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Sharma A, Wu L, Bloom S, Stanga P, Walinjkar J, Netralaya SR, Patel AQ, Netralaya R, Nicholson L, Lanzetta P, Veritti D, Sarao V, Boyer D, Cheung CMG, Gupta A, Agrawal V, Rezaei KA. RWC Update: Different Surgical Techniques for Macular Hole Associated With Retinal Detachment; Diabetic Macular Edema - How Do You Treat Patients With Good Visual Acuity?; Benign Familial Fleck Retina. Ophthalmic Surg Lasers Imaging Retina 2024; 55:249-252. [PMID: 38752801 DOI: 10.3928/23258160-20240425-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
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Veritti D, Sarao V, Martinuzzi D, Menzio S, Lanzetta P. Submacular hemorrhage during neovascular age-related macular degeneration: a meta-analysis and meta-regression on the use of tPA and anti-VEGFs. Ophthalmologica 2024:000537939. [PMID: 38555635 DOI: 10.1159/000537939] [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: 11/17/2023] [Accepted: 02/16/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Submacular hemorrhage (SMH) associated with neovascular age-related macular degeneration (nAMD) precipitates rapid visual decline and impacts quality of life. Treatments vary, but combined recombinant tissue plasminogen activator (tPA) and anti-vascular endothelial growth factor (anti-VEGF) therapy has gained prominence as a viable treatment option. OBJECTIVES This study aims to evaluate the efficacy of the combination of tPA and anti-VEGF. METHODS We conducted a systematic review meta-analysis following PRISMA guidelines, focusing on studies examining tPA and anti-VEGF therapy in SMH secondary to nAMD. Outcomes measured were change in best-corrected visual acuity (BCVA) and success rate of SMH displacement. Meta-regression assessed the relative efficacy of intravitreal and subretinal delivery. RESULTS Out of 257 initial reports, 22 studies involving 29 patient populations met inclusion criteria. Our analysis showed significant improvement in BCVA and a high rate of successful SMH displacement with combined tPA and anti-VEGF therapy. No significant differences were found between subretinal and intravitreal tPA administration. Furthermore, when evaluating the effects of subretinal versus intravitreal anti-VEGF administration in patients treated with subretinal tPA, the results indicated similar efficacy. CONCLUSIONS Combined tPA and anti-VEGF therapy is effective in managing SMH in nAMD patients, significantly improving visual acuity and SMH displacement. The location of tPA and anti-VEGF delivery did not significantly impact outcomes.
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Veritti D, Rubinato L, Sarao V, De Nardin A, Foresti GL, Lanzetta P. Behind the mask: a critical perspective on the ethical, moral, and legal implications of AI in ophthalmology. Graefes Arch Clin Exp Ophthalmol 2024; 262:975-982. [PMID: 37747539 PMCID: PMC10907411 DOI: 10.1007/s00417-023-06245-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/24/2023] [Accepted: 09/15/2023] [Indexed: 09/26/2023] Open
Abstract
PURPOSE This narrative review aims to provide an overview of the dangers, controversial aspects, and implications of artificial intelligence (AI) use in ophthalmology and other medical-related fields. METHODS We conducted a decade-long comprehensive search (January 2013-May 2023) of both academic and grey literature, focusing on the application of AI in ophthalmology and healthcare. This search included key web-based academic databases, non-traditional sources, and targeted searches of specific organizations and institutions. We reviewed and selected documents for relevance to AI, healthcare, ethics, and guidelines, aiming for a critical analysis of ethical, moral, and legal implications of AI in healthcare. RESULTS Six main issues were identified, analyzed, and discussed. These include bias and clinical safety, cybersecurity, health data and AI algorithm ownership, the "black-box" problem, medical liability, and the risk of widening inequality in healthcare. CONCLUSION Solutions to address these issues include collecting high-quality data of the target population, incorporating stronger security measures, using explainable AI algorithms and ensemble methods, and making AI-based solutions accessible to everyone. With careful oversight and regulation, AI-based systems can be used to supplement physician decision-making and improve patient care and outcomes.
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Affiliation(s)
- Daniele Veritti
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy.
| | - Leopoldo Rubinato
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
| | - Valentina Sarao
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare - IEMO, Udine, Italy
| | - Axel De Nardin
- Department of Mathematics, Informatics and Physics, University of Udine, Udine, Italy
| | - Gian Luca Foresti
- Department of Mathematics, Informatics and Physics, University of Udine, Udine, Italy
| | - Paolo Lanzetta
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare - IEMO, Udine, Italy
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Sarao V, Veritti D, De Nardin A, Misciagna M, Foresti G, Lanzetta P. Explainable artificial intelligence model for the detection of geographic atrophy using colour retinal photographs. BMJ Open Ophthalmol 2023; 8:e001411. [PMID: 38057106 PMCID: PMC10711821 DOI: 10.1136/bmjophth-2023-001411] [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: 07/21/2023] [Accepted: 11/22/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE To develop and validate an explainable artificial intelligence (AI) model for detecting geographic atrophy (GA) via colour retinal photographs. METHODS AND ANALYSIS We conducted a prospective study where colour fundus images were collected from healthy individuals and patients with retinal diseases using an automated imaging system. All images were categorised into three classes: healthy, GA and other retinal diseases, by two experienced retinologists. Simultaneously, an explainable learning model using class activation mapping techniques categorised each image into one of the three classes. The AI system's performance was then compared with manual evaluations. RESULTS A total of 540 colour retinal photographs were collected. Data was divided such that 300 images from each class trained the AI model, 120 for validation and 120 for performance testing. In distinguishing between GA and healthy eyes, the model demonstrated a sensitivity of 100%, specificity of 97.5% and an overall diagnostic accuracy of 98.4%. Performance metrics like area under the receiver operating characteristic (AUC-ROC, 0.988) and the precision-recall (AUC-PR, 0.952) curves reinforced the model's robust achievement. When differentiating GA from other retinal conditions, the model preserved a diagnostic accuracy of 96.8%, a precision of 90.9% and a recall of 100%, leading to an F1-score of 0.952. The AUC-ROC and AUC-PR scores were 0.975 and 0.909, respectively. CONCLUSIONS Our explainable AI model exhibits excellent performance in detecting GA using colour retinal images. With its high sensitivity, specificity and overall diagnostic accuracy, the AI model stands as a powerful tool for the automated diagnosis of GA.
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Affiliation(s)
- Valentina Sarao
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare (IEMO), Udine, Italy
| | - Daniele Veritti
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
| | - Axel De Nardin
- Department of Mathematics, Computer Science and Physics, University of Udine, Udine, Italy
| | - Micaela Misciagna
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
| | - Gianluca Foresti
- Department of Mathematics, Computer Science and Physics, University of Udine, Udine, Italy
| | - Paolo Lanzetta
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare (IEMO), Udine, Italy
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Veritti D, Sarao V, Chhablani J, Loewenstein A, Lanzetta P. The ideal intravitreal injection setting: office, ambulatory surgery room or operating theatre? A narrative review and international survey. Graefes Arch Clin Exp Ophthalmol 2023; 261:3299-3306. [PMID: 37199802 PMCID: PMC10587024 DOI: 10.1007/s00417-023-06108-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/02/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023] Open
Abstract
PURPOSE This study reviews evidence and provides recommendations for the ideal setting of intravitreal injection (IVI) administration of vascular endothelial growth factor (VEGF) inhibitors. METHODS A multi-step approach was employed, including content analysis of regulations and guidelines, a systematic literature review, and an international survey assessing perioperative complications and endophthalmitis incidence in relation to injection settings. The literature review searched PubMed and Cochrane databases from 2006 to 2022, focusing on studies reporting correlations between complications and treatment settings. The survey utilized a web-based questionnaire distributed to clinical sites and the international ophthalmic community, with data managed using electronic capture tools. RESULTS We reviewed regulations and guidelines from 23 countries across five continents, finding significant variation in IVI administration settings. In most countries, IVI is primarily administered in outpatient clean rooms (96%) or offices (39%), while in others, it is restricted to ambulatory surgery rooms or hospital-based operating theatres (4%). The literature review found that endophthalmitis risk after IVI is generally low (0.01% to 0.26% per procedure), with no significant difference between office-based and operating room settings. The international survey (20 centers, 96,624 anti-VEGF injections) found low overall incidences of severe perioperative systemic adverse events and endophthalmitis, independent of injection settings. CONCLUSION No significant differences in perioperative complications were observed among various settings, including operating theatres, ambulatory surgery rooms, offices, hospitals, or extra-hospital environments. Choosing the appropriate clinical setting can optimize patient management, potentially increasing effectiveness, quality, productivity, and capacity.
