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Li S, Sun L, Zhao X, Zhang Z, Luo X, Ding X. Beyond the Visual Acuity: Assessing the Visual Function in mCNV Patients After Anti-VEGF Treatment. Front Med (Lausanne) 2021; 8:709584. [PMID: 34532329 PMCID: PMC8438148 DOI: 10.3389/fmed.2021.709584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/26/2021] [Indexed: 12/05/2022] Open
Abstract
Purpose: To investigate visual function and vision-related quality of life (VR-QoL) changes in patients with myopic choroidal neovascularization (mCNV) after ranibizumab treatment. Methods: Quantitatively evaluate the objective tests of visual function (visual acuity, microperimetry, and metamorphopsia by m-Charts) before and after 3+prn (pro re neta) ranibizumab treatment for 1 year. The National Eye Institute 25-Item Visual Function Questionnaire (VFQ-25) was performed to evaluate the VR-QoL. Results: A total of 57 eyes of 57 patients were included in this study. The median average metamorphopsia score was 0.65 before treatment and improved to 0.45 after treatment (p = 0.0003). There was also a significant difference in the average threshold, macular integrity, and proportion of patients with stable fixation by the microperimetry (p < 0.000, p < 0.0001, and p = 0.03, respectively). After treatment, the VR-QoL composite, general vision subscale, and vision-related mental health subscale score were increased with borderline or statistical significance (p = 0.088, p = 0.0038, and p = 0.012, respectively). Subgroup analysis demonstrated parallel improvement of the VR-QoL score, metamorphopsia, average macular threshold, and fixation stability in patients with or without visual acuity increase. By multiple linear regression analysis, the VFQ-25 score after anti-VEGF treatment was only associated with the baseline VFQ-25 score and macular integrity. Improvements in the VFQ-25 score were only associated with changes in the metamorphopsia score. Conclusions: Integral lifting in several aspects of visual function was observed in mCNV after ranibizumab treatment. Macular integrity and metamorphopsia, but not visual acuity, were associated with VR-QoL.
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Affiliation(s)
- Songshan Li
- State Key Laboratory of Ophthalmology, Retina Division, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Limei Sun
- State Key Laboratory of Ophthalmology, Retina Division, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiujuan Zhao
- State Key Laboratory of Ophthalmology, Retina Division, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhaotian Zhang
- State Key Laboratory of Ophthalmology, Retina Division, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoling Luo
- State Key Laboratory of Ophthalmology, Retina Division, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyan Ding
- State Key Laboratory of Ophthalmology, Retina Division, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Yang Y, Dunbar H. Clinical Perspectives and Trends: Microperimetry as a trial endpoint in retinal disease. Ophthalmologica 2021; 244:418-450. [PMID: 33567434 DOI: 10.1159/000515148] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/03/2021] [Indexed: 11/19/2022]
Abstract
Endpoint development trials are underway across the spectrum of retinal disease. New validated endpoints are urgently required for the assessment of emerging gene therapies and in preparation for the arrival of novel therapeutics targeting early stages of common sight-threatening conditions such as age-related macular degeneration. Visual function measures are likely to be key candidates in this search. Over the last two decades, microperimetry has been used extensively to characterize functional vision in a wide range of retinal conditions, detecting subtle defects in retinal sensitivity that precede visual acuity loss and tracking disease progression over relatively short periods. Given these appealing features, microperimetry has already been adopted as an endpoint in interventional studies, including multicenter trials, on a modest scale. A review of its use to date shows a concurrent lack of consensus in test strategy and a wealth of innovative disease and treatment-specific metrics which may show promise as clinical trial endpoints. There are practical issues to consider, but these have not held back its popularity and it remains a widely used psychophysical test in research. Endpoint development trials will undoubtedly be key in understanding the validity of microperimetry as a clinical trial endpoint, but existing signs are promising.
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Affiliation(s)
- Yesa Yang
- UCL Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Hannah Dunbar
- UCL Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
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Xiao M, Liu Y, Wang L, Liang J, Wang T, Zhai Y, Wang Y, Liu S, Liu W, Luo X, Wang F, Sun X. Intraocular VEGF deprivation induces degeneration and fibrogenic response in retina. FASEB J 2019; 33:13920-13934. [DOI: 10.1096/fj.201901283rr] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Meichun Xiao
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Liu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lingyu Wang
- GloriousMed Technology Company, Limited, Shanghai, China
| | - Jian Liang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
| | - Tianjun Wang
- School of Life Science, University of Liverpool, Liverpool, United Kingdom
| | - Yuanqi Zhai
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Yafang Wang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shu Liu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjia Liu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xueting Luo
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
| | - Fenghua Wang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
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4
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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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5
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Hong IH, Park SP. Quantitative physiological measurements to evaluate the response of antivascular endothelial growth factor treatment in patients with neovascular diseases. Indian J Ophthalmol 2017; 65:559-568. [PMID: 28724811 PMCID: PMC5549406 DOI: 10.4103/ijo.ijo_278_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Antivascular endothelial growth factor (VEGF) treatment is still used intravitreally worldwide for various neovascular diseases, despite other available, approved treatments. We performed a systematic search of the literature focused on visual physiology studies. We used the online biomedical search engine PubMed and searched key words including “M-chart,” “Preferential Hyperacuity Perimetry,” “microperimetry,” (MP) “electroretinography,” and “contrast sensitivity” to estimate treatment efficacy of anti-VEGF treatments in a quantitative manner. Many studies were identified which used a variety of methodologies, disease entities, injected agents, and patient populations, making it difficult to obtain a direct comparison of their results. However, favorable functional outcomes achieved using current quantitative methods would lend further confidence to the effectiveness of a treat-and-extend protocol using intravitreal anti-VEGF for the management of patients with neovascular diseases. Despite anti-VEGF's wide use, a well-designed longitudinal multicenter study to systematically evaluate and compare different physiological methods or parameters in patients with neovascular diseases is still lacking, though it would benefit therapeutic decisions.
