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Ando T, Kubota M, Yasukawa T, Miyase T, Ishiguro K, Esaki Y, Kato A, Kokuzawa S, Hirano Y, Sakaguchi H. Macular hole with retinal pigment epithelium tear after anti-VEGF therapy in an eye with neovascular age-related macular degeneration. Am J Ophthalmol Case Rep 2024; 36:102126. [PMID: 39149619 PMCID: PMC11324838 DOI: 10.1016/j.ajoc.2024.102126] [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: 09/22/2023] [Revised: 06/26/2024] [Accepted: 07/12/2024] [Indexed: 08/17/2024] Open
Abstract
Purpose To report a case of a full-thickness macular hole (FTMH) associated with a retinal pigment epithelium (RPE) tear after anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (nvAMD), which was successfully closed by vitreous surgery. Observations A 73-year-old man with nvAMD in the right eye received an intravitreal aflibercept injection due to enlarged pigment epithelial detachment. However, 2 days after the third injection, the patient experienced a sudden decline in vision. An FTMH with a tear in the underlying RPE was detected. The FTMH was closed using vitrectomy combined with the inverted internal limiting membrane (ILM) flap technique. Conclusions and Importance Our case highlights a rare complication of both an FTMH and an RPE tear after anti-VEGF therapy. Vitrectomy, with the inverted ILM flap technique, proved effective in closing the FTMH despite the complexity of the case.
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Affiliation(s)
- Tomoko Ando
- Department of Ophthalmology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, Gifu, 501-1194, Japan
| | - Masaomi Kubota
- Department of Ophthalmology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, Gifu, 501-1194, Japan
| | - Tsutomu Yasukawa
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Taishi Miyase
- Department of Ophthalmology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, Gifu, 501-1194, Japan
| | - Kiyona Ishiguro
- Department of Ophthalmology, Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan
| | - Yuya Esaki
- Department of Ophthalmology, Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan
| | - Aki Kato
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Satoko Kokuzawa
- Department of Ophthalmology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, Gifu, 501-1194, Japan
| | - Yoshio Hirano
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Hirokazu Sakaguchi
- Department of Ophthalmology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, Gifu, 501-1194, Japan
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Maywood MJ, Parikh R, Deobhakta A, Begaj T. PERFORMANCE ASSESSMENT OF AN ARTIFICIAL INTELLIGENCE CHATBOT IN CLINICAL VITREORETINAL SCENARIOS. Retina 2024; 44:954-964. [PMID: 38271674 DOI: 10.1097/iae.0000000000004053] [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: 01/27/2024]
Abstract
PURPOSE To determine how often ChatGPT is able to provide accurate and comprehensive information regarding clinical vitreoretinal scenarios. To assess the types of sources ChatGPT primarily uses and to determine whether they are hallucinated. METHODS This was a retrospective cross-sectional study. The authors designed 40 open-ended clinical scenarios across four main topics in vitreoretinal disease. Responses were graded on correctness and comprehensiveness by three blinded retina specialists. The primary outcome was the number of clinical scenarios that ChatGPT answered correctly and comprehensively. Secondary outcomes included theoretical harm to patients, the distribution of the type of references used by the chatbot, and the frequency of hallucinated references. RESULTS In June 2023, ChatGPT answered 83% of clinical scenarios (33/40) correctly but provided a comprehensive answer in only 52.5% of cases (21/40). Subgroup analysis demonstrated an average correct score of 86.7% in neovascular age-related macular degeneration, 100% in diabetic retinopathy, 76.7% in retinal vascular disease, and 70% in the surgical domain. There were six incorrect responses with one case (16.7%) of no harm, three cases (50%) of possible harm, and two cases (33.3%) of definitive harm. CONCLUSION ChatGPT correctly answered more than 80% of complex open-ended vitreoretinal clinical scenarios, with a reduced capability to provide a comprehensive response.
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Affiliation(s)
- Michael J Maywood
- Department of Ophthalmology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
| | - Ravi Parikh
- Manhattan Retina and Eye Consultants, New York, New York
- Department of Ophthalmology, New York University School of Medicine, New York, New York
| | | | - Tedi Begaj
- Department of Ophthalmology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
- Associated Retinal Consultants, Royal Oak, Michigan
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Skalicky N, Hatz-Wurziger K. Long-term Follow-Up and Regeneration of Retinal Pigment Epithelium (RPE) after Tears of the Epithelium in Exudative Age-Related Macular Degeneration (AMD). Klin Monbl Augenheilkd 2024; 241:453-458. [PMID: 38484787 PMCID: PMC11038832 DOI: 10.1055/a-2248-9986] [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: 10/24/2023] [Accepted: 12/21/2023] [Indexed: 04/25/2024]
Abstract
BACKGROUND The goals of this study are to evaluate potential long-term visual deterioration associated with retinal pigment epithelial (RPE) tears in patients with neovascular age-related macular degeneration (nAMD) and to find treatment-related and morphological factors that might influence the outcomes. PATIENTS AND METHODS This retrospective study enrolled 21 eyes of 21 patients from the database of Vista Eye Clinic Binningen, Switzerland, diagnosed with RPE tears, as confirmed by spectral domain optical coherence tomography (SD-OCT), with a minimum follow-up period of 12 months. Treatment history before and after RPE rupture with anti-VEGF therapy, visual acuity, and imaging (SD-OCT) were analyzed and statistically evaluated for possible correlations. RESULTS Mean patient age was 80.5 ± 6.2 years. The mean length of total follow-up was 39.7 ± 13.9 months. The mean pigment epithelial detachment (PED) height increased by 363.8 ± 355.5 µm from the first consultation to 562.8 ± 251.5 µm at the last consultation prior to rupture. Therefore, a higher risk of RPE rupture is implied as a result of an increase in PED height (p = 0.004, n = 14). The mean visual acuity before rupture was 66.2 ± 16.0 letters. Mean visual acuity deteriorated to 60.8 ± 18.6 letters at the first consultation after rupture (p = 0.052, n = 21). A statistically nonsignificant decrease in vision was noted in the follow-up period. After 2 years, the mean BCVA decreased by 10.5 ± 23.7 ETDRS letters (p = 0.23, n = 19). PED characteristics before rupture and amount of anti-VEGF injections after rupture did not affect the visual outcome. None of the 21 patients included in our study showed a visual improvement in the long-term follow-up. RPE atrophy increased significantly from 3.35 ± 2.94 mm2 (baseline) to 6.81 ± 6.25 mm2 over the course of 2 years (p = 0.000 013, n = 20). CONCLUSIONS The overall mean vision decrease after rupture was without statistical significance. There was no significant change in BCVA at the 2-year follow-up, independent of the amount of anti-VEGF injections provided. In this study, there was a significant increase in RPE defect over a follow-up of 2 years, implying progression of contraction of RPE and/or macular atrophy.
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Affiliation(s)
| | - Katja Hatz-Wurziger
- Vista Eye Clinic, Binningen, Switzerland
- University of Basel, Faculty of Medicine, Basel, Switzerland
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Zhou R, Lu P, He M, Chen J, Shi Y, Han F, Cai Y. A real-world disproportionality analysis of anti-VEGF drugs from the FDA Adverse Event Reporting System. Expert Opin Drug Saf 2024; 23:363-371. [PMID: 37665052 DOI: 10.1080/14740338.2023.2250717] [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: 02/26/2023] [Accepted: 07/10/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND The association between anti-vascular endothelial growth factor (VEGF) drugs and ocular adverse events (AEs) has been reported, but large real-world studies of their association with systemic AEs are still lacking. METHODS A disproportionality analysis of reports from the FDA Adverse Event Reporting System from January 2004 to September 2021 was conducted to detect the significant ADR signals with anti-VEGF drugs (including aflibercept, bevacizumab, brolucizumab, pegaptanib, and ranibizumab). RESULTS A total of 2980 reported cases with 7125 drug-AEs were included. Five drugs were all associated with eye disorders, and pegaptanib and ranibizumab were also associated with cardiac disorders. For ranibizumab, pegaptanib, bevacizumab and aflibercept, the proportions of cardiac AEs were 8.57%, 5.62%, 3.43% and 3.20%, respectively, and the proportions of central nervous AEs were 8.81%, 7.41, 5.86% and 5.68%, respectively. In multiple comparisons, ranibizumab was significantly higher than bevacizumab and aflibercept in the proportion of cardiac AEs (P < 0.001), and ranibizumab was significantly higher than aflibercept in central nervous AEs (P < 0.001). CONCLUSIONS Our findings support the associations between anti-VEGF drugs and ocular AEs, cardiac AEs, and central nervous AEs. After intravitreal injection, attention should not only be paid to ocular symptoms, but also to systemic symptoms.
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Affiliation(s)
- Ruishan Zhou
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Peiwen Lu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Mingxiu He
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Junheng Chen
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yiyang Shi
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Fangfang Han
- School of Medical Information and Engineering, Guangdong Pharmaceutical University, Guangzhou, China
- NMPA Key Laboratory for Technology Research and Evaluation of Pharmacovigilance, Guangzhou, China
| | - Yongming Cai
- School of Medical Information and Engineering, Guangdong Pharmaceutical University, Guangzhou, China
- NMPA Key Laboratory for Technology Research and Evaluation of Pharmacovigilance, Guangzhou, China
- Guangdong Provincial Traditional Chinese Medicine Precision Medicine Big Data Engineering Technology Research Center, Guangzhou, China
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Shi H, Guo N, Zhao Z, Duan J. ASSOCIATION BETWEEN RETINAL PIGMENT EPITHELIUM TEAR AND ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY: A Systematic Review and Meta-Analysis. Retina 2024; 44:179-188. [PMID: 37824816 DOI: 10.1097/iae.0000000000003922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
PURPOSE To identify the prevalence of retinal pigment epithelium tear (RPET) after anti-vascular endothelial growth factor (VEGF) therapy and determine the efficacy of continued anti-VEGF therapy in patients with RPET. METHODS All relevant clinical trials and observational studies in several online databases were screened. The main outcomes were the incidence of RPET after anti-VEGF therapy and changes in visual acuity for patients with RPET treated with continued anti-VEGF. RESULTS The pooled incidence of RPET after anti-VEGF therapy from 24 studies with 17,354 patients was 1.9% (95% CI: 1.3-2.7). Most new RPET cases were concentrated in the first month at baseline or after the first injection during anti-VEGF therapy and gradually decreased by the subsequent month or injection. 13 studies with 157 patients reported that for patients who received anti-VEGF therapy after RPET, their pooled best-corrected visual acuity improved, but did not reach a significant level (standardized mean differences 0.34; 95% CI: -0.03 to 0.71). CONCLUSION The incidence of RPET after anti-VEGF therapy is low. The intravitreal anti-VEGF injection may accelerate this process. For patients with RPET, maintenance of anti-VEGF therapy ensures visual acuity stability.
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Affiliation(s)
- Hekai Shi
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, China; and
| | - Nuojin Guo
- Hebei Medical University, Shijiazhuang, China
| | - Zeming Zhao
- Hebei Medical University, Shijiazhuang, China
| | - Jialiang Duan
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, China; and
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Maruyama-Inoue M, Yanagi Y, Inoue T, Kadonosono K. Comparison of functional and morphologic changes between brolucizumab and faricimab in neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2024; 262:589-599. [PMID: 37750953 PMCID: PMC10844403 DOI: 10.1007/s00417-023-06241-8] [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: 04/18/2023] [Revised: 08/15/2023] [Accepted: 09/08/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE This study aimed to compare functional and morphologic changes in the loading phase between patients with treatment-naïve macular neovascularization (MNV) due to neovascular age-related macular degeneration (nAMD) treated with either intravitreal brolucizumab (IVBr) or intravitreal faricimab (IVF) injections in a clinical setting. METHODS We retrospectively studied 92 consecutive eyes of 90 patients with neovascular nAMD who were scheduled to receive IVBr (42 eyes of 41 patients) or IVF (50 eyes of 49 patients) injections between October 2021 and December 2022. All patients received three consecutive monthly injections of 6.0 mg/0.05 mL brolucizumab or 6.0 mg/0.05 mL faricimab. The best-corrected visual acuity (BCVA), central foveal thickness (CFT), and central choroidal thickness (CCT) at baseline and 1, 2, and 4 months after the initial treatment were measured and compared between the groups. RESULTS Thirty-seven eyes in IVBr group and forty-seven eyes in IVF group who finished treatments in the loading phase were assessed at the follow-up examination. The BCVA, CFT, and CCT changed significantly after loading phase in both groups (P < 0.05 for both comparisons). The IVBr group had more rapid improvement of the BCVA (P = 0.037) at 1 month than the IVF group, but there was no difference at 4 months (P = 0.367). The CFT and CCT decreases tended to be greater in the IVBr group than in the IVF group throughout the follow-up period. Of the five eyes excluded from the IVBr group, one eye (2.4%) each had intraocular inflammation (IOI) and was a non-responder, and two eyes (4.8%) had retinal pigment epithelial tears after treatment. Of the three eyes excluded from the IVF group, two eyes (4.0%) did not respond to the treatment. CONCLUSIONS Both IVBr and IVF injections were well-tolerated and improved the VA in treatment-naïve patients with MNV due to nAMD after a loading phase, although IVBr caused a trend toward faster visual improvements in the BCVA. The IVBr group also had greater reductions of the CFT and CCT than the IVF group. However, the potential for adverse events and no response to treatment with each drug are considerations.
