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Kitano M, Aoki S, Kitamoto K, Azuma K, Fujino R, Inoue T, Obata R. Association between time to treatment and outcome in branch retinal vein occlusion. Int Ophthalmol 2024; 44:353. [PMID: 39182206 DOI: 10.1007/s10792-024-03272-w] [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: 05/14/2024] [Accepted: 07/29/2024] [Indexed: 08/27/2024]
Abstract
PURPOSE To investigate the association between the time from onset to initial treatment and changes in visual acuity or the number of treatments in patients with branch retinal vein occlusion (BVO). DESIGN Retrospective. METHODS Thirty-nine eyes of 39 consecutive patients with untreated acute-phase BVO who visited the University of Tokyo Hospital and were followed up for at least one year were included. The patients were initially treated with anti-vascular endothelial growth factor (VEGF) therapy and additional pro re nata therapy within six months of onset. The patients were classified according to the time from disease onset to the first treatment (group A: 28 days or less, group B: over 28 days). RESULTS The mean (SD) age was 73 ± 8 years, and 19 patients were male. The mean (SD) time to the first treatment was 31.6 ± 17.9 days. The mean (SD) logMAR visual acuity at first treatment was 0.37 ± 0.30. After 12 months of treatment, the mean (SD) logMAR change was - 0.15 ± 0.23, and the mean number (SD) of treatments was 3.1 ± 1.7. No significant association was observed between the timing of treatment initiation and changes in logMAR visual acuity. Patients in group A and central macular thickness at the initial visit were independently associated with the greater number of treatments at one year (p = 0.03 and p = 0.01, respectively). CONCLUSIONS At one year, the time between onset and the start of anti-VEGF therapy for BVO was not associated with subsequent visual acuity changes. Meanwhile, it may have significant association with the number of treatments.
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Affiliation(s)
- Marie Kitano
- Department of Ophthalmology, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- JR Tokyo General Hospital, 2-1-3 Yoyogi, Shibuya-ku, Tokyo, 151-8528, Japan
| | - Shuichiro Aoki
- Department of Ophthalmology, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kohdai Kitamoto
- Department of Ophthalmology, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Keiko Azuma
- Department of Ophthalmology, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ryosuke Fujino
- Department of Ophthalmology, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tatsuya Inoue
- Department of Ophthalmology, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- Department of Ophthalmology and Micro-Technology, Yokohama City University, 4-57 Urafune, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Ryo Obata
- Department of Ophthalmology, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
- Department of Ophthalmology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
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Xue J, Feng Z, Zeng L, Wang S, Zhou X, Xia J, Deng A. Soul: An OCTA dataset based on Human Machine Collaborative Annotation Framework. Sci Data 2024; 11:838. [PMID: 39095383 PMCID: PMC11297209 DOI: 10.1038/s41597-024-03665-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 07/19/2024] [Indexed: 08/04/2024] Open
Abstract
Branch retinal vein occlusion (BRVO) is the most prevalent retinal vascular disease that constitutes a threat to vision due to increased venous pressure caused by venous effluent in the space, leading to impaired visual function. Optical Coherence Tomography Angiography (OCTA) is an innovative non-invasive technique that offers high-resolution three-dimensional structures of retinal blood vessels. Most publicly available datasets are collected from single visits with different patients, encompassing various eye diseases for distinct tasks and areas. Moreover, due to the intricate nature of eye structure, professional labeling not only relies on the expertise of doctors but also demands considerable time and effort. Therefore, we have developed a BRVO-focused dataset named Soul (Source of ocular vascular) and propose a human machine collaborative annotation framework (HMCAF) using scrambled retinal blood vessels data. Soul is categorized into 6 subsets based on injection frequency and follow-up duration. The dataset comprises original images, corresponding blood vessel labels, and clinical text information sheets which can be effectively utilized when combined with machine learning.
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Affiliation(s)
- Jingyan Xue
- School of Computer Science and Technology, Beijing Jiaotong University, Beijing, 100044, China
| | - Zhenhua Feng
- Department of Ophthalmology, the Affiliated hospital of Shandong Second Medical University, Weifang, 261000, China
| | - Lili Zeng
- School of Computer Science and Technology, Beijing Jiaotong University, Beijing, 100044, China
| | - Shuna Wang
- Department of Ophthalmology, the Affiliated hospital of Shandong Second Medical University, Weifang, 261000, China
| | - Xuezhong Zhou
- School of Computer Science and Technology, Beijing Jiaotong University, Beijing, 100044, China.
| | - Jianan Xia
- School of Computer Science and Technology, Beijing Jiaotong University, Beijing, 100044, China.
| | - Aijun Deng
- Department of Ophthalmology, the Affiliated hospital of Shandong Second Medical University, Weifang, 261000, China.
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Lee MW, Jun JH, Seong HJ. Longitudinal changes in each retinal layer thickness in patients with non-ischemic central retinal vein occlusion. EYE AND VISION (LONDON, ENGLAND) 2024; 11:29. [PMID: 39085961 PMCID: PMC11293173 DOI: 10.1186/s40662-024-00397-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 06/23/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND To identify longitudinal changes in each retinal layer thickness in central retinal vein occlusion (CRVO) patients with resolved macular edema (ME). METHODS In this retrospective observational study, CRVO patients without a recurrence of ME for more than 3 years and normal controls were enrolled. Each retinal layer thickness of the parafoveal area, including ganglion cell complex (GCC), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), photoreceptor layer (PRL), and retinal pigment epithelium (RPE) was measured. After the resolution of ME, three more examinations with a 1-year interval were analyzed. RESULTS A total of 98 eyes were enrolled, 50 eyes for the control group and 48 eyes for the CRVO group. The baseline GCC thickness was 114.2 ± 15.6 μm and 104.2 ± 25.4 μm in the control and CRVO groups, respectively, which was significantly different (P = 0.022). The thicknesses of other layers including INL, OPL, ONL, PRL, and RPE were not significantly different at baseline. The reduction rate of GCC, INL, OPL, and ONL was - 3.92, - 1.33, - 0.91, and - 2.31 μm/year in the CRVO group, whereas no significant reductions were observed in the control group. Best-corrected visual acuity was significantly associated with changes in the GCC, OPL, and ONL in the CRVO group. CONCLUSIONS In patients with CRVO, even in the absence of recurrent ME, retinal damage progresses over time, evidenced by thinning of the inner retina and outer retina including OPL and ONL. These changes may be associated with alterations in visual function.
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Affiliation(s)
- Min-Woo Lee
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea.
- Department of Ophthalmology, Konyang University Hospital, #1643 Gwanjeo-Dong, Seo-Gu, Daejeon, Korea.
| | - Ji-Ho Jun
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Hyun-Je Seong
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
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Karalezli A, Kaderli ST, Kaderli A, Kaya C, Sul S. Comparison of changes in number of hyperreflective dots after intravitreal ranibizumab or dexamethasone implant in patients with branch retinal vein occlusion. Taiwan J Ophthalmol 2024; 14:387-393. [PMID: 39430351 PMCID: PMC11488816 DOI: 10.4103/tjo.tjo-d-22-00177] [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: 12/15/2022] [Accepted: 03/01/2023] [Indexed: 10/22/2024] Open
Abstract
PURPOSE To compare the effect of intravitreal ranibizumab (IVR) or intravitreal dexamethasone implants (IVD) on the regression of hyperreflective dots (HRDs) in patients with branch retinal vein occlusion (BRVO). MATERIALS AND METHODS Thirty-seven eyes with cystoid macular edema who received IVR or IVD and followed up for at least 12 months were included in this study. The patients were divided into three Groups according to intravitreal treatments. Group 1 consisted of 12 eyes who received only IVD, Group 2 consisted of 10 eyes who received only IVR, and Group 3 consisted of 15 eyes who received both IVD and IVR. The number of HRDs and best-corrected visual acuity (BCVA) were compared between the Groups through the follow-up time. RESULTS The mean number of HRDs in inner and outer retinal layers was significantly decreased in Group 1 and Group 3 (For Group 1; P < 0.001, P = 0.001, for Group 3; P < 0.001, P < 0.001). At the 1st year, the number of HRDs in inner and outer retinal layers was significantly lower in Group 1 and Group 3 than Group 2 (All P < 0.05). The BCVA was higher in Group 3 than Group 2 at 1st year (P = 0.048). CONCLUSION The HRDs should be considered inflammatory markers in the follow-up of CME in BRVO.
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Affiliation(s)
- Aylin Karalezli
- Department of Ophthalmology, Mugla Sitki Kocman University School of Medicine, Mugla, Turkey
| | - Sema Tamer Kaderli
- Department of Ophthalmology, Mugla Sitki Kocman Education and Training Hospital, Mugla, Turkey
| | - Ahmet Kaderli
- Department of Ophthalmology, Mugla Sitki Kocman University School of Medicine, Mugla, Turkey
| | - Cansu Kaya
- Department of Ophthalmology, Mugla Sitki Kocman University School of Medicine, Mugla, Turkey
| | - Sabahattin Sul
- Department of Ophthalmology, Mugla Sitki Kocman University School of Medicine, Mugla, Turkey
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Cullhed Farrell A, Epstein D. RETINAL VEIN OCCLUSIONS BEFORE AND DURING THE COVID-19 PANDEMIC: Visual Outcomes and Treatment Patterns in a Country with no Mandatory Lockdown. Retina 2024; 44:1045-1051. [PMID: 38346093 DOI: 10.1097/iae.0000000000004065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
PURPOSE To investigate the incidence, treatment patterns, and visual outcomes in patients with branch retinal vein occlusion (RVO) and central RVO before and during the COVID-19 pandemic in a country with no mandatory lockdown. METHODS This retrospective study included 788 patients presenting with a RVO during the years 2019 to 2022 at St. Erik Eye Hospital. The control group and study groups consisted of patients presenting before and during the pandemic, respectively. RESULTS The incidence of diagnosed RVO cases decreased from 281 patients before the pandemic to 236 patients during the first year of the pandemic ( P < 0.05). In patients with branch RVO at the end of follow-up, the best-corrected visual acuity improved 10.3 letters (95% confidence intervals [CI] 7.6-12.9) in the control group compared with 14.3 letters (95% CI 12.6-16.0) in the study groups ( P < 0.05). In patients with central RVO, the best-corrected visual acuity improved 6.3 letters (95% CI 2.7-10.0) in the control group compared with 8.6 letters (95% CI 5.7-11.4) in the study groups (p = NS). Overall, the number of intravitreal anti-vascular endothelial growth factor injections increased from 7.0 (95% CI 6.6-7.3) in the control group to 7.6 (95% CI 7.4-7.8) in the study groups ( P < 0.05). CONCLUSION Good visual and anatomical outcomes were sustained, and the number of intravitreal anti-vascular endothelial growth factor injections increased significantly in patients with RVO during the COVID-19 pandemic.
