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Kubicka-Trząska A, Bugara D, Żuber-Łaskawiec K, Pociej-Marciak W, Markiewicz A, Romanowska-Dixon B, Karska-Basta I. Use of Optical Coherence Tomography and Optical Coherence Tomography Angiography in the Diagnosis and Follow-Up of Endogenous Candida Endophthalmitis: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:207. [PMID: 38399495 PMCID: PMC10890289 DOI: 10.3390/medicina60020207] [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: 12/03/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024]
Abstract
Background: Endogenous Candida endophthalmitis (ECE) is a rare but sight-threatening disease. Patients with ECE present with various clinical signs and symptoms, which can complicate the diagnosis. The aim of this report was to demonstrate the outcomes of treatment and to diagnose macular complications caused by intraocular inflammation. Case presentation: A 41-year-old woman with a history of acute intermittent porphyria presented with a progressive vision loss in her left eye. Left-eye OCT revealed findings consistent with a fungal etiology, which was confirmed by the culture of swabs collected from a central vein catheter. The outcomes of intravenous fluconazole treatment were not satisfactory, and the patient developed recurrent attacks of porphyria, suggesting a porphyrogenic effect of systemic antifungal therapy. Repeated intravitreal injections with amphotericin B led to a gradual regression of inflammatory lesions. However, follow-up examinations revealed active macular neovascularization (MNV) on both OCT and OCTA scans. The patient was administered intravitreal bevacizumab. At the 11th month of follow-up, OCT and OCTA scans showed significant inflammatory lesions regression with macula scarring, and no MNV activity was detected. Conclusions: This case highlights the importance of OCT and OCTA as valuable noninvasive imaging techniques for the identification of ECE, the monitoring of its clinical course, and the diagnosis of macular complications.
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Affiliation(s)
- Agnieszka Kubicka-Trząska
- Department of Ophthalmology, Faculty of Medicine, Medical College, Jagiellonian University, ul. Kopernika 38, 31-501 Krakow, Poland; (D.B.); (K.Ż.-Ł.); (W.P.-M.); (A.M.); (B.R.-D.); (I.K.-B.)
- Clinic of Ophthalmology and Ocular Oncology, University Hospital, ul. Kopernika 38, 31-501 Krakow, Poland
| | - Dawid Bugara
- Department of Ophthalmology, Faculty of Medicine, Medical College, Jagiellonian University, ul. Kopernika 38, 31-501 Krakow, Poland; (D.B.); (K.Ż.-Ł.); (W.P.-M.); (A.M.); (B.R.-D.); (I.K.-B.)
| | - Katarzyna Żuber-Łaskawiec
- Department of Ophthalmology, Faculty of Medicine, Medical College, Jagiellonian University, ul. Kopernika 38, 31-501 Krakow, Poland; (D.B.); (K.Ż.-Ł.); (W.P.-M.); (A.M.); (B.R.-D.); (I.K.-B.)
- Clinic of Ophthalmology and Ocular Oncology, University Hospital, ul. Kopernika 38, 31-501 Krakow, Poland
| | - Weronika Pociej-Marciak
- Department of Ophthalmology, Faculty of Medicine, Medical College, Jagiellonian University, ul. Kopernika 38, 31-501 Krakow, Poland; (D.B.); (K.Ż.-Ł.); (W.P.-M.); (A.M.); (B.R.-D.); (I.K.-B.)
- Clinic of Ophthalmology and Ocular Oncology, University Hospital, ul. Kopernika 38, 31-501 Krakow, Poland
| | - Anna Markiewicz
- Department of Ophthalmology, Faculty of Medicine, Medical College, Jagiellonian University, ul. Kopernika 38, 31-501 Krakow, Poland; (D.B.); (K.Ż.-Ł.); (W.P.-M.); (A.M.); (B.R.-D.); (I.K.-B.)
