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Nihei A, Yamamoto M, Hirayama K, Kyo A, Misawa N, Kohno T, Honda S. The impact of removing the epiretinal membrane and inner limiting membrane for sustained subretinal fluid by macular neovascularization refractory to anti-VEGF therapy. Am J Ophthalmol Case Rep 2024; 35:102078. [PMID: 38846070 PMCID: PMC11154113 DOI: 10.1016/j.ajoc.2024.102078] [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: 01/28/2024] [Revised: 04/09/2024] [Accepted: 04/26/2024] [Indexed: 06/09/2024] Open
Abstract
Purpose Anti-vascular endothelial growth factor (VEGF) therapy is the most prevalent intervention for exudative lesions secondary to neovascular age-related macular degeneration (nAMD) and other macular neovascularization (MNV). However, in some cases refractory to the latest anti-VEGF agents is associated with epiretinal membrane (ERM) or vitreomacular traction. We applied a vitrectomy to remove those pathologies which may be effective for reducing the exudation. Observations In this case report, we present 2 cases with sustained subretinal fluid and macular neovascularization secondary to nAMD or dome-shaped macula that poorly responded to anti-VEGF therapy. In both cases, removing thin ERM or vitreomacular traction with an inner limiting membrane peeling promptly resolved the subretinal fluid and no recurrence was observed thereafter. Conclusions and importance Vitrectomy could be an effective modality for anti-VEGF drug-resistant MNV cases with vitreomacular traction or ERM even in the anti-VEGF era.
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Affiliation(s)
- Aki Nihei
- Department of Ophthalmology and Visual Sciences, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Manabu Yamamoto
- Department of Ophthalmology and Visual Sciences, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kumiko Hirayama
- Department of Ophthalmology and Visual Sciences, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Akika Kyo
- Department of Ophthalmology and Visual Sciences, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Norihiko Misawa
- Department of Ophthalmology and Visual Sciences, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Takeya Kohno
- Department of Ophthalmology and Visual Sciences, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Honda
- Department of Ophthalmology and Visual Sciences, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Lange C, Boneva S, Wieghofer P, Sebag J. Hyalocytes-guardians of the vitreoretinal interface. Graefes Arch Clin Exp Ophthalmol 2024; 262:2765-2784. [PMID: 38568222 PMCID: PMC11377362 DOI: 10.1007/s00417-024-06448-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 09/06/2024] Open
Abstract
Originally discovered in the nineteenth century, hyalocytes are the resident macrophage cell population in the vitreous body. Despite this, a comprehensive understanding of their precise function and immunological significance has only recently emerged. In this article, we summarize recent in-depth investigations deciphering the critical role of hyalocytes in various aspects of vitreous physiology, such as the molecular biology and functions of hyalocytes during development, adult homeostasis, and disease. Hyalocytes are involved in fetal vitreous development, hyaloid vasculature regression, surveillance and metabolism of the vitreoretinal interface, synthesis and breakdown of vitreous components, and maintenance of vitreous transparency. While sharing certain resemblances with other myeloid cell populations such as retinal microglia, hyalocytes possess a distinct molecular signature and exhibit a gene expression profile tailored to the specific needs of their host tissue. In addition to inflammatory eye diseases such as uveitis, hyalocytes play important roles in conditions characterized by anomalous posterior vitreous detachment (PVD) and vitreoschisis. These can be hypercellular tractional vitreo-retinopathies, such as macular pucker, proliferative vitreo-retinopathy (PVR), and proliferative diabetic vitreo-retinopathy (PDVR), as well as paucicellular disorders such as vitreo-macular traction syndrome and macular holes. Notably, hyalocytes assume a significant role in the early pathophysiology of these disorders by promoting cell migration and proliferation, as well as subsequent membrane contraction, and vitreoretinal traction. Thus, early intervention targeting hyalocytes could potentially mitigate disease progression and prevent the development of proliferative vitreoretinal disorders altogether, by eliminating the involvement of vitreous and hyalocytes.
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Affiliation(s)
- Clemens Lange
- Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany.
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Stefaniya Boneva
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Wieghofer
- Cellular Neuroanatomy, Institute of Theoretical Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - J Sebag
- VMR Institute for Vitreous Macula Retina, Huntington Beach, CA, USA.
- Doheny Eye Institute, UCLA, Pasadena, CA, USA.
- Department of Ophthalmology, Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
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Boneva S, Haritoglou C, Schultheiss M, Binder S, Sebag J. [Role of vitreous in the pathogenesis of neovascular age-related macular degeneration]. DIE OPHTHALMOLOGIE 2023; 120:992-998. [PMID: 37801159 DOI: 10.1007/s00347-023-01934-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/07/2023]
Abstract
Age-related changes in vitreous molecular and anatomic morphology begin early in life and involve two major processes: vitreous liquefaction and weakening of vitreo-retinal adhesion. An imbalance in these two processes results in anomalous posterior vitreous detachment (PVD), which comprises, among other conditions, vitreo-macular adhesion (VMA) and traction (VMT). VMA is more common in patients with neovascular age-related macular degeneration (nAMD) than age-matched control patients, with the site of posterior vitreous adherence to the inner retina correlating with location of neovascular complexes. The pernicious effects of an attached posterior vitreous on age-related macular degeneration (AMD) progression involve mechanical forces, enhanced fluid influx and inflammation in and between the retinal layers, hypoxia leading to an accumulation of vascular endothelial growth factor (VEGF) and other stimulatory cytokines, and probably an infiltration of hyalocytes. It has been shown that vitrectomy not only mitigates progression to end-stage AMD, but existing choroidal neovascularization regresses after surgery. Thus, surgical PVD induction during vitrectomy or by pharmacologic vitreolysis may be considered in non-responders to anti-VEGF treatment with concomitant VMA.
