1
|
Garg SJ, Hadziahmetovic M. Verteporfin Photodynamic Therapy for the Treatment of Chorioretinal Conditions: A Narrative Review. Clin Ophthalmol 2024; 18:1701-1716. [PMID: 38881707 PMCID: PMC11178081 DOI: 10.2147/opth.s464371] [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: 02/16/2024] [Accepted: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
Photodynamic therapy (PDT) with verteporfin involves intravenous administration of a photosensitizer followed by its laser light activation at the target site to inhibit aberrant choroidal vascularization. This narrative review provides an overview of the role verteporfin PDT plays in the management of chorioretinal conditions. A PubMed literature review of all English-language articles published through October 19, 2023, was conducted to identify relevant references. Verteporfin PDT has been shown to be safe and effective for the treatment of patients with choroidal neovascularization (CNV) due to neovascular age-related macular degeneration and is often used in combination with a vascular endothelial growth factor (VEGF) inhibitor. Additionally, patients with polypoidal choroidal vasculopathy, a subtype of neovascular age-related macular degeneration, also benefit from verteporfin PDT combined with a VEGF inhibitor for improving visual acuity. Verteporfin PDT has also been effective in treating patients with peripapillary CNV, as well as eyes with CNV due to ocular histoplasmosis and pathologic myopia. Reduced dose and/or fluence PDT protocols have been effective in patients with central serous chorioretinopathy while reducing adverse effects. In eyes with choroidal hemangioma, tumor regression and visual outcomes have been improved with verteporfin PDT treatment. Photodynamic therapy with verteporfin continues to play an important role in the management of chorioretinal conditions.
Collapse
Affiliation(s)
- Sunir J Garg
- Retina Service, Wills Eye Hospital, Philadelphia, PA, USA
| | | |
Collapse
|
2
|
Janetos TM, Goldstein DA, Yeldandi A, Kurup SP, Bhat P. Multimodal imaging of an acute presentation of ocular histoplasmosis syndrome in an immunocompetent patient. Am J Ophthalmol Case Rep 2023; 32:101896. [PMID: 37546375 PMCID: PMC10400860 DOI: 10.1016/j.ajoc.2023.101896] [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: 02/26/2023] [Revised: 07/04/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023] Open
Abstract
Purpose Presumed ocular histoplasmosis syndrome (POHS) is a posterior segment disorder that is usually subclinical unless choroidal neovascular membrane (CNVM) develops. It is thought to be the sequela of a prior systemic infection with Histoplasma capsulatum, and evidence supporting this association is based on epidemiologic, animal, and few enucleation studies. Acute presentation of chorioretinal involvement during an initial histoplasmosis systemic infection in immunocompetent patients is rarely reported, presumably due to the usual lack of or minimal symptoms of both the systemic and ocular disease. We report on an immunocompetent male with choroidal lesions detected during disseminated histoplasmosis infection and characterize the lesions using multimodal imaging. Observations A 17-year-old male presented when routine optometry screening detected two deep, yellowish-white lesions in the left fundus. Optical coherence tomography (OCT) imaging confirmed a choroidal mass with extension through Bruch's membrane into the subretinal space and a small amount of subretinal fluid. Fluorescein angiography was suggestive of CNVM. There were no clinical findings of intraocular inflammation, and the patient was initially lost to follow-up. Eight weeks after last follow-up, the patient presented to the emergency department with fatigue, mild respiratory symptoms, and abdominal pain for the last month. Imaging revealed a mediastinal mass with hilar extension and innumerable nodules throughout the lung and spleen. Serum Histoplasma IgM/IgG were positive, and biopsy of the mediastinal mass revealed Histoplasma organisms. The patient was treated with antifungals and discharged. The patient underwent an extensive immunologic evaluation while admitted, which did not reveal an underlying immunodeficiency. On last follow-up, the choroidal lesions were smaller and more consolidated, and the subretinal fluid had resolved. Conclusions and Importance We present a patient with choroidal lesions in the setting of disseminated systemic histoplasmosis infection and characterize a lesion using multimodal imaging. The presentation of acute chorioretinal lesions in the setting of biopsy proven systemic Histoplasma infection supports H. capsulatum as the etiology of POHS.