- Clinic of Ophthalmology and Ocular Oncology, University Hospital, ul. Kopernika 38, 31-501 Krakow, Poland
| | - Bożena Romanowska-Dixon
- Department of Ophthalmology, Faculty of Medicine, Medical College, Jagiellonian University, ul. Kopernika 38, 31-501 Krakow, Poland; (D.B.); (K.Ż.-Ł.); (W.P.-M.); (A.M.); (B.R.-D.); (I.K.-B.)
- Clinic of Ophthalmology and Ocular Oncology, University Hospital, ul. Kopernika 38, 31-501 Krakow, Poland
| | - Izabella Karska-Basta
- Department of Ophthalmology, Faculty of Medicine, Medical College, Jagiellonian University, ul. Kopernika 38, 31-501 Krakow, Poland; (D.B.); (K.Ż.-Ł.); (W.P.-M.); (A.M.); (B.R.-D.); (I.K.-B.)
- Clinic of Ophthalmology and Ocular Oncology, University Hospital, ul. Kopernika 38, 31-501 Krakow, Poland
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Tian Y, Zhang T, Li J, Tao Y. Advances in development of exosomes for ophthalmic therapeutics. Adv Drug Deliv Rev 2023; 199:114899. [PMID: 37236425 DOI: 10.1016/j.addr.2023.114899] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/18/2023] [Accepted: 05/21/2023] [Indexed: 05/28/2023]
Abstract
Exosomes contain multiple bioactive molecules and maintain the connection between cells. Recent advances in exosome-based therapeutics have witnessed unprecedented opportunities in treating ophthalmic diseases, including traumatic diseases, autoimmune diseases, chorioretinal diseases and others. Utilization of exosomes as delivery vectors to encapsulate both drugs and therapeutic genes could yield higher efficacy and avoid the unnecessary immune responses. However, exosome-based therapies also come with some potential ocular risks. In this review, we first present a general introduction to exosomes. Then we provide an overview of available applications and discuss their potential risks. Moreover, we review recently reported exosomes as delivery vectors for ophthalmic diseases. Finally, we put forward future perspectives to grapple with its translation and underlying issues.
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Affiliation(s)
- Ying Tian
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, PR China
| | - Tao Zhang
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, PR China
| | - Jing Li
- Beijing Key Laboratory of DNA Damage Response, College of Life Sciences, Capital Normal University, Beijing 100048, PR China
| | - Yong Tao
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, PR China.
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3
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Kodjikian L, Abukhashabah A, Fardeau C, Tadayoni R, Brézin A, Dumas S, Weber M, Bernard L, Loria O, Decullier E, Huot L, Mathis T. Efficacy and safety of Aflibercept for the treatment of inflammatory choroidal neovascularization: The ALINEA study. Acta Ophthalmol 2023; 101:e43-e49. [PMID: 35822428 DOI: 10.1111/aos.15214] [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: 05/05/2022] [Revised: 06/07/2022] [Accepted: 06/26/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate mean change in best-corrected visual acuity (BCVA) at 52 weeks in patients with inflammatory choroidal neovascularization (CNV) treated with aflibercept. METHODS We conducted a prospective non-comparative open-label trial. Following one mandatory intravitreal injection of aflibercept, patients were treated under a pro re nata (PRN) dosing regimen with monthly visits. RESULTS A total of 19 patients were included, but one presented exclusion criteria; 16 patients were followed for the whole 52-week study, and data for the primary endpoint analysis were available for 14. At baseline, mean BCVA and mean central retinal thickness (CRT) were 64.53 (±19.64) letters and 351.79 (±97.77) μm, respectively. At 52 weeks, the mean change in BCVA was +9.50 (±12.90) letters [95%CI = +2.05-+16.95]. One patient had lost more than 15-letters at 24 weeks, and another one at 52 weeks. CRT change was -62.77 (±100.73) μm at 24 weeks and -66.53 (±97.47) μm at 52 weeks. There was a mean number of 3.56 (±3.29) intravitreal injections at 52 weeks (min = 1; max = 12). No serious ocular adverse events related to the treatment were reported. CONCLUSIONS Our study shows that aflibercept is clinically effective, both anatomically and functionally in the treatment of inflammatory CNV. Following the first injection, the PRN strategy appears sufficient for treating most choroidal neovessels.
