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Azuara-Blanco A, McCorry N, Tatham AJ, Georgoulas S, Founti P, Schweitzer C, Meier-Gibbons F, Denis P, Tuulonen A, Johannesson G, Martínez de la Casa JM, Prokosch V, Giannoulis DA, Abegão Pinto L, Garway-Heath D, Topouzis F. European Glaucoma Society research priorities for glaucoma care. Br J Ophthalmol 2024:bjo-2023-323648. [PMID: 37923373 DOI: 10.1136/bjo-2023-323648] [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: 03/29/2023] [Accepted: 10/13/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND/AIMS The goal of health research is to improve patients care and outcomes. Thus, it is essential that research addresses questions that are important to patients and clinicians. The aim of this study was to develop a list of priorities for glaucoma research involving stakeholders from different countries in Europe. METHODS We used a three-phase method, including a two-round electronic Delphi survey and a workshop. The clinician and patient electronic surveys were conducted in parallel and independently. For phase I, the survey was distributed to patients from 27 European countries in 6 different languages, and to European Glaucoma Society members, ophthalmologists with expertise in glaucoma care, asking to name up to five research priorities. During phase II, participants were asked to rank the questions identified in phase I using a Likert scale. Phase III was a 1 day workshop with patients and clinicians. The purpose was to make decisions about the 10 most important research priorities using the top 20 priorities identified by patients and clinicians. RESULTS In phase I, 308 patients and 150 clinicians were involved. In phase II, the highest-ranking priority for both patients and clinicians was 'treatments to restore vision'. In phase III, eight patients and four clinicians were involved. The top three priorities were 'treatments to stop sight loss', 'treatments to restore vision' and 'improved detection of worsening glaucoma'. CONCLUSION We have developed a list of priorities for glaucoma research involving clinicians and patients from different European countries that will help guide research efforts and investment.
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Affiliation(s)
| | - Noleen McCorry
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Andrew J Tatham
- Ophthalmology Department, Princess Alexandra Eye Pavilion, Edinburgh, UK
| | - Stelios Georgoulas
- Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Panayiota Founti
- Glaucoma Service, Moorfields Eye Hospital City Road Campus, London, UK
| | - Cedric Schweitzer
- Ophthalmology, University Hospital Centre Bordeaux, Bordeaux, France
| | | | - Philippe Denis
- Service d'Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Anja Tuulonen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Gauti Johannesson
- Department of Clinical Sciences, Ophthalmology, Umeå University, Umea, Sweden
| | | | - Verena Prokosch
- Department of Ophthalmology, University of Cologne, Koln, Germany
| | - Dimitrios A Giannoulis
- First Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Luis Abegão Pinto
- Department of Ophthalmology, Santa Maria Hospital, University of Lisbon, Lisboa, Portugal
| | - David Garway-Heath
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Fotis Topouzis
- First Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Shin YI, Kim YK, Jeoung JW, Park KH. Intraocular pressure reduction and progression of highly myopic glaucoma: a 12-year follow-up cohort study. Br J Ophthalmol 2023:bjo-2022-323069. [PMID: 38164537 DOI: 10.1136/bjo-2022-323069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 11/05/2023] [Indexed: 01/03/2024]
Abstract
AIMS To investigate any association between intraocular pressure (IOP) reduction amount and open-angle glaucoma (OAG) progression in highly myopic eyes and to determine the associated risk factors. METHODS One hundred and thirty-one (131) eyes of 131 patients with highly myopic OAG, all of whom had received topical medications and been followed for 5 years or longer, were enrolled. Based on the IOP reduction percentage, patients were categorised into tertile groups, and subsequently, the upper-tertile and lower-tertile groups were compared for the cumulative probability of glaucoma progression. Kaplan-Meier survival analysis and log-rank testing were applied in the comparison, and multivariate analysis with Cox's proportional hazard model, additionally, was performed to identify progression risk factors. RESULTS Throughout the average 11.6±4.4 year follow-up on the 131 eyes (mean age, 41.2 years at initial visit; baseline IOP, 16.4 mm Hg), 72 eyes (55.0%) showed glaucoma progression. The upper-tertile group (IOP reduction percentage>23.7%) showed a high cumulative probability of non-progression relative to the lower-tertile group (IOP reduction percentage<11.0%; p=0.034), according to the Kaplan-Meier analysis. Presence of disc haemorrhage (DH; HR=2.189; p=0.032) was determined by the multivariate Cox's proportional hazard model to be significantly associated with glaucoma progression. For progressors, the average rate of retinal nerve fibre layer thickness thinning was -0.88±0.74 µm/year, while the MD change was -0.42±0.36 dB/year. CONCLUSIONS Glaucoma progression is associated with amount of IOP reduction by topical medications in highly myopic eyes, and DH occurrence is a glaucoma progression risk factor.
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Affiliation(s)
- Young In Shin
- Department of Ophthalmology, Seoul National University Hospital, Jongno-gu, South Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
| | - Young Kook Kim
- Department of Ophthalmology, Seoul National University Hospital, Jongno-gu, South Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University Hospital, Jongno-gu, South Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University Hospital, Jongno-gu, South Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
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Khoramnia R, Peto T, Koch F, Taylor SR, Castro de Sousa JP, Hill L, Bailey C, Chakravarthy U. Safety and effectiveness of the fluocinolone acetonide intravitreal implant (ILUVIEN): 3-year results from the European IRISS registry study. Br J Ophthalmol 2023; 107:1502-1508. [PMID: 35840291 PMCID: PMC10579189 DOI: 10.1136/bjo-2022-321415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/20/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The ILUVIEN Registry Safety Study was a multicentre, open-label, non-randomised, observational, phase 4 study designed to assess the safety and effectiveness of the fluocinolone acetonide (FAc) implant in all indications in real-world practices in Europe. METHODS The study included data collected prospectively and retrospectively. Patients receiving FAc implants between 2013 and 2017 were included and monitored until the last patient reached ≥3 years of follow-up. Mean intraocular pressure (IOP) data over the course of the study, along with IOP events, use of IOP-lowering therapy, mean change in visual acuity (VA) and information on supplemental therapy use were analysed post-FAc implantation. RESULTS Six hundred and ninety-five eyes from 556 patients, with a mean±SD follow-up of 1150.5±357.36 days, were treated with a FAc implant. 96.7% of eyes had chronic diabetic macular oedema (cDMO). IOP lowering was achieved in 34.5% of eyes using topical agents and 4.3% by surgery. Seventy-three eyes (64.6% of 113 phakic) required cataract surgery during follow-up. Mean VA increased from a baseline of 52.2 letters to 57.1 letters at month 36, with improvement observed up to month 48. Supplementary therapies were given in 43.7% of eyes. When classified by length of cDMO less than or greater than the median duration those with a shorter history experienced greater VA gains than those with a longer history. CONCLUSION This study confirms the favourable, long-term benefit-to-risk profile of the FAc implant in eyes with cDMO, with an additional benefit in patients when this therapy is administered earlier.
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Affiliation(s)
- Ramin Khoramnia
- International Vision Correction Research Centre, Department of Ophthalmology, University Hospital Heidelberg, Heidelberg, Germany
| | - Tunde Peto
- Centre for Public Health, Blackwell's Queen's University, Belfast, UK
| | - Frank Koch
- Department of Ophthalmology, Section of Vitreo-Retinal Surgery, Hospital of the Goethe University, Frankfurt am Main, Germany
| | - Simon R Taylor
- Department of Ophthalmology, University of Surrey, Guildford, UK
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Leister N, Trieschmann U, Yücetepe S, Ulrichs C, Muenke N, Wendt S, Menzel C, Heindl LM. Nalbuphine as analgesic in preschool children undergoing ophthalmic surgery and the occurrence of emergence delirium. Br J Ophthalmol 2023; 107:1522-1525. [PMID: 35817561 DOI: 10.1136/bjo-2022-321575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/04/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Perioperative pain in children is often inadequately treated, and emergence agitation is common. The purpose of this analysis was to determine whether nalbuphine is suitable for perioperative eye pain and to analyse if it influences the occurrence of emergence delirium/agitation (EDA) in children undergoing ophthalmic surgery in general anaesthesia. METHODS Retrospective cohort analysis of 50 children in preschool age undergoing general anaesthesia for ophthalmic surgery receiving nalbuphine as a postoperative analgesic in a German university hospital from June 2020 to February 2021.Scores and values for pain and EDA were routinely recorded after awakening and during the stay in the recovery room. Data were evaluated retrospectively from the medical records. RESULTS A total of 50 children (17 girls and 33 boys) underwent general anaesthesia for ophthalmic surgery. The median age of the children included was 20.5 months (range, 1-68 months), the median body weight was 12.25 kg (range, 2.9-29 kg). All patients received ibuprofen (10 mg/kg1) during induction of anaesthesia and nalbuphine (0.1 mg/kg) at the end of surgery. All patients had an Paediatric-Anaesthesia-Emergence-Delirium-I-score (PAED-ED-I Score) of less than 6 and acceptable Face-Legs-Activity-Cry-Consolability-scores (FLACC less than 3) on waking and on leaving the recovery room. CONCLUSION Nalbuphine shows a sufficient analgesic effect for pain therapy following ophthalmic surgery in preschool children. Nalbuphine seems to reduce the incidence of EDA in children undergoing ophthalmic surgery.
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Affiliation(s)
- Nicolas Leister
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Uwe Trieschmann
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Sirin Yücetepe
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christoph Ulrichs
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Nikolas Muenke
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Stefanie Wendt
- Department of Cardiothoracic Surgery and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christoph Menzel
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Ludwig M Heindl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Dusseldorf, Cologne, Germany
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Granstam E, Rönnblom A. Occurrence of uveitis in a population-based cohort of inflammatory bowel diseases followed for 10 years: an observational study. BMJ Open Ophthalmol 2023; 8:e001318. [PMID: 37493645 PMCID: PMC10351296 DOI: 10.1136/bmjophth-2023-001318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/27/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE The coexistence of inflammatory bowel diseases (IBDs) and uveitis has been known for 100 years. The reported frequency by which these conditions appear in the same patient has varied considerably. The aim of this study was to investigate the occurrence of uveitis in a well-defined population-based cohort of patients with IBD including all age groups and followed for at least 10 years. METHOD AND ANALYSIS All newly diagnosed patients with ulcerative colitis and Crohn's disease in the county of Uppsala between 2005 and 2009 were prospectively followed. At the end of 2022, the medical notes were checked and all contacts with the healthcare system regarding ocular symptoms were scrutinised. RESULTS A total of 330 patients with ulcerative colitis and 153 patients with Crohn's disease were included in the cohort. Four hundred and forty-two of these (91.5%) could be followed for 10 years or until death. Thirteen patients with ulcerative colitis were affected by uveitis (3.9%), and one of the patients with Crohn's disease (0.7%). Most often the uveitis was diagnosed after the bowel disease (median 8.9 years, 7.7 years SD). CONCLUSION Low occurrence of uveitis was identified in the IBD population. All affected individuals except one were diagnosed with ulcerative colitis. Most of the patients had their eye disease around 10 years later than their IBD diagnosis. It is suggested that systemic anti-inflammatory treatment for the IBD protects against intraocular inflammation in this cohort.
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Affiliation(s)
- Elisabet Granstam
- Center for Clinical Research Region Västmanland, Uppsala Universitet, Västerås, Sweden
- Ophthalmology, Region Västmanland, Västerås, Sweden
| | - Anders Rönnblom
- Medical Sciences, Uppsala University Faculty of Medicine, Uppsala, Sweden
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Zhang Y, Huang W, Tian Q, Bai G, Wu W, Yin H, Hu L, Chen X. Network pharmacology and biochemical experiments reveal the antiapoptotic mechanism of huperzine A for treating diabetic retinopathy. Br J Ophthalmol 2023:bjo-2023-323639. [PMID: 37339867 DOI: 10.1136/bjo-2023-323639] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND/AIMS Diabetic retinopathy is the most common eye disease that causes blindness in the working population. Neurodegeneration is the early sign of diabetic retinopathy, but no drug has been approved for delaying or reversing retinal neurodegeneration. Huperzine A, a natural alkaloid isolated from Huperzia serrata, displays neuroprotective and antiapoptotic effects in treating neurodegenerative disorders. Our study aims to investigate the effect of huperzine A in preventing retinal neurodegeneration of diabetic retinopathy and its possible mechanism. METHODS Diabetic retinopathy model was induced by streptozotocin. H&E staining, optical coherence tomography, immunofluorescence staining and angiogenic factors were used to determine the degree of retinal pathological injury. The possible molecular mechanism was unrevealed by network pharmacology analysis and further validated by biochemical experiments. RESULTS In our study, we demonstrated that huperzine A has a protective effect on the diabetes retina in a diabetic rat model. Based on the network pharmacology analysis and biochemical studies, huperzine A may treat diabetic retinopathy via key target HSP27 and apoptosis-related pathways. Huperzine A may modulate the phosphorylation of HSP27 and activate the antiapoptotic signalling pathway. CONCLUSION Our findings revealed that huperzine A might be a potential therapeutic drug to prevent diabetic retinopathy. It is the first-time combining network pharmacology analysis with biochemical studies to explore the mechanism of huperzine A in preventing diabetic retinopathy.
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Affiliation(s)
- Ying Zhang
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Provincial Key Lab of Ophthalmology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Institute of Translational Medicine, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wunan Huang
- Lanzhou University First Affiliated Hospital, Lanzhou University, Lanzhou, Gansu, China
| | - Qing Tian
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Provincial Key Lab of Ophthalmology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Institute of Translational Medicine, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Guannan Bai
- National Clinical Research Center for Child Health, Zhejiang University School of Medicine Children's Hospital, Hangzhou, Zhejiang, China
| | - Wei Wu
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Provincial Key Lab of Ophthalmology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Houfa Yin
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Provincial Key Lab of Ophthalmology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lidan Hu
- National Clinical Research Center for Child Health, Zhejiang University School of Medicine Children's Hospital, Hangzhou, Zhejiang, China
| | - Xiangjun Chen
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Provincial Key Lab of Ophthalmology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Institute of Translational Medicine, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Mase O, Qasem M, Beare N. Systematic review of studies comparing infliximab and adalimumab in autoimmune uveitis. BMJ Open Ophthalmol 2023; 8:e001303. [PMID: 37493653 PMCID: PMC10277136 DOI: 10.1136/bmjophth-2023-001303] [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: 03/28/2023] [Accepted: 05/30/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE This study aimed to review effectiveness studies comparing two biological anti-tumour necrosis factor agents, adalimumab (ADA) and infliximab (IFX), in the management of autoimmune uveitis. METHODS A systematic search was conducted across PubMed, Scopus, Web of Science and Google Scholar from 2014 until February 2022. The search included the following keywords "Adalimumab", "Infliximab", "Autoimmune", "Anterior", "Intermediate", "Posterior", "Panuveitis", "Refractory" and "Uveitis". Primary studies comparing both ADA and IFX in a population of autoimmune uveitis patients were considered. Outcomes of interest were measures of response to treatment and incidence of adverse events. RESULTS The preliminary literature search generated 7156 references. Six studies fulfilled the eligibility criteria and were included in the final analysis; all were non-randomised, retrospective or observational. The included studies found similar effectiveness and side effect profiles for both ADA and IFX in the management of autoimmune uveitis, however, one did not report effectiveness for each separately, and three were limited to Behcet's disease. CONCLUSION ADA and IFX seem to display comparable effectiveness and safety profiles. However, the available evidence remains scarce, of low quality and at high risk of bias. A direct comparison between ADA and IFX through large randomised controlled trials is needed to provide more substantial evidence of equivalence or superiority in uveitis.