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Affiliation(s)
- Maiko Maruyama-Inoue
- Department of Ophthalmology and Micro-technology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan.
| | - Yasuo Yanagi
- Department of Ophthalmology and Micro-technology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan
| | - Tatsuya Inoue
- Department of Ophthalmology and Micro-technology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan
| | - Kazuaki Kadonosono
- Department of Ophthalmology and Micro-technology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan
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Correia Barbosa R, Teixeira C. Spontaneous Massive Retinal Pigment Epithelium Tear: A Case Report of a Dramatic Complication of Age-Related Macular Degeneration. Cureus 2024; 16:e52980. [PMID: 38406066 PMCID: PMC10894455 DOI: 10.7759/cureus.52980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Retinal pigment epithelium (RPE) tears occur when the RPE acutely breaks and retracts, leaving the underlying Bruch's membrane and choroid exposed. They usually happen in areas of previous pigment epithelial detachments and are generally associated with age-related macular degeneration (AMD). The purpose of this report is to describe a case of a spontaneous massive central RPE tear in a patient with untreated AMD. A 67-year-old female patient presented with complaints of sudden decreased vision in her right eye. Her best-corrected visual acuity was 2/20, and fundoscopy revealed a massive central retinal hemorrhage with intraretinal, subretinal, and sub-RPE blood. The patient started anti-vascular endothelial growth factor (VEGF) treatment, and after the blood was reabsorbed, a very large central tear of the RPE involving the central macula was evident, with a layer of detached retina folded on itself. She received continuous anti-VEGF therapy, and the final measurement of her visual acuity was 2/200, despite the complete reabsorption of the hemorrhage. RPE tears may occur spontaneously as part of the natural history of AMD or be triggered by the initiation of anti-VEGF treatment in the presence of large pigment epithelium detachments. There are currently no strategies to prevent their spontaneous development, and they constitute a dramatic complication of AMD. The prognosis is dependent on the size and location of the lesion, and the visual loss is irreversible.
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Affiliation(s)
- Renato Correia Barbosa
- Ophthalmology, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos (ULSM), Matosinhos, PRT
| | - Carla Teixeira
- Ophthalmology, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos (ULSM), Matosinhos, PRT
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Takemoto M, Kitamura Y, Kakisu M, Shimizu D, Baba T. Retinal Pigment Epithelial Tears after Ex-PRESS Filtration Surgery in a Glaucoma Patient with a History of Ischemic Optic Neuropathy. Case Rep Ophthalmol Med 2023; 2023:6645156. [PMID: 37920746 PMCID: PMC10620019 DOI: 10.1155/2023/6645156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 11/04/2023] Open
Abstract
Background To describe a case of retinal pigment epithelial tears (RPE tears) and serous retinal detachment (SRD) after Ex-PRESS filtration surgery for primary open-angle glaucoma (POAG) combined with ischemic optic neuropathy. Case Presentation. This case report involved a 69-year-old woman who underwent Ex-PRESS filtration surgery for right POAG. She had a history of systemic arteriosclerotic disease and subacute progressive visual field loss due to suspected ischemic optic neuropathy in her right eye. The right preoperative visual acuity was 0.7, and intraocular pressure (IOP) was 19 mmHg with maximum glaucoma eye drops. RPE detachment was not observed in the fundus. On day 9 after surgery, the IOP was 6 mmHg, and mild choroidal detachment was observed. On day 13, although IOP remained almost unchanged at 7 mmHg, bullous SRD was observed in the inferior retina, including the macula, and RPE tears were observed along the superior arcade vessel. While subretinal fluid gradually decreased with increasing IOP, tractional retinal folds persisted along the superior arcade, accompanied by macular degeneration. Conclusion We experienced a case of RPE tears after Ex-PRESS filtration surgery. In addition to choroidal detachment in the setting of hypotony, a pathologic condition causing structural fragility of the RPE layer may contribute to the development of RPE tears.
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Affiliation(s)
- Mamiko Takemoto
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Japan
- Department of Ophthalmology, International University of Health and Welfare Narita Hospital, Japan
| | - Yuta Kitamura
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Japan
| | - Masato Kakisu
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Japan
- Department of Ophthalmology, Japanese Red Cross Narita Hospital, Japan
| | - Daisuke Shimizu
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Japan
| | - Takayuki Baba
- Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Japan
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Venkatesh R, Handa A, Prabhu V, Chitturi SP, Joshi A, Acharya I, Mangla R, Yadav NK, Chhablani J. Central posterior hyaloid fibrosis: evolution and outcomes. Int J Retina Vitreous 2023; 9:54. [PMID: 37679852 PMCID: PMC10486079 DOI: 10.1186/s40942-023-00494-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023] Open
Abstract
PURPOSE To report contributory factors and clinical outcomes of central posterior hyaloid fibrosis (CPHF) associated with neovascular age-related macular degeneration (nAMD). METHODS In this retrospective, single-center study, patients with CPHF and nAMD were included. Demographic and imaging characteristics, as well as the anatomical and functional outcomes, of these patients were analysed. RESULTS We identified 530 eyes in 273 patients with chronic predominantly scarred macular neovascularisation (MNV), and 32 eyes in 29 patients revealed CPHF, representing a prevalence of 6%. Patients had a mean age of 72.76 years. Before and during the development of CPHF, Type 2 MNV was observed in all eyes. At the time of MNV diagnosis, mean logMAR visual acuity was 1.308 ± 0.559 (20/407). The average time to develop CPHF was 27.3 months since the diagnosis of MNV. At the time of CPHF identification, the mean logMAR visual acuity was 1.498 ± 0.374 (20/630). RPE tear was observed in 6% (n = 2) of CPHF eyes. The average number of intravitreal anti-VEGF injections administered prior to the diagnosis of CPHF was 2.4 and after the onset of CPHF was 0.9. The final visual acuity was not significantly different at the final follow-up visit [1.304 ± 0.42 (20/402); p = 0.646]. CONCLUSION Rarely observed in eyes with predominantly scarred subfoveal type 2 MNVs and extensive subretinal fibrosis, CPHF is associated with poor visual outcomes. Its presence could possibly suggest a profibrotic effect of MNV on the posterior hyaloid. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Ramesh Venkatesh
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India.
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 800, Pittsburg, PA, 15213, USA.
| | - Ashit Handa
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Vishma Prabhu
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Sai Prashanti Chitturi
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Aishwarya Joshi
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Isha Acharya
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Rubble Mangla
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Naresh Kumar Yadav
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 800, Pittsburg, PA, 15213, USA
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Wąsowska A, Sendecki A, Boguszewska-Chachulska A, Teper S. Polygenic Risk Score and Rare Variant Burden Identified by Targeted Sequencing in a Group of Patients with Pigment Epithelial Detachment in Age-Related Macular Degeneration. Genes (Basel) 2023; 14:1707. [PMID: 37761846 PMCID: PMC10531282 DOI: 10.3390/genes14091707] [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: 06/16/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
A subset of ophthalmic imaging examination results from 334 patients were subjected to reanalysis to identify a specific group of patients with pigment epithelial detachment (PED) in at least one eye. Overall, we found a subgroup of 47 patients manifesting PED and studied their genotypes in comparison to those of patients with age-related macular degeneration without PED and healthy controls. We established a polygenic risk score that allowed the explanation of 16.3% of the variation within the disease. The highest predictive value was achieved for a model consisting of six non-coding variants: rs760306 (BEST1), rs148662546 (BEST1), rs11569560 (C3), rs74600252 (GUCA1B), rs2240688 (PROM1), and rs185507582 (TCF4). The risk of PED occurrence was found to be the highest in the first tercile, showing a 7.89-fold higher risk compared to the third tercile for AMD without PED (95% CI: 2.87; 21.71, p < 0.001) and a 7.22-fold higher risk compared to the healthy controls (95% CI: 2.60; 20.06, p < 0.001). In addition, we focused on rare variants in targeted genes. The rare variants' burden was compared among the groups, but no statistical significance was observed in the number of rare variants, predicted functional effects, or pathogenicity classification.
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Affiliation(s)
- Anna Wąsowska
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
- Genomed S.A., 02-972 Warszawa, Poland
| | - Adam Sendecki
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
| | | | - Sławomir Teper
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
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Ozawa Y, Ohgami K, Sasaki K, Hirano K, Sunaya T. Long-term surveillance provides real-world evidences of safety and effectiveness in intravitreal aflibercept treatment for age-related macular degeneration. Sci Rep 2023; 13:10597. [PMID: 37391547 PMCID: PMC10313657 DOI: 10.1038/s41598-023-37584-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023] Open
Abstract
This prospective, multicentre, postmarketing surveillance were conducted to report on the long-term safety and effectiveness of intravitreal aflibercept (IVT-AFL) treatment in clinical practice of Japanese patients with neovascular age-related macular degeneration (nAMD) who newly initiated IVT-AFL treatment. The primary outcomes were the incidence of adverse events (AEs) and of adverse drug reactions (ADRs) over 36 months. Number of injections, timing of ADR occurrence, and some effectiveness index were also summarised. A total of 3,872 patients received 7.2 ± 5.8 (mean ± standard deviation) injections, and AEs occurred in 5.73% of patients. ADRs were reported in 2.76% of patients, with ocular and nonocular ADRs in 2.07% and 0.72% of patients, respectively. Most vitreo-retinal events developed within 6 months of initial IVT-AFL treatment, and most instances of increased intraocular pressure and cerebral infarction developed after 6 months of follow-up. Mean best-corrected visual acuity and central retinal thickness were numerically better throughout the follow-up period compared with baseline. These results indicated acceptable tolerability and effectiveness of IVT-AFL treatment in patients with nAMD in clinical practice in Japan. Information regarding the risk and the timing of ADRs is valuable for safe and effective long-term treatment of patients with nAMD.Trial registration number: NCT01756248.
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Affiliation(s)
- Yoko Ozawa
- Department of Clinical Regenerative Medicine Eye Center, Fujita Medical Innovation Center Tokyo, Fujita Health University School of Medicine, Tokyo, Japan.
- Department of Ophthalmology, St. Luke's International Hospital, Tokyo, Japan.
- Department of Ophthalmology, St. Luke's International University, Tokyo, Japan.
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
| | - Kazuhiro Ohgami
- Medical Affairs and Pharmacovigilance, Bayer Yakuhin, Ltd., Osaka, Japan
| | - Koji Sasaki
- Medical Affairs and Pharmacovigilance, Bayer Yakuhin, Ltd., Osaka, Japan
| | - Kazufumi Hirano
- Medical Affairs and Pharmacovigilance, Bayer Yakuhin, Ltd., Osaka, Japan
| | - Toshiyuki Sunaya
- Research and Development Japan, Bayer Yakuhin, Ltd., Osaka, Japan
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12
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Cayzac V, Sagnard M, Valero B, Voisin H, El Chehab H. Retinal Pigment Epithelium Tear After Nonpenetrating Deep Sclerectomy. J Glaucoma 2023; 32:e60-e62. [PMID: 36795517 DOI: 10.1097/ijg.0000000000002175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/26/2022] [Indexed: 02/17/2023]
Abstract
Retinal pigment epithelium (RPE) tear is a common complication in the context of neovascular age-related macular degeneration treated by intravitreal injections of antivascular endothelial growth factor drugs. There are some reports of such complications after trabeculectomy but none after nonpenetrating deep sclerectomy (NPDS). A 57-year-old man presented to our hospital with uncontrolled advanced glaucoma of his left eye. NPDS with adjunctive use of mitomycin C was performed with no intraoperative complication. On the seventh postoperative day clinical examination and multimodal imaging revealed a macular RPE tear in the operated eye. Subretinal fluid induced by the tear resolved within 2 months with an increase in intraocular pressure. To the best of our knowledge, this article discusses the first reported case of RPE tear occurring just after NPDS.