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Affiliation(s)
- Daniele Veritti
- Department of Medicine - Ophthalmology, University of Udine, Piazzale Santa Maria Della Misericordia, 33100, Udine, Italy
| | - Valentina Sarao
- Department of Medicine - Ophthalmology, University of Udine, Piazzale Santa Maria Della Misericordia, 33100, Udine, Italy
- Istituto Europeo Di Microchirurgia Oculare - IEMO, Udine, Italy
| | - Jay Chhablani
- Department of Ophthalmology, UPMC Eye Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Medical, Tel Aviv University, Tel Aviv, Israel
| | - Paolo Lanzetta
- Department of Medicine - Ophthalmology, University of Udine, Piazzale Santa Maria Della Misericordia, 33100, Udine, Italy.
- Istituto Europeo Di Microchirurgia Oculare - IEMO, Udine, Italy.
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Lin TPH, Sen M, Gupta V, Agrawal R, Lanzetta P, Giannaccare G, Chan CKM, Agrawal K, Menia NK, Rojas-Carabali W, Arora A, Martinuzzi D, Taloni A, Rubinato L, Coco G, Sarao V, Veritti D, Chen L, Honavar SG, Lam DSC. Update on coronavirus disease 2019: Ophthalmic Manifestations and Adverse Reactions to Vaccination. Asia Pac J Ophthalmol (Phila) 2023; 12:512-536. [PMID: 38117598 DOI: 10.1097/apo.0000000000000647] [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: 09/19/2023] [Accepted: 10/12/2023] [Indexed: 12/22/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 was one of the most devastating public health issues in recent decades. The ophthalmology community is as concerned about the COVID-19 pandemic as the global public health community is, as COVID-19 was recognized to affect multiple organs in the human body, including the eyes, early in the course of the outbreak. Ophthalmic manifestations of COVID-19 are highly variable and could range from mild ocular surface abnormalities to potentially sight and life-threatening orbital and neuro-ophthalmic diseases. Furthermore, ophthalmic manifestations may also be the presenting or the only findings in COVID-19 infections. Meanwhile, global vaccination campaigns to attain herd immunity in different populations are the major strategy to mitigate the pandemic. As novel vaccinations against COVID-19 emerged, so were reports on adverse ophthalmic reactions potentially related to such. As the world enters a post-pandemic state where COVID-19 continues to exist and evolve as an endemic globally, the ophthalmology community ought to be aware of and keep abreast of the latest knowledge of ophthalmic associations with COVID-19 and its vaccinations. This review is a summary of the latest literature on the ophthalmic manifestations of COVID-19 and the adverse ophthalmic reactions related to its vaccinations.
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Affiliation(s)
- Timothy P H Lin
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
| | - Mrittika Sen
- Ocular Oncology and Ophthalmic Plastic Surgery Services, Raghunath Netralaya, Mumbai, India
| | - Vishali Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Agrawal
- Lee Kong Chiang School of Medicine, Nanyang Technological University, Singapore
- Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Singapore Eye Research Institute, The Academia, Singapore, Singapore
- Duke NUS Medical School, National University of Singapore, Singapore
| | - Paolo Lanzetta
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare, Udine, Italy
| | - Giuseppe Giannaccare
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Carmen K M Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
| | - Kajal Agrawal
- Lee Kong Chiang School of Medicine, Nanyang Technological University, Singapore
| | - Nitin Kumar Menia
- All India Institute of Medical Sciences, Jammu, Jammu and Kashmir, India
| | - William Rojas-Carabali
- Lee Kong Chiang School of Medicine, Nanyang Technological University, Singapore
- Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
| | - Atul Arora
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Andrea Taloni
- University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Leopoldo Rubinato
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
| | - Giulia Coco
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Valentina Sarao
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare, Udine, Italy
| | - Daniele Veritti
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
| | - Lizhen Chen
- C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, China
| | - Santosh G Honavar
- Ocular Oncology and Ophthalmic Plastic Surgery Services, Centre for Sight Eye Hospital, Hyderabad, India
| | - Dennis S C Lam
- The International Eye Research Institute of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China
- The C-MER Dennis Lam and Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China
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Dal Bello S, Martinuzzi D, Tereshko Y, Veritti D, Sarao V, Gigli GL, Lanzetta P, Valente M. The Present and Future of Optic Pathway Glioma Therapy. Cells 2023; 12:2380. [PMID: 37830595 PMCID: PMC10572241 DOI: 10.3390/cells12192380] [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: 07/10/2023] [Revised: 08/31/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023] Open
Abstract
Optic pathway gliomas (OPGs) encompass two distinct categories: benign pediatric gliomas, which are characterized by favorable prognosis, and malignant adult gliomas, which are aggressive cancers associated with a poor outcome. Our review aims to explore the established standards of care for both types of tumors, highlight the emerging therapeutic strategies for OPG treatment, and propose potential alternative therapies that, while originally studied in a broader glioma context, may hold promise for OPGs pending further investigation. These potential therapies encompass immunotherapy approaches, molecular-targeted therapy, modulation of the tumor microenvironment, nanotechnologies, magnetic hyperthermia therapy, cyberKnife, cannabinoids, and the ketogenic diet. Restoring visual function is a significant challenge in cases where optic nerve damage has occurred due to the tumor or its therapeutic interventions. Numerous approaches, particularly those involving stem cells, are currently being investigated as potential facilitators of visual recovery in these patients.
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Affiliation(s)
- Simone Dal Bello
- Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Deborah Martinuzzi
- Department of Medicine—Ophthalmology, University of Udine, 33100 Udine, Italy
| | - Yan Tereshko
- Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Daniele Veritti
- Department of Medicine—Ophthalmology, University of Udine, 33100 Udine, Italy
| | - Valentina Sarao
- Department of Medicine—Ophthalmology, University of Udine, 33100 Udine, Italy
| | - Gian Luigi Gigli
- Department of Medical Area, University of Udine, 33100 Udine, Italy
| | - Paolo Lanzetta
- Department of Medicine—Ophthalmology, University of Udine, 33100 Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
- Department of Medical Area, University of Udine, 33100 Udine, Italy
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Sharma A, Holz FG, Regillo CD, Freund KB, Sarraf D, Khanani AM, Baumal C, Holekamp N, Tadayoni R, Kumar N, Parachuri N, Kuppermann BD, Bandello F, Querques G, Loewenstein A, Özdek Ş, Rezai K, Laurent K, Bilgic A, Lanzetta P, Zur D, Yannuzzi N, Corradetti G, Kaiser P, Hilely A, Boyer D, Rachitskaya A, Chakravarthy U, Wintergerst M, Sarao V, Parolini B, Mruthyunjaya P, Nguyen QD, Do D, Keane PA, Hassan T, Sridhar J, Eichenbaum D, Grewal D, Splitzer M. Biosimilars for retinal diseases: United States-Europe awareness survey (Bio-USER - survey). Expert Opin Biol Ther 2023; 23:851-859. [PMID: 36726203 DOI: 10.1080/14712598.2023.2176218] [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: 09/23/2022] [Accepted: 01/31/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE To assess the awareness of biosimilar intravitreal anti-VEGF agents among retina specialists practicing in the United States (US) and Europe. METHODS A 16-question online survey was created in English and distributed between Dec 01, 2021 and Jan 31, 2022. A total of 112 respondents (retinal physicians) from the US and Europe participated. RESULTS The majority of the physicians (56.3%) were familiar with anti-VEGF biosimilars. A significant number of physicians needed more information (18.75%) and real world data (25%) before switching to a biosimilar. About one half of the physicians were concerned about biosimilar safety (50%), efficacy (58.9 %), immunogenicity (50%), and their efficacy with extrapolated indications (67.8 %). Retinal physicians from the US were less inclined to shift from off-label bevacizumab to biosimilar ranibizumab or on-label bevacizumab (if approved) compared to physicians from Europe (p=0.0001). Furthermore, physicians from the US were more concerned about biosimilar safety (p=0.0371) and efficacy compared to Europe (p= 0.0078). CONCLUSIONS The Bio-USER survey revealed that while the majority of retinal physicians need additional information regarding the safety, efficacy and immunogenicity when making clinical decisions regarding their use. Retinal physicians from US are more comfortable in continuing to use off-label bevacizumab compared to physicians from Europe.