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Affiliation(s)
- Oliver Mase
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Mustafa Qasem
- St Paul's Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Nicholas Beare
- St Paul's Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
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Shih EJ, Chen JK, Tsai PJ, Bee YS. Differences in characteristics, aetiologies, isolated pathogens, and the efficacy of antibiotics in adult patients with preseptal cellulitis and orbital cellulitis between 2000-2009 and 2010-2019. Br J Ophthalmol 2023; 107:331-336. [PMID: 34607790 DOI: 10.1136/bjophthalmol-2021-318986] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 09/08/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To understand whether the epidemiology, aetiologies, common pathogens and the antibiotic efficacy against the identified bacteria of periorbital cellulitis in adults have changed recently (2010-2019) compared with the past decade (2000-2009). METHODS Adult patients (n=224) diagnosed with preseptal cellulitis and orbital cellulitis admitted to Kaohsiung Veterans General Hospital during 2000-2019 were retrospectively reviewed. Demographic and clinical characteristics, isolated pathogens and antibiotic susceptibility tests against the commonly cultured bacteria were analysed. RESULTS Preseptal cellulitis showed a tendency of female predominance. Patients in their 60s showed an incidence peak; more cases were observed during winter. The most common predisposing factor was dacryocystitis (15.5%-30.5%), followed by hordeolum (15.5%-24.8%). Aetiology of sinusitis (p=0.001) decreased and that of conjunctivitis (p=0.007) increased significantly with time. Culture results of nasopharyngeal swabs and local abscess showed higher positivity rate than conjunctival swab. The most common isolates were methicillin-susceptible Staphylococcus aureus, methicillin-resistant S. aureus, coagulase-negative staphylococci and Pseudomonas aeruginosa. Antibiotics including fluoroquinolones and vancomycin were effective; in contrast, ampicillin/sulbactam and oxacillin showed decreasing efficacy against gram-positive bacteria. For antibiotic treatment against P. aeruginosa, fluoroquinolones, ceftazidime, piperacillin and imipenem were ideal choices. CONCLUSION In isolated pathogens, the increasing trend of methicillin-resistant S. aureus detection was compatible with reducing oxacillin efficacy against periorbital infection. In our study, the report of antibiotic efficacy against the most common identified bacteria offered empirical choices for hospitalised patients with periorbital infection before obtaining culture results.
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Affiliation(s)
- En-Jie Shih
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang Ming University, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Jui-Kuang Chen
- Division of Infectious Diseases, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Pei-Jhen Tsai
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Youn-Shen Bee
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan .,Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan.,Yuh-Ing Junior College of Health Care and Management, Kaohsiung, Taiwan
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Nguyen QD, Moshfeghi AA, Lim JI, Ponomareva E, Chauhan A, Rao R, Sherman S. Simulation of long-term impact of intravitreal anti-VEGF therapy on patients with severe non-proliferative diabetic retinopathy. BMJ Open Ophthalmol 2023; 8:bmjophth-2022-001190. [PMID: 37278412 DOI: 10.1136/bmjophth-2022-001190] [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: 10/21/2022] [Accepted: 03/01/2023] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVE A simulation model was constructed to assess long-term outcomes of proactively treating severe non-proliferative diabetic retinopathy (NPDR) with anti-vascular endothelial growth factor (anti-VEGF) therapy versus delaying treatment until PDR develops. METHODS AND ANALYSIS Simulated patients were generated using a retrospective real-world cohort of treatment-naive patients identified in an electronic medical records database (IBM Explorys) between 2011 and 2017. Impact of anti-VEGF treatment was derived from clinical trial data for intravitreal aflibercept (PANORAMA) and ranibizumab (RISE/RIDE), averaged by weighted US market share. Real-world risk of PDR progression was modelled using Cox multivariable regression. The Monte Carlo simulation model examined rates of progression to PDR and sustained blindness (visual acuity <20/200) for 2 million patients scaled to US NPDR disease prevalence. Simulated progression rates from severe NPDR to PDR over 5 years and blindness rates over 10 years were compared for delayed versus early-treatment patients. RESULTS Real-world data from 77 454 patients with mild-to-severe NPDR simulated 2 million NPDR patients, of which 86 680 had severe NPDR. Early treatment of severe NPDR with anti-VEGF therapy led to a 51.7% relative risk reduction in PDR events over 5 years (15 704 early vs 32 488 delayed), with a 19.4% absolute risk reduction (18.1% vs 37.5%). Sustained blindness rates at 10 years were 4.4% for delayed and 1.9% for early treatment of severe NPDR. CONCLUSION The model suggests treating severe NPDR early with anti-VEGF therapy, rather than delaying treatment until PDR develops, could significantly reduce PDR incidence over 5 years and sustained blindness over 10 years.
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Affiliation(s)
- Quan Dong Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Andrew A Moshfeghi
- Department of Ophthalmology, Keck School of Medicine, Roski Eye Institute, University of Southern California, Los Angeles, California, USA
| | - Jennifer I Lim
- Department of Ophthalmology, University of Illinois at Chicago, Illinois Eye and Ear Infirmary, Chicago, Illinois, USA
| | | | | | - Rohini Rao
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Steven Sherman
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
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Goldfarb JA, Ferrarotto R, Gross N, Goepfert R, Debnam JM, Gunn B, Nagarajan P, Esmaeli B. Immune checkpoint inhibitors for treatment of periorbital squamous cell carcinoma. Br J Ophthalmol 2023; 107:320-323. [PMID: 34625433 DOI: 10.1136/bjophthalmol-2021-319417] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/27/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE To report on the outcomes of immunotherapy in patients with locally advanced periorbital squamous cell carcinoma. METHODS We performed a retrospective chart review of seven consecutive patients with locally advanced periorbital cutaneous squamous cell carcinoma treated with anti-PD-1 immunotherapy. Treatments and therapeutic outcomes were reviewed. RESULTS Of the seven patients, six were treated with cemiplimab, and one was treated with pembrolizumab. Five patients were treated with immunotherapy as neoadjuvant therapy before planned surgical resection; two patients received immunotherapy for treatment of advanced recurrent lesions deemed unresectable following multiple previous excisions and radiation therapy. In all seven patients, measurable clinical and/or radiologic response was observed. CONCLUSIONS Our findings support the emerging role of anti-PD-1 immunotherapy in the management of locally advanced periorbital cutaneous squamous cell carcinoma.
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Affiliation(s)
- Jeremy Allan Goldfarb
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Renata Ferrarotto
- Department of Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Neil Gross
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ryan Goepfert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - James Matthew Debnam
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Division of Radiation Oncology, Houston, Texas, USA
| | - Priyadharsini Nagarajan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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11
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Murakami T, Okamoto F, Sugiura Y, Morikawa S, Okamoto Y, Hiraoka T, Oshika T. Contrast sensitivity and quality of life following intravitreal ranibizumab injection for central retinal vein occlusion. Br J Ophthalmol 2023; 107:254-260. [PMID: 34452939 DOI: 10.1136/bjophthalmol-2021-319863] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/17/2021] [Indexed: 01/27/2023]
Abstract
SYNOPSIS/PRECIS We investigated the relationship between contrast sensitivity (CS) and vision-related quality of life (VR-QOL) in patients with central retinal vein occlusion following ranibizumab intravitreal injection; CS showed a stronger association with VR-QOL than visual acuity. BACKGROUND/AIMS To investigate the relationship between CS, VR-QOL and optical coherence tomography (OCT) findings in patients with cystoid macular oedema secondary to central retinal vein occlusion (CRVO-CMO) following intravitreal injection of ranibizumab. METHODS This was a multicentre, open-label, single-arm, prospective study. The study included 23 patients with CRVO-CMO who were followed up for 12 months after treatment. The best-corrected visual acuity (BCVA), letter contrast sensitivity (LCS) and OCT images were obtained every month. For VR-QOL assessment, the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) was administered to the patients before treatment and at 3, 6 and 12 months following treatment. RESULTS The LCS and VFQ-25 composite score improved significantly from baseline to 12 months following treatment. The multiple regression analysis revealed that the LCS of the affected eye and BCVA of the fellow eye were related to the VFQ-25 composite score following treatment. The LCS improvement showed a significant correlation with the improvement in the VFQ-25 composite score, whereas the BCVA improvement was not correlated with the improvement in the VFQ-25 composite score. Stepwise multiple regression analyses revealed that, at the time of macular oedema resolution, the distance between the external limiting membrane and retinal pigment epithelium (ELM-RPE) and average ganglion cell-inner plexiform layer (GCIPL) thickness were associated with LCS. CONCLUSION CS had a stronger association with VR-QOL than with BCVA in patients with CRVO-CMO. With the resolution of macular oedema, CS was associated with ELM-RPE thickness and average GCIPL thickness.
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Affiliation(s)
- Tomoya Murakami
- Department of Ophthalmology, University of Tsukuba Faculty of Medicine, Tsukuba, Ibaraki, Japan
| | - Fumiki Okamoto
- Department of Ophthalmology, University of Tsukuba Faculty of Medicine, Tsukuba, Ibaraki, Japan
| | - Yoshimi Sugiura
- Department of Ophthalmology, University of Tsukuba Faculty of Medicine, Tsukuba, Ibaraki, Japan
| | - Shohei Morikawa
- Department of Ophthalmology, University of Tsukuba Faculty of Medicine, Tsukuba, Ibaraki, Japan
| | - Yoshifumi Okamoto
- Department of Ophthalmology, University of Tsukuba Faculty of Medicine, Tsukuba, Ibaraki, Japan.,Department of Ophthalmology, Mito Kyodo General Hospital, Mito, Ibaraki, Japan
| | - Takahiro Hiraoka
- Department of Ophthalmology, University of Tsukuba Faculty of Medicine, Tsukuba, Ibaraki, Japan
| | - Tetsuro Oshika
- Department of Ophthalmology, University of Tsukuba Faculty of Medicine, Tsukuba, Ibaraki, Japan
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12
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Sterling J, Hua P, Dunaief JL, Cui QN, VanderBeek BL. Glucagon-like peptide 1 receptor agonist use is associated with reduced risk for glaucoma. Br J Ophthalmol 2023; 107:215-220. [PMID: 34413054 PMCID: PMC8857286 DOI: 10.1136/bjophthalmol-2021-319232] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/06/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND/AIMS Glucagon-like peptide-1 receptor (GLP-1R) agonists regulate blood glucose and are commonly used to treat type 2 diabetes mellitus. Recent work showed that treatment with the GLP-1R agonist NLY01 decreased retinal neuroinflammation and glial activation to rescue retinal ganglion cells in a mouse model of glaucoma. In this study, we used an insurance claims database (Clinformatics Data Mart) to examine whether GLP-1R agonist exposure impacts glaucoma risk. METHODS A retrospective cohort of patients who initiated a new GLP-1R agonist was 1:3 age, gender, race, classes of active diabetes medications and year of index date matched to patients who initiated a different class of oral diabetic medication. Inverse probability of treatment weighting (IPTW) was used within a multivariable Cox proportional hazard regression model to test the association between GLP-1R agonist exposure and a new diagnosis of primary open-angle glaucoma, glaucoma suspect or low-tension glaucoma. RESULTS Cohorts were comprised of 1961 new users of GLP-1R agonists matched to 4371 unexposed controls. After IPTW, all variables were balanced (standard mean deviation <|0.1|) between cohorts. Ten (0.51%) new diagnoses of glaucoma were present in the GLP-1R agonist cohort compared with 58 (1.33%) in the unexposed controls. After adjustment, GLP-1R exposure conferred a reduced hazard of 0.56 (95% CI: 0.36 to 0.89, p=0.01), suggesting that GLP-1R agonists decrease the risk for glaucoma. CONCLUSIONS GLP-1R agonist use was associated with a statistically significant hazard reduction for a new diagnosis of glaucoma. Our findings support further investigations into the use of GLP-1R agonists in glaucoma prevention.
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Affiliation(s)
- Jacob Sterling
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Medical Scientist Training Program, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Peiying Hua
- Center for Preventative Ophthalmology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Joshua L Dunaief
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Qi N Cui
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brian L VanderBeek
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics & Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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13
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Shen LL, Xie Y, Sun M, Ahluwalia A, Park MM, Young BK, Del Priore LV. Associations of systemic health and medication use with the enlargement rate of geographic atrophy in age-related macular degeneration. Br J Ophthalmol 2023; 107:261-266. [PMID: 34489337 PMCID: PMC8898317 DOI: 10.1136/bjophthalmol-2021-319426] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/23/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND The associations of geographic atrophy (GA) progression with systemic health status and medication use are unclear. METHODS We manually delineated GA in 318 eyes in the Age-Related Eye Disease Study. We calculated GA perimeter-adjusted growth rate as the ratio between GA area growth rate and mean GA perimeter between the first and last visit for each eye (mean follow-up=5.3 years). Patients' history of systemic health and medications was collected through questionnaires administered at study enrolment. We evaluated the associations between GA perimeter-adjusted growth rate and 27 systemic health factors using univariable and multivariable linear mixed-effects regression models. RESULTS In the univariable model, GA perimeter-adjusted growth rate was associated with GA in the fellow eye at any visit (p=0.002), hypertension history (p=0.03), cholesterol-lowering medication use (p<0.001), beta-blocker use (p=0.02), diuretic use (p<0.001) and thyroid hormone use (p=0.03). Among the six factors, GA in the fellow eye at any visit (p=0.008), cholesterol-lowering medication use (p=0.002), and diuretic use (p<0.001) were independently associated with higher GA perimeter-adjusted growth rate in the multivariable model. GA perimeter-adjusted growth rate was 51.1% higher in patients with versus without cholesterol-lowering medication use history and was 37.8% higher in patients with versus without diuretic use history. CONCLUSIONS GA growth rate may be associated with the fellow eye status, cholesterol-lowering medication use, and diuretic use. These possible associations do not infer causal relationships, and future prospective studies are required to investigate the relationships further.
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Affiliation(s)
- Liangbo L Shen
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
| | - Yangyiran Xie
- Department of Ophthalmology and Visual Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Mengyuan Sun
- Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, Connecticut, USA
| | - Aneesha Ahluwalia
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA
| | - Michael M Park
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Benjamin K Young
- Department of Ophthalmology and Visual Science, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Lucian V Del Priore
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
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14
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Erras A, Shahrvini B, Weinreb RN, Baxter SL. Review of glaucoma medication adherence monitoring in the digital health era. Br J Ophthalmol 2023; 107:153-159. [PMID: 33858837 PMCID: PMC8517037 DOI: 10.1136/bjophthalmol-2020-317918] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 02/19/2021] [Accepted: 04/05/2021] [Indexed: 02/03/2023]
Abstract
Current glaucoma treatments aim to lower intraocular pressure, often with topical ocular hypotensive medications. Unfortunately, the effectiveness of these medications depends on sustained patient adherence to regimens which may involve instilling multiple medications several times daily. Patient adherence to glaucoma medications is often low. Recent innovations in digital sensor technologies have been leveraged to confirm eyedrop medication usage in real-time and relay this information back to providers. Some sensors have also been designed to deliver medication reminders and notifications as well as assist with correct eyedrop administration technique. Here, we review recent innovations targeted at improving glaucoma medication adherence and discuss their limitations.