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Affiliation(s)
- Laurent Kodjikian
- Hospices Civils de Lyon, Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Lyon, France.,Université Lyon 1, Lyon, France.,UMR5510 MATEIS, CNRS, INSA Lyon, Université Lyon 1, Villeurbanne, France
| | - Amro Abukhashabah
- Hospices Civils de Lyon, Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Lyon, France.,Ophthalmology Department, King Abdulaziz University, Rabigh, Saudi Arabia
| | - Christine Fardeau
- Ophthalmology Department, Reference Center for Rare Diseases, La Pitié-Salpêtriètre Hospital, Paris-Sorbonne University, Paris, France
| | - Ramin Tadayoni
- Université de Paris, Service d'Ophtalmologie, AP-HP, Hôpital Lariboisière, Paris, France.,Service d'Ophtalmologie, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Antoine Brézin
- Hôpital Cochin, Service d'Ophtalmologie, Université de Paris, Paris, France
| | | | - Michel Weber
- Hôpital Universitaire Centre Nantes, Nantes, France
| | - Lorraine Bernard
- Université Lyon 1, Lyon, France.,Pôle de Santé Publique, Service de Biostatistique et Bioinformatique, Hospices Civils de Lyon, Lyon, France.,CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbane, France
| | - Olivier Loria
- Hospices Civils de Lyon, Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Lyon, France.,UMR5510 MATEIS, CNRS, INSA Lyon, Université Lyon 1, Villeurbanne, France
| | - Evelyne Decullier
- Pôle de Santé Publique, Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Lyon, France
| | - Laure Huot
- Université Lyon 1, Lyon, France.,Pôle de Santé Publique, Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Lyon, France
| | - Thibaud Mathis
- Hospices Civils de Lyon, Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Lyon, France.,Université Lyon 1, Lyon, France.,UMR5510 MATEIS, CNRS, INSA Lyon, Université Lyon 1, Villeurbanne, France
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Li Z, Zhou KW, Chen F, Shang F, Wu MX. Celastrol inhibits laser-induced choroidal neovascularization by decreasing VEGF induced proliferation and migration. Int J Ophthalmol 2022; 15:1221-1230. [PMID: 36017049 DOI: 10.18240/ijo.2022.08.01] [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: 01/13/2022] [Accepted: 04/13/2022] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate celastrol's effect on choroidal neovascularization (CNV). METHODS In this study, neovascular formation in vitro (tube formation and aortic ring culture) and in vivo (laser induced neovascular in mice) was treated with celastrol to evaluate this natural compound's impact on CNV. Western blot was applied to explore the possible mechanism for it. For in vitro assay, triplicate for each group was repeated at least three times. For in vivo assay, each group contains 5 mice. RESULTS Celastrol supressed tube formation and aortic ring sprout neovascularization. In vitro assay exhibited that celastrol inhibiting vascular endothelial growth factor (VEGF)-induced proliferation and migration of human umbilical vein endothelial cells and human choroidal endothelial cells, and by blocking VEGF signaling. Furthermore, intraperitoneal administration of celastrol significantly reduced the area of laser-induced CNV in an in vivo mouse model. By day 14, the area of CNV had decreased by 49.15% and 80.26% in the 0.1 mg/kg celastrol-treated group (n=5) and in the 0.5 mg/kg celastrol treated group (n=5), respectively, compared to the vehicle-treated group (n=5). CONCLUSION Celastrol inhibits CNV by inhibiting VEGF-induced proliferation and migration of vascular endothelial cells, indicating that celastrol is a potent, natural therapeutic compound for the prevention of CNV.