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Affiliation(s)
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Carl D Regillo
- The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, USA
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
| | - David Sarraf
- Stein Eye Institute, UCLA, Los Angeles, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Arshad M Khanani
- Sierra Eye Associates, Reno, NV, USA and The University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - Caroline Baumal
- Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts
| | | | - Ramin Tadayoni
- Université Paris Cité, AP-HP, Lariboisière, St Louis and Fondation Adolphe de Rothschild hospitals, Paris, France
| | | | | | - Baruch D Kuppermann
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, CA, USA
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Veritti D, Sarao V, Di Bin F, Lanzetta P. Pharmacokinetic and Pharmacodynamic Rationale for Extending VEGF Inhibition Increasing Intravitreal Aflibercept Dose. Pharmaceutics 2023; 15:pharmaceutics15051416. [PMID: 37242658 DOI: 10.3390/pharmaceutics15051416] [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: 02/16/2023] [Revised: 04/01/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The effects of various dosages and treatment regimens on intravitreal aflibercept concentrations and the proportion of free vascular endothelial growth factor (VEGF) to total VEGF were evaluated using a drug and disease assessment model. The 8 mg dosage received specific attention. METHODS A time-dependent mathematical model was developed and implemented using Wolfram Mathematica software v12.0. This model was used to obtain drug concentrations after multiple doses of different aflibercept dosages (0.5 mg, 2 mg, and 8 mg) and to estimate the time-dependent intravitreal free VEGF percentage levels. A series of fixed treatment regimens were modeled and evaluated as potential clinical applications. RESULTS The simulation results indicate that 8 mg aflibercept administered at a range of treatment intervals (between 12 and 15 weeks) would allow for the proportion of free VEGF to remain below threshold levels. Our analysis indicates that these protocols maintain the ratio of free VEGF below 0.001%. CONCLUSIONS Fixed q12-q15 (every 12-15 weeks) 8 mg aflibercept regimens can produce adequate intravitreal VEGF inhibition.
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Affiliation(s)
- Daniele Veritti
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy
| | - Valentina Sarao
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy
- Istituto Europeo di Microchirurgia Oculare (IEMO), 33100 Udine, Italy
| | - Francesco Di Bin
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy
| | - Paolo Lanzetta
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy
- Istituto Europeo di Microchirurgia Oculare (IEMO), 33100 Udine, Italy
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Iglicki M, Busch C, Lanzetta P, Sarao V, Veritti D, Rassu N, Lupidi M, Cebeci Z, Fraser-Bell S, Bernal-Morales C, Sala-Puigdollers A, Zarranz-Ventura J, Gallego-Pinazo R, Maiti A, D'Amico Ricci G, Udaondo P, Loewenstein A, Chhablani J, Zur D. Vitrectomized vs non-vitrectomized eyes in DEX implant treatment for DMO-Is there any difference? the VITDEX study. Eye (Lond) 2023; 37:280-284. [PMID: 35043004 PMCID: PMC9873723 DOI: 10.1038/s41433-022-01931-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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: 06/29/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE We aimed to compare visual and anatomical outcome in vitrectomized and non-vitrectomized eyes treated with dexamethasone (DEX) implant due to diabetic macular oedema (DMO). DESIGN Multicenter, retrospective, interventional study. PARTICIPANTS 236 eyes from 234 patients with DMO with or without previous vitrectomy performed with follow-up of 12 months. METHODS Records were reviewed for cases of DMO treated with DEX implant in vitrectomized and not vitrectomized eyes. Best corrected visual acuity (BCVA), central subfoveal thickness (CST), and intraocular pressure (IOP) were recorded at baseline and 12 months after treatment with DEX implants. Correlations between vitreous status and visual and anatomical outcome, as well as safety profile were analysed. MAIN OUTCOME MEASURES BCVA and CST over follow-up period. SECONDARY OUTCOMES cataract rate formation, intraocular pressure increase, number of implants needed. RESULTS The non-vitrectomized group included 130 eyes (55.1%), the vitrectomized group included 106 eyes (44.9%). The groups were well balanced for age and gender (p = 0.540, and p = 0.053, respectively). Both groups showed statistically significant improvement in BCVA and CST (for all groups: p < 0.001). There was no significant difference between the groups in terms of change in vision (p = 0.89) and anatomy (p = 0.65). The mean number of DEX implants given during follow-up was 3.5 in both groups, and there was no significant difference between the groups (p = 0.81). CONCLUSION We demonstrated similar anatomical and functional efficacy of DEX implant in non-vitrectomized and vitrectomized eyes. Its efficacy was not influenced by full vitrectomy for diabetic retinopathy complications. Safety profile was well balanced between groups.
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Affiliation(s)
- Matias Iglicki
- Private Retina Office, University of Buenos Aires, Buenos Aires, Argentina.
| | - Catharina Busch
- Department of Ophthalmology, University of Leipzig, Leipzig, Germany
| | - Paolo Lanzetta
- Department of Medicine-Ophthalmology, University of Udine, Piazzale S. Maria della Misericordia, 33100, Udine, Italy
| | - Valentina Sarao
- Department of Medicine-Ophthalmology, University of Udine, Piazzale S. Maria della Misericordia, 33100, Udine, Italy
| | - Daniele Veritti
- Department of Medicine-Ophthalmology, University of Udine, Piazzale S. Maria della Misericordia, 33100, Udine, Italy
| | - Nicolò Rassu
- Department of Medicine-Ophthalmology, University of Udine, Piazzale S. Maria della Misericordia, 33100, Udine, Italy
| | - Marco Lupidi
- Department of Medicine and Surgery, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, 06156, Perugia, Italy
- Fondazione per la Macula Onlus, Di.N.O.G.Mi., University Eye Clinic, Viale Benedetto XV, 16132, Genova, Italy
- Centre de l'Odéon, 113 Boulevard St Germain, 75006, Paris, France
| | - Zafer Cebeci
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Samantha Fraser-Bell
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | | | | | | | | | - Aniruddha Maiti
- Susrut Eye Foundation & Research Centre Kolkata, Kolkata, India
| | | | | | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jay Chhablani
- University of Pittsburgh, UPMC Eye Center, Pittsburgh, PA, USA
| | - Dinah Zur
- Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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11
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Veritti D, Sarao V, Soppelsa V, Danese C, Chhablani J, Lanzetta P. Managing Neovascular Age-Related Macular Degeneration in Clinical Practice: Systematic Review, Meta-Analysis, and Meta-Regression. J Clin Med 2022; 11:jcm11020325. [PMID: 35054021 PMCID: PMC8781865 DOI: 10.3390/jcm11020325] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 12/23/2022] Open
Abstract
The use of anti-vascular endothelial growth factor (VEGF) agents has profoundly changed the prognosis of neovascular age-related macular degeneration (nAMD). As clinical experiences have accumulated, it has become mandatory to summarize data to give information that can be useful in everyday practice. We conducted a systematic review to identify randomized controlled trials (RCTs) and observational studies that reported 12-month changes in best-corrected visual acuity (BCVA) in patients with nAMD on anti-VEGF monotherapy. Data were analyzed in a random-effects meta-analysis with BCVA change as the primary outcome. Meta-regression was conducted to evaluate the impact of multiple covariates. Four hundred and twelve heterogeneous study populations (109,666 eyes) were included. Anti-VEGFs induced an overall improvement of +5.37 ETDRS letters at 12 months. Meta-regression showed that mean BCVA change was statistically greater for RCTs (p = 0.0032) in comparison with observational studies. Populations following a proactive regimen had better outcomes than those following a reactive treatment regimen. Mean BCVA change was greater in younger populations, with lower baseline BCVA and treated with a higher number of injections (p < 0.001). Our results confirm that anti-VEGFs may produce a significant functional improvement at 12 months in patients with nAMD.
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Affiliation(s)
- Daniele Veritti
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy; (D.V.); (V.S.); (V.S.); (C.D.)
| | - Valentina Sarao
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy; (D.V.); (V.S.); (V.S.); (C.D.)
- Istituto Europeo di Microchirurgia Oculare (IEMO), 33100 Udine, Italy
| | - Valentina Soppelsa
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy; (D.V.); (V.S.); (V.S.); (C.D.)
| | - Carla Danese
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy; (D.V.); (V.S.); (V.S.); (C.D.)
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, Pittsburg, PA 15261, USA;
| | - Paolo Lanzetta
- Department of Medicine-Ophthalmology, University of Udine, 33100 Udine, Italy; (D.V.); (V.S.); (V.S.); (C.D.)