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Affiliation(s)
- Alaa Erras
- Hamilton Glaucoma Center, Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Bita Shahrvini
- Hamilton Glaucoma Center, Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Sally L Baxter
- Hamilton Glaucoma Center, Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA .,Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
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15
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Cornish EE, Teo KYC, Gillies MC, Lim LL, Nguyen V, Wickremasinghe S, Mehta H, McAllister IL, Fraser-Bell S. Five-year outcomes of eyes initially enrolled in the 2-year BEVORDEX trial of bevacizumab or dexamethasone implants for diabetic macular oedema. Br J Ophthalmol 2023; 107:79-83. [PMID: 34340975 PMCID: PMC9763198 DOI: 10.1136/bjophthalmol-2021-319839] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/14/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The BEVORDEX trial compared outcomes of eyes with diabetic macular oedema (DMO) randomised to receive either intravitreal dexamethasone (DEX-) implant or bevacizumab over 2 years. We assessed long-term efficacy and safety outcomes 5 years from enrolment. METHODS Patients received standard clinical care after they finished the study. Their files were reviewed for visual and anatomical outcomes, post-trial treatments and complications. RESULTS Three-year and five-year data were available for 82% and 59% of eyes enrolled in the BEVORDEX study, respectively. Visual acuity gains at end of trial were generally lost by both treatment groups at 5 years but the macular thickness did not change from end of trial to 5 years. A similar proportion of eyes from each treatment group gained ≥10 letters at 5 years from enrolment in the BEVORDEX trial.Eyes that were initially randomised to the DEX-implant group had significantly fewer treatments but were more likely to develop proliferative diabetic retinopathy (PDR) over the 5-year period compared with eyes initially randomised to bevacizumab. The proportion of eyes that had cataract surgery by 5 years was similar between initial treatment groups. CONCLUSIONS Eyes in the BEVORDEX trial had similar 5-year rates of cataract surgery, however, more eyes converted to PDR in the group initially treated with DEX-implant. Eyes that were initially treated for 2 years with either intravitreal DEX-implant of bevacizumab followed by standard of care had similar visual and anatomical outcomes at 5 years.
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Affiliation(s)
- Elisa E Cornish
- Department of Ophthalmology, The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia .,Department of Ophthalmology, Sydney and Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Kelvin YC Teo
- Department of Ophthalmology, The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia,Department of Ophthalmology, Singapore National Eye Centre, Singapore
| | - Mark C Gillies
- Department of Ophthalmology, The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia,Department of Ophthalmology, Sydney and Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Lyndell L Lim
- Department of Ophthalmology, Centre for Eye Research Australia Ltd, East Melbourne, Victoria, Australia
| | - Vuong Nguyen
- Department of Ophthalmology, The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
| | - Sanjeewa Wickremasinghe
- Department of Ophthalmology, Centre for Eye Research Australia Ltd, East Melbourne, Victoria, Australia
| | - Hemal Mehta
- Department of Ophthalmology, The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia,Ophthalmology Department, Royal Free London NHS Foundation Trust, London, UK
| | - Ian L McAllister
- University of Western Australia, Lions Eye Institute, Nedlands, Western Australia, Australia
| | - Samantha Fraser-Bell
- Department of Ophthalmology, The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia,Department of Ophthalmology, Sydney and Sydney Eye Hospital, Sydney, New South Wales, Australia
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16
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Holz FG, Abreu-Gonzalez R, Bandello F, Duval R, O'Toole L, Pauleikhoff D, Staurenghi G, Wolf A, Lorand D, Clemens A, Gmeiner B. Does real-time artificial intelligence-based visual pathology enhancement of three-dimensional optical coherence tomography scans optimise treatment decision in patients with nAMD? Rationale and design of the RAZORBILL study. Br J Ophthalmol 2023; 107:96-101. [PMID: 34362776 PMCID: PMC9763175 DOI: 10.1136/bjophthalmol-2021-319211] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/23/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND/RATIONALE Artificial intelligence (AI)-based clinical decision support tools, being developed across multiple fields in medicine, need to be evaluated for their impact on the treatment and outcomes of patients as well as optimisation of the clinical workflow. The RAZORBILL study will investigate the impact of advanced AI segmentation algorithms on the disease activity assessment in patients with neovascular age-related macular degeneration (nAMD) by enriching three-dimensional (3D) retinal optical coherence tomography (OCT) scans with automated fluid and layer quantification measurements. METHODS RAZORBILL is an observational, multicentre, multinational, open-label study, comprising two phases: (a) clinical data collection (phase I): an observational study design, which enforces neither strict visit schedule nor mandated treatment regimen was chosen as an appropriate design to collect data in a real-world clinical setting to enable evaluation in phase II and (b) OCT enrichment analysis (phase II): de-identified 3D OCT scans will be evaluated for disease activity. Within this evaluation, investigators will review the scans once enriched with segmentation results (i.e., highlighted and quantified pathological fluid volumes) and once in its original (i.e., non-enriched) state. This review will be performed using an integrated crossover design, where investigators are used as their own controls allowing the analysis to account for differences in expertise and individual disease activity definitions. CONCLUSIONS In order to apply novel AI tools to routine clinical care, their benefit as well as operational feasibility need to be carefully investigated. RAZORBILL will inform on the value of AI-based clinical decision support tools. It will clarify if these can be implemented in clinical treatment of patients with nAMD and whether it allows for optimisation of individualised treatment in routine clinical care.
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Affiliation(s)
- Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Rodrigo Abreu-Gonzalez
- Department of Ophthalmology, University Hospital of La Candelaria, Santa Cruz de Tenerife, Spain
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, University Vita Salute Hospital San Raffaele, Milano, Italy
| | - Renaud Duval
- Department of Ophthalmology, Maisonneuve-Rosemont Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Louise O'Toole
- Department of Ophthalmology, Bon Secours Hospital Dublin, Dublin, Ireland
| | | | - Giovanni Staurenghi
- Dipartimento di Scienze Cliniche Luigi Sacco, Eye Clinic, University of Milan, Milan, Italy
| | - Armin Wolf
- Department of Ophthalmology, University of Ulm, Ulm, Germany
| | | | - Andreas Clemens
- Novartis Pharma AG, Basel, Switzerland,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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17
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Relton SD, Chi GC, Lotery A, West RM, McKibbin M. Associations with visual acuity outcomes after 12 months of treatment in 9401 eyes with neovascular AMD. BMJ Open Ophthalmol 2022; 7:bmjophth-2022-001038. [PMID: 36161843 PMCID: PMC9240889 DOI: 10.1136/bmjophth-2022-001038] [Citation(s) in RCA: 2] [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: 04/11/2022] [Accepted: 05/31/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To record visual acuity outcomes after 12 months of treatment for neovascular age-related macular degeneration (NvAMD), investigate variation between sites and explore associations with baseline characteristics and care processes. METHODS AND ANALYSIS Anonymised demographic and clinical data were extracted from electronic medical records at treating National Health Service (NHS) Trusts. Associations with acuity outcomes were investigated using multivariate linear and logistic regression. RESULTS Analysis included 9401 eyes (7686 patients) treated at 13 NHS Trusts. From baseline to month 12, median acuity improved from LogMAR 0.50 (IQR 0.30-0.80) to 0.40 (0.22-0.74) and the proportion of eyes with LogMAR ≥0.3 increased from 34.5% to 39.8%. Baseline visual acuity was the strongest predictor of visual acuity outcomes. For each LogMAR 0.1 worsening of baseline acuity, the acuity at 12 months was improved by LogMAR 0.074 (95% CI 0.073 to 0.074) and the odds of a 'poor' acuity outcome was multiplied by 1.66 (95% CI 1.61 to 1.70). Younger age, independent living status, lower socioeconomic deprivation, timely loading phase completion and higher number of injections were associated with better acuity outcomes. Despite case-mix adjustments, there was evidence of significant variation in acuity outcomes between sites. CONCLUSIONS Even after adjustment for other variables, variation in acuity outcomes after NvAMD treatment within the NHS remains. Meaningful comparison of outcomes between different providers requires adjustment for a range of baseline characteristics, not visual acuity alone. Identifying best practice at sites with better outcomes and adapting local care processes are required to tackle this health inequality.
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Affiliation(s)
- SD Relton
- Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - GC Chi
- Genentech Inc, South San Francisco, California, USA
| | - Andrew Lotery
- Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
| | - RM West
- Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | | | - Martin McKibbin
- Ophthalmology, St James's University Hospital, Leeds, West Yorkshire, UK
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18
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Francis JH, Winebrake JP, Abramson DH. Uveal lymphoid hyperplasia: treatment with combination antibiotics and steroids. Br J Ophthalmol 2022; 107:786-789. [PMID: 35190399 DOI: 10.1136/bjophthalmol-2021-319483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 01/04/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Uveal lymphoid hyperplasia (formerly benign reactive hyperplasia of the choroid) spans histopatholological characteristics ranging from reactive hyperplasia to low-grade lymphoid neoplasm. There is strong evidence that other low-grade lymphoid neoplasms, particularly of gastric derivations, respond to oral antibiotics. Here, we explore that response of uveal lymphoid hyperplasia to treatment with only oral antibiotics and steroids. METHODS Four eyes of three patients with clinically diagnosed uveal lymphoid hyperplasia were treated with a course of oral antibiotics and steroids. The main outcome was clinical response of choroidal infiltrate by optical coherence tomography (OCT) measurements of choroidal thickness and visual acuity. Secondary outcome measure included local and systemic recurrence. Clinical response was evaluated by clinical exam, fundus photography, ultrasound and OCT. RESULTS All 4 eyes displayed a clinical response at a median 2 weeks after starting oral antibiotics and steroid course. The choroidal infiltration regressed as evidenced by: decrease of choroidal thickness by a median of 421 nm, myopic shift in refractive error by a median of 0.50 Diopters, and improved vision by a median of 1.5 Snellen lines. At a median of 51-month follow-up, all four eyes had a sustained complete response and no patient has developed systemic disease to date. CONCLUSIONS In this small cohort of patients with uveal lymphoid hyperplasia, measurable and sustained clinical responses were observed with antibiotics/steroids, without systemic recurrence. This suggests combination antibiotic/steroid therapy is a reasonable treatment for select cases of uveal lymphoid hyperplasia, and may avoid the need for systemic chemotherapy/monoclonal antibody and/or external beam irradiation.
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Affiliation(s)
- Jasmine H Francis
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - James P Winebrake
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - David H Abramson
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
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19
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Ademola-Popoola DS, Fajolu IB, Gilbert C, Olusanya BA, Onakpoya OH, Ezisi CN, Musa KO, Chan RVP, Okeigbemen VW, Muhammad RC, Malik ANJ, Adio AO, Bodunde OT, Rafindadi AL, Oluleye TS, Tongo OO, Badmus SA, Adebara OV, Padhi TR, Ezenwa BN, Obajolowo TS, Olokoba LB, Olatunji VA, Babalola YO, Ugalahi MO, Adenekan A, Adesiyun OO, Sahoo J, Miller MT, Uhumwangho OM, Olagbenro AS, Adejuyigbe EA, Ezeaka CVC, Mokuolu O, Ogunlesi TA, Ogunfowora OB, Abdulkadir I, Abdullahi FL, Fabiyi AT, Hassan LHL, Baiyeroju AM, Opara PI, Oladigbolu K, Eneh AU, Fiebai BE, Mahmud-Ajeigbe FA, Peter EN, Abdullahi HS. Strengthening retinopathy of prematurity screening and treatment services in Nigeria: a case study of activities, challenges and outcomes 2017-2020. BMJ Open Ophthalmol 2021; 6:e000645. [PMID: 34514173 PMCID: PMC8383855 DOI: 10.1136/bmjophth-2020-000645] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 08/02/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives Retinopathy of prematurity (ROP) will become a major cause of blindness in Nigerian children unless screening and treatment services expand. This article aims to describe the collaborative activities undertaken to improve services for ROP between 2017 and 2020 as well as the outcome of these activities in Nigeria. Design Descriptive case study. Setting Neonatal intensive care units in Nigeria. Participants Staff providing services for ROP, and 723 preterm infants screened for ROP who fulfilled screening criteria (gestational age <34 weeks or birth weight ≤2000 g, or sickness criteria). Methods and analysis A WhatsApp group was initiated for Nigerian ophthalmologists and neonatologists in 2018. Members participated in a range of capacity-building, national and international collaborative activities between 2017 and 2018. A national protocol for ROP was developed for Nigeria and adopted in 2018; 1 year screening outcome data were collected and analysed. In 2019, an esurvey was used to collect service data from WhatsApp group members for 2017-2018 and to assess challenges in service provision. Results In 2017 only six of the 84 public neonatal units in Nigeria provided ROP services; this number had increased to 20 by 2018. Of the 723 babies screened in 10 units over a year, 127 (17.6%) developed any ROP; and 29 (22.8%) developed type 1 ROP. Only 13 (44.8%) babies were treated, most by intravitreal bevacizumab. The screening criteria were revised in 2020. Challenges included lack of equipment to regulate oxygen and to document and treat ROP, and lack of data systems. Conclusion ROP screening coverage and quality improved after national and international collaborative efforts. To scale up and improve services, equipment for neonatal care and ROP treatment is urgently needed, as well as systems to monitor data. Ongoing advocacy is also essential.
