FAF were identified, including normal, hyper-autofluorescent, hypo-autofluorescent, patchy, multifocal, and spoke-like patterns. Applying Gass's classification for defining consecutive stages of Best vitelliform macular dystrophy (namely vitelliform, pseudohypopyon, vitelliruptive, atrophic, and cicatricial) identified no pattern as stage-specific. Patchy patterns had the highest prevalence. A statistically significant difference (Kruskal-Wallis ANOVA) was found among hyper-autofluorescent, patchy, and hypo-autofluorescent patterns, both in short-wavelength (P = .001) and near-infrared FAF (P = .001). Hyper-autofluorescent and hypo-autofluorescent patterns were associated with better and worse BCVA, respectively. CONCLUSIONS Six main patterns on both short-wavelength and near-infrared FAF were identified in Best vitelliform macular dystrophy. No FAF pattern can be considered stage-specific. Although a difference in the BCVA among the FAF patterns was registered, only a longitudinal study designed to evaluate the clinical and FAF modifications over the follow-up will help clarify the prognostic implications of each FAF pattern.
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Iacono P, Battaglia Parodi M, Papayannis A, Kontadakis S, Da Pozzo S, Cascavilla ML, La Spina C, Varano M, Bandello F. Fluorescein angiography and spectral-domain optical coherence tomography for monitoring anti-VEGF therapy in myopic choroidal neovascularization. Ophthalmic Res 2014; 52:25-31. [PMID: 24861045 DOI: 10.1159/000358331] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 01/03/2014] [Indexed: 01/02/2023]
Abstract
AIM To evaluate the agreement between fluorescein angiography (FA) and spectral-domain optical coherence tomography (SD-OCT) in detecting myopic choroidal neovascularization (CNV) activity during bevacizumab treatment. METHODS Thirty-four patients with subfoveal myopic CNV were prospectively enrolled. FA and SD-OCT were performed at baseline and at all planned monthly visits. After the first injection, additional treatments were administered following detection of fluid on SD-OCT and/or leakage on FA. κ-Analysis was performed to examine the agreement between FA and SD-OCT. RESULTS At baseline, FA and SD-OCT agreed in 26/34 cases (κ=0.23); sensitivity and specificity were 77.4 and 66.7%, respectively. Seven eyes presented leakage on FA with no fluid on SD-OCT, 1 case showed intraretinal fluid on SD-OCT and no leakage on FA. At the 1-month examination, specificity and κ-value improved, and 30/34 cases showed complete concordance. At the 3- and 4-month examinations, a discordance was noted in 6 cases. From the 5-month examination on, a correspondence was achieved in at least 30/34 cases and reached a perfect match in 11 sessions. CONCLUSIONS Our study confirms the key role of FA in diagnosing myopic CNV. It seems possible there may be a role for SD-OCT in assisting FA to monitor the myopic CNV activity during anti-vascular endothelial growth factor antibody treatment.
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Affiliation(s)
- Pierluigi Iacono
- G.B. Bietti Foundation for Ophthalmology, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
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Parodi MB, Iacono P, Campa C, La Spina C, Triolo G, Lattanzio R, Bandello F. Dexamethasone tachyphylaxis in the treatment of macular oedema. Acta Ophthalmol 2014; 92:e243-4. [PMID: 24020627 DOI: 10.1111/aos.12255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Maurizio Battaglia Parodi
- Department of Ophthalmology; Scientific Institute San Raffaele; University Vita-Salute; Milano Italy
| | | | - Claudio Campa
- Eye Clinic; Arcispedale Sant'Anna - Ferrara University Hospital; Ferrara Italy
| | - Carlo La Spina
- Department of Ophthalmology; Scientific Institute San Raffaele; University Vita-Salute; Milano Italy
| | - Giacinto Triolo
- Department of Ophthalmology; Scientific Institute San Raffaele; University Vita-Salute; Milano Italy
| | - Rosangela Lattanzio
- Department of Ophthalmology; Scientific Institute San Raffaele; University Vita-Salute; Milano Italy
| | - Francesco Bandello
- Department of Ophthalmology; Scientific Institute San Raffaele; University Vita-Salute; Milano Italy