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Affiliation(s)
- Stefaniya Boneva
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland.
| | | | - Maximilian Schultheiss
- Augenklinik Herzog Carl Theodor, München, Deutschland
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Susanne Binder
- Lehrstuhl für Ophthalmologie, Sigmund Freud Universität, Wien, Österreich
| | - J Sebag
- VMR Institute for Vitreous Macula Retina, Huntington Beach, CA, USA
- Doheny Eye Institute, Pasadena, CA, USA
- Department of Ophthalmology, Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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Siotto-Pintor E, Tatti F, Peiretti E. AMNIOTIC MEMBRANE TRANSPLANT IN A PATIENT WITH RECURRENT MACULAR HOLE AND ATROPHIC AGE-RELATED MACULAR DEGENERATION. Retin Cases Brief Rep 2023; 17:482-485. [PMID: 37364214 DOI: 10.1097/icb.0000000000001227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
PURPOSE To report a case of a recurrent macular hole (MH) and atrophic age-related macular degeneration in a patient, treated with human amniotic membrane transplant. METHODS Interventional case report. RESULTS A 72-year-old man was referred to our Retina Unit for a recurrent MH associated with atrophic age-related macular degeneration. The patient was already operated for a full-thickness MH without any anatomical and functional benefit. A 25-gauge vitrectomy, under local anesthesia was performed. A human amniotic membrane patch was transplanted under the retina through a 180° retinectomy to close the MH and eventually exploit his regenerative effects on the atrophic pigment epithelium. Follow-up was taken at 1, 3, and 6 months and 1 year. No intra- or postoperative complications were recorded. At 1 month, a complete MH closure was achieved, and best-corrected visual acuity increased from 20/400 to 20/320. Unfortunately, after 1 year, the macular atrophic area increased and the best-corrected visual acuity came back to 20/400. CONCLUSION A human amniotic membrane was used to close a MH in a patient with atrophic age-related macular degeneration, although progression of the geographic atrophy continued after MH closure.
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Touma-Falci L, Moreira-Neto CA, Taleb AC, Prieto MB, Packer T, Oliveira JCB, Birck MG, Julian GS, Forestiero FJ. Age-related macular degeneration and resource utilization in the Brazilian public healthcare system: a real-world retrospective study. BMC Ophthalmol 2021; 21:430. [PMID: 34903203 PMCID: PMC8667450 DOI: 10.1186/s12886-021-02181-1] [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: 12/17/2020] [Accepted: 10/06/2021] [Indexed: 12/04/2022] Open
Abstract
Background Age-related macular degeneration (AMD) is a disease that causes damage in the macular region of the retina, leading to irreversible blindness. This study aims to understand the profile and care of patients with AMD and its cost at the Brazilian public health system to identify AMD-care needs. Methods This is a retrospective observational study of AMD with real-world data from the Brazilian public healthcare system, using DATASUS claim databases. Patients with AMD were selected from 01/Jan/2014 to 31/Jan/2020; had at least one claim of ICD10 code H35.3 (Degeneration of macula and posterior pole), and were submitted to one of two procedures exclusively available for AMD patients - optical coherence tomography (OCT) and medical treatment of retinal disease (antiangiogenic); aged ≥18 years at first ICD10 claim, and presenting at least 1 year of follow-up in the database. We described patients’ characteristics, healthcare resource utilization and cost, and the antiangiogenic intravitreal treatment received by AMD patients, including the number of doses and interval time between them. Results Patients searching for AMD treatment since 2014 were mostly females (59%), white (61%), and a mean age of 72 years. They were mainly located in the Southeast (87%), and few patients were found in the North (1%) and Central-West (1.5%) regions, probably reflecting where the Brazilian guideline to treat AMD (Protocolo Clínico e Diretrizes Terapêuticas - PCDT) was incorporated as routine care for AMD. The average antiangiogenic dose of 2.5 antiangiogenic therapies within a year was below the expected. Most injections had an interval time of 20 to 40 days between doses, although some patients were treated more than 100 days. Another setback is that patients traveled longer distances for OCT and antiangiogenic treatment than overall AMD-healthcare, between 10 and 100 km. Conclusions AMD patients seem to be undertreated, as they receive a mean of 2.5 doses of antiangiogenic treatment within a year. Inequalities among regions are evident, as the Southeast and South regions comprise almost all patients receiving the treatment from the public health system, probably reflecting the region with more access to AMD care according to PCDT recommendations. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-02181-1.
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Affiliation(s)
- Liane Touma-Falci
- Novartis Biociências SA, Vicente Rao Avenue, 90, São Paulo, SP, 04636-000, Brazil
| | | | | | - Marcela Bach Prieto
- Novartis Biociências SA, Vicente Rao Avenue, 90, São Paulo, SP, 04636-000, Brazil
| | - Thais Packer
- Novartis Biociências SA, Vicente Rao Avenue, 90, São Paulo, SP, 04636-000, Brazil
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Influence of vitrectomy on the progression of dry age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2020; 259:847-853. [PMID: 33064198 DOI: 10.1007/s00417-020-04943-x] [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: 07/16/2020] [Revised: 09/09/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To demonstrate whether pars plana vitrectomy (PPV) changes the progression of dry age-related macular degeneration (AMD) by assessing longitudinal changes in drusen volume over follow-up. METHODS Dry AMD patients who had undergone unilateral PPV for symptomatic vitreomacular disorders were evaluated for the progression of disease by spectral domain-optical coherence tomography (SD-OCT) features including drusen volume, development of geographic atrophy, or choroidal neovascularization during follow-up. Drusen volume was manually calculated using an image processing software (ImageJ, NIH) on raster SD-OCT scans. Mean change in drusen volume of surgery eyes was compared with values of the fellow eyes of the same subjects (control group). RESULTS Among 183 eyes with both vitreoretinal disorder and dry AMD, 48 eyes of 24 patients met the inclusion criteria and were included. The mean drusen volume change during a mean of 25.49 ± 23.35 months of follow-up (range: 6.00-86.87 months) was 4.236.899 ± 20.488.913 μm3 in the study eye and 7.796.357 ± 34.798.519 μm3 in the fellow eye (p = 0.297). Best-corrected visual acuity (BCVA) significantly increased from 0.40 ± 0.18 logMAR (≈ 20/50 Snellen equivalent) to 0.32 ± 0.31 (≈ 20/41 Snellen equivalent) after surgery (p = 0.012) in the study group while BCVA remained stable in the control group (0.19 ± 0.34 logMAR [≈ 20/30 Snellen equivalent] at baseline and 0.20 ± 0.31 logMAR [≈ 20/31 Snellen equivalent], p = 0.432). Choroidal neovascularization developed in 1 vitrectomized eye (4.54%) and in 1 eye (4.54%) from the control group during follow-up. CONCLUSION Vitrectomy did not seem to worsen dry AMD progression; even more visual acuity may improve despite a slight increase in drusen volume following surgery.