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Affiliation(s)
- Dupe S Ademola-Popoola
- Department of Ophthalmology, University of Ilorin, Ilorin, Kwara, Nigeria.,Paediatric Ophthalmology and Strabismus Unit, Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria
| | - Iretiola B Fajolu
- Department of Neonatology/Perinatology, Paediatrics, University of Lagos College of Medicine/ Lagos University Teaching Hospital, Lagos, Nigeria
| | - Clare Gilbert
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Bolutife A Olusanya
- Paediatric Ophthalmology & Strabismus Unit, Department of Ophthalmology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Oyo, Nigeria
| | - Oluwatoyin H Onakpoya
- Retinal Unit, Department of Ophthalmology, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun, Nigeria
| | - Chinyelu N Ezisi
- Pediatric Ophthalmology and Strabismus Unit, Department of Ophthalmology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria
| | - Kareem O Musa
- Paediatric Ophthalmology and Strabismus Unit, Department of Ophthalmology, Lagos University Teaching Hospital, Idi-araba, Lagos, Nigeria
| | - Robison Vernon Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Valentina W Okeigbemen
- Paediatric Ophthalmology Unit, Department of Ophthalmology, University of Benin Teaching Hospital, Benin City, Edo, Nigeria
| | - Rilwan C Muhammad
- Department of Ophthalmology, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | | | - Adedayo O Adio
- Paediatric Ophthalmology Unit, Department of Ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers, Nigeria
| | - Olubunmi T Bodunde
- Department of Ophthalmology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - Abdulkadir L Rafindadi
- Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Tunji S Oluleye
- Vitreoretinal Unit, Department of Ophthalmology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Oyo, Nigeria
| | - Olukemi O Tongo
- Department of Paediatrics, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Oyo, Nigeria
| | - Sarat A Badmus
- Paediatric Ophthalmology Unit, Department of Ophthalmology, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria
| | - Olufunmilayo V Adebara
- Neonatal Unit, Department of Paediatrics, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria
| | - Tapas Ranjan Padhi
- Vitreoretinal Services, LV Prasad Eye Institute Bhubaneswar Campus, Bhubaneswar, India
| | - Beatrice N Ezenwa
- Department of Neonatology/Perinatology, Paediatrics, University of Lagos College of Medicine/ Lagos University Teaching Hospital, Lagos, Nigeria
| | - Tokunbo S Obajolowo
- Paediatric Ophthalmology and Strabismus Unit, Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria
| | - Lateefat B Olokoba
- Vitreoretinal Unit, Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria
| | - Victoria A Olatunji
- Vitreoretinal Unit, Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria
| | - Yewande Olubunmi Babalola
- Vitreoretinal Unit, Department of Ophthalmology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Oyo, Nigeria
| | - Mary O Ugalahi
- Paediatric Ophthalmology & Strabismus Unit, Department of Ophthalmology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Oyo, Nigeria
| | - Adetunji Adenekan
- Vitreoretinal Unit, Department of Ophthalmology, University of Lagos, Lagos, Nigeria
| | - Omotayo O Adesiyun
- Department of Paediatrics, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria
| | - Jagdish Sahoo
- Neonatology, IMS and SUM Hospital, Kalinga Nagar, Bhubaneswar, Odisha, India, Bhubaneswar, Odisha, India
| | - Marilyn T Miller
- Department of Ophthalmology, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Odarosa M Uhumwangho
- Vitreoretinal Unit, Department of Ophthalmology, University of Benin Teaching Hospital, Benin City, Edo, Nigeria
| | - Adeduntan S Olagbenro
- Department of Ophthalmology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - Ebunoluwa A Adejuyigbe
- Peadiatrics and Child Health, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria
| | - Chinyere V C Ezeaka
- Department of Neonatology/Perinatology, Paediatrics, University of Lagos College of Medicine/ Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olugbenga Mokuolu
- Neonatal Unit, Department of Paediatrics, University of Ilorin, Ilorin, Kwara, Nigeria
| | - Tinuade A Ogunlesi
- Department of Paediatrics, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - Olusoga B Ogunfowora
- Department of Paediatrics, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - Isa Abdulkadir
- Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Fatima L Abdullahi
- Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Abosede T Fabiyi
- Special Care Baby Unit, Nursing Service, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Laila H L Hassan
- Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Aderonke M Baiyeroju
- Paediatric Ophthalmology & Strabismus Unit, Department of Ophthalmology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Oyo, Nigeria
| | - Peace I Opara
- Department of Paediatrics, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers, Nigeria
| | - Kehinde Oladigbolu
- Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Augusta U Eneh
- Department of Paediatrics, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers, Nigeria
| | - Bassey E Fiebai
- Vitreoretinal Unit, Department of Ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers, Nigeria
| | - Fatima A Mahmud-Ajeigbe
- Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Elijah N Peter
- Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Hawwa S Abdullahi
- Department of Ophthalmology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
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Alvarez OP, Zein M, Galor A, Karp CL. Management of ocular surface squamous neoplasia: Bowman Club Lecture 2021. BMJ Open Ophthalmol 2021; 6:e000842. [PMID: 34395915 PMCID: PMC8317100 DOI: 10.1136/bmjophth-2021-000842] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/04/2021] [Indexed: 12/01/2022] Open
Abstract
The gold-standard treatment for ocular surface squamous neoplasia (OSSN) has traditionally been surgical excision with wide margins and a no-touch technique. However, surgery may be associated with several unfavourable sequelae, as well as significant recurrence rates if margins are positive. In recent years, topical chemotherapy with 5-fluorouracil, interferon α-2b and mitomycin C have emerged as valuable agents capable of effectively treating OSSN with varying adverse effects. These medical treatment options usually present additional costs to the patient but can allow patients to avoid surgery with fewer long-term effects. Anterior segment high-resolution optical coherence tomography is an excellent tool for diagnosing and monitoring OSSN and can be a useful aid for both surgical and medical treatments of OSSN.
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Affiliation(s)
- Osmel P Alvarez
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mike Zein
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Ophthalmology, Miami Veterans Administration, Miami, FL, USA
| | - Carol L Karp
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA
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21
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Abdel-Aty A, Kombo N. Factors affecting the resolution of acute non-infectious anterior scleritis. Br J Ophthalmol 2021; 106:1672-1677. [PMID: 34210671 DOI: 10.1136/bjophthalmol-2021-318808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/01/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Tumor necrosis factor alpha (TNF-⍺) inhibitors are increasingly being used to treat scleritis, however, their efficacy has not been compared to older treatments. Additionally, few studies have assessed differences in the course of scleritis among different patient groups. We identify demographic factors, comorbidities and treatments associated with the resolution of acute scleritis. METHODS The records of patients with non-infectious anterior scleritis who presented between 1 January 2013 and 1 January 2018 were retrospectively reviewed. RESULTS A total of 141 patients (169 eyes) with anterior scleritis were identified. 92.9% had diffuse anterior scleritis, 5.0% had nodular anterior scleritis and 2.1% had necrotising scleritis. Topical corticosteroids were used in 66.7% of patients, systemic non-steroidal anti-inflammatory drugs (NSAIDs) in 48.9% and systemic corticosteroids in 37.6%. Non-corticosteroid immunomodulatory therapies were required in 37.6% of patients. In a Cox proportionate hazards model, factors positively associated with the resolution of an episode of scleritis included NSAID use (HR=2.145; 95% CI 1.200 to 3.832), Hispanic race (HR=2.991; 95% CI 1.115 to 7.341) and lupus erythematous (HR=6.175; 95% CI 1.774 to 21.489). Bilateral scleritis was negatively associated with resolution (HR=0.437; 95% CI 0.196 to 0.972). TNF-⍺ inhibitors (HR=3.346; 95% CI 1.277-8.763), NSAID use (HR=2.558; 95% CI 1.383 to 4.729), lupus erythematosus (HR=5.251; 95% CI 1.478 to 18.659) and Hispanic race (HR=3.198; 95% CI 1.022 to 10.005) were significantly positively associated with steroid sparing resolution. CONCLUSION Patient characteristics including a lupus diagnosis and Hispanic race were associated with faster times to symptom resolution and steroid sparing resolution, as were treatments including systemic NSAIDs and TNF-⍺ inhibitors. Due to limitations in the available data, this analysis did not account for disease severity. Future prospective studies will further elucidate the relationship between these factors and patient outcomes.
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Affiliation(s)
- Ahmad Abdel-Aty
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ninani Kombo
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
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22
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Abstract
Optic perineuritis (OPN) is a rare inflammatory disorder in which the inflammation is confined to optic nerve sheath. It can be idiopathic or secondary to underlying systemic autoimmune disorder. It usually presents with unilateral progressive diminution of vision with pain on eye movements and optic disc oedema. Hence, clinically OPN mimics optic neuritis resulting in delayed diagnosis and suboptimal treatment. In contrast to optic neuritis, patients with OPN are usually of older age group and more likely show sparing of central vision. MRI is an important tool for diagnosis of OPN apart from optic nerve sheath biopsy. Perineural enhancement on MRI is diagnostic of OPN. Oral corticosteroid therapy gives dramatic and rapid improvement in signs and symptoms. Rapid tapering of steroids increases the risk of relapse. Overall, prognosis of OPN is generally good if adequate treatment is given timely.
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Affiliation(s)
- Sukriti Gupta
- Ophthalmology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
| | - Prabhpreet Sethi
- National Institute of TB and Respiratory Diseases, New Delhi, Delhi, India
| | - RamKrishan Duvesh
- Ophthalmology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
| | - Harinder Singh Sethi
- Ophthalmology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
| | - Mayuresh Naik
- Ophthalmology, Hamdard Institute of Medical Science and Research, New Delhi, India
| | - Harminder K Rai
- Ophthalmology, Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, Derbyshire, UK
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23
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Ma T, Sims JL, Bennett S, Chew S, Niederer RL. High rate of conversion from ocular hypertension to glaucoma in subjects with uveitis. Br J Ophthalmol 2021; 106:1520-1523. [PMID: 34020941 DOI: 10.1136/bjophthalmol-2021-318809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/31/2021] [Accepted: 05/05/2021] [Indexed: 11/03/2022]
Abstract
AIMS To examine presentation, management and long-term sequelae of ocular hypertension and uveitic glaucoma. METHODS Retrospective observational study of all subjects with uveitic glaucoma or ocular hypertension seen in Auckland uveitis clinics over the last 10 years. RESULTS A total of 188 eyes of 139 subjects with uveitic glaucoma or ocular hypertension were included for analysis. Total follow-up was 1854.5 eye years (mean 9.9 years). The mean age at uveitis diagnosis was 49.3 years. 52.5% of subjects were male. The most common diagnoses were idiopathic uveitis (29.3%), sarcoidosis (13.3%), herpes zoster (6.9%), HLA-B27 uveitis (6.9%), tuberculosis (5.9%) and Posner-Schlossmann or cytomegalovirus (CMV) uveitis (5.3%). Median intraocular pressure (IOP) at diagnosis was 35 mm Hg (IQR 29-45). 144 eyes (77.0%) developed glaucoma during the follow-up period, of whom 41 lost some central vision due to glaucoma. Oral acetazolamide was required for IOP control in 64.5%, 50 eyes underwent trabeculectomy, 18 eyes required a tube and 6 underwent minimally invasive glaucoma surgery. CONCLUSION Rapid progression was observed from ocular hypertension to uveitic glaucoma. Uveitic glaucoma is aggressive, with high likelihood of requiring surgical management and high risk of central vision loss. Close collaboration between uveitis and glaucoma specialists is required to maximise outcomes for these patients.
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Affiliation(s)
- Tiffany Ma
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Joanne L Sims
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Sonya Bennett
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Shenton Chew
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Rachael L Niederer
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand .,Department of Ophthalmology, University of Auckland, Auckland, New Zealand
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Xie L, Zhou H, Song H, Sun M, Yang M, Lai YM, Xu Q, Wei S. Comparative analysis of immunosuppressive therapies for myelin oligodendrocyte glycoprotein antibody-associated optic neuritis: a cohort study. Br J Ophthalmol 2021; 106:1587-1595. [PMID: 33931394 DOI: 10.1136/bjophthalmol-2020-318769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 11/04/2022]
Abstract
AIMS The optimal immunosuppressive therapy (IST) in patients with myelin oligodendrocyte glycoprotein antibody-associated optic neuritis (MOG-ON) remains uncertain. This study aimed to observe the disease course of MOG-ON and evaluate the therapeutic efficacy and tolerability of conventional immunosuppressants through Chinese cohort analysis. METHODS This bidirectional cohort study included 121 patients with MOG-ON between January 2015 and December 2018. The clinical features and annualised relapse rate (ARR) of patients with and without IST were analysed. RESULTS The median age at onset was 17.5 years, and the sex ratio (F:M) was 1.24. Of 121 patients, 77 patients relapsed and 61 patients were younger than 18 years at disease onset. The overall median ARR of 63 patients in the non-IST group was 0.5, with 46.0% patients showing relapse at a median follow-up of 33.5 months. In the IST group, the ARR decreased from 1.75 pre-IST to 0.00 post-IST in 53 patients who received IST exceeding 6 months, with 20.8% patients showing relapse at a median follow-up of 23.8 months. The relapse rates of patients treated with rituximab (RTX) and mycophenolate mofetil (MMF) were not statistically different, but the rate of discontinuation was significantly lower in the RTX-treated group (18.2% vs 57.7%, p=0.0017). CONCLUSION This study provides Class III evidence that both MMF and RTX may lower disease activity in patients with MOG-ON, and RTX showed better tolerability than MMF. However, observation after a single attack remains a good option because less than half of patients not on treatment suffered a relapse.
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Affiliation(s)
- Lindan Xie
- Medical School, Nankai University, Tianjin, China.,Medical Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Huanfen Zhou
- Medical Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Honglu Song
- Medical Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Mingming Sun
- Medical Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Mo Yang
- Medical Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Ying Meng Lai
- Medical Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Quangang Xu
- Medical Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Shihui Wei
- Medical School, Nankai University, Tianjin, China .,Medical Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
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Downey L, Acharya N, Devonport H, Gale R, Habib M, Manjunath V, Mukherjee R, Severn P. Treatment choices for diabetic macular oedema: a guideline for when to consider an intravitreal corticosteroid, including adaptations for the COVID-19 era. BMJ Open Ophthalmol 2021; 6:e000696. [PMID: 34192155 PMCID: PMC8088120 DOI: 10.1136/bmjophth-2020-000696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/03/2021] [Accepted: 02/11/2021] [Indexed: 12/20/2022] Open
Abstract
First-line treatment of centrally involved diabetic macular oedema (CI-DMO) is often with an anti-vascular endothelial growth factor (anti-VEGF) agent. Although this can provide efficacy in the majority of eyes, a sizeable proportion do not respond sufficiently and many continue to receive anti-VEGF therapy after it may be optimal. This imposes a treatment burden on both patients and clinicians and, most importantly of all, can be sight threatening. Changing treatment to an intravitreal corticosteroid implant at the appropriate time may help optimise patient outcomes and reduce injection frequency, thereby reducing treatment burden. Eight retina specialists convened to discuss how to ensure eyes with CI-DMO receiving intravitreal anti-VEGF therapy are evaluated for a potential change to intravitreal corticosteroid therapy at the most effective time in their treatment journey. They concluded that clear criteria on when to consider changing treatment would be helpful and so developed a consensus guideline covering key decision points such as when and how to assess response to anti-VEGF therapy, when to consider a change to corticosteroid therapy and when and how to assess the response to corticosteroid therapy. The guideline was developed before the COVID-19 pandemic but, with the additional challenges arising from this including even greater pressure on clinic capacity, it is more important than ever to reconsider current working practices and adopt changes to improve patient care while also easing pressure on clinic capacity, reducing hospital visits and maintaining patient safety. This publication therefore also includes suggestions for adapting the guidelines in the COVID-19 era.
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Affiliation(s)
- Louise Downey
- Department of Ophthalmology, Hull Royal Infirmary, Hull, Kingston upon Hull, UK
| | - Nachiketa Acharya
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK
| | - Helen Devonport
- Department of Ophthalmology, Bradford Royal Infirmary, Bradford, UK
| | - Richard Gale
- Department of Ophthalmology, York Hospital, York, UK
| | - Maged Habib
- Department of Ophthalmology, Sunderland Eye Infirmary, Sunderland, UK
| | - Vina Manjunath
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | | - Philip Severn
- Department of Ophthalmology, James Cook University Hospital, Middlesbrough, UK
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Sejournet L, Kerever S, Mathis T, Kodjikian L, Jamilloux Y, Seve P. Therapeutic drug monitoring guides the management of patients with chronic non-infectious uveitis treated with adalimumab: a retrospective study. Br J Ophthalmol 2021; 106:1380-1386. [PMID: 33875451 DOI: 10.1136/bjophthalmol-2021-319072] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/23/2021] [Accepted: 04/06/2021] [Indexed: 12/19/2022]
Abstract
AIM To assess the relevance of therapeutic drug monitoring (TDM) of adalimumab (ADA) treatment for the control of intraocular inflammation and treatment adjustment in chronic non-infectious uveitis (CNIU). METHODS Retrospective study of CNIU patients treated with ADA and for whom at least one dosage of serum ADA level and an antibodies against ADA (AAA) serology were performed, between June 2003 and July 2019. RESULTS A total of 44 ADA-treated patients benefited from a TDM. A total of 48/79 (61%) TDM were performed in responders, 11/79 (14%) in primary non-responders, and 20/79 (25%) in secondary non-responders. Responders had significantly higher ADA levels than non-responders (p=0.0004). AAA were detectable in six patients, they were primary non-responders (n=2), secondary non-responders (n=3) or responders (n=1). In the five non-responders and immunised patients, ADA was switched (to golimumab or methotrexate). Among non-responders, TDM led to an increased frequency of injections 12/31 (38%), increased dose 1/31 (3%) and switch of treatment 10/31 (32%) (one missing data). No modification of biotherapy was performed 7/31 (22%) and only local or oral corticotherapy was adjusted. In 24/31 cases of therapeutic adjustment in non-responders, an improvement was observed in 87% of cases. Among responders for whom the ADA level was above the efficacy threshold, the frequency of injections was decreased for 15/31 (48.4%) cases and no relapse was observed in 12/15 (80%) cases. CONCLUSION TDM of ADA treatment proved relevant to provide CNIU patients with a personalised and optimised treatment course (in terms of frequency and type of drug).
