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Vilares-Morgado R, Ferreira AM, Rocha-Sousa A, Carneiro Â, Barbosa-Breda J. Effect of Repeated Intravitreal Injections in Glaucoma Spectrum Diseases [Response to Letter]. Clin Ophthalmol 2023; 17:3799-3800. [PMID: 38105913 PMCID: PMC10725080 DOI: 10.2147/opth.s452567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023] Open
Affiliation(s)
- Rodrigo Vilares-Morgado
- Department of Ophthalmology, Centro Hospitalar E Universitário de São João, Porto, Portugal
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Ana Margarida Ferreira
- Department of Ophthalmology, Centro Hospitalar E Universitário de São João, Porto, Portugal
| | - Amândio Rocha-Sousa
- Department of Ophthalmology, Centro Hospitalar E Universitário de São João, Porto, Portugal
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar E Universitário de São João, Porto, Portugal
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - João Barbosa-Breda
- Department of Ophthalmology, Centro Hospitalar E Universitário de São João, Porto, Portugal
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
- KULeuven, Research Group Ophthalmology, Department of Neurosciences, Leuven, Belgium
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Vilares-Morgado R, Correia V, Ferreira AM, Alves F, Melo AB, Estrela-Silva S, Araújo J, Tavares-Ferreira J, Silva M, Rocha-Sousa A, Carneiro A, Barbosa-Breda J. Effect of Repeated Intravitreal Injections in Glaucoma Spectrum Diseases. Clin Ophthalmol 2023; 17:3613-3627. [PMID: 38026596 PMCID: PMC10676727 DOI: 10.2147/opth.s441500] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose To evaluate whether repeated intravitreal injections (IVI) with an anti-vascular endothelial growth factor (anti-VEGF) agent are associated with glaucomatous progression in eyes with glaucoma spectrum diseases (GSD). Methods Single-center, retrospective, longitudinal study of patients with bilateral and similar GSD who: (1) received ≥8 IVI in only one eye during the study period; (2) had ≥2 retinal nerve fiber layer thickness (RNFL) measurements obtained by spectral-domain optical coherence tomography (SD-OCT) at least 12 months apart. The primary outcome was the absolute RNFL thickness change, comparing injected and fellow uninjected eyes. Linear mixed effects models were constructed, including a multivariable model. Results Sixty-eight eyes from 34 patients were included, 34 injected and 34 fellow uninjected eyes. Average baseline age was 67.68±21.77 years with a follow-up of 3.66±1.89 years and 25.12±14.49 IVI. RNFL thickness decreased significantly from 80.92±15.78 to 77.20±17.35 μm (p<0.001; -1.18±1.93 μm/year) in injected eyes and from 79.95±17.91 to 76.61±17.97 μm (p<0.001; -1.07±0.98 μm/year) in uninjected eyes. In a multivariable linear mixed model of injected eyes, only higher baseline RNFL thickness (p < 0.001) significantly predicted higher absolute RNFL thickness loss. Neither absolute RNFL thickness variation (p=0.716) nor RNFL rate (p=0.779) was significantly different between paired injected and uninjected eyes. Absolute IOP variation was not significantly different between groups (16.62±4.77 to 15.09±4.34 mmHg in injected eyes and 17.68±5.01 to 14.50±3.39 mmHg in fellow uninjected eyes; p=0.248). The proportion of eyes receiving glaucoma medical treatment increased significantly in both groups (55.9% to 76.5% in injected eyes; p=0.039; 58.8% to 76.5% in uninjected eyes; p = 0.031). The number of glaucoma medications also increased significantly in both groups (1.03±1.11 to 1.59±1.18 glaucoma medications in injected eyes; p=0.003; 1.09±1.11 to 1.56±1.19 glaucoma medications in uninjected eyes; p=0.003). Conclusion Repeated IVI do not seem to accelerate glaucomatous progression. Future studies with a longer follow-up are needed.
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Affiliation(s)
- Rodrigo Vilares-Morgado
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Vera Correia
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Margarida Ferreira
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Flávio Alves
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - António Benevides Melo
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sérgio Estrela-Silva
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Joana Araújo
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Tavares-Ferreira
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marta Silva
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Amândio Rocha-Sousa
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Angela Carneiro
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - João Barbosa-Breda
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
- KULeuven, Research Group Ophthalmology, Department of Neurosciences, Leuven, Belgium
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Zivkovic M, Radosavljevic A, Zlatanovic M, Jaksic V, Davidovic S, Stamenkovic M, Todorovic I, Jaksic J. Influence of Multiple Anti-VEGF Injections on Retinal Nerve Fiber Layer and Ganglion Cell-Inner Plexiform Layer Thickness in Patients with Exudative Age-Related Macular Degeneration. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59010138. [PMID: 36676762 PMCID: PMC9862962 DOI: 10.3390/medicina59010138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/26/2022] [Accepted: 12/29/2022] [Indexed: 01/12/2023]
Abstract
Backgrounds and Objectives: To analyze the influence of multiple anti-VEGF intravitreal injections for exudative age-related macular degeneration on the thickness of peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GC + IPL) using spectral domain optical coherence tomography (SD-OCT). Materials and Methods: A prospective interventional study of consecutive patients treated with intravitreal bevacizumab (IVB) was performed. Average and sectorial values of RNFL and GC + IPL thickness were recorded using Cirrus SD-OCT at 0, 6, 12, and 24 months. Patients suffering from any ocular disease that could affect RNFL or GC + IPL thickness were excluded. Results: A total of 135 patients (70 women and 65 men, aged 65 ± 15 years) were included. The average number of injections per patient was 12.4 ± 2.4. Average RNFL and GC + IPL thickness prior to the first injection (87.6 ± 12.2 and 47.2 ± 15.5 respectively), and after 24-month follow-up (86.2 ± 12.6 and 46.7 ± 11.9 respectively) did not differ significantly (p > 0.05). There was a significant decrease in GC2, GC5 segments, and minimum GC + IPL thickness. Conclusion: Repeated anti-VEGF treatment did not cause significant changes in the thickness of RNFL and GC + IPL layers over a period of 24 months. The detected decrease in GC2 and GC5 sectors, as well as in minimum GC + IPL thickness, could be a sign of ganglion cell damage induced by the treatment or could occur during the natural course of the disease.
