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Wykoff CC, Garmo V, Tabano D, Menezes A, Kim E, Fevrier HB, LaPrise A, Leng T. Impact of Anti-VEGF Treatment and Patient Characteristics on Vision Outcomes in Neovascular Age-related Macular Degeneration: Up to 6-Year Analysis of the AAO IRIS® Registry. Ophthalmol Sci 2024; 4:100421. [PMID: 38187126 PMCID: PMC10767511 DOI: 10.1016/j.xops.2023.100421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 01/09/2024]
Abstract
Purpose To evaluate anti-VEGF treatment patterns and the influence of patient demographic and clinical characteristics on up to 6-year vision outcomes in neovascular age-related macular degeneration. Design Retrospective, multicenter, noninterventional registry study with up to 6 years of follow-up. Participants A cohort of 254 655 eyes (226 767 patients) with first anti-VEGF injection and at least 2 years of follow-up; 160 423 eyes had visual acuity (VA) data. Methods Anonymized patient data were collected in the United States through the IRIS® Registry (Intelligent Research in Sight). Main Outcome Measures Changes in VA from baseline; frequency of and gaps between intravitreal anti-VEGF injections; treatment discontinuations; switching anti-VEGF agents; and influence of baseline clinical and demographic characteristics on VA. Results After a mean VA increase of 3.0 ETDRS letters at year 1, annual decreases led to a net loss from baseline of 4.6 letters after 6 years. Patients with longer follow-ups had better baseline and follow-up VA. From a mean of 7.2 in year 1 and 5.6 in year 2, mean injections plateaued between 4.2 to 4.6 in years 3 through 6. Treatment was discontinued in 38.8% of eyes and switched in 32.3%. When adjusting for differences at baseline, every additional injection resulted in a 0.68 letter improvement from baseline to year 1; thus, multiple injections in a year have the potential to be clinically meaningful. Older age, male gender, Medicaid insurance, and not being treated by a retina specialist were associated with a higher likelihood of vision loss at year 1. Of the patients, 58.5% lost ≥ 10 letters VA at least once during follow-up, with 14.5% of patients experiencing sustained poor vision after a median of 3.4 years. Conclusions After modest mean VA improvement with intravitreal anti-VEGF injections at year 1, patients netted a loss of VA by year 6. Injection frequency decreased over time, and this was paired with a relatively high rate of discontinuation. Modeling suggested that more frequent injections were associated with better VA. Difficulty with continuous adherence to frequent intravitreal injections may have contributed to undertreatment resulting in less-than-optimal vision outcomes. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Charles C. Wykoff
- Retinal Consultants of Texas, Retina Consultants of America, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | | | - David Tabano
- Genentech, Inc., South San Francisco, California
| | | | - Eunice Kim
- Genentech, Inc., South San Francisco, California
| | | | | | - Theodore Leng
- Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, California
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2
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Singh R, Davoudi S, Ness S. Preventive factors, diagnosis, and management of injection-related endophthalmitis: a literature review. Graefes Arch Clin Exp Ophthalmol 2022; 260:2399-2416. [PMID: 35278125 PMCID: PMC8917335 DOI: 10.1007/s00417-022-05607-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Intravitreal medication injections represent the gold standard treatment for a variety of potentially blinding chorioretinal vascular diseases. Despite their excellent safety profile, they are associated with the feared complication of injection-related endophthalmitis (IRE). Though the overall incidence of IRE is low, due to the ever-increasing number of injections being performed, it is a complication that all retina specialists are likely to encounter. This article reviews various factors that could potentially influence the risk of IRE and discusses evidence-based strategies for management. METHOD PubMed was searched for keywords "intravitreal injection" and "endophthalmitis" from the period of 1995-2021. Relevant articles were reviewed and selected articles were analyzed with respect to the incidence, potential preventive factors, clinical presentation, microbial profile, management, and outcomes for IRE. RESULTS There is strong consensus supporting the use of povidone iodine topical antiseptic, eyelid retraction away from the injection site, and avoiding treatment of eyes with active surface or eyelid disease, but there is less agreement on the use of face masks versus "no-talking" policies and optimal anesthetic technique. Current evidence comparing tap and inject or early vitrectomy for treatment of IRE is inadequate to determine an optimal treatment strategy. CONCLUSION Intravitreal injections are sight saving, but even using established prophylactic measures there remains a small but real risk of infectious injection-related complications. Further investigations comparing tap and inject versus vitrectomy may help to establish optimal treatment, although the rarity of IRE makes designing adequately powered prospective trials a difficult task.