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Affiliation(s)
| | - Sebastien Kerever
- Hospital Lariboisière Anaesthesiology and Resuscitation Unit, Paris, France
| | - Thibaud Mathis
- Ophthalmology, Hopital de La Croix-Rousse Ophtalmologie, Lyon, France
| | - Laurent Kodjikian
- Ophthalmology, Hopital de La Croix-Rousse Ophtalmologie, Lyon, France
| | - Yvan Jamilloux
- Internal Medicine, Hopital de la Croix-Rousse Service de Medecine Interne, Lyon, France
| | - Pascal Seve
- Internal Medicine, Hopital de la Croix-Rousse Service de Medecine Interne, Lyon, France .,Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
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Cheng Y, Sun S, Deng X, Zhu X, Linghu D, Sun X, Liang J. Systemic conbercept pharmacokinetics and VEGF pharmacodynamics following intravitreal injections of conbercept in patients with retinopathy of prematurity. Br J Ophthalmol 2021; 106:1295-1300. [PMID: 33836990 DOI: 10.1136/bjophthalmol-2021-319131] [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: 02/22/2021] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Data on serum vascular endothelial growth factor (VEGF) and drug levels in patients with retinopathy of prematurity (ROP) following intravitreal injections of conbercept (IVC) are lacking. METHODS Multicentre, prospective, non-randomised study of patients with aggressive posterior retinopathy of prematurity (APROP) or type 1 ROP who had not received other treatment. All infants received therapy in both eyes plus intravitreal IVC 0.25 mg/0.025 mL in one eye and had at least 6 months of follow-up. Blood samples were collected before and 1 week and 4 weeks after IVC. The main outcome measures were serum conbercept and VEGF concentrations. RESULTS Forty infants with APROP or type 1 ROP were enrolled. The mean serum VEGF at baseline and 1 week and 4 weeks after a total of 0.25 mg of IVC was 953.35±311.90 pg/mL, 303.46±181.89 pg/mL and 883.12±303.89 pg/mL, respectively. Serum VEGF 1 week after IVC was significantly lower (p<0.05) than baseline, and at 4 weeks after IVC, it was significantly higher (p<0.05) than at 1 week. There was no significant difference (p>0.05) between baseline and 4 weeks. Serum conbercept was below the limit of quantitation (BLOQ) at baseline and 4 weeks and was 19.81±7.60 ng/mL at 1 week. CONCLUSION Serum VEGF 1 week after IVC was significantly lower than baseline but returned to baseline at 4 weeks. Serum conbercept increased at 1 week and was BLOQ at 4 weeks.
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Affiliation(s)
- Yong Cheng
- Department of Ophthalmology, Peking University People's Hospital, Eye diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Clinical Centre of Optometry, College of Optometry, Peking University Health science center, Beijing, China
| | - Shuang Sun
- Department of Ophthalmology,Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Xun Deng
- Department of Ophthalmology, Peking University People's Hospital, Eye diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Clinical Centre of Optometry, College of Optometry, Peking University Health science center, Beijing, China
| | - Xuemei Zhu
- Department of Ophthalmology, Peking University People's Hospital, Eye diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Clinical Centre of Optometry, College of Optometry, Peking University Health science center, Beijing, China
| | - Dandan Linghu
- Department of Ophthalmology, Peking University People's Hospital, Eye diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Clinical Centre of Optometry, College of Optometry, Peking University Health science center, Beijing, China
| | - Xiantao Sun
- Department of Ophthalmology,Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Jianhong Liang
- Department of Ophthalmology, Peking University People's Hospital, Eye diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Clinical Centre of Optometry, College of Optometry, Peking University Health science center, Beijing, China
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McClard CK, Wang R, Windham V, Munoz J, Gomez S, Fried S, Saroj N, Regillo C, Wykoff CC, Strutt AM. Questionnaire to Assess Life Impact of Treatment by Intravitreal Injections (QUALITII): Development of a patient-reported measure to assess treatment burden of repeat intravitreal injections. BMJ Open Ophthalmol 2021; 6:e000669. [PMID: 33912685 PMCID: PMC8031709 DOI: 10.1136/bmjophth-2020-000669] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 01/22/2023] Open
Abstract
Objective To understand patient burden of treatment of repeated intravitreal injections (IVI) in the management of exudative retinal diseases. Methods and analysis Participants were sampled from a large urban retina specialty practice in Houston, Texas, USA, based on history of ongoing receipt of IVI. The 50-item Questionnaire to Assess Life Impact of Treatment by Intravitreal Injections questionnaire was developed to evaluate the patient experience including discomfort, anxiety, inconvenience and satisfaction. Categorial principal components analysis (CATPCA) was performed to assess construct validity and internal consistency. A subset of these items was used to establish a measure of total treatment burden, referred to as the IVI Treatment Burden Score (TBS). Results 142 patients participated in this study. CATPCA analysis revealed five dimensions of patient burden: disruption of normal routine or capacity, anxiety, frequency of visits, chronicity of disease and perceived treatment value or satisfaction. Together, these dimensions accounted for 67% of variance explained. Cronbach's alpha was 0.97. The most frequently cited cause of discomfort was the feeling after anaesthetic wore off. The most common source of anxiety was fear of injection and associated discomfort or pain. Regarding inconvenience, patients reported temporary postinjection debilitation, requiring an average of 8 hours for recovery per treatment. The most frequently identified sources of satisfaction were confidence in the provider or treatment and interactions with staff. Conclusions Understanding and quantifying the patient burden associated with repeated IVI for exudative retinal diseases can reveal opportunities to improve delivery methods. The TBS could serve to inform strategies to maximise treatment adherence and optimise patient experiences.
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Affiliation(s)
- Cynthia K McClard
- Ophthalmology, Dean McGee Eye Institute, Oklahoma City, Oklahoma, USA.,The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Rui Wang
- Ophthalmology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | | | - Jose Munoz
- Retina Consultants of Texas, Houston, Texas, USA
| | - Samuel Gomez
- Retina Consultants of Texas, Houston, Texas, USA
| | - Sagit Fried
- Ben Gurion University of the Negev, Beersheba, Israel
| | | | - Carl Regillo
- Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Charles Clifton Wykoff
- Retina Consultants of Texas, Retina Consultants of America; Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA
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Hida RY, Silva CB, Romero-Kusabara IL, Mimica LMJ. Short-chain cyanoacrylates and long-chain cyanoacrylates (Dermabond) have different antimicrobial effects. BMJ Open Ophthalmol 2021; 6:e000591. [PMID: 33791434 PMCID: PMC7978097 DOI: 10.1136/bmjophth-2020-000591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 12/19/2020] [Accepted: 12/31/2020] [Indexed: 11/14/2022] Open
Abstract
Objective To compare the antimicrobial effect in vitro of a short-chain cyanoacrylate with a long-chain cyanoacrylate (Dermabond, Ethicon, Johnson and Johnson, USA) against bacterial strains. Methods and analysis The following bacterial strains were analysed: Staphylococcus aureus, Escherichia coli, Klebsiella pneumonia and Pseudomonas aeruginosa. For each microorganism, standardised sterile discs (6 mm) containing 10 µL of ethyl-cyanoacrylate and 2-octyl cyanoacrylate were applied to the plate. All plates received a blank filter-paper disc with no adhesive (control). All plates were incubated for 24 hours, after which the bacterial inhibitory halos, if present, were measured in millimetres in its greater length. Results Inhibitory halos were observed for both adhesives for S. aureus. Inhibition halos were observed only for ethyl-cyanoacrylate for K. pneumoniae and E. coli. No inhibition halo was observed for P. aeruginosa in any sample. The relationship between the total size of the inhibition halos and the diameter of the paper filter for S. aureus was statistically significant compared with 2-octyl cyanoacrylate. Conclusion Data shown conclude that ethyl-cyanoacrylate showed in vitro bacteriostatic activity for S. aureus, E. coli and K. pneumoniae. 2-Octyl cyanoacrylate showed in vitro lower bacteriostatic activity only against S. aureus when compared with ethyl-cyanoacrylate. No in vitro bactericidal activity of ethyl-cyanoacrylate or 2-octyl cyanoacrylate was observed.
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Affiliation(s)
- Richard Yudi Hida
- Department of Ophthalmology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,Department of Ophthalmology, Keio University- School of Medicine, Tokyo, Japan.,Department of Ophthalmology, Universidade de São Paulo (USP), São Paulo, Brazil
| | - Cely Barreto Silva
- Department of Microbiologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Sao Paulo, São Paulo, Brazil
| | | | - Lycia Mara Jenne Mimica
- Department of Microbiologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Sao Paulo, São Paulo, Brazil
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30
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Samadi B, Lundstrom M, Zetterberg M, Nilsson I, Montan P, Behndig A, Kugelberg M. Anti-inflammatory treatment after cataract surgery in Sweden: changes in prescribing patterns from 2010 to 2017. BMJ Open Ophthalmol 2021; 6:e000635. [PMID: 33880412 PMCID: PMC7993195 DOI: 10.1136/bmjophth-2020-000635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/19/2021] [Accepted: 02/01/2021] [Indexed: 11/29/2022] Open
Abstract
Aims To investigate changes in the prescribing patterns of postoperative eye drops following cataract surgery in Sweden from 2010 to 2017. Methods Data from cataract procedures registered in the National Cataract Register during the month of March from 2010 to 2017 were record linked and sent to the Swedish Prescribed Drug Register, which allowed us to determine which eye drops the patients had obtained from 3 months presurgery to 2 weeks post surgery. Results During the 8-year study period, 54 889 surgeries were registered. Combination treatment with steroid and non-steroidal anti-inflammatory drug (NSAID) eye drops increased from 12% in 2010 to 60% in 2017 (p<0.001) while monotherapy with steroids decreased from 71% in 2010 to 26% in 2017 (p<0.001). Monotherapy with NSAIDs after surgery was fairly stable, at 17% in 2010 and 13% in 2017 (p<0.001). Combination treatment was more frequent in patients with diabetic retinopathy (p<0.001) or age-related macular degeneration (p<0.001), while monotherapy with steroids was more frequent in patients with glaucoma (p<0.001). The proportion of monotherapy or combination therapy varied widely between ophthalmic clinics. The prescription of antibiotic eye drops after surgery also varied greatly between clinics, from 0% to 63%, with a national average of 4.9%. Conclusion There is a change in the prescription pattern of anti-inflammatory eye drops after cataract surgery in Sweden, with less monotherapy and an increasing proportion of patients receiving a combination of steroid and NSAID eye drops.
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Affiliation(s)
- Behrad Samadi
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Mats Lundstrom
- Department of Clinical Sciences, Ophthalmology, Faculty of Medicine, Lund University, Karlskrona, Sweden
| | - Madeleine Zetterberg
- Department of Clinical Neuroscience, University of Gothenburg, Mölndal, Sweden.,Ophthalmology, Sahlgrenska University Hospital, Goteborg, Sweden
| | | | - Per Montan
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, St Erik Eye Hospital, Stockholm, Sweden
| | - Anders Behndig
- RC Syd, Blekinge Hospital Karlskrona, Karlskrona, Sweden
| | - Maria Kugelberg
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, St Erik Eye Hospital, Stockholm, Sweden
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31
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Zhai R, Wang Z, Sheng Q, Fan X, Kong X, Sun X. Polymorphisms of the cytomegalovirus glycoprotein B genotype in patients with Posner-Schlossman syndrome. Br J Ophthalmol 2021; 106:1240-1244. [PMID: 33753409 PMCID: PMC9411906 DOI: 10.1136/bjophthalmol-2020-318284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/16/2021] [Accepted: 03/07/2021] [Indexed: 02/05/2023]
Abstract
Aims The aim of this observational study was to report the distribution of glycoprotein B (gB) genotypes in the eyes of cytomegalovirus (CMV) positive patients with Posner-Schlossman syndrome (PSS), and to investigate their clinical characteristics and outcomes. Methods We collected aqueous humour samples from 165 patients clinically diagnosed with PSS between 2017 and 2019. PCR was performed to analyse the CMV DNA and identify the gB genotypes in the samples. Clinical characteristics and responses to antiviral treatment were compared among patients with different gB genotypes. Results CMV DNA was detected in 94 (56.97%) of the 165 aqueous humour specimens analysed. Owing to the quantity requirement for CMV gB genotype analysis, results could be obtained from only 14 specimens. CMV gB type 1 was detected in 11 samples (78.6%), whereas CMV gB type 3 was detected in three samples (21.4%). No other gB genotypes or mixed genotypes were detected. Overall, 9.1% (1/11) of the patients in the gB type 1 group and 66.7% (2/3) of the patients in the gB type 3 group had bilateral attacks (p=0.093). The concentration of anti-CMV immunoglobulin G (IgG) in the type 1 group was 0.94±0.79 s/co (ratio of aqueous humour CMV IgG/serum CMV IgG to aqueous humour albumin concentration/serum albumin concentration), whereas that in the type 3 group was 0.67±0.71 s/co. Conclusion Genotype 1 was the most prevalent genotype in the aqueous humour of CMV-infected patients with PSS. Bilateral attack was predominant among patients with gB genotype 3. CMV gB gene may be related to the pathogenicity of CMV virus strain in patients with PSS.
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Affiliation(s)
- Ruyi Zhai
- Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Zhujian Wang
- Department of Clinical Laboratory, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Qilian Sheng
- Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Xintong Fan
- Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Xiangmei Kong
- Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, Shanghai, China .,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Xinghuai Sun
- Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China.,State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science,Fudan University, Shanghai, China
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Chen CW, Zhu Q, Duan YB, Yao JY. Comparison between binocular therapy and patching for treatment of amblyopia: a meta-analysis of randomised controlled trials. BMJ Open Ophthalmol 2021; 6:e000625. [PMID: 33718612 PMCID: PMC7908277 DOI: 10.1136/bmjophth-2020-000625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/12/2021] [Accepted: 02/06/2021] [Indexed: 11/04/2022] Open
Abstract
Several studies have compared binocular therapy and patching for the treatment of amblyopia. However, most of them involved a small number of cases and reported controversial results. Thus, the benefit of binocular therapy remains to be confirmed. We conducted a meta-analysis to evaluate the efficacy of binocular therapy versus patching and to testify whether binocular therapy could become supplementary method in children with amblyopia. Randomised controlled trials that evaluated the efficacy of binocular therapy for amblyopia versus patching were identified using PubMed, Embase, Cochrane Library, Ovid, Web of Science, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform. Data screening, extraction and quality assessment were performed independently by two researchers. Six trials were identified and analysed to compare binocular therapy (708 eyes) with patching (664 eyes) for change in best-corrected visual acuity and stereoacuity. Efficacy estimates were evaluated by standard mean difference (SMD) and 95% CI. The best-corrected visual acuity in binocular group was better than that of in patching group (SMD=-0.21 logarithm of the minimum angle of resolution (log MAR), 95% CI of -0.50 to 0.08 log MAR, p=0.003). The results showed statistically significant difference in the change of best-corrected visual acuity between the groups, but not in stereoacuity. Binocular therapy may be a promising treatment of conditions affecting visual acuity, and could be applied as a supplementary method to patching for amblyopia in clinical practice. The present analysis showed that some children with amblyopia may benefit from binocular therapy. Nevertheless, larger randomised controlled clinical trials are required to confirm these findings.