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Affiliation(s)
- Maja Zivkovic
- Department of Ophthalmology, Medical Faculty, University of Nis, 18000 Nis, Serbia
- Ophthalmology Eye Hospital “Clinic Maja”, 18000 Nis, Serbia
| | - Aleksandra Radosavljevic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Eye Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Correspondence: ; Tel.: +381-11-2688-997; Fax: +381-11-2688-164
| | - Marko Zlatanovic
- Department of Ophthalmology, Medical Faculty, University of Nis, 18000 Nis, Serbia
- Ophthalmology Eye Hospital “Clinic Maja”, 18000 Nis, Serbia
| | - Vesna Jaksic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Eye Clinic, Clinical Center Zvezdara, 11000 Belgrade, Serbia
| | - Sofija Davidovic
- Department of Ophthalmology, Medical Faculty, University of Novi Sad, 21000 Novi Sad, Serbia
| | | | - Ivana Todorovic
- Eye Clinic, Clinical Center Zvezdara, 11000 Belgrade, Serbia
| | - Jana Jaksic
- Eye Clinic, Clinical Center Zvezdara, 11000 Belgrade, Serbia
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Pirinen I, Leinonen S, Helminen M, Hujanen P, Vaajanen A, Tuulonen A, Uusitalo‐Järvinen H. Glaucoma progression in patients receiving intravitreal
anti‐VEGF
treatment for neovascular age‐related macular degeneration. Acta Ophthalmol 2022; 101:261-265. [PMID: 36398433 DOI: 10.1111/aos.15288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 10/24/2022] [Accepted: 10/29/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to investigate how often glaucoma and neovascular age-related macular degeneration (nAMD) occur in the same patient and to evaluate whether glaucoma progression is faster in eyes treated with intravitreal anti-VEGF medications for nAMD. METHODS This single-centre retrospective real-world data (RWD) consists of medical records of 6314 glaucoma and 2166 nAMD patients treated in 2008-2017 in Tays Eye Centre, Finland. To study glaucoma progression, changes in visual fields (mean deviation [MD], dB/year), IOP (mmHg/year) and fundus photographs (progression, yes/no) were compared in glaucoma eyes with and without anti-VEGF treatment for nAMD and ≥1 year follow-up. RESULTS During the 10-year period, 147 patients with glaucoma received intravitreal anti-VEGF treatment for nAMD corresponding to 2% of glaucoma and 7% of nAMD patients. The mean change in MD was -0.70 dB/year (SD 1.8) vs. -0.27 dB/year (SD 1.7) (p = 0.027) in glaucoma eyes with (n = 37) and without (n = 4304) anti-VEGF injections, respectively. In patients with bilateral glaucoma and unilateral nAMD treated with anti-VEGF injections (n = 20), MD declined at -0.62 dB/year (SD 1.9) vs 0.33 dB/year (SD 1.5) (p = 0.654), and glaucoma progression was detected in 14/20 vs 10/20 (p = 0.219) fundus photographs in eyes with anti-VEGF treatment compared with their untreated fellow eyes. CONCLUSION nAMD and glaucoma were found co-existing in the same eye at rates that were similar to the age-corrected prevalence of the two diseases in the general population. Our results suggest that intravitreal anti-VEGF treatment for nAMD may accelerate glaucoma progression.
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Affiliation(s)
- Inka Pirinen
- Tays Eye Centre, Tampere University Hospital Tampere Finland
- Faculty of Medicine and Health Technology, Tampere University Tampere Finland
| | - Sanna Leinonen
- Tays Eye Centre, Tampere University Hospital Tampere Finland
- Faculty of Medicine and Health Technology, Tampere University Tampere Finland
| | - Mika Helminen
- Faculty of Social Sciences, Health Sciences, Tampere University Tampere Finland
- Tays Research Services, Tampere University Hospital Tampere Finland
| | - Pekko Hujanen
- Tays Eye Centre, Tampere University Hospital Tampere Finland
| | - Anu Vaajanen
- Faculty of Medicine and Health Technology, Tampere University Tampere Finland
- Health Center Mehilainen Helsinki Finland
- Health Center Terveystalo Tampere Finland
| | - Anja Tuulonen
- Tays Eye Centre, Tampere University Hospital Tampere Finland
| | - Hannele Uusitalo‐Järvinen
- Tays Eye Centre, Tampere University Hospital Tampere Finland
- Faculty of Medicine and Health Technology, Tampere University Tampere Finland
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Shah SM, Boopathiraj N, Starr MR, Dalvin LA, AbouChehade J, Damento G, Garcia MD, Hodge DO, Bakri SJ, Sit AJ, Iezzi R. Risk, Prevalence, and Progression of Glaucoma in Eyes With Age-Related Macular Degeneration Treated With Intravitreal Anti-Vascular Endothelial Growth Factor Injections. Am J Ophthalmol 2022; 243:98-108. [PMID: 35932820 PMCID: PMC10107401 DOI: 10.1016/j.ajo.2022.