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Bang JW, Bang CW, Lee MS, Jeon HM, Yoon HS. Observational Study in Drusen Patients with Epiretinal Membrane after Vitrectomy and Membrane Peeling. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.10.1149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lu AQ, Prensky JG, Baker PS, Scott IU, Mahmoud TH, Todorich B. Update on medical and surgical management of submacular hemorrhage. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1725474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Amy Q. Lu
- Department of Ophthalmology, Penn State College of Medicine, Hershey, PA, USA
| | | | | | - Ingrid U. Scott
- Department of Ophthalmology, Penn State College of Medicine, Hershey, PA, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Tamer H. Mahmoud
- Department of Ophthalmology, Oakland University William Beaumont School of Medicine, and Associated Retinal Consultants, PC, Royal Oak, MI, USA
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Furashova O, Engelmann K. To Peel or Not to Peel: Pars Plana Vitrectomy with Macular Membrane Peel in Eyes with Abnormalities of Vitreomacular Interface and Coexisting Dry Age-Related Macular Degeneration. Clin Ophthalmol 2020; 14:389-396. [PMID: 32103885 PMCID: PMC7023885 DOI: 10.2147/opth.s240480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/03/2020] [Indexed: 11/27/2022] Open
Abstract
Purpose To evaluate the outcome of macular surgery with ILM- and epiretinal membrane peel associated with significant dry age-related macular degeneration (AMD) as defined by the Age-Related Eye Disease Study (AREDS). Patients and Methods Institutional. Retrospective case-control study. A total of 42 pseudophacic eyes of 39 patients (7 with full thickness macular hole and 35 with epiretinal membrane) with coexisting dry AMD underwent pars plana vitrectomy (PPV) with internal limiting membrane (ILM) and epiretinal membrane peel. Preoperative and postoperative data including best corrected visual acuity (BCVA), AMD grade according to AREDS, central retinal thickness (CRT), development of choroidal neovascularization (CNV), and central retinal atrophy have been evaluated. Twenty-eight fellow eyes with dry AMD of the included 39 patients served as a control group. Results A significant improvement in the visual acuity could be observed after surgery (initial BCVA 0.47±0.31 logarithm of the minimal angle of resolution (logMAR) vs 0.33±0.29logMAR 9 months postoperatively; p=0.006). CRT decreased significantly after surgery (p<0.001). In the surgery group, there were 4 eyes (9.5%) with CNV and 1 eye (2.5%) with new central retinal atrophy development after surgery. All these eyes had preoperative AREDS 3 (4 eyes) or AREDS 4 (1 eye) AMD category. In the control group, there was 1 eye (4%) with CNV and 4 eyes (14%) with new central retinal atrophy development during the follow-up of 9 months. These eyes had initially AREDS 2 (1 eye), AREDS 3 (3 eyes) or AREDS 4 (1 eye) AMD category. Conclusion Eyes with dry AMD of AREDS 3 and AREDS 4 with coexisting VMI abnormalities improve significantly after PPV with membrane peel. While there is a higher risk of CNV development after surgery (9.5%) in these eyes, the vitrectomy does not seem to accelerate central retinal atrophy progression compared to the fellow eyes course.
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Affiliation(s)
- Olga Furashova
- Department of Ophthalmology, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Katrin Engelmann
- Department of Ophthalmology, Klinikum Chemnitz gGmbH, Chemnitz, Germany
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Obeid A, Ali FS, Deaner JD, Gao X, Hsu J, Chiang A. Outcomes of Pars Plana Vitrectomy for Epiretinal Membrane in Eyes With Coexisting Dry Age-related Macular Degeneration. Ophthalmol Retina 2019; 2:765-770. [PMID: 31047527 DOI: 10.1016/j.oret.2018.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 12/21/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE There has been limited evidence on the benefits of pars plana vitrectomy with membrane peel (PPV-MP) for epiretinal membrane (ERM) in eyes with dry age-related macular degeneration (AMD). We sought to assess anatomic and functional outcomes of PPV-MP for ERM in this subset of eyes. DESIGN A retrospective cohort study. PARTICIPANTS Patients with dry AMD who underwent PPV-MP for ERM from January 1, 2010, to December 1, 2016. METHODS Visual acuity (VA) and central foveal thickness (CFT) as measured on spectral-domain OCT were recorded and analyzed for the preoperative, 6-month, and final follow-up visits. The presence of cystoid macular edema (CME) and ellipsoid zone (EZ) integrity were recorded and compared with postoperative imaging. Conversion to neovascular AMD in eyes for which at least 2 years of follow-up were available, as confirmed by either OCT and/or fluorescein angiography and documentation of treatment with intravitreal antivascular endothelial growth factor, was recorded and compared between case eyes that underwent PPV-MP versus fellow control eyes. MAIN OUTCOME MEASURES Postoperative VA. RESULTS A total of 38 eyes from 38 patients met the study criteria. There was a significant improvement in the median (interquartile range, [IQR]) logarithm of the minimum angle of resolution [logMAR] VA from 0.60 (IQR 0.46-1.00) (20/80, Snellen equivalent) at the preoperative visit, to 0.48 (IQR 0.30-0.70) (20/60, Snellen equivalent) at the 6-month follow-up visit (P = 0.04), and to 0.48 (IQR 0.30-0.70) (20/60, Snellen equivalent) at the final visit (P = 0.01). There was a significant median decrease in CFT at the final visit (P < 0.001) compared with the preoperative CFT. Only eyes with either CME or an intact EZ showed significant improvement in median logMAR VA at the final visit compared with the preoperative visit (P = 0.01 and P = 0.004, respectively). In a subgroup analysis of eyes for which a minimum of 2 years of follow-up were available, 4 of 25 (16.0%) vitrectomized eyes and 1 of 25 (4.0%) fellow control eyes progressed to neovascular AMD (P = 0.16). CONCLUSIONS PPV-MP appears to confer anatomic and functional improvement in eyes with ERM and coexisting dry AMD. Moreover, greater preoperative CFT, the presence of CME, and an intact EZ were predictors of VA improvement in these eyes.