Collapse
Affiliation(s)
- Timothy M. Janetos
- Northwestern University Feinberg School of Medicine, Department of Ophthalmology, Chicago, IL, USA
| | - Debra A. Goldstein
- Northwestern University Feinberg School of Medicine, Department of Ophthalmology, Chicago, IL, USA
| | - Anjana Yeldandi
- Northwestern University Feinberg School of Medicine, Department of Pathology, Chicago, IL, USA
| | - Sudhi P. Kurup
- Northwestern University Feinberg School of Medicine, Department of Ophthalmology, Chicago, IL, USA
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Pooja Bhat
- University of Illinois Eye and Ear Infirmary, Chicago, IL, USA
| |
Collapse
|
3
|
Labriola LT, Vangipuram G, Zarnegar A, Tsipursky M, Besecker J, Almasov A, Garwood KC, Blinder KJ. Use of Adjunctive Corticosteroid With Antivascular Endothelial Growth Factor Agents in the Treatment of Choroidal Neovascular Membrane Associated With Presumed Ocular Histoplasmosis. JOURNAL OF VITREORETINAL DISEASES 2023; 7:510-520. [PMID: 37974925 PMCID: PMC10649456 DOI: 10.1177/24741264231201778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Purpose: To evaluate the impact of combination treatment of antivascular endothelial growth factor (anti-VEGF) intravitreal injections and corticosteroids in patients with choroidal neovascularization (CNV) secondary to presumed ocular histoplasmosis syndrome (POHS). Methods: A retrospective multicenter study was conducted in a cohort from Illinois and Missouri. Patients were identified over an 8-year period, and data were evaluated over a 1-year study window commencing with treatment initiation. Group 1 included patients treated with intravitreal injections of anti-VEGF, and group 2 included those who received intravitreal injections of anti-VEGF and adjuvant corticosteroids. Optical coherence tomography (OCT) measurements and increases in Early Treatment Diabetic Retinopathy Study (ETDRS) letter score were compared between each group. Results: Using the method of last visit carried forward, the visual acuity (VA) in group 2 was 6.42 ETDRS letters better than the VA in group 1 at the final assessment. Patients in group 2 had a mean ETDRS letter gain of 21.50 (P = .06) from the initial baseline vision. The average amount of decrease in OCT central subfield thickness compared with baseline was lower in group 1 (80.9 ± 129.8 µm) vs group 2 (102.8 ± 90.40 µm) at the 1-year follow-up visit (P = .25). Conclusions: Approved treatment of CNV secondary to POHS is limited. Adjuvant corticosteroid treatment in patients with CNV secondary to POHS may provide better long-term vision and OCT outcomes than anti-VEGF alone and may offer an additional therapy option for these patients.
Collapse
Affiliation(s)
- Leanne T. Labriola
- Southwest Pennsylvania Eye Center Washington, PA, USA
- Sewickley Eye Group, Sewickley, PA, USA
| | | | | | | | | | | | | | | |
Collapse
|
4
|
Dutta Majumder P, Mochizuki M, González-López JJ, Gonzales J, Sharma M, Sharma K, Biswas J. Laboratory Investigations in Infectious Uveitis. Ocul Immunol Inflamm 2023; 31:1405-1415. [PMID: 36698066 DOI: 10.1080/09273948.2022.2164728] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 01/27/2023]
Abstract
Laboratory investigations can play a significant role in the diagnosis and decision-making of infectious uveitis. Though direct demonstration of the infective organism remains the gold standard of diagnosis, it is not always possible with ocular tissues. Recent advancements in molecular techniques have made it possible to overcome these limitations and to identify the genomic DNA of pathogens associated with infectious uveitis. Techniques such as next-generation sequencing can analyze all DNA-based lifeforms, regardless of whether they are bacteria, fungi, viruses, or parasites and have been used in the laboratory diagnosis of intraocular inflammation. On the other hand, serological tests, though they dominate the diagnostic landscape of various infectious etiologies in uveitis in routine clinical practice, have varied specificities and sensitivities in different infectious uveitis. In this review, we focus on various methods of laboratory diagnosis of infectious uveitis and discuss the recent advances in molecular diagnosis and their role in various infectious clinical entities.