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Affiliation(s)
- Anna Cullhed Farrell
- Karolinska Institutet Department of Clinical Neuroscience, St. Erik Eye Hospital, Stockholm, Sweden
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Hattenbach LO, Abreu F, Arrisi P, Basu K, Danzig CJ, Guymer R, Haskova Z, Heier JS, Kotecha A, Liu Y, Loewenstein A, Seres A, Willis JR, Wykoff CC, Paris LP. BALATON and COMINO: Phase III Randomized Clinical Trials of Faricimab for Retinal Vein Occlusion: Study Design and Rationale. OPHTHALMOLOGY SCIENCE 2023; 3:100302. [PMID: 37810589 PMCID: PMC10556281 DOI: 10.1016/j.xops.2023.100302] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023]
Abstract
Purpose Dual inhibition of angiopoietin-2 and VEGF-A with faricimab (Vabysmo) offers excellent visual acuity gains with strong durability in patients with diabetic macular edema (ME) and neovascular age-related macular degeneration. The phase III BALATON/COMINO (NCT04740905/NCT04740931) trials will investigate the efficacy, safety, and durability of faricimab in patients with ME due to retinal vein occlusion (RVO). Design Two identically designed global, randomized, double-masked, active comparator-controlled studies. Participants Anti-VEGF treatment-naive patients with branch, central, or hemiretinal RVO. Methods Patients were randomized to 6 monthly injections of faricimab 6.0 mg or aflibercept 2.0 mg. From weeks 24 to 72, all patients received faricimab 6.0 mg administered in up to 16-week intervals using an automated treatment algorithm to generate a treat-and-extend-based personalized treatment interval dosing regimen. Personalized treatment interval adjustments were based on changes in central subfield thickness (CST) and best-corrected visual acuity (BCVA). Main Outcome Measures Primary end point was noninferiority of faricimab versus aflibercept in mean change from baseline in BCVA (week 24; noninferiority margin: 4 letters). Secondary end points (weeks 0-24) were mean change from baseline in BCVA, CST, and National Eye Institute Visual Function Questionnaire 25 composite score; proportion of patients gaining or avoiding loss of ≥ 15/≥ 10/≥ 5/> 0 letters. Secondary end points (weeks 24-72) were treatment durability (week 68); continuation of weeks 0 to 24 end points. Ocular/nonocular adverse events will be assessed. Results In total, 1282 patients across 22 countries were enrolled (BALATON, 553 patients, 149 centers; COMINO, 729 patients, 193 centers). Conclusions Using a novel automated interval algorithm, BALATON/COMINO will evaluate the efficacy and safety of faricimab for ME secondary to RVO and provide key insights into how to personalize treatment. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
| | | | | | - Karen Basu
- Roche Products (Ireland), Dublin, Ireland
| | - Carl J. Danzig
- Rand Eye Institute, Deerfield Beach, Florida
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Robyn Guymer
- The Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, East Melbourne, Australia
| | | | | | | | - Ying Liu
- Genentech, Inc., South San Francisco, California
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7
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Pant P, Kundu A, Rathinavelu JK, Wei X, Agrawal R, Stinnett SS, Kim JS, Thomas AS, Fekrat S. Longitudinal Assessment of the Choroidal Vascularity Index in Eyes with Branch Retinal Vein Occlusion-Associated Cystoid Macular Edema. Ophthalmol Ther 2023; 12:2103-2115. [PMID: 37221425 PMCID: PMC10287880 DOI: 10.1007/s40123-023-00731-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/03/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION Cystoid macular edema (CME) is the most common cause of central vision loss in eyes with branch retinal vein occlusion (BRVO eyes). In recent literature, choroidal vascularity index (CVI) has been proposed to be an enhanced depth imaging optical coherence tomography (EDI-OCT) metric that may help characterize choroidal vascular changes in the setting of retinal ischemia, and potentially prognose visual outcomes and treatment patterns for patients with BRVO-related CME. This study sought to further characterize choroidal vascular changes in BRVO by comparing the CVI, subfoveal choroidal thickness (SFCT), and central subfield thickness (CST) in BRVO eyes with CME compared to unaffected fellow eyes. METHODS This was a retrospective cohort study. Subjects included treatment-naïve BRVO eyes with CME diagnosed within 3 months of onset of symptoms and unaffected fellow eyes. EDI-OCT images were collected at baseline and at the 12-month follow-up visit. CVI, SFCT, and CST were measured. Demographics, treatment patterns, and best-corrected visual acuity (VA) were abstracted. Median CVI, SFCT, CST, and VA were compared between the two cohorts. Longitudinal relationships between these variables were analyzed. RESULTS A total of 52 treatment-naïve eyes with BRVO and CME and 48 unaffected fellow eyes were identified. Baseline CVI was lower in eyes with BRVO than in fellow eyes (64.7% vs. 66.4%, P = 0.003). At 12 months, there was no difference in CVI between BRVO eyes and fellow eyes (65.7% vs 65.8%, P = 0.536). In BRVO eyes, there was a strong correlation between reduced CST and improved VA over the 12-month study period (r = 0.671, P < 0.001). CONCLUSION There are differences in CVI in treatment-naïve BRVO eyes with CME at presentation compared to fellow eyes, but these differences resolve over time. Anatomic changes in macular thickness in BRVO eyes with CME may be correlated with VA outcomes.
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Affiliation(s)
- Praruj Pant
- Department of Ophthalmology, Duke University School of Medicine, 2531 Erwin Rd., Durham, NC, 27705, USA
| | - Anita Kundu
- Department of Ophthalmology, Duke University School of Medicine, 2531 Erwin Rd., Durham, NC, 27705, USA
| | - Jay K Rathinavelu
- Department of Ophthalmology, Duke University School of Medicine, 2531 Erwin Rd., Durham, NC, 27705, USA
| | - Xin Wei
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Sandra S Stinnett
- Department of Ophthalmology, Duke University School of Medicine, 2531 Erwin Rd., Durham, NC, 27705, USA
| | - Jane S Kim
- Department of Ophthalmology, Duke University School of Medicine, 2531 Erwin Rd., Durham, NC, 27705, USA
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Akshay S Thomas
- Department of Ophthalmology, Duke University School of Medicine, 2531 Erwin Rd., Durham, NC, 27705, USA
- Tennessee Retina, Nashville, TN, USA
| | - Sharon Fekrat
- Department of Ophthalmology, Duke University School of Medicine, 2531 Erwin Rd., Durham, NC, 27705, USA.
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Zhou Y, Qi J, Liu H, Liang S, Guo T, Chen J, Pan W, Tan H, Wang J, Xu H, Chen Z. Increased intraocular inflammation in retinal vein occlusion is independent of circulating immune mediators and is involved in retinal oedema. Front Neurosci 2023; 17:1186025. [PMID: 37554292 PMCID: PMC10405077 DOI: 10.3389/fnins.2023.1186025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/29/2023] [Indexed: 08/10/2023] Open
Abstract
We aim to understand the link between systemic and intraocular levels of inflammatory mediators in treatment-naïve retinal vein occlusion (RVO) patients, and the relationship between inflammatory mediators and retinal pathologies. Twenty inflammatory mediators were measured in this study, including IL-17E, Flt-3 L, IL-3, IL-8, IL-33, MIP-3β, MIP-1α, GRO β, PD-L1, CD40L, IFN-β, G-CSF, Granzyme B, TRAIL, EGF, PDGF-AA, PDGF-AB/BB, TGF-α, VEGF, and FGFβ. RVO patients had significantly higher levels of Flt-3 L, IL-8, MIP-3β, GROβ, and VEGF, but lower levels of EGF in the aqueous humor than cataract controls. The levels of Flt-3 L, IL-3, IL-33, MIP-1α, PD-L1, CD40 L, G-CSF, TRAIL, PDGF-AB/BB, TGF-α, and VEGF were significantly higher in CRVO than in BRVO. KEGG pathway enrichment revealed that these mediators affected the PI3K-Akt, Ras, MAPK, and Jak/STAT signaling pathways. Protein-Protein Interaction (PPI) analysis showed that VEGF is the upstream cytokine that influences IL-8, G-CSF, and IL-33 in RVO. In the plasma, the level of GROβ was lower in RVO than in controls and no alterations were observed in other mediators. Retinal thickness [including central retinal thickness (CRT) and inner limiting membrane to inner plexiform layer (ILM-IPL)] positively correlated with the intraocular levels of Flt-3 L, IL-33, GROβ, PD-L1, G-CSF, and TGF-α. The size of the foveal avascular zone positively correlated with systemic factors, including the plasma levels of IL-17E, IL-33, INF-β, GROβ, Granzyme B, and FGFβ and circulating high/low-density lipids and total cholesterols. Our results suggest that intraocular inflammation in RVO is driven primarily by local factors but not circulating immune mediators. Intraocular inflammation may promote macular oedema through the PI3K-Akt, Ras, MAPK, and Jak/STAT signaling pathways in RVO. Systemic factors, including cytokines and lipid levels may be involved in retinal microvascular remodeling.
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Affiliation(s)
- Yufan Zhou
- Changsha Aier Eye Hospital, Changsha, China
- Aier School of Ophthalmology, Central South University, Changsha, China
| | - Jinyan Qi
- Aier School of Ophthalmology, Central South University, Changsha, China
- Aier Institute of Optometry and Vision Science, Changsha, China
| | - Hengwei Liu
- Changsha Aier Eye Hospital, Changsha, China
- Aier School of Ophthalmology, Central South University, Changsha, China
| | - Shengnan Liang
- Changsha Aier Eye Hospital, Changsha, China
- Aier School of Ophthalmology, Central South University, Changsha, China
| | - Tingting Guo
- Changsha Aier Eye Hospital, Changsha, China
- The First Clinical Medical College of Jinan University, Guangzhou, China
| | - Juan Chen
- Changsha Aier Eye Hospital, Changsha, China
| | - Wei Pan
- Aier Institute of Optometry and Vision Science, Changsha, China
| | | | - Jie Wang
- Changsha Aier Eye Hospital, Changsha, China
| | - Heping Xu
- Aier School of Ophthalmology, Central South University, Changsha, China
- Aier Institute of Optometry and Vision Science, Changsha, China
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Zhongping Chen
- Changsha Aier Eye Hospital, Changsha, China
- Aier School of Ophthalmology, Central South University, Changsha, China
- Aier Institute of Optometry and Vision Science, Changsha, China
- School of Stomatology and Ophthalmology, Xianning Medical College, Hubei University of Science and Technology, Xianning, China
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Osaka R, Muraoka Y, Nagasato D, Mitamura Y, Nishigori N, Murakami T, Suzuma K, Tabuchi H, Tsujikawa A. Binocular metamorphopsia in patients with branch retinal vein occlusion: a multi-center study. Int Ophthalmol 2023:10.1007/s10792-023-02731-0. [PMID: 37227617 PMCID: PMC10400688 DOI: 10.1007/s10792-023-02731-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 04/22/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE The pathology of branch retinal vein occlusion (BRVO), a retinal circulatory disease, is related to monocular metamorphopsia-related vision impairment of the affected eyes, but the association of binocular metamorphopsia in such patients is unclear. This study aimed to examine the frequency of binocular metamorphopsia and its association with the clinical characteristics of patients with BRVO. METHODS A total of 87 patients who were treated for BRVO-associated macular edema (ME) were included in this study. At baseline and 1 and 3 months after the initiation of anti-vascular endothelial growth factor (VEGF) treatment, we quantified metamorphopsia in the affected eyes and binocular metamorphopsia using the M-CHARTS® diagnostic tool. RESULTS At baseline, 53 and 7 patients had metamorphopsia in the affected eyes and binocular metamorphopsia, respectively. Although the visual acuity improved significantly after the initiation of anti-VEGF treatment, the mean M-CHARTS score in the affected eyes did not change from the baseline score. At 3 months, 9 patients showed binocular metamorphopsia; it was significantly associated with metamorphopsia in the affected eyes with a 95% confidence interval of 0.021-0.122 (β = 0.306, p = 0.006). CONCLUSION Metamorphopsia in the affected eyes can cause binocular metamorphopsia in patients with BRVO-ME.
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Affiliation(s)
- Rie Osaka
- Department of Ophthalmology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yuki Muraoka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - 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
| | - Yoshinori Mitamura
- Department of Technology and Design Thinking for Medicine, Hiroshima University Graduate School, Hiroshima, Japan
| | - Naomi Nishigori
- 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
| | - Kiyoshi Suzuma
- Department of Ophthalmology, Faculty of Medicine, Kagawa University, Kagawa, 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
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Karimi S, Nikkhah H, Nafisi H, Nouri H, Ansari I, Barkhordari S, Samnejad S, Abtahi SH. Acetazolamide and bevacizumab combination therapy versus bevacizumab monotherapy in macular edema secondary to retinal vein occlusion. J Fr Ophtalmol 2023; 46:322-326. [PMID: 36739258 DOI: 10.1016/j.jfo.2022.09.025] [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: 08/30/2022] [Accepted: 09/26/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE To determine and compare the efficacy of intravitreal bevacizumab (IVB) and oral acetazolamide (OA) combination therapy versus IVB monotherapy in patients with macular edema secondary to retinal vein occlusion (RVO). METHODS This randomized clinical trial included 54 eyes of 52 patients with RVO central macular thickness (CMT) of more than 300μm, and best corrected visual acuity (BCVA) between 20/400 and 20/40. Eligible patients were randomly assigned to two groups: (I) IVB and OA (250mg twice daily) combination therapy or (II) IVB monotherapy. Ocular injections were repeated monthly for up to three months; BCVA and CMT were measured monthly. RESULTS Both regimens resulted in significant reduction in CMT (534±150μm to 352±90μm in the IVB+OA group, P<0.001; and 580±175μm to 362±90μm in the IVB group, P<0.001); neither showed superiority in this regard. Likewise, BCVA showed significant improvement in both groups (0.87±0.56 to 0.53±0.28 LogMAR in the IVB+OA group, P=0.001; and 0.85±0.62 to 0.46±0.4 LogMAR in the IVB group, P<0.001), with no intergroup difference. CONCLUSION Addition of oral acetazolamide to IVB in eyes with macular edema secondary to RVO may not result in additional short-term benefits regarding functional and anatomical outcomes. TRIAL REGISTRATION ClinicalTrials.gov, NCT05290948, registered on March 22, 2022. https://clinicaltrials.gov/ct2/show/NCT05290948.