- Istituto Europeo di Microchirurgia Oculare (IEMO), 33100 Udine, Italy
- Correspondence: ; Tel.: +39-04-3255-9907
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12
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Veritti D, Sarao V, Bandello F, Lanzetta P. Response to: Should we establish a new normality for ophthalmic training in the COVID-19 pandemic? Eur J Ophthalmol 2021; 32:NP345. [PMID: 34751036 DOI: 10.1177/11206721211053511] [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: 11/16/2022]
Affiliation(s)
- Daniele Veritti
- Department of Medicine - Ophthalmology, 9316University of Udine, Udine, Italy
| | - Valentina Sarao
- Department of Medicine - Ophthalmology, 9316University of Udine, Udine, Italy
| | | | - Paolo Lanzetta
- Department of Medicine - Ophthalmology, 9316University of Udine, Udine, Italy
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13
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Veritti D, Sarao V, Bandello F, Lanzetta P. Response to: New norms in ophthalmic surgery during the COVID-19 pandemic: A narrative review from a Malaysia tertiary eye care center. Eur J Ophthalmol 2021; 32:NP346. [PMID: 34747222 DOI: 10.1177/11206721211055617] [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: 11/15/2022]
Affiliation(s)
- Daniele Veritti
- Department of Medicine - Ophthalmology, 9316University of Udine, Udine, Italy
| | - Valentina Sarao
- Department of Medicine - Ophthalmology, 9316University of Udine, Udine, Italy
| | | | - Paolo Lanzetta
- Department of Medicine - Ophthalmology, 9316University of Udine, Udine, Italy
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14
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Veritti D, Sarao V, Bandello F, Lanzetta P. Response to: Letter to the editor: Infection control measures in ophthalmology during the COVID-19 outbreak: A narrative review from an early experience in Italy. Eur J Ophthalmol 2021; 32:NP344. [PMID: 34747195 DOI: 10.1177/11206721211055625] [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: 11/15/2022]
Affiliation(s)
- Daniele Veritti
- Department of Medicine - Ophthalmology, 9316University of Udine, Udine, Italy
| | - Valentina Sarao
- Department of Medicine - Ophthalmology, 9316University of Udine, Udine, Italy
| | | | - Paolo Lanzetta
- Department of Medicine - Ophthalmology, 9316University of Udine, Udine, Italy
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Veritti D, Sarao V, Bandello F, Lanzetta P. Lens fogging comment on "Infection control measures in ophthalmology during the COVID-19 outbreak: A narrative review from an early experience in Italy". Eur J Ophthalmol 2021; 32:NP349-NP350. [PMID: 34747248 DOI: 10.1177/11206721211055616] [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: 11/16/2022]
Affiliation(s)
- Daniele Veritti
- Department of Medicine - Ophthalmology, 9316University of Udine, Udine, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Valentina Sarao
- Department of Medicine - Ophthalmology, 9316University of Udine, Udine, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Bandello
- Department of Medicine - Ophthalmology, 9316University of Udine, Udine, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Lanzetta
- Department of Medicine - Ophthalmology, 9316University of Udine, Udine, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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Vujosevic S, Toma C, Sarao V, Veritti D, Brambilla M, Muraca A, De Cillà S, Villani E, Nucci P, Lanzetta P. Color Fundus Autofluorescence to Determine Activity of Macular Neovascularization in Age-Related Macular Degeneration. Transl Vis Sci Technol 2021; 10:33. [PMID: 34003918 PMCID: PMC7910646 DOI: 10.1167/tvst.10.2.33] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate with color fundus autofluorescence (FAF) different lesion components of macular neovascularization (MNV) secondary to age-related macular degeneration (AMD) and to assess its activity. Methods In total, 137 eyes (102 patients) with MNV underwent a complete eye examination, including color fundus photography, optical coherence tomography (OCT), OCT angiography, and confocal color FAF, with an excitation wavelength at 450 nm. Each image was imported into a custom-image analysis software for quantitative estimation of emission wavelength and green and red emission fluorescence (GEFC/REFC) intensity, considering both single components of neovascular AMD and different MNV types (type 1 and type 2 MNV, active and inactive MNV). Results Subretinal fluid (SRF) had significantly higher values of GEFC (P = 0.008 and P = 0.0004) and REFC intensity (P = 0.005 and P = 0.0003) versus fibrosis and atrophy. The emission wavelength from SRF was lower compared to atrophy (P = 0.024) but not to fibrosis (P = 0.46). No significant differences were detected between type 1 and 2 MNV. Considering active versus inactive MNVs, a difference was detected for all evaluated parameters (P < 0.001). Mean FAF wavelength of both MNV with SRF and intraretinal fluid (IRF) was lower versus inactive MNV (P < 0.001 and P = 0.005). MNV with SRF (P < 0.001) had higher values of GEFC and REFC versus inactive MNV (P < 0.001). MNV with IRF had higher values of GEFC versus inactive MNV (P = 0.05). Conclusions Quantitative color FAF can differentiate active versus inactive MNV, whereas no differences were found between type 1 and type 2 MNV. If these data can be further confirmed, color FAF may be useful for automatic detection of active MNV in AMD and as a guide for treatment. Translational Relevance Automatic quantitative evaluation of green and red emission components of FAF in AMD can help determine the activity of MNV and guide the treatment.
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Affiliation(s)
- Stela Vujosevic
- Eye Clinic IRCCS MultiMedica, Milan, Italy.,University Hospital Maggiore della Carità, Eye Clinic, Novara, Italy
| | - Caterina Toma
- University Hospital Maggiore della Carità, Eye Clinic, Novara, Italy
| | - Valentina Sarao
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy.,Istituto Europeo di Microchirurgia Oculare-IEMO, Udine, Italy
| | - Daniele Veritti
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
| | - Marco Brambilla
- Department of Medical Physics, University Hospital Maggiore Della Carità, Novara, Italy
| | - Andrea Muraca
- University Hospital Maggiore della Carità, Eye Clinic, Novara, Italy
| | - Stefano De Cillà
- University Hospital Maggiore della Carità, Eye Clinic, Novara, Italy.,Department of Health Sciences, University East Piedmont "A. Avogadro," Novara, Italy
| | - Edoardo Villani
- Eye Clinic IRCCS MultiMedica, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paolo Nucci
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paolo Lanzetta
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy.,Istituto Europeo di Microchirurgia Oculare-IEMO, Udine, Italy
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Veritti D, Sarao V, Soppelsa V, Lanzetta P. Managing Diabetic Macular Edema in Clinical Practice: Systematic Review and Meta-Analysis of Current Strategies and Treatment Options. Clin Ophthalmol 2021; 15:375-385. [PMID: 33551641 PMCID: PMC7856351 DOI: 10.2147/opth.s236423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/22/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose This meta-analysis aims to summarize 12-month best-corrected visual acuity (BCVA) outcomes in response to anti-vascular endothelial growth factor (VEGF) therapy and dexamethasone implant for the treatment of diabetic macular edema (DME) and to identify factors affecting treatment response using evidence generated from meta-regression. Methods A systematic review of electronic databases was conducted to identify randomized controlled trials (RCTs) and real-life/observational studies that reported 12-month changes in BCVA in patients with DME on anti-VEGF or dexamethasone implant treatment in monotherapy. Study factors that were analyzed are baseline patient characteristics, study type, drug employed, number of injections and 12-month change in BCVA. Data were pooled in a random-effects meta-analysis with BCVA change as the main outcome. Meta-regression was conducted to assess the impact of multiple covariates. Results One-hundred-five heterogeneous study populations (45,032 eyes) were identified and included in the analysis. The use of anti-VEGFs and dexamethasone implant induced an overall increase of +8.13 ETDRS letters in BCVA at 12 months of follow-up. Meta-regression provided evidence that mean BCVA change using anti-VEGFs was not statistically higher for RCTs (p=0.35) compared to observational studies. Dexamethasone implant showed a trend for better results in observational studies over RCTs. Populations following a fixed aflibercept regimen performed better than those following a reactive treatment regimen. Mean BCVA gain was higher in younger populations (p<0.001), with lower baseline BCVA (p<0.0001) and longer diabetes duration (p<0.0001), receiving a higher number of injections (p<0.0001). Conclusion Intravitreal therapy with anti-VEGFs or dexamethasone implant produces a significant improvement in BCVA at 12 months in patients with DME. Meta-regression identified the modifiable covariates that can be targeted in order to maximize functional results.
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Affiliation(s)
- Daniele Veritti
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
| | - Valentina Sarao
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy.,Istituto Europeo di Microchirurgia Oculare (IEMO), Udine, Italy
| | - Valentina Soppelsa
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
| | - Paolo Lanzetta
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy.,Istituto Europeo di Microchirurgia Oculare (IEMO), Udine, Italy
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18
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Sarao V, Veritti D, Lanzetta P. Automated diabetic retinopathy detection with two different retinal imaging devices using artificial intelligence: a comparison study. Graefes Arch Clin Exp Ophthalmol 2020; 258:2647-2654. [DOI: 10.1007/s00417-020-04853-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/12/2020] [Accepted: 07/14/2020] [Indexed: 12/14/2022] Open
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Lanzetta P, Sarao V, Scanlon PH, Barratt J, Porta M, Bandello F, Loewenstein A. Correction to: Fundamental principles of an effective diabetic retinopathy screening program. Acta Diabetol 2020; 57:907-908. [PMID: 32419091 PMCID: PMC7311502 DOI: 10.1007/s00592-020-01541-5] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Authors would like to correct few errors in their publication which are listed below.
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Affiliation(s)
- Paolo Lanzetta
- Department of Medicine - Ophthalmology, University of Udine, Piazzale S. Maria della Misericordia, 33100, Udine, Italy.