Collapse
Affiliation(s)
| | - Manabu Mochizuki
- Miyata Eye Hospital, Miyakonojo, Japan
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Julio J González-López
- Ophthalmology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Surgery Department, Universidad de Alcalá, Madrid, Spain
| | - John Gonzales
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Megha Sharma
- Department of Microbiology, All India Institute of Medical Sciences, Bilaspur, India
| | - Kusum Sharma
- Department of Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh (PGIMER), Chandigarh, India
| | - Jyotirmay Biswas
- Director of Uveitis & Ocular Pathology, Sankara Nethralaya, Chennai, India
| |
Collapse
|
5
|
Voide N. Presumed Ocular Histoplasmosis Syndrome in a Five-Year-Old Girl in a Non-Endemic Area. Klin Monbl Augenheilkd 2023; 240:578-580. [PMID: 37164440 DOI: 10.1055/a-2004-5629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Nathalie Voide
- Ophthalmology/Strabismus and Pediatric Ophthalmology Unit, Jules Gonin Eye Hospital, Lausanne, Switzerland
| |
Collapse
|
6
|
Agarwal A, Pichi F, Invernizzi A, Grewal DS, Singh RB, Upadhyay A. Stepwise approach for fundus imaging in the diagnosis and management of posterior uveitis. Surv Ophthalmol 2023; 68:446-480. [PMID: 36724831 DOI: 10.1016/j.survophthal.2023.01.006] [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: 09/04/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 01/30/2023]
Abstract
An array of retinochoroid imaging modalities aid in comprehensive evaluation of the immunopathological changes in the retina and choroid, forming the core component for the diagnosis and management of inflammatory disorders such as uveitis. The recent technological breakthroughs have led to the development of imaging platforms that can evaluate the layers of retina and choroid and the structural and functional alteration in these tissues. Ophthalmologists heavily rely on imaging modalities such as dye-based angiographies (fluorescein angiography and indocyanine green angiography), optical coherence tomography, fundus autofluorescence, as well as dye-less angiography such as optical coherence tomography angiograph,y for establishing a precise diagnosis and understanding the pathophysiology of the diseases. Furthermore, these tools are now being deployed with a 'multimodal' approach for swift and accurate diagnosis. In this comprehensive review, we outline the imaging platforms used for evaluation of posterior uveitis and discuss the organized, algorithmic approach for the assessment of the disorders. Additionally, we provide an insight into disease-specific characteristic pathological changes and the established strategies to rule out disorders with overlapping features on imaging.
Collapse
Affiliation(s)
- Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Department of Ophthalmology, Maastricht University Medical Center+, Maastricht, The Netherlands; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
| | - Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy; Discipline of Ophthalmology, The University of Sydney, Save Sight Institute, Sydney Medical School, Sydney, New South Wales, Australia
| | - Dilraj S Grewal
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rohan Bir Singh
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands; Ophthalmology and Visual Sciences, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Awaneesh Upadhyay
- Department of Ophthalmology, EyeQ Super-specialty Hospitals, Noida, Uttar Pradesh, India
| |
Collapse
|
7
|
Behera RK, Gupta PC, Khurana S, Sehgal S, Sharma S, Ram J. A rare presentation of ocular histoplasmosis in a patient with systemic nocardiosis. Indian J Ophthalmol 2022; 70:2689-2691. [PMID: 35791207 PMCID: PMC9426055 DOI: 10.4103/ijo.ijo_2633_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Ranjan K Behera
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Parul C Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surbhi Khurana
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shobha Sehgal
- Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Suryaprakash Sharma
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jagat Ram
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
8
|
Richey BF, Obrock RS, Gee ZM, Lu DY, Jacobsen G, Richards SC. SMOKING, RURAL RESIDENCE AND DIABETES AS RISK FACTORS FOR PRESUMED OCULAR HISTOPLASMOSIS SYNDROME. Retina 2022; 42:369-374. [PMID: 34690340 PMCID: PMC8765210 DOI: 10.1097/iae.0000000000003322] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the relationship of smoking, urbanicity, and diabetes to presumed ocular histoplasmosis syndrome (POHS) and associated choroidal neovascularization (CNV). METHODS Medical records of 751 adult patients with POHS were reviewed, including 603 patients without CNV and 148 patients with CNV. Age-matched and gender-matched controls were randomly selected from the same practice for comparison. Statistical comparisons of smoking history, urbanicity, and diabetic history were performed using chi-square and conditional logistic regression analyses. RESULTS Increased rates of current or former smoking, rural residence, and diabetes were found in patients with POHS compared with controls. POHS patients with CNV had increased rates of current or former smoking and rural residence as compared with controls. CONCLUSION A history of current or past smoking is associated with an increased risk of developing both POHS alone and POHS with CNV. We did not find a significant additional risk of smoking on the development of CNV in patients with POHS. Patients living in rural locations are more likely than those in urban locations to develop both POHS and POHS with CNV. Diabetics may be more likely to develop POHS than nondiabetics.