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Affiliation(s)
| | - Samaneh Davoudi
- Boston Medical Center, 85 East Concord Street, 8th Floor, Boston, MA, 02118, USA
| | - Steven Ness
- Boston Medical Center, 85 East Concord Street, 8th Floor, Boston, MA, 02118, USA.
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Rizwan A, Asghar A, Sughra U, Yasmin N. Endophthalmitis Postintravitreal Bevacizumab Injections: Incidence, Management, and Visual Outcome in Tertiary Care Center in Pakistan. Oman J Ophthalmol 2022; 15:20-24. [PMID: 35388253 PMCID: PMC8979382 DOI: 10.4103/ojo.ojo_103_21] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/23/2021] [Accepted: 08/28/2021] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The purpose is to study the incidence, characteristics, management, and visual outcome of endophthalmitis postintravitreal bevacizumab (Avastin®) injections. METHODS Retrospective cohort study conducted at Fauji Foundation Hospital that is a tertiary care center in Rawalpindi, Pakistan. The study duration was from January 1, 2015 to March 31, 2020. A total of 2321 eyes of 1407 patients were treated with Intravitreal bevacizumab (IVB) in a minor operation theater using standard aseptic measures. We studied the incidence, clinical characteristics, treatment, and visual outcomes of endophthalmitis post-IVB. RESULTS Seven eyes (0.30%) out of 2321 eyes developed post-IVB endophthalmitis during the study period. Three eyes (42.8%) were culture positive and four eyes (57.2%) were culture negative. Five eyes (71.4%) showed visual improvement and two eyes (28.6%) did not show visual improvement. CONCLUSION Prompt intravitreal antibiotic along with vitreous tap in cases of postintravitreal endophthalmitis may prevent vision loss which provides a useful alternative to immediate pars plana vitrectomy that requires more expertise, equipment, and an operation theater.
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Affiliation(s)
- Amna Rizwan
- Department of Ophthalmology, KEMU, Lahore, Pakistan,Address for correspondence: Dr. Amna Rizwan, Department of Ophthalmology, KEMU, Lahore, Pakistan. E-mail:
| | - Asfandyar Asghar
- Department of Ophthalmology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Ume Sughra
- Department of Community Medicine, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Naila Yasmin
- Department of Ophthalmology, Fauji Foundation Hospital, Rawalpindi, Pakistan
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4
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Mounirou BAM, Adam ND, Yakoura AKH, Aminou MSM, Liu YT, Tan LY. Diabetic Retinopathy: An Overview of Treatments. Indian J Endocrinol Metab 2022; 26:111-118. [PMID: 35873941 PMCID: PMC9302419 DOI: 10.4103/ijem.ijem_480_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 03/04/2022] [Accepted: 03/16/2022] [Indexed: 11/21/2022] Open
Abstract
Diabetic retinopathy (DR), substantially impacts the quality of life of diabetic patients, it remains, in developed countries, the leading cause of vision loss in working-age adults (20-65 years). Currently, about 90 million diabetics suffer from DR. DR is a silent complication that in its early stages is asymptomatic. However, over time, chronic hyperglycemia can lead to sensitive retinal damage, leading to fluid accumulation and retinal haemorrhage (HM), resulting in cloudy or blurred vision. It can, therefore, lead to severe visual impairment or even blindness if left untreated. It can be classified into nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). NPDR is featured with intraretinal microvasculature changes and can be further divided into mild, moderate, and severe stages that may associate with diabetic macular oedema (DME). PDR involves the formation and growth of new blood vessels (retinal neovascularisation) under low oxygen conditions. Early identification and treatment are key priorities for reducing the morbidity of diabetic eye disease. In the early stages of DR, a tight control of glycemia, blood pressure, plasma lipids, and regular monitoring can help prevent its progression to more advanced stages. In advanced stages, the main treatments of DR include intraocular injections of anti-vascular endothelial growth factor (VEGF) antibodies, laser treatments, and vitrectomy. The aim of this review is to provide a comprehensive overview of the published literature pertaining to the latest progress in the treatment of DR.
