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Català-Mora J, Santamaría Álvarez JF, Kyriakou D, Alforja S, Barraso Rodrigo M, Blasco Palacio PB, Casaroli-Marano R, Cobos Martín E, Coco Martín RM, Esmerado C, García Tirado A, García P, Gómez-Benlloch A, Rodríguez Fernández CA, Vilaplana Mira F. Protocol for the treatment of cystoid macular edema secondary to retinitis pigmentosa and other inherited retinal dystrophies. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024; 99:67-81. [PMID: 37940089 DOI: 10.1016/j.oftale.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/15/2023] [Indexed: 11/10/2023]
Abstract
Inherited retinal dystrophies (IRD) are the leading cause of legal blindness in the working population. Cystic macular edema (CME) is one of the treatable causes of visual loss, affecting up to 50% of the patients. A bibliographic review has been carried out combining "inherited retinal dystrophy", "retinitis pigmentosa", "macular oedema" and a diagnostic-therapeutic protocol according to the levels of evidence and recommendations of the "US Agency for Healthcare Research and Quality". This protocol has been discussed in the monthly meetings of the XAREA DHR group with the participation of more than 25 ophthalmologists, creating a consensus document. The etiology of CME is multifactorial: dysfunction of the blood-retinal barrier, retinal pigment epithelium, and Müller cells, inflammation, and vitreous traction. OCT is the test of choice for the diagnosis and follow-up of CME associated with IRD. The drugs with the highest degree of scientific evidence are carbonic anhydrase inhibitors (IAC). Intravitreal corticosteroids, anti-VEGF, and vitrectomy with peeling of the internal limiting membrane do not have sufficient evidence. A treatment scheme is proposed for the CME in IRD in adults, another for pediatric patients and another for IRD and cataract surgery. Oral and topical IACs are effective in the treatment of CME secondary to IRD. Treatment with corticosteroids, anti-VEGF, and vitrectomy are second-line options. Randomized clinical trials are required to establish the therapeutic scale in these patients.
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Affiliation(s)
- J Català-Mora
- CSUR Distrofias Hereditarias de Retina, Hospital Sant Joan de Déu, Institut Oftalmològic del Pilar, Esplugues de Llobregat, Barcelona, Spain; Distrofias Hereditarias de Retina, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - J F Santamaría Álvarez
- Distrofias Hereditarias de Retina, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - D Kyriakou
- Servicio de Oftalmología, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - S Alforja
- Departamento de Cirugía, Facultad de Medicina y Ciencias de la Salud, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - M Barraso Rodrigo
- CSUR Distrofias Hereditarias de Retina, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | | | - R Casaroli-Marano
- Departamento de Cirugía, Facultad de Medicina y Ciencias de la Salud, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - E Cobos Martín
- Distrofias Hereditarias de Retina, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - R M Coco Martín
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Facultad de Medicina de la Universidad de Valladolid, Valladolid, Spain; RICORS de Enfermedades Inflamatorias, Instituto de Salud Carlos III, Madrid, Spain
| | - C Esmerado
- Hospital Viladecans, Viladecans, Barcelona, Spain
| | - A García Tirado
- Servicio de Oftalmología, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - P García
- Servicio de Oftalmología, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - A Gómez-Benlloch
- Servicio de Oftalmología, Hospital General de Granollers, Granollers, Barcelona, Spain; Servicio de Oftalmología, Hospital Universitario General de Cataluña, Sant Cugat del Vallès, Barcelona, Spain; Servicio de Oftalmología, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - C A Rodríguez Fernández
- Distrofias Hereditarias de Retina, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - F Vilaplana Mira
- Servicio de Oftalmología, Hospital Germans Trias i Pujols, Badalona, Barcelona, Spain
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Shigesada N, Shikada N, Shirai M, Toriyama M, Higashijima F, Kimura K, Kondo T, Bessho Y, Shinozuka T, Sasai N. Combination of blockade of endothelin signalling and compensation of IGF1 expression protects the retina from degeneration. Cell Mol Life Sci 2024; 81:51. [PMID: 38252153 PMCID: PMC10803390 DOI: 10.1007/s00018-023-05087-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 12/01/2023] [Accepted: 12/12/2023] [Indexed: 01/23/2024]
Abstract
Retinitis pigmentosa (RP) and macular dystrophy (MD) cause severe retinal dysfunction, affecting 1 in 4000 people worldwide. This disease is currently assumed to be intractable, because effective therapeutic methods have not been established, regardless of genetic or sporadic traits. Here, we examined a RP mouse model in which the Prominin-1 (Prom1) gene was deficient and investigated the molecular events occurring at the outset of retinal dysfunction. We extracted the Prom1-deficient retina subjected to light exposure for a short time, conducted single-cell expression profiling, and compared the gene expression with and without stimuli. We identified the cells and genes whose expression levels change directly in response to light stimuli. Among the genes altered by light stimulation, Igf1 was decreased in rod photoreceptor cells and astrocytes under the light-stimulated condition. Consistently, the insulin-like growth factor (IGF) signal was weakened in light-stimulated photoreceptor cells. The recovery of Igf1 expression with the adeno-associated virus (AAV) prevented photoreceptor cell death, and its treatment in combination with the endothelin receptor antagonist led to the blockade of abnormal glial activation and the promotion of glycolysis, thereby resulting in the improvement of retinal functions, as assayed by electroretinography. We additionally demonstrated that the attenuation of mammalian/mechanistic target of rapamycin (mTOR), which mediates IGF signalling, leads to complications in maintaining retinal homeostasis. Together, we propose that combinatorial manipulation of distinct mechanisms is useful for the maintenance of the retinal condition.