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To examine the risk, prevalence, and progression of glaucoma development in age-related macular degeneration (AMD) eyes receiving intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections compared to controls. DESIGN Retrospective clinical cohort study. METHODS Retrospective review of eyes receiving intravitreal anti-VEGF injections from January 1, 2004, to December 31, 2013, for exudative AMD. Age- and sex-matched control groups of eyes included eyes with nonexudative AMD (NEAMD) and no AMD. Eyes with a diagnosis of glaucoma or glaucoma suspect were reviewed for injection details, type and date of glaucoma diagnosis, glaucoma treatments, standard automated perimetry (SAP), and spectral domain optical coherence tomography (SD-OCT). Qualitative progression was determined by indication of glaucoma progression in provider notes. Quantitative progression was assessed based on change in mean deviation (MD) on SAP, retinal nerve fiber layer thickness on SD-OCT, and intraocular pressure (IOP). RESULTS There were 707 eyes of 504 patients treated with anti-VEGF injections and 1008 eyes in the NEAMD and no-AMD cohorts. There was no difference in glaucoma or suspect prevalence at initial presentation between eyes treated with injections and NEAMD (6.9% vs 9.7%, P = .22) or no-AMD controls (vs 8.5%, P = .55). There was no difference in cumulative 5-year probability of new glaucoma diagnosis after anti-VEGF injections compared to NEAMD (1.9% vs 1.0%, P = .69) or no-AMD controls (vs 1.6%, P = .88). There was no difference in qualitative progression of glaucoma in the injection cohort vs NEAMD (P = .19) or no-AMD controls (P = .61). The rate of MD change in injection eyes was similar to NEAMD eyes (P = .74) but greater than no-AMD eyes (P = .02). Eyes receiving injections required more topical glaucoma medications compared with NEAMD (P = .03) and more glaucoma laser treatments compared with no-AMD controls (P = .009). Eyes receiving injections did not require more frequent incisional glaucoma surgery compared with NEAMD (21.0% vs 15.0%, P = .95) or no-AMD controls (vs 10.0%, P = .10). CONCLUSION Eyes treated with intravitreal anti-VEGF injections for exudative AMD did not have increased risk of developing glaucoma compared with controls. Of those with a glaucoma diagnosis, exudative AMD eyes receiving injections required a greater number of topical glaucoma medications compared with NEAMD eyes and had a greater rate of MD loss than no-AMD controls.
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Affiliation(s)
- Saumya M. Shah
- Mayo Clinic Department of Ophthalmology, 200 1 St SW, Rochester, MN 55905
| | - Nithya Boopathiraj
- Mayo Clinic Department of Ophthalmology, 200 1 St SW, Rochester, MN 55905
| | - Matthew R. Starr
- Mayo Clinic Department of Ophthalmology, 200 1 St SW, Rochester, MN 55905
| | - Lauren A. Dalvin
- Mayo Clinic Department of Ophthalmology, 200 1 St SW, Rochester, MN 55905
| | | | - Gena Damento
- Mayo Clinic Department of Ophthalmology, 200 1 St SW, Rochester, MN 55905
| | - Maria D. Garcia
- Mayo Clinic Department of Ophthalmology, 200 1 St SW, Rochester, MN 55905
| | - David O. Hodge
- Department of Health Sciences Research/Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Sophie J. Bakri
- Mayo Clinic Department of Ophthalmology, 200 1 St SW, Rochester, MN 55905
| | - Arthur J. Sit
- Mayo Clinic Department of Ophthalmology, 200 1 St SW, Rochester, MN 55905
| | - Raymond Iezzi
- Mayo Clinic Department of Ophthalmology, 200 1 St SW, Rochester, MN 55905
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Munk MR, Somfai GM, de Smet MD, Donati G, Menke MN, Garweg JG, Ceklic L. The Role of Intravitreal Corticosteroids in the Treatment of DME: Predictive OCT Biomarkers. Int J Mol Sci 2022; 23:ijms23147585. [PMID: 35886930 PMCID: PMC9319632 DOI: 10.3390/ijms23147585] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/18/2022] Open
Abstract
This work aims to summarize predictive biomarkers to guide treatment choice in DME. Intravitreal anti-VEGF is considered the gold standard treatment for centers involving DME, while intravitreal steroid treatment has been established as a second-line treatment in DME. However, more than 1/3 of the patients do not adequately respond to anti-VEGF treatment despite up to 4-weekly injections. Not surprisingly, insufficient response to anti-VEGF therapy has been linked to low-normal VEGF levels in the serum and aqueous humor. These patients may well benefit from an early switch to intravitreal steroid treatment. In these patients, morphological biomarkers visible in OCT may predict treatment response and guide treatment decisions. Namely, the presence of a large amount of retinal and choroidal hyperreflective foci, disruption of the outer retinal layers and other signs of chronicity such as intraretinal cysts extending into the outer retina and a lower choroidal vascular index are all signs suggestive of a favorable treatment response of steroids compared to anti-VEGF. This paper summarizes predictive biomarkers in DME in order to assist individual treatment decisions in DME. These markers will help to identify DME patients who may benefit from primary dexamethasone treatment or an early switch.