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Affiliation(s)
- S Karimi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Torfe Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Clinical Research Development Unit of Torfe Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - H Nikkhah
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Torfe Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Clinical Research Development Unit of Torfe Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - H Nafisi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Clinical Research Development Unit of Torfe Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - H Nouri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - I Ansari
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Clinical Research Development Unit of Torfe Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S Barkhordari
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Clinical Research Development Unit of Torfe Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S Samnejad
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Clinical Research Development Unit of Torfe Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S-H Abtahi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Torfe Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Clinical Research Development Unit of Torfe Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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11
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Bhambra N, Sayal AP, Popovic MM, Muni RH, Kertes PJ. Combination intravitreal anti-vascular endothelial growth factor inhibitors and macular laser photocoagulation relative to intravitreal injection monotherapy in macular oedema secondary to retinal vein occlusion: a meta-analysis of randomized controlled trials. Eye (Lond) 2022; 36:2271-2278. [PMID: 34819660 PMCID: PMC9674600 DOI: 10.1038/s41433-021-01833-2] [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: 05/22/2021] [Revised: 10/05/2021] [Accepted: 10/21/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVES This meta-analysis investigates the efficacy and safety of intravitreal anti-VEGF injections (IVI) compared to combination laser photocoagulation and IVI (LPC-IVI) in treating macular oedema secondary to retinal vein occlusion (RVO). SUBJECTS/METHODS A literature search of MEDLINE, EMBASE and Cochrane CENTRAL was conducted from inception until March 2021. Randomized controlled trials that reported relevant efficacy and/or safety parameters following LPC-IVI relative to IVI were included. Meta-analysis was conducted with a random effects model. The primary outcome was best-corrected visual acuity (BCVA), while secondary outcomes were central macular thickness (CMT), central retinal thickness (CRT), central subfield thickness (CST), number of IVIs received, and incidence of adverse events. RESULTS A total of 10 studies were included, for which 362 eyes were randomized to LPC-IVI and 365 to IVI. In comparing macular laser photocoagulation with IVI (MLP-IVI) in BRVO patients, no significant differences were seen in final BCVA (p = 0.78) or change in BCVA (p = 0.09) after treatment. Similarly, no significant differences were seen in final CMT (p = 0.54), change in CMT (p = 0.33), final CRT (p = 0.90), change in CRT (p = 0.97), or number of injections required (p = 0.78). The same results were seen in subgroup analyses for macular laser without peripheral laser in BRVO and CRVO patients. Consistent results were observed when considering peripheral LPC-IVI to IVI in BRVO and CRVO. CONCLUSIONS No significant differences were seen between combination MLP-IVI or peripheral LPC-IVI relative to IVI monotherapy for final BCVA or OCT parameters in macular oedema secondary to RVO.
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Affiliation(s)
| | - Aman P Sayal
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.
- John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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12
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Drozdova EA. [Long-term outcomes of anti-VEGF therapy for macular edema in retinal vein occlusion]. Vestn Oftalmol 2022; 138:140-148. [PMID: 35801893 DOI: 10.17116/oftalma2022138031140] [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: 06/15/2023]
Abstract
Antiangiogenic therapy (anti-VEGF) is the standard in the treatment of many retinal vascular diseases, including macular edema associated with retinal vein occlusion (RVO). A large evidentiary basis has been collected, consisting of randomized clinical trials in which anti-VEGF therapy demonstrated a significant advantage over laser photocoagulation and placebo in patients with RVO. However, in everyday clinical practice the results are not always comparable to randomized clinical trials. This review presents an analysis of the current studies based on actual clinical practice. Their results helped identify the main aspects of antiangiogenic therapy that could improve the treatment outcomes for patients with RVO. Additionally, the article discusses the predictive factors for therapy outcomes and the effect of anti-VEGF therapy on the development of neovascular complications in patients with ischemic RVO.
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Affiliation(s)
- E A Drozdova
- South-Ural State Medical University, Chelyabinsk, Russia
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13
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Arrigo A, Bandello F. Retinal vein occlusion: drug targets and therapeutic implications. Expert Opin Ther Targets 2021; 25:847-864. [PMID: 34775882 DOI: 10.1080/14728222.2021.2005026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The pathogenesis of retinal vein occlusion (RVO) is extremely complex and includes several mediators. These mediators represent potential drug targets that can be used in the development of intravitreal drugs. AREAS COVERED PubMed/MEDLINE databases were accessed between April-May 2021 to find the most relevant scientific papers regarding drug targets and therapeutic implications in RVO, focusing on current therapeutic options and potential cornerstones of future advances in treatment. EXPERT OPINION Before the introduction of intravitreal therapies, the visual outcome following a diagnosis of RVO was extremely poor. Anti-VEGF and corticosteroid treatments have radically changed RVO prognosis, helping to preserve patients' visual function and their quality of life. According to current clinical data, anti-VEGF and corticosteroid drugs are associated with both pros and cons; the present recommendation is to employ anti-VEGF molecules as a first-line treatment. Advances in our understanding of the biomolecular characteristics of RVO offer a solid basis for the development of new therapeutic targets and treatments.
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Affiliation(s)
- Alessandro Arrigo
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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14
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Disease-modifying effects of ranibizumab for central retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 2021; 260:799-805. [PMID: 34613454 PMCID: PMC8850212 DOI: 10.1007/s00417-021-05224-x] [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: 12/09/2020] [Revised: 03/19/2021] [Accepted: 04/27/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To identify anatomic endpoints altered by intravitreal ranibizumab in central retinal vein occlusion (CRVO) to determine any potential underlying disease modification that occurs with anti-vascular endothelial growth factor (anti-VEGF) therapy beyond best-corrected visual acuity and central optical coherence tomography outcomes. Methods A post hoc analysis of a double-masked, multicenter, randomized clinical trial was performed. A total of 392 patients with macular edema after CRVO were randomized 1:1:1 to receive monthly intraocular injections of 0.3 or 0.5 mg of ranibizumab or sham injections. Central reading center-read data were reviewed to explore potential anatomic endpoints altered by therapy. Results At 6 months, there was a reduction in the ranibizumab groups compared with sham groups with respect to total area of retinal hemorrhage (median change from baseline in disc areas: − 1.17 [sham], − 2.37 [ranibizumab 0.3 mg], − 1.64 [ranibizumab 0.5 mg]), development of disc neovascularization (prevalence: 3% [sham], 0% [ranibizumab 0.3 mg], 0% [ranibizumab 0.5 mg]), and presence of papillary swelling (prevalence: 22.9% [sham], 8.0% [ranibizumab 0.3 mg], 8.3% [ranibizumab 0.5 mg], p < 0.01). There was no difference between groups in collateral vessel formation. Analysis of vitreous and preretinal hemorrhage could not be performed due to low frequency of events in both treated and sham groups. Conclusions Ranibizumab for CRVO resulted in beneficial disease-modifying effects through a reduction in retinal hemorrhage, neovascularization, and papillary swelling. These findings may form the basis for future work in the development of a treatment response or severity scale for eyes with CRVO.
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15
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Matsumoto M, Suzuma K, Akiyama F, Yamada K, Harada S, Tsuiki E, Kitaoka T. Retinal Vascular Resistance Significantly Correlates With Visual Acuity After 1 Year of Anti-VEGF Therapy in Central Retinal Vein Occlusion. Transl Vis Sci Technol 2021; 10:19. [PMID: 34559183 PMCID: PMC8475282 DOI: 10.1167/tvst.10.11.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate whether the resistivity of all retinal vessels, termed total capillary resistance (TCR), after anti-vascular endothelial growth factor (VEGF) treatment was correlated with the outcomes of patients with macular edema secondary to central retinal vein occlusion (CRVO). Methods In total, 67 patients with nonischemic CRVO were enrolled in this retrospective observational case series. In each patient, we examined visual acuity; central retinal thickness (CRT); mean blur rate (MBR), which represents retinal blood flow velocity; and TCR. MBR and TCR were measured by laser speckle flowgraphy. Results During the 1-year follow-up period, nine of 67 eyes (13.4%) converted to the ischemic type (converted group), whereas 58 eyes (86.6%) remained unchanged (nonischemic group). Mean CRT significantly decreased in all groups; however, the mean visual acuity significantly improved only in the nonischemic group. Mean MBR significantly increased in the nonischemic group but remained unchanged in the converted group. Mean TCR was significantly reduced in the nonischemic group but remained unchanged in the converted group. Multiple linear regression analysis revealed that MBR and TCR were the independent factors with the strongest and second strongest correlations with visual acuity after treatment, respectively. Conclusions These findings suggest that measurements of the independent factors MBR and TCR are useful for evaluating anti-VEGF treatments in patients with CRVO. Translational Relevance Development of clinically relevant technologies.
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Affiliation(s)
- Makiko Matsumoto
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Kiyoshi Suzuma
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Kagawa University, Kagawa, Japan
| | - Fumito Akiyama
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Kanako Yamada
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Shiori Harada
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Eiko Tsuiki
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Takashi Kitaoka
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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16
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Lotery A, Clemens A, Tuli R, Xu X, Shimura M, Nardi M, Ziemssen F, Dunger-Baldauf C, Tadayoni R. Effectiveness and safety of ranibizumab in patients with central retinal vein occlusion: results from the real-world, global, LUMINOUS study. Eye (Lond) 2021; 36:1656-1661. [PMID: 34326500 PMCID: PMC9307792 DOI: 10.1038/s41433-021-01702-y] [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: 12/14/2020] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate the effectiveness, treatment patterns and long-term safety of ranibizumab 0.5 mg in treatment-naïve patients with central retinal vein occlusion (CRVO) in a real-world setting. Methods LUMINOUS, a 5-year, global, prospective, multicentre, multi-indication, observational, open-label study, recruited treatment naïve or prior treated patients who were treated as per the local ranibizumab label. Here, we report the mean change in visual acuity (VA; Early Treatment Diabetic Retinopathy Study [ETDRS] letters), treatment exposure over year (Y) 1 and 5-year safety in treatment-naïve CRVO patients. Results At baseline, the mean age of treatment-naïve CRVO patients (n = 327) was 68.9 years, with a mean (Standard deviation [SD]) VA of 40.6 (23.9) letters. At Y1, patients (n = 144) had a mean (SD) VA gain from baseline of 10.8 (19.66) letters, with a mean (SD) of 5.4 (2.65) ranibizumab injections. Patients demonstrated mean (SD) VA gains of 2.7 (19.35), 11.6 (20.56), 13.9 (18.08), 11.1 (18.46) and 8.2 (24.86) letters with 1, 2–3, 4–5, 6–8 and >8 ranibizumab injections, respectively. Mean (SD) VA gains at Y1 in patients receiving loading (67.4%) and no loading dose (32.6%) was 11.9 (20.42) and 8.4 (17.99) letters, respectively. Over five years, the incidence of ocular/non-ocular adverse events (AEs) and serious AEs was 11.3%/8.6% and 1.2%/6.7%, respectively. Conclusions These results demonstrate the effectiveness of ranibizumab in treatment-naïve CRVO patients at Y1 with clinically meaningful VA gains and no new safety findings over five years. These findings may help inform routine practice and enable better clinical management to achieve optimal visual outcomes.
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Affiliation(s)
- Andrew Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Andreas Clemens
- Novartis Pharma AG, Basel, Switzerland. .,Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Raman Tuli
- Department of Ophthalmology, University of Ottawa, Ottawa, Canada
| | - Xun Xu
- Department of Ophthalmology, Shanghai First People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Masahiko Shimura
- Department of Ophthalmology, Tokyo Medical University Hachioji Medical Center, Hachioji-shi, Tokyo-To, Japan
| | - Marco Nardi
- Ophthalmology Unit, University of Pisa, Pisa, Italy
| | - Focke Ziemssen
- Department for Ophthalmology, Eberhard Karl University Tübingen, Tübingen, Germany
| | | | - Ramin Tadayoni
- Université de Paris, Ophthalmology Department, AP-HP, Lariboisière, Saint Louis and Fondation Rothschild Hospitals, Paris, France
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17
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Nishinaka A, Nakamura S, Tanaka M, Masuda T, Inoue Y, Yamamoto T, Imai T, Hidaka Y, Shimazawa M, Hara H. Excess adiponectin in eyes with progressive ocular vascular diseases. FASEB J 2021; 35:e21313. [PMID: 33484194 DOI: 10.1096/fj.202001740rr] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 11/11/2022]
Abstract
Anti-vascular endothelial growth factor (VEGF) therapies are now the first-line treatment for many ocular diseases, but some patients are non-responders to these therapies. The purpose of this study was to determine whether the level of adiponectin increased the pathogenesis of retinal edema and neovascularization in the retina of progressive ocular vascular diseases. We examined the role played by adiponectin in two types of cells and animal models which are retinal vein occlusion (RVO) and oxygen-induced retinopathy (OIR) mice. Our results showed that an injection of anti-adiponectin antibody ameliorated the retinal edema and ischemia through the depression of the expression level of VEGF-related factors and tight junction-related proteins in the retina of RVO mice. The intravitreal injection of anti-adiponectin antibody also decreased the degree of retinal neovascularization in an OIR mice. In addition, exposure of human retinal microvascular endothelial cells and human brain microvascular pericytes in culture to adiponectin increased both the vascular permeability and neovascularization through the increase of inflammatory factor and the dropout of the pericytes. These findings indicate that adiponectin plays a critical role in retinal edema and neovascularization, and adiponectin is a potential therapeutic target for the treatment of diabetic macular edema, proliferative diabetic retinopathy, and RVO.
