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Ip MS, Scott IU, VanVeldhuisen PC, Oden NL, Blodi BA. Month 60 Imaging Findings and Relationship to Treatment Outcomes Following Anti-VEGF Therapy for Macular Edema Due to Central or Hemi-Retinal Vein Occlusion. Am J Ophthalmol 2024; 260:147-159. [PMID: 38061584 DOI: 10.1016/j.ajo.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/21/2024]
Abstract
PURPOSE To evaluate imaging findings from SCORE2 participants through 60 months, to describe the degree of resolution or progression of these variables, and to correlate changes in these imaging findings to treatment outcomes such as visual acuity and the number of treatments administered. METHODS SCORE2 participants were followed for up to 60 months. Visual acuity, injection frequency and imaging tests color fundus photography (CFP), optical coherence tomography (OCT), and ultra-widefield fluorescein angiography [UWFA]) were performed throughout this period. RESULTS Less than 6% of eyes had subretinal fluid at month 60. Disorganization of the retinal inner layers (DRIL) was the most likely finding to persist, present in 96% of eyes at baseline and unchanged at 95% at month 60. For UWFA, at baseline, there was a mean of 5.0% non-perfusion area (95% CI: 3.3%-6.8%) in the NETWORC grid with little change to month 60. For the Early Treatment Diabetic Retinopathy Study (ETDRS) grid, at baseline, there was a mean of 2.3% non-perfusion area (95% CI: 0.7%-3.9%) with little change to month 60. There was no correlation between any of the imaging variables at baseline and change in visual acuity to month 60 or in the number of injections following the variable treatment timeframe (month 12 to month 60). CONCLUSIONS These analyses provide an anatomic explanation for persistent functional deficits many years following initial treatment. Clinical practice patterns should consider evaluation with these imaging tests to help explain persistent functional deficits in many eyes. Additionally, these 8 baseline imaging variables generally should not be relied on to predict visual acuity or intensity of treatment. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Michael S Ip
- From the Doheny Eye Institute (M.S.I.), University of California-Los Angeles, Los Angeles, California, USA.
| | - Ingrid U Scott
- Departments of Ophthalmology and Public Health Sciences (I.U.S.), Penn State College of Medicine, Hershey, Pennsylvania, USA
| | | | - Neal L Oden
- The Emmes Company, LLC (P.C.V., N.L.O.), Rockville, Maryland, USA
| | - Barbara A Blodi
- University of Wisconsin Reading Center (B.A.B.), Madison, Wisconsin, USA
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Nanji K, Sarohia GS, Xie J, Patil NS, Phillips M, Zeraatkar D, Thabane L, Guymer RH, Kaiser PK, Sivaprasad S, Sadda SR, Wykoff CC, Chaudhary V. Anti-vascular endothelial growth factor therapy and retinal non-perfusion in diabetic retinopathy: A meta-analysis of randomised trials. Acta Ophthalmol 2024; 102:e31-e41. [PMID: 37042340 DOI: 10.1111/aos.15673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/19/2023] [Accepted: 03/27/2023] [Indexed: 04/13/2023]
Abstract
PURPOSE Retinal non-perfusion (RNP) is fundamental to disease onset and progression in diabetic retinopathy (DR). Whether anti-vascular endothelial growth factor (anti-VEGF) therapy can modify RNP progression is unclear. This investigation quantified the impact of anti-VEGF therapy on RNP progression compared with laser or sham at 12 months. METHODS A systematic review and meta-analysis of randomised controlled trials (RCTs) were performed; Ovid MEDLINE, EMBASE and CENTRAL were searched from inception to 4th March 2022. The change in any continuous measure of RNP at 12 months and 24 months was the primary and secondary outcomes, respectively. Outcomes were reported utilising standardised mean differences (SMD). The Cochrane Risk of Bias Tool version-2 and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines informed risk of bias and certainty of evidence assessments. RESULTS Six RCTs (1296 eyes) and three RCTs (1131 eyes) were included at 12 and 24 months, respectively. Meta-analysis demonstrated that RNP progression may be slowed with anti-VEGF therapy compared with laser/sham at 12 months (SMD: -0.17; 95% confidence interval [CI]: -0.29, -0.06; p = 0.003; I2 = 0; GRADE rating: LOW) and 24-months (SMD: -0.21; 95% CI: -0.37, -0.05; p = 0.009; I2 = 28%; GRADE rating: LOW). The certainty of evidence was downgraded due to indirectness and due to imprecision. CONCLUSION Anti-VEGF treatment may slightly impact the pathophysiologic process of progressive RNP in DR. The dosing regimen and the absence of diabetic macular edema may impact this potential effect. Future trials are needed to increase the precision of the effect and inform the association between RNP progression and clinically important events. PROSPERO REGISTRATION CRD42022314418.
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Affiliation(s)
- Keean Nanji
- Department of Surgery, Division of Ophthalmology, McMaster University, 2757 King Street East, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada
| | - Gurkaran S Sarohia
- Department of Ophthalmology and Visual Sciences, University of Alberta, 2319 Active Treatment Centre, 10240 Kingsway Avenue NW, Edmonton, Alberta, Canada, T5H 3V8
| | - Jim Xie
- Department of Surgery, Division of Ophthalmology, McMaster University, 2757 King Street East, Hamilton, Ontario, Canada
| | - Nikhil S Patil
- Department of Surgery, Division of Ophthalmology, McMaster University, 2757 King Street East, Hamilton, Ontario, Canada
| | - Mark Phillips
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada
- Biostatistics Unit, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Department of Surgery (Ophthalmology), the University of Melbourne, Melbourne, Australia
| | - Peter K Kaiser
- Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio, USA
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Srinivas R Sadda
- Doheny Eye Institute, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California, USA
| | - Charles C Wykoff
- Retina Consultants of Texas, Houston, Texas, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA
| | - Varun Chaudhary
- Department of Surgery, Division of Ophthalmology, McMaster University, 2757 King Street East, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada
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3
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Qu S, Zou Y, Yang L, Wu H. The progress of assessment methods and treatments of neovascular glaucoma secondary to central retinal vein occlusion. Front Med (Lausanne) 2024; 10:1280776. [PMID: 38259837 PMCID: PMC10800625 DOI: 10.3389/fmed.2023.1280776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Neovascular glaucoma is a condition that results from central retinal vein occlusion and often leads to blindness. Accurate evaluation and appropriate treatment are crucial for patients. However, there is currently no uniform and clear standard to differentiate between ischemic and non-ischemic central retinal vein occlusion. Also, the assessment of neovascular glaucoma progression is uncertain. Meanwhile, although pan-retinal photocoagulation is a standard treatment to prevent the onset of neovascular glaucoma, its actual efficacy and the timing of intervention remain highly controversial. It is still challenging to balance the risks of side effects in the visual field against the uncertain effectiveness of the treatment. This paper delves into the pathogenesis of neovascular glaucoma to understand the development of therapeutic approaches. By taking into account various assessment criteria of central retinal vein occlusion and neovascular glaucoma over the years, combining functional tests and morphological tests provides the most accurate and rigorous solution. The age of patients, the extent, location, and duration of retinal ischemia are the primary factors that affect the severity and extent of ischemic central retinal vein occlusion and induce serious complications. From the perspective of prevention and treatment, the ischemic index is closely related to the development of neovascularization. The paper provides essential insights into the mechanism, efficacy, complications, and optimal timing of pan-retinal photocoagulation. Comparing the treatment effects of pan-retinal photocoagulation and intravitreal anti-VEGF injections, we suggest a combination of both treatments to explore effective treatment with fewer side effects in the long term. This article details the debate on the above issues and explores ideas for the clinical diagnosis and preventive treatment of neovascular glaucoma that results from ischemic central retinal vein occlusion.
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Affiliation(s)
| | | | | | - Hong Wu
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
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4
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Rudnick ND, Vingopoulos F, Wang JC, Garg I, Cui Y, Zhu Y, Le R, Katz R, Lu Y, Patel NA, Miller JB. Characterising collateral vessels in eyes with branch retinal vein occlusions using widefield swept-source optical coherence tomography angiography. Br J Ophthalmol 2023; 107:1887-1891. [PMID: 36323493 DOI: 10.1136/bjo-2021-320356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/15/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND/AIMS To characterise the morphology, location and functional significance of both macular and extramacular collateral vessels (CVs) in patients with a history of branch retinal vein occlusion (BRVO) using widefield swept-source optical coherence tomography angiography (WF SS OCTA). METHODS Patients with a history of BRVO underwent WF SS OCTA testing to acquire 12×12 mm images, which were evaluated for CVs and non-perfusion area (NPA). Region of interest analysis of individual CVs was performed to identify correlations between CV size, depth and retinal location. Mixed effects multivariate regression analyses of factors associated with NPA and visual acuity (VA) were performed. RESULTS Fifty-five CVs were identified in 28 BRVO eyes from 27 patients. CVs were identified in 42.9% (12/28) of eyes with a history of BRVO, and of these, 45.5% (25/55) were extramacular. The majority of CVs (87.3%, 48/55) coursed through both the superficial and the deep capillary plexus (DCP), while a subset (12.7%, 7/55) were strictly superficial. No CVs were found to course strictly through the DCP alone. CV depth increased with distance from the optic disc (p=0.011) and CV size increased with distance from the fovea (p=0.005). There were no statistically significant associations between CVs and NPA, or between CVs and VA. CONCLUSIONS WF SS OCTA revealed that a large fraction of CVs that form after BRVO are extramacular, and the morphology of CVs varies as a function of retinal location. Depth-resolved study of CVs may offer valuable insights on the pathophysiological mechanisms leading to the development of macular oedema.
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Affiliation(s)
- Noam D Rudnick
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Retinal Imaging Laboratory, Boston, Massachusetts, USA
| | - Filippos Vingopoulos
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Retinal Imaging Laboratory, Boston, Massachusetts, USA
| | - Jay C Wang
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Retinal Imaging Laboratory, Boston, Massachusetts, USA
- Department of Ophthalmology & Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Itika Garg
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Retinal Imaging Laboratory, Boston, Massachusetts, USA
| | - Ying Cui
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Retinal Imaging Laboratory, Boston, Massachusetts, USA
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying Zhu
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Retinal Imaging Laboratory, Boston, Massachusetts, USA
- Eye Center of Xiangya Hospital, Department of Ophthalmology, Central South University, Changsha, China
| | - Rongrong Le
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Retinal Imaging Laboratory, Boston, Massachusetts, USA
- Department of Ophthalmology, Wenzhou Medical University, Wenzhou, China
| | - Raviv Katz
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Retinal Imaging Laboratory, Boston, Massachusetts, USA
| | - Yifan Lu
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Retinal Imaging Laboratory, Boston, Massachusetts, USA
| | - Nimesh A Patel
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - John B Miller
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Retinal Imaging Laboratory, Boston, Massachusetts, USA
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5
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Laurance S, Marin M, Colin Y. Red Blood Cells: A Newly Described Partner in Central Retinal Vein Occlusion Pathophysiology? Int J Mol Sci 2023; 24:ijms24021072. [PMID: 36674586 PMCID: PMC9864680 DOI: 10.3390/ijms24021072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/21/2022] [Accepted: 12/29/2022] [Indexed: 01/09/2023] Open
Abstract
Central retinal vein occlusion (CRVO) is a frequent retinal disorder inducing blindness due to the occlusion of the central vein of the retina. The primary cause of the occlusion remains to be identified leading to the lack of treatment. To date, current treatments mainly target the complications of the disease and do not target the primary dysfunctions. CRVO pathophysiology seems to be a multifactorial disorder; several studies did attempt to decipher the cellular and molecular mechanisms underlying the vessel obstruction, but no consensual mechanism has been found. The aim of the current review is to give an overview of CRVO pathophysiology and more precisely the role of the erythroid lineage. The review presents emerging data on red blood cell (RBC) functions besides their role as an oxygen transporter and how disturbance of RBC function could impact the whole vascular system. We also aim to gather new evidence of RBC involvement in CRVO occurrence.
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Zhang M, Liu Y, Song M, Yu Y, Ruan S, Zheng K, Wang F, Sun X. Intravitreal Dexamethasone Implant Has Better Retinal Perfusion than Anti-Vascular Endothelial Growth Factor Treatment for Macular Edema Secondary to Retinal Vein Occlusion: A Five-Year Real-World Study. Ophthalmic Res 2022; 66:247-258. [PMID: 36215955 DOI: 10.1159/000527447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/15/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of the study was to investigate the long-term effect of intravitreal dexamethasone (DEX) implant and anti-vascular endothelial growth factor (VEGF) injection on macular edema (ME) secondary to retinal vein occlusion (RVO) in a real-world setting. METHODS The medical records of RVO-ME cases, with intravitreal injections and followed up for at least 5 years, were retrospectively reviewed. Changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) were primary outcomes. Images of fluorescence angiography and swept-source optical coherence tomography angiography were analyzed. Foveal avascular zone (FAZ) metrics and perfusion density at the last visit were also compared between the two treatments. RESULTS A total of 16 patients were recruited, 8 in the anti-VEGF group and 8 in the DEX group. At the 5th year, the BCVA and the CMT in the DEX group were not different from those in the anti-VEGF group (0.69 ± 0.36 LogMAR vs. 0.57 ± 0.30 LogMAR, p = 0.574; 183.25 ± 97.31 µm vs. 195.38 ± 40.92 µm, p = 0.442). Compared with the anti-VEGF group, the DEX group had higher FAZ circularity index (0.57 ± 0.14 vs. 0.68 ± 0.14, p = 0.130) and higher retinal perfusion density (0.45 ± 0.02 vs. 0.39 ± 0.03, p = 0.001), especially in the deep capillary plexus. CONCLUSION DEX implant and anti-VEGF injection had comparative long-term effects on RVO-ME. Compared with the anti-VEGF treatment, the DEX treatment had advantages in maintaining retinal perfusion in patients with RVO.