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Affiliation(s)
- In Hwan Hong
- Department of Ophthalmology, Hallym University Medical Center, Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Sung Pyo Park
- Department of Ophthalmology, Hallym University Medical Center, Kangdong Sacred Heart Hospital, Seoul, South Korea
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Lambert NG, Zhang X, Rai RR, Uehara H, Choi S, Carroll LS, Das SK, Cahoon JM, Kirk BH, Bentley BM, Ambati BK. Subretinal AAV2.COMP-Ang1 suppresses choroidal neovascularization and vascular endothelial growth factor in a murine model of age-related macular degeneration. Exp Eye Res 2016; 145:248-257. [PMID: 26775053 PMCID: PMC5862038 DOI: 10.1016/j.exer.2016.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 12/21/2015] [Accepted: 01/12/2016] [Indexed: 11/17/2022]
Abstract
To assess whether Tie2-mediated vascular stabilization ameliorates neovascular age-related macular degeneration (AMD), we investigated the impact of adeno-associated virus-mediated gene therapy with cartilage oligomeric matrix protein angiopoietin-1 (AAV2.COMP-Ang1) on choroidal neovascularization (CNV), vascular endothelial growth factor (VEGF), and hypoxia-inducible factor (HIF) in a mouse model of the disease. We treated mice with subretinal injections of AAV2.COMP-Ang1 or control (AAV2.AcGFP, AAV2.LacZ, and phosphate-buffered saline). Subretinal AAV2 localization and plasmid protein expression was verified in the retinal pigment epithelium (RPE)/choroid of mice treated with all AAV2 constructs. Laser-assisted simulation of neovascular AMD was performed and followed by quantification of HIF, VEGF, and CNV in each experimental group. We found that AAV2.COMP-Ang1 was associated with a significant reduction in VEGF levels (29-33%, p < 0.01) and CNV volume (60-70%, p < 0.01), without a concomitant decrease in HIF1-α, compared to all controls. We concluded that a) AAV2 is a viable vector for delivering COMP-Ang1 to subretinal tissues, b) subretinal COMP-Ang1 holds promise as a prospective treatment for neovascular AMD, and c) although VEGF suppression in the RPE/choroid may be one mechanism by which AAV2.COMP-Ang1 reduces CNV, this therapeutic effect may be hypoxia-independent. Taken together, these findings suggest that AAV2.COMP-Ang1 has potential to serve as an alternative or complementary option to anti-VEGF agents for the long-term amelioration of neovascular AMD.
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Affiliation(s)
| | - Xiaohui Zhang
- Ambati Lab, John A. Moran Eye Center, Salt Lake City, UT, USA; Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - Ruju R Rai
- Ambati Lab, John A. Moran Eye Center, Salt Lake City, UT, USA; Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - Hironori Uehara
- Ambati Lab, John A. Moran Eye Center, Salt Lake City, UT, USA; Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - Susie Choi
- Ambati Lab, John A. Moran Eye Center, Salt Lake City, UT, USA; Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - Lara S Carroll
- Ambati Lab, John A. Moran Eye Center, Salt Lake City, UT, USA; Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - Subrata K Das
- Ambati Lab, John A. Moran Eye Center, Salt Lake City, UT, USA; Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - Judd M Cahoon
- Ambati Lab, John A. Moran Eye Center, Salt Lake City, UT, USA
| | - Brian H Kirk
- Ambati Lab, John A. Moran Eye Center, Salt Lake City, UT, USA
| | | | - Balamurali K Ambati
- Ambati Lab, John A. Moran Eye Center, Salt Lake City, UT, USA; Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, UT, USA.
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7
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Hartmann KI, Oster SF, Amini P, Bartsch DU, Cheng L, Freeman WR. SLO-Microperimetry in Wet Age-Related Macular Degeneration During Anti-VEGF Therapy. Ophthalmic Surg Lasers Imaging Retina 2015; 46:824-30. [PMID: 26431297 DOI: 10.3928/23258160-20150909-06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 06/23/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the morphological and functional outcome of wet age-related macular degeneration (AMD) during antivascular endothelial growth factor therapy with bevacizumab using SLO microperimetry (SLO-MP) with eye tracking. PATIENTS AND METHODS First, reproducibility was tested over the choroidal neovascularization (CNV) in 21 eyes of 19 patients with wet AMD. Second, 21 eyes of 19 patients with active CNV were studied longitudinally during bevacizumab therapy. Best-corrected visual acuity, SLO-MP, spectral-domain optical coherence tomography and fluorescein angiography were performed. RESULTS There was good reproducibility with a concordance correlation coefficient of 0.85. In the longitudinal study, eyes with anatomical response demonstrated a significant increase of retinal sensitivity. Non-responders showed no change in SLO-MP. Retinal sensitivity at baseline had a significant predictive value for the change in retinal sensitivity during therapy with bevacizumab (P=.032). CONCLUSION SLO-MP is able to analyze retinal function overlying lesions in wet AMD and can be a useful tool to monitor therapy in patients with macular diseases.