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Affiliation(s)
- Anri Nishinaka
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Shinsuke Nakamura
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Miruto Tanaka
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Tomomi Masuda
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Yuki Inoue
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Takumi Yamamoto
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Takahiko Imai
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Yae Hidaka
- 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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18
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Zhou L, Shi DP, Chu WJ, Song S, Hao XH, Yang LL, Xu HF. Nicotinamide suppresses bevacizumab-induced epithelial-mesenchymal transition of ARPE-19 cells by attenuating oxidative stress. Int J Ophthalmol 2021; 14:481-488. [PMID: 33875936 DOI: 10.18240/ijo.2021.04.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/12/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the effects of nicotinamide (NAM) on bevacizumab (BEV)-induced epithelial-mesenchymal transition (EMT) of human retinal pigment epithelial cells (ARPE-19) and the underling mechanisms. METHODS ARPE-19 cells were treated with BEV for 24, 48, and 72h, and the variation degrees of EMT-related markers (fibronectin, α-SMA, vimentin, and ZO-1) were assessed by Western blotting to select the optimal treatment time point which exhibited the most obvious changes of EMT-related markers for the subsequent experiments. Furthermore, NAM was added to the medium, the mRNA and protein levels of the EMT-related markers were then measured. The accumulation of reactive oxygen species (ROS) and H2O2 and the total antioxidant capacity (TAC) of the cells were also measured to evaluate the level of oxidative stress. RESULTS After being treated with BEV for 72h, the protein expression levels of EMT-related markers in ARPE-19 cells showed significant changes. Meanwhile the levels of ROS and H2O2 were obviously increased, and the TAC of ARPE-19 cells was decreased. Totally 72h was chosen to be the optimal treatment time point in subsequent experiments. Furthermore, NAM inhibited BEV-induced EMT by downregulating fibronectin, α-SMA, and vimentin and upregulating ZO-1, decreased the accumulation of ROS and H2O2, and enhanced TAC in BEV-treated ARPE-19 cells. CONCLUSION This study demonstrates that NAM suppressed BEV-induced EMT in ARPE-19 cells by attenuating oxidative stress. Hence, NAM may be a potential therapeutic agent for alleviating neovascular fibrosis of the ocular fundus after anti-vascular endothelial growth factor therapy.
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Affiliation(s)
- Li Zhou
- Medical College, Qingdao University, Qingdao 266071, Shandong Province, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
| | - De-Peng Shi
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
| | - Wen-Juan Chu
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
| | - Shan Song
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
| | - Xiang-Hui Hao
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
| | - Ling-Ling Yang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
| | - Hai-Feng Xu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China.,Qingdao Eye Hospital, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
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Yuksel B, Karti O, Celik O, Kerci SG, Kusbeci T. Low frequency ranibizumab versus dexamethasone implant for macular oedema secondary to branch retinal vein occlusion. Clin Exp Optom 2021; 101:116-122. [DOI: 10.1111/cxo.12586] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/27/2017] [Accepted: 03/31/2017] [Indexed: 01/20/2023] Open
Affiliation(s)
- Bora Yuksel
- Department of Ophthalmology, Bozyaka Training and Research Hospital, Izmir, Turkey,
| | - Omer Karti
- Department of Ophthalmology, Bozyaka Training and Research Hospital, Izmir, Turkey,
| | - Ozan Celik
- Department of Ophthalmology, Bozyaka Training and Research Hospital, Izmir, Turkey,
| | | | - Tuncay Kusbeci
- Department of Ophthalmology, Bozyaka Training and Research Hospital, Izmir, Turkey,
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20
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Steinle NC, Du W, Gibson A, Saroj N. Outcomes by Baseline Choroidal Neovascularization Features in Age-Related Macular Degeneration. ACTA ACUST UNITED AC 2021; 5:141-150. [DOI: 10.1016/j.oret.2020.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 11/28/2022]
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21
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Lo T, Lent-Schochet D, Luu KY, Kuriyan AE, Weiss MY, Rachitskaya AV, Singh RP, Wai KM, Campbell JP, Gupta K, Nudleman E, Chen KC, Yiu G. Patterns and Predictors of Successful Treatment Discontinuation in Retinal Vein Occlusions With Macular Edema in the Real World. Ophthalmic Surg Lasers Imaging Retina 2021; 52:84-92. [PMID: 33626169 DOI: 10.3928/23258160-20210201-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/05/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To identify factors associated with successful treatment discontinuation in eyes with retinal vein occlusions (RVOs) and macular edema (ME) in real-world settings. PATIENTS AND METHODS Retrospective study of 214 eyes with RVO and ME with 24-month follow-up at five academic centers. Regression analyses identified factors associated with (1) successful treatment discontinuation for at least 6 months without fluid recurrence and (2) best-corrected visual acuity (BCVA) at 24 months. RESULTS Forty percent of eyes with branch RVO and 35% with central RVO (CRVO) / hemi-retinal RVO (HRVO) successfully discontinued therapy without fluid recurrence, with median time to discontinuation of 6 and 7 months, respectively. Lower 6-month central subfield thickness was associated with greater likelihood of treatment discontinuation within 24 months for eyes with CRVO/HRVO (P = .001), whereas better 6-month BCVA was associated with better 24-month BCVA for all RVO subtypes (P < .001). CONCLUSION Early anatomic response at 6 months is associated with greater likelihood of stopping treatments. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:84-92.].
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Murata T, Kondo M, Inoue M, Nakao S, Osaka R, Shiragami C, Sogawa K, Mochizuki A, Shiraga R, Ohashi Y, Kaneko T, Chandrasekhar C, Tsujikawa A, Kamei M. The randomized ZIPANGU trial of ranibizumab and adjunct laser for macular edema following branch retinal vein occlusion in treatment-naïve patients. Sci Rep 2021; 11:551. [PMID: 33436683 PMCID: PMC7804316 DOI: 10.1038/s41598-020-79051-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/04/2020] [Indexed: 11/09/2022] Open
Abstract
The ZIPANGU study assessed the efficacy and safety of ranibizumab as a one loading dose + pro re nata (one + PRN) regimen with/without focal/grid laser among treatment-naïve patients suffering from macular edema (ME) following branch retinal vein occlusion (BRVO). ZIPANGU was a phase IV, prospective, randomized, open-label, active-controlled, 12-month, two-arm, multicenter study. Treatment-naïve patients with visual impairment (19–73 letters) caused by ME, defined as central subfield thickness (CSFT) > 300 µm, due to BRVO were randomly assigned to ranibizumab monotherapy (n = 29) or combination therapy (ranibizumab + focal/grid short-pulse laser, n = 30). The primary endpoint was the number of ranibizumab injections. Secondary endpoints were mean changes in best-corrected visual acuity (BCVA) and CSFT, and safety. There were no statistically significant differences in the mean number of ranibizumab injections between monotherapy (4.3 injections) vs. combination (4.1 injections) therapy, or in CSFT. BCVA improvement in the monotherapy arm (22.0 letters) was better than the combination therapy arm (15.0 letters) (p = 0.035). Overall, both regimens appeared to be safe and well tolerated. One + PRN ranibizumab is safe and efficacious in treatment-naïve patients with ME secondary to BRVO. A conjunctive laser treatment did not lead to better functional outcomes or fewer ranibizumab injections.
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Affiliation(s)
- Toshinori Murata
- Department of Ophthalmology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan.
| | - Mineo Kondo
- Department of Ophthalmology, Mie University Graduate School of Medicine, Mie, Japan
| | - Makoto Inoue
- Department of Ophthalmology, Kyorin Eye Center, Kyorin University School of Medicine, Tokyo, Japan
| | - Shintaro Nakao
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Rie Osaka
- Department of Ophthalmology, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Chieko Shiragami
- Department of Ophthalmology, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Kenji Sogawa
- Department of Ophthalmology, Asahikawa Medical University, Hokkaido, Japan
| | | | | | | | | | | | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Motohiro Kamei
- Department of Ophthalmology, Aichi Medical University, Aichi, Japan
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Kurtul BE, Çakmak Aİ, Elbeyli A, Özarslan Özcan D, Özcan SC, Cankurtaran V. Assessment of platelet-to-lymphocyte ratio in patients with retinal vein occlusion. Ther Adv Ophthalmol 2020; 12:2515841420971949. [PMID: 33283155 PMCID: PMC7686591 DOI: 10.1177/2515841420971949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 11/15/2022] Open
Abstract
Purpose: To investigate platelet-to-lymphocyte ratio (PLR) in retinal vein occlusion
(RVO) patients. Methods: In this study, we retrospectively reviewed data of 32 patients with RVO (RVO
group) and 32 age- and sex-matched participants without RVO (control group)
between January 2017 and March 2019. The PLR was determined by dividing the
platelet count by the lymphocyte count. Results: Age and gender were comparable between the groups (p = 0.204
and p = 0.800, respectively). PLR was significantly
elevated in the RVO group compared with the control group (137 (113–164) vs
101 (86–129), p = 0.001)). In the receiver operator
characteristics curve analysis, the optimal cut-off value of PLR for
predicting RVO was 123, with 69% sensitivity and 72% specificity. Conclusion: We report that PLR are elevated in RVO, suggesting that PLR may be a useful
marker for RVO.
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Affiliation(s)
- Bengi Ece Kurtul
- Department of Ophthalmology, Tayfur Ata Sökmen Faculty of Medicine, Hatay Mustafa Kemal University, 31060, Alahan, Hatay, Turkey
| | - Ayșe İdil Çakmak
- Department of Ophthalmology, Tayfur Ata Sökmen Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Ahmet Elbeyli
- Department of Ophthalmology, Tayfur Ata Sökmen Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Deniz Özarslan Özcan
- Department of Ophthalmology, Tayfur Ata Sökmen Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Sait Coșkun Özcan
- Department of Ophthalmology, Tayfur Ata Sökmen Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Veysel Cankurtaran
- Department of Ophthalmology, Tayfur Ata Sökmen Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
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Shah SM, Khanna CL, Yamanuha J, Bakri SJ. "Glaucomatous fields" after monthly intravitreal injections: Normal tension glaucoma or a mimicker? Am J Ophthalmol Case Rep 2020; 20:100904. [PMID: 32964169 PMCID: PMC7490721 DOI: 10.1016/j.ajoc.2020.100904] [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: 05/07/2020] [Revised: 08/10/2020] [Accepted: 08/20/2020] [Indexed: 11/20/2022] Open
Abstract
Purpose Anti-vascular endothelial growth factor (VEGF) injections, while used to effectively treat numerous retinal vascular conditions, can be associated with transient and prolonged ocular hypertension. There is minimal literature detailing the development of normal-tension glaucoma (NTG) following intravitreal anti-VEGF injections. Observations A 38-year-old Caucasian male with no medical or ocular history was diagnosed with an inferior HRVO with macular edema in the left eye. The patient received a total of eleven monthly intravitreal aflibercept injections over one year, with maintenance of stable vision and intraocular pressure (IOP) throughout the treatment period and during follow-up. Nine months after the last aflibercept injection, cup-to-disc asymmetry, inferior thinning of retinal nerve fiber layer (RNFL), and reduced superior visual field was evident in the left eye. Clinically, the patient was consistent with normal tension glaucoma and thus, the patient was started on daily timolol drops; however, the role of the glaucomatous findings being secondary to repeated injection-related IOP elevations is possible. Conclusions and Importance While the clinical features based on visual fields and RNFL thinning with unmedicated normotensive IOP may suggest NTG in a patient, this clinical presentation may be a masquerader of NTG with the etiology of the glaucoma optic neuropathy caused by cumulative impact of transient IOP elevations secondary to intravitreal injections.
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Affiliation(s)
- Saumya M. Shah
- Mayo Clinic, Department of Ophthalmology, Rochester, MN, USA
| | | | - Justin Yamanuha
- Mayo Clinic, Department of Ophthalmology, Rochester, MN, USA
- Mayo Clinic Health System, Department of Ophthalmology, La Crosse, WI, USA
| | - Sophie J. Bakri
- Mayo Clinic, Department of Ophthalmology, Rochester, MN, USA
- Corresponding author. Mayo Clinic, Department of Ophthalmology, 200 First Street, SW, Rochester, MN, 55905, USA.