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Affiliation(s)
- Min Zhang
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China,
| | - Yang Liu
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Minlu Song
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Yu
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Shang Ruan
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kairong Zheng
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
- Nursing Department, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fenghua Wang
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
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Viggiano P, Grassi MO, Pignataro M, Boscia G, Borrelli E, Molfetta T, Evangelista F, Alessio G, Boscia F. Topographical Analysis of the Choriocapillaris Reperfusion After Loading Anti-VEGF Therapy in Neovascular AMD. Transl Vis Sci Technol 2022; 11:18. [PMID: 36135978 PMCID: PMC9513736 DOI: 10.1167/tvst.11.9.18] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to evaluate choriocapillaris vascular density changes around macular neovascularization (MNV) before and after anti-vascular endothelium growth factor (VEGF) injections by optical coherence tomography angiography (OCTA). Methods Treatment-naïve eyes with a diagnosis of exudative AMD and type 1 MNV were included. En face optical coherence tomography angiograms were analyzed for percentage of choriocapillaris (CC) flow deficit percentage (FD%), the FD average area (FDa), and the FD number (FDn) in 5 progressive 200-µm-wide concentric rings (R1, R2, R3, R4, and R5) surrounding the dark halo around the MNV. The OCTA acquisition was performed at the following visits: (i) before the loading phase of intravitreal injection of aflibercept or ranibizumab (T1), and (ii) 1 month after the last intravitreal injection of loading phase comprising 3 monthly injections (T2). Results A total of 30 eyes of 30 Caucasian patients with treatment naïve neurovascular AMD (nAMD) were included in the study. All rings showed a progressive FD% reduction at T2 in comparison to T1 values indicating gradual CC reperfusion of the peripheral rings. Furthermore, we found a progressive contraction of the FD average area in all the rings considered (P < 0.05). On the other hand, at T2, a significant increase in the FD number of the 5 rings was displayed, as compared to T1 (P < 0.05). Conclusions Our analysis showed topographical CC reperfusion after loading anti-VEGF therapy. CC flow deficits were greater around the associated dark halo before treatment, followed by a progressive recovery of CC flow after intravitreal therapy. Translational Relevance OCTA may be used to assess the development and progression of MNV but also in assessing response to intravitreal injections of anti-VEGF.
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Affiliation(s)
- Pasquale Viggiano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Maria Oliva Grassi
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Mariagrazia Pignataro
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Giacomo Boscia
- Ophthalmology Unit, A.O.U. City of Health and Science of Turin, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Enrico Borrelli
- Ophthalmology Department, San Raffaele University Hospital, Milan, Italy
| | - Teresa Molfetta
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Federica Evangelista
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti- Pescara, Chieti, Italy
| | - Giovanni Alessio
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Francesco Boscia
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
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Araki S, Sakimoto S, Shiozaki D, Ueda C, Hara C, Fukushima Y, Sayanagi K, Sakaguchi H, Nishida K. Microvascular Changes in the Cystic Lesion of Branch Retinal Vein Occlusion Imaged by Swept-Source Optical Coherence Tomography Angiography. Biomed Hub 2022; 7:99-105. [PMID: 36262676 PMCID: PMC9574207 DOI: 10.1159/000525497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/03/2022] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> This study aimed to describe the quantitative features of the microvasculature in the cystic lesions of branch retinal vein occlusion (BRVO). <b><i>Methods:</i></b> A total of 43 eyes with BRVO, treated with anti-vascular endothelial growth factor therapy, were analyzed. Using wide-field swept-source optical coherence tomography angiography (OCTA), en face OCT images were obtained by depth-integrated reflectivity of the retina, and vascular density (VD), vascular length (VL), vascular lacunarity, and fractal dimension (FD) were evaluated in a 12 × 12-mm area of retinal nonperfusion. <b><i>Results:</i></b> The mean area of affected lesions was 38.7 ± 19.8 mm<sup>2</sup>, and cystic lesions were 8.5 ± 10.1 mm<sup>2</sup>. VD, VL, and FD were significantly decreased in the cystic lesions compared to other affected lesions in the same eyes (<i>p</i> = 0.0010, <i>p</i> = 0.0001, and <i>p</i> = 0.0003, respectively) and in all eyes (<i>p</i> = 0.0281, <i>p</i> = 0.0050, and <i>p</i> < 0.0001, respectively). VD in cystic lesions within the vascular arcade (25 eyes) correlated with best-corrected visual acuity on OCTA (<i>r</i> = −0.433, and <i>p</i> = 0.0492). <b><i>Conclusions:</i></b> Vascular structure in the cystic lesions was unpreserved compared to the other lesions in BRVO. These findings may help in understanding the pathophysiology of retinal edema in BRVO.
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Affiliation(s)
- Satoko Araki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Susumu Sakimoto
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan
- *Susumu Sakimoto,
| | - Daiki Shiozaki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Chihiro Ueda
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Chikako Hara
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoko Fukushima
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan
| | - Kaori Sayanagi
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hirokazu Sakaguchi
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan
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The impact of laboratory findings and optical coherence tomography biomarkers on response to intravitreal anti-VEGF treatment in patients with retinal vein occlusion. Int Ophthalmol 2022; 42:3449-3457. [PMID: 35538256 DOI: 10.1007/s10792-022-02344-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 04/18/2022] [Indexed: 10/18/2022]
Abstract
AIMS To investigate potential laboratory and imaging biomarkers as treatment response predictors to intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents in patients with retinal vein occlusion (RVO). METHODS Participants in this prospective study were 53 patients with treatment naïve macular edema secondary to RVO, treated with intravitreal anti-VEGF agents and followed-up for 12 months. At baseline, all participants underwent best-corrected visual acuity measurement, dilated fundoscopy, optical coherence tomography and fluorescein angiography (FFA), while full blood count and biochemical analysis of various parameters was also performed. At month 12, treatment response was examined and classified as "favorable" or "non-response". Potential associations between laboratory/imaging biomarkers and treatment response were assessed. RESULTS Univariate analysis showed that "favorable" response at month 12 after initiation of anti-VEGF treatment was correlated with baseline central subfield thickness (CST) < 464 μm (p < 0.001), absence of subretinal fluid (p = 0.004), absence of hyperreflective foci (HF) (p = 0.004), intact ellipsoid zone (EZ) and external limiting membrane (ELM) (p < 0.001 and p = 0.001, respectively), absence of epiretinal membrane (ERM) (p = 0.020) and absence of macular ischemia on FFA (p < 0.001), while increased monocytes-to-lymphocytes ratio was also associated with "favorable" treatment response (p = 0.010). All other laboratory parameters did not reach statistical significance. However, at the multivariate analysis, EZ and ELM status, HF, macular ischemia and monocytes-to-lymphocytes ratio were found to be independent predictors of treatment response. CONCLUSIONS Intact EZ and ELM, absence of HF, absence of macular ischemia and increased monocytes-to-lymphocytes ratio at baseline can predict "favorable" treatment response in patients with treatment naïve macular edema secondary to RVO.
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Nagasato D, Muraoka Y, Tanabe M, Nishigori N, Osaka R, Mitamura Y, Tabuchi H, Kadomoto S, Murakami T, Ooto S, Suzuma K, Tsujikawa A. Foveal Thickness Fluctuation in Anti-vascular Endothelial Growth Factor Treatment for Branch Retinal Vein Occlusion: A Long-term Study. Ophthalmol Retina 2022; 6:567-574. [PMID: 35218996 DOI: 10.1016/j.oret.2022.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE OR PURPOSE Branch retinal vein occlusion (BRVO) causes macular edema (ME) that can be controlled with anti-vascular endothelial growth factor (VEGF) treatments. However, these treatments are not curative, necessitating additional anti-VEGF treatments at recurrences. Long-term results, optimal anti-VEGF treatment regimens, and the comprehensive effects of ME recurrences are largely unknown. Thus, we aimed to examine the effects of foveal thickness (FT) fluctuation (FTF) on visual and morphologic outcomes following anti-VEGF treatments for BRVO-ME administered via a pro re nata regimen. DESIGN A retrospective, observational case series SUBJECTS, PARTICIPANTS AND/OR CONTROLS: This study analyzed 309 treatment-naïve patients (309 eyes) with BRVO-ME between 2012 and 2021 at a multi-center retinal practice. METHODS, INTERVENTION, OR TESTING FT was assessed via optical coherence tomography (OCT) at each study visit. MAIN OUTCOME MEASURES We evaluated the logarithm of the minimal angle of resolution best corrected visual acuity (logMAR BCVA) and the defect length of the foveal ellipsoid zone (EZ) band measured via OCT. RESULTS At baseline, the mean logMAR BCVA was 0.30±0.30 and the mean FT was 503±162 μm. The number of anti-VEGF injections for BRVO-ME was 5.8±4.6 during the mean follow-up period (50.6±22.2 months). At the final examination, the mean logMAR BCVA and FT values were significantly improved compared with the baseline. Multiple regression analyses showed that age, baseline logMAR BCVA, and FTF were significantly associated with the final logMAR BCVA (β=0.20, 0.35, and 0.30, respectively). FTF (divided into Groups 0-3 in ascending order of FTF) was significantly associated with the logMAR BCVA and the defect length of the foveal EZ band at the final examination. The defect lengths of the foveal EZ band were longitudinally shortened in Groups 0-1 and were slightly prolonged in Groups 2-3. The logMAR BCVA maintained improvements in Groups 0-1, and worsened slightly in Groups 2-3. CONCLUSIONS FTF was significantly associated with visual acuity and foveal photoreceptor status. Thus, may improve the morphologic and functional prognoses of eyes with BRVO by identifying the characteristics of eyes with a larger FTF, and consequently controlling the FTF more strictly.
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Affiliation(s)
- Daisuke Nagasato
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan; Department of Technology and Design Thinking for Medicine, Hiroshima University Graduate School, Hiroshima, Japan; Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Yuki Muraoka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Mao Tanabe
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan
| | - Naomi Nishigori
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Rie Osaka
- Department of Ophthalmology, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Yoshinori Mitamura
- Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Hitoshi Tabuchi
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan; Department of Technology and Design Thinking for Medicine, Hiroshima University Graduate School, Hiroshima, Japan; Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Shin Kadomoto
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan
| | - Tomoaki Murakami
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sotaro Ooto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kiyoshi Suzuma
- Department of Ophthalmology, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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11
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Gurudas S, Patrao N, Nicholson L, Sen P, Ramu J, Sivaprasad S, Hykin P. Visual Outcomes Associated With Patterns of Macular Edema Resolution in Central Retinal Vein Occlusion Treated With Anti-Vascular Endothelial Growth Factor Therapy: A Post Hoc Analysis of the Lucentis, Eylea, Avastin in Vein Occlusion (LEAVO) Trial. JAMA Ophthalmol 2022; 140:143-150. [PMID: 34989804 PMCID: PMC8739814 DOI: 10.1001/jamaophthalmol.2021.5619] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
IMPORTANCE It is unclear how visual outcomes vary between patterns of macular edema (ME) resolution in eyes with central retinal vein occlusion (CRVO). OBJECTIVE To assess best-corrected visual acuity (BCVA) outcomes at 100 weeks based on macular fluid resolution patterns by 52 and 100 weeks among patients receiving anti-vascular endothelial growth factor therapy for CRVO-related ME. DESIGN, SETTING, AND PARTICIPANTS Post hoc analysis of the prospective, 3-arm, double-masked, randomized noninferiority trial Lucentis, Eylea, Avastin in Vein Occlusion (LEAVO), which evaluated intravitreal aflibercept (2.0 mg/0.05 mL), bevacizumab (1.25-mg/0.05 mL), or ranibizumab (0.5 mg/0.05 mL) over 100 weeks in adult patients (18 years and older) with CRVO-related ME with BCVA Early Treatment Diabetic Retinopathy Study (ETDRS) letter score of 19 to 78 in the study eye (approximate Snellen equivalent, 20/400 to 20/32, respectively) from December 2014 to December 2016 at 44 UK National Health Service ophthalmology departments. A total of 140 of 154 eyes were randomized to aflibercept, 144 of 154 randomized to bevacizumab, and 141 of 155 randomized to ranibizumab. Data were analyzed from January 2019 to March 2019. EXPOSURES Persistent ME included eyes with central subfield thickness (CST) 320 μm or greater, and persistently dry macula (no ME) included eyes with CST less than 320 μm at 52 and 100 weeks. Recurrent ME included eyes that did not meet the criteria for persistently dry or wet. If CST was missing, the closest intervening visit was carried forward. MAIN OUTCOMES AND MEASURES Adjusted mean BCVA at 100 weeks. RESULTS The mean (SD) age of the 425 included participants was 69.2 (12.7) years, and 243 participants (57.2%) were men. A total of 425 eyes from 425 participants were included. By 100 weeks, 117 eyes (28.5%) were persistently dry, 44 (10.7%) were persistently wet (with ME), and 250 (60.8%) had recurrent ME. Persistent ME at 100 weeks was associated with worse VA compared with dry macula (adjusted difference, -10.98 ETDRS letters; 95% CI, -16.19 to -5.76; P < .001) and recurrent ME (adjusted difference, -5.39 letters; 95% CI, -10.15 to -0.64; P = .03). By 52 weeks, individuals with persistent ME also had poorer 100-week BCVA compared with individuals with dry macula (adjusted difference, -7.39; 95% CI, -11.72 to -3.05; P < .001) and recurrent ME (adjusted difference, -3.92; 95% CI, -8.05 to 0.20; P = .06). By 100 weeks, more eyes treated with bevacizumab had persistently wet macula than those treated with aflibercept (26 of 140 [18.6%] vs 7 of 134 [5.2%]; difference, 13.3%; 95% CI, 5.9 to 20.8; P < .001) or ranibizumab (11 of 137 [8%]; difference, 10.5%; 95% CI, 2.7 to 18.4; P = .01). CONCLUSIONS AND RELEVANCE These findings suggest that attempts should be made to maintain persistently fluid-free macula for optimal visual acuity outcomes.