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Affiliation(s)
- Bassirou A. M. Mounirou
- Department of Endocrinology and Metabolic Diseases, First Affiliated Hospital of Jiamusi University, Jiamusi, China
| | - Nouhou D. Adam
- Department of Ophthalmology, Lamorde National Hospital, Niamey, Niger
| | | | - Mahamane S. M. Aminou
- Department of Endocrinology and Metabolic Diseases, General Reference Hospital of Niamey, Niger
| | - Yu T. Liu
- Department of Ophthalmology, Lamorde National Hospital, Niamey, Niger
| | - Li Y. Tan
- Department of Endocrinology and Metabolic Diseases, First Affiliated Hospital of Jiamusi University, Jiamusi, China
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Ogura Y, Iida T, Lee WK, Cheung CMG, Mitchell P, Leal S, Schmelter T, Ishibashi T. Efficacy and safety of intravitreal aflibercept for polypoidal choroidal vasculopathy: 96-week outcomes in the Japanese subgroup of the PLANET study. Jpn J Ophthalmol 2021; 65:344-353. [PMID: 33474611 DOI: 10.1007/s10384-020-00805-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/31/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of intravitreal aflibercept (IVT-AFL) versus IVT-AFL plus rescue photodynamic therapy (IVT-AFL + rPDT) in the subgroup of Japanese patients with polypoidal choroidal vasculopathy (PCV) enrolled in the PLANET study. STUDY DESIGN A 96-week, double-masked, sham-controlled phase-3b/4 randomized clinical trial conducted at multiple centers from May 2014 to August 2016. PATIENTS AND METHODS Patients with PCV (BCVA 73-24 ETDRS letters [20/40-20/320 Snellen]) received 3 initial monthly doses of IVT-AFL 2 mg. At week 12, the patients were randomly assigned 1:1 to IVT-AFL + sham PDT or IVT-AFL + rPDT. Patients not requiring rescue received IVT-AFL every 8 weeks; those requiring rescue received IVT-AFL monthly plus sham/active PDT. Following week 52, the treatment intervals could be extended > 8 weeks. RESULTS The baseline demographics for the 159 Japanese patients were balanced. At week 96, the mean BCVA change was + 9.7 (IVT-AFL) versus + 9.5 letters (IVT-AFL + rPDT) (least-squares mean difference of - 0.3; 95% CI, - 3.7 to 3.1); the mean central subfield thickness reduction was - 148.0 µm versus - 145.9 µm. Overall, 17.1% of the patients required rescue PDT. At week 96, 25.0% (IVT-AFL) and 37.9% (IVT-AFL + rPDT) of the patients had complete polyp regression; 84.1% (IVT-AFL) and 88.4% (IVT-AFL + rPDT) of the patients had no evidence of active polyps. The mean number of injections (weeks 52-96) were 4.6 (IVT-AFL) and 4.5 (IVT-AFL + rPDT). Overall, 36.0% (IVT-AFL) and 33.8% (IVT-AFL + rPDT) of the patients experienced ocular treatment-emergent adverse events. CONCLUSION IVT-AFL monotherapy was efficacious for the treatment of Japanese patients with PCV, and the addition of rescue PDT did not show additional benefits.
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Affiliation(s)
- Yuichiro Ogura
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601, Japan.
| | - Tomohiro Iida
- Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Chui Ming Gemmy Cheung
- Singapore National Eye Centre and Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS, National University of Singapore, Singapore, Singapore
| | - Paul Mitchell
- University of Sydney, Westmead Institute for Medical Research, Sydney, Australia
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Badawi AH, Semidey VA, Magliyah M, Al-Dhibi H. Updated Systematic Review and Clinical Spectrum of Peripheral Exudative Hemorrhagic Chorioretinopathy. Middle East Afr J Ophthalmol 2020; 27:4-9. [PMID: 32549717 PMCID: PMC7276165 DOI: 10.4103/meajo.meajo_85_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/12/2020] [Accepted: 04/17/2020] [Indexed: 11/20/2022] Open
Abstract
Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is a rare retinal vasculopathy that might cause subretinal and/or vitreous hemorrhages. Although the primary etiology is still unknown, choroidal neovascularization is mainly involved in the pathogenesis. The main risk factors are age and systemic hypertension. Ancillary testing such as fluorescein angiography, indocyanine green angiography and ultrasonography can be of great value for diagnosing this entity and distinguishing PEHCR from other lesions as choroidal melanoma and retinal vasoproliferative tumor. Various treatments have been reported including photocoagulation, cryotherapy, intravitreal injection of anti-vascular endothelial growth factor (Anti-VEGF) and surgical intervention as pars plana vitrectomy. This review handles an up-to-date perspective regarding PEHCR.