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Zhong P, He M, Yu H, Wu Q, Peng Q, Huang M, Xue Y, Yang X. A Meta-Analysis of Cardiovascular Events Associated with Intravitreal Anti-VEGF Treatment in Patients with Retinal Vein Occlusion. Curr Eye Res 2020; 45:615-622. [PMID: 31670978 DOI: 10.1080/02713683.2019.1687727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/17/2019] [Accepted: 10/25/2019] [Indexed: 02/05/2023]
Abstract
Purpose: Retinal vein occlusion is associated with an increased risk of cardiovascular diseases. Anti-vascular endothelial growth factor has been widely used as a treatment option. However, the systemic safety of intravitreal anti-vascular endothelial growth factor for retinal vein occlusion patients is still unclear.Materials and Methods: A meta-analysis was conducted to investigate all randomized controlled trials published up to February 2019 of retinal vein occlusion patients who received intravitreal anti-vascular endothelial growth factor vs. control treatments. Fixed effect models were used and results were reported as odds ratios and 95% confidence intervals.Results: Eight trials that evaluated 2320 patients were retrieved. Anti-vascular endothelial growth factor did not significantly increase the risks of cardiovascular events (odds ratio,1.54; 95% confidence interval, 0.66-3.57), hypertension (odds ratio, 0.92; 95% confidence interval, 0.63-1.33), or heart rate disorders (odds ratio,1.53; 95% confidence interval, 0.37-6.28) when compared with control treatment. Subgroup analyses did not show a significant increase of cardiovascular events in aflibercept (odds ratio,1.96; 95% confidence interval, 0.44-8.81) vs. ranibizumab trials (odds ratio, 1.47; 95% confidence interval, 0.54-4.02); 0.5 mg ranibizumab trials (odds ratio, 1.73; 95% confidence interval, 0.61-4.96) vs. 0.3 mg ranibizumab trials (odds ratio, 0.70; 95% confidence interval, 0.14-3.59); nor branch retinal vein occlusion (odds ratio, 1.32; 95% confidence interval, 0.40-4.33) vs. central retinal vein occlusion trials (odds ratio, 1.93; 95% confidence interval, 0.59-6.29).Conclusions: Intravitreal administration of anti-vascular endothelial growth factor did not significantly increase the risks of cardiovascular events, hypertension or heart rate disorders in retinal vein occlusion patients.
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Affiliation(s)
- Pingting Zhong
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Miao He
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Honghua Yu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qiaowei Wu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Southern Medical University, Guangzhou, China
| | - Qingsheng Peng
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Manqing Huang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yunlian Xue
- Statistics Office, Information and Statistics Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaohong Yang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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26
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Li L, Hu X, Yang Z, Chen X, Guo L, Zhu C, Zhang Z, Pan Q. Optical quality assessment in branch retinal vein occlusion after monthly intravitreal ranibizumab injection: a prospective, case-control study. Curr Eye Res 2019; 45:1005-1011. [PMID: 31873038 DOI: 10.1080/02713683.2019.1708954] [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: 10/25/2022]
Abstract
PURPOSE To evaluate optical quality and intraocular scattering using the Optical Quality Analysis System (OQAS) II in branch retinal vein occlusion (BRVO) and to investigate the influences of retinal changes on optical quality. MATERIALS AND METHODS Sixty-two patients with diagnosis of BRVO were enrolled in this prospective, case-control study. The control group consisted of the patients' fellow eyes. Initial logMAR visual acuity, central macular thickness, and optical quality parameters including modulation transfer function cutoff frequency (MTF cut off), Strehl ratio (SR), objective scatter index (OSI) and OQAS values (OVs) at 100%, 20%, and 9% contrast levels were measured. Every BRVO-affected eye was treated with monthly intravitreal ranibizumab injection. We investigated the differences between clinical parameters of the BRVO-affected eye and those of the control eye and changes in those parameters on the basis of the clinical course of BRVO over 3 months. RESULTS All the OQAS parameters measured except objective refraction error differed statistically significantly between the two groups. As macular thickness decreased and visual acuity improved, all the optical quality parameters except for objective refraction error and OV at 100% contrast gradually recovered with time after treatment but did not return to normal compared with the control eye. Only visual acuity was found to be significantly related to central macular thickness change (p = .027). CONCLUSIONS BRVO resulted in declined visual acuity and optical quality. It is suggested that the optical quality parameters are affected by the inner layers of the retina in BRVO.
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Affiliation(s)
- Lili Li
- Departments of Radiation Oncology and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University , Wenzhou, China
| | - Xuting Hu
- Department of fundus surgery, The Eye Hospital of Wenzhou Medical University , Wenzhou, China
| | - Zhengwei Yang
- Department of fundus surgery, The Eye Hospital of Wenzhou Medical University , Wenzhou, China
| | - Xuhao Chen
- Department of fundus surgery, The Eye Hospital of Wenzhou Medical University , Wenzhou, China
| | - Linning Guo
- Department of fundus surgery, The Eye Hospital of Wenzhou Medical University , Wenzhou, China
| | - Chenlei Zhu
- Department of fundus surgery, The Eye Hospital of Wenzhou Medical University , Wenzhou, China
| | - Zongduan Zhang
- Department of fundus surgery, The Eye Hospital of Wenzhou Medical University , Wenzhou, China
| | - Qintuo Pan
- Department of fundus surgery, The Eye Hospital of Wenzhou Medical University , Wenzhou, China
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27
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Stallworth JY, Thomas AS, Constantine R, Stinnett SS, Fekrat S. Treatment Patterns and Clinical Outcomes for Central Retinal Vein Occlusion in the Antivascular Endothelial Growth Factor Era. JOURNAL OF VITREORETINAL DISEASES 2019; 4:13-21. [PMID: 37009559 PMCID: PMC9976087 DOI: 10.1177/2474126419878922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: This article describes treatment patterns and visual outcomes for central retinal vein occlusion (CRVO) in the antivascular endothelial growth factor (anti-VEGF) era. Methods: A retrospective cohort study of eyes diagnosed with CRVO between 2009 and 2016 was conducted. Treatment history and visual acuity (VA) measurements were abstracted from medical records and analyzed. Results: A total of 476 eyes of 476 patients (median age 67 years, median follow-up 25.4 months) were included. Optical coherence tomography was obtained in 93.9% and fluorescein angiography in 80% of cases on presentation. Mean VA at presentation and final visit was 20/60 and 20/94, respectively, for eyes with nonischemic CRVO, whereas that of ischemic cases remained worse than 20/800 at final follow-up. Intravitreal bevacizumab was the most common first treatment (42.2%). Intravitreal steroid was the first treatment in 3.6% and ultimately administered in 11.3% of eyes. In the first year, an average of 5.2 ± 3.6 and 2.2 ± 3.4 anti-VEGF injections were given in treatment-naive and nontreatment-naive eyes, respectively. Conclusions: In our real-world cohort, anti-VEGF injection burden and frequency are lower than in published clinical trials. Visual outcomes in both ischemic and nonischemic eyes with CRVO are poorer than expected and worse than those recorded in controlled trial settings.
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Affiliation(s)
| | | | | | | | - Sharon Fekrat
- Department of Ophthalmology, Duke University, Durham, NC, USA
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28
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NOVEL OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY BIOMARKER IN BRANCH RETINAL VEIN OCCLUSION MACULAR EDEMA. Retina 2019; 39:1906-1916. [DOI: 10.1097/iae.0000000000002264] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Lashay A, Riazi-Esfahani H, Mirghorbani M, Yaseri M. Intravitreal Medications for Retinal Vein Occlusion: Systematic Review and Meta-analysis. J Ophthalmic Vis Res 2019; 14:336-366. [PMID: 31660113 PMCID: PMC6815330 DOI: 10.18502/jovr.v14i3.4791] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 04/29/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose
To evaluate the outcomes of different intravitreal injections for the treatment of retinal vein occlusion including central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). Methods
PubMed, Cochrane, the metaRegister of ControlledTrials, and ClinicalTrials were searched for intravitreal anti-Vascular Endothelial Growth Factor (VEGF) and steroids with relevant keywords and date limitation of 2009-2018. Meta-analysis was performed on studies that met the defined inclusion criteria. Main outcomes were visual acuity (VA) and central macular thickness (CMT). Results Out of 681 studies, 36 articles (including 21 reporting CRVO and 15 dealing with BRVO) were selected for systematic review. All five intravitreal drugs including triamcinolone, dexamethasone, ranibizumab, bevacizumab, and aflibercept showed improvement of CMT and VA as compared to placebo or laser treatment. Six randomized controlled trials were selected for meta-analysis in RVO patients. The pooled mean difference of visual improvement between sham and ranibizumab was 12.7 Early Treatment for Diabetic Retinopathy Study (ETDRS) letters (95%CI: 11.00 to 13.2), and the pooled mean difference in CMT reduction was 221μm (95%CI: 153 to 284); both changes were significantly in favor of ranibizumab. The pooled mean difference of visual improvement between bevacizumab and triamcinolone was 5.3 ETDRS letters in favor of bevacizumab (95%CI: 16 μm to 17.5 μm). Triamcinolone led to 68.1 μm greater CMT reduction than bevacizumab (95%CI: 58 μm to 76 μm). However, none of these differences were statistically significant. Conclusion Treatment with anti-VEGF agents in RVO is superior to observation. No significant difference was seen between the eyes treated with bevacizumab or triamcinolone based on these results.
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Affiliation(s)
- Alireza Lashay
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Riazi-Esfahani
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Mirghorbani
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
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30
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Valkenburg D, Runhart EH, Bax NM, Liefers B, Lambertus SL, Sánchez CI, Cremers FPM, Hoyng CB. Highly Variable Disease Courses in Siblings with Stargardt Disease. Ophthalmology 2019; 126:1712-1721. [PMID: 31522899 DOI: 10.1016/j.ophtha.2019.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/06/2019] [Accepted: 07/10/2019] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To investigate intersibling phenotypic concordance in Stargardt disease (STGD1). DESIGN Retrospective cohort study. PARTICIPANTS Siblings with genetically confirmed STGD1 and at least 1 available fundus autofluorescence (FAF) image of both eyes. METHODS We compared age at onset within families. Disease duration was matched to investigate differences in best-corrected visual acuity (BCVA) and compared the survival time for reaching severe visual impairment (<20/200 Snellen or >1.0 logarithm of the minimum angle of resolution [logMAR]). Central retinal atrophy area was quantified independently by 2 experienced graders using semiautomated software and compared between siblings. Both graders performed qualitative assessment of FAF and spectral-domain (SD) OCT images to identify phenotypic differences. MAIN OUTCOME MEASURES Differences in age at onset, disease duration-matched BCVA, time to severe visual impairment development, FAF atrophy area, FAF patterns, and genotypes. RESULTS Substantial differences in age at onset were present in 5 of 17 families, ranging from 13 to 39 years. Median BCVA at baseline was 0.60 logMAR (range, -0.20 to 2.30 logMAR; Snellen equivalent, 20/80 [range, 20/12-hand movements]) in the right eye and 0.50 logMAR (range, -0.20 to 2.30 logMAR; Snellen equivalent, 20/63 [range, 20/12-hand movements]) in the left eye. Disease duration-matched BCVA was investigated in 12 of 17 families, and the median difference was 0.41 logMAR (range, 0.00-1.10 logMAR) for the right eye and 0.41 logMAR (range, 0.00-1.08 logMAR) for the left eye. We observed notable differences in time to severe visual impairment development in 7 families, ranging from 1 to 29 years. Median central retinal atrophy area was 11.38 mm2 in the right eye (range, 1.98-44.78 mm2) and 10.59 mm2 in the left eye (range, 1.61-40.59 mm2) and highly comparable between siblings. Similarly, qualitative FAF and SD OCT phenotypes were highly comparable between siblings. CONCLUSIONS Phenotypic discordance between siblings with STGD1 carrying the same ABCA4 variants is a prevalent phenomenon. Although the FAF phenotypes are highly comparable between siblings, functional outcomes differ substantially. This complicates both sibling-based prognosis and genotype-phenotype correlations and has important implications for patient care and management.
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Affiliation(s)
- Dyon Valkenburg
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Esmee H Runhart
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nathalie M Bax
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bart Liefers
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stanley L Lambertus
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Clara I Sánchez
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frans P M Cremers
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carel B Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
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31
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Xu J, Hao X, Lu B, Ming J, Li X, Qi Y, Xie L. Intervention of artemisinin in macular edema associated with retinal vein occlusion: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e16044. [PMID: 31232939 PMCID: PMC6636968 DOI: 10.1097/md.0000000000016044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 05/23/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Artemisinin was discovered to be highly effective antimalarial drugs shortly after the isolation of the parent artemisinin in 1971 in China. It is derived from extracts of sweet wormwood (Artemisia annua) and are well established for the treatment of malaria. Recently, artemisinin has been shown that it might have therapeutic value for several other diseases. The purpose of this review is to assess the efficacy of artemisinin as a treatment for macular edema associated with retinal vein occlusion. METHODS AND ANALYSIS A systematic literature search will be performed in all available databases to quantitatively review eligible studies and identify all relevant data. We will include randomized controlled trials assessing efficacy of artemisinin as a treatment for macular edema associated with retinal vein occlusion. The methodological qualities, including the risk of bias, will be evaluated using the Cochrane risk of bias assessment tool, while confidence in the cumulative evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. ETHICS AND DISSEMINATION Ethical approval is not required, as this study is based on the review of published research. This review will be published in a peer-reviewed journal and disseminated both electronically and in print. PROSPERO REGISTRATION NUMBER The protocol for this systematic review has been registered on PROSPERO under the number CRD42019131408.