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Affiliation(s)
- Sarega Gurudas
- University College of London Institute of Ophthalmology, London, United Kingdom
| | - Namritha Patrao
- National Institute for Health Research Moorfields Biomedical Research Centre, London, United Kingdom
| | - Luke Nicholson
- University College of London Institute of Ophthalmology, London, United Kingdom,National Institute for Health Research Moorfields Biomedical Research Centre, London, United Kingdom
| | - Piyali Sen
- University College of London Institute of Ophthalmology, London, United Kingdom,National Institute for Health Research Moorfields Biomedical Research Centre, London, United Kingdom
| | - Jayashree Ramu
- National Institute for Health Research Moorfields Biomedical Research Centre, London, United Kingdom
| | - Sobha Sivaprasad
- University College of London Institute of Ophthalmology, London, United Kingdom,National Institute for Health Research Moorfields Biomedical Research Centre, London, United Kingdom
| | - Philip Hykin
- University College of London Institute of Ophthalmology, London, United Kingdom,National Institute for Health Research Moorfields Biomedical Research Centre, London, United Kingdom
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12
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Nakamura S, Hara H. [Prospects and Challenges of Anti-VEGF Drug Treatment for Pathological Angiogenesis of the Retina]. YAKUGAKU ZASSHI 2021; 141:1307-1317. [PMID: 34853203 DOI: 10.1248/yakushi.21-00158-1] [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: 11/22/2022]
Abstract
The number of patients with exudative age-related macular degeneration, diabetic retinopathy and retinal vein occlusion is expected to rise in proportion with the aging of the population and increasing diabetes patients. Also, they are the most common diseases caused by intraocular neovascularization and are often difficult to treat. Currently, anti-vascular endothelial growth factor (VEGF) therapy has been developed and has demonstrated excellent results in treating macular edema, and many patients have avoided blindness. Unfortunately, there are problems with cases that do not respond to the anti-VEGF drugs and complications of administration. It is necessary to deepen the understanding of the physiological and pathological retinal roles of VEGF and to optimize the anti-VEGF therapy. There are also no drugs indicated for the regression of neovascularization itself. The solution to this problem is to develop novel therapies targeting other than VEGF. In this symposium review, we introduce the roles of VEGF in the ischemic retina and anti-angiogenic factors as promising therapeutic targets.
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Affiliation(s)
- Shinsuke Nakamura
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University
| | - Hideaki Hara
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University
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13
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Campochiaro PA. Retinal and Choroidal Vascular Diseases: Past, Present, and Future: The 2021 Proctor Lecture. Invest Ophthalmol Vis Sci 2021; 62:26. [PMID: 34817536 PMCID: PMC8637787 DOI: 10.1167/iovs.62.14.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Peter A Campochiaro
- Departments of Ophthalmology and Neuroscience, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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14
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Spooner K, Fraser-Bell S, Hong T, Chang A. Optical-coherence tomography angiography and ultrawide-field angiography findings in eyes with refractory macular edema secondary to retinal vein occlusion switched to aflibercept: A subanalysis from a 48-week prospective study. Taiwan J Ophthalmol 2021; 11:352-358. [PMID: 35070663 PMCID: PMC8757531 DOI: 10.4103/tjo.tjo_17_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/09/2020] [Indexed: 11/17/2022] Open
Abstract
PURPOSE: To evaluate anatomical changes on ultra-wide-field fluorescein-angiography and optical coherence angiography (OCT-A) among a cohort with treatment-resistant macular edema secondary to retinal vein occlusions (RVO) switched to aflibercept. MATERIALS AND METHODS: Patients with persistent macular edema despite previous bevacizumab and/or ranibizumab were switched to aflibercept in a 48-week prospective trial. Ultra-wide-field fluorescein angiography (UWFFA) and OCT-A were performed at baseline, week-24 and week-48. The ischemic index was calculated from UWFFA and the areas of vascular perfusion. The foveal avascular zone (FAZ) were quantitatively evaluated on OCT-A. RESULTS: Eighteen patients (mean age, 70.3±8.6 years) were recruited. Mean central macular thickness (CMT) was significantly reduced at 48-weeks compared to baseline (-87.6±48.8 μm, P < 0.001 and -191.0±128.3μm, P < 0.001 among BRVO and CRVO eyes, respectively). The mean baseline ischemic index as measured on Optos wide-field angiography was 10.9%±8.3 and decreased to 5.7%±4.2 (P = 0.028), at week 48. The mean FAZ areas of the SCP and DCP reduced by -0.06 ± 0.12 mm 2 and -0.17± 0.45 mm 2 , respectively. FAZ area on OCT-A was stable in eyes with stable or improved vision but increased in size in eyes with baseline macular ischemia and those with lower gains in BCVA at week 48 (R 2 =0.719, P = 0.05 and R 2 =0.516, P = 0.01). CONCLUSION: There was a reduction in macular edema measured on OCT at 48-weeks in eyes switched to aflibercept with chronic macular edema due to retinal vein occlusion. There was also a reduction in retinal ischemia as measured using UWFFA.
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Affiliation(s)
- Kimberly Spooner
- Sydney Retina, Sydney NSW, Australia.,Sydney Institute of Vision Science, Sydney, NSW, Australia.,University of Sydney, Sydney NSW, Australia
| | - Samantha Fraser-Bell
- Sydney Retina, Sydney NSW, Australia.,University of Sydney, Sydney NSW, Australia
| | - Thomas Hong
- Sydney Retina, Sydney NSW, Australia.,Sydney Institute of Vision Science, Sydney, NSW, Australia
| | - Andrew Chang
- Sydney Retina, Sydney NSW, Australia.,Sydney Institute of Vision Science, Sydney, NSW, Australia.,University of Sydney, Sydney NSW, Australia
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15
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Wei P, Liu C, Zhang Y, Yang L. Evaluation of retinal sensitivity and microstructure in areas of capillary nonperfusion of eyes with branch retinal vein occlusion. BMC Ophthalmol 2021; 21:331. [PMID: 34507529 PMCID: PMC8434714 DOI: 10.1186/s12886-021-02089-w] [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: 03/08/2021] [Accepted: 08/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate macular microstructure alterations in the parafoveal nonperfusion areas of eyes with branch retinal vein occlusions (BRVO), and to investigate their impact on retinal sensitivity. Methods This was a cross-sectional study including thirteen BRVO patients with parafoveal capillary nonperfusion areas (NPA). Multiple modalities including microperimetry, optical coherence tomography angiography, and optical coherence tomography were performed to measure retinal sensitivity and thickness, and to identify the microstructure changes and perfusion status. Results The retinal sensitivity and thickness in the NPA were significantly lower than those in the perfusion areas (PA) (P = 0.001, P = 0.003). Microstructure changes, including disorganization of the retinal inner layers (DRIL), disruption of the outer retinal layers, and cysts were more frequently observed in NPA (P = 0.002, P = 0.018, P = 0.068). Within NPA, the retinal sensitivity of areas with DRIL, and outer retinal layers disruption was significantly lower than that of the areas without DRIL (P = 0.016), and with intact outer retinal layers (P < 0.001), respectively. 1dB increase in retinal sensitivity was correlated with 2.2 μm (95 % confidence interval, 1.71–2.7) increase of the thickness (P < 0.001). The retinal sensitivity was significantly lower at points with both DRIL and outer retinal layers disruption than at the points with DRIL or outer retina layers disruption alone (P = 0.001, P = 0.001). Conclusions Alterations in the macular microstructure are associated with ischemia, especially DRIL. DRIL and outer retinal layers disruption are imaging features that have important implications for local retinal sensitivity in the ischemic areas, and where the microstructure of both inner and outer retinal layers is disrupted the function is further destructed.
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Affiliation(s)
- Puying Wei
- Department of Ophthalmology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, 100034, Beijing, China
| | - Chenchen Liu
- Department of Ophthalmology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, 100034, Beijing, China
| | - Yanzhen Zhang
- Department of Ophthalmology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, 100034, Beijing, China
| | - Liu Yang
- Department of Ophthalmology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, 100034, Beijing, China.
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16
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Khayat M, Perais J, Wright DM, Williams M, Lois N. Anatomic-Functional Correlates in Lesions of Retinal Vein Occlusion. Invest Ophthalmol Vis Sci 2021; 62:10. [PMID: 34100891 PMCID: PMC8196416 DOI: 10.1167/iovs.62.7.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate anatomic–functional associations at sites of retinal lesions in retinal vein occlusion (RVO). Methods This pilot, prospective, observational study was conducted at the Northern Ireland Clinical Research Facility (NICRF) of Queen's University and the Belfast Health and Social Care Trust, Northern Ireland, between August 1, 2018, and September 30, 2019. The study included 10 treatment-naïve patients with RVO (10 RVO eyes and 10 fellow eyes). There were 81 points/sites assessed for each eye at baseline; six patients were re-assessed 6 months after anti-vascular endothelial growth factor therapy at the same locations. We investigated associations between retinal sensitivity and presence of structural RVO lesions, including retinal ischemia, hemorrhages, intraretinal fluid (IRF) and subretinal fluid outside the foveal/parafoveal regions. Comparisons were made between RVO eyes and fellow eyes at baseline, and between RVO eyes at baseline and at 6 months after treatment. Regression models were used to investigate anatomic–functional associations. Results At baseline, strong associations were found between reduced retinal sensitivity and presence of ischemia (estimate = −2.08 dB; P < 0.001), intraretinal fluid (estimate = −7.82 dB; P < 0.001), and subretinal fluid (estimate = −8.66 dB; P < 0.001). Resolution of subretinal fluid but not intraretinal fluid was associated with improved function (estimate = 2.40 dB [P = 0.022]; estimate = 1.16 dB [P = 0.228], respectively). However, reperfusion of ischemic retina, observed in 31 of 486 points (6%) 6 months after anti-vascular endothelial growth factor therapy, was associated with a further decrease in retinal sensitivity (estimate = −2.34 dB; P = 0.035). Conclusions Retinal sensitivity was decreased at sites of RVO lesions. Decreased function at sites of retinal ischemia did not recover after treatment, even when reperfusion occurred.
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Affiliation(s)
- Meiaad Khayat
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, United Kingdom.,The Department of Anatomy, Faculty of Medicine-Rabigh, King Abdulaziz University, Saudi Arabia
| | - Jennifer Perais
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, United Kingdom
| | - David M Wright
- The Centre for Public Health, School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, United Kingdom
| | - Michael Williams
- The Ophthalmology Department, The Belfast Health and Social Care Trust, Belfast, United Kingdom.,The Centre for Medical Education, School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, United Kingdom
| | - Noemi Lois
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, United Kingdom.,The Ophthalmology Department, The Belfast Health and Social Care Trust, Belfast, United Kingdom
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17
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GAP IN CAPILLARY PERFUSION AND BURDEN OF TREATMENT IN BRANCH RETINAL VEIN OCCLUSION: A Wide-Field Optical Coherence Tomography Angiography Study. Retina 2021; 41:1227-1235. [PMID: 33149096 DOI: 10.1097/iae.0000000000003006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate correlations between the burden of antivascular endothelial growth factor treatment and microperfusion status in superficial capillary plexus and deep capillary plexus (SCP and DCP) using wide-field optical coherence tomography angiography. METHODS A total 19 eyes with branch retinal vein occlusion were included in this retrospective study. Area of foveal avascular zone, capillary nonperfusion area, vascular density, and perfusion gap were compared between superficial capillary plexus and DCP. Internal areas of 3, 6, and 12 mm in diameter around the fovea were analyzed separately. RESULTS The mean number of injections per months was 0.20 ± 0.12. The number of antivascular endothelial growth factor injections per month showed a significant correlation with perfusion gap in 12 mm area (P = 0.010), but not with perfusion gap in 3-mm or 6-mm area. Correlations were also found between the final best-corrected visual acuity and vascular density in the 12 mm area of DCP (P = 0.031) and foveal avascular zone area (P = 0.033). CONCLUSION Wide-field optical coherence tomography angiography is very useful for assessing the microperfusion status in branch retinal vein occlusion. In extended field of view (12 mm × 12 mm), a larger perfusion gap was associated with frequent requirements of antivascular endothelial growth factor injections for macular edema. Reduction in vessel density was significantly correlated with poor visual outcome.