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Affiliation(s)
- Vincent Cayzac
- Department of Ophthalmology, Sainte Anne Military Hospital, Toulon, France
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Palmieri F, Younis S, Raslan W, Fabozzi L. Bacillary Layer Detachment in Neovascular Age-Related Macular Degeneration: Case Series. Biomedicines 2023; 11:biomedicines11030988. [PMID: 36979967 PMCID: PMC10046666 DOI: 10.3390/biomedicines11030988] [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: 02/18/2023] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
PURPOSE This study seeks to report the clinical and multimodal imaging findings of eight eyes of seven patients with neovascular age-related macular degeneration (nAMD) who developed bacillary layer detachment (BALAD). Setting/Venue: The patients were analysed at the Western Eye Hospital in London, UK. METHODS The approaches of this research include clinical examinations and multimodal imaging-based description of cases of nAMD with BALAD. RESULTS We report multimodal imaging findings of bacillary layer detachment (BALAD) in patients with nAMD. CONCLUSIONS A bacillary layer detachment was detected in patients with neovascular age-related macular degeneration. This multimodal imaging finding is not commonly described in the literature for this disease.
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Affiliation(s)
- Filomena Palmieri
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London NW1 5QH, UK
- Surgery, Cancer and Cardiovascular Division, Ophthalmology Department, Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Saad Younis
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London NW1 5QH, UK
- Surgery, Cancer and Cardiovascular Division, Ophthalmology Department, Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Walid Raslan
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London NW1 5QH, UK
- Surgery, Cancer and Cardiovascular Division, Ophthalmology Department, Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Lorenzo Fabozzi
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London NW1 5QH, UK
- Surgery, Cancer and Cardiovascular Division, Ophthalmology Department, Imperial College Healthcare NHS Trust, London W2 1NY, UK
- Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK
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Ranjan R, Manayath G, Khanna A, Venkatapathy N. Healing pattern of subfoveal retinal pigment epithelium rip and aperture in central serous chorioretinopathy. Oman J Ophthalmol 2023; 16:170-174. [PMID: 37007249 PMCID: PMC10062083 DOI: 10.4103/ojo.ojo_331_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 10/25/2022] [Accepted: 12/02/2022] [Indexed: 02/23/2023] Open
Abstract
This report describes a rare case of spontaneous Grade-4 retinal pigment epithelium (RPE) rip of serous pigment epithelial detachment (PED) in central serous chorioretinopathy (CSC) and RPE aperture in the fellow eye, with favorable long-term outcomes. A 38-year-old man presented with defective vision (20/30) in the left eye (LE) due to bullous CSC associated with a large extramacular RPE rip located temporally and inferior exudative retinal detachment. Optical coherence tomography (OCT) confirmed a subfoveal serous PED with RPE aperture, subretinal fluid (SRF) and fibrinous exudation, and a large extramacular RPE rip temporally. The right eye (RE) had an asymptomatic large serous PED. The LE was treated with low-fluence photodynamic therapy, which resulted in the closure of RPE aperture and complete resolution of PED and SRF. Six-month later, the patient presented with sudden defective vision (20/120) in the RE secondary to a large fovea-involving (Grade-4) RPE rip with SRF as confirmed on OCT. Fluorescein angiography showed two extrafoveal active point leaks, which were treated with focal photocoagulation. He was also started on oral eplerenone. On subsequent serial follow-ups over 1 year, OCT showed SRF resolution and patchy reorganization of the subfoveal RPE-photoreceptor complex with good visual outcome (20/30).
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15
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Zheng C, Wang K, Zhang M, Tao Q, Li X, Zhang X. Outcomes of retinal pigment epithelial detachment in Vogt-Koyanagi-Harada disease: a longitudinal analysis. BMC Ophthalmol 2022; 22:446. [PMID: 36401187 PMCID: PMC9675062 DOI: 10.1186/s12886-022-02675-6] [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: 07/08/2022] [Accepted: 11/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background The aim of this study was to report the clinical profile and outcomes of retinal pigment epithelial detachment (PED) in Vogt-Koyanagi-Harada (VKH) disease, and to evaluate the correlation between PED and the subsequent development of central serous chorioretinopathy (CSC) throughout the whole corticosteroid treatment course. Methods The retrospective study enrolled a total of 470 eyes with VKH, and 12 eyes with VKH and PED were recruited. Patients were divided into two groups according to the CSC onset or not throughout the whole course (the CSC group and non-CSC group). Best-corrected visual acuity (BCVA) improvement, and PED angle (PEDA, the angle between the two lines of the vertex of the lifted retinal pigment epithelium to the two edge points of the Bruch membrane) were compared between the two groups. Results CSC developed at the site of the PED in 5 of the 12 eyes with PED, while in the remaining 7 eyes PED gradually resolved following therapy. The prevalence of PED and CSC in VKH was 2.55% (12/470) and 1.06% (5/470), respectively. BCVA improvement in the non-CSC group was greater than that in the CSC group, but without a statistical difference (P = 0.25). PEDA was significantly smaller in the CSC group than in the non-CSC group (P = 0.03). Conclusion PEDA is an ideal parameter to reflect hydrostatic pressure and stretches for RPE. As PED predisposes to the development of CSC in selected VKH eyes, PEDA may be a valuable predictive factor for the development of classic CSC in VKH cases.
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Affiliation(s)
- Chuanzhen Zheng
- grid.412729.b0000 0004 1798 646XTianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fu Kang Road, Tianjin, 300384 China
| | - Kaixuan Wang
- grid.412729.b0000 0004 1798 646XTianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fu Kang Road, Tianjin, 300384 China
| | - Mi Zhang
- grid.412729.b0000 0004 1798 646XTianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fu Kang Road, Tianjin, 300384 China
| | - Qingqin Tao
- grid.412729.b0000 0004 1798 646XTianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fu Kang Road, Tianjin, 300384 China
| | - Xiaorong Li
- grid.412729.b0000 0004 1798 646XTianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fu Kang Road, Tianjin, 300384 China
| | - Xiaomin Zhang
- grid.412729.b0000 0004 1798 646XTianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fu Kang Road, Tianjin, 300384 China
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16
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Toto L, Ruggeri ML, D'Aloisio R, De Nicola C, Trivigno C, Cerino L, Di Marzio G, Di Nicola M, Porreca A, Mastropasqua R. Brolucizumab Intravitreal Injection in Macular Neovascularization Type 1: VA, SD-OCT, and OCTA Parameter Changes during a 16-Week Follow-Up. Ophthalmic Res 2022; 66:218-227. [PMID: 36162382 DOI: 10.1159/000526851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/31/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to assess early anatomical and functional changes after brolucizumab intravitreal injection (BIVI) in patients with age-related macular degeneration (AMD) and macular neovascularization type 1 (MNV1). METHODS A total of 24 eyes of 24 patients suffering from naïve AMD with MNV1 candidates to BIVI as per label with q12/q8 dosing regimen after the loading dose were enrolled in this prospective study. Main outcome measures during a 16-week follow-up period included changes in best corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal subretinal fluid (SSRF) thickness (SSRFT), subfoveal sub-retinal pigment epithelium (RPE) fluid thickness (SSRPEFT), subfoveal choroidal thickness (SFCT), and pigment epithelial detachment (PED) maximum height (PED-MH). In addition, MNV1 flow area; percentages of eyes with intraretinal fluid (IRF), subretinal fluid, and sub-RPE fluid at different time points; and percentages of eyes candidates to a q8 or q12 injection interval after disease activity assessment at week 16 were evaluated. RESULTS BCVA improved significantly from baseline (T0) to week 12 (T3) (p = 0.028). CMT showed a significant reduction from 456 ± 123 µm at T0 to 265 ± 85 µm at T3 (p < 0.001). SSRFT and SSRPEFT reduced significantly as well (p < 0.001 and p = 0.049, respectively). PED-MH and SFCT reduced significantly at the different time points (p = 0.020; p = 0.006, respectively). IRF presence changed significantly from 41.7% of eyes at T0 to 20.8% at T3 (p = 0.045). SSRF reduced significantly during follow-up, being present in 62.5% of eyes at T0 and 4.2% of eyes at T3 (p < 0.001). Subfoveal sub-RPE fluid decreased significantly during time, being present in 20.8% of eyes at T0 and 0% at T3 (p = 0.013). Most of the eyes (18 eyes, 75%) at week 16 after disease activity assessment were shifted in the q12 interval, and only a minority of eyes shifted in a q8 interval (6 eyes, 25%). CONCLUSION Brolucizumab is efficient in AMD patients with MNV1 by reducing all retinal fluids during the loading phase and shows reduction of macular thickness, choroidal thickness, and PED height. Most eyes at disease activity assessment (75%) fall into 12-week interval and the minority (25%) into the 8-week interval.
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Affiliation(s)
- Lisa Toto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Maria Ludovica Ruggeri
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Rossella D'Aloisio
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Chiara De Nicola
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Chiara Trivigno
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Luca Cerino
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Guido Di Marzio
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Marta Di Nicola
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, University "G. D'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Annamaria Porreca
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, University "G. D'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Rodolfo Mastropasqua
- Ophthalmology Clinic, Department of Neurosciences, Imaging and Clinical Science, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
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17
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Zhao C, Huang Y, Chen L, Ye S, Liu XQ. The Association Between Circulating Sex Hormones and Central Serous Chorioretinopathy: A Case-Control Study. Ther Clin Risk Manag 2022; 18:855-865. [PMID: 36046103 PMCID: PMC9423108 DOI: 10.2147/tcrm.s370133] [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: 04/20/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background Central serous chorioretinopathy (CSC) is preferential cocurated in males, however the associations between sex hormones and CSC incidence or progression remains unclear. The sex hormone concentration assessments in CSC cases and healthy controls will update the knowledge in CSC management. Methods This case-control study included 59 CSC cases and 30 healthy controls, from January 2019 to December 2020. The CSC cases would be defined as spontaneous resolved if the subretinal fluid were absorbed within three months. The concentrations of total testosterone (TT), free testosterone (FT), estradiol (E2), sex hormone-binding globulin (SHBG), progesterone, leuteinizing hormone (LH) and dehydroepiandrosterone sulfate (DHEA-S) were detected in all the participants. The relationships between sex hormone concentrations and CSC-related characteristics were analyzed with Pearson correlation analyses. Results Significantly increased TT, FT, FT/E2 ratio, SHBG concentrations as well as decreased DHEA-S level were detected in non-resolved CSC group compared with the control group. Comparing with the resolved ones, it was found that TT, FT and SHBG concentrations were increased in the non-resolved CSC. A significant positive correlation between TT concentrations and CMT (R2=0.168, P=0.031) as well as SRF height (R2=0.146, P=0.045) were detected in the non-solved CSC group. Conclusion Different concentrations of TT, FT, FT/E2 ratio, DHEA-S and SHBG were detected in resolved and non-resolved CSC cases. Sex hormones were related to CSC symptom durations and related parameters.