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Battaglia Parodi M, Iacono P, La Spina C, Berchicci L, Scotti F, Leys A, Introini U, Bandello F. Intravitreal bevacizumab for nonsubfoveal choroidal neovascularization associated with angioid streaks. Am J Ophthalmol 2014; 157:374-377.e2. [PMID: 24211865 DOI: 10.1016/j.ajo.2013.10.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 10/22/2013] [Accepted: 10/23/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the effects of intravitreal bevacizumab injections in the treatment of nonsubfoveal choroidal neovascularization (CNV) associated with angioid streaks. DESIGN Nonrandomized, interventional, prospective case series. METHODS Fifteen patients (15 eyes) affected by juxtafoveal or extrafoveal CNV secondary to angioid streaks were enrolled in the study. All patients underwent a complete ophthalmologic examination, including best-corrected visual acuity (BCVA) measurement on Early Treatment Diabetic Retinopathy Study (ETDRS) chart, optical coherence tomography (OCT), and fluorescein angiography (FA). The protocol treatment included a first injection, followed by repeated injections over a 12-month follow-up period on the basis of the detection of new hemorrhage on biomicroscopic examination, any type of fluid on OCT, or presence of leakage on FA. PRIMARY OUTCOME MEASURES Mean changes in BCVA and proportion of eyes gaining at least 10 letters (2 ETDRS lines) at the end of the follow-up. SECONDARY OUTCOMES Mean changes of central macular thickness (CMT) and extension to the fovea. RESULTS Mean BCVA did not change throughout the follow-up period, being 0.2 ± 0.2 logMAR at baseline and 0.2 ± 0.3 logMAR at the 12-month examination. A functional improvement of at least 2 ETDRS lines was achieved by 5 eyes (33%), with 3 eyes (20%) gaining 3 lines. Mean CMT at baseline was 215 ± 13 μm and 225 ± 85 μm at the 12-month examination. Two eyes (13.3%) showed CNV extension to the fovea. CONCLUSIONS Intravitreal bevacizumab injection can be a beneficial approach for the management of nonsubfoveal CNV secondary to angioid streaks over a 1-year follow-up.
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Parodi MB, Iacono P, La Spina C, Knutsson KA, Mansour A, Arevalo JF, Bandello F. Intravitreal bevacizumab for choroidal neovascularisation in serpiginous choroiditis. Br J Ophthalmol 2014; 98:519-22. [DOI: 10.1136/bjophthalmol-2013-304237] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Varano M, Iacono P, Giorno P, Chiaravalloti A, Parravano M. Photodynamic Therapy in Subfoveal and Juxtafoveal Myopic Choroidal Neovascularization: A 10-year Retrospective Analysis. Ophthalmologica 2014; 231:204-10. [DOI: 10.1159/000357504] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 11/18/2013] [Indexed: 11/19/2022]
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Parodi MB, Iacono P, Menchini F, Sheth S, Polini G, Pittino R, Bandello F. Intravitreal bevacizumab versus ranibizumab for the treatment of retinal angiomatous proliferation. Acta Ophthalmol 2013; 91:267-73. [PMID: 21951313 DOI: 10.1111/j.1755-3768.2011.02265.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [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: 01/29/2023]
Abstract
PURPOSE To evaluate the effects of intravitreal bevacizumab and ranibizumab treatments in retinal angiomatous proliferation (RAP). METHODS Fifty patients affected by RAP were randomly assigned either to intravitreal bevacizumab injection (IVBI) or intravitreal ranibizumab injection (IVRI). After a loading phase including three consecutive monthly injections, the retreatment was administered in cases of persistent RAP. The primary outcome measures were the mean changes in BCVA between the two treatment groups, and the proportion of eyes gaining 1 and 3 lines at the end of the follow-up. Secondary outcomes included central macular thickness (CMT) changes and progression to more advanced stages of RAP. RESULTS Fifty patients affected by stage 1 and 2 RAP were recruited. Twenty-six and 24 patients received IVBI and IVRI, respectively. At the baseline, mean best corrected visual acuity (BCVA) values were 0.59 ± 0.21 (LogMAR ± SD, approximately corresponding to 20/80 Snellen Equivalent-SE) in IVBI group and 0.66 ± 0.33 (approximately 20/90 SE) in IVRI group with no statistical difference. At 12-month examination, both groups showed a statistically significant improvement in the BCVA, with a final mean value of 0.43 ± 0.24 (approximately 20/54 SE) in IVBI group and 0.50 ± 0.32 (approximately 20/63 SE) in the IVRI group. A BCVA gain of 1 and 3 lines was registered in 20 and 8 eyes, respectively, in the IVBI group. Similarly, 17 and 7 eyes showed an improvement of 1 or 3 lines, respectively, in the IVRI group. The CMT reduced significantly from baseline to 12-month examination in both groups. A lower proportion of eyes with complete pigment epithelium detachment resolution was noted in the IVBI group than in the IVRI group (40% versus 90%). CONCLUSIONS Our study shows that both IVBI and IVRI are equally effective in improving the BCVA over a 1-year follow-up in eyes affected by stage 1 and 2 RAP.
