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Victor AA, Andayani G, Djatikusumo A, Yudantha AR, Hutapea MM, Ardhia SH, Suryoadji KA. Recurrence risk of myopic choroidal neovascularisation: a systematic review of current study. BMJ Open Ophthalmol 2023; 8:e001396. [PMID: 37816549 PMCID: PMC10565155 DOI: 10.1136/bmjophth-2023-001396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/27/2023] [Indexed: 10/12/2023] Open
Abstract
INTRODUCTION The rising prevalence of myopia is a concern in ophthalmology, with myopic choroidal neovascularisation (m-CNV) significantly affecting vision. However, long-term outcomes of m-CNV management have been unsatisfactory, leading to high recurrence rates. These studies aim to identify risk factors for m-CNV recurrence. METHODS Comprehensive review followed a pre-registered plan in the International Prospective Register of Systematic Reviews (PROSPERO). The search strategy used various databases including PubMed, Cochrane Library, Embase, Scopus and ScienceDirect using the keywords 'Myopic Choroidal Neovascularization', 'Recurrence' and 'Risk'. Eligible studies were identified and analysed based on predetermined criteria. This study was registered on PROSPERO (CRD4202343461). RESULTS The systematic review included three retrospective studies investigating risk factors associated with m-CNV recurrence. These factors are: (1) requiring three or more injections for initial disease control, (2) older age, (3) larger myopic macular neovascularisation, (4) juxtafoveal CNV, (5) larger height of hyper-reflective foci (HRF) and (6) destruction or absence of the ellipsoid zone (EZ) and retinal pigment epithelium (RPE). CONCLUSION Risk factors for m-CNV recurrence include a greater number of required injections, older age, large macular CNV, juxtafoveal location, increased HRF height and changes in EZ and RPE structure. Understanding these factors can inform personalised treatment approaches and improve patient outcomes by identifying individuals at higher risk of recurrence and implementing proactive measures to mitigate the impact of m-CNV recurrence and progression. Further investigation is needed to enhance our understanding of the underlying mechanisms and develop innovative therapeutic approaches for effective m-CNV management. PROSPERO REGISTRATION NUMBER CRD4202343461.
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Affiliation(s)
- Andi Arus Victor
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Gitalisa Andayani
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Ari Djatikusumo
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Anggun Rama Yudantha
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Mario Marbungaran Hutapea
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Seruni Hanna Ardhia
- Research Assistant, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Jain M, Narayanan R, Jana P, Mohamed A, Raman R, Verkicharla P, Padhy SK, Das AV, Chhablani J. Incidence, predictors and re-treatment outcomes of recurrent myopic choroidal neo-vascularization. PLoS One 2022; 17:e0271342. [PMID: 35862476 PMCID: PMC9302801 DOI: 10.1371/journal.pone.0271342] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 06/28/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives To evaluate incidence, predictors, and re-treatment outcome of recurrent myopic choroidal neovascularization (m-CNV). Methods Retrospective consecutive observational series. From year 2014 to 2019, 167 eyes of 167 patients of treatment naïve m-CNV were enrolled. 59 and 108 eyes were treated with intra-vitreal ranibizumab and bevacizumab mono-therapy, respectively. Recurrence was defined as re-appearance of CNV activity, confirmed on optical coherence tomography (OCT) after at least 3 months of cessation of anti-VEGF therapy. Incidence of recurrence, predictors and re-treatment outcomes were studied. Results Overall, mean age and spherical equivalence (SE) was 47.95 ± 14.72 years and -12.19 ± 4.93 D respectively. Males constituted 50.9%. 44 eyes (26.4%) had a recurrence during a mean follow up of 16.5 ± 12.86 months. Kaplan-Meier survival analysis showed the risk of recurrence was 8, 26 and, 33.6% at 6, 12 and 18 months, respectively. Age (p = 0.511), gender (p = 0.218), SE (p = 0.092), anti-VEGF (p = 0.629) and baseline BCVA (p = 0.519) did not influence recurrence. Number of injections administered to control the disease in the first episode was the only significant predictor of recurrence (Cox Proportional Hazard Ratio 2.89–3.07, 95% Confidence Interval: 1.28–7.45; p = 0.005). At 12 months, eyes requiring one injection in first episode had a recurrence rate of 12% versus 45% in eyes requiring 3 or more injections in the first episode. A mean number of 1.9 additional injections per eye was needed during re-treatment. Final BCVA in the recurrence group was similar to that of non-recurrence group (0.53 ± 0.40 versus 0.55 ± 0.36 LogMAR; p = 0.755). Baseline BCVA (p = 0.0001) was the only predictor of final visual outcome irrespective of anti-VEGF drug (p = 0.38). Conclusion Eyes requiring greater number of injections for disease control in first episode are “at risk” of early m-CNV recurrence. However, recurrence does not adversely affect visual outcome, if treated adequately.