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8
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Intravitreal bevacizumab for choroidal neovascularization due to pathologic myopia: long-term outcomes. Graefes Arch Clin Exp Ophthalmol 2015; 254:445-54. [DOI: 10.1007/s00417-015-3076-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 05/25/2015] [Accepted: 06/02/2015] [Indexed: 01/14/2023] Open
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9
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Tarallo V, De Falco S. The vascular endothelial growth factors and receptors family: Up to now the only target for anti-angiogenesis therapy. Int J Biochem Cell Biol 2015; 64:185-9. [PMID: 25936669 DOI: 10.1016/j.biocel.2015.04.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/16/2015] [Accepted: 04/17/2015] [Indexed: 10/23/2022]
Abstract
Angiogenesis is a complex biological phenomenon essential for a correct embryonic development and for post-natal growth. In adult life, it is a tightly regulated process but in several pathological conditions, angiogenesis results abnormal with either excessive or insufficient proliferation of blood vessels. The pro-angiogenic members of VEGF family, VEGF-A, VEGF-B and placental growth factor (PlGF), and the related receptors, VEGFR-1 and VEGFR-2, have a central and decisive role in pathological angiogenesis. Indeed, they are the targets for anti-angiogenic drugs currently approved: bevacizumab and ranibizumab, that specifically inhibit VEGF-A; aflibercept, that is able to prevent the activity of VEGF-A, VEGF-B and PlGF; several multirtarget tyrosine kinase inhibitors that are able to prevent VEGFR-1 and/or VEGFR-2 signaling. The anti-angiogenesis therapy has represented one of the most active fields of drug discovery of last decade and promises to be further expanded due the wide number of diseases for which it may by applied.
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Affiliation(s)
- Valeria Tarallo
- Angiogenesis Lab, Institute of Genetics and Biophysics 'Adriano Buzzati-Traverso' - CNR, 80131 Naples, Italy.
| | - Sandro De Falco
- Angiogenesis Lab, Institute of Genetics and Biophysics 'Adriano Buzzati-Traverso' - CNR, 80131 Naples, Italy; IRCCS MultiMedica, 20099 Milan, Italy.
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10
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El Matri L, Chebil A, Kort F. Current and emerging treatment options for myopic choroidal neovascularization. Clin Ophthalmol 2015; 9:733-44. [PMID: 25987831 PMCID: PMC4422283 DOI: 10.2147/opth.s49437] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Choroidal neovascularization (CNV) is the main cause of visual impairment in highly myopic patients younger than 50 years of age. There are different treatments for myopic CNV (mCNV), with 5- to 10-year outcomes currently. Chorioretinal atrophy is still the most important determinant factor for visual outcome. The purpose of this study is to provide an overview of the current treatments for mCNV, including laser, surgical management, verteporfin photodynamic therapy, and mainly anti-vascular endothelial growth factor therapy. Emerging treatment options are also discussed.
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Affiliation(s)
- Leila El Matri
- Department B of Ophthalmology, Hedi Rais Institute of Ophthalmology, Faculty of Medicine of Tunis, University of El Manar, Tunis, Tunisia
| | - Ahmed Chebil
- Department B of Ophthalmology, Hedi Rais Institute of Ophthalmology, Faculty of Medicine of Tunis, University of El Manar, Tunis, Tunisia
| | - Fedra Kort
- Department B of Ophthalmology, Hedi Rais Institute of Ophthalmology, Faculty of Medicine of Tunis, University of El Manar, Tunis, Tunisia
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11
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Zhang X, Das SK, Passi SF, Uehara H, Bohner A, Chen M, Tiem M, Archer B, Ambati BK. AAV2 delivery of Flt23k intraceptors inhibits murine choroidal neovascularization. Mol Ther 2014; 23:226-34. [PMID: 25306972 DOI: 10.1038/mt.2014.199] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 10/02/2014] [Indexed: 01/09/2023] Open
Abstract
Long-term inhibition of extracellular vascular endothelial growth factor (VEGF) in the treatment of age-related macular degeneration (AMD) may induce retinal neuronal toxicity and risk other side effects. We developed a novel strategy which inhibits retinal pigment epithelium (RPE)-derived VEGF, sparing other highly sensitive retinal tissues. Flt23k, an intraceptor inhibitor of VEGF, was able to inhibit VEGF in vitro. Adeno-associated virus type 2 (AAV2)-mediated expression of Flt23k was maintained for up to 6 months postsubretinal injection in mice. Flt23k was able to effectively inhibit laser-induced murine choroidal neovascularization (CNV). VEGF levels in the RPE/choroid complex decreased significantly in AAV2.Flt23k treated eyes. Neither retinal structure detected by Heidelberg Spectralis nor function measured by electroretinography (ERG) was adversely affected by treatment with AAV2.Flt23k. Hence AAV2.Flt23k can effectively maintain long-term expression and inhibit laser-induced CNV in mice through downregulation of VEGF while maintaining a sound retinal safety profile. These findings suggest a promising novel approach for the treatment of CNV.