- Istituto Europeo di Microchirurgia Oculare (IEMO), Udine, Italy.
| | - Valentina Sarao
- Department of Medicine - Ophthalmology, University of Udine, Piazzale S. Maria della Misericordia, 33100, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare (IEMO), Udine, Italy
| | - Peter H Scanlon
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Jane Barratt
- International Federation on Ageing, Toronto, Canada
| | - Massimo Porta
- Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Anat Loewenstein
- Department of Ophthalmology Tel Aviv Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lanzetta P, Sarao V, Scanlon PH, Barratt J, Porta M, Bandello F, Loewenstein A. Fundamental principles of an effective diabetic retinopathy screening program. Acta Diabetol 2020; 57:785-798. [PMID: 32222818 PMCID: PMC7311555 DOI: 10.1007/s00592-020-01506-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/14/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Diabetic retinopathy (DR) is the leading cause of blindness among working-age adults worldwide. Early detection and treatment are necessary to forestall vision loss from DR. METHODS A working group of ophthalmic and diabetes experts was established to develop a consensus on the key principles of an effective DR screening program. Recommendations are based on analysis of a structured literature review. RESULTS The recommendations for implementing an effective DR screening program are: (1) Examination methods must be suitable for the screening region, and DR classification/grading systems must be systematic and uniformly applied. Two-field retinal imaging is sufficient for DR screening and is preferable to seven-field imaging, and referable DR should be well defined and reliably identifiable by qualified screening staff; (2) in many countries/regions, screening can and should take place outside the ophthalmology clinic; (3) screening staff should be accredited and show evidence of ongoing training; (4) screening programs should adhere to relevant national quality assurance standards; (5) studies that use uniform definitions of risk to determine optimum risk-based screening intervals are required; (6) technology infrastructure should be in place to ensure that high-quality images can be stored securely to protect patient information; (7) although screening for diabetic macular edema (DME) in conjunction with DR evaluations may have merit, there is currently insufficient evidence to support implementation of programs solely for DME screening. CONCLUSION Use of these recommendations may yield more effective DR screening programs that reduce the risk of vision loss worldwide.
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Affiliation(s)
- Paolo Lanzetta
- Department of Medicine - Ophthalmology, University of Udine, Piazzale S. Maria della Misericordia, 33100, Udine, Italy.
- Istituto Europeo di Microchirurgia Oculare (IEMO), Udine, Italy.
| | - Valentina Sarao
- Department of Medicine - Ophthalmology, University of Udine, Piazzale S. Maria della Misericordia, 33100, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare (IEMO), Udine, Italy
| | - Peter H Scanlon
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Jane Barratt
- International Federation on Ageing, Toronto, Canada
| | - Massimo Porta
- Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Anat Loewenstein
- Department of Ophthalmology Tel Aviv Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Veritti D, Sarao V, Bandello F, Lanzetta P. Infection control measures in ophthalmology during the COVID-19 outbreak: A narrative review from an early experience in Italy. Eur J Ophthalmol 2020; 30:621-628. [PMID: 32418481 PMCID: PMC7265098 DOI: 10.1177/1120672120927865] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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] [Indexed: 12/21/2022]
Abstract
Introduction The novel coronavirus (SARS-CoV-2) is infecting people and spreading easily from person-to-person. Cases have been detected in most countries worldwide. Italy is one of the most affected countries as of 30 March 2020. Public health response includes a rapid reorganization of the Italian National Healthcare System in order to reduce transmission of COVID-19 within hospitals and healthcare facilities, while optimizing the assistance to patients with severe COVID-19 complications. Methods We analysed the actions that were taken in three ophthalmology centres in northern Italy during the SARS-CoV-2 outbreak and how these measures affected patient’s attendance. In addition, due to the rapidly evolving scenario, we reviewed the evidence available during the course of this pandemic. Results A full reorganization of ophthalmology services is mandatory according to current existing infection containment measures in order to continue dispensing urgent procedures without endangering the community with amplification of the diffusion chain. Ophthalmologists are considered at elevated risk of exposure when caring patients and vice versa, due to their close proximity during eye examination. High volumes of procedures typically generated by ophthalmologists with concurrent implications on the risk of infection are considered when re-assessing healthcare facilities reorganization. Conclusion Containment measures in the event of pandemic due to infective agents should be well known by healthcare professionals and promptly applied in order to mitigate the risk of nosocomial transmission and outbreak.
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Affiliation(s)
- Daniele Veritti
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy.,Department of Ophthalmology, Ospedale Santa Maria della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Valentina Sarao
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy.,Department of Ophthalmology, Ospedale Santa Maria della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy.,Istituto Europeo di Microchirurgia Oculare (IEMO), Udine, Italy
| | - Francesco Bandello
- Vita-Salute San Raffaele University, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Lanzetta
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy.,Department of Ophthalmology, Ospedale Santa Maria della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy.,Istituto Europeo di Microchirurgia Oculare (IEMO), Udine, Italy
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Veritti D, Sarao V, De Nadai K, Chizzolini M, Parmeggiani F, Perissin L, Lanzetta P. Dexamethasone Implant Produces Better Outcomes than Oral Acetazolamide in Patients with Cystoid Macular Edema Secondary to Retinitis Pigmentosa. J Ocul Pharmacol Ther 2020; 36:190-197. [DOI: 10.1089/jop.2018.0153] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Daniele Veritti
- Department of Medicine—Ophthalmology and University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare—IEMO, Udine, Italy
| | - Valentina Sarao
- Department of Medicine—Ophthalmology and University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare—IEMO, Udine, Italy
| | - Katia De Nadai
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Center for Retinitis Pigmentosa of Veneto Region, Camposampiero Hospital, Azienda ULSS 6 Euganea, Padova, Italy
| | - Marzio Chizzolini
- Center for Retinitis Pigmentosa of Veneto Region, Camposampiero Hospital, Azienda ULSS 6 Euganea, Padova, Italy
| | - Francesco Parmeggiani
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Center for Retinitis Pigmentosa of Veneto Region, Camposampiero Hospital, Azienda ULSS 6 Euganea, Padova, Italy
- Center for the Study of Inflammation, University of Ferrara, Ferrara, Italy
| | - Laura Perissin
- Department of Department of Medicine, University of Udine, Udine, Italy
| | - Paolo Lanzetta
- Department of Medicine—Ophthalmology and University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare—IEMO, Udine, Italy
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Veritti D, Sarao V, Samassa F, Danese C, Löwenstein A, Schmidt-Erfurth U, Lanzetta P. State-of-the art pharmacotherapy for non-neovascular age-related macular degeneration. Expert Opin Pharmacother 2020; 21:773-784. [PMID: 32153203 DOI: 10.1080/14656566.2020.1736557] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Age-related macular degeneration (AMD) is the most common cause of blindness among the elderly in the industrialized world. While effective treatment is available for neovascular AMD, no therapy is successful for the non-neovascular form. Herein, the authors report the current knowledge on non-neovascular AMD pathogenesis and the promising research on treatments. AREAS COVERED In the present review, the authors summarize the most recent advances in the treatment of non-neovascular AMD and provide an update on current treatment strategies. Evidence available from preclinical and clinical studies and from a selective literature search is reported. EXPERT OPINION When investigating AMD, numerous pathological cascades and alterations of physiological processes have been investigated. It is well-known that AMD is a multifactorial disease, with environmental causes and genetics playing a role. Perturbations in multiple pathogenic pathways have been identified and this led to the development of several molecules directed at specific therapeutic targets. However, despite the huge research effort, the only proven approach so far is oral antioxidant supplementation. We believe that, in addition to successful advancement of promising drugs, further research should be directed at tailoring therapy to specific patient groups, eventually employing a combinational therapy strategy.