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Affiliation(s)
- Mukesh Jain
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Raja Narayanan
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Indian Health Outcomes, Public Health, and Economics Research Centre (IHOPE), Hyderabad, Telangana, India
- * E-mail:
| | - Priya Jana
- Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Ashik Mohamed
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rajiv Raman
- Department of Vitreoretinal Services, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Pavan Verkicharla
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Srikanta Kumar Padhy
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Anthony Vipin Das
- Indian Health Outcomes, Public Health, and Economics Research Centre (IHOPE), Hyderabad, Telangana, India
- Department of eyeSmart EMR & AEye, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Jay Chhablani
- UPMC Eye Centre, University of Pittsburgh, Pittsburgh, PA, United States of America
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Cui Z, Zhou W, Chang Q, Zhang T, Wang H, Meng X, Liu Y, Yan H. Cost-Effectiveness of Conbercept vs. Ranibizumab for Age-Related Macular Degeneration, Diabetic Macular Edema, and Pathological Myopia: Population-Based Cohort Study and Markov Model. Front Med (Lausanne) 2021; 8:750132. [PMID: 34926500 PMCID: PMC8676057 DOI: 10.3389/fmed.2021.750132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/02/2021] [Indexed: 12/15/2022] Open
Abstract
Background: With the advent of aging society of China, fundus diseases related to pathological neovascularization, including age-related macular degeneration (AMD), diabetic macular edema (DME), and pathological myopia (PM), have become an increasingly serious medical and health problems. As effective drugs of the treatment, conbercept and ranibizumab have been commonly used and covered by the national basic medical insurance in China. However, the pharmacoeconomic evaluation of conbercept vs. ranibizumab for DME and PM remains lacking. This study would assess the cost-effectiveness of conbercept and ranibizumab for the treatment of AMD, DME, and PM from the perspective of Chinese payers. Methods: A Markov chain model was constructed based on the visual conditions of the patient indicated by the number of letters in best corrected visual acuity (BCVA). We conducted models based on real-world scenario to calculate the cost per the quality-adjusted life-year (QALY) gained. A 1-year cycle length and a 10-year simulation treatment were applied and the number of injections of conbercept and ranibizumab was assumed to the average number within 10 years. Transition probabilities, costs, utility data, and other parameters were obtained from literature searches. A 3.5% discounting rate was applied for both the costs and utilities. Results: The incremental cost-effectiveness ratios (ICERs) were more favorable for conbercept than ranibizumab in treatment of AMD, DME, and PM, with associated ICER of 66,669 renminbi (RMB), −258,813 RMB, and −373,185 RMB per QALY gained. Compared with ranibizumab, the incremental effectiveness of conbercept in treatment of AMD, DME, and PM was −0.665 QALYs, 0.215 QALYs, and 0.029 QALYs, respectively. The sensitivity analysis showed the same findings, although the ICER is sensitive to the costs of this program. Conclusion: Under the current Chinese healthcare setting, conbercept is suitable and cost-effective in treatment of AMD, DME, and PM compared with ranibizumab.