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Affiliation(s)
| | - Valmore A Semidey
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Moustafa Magliyah
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology, Prince Mohammed Medical City, AlJouf, Saudi Arabia
| | - Hassan Al-Dhibi
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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7
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Wakuta M, Nomi N, Ogata T, Ota M, Yamashiro C, Hatano M, Yanai R, Tokuda K, Kimura K. A Trinity regimen with aflibercept for treatment-naïve neovascular age-related macular degeneration: 2-year outcomes. Graefes Arch Clin Exp Ophthalmol 2020; 258:1663-70. [PMID: 32436085 DOI: 10.1007/s00417-020-04745-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/02/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To evaluate the advantages of the Trinity regimen for treatment-naïve neovascular age-related macular degeneration (nAMD). METHODS Thirty-one treatment-naïve nAMD eyes were treated using the Trinity regimen with an intravitreal aflibercept injection (IVA) and evaluated after 24 months. Three treatment methods, pro re nata (PRN), treat and extend (TAE), and fixed regimen were changed depending on recurrence frequency. After the initial treatment, PRN or TAE (started for 4 or 8 weeks) was selected as per the recurrence interval. Subsequently, the recurrence interval became constant, transitioning from a TAE to fixed regimen. When the recurrence frequency became irregular, the treatment regimen was changed to TAE. RESULTS After the initial treatment, 15 eyes (48.4%) were allocated to the PRN group, 12 (38.7%) to the TAE 8-week group, and 4 (12.9%) to the TAE 4-week group. Mean logMAR significantly improved in all cases, 0.53 ± 0.40 at baseline to 0.36 ± 0.34 at 24 months (p < 0.01), in the PRN group (0.63 ± 0.46 to 0.42 ± 0.43, p < 0.01), and the TAE 8-week group (0.44 ± 0.29 to 0.27 ± 0.19, p < 0.05). LogMAR in the TAE 4-week group was maintained. The mean number of injections for all and in the PRN, TAE 8-week, and TAE 4-week groups were 9.7, 5.3, 13.1, and 15.8, respectively, with the PRN group being significantly less (p < 0.01). CONCLUSION The Trinity regimen delivered the benefits of the PRN, TAE, and FIXED regimens while minimizing injections during the early treatment phase without visual loss. TRIAL REGISTRATION This trial was registered with the University Hospital Medical Information Network (UMIN ID: 000038335).
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Sen P, Abraham S, Jain S, Gopal L, Bhende P. Treatment outcomes of zone 1 retinopathy of prematurity: A study from a tertiary eye care center in South India. Taiwan J Ophthalmol 2020; 9:255-261. [PMID: 31942431 PMCID: PMC6947749 DOI: 10.4103/tjo.tjo_62_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/16/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE: The main purpose is to study the treatment outcomes of zone 1 retinopathy of prematurity (ROP). MATERIALS AND METHODS: A retrospective analysis was done of infants diagnosed with zone 1 ROP with any stage with or without plus disease who were treated with either laser photocoagulation and/or intravitreal injection of antivascular endothelial growth factor (anti-VEGF) agents and/or underwent surgery according to their stage at presentation. The retinal outcome at the final visit was analyzed. A favorable outcome was characterized by an attached retina at the posterior pole with regression of ROP (regression of plus disease as well as new vessels) while an unfavorable outcome was detached retina at posterior pole in spite of treatment. RESULTS: Seventy-eight eyes of 39 infants presented with zone 1 ROP in various stages with plus disease in 50% cases. About 60 eyes underwent treatment. Forty eyes (66.6%) had an attached retina at the final follow-up. Thirty-three eyes (55%) underwent monotherapy with 14 eyes (23.3%) showing regression of ROP with laser alone. Nineteen (31.6%) eyes were treated only by surgery. Of these, a favorable outcome was seen in four eyes (44.4%) with Stage 4 disease and three eyes (30%) with Stage 5 disease. None of the eyes received anti-VEGF as monotherapy. A combination of two or more modalities was required in the remaining 27 eyes (45%). Six eyes (10%) needed anti-VEGF injections in addition to laser and six eyes needed surgery in addition to laser to achieve a favorable outcome. Six eyes (10%) required surgery in addition to both laser and anti-VEGF therapy, and one eye (1.6%) required surgery in addition to anti-VEGF therapy for a favorable final outcome. Among the eyes undergoing treatment, 66.6% had a favorable outcome with 92.9% of eyes in Stage 3, 59% in Stage 4, and 33% in Stage 5 showing regression of disease and attached retina. CONCLUSION: In spite of the aggressive nature of zone 1 ROP, favorable outcome is possible as was seen in 66.6% of our cases. A multipronged approach using a combination of laser, intravitreal anti-VEGF agents with or without surgery may be necessary for the management of these eyes.