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Affiliation(s)
- Anthony Obeid
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Ferhina S Ali
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Jordan D Deaner
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Xinxiao Gao
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania; Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jason Hsu
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Allen Chiang
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania.
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Epiretinal Membrane Surgery Outcomes in Eyes with Subretinal Drusenoid Deposits: A Case Control Study. Ophthalmol Retina 2018; 2:1218-1226. [PMID: 31047194 DOI: 10.1016/j.oret.2018.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 06/09/2018] [Accepted: 06/19/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate outcomes of epiretinal membrane (ERM) surgery in eyes with subretinal drusenoid deposits (SRDDs) and to compare them with those with isolated ERM. DESIGN Retrospective case-control study of consecutive patients who underwent pars plana vitrectomy (PPV) with ERM peeling. PARTICIPANTS Twenty-five patients with SRDDs on spectral-domain (SD)-OCT who underwent surgery for ERM were included in the study. From the same cohort, for each case, we selected 2 age-matched control participants (50 eyes with isolated ERM). Preoperative best-corrected visual acuity (BCVA) also was matched as closely as possible. METHODS All participants underwent PPV and ERM peel for primary ERM. MAIN OUTCOME MEASURES Postoperative BCVA, improvement in BCVA, preoperative and postoperative central macular thickness, surgical complications, and development of age-related macular degeneration (AMD) were recorded. RESULTS At final examination, mean postoperative BCVA was significantly less for eyes with SRDDs (0.51 logarithm of the minimal angle of resolution [logMAR] vs. 0.21 logMAR; P = 0.0001). Eyes with SRDDs demonstrated less improvement in BCVA after ERM surgery (0.13 logMAR vs. 0.30 logMAR; P = 0.0032). Eyes with SRDDs were significantly less likely to gain 2 or more Snellen lines of BCVA after ERM surgery (28% vs. 56%; P = 0.028). Three of 25 patients (12%) undergoing ERM surgery showed worsening of Snellen BCVA by 2 lines or more. Three of 25 eyes (12%) with SRDDs demonstrated advanced AMD after surgery, compared with 0 participants in the control group (P = 0.034). CONCLUSIONS Epiretinal membrane surgery in eyes with SRDDs is associated with less favorable visual outcomes. Fewer patients demonstrate gain in BCVA, whereas a significant number show a deleterious decline. After surgery, AMD incidence seems high and patients may have an increased risk of raised intraocular pressure. These findings require further study to establish whether this represents a causal relationship. Surgeons should be vigilant for these complications. Appropriate patient counseling during the consenting process must be made.
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VITRECTOMY FOR INTERMEDIATE AGE-RELATED MACULAR DEGENERATION ASSOCIATED WITH TANGENTIAL VITREOMACULAR TRACTION. Retina 2018; 38:531-540. [DOI: 10.1097/iae.0000000000001573] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Suzuki H, Morishita S, Kohmoto R, Fukumoto M, Sato T, Kida T, Ueki M, Oku H, Nakamura K, Ikeda T. The effect of vitreomacular adhesion in exudative age-related macular degeneration on the results of ranibizumab intravitreal injection. Clin Ophthalmol 2017; 11:1471-1475. [PMID: 28860695 PMCID: PMC5565387 DOI: 10.2147/opth.s141779] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To investigate whether vitreomacular adhesion (VMA) affects the outcome of anti-vascular endothelial growth factor (VEGF) therapy for the treatment of exudative age-related macular degeneration (AMD) in Japanese patients. SUBJECTS AND METHODS Of 88 Japanese AMD patients (28 men and 60 women, mean age: 72.7±7.5 years) who underwent intravitreal injection of ranibizumab for 3 years from 2010 to 2013, this study involved 12 eyes of 12 patients (10 men and two women) in whom VMA was observed based on optical coherence tomography (OCT) findings (VMA [+] group) and 17 eyes of 16 patients (seven men and nine women, control group) in whom no VMA was observed (VMA [-] group). In all enrolled patients, ranibizumab was administered monthly for 3 months, and then administered as needed (ie, pro re nata) when deterioration was observed. The two groups were then compared in regard to changes in visual acuity (VA) and the frequency of ranibizumab administration over a 1-year period. RESULTS No significant difference was found between the two groups in regard to the transformation of the mean logarithm of the minimum angle of resolution VA change after the first visit. Over the 1-year treatment, the mean frequency of ranibizumab administration for the VMA (+) group was 5.6±2.5 times and for the VMA (-) group was 3.8±1.1 times, thus illustrating a significant difference between the two groups (Mann-Whitney's U-test: P<0.05). CONCLUSION Our findings show that the mean frequency of ranibizumab administration for the VMA (+) group was higher than that in the VMA (-) group, thus indicating that VMA might possibly be involved in the progress of AMD pathology.