Collapse
Affiliation(s)
| | | | - Zachary M. Gee
- College of Osteopathic Medicine, Des Moines University, Des Moines, Iowa
| | - David Y. Lu
- Department of Ophthalmology, Henry Ford Hospital, Detroit, Michigan; and
| | - Gordon Jacobsen
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | | |
Collapse
|
9
|
Shivaji S, Jayasudha R, Prashanthi GS, Arunasri K, Das T. Fungi of the human eye: Culture to mycobiome. Exp Eye Res 2022; 217:108968. [PMID: 35120870 DOI: 10.1016/j.exer.2022.108968] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 11/02/2021] [Accepted: 01/26/2022] [Indexed: 11/04/2022]
Abstract
The focus of the current review is multi-fold and compares the diversity and abundance of fungi on the ocular surface by the conventional culture-based method with the more sensitive, high throughput, culture-independent NGS method. The aim is to highlight the existence of a core ocular mycobiome and explore the transition of the ocular fungal microbiota from the normal eye to the diseased eye. PubMed, Google Scholar and Medline were used to search for publications and reviews related to cultivable fungi and the mycobiome of the normal and diseased eye. The conventional cultivable approach and the NGS approach confirm that the eye has its own mycobiome and several confounding factors (age, gender, ethnicity etc.) influence the mycobiome. Further, dysbiosis in the mycobiome appears to be associated with ocular diseases and thus impacts the health of the human eye. Considering that the mycobiome of the eye is influenced by several confounding factors and also varies with respect to the disease status of the eye there is a need to extensively explore the mycobiome under different physiological conditions, different ethnicities, geographical regions etc. Such studies would unravel the diversity and abundance of the mycobiomes and contribute to our understanding of ocular health. Research focused on ocular mycobiomes may eventually help to build a targeted and individualized treatment.
Collapse
Affiliation(s)
- Sisinthy Shivaji
- Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
| | - Rajagopalaboopathi Jayasudha
- Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
| | - Gumpili Sai Prashanthi
- Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
| | - Kotakonda Arunasri
- Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
| | - Taraprasad Das
- Srimati Kanuri Santhamma Centre for Vitreo Retinal Diseases, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
| |
Collapse
|
10
|
Presumed ocular histoplasmosis syndrome. J Fr Ophtalmol 2021; 44:1468-1470. [PMID: 34598824 DOI: 10.1016/j.jfo.2021.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/23/2022]
|
11
|
Xu TT, Reynolds MM, Hodge DO, Smith WM. Epidemiology and Clinical Characteristics of Presumed Ocular Histoplasmosis in Olmsted County, Minnesota. Ocul Immunol Inflamm 2021; 30:1039-1043. [PMID: 33661067 DOI: 10.1080/09273948.2020.1859549] [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] [Indexed: 10/22/2022]
Abstract
Purpose: To describe the incidence, prevalence, and clinical characteristics of presumed ocular histoplasmosis syndrome (POHS) in a Histoplasma endemic region.Methods: The International Classification of Diseases, 9th and 10th Revision codes were used to search the Rochester Epidemiology Project, a record-linkage system for medical care provided in Olmsted County, MN. Medical records were reviewed to confirm POHS diagnoses in county residents from January 1, 2006, to December 31, 2015. Age- and sex-adjusted incidence rates were calculated and adjusted to the 2010 U.S. White population.Results: There were 18 incident cases (30 eyes) and 87 prevalent cases (131 eyes). The incidence rate was 1.35 per 100,000 per year. The mid-study prevalence rate was 0.064%. Choroidal neovascularization (CNV) occurred in 17.4% of the affected eyes. At the last follow-up, 16.8% of the affected eyes had POHS-related decreased visual acuity (<20/40).Conclusion: This study assesses the epidemiology and clinical features of POHS in a Midwestern U.S. county.ABBREVIATIONS/ACRONYMS; POHS = Presumed ocular histoplasmosis syndrome; ICD = International Classification of Diseases; CI = Confidence interval; VA = Visual acuity; Anti-VEGF = Anti-vascular endothelial growth factor; REP = Rochester Epidemiology Project, CNV = Choroidal neovascularization.