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Affiliation(s)
- Marion R. Munk
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, 3010 Bern, Switzerland
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60208, USA
- Correspondence: ; Tel.: +41-31-632-25-01
| | - Gabor Mark Somfai
- Department of Ophthalmology, Stadtspital Zürich, 8063 Zurich, Switzerland;
- Spross Research Institute, 8063 Zurich, Switzerland
- Department of Ophthalmology, Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Marc D. de Smet
- Medical/Surgical Retina and Ocular Inflammation, University of Lausanne, MIOS SA, 1015 Lausanne, Switzerland;
| | - Guy Donati
- Centre Ophtalmologique de la Colline, University of Geneve, 1205 Geneve, Switzerland;
| | - Marcel N. Menke
- Department of Ophthalmology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland;
| | - Justus G. Garweg
- Swiss Eye Institute, Berner Augenklinik am Lindenhofspital, 3012 Bern, Switzerland;
| | - Lala Ceklic
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, 3010 Bern, Switzerland
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Gunay BO, Esenulku CM. Retinal nerve fibre layer and ganglion cell layer thickness changes following intravitreal aflibercept for age-related macular degeneration. Cutan Ocul Toxicol 2022; 41:91-97. [PMID: 35135401 DOI: 10.1080/15569527.2022.2034843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate the effect of intravitreal aflibercept (IVA) injections on peripapillary retinal nerve fibre layer thickness (RNFLT) and macular ganglion cell layer thickness (GCLT) in neovascular age-related macular degeneration (nAMD) patients during a 1-year follow-up. METHODS This is a prospective study including 34 patients who were treated with aflibercept for treatment-naive nAMD. Following a loading phase of 3-monthly aflibercept, re-injections were performed on a pro re nata regimen for 12 months. Best-corrected visual acuity, intraocular pressure, and spectral-domain-optical coherence tomography analysis were performed at baseline and 1 month, 3 months, 6 months, and 12 months following treatment. Peripapillary RNFLT and macular GCLT along with the central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) were evaluated at each visit. RESULTS Mean number of aflibercept injections was 6.0 ± 1.8. Significant thinning was observed at the central macular ganglion cell layer and at 1 mm superior, temporal, and nasal ganglion cell layer compared to baseline at 1-year (p < 0.05). No significant change of RNFLT was shown (p > 0.05). Mean CMT and SFCT were significantly reduced after IVA therapy (p < 0.05, for both). No correlation was found between injection number and GCLT change. CONCLUSIONS Intravitreal aflibercept caused significant ganglion cell layer thinning during a 1-year follow-up without any changes in RNFLT. Intravitreal aflibercept itself may have a chance to induce decreased GCLT in nAMD patients.
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Affiliation(s)
- Betul Onal Gunay
- University of Health Sciences, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Cenap Mahmut Esenulku
- University of Health Sciences, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
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8
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Swaminathan SS, Kunkler AL, Quan AV, Medert CM, Vanner EA, Feuer W, Chang TC. Rates of RNFL Thinning in Patients with Suspected or Confirmed Glaucoma Receiving Unilateral Intravitreal Injections for Exudative AMD. Am J Ophthalmol 2021; 226:206-216. [PMID: 33359714 DOI: 10.1016/j.ajo.2020.12.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE This study evaluated whether the rate of retinal nerve fiber layer (RNFL) thinning is faster in eyes receiving intravitreal injections than in fellow uninjected eyes among patients suspected of having or confirmed to have glaucoma and exudative age-related macular degeneration (AMD). DESIGN Retrospective comparative cohort study. METHODS Patients with a diagnosis of unilateral exudative AMD and confirmed to have or suspected of having glaucoma in both eyes receiving unilateral intravitreal injections were identified. Those with ≥3 RNFL optical coherence tomography scans and ≥6 injections were included in the study. Rates of RNFL thinning in the injected eye versus the uninjected eye were estimated using linear mixed models. The main outcome measurement was the differences in rates of RNFL thinning in the injected versus the fellow uninjected eye. The effects of postinjection elevation of intraocular pressure (IOP), injection frequency, and number of injections were also evaluated. RESULTS A total of 53 patients met the inclusion criteria, receiving 26.4 ± 15.9 intravitreal injections. The average rate of RNFL thinning in uninjected eyes was -0.620 μm/year (P = .029). Injected eyes had an additional incremental loss of -0.385 μm/year, but this value was not statistically significant (95% confidence interval [CI]: -1.147 to 0.379 μm/year; P = .324). Subgroup analysis with only glaucoma patients (n = 33) also demonstrated a nonsignificant effect of injections (-0.568 μm/year; 95% CI: -1.454 to 0.319 μm/year; P = .212). Postinjection IOP elevation, injection frequency, and total number of injections were not associated with faster RNFL loss. CONCLUSIONS Among exudative AMD patients with glaucoma or suspected of having glaucoma, the rate of RNFL thinning in eyes receiving intravitreal injections did not significantly differ from that of fellow uninjected eyes.
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Assessment of patient specific information in the wild on fundus photography and optical coherence tomography. Sci Rep 2021; 11:8621. [PMID: 33883573 PMCID: PMC8060417 DOI: 10.1038/s41598-021-86577-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/09/2021] [Indexed: 12/25/2022] Open
Abstract
In this paper we analyse the performance of machine learning methods in predicting patient information such as age or sex solely from retinal imaging modalities in a heterogeneous clinical population. Our dataset consists of N = 135,667 fundus images and N = 85,536 volumetric OCT scans. Deep learning models were trained to predict the patient’s age and sex from fundus images, OCT cross sections and OCT volumes. For sex prediction, a ROC AUC of 0.80 was achieved for fundus images, 0.84 for OCT cross sections and 0.90 for OCT volumes. Age prediction mean absolute errors of 6.328 years for fundus, 5.625 years for OCT cross sections and 4.541 for OCT volumes were observed. We assess the performance of OCT scans containing different biomarkers and note a peak performance of AUC = 0.88 for OCT cross sections and 0.95 for volumes when there is no pathology on scans. Performance drops in case of drusen, fibrovascular pigment epitheliuum detachment and geographic atrophy present. We conclude that deep learning based methods are capable of classifying the patient’s sex and age from color fundus photography and OCT for a broad spectrum of patients irrespective of underlying disease or image quality. Non-random sex prediction using fundus images seems only possible if the eye fovea and optic disc are visible.