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Affiliation(s)
- Chun-Wen Chen
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Qin Zhu
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Yu-Bing Duan
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Jing-Yan Yao
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
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Hunt AR, Nguyen V, Creuzot-Garcher CP, Alforja S, Gabrielle PH, Zarranz-Ventura J, Guillemin M, Fraser-Bell S, Casaroli Marano RP, Arnold J, McAllister IL, O'Toole L, Gillies MC, Barthelmes D, Mehta H. Twelve-month outcomes of ranibizumab versus aflibercept for macular oedema in branch retinal vein occlusion: data from the FRB! registry. Br J Ophthalmol 2021; 106:1178-1184. [PMID: 33712484 DOI: 10.1136/bjophthalmol-2020-318491] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/12/2021] [Accepted: 03/04/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND/AIMS To compare the efficacy of ranibizumab (0.5 mg) with aflibercept (2 mg) in the treatment of cystoid macular oedema due to branch retinal vein occlusion (BRVO) over 12 months. METHODS A multicentre, international, database observational study recruited 322 eyes initiating therapy in real-world practice over 5 years. The main outcome measure was mean change in EDTRS letter scores of visual acuity (VA). Secondary outcomes included anatomic outcomes, percentage of eyes with VA >6/12 (70 letters), number of injections and visits, time to first inactivity, switching or non-completion. RESULTS Generalised mixed effect models demonstrated that mean (95% CI) adjusted 12-month VA changes for ranibizumab and aflibercept were similar (+10.8 (8.2 to 13.4) vs +10.9 (8.3 to 13.5) letters, respectively, p=0.59). The mean adjusted change in central subfield thickness (CST) was greater for aflibercept than ranibizumab (-170 (-153 to -187) µm vs -147 (-130 to -164) µm, respectively, p=0.001). The overall median (Q1, Q3) of 7 (4, 8) injections and 9 (7, 11) visits was similar between treatment groups. First grading of inactivity occurred sooner with aflibercept (p=0.01). Switching was more common from ranibizumab (37 eyes, 23%) than from aflibercept (17 eyes, 11%; p=0.002). CONCLUSION Visual outcomes at 12 months in this direct comparison of ranibizumab and aflibercept for BRVO in real-world practice were generally good and similar for the 2 drugs, despite a greater effect of aflibercept on CST and time to first grading of inactivity.
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Affiliation(s)
- Adrian R Hunt
- Medical Retina, Westmead Hospital, Westmead, New South Wales, Australia .,Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Vuong Nguyen
- Clinical Ophthalmology & Eye Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Socorro Alforja
- Institut Clínic de Oftalmologia (ICOF), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Pierre-Henry Gabrielle
- Ophthalmology, Centre Hospitalier Universitaire de Dijon, Dijon, Bourgogne, France.,Eye and Nutrition Research Group, Centre des Sciences du Goût et de l'Alimentation, INRA Centre de Dijon, Dijon, Bourgogne, France
| | | | - Martin Guillemin
- Ophthalmology, Centre Hospitalier Universitaire de Dijon, Dijon, Bourgogne, France
| | - Samantha Fraser-Bell
- Clinical Ophthalmology & Eye Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Jennifer Arnold
- Marsden Eys Specialists, Parramatta, Greater Western Sydney, Australia
| | - Ian L McAllister
- Lions Eye Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | | | - Mark C Gillies
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Daniel Barthelmes
- UniversitatsSpital Zurich Augenklinik und Poliklinik, Zurich, ZH, Switzerland
| | - Hemal Mehta
- Medical Retina, Sydney Eye Hospital, Sydney, New South Wales, Australia.,Medical Retina, Moorfields Eye Hospital, London, UK
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34
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Kousha O, Delle Fave MM, Cozzi M, Carini E, Pagliarini S. Diabetic maculopathy: multicolour and SD-OCT versus fundus photography. BMJ Open Ophthalmol 2021; 6:e000514. [PMID: 33681471 PMCID: PMC7898856 DOI: 10.1136/bmjophth-2020-000514] [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: 05/19/2020] [Revised: 11/08/2020] [Accepted: 02/08/2021] [Indexed: 11/03/2022] Open
Abstract
Objective The English Diabetic Eye Screening (DES) programme recommends patients with M1 diabetic maculopathy to be referred to hospital eye services. DES uses flash fundus photography as the reference standard for maculopathy grading. We compared multicolour versus non-stereoscopic fundus photography at identifying M1 maculopathy, with spectral domain optical coherence tomography (SD-OCT) identifying macular thickening. Methods and analysis This cross-sectional study included 345 patients with R1M1 referred from DES and reviewed in secondary care with fundus photographs, multicolour and SD-OCT. Maculopathy was graded based on DES exudate criteria on both multicolour and fundus photography in a blind fashion by two independent graders. Macular thickness was ascertained on SD-OCT. Results Intergrader agreement on grading maculopathy using fundus photography (Cohen's κ=0.91) and multicolour (Cohen's κ=0.82) was 'almost perfect'. Agreement between fundus photography and multicolour on grading maculopathy (Cohen's κ=0.76) was 'substantial'. Compared with fundus photography, multicolour had sensitivity of 87% (95% CI 81% to 93%) and specificity of 90% (95% CI 87% to 94%) in detecting M1 maculopathy. SD-OCT identified 84 eyes with macular thickening, 47 of which were graded as M0 by fundus photography. 5 eyes with exudates and severe macular oedema requiring urgent intervention were also missed on fundus photography but not on multicolour. Multicolour, when complemented by SD-OCT, did not miss any clinically significant macular oedema. Conclusion Multicolour integrates synergistically in a single platform with SD-OCT providing effective monitoring of M1 diabetic maculopathy. The need for fundus photography is eliminated by multicolour/SD-OCT in dedicated R1M1 virtual clinics not requiring parallel diabetic retinopathy grading.
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Affiliation(s)
- Obaid Kousha
- Department of Ophthalmology, Ninewells Hospital, Dundee, UK
| | | | - Mariano Cozzi
- Department of Biomedical and Clinical Science, Luigi Sacco University Hospital, Milano, Lombardia, Italy
| | - Elisa Carini
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco University Hospital, Milano, Lombardia, Italy
| | - Sergio Pagliarini
- Department of Ophthalmology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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35
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Yamanishi R, Okada N, Shimizu E, Fujishima H. Elevated levels of prostaglandin E 2 in the tears of patients with severe allergic conjunctivitis and primary cultured conjunctival cells are suppressed by ketotifen and dexamethasone. BMJ Open Ophthalmol 2021; 6:e000571. [PMID: 33553650 PMCID: PMC7839870 DOI: 10.1136/bmjophth-2020-000571] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/06/2020] [Accepted: 12/10/2020] [Indexed: 12/14/2022] Open
Abstract
Objective We examined the production of prostaglandin E2 (PGE2), which is the key prostaglandin involved in inflammatory disorders of the ocular surface. Tears and conjunctival fibroblasts were evaluated in order to assess allergic inflammation and the effect of specific drugs. Methods and analysis PGE2 was measured in tears from both patients and normal volunteers. Primary cultures of human conjunctival fibroblasts were incubated with interleukin (IL)-4 and tumour necrosis factor (TNF)-α with or without ketotifen fumarate or dexamethasone. The culture supernatants were removed 24 hours after exposure and the concentrations of PGE2 were quantified by ELISA. Results Significantly higher levels of PGE2 were observed in the tears of patients with severe allergic conjunctivitis than in those with post-surgical inflammation (p=0.02), and this production was reduced by eye drops. Stimulation with IL-4 and TNF-α induced the generation of PGE2 in supernatants of conjunctival fibroblasts, and this production was significantly downregulated by ketotifen fumarate or steroids. Conclusion PGE2 may participate in the pathogenesis of severe ocular allergic disease, and both ketotifen fumarate and steroid reduce the production of PGE2.
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Affiliation(s)
- Ryutaro Yamanishi
- Department of Ophthalmology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Naoko Okada
- Department of Pharmaceutical Sciences, Nihon Pharmaceutical University, Kita adachi-gun, Saitama, Japan
| | - Eisuke Shimizu
- Department of Ophthalmology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hiroshi Fujishima
- Department of Ophthalmology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.,Ophthalmology, Tsurumi University Dental Hospital, Yokohama, Kanagawa, Japan
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36
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Orii Y, Gozawa M, Takamura Y, Takeuchi Y, Morioka M, Yamada Y, Matsumura T, Sugimoto M, Inatani M. Comparison of the intraocular pressure following an intravitreal triamcinolone acetonide injection for diabetic macula oedema in vitrectomised and non-vitrectomised eyes. BMJ Open Ophthalmol 2021; 6:e000620. [PMID: 33490603 PMCID: PMC7798713 DOI: 10.1136/bmjophth-2020-000620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/19/2020] [Accepted: 12/22/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the intraocular pressure (IOP) after an intravitreal triamcinolone acetonide (IVTA) between vitrectomised and non-vitrectomised eyes in patients with diabetes and diabetic macular oedema (DME). Design Retrospective comparative study Methods Medical records of 157 patients (157 eyes) with type 2 diabetes who received IVTA for DME were reviewed, and the best-corrected visual acuity, IOP and optical central retinal thickness (CRT) were compared preoperatively, at 1, 4, 12 and 24 weeks after IVTA between the vitrectomised and non-vitrectomised groups. Results IOP significantly increased at 1 (p<0.0001), 4 (p<0.0001), 8 (p<0.0001), 12 (p=0.0019), 16 (p=0.0006) and 20 weeks (p=0.0191) in the non-vitrectomised group, whereas a significant increase was only observed at 1 (p=0.0003) and 4 weeks (p=0.0006) in the vitrectomised group. ΔIOP, IOP changes from baseline, in the non-vitrectomised group was significantly higher than that in the vitrectomised group at 4 (p=0.0014), 8 (p=0.0081), 12 (p=0.0032) and 16 weeks (p=0.0038). No significant difference was observed in logMAR and CRT at any time point after IVTA between the two groups. Conclusions After an initial IVTA, increased IOP and ΔIOP from the baseline IOP were significantly more frequently observed in the non-vitrectomised than that in the vitrectomised group. IVTA is a safer and more effective treatment option for DME in vitrectomised than that in non-vitrectomised eyes.
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Affiliation(s)
- Yusuke Orii
- Department of Ophthalmology, University of Fukui Faculty of Medical Sciences, Yoshida-gun, Japan
| | - Makoto Gozawa
- Department of Ophthalmology, University of Fukui Faculty of Medical Sciences, Yoshida-gun, Japan
| | - Yoshihiro Takamura
- Department of Ophthalmology, University of Fukui Faculty of Medical Sciences, Yoshida-gun, Japan
| | - Yuko Takeuchi
- Department of Ophthalmology, University of Fukui Faculty of Medical Sciences, Yoshida-gun, Japan
| | - Masakazu Morioka
- Department of Ophthalmology, University of Fukui Faculty of Medical Sciences, Yoshida-gun, Japan
| | - Yutaka Yamada
- Department of Ophthalmology, University of Fukui Faculty of Medical Sciences, Yoshida-gun, Japan
| | - Takehiro Matsumura
- Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | | | - Masaru Inatani
- Department of Ophthalmology, University of Fukui Faculty of Medical Sciences, Yoshida-gun, Japan
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Shen LL, Sun M, Ahluwalia A, Park MM, Young BK, Lad EM, Toth C, Del Priore LV. Natural history of central sparing in geographic atrophy secondary to non-exudative age-related macular degeneration. Br J Ophthalmol 2020; 106:689-695. [PMID: 33361441 DOI: 10.1136/bjophthalmol-2020-317636] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/17/2020] [Accepted: 12/07/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The macular central 1 mm diameter zone is crucial to patients' visual acuity, but the long-term natural history of central sparing in eyes with geographic atrophy (GA) is unknown. METHODS We manually segmented GA in 210 eyes with GA involving central 1 mm diameter zone (mean follow-up=3.8 years) in the Age-Related Eye Disease Study. We measured the residual area in central 1 mm diameter zone and calculated central residual effective radius (CRER) as square root of (residual area/π). A linear mixed-effects model was used to model residual size over time. We added a horizontal translation factor to each data set to account for different durations of GA involving the central zone. RESULTS The decline rate of central residual area was associated with baseline residual area (p=0.008), but a transformation from central residual area to CRER eliminated this relationship (p=0.51). After the introduction of horizontal translation factors to each data set, CRER declined linearly over approximately 13 years (r2=0.80). The growth rate of total GA effective radius was 0.14 mm/year (95% CI 0.12 to 0.15), 3.7-fold higher than the decline rate of CRER (0.038 mm/year, 95% CI 0.034 to 0.042). The decline rate of CRER was 53.3% higher in eyes with than without advanced age-related macular degeneration in the fellow eyes at any visit (p=0.007). CONCLUSIONS CRER in eyes with GA declined linearly over approximately 13 years and may serve as an anatomic endpoint in future clinical trials aiming to preserve the central zone.
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Affiliation(s)
- Liangbo L Shen
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mengyuan Sun
- Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, Connecticut, USA
| | - Aneesha Ahluwalia
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael M Park
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Benjamin K Young
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Eleonora M Lad
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Cynthia Toth
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Lucian V Del Priore
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
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Foss A, Haydock R, Childs M, Duley LM, Empeslidis T, Dhar-Munshi S, Montgomery AA, Ogollah R, Ozolins M, Tesha P, Mitchell E. TANDEM TRIAL: a factorial randomised controlled trial of dose and review schedule of bevacizumab (Avastin) for neovascular macular degeneration in the East Midlands. BMJ Open Ophthalmol 2020; 5:e000588. [PMID: 33344775 PMCID: PMC7725082 DOI: 10.1136/bmjophth-2020-000588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 11/26/2022] Open
Abstract
Objective Neovascular age-related macular degeneration (nAMD) causes damage to the macula and severe vision loss. Bevacizumab is the most cost-effective nAMD treatment. The TANDEM trial was designed to determine whether, in patients with nAMD, low-dose bevacizumab is non-inferior to the standard dose in terms of visual deterioration and whether a bimonthly regimen is non-inferior to monthly, treatment as required, regimens. Methods This was a multicentre, 2×2 factorial, double-masked, non-inferiority randomised trial with patients considered eligible if they met the National Institute for Health and Care Excellence criteria for nAMD treatment with ranibizumab. Participants were randomly assigned to standard (1.25 mg) or low (0.625 mg) dose bevacizumab and either monthly or bimonthly review regimen. The primary outcome was time to vision deterioration, defined as reduction of ≥15 letters (three lines) during the loading phase (visual acuity scores at visits B and C compared with the initial visit A), or ≥6 letters (one line) during the maintenance phase (visual acuity scores at subsequent visits compared with mean vision at visits A–C). Results In total 812 participants (918 eyes) were randomised into the trial. The low dose showed some evidence of being non-inferior to standard dose (HR 1.07; 95% CI 0.80 to 1.42), however, there was no strong evidence of bimonthly review being non-inferior to monthly review (HR 1.45; 95% CI 1.09 to 1.94). There was no difference in visual acuity when assessed at 9 months and no major differences in the frequency of serious adverse events or reactions between the groups. Conclusion The standard dose of bevacizumab can be halved without compromising efficacy. Bimonthly review cannot be considered to be no worse than monthly review.