Collapse
Affiliation(s)
- Timothy T Xu
- Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Margaret M Reynolds
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida, USA
| | - Wendy M Smith
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
12
|
Niederer R, Bar A, Al-Ani H, Sharief L, Sar S, Segal A, Lightman S, Tomkins-Netzer O. Management of inflammatory choroidal neovascular membranes. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2021.1842196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Rachael Niederer
- University of Auckland, Auckland District Health Board, Auckland, New Zealand
| | - Asaf Bar
- Department of Ophthalmology, Wolfson Medical Centre, Tel Aviv-Yafo, Israel
| | - Haya Al-Ani
- University of Auckland, Auckland District Health Board, Auckland, New Zealand
| | - Lazha Sharief
- UCL/Institute of Ophthalmology and Moorfileds Eye Hospital, London, UK
| | - Shaul Sar
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Adi Segal
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Sue Lightman
- UCL/Institute of Ophthalmology and Moorfileds Eye Hospital, London, UK
| | - Oren Tomkins-Netzer
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
13
|
Paez-Escamilla M, Jhingan M, Gallagher DS, Singh SR, Fraser-Bell S, Chhablani J. Age-related macular degeneration masqueraders: From the obvious to the obscure. Surv Ophthalmol 2020; 66:153-182. [PMID: 32971140 DOI: 10.1016/j.survophthal.2020.08.005] [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: 01/20/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 01/05/2023]
Abstract
Age-related macular degeneration (AMD) is one of the leading causes of blindness worldwide with increasing prevalence owing to increased life expectancy. Intravitreal injections of antivascular endothelial growth factor agents are commonly used in exudative AMD and oral antioxidant medication for nonexudative AMD; however, many disorders mimic exudative and nonexudative AMD, and misdiagnosis can seriously affect the management of these patients. We summarize the demographics and clinical and imaging characteristics of each of the conditions that masquerade as AMD. As some of the conditions have features of AMD, a short update on the classical features of AMD is also included.
Collapse
Affiliation(s)
- Manuel Paez-Escamilla
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mahima Jhingan
- Jacobs Retina Center at Shiley Eye Center, University of California, San Diego, La Jolla, California, USA
| | - Denise S Gallagher
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sumit Randhir Singh
- Jacobs Retina Center at Shiley Eye Center, University of California, San Diego, La Jolla, California, USA
| | | | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
| |
Collapse
|
14
|
Abstract
PURPOSE To review the wide variety of treatment modalities available for choroidal neovascularization secondary to the presumed ocular histoplasmosis syndrome. METHODS A literature search was performed to review the multitude of studies conducted to investigate the efficacy and safety of treatment modalities available for choroidal neovascularization secondary to the presumed ocular histoplasmosis syndrome. RESULTS Each treatment modality is reviewed, with the studies summarized and presented to support or refute the method of treatment. Two case reports are presented to demonstrate the treatment regimens. CONCLUSION This is a comprehensive review of the treatment modalities available to address choroidal neovascularization secondary to the presumed ocular histoplasmosis syndrome. Investigators will continue to strive toward higher efficacy and safety with future innovations in the field.
Collapse
|
15
|
Cissé Y, Bai L, Chen MT. LncRNAs in ocular neovascularizations. Int J Ophthalmol 2019; 12:1959-1965. [PMID: 31850182 PMCID: PMC6901876 DOI: 10.18240/ijo.2019.12.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/29/2019] [Indexed: 12/13/2022] Open
Abstract
The prevalence of eye diseases worldwide is dramatically increasing and represents a major concern in underdeveloped and developed regions. Ocular diseases, previously associated with a higher depression risk, also impose a substantial economic burden on affected families, thus early detection and/or accurate treatment in order to avoid and prevent blindness should be emphasized. Ocular neovascularization (NV), the leading cause of blindness in a variety of eye diseases, is a pathologic process characterized by the formation, proliferation and infiltration of anomalous, tiny and leaky fragile blood vessels within the eye. Genetics have been suspected to play an important role in the occurrence of eye diseases, with the detection of a numbers of specific gene mutations. Long non-coding RNA (lncRNAs) are novel class of regulatory molecules previously associated with various biological processes and diseases, however the nature of the relation and pathways by which they might contribute to the development of corneal, choroidal and retinal NV have not yet been completely elucidated. In this review, we focus on the regulation and characteristics of lncRNAs, summarize results from ocular NV-related studies and discuss the implication of lncRNAs in ocular NV development.