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Kumagai K, Ogino N, Fukami M, Furukawa M. Long-term outcomes of intravitreous bevacizumab or tissue plasminogen activator or vitrectomy for macular edema due to branch retinal vein occlusion. Clin Ophthalmol 2019; 13:617-626. [PMID: 31043767 PMCID: PMC6469473 DOI: 10.2147/opth.s195600] [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] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to determine the long-term outcomes of intravitreal bevacizumab (IVB) or intravitreal tissue plasminogen activator (tPA) or vitrectomy for macular edema associated with a branch retinal vein occlusion (BRVO). Methods This was a retrospective, interventional case series. Forty-one patients received a single 1.25 mg of IVB injection and followed by pro re nata protocol, 71 patients received a single intravitreal tPA, and 116 patients underwent phacovitrectomy with intraocular lens implantation. Results The baseline characteristics and follow-up periods were not significantly different among the three groups. The mean follow-up period was 55.5 months with a range of 12-160 months. Sixteen patients (39.0%) in the IVB group, 24 patients (33.8%) in the tPA group, and two patients (1.7%) in the vitrectomy group underwent additional surgeries during the follow-up period. The best-corrected visual acuity (BCVA) significantly improved in all groups at 1 year after the initial treatment (all, P<0.0001) and at the final visit (all, P<0.0001). The differences in the BCVA between the three groups were not significant at all times after the initial treatment. Conclusion The three groups led to similar long-term good visual outcomes. However, additional surgeries were performed in more than 30% of patients in the IVB and tPA groups.
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Affiliation(s)
| | | | - Marie Fukami
- Kami-iida Daiichi General Hospital, Nagoya, Aichi, Japan,
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33
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Spooner K, Fraser-Bell S, Hong T, Chang AA. Five-year outcomes of retinal vein occlusion treated with vascular endothelial growth factor inhibitors. BMJ Open Ophthalmol 2019; 4:e000249. [PMID: 30997407 PMCID: PMC6440600 DOI: 10.1136/bmjophth-2018-000249] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose Report 5-year outcomes of patients receiving anti-vascular endothelial growth factor (VEGF) for the treatment of macular oedema secondary to retinal vein occlusion (RVO. Methods Retrospective review of eyes with RVO which initiated anti-VEGF treatment. Data including age, gender, visual acuity (VA) and injection numbers were obtained from medical records. Optical coherence tomography scans were graded for presence or absence of macular oedema and central foveal thickness (CFT). Macular perfusion was assessed on fundus fluorescein angiography by masked graders. Results 68 eyes (31 branch RVO, BRVO; 35 central RVO, CRVO and 2 hemi-RVO) with 5 years of follow-up after initiation of anti-VEGF treatment. Mean change in VA at 5 years was + 9.6 ± 21.6 letters among CRVO eyes and + 14.2 ± 15.6 letters among eyes with BRVO (p=0.001). Vision of 20/40 or better was achieved in 65 % of treated eyes. The proportion of eyes with a three-line improvement of vision (15 letters) at 5 years was 22 %. Mean CFT decreased by 257.6 ± 249.8 µm in eyes with CRVO and 145.6 ± 143.3 µm in eyes with BRVO. Conclusion The results confirm good long-term outcomes can be achieved with anti-VEGF therapy for RVO.
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Affiliation(s)
- Kimberly Spooner
- Research, Sydney Institute of Vision Science, Sydney, New South Wales, Australia.,Department of Ophthalmology, University of Sydney, Sydney, New South Wales, Australia
| | - Samantha Fraser-Bell
- Department of Opthalmology and Eye Health, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Thomas Hong
- Sydney Institute of Vision Science, Sydney, New South Wales, Australia
| | - Andrew A Chang
- Sydney Institute of Vision Science, Sydney, New South Wales, Australia
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Hirabayashi K, Tanaka M, Imai A, Toriyama Y, Iesato Y, Sakurai T, Kamiyoshi A, Ichikawa-Shindo Y, Kawate H, Tanaka M, Dai K, Cui N, Wei Y, Nakamura K, Iida S, Matsui S, Yamauchi A, Murata T, Shindo T. Development of a Novel Model of Central Retinal Vascular Occlusion and the Therapeutic Potential of the Adrenomedullin-Receptor Activity-Modifying Protein 2 System. THE AMERICAN JOURNAL OF PATHOLOGY 2019; 189:449-466. [PMID: 30658846 DOI: 10.1016/j.ajpath.2018.10.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/03/2018] [Accepted: 10/23/2018] [Indexed: 12/20/2022]
Abstract
Central retinal vein occlusion (CRVO) is an intractable disease that causes visual acuity loss with retinal ischemia, hemorrhage, and edema. In this study, we developed an experimental CRVO model in mice and evaluated the therapeutic potential of the pleiotropic peptide adrenomedullin (ADM) and its receptor activity-modifying protein 2 (RAMP2). The CRVO model, which had phenotypes resembling those seen in the clinic, was produced by combining i.p. injection of Rose bengal, a photoactivator dye enhancing thrombus formation, with laser photocoagulation. Retinal vascular area, analyzed using fluorescein angiography and fluorescein isothiocyanate-perfused retinal flat mounts, was decreased after induction of CRVO but gradually recovered from day 1 to 7. Measurements of retinal thickness using optical coherence tomography and histology revealed prominent edema early after CRVO, followed by gradual atrophy. Reperfusion after CRVO was diminished in Adm and Ramp2 knockout (KO) mice but was increased by exogenous ADM administration. CRVO also increased expression of a coagulation factor, oxidative stress markers, and a leukocyte adhesion molecule in both wild-type and Adm KO mice, and the effect was more pronounced in Adm KO mice. Using retinal capillary endothelial cells, ADM was found to directly suppress retinal endothelial injury. The retinoprotective effects of the Adm-Ramp2 system make it a novel therapeutic target for the treatment of CRVO.
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Affiliation(s)
- Kazutaka Hirabayashi
- Department of Cardiovascular Research, Shinshu University Graduate School of Medicine, Nagano, Japan; Department of Ophthalmology, Shinshu University School of Medicine, Nagano, Japan
| | - Masaaki Tanaka
- Department of Cardiovascular Research, Shinshu University Graduate School of Medicine, Nagano, Japan; Department of Ophthalmology, Shinshu University School of Medicine, Nagano, Japan
| | - Akira Imai
- Department of Cardiovascular Research, Shinshu University Graduate School of Medicine, Nagano, Japan; Department of Ophthalmology, Shinshu University School of Medicine, Nagano, Japan
| | - Yuichi Toriyama
- Department of Cardiovascular Research, Shinshu University Graduate School of Medicine, Nagano, Japan; Department of Ophthalmology, Shinshu University School of Medicine, Nagano, Japan
| | - Yasuhiro Iesato
- Department of Cardiovascular Research, Shinshu University Graduate School of Medicine, Nagano, Japan; Department of Ophthalmology, Shinshu University School of Medicine, Nagano, Japan
| | - Takayuki Sakurai
- Department of Cardiovascular Research, Shinshu University Graduate School of Medicine, Nagano, Japan
| | - Akiko Kamiyoshi
- Department of Cardiovascular Research, Shinshu University Graduate School of Medicine, Nagano, Japan
| | - Yuka Ichikawa-Shindo
- Department of Cardiovascular Research, Shinshu University Graduate School of Medicine, Nagano, Japan
| | - Hisaka Kawate
- Department of Cardiovascular Research, Shinshu University Graduate School of Medicine, Nagano, Japan
| | - Megumu Tanaka
- Department of Cardiovascular Research, Shinshu University Graduate School of Medicine, Nagano, Japan
| | - Kun Dai
- Department of Cardiovascular Research, Shinshu University Graduate School of Medicine, Nagano, Japan
| | - Nanqi Cui
- Department of Cardiovascular Research, Shinshu University Graduate School of Medicine, Nagano, Japan
| | - Yangxuan Wei
- Department of Cardiovascular Research, Shinshu University Graduate School of Medicine, Nagano, Japan
| | - Keisei Nakamura
- Department of Cardiovascular Research, Shinshu University Graduate School of Medicine, Nagano, Japan
| | - Shiho Iida
- Department of Cardiovascular Research, Shinshu University Graduate School of Medicine, Nagano, Japan
| | - Shuhei Matsui
- Department of Cardiovascular Research, Shinshu University Graduate School of Medicine, Nagano, Japan; Department of Anesthesiology, Shinshu University School of Medicine, Nagano, Japan
| | | | - Toshinori Murata
- Department of Ophthalmology, Shinshu University School of Medicine, Nagano, Japan
| | - Takayuki Shindo
- Department of Cardiovascular Research, Shinshu University Graduate School of Medicine, Nagano, Japan.
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Lloyd Clark W, Liu M, Kitchens J, Wang PW, Haskova Z. Baseline characteristics associated with early visual acuity gains after ranibizumab treatment for retinal vein occlusion. BMC Ophthalmol 2019; 19:11. [PMID: 30621653 PMCID: PMC6325686 DOI: 10.1186/s12886-018-1012-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/14/2018] [Indexed: 11/24/2022] Open
Abstract
Background To identify baseline patient characteristics associated with early clinically significant visual acuity (VA) improvements within 3 months of treatment initiation in ranibizumab-treated patients with retinal vein occlusion (RVO) in the SHORE study. Methods Post hoc analysis of baseline patient characteristics in the randomized, open-label, vision examiner–masked SHORE phase 4 study that compared monthly versus pro re nata dosing of ranibizumab in patients with branch and central RVO. Patients who enrolled in SHORE fulfilled eligibility criteria per protocol (N = 202). SHORE data were retrospectively analyzed to identify baseline patient characteristics associated with early clinically significant improvements in VA, defined as improvement to a Snellen equivalent of 20/40 or better vision (≥ 69 Early Treatment Diabetic Retinopathy Study [ETDRS] letters) or an increase in best-corrected VA (BCVA) of 15 or more ETDRS letters from baseline within 3 months of treatment initiation. Main outcome measures were BCVA gain of 15 or more ETDRS letters from baseline, Snellen equivalent of 20/40 or better vision, and baseline factors associated with early clinically significant improvement in BCVA. Results The median time for patients to achieve a BCVA of 20/40 or better was 59 days and the median time for patients to gain 15 or more ETDRS letters was 63 days. Better baseline BCVA (> 50 ETDRS letters/Snellen equivalent ≥ 20/100), greater baseline total macular volume (> 9.99 mm3), and presence of subretinal fluid at baseline were all associated with early improvement to 20/40 or better vision (ETDRS equivalent ≥ 69 letters; P < .0001, P = .02, and P = .03, respectively). Conclusions This retrospective analysis found that better BCVA, greater total macular volume, and presence of subretinal fluid at baseline were associated with more rapid vision gains. Clinicians may find these helpful when considering the likelihood of achieving early clinically significant VA improvements with ranibizumab in patients with RVO. Trial registration ClinicalTrials.gov NCT01277302.
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Affiliation(s)
- W Lloyd Clark
- Palmetto Retina Center, 124 Sunset Court, West Columbia, SC, 29169, USA.
| | - Mimi Liu
- Colorado Retina Associates, Denver, CO, USA
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Sun MM, Chan AM, Law SM, Duarte S, Diaz-Aguilar D, Wadehra M, Gordon LK. Epithelial Membrane Protein-2 (EMP2) Antibody Blockade Reduces Corneal Neovascularization in an In Vivo Model. Invest Ophthalmol Vis Sci 2019; 60:245-254. [PMID: 30646013 PMCID: PMC6336205 DOI: 10.1167/iovs.18-24345] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 12/03/2018] [Indexed: 12/15/2022] Open
Abstract
Purpose Pathologic corneal neovascularization is a major cause of blindness worldwide, and treatment options are currently limited. VEGF is one of the critical mediators of corneal neovascularization but current anti-VEGF therapies have produced limited results in the cornea. Thus, additional therapeutic agents are needed to enhance the antiangiogenic arsenal. Our group previously demonstrated epithelial membrane protein-2 (EMP2) involvement in pathologic angiogenesis in multiple cancer models including breast cancer and glioblastoma. In this paper, we investigate the efficacy of anti-EMP2 immunotherapy in the prevention of corneal neovascularization. Methods An in vivo murine cornea alkali burn model was used to study pathologic neovascularization. A unilateral corneal burn was induced using NaOH, and subconjunctival injection of either anti-EMP2 antibody, control antibody, or sterile saline was performed after corneal burn. Neovascularization was clinically scored at 7 days postalkali burn, and eyes were enucleated for histologic analysis and immunostaining including VEGF, CD31, and CD34 expression. Results Anti-EMP2 antibody, compared to control antibody or vehicle, significantly reduced neovascularization as measured by clinical score and central cornea thickness, as well as by histologic reduction of neovascularization, decreased CD34 staining, and decreased CD31 staining. Incubation of corneal limbal cells in vitro with anti-EMP2 blocking antibody significantly decreased EMP2 expression, VEGF expression and secretion, and cell migration. Conclusions This work demonstrates the effectiveness of EMP2 as a novel target in pathologic corneal neovascularization in an animal model and supports additional investigation into EMP2 antibody blockade as a potential new therapeutic option.