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10
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Retinal Genomic Fabric Remodeling after Optic Nerve Injury. Genes (Basel) 2021; 12:genes12030403. [PMID: 33799827 PMCID: PMC7999523 DOI: 10.3390/genes12030403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/14/2021] [Accepted: 02/19/2021] [Indexed: 12/16/2022] Open
Abstract
Glaucoma is a multifactorial neurodegenerative disease, characterized by degeneration of the retinal ganglion cells (RGCs). There has been little progress in developing efficient strategies for neuroprotection in glaucoma. We profiled the retina transcriptome of Lister Hooded rats at 2 weeks after optic nerve crush (ONC) and analyzed the data from the genomic fabric paradigm (GFP) to bring additional insights into the molecular mechanisms of the retinal remodeling after induction of RGC degeneration. GFP considers three independent characteristics for the expression of each gene: level, variability, and correlation with each other gene. Thus, the 17,657 quantified genes in our study generated a total of 155,911,310 values to analyze. This represents 8830x more data per condition than a traditional transcriptomic analysis. ONC led to a 57% reduction in RGC numbers as detected by retrograde labeling with 1,1'-dioctadecyl-3,3,3,3'-tetramethylindocarbocyanine perchlorate (DiI). We observed a higher relative expression variability after ONC. Gene expression stability was used as a measure of transcription control and disclosed a robust reduction in the number of very stably expressed genes. Predicted protein-protein interaction (PPI) analysis with STRING revealed axon and neuron projection as mostly decreased processes, consistent with RGC degeneration. Conversely, immune response PPIs were found among upregulated genes. Enrichment analysis showed that complement cascade and Notch signaling pathway, as well as oxidative stress and kit receptor pathway were affected after ONC. To expand our studies of altered molecular pathways, we examined the pairwise coordination of gene expressions within each pathway and within the entire transcriptome using Pearson correlations. ONC increased the number of synergistically coordinated pairs of genes and the number of similar profiles mainly in complement cascade and Notch signaling pathway. This deep bioinformatic study provided novel insights beyond the regulation of individual gene expression and disclosed changes in the control of expression of complement cascade and Notch signaling functional pathways that may be relevant for both RGC degeneration and remodeling of the retinal tissue after ONC.
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Karahan E, Abdelhakim A, Durmaz C, Tezel TH. Relief of Cystoid Macular Edema-Induced Focal Axonal Compression with Anti-Vascular Endothelial Growth Factor Treatment. Transl Vis Sci Technol 2020; 9:18. [PMID: 32818105 PMCID: PMC7396171 DOI: 10.1167/tvst.9.4.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 12/07/2019] [Indexed: 12/16/2022] Open
Abstract
Purpose To evaluate the mechanical compression of retinal nerve fiber layer (RNFL) by intraretinal cysts in macular edema and its relief with anti-vascular endothelial growth factor (anti-VEGF) treatment. Methods Optical coherence tomography scans were used to measure RNFL thickness and reflectance at seven preselected points at and around the peak of the edema before and after anti-VEGF treatment in 10 patients (11 eyes) with branch retina vein occlusion (BRVO) and diabetic macular edema (DME). Scans through nonedematous retina and from the fellow eyes were taken as controls. Correlations were sought between the changes in retinal and RNFL thickness, RNFL reflectance, and the size of the intraretinal cysts. Results Postinjection RNFL thickness decreased significantly only at peak point of the edema (18.1 ± 2.7 vs. 13.8 ± 1.2 µm; P = 0.038), at its nasal edge (20.1 ± 2.7 vs. 15.5 ± 1.4 µm; P = 0.026), and 500 µm away from its nasal border (35.7 ± 6.0 vs. 20.1 ± 2.7 µm; P = 0.006) suggesting focal stagnation of the axoplasmic flow owing to compression at its peak point. Significant postinjection decreases in RNFL reflectivity were also noted at peak point of the cyst (164.9 ± 10.3 vs. 141.5 ± 12.6 arbitrary units [AU]; P = 0.037), at its nasal edge (166.8 ± 7.8 vs. 135.1 ± 10.2 AU; P = 0.02), and 1500 µm away from temporal edge (160.2 ± 6.2 vs. 141.1 ± 6.4 AU; P = 0.022). Cyst proximity to RNFL (D50 = 50 µm) was the only determinant significantly affecting the magnitude of the RNFL thickness change after anti-VEGF treatment (P = 0.001). Conclusions Intraretinal cysts due to BRVO and DME locally compress overlying axons and induce anatomic changes suggestive of axoplasmic stagnation. This compression can be relieved with anti-VEGF treatment. Translational Relevance Focal compression of RFNL by retinal cysts may indicate a need for early treatment of macular edema to prevent axonal loss, especially in patients with low axonal reserve
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Affiliation(s)
- Eyyup Karahan
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA.,Department of Ophthalmology, Balikesir University, Balikesir, Turkey
| | - Aliaa Abdelhakim
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Ceren Durmaz
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA.,Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| | - Tongalp H Tezel
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
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Comparison of Drusen Volume Assessed by Two Different OCT Devices. J Clin Med 2020; 9:jcm9082657. [PMID: 32824455 PMCID: PMC7464253 DOI: 10.3390/jcm9082657] [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: 07/20/2020] [Revised: 08/06/2020] [Accepted: 08/09/2020] [Indexed: 11/17/2022] Open
Abstract
To compare drusen volume between Heidelberg Spectral Domain (SD-) and Zeiss Swept-Source (SS) PlexElite Optical Coherence Tomography (OCT) determined by manual and automated segmentation methods. Thirty-two eyes of 24 patients with Age-Related Macular Degeneration (AMD) and drusen maculopathy were included. In the central 1 and 3 mm ETDRS circle drusen volumes were calculated and compared. Drusen segmentation was performed using automated manufacturer algorithms of the two OCT devices. Then, the automated segmentation was manually corrected and compared and finally analyzed using customized software. Though on SD-OCT, there was a significant difference of mean drusen volume prior to and after manual correction (mean difference: 0.0188 ± 0.0269 mm3, p < 0.001, corr. p < 0.001, correlation of r = 0.90), there was no difference found on SS-OCT (mean difference: 0.0001 ± 0.0003 mm3, p = 0.262, corr. p = 0.524, r = 1.0). Heidelberg-acquired mean drusen volume after manual correction was significantly different from Zeiss-acquired drusen volume after manual correction (mean difference: 0.1231 ± 0.0371 mm3, p < 0.001, corr. p < 0.001, r = 0.68). Using customized software, the difference of measurements between both devices decreased and correlation among the measurements improved (mean difference: 0.0547 ± 0.0744 mm3, p = 0.02, corr. p = 0.08, r = 0.937). Heidelberg SD-OCT, the Zeiss PlexElite SS-OCT, and customized software all measured significantly different drusen volumes. Therefore, devices/algorithms may not be interchangeable. Third-party customized software helps to minimize differences, which may allow a pooling of data of different devices, e.g., in multicenter trials.