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Affiliation(s)
- Xiaohui Zhang
- Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Subrata K Das
- Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Samuel F Passi
- Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Hironori Uehara
- Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Austin Bohner
- Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Marcus Chen
- Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Michelle Tiem
- Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Bonnie Archer
- Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
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12
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Wong TY, Ohno-Matsui K, Leveziel N, Holz FG, Lai TY, Yu HG, Lanzetta P, Chen Y, Tufail A. Myopic choroidal neovascularisation: current concepts and update on clinical management. Br J Ophthalmol 2014; 99:289-96. [PMID: 24990871 PMCID: PMC4345796 DOI: 10.1136/bjophthalmol-2014-305131] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Choroidal neovascularisation (CNV) is a common vision-threatening complication of myopia and pathological myopia. Despite significant advances in understanding the epidemiology, pathogenesis and natural history of myopic CNV, there is no standard definition of myopic CNV and its relationship to axial length and other myopic degenerative changes. Several treatments are available to ophthalmologists, but with the advent of new therapies there is a need for further consensus and clinical management recommendations. Verteporfin photodynamic therapy has been an established treatment for subfoveal myopic CNV for many years, but this treatment does not restore visual acuity and is associated with long-term chorioretinal atrophy. More recently, clinical trials investigating the efficacy and safety of anti-vascular endothelial growth factor agents in patients with myopic CNV have demonstrated substantial visual acuity gains and quality of life increases compared with photodynamic therapy. These enhanced outcomes provide updated evidence-based clinical management guidelines of myopic CNV, and increase the need for a generally accepted definition for myopic CNV. This review critically summarises the latest myopic CNV literature in the context of clinical experience and recommends a myopic CNV treatment algorithm.
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Affiliation(s)
- Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, National University of Singapore, Singapore, Singapore
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nicolas Leveziel
- Faculté de Médecine de Poitiers, Department of Ophthalmology, Poitiers, France
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Timothy Y Lai
- Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, The Chinese University of Hong Kong, People's Republic of China
| | - Hyeong Gon Yu
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Paolo Lanzetta
- Department of Ophthalmology, University of Udine, Piazzale S. Maria della Misericordia, Udine, Italy
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Adnan Tufail
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
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13
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Intravitreal anti-vascular endothelial growth factor for choroidal neovascularization secondary to pathologic myopia: systematic review and meta-analysis. Retina 2014; 33:1375-92. [PMID: 23514793 DOI: 10.1097/iae.0b013e31827d260a] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSES To update existing evidence and evaluate intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections for myopic choroidal neovascularization. METHODS The authors conducted comprehensive search in PubMed, EMBASE, Cochrane Library, Biosis Preview, and LILACS. Included studies were categorized by study design. Comparative studies were classified as randomized controlled trials (RCTs) and non-RCT studies, and these two types of studies were presented and meta-analyzed separately for the following comparisons: 1) anti-VEGF versus photodynamic therapy, 2) anti-VEGF monotherapy versus combination therapy with photodynamic therapy, 3) single versus 3 monthly injections followed by pro re nata (PRN) treatment, and 4) ranibizumab versus bevacizumab. Noncomparative prospective series were pooled to estimate mean visual gain, mean retinal thickness change, and the average number of anti-VEGF injections required for myopic choroidal neovascularization. Ocular and systemic adverse events were also summarized. RESULTS Literature search yielded 18 comparative studies and 83 noncomparative studies. Superiority of anti-VEGF over photodynamic therapy in a 24-month period was confirmed by 2 RCTs and 6 non-RCT studies. The influence of combined photodynamic therapy was uncertain based on two non-RCT studies. Three non-RCT studies showed that the visual outcomes of 3+PRN injections might be slightly better than 1+PRN injections within 1 year. No difference was observed between ranibizumab and bevacizumab in two RCTs and one non-RCT study. The estimated visual improvement was two lines on average. Adverse events were uncommon as reported. CONCLUSION Accumulating evidence confirmed that anti-VEGF injections should be the first-line therapy for myopic choroidal neovascularization.