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Affiliation(s)
- Chun Zhao
- Department of Ophthalmology, Tenth People's Hospital Affiliated to Shanghai Tongji University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Yan Huang
- Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, People's Republic of China
| | - Lei Chen
- Department of Ophthalmology, Tenth People's Hospital Affiliated to Shanghai Tongji University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Sheng Ye
- Department of Ophthalmology, Tenth People's Hospital Affiliated to Shanghai Tongji University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Xiao-Qiang Liu
- Department of Ophthalmology, Tenth People's Hospital Affiliated to Shanghai Tongji University School of Medicine, Shanghai, 200072, People's Republic of China
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18
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Foster WJ, Berg BW, Luminais SN, Hadayer A, Schaal S. Computational Modeling of Ophthalmic Procedures: Computational Modeling of Ophthalmic Procedures. Am J Ophthalmol 2022; 241:87-107. [PMID: 35358485 PMCID: PMC9444883 DOI: 10.1016/j.ajo.2022.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 01/16/2022] [Accepted: 03/17/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To explore how finite-element calculations can continue to contribute to diverse problems in ophthalmology and vision science, we describe our recent work on modeling the force on the peripheral retina in intravitreal injections and how that force increases with shorter, smaller gauge needles. We also present a calculation that determines the location and stress on a retinal pigment epithelial detachment during an intravitreal injection, the possibility that stress induced by the injection can lead to a tear of the retinal pigment epithelium. BACKGROUND Advanced computational models can provide a critical insight into the underlying physics in many surgical procedures, which may not be intuitive. METHODS The simulations were implemented using COMSOL Multiphysics. We compared the monkey retinal adhesive force of 18 Pa with the results of this study to quantify the maximum retinal stress that occurs during intravitreal injections. CONCLUSIONS Currently used 30-gauge needles produce stress on the retina during intravitreal injections that is only slightly below the limit that can create retinal tears. As retina specialists attempt to use smaller needles, the risk of complications may increase. In addition, we find that during an intravitreal injection, the stress on the retina in a pigment epithelial detachment occurs at the edge of the detachment (found clinically), and the stress is sufficient to tear the retina. These findings may guide physicians in future clinical research. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- William J Foster
- From the Department of Bioengineering (W.J.F.), Lewes Katz School of Medicine (B.W.B., S.N.L.), Temple University, Philadelphia, Pennsylvania, USA; Altasciences, Montréal, Québec, Canada (W.J.F.).
| | - Brian W Berg
- From the Department of Bioengineering (W.J.F.), Lewes Katz School of Medicine (B.W.B., S.N.L.), Temple University, Philadelphia, Pennsylvania, USA
| | - Steven N Luminais
- From the Department of Bioengineering (W.J.F.), Lewes Katz School of Medicine (B.W.B., S.N.L.), Temple University, Philadelphia, Pennsylvania, USA
| | - Amir Hadayer
- Department of Ophthalmology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (A.H.)
| | - Shlomit Schaal
- Department of Ophthalmology, University of Massachusetts Medical School, Worcester, Massachusetts, USA (S.S.)
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19
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Xu M, Fan R, Fan X, Shao Y, Li X. Progress and Challenges of Anti-VEGF Agents and Their Sustained-Release Strategies for Retinal Angiogenesis. Drug Des Devel Ther 2022; 16:3241-3262. [PMID: 36172053 PMCID: PMC9512290 DOI: 10.2147/dddt.s383101] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/10/2022] [Indexed: 11/23/2022] Open
Abstract
Currently, the treatment for ocular neovascular diseases, including diabetic macular edema (DME) and age-related macular degeneration (AMD), mainly involves repeated intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs. Although it can preserve vision, repeated injections are an invasive treatment modality, leading to serious complications and reducing patient adherence to treatment. To reduce the frequency of administration, prolong the time of drug action, and avoid repeated intravitreal injections, the combination of sustained-release materials with anti-VEGF drug therapy has become an emphasis in ophthalmology. In this review, we highlight the current state of anti-VEGF technology, its challenges, and the sustained-release strategies under investigation or being used in clinical practice. Both continuous release and considerable therapeutic effects can be achieved by encapsulating anti-VEGF drugs in sustained-release materials to minimize the number of intravitreal injections. At present, two sustained-release materials are being tested in clinical research, and although basic research shows the strong therapeutic application prospects of extended-release drugs, its challenges mainly involve the discrepancy between the release rates in vitro and the efficiency of the drugs in vivo. Briefly, sustained release of anti-VEGF agents is an advantageous strategy for treating retinal angiogenesis.
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Affiliation(s)
- Manhong Xu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, People’s Republic of China
| | - Ruiyan Fan
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, People’s Republic of China
| | - Xiaoe Fan
- Department of Ophthalmology, Jincheng People’s Hospital, Jincheng, People’s Republic of China
| | - Yan Shao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, People’s Republic of China
| | - Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, People’s Republic of China
- Correspondence: Xiaorong Li; Yan Shao, No. 251 Fukang Road, Nankai Distinct, Tianjin, 300384, People’s Republic of China, Tel +86 186 2281 8042; +86 186 2281 8042, Fax +86 022-86428777, Email ;
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20
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Karasavvidou EM, Tranos P, Panos GD. Brolucizumab for the Treatment of Degenerative Macular Conditions: A Review of Clinical Studies. Drug Des Devel Ther 2022; 16:2659-2680. [PMID: 35971530 PMCID: PMC9375562 DOI: 10.2147/dddt.s378450] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/04/2022] [Indexed: 12/13/2022] Open
Abstract
Age-related macular degeneration (AMD), diabetic retinopathy and retinal vein occlusion represent some of the commonest degenerative conditions that lead to severe vision impairment in the developed countries. The gold standard treatment of complications associated with these conditions is the intravitreal administration of anti-vascular endothelial growth factor (VEGF) agents. Brolucizumab is a newly developed, humanised, single-chain fragment of a monoclonal antibody binding all VEGF-A isoforms, which was recently approved for the treatment of neovascular AMD. Intravitreal brolucizumab promises to reduce treatment burden for nAMD patients by achieving comparable therapeutic outcomes with fewer clinic visits. Promising also appears its use for the treatment of more challenging maculopathies like diabetic macular oedema (DMO). The aim of this review is to describe the special pharmacological properties of brolucizumab and display the outcomes of the most important clinical trials and real-world studies regarding its efficacy and safety for the management of degenerative macular disorders.
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Affiliation(s)
| | | | - Georgios D Panos
- Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
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21
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Blue-light fundus autofluorescence imaging of pigment epithelial detachments. Eye (Lond) 2022; 37:1191-1201. [PMID: 35581370 PMCID: PMC10102186 DOI: 10.1038/s41433-022-02076-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 03/18/2022] [Accepted: 04/19/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Pigment epithelial detachments (PEDs) occur in association with various chorioretinal diseases. With respect to the broad clinical spectrum of PEDs we describe fundus autofluorescence (FAF) characteristics of PEDs. METHODS Ninety-three eyes of 66 patients (mean age 71.9 ± 11.1) with uni- or bilateral PED ( ≥ 350 µm) were included in a retrospective cross-sectional study. PEDs were secondary to age-related macular degeneration (n = 79), central serous chorioretinopathy (n = 7), polypoidal choroidal vasculopathy (n = 2), pattern dystrophy (n = 3) or idiopathic PED (n = 2). FAF images were recorded using confocal scanning laser ophthalmoscopy (488 nm excitation wavelength, detection of emission >500 nm). Diagnosis of PED was confirmed using spectral-domain optical coherence tomography. A qualitative FAF grading system was established, and grading was performed by two independent readers. RESULTS PEDs showed highly variable characteristics on FAF imaging. FAF within the area of PED was found to be irregular/granular (n = 59, 63.4%), increased (n = 28, 30.1%), decreased (n = 3, 3.2 %), or normal (n = 3, 3.2%). Accompanying FAF changes included condensation of macular pigment (n = 67, 72.0%), focally increased FAF at the PED apex (n = 14, 15.1%) or elsewhere (n = 52, 55.9%), focally decreased FAF (n = 23, 24.7%), a cartwheel-like pattern (n = 10, 10.8%), a doughnut sign (n = 6, 6.5%), and a halo of decreased FAF encircling the PED (completely n = 20, 21.5% or incompletely n = 20, 21.5%). CONCLUSIONS PEDs show a variety of abnormal patterns on FAF imaging. These changes in FAF signals may be secondary to morphological and metabolic alterations within corresponding retinal layers and do not necessarily correspond with the underlying PED subtype or a specific pathology.
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22
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Venkatesh R, Agrawal R, Thomas S, Reddy NG, Gupta A, Yadav NK, Chhablani J. Sequential retinal pigment epithelium tears following intravitreal Ranibizumab injections for age-related macular degeneration. Eur J Ophthalmol 2022; 33:NP100-NP104. [PMID: 35388732 DOI: 10.1177/11206721221093025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report a case of sequential retinal pigment epithelium (RPE) tears following intravitreal Ranibizumab injections for neovascular age-related macular degeneration (AMD). METHODS Retrospective, observational case. CASE DESCRIPTION A 75-year-old hypertensive male was diagnosed with active neovascular AMD and pre-existing RPE tear in the left eye. His presenting best-corrected visual acuity was counting finger @ 1 metre, <N36 in the right eye and 6/9, N8 in the left eye respectively. The right eye fundus had a scarred choroidal neovascular membrane (CNV) with extensive hard exudates. The left eye fundus showed active CNV, subretinal fluid and haemorrhage and a large RPE tear inferior to the fovea with rolled up margins. Following treatment with intravitreal Ranibizumab injection (Accentrix®, Alcon, 0.5 mg/0.05 ml) at monthly intervals, patient developed two extra RPE tears following each injection adjacent to the existing RPE tear. At the final follow-up visit, his CNV had regressed and visual acuity was maintained at 6/6, N6. No additional RPE tears were noted. CONCLUSION Pathogenesis of sequential RPE tears remains unclear. There is a need to look out for new RPE tears which can affect vision in a patient with neovascular AMD following CNV treatment.
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Affiliation(s)
- Ramesh Venkatesh
- Dept. of Retina and Vitreous, 80219Narayana Nethralaya, Bangalore, India
| | - Rohit Agrawal
- Dept. of Retina and Vitreous, 80219Narayana Nethralaya, Bangalore, India
| | - Sherina Thomas
- Dept. of Retina and Vitreous, 80219Narayana Nethralaya, Bangalore, India
| | | | - Aditi Gupta
- Dept. of Retina and Vitreous, 80219Narayana Nethralaya, Bangalore, India
| | - Naresh Kumar Yadav
- Dept. of Retina and Vitreous, 80219Narayana Nethralaya, Bangalore, India
| | - Jay Chhablani
- University of Pittsburgh School of Medicine, Medical Retina and Vitreoretinal Surgery, Pittsburg, PA, United States
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23
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Zaytseva OV, Neroeva NV, Okhotsimskaya TD, Bobykin EV. [Current view on the issue of insufficient effectiveness of anti-VEGF therapy for age-related macular degeneration]. Vestn Oftalmol 2022; 138:90-99. [PMID: 35234427 DOI: 10.17116/oftalma202213801190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Due to the significant medical and social importance of neovascular (wet) age-related macular degeneration (wAMD), increasing the effectiveness of anti-VEGF therapy used to treat this disease is one of the high-priority problems in modern retinology. This article focuses on pathobiological aspects and clinical manifestations of incomplete responses to anti-VEGF therapy of wAMD, considers the proposed ways to improve the terminology and classification of responses to therapy, as well as the assessment of its correctness and effectiveness of the treatment. It also discusses the available ways to optimize anti-VEGF therapy and define the criteria of its termination in cases when the treatment proves to be futile.
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Affiliation(s)
- O V Zaytseva
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia.,A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - N V Neroeva
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - T D Okhotsimskaya
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - E V Bobykin
- Ural State Medical University, Yekaterinburg, Russia
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24
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Rana HS, Cox AR, Biles EC, Broderick K. Giant Retinal Pigment Epithelium Tear Resulting in Neurosensory Retinal Detachment: An Atypical Case. JOURNAL OF VITREORETINAL DISEASES 2022; 6:461-466. [PMID: 37009533 PMCID: PMC9954782 DOI: 10.1177/24741264211062928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: We report a rare case of neurosensory retinal detachment (RD) in the setting of a giant retinal pigment epithelium (RPE) tear. Methods: A 58-year-old man presented with a macula-involving RD in the left eye. Exam revealed a neurosensory detachment inferiorly and RPE abnormalities temporally. Optical coherence tomography showed a large RPE tear and detachment in the temporal macula contiguous with a neurosensory RD. Results: No clear etiology was identified and failure of conservative management led to vitrectomy with RD repair. Follow-up intravenous fluorescein angiography 3 months postoperatively showed a large RPE window defect. Conclusions: RPE tears are common; however, concomitant neurosensory RD is rare. A thorough workup to determine treatable causative factors is necessary; in the event of idiopathic diagnosis, close follow-up is necessary to determine the need for surgery. Pars plana vitrectomy, external drainage of subretinal fluid, endolaser, and 5000-centistoke silicone oil placement were successful in this patient.