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Affiliation(s)
- Parveen Sen
- Department of Retina, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sharanya Abraham
- Department of Uvea, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Smriti Jain
- Department of Retina, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Lingam Gopal
- Department of Retina, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Pramod Bhende
- Department of Retina, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Chen YY, Chou P, Huang YF, Chien HJ, Wu YC, Lee CC, Huang LY, Chen HH. Repeated intravitreal injections of antivascular endothelial growth factor in patients with neovascular age-related macular degeneration may increase the risk of ischemic optic neuropathy. BMC Ophthalmol 2019; 19:268. [PMID: 31888553 PMCID: PMC6937927 DOI: 10.1186/s12886-019-1284-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 12/23/2019] [Indexed: 12/12/2022] Open
Abstract
Background Previous case reports have demonstrated the occurrence of ischemic optic neuropathy (ION) following intravitreal injections of antivascular endothelial growth factor (anti-VEGF). However, no previous studies have investigated the impact of injection numbers on the risk of ION. The aim of our study was to investigate whether repeated intravitreal injections of anti-VEGF would increase the risk of subsequent ION in patients with neovascular age-related macular degeneration (AMD). Methods A population-based, retrospective cohort study using the Taiwan National Health Insurance Research Database was conducted from 2007 to 2013. Neovascular AMD patients receiving intravitreal injections of anti-VEGF during the study period were enrolled in the study cohort. Enrollees were divided into three groups according to the categorized levels of injection number (first level: < 10 times, second level: 10–15 times, and third level: > 15 times). Kaplan-Meier curves were generated to compare the cumulative hazard of subsequent ION among the three groups. Cox regression analyses were used to estimate crude and adjusted hazard ratios (HRs) for ION development with respect to the different levels of injection numbers. The confounders included for adjustment were age, sex, and comorbidities (diabetes, hypertension, hyperlipidemia, ischemic heart disease, and glaucoma). Results In total, the study cohort included 77,210 patients. Of these, 26,520, 38,010, and 12,680 were in the first-, second-, and third-level groups, respectively. The Kaplan-Meier method revealed that the cumulative hazards of ION were significantly higher in those who had a higher injection number. After adjusting for confounders, the adjusted HRs for ION in the second- and third-level groups were 1.91 (95% confidence interval [CI], 1.32–2.76) and 2.20 (95% CI, 1.42–3.43), respectively, compared with those in the first-level group. Conclusions Among patients with neovascular AMD, those who receive a higher number of anti-VEGF injections have a significantly higher risk of developing ION compared with individuals who receive a lower number of injections.