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Abstract
Angiogenesis is a complex biological phenomenon that forms new blood vessels from the pre-existing vasculature. Aberrant angiogenesis has been implicated in a variety of diseases such as cancer, atherosclerosis, arthritis, obesity, pulmonary hypertension, diabetic retinopathy, and age-related macular degeneration. These conditions collectively affect nearly 10% of the global population. Much effort has focused on identifying new therapeutic agents that inhibit pathological angiogenesis since 1971, when Judah Folkman published the hypothesis that tumor growth is angiogenesis-dependent and that its inhibition may be therapeutic. In 2004, the U.S. Food and Drug Administration approved the first antiangiogenic drug for the treatment of metastatic colon cancer, bevacizumab (Avastin, Genentech). This drug is a humanized monoclonal antibody that neutralizes the vascular endothelial growth factor. It is used in combination with chemotherapy, and its use began the era of antiangiogenesis therapy. Several new therapeutic agents have been added to the list of approved drugs, and clinical trials of new therapeutic options and antiangiogenic agents are ongoing. This review describes the progress made in the first decade of antiangiogenesis therapy, and addresses both validated and possible targets for future drug development.
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Affiliation(s)
- Sandro De Falco
- Angiogenesis LAB, Institute of Genetics and Biophysics 'Adriano Buzzati-Traverso', Napoli, Italy
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15
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Acton JH, Greenstein VC. Fundus-driven perimetry (microperimetry) compared to conventional static automated perimetry: similarities, differences, and clinical applications. Can J Ophthalmol 2013; 48:358-63. [PMID: 24093180 DOI: 10.1016/j.jcjo.2013.03.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 03/21/2013] [Accepted: 03/28/2013] [Indexed: 10/26/2022]
Abstract
Fundus-driven perimetry, commonly known as microperimetry, is a technique for measuring visual field sensitivity, whilst simultaneously viewing the fundus. In this article, we review the technique, focusing on the MP-1 microperimeter (Nidek Instruments, Inc, Padua, Italy); we compare it with conventional static automated perimetry, emphasizing the importance of understanding the effects of the different stimulus conditions and data analyses on the interpretation of microperimetry data. The clinical applications of the technique, in the evaluation of functional and structural changes that accompany retinal diseases, are illustrated by its use in patients with age-related macular degeneration, Stargardt disease, and retinitis pigmentosa. In addition, the advantages and limitations of the technique are summarized.
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Affiliation(s)
- Jennifer H Acton
- School of Optometry and Vision Sciences, Cardiff University, Maindy Road, Cardiff, Wales, CF24 4LU, United Kingdom.
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16
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Inhoffen W, Ziemssen F. [Morphological features of myopic choroidal neovascularization: differences to neovascular age-related macular degeneration]. Ophthalmologe 2013; 109:749-57. [PMID: 22911352 DOI: 10.1007/s00347-011-2498-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Choroidal neovascularization due to pathological myopia (mCNV) differs in important characteristics from lesions seen in age-related macular degeneration (ARMD). Myopic CNV is associated with typical phenomena, such as lacquer cracks or patchy atrophy drusen or pigment epithelium detachment are rare occurrences. The dimensions of mCNV and the extent of leakage are substantially smaller. The heterogeneous combination of thinning and concomitant staphyloma often complicates the early detection of neovascular lesions. Diagnosis and evaluation of the clinical progress are only possible using the combination of different imaging modalities, e.g. funduscopy, fluorescein angiography (FLA) and spectral domain optical coherence tomography (SD-OCT). Special forms, such as periconal mCNV or dome-shaped variants exhibit a typical progression and response to therapy. In the course of the disease a progressive pigmentation and secondary atrophy occur and later, depigmentation of the mCNV complicates the demarcation of the original mCNV within the zone of atrophy. Extensive information and counselling seem to be mandatory in order to allow a better self-assessment. Sometimes, patients notice the first symptoms of recurrent mCNV activity before confirmation is possible by objective diagnostics.
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Affiliation(s)
- W Inhoffen
- Department für Augenheilkunde, Universität Tübingen, Schleichstrasse 12-16, Tübingen, Germany.
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Comparison between MP-1 and Humphrey visual field defects in glaucoma and retinitis pigmentosa. Optom Vis Sci 2012; 89:1050-8. [PMID: 22733099 DOI: 10.1097/opx.0b013e31825da18c] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To compare MP-1 microperimeter and Humphrey Field Analyzer (HFA) defects, in patients with retinitis pigmentosa (RP), a disease primarily affecting the photoreceptors, and in patients with glaucoma, a disease primarily affecting postreceptoral ganglion cells, and to analyze the similarities and differences between the results. METHODS Eleven patients (11 eyes) with RP and 10 patients (10 eyes) with primary open-angle glaucoma (OAG) underwent MP-1 and HFA visual field testing (10-2 pattern). All tested eyes had defects encroaching within 10° of fixation. MP-1 total deviation (TD) probability defects, derived from a previously collected normative database of 50 subjects, were compared to HFA TD defects and to the local defect map of the MP-1. Test duration was compared between instruments. RESULTS In RP patients, MP-1 scotomata were deeper and wider than HFA defects; however in OAG, the opposite was observed. Examination duration in both patient groups was 12 to 14 min for the MP-1 and 6 min for the HFA. The MP-1 local defect map tended to overestimate defects compared to the MP-1 TD analysis. CONCLUSIONS The differences in results between the MP-1 and HFA for the two groups of patients with RP and OAG can be attributed to the different adaptation levels and to the dynamic range of test lights available for the two instruments. The clinician should also be aware of the possible consequences of the differences in the method of derivation of normative data for the two instruments, as this may affect the interpretation of visual field results.