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Affiliation(s)
- Zhuang Cui
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wei Zhou
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Qinxue Chang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Tiantian Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Hui Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xiangda Meng
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuanyuan Liu
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Hua Yan
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
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Kim DY, Jo YJ, Kim JY, Chae JB, Cho IH, Kim HD, Seo YS, Shin JA, Kang S, Chang YS, Lee YH. Surgical Outcomes of Vitrectomy for Macular Hole-induced Retinal Detachment According To Various Surgical Methods: A Multicenter Retrospective Study. Semin Ophthalmol 2021; 36:728-733. [PMID: 33750260 DOI: 10.1080/08820538.2021.1900288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the surgical outcomes of vitrectomy for macular hole-induced retinal detachment(MHRD), with respect to the surgical adjunctive method used. METHOD We performed retrospective multicenter study of patients who underwent vitrectomy for MHRD. The visual/anatomical outcomes after vitrectomy were analyzed. We also analyzed these outcomes according to surgical method and the presence of persistent macular hole after the vitrectomy. RESULT Thirty-four patients (34 eyes) from 6 hospitals were included in this study. The mean age of the patients was 64.56 ± 12.23 years; 31 patients (91.2%) were female. The mean LogMAR best-corrected visual acuity (BCVA) significantly improved 6 months after vitrectomy (p < .001). Retinal detachment completely improved in 32 eyes (94.1%). The visual prognoses and macular hole closure rates were not different depending on subretinal fluid drainage site. The presence or absence of a persistent macular hole after vitrectomy did not affect the visual outcomes. However, the recurrence of MHRD was significantly higher in eyes with persistent macular holes(p = .015). CONCLUSION The surgeries to treat MHRD differed in terms of the procedure depending on the surgeons, but the visual outcomes did not differ depending on the surgical adjunctive method employed. There were no differences in the visual prognoses, regardless of whether there was a persistent macular hole; however, recurrence was significantly higher in eyes with persistent macular holes. Therefore, further surgical treatment might be considered for eyes with persistent macular holes after MHRD surgery.
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Affiliation(s)
- Dong Yoon Kim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Young Joon Jo
- Department of Ophthalmology, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea d Department of Ophthalmology, University of Dankook, Dankook University Hospital, Dankook, Republic of Korea
| | - Jung-Yeul Kim
- Department of Ophthalmology, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea d Department of Ophthalmology, University of Dankook, Dankook University Hospital, Dankook, Republic of Korea
| | - Ju Byung Chae
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - In Hwan Cho
- Department of Ophthalmology, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
| | - Hoon Dong Kim
- Department of Ophthalmology, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
| | - Young Seung Seo
- Department of Ophthalmology, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea d Department of Ophthalmology, University of Dankook, Dankook University Hospital, Dankook, Republic of Korea
| | - Jeong Ah Shin
- Department of Ophthalmology, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
| | - Seungbum Kang
- Department of Ophthalmology, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
| | - Young Suk Chang
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Young Hoon Lee
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea.,Department of Ophthalmology and Visual Science, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
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Ling L, Liu Y, Zhou B, Gao F, Hu Z, Tian M, Xing Y, Ji K, Sun T, Zhou W. Inverted Internal Limiting Membrane Flap Technique versus Internal Limiting Membrane Peeling for Vitrectomy in Highly Myopic Eyes with Macular Hole-Induced Retinal Detachment: An Updated Meta-Analysis. J Ophthalmol 2020; 2020:2374650. [PMID: 32908680 PMCID: PMC7463360 DOI: 10.1155/2020/2374650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/22/2020] [Accepted: 06/18/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The aim of this meta-analysis was to compare morphological and functional outcomes between vitrectomy with the inverted internal limiting membrane (ILM) flap technique and vitrectomy with internal limiting membrane peeling in highly myopic eyes with macular hole- (MH-) induced retinal detachment (MHRD). METHODS The PubMed, Web of Science, Embase, and Cochrane Library databases were comprehensively searched from inception to November 10, 2019, for published studies comparing the two techniques for the treatment of MHRD. The outcomes in the collected articles included the postoperative MH closure rate, retinal reattachment rate, and best-corrected visual acuity (BCVA). Review Manager (version 5.3) was used for analyses. RESULTS In total, seven retrospective studies comparing the inverted ILM flap technique with ILM peeling for the treatment of MHRD were included. The MH closure rate was significantly higher in the inverted ILM flap group than in the ILM peeling group at 6 and 12 months after initial surgery (OR = 15.39; 95% CI: 6.68 to 35.43;P < 0.00001 and OR = 12.58, 95% CI: 3.51 to 45.08; P=0.0001), while the retinal reattachment rate was similar in both groups at 6 months after initial surgery (OR = 2.40; 95% CI: 0.89 to 6.50; P=0.08). Besides, the postoperative BCVA was significantly better in the inverted ILM flap group than in the ILM peeling group at 12 months after initial surgery (MD = -0.35; 95% CI: -0.52 to -0.18; P < 0.0001). CONCLUSIONS Thus, the MH closure rate and postoperative BCVA may be better with the inverted ILM flap technique than with ILM peeling for myopic MHRD, while the postoperative retinal reattachment rate appears to be similar with both techniques. Therefore, in the future, vitrectomy with the inverted ILM flap technique should be preferred over standard ILM peeling technique for the treatment of MHRD in highly myopic eyes.