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Affiliation(s)
- Yu-Yen Chen
- Department of Ophthalmology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
| | - Pesus Chou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Fang Huang
- Department of Ophthalmology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Hung-Jen Chien
- Department of Ophthalmology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Yu-Chieh Wu
- Department of Ophthalmology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Chia-Chi Lee
- Department of Ophthalmology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Li-Ying Huang
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei, Taiwan.,Department of Medical Education, Fu Jen Catholic University Hospital, New Taipei, Taiwan
| | - Hsin-Hua Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Biomedical Science and Rong-Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, Taiwan
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10
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Hsia Y, Yang CH, Hsieh YT, Yang CM, Ho TC, Lai TT. Hyperreflective foci in predicting the treatment outcome of antivascular endothelial growth factor in neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2019; 258:273-280. [PMID: 31828425 DOI: 10.1007/s00417-019-04546-1] [Citation(s) in RCA: 14] [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] [Received: 08/19/2019] [Revised: 11/04/2019] [Accepted: 11/11/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To describe the optical coherence tomographic findings of hyperreflective foci (HF) in neovascular age-related macular degeneration and evaluate the use of HF to predict visual outcome after antivascular endothelium growth factor (anti-VEGF) therapy. METHODS This was a post-hoc analysis of a retrospective cohort study. Hyperreflective foci were localized in the inner retina, outer retina, or subretinal fluid (SRF) layer. The treatment response of HF was recorded. The association between HF and visual outcome was analyzed. RESULTS We enrolled 126 eyes. Hyperreflective foci involving more than one layer were associated with poor initial visual acuity (P < 0.001). Hyperreflective foci in each layer at baseline were negatively correlated with baseline visual acuity. At 3 months posttreatment, HF in the SRF layer had decreased significantly (P = 0.003), which was faster compared with HF in other layers. Baseline HF status at each layer was not associated with final visual outcome. The eyes with reduced HF in the SRF at 3 months had better visual improvement at 12 months (P = 0.038). CONCLUSION Hyperreflective foci involving multiple layers were associated with poor initial visual acuity but not with final visual outcome. With anti-VEGF treatment, HF in the SRF layer resolved faster, which may predict better visual outcome.
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Affiliation(s)
- Yun Hsia
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tzyy-Chang Ho
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tso-Ting Lai
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan. .,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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11
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Kimura S, Morizane Y, Hosokawa MM, Shiode Y, Doi S, Hosogi M, Fujiwara A, Okanouchi T, Inoue Y, Shiraga F. Outcomes of vitrectomy combined with subretinal tissue plasminogen activator injection for submacular hemorrhage associated with polypoidal choroidal vasculopathy. Jpn J Ophthalmol 2019; 63:382-388. [PMID: 31243593 DOI: 10.1007/s10384-019-00679-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To examine the outcomes of vitrectomy with subretinal tissue plasminogen activator (tPA) injection and postoperative intravitreal antivascular endothelial growth factor (VEGF) injection for submacular hemorrhage (SMH) associated with polypoidal choroidal vasculopathy (PCV). STUDY DESIGN Retrospective, consecutive case series. METHODS Patients who underwent vitrectomy for SMH associated with PCV and who were followed up for at least 12 months were included. Surgery consisted of vitrectomy with subretinal tPA and air tamponade. Postoperative intravitreal anti-VEGF was administered pro re nata. The following were examined: best-corrected visual acuity (BCVA) at baseline, at 1 month, and at the final visit; the percentage of patients requiring anti-VEGF postoperatively; and the number of injections administered. RESULTS This study included 23 eyes of 23 patients (21 men, 2 women) with a mean age of 72.5 ± 9.0 years. The mean duration from disease onset to surgery was 9.0 ± 6.6 days. The mean maximum SMH size was 5.8 ± 4.8 disc diameters. The mean follow-up period was 33 ± 14 months. The BCVA was significantly improved when compared with baseline 1 month after surgery and at the final visit. Postoperative anti-VEGF was required for 91% of the eyes. In eyes that underwent anti-VEGF therapy until the final visit, the mean injection number was 4.1/year. CONCLUSIONS Vitrectomy with subretinal tPA and air tamponade improved visual acuity in patients with SMH associated with PCV. Postoperative intravitreal anti-VEGF injection maintained the improved BCVA throughout a mean period of 33 months.
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Affiliation(s)
- Shuhei Kimura
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yuki Morizane
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Mio Morizane Hosokawa
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yusuke Shiode
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Shinichiro Doi
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Mika Hosogi
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Atsushi Fujiwara
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | | | | | - Fumio Shiraga
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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12
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Juncal VR, Francisconi CLM, Altomare F, Chow DR, Giavedoni LR, Muni RH, Berger AR, Wong DT. Same-Day Bilateral Intravitreal Anti-Vascular Endothelial Growth Factor Injections: Experience of a Large Canadian Retina Center. Ophthalmologica 2019; 242:1-7. [PMID: 30928983 DOI: 10.1159/000499115] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/25/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the outcomes and complications of bilateral same-day intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections. METHODS This is a single-center, retrospective study that included 524 eyes of 262 patients who received concomitant bilateral intravitreal anti-VEGF injections in 2016 at St. Michael's Hospital, Toronto. If any of the patients were receiving simultaneous bilateral injections on a regular basis prior to 2016, data pertaining to previous injections were also reviewed. Everyone received bevacizumab, ranibizumab, or aflibercept in an office setting. RESULTS A total of 9,798 intravitreal anti-VEGF injections (4,899 bilateral injection sessions) were performed in 524 eyes of 262 patients. The average number of bilateral injection sessions per patient was 18.7 ± 14.1. Ranibizumab was the most commonly used anti-VEGF drug (83.8%). The incidence of endophthalmitis was 0.01%, and there were 2 episodes of acute intraocular inflammation among the 9,798 injections (0.02%). All 3 cases occurred after treatment with ranibizumab. There were 2 deaths (0.76%) due to nonvascular causes but no vascular related systemic adverse events were reported. CONCLUSIONS Same-day bilateral intravitreal anti-VEGF injections present a low rate of complications and are well tolerated by patients. This safe practice may reduce the burden on the health-care system and on the patients.