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Affiliation(s)
- Harkaran S. Rana
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Anthony R. Cox
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Evan C. Biles
- Medical University of South Carolina, College of Medicine, Charleston, SC, USA
| | - Kevin Broderick
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, MD, USA
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25
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Zhu Z, Xiao J, Luo L, Yang B, Zou H, Zhang C. Complete recovery of the retinal pigment epithelium layer after spontaneous large serous retinal pigment epithelial tear. Eur J Ophthalmol 2022; 33:NP93-NP99. [PMID: 35112919 DOI: 10.1177/11206721221077549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The objective of this study is to report a case of complete recovery of the retinal pigment epithelium (RPE) layer after spontaneous large serous RPE tear and explore the possible RPE repair mechanism. CASE DESCRIPTION A 63-year-old male patient developed serous detachment of the RPE in the macula of his left eye. During the follow-up period, an oval-shaped RPE tear spontaneously occurred in the macular area, and fundus autofluorescence showed that the torn area was 6.59 mm2. Spectral-domain optical coherence tomography (OCT) revealed that the subretinal fluid had been absorbed and that the continuity of the RPE layer was gradually restored from the periphery to the center over the course of 9 months. Moreover, visual acuity (VA) in the left eye was restored to 20/20, and there was no significant difference in macular function between the two eyes, as measured by multifocal electroretinography, at the last follow-up. In addition, the patient received no special treatment during the entire follow-up period. CONCLUSION The integrity of the RPE layer can be restored completely after extensive RPE tear, and recovered RPE may allow the recovery of macular function.
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Affiliation(s)
- Zhe Zhu
- 154454Eye Center of the Second Hospital of Jilin University, Changchun, Jilin, China
| | - Jun Xiao
- 154454Eye Center of the Second Hospital of Jilin University, Changchun, Jilin, China
| | - Lifu Luo
- 154454Eye Center of the Second Hospital of Jilin University, Changchun, Jilin, China
| | - Bo Yang
- 154454Eye Center of the Second Hospital of Jilin University, Changchun, Jilin, China
| | - He Zou
- 154454Eye Center of the Second Hospital of Jilin University, Changchun, Jilin, China
| | - Chenchen Zhang
- 154454Eye Center of the Second Hospital of Jilin University, Changchun, Jilin, China
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26
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Šín M. BROLUCIZUMAB - A NEW PLAYER IN THE FIELD OF ANTI-VEGF THERAPY OF NEOVASCULAR AGE-RELATED MACULAR DEGENERATION. A REVIEW. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2022; 78:3-8. [PMID: 35300497 DOI: 10.31348/2021/19] [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: 06/14/2023]
Abstract
Vascular endothelial growth factor (VEGF) has been identified as a major promoter of the development of choroidal neovascularization in age-related macular degeneration. The development of choroidal neovascularization can be slowed by preventing the binding of vascular endothelial growth factor to cellular VEGF receptor-2 present on vascular endothelial cells, which represents the major proangiogenic stimulus. Advances in the development of anti-VEGF therapy have led to significant improvement in visual acuity outcomes in recent years that neovascular age-related macular degeneration can no longer be considered an incurable disease. Despite its many advantages, the current standard of care, which is the frequent application of VEGF blockers to the vitreous, is a significant burden on both the patient and the healthcare system. This review is aim on a new brolucizumab molecule (also known as RTH 258 or formerly ESBA 1008). The article focuses on the molecular aspects of the drug and an overview of the basic preclinical and clinical studies that were performed during drug development. Brolucizumab is a single chain fragment of a humanized monoclonal antibody with a molecular weight of 26 kDa that inhibits VEGF-A. Preclinical animal studies have shown good penetration of the molecule through the retina with minimal systemic exposure. The SEE study (phase 1/2) demonstrated safety and tolerability after drug administration. The OSPREY (phase 2) study demonstrated the same efficacy of brolucizumab on visual acuity in the 8-week dosing regimen compared to aflibercept. In the same study, patients were also pilot tested in a 12-week dosing regimen. The HAWK and HARRIER studies (phase 3) demonstrated the efficacy of the drug at a dose of 6 mg in a 12-week dosing schedule in 55.6 % and 51 % of patients, respectively.
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27
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The Contemporary Role of Photodynamic Therapy in the Treatment of Pachychoroid Diseases. J Ophthalmol 2021; 2021:6590230. [PMID: 34725570 PMCID: PMC8556979 DOI: 10.1155/2021/6590230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022] Open
Abstract
Recent advances in retinal imaging technology have improved our understanding in the pathogenesis and evolvement of various chorioretinal diseases. Central serous chorioretinopathy and polypoidal choroidal vasculopathy are now recognized to belong to the same spectrum of disorders known as pachychoroid diseases. Pachychoroid diseases have similar pathogenesis pathway and common characteristics of thickened choroid, dilated outer choroidal vessels, and thinning of choriocapillaris. More disease entities have been identified to belong to this disease spectrum. Photodynamic therapy can induce choroidal hypoperfusion, remodeling of abnormal choroidal vessels, and reduction of choroidal congestion. It is known to be an effective treatment for chronic central serous chorioretinopathy and polypoidal choroidal vasculopathy. Many new studies are being performed to investigate its efficacy in other pachychoroid diseases. In this review, we provided an overview of the rationale, efficacy, and treatment strategies of photodynamic therapy in different pachychoroid diseases and discussed its role in the management along with other treatment modalities with most updated clinical evidence.
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28
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Clinical associations and prognostic implications of repair tissue proliferation in eyes with retinal pigment epithelium tears. Retina 2021; 42:519-528. [PMID: 34743132 DOI: 10.1097/iae.0000000000003332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate demographic and clinical factors influencing the longitudinal changes of retinal pigment epithelium (RPE) dehiscence area after RPE tears, including the presence of RPE tear-associated repair proliferation (TARP), and identify factors associated with TARP development over follow-up. METHODS Retrospective, single-center, observational cohort study of patients with a history of macular neovascularization and RPE tear. The area of RPE dehiscence was measured on repeated short-wavelength fundus autofluorescence imaging. Associations between potential covariates and RPE dehiscence areas were tested with multivariable linear mixed models. Associations between TARP development and clinical variables were investigated with Cox regression models. Factors associated with visual acuity changing rates were explored with linear mixed models. RESULTS Thirty-seven eyes of 36 patients were included in this study and followed for a median time of 18 months. TARP was identified in 27 eyes (73%). The median time for TARP detection was 112 days; none of the investigated factors was significantly associated with TARP occurrence. The presence of TARP (β estimate: -0.042 mm2/month, p=0.001) and female gender (β estimate: -0.035 mm2/month, p=0.006) were associated with slower rates of RPE dehiscence enlargement over time. Faster rates of visual improvement were seen in eyes with TARP compared with those without TARP (β = -0.010 LogMAR/month if TARP was present, p=0.008). CONCLUSION RPE tear repair with TARP and female gender were associated with slower RPE degeneration after RPE tears. The presence of TARP was associated better visual prognosis. Additional research on factors promoting TARP development may have therapeutic and prognostic implications.
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Maitray A, Kohli P, Babu N. Serpentine retinal pigment epithelial tear. Taiwan J Ophthalmol 2021; 11:321-324. [PMID: 34703752 PMCID: PMC8493993 DOI: 10.4103/tjo.tjo_23_21] [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: 02/09/2021] [Accepted: 05/14/2021] [Indexed: 11/09/2022] Open
Abstract
We report a case of retinal pigment epithelial tear in a patient with peripheral exudative hemorrhagic chorioretinopathy (PEHCR). A 60-year-old diabetic female presented with left eye metamorphopsia. Fundus examination showed bilateral peripheral retinal pigment epithelium (RPE) degeneration, and a large serpentine-shaped RPE degeneration tract extending from the superotemporal arcade to the inferior periphery with associated subretinal hemorrhages in her left eye. This tract curved around the fovea, just sparing it. Fundus fluorescein and indocyanine green angiographies showed bilateral polyps in the superotemporal periphery. Optical coherence tomography through the tract showed scrolled up RPE at its edges with bare underlying Bruch's membrane and choroid in the region of the rip. There was no sign of an underlying pigment epithelial detachment. The patients with PEHCR should be prognosticated about such a rare vision-threatening macular complication.
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Affiliation(s)
- Aditya Maitray
- Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Piyush Kohli
- Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Naresh Babu
- Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
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30
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Foss A, Rotsos T, Empeslidis T, Chong V. The Development of Macular Atrophy in Patients with Wet Age-Related Macular Degeneration Receiving Anti-VEGF Treatment. Ophthalmologica 2021; 245:204-217. [PMID: 34695835 DOI: 10.1159/000520171] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/08/2021] [Indexed: 11/19/2022]
Abstract
Age-related macular degeneration (AMD) is a leading cause of blindness. Late AMD can be classified into exudative (commonly known as wet AMD [wAMD]) or dry AMD, both of which may progress to macular atrophy (MA). MA causes irreversible vision loss and currently has no approved pharmacological treatment. The standard of care for wAMD is treatment with anti-vascular endothelial growth factors (VEGF). However, recent evidence suggests that anti-VEGF treatment may play a role in the development of MA. Therefore, it is important to identify risk factors for the development of MA in patients with wAMD. For example, excessive blockade of VEGF through intense use of anti-VEGF agents may accelerate the development of MA. Patients with type III macular neovascularisation (retinal angiomatous proliferation) have a particularly high risk of MA. These patients are characterised as having a pre-existing thin choroid (age-related choroidopathy), suggesting that the choroidal circulation is unable to respond to increased VEGF expression. Evidence suggests that subretinal fluid (possibly indicative of residual VEGF activity) may play a protective role. Patients receiving anti-VEGF agents must be assessed for overall risk of MA and there is an unmet medical need to prevent the development of MA without undertreating wAMD.
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Affiliation(s)
- Alexander Foss
- University of Nottingham Medical School, Queen's Medical Centre, Nottingham, United Kingdom
| | - Tryfon Rotsos
- Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Theo Empeslidis
- Boehringer Ingelheim International GmbH, Ingelheim Am Rhein, Germany
| | - Victor Chong
- Boehringer Ingelheim International GmbH, Ingelheim Am Rhein, Germany
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31
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Lee WH, Kim BJ, Han YS. Bilateral retinal pigment epithelial tears in acute central serous chorioretinopathy without bullous retinal detachment: A case report. Medicine (Baltimore) 2021; 100:e27391. [PMID: 34596164 PMCID: PMC8483866 DOI: 10.1097/md.0000000000027391] [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: 06/12/2021] [Accepted: 09/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Several reports have described retinal pigment epithelial (RPE) tears in central serous chorioretinopathy (CSC). However, there have been no reports of spontaneously large RPE tears in acute CSC without bullous retinal detachment (RD). Herein, we report and provide sequential images of a case of bilateral spontaneous large RPE tears in patient with acute CSC without bullous RD. PATIENT CONCERNS An 88-year-old female patient was admitted with impaired vision in both eyes, which began 10 days prior. The visual acuity was 0.4 and 0.5 in the right and left eye, respectively. She had started taking oral steroids 2 weeks prior for polymyalgia. DIAGNOSIS Ophthalmologic examinations, including fundus photography, optical coherence tomography, and fluorescence angiography, were performed, and she was diagnosed with steroid-induced acute CSC in both eyes with large pigment epithelial detachment (PED) of approximately 4-disc diameter. Discontinuation of steroids and follow-up ophthalmic examinations were performed. However, a spontaneous large RPE tear occurred in the right eye. INTERVENTIONS We performed follow-ups more frequently and CSC treatment such as laser photocoagulation, photodynamic therapy, and anti-vascular endothelial growth factor injections were not performed. OUTCOMES Nine months later, a spontaneous large RPE tear occurred sequentially in the left eye. Her final visual acuity was 0.3 and 0.15 in the right and left eye, respectively. LESSONS Patients may spontaneously develop large RPE tears in both eyes, despite no treatment for acute CSC with non-bullous RD. Large PED and old age may affect this. Therefore, for a CSC patient with a large PED and advanced age, attention must be paid when determining treatment.