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Affiliation(s)
- Naoya Shigesada
- Division of Biological Science, Nara Institute of Science and Technology, Ikoma, 630-0192, Japan
| | - Naoya Shikada
- Division of Biological Science, Nara Institute of Science and Technology, Ikoma, 630-0192, Japan
| | - Manabu Shirai
- Omics Research Center (ORC), National Cerebral and Cardiovascular Center, Suita, Osaka, 564-8565, Japan
| | - Michinori Toriyama
- Department of Biomedical Chemistry, School of Science and Technology, Kwansei Gakuin University, Sanda, 669-1337, Japan
| | - Fumiaki Higashijima
- Department of Ophthalmology, Graduate School of Medicine, Yamaguchi University, Ube, 755-0046, Japan
| | - Kazuhiro Kimura
- Department of Ophthalmology, Graduate School of Medicine, Yamaguchi University, Ube, 755-0046, Japan
| | - Toru Kondo
- Division of Stem Cell Biology, Institute for Genetic Medicine, Hokkaido University, Sapporo, 060-0815, Japan
| | - Yasumasa Bessho
- Division of Biological Science, Nara Institute of Science and Technology, Ikoma, 630-0192, Japan
| | - Takuma Shinozuka
- Division of Biological Science, Nara Institute of Science and Technology, Ikoma, 630-0192, Japan
| | - Noriaki Sasai
- Division of Biological Science, Nara Institute of Science and Technology, Ikoma, 630-0192, Japan.
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Arias JD, Kalaw FGP, Alex V, Yassin SH, Ferreyra H, Walker E, Wagner NE, Borooah S. Investigating the associations of macular edema in retinitis pigmentosa. Sci Rep 2023; 13:14187. [PMID: 37648803 PMCID: PMC10469217 DOI: 10.1038/s41598-023-41464-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/27/2023] [Indexed: 09/01/2023] Open
Abstract
Macular edema (ME), the accumulation of intraretinal fluid in the macula, is a common sight affecting sequelae of retinitis pigmentosa (RP). However, it is unclear why some patients develop ME, and others do not. This study aims to identify associations between clinical-genetic factors in RP with ME. Patients with clinically confirmed RP cases were identified from the inherited retinal disease database at a large tertiary referral academic center. Demographic and genetic testing findings were noted. Additionally, optical coherence tomography volume scans were graded using a validated grading system. One hundred and six patients (73.1%) were found to have ME in at least one eye (OD = 88, mean = 37.9%, OS = 98, mean = 31.7%). Structurally, the presence of epiretinal membrane (ERM) (p < 0.007) and vitreo-macular traction (VMT) (p < 0.003) were significantly associated with ME. Additionally, X-linked (p < 0.032) and autosomal dominant inheritance (p < 0.039) demonstrated a significant association with ME, with RP1 (p < 0.045) and EYS (p < 0.017) pathogenic variants also significantly associated with ME. This study, in a large cohort of RP patients, confirms previous retinal structural associations for ME in RP and identifies potential new genetic associations.
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Affiliation(s)
- Juan D Arias
- Jacobs Retina Center, University of California San Diego, San Diego, CA, USA
| | - Fritz Gerald P Kalaw
- Jacobs Retina Center, University of California San Diego, San Diego, CA, USA
- Ophthalmology - Retina Division, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California San Diego, 9415 Campus Point Drive, San Diego, CA, 92093, USA
| | - Varsha Alex
- Jacobs Retina Center, University of California San Diego, San Diego, CA, USA
- Ophthalmology - Retina Division, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California San Diego, 9415 Campus Point Drive, San Diego, CA, 92093, USA
| | - Shaden H Yassin
- Jacobs Retina Center, University of California San Diego, San Diego, CA, USA
- Ophthalmology - Retina Division, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California San Diego, 9415 Campus Point Drive, San Diego, CA, 92093, USA
| | - Henry Ferreyra
- Jacobs Retina Center, University of California San Diego, San Diego, CA, USA
- Ophthalmology - Retina Division, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California San Diego, 9415 Campus Point Drive, San Diego, CA, 92093, USA
| | - Evan Walker
- Jacobs Retina Center, University of California San Diego, San Diego, CA, USA
- Ophthalmology - Retina Division, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California San Diego, 9415 Campus Point Drive, San Diego, CA, 92093, USA
| | - Naomi E Wagner
- Ophthalmology - Retina Division, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California San Diego, 9415 Campus Point Drive, San Diego, CA, 92093, USA
| | - Shyamanga Borooah
- Jacobs Retina Center, University of California San Diego, San Diego, CA, USA.
- Ophthalmology - Retina Division, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California San Diego, 9415 Campus Point Drive, San Diego, CA, 92093, USA.