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Froger N, Matonti F, Roubeix C, Forster V, Ivkovic I, Brunel N, Baudouin C, Sahel JA, Picaud S. VEGF is an autocrine/paracrine neuroprotective factor for injured retinal ganglion neurons. Sci Rep 2020; 10:12409. [PMID: 32710087 PMCID: PMC7382485 DOI: 10.1038/s41598-020-68488-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/18/2020] [Indexed: 02/01/2023] Open
Abstract
Vascular endothelial growth factor-A (VEGF) is the angiogenic factor promoting the pathological neovascularization in age-related macular degeneration (AMD) or diabetic macular edema (DME). Evidences have suggested a neurotrophic and neuroprotective role of VEGF, albeit in retina, cellular mechanisms underlying the VEGF neuroprotection remain elusive. Using purified adult retinal ganglion cells (RGCs) in culture, we demonstrated here that VEGF is released by RGCs themselves to promote their own survival, while VEGF neutralization by specific antibodies or traps drastically reduced the RGC survival. These results indicate an autocrine VEGF neuroprotection on RGCs. In parallel, VEGF produced by mixed retinal cells or by mesenchymal stem cells exerted a paracrine neuroprotection on RGCs. Such neuroprotective effect was obtained using the recombinant VEGF-B, suggesting the involvement of VEGF-R1 pathway in VEGF-elicited RGC survival. Finally, glaucomatous patients injected with VEGF traps (ranibizumab or aflibercept) due to either AMD or DME comorbidity, showed a significant reduction of RGC axon fiber layer thickness, consistent with the plausible reduction of the VEGF autocrine stimulation of RGCs. Our results provide evidence of the autocrine neuroprotective function of VEGF on RGCs is crucially involved to preserve injured RGCs such as in glaucomatous patients.
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Affiliation(s)
- Nicolas Froger
- Sorbonne Université, INSERM, CNRS, Institut de La Vision, 17 rue Moreau, 75012, Paris, France.
| | - Frédéric Matonti
- Sorbonne Université, INSERM, CNRS, Institut de La Vision, 17 rue Moreau, 75012, Paris, France.,Centre Monticelli Paradis, 433 bis rue Paradis, 13008, Marseille, France.,Aix Marseille Univ, CNRS, INT, Inst Neurosci Timone, 13005, Marseille, France
| | - Christophe Roubeix
- Sorbonne Université, INSERM, CNRS, Institut de La Vision, 17 rue Moreau, 75012, Paris, France
| | - Valérie Forster
- Sorbonne Université, INSERM, CNRS, Institut de La Vision, 17 rue Moreau, 75012, Paris, France
| | - Ivana Ivkovic
- Sorbonne Université, INSERM, CNRS, Institut de La Vision, 17 rue Moreau, 75012, Paris, France
| | - Nadège Brunel
- UMS 29 INSERM Plateforme FluExGen UPMC, 75012, Paris, France
| | - Christophe Baudouin
- Sorbonne Université, INSERM, CNRS, Institut de La Vision, 17 rue Moreau, 75012, Paris, France.,CHNO Des Quinze-Vingts, DHU Sight Restore, INSERM-DGOS CIC 1423, 75012, Paris, France
| | - José-Alain Sahel
- Sorbonne Université, INSERM, CNRS, Institut de La Vision, 17 rue Moreau, 75012, Paris, France.,CHNO Des Quinze-Vingts, DHU Sight Restore, INSERM-DGOS CIC 1423, 75012, Paris, France.,Fondation Ophtalmologique Adolphe de Rothschild, 75020, Paris, France.,Department of Ophthalmology, The University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Serge Picaud
- Sorbonne Université, INSERM, CNRS, Institut de La Vision, 17 rue Moreau, 75012, Paris, France. .,Fondation Ophtalmologique Adolphe de Rothschild, 75020, Paris, France.