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18
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Hykin P, Prevost AT, Sivaprasad S, Vasconcelos JC, Murphy C, Kelly J, Ramu J, Alshreef A, Flight L, Pennington R, Hounsome B, Lever E, Metry A, Poku E, Yang Y, Harding SP, Lotery A, Chakravarthy U, Brazier J. Intravitreal ranibizumab versus aflibercept versus bevacizumab for macular oedema due to central retinal vein occlusion: the LEAVO non-inferiority three-arm RCT. Health Technol Assess 2021; 25:1-196. [PMID: 34132192 PMCID: PMC8287375 DOI: 10.3310/hta25380] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Licensed ranibizumab (0.5 mg/0.05 ml Lucentis®; Novartis International AG, Basel, Switzerland) and aflibercept (2 mg/0.05 ml Eylea®; Bayer AG, Leverkusen, Germany) and unlicensed bevacizumab (1.25 mg/0.05 ml Avastin®; F. Hoffmann-La Roche AG, Basel, Switzerland) are used to treat macula oedema due to central retinal vein occlusion, but their relative clinical effectiveness, cost-effectiveness and impact on the UK NHS and Personal Social Services have never been directly compared over the typical disease treatment period. OBJECTIVE The objective was to compare the clinical effectiveness and cost-effectiveness of three intravitreal antivascular endothelial growth factor agents for the management of macula oedema due to central retinal vein occlusion. DESIGN This was a three-arm, double-masked, randomised controlled non-inferiority trial. SETTING The trial was set in 44 UK NHS ophthalmology departments, between 2014 and 2018. PARTICIPANTS A total of 463 patients with visual impairment due to macula oedema secondary to central retinal vein occlusion were included in the trial. INTERVENTIONS The participants were treated with repeated intravitreal injections of ranibizumab (n = 155), aflibercept (n = 154) or bevacizumab (n = 154). MAIN OUTCOME MEASURES The primary outcome was an increase in the best corrected visual acuity letter score from baseline to 100 weeks in the trial eye. The null hypothesis that aflibercept and bevacizumab are each inferior to ranibizumab was tested with a non-inferiority margin of -5 visual acuity letters over 100 weeks. Secondary outcomes included additional visual acuity, and imaging outcomes, Visual Function Questionnaire-25, EuroQol-5 Dimensions with and without a vision bolt-on, and drug side effects. Cost-effectiveness was estimated using treatment costs and Visual Function Questionnaire-Utility Index to measure quality-adjusted life-years. RESULTS The adjusted mean changes at 100 weeks in the best corrected visual acuity letter scores were as follows - ranibizumab, 12.5 letters (standard deviation 21.1 letters); aflibercept, 15.1 letters (standard deviation 18.7 letters); and bevacizumab, 9.8 letters (standard deviation 21.4 letters). Aflibercept was non-inferior to ranibizumab in the intention-to-treat population (adjusted mean best corrected visual acuity difference 2.23 letters, 95% confidence interval -2.17 to 6.63 letters; p = 0.0006), but not superior. The study was unable to demonstrate that bevacizumab was non-inferior to ranibizumab in the intention-to-treat population (adjusted mean best corrected visual acuity difference -1.73 letters, 95% confidence interval -6.12 to 2.67 letters; p = 0.071). A post hoc analysis was unable to demonstrate that bevacizumab was non-inferior to aflibercept in the intention-to-treat population (adjusted mean best corrected visual acuity difference was -3.96 letters, 95% confidence interval -8.34 to 0.42 letters; p = 0.32). All per-protocol population results were the same. Fewer injections were required with aflibercept (10.0) than with ranibizumab (11.8) (difference in means -1.8, 95% confidence interval -2.9 to -0.8). A post hoc analysis showed that more bevacizumab than aflibercept injections were required (difference in means 1.6, 95% confidence interval 0.5 to 2.7). There were no new safety concerns. The model- and trial-based cost-effectiveness analyses estimated that bevacizumab was the most cost-effective treatment at a threshold of £20,000-30,000 per quality-adjusted life-year. LIMITATIONS The comparison of aflibercept and bevacizumab was a post hoc analysis. CONCLUSION The study showed aflibercept to be non-inferior to ranibizumab. However, the possibility that bevacizumab is worse than ranibizumab and aflibercept by 5 visual acuity letters cannot be ruled out. Bevacizumab is an economically attractive treatment alternative and would lead to substantial cost savings to the NHS and other health-care systems. However, uncertainty about its relative effectiveness should be discussed comprehensively with patients, their representatives and funders before treatment is considered. FUTURE WORK To obtain extensive patient feedback and discuss with all stakeholders future bevacizumab NHS use. TRIAL REGISTRATION Current Controlled Trials ISRCTN13623634. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 38. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Philip Hykin
- National Institute for Health Research Moorfields Biomedical Research Centre, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - A Toby Prevost
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Sobha Sivaprasad
- National Institute for Health Research Moorfields Biomedical Research Centre, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Joana C Vasconcelos
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Caroline Murphy
- King's Clinical Trials Unit at King's Health Partners, King's College London, London, UK
| | - Joanna Kelly
- King's Clinical Trials Unit at King's Health Partners, King's College London, London, UK
| | - Jayashree Ramu
- National Institute for Health Research Moorfields Biomedical Research Centre, London, UK
| | - Abualbishr Alshreef
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Laura Flight
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rebekah Pennington
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Ellen Lever
- King's Clinical Trials Unit at King's Health Partners, King's College London, London, UK
| | - Andrew Metry
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Edith Poku
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Yit Yang
- The Eye Infirmary, New Cross Hospital, Wolverhampton, UK
| | - Simon P Harding
- Eye and Vision Science, University of Liverpool, and St Paul's Eye Unit, Royal Liverpool University Hospitals, Liverpool, UK
| | - Andrew Lotery
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Usha Chakravarthy
- Department of Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - John Brazier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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19
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Changes in Macular Microvascular Structure in Macular Edema Secondary to Branch Retinal Vein Occlusion Treated with Antivascular Endothelial Growth Factor for One Year. J Ophthalmol 2021; 2021:6645452. [PMID: 34055397 PMCID: PMC8149245 DOI: 10.1155/2021/6645452] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/27/2021] [Accepted: 05/03/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To observe the changes in macular microvascular structure and the correlation between anatomy and visual function in patients with macular edema secondary to branch retinal vein occlusion (BRVO) treated with antivascular endothelial growth factor for one year. Methods This prospective study enrolled 39 patients (one eye per patient) who received intravitreal injections of ranibizumab for macular edema secondary to BRVO. All patients received a minimum of 3 initial monthly ranibizumab injections and criteria-driven pro re nata (PRN) dosing thereafter for visual acuity (VA) and central retinal thickness (CRT) stabilization. The follow-up period of this study was one year. The vascular density (VD) of the superficial retinal capillary plexus (SCP) and deep retinal capillary plexus (DCP), the foveal avascular zone (FAZ) area, the FAZ perimeter, the VD within a 300 μm wide ring surrounding the FAZ (FD-300), and the acircularity index (AI) were measured automatically by optical coherence tomography angiography (OCTA) at baseline, month 6, and month 12. Results Compared with those before treatment, the VD of the SCP significantly decreased 6 months after treatment (P < 0.05), while the area and perimeter of the FAZ increased significantly (P < 0.01). After 12 months of treatment, the area and perimeter of the FAZ increased significantly (P < 0.01). There was no significant difference in any parameters between 12 months and 6 months after treatment (P > 0.05). The change in BCVA was negatively correlated with the VD of the SCP at 12 months (P=0.0447, r = -0.3233). There was a relationship between the DBP and AI, and CRT was related to VD of DCP at baseline (P=0.028, 0.0209; r = 0.383, -0.384). The PERIM and AI at 12 months were significantly associated with the recurrence of macular edema, and the changes in vascular density in the SCP and PERIM were significantly associated with the number of injections within 12 months (P < 0.05). Conclusions One year after ranibizumab treatment, the area and perimeter of the FAZ were enlarged, while the VD of the SCP and DCP remained stable, which indicated that ranibizumab treatment did not improve macular blood supply and macular ischemia in BRVO patients.
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Park JH, Kim EC. The Structural and Comparative Analysis of Intravitreal Dexamethasone Implant (Ozurdex) and Anti-VEGF Injection in Branched Retinal Vein Occlusion Patients by Optical Coherence Tomography Angiography Images Quantitation. Semin Ophthalmol 2021; 36:475-481. [PMID: 33843438 DOI: 10.1080/08820538.2021.1890146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background and Objective: To evaluate and compare the structural changes of retinal vasculature after intravitreal dexamethasone implant (Ozurdex) insertion and antivascular endothelial growth factor (anti-VEGF) injection in patients with branched retinal vein occlusion (BRVO) using optical coherence tomography angiography (OCTA).Study Design/Materials and Methods: We retrospectively analyzed 39 patients with unilateral BRVO. Subjects were divided into two groups according to treatment agent: Ozurdex (n = 18) and anti-VEGF (n = 21). Swept Source (SS) OCT and OCTA were performed and images were analyzed quantitatively using ImageJ (National Institutes of Health) software. Intravitreal implant and anti-VEGF injections were performed following a prn regimen. The specific anti-VEGF agent used was chosen among bevacizumab, ranibizumab and aflibercept.Results: Of the 39 patients (mean ± SD age, 70.0 ± 8.9 years [range, 48-89 years]; 20 men [51.0%]) with unilateral BRVO, in an independent two-sample t test, there was greater vascular reperfusion of the choriocapillaris slab in the intravitreal Ozurdex implant group than in the anti-VEGF group using the angiography mode (P = .013). Increased number of particles was more prominent in intravitreal anti-VEGF injection group than intravitreal Ozurdex implant group in outer retina slab of En-face mode (P = .039). There was no statistically significant difference between the 2 treatment groups in relation to the Early Treatment Diabetic Retinopathy Study (ETDRS) density map and other angiography slabs; and the superficial, deep, and outer retina.Conclusions: Results of a quantitative analysis of OCTA images using ImageJ software suggest that the intravitreal Ozurdex implant induced increased retinal vascular perfusion compared with anti-VEGF injection for the treatment of BRVO.
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Affiliation(s)
- Jin Heung Park
- St. Mary's JIN Eye Center, Seoul, Seoul, Republic of Korea
| | - Eun Chul Kim
- Department of Ophthalmology, Bucheon St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
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Ye P, Zhu T, Zheng F, Zhou M, Fang X, Yao K. Microvascular comparison in younger and older patients with retinal vein occlusion analyzed by OCT angiography. BMC Ophthalmol 2021; 21:161. [PMID: 33820544 PMCID: PMC8022394 DOI: 10.1186/s12886-021-01931-5] [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: 02/01/2021] [Accepted: 03/19/2021] [Indexed: 11/17/2022] Open
Abstract
Background To compare changes in retinal microvasculature of young and elderly patients with retinal vein occlusion (RVO) after anti-VEGF treatment. Methods RVO patients who underwent anti-VEGF treatment were retrospectively reviewed and categorized into two groups based on age. The OCT angiography images were obtained during each visit. Best corrected visual acuity (BCVA), vessel density (VD) and foveal avascular zone (FAZ) were measured and compared between the two groups. Vision improvements and retinal microvasculature changes were also correlated. Results Twenty patients with 20 eyes were enrolled in the younger group and 46 patients with 46 eyes were enrolled in the older group. Younger patients demonstrated better BCVA, higher VD and smaller FAZ than older patients at 12 months after the first anti-VEGF treatment. The improvement of VD was observed only in the younger group. A positive correlation between vision improvement and VD increase was noted. Conclusions Young patients with RVO can achieve rapid rehabilitation of deep retinal vasculature which lead to a better visual outcome.
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Affiliation(s)
- Panpan Ye
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88, Jiefang Road, 310009, Hangzhou, China
| | - Tiepei Zhu
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88, Jiefang Road, 310009, Hangzhou, China
| | - Fang Zheng
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88, Jiefang Road, 310009, Hangzhou, China
| | - Min Zhou
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88, Jiefang Road, 310009, Hangzhou, China.,The Institute of Translational Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoyun Fang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88, Jiefang Road, 310009, Hangzhou, China.
| | - Ke Yao
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88, Jiefang Road, 310009, Hangzhou, China.
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Tripathy S, Le HG, Cicinelli MV, Gill MK. Longitudinal Changes on Optical Coherence Tomography Angiography in Retinal Vein Occlusion. J Clin Med 2021; 10:jcm10071423. [PMID: 33916005 PMCID: PMC8037411 DOI: 10.3390/jcm10071423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/20/2021] [Accepted: 03/25/2021] [Indexed: 01/26/2023] Open
Abstract
Background: To evaluate the longitudinal changes on optical coherence tomography angiography (OCTA) in retinal vein occlusion (RVO). Methods: Retrospective study of patients with RVO treated with intravitreal anti-vascular endothelial growth factors (VEGF) for macular edema. Foveal avascular zone (FAZ) area, vessel density (VD), vessel length density (VLD), and adjusted flow index (AFI) were calculated. The unaffected eye of each participant was used as a control. Results: Twelve RVO eyes were included, receiving 6 ± 3 anti-VEGF injections over a follow-up of 10.4 ± 3.1 months. Compared to fellow eyes, RVO eyes had lower VD and VLD at inclusion (p = 0.07 and p = 0.04) and last visit (p = 0.002 and p < 0.001). VD, AFI, and VLD did not change over time, while FAZ area increased in RVO eyes (+0.016 ± 0.024 mm2, p = 0.04). AFI correlated with duration of disease (r = 0.63, p = 0.02). Visual acuity was inversely related to VD and VLD over the follow-up. Conclusions: OCTA parameters remained stable with sustained anti-VEGF treatment in RVO, while changes in the FAZ area may suggest capillary remodeling after RVO.