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Wang J, Kang Z. Summary of prognostic factors for choroidal neovascularization due to pathological myopia treated by intravitreal bevacizumab injection. Graefes Arch Clin Exp Ophthalmol 2012; 250:1717-23. [PMID: 23007232 DOI: 10.1007/s00417-012-2159-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 09/01/2012] [Accepted: 09/04/2012] [Indexed: 12/21/2022] Open
Abstract
AIM This systematic review assesses the prognostic factors for intravitreal bevacizumab injection (IVB) in the treatment of choroidal neovascularization (CNV) due to pathological myopia. METHODS The literature searches were performed in Ovid Medline, EMBASE and CENTRAL. Relevant studies with prognostic data on best corrected vision acuity (BCVA) after intravitreal bevacizumab injection were included for review. Two reviewers participated in the data retrieval and independently assessed each included study. RESULTS A total 252 articles were retrieved, including 16 studies containing the most updated and complete data on prognostic factors for neovascularization due to pathological myopia treated by intravitreal bevacizumab injection. A great number of quantitative, clinical, and treatment-related factors were determined to have a positive influence on vision outcome after intravitreal bevacizumab. CONCLUSION A lower rate of development of chorioretinal atrophy, smaller pretreatment CNV size, and younger age were indentified as the most consistently significant prognostic factors affecting the efficacy of IVB in eyes of myopic CNV and were associated with improved BCVA. A worse BCVA after IVB in eyes with myopic CNV probably was associated with subfoveal CNV, lower baseline BCVA, longer duration of CNV, incomplete regression of CNV, subretinal hemorrhage, and previous PDT treatment. No apparent association were observed between the refraction error, axial length, lens status and change in BCVA after IVB. We indentified significant prognostic factors in this systematic review study that might allow for the selection of patients with myopic CNV which are most likely to benefit from IVB.
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Affiliation(s)
- Jianghui Wang
- Eye hospital of China academy of Chinese medical sciences, Shijingshan District, Beijing, 100040, China
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PROGNOSTIC FACTORS FOR VISUAL OUTCOME AFTER INTRAVITREAL ANTI-VEGF INJECTION FOR NAIVE MYOPIC CHOROIDAL NEOVASCULARIZATION. Retina 2012. [DOI: 10.1097/iae.0b013e318227aa09] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Neelam K, Cheung CMG, Ohno-Matsui K, Lai TYY, Wong TY. Choroidal neovascularization in pathological myopia. Prog Retin Eye Res 2012; 31:495-525. [PMID: 22569156 DOI: 10.1016/j.preteyeres.2012.04.001] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 04/13/2012] [Accepted: 04/16/2012] [Indexed: 12/21/2022]
Abstract
Myopic choroidal neovascularization (CNV) is one of the leading causes of visual impairment worldwide. The clinical and socioeconomic impact of myopic CNV in Asian countries is particularly significant due to rising trend in the prevalence and severity of pathological myopia. The exact pathogenesis of myopic CNV remains unclear and there is paucity of information with respect to incidence and risk factors for myopic CNV from prospective studies. Furthermore, there are no recognized measures that may prevent or delay the development of CNV in eyes with pathological myopia. Advances have been made in the diagnosis and characterization of myopic CNV over the years. Until recently, treatment modalities for myopic CNV were limited to thermal laser photocoagulation and photodynamic therapy with verteporfin, both these modalities primarily aim at prevention of further visual loss. In the last 5 years, inhibitors of vascular endothelial growth factor (VEGF) have been used successfully and may improve vision to some extent. Nevertheless, the long-term safety and efficacy of anti-VEGF agents remains unknown. Furthermore, the risk of developing chorioretinal atrophy remains the key factor in determining the final visual outcome. This review article summarizes the current literature on myopic CNV, highlighting new evolving diagnostic and treatment modalities, prognostic factors influencing visual outcome, and areas of future research.
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Affiliation(s)
- Kumari Neelam
- Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore
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Ng DS, Kwok AKH, Chan CW. Anti-vascular endothelial growth factor for myopic choroidal neovascularization. Clin Exp Ophthalmol 2012; 40:e98-e110. [PMID: 21902785 DOI: 10.1111/j.1442-9071.2011.02684.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Myopic choroidal neovascularization (CNV) is a vision-threatening complication in the eyes with pathological myopia, which is particularly prevalent among young and middle-aged Asians globally. To date, the verteporfin in photodynamic therapy study is the only randomized-controlled study in treatment of subfoveal myopic CNV. However, its long-term benefit is controversial. Recently, intravitreal injections of anti-vascular endothelial growth factors have shown promising results. In the absence of randomized-controlled trial comparing the efficacy of anti-vascular endothelial growth factors with photodynamic therapy and placebo, the purpose of this article is to review the current studies on functional and anatomical outcomes in both subfoveal and juxtafoveal myopic CNV. Furthermore, the influences of various doses and frequencies, as well as age and previous photodynamic therapy treatment on its effect are described.