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Effects of Intravitreal Anti-VEGF Therapy on Glaucoma-like Progression in Susceptible Eyes. J Glaucoma 2020; 28:1035-1040. [PMID: 31633617 DOI: 10.1097/ijg.0000000000001382] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PRéCIS:: Intravitreal anti-vascular endothelial growth factor (VEGF) injections may accelerate glaucomatous change in patients with preexisting glaucoma or ocular hypertension (OHT). The safety of long-term injections in this specific population may be reflected in the need for additional glaucoma interventions. PURPOSE The purpose of this study was to investigate whether repeated anti-VEGF injections accelerate structural and functional glaucomatous change in eyes with preexisting glaucoma or OHT. MATERIALS AND METHODS This is a retrospective, observational study of injected and noninjected fellow eyes. A total of 28 patients with preexisting glaucoma or OHT, who received ≥6 unilateral anti-VEGF injections for concurrent neovascular retinal disease, were selected for chart review. Primary outcome measures were rate of visual field loss in dB/year, rate of change in retinal nerve fiber layer (RNFL) thickness in microns/year, and need for additional glaucoma medications, surgery, or laser. RESULTS The number of eyes requiring additional glaucoma surgery or laser was 8 of 28 (28.6%) for the injected group and 2 of 28 (7.1%) for the noninjected group. A significantly greater proportion of injected eyes required invasive glaucoma intervention (P=0.034). Average rate of decline in mean deviation and change in pattern standard deviation were both significantly greater in injected eyes (P=0.029; P=0.019). Estimated mean rate of global retinal nerve fiber layer change was -4.27 µm/y for the injected group and -1.17 µm/y for the noninjected group and was significant only for injected eyes (P=0.014). Only the superior quadrant exhibited thinning that was significantly different between groups (P=0.030). CONCLUSIONS Intravitreal injections were associated with accelerated functional and structural glaucoma-like change in susceptible eyes. Clinicians should assess the need for glaucoma medications or other interventions over the course of anti-VEGF therapy.
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Effect of Intravitreal Injections on Retinal Imaging Metrics in Glaucomatous and Non-Glaucomatous Eyes. CURRENT OPHTHALMOLOGY REPORTS 2020; 8:111-119. [PMID: 33738146 DOI: 10.1007/s40135-020-00235-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose of Review To summarize the available literature on retinal imaging metrics in the context of intravitreal injections in glaucomatous and non-glaucomatous eyes. Recent Findings The retinal nerve fiber layer (RNFL) in injected non-glaucomatous eyes appears to thin at a similar rate to uninjected fellow eyes. A total of four studies evaluating RNFL thinning in injected glaucomatous eyes yielded mixed results, with more recent longitudinal investigations suggesting a potential association. The ganglion cell-inner plexiform layer is also being studied as a potential endpoint in both glaucomatous and non-glaucomatous eyes following intravitreal injections.
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Lee SW, Sim HE, Park JY, Kim JS, Chang IB, Park YS, Hwang JH. Changes in inner retinal layer thickness in patients with exudative age-related macular degeneration during treatment with anti-vascular endothelial growth factor. Medicine (Baltimore) 2020; 99:e19955. [PMID: 32332680 PMCID: PMC7220743 DOI: 10.1097/md.0000000000019955] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to identify any changes that occur in the retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GC-IPL) in patients with exudative age-related macular degeneration (AMD) during treatment with anti-vascular endothelial growth factor (VEGF) injections.Patients were enrolled in this retrospective study if they had exudative AMD, had received at least 3 injections of ranibizumab or aflibercept, and had a minimum of 12 months of follow-up. We analyzed the changes in the RNFL and GC-IPL using spectral-domain optical coherence tomography in rescan mode.Fifty-two eyes of 52 patients who had been treated with repeated anti-VEGF injections for exudative AMD were included. At the final visit, there was no significant between-group difference in best-corrected visual acuity or intraocular pressure. There was a significant decrease in central macular thickness in all groups (P < .05). There was a decrease in RNFL thickness that was only statistically significant in the ranibizumab group and when the ranibizumab or aflibercept groups were combined (P = .036 and .044, respectively). The thickness of the GC-IPL layer was significantly decreased in the aflibercept and total group (P = .035 and P = .048, respectively).The thicknesses of the RNFL and GC-IPL decreased in patients with exudative AMD who underwent repeated anti-VEGF injections.
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Affiliation(s)
- Seong Woo Lee
- Department of Ophthalmology, Sanggye Paik Hospital, Inje University, Seoul
| | - Ha Eun Sim
- Department of Ophthalmology, Sanggye Paik Hospital, Inje University, Seoul
| | - Jae Yong Park
- Department of Ophthalmology, Sanggye Paik Hospital, Inje University, Seoul
| | - Jae Suk Kim
- Department of Ophthalmology, Sanggye Paik Hospital, Inje University, Seoul
| | - In Beom Chang
- Department of Ophthalmology, Busan Paik Hospital, Inje University, Busan
| | | | - Je Hyung Hwang
- Department of Ophthalmology, Sanggye Paik Hospital, Inje University, Seoul
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Rud'ko AS, Budzinskaya MV, Andreeva IV, Karpilova MA, Smirnova TV. [Effect of intravitreal injections of ranibizumab and aflibercept on the retinal nerve fiber layer in patients with concomitant neovascular age-related macular degeneration and glaucoma]. Vestn Oftalmol 2019; 135:177-183. [PMID: 31691657 DOI: 10.17116/oftalma2019135052177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To study the effect of ranibizumab and aflibercept on the thickness of retinal nerve fiber layer (RNFL) in patients with neovascular age-related macular degeneration (nAMD) and primary open-angle glaucoma (POAG). MATERIAL AND METHODS The study included 62 patients (62 eyes) with nAMD and comorbid POAG. Patients were divided into two groups depending on the anti-VEGF treatment. The first group included 42 patients (42 eyes) who received injections of ranibizumab. The second group consisted of 20 patients (20 eyes) who received aflibercept. All patients received three injections of ranibizumab or aflibercept with one-month intervals. In addition to standard ophthalmic examination, patients underwent optical coherence tomography of the macular area and peripapillary RNFL. RESULTS After anti-VEGF treatment, patients of both groups exhibited improvements expressed in reduced macular edema, increased visual acuity and absence of intraocular pressure (IOP) changes, as well as no statistically significant changes in the width and depth of excavation. There was a statistically significant decrease of peripapillary RNFL thickness in the temporal quadrant after treatment. CONCLUSION The decrease of peripapillary RNFL thickness in the temporal quadrant occurs due to resorption of macular edema. In the absence of statistically significant changes in IOP, width and depth of excavation, intravitreal injections of ranibizumab and aflibercept can be considered safe treatment options for patients with concomitant nAMD and POAG.