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Affiliation(s)
- Hiroyuki Suzuki
- Department of Ophthalmology, Osaka Medical College, Takatsuki-City, Osaka, Japan
| | - Seita Morishita
- Department of Ophthalmology, Osaka Medical College, Takatsuki-City, Osaka, Japan
| | - Ryohsuke Kohmoto
- Department of Ophthalmology, Osaka Medical College, Takatsuki-City, Osaka, Japan
| | - Masanori Fukumoto
- Department of Ophthalmology, Osaka Medical College, Takatsuki-City, Osaka, Japan
| | - Takaki Sato
- Department of Ophthalmology, Osaka Medical College, Takatsuki-City, Osaka, Japan
| | - Teruyo Kida
- Department of Ophthalmology, Osaka Medical College, Takatsuki-City, Osaka, Japan
| | - Mari Ueki
- Department of Ophthalmology, Osaka Medical College, Takatsuki-City, Osaka, Japan
| | - Hidehiro Oku
- Department of Ophthalmology, Osaka Medical College, Takatsuki-City, Osaka, Japan
| | | | - Tsunehiko Ikeda
- Department of Ophthalmology, Osaka Medical College, Takatsuki-City, Osaka, Japan
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Wang L, Lee AYW, Wigg JP, Peshavariya H, Liu P, Zhang H. miR-126 Regulation of Angiogenesis in Age-Related Macular Degeneration in CNV Mouse Model. Int J Mol Sci 2016; 17:ijms17060895. [PMID: 27338342 PMCID: PMC4926429 DOI: 10.3390/ijms17060895] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/17/2016] [Accepted: 05/18/2016] [Indexed: 02/06/2023] Open
Abstract
miR-126 has recently been implicated in modulating angiogenic factors in vascular development. Understandings its biological significance might enable development of therapeutic interventions for diseases like age-related macular degeneration (AMD). We aimed to determine the role of miR-126 in AMD using a laser-induced choroidal neovascularization (CNV) mouse model. CNV was induced by laser photocoagulation in C57BL/6 mice. The CNV mice were transfected with scrambled miR or miR-126 mimic. The expression of miR-126, vascular endothelial growth factor-A (VEGF-A), Kinase insert domain receptor (KDR) and Sprouty-related EVH1 domain-containing protein 1 (SPRED-1) in ocular tissues were analyzed by qPCR and Western blot. The overexpression effects of miR-126 were also proven on human microvascular endothelial cells (HMECs). miR-126 showed a significant decrease in CNV mice (p < 0.05). Both mRNA and protein levels of VEGF-A, KDR and SPRED-1 were upregulated with CNV; these changes were ameliorated by restoration of miR-126 (p < 0.05). CNV was reduced after miR-126 transfection. Transfection of miR-126 reduced the HMECs 2D-capillary-like tube formation (p < 0.01) and migration (p < 0.01). miR-126 has been shown to be a negative modulator of angiogenesis in the eye. All together these results high lights the therapeutic potential of miR-126 suggests that it may contribute as a putative therapeutic target for AMD in humans.
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Affiliation(s)
- Lei Wang
- Eye Hospital, First Affiliated Hospital, Harbin Medical University, Harbin 150001, China.
| | - Amy Yi Wei Lee
- Department of Pharmacology and Therapeutics, Drug Delivery Unit, Centre for Eye Research Australia, University of Melbourne, East Melbourne VIC 3000, Australia.
| | - Jonathan P Wigg
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, East Melbourne VIC 3000, Australia.
| | - Hitesh Peshavariya
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, East Melbourne VIC 3000, Australia.
| | - Ping Liu
- Eye Hospital, First Affiliated Hospital, Harbin Medical University, Harbin 150001, China.
| | - Hong Zhang
- Eye Hospital, First Affiliated Hospital, Harbin Medical University, Harbin 150001, China.
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, East Melbourne VIC 3000, Australia.
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Ichiyama Y, Ohji M. The possible mechanisms of subretinal fluid resolution after vitrectomy. Graefes Arch Clin Exp Ophthalmol 2016; 254:1445. [PMID: 27004800 DOI: 10.1007/s00417-016-3328-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/15/2016] [Indexed: 10/22/2022] Open
Affiliation(s)
- Yusuke Ichiyama
- Department of Ophthalmology, Shiga University of Medical Science, Seta Tsukinowacho, Otsu, Shiga, 520-2192, Japan.
| | - Masahito Ohji
- Department of Ophthalmology, Shiga University of Medical Science, Seta Tsukinowacho, Otsu, Shiga, 520-2192, Japan
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Kimura S, Morizane Y, Toshima S, Hosogi M, Kumase F, Hosokawa M, Shiode Y, Fujiwara A, Shiraga F. Efficacy of vitrectomy and inner limiting membrane peeling in age-related macular degeneration resistant to anti-vascular endothelial growth factor therapy, with vitreomacular traction or epiretinal membrane. Graefes Arch Clin Exp Ophthalmol 2016; 254:1731-6. [PMID: 26951250 DOI: 10.1007/s00417-016-3314-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/28/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022] Open
Abstract
PURPOSE We assessed the efficacy of vitrectomy and inner limiting membrane (ILM) peeling, followed by anti-vascular endothelial growth factor (VEGF) therapy, anti-VEGF-resistant age-related macular degeneration (AMD) due to vitreomacular traction (VMT) or epiretinal membrane (ERM). METHODS We identified six patients with anti-VEGF-resistant AMD due to VMT or ERM amongst a total of 588 patients with AMD (821 eyes) referred to Okayama University Hospital between February 2012 and May 2014. These patients underwent vitrectomy to release the VMT (4 cases) or remove the ERM (2 cases), along with ILM peeling. The regimen used for intravitreal injections of anti-VEGF reagents after surgery was based on the severity of exudative changes in each patient. Preoperative and postoperative best-corrected visual acuity (BCVA) and central retinal thickness (CRT) measurements were compared. RESULTS After vitrectomy and ILM peeling, all six patients responded to anti-VEGF therapy, which was then able to maintain dry retinas. Mean BCVA did not improve significantly (0.49 ± 0.28 before vs. 0.43 ± 0.38 after surgery, P = 0.538). However, mean CR was significantly decreased after surgery, from 423 ± 83.5 μm to 257 ± 75.8 μm (P = 0.0078). CONCLUSIONS Vitrectomy and ILM peeling followed by anti-VEGF therapy may be a useful therapeutic option for anti-VEGF-resistant AMD with VMT or ERM.