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Affiliation(s)
- Woo Hyuk Lee
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Bum Jun Kim
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Yong Seop Han
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
- Health Science Institute, Gyeongsang National University, Jinju, Republic of Korea
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32
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Halabi R, Watterston C, Hehr CL, Mori-Kreiner R, Childs SJ, McFarlane S. Semaphorin 3fa Controls Ocular Vascularization From the Embryo Through to the Adult. Invest Ophthalmol Vis Sci 2021; 62:21. [PMID: 33595613 PMCID: PMC7900886 DOI: 10.1167/iovs.62.2.21] [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] [Indexed: 12/18/2022] Open
Abstract
Purpose Pathological blood vessel growth in the eye is implicated in several diseases that result in vision loss, including age-related macular degeneration and diabetic retinopathy. The limits of current disease therapies have created the need to identify and characterize new antiangiogenic drugs. Here, we identify the secreted chemorepellent semaphorin-3fa (Sema3fa) as an endogenous anti-angiogenic in the eye. Methods We generated a CRISPR/Cas9 sema3fa zebrafish mutant line, sema3faca304/304. We assessed the retinal and choroidal vasculature in both larval and adult wild-type and sema3fa mutant zebrafish. Results We find sema3fa mRNA is expressed by the ciliary marginal zone, neural retina, and retinal pigment epithelium of zebrafish larvae as choroidal vascularization emerges and the hyaloid/retinal vasculature is remodeled. The hyaloid vessels of sema3fa mutants develop appropriately but fail to remodel during the larval period, with adult mutants exhibiting a denser network of capillaries in the retinal periphery than seen in wild-type. The choroid vasculature is also defective in that it develops precociously, and aberrant, leaky sprouts are present in the normally avascular outer retina of both sema3faca304/304 larvae and adult fish. Conclusions Sema3fa is a key endogenous signal for maintaining an avascular retina and preventing pathologic vascularization. Furthermore, we provide a new experimentally accessible model for studying choroid neovascularization (CNV) resulting from primary changes in the retinal environment that lead to downstream vessel infiltration.
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Affiliation(s)
- Rami Halabi
- Graduate Program in Neuroscience, University of Calgary, Calgary, Canada.,Department of Cell Biology and Anatomy, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Charlene Watterston
- Department of Biochemistry and Molecular Biology, University of Calgary, Calgary, Canada
| | - Carrie Lynn Hehr
- Department of Cell Biology and Anatomy, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Risa Mori-Kreiner
- Graduate Program in Neuroscience, University of Calgary, Calgary, Canada.,Department of Cell Biology and Anatomy, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Sarah J Childs
- Department of Biochemistry and Molecular Biology, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Sarah McFarlane
- Department of Cell Biology and Anatomy, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
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OCT Biomarkers in Neovascular Age-Related Macular Degeneration: A Narrative Review. J Ophthalmol 2021; 2021:9994098. [PMID: 34336265 PMCID: PMC8313359 DOI: 10.1155/2021/9994098] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/13/2021] [Indexed: 12/13/2022] Open
Abstract
Age-related macular degeneration (AMD) is the leading cause of legal blindness in elderly people. Neovascular AMD (nAMD) is responsible for the majority of cases of severe visual loss in eyes with AMD. Optical coherence tomography (OCT) is the most widely used technology for the diagnosis and follow-up of nAMD patients, which is widely used to study and guide the clinical approach, as well as to predict and evaluate treatment response. The aim of this review is to describe and analyze various structural OCT-based biomarkers, which have practical value during both initial assessment and treatment follow-up of nAMD patients. While central retinal thickness has been the most common and one of the first OCT identified biomarkers, today, other qualitative and quantitative biomarkers provide novel insight into disease activity and offer superior prognostic value and better guidance for tailored therapeutic management. The key importance of retinal fluid compartmentalization (intraretinal fluid, subretinal fluid, and subretinal pigment epithelium (RPE) fluid) will be discussed firstly. In the second part, the structural alterations of different retinal layers in various stages of the disease (photoreceptors layer integrity, hyperreflective dots, outer retinal tubulations, subretinal hyperreflective material, and retinal pigment epithelial tears) will be analyzed in detail. The last part of the review will focus on how alterations of the vitreoretinal interface (vitreomacular adhesion and traction) and of the choroid (sub-RPE hyperreflective columns, prechoroidal clefts, choroidal caverns, choroidal thickness and choroidal volume, and choroidal vascular index) interact with nAMD progression. OCT technology is evolving very quickly, and new retinal biomarkers are continuously described. This up-to-date review article provides a comprehensive description on how structural OCT-based biomarkers provide a valuable tool to monitor the progression of the disease and the treatment response in nAMD patients. Thus, in this perspective, clinicians will be able to allocate hospital resources in the best possible way and tailor treatment to the individual patient's needs.
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Budzinskaya MV, Shelankova AV. [Retinal pigment epithelial tear in age-related macular degeneration]. Vestn Oftalmol 2021; 137:115-120. [PMID: 34156786 DOI: 10.17116/oftalma2021137031115] [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: 11/18/2022]
Abstract
Retinal pigment epithelial tear (RPET) occurs in a number of diseases, most often in age-related macular degeneration (AMD). RPET develops in the setting of retinal pigment epithelium (RPE) detachment and represents a violation of the integrity of its monolayer accompanied by the formation of a demarcation line between the RPE atrophy area and RPE folds. Its incidence varies widely. In the earlier studies, diagnosis of RPET was performed using fluorescent angiography or angiography with indocyanine green (ICG-FA). The advent of optical coherence tomography made the detection of RPET easier and more accessible. The mechanism of RPET formation is quite polymorphic and ambiguous. Scientific literature contains descriptions of the occurrence of RPET when using both ranibizumab and aflibercept, and bevacizumab in equal proportions, implying that the drug choice does not affect the occurrence of complications. Continuous monitoring and adherence to anti-VEGF therapy leads to better anatomical and functional results in the long term, which is crucial for improving the quality of life of patients with age-related macular degeneration. This article reviews the literature and presents current data on RPET, identifies risk factors and mechanisms of its development, provides classification, and describes modern options for its diagnosis and treatment.
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35
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Clinical features of cases with retinal pigment epithelium aperture. Am J Ophthalmol Case Rep 2021; 22:101083. [PMID: 33898860 PMCID: PMC8056229 DOI: 10.1016/j.ajoc.2021.101083] [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: 11/07/2019] [Revised: 11/17/2020] [Accepted: 03/29/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose To report the clinical findings of the patients with retinal pigment epithelium (RPE) aperture secondary to age-related macular degeneration (AMD). Methods A retrospective data analysis was conducted of patients at the University of Tokyo Hospital eye clinic, from the year September 1st, 2012 to 2019. Review of the medical records of patients with RPE aperture accompanied by AMD was performed. We investigated age, best-corrected visual acuity (BCVA), images of spectral domain optical coherence tomography, short-wave fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography, and retinal sensitivity measured with microperimetry. The change in visual acuity or the area of the aperture during the follow-up period was analyzed. Results Five eyes of 5 patients (4 men, one woman) were included in the analysis. The mean age at presentation was 78.6 ± 9.1 years. The average length of follow-up was 23.6 ± 17.9 months. The RPE apertures appeared as round, either at the apex or at the base of PED, with no evidence of accompanying CNV but subretinal detachment (SRD) above the aperture. On FAF, the apertures appeared as sharply demarcated round areas of hypoautofluorescence. The FA revealed sharply demarcated round areas of window defects in the early and mid-phase with leakage in the late phase corresponding to SRD. The area of apertures enlarged during the follow-up period. Mean BCVA got worse from 0.20 logMAR at the initial presentation to 0.39 logMAR at the last visit. The retinal sensitivity was reduced but partly preserved above the area of aperture. Conclusions and importance RPE aperture was found in some patients with drusenoid PED secondary to AMD. It enlarged during follow-up. Visual acuity was declined. Retinal sensitivity was decreased but partly preserved.
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Ferro Desideri L, Traverso CE, Nicolò M. Brolucizumab: a novel anti-VEGF humanized single-chain antibody fragment for treating w-AMD. Expert Opin Biol Ther 2021; 21:553-561. [PMID: 33899632 DOI: 10.1080/14712598.2021.1915278] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Wet age-related macular degeneration (w-AMD) represents the leading cause of visual impairment in the elderly in the developed countries. Intravitreal antivascular endothelial growth factor (VEGF) drugs are currently considered as the first-line treatment option for treating w-AMD; however, the frequent injection intervals have lit the way to investigate novel anti-VEGF agents allowing a more extended treatment regimen. Brolucizumab is a single-chain antibody fragment targeting all the isoforms of VEGF-A. Phase III HAWK and HARRIER trials have shown a longer durability and superior anatomical outcomes as compared with the standard of care by adopting a quarterly regimen for treating w-AMD. Brolucizumab has been approved in Europe, USA, and Japan for the management of w-AMD. AREAS COVERED This article presents an overview of w-AMD and investigates the progress of brolucizumab through clinical trials. It offers insights into where brolucizumab may be placed in the current market of anti-VEGF agents and its potential advantages over the previous molecules adopted for treating w-AMD. EXPERT OPINION The possibility of administering brolucizumab with more dilated treatment intervals represents an important advantage to decrease the treatment burden and improve patient compliance. Brolucizumab represents a possible drug switching option in non-responding patients to other anti-VEGF drugs.
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Affiliation(s)
- Lorenzo Ferro Desideri
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Italy
| | - Carlo Enrico Traverso
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Italy.,Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Massimo Nicolò
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Italy.,Ospedale Policlinico San Martino IRCCS, Genoa, Italy.,Fondazione per La Macula Onlus, Genoa, Italy
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Mitchell P, Rodríguez FJ, Joussen AM, Koh A, Eter N, Wong DT, Korobelnik JF, Okada AA. MANAGEMENT OF RETINAL PIGMENT EPITHELIUM TEAR DURING ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY. Retina 2021; 41:671-678. [PMID: 33346626 PMCID: PMC7989608 DOI: 10.1097/iae.0000000000003083] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This article aims to review current evidence on the development, diagnosis, and management of retinal pigment epithelium (RPE) tear during anti-vascular endothelial growth factor (VEGF) therapy. METHODS Literature searches were performed using MEDLINE/PubMed databases (cut-off date: August 2019). RESULTS Three key recommendations were made based on existing literature and clinical experience: 1) Multimodal imaging with color fundus photography, optical coherence tomography, near-infrared reflectance imaging, fundus autofluorescence imaging, optical coherence tomography-angiography, and/or fluorescein angiography are recommended to diagnose RPE tear and assess risk factors. Retinal pigment epithelium tears can be graded by size and foveal involvement. 2) Patients at high risk of developing RPE tear should be monitored after each anti-VEGF injection. If risk factors worsen, it is not yet definitively known whether anti-VEGF administration should be more frequent, or alternatively stopped in such patients. Prospective research into high-risk characteristics is needed. 3) After RPE tear develops, anti-VEGF treatment should be continued in patients with active disease (as indicated by presence of intraretinal or subretinal fluid), although cessation of therapy should be considered in eyes with multilobular tears. CONCLUSION Although evidence to support the assumption that anti-VEGF treatment contributes to development of RPE tear is not definitive, some data suggest this link.
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Affiliation(s)
- Paul Mitchell
- Department of Ophthalmology, Centre for Vision Research, Westmead Institute for Medical Research, the University of Sydney, Sydney, Australia
| | - Francisco J. Rodríguez
- Fundación Oftalmologica Nacional, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | | | - Adrian Koh
- Eye and Retina Surgeons, Camden Medical Centre, Singapore
| | - Nicole Eter
- Department of Ophthalmology, University of Münster Medical Center, Münster, Germany
| | - David T. Wong
- Unity Health Toronto, St. Michael's Hospital, University of Toronto, Canada
| | - Jean-François Korobelnik
- Service d'ophtalmologie, CHU Bordeaux, Bordeaux, France
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Team LEHA, UMR 1219, Bordeaux, France; and
| | - Annabelle A. Okada
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
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THE OCCURRENCE, CHARACTERISTICS, MANAGEMENT, AND PROGNOSIS OF RETINAL PIGMENT EPITHELIUM TEARS IN PATIENTS WITH POLYPOIDAL CHOROIDAL VASCULOPATHY: A Retrospective Study of 397 Patients. Retina 2021; 40:477-489. [PMID: 30475788 DOI: 10.1097/iae.0000000000002389] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate retinal pigment epithelium (RPE) tears in patients with polypoidal choroidal vasculopathy. METHOD A retrospective review of polypoidal choroidal vasculopathy cases with confirmed RPE tears was conducted. Patients' comprehensive clinical data were collected and analyzed. The treatment strategy was a loading dose of one intravitreal antivascular endothelial growth factor injection, combined with additional injections if exudative activities or visual deterioration were detected. RESULTS Among 397 polypoidal choroidal vasculopathy patients, 33 patients with RPE tears (8.3%) were included. 42.4% of them happened spontaneously. Pigment epithelial detachment (PED) occurred more frequently in RPE tear patients and most of them had serous vascularized or hemorrhagic PED. The height and greatest linear diameter of PED, and the subfoveal choroidal thickness of these cases were significantly larger, whereas the central foveal thickness was significantly smaller. Most of the RPE tears occurred at the edge of the PED. After our treatment strategy, patients' best-corrected visual acuity improved significantly from 2.13 ± 1.24 (median 20/52) to 1.32 ± 1.31 (median 20/166). Large subretinal hemorrhage may increase the risk of the formation of subretinal fibrosis (P < 0.05). CONCLUSION Retinal pigment epithelium tears in polypoidal choroidal vasculopathy are associated with high subRPE hydrostatic pressure, produced by a large PED or hemorrhage. After our intervention strategy, this condition may not necessarily result in poor prognosis.