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Affiliation(s)
- Daniele Veritti
- Department of Medicine - Ophthalmology, University of Udine , Udine, Italy
| | - Valentina Sarao
- Department of Medicine - Ophthalmology, University of Udine , Udine, Italy.,Istituto Europeo Di Microchirurgia Oculare (IEMO) , Udine, Italy
| | - Francesco Samassa
- Department of Medicine - Ophthalmology, University of Udine , Udine, Italy
| | - Carla Danese
- Department of Medicine - Ophthalmology, University of Udine , Udine, Italy
| | - Anat Löwenstein
- Division of Ophthalmology, Tel Aviv Medical Center , Tel Aviv, Israel
| | | | - Paolo Lanzetta
- Department of Medicine - Ophthalmology, University of Udine , Udine, Italy.,Istituto Europeo Di Microchirurgia Oculare (IEMO) , Udine, Italy
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Rajesh B, Zarranz-Ventura J, Fung AT, Busch C, Sahoo NK, Rodriguez-Valdes PJ, Sarao V, Mishra SK, Saatci AO, Udaondo Mirete P, Querques G, Farah ME, Lanzetta P, Arevalo JF, Kodjikian L, Chhablani J. Safety of 6000 intravitreal dexamethasone implants. Br J Ophthalmol 2019; 104:39-46. [PMID: 31040132 DOI: 10.1136/bjophthalmol-2019-313991] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the real-life safety profile of intravitreal dexamethasone implant injection for various retinal conditions. METHODS Retrospective multicenter analysis of intravitreal dexamethasone implant injections (700 µg) due to various retinal conditions including central retinal venous occlusion (1861 injections), diabetic macular oedema (3104 injections), post-surgical cystoid macular oedema (305 injections) and uveitis (381 injections). The eyes were evaluated mainly for the occurrence of adverse events such as glaucoma, cataract, retinal detachment and endophthalmitis along during the follow-up period. RESULTS A total of 6015 injections in 2736 eyes of 1441 patients (mean age of 65.7±12.9 years) were in total analysed over an average period of 18 months (range 6 months to 102 months). A total of 576 eyes (32.5% of the phakic eyes) developed cataract requiring surgical intervention. However, visually insignificant cataract progression was observed in another 259 phakic eyes (14.6%) which did not require surgical removal. A total of 727 eyes (26.5%) experienced an intraocular pressure (IOP) rise of >25 mm Hg, with 155 eyes (5.67%) having a prior history of glaucoma and 572 eyes (20.9%) having new onset IOP rise. Overall, more than 90% of eyes with IOP rise were managed medically, and 0.5% eyes required filtering surgery. Endophthalmitis (0.07%), retinal detachment (0.03%) and vitreous haemorrhage (0.03%) were rare. There was no significant change in visual acuity (p=0.87) and central macular thickness (p=0.12) at the last follow-up. CONCLUSION This is the largest real-life study assessing the safety of intravitreal dexamethasone implant injections in various retinal conditions. Cataract progression and intraocular pressure rise are the most common side effects, but are often rather easily manageable.
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Affiliation(s)
| | - Javier Zarranz-Ventura
- Hospital Clínic de Barcelona Insi, Instituto Clinic de Barcelona, Instituto Clinic de Oftalmología (ICOF), Barcelona, Spain
| | - Adrian T Fung
- Department of Ophthalmology, Westmead Hospital, Sydney, Australian Capital Territory, Australia.,Save Sight Institute, Sydney Eye Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Catharina Busch
- Department of Ophthalmology, Universitatsklinikum Leipzig, Leipzig, Germany
| | - Niroj Kumar Sahoo
- Vitreo-retina, L V Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
| | - Patricio J Rodriguez-Valdes
- Ophthalmology, Instituto de Oftalmología y Ciencias Visuales, Escuela de Medicina, Tecnológico de Monterrey, San Pedro Garza García, Mexico
| | - Valentina Sarao
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
| | | | | | | | | | - Michel Eid Farah
- Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - J Fernando Arevalo
- Retina and Vitreous, Clinica Oftalmologica Centro Caracas, Caracas, Venezuela
| | - Laurent Kodjikian
- Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France.,CNRS UMR 5510 Mateis, University of Lyon, Lyon, France
| | - Jay Chhablani
- Vitreo-retina, L V Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
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Sarao V, Veritti D, Maurutto E, Rassu N, Borrelli E, Loewenstein A, Sadda S, Lanzetta P. Pharmacotherapeutic management of macular edema in diabetic subjects undergoing cataract surgery. Expert Opin Pharmacother 2018; 19:1551-1563. [PMID: 30185069 DOI: 10.1080/14656566.2018.1516206] [Citation(s) in RCA: 6] [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: 12/15/2022]
Abstract
INTRODUCTION Cataracts and diabetes are widespread pathologies that are of growing concern to the global population. In diabetic patients who have had cataract surgery, the worsening of preexisting diabetic macular edema or occurrence of pseudophakic cystoid macular edema are common causes of visual impairment even with the most advanced surgical techniques available today for phacoemulsification. AREAS COVERED In this review, the authors assess the available literature to evaluate and compare different drugs, with the aim of establishing the best pharmacological strategies for the prevention and treatment of macular edema in diabetic patients undergoing cataract surgery. EXPERT OPINION Guidelines for the optimal management of diabetic macular edema in conjunction with cataract surgery or treatment of pseudophakic cystoid macular edema in diabetic patients are still lacking. To treat these conditions, clinicians need to understand the pharmacokinetics, posology, and efficacy of available drugs: topical non-steroidal anti-inflammatory drugs (NSAIDs), intravitreal anti-vascular endothelial growth factors (VEGFs), and both topical and intravitreal steroids. Diabetic patients undergoing cataract surgery should receive topical NSAIDs to prevent pseudophakic cystoid macular edema. Intravitreal anti-VEGFs and steroids, in association with cataract surgery, are indicated for patients with preexisting diabetic macular edema or those at high risk of macular edema after surgery.
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Affiliation(s)
- Valentina Sarao
- a Department of Medicine - Ophthalmology , University of Udine , Udine , Italy.,b Istituto Europeo di Microchirurgia Oculare (IEMO) , Udine , Italy
| | - Daniele Veritti
- a Department of Medicine - Ophthalmology , University of Udine , Udine , Italy.,b Istituto Europeo di Microchirurgia Oculare (IEMO) , Udine , Italy
| | - Erica Maurutto
- b Istituto Europeo di Microchirurgia Oculare (IEMO) , Udine , Italy
| | - Nicolò Rassu
- b Istituto Europeo di Microchirurgia Oculare (IEMO) , Udine , Italy
| | - Enrico Borrelli
- c Ophthalmology Clinic, Department of Medicine and Science of Ageing , University G. D'Annunzio Chieti-Pescara , Chieti , Italy
| | | | - Srinivas Sadda
- e Doheny Eye Institute , Los Angeles , CA , USA.,f Department of Ophthalmology, David Geffen School of Medicine , University of California , Los Angeles , CA , USA
| | - Paolo Lanzetta
- a Department of Medicine - Ophthalmology , University of Udine , Udine , Italy.,b Istituto Europeo di Microchirurgia Oculare (IEMO) , Udine , Italy
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Borrelli E, Nittala MG, Abdelfattah NS, Lei J, Hariri AH, Shi Y, Fan W, Cozzi M, Sarao V, Lanzetta P, Staurenghi G, Sadda SR. Comparison of short-wavelength blue-light autofluorescence and conventional blue-light autofluorescence in geographic atrophy. Br J Ophthalmol 2018; 103:bjophthalmol-2018-311849. [PMID: 29871967 PMCID: PMC6709768 DOI: 10.1136/bjophthalmol-2018-311849] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 01/03/2018] [Revised: 05/15/2018] [Accepted: 05/22/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND/AIMS To systematically compare the intermodality and inter-reader agreement for two blue-light confocal fundus autofluorescence (FAF) systems. METHODS Thirty eyes (21 patients) with a diagnosis of geographic atrophy (GA) were enrolled. Eyes were imaged using two confocal blue-light FAF devices: (1) Spectralis device with a 488 nm excitation wavelength (488-FAF); (2) EIDON device with 450 nm excitation wavelength and the capability for 'colour' FAF imaging including both the individual red and green components of the emission spectrum. Furthermore, a third imaging modality (450-RF image) isolating and highlighting the red emission fluorescence component (REFC) was obtained and graded. Each image was graded by two readers to assess inter-reader variability and a single image for each modality was used to assess the intermodality variability. RESULTS The 95% coefficient of repeatability (1.35 mm2 for the 488-FAF-based grading, 8.13 mm2 for the 450-FAF-based grading and 1.08 mm2 for the 450-RF-based grading), the coefficient of variation (1.11 for 488-FAF, 2.05 for 450-FAF, 0.92 for 450-RF) and the intraclass correlation coefficient (0.994 for 488-FAF, 0.711 for 450-FAF, 0.997 for 450-RF) indicated that 450-FAF-based and 450-RF-based grading have the lowest and highest inter-reader agreements, respectively. The GA area was larger for 488-FAF images (median (IQR) 2.1 mm2 (0.8-6.4 mm2)) than for 450-FAF images (median (IQR) 1.0 mm2 (0.3-4.3 mm2); p<0.0001). There was no significant difference in lesion area measurement between 488-FAF-based and 450-RF-based grading (median (IQR) 2.6 mm2 (0.8-6.8 mm2); p=1.0). CONCLUSION The isolation of the REFC from the 450-FAF images allowed for a reproducible quantification of GA. This assessment had good comparability with that obtained with 488-FAF images.