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Affiliation(s)
- Zhen Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Ke-Wen Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China.,Department of Physiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
| | - Fang Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Fu Shang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Ming-Xing Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
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Sarcoid Uveitis: An Intriguing Challenger. Medicina (B Aires) 2022; 58:medicina58070898. [PMID: 35888617 PMCID: PMC9316395 DOI: 10.3390/medicina58070898] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022] Open
Abstract
The purpose of our work is to describe the actual knowledge concerning etiopathogenesis, clinical manifestations, diagnostic procedures, complications and therapy of ocular sarcoidosis (OS). The study is based on a recent literature review and on the experience of our tertiary referral center. Data were retrospectively analyzed from the electronic medical records of 235 patients (461 eyes) suffering from a biopsy-proven ocular sarcoidosis. Middle-aged females presenting bilateral ocular involvement are mainly affected; eye involvement at onset is present in one-third of subjects. Uveitis subtype presentation ranges widely among different studies: panuveitis and multiple chorioretinal granulomas, retinal segmental vasculitis, intermediate uveitis and vitreitis, anterior uveitis with granulomatous mutton-fat keratic precipitates, iris nodules, and synechiae are the main ocular features. The most important complications are cataract, glaucoma, cystoid macular edema (CME), and epiretinal membrane. Therapy is based on the disease localization and the severity of systemic or ocular involvement. Local, intravitreal, or systemic steroids are the mainstay of treatment; refractory or partially responsive disease has to be treated with conventional and biologic immunosuppressants. In conclusion, we summarize the current knowledge and assessment of ophthalmological inflammatory manifestations (mainly uveitis) of OS, which permit an early diagnostic assay and a prompt treatment.
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Wai KM, Gong D, Rodriguez M, Cunningham Jr ET, Vavvas DG, Eliott D. Acute Syphilitic Posterior Placoid Chorioretinitis With Subfoveal Choroidal Neovascularization Managed With Anti-VEGF Therapy. JOURNAL OF VITREORETINAL DISEASES 2022; 6:246-250. [PMID: 35967270 PMCID: PMC9368478 DOI: 10.1177/24741264211057663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE We describe the development and management of choroidal neovascularization (CNV) in a patient with acute syphilitic posterior placoid chorioretinitis (ASPPC). METHODS A retrospective case review is presented. RESULTS A 66-year-old man presented with unilateral blurry vision. He had a history of systemic syphilis infection twice, the last diagnosed 15 years before presentation and treated with intravenous ceftriaxone, resulting in seroreversion of an initially positive rapid plasma reagin (RPR). Examination revealed ASPPC with subfoveal CNV. Repeat testing revealed an RPR titer of 1:16 384. He was treated with 6 monthly intravitreal injections of bevacizumab and systemic antibiotics, resulting in resolution of his ASPPC and regression of his CNV. CONCLUSIONS CNV is a rare complication of ASPPC. Multimodal imaging can be useful to suggest the diagnosis, and prompt treatment with systemic antibiotics and intravitreal anti-vascular endothelial growth factor agents can lead to resolution of ASPPC and regression of CNV, respectively.
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Affiliation(s)
- Karen M. Wai
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Dan Gong
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | | | - Emmett T. Cunningham Jr
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, CA, USA
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA
- The Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
| | - Demetrios G. Vavvas
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Dean Eliott
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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Bou Ghanem G, Neri P, Dolz-Marco R, Albini T, Fawzi A. Review for Diagnostics of the Year: Inflammatory Choroidal Neovascularization – Imaging Update. Ocul Immunol Inflamm 2022; 31:819-825. [PMID: 35404739 DOI: 10.1080/09273948.2022.2046793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Inflammatory choroidal neovascularization (iCNV) is a rare complication of uveitis but is a major cause of vision compromise in affected patients. Fluorescein angiography (FA) has been the gold standard for diagnosis. However, it is an invasive modality and when used alone, it might be difficult to distinguish iCNV from inflammatory lesions. Optical coherence tomography (OCT) is a noninvasive and rapid imaging modality that can provide additional features to diagnose iCNV. OCT angiography (OCTA) uses intrinsic motion contrast to visualize flow and is useful to distinguish iCNV from inflammatory lesions. However, its role in evaluating iCNV activity and treatment response is still unclear and more studies are required to reach consensus. In conclusion, the use of data from multimodal imaging is necessary to identify and promptly treat iCNV, thus preserving patient vision.