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Affiliation(s)
- Ling Ling
- Affiliated Eye Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yao Liu
- Affiliated Eye Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Baixing Zhou
- Affiliated Eye Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Feifei Gao
- Affiliated Eye Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhe Hu
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Man Tian
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yiqiao Xing
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Kaibao Ji
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Tao Sun
- Affiliated Eye Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wentian Zhou
- Affiliated Eye Hospital of Nanchang University, Nanchang, Jiangxi, China
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Laviers H, Li JPO, Grabowska A, Charles SJ, Charteris D, Haynes RJ, Laidlaw DAH, Steel DH, Yorston D, Williamson TH, Zambarakji H. The management of macular hole retinal detachment and macular retinoschisis in pathological myopia; a UK collaborative study. Eye (Lond) 2018; 32:1743-1751. [PMID: 30013156 DOI: 10.1038/s41433-018-0166-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 06/06/2018] [Accepted: 06/11/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To study UK practice patterns for the management of retinal detachment secondary to macular hole (MHRD) and macular retinoschisis (MRS) in pathological myopia (PM). To review the anatomical and visual outcomes of the surgically managed cases. METHODS A prospective observational case series for the management of MHRD was undertaken in association with the British Ophthalmological Surveillance Unit (BOSU). The results were combined with retrospective data, collected by the COllaboration of British RetinAl Surgeons (COBRA), on the management of both MHRD and MRS in PM in the UK. A total of 20 cases of MHRD and 53 cases of MRS (27 surgical cases and 26 cases managed conservatively) are reported in this combined study. RESULTS MHRD: Mean baseline best corrected visual acuity (BCVA) was 1.60 logMAR. All cases underwent pars plana vitrectomy (PPV). Mean post-operative BCVA was 1.49 logMAR (p = 0.674). The macular hole was closed in 5/20 (25%) cases, open/flat in 10/20 (50%) cases and open/elevated in 4/20 cases (20%). MRS: Mean baseline BCVA was 0.87 logMAR in the surgical group and 0.45 logMAR in the conservatively managed group (p = 0.002). All eyes that had surgical intervention underwent PPV. Mean post-operative BCVA was 0.68 logMAR (p = 0.183). Anatomical outcomes demonstrated a persistent MRS in 2/27 (7.4%) cases, partial resolution in 7/27 (25.9%) cases and complete resolution in 16/27 (59.2%) cases. CONCLUSIONS PPV is the only surgical procedure performed for the management of MHRD and MRS amongst the study participants. Success rates and visual outcomes are limited for MHRD and consistent with the current literature for MRS.
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Affiliation(s)
- Heidi Laviers
- The Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Foundation Trust, London, UK
| | | | - Anna Grabowska
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Stephen J Charles
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | | | - Richard J Haynes
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - David H Steel
- Sunderland Eye Infirmary, NHS Trust, Sunderland, UK.,Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - David Yorston
- Tennent Institute of Ophthalmology, Gartnavel Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Tom H Williamson
- Ophthalmology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Hadi Zambarakji
- The Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Foundation Trust, London, UK.
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Cheung CMG, Arnold JJ, Holz FG, Park KH, Lai TY, Larsen M, Mitchell P, Ohno-Matsui K, Chen SJ, Wolf S, Wong TY. Myopic Choroidal Neovascularization. Ophthalmology 2017; 124:1690-1711. [DOI: 10.1016/j.ophtha.2017.04.028] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 04/03/2017] [Accepted: 04/24/2017] [Indexed: 02/07/2023] Open
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Abstract
PURPOSE To assess the posterior vitreous release rates following a single, office-based intravitreal injection of expansile gas in treating vitreomacular traction. METHODS Thirty eyes of 29 consecutive patients with symptomatic vitreomacular traction received a single, office-based intravitreal injection of up to 0.3 mL of 100% perfluoropropane (C3F8). RESULTS Overall, vitreomacular traction release occurred in 25 of 30 eyes by the final follow-up visit (83% final release rate); furthermore, 90% (9 of 10 eyes) with diabetes mellitus released, 83% (5 of 6 eyes) with concurrent epiretinal membrane released, and 83% (5 of 6 eyes) previously treated with ocriplasmin released. Vitreomacular traction release occurred overnight in some patients and was documented on spectral domain optical coherence tomography at an average of 13 days (range, 1-62 days). The phakic release rate was 89% (16 of 18 eyes) versus a 75% pseudophakic release rate (9 of 12 eyes) (P = 0.3173). Ellipsoid zone changes on spectral domain optical coherence tomography occurred in 1 of 30 gas-treated eyes. One patient developed pupillary block. CONCLUSION Office-based intravitreal injection of C3F8 offers an inexpensive and effective treatment for vitreomacular traction, including for patients who underwent previous ocriplasmin administration and in patients with diabetes mellitus or epiretinal membrane.