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Affiliation(s)
- Maurizio B Parodi
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milano, Italy
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Battaglia Parodi M, De Benedetto U, Vergallo S, Knutsson KA, Bandello F, Lanzetta P, Iacono P. Intravitreal Bevacizumab for Retinal Neovascularizations Associated with Myelinated Nerve Fibers. J Ocul Pharmacol Ther 2013; 29:442-3. [DOI: 10.1089/jop.2012.0094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Maurizio Battaglia Parodi
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Milano, Italy
| | - Umberto De Benedetto
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Milano, Italy
| | | | - Karl Anders Knutsson
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Milano, Italy
| | - Francesco Bandello
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Milano, Italy
| | - Paolo Lanzetta
- Department of Ophthalmology, University of Udine, Udine, Italy
| | - Pierluigi Iacono
- Fondazione G.B. Bietti per l'Oftalmologia, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
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De Benedetto U, Battaglia Parodi M, Knutsson KA, Lattanzio R, Bandello F, Iacono P. Macular hole after injection of dexamethasone intravitreal implant for macular oedema due to central retinal vein occlusion. Acta Ophthalmol 2013; 91:e75-7. [PMID: 22863290 DOI: 10.1111/j.1755-3768.2012.02484.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Parodi MB, Iacono P, Papayannis A, Kontadakis SD, Cascavilla M, Pierro L, Gagliardi M, Bandello F. Intravitreal ranibizumab for pigment epithelium detachment with subfoveal occult choroidal neovascularization: a prospective 24-month case series. Am J Ophthalmol 2013; 155:103-108.e2. [PMID: 23022164 DOI: 10.1016/j.ajo.2012.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [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: 11/06/2011] [Revised: 07/05/2012] [Accepted: 07/10/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the effects of intravitreal ranibizumab injection in patients affected by pigment epithelial detachment associated with occult subfoveal choroidal neovascularization. DESIGN Prospective, interventional case series. METHODS PARTICIPANTS Forty eyes of 40 patients were considered for the purpose of the study. Consecutive patients were recruited for a 24-month study. All patients underwent a complete ophthalmic examination, including best-corrected visual acuity on Early Treatment Diabetic Retinopathy Study (ETDRS) charts. After a 3-monthly loading phase, further intravitreal ranibizumab injections were administered on the basis of detection of any type of fluid on optical coherence tomography. PRIMARY OUTCOME MEASURES Changes in mean best-corrected visual acuity at 12 and 24 months and the proportion of eyes losing fewer than 15 letters (corresponding to 3 ETDRS lines) from baseline visual acuity. SECONDARY OUTCOME MEASURES Changes in central macular thickness on optical coherence tomography and variation in mean area of the entire lesion. RESULTS Forty patients were included. Mean best-corrected visual acuity decreased from 20/66 (58 ETDRS letters) to 20/83 (53 letters) at 12 months and 20/112 (489 ETDRS letters) at 24 months (P = .003). Eighty percent and 67.5% of eyes lost fewer than 3 lines at 12 and 24 months, respectively. Mean central macular thickness passed from 545 μm to 428 μm at 12 months and 426 μm at 24 months. Mean lesion area changed from 6826 μm(2) to 6312 μm(2) at 12 months and 6010 μm(2) at 24 months. CONCLUSIONS The treatment of pigment epithelial detachment associated with occult subfoveal choroidal neovascularization with intravitreal ranibizumab injection after a 3-monthly loading phase and pro re nata strategy can lead to partial results over a 24-month follow-up. Further investigations are warranted to establish the best therapeutic approach to this disease.