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Affiliation(s)
- Ghazi Bou Ghanem
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Piergiorgio Neri
- The Eye Department, Cleveland Clinic Abu Dhabi, UAE
- Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine of the Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Thomas Albini
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Amani Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Pichi F, Carreño E, Pavesio C, Denniston AK, Grewal DS, Deak G, Khairallah M, Ruiz-Cruz M, de Oliveira Dias JR, Adan A, Burke T, Invernizzi A, Schlaen A, Tian M, Agarwal AK, Tucker WR, Sen HN, Lin P, Lim LL, Pepple KL, Munk MR. Consensus-based recommendations for optical coherence tomography angiography reporting in uveitis. Br J Ophthalmol 2022:bjophthalmol-2021-320021. [PMID: 35135783 DOI: 10.1136/bjophthalmol-2021-320021] [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: 07/06/2021] [Accepted: 01/29/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To establish a consensus in the nomenclature for reporting optical coherence tomography angiography (OCTA findings in uveitis. METHODS The modified Delphi process consisted of two rounds of electronic questionnaires, followed by a face-to-face meeting conducted virtually. Twenty-one items were included for discussion. The three main areas of discussion were: wide field OCTA (WF-OCTA), nomenclature of OCTA findings and OCTA signal attenuation assessment and measurement. Seventeen specialists in uveitis and retinal imaging were selected by the executive committee to constitute the OCTA nomenclature in Uveitis Delphi Study Group. The study endpoint was defined by the degree of consensus for each question: 'strong consensus' was defined as >90% agreement, 'consensus' as 85%-90% and 'near consensus' as >80% but <85%. RESULTS There was a strong consensus to apply the term 'wide field' to OCTA images measuring over 70° of field of view, to use the terms 'flow void' and 'non-detectable flow signal' to describe abnormal OCTA flow signal secondary to vessels displacement and slow flow respectively, to use the terms 'loose' and 'dense' to describe the appearance of inflammatory choroidal neovascularisation, and to use the percentage of flow signal decrease to measure OCTA ischaemia with a threshold greater than or equal to 30% as a 'large area'. CONCLUSIONS This study sets up consensus recommendations for reporting OCTA findings in uveitis by an expert panel, which may prove suitable for use in routine clinical care and clinical trials.
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Affiliation(s)
- Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE .,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Ester Carreño
- Ocular Inflammation Unit, Ophthalmology Department, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | - Carlos Pavesio
- Moorfields Eye Hospital and Biomedical Research Centre, Institute of Ophthalmology, UCL, London, UK
| | - Alastair K Denniston
- Department of Ophthalmology, University Hospitals Birmingham NHSFT, Birmingham, UK
| | - Dilraj S Grewal
- Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gabor Deak
- Department of Ophthalomology, Medical University Vienna, Vienna, Austria
| | - Moncef Khairallah
- Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine of Monastir, Monastir, Tunisia
| | | | | | - Alfredo Adan
- Ophthalmology Department, Hospital Clinic, Barcelona, Spain
| | - Tomas Burke
- Bristol Eye Hospital, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK
| | - Alessandro Invernizzi
- Eye Clinic, Department of Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Ariel Schlaen
- Ophthalmology Service, Hospital de Clinicas "José de San Martín", Universidad de Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
| | - Meng Tian
- Ophthalmology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Aniruddha Kishandutt Agarwal
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.,Department of Ophthalmology and Visual Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - William R Tucker
- Moorfields Eye Hospital and Biomedical Research Centre, Institute of Ophthalmology, UCL, London, UK
| | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Phoebe Lin
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Lyndell L Lim
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Kathryn L Pepple
- Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Marion R Munk