Collapse
Affiliation(s)
- Yacouba Cissé
- Department of Ophthalmology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Lang Bai
- Department of Ophthalmology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Min-Ting Chen
- Department of Ophthalmology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| |
Collapse
|
16
|
Pujari A, Rakheja V, Bajaj MS, Sen S, Yadav B. Isolated conjunctival histoplasmosis in an elderly patient: a rare but important scenario. Can J Ophthalmol 2019; 54:e15-e16. [DOI: 10.1016/j.jcjo.2018.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/30/2018] [Accepted: 04/04/2018] [Indexed: 11/30/2022]
|
17
|
EFFICACY AND SAFETY OF RANIBIZUMAB FOR THE TREATMENT OF CHOROIDAL NEOVASCULARIZATION DUE TO UNCOMMON CAUSE: Twelve-Month Results of the MINERVA Study. Retina 2018; 38:1464-1477. [PMID: 28704254 PMCID: PMC6086222 DOI: 10.1097/iae.0000000000001744] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Supplemental Digital Content is Available in the Text. Ranibizumab was effective in treating choroidal neovascularization of various etiologies, with a treatment effect of +9.9 letters versus sham at Month 2 and a mean gain of 11.0 letters from baseline to Month 12. The beneficial effects of ranibizumab were observed across all etiology subgroups. Purpose: To evaluate the efficacy and safety of ranibizumab 0.5 mg in adult patients with choroidal neovascularization because of an uncommon cause enrolled in the 12-month MINERVA study. Methods: In this Phase III, double-masked study, adult (≥18 years) patients (N = 178) were randomized 2:1 to receive either ranibizumab (n = 119) or sham (n = 59) at baseline and, if needed, at Month 1 and open-label individualized ranibizumab from Month 2. Best-corrected visual acuity change from baseline to Month 2 (primary endpoint) and Month 12, treatment exposure, and safety over 12 months were reported. Subgroup analysis was conducted on five predefined choroidal neovascularization etiologies (angioid streak, postinflammatory, central serous chorioretinopathy, idiopathic, and miscellaneous). Results: Ranibizumab showed superior efficacy versus sham from baseline to Month 2 (adjusted least-squares mean best-corrected visual acuity: +9.5 vs. −0.4 letters; P < 0.001). At Month 12, the mean best-corrected visual acuity change was +11.0 letters (ranibizumab) and +9.3 letters (sham). Across the 5 subgroups, the treatment effect ranged from +5.0 to +14.6 letters. The mean number of ranibizumab injections was 5.8 (ranibizumab arm) with no new ocular or nonocular adverse events. Conclusion: Ranibizumab 0.5 mg resulted in clinically significant treatment effect versus sham at Month 2. Overall, ranibizumab was effective in treating choroidal neovascularization of various etiologies with no new safety findings.
Collapse
|
18
|
Zanotti P, Chirico C, Gulletta M, Ardighieri L, Casari S, Roldan EQ, Izzo I, Pinsi G, Lorenzin G, Facchetti F, Castelli F, Focà E. Disseminated Histoplasmosis as AIDS-presentation. Case Report and Comprehensive Review of Current Literature. Mediterr J Hematol Infect Dis 2018; 10:e2018040. [PMID: 30002796 PMCID: PMC6039081 DOI: 10.4084/mjhid.2018.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 05/14/2018] [Indexed: 12/21/2022] Open
Abstract
Progressive disseminated histoplasmosis (PDH) is an AIDS-defining illness with a high lethality rate if not promptly treated. The wide range of its possible clinical manifestations represents the main barrier to diagnosis in non-endemic countries. Here we present a case of PDH with haemophagocytic syndrome in a newly diagnosed HIV patient and a comprehensive review of disseminated histoplasmosis focused on epidemiology, clinical features, diagnostic tools and treatment options in HIV-infected patients.