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Affiliation(s)
- Alexander Foss
- Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Rebecca Haydock
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Margaret Childs
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Lelia M Duley
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Theo Empeslidis
- Department of Ophthalmology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sushma Dhar-Munshi
- Department of Ophthalmology, Kings Mill Hospital, Sherwood Forest Hospitals NHS Foundation Trust, Sutton-In-Ashfield, Nottinghamshire, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Reuben Ogollah
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Mara Ozolins
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Paul Tesha
- Department of Ophthalmology, Lincoln County Hospital, United Lincolnshire Hospitals NHS Trust, Lincoln, Lincolnshire, UK
| | - Eleanor Mitchell
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, Nottinghamshire, UK
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Kilgore KP, Wang F, Stern NC, Jamali Dogahe S, White LJ, Khanna CL. Health-related quality of life in Ahmed FP7, and Baerveldt 250 and 350 patients compared with medical controls. Br J Ophthalmol 2020; 106:356-361. [PMID: 33328185 DOI: 10.1136/bjophthalmol-2020-317856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/14/2020] [Accepted: 10/30/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To compare health-related quality of life (HRQoL) in patients with Ahmed FP7 (FP7), Baerveldt 250 (B250) and Baerveldt 350 (B350) glaucoma drainage device (GDDs), and medically treated controls. METHODS This was a prospective cohort study from August 2017 to July 2019. The NEI 25-Item Visual Function Questionnaire (VFQ-25), the Adult Strabismus-20 questionnaire (AS-20) and the Diplopia Questionnaire were conducted ≥30 days postoperatively in GDD patients, on enrolment for controls. Age, sex, treatment type, visual acuity, mean deviation and diplopia were evaluated for association with HRQoL RESULTS: Of the 128 GDD patients enrolled, 35 (27.3%) had FP7, 32 (25.0%) had B250 and 61 (47.7%) had B350. In univariate analysis, decreased HRQoL was associated with younger age (r2 range 0.042-0.071), diplopia (r2 range 0.039-0.119), GDD treatment (r2 range 0.023-0.103), lower visual acuity (r2 range 0.021-0.215) and worse mean deviation (r2 range 0.029-0.131). All GDD groups had lower HRQoL subscores than the controls. HRQoL scores were lower compared with controls among B350 patients for AS-20 Self-perception subscale, B250 and B350 for Reading and General Function subscales, and FP7 and B350 for VFQ-25 Visual Functioning subscale. There were no significant differences among the GDDs. CONCLUSIONS Glaucoma patients with a younger age, diplopia, lower visual acuity, worse mean deviation or a GDD had lower HRQoL. Those with B350 had lower self-perception scores, consistent with previous reports in the literature. This subscale was not diminished in FP7 or B250, so the decreased self-perception scores may be due to greater visibility or awareness of the B350.
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Affiliation(s)
- Khin P Kilgore
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Ophthalmology, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - Feng Wang
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Ophthalmology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Nicole C Stern
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Launia J White
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Cheryl L Khanna
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
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Singh SR, Iovino C, Zur D, Masarwa D, Iglicki M, Gujar R, Lupidi M, Maltsev DS, Bousquet E, Bencheqroun M, Amoroso F, Lima LH, Padhy SK, Govindahari V, Chandra K, Souied EH, Rodriguez FJ, Daza LA, Rios HA, Cagini C, Peiretti E, Behar-Cohen F, Chhablani J. Central serous chorioretinopathy imaging biomarkers. Br J Ophthalmol 2020; 106:553-558. [PMID: 33288526 DOI: 10.1136/bjophthalmol-2020-317422] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/21/2020] [Accepted: 11/18/2020] [Indexed: 11/04/2022]
Abstract
PURPOSE To identify the factors predicting the visual and anatomical outcomes in eyes with central serous chorioretinopathy (CSCR) through 12 months. METHODS Patients with diagnosis of CSCR, either acute or chronic, were included in this multicentric, retrospective study. Demographic factors; systemic risk factors; central macular thickness (CMT), subfoveal choroidal thickness (SFCT), linear extent of ellipsoid zone (EZ) and interdigitation zone damage on optical coherence tomography; details of leak on fluorescein angiography and indocyanine green angiography were included as predictors of anatomical and visual outcomes. Regression analysis was performed to correlate the changes in best corrected visual acuity (BCVA) and resolution of disease activity. RESULTS A total of 231 eyes of 201 patients with a mean age (49.7±11.8 years) were analysed. A total of 97 and 134 eyes were classified as acute and chronic CSCR. BCVA (0.35±0.31 to 0.24±0.34; p<0.001), baseline optical coherence tomography (OCT) parameters including CMT (p<0.001), subretinal fluid (SRF) height (p<0.001) and SFCT (p=0.05) showed a significant change through 12 months. Multivariate regression analysis showed change in CMT (p≤0.01) and SRF height at baseline (p=0.05) as factors predictive of good visual outcome. Logistic regression analysis revealed changes in both CMT (p=0.009) and SFCT (p=0.01) through 12 months to correlate with the resolution of disease. CONCLUSION OCT parameters such as changes in both CMT and SFCT along with subfoveal EZ damage can be predictive of disease resolution whereas changes in CMT and baseline SRF height correlate well with changes in BCVA through 12 months.
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Affiliation(s)
- Sumit Randhir Singh
- Jacobs Retina Center, University of California San Diego, La Jolla, California, USA
| | - Claudio Iovino
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, Università degli studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Dinah Zur
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dua Masarwa
- Department of Ophthalmology, Barzilai University Medical Center, Ashkelon, Israel
| | - Matias Iglicki
- Private Retina Service, University of Buenos Aires, Buenos Aires, Argentina
| | - Ramkailash Gujar
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, Perugia, Italy
| | - Marco Lupidi
- Department of Ophthalmology, University of Perugia, Perugia, Italy
| | - Dmitrii S Maltsev
- Ophthalmology, Military Maedical Academy, Saint Petersburg, Russian Federation
| | | | - Mehdi Bencheqroun
- Ophtalmopôle, Cochin Hospital, Paris Descartes University, Paris, France
| | - Francesca Amoroso
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, Creteil, France
| | - Luiz H Lima
- Ophthalmology, Federal University of Sao Paulo, São Paulo, Brazil
| | | | - Vishal Govindahari
- Retina and Uveitis Service, L V Prasad Eye Institute, MTC Campus, Bhubaneswar, India
| | - Khushboo Chandra
- Dept. of Vitreoretina, Disha Eye Hospitals Pvt Ltd, Kolkata, India
| | - Eric H Souied
- Ophthalmology, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | | | - Laura A Daza
- Fundacion Oftalmologica Nacional, Universidad del Rosario, Bogota, Colombia
| | - Hernan A Rios
- Fundacion Oftalmologica Nacional, Universidad del Rosario, Bogota, Colombia
| | - Carlo Cagini
- Department of Biomedical and Surgical Sciences, University of Perugia School of Medicine and Surgery, Perugia, Italy
| | - Enrico Peiretti
- Eye Clinic, Universita degli Studi di Cagliari, Cagliari, Italy
| | | | - Jay Chhablani
- UPMC Eye Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Bertrand JA, Woodward DF, Sherwood JM, Wang JW, Overby DR. The role of EP 2 receptors in mediating the ultra-long-lasting intraocular pressure reduction by JV-GL1. Br J Ophthalmol 2020; 105:1610-1616. [PMID: 33239414 DOI: 10.1136/bjophthalmol-2020-317762] [Citation(s) in RCA: 4] [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: 08/17/2020] [Revised: 10/23/2020] [Accepted: 10/30/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND A single application of JV-GL1 substantially lowers non-human primate intraocular pressure (IOP) for about a week, independent of dose. This highly protracted effect does not correlate with its ocular biodisposition or correlate with the once-daily dosing regimen for other prostanoid EP2 receptor agonists such as trapenepag or omidenepag. The underlying pharmacological mechanism for the multiday extended activity of JV-GL1 is highly intriguing. The present studies were intended to determine EP2 receptor involvement in mediating the long-term ocular hypotensive activity of JV-GL1 by using mice genetically deficient in EP2 receptors. METHODS The protracted IOP reduction produced by JV-GL1 was investigated in C57BL/6J and EP2 receptor knock-out mice (B6.129-Ptger2tm1Brey /J; EP2KO). Both ocular normotensive and steroid-induced ocular hypertensive (SI-OHT) mice were studied. IOP was measured tonometrically under general anaesthesia. Aqueous humour outflow facility was measured ex vivo using iPerfusion in normotensive C57BL/6J mouse eyes perfused with 100 nM de-esterified JV-GL1 and in SI-OHT C57BL/6J mouse eyes that had received topical JV-GL1 (0.01%) 3 days prior. RESULTS Both the initial 1-day and the protracted multiday effects of JV-GL1 in the SI-OHT model for glaucoma were abolished by deletion of the gene encoding the EP2 receptor. Thus, JV-GL1 did not lower IOP in SI-OHT EP2KO mice, but in littermate SI-OHT EP2WT control mice, JV-GL1 statistically significantly lowered IOP for 4-6 days. CONCLUSIONS Both the 1-day and the long-term effects of JV-GL1 on IOP are entirely EP2 receptor dependent.
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Affiliation(s)
| | - David F Woodward
- Dept. of Bioengineering, Imperial College London, London, UK.,JeniVision Inc, Suite 200, Irvine, California, USA
| | | | - Jenny W Wang
- JeniVision Inc, Suite 200, Irvine, California, USA
| | - Darryl R Overby
- Dept. of Bioengineering, Imperial College London, London, UK
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Ahmed M, Putri C, Quhill H, Quhill F. Evaluation of 0.2 µg/day fluocinolone acetonide (ILUVIEN) implant in a cohort of previously treated patients with diabetic macular oedema (DMO): a 36-month follow-up clinical case series. BMJ Open Ophthalmol 2020; 5:e000484. [PMID: 32656358 PMCID: PMC7337879 DOI: 10.1136/bmjophth-2020-000484] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/21/2020] [Accepted: 06/01/2020] [Indexed: 12/22/2022] Open
Abstract
Objective To assess the real-world effectiveness and safety of single injection of a fluocinolone acetonide (FAc) implant in previously treated patients with recurrent diabetic macular oedema (DMO) over a 36-month follow-up period. Methods and Analysis This is a retrospective study conducted at a single ophthalmology department at the Royal Hallamshire Hospital, Sheffield, UK. Data were collected using electronic medical records to identify all patients treated with a FAc implant for DMO between March 2014 and November 2014, followed with a 36-month clinic follow-up. Outcomes measured included mean change in best-recorded visual acuity (BRVA) and central macular thickness (CMT) over the period of 36 months, treatment burden pre-implant and post-implant, and functional and anatomical responder rates. Results Twenty-six eyes (n=22 patients) were treated with single intravitreal FAc implant followed with 36 months of follow-up. At 24 and 36 months, 86.4% and 75.0% of patients maintained or gained vision post-FAc implant in routine clinical practice. The mean BRVA increased from 41.8 to 54.6 letters at month 24 and 45.8 letters at month 36, with 50.0% and 33.3% of patients achieving a ≥15 letter improvement at months 24 and 36, respectively. The mean CMT reduced from 600.8 µm at baseline to 351.0 µm and 392.5 µm at months 24 and 36, respectively. Overall, a mean of one treatment every 13.33 months post-FAc implant (vs 3.24 months pre-FAc implant) was reported. Eleven eyes had an increased intraocular pressure of ≥10 mm Hg and 12 eyes had an increase to ≥25 mm Hg from baseline. Conclusion These results further support the effectiveness and safety of FAc implant in previously treated patients with persistent or recurrent DMO in a real-world clinical practice.
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Affiliation(s)
- Muna Ahmed
- Ophthalmology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, Yorkshire, UK
| | - Christine Putri
- Ophthalmology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, Yorkshire, UK
| | - Hibba Quhill
- Ophthalmology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, Yorkshire, UK
| | - Fahd Quhill
- Ophthalmology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, Yorkshire, UK
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Blindbæk SL, Peto T, Grauslund J. Retinal arteriolar oxygen saturation predicts the need for intravitreal aflibercept in patients with diabetic macular oedema. BMJ Open Ophthalmol 2020; 5:e000382. [PMID: 32524033 PMCID: PMC7259848 DOI: 10.1136/bmjophth-2019-000382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/07/2019] [Accepted: 12/09/2019] [Indexed: 11/25/2022] Open
Abstract
Objective Given the increasing burden of repetitive intravitreal injections in diabetic macular oedema (DMO) treatment, non-invasive markers of treatment outcome are needed. Hence, we aimed to examine retinal oximetry parameters as markers of need for intravitreal aflibercept in patients with DMO. Methods This study was based on data from a 12-month clinical trial including 35 eyes of 25 patients with centre involving DMO. Retinal oximetry, visual acuity (VA) and central retinal thickness (CRT) were performed at baseline (BL). Patients then received 3 monthly injections of aflibercept followed by focal/grid laser photocoagulation. From month 4 (M4) through 12 (M12), patients were followed monthly and additional injections were given pro re nata if criteria of retreatment were met. We evaluated the difference in need for intravitreal aflibercept in groups of eyes with the highest and lowest retinal arteriolar and venular oxygen saturations, respectively. Results From BL-M12, overall VA letter score improved by 8.7 (7.2–10.2). Likewise CRT reduced by 100.7 (68.2–133.3) µm and the mean number of injections was 4.3 (3.8–4.8). Overall retinal arteriolar and venular oxygen saturations were 95.7 (93.0–98.4)% and 62.7 (59.4–65.9)% at BL. Eyes with the highest retinal arteriolar oxygen saturations had significantly more injections between BL and M12 compared with eyes with the lowest retinal arteriolar oxygen saturations (5.0 (4.2–5.8) vs 3.6 (3.1–4.0), p=0.002). Conclusion Higher retinal arteriolar oxygen saturation independently predicted the need for more intravitreal aflibercept during the first year of DMO treatment and may serve as a valuable adjunctive to established procedures for retinal imaging in terms of individualised treatment plans. Trial registration number NCT02554747
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Affiliation(s)
- Søren Leer Blindbæk
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Tunde Peto
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center Odense, Odense, Denmark
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Byun M, Osher J, Riemann CD. Fluocinolone acetonide (0.19 mg) intravitreal implant reduces treatment burden and improves practice resource utilisation for patients with diabetic macular oedema. BMJ Open Ophthalmol 2020; 5:e000416. [PMID: 32518834 PMCID: PMC7254114 DOI: 10.1136/bmjophth-2019-000416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/20/2020] [Accepted: 01/25/2020] [Indexed: 11/03/2022] Open
Abstract
Objective Patients with diabetic macular oedema (DME) are known to have significantly greater medical treatment burden than patients with non-DME. Frequent injections and office visits can have a substantial impact on patient adherence and quality of life. This analysis assesses the impact of the 0.19 mg fluocinolone acetonide (FAc) implant (or injection) on treatment burden and practice resource utilisation in patients with DME. Methods and analysis This study is a single-centre retrospective chart review of 30 eyes (23 patients) that received a single FAc implant. Data was collected for a 12-month period pre-injection and post-injection of the FAc implant. Primary outcomes included the frequency of injections and ophthalmology office visits. Secondary outcomes included visual acuity (VA), intraocular pressure (IOP) and central subfield thickness (CSFT). Results The injection frequency significantly decreased from one injection every 2.6 months pre-injection to one injection every 8.8 months post-injection of the FAc implant (p<0.001). Sixty-three percent of the subjects did not require additional injections post-FAc implant. The mean number of ophthalmology office visits significantly decreased from 12.7 visits pre-FAc to 9.3 visits post-FAc implant (p<0.001). The mean VA (p=0.24) and CSFT (p=0.39) showed a mild numerical improvement that was not statistically significant. Thirty-seven percent of the eyes required additional IOP lowering drops. No eyes required incisional glaucoma surgeries. Conclusions The FAc implant significantly decreased the treatment burden and improved practice resource utilisation while maintaining or improving VA and CSFT. IOP events were mostly well-controlled with drops and no eyes required incisional glaucoma surgery.