- Ophthalmology, Inselspital, University Hospital Bern, Bern, Switzerland.,Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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Kim M, Lee J, Park YG, Park YH. Long-Term Analysis of Clinical Features and Treatment Outcomes of Inflammatory Choroidal Neovascularization. Am J Ophthalmol 2022; 233:18-29. [PMID: 34298010 DOI: 10.1016/j.ajo.2021.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/01/2021] [Accepted: 07/14/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE To investigate the long-term clinical features and treatment outcomes of patients with inflammatory choroidal neovascularization (CNV) treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF). DESIGN Retrospective, interventional, consecutive case series. METHODS Sixty-five eyes of 65 patients with inflammatory CNV treated with anti-VEGF injections and followed up at least 12 months were included. Retrospective chart review was conducted at a single tertiary referral center. RESULTS Study participants were followed up for 60.6 ± 42.8 (range, 16-160) months. Mean age was 33.4 ± 10.8 years, and mean refractive error was -3.94 ± 1.35 D in spherical equivalent. Final best-corrected visual acuity (BCVA) was 0.21 ± 0.20 logMAR after treatment. Patients were treated with bevacizumab (76.9%), ranibizumab (4.6%), aflibercept (3.1%), and drug combinations (15.4%). Systemic corticosteroid or immunosuppressant use was not correlated with visual outcome, required number of anti-VEGF injections, and recurrence. Commonly occurring optical coherence tomography (OCT) features included ellipsoid zone disruption, choroidal hypertransmission, retinal pigment epithelium atrophy or absence (RPEA), intraretinal hyperreflective foci (HRF), choroidal vessel engorgement, focal choroidal excavation, and irregular vascular loops (on OCT angiography). RPEA after treatment (β = 0.238, P = .036) and BCVA (β = 0.267, P = .029) showed significant correlation with final BCVA. A total of 28 patients (43.1%) experienced recurrence; intraretinal HRF after treatment was the single risk factor for recurrence (odds ratio = 2.712, P = .031). CONCLUSIONS Inflammatory CNV recurrence showed higher rates over time after anti-VEGF treatment than previously reported, even though the overall visual outcome was good. Baseline BCVA and RPEA after treatment are significant predictors for visual outcome. Intraretinal HRF after anti-VEGF treatment suggests the potential risk of recurrence.
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Affiliation(s)
- Mirinae Kim
- Department of Ophthalmology and Visual Science (M.K., J.L., Y-G.P., Y.-H.P.), College of Medicine, The Catholic University of Korea, Seoul, South Korea; Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital (M.K., Y.-G.P., Y.H.P.), Seoul, South Korea
| | - Junhyuck Lee
- Department of Ophthalmology and Visual Science (M.K., J.L., Y-G.P., Y.-H.P.), College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young-Gun Park
- Department of Ophthalmology and Visual Science (M.K., J.L., Y-G.P., Y.-H.P.), College of Medicine, The Catholic University of Korea, Seoul, South Korea; Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital (M.K., Y.-G.P., Y.H.P.), Seoul, South Korea
| | - Young-Hoon Park
- Department of Ophthalmology and Visual Science (M.K., J.L., Y-G.P., Y.-H.P.), College of Medicine, The Catholic University of Korea, Seoul, South Korea; Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital (M.K., Y.-G.P., Y.H.P.), Seoul, South Korea.
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11
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Zicarelli F, Azzolini C, Cornish E, Agarwal A, Khochtali S, Airaldi M, Khairallah M, Viola F, Staurenghi G, McCluskey P, Invernizzi A. OPTICAL COHERENCE TOMOGRAPHY FEATURES OF CHOROIDAL NEOVASCULARIZATION AND THEIR CORRELATION WITH AGE, GENDER, AND UNDERLYING DISEASE. Retina 2021; 41:1076-1083. [PMID: 33079791 DOI: 10.1097/iae.0000000000002984] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the influence of age, gender, and underlying disease on the optical coherence tomography (OCT) features of choroidal neovascularization (CNV) secondary to inflammation, myopia (mCNV), and age-related macular degeneration (AMD-CNV). METHODS Demographic and clinical data of eyes with treatment-naive inflammatory CNV, mCNV, and Type 2 AMD-CNV were collected. Optical coherence tomography images were reviewed to determine the presence of pitchfork sign, pigment epithelial detachment, subretinal fluid (SRF), intraretinal cysts, subretinal hyperreflective material, atrophy, and outer retinal disruption graded 1 to 4. The influence of demographics and underlying etiology on OCT signs was investigated. RESULTS One hundred and eighty-five eyes from 179 patients were enrolled. The mean [SD] age was 36 [±14.4], 62 [±18], and 77 [±8] for the inflammatory CNV, mCNV, and AMD-CNV, respectively (P < 0.001). Multiple linear regression showed that the presence of pitchfork sign was negatively associated with age (P < 0.0001), regardless of underlying disease. By contrast, the SRF, pigment epithelial detachment, intraretinal cysts, and the outer retinal disruption were all positively influenced by age, regardless of gender and underlying disease (all P < 0.01). Logistic regression showed that none of the OCT signs increased the likelihood for diagnosis of inflammatory CNV. By contrast, the absence of SRF was suggestive for mCNVs, and the presence of pigment epithelial detachment and SRF was suggestive for AMD-CNVs. CONCLUSION The age of the patient had a significant effect on the OCT appearance of the CNV, particularly the presence of a pitchfork sign, regardless of the underlying etiology. The absence of SRF was suggestive for a diagnosis of mCNVs. The presence of SRF and pigment epithelial detachment was suggestive for AMD-CNVs.