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Affiliation(s)
- Enrico Borrelli
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Medicine and Science of Ageing, Ophthalmology Clinic, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Muneeswar Gupta Nittala
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Nizar Saleh Abdelfattah
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jianqin Lei
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Amir H Hariri
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Yue Shi
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Wenying Fan
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Mariano Cozzi
- Department of Medicine and Ophthalmology, University of Udine Piazzale S. Maria della Misericordia, Udine, Italy
| | - Valentina Sarao
- Istituto Europeo di Microchirurgia Oculare-IEMO, Udine, Italy
- Eye Clinic, Department of Biomedical and Clinical Science 'Luigi Sacco', Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Paolo Lanzetta
- Istituto Europeo di Microchirurgia Oculare-IEMO, Udine, Italy
- Eye Clinic, Department of Biomedical and Clinical Science 'Luigi Sacco', Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Giovanni Staurenghi
- Department of Medicine and Ophthalmology, University of Udine Piazzale S. Maria della Misericordia, Udine, Italy
| | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Al-khersan H, Hariprasad SM, Chhablani J, Al-khersan H, Hariprasad SM, Chhablani JK, Agarwal K, Ansari W, Agrawal KU, Arevalo JF, Banker AS, Farah ME, Goel N, Gupta V, Jain NV, Lanzetta P, Loewenstein A, Mehrotra N, Modi A, Nagpal M, Rosenblatt A, Sarao V, Sarvaiya C, Singh RP, Veritti D, Yadav NK. Early Response to Intravitreal Dexamethasone Implant Therapy in Diabetic Macular Edema May Predict Visual Outcome. Am J Ophthalmol 2017; 184:121-128. [PMID: 29032109 DOI: 10.1016/j.ajo.2017.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/01/2017] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine whether early visual acuity response to intravitreal dexamethasone implant therapy in diabetic macular edema (DME) is associated with long-term outcome. DESIGN Retrospective case series. METHODS Multicenter (8 sites) retrospective review of medical records of eyes with DME treated with 0.7 mg intravitreal dexamethasone implant and minimum 18-month follow-up. One hundred and two eyes were included. Eyes with vitreoretinal interface abnormalities or that had undergone vitrectomy were excluded. Eyes were categorized into 3 groups based on change in best-corrected visual acuity (BCVA) at 3 months (logMAR equivalence of <5-letter, 5-9-letter, or ≥10-letter gain). Visual acuity outcomes were determined for each early response group. The relationship between early (3-month) and overall change in BCVA was assessed using regression analysis. RESULTS In the study population (102 eyes), <5-letter, 5- to 9-letter, and ≥10-letter BCVA improvements were seen in 44.1%, 18.6%, and 37.3% of eyes, respectively, at 3 months. Among suboptimal (<5-letter) responders at 3 months, 6.7% showed ≥10-letter gains at study conclusion compared to 29% in the robust (≥10-letter) early response group (P = .009). Change in BCVA at 3 months showed significant positive correlation with overall change in BCVA (coefficient = 0.44, P = .002). CONCLUSIONS A similar proportion of eyes demonstrated suboptimal (<5-letter) and robust (≥10-letter) early response to treatment at 3 months. Eyes with a robust early response demonstrated ≥10-letter long-term gain in BCVA at a significantly higher rate compared to those with poor early response. Early treatment response directly correlated with overall change in BCVA.
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Veritti D, Sarao V, Francescutti L, Rota N, Loewenstein A, Borrelli E, Sadda SR, Lanzetta P. Optical coherence tomography angiography findings in diabetic retinopathy. Expert Review of Ophthalmology 2017. [DOI: 10.1080/17469899.2017.1395698] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Daniele Veritti
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare - IEMO, Udine, Italy
| | - Valentina Sarao
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare - IEMO, Udine, Italy
| | | | - Nestore Rota
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
| | - Anat Loewenstein
- Ophthalmology Department, Tel Aviv Medical Center and The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Enrico Borrelli
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D’Annunzio Chieti-Pescara, Chieti, Italy
| | - Srinivas R. Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Paolo Lanzetta
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare - IEMO, Udine, Italy
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Borrelli E, Lei J, Balasubramanian S, Uji A, Cozzi M, Sarao V, Lanzetta P, Staurenghi G, Sadda SR. Green emission fluorophores in eyes with atrophic age-related macular degeneration: a colour fundus autofluorescence pilot study. Br J Ophthalmol 2017; 102:827-832. [DOI: 10.1136/bjophthalmol-2017-310881] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 07/31/2017] [Accepted: 08/29/2017] [Indexed: 11/03/2022]
Abstract
Background/AimsTo investigate the presence of short-wave fluorophores within regions of age-related macular degeneration (AMD)-associated macular atrophy (MA) area.MethodsThis is a prospective, observational, cross-sectional case series. 25 eyes (18 patients) with late AMD and clinically identified MA were enrolled. Eyes were imaged using a confocal light-emitting diode blue-light fundus autofluorescence (FAF) device (EIDON, CenterVue, Padua, Italy) with 450 nm excitation wavelength and the capability for ‘colour’ FAF imaging, including both the individual red and green components of the emission spectrum. To produce images with a high contrast for isolating the green component, the red component was subtracted from the total FAF image. The main outcome measure was the presence of green emission fluorescence component (GEFC) within the MA area. Volume spectral domain optical coherence tomography (SD-OCT) scans were obtained through the macula and the OCT was correlated with the MA lesions identified on the FAF images, including regions of increased GEFC.ResultsOf the investigated eyes, 11 out of 25 (44.0 %) showed the absence of GEFC in the MA area, whereas 14 eyes (56.0%) were characterised by GEFC within the MA area. The presence and distribution of GEFC in the MA area correlated with the presence of hyper-reflective material over Bruch’s membrane on the corresponding SD-OCT scans.ConclusionShort-wave fluorophores, which contribute to the GEFC, are present in the MA area and appear to correspond to residual debris or drusenoid material. Short-wavelength fluorophores revealed by colour FAF imaging may warrant further study.
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Abstract
INTRODUCTION Fluocinolone acetonide intravitreal implant is a non-erodible implant approved for the treatment of diabetic macular edema (DME) insufficiently responsive to available therapies. Areas covered: The injectable intravitreal implant releases fluocinolone acetonide at an average rate of 0.2 µg/day for at least 36 months. The two pooled pivotal FAME trials showed that, in patients with DME previously treated with laser photocoagulation, fluocinolone acetonide intravitreal implant was more beneficial than sham injection when looking at the proportion of patients with an improvement from baseline in visual acuity of more than 15 letters at 24 months and at 36 months. Cataract (82%) and intraocular pressure (IOP) elevation (37%) were the most common adverse events. Raised IOP was mostly treated with IOP-lowering medications, with <5% of eyes requiring incisional IOP-lowering surgery. FAME trial program results are confirmed by a series of real-world studies in eyes with chronic/recalcitrant DME. Expert opinion: data indicate that fluocinolone acetonide intravitreal implant is a useful second-line option for the treatment of DME.
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Affiliation(s)
- Daniele Veritti
- a Department of Medicine - Ophthalmology , University of Udine , Udine , Italy.,b Istituto Europeo di Microchirurgia Oculare (IEMO) , Udine , Italy
| | - Valentina Sarao
- b Istituto Europeo di Microchirurgia Oculare (IEMO) , Udine , Italy
| | - Laura Diplotti
- a Department of Medicine - Ophthalmology , University of Udine , Udine , Italy
| | - Francesco Samassa
- a Department of Medicine - Ophthalmology , University of Udine , Udine , Italy
| | - Paolo Lanzetta
- a Department of Medicine - Ophthalmology , University of Udine , Udine , Italy.,b Istituto Europeo di Microchirurgia Oculare (IEMO) , Udine , Italy
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Sarao V, Veritti D, Furino C, Giancipoli E, Alessio G, Boscia F, Lanzetta P. Dexamethasone implant with fixed or individualized regimen in the treatment of diabetic macular oedema: six-month outcomes of the UDBASA study. Acta Ophthalmol 2017; 95:e255-e260. [PMID: 28139100 DOI: 10.1111/aos.13395] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 12/16/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate a pro re nata administration of Ozurdex® implant versus a single administration for treating diabetic macular oedema (DME). METHODS This exploratory study is designed as a comparative, multicentre, randomized study with a follow-up of 6 months. Patients with DME were assigned to treatment at baseline either with a single Ozurdex® implant during the entire six-month follow-up (fixed group) or Ozurdex® implant followed by retreatment on an individualized basis (PRN group). Patients were scheduled for monthly evaluation based on assessment of best-corrected visual acuity (BCVA) and optical coherence tomography. RESULTS Twenty eyes were enrolled to the PRN group, and 22 were included in the fixed group. Following an equally steady, initial gain up to month 1, and maintenance up to month 3, vision started to decline in the fixed regimen group. At 6 months, a difference of 0.11 logMAR in BCVA was observed in favour of the PRN group. Compared to baseline, a significant reduction in retinal thickness was achieved up to month 2, when the fixed regimen group had begun to revert to pretreatment level. At 4 and 5 months, the difference in thickness between the two groups was statistically significant (p < 0.05). Mean number of treatments was 1.6 in the PRN group. Both fixed and PRN administration of Ozurdex showed a good safety profile. CONCLUSION A personalized treatment with monthly monitoring and retreatment as needed is effective in maintaining functional and anatomical benefits of Ozurdex® .