Collapse
Affiliation(s)
- Paola Zanotti
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili General Hospital, Brescia, Italy
| | - Claudia Chirico
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili General Hospital, Brescia, Italy
| | - Maurizio Gulletta
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili General Hospital, Brescia, Italy
| | - Laura Ardighieri
- Pathology Unit, University of Brescia and ASST Spedali Civili General Hospital, Brescia, Italy
| | | | - Eugenia Quiros Roldan
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili General Hospital, Brescia, Italy
| | - Ilaria Izzo
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili General Hospital, Brescia, Italy
| | - Gabriele Pinsi
- Microbiology and Virology Unit, University of Brescia and ASST Spedali Civili General Hospital, Brescia, Italy
| | - Giovanni Lorenzin
- Microbiology and Virology Unit, University of Brescia and ASST Spedali Civili General Hospital, Brescia, Italy
- Institute of Microbiology and Virology, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Italy
| | - Fabio Facchetti
- Pathology Unit, University of Brescia and ASST Spedali Civili General Hospital, Brescia, Italy
| | - Francesco Castelli
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili General Hospital, Brescia, Italy
| | - Emanuele Focà
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili General Hospital, Brescia, Italy
| |
Collapse
|
19
|
Cunningham ET, Rao NA, Gupta A, Zierhut M. Infections and Inflammation Occurring in the Subretinal Space. Ocul Immunol Inflamm 2018; 26:329-332. [PMID: 29630452 DOI: 10.1080/09273948.2018.1457355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Emmett T Cunningham
- a Department of Ophthalmology , California Pacific Medical Center , San Francisco , California , USA.,b The Department of Ophthalmology , Stanford University School of Medicine , Stanford , California , USA.,c The Francis I. Proctor Foundation , UCSF School of Medicine , San Francisco , California , USA
| | - Narsing A Rao
- d USC Roski Eye Institute, Department of Ophthalmology , University of Southern California , Los Angles , California , USA
| | - Amod Gupta
- e The Department of Ophthalmology , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Manfred Zierhut
- f Centre for Ophthalmology , University Tuebingen , Tuebingen , Germany
| |
Collapse
|
20
|
Vottonen P. Anti-vascular endothelial growth factors treatment of wet age-related macular degeneration: from neurophysiology to cost-effectiveness. Acta Ophthalmol 2018; 96 Suppl A109:1-46. [PMID: 29468838 DOI: 10.1111/aos.13706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Pasi Vottonen
- Department of Ophthalmology; Kuopio University Hospital; University of Eastern Finland; Kuopio Finland
| |
Collapse
|
21
|
Wood EH, Whitted RJ, Stone TW, Isernhagen RD, Wood WJ, Holcomb DM, Kitchens JW. PRN Ranibizumab in the Treatment of Choroidal Neovascularization Secondary to Ocular Histoplasmosis. Ophthalmic Surg Lasers Imaging Retina 2018; 49:20-26. [DOI: 10.3928/23258160-20171215-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 05/01/2017] [Indexed: 11/20/2022]
|
22
|
Exudative retinal detachment. Surv Ophthalmol 2017; 62:723-769. [DOI: 10.1016/j.survophthal.2017.05.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 05/01/2017] [Accepted: 05/05/2017] [Indexed: 12/11/2022]
|
23
|
Wang JC, Laíns I, Sobrin L, Miller JB. Distinguishing White Dot Syndromes With Patterns of Choroidal Hypoperfusion on Optical Coherence Tomography Angiography. Ophthalmic Surg Lasers Imaging Retina 2017; 48:638-646. [DOI: 10.3928/23258160-20170802-06] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 04/28/2017] [Indexed: 11/20/2022]
|
24
|
Barth T, Zeman F, Helbig H, Gamulescu MA. Intravitreal anti-VEGF treatment for choroidal neovascularization secondary to punctate inner choroidopathy. Int Ophthalmol 2017; 38:923-931. [PMID: 28424992 DOI: 10.1007/s10792-017-0536-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 04/10/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the outcome of patients with choroidal neovascularization (CNV) secondary to punctate inner choroidopathy (PIC) receiving intravitreal anti-VEGF (vascular endothelial growth factor) injections. METHODS Sixteen eyes of 16 patients diagnosed with CNV secondary to PIC were retrospectively assessed. RESULTS Eleven women and five men with a mean age of 35 years (SD 11, range 16-56 years) received intravitreal anti-VEGF for PIC-related CNV. On average, 3.5 injections (SD 2.7, range 1-9) were given per eye. Thirteen eyes were treated with bevacizumab, two eyes with ranibizumab and one eye received both substances. The mean follow-up was 15 months (SD 11, range 6-40 months). BCVA improved in eight eyes (mean Δ +2.8 lines), remained stable in four eyes and decreased in four eyes (mean Δ -4.3 lines). CONCLUSIONS CNV development is a frequent complication of PIC. Intravitreal anti-VEGF therapy seems to be safe and effective for PIC-related CNV.