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Affiliation(s)
- Verena R Juncal
- Department of Ophthalmology, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Carolina L M Francisconi
- Department of Ophthalmology, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Filiberto Altomare
- Department of Ophthalmology, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - David R Chow
- Department of Ophthalmology, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Toronto Retina Institute, North York, Ontario, Canada
| | - Louis R Giavedoni
- Department of Ophthalmology, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Alan R Berger
- Department of Ophthalmology, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Toronto Retina Institute, North York, Ontario, Canada
| | - David T Wong
- Department of Ophthalmology, St. Michael's Hospital, Toronto, Ontario, Canada, .,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada, .,Department of Ophthalmology, Oakville Trafalgar Hospital, Oakville, Ontario, Canada,
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13
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Das GK, Sahu PK, Biakthangi LVL, Jain D. Evaluation of intravitreal bevacizumab as monotherapy and in combination with macular grid laser photocoagulation in diffuse diabetic macular edema. Oman J Ophthalmol 2018; 11:248-253. [PMID: 30505116 PMCID: PMC6219322 DOI: 10.4103/ojo.ojo_196_2016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The objective of the study was to compare the efficacy of intravitreal bevacizumab (IVB) as monotherapy versus combination with modified macular grid (MMG) laser photocoagulation in the primary treatment of diffuse diabetic macular edema (DDME). MATERIALS AND METHODS A prospective randomized trial was carried out in sixty eyes with DDME after Institutional Ethical clearance. Group A received three doses of IVB at a 1-month interval. Group B received MMG in addition to IVB. Complete examination including best-corrected visual acuity (BCVA) (Snellen's), central macular thickness (CMT) using spectral domain-optical coherence tomography was carried out at 0, 1, 4, 8, 12, and 24 weeks. RESULTS mean CMT at baseline, 12 and 24 weeks in Group A was 401 (±76), 280 (±49), and 307 (±46) and in Group B, 405 (±73), 237 (±33), and 242 (±45), respectively. Group B had significantly greater reductions (P < 0.001) from 12 weeks onward. BCVA and contrast sensitivity showed improvements with no significant difference. CONCLUSION Combined therapy has more advantage in primary DDME by reducing CMT on longer follow-up.
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Affiliation(s)
- Gopal K Das
- Department of Ophthalmology, University College of Medical Sciences and GTB Hospital, Delhi University, New Delhi, India
| | - Pramod K Sahu
- Department of Ophthalmology, University College of Medical Sciences and GTB Hospital, Delhi University, New Delhi, India
| | - Laura V L Biakthangi
- Department of Ophthalmology, University College of Medical Sciences and GTB Hospital, Delhi University, New Delhi, India
| | - Divya Jain
- Department of Ophthalmology, University College of Medical Sciences and GTB Hospital, Delhi University, New Delhi, India
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14
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Sen P, Vinay Kumar S, Bhende M, Sharma T. Combined argon laser photocoagulation and antivascular endothelial growth factor for management of macular polypoidal choroidal vasculopathy. Oman J Ophthalmol 2016; 9:139-143. [PMID: 27843227 PMCID: PMC5084495 DOI: 10.4103/0974-620x.192263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aim: To evaluate the efficacy of combination therapy of argon laser photocoagulation and intravitreal antivascular endothelial growth factor (VEGF) injection in idiopathic polypoidal choroidal vasculopathy (PCV) involving macula. Materials and Methods: A retrospective interventional study involving 12 eyes of 11 patients diagnosed with PCV involving the macula on indocyanine green angiography (ICGA). Intravitreal anti-VEGF was given in eyes with significant subretinal/sub retinal pigment epithelium hemorrhage or exudation. ICGA-guided focal laser was done to extrafoveal leaking polyps. Mean change in best-corrected visual acuity (BCVA) and regression of polyp as seen on ICGA were evaluated at the final follow-up. Statistical Analysis: It was done using SPSS 17.0. – Mann-Whitney test. Results: 12 eyes of 11 patients underwent argon laser with intravitreal anti-VEGF injection. Ten patients were males and one female. Mean age was 65.75 ± 5.2 years. The mean number of injections given was 3.66 ± 1.5 (2–6) per eye. Mean number of laser sessions required was 1.33 ± 0.65 (1–3) per eye. BCVA improved in 25% (n = 3), remained stable in stable in 50% (n = 6) eyes, and decreased in 25% (n = 3) eyes. The regression of polypoidal lesions on ICGA was seen in 75% (n = 9) of eyes. Persistent subretinal fluid seen in 25% (n = 3) of eyes. The mean duration of follow-up was 15.41 ± 10.27 (3–36) months. Conclusion: Combined argon laser photocoagulation with intravitreal anti-VEGF injection helps in decreasing exudation and results in stabilization of the disease with visual improvement in eyes with PCV involving macula.