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Xu H, Chen M. Immune response in retinal degenerative diseases - Time to rethink? Prog Neurobiol 2022; 219:102350. [PMID: 36075351 DOI: 10.1016/j.pneurobio.2022.102350] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/24/2022] [Accepted: 09/02/2022] [Indexed: 11/30/2022]
Abstract
Retinal degeneration comprises a group of diseases whereby either the retinal neurons or the neurovascular unit degenerates leading to the loss of visual function. Although the initial cause varies in different conditions, inflammation is known to play an important role in disease pathogenesis. Recent advances in molecular and cell biology and systems biology have yielded unexpected findings, including the heterogeneity of immune cells in the degenerative retina, bidirectional neuron-microglia cross talk, and links to the gut microbiome. Here we discuss the immune response in retinal degenerative conditions, taking into account both regional (retinal) and systemic factors. We propose to classify retinal degeneration into dry and wet forms based on whether the blood-retinal barrier (BRB) is breached and fluid is accumulated in retinal parenchyma. The dry form has a relatively intact BRB and is characterised by progressive retinal thinning. Immune response to degenerative insults is dominated by the retinal defence system, which remains to be regulated by neurons. In contrast, the wet form has retinal oedema due to BRB damaged. Inflammation is executed by infiltrating immune cells as well as the retinal defence system. The gut microbiome will have easy access to the retina in wet retinal degeneration and may affect significantly retinal immune response.
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Affiliation(s)
- Heping Xu
- Aier Institute of Optometry and Vision Science, Changsha 410000, China; The Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, BT9 7BL, UK.
| | - Mei Chen
- The Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, BT9 7BL, UK.
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Ruff A, Tezel A, Tezel TH. Anatomical and functional correlates of cystic macular edema in retinitis pigmentosa. PLoS One 2022; 17:e0276629. [PMID: 36269735 PMCID: PMC9586413 DOI: 10.1371/journal.pone.0276629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
Cystoid macular edema (CME) is a major cause of central visual deterioration in retinitis pigmentosa. The exact reason for CME and its prognostic significance in this patient population is unknown. We seek to find clues to answer these questions by examining the anatomical correlations between retinal cysts and retinal morphometric parameters in a cohort of patients with retinitis pigmentosa and CME. For this reason, 103 patients (196 eyes) with untreated cystoid macular edema (CME) were identified from a pool of 578 genotyped patients with retinitis pigmentosa. Image analyses were conducted using three central horizontal OCT scans of these patients to calculate cross-sectional areas of the retinal nerve fiber layer, outer retinal, inner retinal, cysts, and total retinal areas. Lengths of the ellipsoid zone and outer limiting membrane were also measured. Best-fit curves were derived for analyzing the factors playing a role in the size of the retinal cysts and the patients’ visual acuity. Generalized Estimating Equation and multivariate linear regression analyses were conducted to determine the correlations between visual acuity, morphometric and clinical data, and the significant cyst size and visual acuity determinants. Twenty-five percent of the screened patients (103/578) had CME. Patients with autosomal dominant retinitis pigmentosa had the highest incidence of CME (43.6%, p<0.001) but also had the best visual acuity (20/34±20/30, p = 0.02). The total cyst area was 0.14±0.18 mm2. Outer retinal area (B = 0.214; p = 0.008), age (B = -0.003; p<0.001) and retinal nerve fiber area (B = 0.411; p = 0.005) were main determinants of the (r = 0.44; p<0.001) cyst size. Cysts resolved with progressing retinal degeneration. Length of the intact ellipsoid zone (B = -5.16E-5; p<0.001), the inheritance pattern (B = 0.04; p = 0.028) and retinal nerve fiber area (B = 0.751; p<0.001) were the main determinants of visual acuity. In patients with retinitis pigmentosa and cystoid macular edema, retinal nerve fiber layer thickness is associated with decreasing visual acuity and cyst size. This finding suggests that intraretinal cysts may compress retinal axons and cause subsequent visual loss in retinitis pigmentosa.
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Affiliation(s)
- Adam Ruff
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | - Alangoya Tezel
- University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - Tongalp H. Tezel
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, United States of America
- * E-mail:
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Chen C, Liu X, Peng X. Management of Cystoid Macular Edema in Retinitis Pigmentosa: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:895208. [PMID: 35652079 PMCID: PMC9149278 DOI: 10.3389/fmed.2022.895208] [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: 03/13/2022] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background To date, various treatments for cystoid macular edema (CME) in retinitis pigmentosa (RP) have been reported. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of current treatments for RP-CME. Methods PubMed, Embase and the Cochrane library were searched from inception to August 2021. ClinicalTrials.gov, WHO ICTRP and ISRCTN were also searched for relevant studies. Only studies published in English were included. The RoB 2 tool was used to evaluate the risk of bias of randomized controlled trials (RCTs), and the MINORS scale was used to assess the methodological quality of non-RCTs. Review manager (Revman) was used to pool the data. The primary outcomes included the change of central macular thickness (CMT) and best-corrected visual acuity (BCVA) from baseline. The secondary outcomes included fluorescein angiography (FA) leakage, rebound of CME and adverse effects. Results Thirty-two studies were included in the current systematic review and 7 studies were used for meta-analysis. Treatments for RP-CME included oral and topical carbonic anhydrase inhibitors (CAIs), systematic and local steroids, anti-VEGF therapy, NSAIDS, grid LASER photocoagulation, subliminal micropulse LASER, vitrectomy, lutein supplement and oral minocycline. CAIs and local steroids were proved to be effective in reducing CMT. The effects of anti-VEGF reagents varied among studies. Regarding other treatments, only one study for each method fitted the inclusion criteria, so the evidence was very limited. Conclusion Topical CAIs, oral CAIs and local steroids are effective in treating RP-CME. However, due to the overall inferior design and small patient number of the included studies, the quality of evidence was poor. Systematic steroids, LASER, NSAIDS and vitrectomy may also be effective, nevertheless, considering the limited number of studies, no conclusion could be drawn regarding these treatments. More well-designed and conducted studies are needed in this field. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021273979, identifier CRD42021273979.