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Affiliation(s)
- Swetapadma Tripathy
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, 645 N Michigan Avenue, Ste 440, Chicago, IL 60611, USA; (S.T.); (H.-G.L.); (M.V.C.)
| | - Hong-Gam Le
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, 645 N Michigan Avenue, Ste 440, Chicago, IL 60611, USA; (S.T.); (H.-G.L.); (M.V.C.)
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, 645 N Michigan Avenue, Ste 440, Chicago, IL 60611, USA; (S.T.); (H.-G.L.); (M.V.C.)
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Manjot K. Gill
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, 645 N Michigan Avenue, Ste 440, Chicago, IL 60611, USA; (S.T.); (H.-G.L.); (M.V.C.)
- Correspondence:
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Alagorie AR, Nittala MG, Velaga S, Zhou B, Rusakevich AM, Wykoff CC, Sadda SR. Association of Intravitreal Aflibercept With Optical Coherence Tomography Angiography Vessel Density in Patients With Proliferative Diabetic Retinopathy: A Secondary Analysis of a Randomized Clinical Trial. JAMA Ophthalmol 2021; 138:851-857. [PMID: 32584384 DOI: 10.1001/jamaophthalmol.2020.2130] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Although previous studies have evaluated the association between anti-vascular endothelial growth factor therapy and macular vessel density, they were confounded by the presence of macular edema, which may be associated with artifacts and segmentation errors in optical coherence tomography angiography (OCTA). Objective To evaluate the association of intravitreal aflibercept with changes in macular vascular density using OCTA in patients with proliferative diabetic retinopathy without diabetic macular edema. Design, Setting, and Participants This post hoc analysis of a randomized clinical trial used data on 40 eyes of 40 patients with proliferative diabetic retinopathy without diabetic macular edema who were enrolled in the Intravitreal Aflibercept for Retinal Nonperfusion in Proliferative Diabetic Retinopathy (RECOVERY) clinical trial from August 1, 2016, to June 31, 2017. Three patients were lost to follow-up at month 12, and 5 patients were excluded from analysis because of poor OCTA image quality, leaving 16 patients in each cohort in the final analysis. Data analysis was performed from March 1, 2018, to January 15, 2019. Intervention In the RECOVERY trial, patients were randomized into cohorts receiving 2 mg of aflibercept injections monthly (n = 20) or quarterly (n = 20) and treated for 12 months. Main Outcomes and Measures The percentage of vascular density (in total scan and foveal and parafoveal regions) was compared before and after 12 months of therapy. Results The sample for this OCTA analysis included 32 eyes from 32 patients (mean [SD] age, 48.37 [12.30] years; 17 [53.1%] male). The mean (SD) total scan vascular density for the superficial vascular complex was 42.28% (4.03%; 95% CI, 40.63%-43.93%) at baseline and 39.64% (4.01%; 95% CI, 37.91%-41.37%) at month 12 (P = .69). For the deep vascular complex, the mean (SD) vascular density was 48.42% (4.99%; 95% CI, 46.36%-50.47%) at baseline and 45.69% (4.63%; 95% CI, 43.69%-47.70%) at month 12 (P = .40). For the choriocapillaris, the mean (SD) vascular density was 64.42% (3.36%; 95% CI, 63.04%-65.81%) at baseline and 62.55% (4.79%; 95% CI, 60.48%-64.62%) at month 12 (P = .16). There was no difference in vascular density parameters between monthly and quarterly injection arms at month 12. Conclusions and Relevance In this study, macular vascular density did not change after 12 months of intravitreal aflibercept therapy. Because nonperfusion is expected to progress in diabetic retinopathy, this finding may represent a beneficial association between anti-vascular endothelial growth factor therapy and macular vascular density. Trial Registration ClinicalTrials.gov Identifier: NCT02863354.
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Affiliation(s)
- Ahmed Roshdy Alagorie
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California.,Department of Ophthalmology, David Geffen School of Medicine at UCLA (University of California, Los Angeles), Los Angeles.,Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Muneeswar Gupta Nittala
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California.,Department of Ophthalmology, David Geffen School of Medicine at UCLA (University of California, Los Angeles), Los Angeles
| | - Swetha Velaga
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California.,Department of Ophthalmology, David Geffen School of Medicine at UCLA (University of California, Los Angeles), Los Angeles
| | - Brenda Zhou
- Retina Consultants of Houston, Houston, Texas
| | | | | | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California.,Department of Ophthalmology, David Geffen School of Medicine at UCLA (University of California, Los Angeles), Los Angeles
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Scott IU, Campochiaro PA, Newman NJ, Biousse V. Retinal vascular occlusions. Lancet 2020; 396:1927-1940. [PMID: 33308475 PMCID: PMC9546635 DOI: 10.1016/s0140-6736(20)31559-2] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 05/29/2020] [Accepted: 07/03/2020] [Indexed: 12/11/2022]
Abstract
Acute retinal vascular occlusions are common causes of visual impairment. Although both retinal artery occlusions and retinal vein occlusions are associated with increased age and cardiovascular risk factors, their pathophysiology, systemic implications, and management differ substantially. Acute management of retinal artery occlusions involves a multidisciplinary approach including neurologists with stroke expertise, whereas treatment of retinal vein occlusions is provided by ophthalmologists. Optimisation of systemic risk factors by patients' primary care providers is an important component of the management of these two disorders.
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Affiliation(s)
- Ingrid U Scott
- Department of Ophthalmology and Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Peter A Campochiaro
- Department of Ophthalmology and Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nancy J Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurological Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
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25
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Campochiaro PA, Akhlaq A. Sustained suppression of VEGF for treatment of retinal/choroidal vascular diseases. Prog Retin Eye Res 2020; 83:100921. [PMID: 33248215 DOI: 10.1016/j.preteyeres.2020.100921] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/15/2020] [Accepted: 11/18/2020] [Indexed: 12/27/2022]
Abstract
Neovascular age-related macular degeneration (NVAMD) is the most prevalent choroidal vascular disease, and diabetic retinopathy (DR) and retinal vein occlusion (RVO) are the most prevalent retinal vascular diseases. In each of these, hypoxia plays a central role by stabilizing hypoxia-inducible factor-1 which increases production of vascular endothelial growth factor (VEGF) and other hypoxia-regulated gene products. High VEGF causes excessive vascular permeability, neovascularization, and in DR and RVO, promotes closure of retinal vessels exacerbating hypoxia and creating a positive feedback loop. Hence once VEGF expression is elevated it tends to remain elevated and drives disease progression. While other hypoxia-regulated gene products also contribute to pathology in these disease processes, it is remarkable how much pathology is reversed by selective inhibition of VEGF. Clinical trials have demonstrated outstanding visual outcomes in patients with NVAMD, DR, or RVO from frequent intraocular injections of VEGF-neutralizing proteins, but for a variety of reasons injection frequency has been substantially less in clinical practice and visual outcomes are disappointing. Herein we discuss the rationale, preclinical, and early clinical results of new approaches that provide sustained suppression of VEGF. These approaches will revolutionize the management of these prevalent retinal/choroidal vascular diseases.
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Affiliation(s)
- Peter A Campochiaro
- The Departments of Ophthalmology and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Anam Akhlaq
- The Departments of Ophthalmology and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Sustained treatment of retinal vascular diseases with self-aggregating sunitinib microparticles. Nat Commun 2020; 11:694. [PMID: 32019921 PMCID: PMC7000758 DOI: 10.1038/s41467-020-14340-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 12/27/2019] [Indexed: 11/16/2022] Open
Abstract
Neovascular age-related macular degeneration and diabetic retinopathy are prevalent causes of vision loss requiring frequent intravitreous injections of VEGF-neutralizing proteins, and under-treatment is common and problematic. Here we report incorporation of sunitinib, a tyrosine kinase inhibitor that blocks VEGF receptors, into a non-inflammatory biodegradable polymer to generate sunitinib microparticles specially formulated to self-aggregate into a depot. A single intravitreous injection of sunitinib microparticles potently suppresses choroidal neovascularization in mice for six months and in another model, blocks VEGF-induced leukostasis and retinal nonperfusion, which are associated with diabetic retinopathy progression. After intravitreous injection in rabbits, sunitinib microparticles self-aggregate into a depot that remains localized and maintains therapeutic levels of sunitinib in retinal pigmented epithelium/choroid and retina for more than six months. There is no intraocular inflammation or retinal toxicity. Intravitreous injection of sunitinib microparticles provides a promising approach to achieve sustained suppression of VEGF signaling and improve outcomes in patients with retinal vascular diseases. Neovascular age-related macular degeneration and diabetic retinopathy are currently treated with repeated intravitreous injections of VEGF neutralizing proteins. Here the authors develop a microparticle-loaded tyrosine kinase inhibitor therapy, which is effective for six months after a single injection in preclinical models.
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27
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Nitta K, Nishinaka A, Hida Y, Nakamura S, Shimazawa M, Hara H. Oral and ocular administration of crocetin prevents retinal edema in a murine retinal vein occlusion model. Mol Vis 2019; 25:859-868. [PMID: 31908404 PMCID: PMC6937220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 12/23/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose We investigated the effects of oral and ocular administration of crocetin in a murine retinal vein occlusion (RVO) model. Crocetin is a type of carotenoid contained in the fruit of gardenia (Gardenia jasminoides Ellis) and the stigma of saffron (Crocus staruts L). Methods This study was performed on a murine RVO model, which was created by laser irradiation of retinal veins. We evaluated the retinal thickness after the oral administration of crocetin (100 mg/kg) 1 and 6 h before laser irradiation, and immediately, 6 h, 12 h, and 18 h after laser irradiation in the murine RVO model. In addition, we measured the retinal layer thickness after administration of crocetin eye drops (0.03% or 0.10%) immediately, 6 h, and 12 h after laser irradiation. Western blotting of retinal tissue was used to determine the expression levels of matrix metalloproteinase (MMP-9), tumor nuclear factor (TNF-α), and occludin after oral administration of crocetin. Results Oral and ocular administration of crocetin improved retinal edema in the murine RVO model. Crocetin administration statistically significantly suppressed overexpression of MMP-9 and TNF-α, and reversed the reduction of occludin. Conclusions These findings indicate that crocetin can protect retinal tight junctions by suppressing retinal edema through an anti-inflammatory effect, which suggests that crocetin may be useful for RVO disease.
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28
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Conti FF, Song W, Rodrigues EB, Singh RP. Changes in retinal and choriocapillaris density in diabetic patients receiving anti-vascular endothelial growth factor treatment using optical coherence tomography angiography. Int J Retina Vitreous 2019; 5:41. [PMID: 31867124 PMCID: PMC6902577 DOI: 10.1186/s40942-019-0192-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 09/21/2019] [Indexed: 12/13/2022] Open
Abstract
Background Optical coherence tomography angiography (OCTA) enables detailed, non-invasive assessment of ocular vasculature. This study uses OCTA imaging to evaluate choriocapillaris and retinal capillary perfusion density (CPD) changes in diabetic retinopathy following anti-vascular endothelial growth factor (VEGF) treatment. Methods Records of 38 eyes at a single institution were reviewed, grouped as non-diabetic controls (19 eyes), diabetes mellitus patients with diabetic retinopathy (DR, 19 eyes) and macular edema (DME). DR eyes were imaged at baseline, 6-months and 12-months after anti-VEGF treatment. Quantitative analyses assessed CPD of the choriocapillaris and retinal plexus. Results DR eyes showed decreased choriocapillaris whole-image CPD (62.6 ± 6.1 vs. 68.4 ± 5.1, p < 0.003), foveal CPD (61.2 ± 7.4 vs. 66.3 ± 9.8, p < 0.014), and parafoveal CPD (61.9 ± 6.6 vs. 68.2 ± 4.8, p < 0.002) at baseline. DR eyes also showed decreased retinal density, including whole-image CPD (46.9 ± 5.1 vs. 50.7 ± 5.6, p < 0.04), foveal CPD (27.6 ± 5.9 vs. 34.1 ± 6.1, p < 0.002), and parafoveal CPD (49.0 ± 5.6 vs. 53.1 ± 6.0, p < 0.011). Following 12 months of anti-VEGF treatment, no changes to retinal or choriocapillaris or CPD were observed. Retinal central subfield thickness decreased (397.1 ± 93.2 µm vs. 294.2 ± 71.5 µm, p < 0.005). Lastly, FAZ area (0.307 ± 0.133 mm2 vs. 0.184 ± 0.058 mm2, p = 0.008) and perimeter (2.415 ± 0.692 mm2 vs. 1.753 ± 0.408 mm2, p = 0.002) were increased in DR eyes at baseline. No changes to FAZ area or perimeter were seen with anti-VEGF treatment in DR eyes. Conclusions Compared to control, choriocapillaris and retinal CPD are reduced in DR, while FAZ area and perimeter are increased. No retinal capillary or choriocapillaris CPD changes were observed in DR eyes following anti-VEGF treatment.