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Romano F, Parrulli S, Battaglia Parodi M, Lupidi M, Cereda M, Staurenghi G, Invernizzi A. Optical coherence tomography features of the repair tissue following RPE tear and their correlation with visual outcomes. Sci Rep 2021; 11:5962. [PMID: 33727575 PMCID: PMC7966766 DOI: 10.1038/s41598-021-85270-x] [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] [Received: 12/06/2020] [Accepted: 02/15/2021] [Indexed: 11/26/2022] Open
Abstract
To assess the optical coherence tomography (OCT) features of the repair tissue after retinal pigment epithelial (RPE) tear in neovascular age-related macular degeneration. Retrospective, observational study. Medical and imaging records of patients that developed tears after starting anti-VEGF treatment and with at least 12 months of follow-up were reviewed. OCT reflectivity of the RPE-subretinal hyperreflective tissue (SHT) complex was measured at 6, 12 and 18 months (when available). Reflectivity of the adjacent unaffected RPE-Bruch’s membrane was taken as internal reference. Other variables: grade and rip occurrence (early/late); number of intravitreal injections; type of macular neovascularization; sub-macular hemorrhage (SMH) at onset. Forty-nine eyes (age: 76.1 ± 7.0 years; VA: 0.54 ± 0.27 LogMAR) were included. Thirty-eight eyes had OCT signs of healing during the follow-up, with 21 showing SMH at baseline. Final VA positively correlated with the number of injections and negatively correlated with the RPE-SHT reflectivity and the presence of SMH (p < 0.001). Reflectivity of the RPE-SHT complex was positively associated with time and SMH at baseline (p < 0.05). In our study, most eyes showed signs of tissue repair after RPE tear. The reflectivity of repair tissue, the SMH presence and the number of anti-VEGF injections appeared to be major predictors of visual outcomes.
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Affiliation(s)
- Francesco Romano
- Eye Clinic, Department of Biomedical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy. .,Eye Clinic, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, University of Milan, Via G.B. Grassi, 74, 20157, Milan, Italy.
| | - Salvatore Parrulli
- Eye Clinic, Department of Biomedical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Maurizio Battaglia Parodi
- Department of Ophthalmology, Scientific Institute San Raffaele, Vita-Salute University, Milan, Italy
| | - Marco Lupidi
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Matteo Cereda
- Eye Clinic, Department of Biomedical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy.,Faculty of Health and Medicine, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
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40
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Vilares-Morgado R, Madeira C, Falcão M, Godinho G, Ribeiro M, Beato J, Pedrosa AC, Brandão E, Falcão-Reis F, Carneiro Â. Predicting retinal pigment epithelium remodelling and its functional impact. Graefes Arch Clin Exp Ophthalmol 2021; 259:2583-2595. [PMID: 33651204 DOI: 10.1007/s00417-021-05129-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 02/05/2021] [Accepted: 02/15/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To identify predictive factors for RPE tear remodelling and its correlation with functional and morphological outcomes. METHODS Retrospective longitudinal study of patients with retinal pigment epithelium (RPE) tears secondary to age-related macular degeneration (AMD). Imaging was performed using spectral-domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF). RPE layer integrity in the RPE-denuded area was examined with SD-OCT, and variation in the RPE-denuded homogeneous hypofluorescent area was examined with FAF over time for each case (eye). Patients were divided in two groups, according to the presence (Rem) or absence (No Rem) of evidence of RPE tear remodelling. Data were collected at three different time points: at baseline (at diagnosis of exudative AMD), at RPE tear diagnosis, and at the last available follow-up. Using SD-OCT, the following parameters were evaluated: type of CNV, type of PED and its dimensions, presence of subretinal (SRF) or intraretinal (IRF) fluid, central retinal thickness (CRT), presence and location of hyperreflective dots, and dimension and location of RPE tear. RESULTS This study included 32 eyes from 31 patients (19 female and 12 male), with RPE tears secondary to AMD. RPE remodelling after tear development was evident in 17 (53.1%) eyes after 7 [1-59] months. Anatomical recovery was associated with a younger age at RPE tear diagnosis (73 ± 7 vs. 81 ± 7 years old, p=0.01), smaller and narrower retinal pigment epithelial detachment (PED) at tear diagnosis (height 369 vs. 602 μm, p=0.02; width 2379 vs. 3378 μm, p=0.04), and the presence of SRF at tear diagnosis (94% vs. 53%, p=0.02). After adjusting for other covariates, a younger age at RPE tear diagnosis maintained significant association with RPE tear remodelling. RPE tear remodelling did not correlate with a better visual outcome at last follow-up (43 ± 22.8 vs. 34 ± 23.8 ETDRS letters, p=0.30). Final VA was directly proportional to VA at tear diagnosis (r= 0.654; p<0.001) and correlated negatively with PED width at tear diagnosis (r = -0.388; p=0.03). CONCLUSION RPE remodelling was evident in half of our sample and was associated with a younger age, smaller and narrower PED at RPE tear diagnosis, and presence of SRF also at tear diagnosis. Nevertheless, this structural recovery did not result in a better functional outcome.
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Affiliation(s)
- Rodrigo Vilares-Morgado
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal.
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Carolina Madeira
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Gonçalo Godinho
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal
| | - Margarida Ribeiro
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Beato
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal
| | - Ana Catarina Pedrosa
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal
| | - Elisete Brandão
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar de São João Hospital, Avenida Prof. Hernâni Monteiro, 4202 - 451, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
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41
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Vidal-Oliver L, García-Ibor F, Duch-Samper AM. Multimodal imaging in retinal pigment epithelium tear. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 97:S0365-6691(21)00014-9. [PMID: 33593630 DOI: 10.1016/j.oftal.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 06/12/2023]
Affiliation(s)
- L Vidal-Oliver
- Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, España.
| | - F García-Ibor
- Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - A M Duch-Samper
- Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, España; Facultad de Medicina, Universitat de València, Valencia, España
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Fursova AZ, Derbeneva AS, Vasilyeva MA, Tarasov MS, Chubar NV, Nikulich IF. [Different types localisation of retinal fluid as prognostic biomarkers in the choice of anti-VEGF therapy for age-related macular degeneration]. Vestn Oftalmol 2020; 136:227-234. [PMID: 33371654 DOI: 10.17116/oftalma2020136062227] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Age-related macular degeneration is an advanced chronic disease and the main cause of vision loss in geriatric patients. Optical coherence tomography (OCT) is a modern method of retinal imaging allowing to detect different types of fluid: intraretinal fluid (IRF), subretinal fluid (SRF) and fluid under pigment epithelial detachment (PED). Finding relevant imaging biomarkers is necessary for identification of basic activity criteria of the disease, choosing treatment algorithms, determining treatment duration and termination criteria, and predicting the outcomes. Presence of IRF is associated with poor functional outcomes. Its presence is an indication for early beginning of treatment aimed at full resorption of the fluid with further possible careful extension of anti-VEGF therapy intervals with a regular follow-up. Degenerative intraretinal cysts developing in the background of subretinal fibrosis in absence of choroidal neovascularization (CNV) should be a sign for discontinuation of anti-VEGF therapy due to the lack of targets. Presence of SRF is associated with favorable outcomes and good treatment prognosis and is not a barrier to the extension of treatment intervals even up to the maximum of 16 weeks as described in existing randomized controlled trials, on the condition of no other CNV activity. PED with active CNV is one of the biomarkers that reveal the need for long-term aggressive therapy. In case of its size gain, it is necessary to restart the anti-VEGF treatment to prevent visual loss in the long-term. Combination of different fluid types is a sign of lasting disease history with a poor outcome prognosis. In this case, anti-VEGF treatment should be started as soon as possible with long-term fixed regimen or Treat-and-extend (T&E) with minimal suitable interval for the patient and precise monitoring of the condition of retina until complete suppression of activity. Developing a personalized approach in each case plays an important role in preserving visual functions.
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Affiliation(s)
- A Zh Fursova
- Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia.,Novosibirsk State Medical University, Novosibirsk, Russia
| | - A S Derbeneva
- Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia.,Novosibirsk State Medical University, Novosibirsk, Russia
| | - M A Vasilyeva
- Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia
| | - M S Tarasov
- Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia.,Novosibirsk State Medical University, Novosibirsk, Russia
| | - N V Chubar
- Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia
| | - I F Nikulich
- Novosibirsk State Regional Clinical Hospital, Novosibirsk, Russia.,Novosibirsk State Medical University, Novosibirsk, Russia
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Incomplete response to Anti-VEGF therapy in neovascular AMD: Exploring disease mechanisms and therapeutic opportunities. Prog Retin Eye Res 2020; 82:100906. [PMID: 33022379 PMCID: PMC10368393 DOI: 10.1016/j.preteyeres.2020.100906] [Citation(s) in RCA: 155] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 12/13/2022]
Abstract
Intravitreal anti-vascular endothelial growth factor (VEGF) drugs have revolutionized the treatment of neovascular age-related macular degeneration (NVAMD). However, many patients suffer from incomplete response to anti-VEGF therapy (IRT), which is defined as (1) persistent (plasma) fluid exudation; (2) unresolved or new hemorrhage; (3) progressive lesion fibrosis; and/or (4) suboptimal vision recovery. The first three of these collectively comprise the problem of persistent disease activity (PDA) in spite of anti-VEGF therapy. Meanwhile, the problem of suboptimal vision recovery (SVR) is defined as a failure to achieve excellent functional visual acuity of 20/40 or better in spite of sufficient anti-VEGF treatment. Thus, incomplete response to anti-VEGF therapy, and specifically PDA and SVR, represent significant clinical unmet needs. In this review, we will explore PDA and SVR in NVAMD, characterizing the clinical manifestations and exploring the pathobiology of each. We will demonstrate that PDA occurs most frequently in NVAMD patients who develop high-flow CNV lesions with arteriolarization, in contrast to patients with capillary CNV who are highly responsive to anti-VEGF therapy. We will review investigations of experimental CNV and demonstrate that both types of CNV can be modeled in mice. We will present and consider a provocative hypothesis: formation of arteriolar CNV occurs via a distinct pathobiology, termed neovascular remodeling (NVR), wherein blood-derived macrophages infiltrate the incipient CNV lesion, recruit bone marrow-derived mesenchymal precursor cells (MPCs) from the circulation, and activate MPCs to become vascular smooth muscle cells (VSMCs) and myofibroblasts, driving the development of high-flow CNV with arteriolarization and perivascular fibrosis. In considering SVR, we will discuss the concept that limited or poor vision in spite of anti-VEGF may not be caused simply by photoreceptor degeneration but instead may be associated with photoreceptor synaptic dysfunction in the neurosensory retina overlying CNV, triggered by infiltrating blood-derived macrophages and mediated by Müller cell activation Finally, for each of PDA and SVR, we will discuss current approaches to disease management and treatment and consider novel avenues for potential future therapies.
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Rani PK, Soni A. Multimodal imaging in retinal pigment epithelium rip with exudative bullous retinal detachment. BMJ Case Rep 2020; 13:13/9/e235731. [PMID: 32907866 DOI: 10.1136/bcr-2020-235731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A middle-aged man presented with exudative retinal detachment in the left eye. He was previously diagnosed as a case of large pigment epithelial detachment in the same eye, for which he was asked to follow-up closely, citing the risk of an retinal pigment epithelium (RPE) rip. Multimodal imaging confirmed the presence of a large RPE rip with exudative retinal detachment. He is a known retrovirus patient on anti-retroviral therapy with stable CD4 counts. He was diagnosed as a possible case of bullous variant of central serous chorioretinopathy and underwent external subretinal fluid drainage. We highlight the multimodal imaging findings of RPE rip with exudative retinal detachment and its impact on the patients visual acuity.