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Long-Term Follow-Up of the Fellow Eye in Patients Undergoing Surgery on One Eye for Treating Myopic Traction Maculopathy. J Ophthalmol 2016; 2016:2989086. [PMID: 27478633 PMCID: PMC4960342 DOI: 10.1155/2016/2989086] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 04/20/2016] [Indexed: 11/17/2022] Open
Abstract
Objective. To observe the fellow eye in patients undergoing surgery on one eye for treating myopic traction maculopathy. Methods. 99 fellow eyes of consecutive patients who underwent unilateral surgery to treat MTM were retrospectively evaluated. All patients underwent thorough ophthalmologic examinations, including age, gender, duration of follow-up, refraction, axial length, intraocular pressure, lens status, presence/absence of a staphyloma, and best-corrected visual acuity (BCVA). Fundus photographs and SD-OCT images were obtained. When feasible, MP-1 microperimetry was performed to evaluate macular sensitivity and fixation stability. Results. At an average follow-up time of 24.7 months, 7% fellow eyes exhibited partial or complete MTM resolution, 68% stabilized, and 25% exhibited progression of MTM. Of the 38 eyes with "normal" macular structure on initial examination, 11% exhibited disease progression. The difference in progression rates in Groups 2, 3, and 4 was statistically significant. Refraction, axial length, the frequency of a posterior staphyloma, chorioretinal atrophy, initial BCVA, final BCVA, and retinal sensitivity all differed significantly among Groups 1-4. Conclusions. Long axial length, chorioretinal atrophy, a posterior staphyloma, and anterior traction contribute to MTM development. Patients with high myopia and unilateral MTM require regular OCT monitoring of the fellow eye to assess progression to myopic pre-MTM. For cases exhibiting one or more potential risk factors, early surgical intervention may maximize the visual outcomes.
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Munk MR, Rückert R, Zinkernagel M, Ebneter A, Wolf S. The role of anti-VEGF agents in myopic choroidal neovascularization: Current standards and future outlook. Expert Opin Biol Ther 2016; 16:477-87. [PMID: 26666589 DOI: 10.1517/14712598.2016.1132696] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The global prevalence of pathologic myopia is 0.9-3.1%, and visual impairment is found in 0.1-0.5% of European and 0.2-1.4% of Asian studies. Myopic choroidal neovascularization (mCNV) affects 5.2-11.3% of pathologic myopia patients and is a leading cause of vision impairment in the working-age population. Characteristic morphological changes and visual-acuity decrease are diagnostic features. Vascular-Endothelial-Growth-Factor (VEGF) has been identified as a trigger for pathologic neovascularization in these highly myopic patients. AREAS COVERED We cover the epidemiology, pathology and diagnostic aspects of mCNV. The history of therapeutic interventions is described, followed by an overview of current standard-of-care (SOC)-blocking VEGF using bevacizumab (off-label), ranibizumab or aflibercept and improving vision up to 13.5-14.4 letters. Despite good efficacy, an unmet medical need remains. We summarize ongoing and future developments of new drugs to treat or potentially cure mCNV. EXPERT OPINION mCNV is a major global health concern. Early detection and treatment is key for a satisfying outcome. The current SOC, VEGF inhibitors, affords good therapeutic efficacy and reasonable disease stabilization with few intravitreal treatments per year. However, the long-term prognosis is still unsatisfactory, and side-effects like chorioretinal atrophy development are of concern. Therefore, efforts should be intensified to develop more effective therapies.