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Affiliation(s)
- Valentina Sarao
- Department of Medical and Biological Sciences - Ophthalmology; University of Udine; Udine Italy
- Istituto Europeo di Microchirurgia Oculare (IEMO); Udine Italy
| | - Daniele Veritti
- Department of Medical and Biological Sciences - Ophthalmology; University of Udine; Udine Italy
- Istituto Europeo di Microchirurgia Oculare (IEMO); Udine Italy
| | - Claudio Furino
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs; University of Bari-Policlinico; Bari Italy
| | | | - Giovanni Alessio
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs; University of Bari-Policlinico; Bari Italy
| | - Francesco Boscia
- Department of Ophthalmology; University of Sassari; Sassari Italy
| | - Paolo Lanzetta
- Department of Medical and Biological Sciences - Ophthalmology; University of Udine; Udine Italy
- Istituto Europeo di Microchirurgia Oculare (IEMO); Udine Italy
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Veritti D, Sarao V, Galiazzo F, Lanzetta P. Early Effects of Dexamethasone Implant on Macular Morphology and Visual Function in Patients with Diabetic Macular Edema. Ophthalmologica 2017; 238:100-105. [PMID: 28558371 DOI: 10.1159/000475889] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 04/19/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the early effects of dexamethasone implant in patients with diabetic macular edema (DME). METHODS Eyes with DME were prospectively included in the study. Best-corrected visual acuity (BCVA) measurement, complete ophthalmic evaluation, and spectral-domain optical coherence tomography were performed at baseline and 1, 2, 3, 7, 14, 21, 28, 60, and 90 days after treatment. RESULTS Twenty-three eyes of 20 patients were included in the study. Mean central retinal thickness (CRT) decreased rapidly after treatment (p < 0.0001, repeated measures ANOVA) from 511 μm at baseline to 469 μm after 1 day (p < 0.05), and 275 μm (p < 0.01) at the end of the follow-up. BCVA gain (p < 0.0001, repeated measures ANOVA) was on average +2 ETDRS letters at day 1 (not significant), +9 letters from day 28 to day 90 (p < 0.01). CONCLUSION Intravitreal dexamethasone implant showed an early and fast effect in reducing CRT and improving BCVA in DME patients.
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Affiliation(s)
- Daniele Veritti
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
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Sarao V, Bertoli F, Veritti D, Lanzetta P. Author’s response. Expert Opin Pharmacother 2015; 16:448. [PMID: 25741543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Affiliation(s)
- Valentina Sarao
- University of Udine, Department of Ophthalmology, Piazza Santa Maria della Misericordia, 33100 Udine, Italy ;
| | - Federica Bertoli
- University of Udine, Department of Ophthalmology, Piazza Santa Maria della Misericordia, 33100 Udine, Italy ;
| | - Daniele Veritti
- University of Udine, Department of Ophthalmology, Piazza Santa Maria della Misericordia, 33100 Udine, Italy ;
- Istituto Europeo di Microchirugia Oculare (IEMO), Udine, Italy
| | - Paolo Lanzetta
- University of Udine, Department of Ophthalmology, Piazza Santa Maria della Misericordia, 33100 Udine, Italy ;
- Istituto Europeo di Microchirugia Oculare (IEMO), Udine, Italy
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Abstract
The aim of this study is to report a case of complete regression of diabetic macular edema after subcutaneous injection of exenatide in a patient with type 2 diabetes mellitus. This study is an interventional case report. Blood investigations, complete ophthalmic examinations and optical coherence tomography were performed. A 55-year-old female affected by poorly controlled type 2 diabetes mellitus presented with visual impairment due to macular edema in the right eye. The left eye showed mild edema without visual loss. Best-corrected visual acuity (BCVA) was 20/80 and 20/20, respectively. The patient was encouraged to improve metabolic control, and the antidiabetic therapy was modified combining exenatide 10 μg subcutaneously twice daily to her regimen of oral metformin. The patient did not receive any ocular treatment. A complete tomographic resolution of macular edema was observed after 1 month and BCVA improved to 20/63. These findings were confirmed for the entire 6-month follow-up duration. No ocular or non-ocular adverse events were recorded. This is the first reported case of complete regression of macular edema in a diabetic patient after subcutaneous injection of exenatide.
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Affiliation(s)
- Valentina Sarao
- Department of Ophthalmology, University of Udine, Piazzale Santa Maria della Misericordia, Udine, Italy
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Sarao V, Veritti D, Prosperi R, Pignatto S, Lanzetta P. A case of CRB1-negative Coats-like retinitis pigmentosa. J AAPOS 2013; 17:414-6. [PMID: 23871396 DOI: 10.1016/j.jaapos.2013.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 10/23/2012] [Revised: 02/18/2013] [Accepted: 02/26/2013] [Indexed: 11/19/2022]
Abstract
Retinitis pigmentosa is a heterogeneous group of ocular diseases that causes progressive degeneration of the photoreceptor cells mainly affecting the rods of the peripheral retina. The association between retinitis pigmentosa and exudative retinopathy was first described in 1956 and has been called "Coats-like retinitis pigmentosa." Mutations in the Crumbs homolog 1 (CRB1) gene have been reported as a risk factor for developing Coats-like changes in patients with autosomal recessive retinitis pigmentosa. We report the case of a 15-year-old girl affected by CRB1 gene-negative retinitis pigmentosa and Coats-like exudative vasculopathy who was successfully treated with laser photocoagulation.
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Veritti D, Sarao V, Lanzetta P. New advances in retina: a report from the International Symposium on Ocular Pharmacology and Therapeutics meeting. Expert Review of Ophthalmology 2013. [DOI: 10.1586/eop.13.15] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Veritti D, Sarao V, Lanzetta P. Bevacizumab and Triamcinolone Acetonide for Choroidal Neovascularization Due to Age-Related Macular Degeneration Unresponsive to Antivascular Endothelial Growth Factors. J Ocul Pharmacol Ther 2013; 29:437-41. [DOI: 10.1089/jop.2012.0173] [Citation(s) in RCA: 14] [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: 11/13/2022] Open
Affiliation(s)
- Daniele Veritti
- Department of Ophthalmology, University of Udine, Udine, Italy
| | - Valentina Sarao
- Department of Ophthalmology, University of Udine, Udine, Italy
| | - Paolo Lanzetta
- Department of Ophthalmology, University of Udine, Udine, Italy
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Abstract
PURPOSE Neovascular age-related macular degeneration (AMD) is a leading cause of blindness, with an increasing incidence as the elderly population expands. Large, multi-center, randomized, clinical trials have been conducted exploring the safety and efficacy of anti-VEGF treatments. This paper aims to discuss the safety and efficacy of pegaptanib, ranibizumab, aflibercept and bevacizumab. New therapeutic agents and treatment strategies are also discussed. PROCEDURES Evidence available from prospective, multicenter, clinical studies and from a selective literature search is utilized to present the results of VEGF inhibition in neovascular AMD and to generate evidence-based recommendations. RESULTS Anti-VEGF treatment is indicated in choroidal neovascularization with active disease and produces a significant benefit in visual acuity. CONCLUSIONS With the advent of anti-VEGF therapy, the prognosis of choroidal neovascularization has changed dramatically. Data from well-conducted clinical trials suggest that approved anti-VEGF drugs are effective and well tolerated.
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Affiliation(s)
- Daniele Veritti
- Department of Ophthalmology, University of Udine, Udine, Italy
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Abstract
INTRODUCTION Triamcinolone acetonide (TA) is a steroidal drug that has been widely administered intravitreally for retinal and choroidal conditions. Safety of steroidal products for intraocular use is essential because of their risk of ocular adverse events. This review comprehensively discusses the safety of intravitreal administration of TA. AREAS COVERED This paper analyzes the mechanisms of action and key pharmacokinetic attributes and provides a discussion of the main clinical trials investigating clinical applications of intravitreal TA. The safety of intravitreal TA is evaluated through a search of the Medline database from 1980 to 2011. The most relevant literature on the safety of intravitreal TA is also discussed. EXPERT OPINION The complications of intravitreal TA therapy include secondary ocular hypertension in about 20 - 40% of eyes, steroid-induced cataract in about 15 - 20% of cases and postinjection infectious endophthalmitis and pseudoendophthalmitis in less than 1%. TA is an effective drug for various retinal and choroidal diseases when delivered intravitreally. It may imply an off-label use and it may be associated with ocular adverse events. Intravitreal TA is not associated with significant systemic safety risks.
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Affiliation(s)
- Daniele Veritti
- University of Udine, Department of Ophthalmology, P.le S. Maria della Misericordia, 33100 Udine, Italy
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Veritti D, Sarao V, Lanzetta P. Update on combination therapy in wet age-related macular degeneration. Expert Review of Ophthalmology 2010. [DOI: 10.1586/eop.10.62] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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