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Affiliation(s)
- Shuhei Kimura
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, 7008558, Japan
| | - Yuki Morizane
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, 7008558, Japan.
| | - Shinji Toshima
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, 7008558, Japan
| | - Mika Hosogi
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, 7008558, Japan
| | - Fumiaki Kumase
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, 7008558, Japan
| | - Mio Hosokawa
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, 7008558, Japan
| | - Yusuke Shiode
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, 7008558, Japan
| | - Atsushi Fujiwara
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, 7008558, Japan
| | - Fumio Shiraga
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, 7008558, Japan
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Semenova NS, Akopyan VS, Rodin AS. [Macular drusen variability: multimodal imaging potential]. Vestn Oftalmol 2016; 132:78-86. [PMID: 28121303 DOI: 10.17116/oftalma2016132678-86] [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] [Indexed: 06/06/2023]
Abstract
UNLABELLED Insufficient and controversial knowledge about the macular drusen (MD), a lack of scientifically proven management methods for drusen and their strong correlation with AMD active progression makes MD an important area of research. AIM The purpose of the study – to assess clinical feature of MD using modern digital imaging technologies. MATERIAL AND METHODS Patients with both hard and soft drusen were studied using fluorescein angiography, swept-source optical coherence tomography (OCT), OCT-angiography, autofluorescence (both short-wavelength and near infra-red), scanning laser ophthalmoscopy in Multicolor mode. The retina, choroid and vitreoretinal interface were assessed on 50 patients with AMD and drusen using different imaging modalities. An additional group of the study was presented by 5 patients with geographic atrophy (GA) formed as a result of soft drusen fading, where retrospective assessment of the OCT scans was performed with special attention to the signs of soft drusen regression associated with atrophy of the overlying RPE. RESULTS Two types of hard drusen were defined as the reticular pseudodrusen and the cuticular drusen. The qualitative and comparative analysis of data for each type of MD was performed. Vitreoretinal interface evaluation demonstrated the correlation between vitreomacular adhesion and mixed reticular and cuticular drusen. The choroidal thickness assessment in 9 different macular sectors in drusenoid eyes does not reveal a significant difference with control group. All of the analysed drusen-faded-eyes initially had been presented with OCT patterns of “nascent” GA. CONCLUSION The modern retinal imaging techniques enable new approach to the diagnostic differentiation and description of various macular drusen types. The value of these methods for AMD prognosis is yet to be further investigated.
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Affiliation(s)
- N S Semenova
- Lomonosov Moscow State University, Faculty of Fundamental Medicine, 27k1 Lomonosovskiy prospekt, Moscow, 119192, Russian Federation
| | - V S Akopyan
- Lomonosov Moscow State University, Faculty of Fundamental Medicine, 27k1 Lomonosovskiy prospekt, Moscow, 119192, Russian Federation
| | - A S Rodin
- Lomonosov Moscow State University, Faculty of Fundamental Medicine, 27k1 Lomonosovskiy prospekt, Moscow, 119192, Russian Federation
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Mason JO, Patel SA. Efficacy of vitrectomy and epiretinal membrane peeling in eyes with dry age-related macular degeneration. Clin Ophthalmol 2015; 9:1999-2003. [PMID: 26604669 PMCID: PMC4629981 DOI: 10.2147/opth.s94948] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To study the efficacy of epiretinal membrane (ERM) peeling in eyes with dry age-related macular degeneration (AMD). Methods We retrospectively analyzed patient charts on 17 eyes (16 patients) that underwent ERM peeling with a concurrent diagnosis of dry AMD. Results Eyes with concurrent dry AMD and with a good preoperative best-corrected visual acuity (BCVA) (better than or equal to 20/50) had a statistically significant mean BCVA improvement at 6 months after ERM peeling. There was a statistical increase in mean BCVA from 20/95 to 20/56 in dry AMD eyes, and no eyes showed worsening in BCVA at 6 months or at most recent follow-up. Five/seventeen (29.4%) eyes had cataract formation or progression. There were no other complications, reoperations, or reoccurrences. Conclusion ERM peeling in eyes with dry AMD may show significant improvement, especially in eyes with good preoperative BCVA. The procedure is relatively safe with low complications and reoccurrences.
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Affiliation(s)
- John O Mason
- Department of Ophthalmology, University of Alabama School of Medicine, Birmingham, AL, USA ; Retina Consultants of Alabama, Callahan Eye Foundation Hospital, Birmingham, AL, USA
| | - Shyam A Patel
- Department of Ophthalmology, University of Alabama School of Medicine, Birmingham, AL, USA
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Effects of Vitreomacular Adhesion on Age-Related Macular Degeneration. J Ophthalmol 2015; 2015:865083. [PMID: 26425354 PMCID: PMC4573628 DOI: 10.1155/2015/865083] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/07/2015] [Indexed: 01/10/2023] Open
Abstract
Herein, we review the association between vitreomacular adhesion (VMA) and neovascular age-related macular degeneration (AMD). Meta-analyses have shown that eyes with neovascular AMD are twice as likely to have VMA as normal eyes. VMA in neovascular AMD may induce inflammation, macular traction, decrease in oxygenation, sequestering of vascular endothelial growth factor (VEGF), and other cytokines or may directly stimulate VEGF production. VMA may also interfere with the treatment effects of anti-VEGF therapy, which is the standard treatment for neovascular AMD, and releasing VMA can improve the treatment response to anti-VEGF treatment in neovascular AMD. We also reviewed currently available methods of relieving VMA.
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20
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Takeyama M, Yoneda M, Gosho M, Iwaki M, Zako M. Decreased VEGF-A and sustained PEDF expression in a human retinal pigment epithelium cell line cultured under hypothermia. Biol Res 2015. [PMID: 26223306 PMCID: PMC4518530 DOI: 10.1186/s40659-015-0034-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Previous reports have described a decrease in retinal temperature and clinical improvement of wet age-related macular degeneration (AMD) after vitrectomy. We hypothesized that the retinal temperature decrease after vitrectomy plays a part in the suppression of wet AMD development. To test this hypothesis, we evaluated the temperature dependence of the expression of vascular endothelial growth factor-A (VEGF-A) and in vitro angiogenesis in retinal pigment epithelium (RPE). Results We cultured ARPE-19 cells at 37, 35, 33 and 31°C and measured the expression of VEGF-A, VEGF-A splicing variants, and pigment epithelium–derived factor (PEDF). We performed an in vitro tube formation assay. The dehydrogenase activity was also evaluated at each temperature. Expression of VEGF-A significantly decreased with decreased temperature while PEDF expression did not. VEGF165 expression and in vitro angiogenesis also were temperature dependent. The dehydrogenase activity significantly decreased as the culture temperature decreased. Conclusions RPE cultured under hypothermia that decreased cellular metabolism also had decreased VEGF-A and sustained PEDF expression, creating an anti-angiogenic environment. This mechanism may be associated with a beneficial effect after vitrectomy in patients with wet AMD.