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Affiliation(s)
- Maurizio Battaglia Parodi
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milano, Italy
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Parodi MB, Iacono P, De Benedetto U, Cascavilla M, Bandello F. Rebound Effect After Intravitreal Dexamethasone Implant for the Treatment of Macular Edema Secondary to Central Retinal Vein Occlusion. J Ocul Pharmacol Ther 2012; 28:566-8. [DOI: 10.1089/jop.2012.0016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Maurizio Battaglia Parodi
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milano, Italy
| | - Pierluigi Iacono
- Fondazione G.B. Bietti per l'Oftalmologia, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Roma, Italy
| | - Umberto De Benedetto
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milano, Italy
| | - Marialucia Cascavilla
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milano, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milano, Italy
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Parodi MB, Cascavilla M, Papayannis A, Kontadakis DS, Bandello F, Iacono P. Intravitreal bevacizumab in advanced-stage neovascular age-related macular degeneration with visual acuity lower than 20/200. ACTA ACUST UNITED AC 2012; 130:934-5. [PMID: 22776937 DOI: 10.1001/archophthalmol.2011.2617] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Bandello F, Berchicci L, La Spina C, Battaglia Parodi M, Iacono P. Evidence for anti-VEGF treatment of diabetic macular edema. Ophthalmic Res 2012; 48 Suppl 1:16-20. [PMID: 22907145 DOI: 10.1159/000339843] [Citation(s) in RCA: 24] [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] [Indexed: 12/17/2022]
Abstract
Diabetic macular edema (DME) is the most important cause of vision loss in patients with diabetes mellitus. Diabetic retinopathy has a remarkable impact on public health and on the quality of life of diabetic patients and thus requires special consideration. The first line of treatment remains the management of systemic risk factors but is often insufficient in controlling DME and currently, laser retinal photocoagulation is considered the standard of care. However, laser treatment reduces the risk of moderate visual loss by approximately 50% without guaranteeing remarkable effects on visual improvement. For these reasons, new strategies in the treatment of DME have been studied, in particular the use of anti-vascular endothelial growth factor (anti-VEGF) drugs. VEGF is a pluripotent growth factor that acts as a vasopermeability factor and an endothelial cell mitogen. For this reason, it represents an interesting candidate as a therapeutic target for the treatment of DME. The aim of this article is to review the evidence behind the use of anti-VEGF drugs in the treatment of DME.
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Affiliation(s)
- F Bandello
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy.
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Parodi MB, Iacono P, Cascavilla M, Zucchiatti I, Bandello F. Compassionate use of dexamethasone implant for the treatment of macular edema secondary to central retinal vein occlusion in a clinical setting. Acta Ophthalmol 2012; 90:e322-3. [PMID: 21939501 DOI: 10.1111/j.1755-3768.2011.02238.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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De Benedetto U, Battaglia Parodi M, Knutsson KA, Librando A, Bandello F, Lanzetta P, Iacono P. Intravitreal bevacizumab for extrafoveal choroidal neovascularization after ocular trauma. J Ocul Pharmacol Ther 2012; 28:550-2. [PMID: 22554238 DOI: 10.1089/jop.2012.0022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To describe two cases of extrafoveal choroidal neovascularization (CNV) after ocular trauma successfully treated with intravitreal bevacizumab injection. METHODS A 41-year-old man presented for progressive visual impairment in the left eye (LE). The patient had a positive history for pseudoxanthoma elasticum and suffered a blunt trauma in the LE 1 year before. Best-corrected visual acuity (BCVA) in the affected eye was 20/100. Fundus examination of the LE revealed angioid streaks and a choroidal rupture with retinal hemorrhages. Fluorescein angiography (FA) revealed an extrafoveal CNV and optical coherence tomography (OCT) findings demonstrated the presence of intraretinal fluid extending to the fovea. The second patient was a 61-year-old man complaining of blurred vision in the LE. Fundus examination of the LE revealed retinal pigment epithelium (RPE) changes, while FA showed the presence of an extrafoveal CNV close to the area of RPE attenuation. Intraretinal fluid extending to the fovea was detectable on OCT examination. An intravitreal injection of bevacizumab was proposed in both cases. RESULTS In the first patient, treatment with one intravitreal bevacizumab injection was successful in contrasting CNV activity, as OCT findings showed a resolution of intraretinal fluid accumulation. BCVA remained unchanged (20/100) over the 12-month follow-up period, most probably due to permanent alteration of the photoreceptors. In the second case, BCVA improved from 20/40 to 20/20 with complete resolution of leakage on FA and fluid on OCT 1 month after a single intravitreal injection of bevacizumab. Visual function remained stable over the 14-month follow-up. CONCLUSIONS Our results indicate that intravitreal bevacizumab is effective in the management of extrafoveal CNV secondary to ocular trauma.
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Affiliation(s)
- Umberto De Benedetto
- Department of Ophthalmology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy.
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