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Affiliation(s)
- Michel M. Sun
- Department of Ophthalmology, Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, California, United States
| | - Ann M. Chan
- Department of Ophthalmology, Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, California, United States
| | - Samuel M. Law
- Department of Ophthalmology, Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, California, United States
| | - Sergio Duarte
- Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States
| | - Daniel Diaz-Aguilar
- Department of Ophthalmology, Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, California, United States
| | - Madhuri Wadehra
- Departments of Pathology and Laboratory Medicine, and Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States
| | - Lynn K. Gordon
- Department of Ophthalmology, Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, California, United States
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Středová M, Stepanov A, Studnička J, Nekolová J, Jirásková N. Ranibizumab in macular oedema secondary to branch retinal vein occlusion - 24 months of treatment. CESKÁ A SLOVENSKÁ OFTALMOLOGIE : CASOPIS CESKÉ OFTALMOLOGICKÉ SPOLECNOSTI A SLOVENSKÉ OFTALMOLOGICKÉ SPOLECNOSTI 2019; 75:190-198. [PMID: 32397721 DOI: 10.31348/2019/4/3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To retrospectively evaluate the efficacy and safety of ranibizumab treatment for macular edema (ME) secondary to branch retina vein occlusion (BRVO) after 24 months. MATERIALS AND METHODS This study included 39 eyes of 39 patients with ME associated with BRVO treated at the Ophthalmology Department of Faculty Hospital in Hradec Kralove. The average age of included patiens was 69,3 years, the mean duration of symptoms before treament was 5,4 months, the mean baseline visual acuity (VA) was 54,6 ETDRS (Early Treatment Diabetic Retinopathy Study) letters, the mean baseline central retinal thickness (CRT) was 544,9 µm. At 64,1% patients a retinal laserphotocoagulation was performed before intravitreal ranibizumab. After one year, the study was discontinued by 17 patiens, the remaining 22 patients were observed for 24 months. Initially, there were 3 doses of intravitreal ranibizumab administered in monthly intervals, further injections were applied according to PRN (pro re nata) regiment. Patients were examined at baseline and then at 3, 6, 9, 12 and 24 months from initiation of the treatment. In this study, the effect of ranibizumab on functional and morphological parameters of the affected eye was monitored, the safety of this treatment was also evaluated. During the follow-up, a statistically significant improvement in VA was achieved in every visit in comparison to baseline parameters, the mean VA gain at the 3 month visit was 12,1 ETDRS letters (p.
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Abstract
PURPOSE Retinal vein occlusion (RVO) is an important cause of visual disability in the modern world. We aim to evaluate the real-world outcomes of patients with RVO treated with anti-vascular endothelial growth factor (VEGF) in Portugal. METHODS We performed a retrospective, observational, multicenter study including 8 centers across Portugal and 200 patients treated with either ranibizumab or bevacizumab. Data were collected at 3 time points: time of diagnosis (0 time point) and 6 and 12 months after initiating treatment. Demographic and clinical data were collected. RESULTS Median visual acuity (VA) and central macular thickness (CMT) improved in the branch RVO (BRVO), central RVO (CRVO), bevacizumab, and ranibizumab groups at 6 and 12 months compared to baseline, with CMT improving further only in the CRVO and ranibizumab groups between 6 and 12 months (p = 0.002 and p = 0.001, respectively). The CMT was lower in the ranibizumab group compared to the bevacizumab group both at 6 and 12 months (p<0.02). Median CMT improved in both the good and poor baseline VA groups at 6 and 12 months compared to baseline (p<0.001). Median VA only improved for the group with poor baseline VA at 6 and 12 months of follow-up (p<0.001). Regression analysis identified several baseline variables as predictors of visual outcomes at 6 and 12 months, with different results depending on the analyzed group. CONCLUSIONS Both treatments were effective, although less effective than results reported in clinical trials. The morphologic response was better with ranibizumab compared to bevacizumab, although functionally there were no differences.
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Hsueh J, Wai KM, Conti FF, Conti TF, Singh RP. Impact of Time to Anti-Vascular Endothelial Growth Factor Intervention on Visual Outcomes for Patients Diagnosed With Retinal Vein Occlusion. Ophthalmic Surg Lasers Imaging Retina 2018; 49:832-837. [PMID: 30457641 DOI: 10.3928/23258160-20181101-03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 10/02/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES To analyze the impact of time to treatment with anti-vascular endothelial growth factor (VEGF) for patients with macular edema (ME) secondary to retinal vein occlusions (RVO) in routine clinical practice. PATIENTS AND METHODS One hundred fifty-five eyes with ME secondary to RVO were identified. Patients were divided into initiation of anti-VEGF treatment at 28 days or fewer after symptom onset (Group A), between 28 and 84 days (Group B), and 84 days or more (Group C). RESULTS A significant central subfield thickness (CST) decrease at 12 months was observed in Groups A, B, and C (-184.14 µm, -204.55 µm, and -170.71 µm, respectively; P < .001). At 12 months, Groups A and B showed significant BCVA improvement (19.14 and 21.11, respectively; P ≤ .001), whereas Group C showed no significant improvement from baseline (4.01; P < .28). CONCLUSIONS Anatomical response as measured by CST did not differ between groups, whereas delays in treatment resulted in smaller BCVA improvement with anti-VEGF treatment. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:832-837.].
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Tomiyasu T, Hirano Y, Suzuki N, Esaki Y, Yasuda Y, Uemura A, Yasukawa T, Yoshida M, Ogura Y. Structural and Functional Analyses of Retinal Ischemia in Eyes with Retinal Vein Occlusion: Relationship with Macular Edema or Microaneurysm Formation. Ophthalmic Res 2018; 61:218-225. [PMID: 30359965 DOI: 10.1159/000493489] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/03/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To study the structural and functional changes of retinal ischemia and investigate their association with macular edema (ME) or microaneurysm (MA) formation in eyes with retinal vein occlusion (RVO). METHODS Sixty eyes of 30 patients (27 eyes with branch [b]RVO, 3 with central RVO, and 30 fellow eyes) were retrospectively reviewed. Optical coherence tomography (OCT), OCT angiography (OCTA), and microperimetry were performed simultaneously to measure retinal thickness and sensitivity. The presence of ME or MA was also assessed using OCT and fluorescein angiography. RESULTS The mean retinal sensitivity in the nonperfused areas (NPAs) deteriorated, and this was significantly (r = -0.379, p = 0.0391*) and inversely correlated with duration from disease onset. ME and MA were unlikely to be observed around the area where the retinal sensitivity decreased. In the NPAs, the mean retinal thickness of the superficial capillary plexus (SCP) (p < 0.0001), deep capillary plexus (DCP) (p = 0.0323), and outer retina (p = 0.0008) were significantly thinner than those in the fellow eyes, respectively. Multivariate regression analysis revealed that the thicknesses of the DCP (β: 0.3107, p = 0.0007) and outer retina (β: 0.3482, p = 0.0001) were the independent correlative factors of the retinal sensitivity, but that SCP thickness was not. CONCLUSION Deep retinal thinning in NPAs was correlated significantly with a decreased retinal sensitivity, which might be a negative predictor of ME and MA in eyes with RVO.
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Affiliation(s)
- Taneto Tomiyasu
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshio Hirano
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan,
| | - Norihiro Suzuki
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuya Esaki
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yusuke Yasuda
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akiyoshi Uemura
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tsutomu Yasukawa
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Munenori Yoshida
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuichiro Ogura
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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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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Trivizki O, Schwartz S, Negri N, Loewenstein A, Rabina G, Shulman S. Noninfectious Inflammatory Response following Intravitreal Bevacizumab Injections: Description of a Cluster of Cases in Two Centers and a Review of the Literature. Ophthalmologica 2018; 240:163-166. [PMID: 30173220 DOI: 10.1159/000492681] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/02/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To report a cluster of high incidence of noninfectious inflammatory reaction shortly after bevacizumab injection. METHODS Data were collected from medical records of consecutive patients who underwent bevacizumab injections and presented with acute uveitis within 1-4 days. RESULTS All 7 patients were injected intravitreally with bevacizumab from different batches and presented with visual deterioration. One patient with anterior uveitis complained of pain. None had hypopyon. Three patients with vitritis underwent a vitreous tap with an intravitreal injection of vancomycin and ceftazidime for possible infectious endophthalmitis. All patients received intensive topical antibiotic drops and steroids, and the intraocular inflammation resolved completely within 1 month. Five patients continued to receive bevacizumab injections without recurrent episodes. CONCLUSIONS Our series demonstrates an incidence of noninfectious inflammatory reaction shortly after bevacizumab injection that is higher than that reported in the literature. The cause is more likely the preparation process in the same compounding pharmacy.
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Affiliation(s)
- Omer Trivizki
- Department of Ophthalmology, Tel-Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shulamit Schwartz
- Department of Ophthalmology, Tel-Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Neta Negri
- Department of Ophthalmology, Tel-Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Anat Loewenstein
- Department of Ophthalmology, Tel-Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gilad Rabina
- Department of Ophthalmology, Tel-Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shiri Shulman
- Department of Ophthalmology, Tel-Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Ophthalmology Institute, Assuta Medical Centers, Tel-Aviv, Israel
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[Statement of the Professional Association of Ophthalmologists (BVA), the German Ophthalmological Society (DOG) and the Retinological Society (RG) on intravitreal treatment of vision-reducing macular edema by retinal vein occlusion : Treatment strategies, status 24 April 2018]. Ophthalmologe 2018; 115:842-854. [PMID: 30143857 DOI: 10.1007/s00347-018-0775-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Okawada H, Saito Y, Iwabuchi S, Kosuge S, Takahashi H, Onda H, Kito M. Relationship between vascular endothelial growth factor and macular edema in retinal vein branch obstruction. Clin Ophthalmol 2018; 12:1379-1382. [PMID: 30122890 PMCID: PMC6086099 DOI: 10.2147/opth.s159109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Vascular endothelial growth factor (VEGF) plays an important role in branch retinal vein occlusion (BRVO) with cystoid macular edema (CME). Monitoring changes in VEGF is crucial for evaluating treatment but requires vitreous or aqueous humor sampling, which hampers its clinical application. We investigated the correlation between VEGF and protein concentration in the aqueous humor (flare) and whether this could be used to monitor treatment-related VEGF changes. Design This retrospective observational study involved 19 previously untreated patients with BRVO. Aqueous humor was obtained, and intravitreal ranibizumab (IVR) injection was administered to these patients. The correlation between VEGF and flare, central retinal thickness (CRT), and best-corrected visual acuity (BCVA) was investigated. Differences in these values were considered between pre-IVR and 1 week and 1–3 months post-IVR. Moreover, in patients with recurrence who received additional IVR, further changes in VEGF were examined. Main outcome measures The end point of this study was BCVA, flare, and CRT at the fovea. Results Significant improvement was seen in BCVA and CRT at all time points and in Flare at 1 vs 3 months post-IVR; nevertheless, additional IVR was necessary in 94% of cases. In a patient with recurrence, CRT did not improve, even though VEGF decreased. Conclusion Flare may be effective for estimating VEGF levels in aqueous humor pre-IVR. Inflammation-related molecules other than VEGF may be related to recurrence.