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Affiliation(s)
- Masayuki Takeyama
- Department of Ophthalmology, Aichi Medical University, Nagakute, 480-1195, Aichi, Japan.
| | - Masahiko Yoneda
- Department of Biochemistry and Molecular Biology, School of Nursing and Health, Aichi Prefectural University, Nagoya, 463-8502, Aichi, Japan.
| | - Masahiko Gosho
- Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba, 305-8575, Ibaraki, Japan.
| | - Masayoshi Iwaki
- Department of Ophthalmology, Aichi Medical University, Nagakute, 480-1195, Aichi, Japan.
| | - Masahiro Zako
- Department of Ophthalmology, Aichi Medical University, Nagakute, 480-1195, Aichi, Japan.
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Zur D, Loewenstein A, Barak A. One-year results from clinical practice of epimacular strontium-90 brachytherapy for the treatment of subfoveal choroidal neovascularization secondary to AMD. Ophthalmic Surg Lasers Imaging Retina 2015; 46:338-43. [PMID: 25856820 DOI: 10.3928/23258160-20150323-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 10/22/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate clinical feasibility, safety, and efficacy of epiretinal strontium-90 brachytherapy in subfoveal choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) in eyes unresponsive to repeated anti-VEGF injections. PATIENTS AND METHODS A retrospective, single-center study on patients treated with strontium-90 brachytherapy for CNV secondary to neovascular AMD. Patients underwent pars plana vitrectomy with a single 24 Gy dose brachytherapy. They were re-treated with anti-VEGF injections on an as-needed basis if subretinal or intraretinal fluid was detected on optical coherence tomography imaging. RESULTS Twenty-two patients were treated, and 20 completed 12 months of follow-up. Ten patients maintained stable vision, eight gained vision, and two lost more than three Snellen lines. The mean best corrected visual acuity change from baseline was -8 ± 5.7 letters. A mean of 5.5 ± 4.4 anti-VEGF injections were administered throughout 12 months. CONCLUSION Epimacular brachytherapy is feasible in clinical practice. While some patients benefit from the treatment and need significantly fewer as-needed injections, others appear not to react to irradiation treatment after 1 year of follow-up. Larger numbers of patients are needed to evaluate therapeutic efficacy and to determine which patients can benefit from combined radiation and anti-VEGF therapy.
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Prospective Retinal and Optic Nerve Vitrectomy Evaluation (PROVE) Study. Ophthalmology 2014; 121:1983-9. [DOI: 10.1016/j.ophtha.2014.04.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 02/26/2014] [Accepted: 04/09/2014] [Indexed: 11/21/2022] Open
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Schramm K, Mueller M, Koch FH, Singh P, Kohnen T, Koss MJ. Effects of core vitrectomy in the treatment of age-related macular degeneration. Acta Ophthalmol 2014; 92:465-72. [PMID: 24690440 DOI: 10.1111/aos.12326] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 10/29/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the clinical efficacy and safety of an additional core vitrectomy to the standard therapy in patients with exudative age-related macular degeneration (ARMD). METHODS In this prospective, controlled, single-centre study, 50 eyes of 50 patients (mean age: 74.1 ± 7.1; median 74 (69/78)) with ARMD were enrolled and randomized 1:1 to group 1 - core vitrectomy additional to three times injections of ranibizumab (3x Rbz) and Group 2 - 3x Rbz (control). 1 16 of 25 eyes in Group 1(64%) and 12 of 25 (48%) in Group 2 had a posterior vitreous detachment (PVD) prior to start of the study. Changes in best-corrected visual acuity (BCVA) using ETDRS charts, central macular thickness and macular volume (OCT) as well as the rate of reinjection with an OCT-based pro renata (PRN) protocol were monitored prospectively over 48 weeks. Forty-seven eyes completed follow-up at week 48. RESULTS In Group 1, 4 of 24 lost 1 line of BCVA (16.7%) and 3 of 24 lost 2 lines (12.5%), whereas 17 of 24 gained more than 1 line (70.8%) and improved in average by 9.8 letters. In Group 2, 3 of 23 remained stable and 20 of 23 gained more than or exactly 1 line (78.3%), resulting in 14.3 letters, with no loss of lines. Central macular thickness decreased by 85.58 μm (28.8%) in Group 1 and by 121.43 μm (32.68%) in Group 2 compared with baseline. In Group 1, four patients received three additional and two patients, two additional Rbz injections. In Group 2, three patients received three additional, three patients two and 12 patients one additional Rbz injections. This yielded in an average injection rate of 3.66 in Group 1 and 4.17 in Group 2 over 48 weeks. Posterior vitreous detachment (PVD) was identified in Group 1 in 16 of 24 (66.7%) and in Group 2 in 12 of 23 (52.2%) patients at baseline. At week 48, 6 of 8 (75%) of the patients in Group 1 with initial attached vitreous showed a vitreal detachment, whereas only 1 of 11 (9%) in Group 2 had a new occurred detachment of the vitreous. No systemic or ocular adverse events were noticed. CONCLUSION An initial core vitrectomy combined with a conventional ranibizumab injection regimen for exudative AMD patients was safe and lead to similar functional results with less intravitreal ranibizumab injections over 48 weeks.