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Affiliation(s)
- Parveen Sen
- Department of Vitreoretina, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - S Vinay Kumar
- Department of Vitreoretina, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Muna Bhende
- Department of Vitreoretina, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Tarun Sharma
- Department of Vitreoretina, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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15
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Sophie R, Akhtar A, Sepah YJ, Ibrahim M, Bittencourt M, Do DV, Nguyen QD. Aflibercept: a Potent Vascular Endothelial Growth Factor Antagonist for Neovascular Age-Related Macular Degeneration and Other Retinal Vascular Diseases. Biol Ther 2012; 2:3. [PMID: 24392297 PMCID: PMC3873045 DOI: 10.1007/s13554-012-0003-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Indexed: 12/27/2022]
Abstract
Introduction In the western hemisphere, age-related macular degeneration (AMD) is the leading cause of visual loss in the elderly. Currently approved therapies for AMD include argon laser, photodynamic therapy, and antivascular endothelial growth factor (VEGF) therapy. The index review discusses aflibercept (VEGF Trap-Eye) in the context of current anti-VEGF therapies for neovascular AMD and other retinal vascular diseases. It highlights important differences between VEGF Trap-Eye and currently used anti-VEGF therapies for neovascular AMD; and discusses the efficacy of these treatments utilizing information from landmark clinical trials. Methods A systematic search of literature was conducted on PubMed, Science Direct, and Scopus with no limitations of language or years of publication. Results Preclinical studies have shown that VEGF Trap-Eye binds to VEGF-A with a higher affinity than other anti-VEGF molecules; and that it also binds to placental growth factor (PlGF). In clinical trials, VEGF Trap-Eye has been shown to be as effective in the treatment of neovascular AMD as other anti-VEGF therapies and possibly to have a longer duration of drug activity. Conclusion VEGF Trap-Eye has enhanced the treatment options currently available for the management of neovascular AMD. The comparable efficacy of VEGF Trap-Eye (to other anti-VEGF agents) coupled with its longer dosing interval may decrease the number of annual office visits for patients with AMD and their caregivers.
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Affiliation(s)
- Raafay Sophie
- Retinal Imaging Research and Reading Center, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Maumenee 745, 21287 Baltimore, Maryland USA
| | - Abeer Akhtar
- Retinal Imaging Research and Reading Center, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Maumenee 745, 21287 Baltimore, Maryland USA
| | - Yasir J Sepah
- Retinal Imaging Research and Reading Center, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Maumenee 745, 21287 Baltimore, Maryland USA
| | - Mohamed Ibrahim
- Retinal Imaging Research and Reading Center, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Maumenee 745, 21287 Baltimore, Maryland USA
| | - Millena Bittencourt
- Retinal Imaging Research and Reading Center, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Maumenee 745, 21287 Baltimore, Maryland USA
| | - Diana V Do
- Retinal Imaging Research and Reading Center, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Maumenee 745, 21287 Baltimore, Maryland USA
| | - Quan Dong Nguyen
- Retinal Imaging Research and Reading Center, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Maumenee 745, 21287 Baltimore, Maryland USA
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