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Affiliation(s)
- Felipe F Conti
- 1Cole Eye Institute, Cleveland Clinic Foundation, 2022 E. 105th St, i Building, Cleveland, OH 44106 USA.,2Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue, NA21, Cleveland, OH 44195 USA.,3Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, 10685 Carnegie Ave, Cleveland, OH 44106 USA.,4Federal University of São Paulo, 781 Pedro de Toledo Street, São Paulo, SP 04039-032 Brazil
| | - Weilin Song
- 2Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue, NA21, Cleveland, OH 44195 USA
| | - Eduardo B Rodrigues
- 4Federal University of São Paulo, 781 Pedro de Toledo Street, São Paulo, SP 04039-032 Brazil
| | - Rishi P Singh
- 1Cole Eye Institute, Cleveland Clinic Foundation, 2022 E. 105th St, i Building, Cleveland, OH 44106 USA.,3Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, 10685 Carnegie Ave, Cleveland, OH 44106 USA
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FIXATION STATUS AFTER RESOLUTION OF MACULAR EDEMA ASSOCIATED WITH BRANCH RETINAL VEIN OCCLUSION. Retina 2019; 39:1896-1905. [DOI: 10.1097/iae.0000000000002250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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Sophie R, Wang PW, Channa R, Quezada-Ruiz C, Clark A, Campochiaro PA. Different Factors Associated with 2-Year Outcomes in Patients with Branch versus Central Retinal Vein Occlusion Treated with Ranibizumab. Ophthalmology 2019; 126:1695-1702. [PMID: 31543350 DOI: 10.1016/j.ophtha.2019.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 06/21/2019] [Accepted: 07/17/2019] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To investigate characteristics associated with visual and anatomic outcomes in branch and central retinal vein occlusion (BRVO and CRVO) patients treated with ranibizumab. DESIGN Post hoc analysis of patients with BRVO and CRVO from 2 multicenter clinical trials who completed month 12 of the HORIZON extension trial. PARTICIPANTS 205 patients with BRVO and 181 patients with CRVO who completed month 12 of the extension trial. METHODS With the use of logistic regression, covariates with a P value < 0.20 from univariate analysis were included in multivariate models to identify independent factors associated with a given outcome (at P < 0.05), with preset variables of disease duration and original treatment assignment. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA) ≥20/40 (≥70 letters), gain ≥15 letters, and central subfield thickness (CST) ≤250 μm at HORIZON month 12. RESULTS In patients with BRVO, good baseline BCVA (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.30-1.79), male sex (OR, 2.48; 95% CI, 1.20-5.13), and normal hematocrit (low vs. normal, OR, 0.26; 95% CI, 0.12-0.59) predicted BCVA ≥20/40; high central foveal thickness (OR, 1.03; 95% CI, 1.01-1.04) and normal hematocrit (low vs. normal, OR, 0.31; 95% CI, 0.15-0.66) predicted BCVA improvement ≥15 letters; and extensive baseline subretinal fluid modestly predicted CST ≤250 μm (OR, 1.08; 95% CI, 1.00-1.16). In patients with CRVO, good baseline BCVA (OR, 1.59; 95% CI, 1.35-1.89), never smoking (OR, 2.80; 95% CI, 1.27-6.17), and young age (OR, 0.58; 95% CI, 0.41-0.82) predicted BCVA ≥20/40; never smoking (OR, 2.13; 95% CI, 1.03-4.39), young age (OR, 0.41; 95% CI, 0.28-0.59), poor baseline BCVA (OR, 0.82; 95% CI, 0.73-0.93), hypertension (OR, 4.47; 95% CI, 1.70-11.75), and low diastolic ocular perfusion pressure (OPP) throughout the study (OR, 0.39; 95% CI, 0.21-0.72) predicted BCVA improvement ≥15 letters; and young age (OR, 0.65; 95% CI, 0.47-0.90), lower mean hematocrit (low vs. normal, OR, 2.81; 95% CI, 1.06-7.49), high systolic OPP throughout the study (OR, 1.61; 95% CI, 1.14-2.27), large areas of central hemorrhage (OR, 1.44; 95% CI, 1.04-2.00), and no subretinal fluid (OR, 2.15; 95% CI, 1.06-4.40) predicted CST ≤250 μm. CONCLUSIONS There are substantial differences in good outcome factors in CRVO versus BRVO, suggesting differences in pathophysiology. Young age, never smoking, hemodilution, and hypertension/high systolic perfusion pressure are more beneficial in CRVO, suggesting that avoidance of sluggish blood flow and maintenance of perfusion may be particularly important in CRVO.
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Affiliation(s)
- Raafay Sophie
- Medical College of Wisconsin, Department of Ophthalmology and Visual Sciences, Milwaukee, Wisconsin
| | - Pin-Wen Wang
- Genentech, Inc., South San Francisco, California
| | - Roomasa Channa
- Baylor College of Medicine, Department of Ophthalmology, Houston, Texas
| | | | - Ann Clark
- Genentech, Inc., South San Francisco, California
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Muraoka Y, Tsujikawa A. Arteriovenous crossing associated with branch retinal vein occlusion. Jpn J Ophthalmol 2019; 63:353-364. [PMID: 31396750 DOI: 10.1007/s10384-019-00676-5] [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] [Received: 11/20/2018] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
Abstract
Branch retinal vein occlusion (BRVO) is defined as the focal occlusion of a first or second-order branch of retinal vein, which occurs most frequently at an arteriovenous (AV) crossing. Direct ophthalmoscopy, color fundus photography, and fluorescein angiography facilitate observation of AV crossings parallel to the retinal plane. Optical coherence tomography (OCT), with its high-depth resolution, enables observation of retinal lesions perpendicular to the retinal plane. OCT angiography (OCTA) provides depth-resolved images of the retinal vasculature by segmenting three-dimensional data. In this review, we discuss novel findings related to affected AV crossings associated with BRVO obtained via OCT and OCTA. The high-depth resolution of OCT or OCTA is useful for observation of the narrowed vein and determination of the vessel position of the affected AV crossing. Studies using OCT and OCTA have shown that BRVO caused by a venous overcrossing is more prevalent than previously reported, and that venous narrowing was significantly greater in instances caused by a venous overcrossing than in those caused by an arterial overcrossing. Moreover, OCTA also revealed that the retinal nonperfusion area size was larger in eyes with BRVO caused by a venous overcrossing than in those with BRVO caused by an arterial overcrossing. This contrasts with earlier findings obtained by conventional imaging modalities predating OCT, which showed that an arterial overcrossing was more common than a venous overcrossing at the causative venous occlusion site in eyes with BRVO. This review discusses these findings and their significance in the study of AV crossing associated with BRVO.
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Affiliation(s)
- Yuki Muraoka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan
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Babiuch AS, Conti TF, Conti FF, Silva FQ, Rachitskaya A, Yuan A, Singh RP. Diabetic macular edema treated with intravitreal aflibercept injection after treatment with other anti-VEGF agents (SWAP-TWO study): 6-month interim analysis. Int J Retina Vitreous 2019; 5:17. [PMID: 31367468 PMCID: PMC6647124 DOI: 10.1186/s40942-019-0167-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/02/2019] [Indexed: 12/24/2022] Open
Abstract
Background Diabetic macular edema (DME) is an important cause of vision loss and despite the anatomical and functional improvement achieved with treatment, there are reports of persistent DME regardless of continuous anti-VEGF therapy. The purpose of this study is to examine the effect of patients with DME previously treated with other anti-VEGF agents who are transitioned to intravitreal aflibercept (IAI) on a fixed dosing regimen. Methods This prospective study included 20 patients presenting with DME with a history of previous anti-VEGF treatment with ranibizumab or bevacizumab. Patients received a 2 mg (0.05 mL) IAI every 4 weeks until no evidence of fluid by optical coherence tomography (OCT) followed by a fixed dosing schedule of 2 mg IAI once every 8 weeks through 24 months. There was a pre-planned interim analysis of the mean absolute change from baseline central foveal thickness at month 6 as measured by OCT. Secondary outcomes included mean change from baseline in ETDRS visual acuity and anatomic parameters. Optical Coherence tomography angiography (OCTA) capillary perfusion density (CPD) after transitioning to IAI therapy were also reported. Results Average central subfield thickness on OCT at baseline was 419.7 ± 92.0 and improved to 303.8 ± 73.1 at 6-months (p < 0.001). At 6 months after IAI treatment, BCVA increased + 1.5 letters from baseline (p = 0.38). OCTA CPD analysis revealed significant increase from baseline in the foveal avascular zone in non-proliferative diabetic retinopathy group (p = 0.02). Conclusions Patients with prior anti-VEGF therapy who were transitioned to IAI therapy revealed significant anatomic improvements through 6 months. Trial registration Treatment of Diabetic Macular Edema With Aflibercept in Subjects Previously Treated With Ranibizumab or Bevacizumab (SwapTwo), Trial registration number: NCT02559180. Date of registration: September 24, 2015.https://clinicaltrials.gov/ct2/show/NCT02559180
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Affiliation(s)
- Amy S Babiuch
- 1Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, i32, Cleveland, OH 44195 USA.,2Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, USA
| | - Thais F Conti
- 1Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, i32, Cleveland, OH 44195 USA.,2Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, USA
| | - Felipe F Conti
- 1Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, i32, Cleveland, OH 44195 USA.,2Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, USA.,3Federal University of São Paulo, São Paulo, Brazil
| | - Fabiana Q Silva
- 1Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, i32, Cleveland, OH 44195 USA
| | | | - Alex Yuan
- 1Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, i32, Cleveland, OH 44195 USA
| | - Rishi P Singh
- 1Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, i32, Cleveland, OH 44195 USA.,2Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, USA.,4Case Western Reserve University, Cleveland, USA
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Widefield OCT-Angiography and Fluorescein Angiography Assessments of Nonperfusion in Diabetic Retinopathy and Edema Treated with Anti-Vascular Endothelial Growth Factor. Ophthalmology 2019; 126:1685-1694. [PMID: 31383483 DOI: 10.1016/j.ophtha.2019.06.022] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/12/2019] [Accepted: 06/18/2019] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To assess change in retinal nonperfusion (NP) after anti-vascular endothelial growth factor (VEGF) therapy for diabetic macular edema (DME) using 2 different imaging modalities: swept-source widefield (SS-WF) OCT angiography (OCTA) and ultra-widefield (UWF) fluorescein angiography (FA). DESIGN Observational case series. PARTICIPANTS Ten eyes of 9 patients with severe nonproliferative diabetic retinopathy (NPDR) or proliferative DR (PDR) initiating 3 monthly anti-VEGF intravitreal injections for DME. METHODS All eyes were imaged with UWF color fundus photographs (CFPs), UWF FA, and SS-WF OCTA at baseline (M0) and 1 month after the third anti-VEGF injection (M3). All images were aligned and divided into 16 boxes for analysis of NP areas by 2 blinded retina specialists. MAIN OUTCOME MEASURES The number of discrepancies between SS-WF OCTA and UWF FA regarding the detection of NP areas and small vessels passing through NP areas; assessment of DR severity on UWF CFP; and change in each NP area between M0 and M3: number of boxes/eye with presence of at least 1 NP area, number of arterioles or venules that disappeared or reappeared, and number of NP areas in which capillaries disappeared or reappeared. RESULTS The diabetic retinopathy (DR) severity score improved by at least 1 stage in 8 of 10 eyes, with a significant decrease in the mean number of microaneurysms and retinal hemorrhages on UWF CFP at M3 versus M0 (n = 40±28 vs. 121±57; P = 0.0020) and regression of fundus neovascularization when present. All NP areas detected on FA were seen on SS-WF OCTA, but additional NP areas were detected on SS-WF OCTA at M0 in 29% (46/160) of boxes. No reperfusion of arterioles or venules was observed at M3 on FA or SS-WF OCTA. Retinal capillaries were only visible on OCTA, and no reperfusion in NP areas was observed even when a reduction in dark areas was visible on FA. CONCLUSIONS No reperfusion of vessels or capillary network was detected in NP areas using 2 imaging techniques, UWF FA and SS-WF OCTA, in eyes with DR after 3 anti-VEGF injections. The detection rate of NP areas was higher with SS-WF OCTA than with UWF FA.
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RETINAL MICROVASCULATURE AND VISUAL ACUITY AFTER INTRAVITREAL AFLIBERCEPT IN EYES WITH CENTRAL RETINAL VEIN OCCLUSION: An Optical Coherence Tomography Angiography Study. Retina 2019; 38:2067-2072. [PMID: 28902097 DOI: 10.1097/iae.0000000000001828] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate vascular perfusion and foveal avascular zone area in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) after intravitreal aflibercept therapy in central retinal vein occlusion eyes and their association with best-corrected visual acuity. METHODS Thirty-five subjects with central retinal vein occlusion and macular edema were evaluated. After macular edema resolution following intravitreal aflibercept, subjects underwent optical coherence tomography angiography to measure SCP and DCP perfusion and the foveal avascular zone within a 3 × 3-mm area. Correlations between best-corrected visual acuity and optical coherence tomography angiography measurements were examined. RESULTS After intravitreal aflibercept therapy, mean retinal vascular area was 3.41 ± 0.74 mm in the SCP and 3.25 ± 0.91 mm in the DCP. Foveal avascular zone area was 1.03 ± 1.04 mm in the SCP and 1.78 ± 1.73 mm in the DCP. Improved best-corrected visual acuity was significantly associated with better SCP and DCP perfusion (both P < 0.001) and with smaller SCP and DCP foveal avascular zone areas (both P < 0.001). Additionally, SCP and DCP perfusion were negatively correlated with macular edema before treatment (P < 0.05) and ischemia (determined via pretreatment fluorescein angiography, P < 0.05), and positively correlated with photoreceptor integrity (P < 0.001). CONCLUSION Patients with better retinal perfusion and less retinal ischemia are associated with better visual outcomes after aflibercept in eyes with central retinal vein occlusion.