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Affiliation(s)
- Danny S Ng
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong
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Abstract
PURPOSE To compare visual fields on the Nidek MP-1 to those obtained on the Humphrey field analyzer (HFA) in healthy volunteers and assess the effects of differences in stimulus parameters and testing strategies that may influence the interpretation of results in patients. A secondary aim was to establish MP-1 normative data to calculate the total deviation analyses and global indices analogous to those used by the HFA. METHODS Fifty healthy volunteers (age 43.5 ± 13.9 years, range, 18 to 68 years) underwent repeat MP-1 and HFA visual field testing, using the 10-2 pattern. MP-1 data were converted to HFA equivalent dB units. Between instrument comparisons of HFA and MP-1 sensitivities, regression of sensitivity with age and examination duration were assessed. Test-retest variability was examined between visits. RESULTS MP-1 (mean = 32.82 dB, SD = 1.92 dB) and HFA sensitivities (mean = 32.84 dB, SD = 1.83 dB) were not significantly different (p = 0.759). SD values for the HFA (range, 1.11 to 3.30 dB) were similar to the MP-1 (range, 0.14 to 2.75 dB). However, asymmetry comparisons between instruments showed significantly decreased superior rather than inferior retinal values for the MP-1. There was a small but significant difference (p = 0.004) in mean test duration between the MP-1 (mean = 6:11 min, SD = 1:49 min) and the HFA (mean = 5:14 min, SD = 0:42 min). There was also a difference in the decline of mean sensitivity with age, a decline of 0.1 and 0.4 dB per decade was noted in MP-1 and HFA sensitivity, respectively. Test-retest variability was similar between instruments. A small but non-significant increase in mean sensitivity at the second visit for both the MP-1 (p = 0.060) and HFA (p = 0.570) was found. CONCLUSIONS Both instruments showed similar variability and test-retest variability when results were compared using equivalent units. However, there are important differences in sensitivity values, stimulus parameters, and testing strategies that have to be taken into account when comparisons are made.
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Silva R. Myopic Maculopathy: A Review. Ophthalmologica 2012; 228:197-213. [DOI: 10.1159/000339893] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 05/27/2012] [Indexed: 11/19/2022]
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Nidek MP1 is able to detect subtle decline in function in inherited and age-related atrophic macular disease with stable visual acuity. Retina 2011; 31:371-9. [PMID: 20921927 DOI: 10.1097/iae.0b013e3181e46af3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE To investigate whether the Nidek MP1 microperimeter (NAVIS software Version 1.7; Nidek Technologies, Padua, Italy) can detect functional decline in progressive atrophic macular disease with stable visual acuity. METHODS Nine eyes of nine patients with stable acuity but progressive inherited or age-related atrophic macular disease evident on fundus autofluorescence imaging were reviewed. Each patient underwent 3 consecutive microperimetry tests at baseline, 6 months, and 12 months. Acuity, fixation, and microperimetry tests were performed at each visit. Changes in acuity, fixation stability, and macular sensitivity were analyzed. To detect regional change in retinal sensitivity, the test grid was divided into clusters based on either topographical or functional features. The mean sensitivities within each zone were also compared across the three visits. RESULTS In this cohort, there was no significant change in visual acuity, fixation stability, and macular sensitivity over 1 year. However, significant decline in mean sensitivity within the central macula and test loci adjacent to dense scotoma was found (P = 0.004 and 0.002, respectively). In contrast, mean sensitivity elsewhere remained stable. CONCLUSION The MP1 can detect significant change in regional retinal sensitivity within 12 months in patients with progressive atrophic macular disease and stable acuity. Individualized analysis of regional sensitivity may be a useful method for quantifying microperimetry.
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Aslan O, Ozdamar Y. Is thermal laser the first but the best choice of treatment for the extrafoveal choroidal neovascularisation? Clin Exp Optom 2010; 93:180-3. [PMID: 20557560 DOI: 10.1111/j.1444-0938.2010.00466.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Ozlem Aslan
- Ankara Ulucanlar Eye Research Hospital, Department of Retinal Diseases, Altindağ, Ankara, Turkey
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Current World Literature. Curr Opin Ophthalmol 2010; 21:239-46. [DOI: 10.1097/icu.0b013e32833983a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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MACULAR FUNCTIONAL CHANGES EVALUATED WITH MP-1 MICROPERIMETRY AFTER INTRAVITREAL BEVACIZUMAB FOR SUBFOVEAL MYOPIC CHOROIDAL NEOVASCULARIZATION. Retina 2010; 30:739-47. [DOI: 10.1097/iae.0b013e3181c59725] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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INTRAVITREAL ANTI-VEGF VERSUS PHOTODYNAMIC THERAPY WITH VERTEPORFIN FOR TREATMENT OF MYOPIC CHOROIDAL NEOVASCULARIZATION. Retina 2010; 30:418-24. [PMID: 20094012 DOI: 10.1097/iae.0b013e3181bd2fe4] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bevacizumab for choroidal neovascularization secondary to pathologic myopia: Is there a decline of the treatment efficacy