Collapse
Affiliation(s)
- T Barth
- Department of Ophthalmology, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - F Zeman
- Centre for Clinical Studies (ZKS), University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - H Helbig
- Department of Ophthalmology, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - M-A Gamulescu
- Department of Ophthalmology, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| |
Collapse
|
25
|
Raven ML, Ringeisen AL, Yonekawa Y, Stem MS, Faia LJ, Gottlieb JL. Multi-modal imaging and anatomic classification of the white dot syndromes. Int J Retina Vitreous 2017; 3:12. [PMID: 28331634 PMCID: PMC5357819 DOI: 10.1186/s40942-017-0069-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 02/27/2017] [Indexed: 12/18/2022] Open
Abstract
The white dot syndromes (WDS) are a diverse group of posterior uveitidies that share similar clinical findings but are unique from one another. Multimodal imaging has allowed us to better understand the morphology, the activity and age of lesions, and whether there is CNV associated with these different ocular pathologies. The “white dot syndromes” and their uveitic masqueraders can now be anatomically categorized based on lesion localization. The categories include local uveitic syndromes with choroidal pathology, systemic uveitic syndromes with choroidal pathology, and multifocal choroiditis with outer retinal/choriocapillaris pathology with uveitis and without uveitis. Neoplastic and infectious etiologies are also discussed given their ability to masquerade as WDS.
Collapse
Affiliation(s)
- Meisha L Raven
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, 600 Highland Ave, Madison, WI 53705 USA.,McPherson Eye Research Institute, Madison, WI USA
| | - Alexander L Ringeisen
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, 600 Highland Ave, Madison, WI 53705 USA
| | - Yoshihiro Yonekawa
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, MI USA
| | - Maxwell S Stem
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, MI USA
| | - Lisa J Faia
- Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, MI USA
| | - Justin L Gottlieb
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, 600 Highland Ave, Madison, WI 53705 USA.,Department of Ophthalmology and Visual Sciences, University of Wisconsin, 2870 University Ave, Room 206, Madison, WI 53705 USA
| |
Collapse
|
26
|
Magnetic nanoparticles: a strategy to target the choroidal layer in the posterior segment of the eye. Sci Rep 2017; 7:43092. [PMID: 28256525 PMCID: PMC5335660 DOI: 10.1038/srep43092] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 01/19/2017] [Indexed: 02/07/2023] Open
Abstract
Despite the higher rate of blindness due to population aging, minimally invasive and selective drug delivery to the eye still remains an open challenge, especially in the posterior segment. The retina, the retinal pigment epithelium (RPE) and the choroid are posterior segment cell layers, which may be affected by several diseases. In particular, damages to the choroid are associated with poor prognosis in the most severe pathologies. A drug delivery approach, able to target the choroid, is still missing. Recently, we demonstrated that intravitreally injected magnetic nanoparticles (MNP) are able to rapidly and persistently localise within the RPE in an autonomous manner. In this work we functionalised the MNP surface with the vascular endothelial growth factor, a bioactive molecule capable of transcytosis from the RPE towards more posterior layers. Such functionalisation successfully addressed the MNPs to the choroid, while MNP functionalised with a control polypeptide (poly-L-lysine) showed the same localisation pattern of the naked MNP particles. These data suggest that the combination of MNP with different bioactive molecules could represent a powerful strategy for cell-specific targeting of the eye posterior segment.
Collapse
|
27
|
Abstract
PURPOSE To describe the first-documented case of histoplasma scleritis in an immunocompetent patient. METHODS Medical and pathological records of the patient described were reviewed. RESULTS A 77-year-old immunocompetent man presented with necrotizing scleritis. Biopsy was consistent with histoplasma species, and culture results confirmed a causative agent of Histoplasma capsulatum. The patient required a long course of treatment, which included topical voriconazole and amphotericin, oral itraconazole and voriconazole, intravenous amphotericin, and periocular voriconazole and amphotericin. After 8 months of treatment, the patient's scleritis resolved, and he maintained good visual acuity. CONCLUSIONS To our knowledge, this is the second report of histoplasma scleritis in the literature and the first report in an immunocompetent patient.
Collapse
|
28
|
Adhi M, Jusufbegovic D, Schaal S. Sequential Chorioretinal Changes in Presumed Ocular Histoplasmosis Syndrome Analyzed Using Spectral Domain Optical Coherence Tomography. Ocul Immunol Inflamm 2016; 25:545-553. [DOI: 10.3109/09273948.2016.1158841] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Mehreen Adhi
- Department of Ophthalmology and Visual Sciences, Kentucky Lions Eye Center, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Denis Jusufbegovic
- Department of Ophthalmology and Visual Sciences, Kentucky Lions Eye Center, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Shlomit Schaal
- Department of Ophthalmology and Visual Sciences, Kentucky Lions Eye Center, University of Louisville School of Medicine, Louisville, Kentucky, USA
| |
Collapse
|
29
|
CHARACTERIZING THE EFFECT OF ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY ON TREATMENT-NAIVE CHOROIDAL NEOVASCULARIZATION USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina 2015; 35:2252-9. [DOI: 10.1097/iae.0000000000000836] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|