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Affiliation(s)
- Federico Zicarelli
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Claudia Azzolini
- Ophthalmological Unit, Department of Clinical Sciences and Community Health, Ca' Granda Foundation-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elisa Cornish
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia
| | - Aniruddha Agarwal
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India ; and
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Matteo Airaldi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Francesco Viola
- Ophthalmological Unit, Department of Clinical Sciences and Community Health, Ca' Granda Foundation-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Peter McCluskey
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia
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Maggio E, Mete M, Polito A, Parrozzani G, Pertile G. Retrobulbar triamcinolone for inflammatory choroidal neovascularization in pregnancy. BMC Ophthalmol 2020; 20:483. [PMID: 33298002 PMCID: PMC7727127 DOI: 10.1186/s12886-020-01759-5] [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: 07/13/2020] [Accepted: 12/04/2020] [Indexed: 11/26/2022] Open
Abstract
Background Choroidal neovascularization (CNV) in pregnancy has rarely been described. A differential diagnosis between inflammatory, idiopathic, and myopic CNV may be challenging. Moreover, there is no consensus on management, and therapeutic options may be further limited by patient and physician concerns about potential risk to the fetus. Herein, we report a case of inflammatory CNV during pregnancy and describe a previously unreported management approach with retrobulbar triamcinolone injections. Case presentation A 36-year-old woman presented with vision loss and metamorphopsia in her right eye while 21 weeks pregnant. She was diagnosed with an inflammatory CNV based on the following multimodal imaging findings: a type 2 lesion with the “pitchfork sign” on OCT, along with the absence of tomographic signs of myopic CNV, and the presence on autofluorescence of multiple hyper-autofluorescent spots, interpreted as focal areas of inflammation at the level of the outer retina and inner choroid. The patient refused oral corticosteroids and any intravitreal injection therapies. Therefore, she was treated with two trans-Tenon’s retrobulbar injections of triamcinolone acetonide after explaining the procedure and acquiring consent. The treatment resulted in a regression of inflammatory signs and a reduction of neovascular activity. No adverse events occurred for the mother or the baby, neither during the pregnancy nor after delivery. Conclusion Inflammatory CNV may be rarely associated with pregnancy. The correct diagnosis is crucial to allow the consideration of all possible management options. To the best of our knowledge, this is the first reported case of treatment with retrobulbar triamcinolone injections. This may represent a suitable therapeutic option in the absence of any other therapeutic approaches.
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Affiliation(s)
- Emilia Maggio
- IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5 - Negrar, 37024, Verona, Italy.
| | - Maurizio Mete
- IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5 - Negrar, 37024, Verona, Italy
| | - Antonio Polito
- IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5 - Negrar, 37024, Verona, Italy
| | - Gloria Parrozzani
- IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5 - Negrar, 37024, Verona, Italy
| | - Grazia Pertile
- IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5 - Negrar, 37024, Verona, Italy
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