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Affiliation(s)
- Chen Chen
- Department of Ophthalmology, The Second People's Hospital of Yunnan Province (Affiliated Hospital of Yunnan University, Fourth Affiliated Hospital of Kunming Medical University), Kunming, China.,Yunnan Clinical Medicine Center for Ocular Disease, Yunnan Eye Institute, Kunming, China.,Key Laboratory of Yunnan Province for the Prevention and Treatment of Ophthalmic Diseases, Yunnan Eye Institute, Kunming, China
| | - Xia Liu
- Department of Ophthalmology, The Second People's Hospital of Yunnan Province (Affiliated Hospital of Yunnan University, Fourth Affiliated Hospital of Kunming Medical University), Kunming, China.,Yunnan Clinical Medicine Center for Ocular Disease, Yunnan Eye Institute, Kunming, China.,Key Laboratory of Yunnan Province for the Prevention and Treatment of Ophthalmic Diseases, Yunnan Eye Institute, Kunming, China
| | - Xiaoyan Peng
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Institute of Ophthalmology, Beijing, China.,Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Frequency of cystoid macular edema and vitreomacular interface disorders in genetically solved syndromic and non-syndromic retinitis pigmentosa. Graefes Arch Clin Exp Ophthalmol 2022; 260:2859-2866. [PMID: 35389060 DOI: 10.1007/s00417-022-05649-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 03/20/2022] [Accepted: 03/25/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Retinitis pigmentosa (RP) corresponds to a group of inherited retinal disorders where progressive rod-cone degeneration is observed. Cystoid macular edema (CME) and vitreomacular interface disorders (VMID) are known to complicate the RP phenotype, challenging an age-old concept of retained central visual acuity. The reported prevalence of these changes varies greatly among different studies. We aim to describe the frequency of CME and VMID and identify predictors of these changes in a cohort of Caucasian patients with genetically solved syndromic (sRP) and non-syndromic RP (nsRP). METHODS Cross-sectional study of patients with genetically solved sRP or nsRP. Genetic testing was clinically oriented in all probands and coordinated by a medical geneticist. The presence/absence of CME and VMIDs such as epiretinal membrane (ERM), vitreomacular traction (VMT), lamellar hole (LH), macular hole (MH), and macular pseudohole (MPH), and the integrity of the neurosensory retina and retinal pigment epithelium were evaluated in individual macular SD-OCT b-scans. Mixed-effects regression analysis models were used to identify significant predictors of BCVA, CME, and VMID. Significance was considered at α < 0.05. RESULTS We included 250 eyes from 125 patients. Mean age was 44.9 ± 15.7 years and 55.2% were male. Eighty-eight patients had nsRP and 37 had sRP. Median BCVA was 0.5 (0.2-1.3) logMAR. CME was found in 17.1% of eyes, while ERM was found in 54.3% of eyes. The frequency of CME (p = 0.45) and ERM (p = 0.07) did not differ between sRP and nsRP patients, nor across different inheritance patterns. Mixed-effects univariate linear regression identified age (p = 0.04), cataract surgery (p < 0.01), and loss of integrity of outer retinal layers (p < 0.01) as significant predictors of lower visual acuity, while increased foveal thickness (p < 0.01) and the presence of CME (p = 0.04) were predictors of higher visual acuity. On mixed-effects multivariable analysis, only increased foveal thickness was significantly associated with better visual acuity (p < 0.01). CONCLUSION We found that the burden of ERM and CME in RP patients is high, highlighting the importance of screening for these potentially treatable conditions to improve the quality of life of RP patients.
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Fenner BJ, Tan TE, Barathi AV, Tun SBB, Yeo SW, Tsai ASH, Lee SY, Cheung CMG, Chan CM, Mehta JS, Teo KYC. Gene-Based Therapeutics for Inherited Retinal Diseases. Front Genet 2022; 12:794805. [PMID: 35069693 PMCID: PMC8782148 DOI: 10.3389/fgene.2021.794805] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/14/2021] [Indexed: 12/14/2022] Open
Abstract
Inherited retinal diseases (IRDs) are a heterogenous group of orphan eye diseases that typically result from monogenic mutations and are considered attractive targets for gene-based therapeutics. Following the approval of an IRD gene replacement therapy for Leber's congenital amaurosis due to RPE65 mutations, there has been an intensive international research effort to identify the optimal gene therapy approaches for a range of IRDs and many are now undergoing clinical trials. In this review we explore therapeutic challenges posed by IRDs and review current and future approaches that may be applicable to different subsets of IRD mutations. Emphasis is placed on five distinct approaches to gene-based therapy that have potential to treat the full spectrum of IRDs: 1) gene replacement using adeno-associated virus (AAV) and nonviral delivery vectors, 2) genome editing via the CRISPR/Cas9 system, 3) RNA editing by endogenous and exogenous ADAR, 4) mRNA targeting with antisense oligonucleotides for gene knockdown and splicing modification, and 5) optogenetic approaches that aim to replace the function of native retinal photoreceptors by engineering other retinal cell types to become capable of phototransduction.