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Abstract
RATIONALE To report a rare case of 8-year-old girl patient with central retinal venous occlusion (CRVO) with hyperhomocysteinemia. PATIENT CONCERNS The patient had a 2-year history on painless visual loss in the left eye. DIAGNOSES All examination results were within normal limits except plasma homocysteine (HCY). Fluorescein angiography (FA) confirmed peripheral capillary non-perfusion (CNP) in the left eye, and OCT showed macular edema. The girl patient was diagnosed as CRVO. INTERVENTIONS Based on all of the test results, laser photocoagulation was performed at peripheral capillary non-perfusion (NP). Ranibizumab was injected into virtreous cavity to reduce the macular edema. Oral folic acid, vitamin B12, and vitamin B6 were performed to the girl. OUTCOMES After 13 months, the girl visual acuity recovered to 20/100 in the left eye. LESSONS All eye examinations should be performed in young patients, and they should undergo treatments immediately after is diagnosed as CRVO.
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Affiliation(s)
| | - Xuemei Pan
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine
| | - Wenjun Jiang
- Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Hongsheng Bi
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine
- Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, China
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Branch Retinal Vein Occlusion: Treatment Outcomes According to the Retinal Nonperfusion Area, Clinical Subtype, and Crossing Pattern. Sci Rep 2019; 9:6569. [PMID: 31024035 PMCID: PMC6483995 DOI: 10.1038/s41598-019-42982-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 04/08/2019] [Indexed: 01/30/2023] Open
Abstract
This prospective study examined 58 eyes with branch retinal vein occlusion (BRVO) to investigate the effects of the nonperfusion area (NPA), clinical subtype, and crossing pattern on the 2-year outcomes of ranibizumab therapy for the macular edema (ME). All eyes received three initial monthly injections, followed by additional pro re nata (PRN) injections. The final best corrected visual acuity (BCVA) and ranibizumab injection number were not associated with the macular NPA or total NPA at baseline or month 12, and they showed no significant differences between the clinical subtypes. However, the incidence of neovascular changes was higher in the major BRVO group than in the macular BRVO group (P = 0.030). Twelve and 19 of the 34 eyes with major BRVO exhibited arterial overcrossing and venous overcrossing, respectively. At baseline, the total NPA did not differ according to the crossing pattern, however, the total NPA was significantly larger in the venous overcrossing group at month 12 (P = 0.047). At month 24, the incidence of neovascular changes was higher in the venous overcrossing group (P = 0.030). Following ranibizumab therapy for BRVO-associated ME, the clinical subtype and the arteriovenous crossing pattern may be associated with neovascular changes.
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37
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Ou WC, Lampen SIR, Wykoff CC. Longitudinal Quantification of Retinal Nonperfusion in the Macula of Eyes With Retinal Vein Occlusion Receiving Anti-VEGF Therapy: Secondary Analysis of the WAVE Randomized Trial. Ophthalmic Surg Lasers Imaging Retina 2019; 49:258-264. [PMID: 29664983 DOI: 10.3928/23258160-20180329-08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 12/04/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVE Longitudinal quantification of retinal nonperfusion (RNP) in eyes with retinal vein occlusion (RVO) undergoing anti-vascular endothelial growth factor therapy. PATIENTS AND METHODS Thirty eyes with ischemic RVO were randomized to ranibizumab (Lucentis; Genentech, South San Francisco, CA) (monotherapy) or ranibizumab plus peripheral laser (combination therapy) in a 12-month, prospective trial. RNP on fluorescein angiography was quantified within the macula through 12 months of follow-up. RESULTS Baseline mean macular RNP areas were 5.04 mm2 and 8.30 mm2 in the monotherapy (n = 5) and combination therapy (n = 15) cohorts, respectively. Through month 12, mean macular RNP area increased 0.36 mm2 and 0.53 mm2 in the monotherapy and combination therapy cohorts, respectively (P = .77). Marked, progressive RNP was observed in three eyes (12%). No areas of reperfusion were detected in any eye. CONCLUSION Among ischemic RVO eyes in WAVE, macular RNP was common at baseline and remained stable over time in most eyes, though marked RNP progression occurred in a minority of eyes. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:258-264.].
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Winegarner A, Wakabayashi T, Fukushima Y, Sato T, Hara-Ueno C, Busch C, Nishiyama I, Shiraki N, Sayanagi K, Nishida K, Sakaguchi H, Nishida K. Changes in Retinal Microvasculature and Visual Acuity After Antivascular Endothelial Growth Factor Therapy in Retinal Vein Occlusion. Invest Ophthalmol Vis Sci 2019; 59:2708-2716. [PMID: 29860457 DOI: 10.1167/iovs.17-23437] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the changes in the retinal microvasculature during the course of anti-VEGF therapy in eyes with macular edema due to retinal vein occlusion (RVO) and their association with visual outcomes. Methods The vessel density (VD) and foveal avascular zone (FAZ) area in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were quantitatively measured by optical coherence tomography angiography (OCTA) in 48 consecutive eyes with RVO before and 1, 3, 6, 9, and 12 months after anti-VEGF therapy. Anti-VEGF therapy was performed either with ranibizumab or aflibercept following a pro re nata (PRN) regimen. The correlation between post-treatment best-corrected visual acuity (BCVA) and changes in the retinal microvasculature evaluated by OCTA were assessed. Results The BCVA improved significantly at 12 months (P < 0.001). Better BCVA at 12 months was significantly associated with a better VD in the SCP and DCP both at baseline (R2 = 0.524, P < 0.001 and R2 = 0.457, P < 0.001, respectively) and at 12 months (R2 = 0.521, P < 0.001 and R2 = 0.662, P < 0.001, respectively). Overall, both VD and FAZ did not change significantly during the 12 months. However, the progression of nonperfusion was observed in the SCP in 6 (13%) eyes and in the DCP in 10 (21%) eyes. The number of macular edema recurrence was significantly associated with a decrease in the VD (P = 0.006 [SCP] and P < 0.001 [DCP]) and less visual gain (P = 0.02) after treatment. Conclusions Anti-VEGF therapy maintains retinal perfusion in most patients with RVO. Preserving retinal perfusion is crucial for better visual outcomes.
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Affiliation(s)
- Andrew Winegarner
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Taku Wakabayashi
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoko Fukushima
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tatsuhiko Sato
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Chikako Hara-Ueno
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Caleb Busch
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Issei Nishiyama
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Nobuhiko Shiraki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kaori Sayanagi
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kentaro Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hirokazu Sakaguchi
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
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Spooner K, Hong T, Bahrami B, Chang A. A meta-analysis of patients with treatment-resistant macular oedema secondary to retinal vein occlusions following switching to aflibercept. Acta Ophthalmol 2019; 97:15-23. [PMID: 30251325 DOI: 10.1111/aos.13802] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 04/01/2018] [Indexed: 11/30/2022]
Abstract
To systematically review anatomical and functional outcomes of switching therapy from bevacizumab and/or ranibizumab to aflibercept in patients with persistent macular oedema secondary to retinal vein occlusions (RVO). A systematic search of aflibercept for the treatment of persistent macular oedema secondary to branch and central RVO was performed in EMBASE, PubMed and Cochrane databases prior to June 2017. The main outcome variables described were best-corrected visual acuity (BCVA) and central macular thickness (CMT). All results were analysed and pooled using random-effects models with 95% confidence intervals (CI). Eight studies met the inclusion criteria with a total of 137 eyes, incorporating both branch and central RVO. Meta-analysis demonstrated a nonsignificant change in BCVA at 6 and 12 months following switch to aflibercept (4.40 letters, 95% CI: -3.10 to 11.90, p = 0.25 and 3.10 letters, 95% CI: -1.74 to 7.94, p = 0.21, respectively). Significant improvement in mean CMT was observed after switch to aflibercept at 6 (-256.00 μm, 95% CI: -318.00 to -194.00, p < 0.001) but not 12 months (-118.00 μm, 95% CI: -261.00 to 25.00, p = 0.11). Switching from bevacizumab/ranibizumab to aflibercept may improve persistent macular oedema secondary to RVO. However, there may be a limitation in the potential of visual recovery.
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Affiliation(s)
- Kimberly Spooner
- Sydney Retina Clinic & Day Surgery; Sydney NSW Australia
- Sydney Institute of Vision Science; Sydney NSW Australia
- University of Sydney; Sydney NSW Australia
| | - Thomas Hong
- Sydney Retina Clinic & Day Surgery; Sydney NSW Australia
- Sydney Institute of Vision Science; Sydney NSW Australia
| | - Bobak Bahrami
- Sydney Retina Clinic & Day Surgery; Sydney NSW Australia
- University of Sydney; Sydney NSW Australia
| | - Andrew Chang
- Sydney Retina Clinic & Day Surgery; Sydney NSW Australia
- Sydney Institute of Vision Science; Sydney NSW Australia
- University of Sydney; Sydney NSW Australia
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40
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Nishinaka A, Inoue Y, Fuma S, Hida Y, Nakamura S, Shimazawa M, Hara H. Pathophysiological Role of VEGF on Retinal Edema and Nonperfused Areas in Mouse Eyes With Retinal Vein Occlusion. ACTA ACUST UNITED AC 2018; 59:4701-4713. [DOI: 10.1167/iovs.18-23994] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Anri Nishinaka
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Yuki Inoue
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Shinichiro Fuma
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Yoshifumi Hida
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Shinsuke Nakamura
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Masamitsu Shimazawa
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Hideaki Hara
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
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EVALUATION OF MACULAR ISCHEMIA IN EYES WITH BRANCH RETINAL VEIN OCCLUSION: An Optical Coherence Tomography Angiography Study. Retina 2018; 38:272-282. [PMID: 28221256 DOI: 10.1097/iae.0000000000001541] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To quantitatively assess macular morphology and perfusion status using optical coherence tomography, and optical coherence tomography angiography in eyes with branch retinal vein occlusion when macular edema has completely resolved, and to investigate the impact on visual function. METHODS Thirty consecutive eyes with branch retinal vein occlusion-macular edema that resolved after treatment with intravitreal ranibizumab injections were included. Macular sensitivity was measured by microperimetry; defect length of foveal ellipsoid zone band was measured using optical coherence tomography; foveal avascular zone and parafoveal nonperfusion areas (NPA) were measured by optical coherence tomography angiography. RESULTS The logarithm of minimum angle of resolution visual acuity was significantly associated with the defect length of the foveal ellipsoid zone band (P = 0.005), the parafoveal NPA in the superficial capillary plexus (P = 0.007), and the parafoveal NPA in the deep capillary plexus (P = 0.006). Macular sensitivity correlated with parafoveal thickness on the affected side (P = 0.034), the defect length of the foveal ellipsoid zone band (P = 0.048), parafoveal NPA in the superficial capillary plexus (P = 0.008), and parafoveal NPA in the deep capillary plexus (P = 0.012). Multivariate analysis where the only significant parameters in the univariate analyses were used as the independent variables showed that parafoveal NPA was most significantly associated with the logarithm of minimum angle of resolution visual acuity (β = 0.500, P = 0.005) and macular sensitivity (β = -0.480, P = 0.007). CONCLUSION In eyes with branch retinal vein occlusion-macular edema resolved by intravitreal ranibizumab treatments, visual function was strongly associated with parafoveal NPA size.
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RANIBIZUMAB FOR RETINAL VEIN OCCLUSION: Predictive Factors and Long-Term Outcomes in Real-Life Data. Retina 2018; 38:559-568. [PMID: 28248827 DOI: 10.1097/iae.0000000000001579] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the long-term anatomical and functional outcomes in patients with retinal vein occlusion (RVO), either central retinal vein occlusion or branch retinal vein occlusion, treated with intravitreal ranibizumab and to determine the predictive factors of the final visual outcome. METHODS This retrospective study included 54 treatment-naive patients with macular edema due to RVO (25 with central retinal vein occlusion and 29 with branch retinal vein occlusion), who were treated with intravitreal ranibizumab (3 monthly injections and pro re nata). Predictive factors for visual outcome were assessed. In addition, the best-corrected visual acuity change and the percentage of patients with edema resolution were evaluated. RESULTS The mean follow-up time was 47.4 ± 11.1 months. At the end of the follow-up, patients with central retinal vein occlusion gained +6.9 letters (∼1 Snellen line), whereas patients with branch retinal vein occlusion gained +15.1 letters (3 Snellen lines). Forty-eight percent of patients in central retinal vein occlusion group and 69.0% in branch retinal vein occlusion group presented resolution of macular edema. Negative predictive factors for the final visual outcome were found to be increasing age, increasing macular thickness, the presence of intraretinal fluid, the duration of RVO >3 months, the ischemic type of RVO, the cystoid type of edema, and the external limiting membrane and ellipsoid zone disruption. CONCLUSION The various predictive factors that determine the visual outcome and possibly define the patients' prognosis after ranibizumab treatment in RVO have been studied. The long follow-up period showed that ranibizumab seems to be safe and effective in the treatment of the disease.