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Affiliation(s)
- Katharina Schramm
- Department of Ophthalmology; Retina Unit; Goethe University; Frankfurt am Main Germany
| | - Michael Mueller
- Department of Ophthalmology; Retina Unit; Goethe University; Frankfurt am Main Germany
| | - Frank H. Koch
- Department of Ophthalmology; Retina Unit; Goethe University; Frankfurt am Main Germany
| | - Pankaj Singh
- Department of Ophthalmology; Retina Unit; Goethe University; Frankfurt am Main Germany
| | - Thomas Kohnen
- Department of Ophthalmology; Retina Unit; Goethe University; Frankfurt am Main Germany
| | - Michael J. Koss
- Department of Ophthalmology; Retina Unit; Goethe University; Frankfurt am Main Germany
- Doheny Eye Institute; Los Angeles CA USA
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Skeie JM, Mahajan VB. Proteomic interactions in the mouse vitreous-retina complex. PLoS One 2013; 8:e82140. [PMID: 24312404 PMCID: PMC3843729 DOI: 10.1371/journal.pone.0082140] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 10/21/2013] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Human vitreoretinal diseases are due to presumed abnormal mechanical interactions between the vitreous and retina, and translational models are limited. This study determined whether nonstructural proteins and potential retinal biomarkers were expressed by the normal mouse vitreous and retina. METHODS Vitreous and retina samples from mice were collected by evisceration and analyzed by liquid chromatography-tandem mass spectrometry. Identified proteins were further analyzed for differential expression and functional interactions using bioinformatic software. RESULTS We identified 1,680 unique proteins in the retina and 675 unique proteins in the vitreous. Unbiased clustering identified protein pathways that distinguish retina from vitreous including oxidative phosphorylation and neurofilament cytoskeletal remodeling, whereas the vitreous expressed oxidative stress and innate immunology pathways. Some intracellular protein pathways were found in both retina and vitreous, such as glycolysis and gluconeogenesis and neuronal signaling, suggesting proteins might be shuttled between the retina and vitreous. We also identified human disease biomarkers represented in the mouse vitreous and retina, including carbonic anhydrase-2 and 3, crystallins, macrophage inhibitory factor, glutathione peroxidase, peroxiredoxins, S100 precursors, and von Willebrand factor. CONCLUSIONS Our analysis suggests the vitreous expresses nonstructural proteins that functionally interact with the retina to manage oxidative stress, immune reactions, and intracellular proteins may be exchanged between the retina and vitreous. This novel proteomic dataset can be used for investigating human vitreoretinopathies in mouse models. Validation of vitreoretinal biomarkers for human ocular diseases will provide a critical tool for diagnostics and an avenue for therapeutics.
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Affiliation(s)
- Jessica M. Skeie
- Omics Laboratory, University of Iowa, Iowa City, Iowa, United States of America
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States of America
| | - Vinit B. Mahajan
- Omics Laboratory, University of Iowa, Iowa City, Iowa, United States of America
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States of America
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Reddy RK, Lalezary M, Kim SJ, Kammer JA, Kuchtey RW, Cherney EF, Recchia FM, Joos KM, Agarwal A, Law JC. Prospective Retinal and Optic Nerve Vitrectomy Evaluation (PROVE) study: findings at 3 months. Clin Ophthalmol 2013; 7:1761-9. [PMID: 24039396 PMCID: PMC3770890 DOI: 10.2147/opth.s49375] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The purpose of this paper is to report the 3-month findings of the Prospective Retinal and Optic Nerve Vitrectomy Evaluation (PROVE) study. Methods Eighty eyes of 40 participants undergoing vitrectomy were enrolled. Participants underwent baseline evaluation of the study (surgical) and fellow (control) eye that included: intraocular pressure, central corneal thickness, gonioscopy, cup-to-disc ratio measurement, color fundus and optic disc photography, automated perimetry, and optical coherence tomography of the macula and optic nerve. Evaluation was repeated at 3 months. Main outcome measures were changes in macula and retinal nerve fiber layer (RNFL) thickness and intraocular pressure. Results All participants completed follow-up. Mean cup-to-disc ratio of study and fellow eyes at baseline was 0.43 ± 0.2 and 0.46 ± 0.2, respectively, and 13% of participants had undiagnosed narrow angles. There was no significant change in intraocular pressure, cup-to-disc ratio, or pattern standard deviation in study eyes compared with baseline or fellow eyes at 3 months. Vision improved in all study eyes at 3 months compared with baseline (P = 0.013), but remained significantly worse than fellow eyes (P < 0.001). Central subfield and temporal peripapillary RNFL thickness were significantly greater in eyes with epiretinal membrane (P < 0.05), and resolution after surgery correlated with visual improvement (P < 0.05). Conclusion The 3-month results do not indicate any increased risk for open-angle glaucoma but suggest that a relatively high percentage of eyes may be at risk of angle closure glaucoma. Temporal RNFL thickness and central subfield were increased in eyes with epiretinal membrane, and resolution correlated with degree of visual recovery.
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Affiliation(s)
- Rahul K Reddy
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, TN, USA
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VITREOUS ATTACHMENT IN AGE-RELATED MACULAR DEGENERATION, DIABETIC MACULAR EDEMA, AND RETINAL VEIN OCCLUSION. Retina 2013; 33:1099-108. [DOI: 10.1097/iae.0b013e31828991d6] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Intracameral concentrations of the fibrinolytic system components in patients with age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2013; 251:2697-704. [DOI: 10.1007/s00417-013-2374-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/29/2013] [Accepted: 05/01/2013] [Indexed: 11/25/2022] Open
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Simpson ARH, Petrarca R, Jackson TL. Vitreomacular adhesion and neovascular age-related macular degeneration. Surv Ophthalmol 2013; 57:498-509. [PMID: 23068973 DOI: 10.1016/j.survophthal.2012.01.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 01/30/2012] [Accepted: 01/31/2012] [Indexed: 02/05/2023]
Abstract
We explore the hypothesis that vitreomacular adhesion (VMA) and vitreomacular traction (VMT) play a role in the pathogenesis and clinical course of neovascular ("wet") age-related macular degeneration (AMD). Several biological theories are offered to explain this possible association, including direct tractional force, altered vitreous oxygenation, altered diffusion coefficients of intravitreal molecules, and alterations in the pharmacokinetics of intravitreal drugs. Release of VMT may improve the clinical course of neovascular AMD, and a few case series suggest that vitrectomy can lead to both a functional and anatomic improvement. A large, randomized, controlled clinical trial is underway, investigating pharmacologic release of VMA in eyes with neovascular AMD.
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Affiliation(s)
- Andrew R H Simpson
- King's College London and King's College Hospital, London, United Kingdom
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31
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Thompson JT. Vitreomacular adhesion and neovascular age-related macular degeneration. Retina 2012; 32 Suppl 2:S216-20. [PMID: 22929324 DOI: 10.1097/iae.0b013e31825beee8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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