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Affiliation(s)
- Beau J Fenner
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Graduate Medical School, Ophthalmology and Visual Sciences Academic Clinical Programme, Singapore, Singapore
| | - Tien-En Tan
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Graduate Medical School, Ophthalmology and Visual Sciences Academic Clinical Programme, Singapore, Singapore
| | | | - Sai Bo Bo Tun
- Singapore Eye Research Institute, Singapore, Singapore
| | - Sia Wey Yeo
- Singapore Eye Research Institute, Singapore, Singapore
| | - Andrew S H Tsai
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Graduate Medical School, Ophthalmology and Visual Sciences Academic Clinical Programme, Singapore, Singapore
| | - Shu Yen Lee
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Graduate Medical School, Ophthalmology and Visual Sciences Academic Clinical Programme, Singapore, Singapore
| | - Chui Ming Gemmy Cheung
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Graduate Medical School, Ophthalmology and Visual Sciences Academic Clinical Programme, Singapore, Singapore
| | - Choi Mun Chan
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Graduate Medical School, Ophthalmology and Visual Sciences Academic Clinical Programme, Singapore, Singapore
| | - Jodhbir S Mehta
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Graduate Medical School, Ophthalmology and Visual Sciences Academic Clinical Programme, Singapore, Singapore.,School of Material Science and Engineering, Nanyang Technological University, Singapore, Singapore.,Yong Loo Lin School of Medicine, Department of Ophthalmology, National University of Singapore, Singapore, Singapore
| | - Kelvin Y C Teo
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Graduate Medical School, Ophthalmology and Visual Sciences Academic Clinical Programme, Singapore, Singapore
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Zhao T, Lie H, Wang F, Liu Y, Meng X, Yin Z, Li S. Comparative Study of a Modified Sub-Tenon's Capsule Injection of Triamcinolone Acetonide and the Intravenous Infusion of Umbilical Cord Mesenchymal Stem Cells in Retinitis Pigmentosa Combined With Macular Edema. Front Pharmacol 2021; 12:694225. [PMID: 34646129 PMCID: PMC8503560 DOI: 10.3389/fphar.2021.694225] [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: 04/12/2021] [Accepted: 09/15/2021] [Indexed: 11/22/2022] Open
Abstract
Retinitis pigmentosa (RP) is a hereditary retinal degenerative disease leading to eventual blindness. When RP is combined with macular edema (ME), the visual impairment further worsens. We compared a modified sub-Tenon’s capsule injection of triamcinolone acetonide (TA) and the intravenous infusion of umbilical cord mesenchymal stem cells (UCMSCs) in the treatment of RP combined with ME (RP-ME) to assess their safety and efficacy in eliminating ME and restoring visual function. A phase I/II clinical trial enrolled 20 patients was conducted. All patients were followed up for 6 months. There were no severe adverse effects in both groups. In retinal morphological tests, the central macular thickness (CMT) in TA group significantly decreased at first week, first and second month after injection (p < 0.05). The CMT in UCMSCs group significantly decreased at first month after infusion. The rate of reduction of CMT in TA group was significantly greater than that in UCMSCs group at second month (p < 0.05). Reversely, the rate of reduction of CMT in UCMSCs group was significantly greater than that in TA group at sixth month (p < 0.05). In visual functional test, although there were no significant differences in visual acuity or visual fields within each group or between groups, but the amplitude of P2 wave of flash visual evoked potential (FVEP) showed significant increasing in TA group at second month in UCMSCs group at sixth month (p < 0.05). At 6th month, the rate of growth in the amplitude of P2 wave in USMCSs group was significantly greater than that in TA group (p < 0.05). This study suggests both modified sub-Tenon’s capsule injection of TA and intravenous infusion of UCMSCs are safe for RP-ME patients. TA injection is more effective at alleviating ME while improving visual function in a short term. UCMSC intravenous infusion shows slow but persistent action in alleviating ME, and can improve the visual function for a longer time. These approaches can be applied separately or jointly depending on the disease condition for patients to benefit maximumly. Clinical Trial Registration:http://www.chictr.org.cn, identifier ChiCTR-ONC-16008839
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Affiliation(s)
- Tongtao Zhao
- Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Hongxuan Lie
- Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China.,Changhai Hospital, The Second Military Medical University (Naval Medical University), Shanghai, China
| | - Fang Wang
- Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Yong Liu
- Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Xiaohong Meng
- Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Zhengqin Yin
- Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Shiying Li
- Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
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10
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Caras IW, Collins LR, Creasey AA. A stem cell JOURNEY IN OPHTHALMOLOGY: From the bench to the clinic. Stem Cells Transl Med 2021; 10:1581-1587. [PMID: 34515419 PMCID: PMC8641078 DOI: 10.1002/sctm.21-0239] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/05/2021] [Accepted: 08/21/2021] [Indexed: 01/10/2023] Open
Abstract
Debilitating diseases of the eye represent a large unmet medical need potentially addressable with stem cell-based approaches. Over the past decade, the California Institute for Regenerative Medicine (CIRM) has funded and supported the translation, from early research concepts to human trials, of therapeutic stem cell approaches for dry age-related macular degeneration, retinitis pigmentosa, and limbal stem cell deficiency. This article chronicles CIRM's journey in the ophthalmology field and discusses some key challenges and questions that were addressed along the way as well as questions that remain.