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Affiliation(s)
- Marion R Munk
- a Ophthalmology , Inselspital, University Hospital Bern , Bern , Switzerland.,b Feinberg School of Medicine , Northwestern University , Chicago , IL , USA
| | - Rene Rückert
- c Eyegnos Ophthalmology Consulting , Bern , Switzerland
| | - Martin Zinkernagel
- a Ophthalmology , Inselspital, University Hospital Bern , Bern , Switzerland
| | - Andreas Ebneter
- a Ophthalmology , Inselspital, University Hospital Bern , Bern , Switzerland
| | - Sebastian Wolf
- a Ophthalmology , Inselspital, University Hospital Bern , Bern , Switzerland
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Tah V, Orlans HO, Hyer J, Casswell E, Din N, Sri Shanmuganathan V, Ramskold L, Pasu S. Anti-VEGF Therapy and the Retina: An Update. J Ophthalmol 2015; 2015:627674. [PMID: 26417453 PMCID: PMC4568374 DOI: 10.1155/2015/627674] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/28/2015] [Accepted: 07/05/2015] [Indexed: 01/31/2023] Open
Abstract
Ocular angiogenesis and macular oedema are major causes of sight loss across the world. Aberrant neovascularisation, which may arise secondary to numerous disease processes, can result in reduced vision as a result of oedema, haemorrhage, and scarring. The development of antivascular endothelial growth factor (anti-VEGF) agents has revolutionised the treatment of retinal vasogenic conditions. These drugs are now commonly employed for the treatment of a plethora of ocular pathologies including choroidal neovascularisation, diabetic macular oedema, and retinal vein occlusion to name a few. In this paper, we will explore the current use of anti-VEGF in a variety of retinal diseases and the impact that these medications have had on visual outcome for patients.
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Affiliation(s)
- Vikas Tah
- The Royal Berkshire NHS Foundation Trust, Craven Road, Reading RG1 5AN, UK
| | - Harry O. Orlans
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | - Jonathan Hyer
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | - Edward Casswell
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | - Nizar Din
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | | | - Louise Ramskold
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | - Saruban Pasu
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
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Cases O, Joseph A, Obry A, Santin MD, Ben-Yacoub S, Pâques M, Amsellem-Levera S, Bribian A, Simonutti M, Augustin S, Debeir T, Sahel JA, Christ A, de Castro F, Lehéricy S, Cosette P, Kozyraki R. Foxg1-Cre Mediated Lrp2 Inactivation in the Developing Mouse Neural Retina, Ciliary and Retinal Pigment Epithelia Models Congenital High Myopia. PLoS One 2015; 10:e0129518. [PMID: 26107939 PMCID: PMC4480972 DOI: 10.1371/journal.pone.0129518] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 05/08/2015] [Indexed: 12/11/2022] Open
Abstract
Myopia is a common ocular disorder generally due to increased axial length of the eye-globe. Its extreme form high myopia (HM) is a multifactorial disease leading to retinal and scleral damage, visual impairment or loss and is an important health issue. Mutations in the endocytic receptor LRP2 gene result in Donnai-Barrow (DBS) and Stickler syndromes, both characterized by HM. To clearly establish the link between Lrp2 and congenital HM we inactivated Lrp2 in the mouse forebrain including the neural retina and the retinal and ciliary pigment epithelia. High resolution in vivo MRI imaging and ophthalmological analyses showed that the adult Lrp2-deficient eyes were 40% longer than the control ones mainly due to an excessive elongation of the vitreal chamber. They had an apparently normal intraocular pressure and developed chorioretinal atrophy and posterior scleral staphyloma features reminiscent of human myopic retinopathy. Immunomorphological and ultrastructural analyses showed that increased eye lengthening was first observed by post-natal day 5 (P5) and that it was accompanied by a rapid decrease of the bipolar, photoreceptor and retinal ganglion cells, and eventually the optic nerve axons. It was followed by scleral thinning and collagen fiber disorganization, essentially in the posterior pole. We conclude that the function of LRP2 in the ocular tissues is necessary for normal eye growth and that the Lrp2-deficient eyes provide a unique tool to further study human HM.
