New frontiers and clinical implications in the pathophysiology of age-related macular degeneration

Risk of Posterior Capsular Rupture during Phacoemulsification in Patients with the History of Anti-VEGF Intravitreal Injections: Results from the Pan-American Collaborative Retina Study (PACORES) Group

Purpose

To assess the risk for capsular rupture during routine phacoemulsification in patients with a history of anti-VEGF injections and other possible risk modifiers such as treatment patterns, type of anti-VEGF agent, and experience of the surgeon, among others.

Methods

This study reviewed the medical records of 11,129 patients from 7 different hospitals in 5 countries. The study included 939 patients that underwent routine phacoemulsification and had a history of anti-VEGF therapy. We excluded patients with known risk factors for capsular rupture, as well as patients with a history of other retinal procedures. The study extracted data regarding general demographics, the number of previous injections, type of anti-VEGF agent, details of cataract surgery, and anti-VEGF treatment patterns.

Results

Overall prevalence of posterior capsular rupture: 7.45% (95% CI: 5.9–9.32%). The mean number of injections per patient was 3.37 ± 2.8. More than 50% of the patients received their last anti-VEGF injection within three months before cataract surgery. The complication rate during intravitreal injections was 1.07%. In the univariate analysis, the experience of the cataract surgeon (inexperience surgeons; OR: 2.93) and the history of prior anti-VEGF therapy (OR: 1.77) were significant risk indicators for PCR (p < 0.05). However, after controlling for age in the multivariate analysis, the trend did not reach a statistical significance.

Conclusion

The risk for capsular rupture is higher in patients with a history of intravitreal anti-VEGF injections.

Matrix Metalloproteinase-7 Aggravated the Oxidized Low Density Lipoprotein-Induced Damage of Human Vascular Endothelial Cells

Introduction: Vascular endothelial injury could induce many cardiovascular diseases. Recently, some studies have indicated that matrix metalloproteinase-7 (MMP-7) was associated with the occurrence and development of cardiovascular diseases. However, whether higher levels of MMP-7 were associated with the occurrence of the vascular endothelial injury is unclear. Material and methods: In this study, ox-LDL was used for the simulation of vascular endothelial injury in HUVECs. Next, we detected the expression of MMP-7 in these cells. After that, we established the cell models with MMP-7 overexpression and knockdown, respectively. At last, the apoptosis and inflammation of HUVECs were detected with corresponding assays. Results: After the stimulation of ox-LDL, the expression of MMP-7 was enhanced compared to the control groups. After the stimulation of ox-LDL and the overexpression of MMP-7, the apoptosis rates of HUVECs were enhanced, while MMP-7 knockdown led to the decreased apoptosis rates of these cells. Furthermore, after the stimulation of ox-LDL and overexpression of MMP-7, the expression of inflammatory factors (IL-6, IL-1β and TNF-α) was promoted. Additionally, the expression of these proteins was repressed after knockdown of MMP-7. Conclusion: MMP-7 aggravated the ox-LDL-induced damage of HUVECs by promoting the apoptosis and inflammation of these cells.

Real Life Data of Treat and Extend Intravitreal Ranibizumab and Aflibercept Therapy in Wet Age-related Macular Degeneration Patients: 3-Year Results

Purpose

To compare functional and anatomic outcome of intravitreal ranibizumab (IVR) and intravitreal aflibercept (IVA) treatments in neovascular age-related macular degeneration by using the treat and extend (TE) protocol.

Methods

In this retrospective chart study, treatment naïve 74 eyes of 74 age-related macular degeneration patients treated with IVR and IVA (38 eyes in IVR and 36 eyes in IVA group) with TE protocol were included. Following three consecutive monthly intravitreal injections, TE protocol was applied to each group. Patients were followed up for at least 36 months. Mean change in best-corrected visual acuity (BCVA), central macula thickness (CMT) and injection numbers over 3 years were compared.

Results

Among 36 months period, the mean number of injections was 17 ± 4 for both groups (p > 0.05). In terms of CMT, there was no statistically significant difference between groups at 36 months compared to baseline. A decrease of 72.55 ± 39.37 μm in CMT was detected in IVR group, whereas the decrease was 70.58 ± 33.96 μm in IVA group (p > 0.05). There was a significant increase in BCVA at 36 months of measurements. In addition, BCVA demonstrated an increase of 4.1 ± 0.44 letters in IVR group and 4.36 ± 0.67 letters in IVA group after 36 months compared to the baseline (p > 0.05).

Conclusions

Both IVR and IVA injections provided significant improvements and stability in BCVA and CMT, however there was no significant difference between IVR and IVA injections with TE protocol of 36 months.