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Affiliation(s)
- Ingrid W Caras
- The California Institute for Regenerative Medicine, Oakland, California, USA
| | - Lila R Collins
- The California Institute for Regenerative Medicine, Oakland, California, USA
| | - Abla A Creasey
- The California Institute for Regenerative Medicine, Oakland, California, USA
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11
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Puthalath A, Samanta R, Saraswat N, Agrawal A, Singh A, Jamil M. A rare case of type 3 usher syndrome with bilateral cystoid macular edema treated with topical dorzolamide. Taiwan J Ophthalmol 2020; 11:183-186. [PMID: 34295626 PMCID: PMC8259521 DOI: 10.4103/tjo.tjo_6_20] [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: 09/06/2019] [Accepted: 01/02/2020] [Indexed: 12/03/2022] Open
Abstract
A 30-year-old female presented with gradually progressive diminution of vision for 1 month, with night blindness for the past 5 years and difficulty in hearing for the past 10 years. Her developmental history and family history were unremarkable. Ocular examination revealed visual acuity of 6/36 in both eyes. Fundus showed features of retinitis pigmentosa with bilateral macular edema. Audiometry revealed bilateral sensorineural hearing loss; although, her vestibular functions were preserved. Clinical diagnosis of Usher syndrome type 3 was made based on normal hearing at birth, delayed presentation of progressive visual and auditory impairment with normal vestibular function, and developmental milestones. Her macular edema resolved after 3 months of treatment with topical dorzolamide therapy. The unique feature of this case is the presence of bilateral macular edema in type 3 Usher syndrome, which is rarely reported in literature.
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Affiliation(s)
- Athul Puthalath
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Ramanuj Samanta
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Neeraj Saraswat
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Ajai Agrawal
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Anupam Singh
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Mahsa Jamil
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
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12
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Al-Moujahed A, Callaway NF, Vail D, Ludwig CA, Ji MH, Moshfeghi DM. Resolution of optic disc pit-associated macular retinoschisis after topical carbonic anhydrase inhibitor treatment: Report of a case. Eur J Ophthalmol 2020; 31:NP25-NP28. [PMID: 32019335 DOI: 10.1177/1120672120904664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Optic disc pits frequently lead to visual deterioration due to macular retinoschisis or serous retinal detachment. Here, we report a case of optic disc pit-associated macular retinoschisis due to intraretinal fluid accumulation that resolved with improvement in visual acuity after treatment with topical dorzolamide. CASE DESCRIPTION A 56-year-old otherwise healthy female with no ocular history presented with 2 weeks of slowly worsening blurry vision in her right eye. Visual acuity was 20/30 in the right eye. Posterior segment examination revealed posterior vitreous detachment, an optic disc pit at 9 o'clock, macular edema and foveoschisis with fluid extending from the optic nerve, and a normal peripheral retina. Optical coherence tomography imaging of the macula showed central subfield thickness of 526 µm. The patient preferred no surgical intervention, so topical dorzolamide 2% three times daily was initiated. Over the next 2 years, the central subfield thickness steadily declined from 526 to 262 µm, and her vision improved to 20/20 with improvement in the macular retinoschisis. CONCLUSION Our report presents a case of resolution of optic disc pit-associated macular retinoschisis due to intraretinal fluid accumulation with possible role for dorzolamide as a potential treatment option.
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Affiliation(s)
- Ahmad Al-Moujahed
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Natalia F Callaway
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Daniel Vail
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Cassie A Ludwig
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Marco H Ji
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Darius M Moshfeghi
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
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13
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Supuran CT. Agents for the prevention and treatment of age-related macular degeneration and macular edema: a literature and patent review. Expert Opin Ther Pat 2019; 29:761-767. [PMID: 31540558 DOI: 10.1080/13543776.2019.1671353] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction: Macular degeneration (MD) and macular edema (ME) are ophthalmologic diseases affecting an increasing number of the aging population. Until recently, there were few therapeutic options for both conditions but the last two decades saw important advances. Areas covered: This review summarizes the agents used for the treatment of age-related MD (AMD), which include verteporfin, for photodynamic therapy, and anti-VEGF agents, the aptamer pegaptanib, the monoclonal antibodies (MAbs) ranibizumab (Lucentis®) and bevacizumab (Avastin®) and the fusion protein aflibercept (Eylea®). All these drugs are effective only for the wet form of AMD, whereas for the dry form there is no treatment available. ME is, on the other hand, treated with nonsteroidal anti-inflammatory drugs and carbonic anhydrase (CA) inhibitors. Recently, MAbs such as ranibizumab and bevacizumab were also shown to be effective for the management of the cystoid and diabetic ME. Expert opinion: There are important advances made in the field in the last years but longer-acting anti-VEGF agents or drugs with less ocular side effects are needed. Many such agents are in clinical development.