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Affiliation(s)
- Olivier Cases
- INSERM, U968, Paris, F-75012, France
- UPMC Univ Paris 06, UMR_S968, Institut de la Vision, Paris, F-75012, France
- CNRS, UMR_7210, Paris, F-75012, France
| | - Antoine Joseph
- INSERM, U968, Paris, F-75012, France
- UPMC Univ Paris 06, UMR_S968, Institut de la Vision, Paris, F-75012, France
- CNRS, UMR_7210, Paris, F-75012, France
| | - Antoine Obry
- CNRS, UMR_6270, PISSARO Proteomics Platform, Institute for Research and Innovation in Biomedicine, Rouen University Hospital, Rouen, F-76821, France
- INSERM, U905, PISSARO Proteomics Platform, Institute for Research and Innovation in Biomedicine, Rouen University Hospital, Rouen, F-76821, France
| | | | - Sirine Ben-Yacoub
- INSERM, U968, Paris, F-75012, France
- UPMC Univ Paris 06, UMR_S968, Institut de la Vision, Paris, F-75012, France
- CNRS, UMR_7210, Paris, F-75012, France
| | - Michel Pâques
- INSERM, U968, Paris, F-75012, France
- UPMC Univ Paris 06, UMR_S968, Institut de la Vision, Paris, F-75012, France
- CNRS, UMR_7210, Paris, F-75012, France
- Centre Hospitalier National d’Ophthalmologie des Quinze-Vingts, INSERM-DHOS CIC 503, Paris, F-75012, France
| | - Sabine Amsellem-Levera
- INSERM, U968, Paris, F-75012, France
- UPMC Univ Paris 06, UMR_S968, Institut de la Vision, Paris, F-75012, France
- CNRS, UMR_7210, Paris, F-75012, France
| | - Ana Bribian
- Grupo de Neurobiologia del Desarollo-GNDe, Hospital Nacional de Parapléjicos, Toledo, Spain
| | - Manuel Simonutti
- INSERM, U968, Paris, F-75012, France
- UPMC Univ Paris 06, UMR_S968, Institut de la Vision, Paris, F-75012, France
- CNRS, UMR_7210, Paris, F-75012, France
| | - Sébastien Augustin
- INSERM, U968, Paris, F-75012, France
- UPMC Univ Paris 06, UMR_S968, Institut de la Vision, Paris, F-75012, France
- CNRS, UMR_7210, Paris, F-75012, France
| | | | - José Alain Sahel
- INSERM, U968, Paris, F-75012, France
- UPMC Univ Paris 06, UMR_S968, Institut de la Vision, Paris, F-75012, France
- CNRS, UMR_7210, Paris, F-75012, France
- Centre Hospitalier National d’Ophthalmologie des Quinze-Vingts, INSERM-DHOS CIC 503, Paris, F-75012, France
| | - Annabel Christ
- Max-Delbrück-Center for Molecular Medicine, Berlin, D-13125, Germany
| | - Fernando de Castro
- Grupo de Neurobiologia del Desarollo-GNDe, Hospital Nacional de Parapléjicos, Toledo, Spain
| | | | - Pascal Cosette
- CNRS, UMR_6270, PISSARO Proteomics Platform, Institute for Research and Innovation in Biomedicine, Rouen University Hospital, Rouen, F-76821, France
| | - Renata Kozyraki
- INSERM, U968, Paris, F-75012, France
- UPMC Univ Paris 06, UMR_S968, Institut de la Vision, Paris, F-75012, France
- CNRS, UMR_7210, Paris, F-75012, France
- * E-mail:
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13
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Su J, Liu X, Zheng L, Cui H. Vitrectomy with internal limiting membrane peeling vs no peeling for Macular Hole-induced Retinal Detachment (MHRD): a meta-analysis. BMC Ophthalmol 2015; 15:62. [PMID: 26091910 PMCID: PMC4475314 DOI: 10.1186/s12886-015-0048-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 06/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND we conducted our meta-analysis of published studies to assess existing evidence about the efficacy and safety of vitrectomy with ILM peeling vs. that of vitrectomy with no ILM peeling for Macular hole-induced retinal detachment. METHODS Databases, including Pubmed, Cochrane Library, Ovid, Web of Science, Wanfang and CNKI, were searched to identify studies comparing outcomes following vitrectomy with ILM peeling and that with no ILM peeling for macular hole-induced retinal detachment. The meta-analysis was performed by RevMan 5.1. RESULTS Six comparative studies comprising 180 eyes were identified. It was indicated that the rate of retinal reattachment (Odds ratio (OR) = 3.03, 95 % Confidence interval (CI):1.35 to 6.78; P = 0.007) and macular hole closure (OR = 6.74, 95 % CI:3.26 to 13.93; P < 0.001) after initial surgery was higher and the rate of recurrent retinal detachment (OR = 0.08, 95 % CI:0.02 to 0.30; P = 0.0002) was lower in the group of vitrectomy with ILM peeling than that in the group of vitrectomy with no ILM peeling. However, the improved BCVA (Weighted mean difference (WMD) = 0.14, 95 % CI: -0.20 to 0.47; P = 0.42) and the rate of postoperative complications were similar between the two groups. CONCLUSION Vitrectomy with internal limiting membrane peeling is an efficient and safe procedure for macular hole-induced retinal detachment.