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Affiliation(s)
- Matthew Byun
- Retina, University of Illinois at Chicago, Chicago, Illinois, United States.,University Retina and Macula Associates, Oak Forest, Illinois, United States
| | - James Osher
- Retina, Cincinnati Eye Institute, Cincinnati, Ohio, United States.,Retina, University of Cincinnati, Cincinnati, Ohio, United States
| | - Christopher D Riemann
- Retina, Cincinnati Eye Institute, Cincinnati, Ohio, United States.,Retina, University of Cincinnati, Cincinnati, Ohio, United States
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Jeon HL, Byun SJ, Pratt NL, Sultana J, Park SJ, Shin JY. Cardiovascular risk in patients receiving ranibizumab for exudative age-related macular degeneration: a nationwide self-controlled case-series study. Br J Ophthalmol 2020; 105:543-548. [PMID: 32522792 DOI: 10.1136/bjophthalmol-2020-316373] [Citation(s) in RCA: 4] [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: 03/23/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 11/03/2022]
Abstract
AIMS To identify the association between ranibizumab and risk of stroke and acute myocardial infarction (AMI) in patients with exudative age-related macular degeneration (AMD). METHODS We identified patients aged ≥45 years who received ranibizumab for exudative AMD from the Korean National Health Insurance database. Of these, we selected patients suffering stroke or AMI for the self-controlled case series. We estimated incidence rate ratios (IRR) for stroke or AMI by comparing incidence rates of ranibizumab-exposed periods to that of baseline using conditional Poisson regression. The risks of haemorrhagic and ischaemic strokes were also calculated separately. RESULTS Among 33 134 patients receiving ranibizumab, 2397 patients had stroke or AMI. The risk of stroke (IRR=0.83, 95% CI 0.75 to 0.91) was not increased during the overall exposed period; however, there was a marginally elevated risk in ≥57 days exposed period (IRR=1.14, 95% CI 1.001 to 1.31). When analysing by the types of stroke, no increased risks of haemorrhagic (IRR=1.01, 95% CI 0.80 to 1.26) and ischaemic stroke (IRR=0.78, 95% CI 0.71 to 0.86) were observed during the exposed period, although the risks of ischaemic and haemorrhagic stroke were slightly elevated during ≥57 days exposed period. We could not find an association between ranibizumab and AMI. CONCLUSIONS Ranibizumab intravitreal injections did not increase the overall risk of stroke or AMI. Although the cardiovascular risk in patient receiving ranibizumab seems to be low, continuous monthly use of ranibizumab for high-risk patients should be judged carefully.
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Affiliation(s)
- Ha-Lim Jeon
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Seong Jun Byun
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea.,Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Nicole L Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Janet Sultana
- Department of Biomedical and Dental Sciences and Morpho-functional Imaging, University of Messina, Messina, Sicily, Italy
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
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Abstract
Thyroid eye disease (TED) affects 25% of patients with Graves' hyperthyroidism, where 1 in 20 patients has active, moderate-to-severe disease that will require medical treatment for reducing TED activity and severity. Intravenous corticosteroid has been the mainstay of treatment for active moderate-to-severe TED. With improved understanding of the pathophysiology of TED, immunotherapy targeting different molecular pathways including T cells, B cells, cytokines and cell surface receptors have been investigated in randomised clinical trials. This review provides an overview of the current advances in medical treatment including teprotumumab, tocilizumab, rituximab and mycophenolate and the indications for their use in the management of active, moderate-to-severe TED.
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Affiliation(s)
- Jwu Jin Khong
- Department of Surgery, University of Melbourne, Centre for Eye Research Australia Ltd, East Melbourne, Victoria, Australia .,Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.,Department of Ophthalmology, Austin Health, Heidelberg, VIC, Australia
| | - Alan McNab
- Department of Surgery, University of Melbourne, Centre for Eye Research Australia Ltd, East Melbourne, Victoria, Australia.,Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
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Kenna PF, Humphries MM, Kiang AS, Brabet P, Guillou L, Ozaki E, Campbell M, Farrar GJ, Koenekoop R, Humphries P. Advanced late-onset retinitis pigmentosa with dominant-acting D477G RPE65 mutation is responsive to oral synthetic retinoid therapy. BMJ Open Ophthalmol 2020; 5:e000462. [PMID: 32426524 PMCID: PMC7228561 DOI: 10.1136/bmjophth-2020-000462] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 03/09/2020] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 01/08/2023] Open
Abstract
Objectives No therapeutic interventions are currently available for autosomal dominant retinitis pigmentosa (adRP). An RPE65 Asp477Gly transition associates with late-onset adRP, reduced RPE65 enzymatic activity being one feature associated with this dominant variant. Our objective: to assess whether in a proof-of-concept study, oral synthetic 9 cis-retinyl acetate therapy improves vision in such advanced disease. Methods and analysis A phase 1b proof-of-concept clinical trial was conducted involving five patients with advanced disease, aged 41-68 years. Goldmann visual fields (GVF) and visual acuities (VA) were assessed for 6-12 months after 7-day treatment, patients receiving consecutive oral doses (40 mg/m2) of 9-cis-retinyl acetate, a synthetic retinoid replacement. Results Pathological effects of D477G variant were preliminarily assessed by electroretinography in mice expressing AAV-delivered D477G RPE65, by MTS [3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxyme- thoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium] assays on RPE viability and enzyme activity in cultured cells. In addition to a mild dominant effect reflected in reduced electroretinographics in mice, and reduced cellular function in vitro, D477G exhibited reduced enzymatic RPE65 activity in vitro. In patients, significant improvements were observed in GVF from baseline ranging from 70% to 200% in three of five subjects aged 67-68 years, with largest improvements at 7-10 months. Of two GVF non-responders, one had significant visual acuity improvement (5-15 letters) from baseline after 6 months. Conclusion Families with D477G variant have been identified in Ireland, the UK, France, the USA and Canada. Effects of single 7-day oral retinoid supplementation lasted at least 6 months, possibly giving visual benefit throughout remaining life in patients with advanced disease, where gene therapy is unlikely to prove beneficial.
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Affiliation(s)
- Paul F Kenna
- Institute of Genetics, University of Dublin, Trinity College, Dublin, Ireland.,The Research Foundation, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Marian M Humphries
- Institute of Genetics, University of Dublin, Trinity College, Dublin, Ireland
| | - Anna-Sophia Kiang
- Institute of Genetics, University of Dublin, Trinity College, Dublin, Ireland
| | - Philippe Brabet
- Neurosciences, Institute for Neurosciences of Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Laurent Guillou
- Neurosciences, Institute for Neurosciences of Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Ema Ozaki
- Institute of Genetics, University of Dublin, Trinity College, Dublin, Ireland
| | - Matthew Campbell
- Institute of Genetics, University of Dublin, Trinity College, Dublin, Ireland
| | - G Jane Farrar
- Institute of Genetics, University of Dublin, Trinity College, Dublin, Ireland
| | - Robert Koenekoop
- Departments of Ophthalmology, Human Genetics, and Paediatric Surgery, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Pete Humphries
- Institute of Genetics, University of Dublin, Trinity College, Dublin, Ireland
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48
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Sayah DN, Szigiato AA, Mazzaferri J, Descovich D, Duval R, Rezende FA, Costantino S, Lesk MR. Correlation of ocular rigidity with intraocular pressure spike after intravitreal injection of bevacizumab in exudative retinal disease. Br J Ophthalmol 2020; 105:392-396. [PMID: 32345604 DOI: 10.1136/bjophthalmol-2019-315595] [Citation(s) in RCA: 4] [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: 11/22/2019] [Revised: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To evaluate the non-invasive measurement of ocular rigidity (OR), an important biomechanical property of the eye, as a predictor of intraocular pressure (IOP) elevation after anti-vascular endothelial growth factor (anti-VEGF) intravitreal injection (IVI). METHODS Subjects requiring IVI of anti-VEGF for a pre-existing retinal condition were enrolled in this prospective cross-sectional study. OR was assessed in 18 eyes of 18 participants by measurement of pulsatile choroidal volume change using video-rate optical coherence tomography, and pulsatile IOP change using dynamic contour tonometry. IOP was measured using Tono-Pen XL before and immediately following the injection and was correlated with OR. RESULTS The average increase in IOP following IVI was 19±9 mm Hg, with a range of 7-33 mm Hg. The Spearman correlation coefficient between OR and IOP elevation following IVI was 0.796 (p<0.001), showing higher IOP elevation in more rigid eyes. A regression line was also calculated to predict the IOP spike based on the OR coefficient, such that IOP spike=664.17 mm Hg·µL×OR + 4.59 mm Hg. CONCLUSION This study shows a strong positive correlation between OR and acute IOP elevation following IVI. These findings indicate that the non-invasive measurement of OR could be an effective tool in identifying patients at risk of IOP spikes following IVI.
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Affiliation(s)
- Diane N Sayah
- Ophthalmology, Maisonneuve-Rosemont Hospital Research Centre, Montreal, Quebec, Canada.,Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | | | - Javier Mazzaferri
- Ophthalmology, Maisonneuve-Rosemont Hospital Research Centre, Montreal, Quebec, Canada
| | - Denise Descovich
- Ophthalmology, Maisonneuve-Rosemont Hospital Research Centre, Montreal, Quebec, Canada
| | - Renaud Duval
- Ophthalmology, Maisonneuve-Rosemont Hospital Research Centre, Montreal, Quebec, Canada.,Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | - Flavio A Rezende
- Ophthalmology, Maisonneuve-Rosemont Hospital Research Centre, Montreal, Quebec, Canada.,Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | - Santiago Costantino
- Ophthalmology, Maisonneuve-Rosemont Hospital Research Centre, Montreal, Quebec, Canada.,Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | - Mark R Lesk
- Ophthalmology, Maisonneuve-Rosemont Hospital Research Centre, Montreal, Quebec, Canada .,Ophthalmology, University of Montreal, Montreal, Quebec, Canada
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49
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Payne JF, Wykoff CC, Clark WL, Bruce BB, Boyer DS, Brown DM. Long-term outcomes of treat-and-extend ranibizumab with and without navigated laser for diabetic macular oedema: TREX-DME 3-year results. Br J Ophthalmol 2020; 105:253-257. [PMID: 32303499 DOI: 10.1136/bjophthalmol-2020-316176] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To evaluate the long-term effects of treat-and-extend dosing of ranibizumab with and without navigated focal laser for diabetic macular oedema (DME). METHODS This is a multicentre, randomised clinical trial where 150 eyes were randomised into three cohorts; Monthly (n=30), TReat and EXtend without macular laser photocoagulation (TREX; n=60), and treat and extend with angiography-GuIded macular LAser photocoagulation (GILA; n=60). During the first 2 years, eyes either received ranibizumab 0.3 mg every 4 weeks or underwent treat-and-extend ranibizumab with or without angiography-guided laser therapy. In the third year, all eyes were treated as needed with ranibizumab for >5 letters vision loss or if the central retinal thickness (CRT) was >325 µm, and all eyes were eligible to receive focal laser. RESULTS 109 eyes (73%) completed the 3-year end-point. At week 156, mean best-corrected visual acuity (BCVA) and CRT improved by 6.9, 9.7, 9.5 letters (p=0.60) and 129, 138, 165 µm (p=0.39), in the Monthly, TREX and GILA cohorts, respectively. These improvements were reached prior to week 104 and no significant changes occurred from week 104 to week 156 (BCVA: p=0.34; CRT: p=0.36). The mean number of injections in the third year was 3.0, 3.1, and 2.4 in the Monthly, TREX and GILA cohorts, respectively (p=0.56). 86 eyes (79%) required at least one ranibizumab injection in the third year. CONCLUSION The improvements achieved after 2 years of treat-and-extend ranibizumab for DME were maintained in the third year with a mean of 3 intravitreal injections. TRIAL REGISTRATION NUMBER FDA IND 119146, NCT01934556.
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Affiliation(s)
- John F Payne
- Palmetto Retina Center, West Columbia, South Carolina, USA
| | - Charles C Wykoff
- Blanton Eye Institute, Houston Methodist Hospital and Weill Cornell Medical College, Retina Consultants of Houston, Houston, Texas, USA
| | - W Lloyd Clark
- Palmetto Retina Center, West Columbia, South Carolina, USA
| | - Beau B Bruce
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
| | - David S Boyer
- Ophthalmology, University of Southern California, Sherman Oaks, California, USA
| | - David M Brown
- The Methodist Hospital, Houston, TX, Houston, Texas, USA
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50
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Ciulla TA, Pollack JS, Williams DF. Visual acuity outcomes and anti-VEGF therapy intensity in diabetic macular oedema: a real-world analysis of 28 658 patient eyes. Br J Ophthalmol 2020; 105:216-221. [PMID: 32265201 PMCID: PMC7848066 DOI: 10.1136/bjophthalmol-2020-315933] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [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: 01/23/2020] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 12/31/2022]
Abstract
Background/Aim To assess visual acuity (VA) outcomes and antivascular endothelial growth factor (anti-VEGF) treatment intensity in diabetic macular oedema (DMO). Methods Retrospective analysis was performed in treatment-naïve patients with DMO from 2013 to 2018 using a database of aggregated de-identified electronic medical records (Vestrum Health). Results At 1 year, 28 658 patient eyes underwent a mean of 6.4 anti-VEGF injections, gaining a mean of +4.2 letters (95% confidence interval for mean gain: +4.0 to +4.5 letters, p<0.001). When stratified by anti-VEGF medication and by years 2013–2018, no clinically meaningful differences in injection frequency or 1-year VA change resulted. At 1 year, 50% of eyes received ≤6 injections, while <20% received 10–13 injections, representing monthly treatment. Mean letters gained at 1 year generally showed a linear relationship with mean number of anti-VEGF injections, beyond two injections. Eyes with good baseline VA (≥20/40) generally were at risk of VA loss at 1 year; those with moderately severe baseline impairment (20/70 to 20/200) who received ≥10 injections improved by a mean of +10.3 letters. Conclusion In clinical practice, patients with DMO undergo fewer anti-VEGF injections and exhibit worse visual gains compared with patients in randomised clinical trials. Visual outcomes correlate with treatment intensity at 1 year, with ceiling effects related to baseline VA.
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Affiliation(s)
- Thomas A Ciulla
- Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, USA .,Retina Service, Midwest Eye Institute, Indianapolis, Indiana, USA
| | - John S Pollack
- Rush University, Chicago, Illinois, USA.,Illinois Retina Associates, Chicago, IL, USA
| | - David F Williams
- University of Minnesota, Minneapolis, Minnesota, USA.,VitreoRetinal Surgery, PA, Minneapolis, MN, USA
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