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Affiliation(s)
- Hideaki Okawada
- Department of Ophthalmology, Showa University, Tokyo, Japan,
| | - Yuta Saito
- Department of Ophthalmology, Showa University, Tokyo, Japan,
| | | | - Shotaro Kosuge
- Department of Ophthalmology, Showa University, Tokyo, Japan,
| | - Haruo Takahashi
- Department of Ophthalmology, Showa University, Tokyo, Japan,
| | - Hidetoshi Onda
- Department of Ophthalmology, Showa University, Tokyo, Japan,
| | - Masahiro Kito
- Department of Ophthalmology, Showa University, Tokyo, Japan,
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Sugiura Y, Okamoto F, Morikawa S, Okamoto Y, Hiraoka T, Oshika T. TIME COURSE OF CHANGES IN METAMORPHOPSIA FOLLOWING INTRAVITREAL RANIBIZUMAB INJECTION FOR BRANCH RETINAL VEIN OCCLUSION. Retina 2018; 38:1581-1587. [DOI: 10.1097/iae.0000000000001740] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Optical coherence tomography findings as a predictor of clinical course in patients with branch retinal vein occlusion treated with ranibizumab. PLoS One 2018. [PMID: 29924853 DOI: 10.1371/journal.pone.0199552.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To examine the relationship between optical coherence tomography (OCT) images and clinical course in eyes with branch retinal vein occlusion (BRVO) treated with intravitreal ranibizumab injection (IVR). DESIGN Prospective cohort study. PARTICIPANTS Thirty eyes of 30 patients with BRVO treated with IVR. METHODS All patients received 1 initial IVR followed by repeated injections in the pro re nata (PRN) regimen. Correlations between logarithm of minimum angle of resolution best-corrected visual acuity (logMAR BCVA) or number of IVRs after 12 months and OCT parameters including the external limiting membrane (ELM), ellipsoid zone (EZ), interdigitation zone (IZ), and photoreceptor outer segment (PROS) length at first resolution of macular edema (ME) were assessed. Resolution of ME was defined as central foveal thickness <300 μm and the absence of subretinal fluid. OCT parameters influencing BCVA and number of IVRs were evaluated using multivariate analysis. Correlations between nonperfusion areas (NPAs) and thinning areas and changes in retinal thickness of BRVO-affected areas were assessed. RESULTS Of the 30 patients, 27 completed this study and were included in the statistical analyses. The mean logMAR BCVA at 3, 6, and 12 months was 0.16 ± 0.19, 0.09 ± 0.20, and 0.07 ± 0.20, respectively, which improved significantly from baseline at each visit (p < 0.0001, respectively), while the mean number of IVRs at 12 months was 3.9 ± 2.2. The mean number of IVRs for the first resolution of ME was 1.6 ± 0.8. Eyes with ELM and EZ defects at the points of first resolution of ME were correlated with a significantly lower BCVA at 12 months compared with eyes with preserved ELMs and EZs (p = 0.035, p = 0.002, respectively). However, eyes with IZ defects at the points of first resolution of ME were not correlated with a significantly lower BCVA at 12 months compared with eyes with preserved IZs (p = 0.160). Defects in the EZ at the points of first resolution of ME significantly affected the number of IVRs at 12 months (p = 0.042), although the ELM and IZ did not. PROS length at the points of first resolution of ME was significantly correlated with BCVA and number of IVRs at 12 months (p = 0.006, p = 0.0008, respectively). In multivariate analysis, PROS length at the points of first resolution of ME had the most significant effect on BCVA and number of IVRs (p = 0.013, p = 0.012, respectively). NPA size on fluorescein angiography and thinning area on OCT within the macular area showed a significant correlation (p = 0.003, r = 0.971). The retinal thickness of ischemic BRVO-affected areas was significantly less than that of control areas at 10, 11, and 12 months (p = 0.001, p = 0.005, p = 0.003, respectively). CONCLUSION We showed that the 1+PRN regimen may be a useful therapy for ME due to BRVO. In addition, PROS length at points of first resolution of ME appears to be a good indicator of BCVA and number of IVRs in BRVO patients.
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Shiono A, Kogo J, Sasaki H, Yomoda R, Jujo T, Tokuda N, Kitaoka Y, Takagi H. Optical coherence tomography findings as a predictor of clinical course in patients with branch retinal vein occlusion treated with ranibizumab. PLoS One 2018; 13:e0199552. [PMID: 29924853 PMCID: PMC6010278 DOI: 10.1371/journal.pone.0199552] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 06/08/2018] [Indexed: 12/24/2022] Open
Abstract
Purpose To examine the relationship between optical coherence tomography (OCT) images and clinical course in eyes with branch retinal vein occlusion (BRVO) treated with intravitreal ranibizumab injection (IVR). Design Prospective cohort study. Participants Thirty eyes of 30 patients with BRVO treated with IVR. Methods All patients received 1 initial IVR followed by repeated injections in the pro re nata (PRN) regimen. Correlations between logarithm of minimum angle of resolution best-corrected visual acuity (logMAR BCVA) or number of IVRs after 12 months and OCT parameters including the external limiting membrane (ELM), ellipsoid zone (EZ), interdigitation zone (IZ), and photoreceptor outer segment (PROS) length at first resolution of macular edema (ME) were assessed. Resolution of ME was defined as central foveal thickness <300 μm and the absence of subretinal fluid. OCT parameters influencing BCVA and number of IVRs were evaluated using multivariate analysis. Correlations between nonperfusion areas (NPAs) and thinning areas and changes in retinal thickness of BRVO-affected areas were assessed. Results Of the 30 patients, 27 completed this study and were included in the statistical analyses. The mean logMAR BCVA at 3, 6, and 12 months was 0.16 ± 0.19, 0.09 ± 0.20, and 0.07 ± 0.20, respectively, which improved significantly from baseline at each visit (p < 0.0001, respectively), while the mean number of IVRs at 12 months was 3.9 ± 2.2. The mean number of IVRs for the first resolution of ME was 1.6 ± 0.8. Eyes with ELM and EZ defects at the points of first resolution of ME were correlated with a significantly lower BCVA at 12 months compared with eyes with preserved ELMs and EZs (p = 0.035, p = 0.002, respectively). However, eyes with IZ defects at the points of first resolution of ME were not correlated with a significantly lower BCVA at 12 months compared with eyes with preserved IZs (p = 0.160). Defects in the EZ at the points of first resolution of ME significantly affected the number of IVRs at 12 months (p = 0.042), although the ELM and IZ did not. PROS length at the points of first resolution of ME was significantly correlated with BCVA and number of IVRs at 12 months (p = 0.006, p = 0.0008, respectively). In multivariate analysis, PROS length at the points of first resolution of ME had the most significant effect on BCVA and number of IVRs (p = 0.013, p = 0.012, respectively). NPA size on fluorescein angiography and thinning area on OCT within the macular area showed a significant correlation (p = 0.003, r = 0.971). The retinal thickness of ischemic BRVO-affected areas was significantly less than that of control areas at 10, 11, and 12 months (p = 0.001, p = 0.005, p = 0.003, respectively). Conclusion We showed that the 1+PRN regimen may be a useful therapy for ME due to BRVO. In addition, PROS length at points of first resolution of ME appears to be a good indicator of BCVA and number of IVRs in BRVO patients.
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Affiliation(s)
- Akira Shiono
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Jiro Kogo
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- * E-mail:
| | - Hiroki Sasaki
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Ryo Yomoda
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Tatsuya Jujo
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Naoto Tokuda
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Yasushi Kitaoka
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hitoshi Takagi
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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The use of bevacizumab and ranibizumab for branch retinal vein occlusion in medicare beneficiaries. Am J Ophthalmol Case Rep 2018; 11:105-108. [PMID: 29998209 PMCID: PMC6038825 DOI: 10.1016/j.ajoc.2018.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/25/2018] [Accepted: 06/18/2018] [Indexed: 11/29/2022] Open
Abstract
Purpose To describe the frequency and variation of intravitreal bevacizumab and ranibizumab use for branch retinal vein occlusion (BVO) in the United States (US). Methods We obtained a 5% random sample of Medicare beneficiaries from the Medicare Denominator and Physician/Supplier Part B claims files from 2010 to 2013 and identified all beneficiaries with an ICD-9-CM code for branch retinal vein occlusion (BVO, 362.36). Patient age, gender, race, state of residence and Charlson Comorbidity Index (CCI) scores were collected. Healthcare Common Procedure Coding System (HSCPS) codes for bevacizumab (J3590, J9035, and J3490) and for ranibizumab (J2778) were used to identify the mode of treatment for each patient. Patients who met the following criteria were excluded from this study: (1) under 65 years of age; (2) residence outside of the 50 United States or the District of Columbia; (3) no Part-B coverage or with HMO coverage that was not processed by Centers for Medicare & Medicaid Services (CMS); (4) concomitant diagnosis of diabetic edema (ICD-9: 362.07) or central retinal vein occlusion (ICD-9: 362.35); and (5) received both or none of the above two treatments. Geographic variation was examined by comparing injection frequencies across the nine US census divisions using Chi-squared analysis. Results During 2010–2013, a majority of the 3944 BVO patients who met the inclusion criteria received bevacizumab compared to ranibizumab (76.7% vs 23.3%). Most patients were aged 75–79 (22.0%) or 80–84 (22.0%), female (61.5%), white (88.3%), and had a CCI score of 1–2 (39.8%). The frequencies of bevacizumab and ranibizumab injections for BVO varied significantly between the US census divisions (p < 0.0001). The highest frequencies of bevacizumab use were in the Mountain (90.6%) and Pacific (82.7%) divisions while the highest frequencies of ranibizumab use were in the West North Central (37.9%) and Mid Atlantic (32.7%) divisions. Conclusions and Importance A majority of Medicare beneficiaries with BVO received bevacizumab compared to ranibizumab from 2010 to 2013, with significant geographic variation in the use of the two anti-VEGF agents. Future research into factors driving geographic variation in the use of these agents may help direct cost-effective strategies for the management of BVO.
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Jumper JM, Dugel PU, Chen S, Blinder KJ, Walt JG. Anti-VEGF treatment of macular edema associated with retinal vein occlusion: patterns of use and effectiveness in clinical practice (ECHO study report 2). Clin Ophthalmol 2018; 12:621-629. [PMID: 29662298 PMCID: PMC5892950 DOI: 10.2147/opth.s163859] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose To evaluate the efficacy, safety, and injection frequency of vascular endothelial growth factor (VEGF) antagonists in the treatment of macular edema secondary to retinal vein occlusion (RVO) in clinical practice. Patients and methods A multicenter retrospective study of the medical records of 165 patients (95 branch RVO, 70 central RVO) treated with at least three anti-VEGF injections in the study eye was conducted. Available data collected for at least 6 months after the first injection included Snellen best-corrected visual acuity (BCVA), central retinal thickness (CRT) by time-domain optical coherence tomography (TD-OCT) or spectral-domain optical coherence tomography (SD-OCT), anti-VEGF injections, other treatments/procedures for RVO, and adverse events. Results At baseline prior to anti-VEGF treatment, mean BCVA was 20/80 Snellen equivalent and mean CRT was 499 μm. Mean number of anti-VEGF injections received was 7.1 during the first year, 5.4 during the second year, and 5.9 during the third year; 51.3% (842/1,641) of injections were ranibizumab, 44.1% (724/1,641) were bevacizumab, and 4.6% (75/1,641) were aflibercept. One in five patients received concomitant focal laser treatment. The percentage of patients achieving both BCVA of 20/40 or better and CRT ≤250 μm on TD-OCT or ≤300 μm on SD-OCT at the same visit (primary endpoint) was 26.1% (30/115) after the first anti-VEGF injection and ranged from 20.0% (7/35) to 36.7% (11/30) after the first 16 injections. After each anti-VEGF injection from the 1st to the 16th, <60% of patients achieved 20/40 or better BCVA and ≤70% of patients achieved CRT ≤250 μm on TD-OCT or ≤300 μm on SD-OCT. The most common treatment-related adverse event was blurry or cloudy vision. Conclusion In this real-world study, a mean of five to seven anti-VEGF injections was administered yearly, and the response to anti-VEGF therapy was suboptimal in many patients. Anti-VEGF therapy was well tolerated.
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Affiliation(s)
| | - Pravin U Dugel
- Retinal Consultants of Arizona, Phoenix, AZ, USA.,USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Guichard MM, Xavier AR, Türksever C, Pruente C, Hatz K. Spectral-Domain Optical Coherence Tomography-Driven Treat-and-Extend and Pro Re Nata Regimen in Patients with Macular Oedema due to Retinal Vein Occlusion: 24-Month Evaluation and Outcome Predictors. Ophthalmic Res 2018; 60:29-37. [PMID: 29566387 DOI: 10.1159/000487489] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/07/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE To analyse the efficacy and outcome predictors of ranibizumab using a spectral-domain optical coherence tomography (SD-OCT)-driven treat-and-extend regimen (TER) versus SD-OCT-driven pro re nata regimen (PRN) in patients with cystoid macular oedema (CME) due to branch or central retinal vein occlusion (BRVO, CRVO). METHODS Retrospective, consecutive case series. Evaluation included best corrected visual acuity (BCVA), morphological parameters on SD-OCT, and treatment frequency. RESULTS From baseline to months 12, 18, and 24, BCVA improved by 16.6 ± 13.1, 15.5 ± 14.4, and 16.6 ± 15.8 letters, respectively, in TER (n = 45), compared to 11.3 ± 17.0, 11.0 ± 15.0, and 10 ± 20.5 letters in PRN (n = 31) (p = 0.152, p = 0.237, p = 0.172). The mean reduction in central retinal thickness was -261 ± 189, -272 ± 188, and -264 ± 158 μm, respectively, in TER, compared to -130 ± 196, -140 ± 210, and -166 ± 207 μm in PRN (p = 0.006, p = 0.017, p = 0.064). 59% (53%) of TER and 22% (17%) of PRN patients showed no intra- or subretinal fluid on SD-OCT at 12 (24) months. Using TER, the maximum recurrence-free treatment interval increased from 8.9 ± 2.3 weeks at 12 months to 9.8 ± 2.3 and 10.5 ± 2.7 weeks at 18 and 24 months, respectively. The number of injections was significantly higher in the TER than in the PRN group. CONCLUSIONS In CME, due to BRVO/CRVO, TER provides better morphological outcome using more injections than PRN.
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Affiliation(s)
| | | | | | - Christian Pruente
- Department of Ophthalmology, University of Basel, Basel, Switzerland.,Department of Ophthalmology, Kantonsspital Liestal, Liestal, Switzerland
| | - Katja Hatz
- Vista Klinik, Binningen, Switzerland.,Department of Ophthalmology, University of Basel, Basel, Switzerland
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