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Affiliation(s)
- Claudiu T Supuran
- NEUROFARBA Department, Sezione di Scienze Farmaceutiche e Nutraceutiche, Università degli Studi di Firenze , Firenze , Italy
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14
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Tripathy K. Cystoid Macular Edema in Retinitis Pigmentosa with Intermediate Uveitis Responded Well to Oral and Posterior Subtenon Steroid. Semin Ophthalmol 2018; 33:492-493. [DOI: 10.1080/08820538.2017.1303521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Koushik Tripathy
- ICARE Eye Hospital & Postgraduate Institute, Noida, Uttar Pradesh, India
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15
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Bakthavatchalam M, Lai FH, Rong SS, Ng DS, Brelen ME. Treatment of cystoid macular edema secondary to retinitis pigmentosa: a systematic review. Surv Ophthalmol 2018; 63:329-339. [DOI: 10.1016/j.survophthal.2017.09.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 09/20/2017] [Accepted: 09/22/2017] [Indexed: 11/17/2022]
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16
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Verbakel SK, van Huet RAC, Boon CJF, den Hollander AI, Collin RWJ, Klaver CCW, Hoyng CB, Roepman R, Klevering BJ. Non-syndromic retinitis pigmentosa. Prog Retin Eye Res 2018; 66:157-186. [PMID: 29597005 DOI: 10.1016/j.preteyeres.2018.03.005] [Citation(s) in RCA: 513] [Impact Index Per Article: 85.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 12/23/2022]
Abstract
Retinitis pigmentosa (RP) encompasses a group of inherited retinal dystrophies characterized by the primary degeneration of rod and cone photoreceptors. RP is a leading cause of visual disability, with a worldwide prevalence of 1:4000. Although the majority of RP cases are non-syndromic, 20-30% of patients with RP also have an associated non-ocular condition. RP typically manifests with night blindness in adolescence, followed by concentric visual field loss, reflecting the principal dysfunction of rod photoreceptors; central vision loss occurs later in life due to cone dysfunction. Photoreceptor function measured with an electroretinogram is markedly reduced or even absent. Optical coherence tomography (OCT) and fundus autofluorescence (FAF) imaging show a progressive loss of outer retinal layers and altered lipofuscin distribution in a characteristic pattern. Over the past three decades, a vast number of disease-causing variants in more than 80 genes have been associated with non-syndromic RP. The wide heterogeneity of RP makes it challenging to describe the clinical findings and pathogenesis. In this review, we provide a comprehensive overview of the clinical characteristics of RP specific to genetically defined patient subsets. We supply a unique atlas with color fundus photographs of most RP subtypes, and we discuss the relevant considerations with respect to differential diagnoses. In addition, we discuss the genes involved in the pathogenesis of RP, as well as the retinal processes that are affected by pathogenic mutations in these genes. Finally, we review management strategies for patients with RP, including counseling, visual rehabilitation, and current and emerging therapeutic options.
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Affiliation(s)
- Sanne K Verbakel
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ramon A C van Huet
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands; Department of Ophthalmology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anneke I den Hollander
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Human Genetics, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rob W J Collin
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Caroline C W Klaver
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Carel B Hoyng
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ronald Roepman
- Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - B Jeroen Klevering
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands.
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17
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Menke B, Walters A, Payne JF. Paradoxical Anatomic Response to Topical Carbonic Anhydrase Inhibitor in X-linked Retinoschisis. Ophthalmic Surg Lasers Imaging Retina 2018; 49:142-144. [PMID: 29443366 DOI: 10.3928/23258160-20180129-11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 09/21/2017] [Indexed: 02/07/2023]
Abstract
An 11-year-old boy presented for central vision blurring in each eye. Visual acuity was 20/80 and examination revealed spoke-wheel foveal schisis and peripheral elevated diaphanous inner retina in each eye. Spectral-domain optical coherence tomography showed inner-retinal, flat-topped cysts in each eye. Electrophysiologic testing was refused, but a clinical diagnosis of X-linked retinoschisis was made. Three months after topical dorzolamide (Trusopt; Santen Pharmaceutical, Osaka, Japan) was started, the macular cysts worsened significantly. The medication was stopped and 3 months later, the macular anatomy returned to baseline. Physicians should be aware of this potential paradoxical anatomic response to topical carbonic anhydrase inhibitor therapy in X-linked retinoschisis. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:142-144.].