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Silva RLE, Kanan Y, Mirando AC, Kim J, Shmueli RB, Lorenc VE, Fortmann SD, Sciamanna J, Pandey NB, Green JJ, Popel AS, Campochiaro PA. Tyrosine kinase blocking collagen IV-derived peptide suppresses ocular neovascularization and vascular leakage. Sci Transl Med 2018; 9. [PMID: 28100839 DOI: 10.1126/scitranslmed.aai8030] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 11/30/2016] [Indexed: 01/20/2023]
Abstract
Vascular endothelial growth factor (VEGF)-neutralizing proteins provide benefit in several retinal and choroidal vascular diseases, but some patients still experience suboptimal outcomes, and the need for frequent intraocular injections is a barrier to good outcomes. A mimetic peptide derived from collagen IV, AXT107, suppressed subretinal neovascularization (NV) in two mouse models predictive of effects in neovascular age-related macular degeneration (NVAMD) and inhibited retinal NV in a model predictive of effects in ischemic retinopathies. A combination of AXT107 and the current treatment aflibercept suppressed subretinal NV better than either agent alone. Furthermore, AXT107 caused regression of choroidal NV. AXT107 reduced the VEGF-induced vascular leakage that underlies macular edema in ischemic retinopathies and NVAMD. In rabbit eyes, which are closer to the size of human eyes, intraocular injection of AXT107 significantly reduced VEGF-induced vascular leakage by 86% at 1 month and 70% at 2 months; aflibercept significantly reduced leakage by 69% at 1 month and did not reduce leakage at 2 months, demonstrating the longer effectiveness of AXT107. AXT107 reduced ligand-induced phosphorylation of multiple receptors: VEGFR2, c-Met, and PDGFRβ. Optimal signaling through these receptors requires complex formation with β3 integrin, which was reduced by AXT107 binding to αvβ3 AXT107 also reduced total VEGFR2 levels by increasing internalization, ubiquitination, and degradation. This biomimetic peptide is a sustained, multitargeted therapy that may provide advantages over intraocular injections of specific VEGF-neutralizing proteins.
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Affiliation(s)
- Raquel Lima E Silva
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Yogita Kanan
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Adam C Mirando
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Jayoung Kim
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Ron B Shmueli
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Valeria E Lorenc
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Seth D Fortmann
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Jason Sciamanna
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Niranjan B Pandey
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,AsclepiX Therapeutics, LLC, Baltimore, MD 21211, USA
| | - Jordan J Green
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Institute for Nanobiotechnology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Aleksander S Popel
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Peter A Campochiaro
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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45
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Optical Coherence Tomography Angiography in Retinal Vein Occlusion: Quantifying Macular Ischemia. CURRENT OPHTHALMOLOGY REPORTS 2018. [DOI: 10.1007/s40135-018-0157-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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46
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Jiang Y, Mieler WF. Update on the Use of Anti-VEGF Intravitreal Therapies for Retinal Vein Occlusions. Asia Pac J Ophthalmol (Phila) 2017; 6:546-553. [PMID: 29204993 DOI: 10.22608/apo.2017459] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/14/2017] [Indexed: 11/08/2022] Open
Abstract
The use of anti-vascular endothelial growth factor (VEGF) therapy in ophthalmology has profoundly changed our management and treatment of conditions such as cystoid macular edema, diabetic macular edema, choroidal neovascularization, and other proliferative retinopathies. Although initially used for the treatment of choroidal neovascularization in neovascular age-related macular degeneration, their application has spread rapidly for other indications as their outcomes have often outperformed previously existing treatments. Retinal vein occlusion (RVO) continues to be one of the leading causes of vision loss secondary to macular edema, in addition to macular ischemia and neovascularization in more severe cases. Before the availability of anti-VEGF therapy, the use of macular grid laser and panretinal photocoagulation was the mainstay of treatment of macular edema and neovascularization, respectively, in patients with RVOs. Two landmarks studies established the guidelines of these treatments for nearly a quarter century. Since the availability of anti-VEGF agents, there has been a paradigm shift in the treatment of RVO. Most importantly, there has also been a significant improvement in visual outcomes in these patients. The goal of this article is to provide a review of the pertinent clinical studies that have investigated the use of anti-VEGF in patients with retinal vein occlusions.
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Affiliation(s)
- Yi Jiang
- University of Illinois at Chicago, Chicago, IL, United States
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47
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Iida Y, Muraoka Y, Ooto S, Suzuma K, Murakami T, Iida-Miwa Y, Ghashut R, Tsujikawa A. Morphologic and Functional Retinal Vessel Changes in Branch Retinal Vein Occlusion: An Optical Coherence Tomography Angiography Study. Am J Ophthalmol 2017; 182:168-179. [PMID: 28837791 DOI: 10.1016/j.ajo.2017.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/27/2017] [Accepted: 08/09/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The present study aimed to investigate the morphology of the retinal vasculature in eyes with branch retinal vein occlusion (BRVO) using optical coherence tomography (OCT) angiography. DESIGN Observational case series. METHODS Fluorescein angiography (FA) and OCT angiography were used to examine macular area and the retinal vasculature at the affected arteriovenous (AV) crossing in 46 patients with BRVO. RESULTS FA revealed that the affected AV crossing pattern involved arterial overcrossing in 23 eyes (50.0%) and venous overcrossing in 11 eyes (23.9%). However, FA failed to detect the crossing pattern in 10 eyes (21.7%). OCT angiography was significantly more effective for identification of the AV crossing pattern than FA (44 eyes; 95.7%; P = .013). The number of eyes with venous overcrossing detected via OCT angiography (20 eyes, 43.5%) was also higher than that detected via FA (P = .047). OCT angiography revealed that venous narrowing (25.5 ± 21.1 μm) was significantly greater in instances of venous overcrossing than in those of arterial overcrossing (46.4 ± 23.7 μm, P = .005). Macular nonperfusion areas (NPAs) were larger in eyes with venous overcrossing than in those with arterial overcrossing (P = .011 for superficial plexus, P = .049 for deep plexus). The peripheral NPA was significantly larger in eyes with venous overcrossing (65.1 ± 35.3 disc area [DA]) than in those with arterial overcrossing (17.2 ± 24.1 DA; P < .001). CONCLUSIONS Our findings suggest that BRVO characterized by venous overcrossing may be more prevalent than previously reported, and that there is a significant association between NPA size and AV crossing pattern.
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Affiliation(s)
- Yuto Iida
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuki Muraoka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Sotaro Ooto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kiyoshi Suzuma
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomoaki Murakami
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuko Iida-Miwa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Rima Ghashut
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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48
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Liu Y, Shen J, Fortmann SD, Wang J, Vestweber D, Campochiaro PA. Reversible retinal vessel closure from VEGF-induced leukocyte plugging. JCI Insight 2017; 2:95530. [PMID: 28931763 DOI: 10.1172/jci.insight.95530] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 08/08/2017] [Indexed: 11/17/2022] Open
Abstract
Clinical trials in patients with macular edema due to diabetic retinopathy or retinal vein occlusion (RVO) have shown that suppression of VEGF not only improves macular edema, but also reopens closed retinal vessels, prevents progression of vessel closure, and improves retinopathy. In this study, we show the molecular basis for those clinical observations. Increased retinal levels of VEGF in mice cause plugging of retinal vessels with leukocytes, vessel closure, and hypoxia. Suppression of VEGF reduces leukocyte plugging, causing reperfusion of closed vessels. Activation of VEGFR1 contributes to leukocyte recruitment, because it is significantly reduced by an anti-VEGFR1-neutralizing antibody. High VEGF increases transcriptional activity of NF-κB and expression of NF-κB target genes, particularly Vcam1. Injection of an anti-VCAM-1-neutralizing antibody reduces VEGF-induced leukocyte plugging. These data explain the broad range of benefits obtained by VEGF suppression in patients with ischemic retinopathies, provide an important insight into the pathogenesis of RVO and diabetic retinopathy, and suggest that sustained suppression of VEGF early in the course of these diseases may prevent vessel closure, worsening ischemia, and disease progression. This study also identifies VEGFR1 and VCAM-1 as molecular targets whose suppression could supplement VEGF neutralization for treatment of RVO and diabetic retinopathy.
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Affiliation(s)
- Yuanyuan Liu
- Department of Ophthalmology and.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jikui Shen
- Department of Ophthalmology and.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Seth D Fortmann
- Department of Ophthalmology and.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jiangxia Wang
- Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Dietmar Vestweber
- Department of Cell Biology, Max-Planck-Institute of Molecular Biomedicine, Muenster, Germany
| | - Peter A Campochiaro
- Department of Ophthalmology and.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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49
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Kashani AH, Chen CL, Gahm JK, Zheng F, Richter GM, Rosenfeld PJ, Shi Y, Wang RK. Optical coherence tomography angiography: A comprehensive review of current methods and clinical applications. Prog Retin Eye Res 2017; 60:66-100. [PMID: 28760677 PMCID: PMC5600872 DOI: 10.1016/j.preteyeres.2017.07.002] [Citation(s) in RCA: 567] [Impact Index Per Article: 81.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 02/06/2023]
Abstract
OCT has revolutionized the practice of ophthalmology over the past 10-20 years. Advances in OCT technology have allowed for the creation of novel OCT-based methods. OCT-Angiography (OCTA) is one such method that has rapidly gained clinical acceptance since it was approved by the FDA in late 2016. OCTA images are based on the variable backscattering of light from the vascular and neurosensory tissue in the retina. Since the intensity and phase of backscattered light from retinal tissue varies based on the intrinsic movement of the tissue (e.g. red blood cells are moving, but neurosensory tissue is static), OCTA images are essentially motion-contrast images. This motion-contrast imaging provides reliable, high resolution, and non-invasive images of the retinal vasculature in an efficient manner. In many cases, these images are approaching histology level resolution. This unprecedented resolution coupled with the simple, fast and non-invasive imaging platform have allowed a host of basic and clinical research applications. OCTA demonstrates many important clinical findings including areas of macular telangiectasia, impaired perfusion, microaneurysms, capillary remodeling, some types of intraretinal fluid, and neovascularization among many others. More importantly, OCTA provides depth-resolved information that has never before been available. Correspondingly, OCTA has been used to evaluate a spectrum of retinal vascular diseases including diabetic retinopathy (DR), retinal venous occlusion (RVO), uveitis, retinal arterial occlusion, and age-related macular degeneration among others. In this review, we will discuss the methods used to create OCTA images, the practical applications of OCTA in light of invasive dye-imaging studies (e.g. fluorescein angiography) and review clinical studies demonstrating the utility of OCTA for research and clinical practice.
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Affiliation(s)
- Amir H Kashani
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of University of Southern California; Los Angeles, CA 90033, United States.
| | - Chieh-Li Chen
- Department of Biomedical Engineering, University of Washington Seattle, Seattle, WA 98195, United States
| | - Jin K Gahm
- Laboratory of Neuro Imaging (LONI), USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, United States
| | - Fang Zheng
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Grace M Richter
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of University of Southern California; Los Angeles, CA 90033, United States
| | - Philip J Rosenfeld
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Yonggang Shi
- Laboratory of Neuro Imaging (LONI), USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, United States
| | - Ruikang K Wang
- Department of Biomedical Engineering, University of Washington Seattle, Seattle, WA 98195, United States
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50
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Minami Y, Nagaoka T, Ishibazawa A, Yoshida A. Correlation between short- and long-term effects of intravitreal ranibizumab therapy on macular edema after branch retinal vein occlusion: a prospective observational study. BMC Ophthalmol 2017; 17:90. [PMID: 28610573 PMCID: PMC5470248 DOI: 10.1186/s12886-017-0485-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 06/08/2017] [Indexed: 11/25/2022] Open
Abstract
Background The correlation between the short- and long-term effects of intravitreal ranibizumab (IVR) on macular edema after branch retinal vein occlusion (BRVO) remains unclear. We assessed the correlation between the short- and long-term effects of IVR on macular edema after BRVO. Methods Twenty-one eyes with macular edema after BRVO were enrolled in this prospective observational study. We measured the foveal thickness (FT) and the best-corrected visual acuity (BCVA) before, 1 day after, and 1 month after IVR (0.5 mg) and then at least every 2 months thereafter until 6 months after the injection. If the macular edema recurred, another injection was administered. The primary endpoint was the change from baseline in the BCVA (ΔVA). Results The mean logarithm of the minimum angle of resolution VA improved significantly (p = 0.01, p < 0.0001, respectively) after 1 day from 0.65 ± 0.28 to 0.51 ± 0.21 (20/89 to 20/63, Snellen equivalent) and after 6 months to 0.29 ± 0.24 (20/39, Snellen equivalent). The mean FT decreased significantly (p < 0.0001) after 1 day from 482 ± 85 μm to 349 ± 75 μm and after 6 months to 305 ± 84 μm. The 1-day VA was significantly (r = 0.68, p = 0.0007) positively correlated with the 6-month VA. The 1-day ΔVA was significantly (r = 0.79, p < 0.0001) positively correlated with the 6-month ΔVA. Conclusions The short-term effects of IVR may predict the long-term effects of IVR in macular edema secondary to BRVO. Trial registration Trial registration number: UMIN000027003. Retrospectively registered. (April/15/2017)
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Affiliation(s)
- Yoshiro Minami
- Department of Ophthalmology, Nayoro City General Hospital, Nishi 7 Minami 8-1, Nayoro, 096-8511, Japan.
| | - Taiji Nagaoka
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Akihiro Ishibazawa
- Department of Ophthalmology, Nayoro City General Hospital, Nishi 7 Minami 8-1, Nayoro, 096-8511, Japan.,Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Akitoshi Yoshida
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
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