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Affiliation(s)
- A S Rud'ko
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - M V Budzinskaya
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - I V Andreeva
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - M A Karpilova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - T V Smirnova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
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Abdolrahimzadeh S, Gharbiya M, Formisano M, Bertini F, Cerini A, Pacella E. Anti-Vascular Endothelial Growth Factor Intravitreal Therapy and Macular Ganglion Cell Layer Thickness in Patients with Neovascular Age-Related Macular Degeneration. Curr Eye Res 2019; 44:1000-1005. [DOI: 10.1080/02713683.2019.1610179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Solmaz Abdolrahimzadeh
- Ophthalmology Unit, NESMOS Department, “Sapienza” University of Rome, St. Andrea Hospital, Rome, Italy
| | - Magda Gharbiya
- Ophthalmology Unit, Department of Sense Organs, “Sapienza” University of Rome, Policlinico Umberto I, Rome, Italy
| | - Martina Formisano
- Ophthalmology Unit, Department of Sense Organs, “Sapienza” University of Rome, Policlinico Umberto I, Rome, Italy
| | - Fabrizio Bertini
- Ophthalmology Unit, Department of Sense Organs, “Sapienza” University of Rome, Policlinico Umberto I, Rome, Italy
| | - Alberto Cerini
- Ophthalmology Unit, Department of Sense Organs, “Sapienza” University of Rome, Policlinico Umberto I, Rome, Italy
| | - Elena Pacella
- Ophthalmology Unit, Department of Sense Organs, “Sapienza” University of Rome, Policlinico Umberto I, Rome, Italy
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Saxena S, Lai TY, Koizumi H, Farah ME, Ferrara D, Pelayes D, Sato T, Meyer CH, Murray T. Anterior chamber paracentesis during intravitreal injections in observational trials: effectiveness and safety and effects. Int J Retina Vitreous 2019; 5:8. [PMID: 30873293 PMCID: PMC6402161 DOI: 10.1186/s40942-019-0157-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 01/23/2019] [Indexed: 02/07/2023] Open
Abstract
A paracentesis prior to an intravitreal injection is a very safe procedure and can prevent IOP-spikes after injections. As these spikes pose the risk of inducing glaucomatous changes particularly in patients with frequent injections and/or with a risk profile, a regular paracentesis prior to an injection may be considered and discussed with the patient.
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Affiliation(s)
- Sandeep Saxena
- 1Department of Ophthalmology, King George's Medical University, Lucknow, India
| | - Timothy Y Lai
- Hong Kong Eye Hospital, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Hideki Koizumi
- 3Department of Ophthalmology, University of the Ryukyus, Okinawa, Japan
| | - Michel E Farah
- 4Department of Ophthalmology, Federal University of Sao Paulo (UNIFESP), São Paulo, Brazil
| | - Daniela Ferrara
- 5Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts USA
| | - David Pelayes
- 6Department of Ophthalmology, Buenos Aires University and Maimonides University, Buenos Aires, Argentina
| | - Tomohito Sato
- 7Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | | | - Timothy Murray
- 9Bascom Palmer Eye Institute, University of Miami, Miami, FL USA
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Makri OE, Vavvas D, Plotas P, Pallikari A, Georgakopoulos CD. The Effect of Ranibizumab on Normal Neurosensory Retina in the Eyes of Patients with Exudative Age Related Macular Degeneration. Open Ophthalmol J 2018; 11:368-376. [PMID: 29399233 PMCID: PMC5759102 DOI: 10.2174/1874364101711010368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 12/14/2017] [Accepted: 12/22/2017] [Indexed: 11/28/2022] Open
Abstract
Background: Anti-vascular endothelial growth factors have become the mainstay treatment for neovascular age related macular degeneration. Prolonged suppression of vascular endothelial growth factor raises concerns as it may result in harmful effects on retina. Objective: The purpose of this retrospective chart review is to evaluate the 1-year effect of treatment with intravitreal injections of ranibizumab on normal neurosensory retinal tissue of patients with exudative age related macular degeneration using the Optical Coherence Tomography (OCT). Method: The study included sixty five eyes of 62 patients (32 male and 30 female; mean age 74.97±8.5 years) with exudative age related macular degeneration treated with intravitreal injections of ranibizumab with a pro re nata treatment regimen over a period of 1 year. The MM5 thickness maps acquired with the Optovue RTVue-100 Fourier-domain OCT at baseline, at 3 months, after the 3 loading doses of ranibizumab, and at the 1 year follow-up visit were used for analysis. Changes of inner and outer retinal thickness in four selected points of normal retina on the MM5 scan were evaluated. Results: The patients received a mean of 6.4 ± 1.8 (median 6, range 3-11) intravitreal injections of ranibizumab over a period of 12 months. No significant change was observed in inner and outer retinal thickness at pre-selected spots of normal retina during the first year of intravitreal administration of ranibizumab. Conclusion: One year treatment with ranibizumab on an individualized, according to need dosing regimen does not seem to induce any detectable structural damage in the unaffected, normal retina.
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Affiliation(s)
- Olga E Makri
- Department of Ophthalmology, Medical School, University of Patras, Patra, Greece
| | - Demetrios Vavvas
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Panagiotis Plotas
- Department of Ophthalmology, Medical School, University of Patras, Patra, Greece
| | - Athina Pallikari
- Department of Ophthalmology, Medical School, University of Patras, Patra, Greece
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Rate of Macular Ganglion Cell-inner Plexiform Layer Thinning in Glaucomatous Eyes With Vascular Endothelial Growth Factor Inhibition. J Glaucoma 2017; 26:980-986. [DOI: 10.1097/ijg.0000000000000776] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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