after 2 years? Graefes Arch Clin Exp Ophthalmol 2010; 248:543-50. [PMID: 20111971 DOI: 10.1007/s00417-009-1285-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 12/13/2009] [Accepted: 12/20/2009] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND The Verteporfin in Photodynamic Therapy (VIP) Study failed to prove a statistically significant benefit for myopic choroidal neovascularization (CNV) at the end of the second year. Therefore, we wanted to evaluate whether the early effects seen under anti-VEGF treatment can be maintained over longer follow-up intervals. METHODS This consecutive case series included all patients at the Centre for Ophthalmology, Tuebingen, with a 2-year follow-up after treatment with 1.25 mg of bevacizumab alone or in combination with photodynamic therapy. Twenty-one eyes from 19 patients were analyzed in the retrospective evaluation of best-corrected visual acuity (BCVA) and central foveal thickness (CFT). RESULTS Mean logMAR BCVA improved from 0.64 at baseline to 0.55 after 1 year (p = 0.32) and remained 0.55 at 2 years (p = 0.23). A subgroup analysis showed that mean logMAR BCVA in the monotherapy group improved from 0.7 to 0.5 at 2 years (n = 11, p = 0.06). In the combined therapy group, mean logMAR BCVA changed from 0.55 to 0.59 at 2 years (n = 10, p = 0.69). Mean CFT decreased significantly in both groups by 168 microm (p < 0.001) and 76 microm (p < 0.05) in the monotherapy and in the combined groups, respectively. No complications or adverse effects were observed. CONCLUSION Although the limitations of the study design have to be acknowledged and carefully discussed, we found no obvious superiority of a combined treatment for myopic CNV, at least in terms of the functional outcome and the injection frequency. The results indicate that bevacizumab might be beneficial in the treatment of patients with CNV secondary to pathologic myopia.
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Besozzi G, Sborgia L, Furino C, Cardascia N, Dammacco R, Sborgia G, Modoni AP, Boscia F. Low-fluence-rate photodynamic therapy to treat subfoveal choroidal neovascularization in pathological myopia. A study of efficacy and safety. Graefes Arch Clin Exp Ophthalmol 2009; 248:497-502. [PMID: 19916015 DOI: 10.1007/s00417-009-1232-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 10/20/2009] [Accepted: 10/22/2009] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND To evaluate the efficacy and safety of low-fluence-rate photodynamic therapy (LFPDT) to treat choroidal neovascularisation (CNV) secondary to pathological myopia (PM). METHODS Twenty-five eyes with CNV in PM underwent LFPDT, with a standard dose of verteporfin and timing but adopting fluence and irradiance rates reduced to 25 mJ/cm2 and 300 mW/cm2, respectively. Best corrected visual acuity (BCVA) was measured and biomicroscopy and fluorescein angiography (FA) were evaluated. Particular attention was paid to choroidal hypoperfusion, and to changes (depigmentation/atrophy) at the RPE level in areas exposed to laser light. RESULTS After a mean follow-up of 13.4+/-2.46 months (range: 12-21), and 1.37+/-0.66 treatments (range: 1-3), BCVA was stable in 29 (91%) eyes. Two (6%) patients gained more than three lines and one (3%) eye lost more than three lines. Mean greatest linear dimension did not change significantly (p=0.08) at the end of follow-up. RPE depigmentation was present in six eyes (18%) and no patient showed RPE atrophy. CONCLUSIONS LFPDT is effective and safe for CNV secondary to PM treatment, stabilizing visual acuity and lesion size and determining only mild RPE changes. Further controlled studies are needed to demonstrate the long-term efficacy and safety of this treatment option.
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Affiliation(s)
- Gianluca Besozzi
- Department of Ophthalmology and ENT, University of Bari, Piazza Giulio Cesare, 11-70124 Bari, Italy
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CCR3 is a target for age-related macular degeneration diagnosis and therapy. Nature 2009; 460:225-30. [PMID: 19525930 PMCID: PMC2712122 DOI: 10.1038/nature08151] [Citation(s) in RCA: 192] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2009] [Accepted: 05/21/2009] [Indexed: 12/31/2022]
Abstract
Age-related macular degeneration (AMD), a leading cause of blindness worldwide, is as prevalent as cancer in industrialized nations. Most blindness in AMD results from invasion of the retina by choroidal neovascularization (CNV). We report that the eosinophil/mast cell chemokine receptor CCR3 is specifically expressed in CNV endothelial cells in humans with AMD, and that, despite the expression of its ligands eotaxin-1, -2, and -3, neither eosinophils nor mast cells are present in human CNV. Genetic or pharmacological targeting of CCR3 or eotaxins inhibited injury-induced CNV in mice. CNV suppression by CCR3 blockade was due to direct inhibition of endothelial cell proliferation, and was uncoupled from inflammation as it occurred in mice lacking eosinophils or mast cells and was independent of macrophage and neutrophil recruitment. CCR3 blockade was more effective at reducing CNV than vascular endothelial growth factor-A (VEGF-A) neutralization, which is currently in clinical use, and, unlike VEGF-A blockade, not toxic to the mouse retina. In vivo imaging with CCR3-targeting quantum dots located spontaneous CNV invisible to standard fluorescein angiography in mice before retinal invasion. CCR3 targeting might reduce vision loss due to AMD through early detection and therapeutic angioinhibition.
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