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Affiliation(s)
- Jing Su
- Department of Ophthalmology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 375 South Wanping Road, Shanghai, 200032, P.R. China.
| | - Xinquan Liu
- Department of Ophthalmology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 375 South Wanping Road, Shanghai, 200032, P.R. China.
| | - Lijun Zheng
- Department of General Surgery, Shanghai Tenth people's Hospital, Tongji University, No. 301 Middle Yanchang road, Shanghai, 200072, P.R. China.
| | - Hongping Cui
- Department of Ophthalmology, Shanghai East Hospital, Tongji University, No.150 Jimo Road, Shanghai, 200120, P.R. China.
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Effect of intravitreal ranibizumab injections on aqueous humour concentrations of vascular endothelial growth factor and pigment epithelium-derived factor in patients with myopic choroidal neovascularisation. Br J Ophthalmol 2015; 99:1004-8. [DOI: 10.1136/bjophthalmol-2014-306465] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 02/18/2015] [Indexed: 12/11/2022]
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15
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Freitas-da-Costa P, Pinheiro-Costa J, Carvalho B, Falcão M, Brandão E, Falcão-Reis F, Carneiro Â. Anti-VEGF Therapy in Myopic Choroidal Neovascularization: Long-Term Results. Ophthalmologica 2014; 232:57-63. [DOI: 10.1159/000360307] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 02/01/2014] [Indexed: 11/19/2022]
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Abstract
PURPOSE To investigate the association between pathological myopia (PM) and immunological/inflammatory markers and to identify the possible risk factors for the formation of myopic choroidal neovascularization (mCNV). METHODS One hundred fourteen unrelated subjects were recruited: 63 PM patients (PM group) with spherical equivalent of at least -8.00 diopters (range, -8.00 to -25.00) and axial length exceeding 26.5 mm, accompanied by characteristic pathologic changes, and 51 emmetropic age- and sex-matched individuals (control group) with spherical equivalent within ±1.0 diopter in both eyes. In the PM group, patients were assigned to two subgroups, mCNV group and no CNV group, according to the results of fluorescein angiography. Serum high-sensitivity C-reactive protein (hs-CRP) and complement profile (C3, C4, and CH50) were assayed. Statistical analysis was performed between the two groups. Binary logistic regression analysis was used to analyze the relative risk factors that were associated with the development of mCNV in the PM group patients. RESULTS The range of axial length was 26.50 to 37.08 mm in the PM group and 22.32 to 24.56 mm in the control group. There were 24 patients in the mCNV group and 39 patients in the no CNV group. The PM group patients had significantly higher serum hs-CRP (p = 0.033), C3 (p = 0.004), and CH50 (p < 0.001) compared with the control group patients. There were no significant differences between the two groups for C4 level (p = 0.071). Binary logistic regression analysis, which included hs-CRP, C3, C4, CH50, age, and sex as covariates, showed that C3 (p = 0.03) and age (p = 0.01) were risk factors for mCNV, whereas serum hs-CRP, C4, CH50, and sex were not statistically significant predictors of mCNV in the PM group patients (p > 0.05). CONCLUSIONS Our data support the hypothesis that immunological/inflammatory markers, namely hs-CRP, C3, and CH50 may play an important role in the development of PM, and that C3 level may be a predictive risk factor for mCNV formation.
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VITRECTOMY WITH OR WITHOUT INTERNAL LIMITING MEMBRANE PEELING FOR EACH STAGE OF MYOPIC TRACTION MACULOPATHY. Retina 2013; 33:2018-25. [DOI: 10.1097/iae.0b013e3182a4892b] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Voykov B, Ziemssen F, Bartz-Schmidt KU. [Therapy of myopic choroidal neovascularization]. Ophthalmologe 2012; 109:766-9. [PMID: 22828745 DOI: 10.1007/s00347-011-2500-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Recently published studies have shown that myopic choroidal neovascularization (mCNV) is efficiently treated by anti-vascular endothelial growth factor (VEGF) drugs. Within a prospective executive study, photodynamic therapy failed to prove a significant difference over the duration of 2 years. Although a systematic evaluation of different retreatment algorithms still has to be done the administration of single injections depending on specialist assessment of morphological changes, predominantly spectral domain optical coherence tomography (SD-OCT) and fundus, has achieved a marked visual improvement. The experience of treating age-related macular degeneration should not be simply transferred to mCNV and an individual approach, not only for female patients of childbearing age, is necessary.
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Affiliation(s)
- B Voykov
- Department für Augenheilkunde, Universität Tübingen, Schleichstrasse 12-16, Tübingen, Germany.
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