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Affiliation(s)
- Padmaja Kumari Rani
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telengana, India
| | - Aniruddh Soni
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telengana, India
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Harada Y, Okumichi H, Miyata M, Hiyama T, Kiuchi Y. Retinal detachment with retinal pigment epithelial tear under hypotony after trabeculectomy: A case report. Am J Ophthalmol Case Rep 2020; 19:100853. [PMID: 32875145 PMCID: PMC7452095 DOI: 10.1016/j.ajoc.2020.100853] [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: 01/25/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 10/31/2022] Open
Abstract
Purpose To report a case of retinal detachment with retinal pigment epithelium (RPE) tear, under hypotony after trabeculectomy, which immediately resolved upon elevation of intraocular pressure. Observations A 67-year-old man who had undergone trabeculectomy presented for treatment of a visual field defect in his left eye. His glaucoma surgery was uneventful. At his first visit to our clinic, the patient's visual acuity was 15/20 in the right eye and 20/40 in the left; intraocular pressure was 18 mmHg in the right and 5 mmHg in the left. Fundus examination of the left eye revealed a retinal detachment, overlying a choroidal detachment, and an RPE tear. The retinal detachment did not resolve with systemic steroid pulse therapy or vitrectomy. The patient was then diagnosed with an exudative retinal detachment with RPE tear under hypotony, and transconjunctival sutures were applied to tighten the scleral flap, to elevate intraocular pressure. After the transconjunctival sutures were applied, intraocular pressure increased to 10 mmHg and the exudative retinal detachment immediately resolved. There was no recurrence of retinal detachment after the intervention. Conclusions and importance Because there have been few case reports of retinal detachment with an RPE tear after glaucoma filtering surgery, no therapeutic strategy has yet been proposed. The findings in this case indicate that intraocular pressure elevation is effective for treating exudative retinal detachment with RPE tear in cases of hypotony after glaucoma filtering surgery.
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Affiliation(s)
- Yosuke Harada
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Hideaki Okumichi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Mayuko Miyata
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Tomona Hiyama
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, Japan
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Bullous Central Serous Chorioretinopathy: A Rare and Atypical Form of Central Serous Chorioretinopathy. A Systematic Review. Pharmaceuticals (Basel) 2020; 13:ph13090221. [PMID: 32872388 PMCID: PMC7559580 DOI: 10.3390/ph13090221] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 01/23/2023] Open
Abstract
Bullous central serous chorioretinopathy (bCSCR) is a rare variant of the central serous chorioretinopathy, complicated by an exudative retinal detachment with shifting fluid. This systematic review aims to present the epidemiology, the pathogenesis, the clinical presentation, the imaging, the differential diagnosis, and the latest treatments of this disease. A total of 60 studies were identified following a literature search adhering to PRISMA guidelines. After full-text evaluation, 34 studies about bCSCR were included. bCSCR usually affects middle-aged men, and the principal risk factor is corticosteroid medications. Pathogenesis is related to an increased choroidal vessel and choriocapillaris permeability, with subsequent subretinal fluid accumulation, rich in fibrin, which may provoke the exudative retinal detachment. Clinical presentation and imaging are fundamental to distinguish bCSCR from other pathologies, avoiding unappropriated treatment. Corticosteroid withdraws (if assumed) and laser photocoagulation of leakage sites seen at angiography may speed up retinal reattachment. Verteporfin photodynamic therapy, transpupillary thermal therapy, oral eplerenone and scleral thinning surgery are other therapeutic options. An early diagnosis might prevent disease progression due to harmful medications as well as unnecessary surgery.
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Plyukhova AA, Budzinskaya MV, Starostin KM, Rejdak R, Bucolo C, Reibaldi M, Toro MD. Comparative Safety of Bevacizumab, Ranibizumab, and Aflibercept for Treatment of Neovascular Age-Related Macular Degeneration (AMD): A Systematic Review and Network Meta-Analysis of Direct Comparative Studies. J Clin Med 2020; 9:jcm9051522. [PMID: 32443612 PMCID: PMC7291235 DOI: 10.3390/jcm9051522] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/07/2020] [Accepted: 05/14/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Since the efficacy of ranibizumab (RBZ), bevacizumab (BVZ) and aflibercept (AFB) is comparable in neovascular age-related macular degeneration (AMD), we conducted a systematic review and meta-analysis to evaluate the long-term safety profiles of these agents, including ocular safety. Methods: Systematic review identifying randomized controlled trials (RCTs) comparing RBZ, BVZ and AFB directly published before March 2019. Serious ocular adverse events (SOAE) of special interest were endophthalmitis, pseudo-endophthalmitis, retinal pigment epithelium tear and newly identified macular atrophy. Results: Thirteen RCTs selected for meta-analysis (4952 patients, 8723 people-years follow-up): 10 compared RBZ vs. BVZ and three RBZ vs. AFB. There were no significant differences in almost all adverse events (systemic and ocular) between BVZ, RBZ and AFB in up to two years’ follow-up. Macular atrophy was reported heterogeneously and not reported as SOAE in most trials. Conclusions: Direct comparison of RBZ, BVZ and AFB safety profiles in the RCT network meta-analytical setting have not revealed a consistent benefit of these three commonly used anti-vascular endothelial growth factor (anti-VEGF) agents in AMD. Network model ranking highlighted potential benefits of RBZ in terms of a systemic safety profile; however, this appears a hypothesis rather than a conclusion. Newly identified macular atrophy is underestimated in RCTs—future real-world data should be focused on SOAE.
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Affiliation(s)
- Anna A. Plyukhova
- Federal State Budget Scientific Research Institute “Scientific Research Institute of Eye Diseases”, 119021 Moscow, Russia;
- Correspondence: (A.A.P.); (M.R.); Tel.: +7-9036128695 (A.A.P.)
| | - Maria V. Budzinskaya
- Federal State Budget Scientific Research Institute “Scientific Research Institute of Eye Diseases”, 119021 Moscow, Russia;
| | | | - Robert Rejdak
- Department of General Ophthalmology with Pediatric Service, Medical University of Lublin, 20079 Lublin, Poland; (R.R.); (M.D.T.)
| | - Claudio Bucolo
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy;
| | - Michele Reibaldi
- Department of Ophthalmology, University of Turin, 10126 Turin, Italy
- Correspondence: (A.A.P.); (M.R.); Tel.: +7-9036128695 (A.A.P.)
| | - Mario D. Toro
- Department of General Ophthalmology with Pediatric Service, Medical University of Lublin, 20079 Lublin, Poland; (R.R.); (M.D.T.)
- Faculty of Medicine, Collegium Medicum Cardinal Stefan Wyszyński University, 01815 Warsaw, Poland
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48
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Nguyen QD, Das A, Do DV, Dugel PU, Gomes A, Holz FG, Koh A, Pan CK, Sepah YJ, Patel N, MacLeod H, Maurer P. Brolucizumab: Evolution through Preclinical and Clinical Studies and the Implications for the Management of Neovascular Age-Related Macular Degeneration. Ophthalmology 2020; 127:963-976. [PMID: 32107066 DOI: 10.1016/j.ophtha.2019.12.031] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/12/2019] [Accepted: 12/18/2019] [Indexed: 01/10/2023] Open
Abstract
Improving or maintaining visual acuity is the main goal for the treatment of neovascular age-related macular degeneration (nAMD). Current nAMD standard of care dictates frequent intravitreal (IVT) anti-vascular endothelial growth factor (VEGF) injections, which places a substantial burden on patients, caregivers, and physicians. Brolucizumab, a newly developed anti-VEGF molecule for nAMD treatment, has demonstrated longer durability and improvement in visual and anatomic outcomes in clinical studies in a q12-week regimen, indicating its potential to reduce treatment burden as an important therapeutic tool in nAMD management. This review focuses on the development of brolucizumab and the preclinical and clinical studies evaluating its efficacy, tolerability, and safety. Brolucizumab (also known as "RTH258" and "ESBA1008") is a humanized, single-chain variable fragment (scFv) antibody with a molecular mass of approximately 26 kDa that inhibits VEGF-A. Preclinical studies show that brolucizumab readily penetrates the retina to reach the retinal pigment epithelium (RPE)/choroid with minimal subsequent systemic exposure. The safety, tolerability, and efficacy of a single IVT brolucizumab administration in patients with treatment-naïve nAMD were first demonstrated in the SEE Phase 1/2 study. The OSPREY Phase 2 study showed brolucizumab to be as efficacious as aflibercept in a q8-week regimen with regard to best-corrected visual acuity (BCVA) and brolucizumab achieving greater fluid resolution. Brolucizumab-treated patients in the OSPREY study were subsequently challenged with a q12-week dosing interval, and the outcomes provided key information for the study design and end points of the Phase 3 studies. In the HAWK and HARRIER Phase 3 studies, after 3 monthly loading injections, brolucizumab treatment regimen (q12-week or q8-week) was guided by individual disease activity assessment using functional and anatomic parameters (central subfield thickness [CST], intraretinal fluid [IRF], or subretinal fluid [SRF]) versus aflibercept (q8-week). Fewer brolucizumab 6-mg treated eyes had disease activity versus aflibercept, and anatomic outcome results at weeks 16 and 48 demonstrate brolucizumab as a potent drying agent. Moreover, of patients treated with 6 mg brolucizumab, 55.6% and 51.0% maintained a q12-week dosing interval immediately after the loading phase until week 48 in HAWK and HARRIER, respectively. These Phase 3 studies demonstrated that the brolucizumab q12-week regimen maintains efficacy and safety while reducing treatment burden associated with regular IVT injections for patients with nAMD.
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Affiliation(s)
- Quan Dong Nguyen
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California.
| | - Arup Das
- Department of Surgery, Division of Ophthalmology, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Diana V Do
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
| | - Pravin U Dugel
- USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Andre Gomes
- Department of Ophthalmology, University of Sao Paulo, Sao Paulo, Brazil
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Adrian Koh
- Eye and Retina Surgeons, Camden Medical Centre, Singapore, Singapore
| | - Carolyn K Pan
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
| | - Yasir J Sepah
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
| | - Nikhil Patel
- Novartis Pharmaceuticals, East Hanover, New Jersey
| | - Heather MacLeod
- Former Employee of Novartis Institutes for Biomedical Research, Novartis, Cambridge, Massachusetts
| | - Patrik Maurer
- Novartis Institutes for Biomedical Research, Novartis, Basel, Switzerland
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49
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Lozano-Bernal OL, López-Herrero F, Lechón-Caballero B, Sánchez-Vicente JL. Use of en face OCT in the diagnosis of a retinal pigment epithelium tear. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2019; 94:e84-e85. [PMID: 31327580 DOI: 10.1016/j.oftal.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/18/2019] [Indexed: 06/10/2023]
Affiliation(s)
- O L Lozano-Bernal
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - F López-Herrero
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - B Lechón-Caballero
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - J L Sánchez-Vicente
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
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50
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Casalino G, Sivagnanavel V, Dowlut S, Keane PA, Chakravarthy U. Spontaneous retinal pigment epithelial tear in type 2 choroidal neovascularization: repair mechanisms following anti-VEGF therapy. Int J Retina Vitreous 2019; 5:4. [PMID: 30693100 PMCID: PMC6343237 DOI: 10.1186/s40942-019-0155-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/05/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND To report the clinical course and the multimodal retinal imaging of a spontaneous retinal pigment epithelial (RPE) tear in a type 2 choroidal neovascularization (CNV) secondary to age-related macular degeneration treated with anti-vascular endothelial growth factor (VEGF) treatment. CASE PRESENTATION A 74 year-old man presented with visual acuity deterioration in the right eye. Multimodal retinal imaging showed a predominantly classic (type 2) CNV complicated by a spontaneous RPE tear. The patient received six intravitreal injections of anti-VEGF which resulted in improvement of the vision and stabilization of the neovascular lesion on optical coherence tomography (OCT). Longitudinal changes of the RPE-photoreceptors interface, including RPE splitting, are reported on OCT. CONCLUSION RPE tears may spontaneously occur in type 2 CNV. Anti-VEGF treatment should be aimed at promoting RPE repair and limiting the extent of the scarring. The mechanisms of RPE repair during treatment may be documented with OCT.
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Affiliation(s)
- Giuseppe Casalino
- Royal Eye Unit, Kingston Hospital NHS Foundation Trust, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Samir Dowlut
- Ophthalmology Macular Service, Belfast Health and Social Care Trust, Queen’s University of Belfast, Belfast, UK
| | | | - Usha Chakravarthy
- Ophthalmology Macular Service, Belfast Health and Social Care Trust, Queen’s University of Belfast, Belfast, UK
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