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18
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Lew YJ, Rinella N, Qin J, Chiang J, Moore AT, Porco TC, Roorda A, Duncan JL. High-resolution Imaging in Male Germ Cell-Associated Kinase (MAK)-related Retinal Degeneration. Am J Ophthalmol 2018; 185:32-42. [PMID: 29103961 PMCID: PMC5732075 DOI: 10.1016/j.ajo.2017.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE To describe the characteristics of MAK-related retinal degeneration using optical coherence tomography angiography (OCTA) and adaptive optics scanning laser ophthalmoscopy (AOSLO). DESIGN Cross-sectional study. METHODS Six patients with rod-cone degeneration and disease-causing mutations in MAK were evaluated with visual acuity, spectral-domain OCT, confocal AOSLO, and OCTA. Foveal avascular zone (FAZ) area, vessel densities, and perfusion densities of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in the central macula in all 6 patients were compared with 5 normal subjects. Cone spacing was measured in 4 patients from AOSLO images and compared with 37 normal subjects. RESULTS Patients ranged from 25 to 81 years of age (mean, 52 years). Visual acuity varied from 20/13 to 20/40+2, except in 1 patient with cystoid macular edema whose vision was 20/60- and 20/70+1. The SCP (P = .012) and DCP (P = .013) vessel density and perfusion density (P =.015 and .013, respectively) were significantly lower in patients compared to normal subjects in the parafoveal region 1.0-3.0 mm from the fovea, but were similar to normal subjects within 1.0 mm of the fovea. The FAZ area was not significantly different from normal (all P ≥ .24). Cone spacing was normal at almost all locations in 2 patients with early disease and increased in 2 patients with advanced disease. CONCLUSIONS Although retinal vascular densities are reduced and cone spacing is increased in advanced disease, central foveal structure is maintained until late stages of disease, which may contribute to preservation of foveal vision in eyes with MAK-related retinal degeneration.
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Affiliation(s)
- Young Ju Lew
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Nicholas Rinella
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Jia Qin
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Joanna Chiang
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Anthony T Moore
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Travis C Porco
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California; Proctor Foundation, University of California, San Francisco, San Francisco, California
| | - Austin Roorda
- School of Optometry and Vision Science Graduate Group, University of California, Berkeley, Berkeley, California
| | - Jacque L Duncan
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
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19
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De Rojas JO, Schuerch K, Mathews PM, Cabral T, Hazan A, Sparrow J, Tsang SH, Suh LH. Evaluating Structural Progression of Retinitis Pigmentosa After Cataract Surgery. Am J Ophthalmol 2017; 180:117-123. [PMID: 28601586 DOI: 10.1016/j.ajo.2017.05.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/26/2017] [Accepted: 05/30/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine whether cataract surgery accelerates disease progression in retinitis pigmentosa (RP). DESIGN Retrospective cohort study. METHODS Seventy eyes of 40 patients with RP were categorized as having had phacoemulsification with intraocular lens implantation vs no cataract surgery at a single tertiary-level institution. Spectral-domain optical coherence tomography (SDOCT) was used to measure the ellipsoid zone (EZ) width, which has been demonstrated to be a reliable marker of RP severity, at baseline and throughout follow-up (median 768 days). RP progression was calculated as the loss of EZ width over time for all patients. Additional postoperative data were collected for the cataract surgery group, including preoperative and postoperative best-corrected visual acuity, incidence of macular edema, posterior capsular opacification, epiretinal membrane, and intraocular lens subluxation. RESULTS Multivariable analysis including age, baseline EZ width, mode of inheritance, and cataract surgery status showed that there was no significant difference in RP progression between the cataract surgery and control groups (P = .23). Mode of inheritance was associated with RP progression, with autosomal recessive RP progressing at 148 μm/year and autosomal dominant RP progressing at 91 μm/year (P = .003). Visual acuity improved in almost all eyes that underwent surgery (17/19, 89%) and remained stable in remaining eyes (2/19, 11%). There was a high incidence of postsurgical posterior capsular opacification (18/19, 95%). There were no serious complications, such as lens subluxation or endophthalmitis. CONCLUSIONS Our findings suggest that cataract surgery is a safe and effective means of improving visual acuity in RP patients and that it does not seem to be associated with faster disease progression as measured using SDOCT.
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Campos Polo R, Rubio Sánchez C, García Guisado DM, Díaz Luque MJ. Eplerenone, a new treatment for an old problem: Retinitis pigmentosa with recalcitrant macular edema. ACTA ACUST UNITED AC 2017. [PMID: 28624313 DOI: 10.1016/j.oftal.2017.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
CASE REPORT The case involves a 35-year-old man, with a history of retinitis pigmentosa, who presented with a bilateral cystoid macular oedema associated with bilateral epiretinal membrane, which was resistant to treatment with oral acetazolamide and intravitreal bevacizumab. The treatment with oral eplerenone was able to improve the visual acuity and macular thickness of this patient. DISCUSSION A variety of treatments have been proposed for the management of cystoid macular oedema, associated with retinitis pigmentosa, with variable results. The treatment with oral eplerenone might be a good option for the control of this condition.
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Affiliation(s)
- R Campos Polo
- Servicio de Oftalmología, Hospital Virgen del Puerto, Plasencia (Cáceres), España.
| | - C Rubio Sánchez
- Servicio de Oftalmología, Hospital Virgen del Puerto, Plasencia (Cáceres), España
| | - D M García Guisado
- Servicio de Oftalmología, Hospital Virgen del Puerto, Plasencia (Cáceres), España
| | - M J Díaz Luque
- Servicio de Oftalmología, Hospital Virgen del Puerto, Plasencia (Cáceres), España
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