1
|
Tong N, Fan W, Su L, Ebraheem A, Uji A, Marion K, Sadda S. RELATIONSHIP BETWEEN OPTICAL COHERENCE TOMOGRAPHY BIOMARKERS AND NUMBER OF INTRAVITREAL RANIBIZUMAB INJECTIONS IN EYES WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION IN THE HARBOR STUDY. Retina 2024; 44:1696-1703. [PMID: 39287532 DOI: 10.1097/iae.0000000000004171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
PURPOSE To correlate baseline spectral-domain optical coherence tomography characteristics with the number of as-needed intravitreal injections of ranibizumab over a 24-month follow-up period in eyes with neovascular age-related macular degeneration. METHODS Two hundred thirty-six eyes of 236 subjects with neovascular age-related macular degeneration treated with ranibizumab 0.5 mg pro re nata in the HARBOR study were enrolled. Baseline spectral-domain optical coherence tomography images were evaluated by certified reading center graders for specific morphologic features of the macular neovascularization lesion and surrounding retina. Baseline optical coherence tomography features and patient demographics correlated with the number of injections over the next 2 years. RESULTS The mean number of injections in the 0.5 mg pro re nata group was 8.07 (median 8, 3-12) after 12 months and 14.25 (median 14, 3-24) after 24 months of treatment. After multivariate, linear, regression analysis, the only baseline parameter that was independently associated with a higher injection frequency at both 12 and 24 months was a greater baseline subretinal fluid thickness. CONCLUSION A greater subretinal fluid thickness at baseline was associated with a higher frequency of pro re nata injections over 12 and 24 months in eyes treated with ranibizumab for neovascular age-related macular degeneration. These findings may be of value in counseling patients who are about to initiate therapy for macular neovascularization.
Collapse
Affiliation(s)
- Nianting Tong
- Doheny Eye Institute, Los Angeles, California
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
- Department of Ophthalmology, Qingdao Municipal Hospital, Qingdao, China
| | - Wenying Fan
- Doheny Eye Institute, Los Angeles, California
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
- Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, China; and
| | - Li Su
- Doheny Eye Institute, Los Angeles, California
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Adel Ebraheem
- Doheny Eye Institute, Los Angeles, California
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Akihito Uji
- Doheny Eye Institute, Los Angeles, California
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Kenneth Marion
- Doheny Eye Institute, Los Angeles, California
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Srinivas Sadda
- Doheny Eye Institute, Los Angeles, California
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| |
Collapse
|
2
|
Choi M, Yoon EG, Nam KT, Yun C. Clinical features associated with the atrophy of fellow eyes in patients with unilateral type 3 macular neovascularization. Int Ophthalmol 2022; 43:973-980. [PMID: 36057916 DOI: 10.1007/s10792-022-02499-9] [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: 04/15/2022] [Accepted: 08/26/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE We sought to investigate the clinical features of eyes with unilateral type 3 macular neovascularization (MNV) according to the degenerative features of fellow eyes. METHODS We retrospectively reviewed 55 patients with unilateral type 3 MNV and identified degenerative features including geographic atrophy (GA) in fellow eyes using multimodal imaging. Then, the clinical features of eyes with type 3 MNV at baseline and during follow-up with anti-vascular endothelial growth factor treatment and an as-needed regimen were compared according to the degenerative features of fellow eyes. RESULTS Eighteen patients (32.7%) had GA in fellow eyes; initial disease manifestations of type 3 MNV eyes including stage, best-corrected visual acuity, and choroidal thickness (CT) did not vary between groups (all P > 0.05). During follow-up, a rate of complete fluid resolution after three monthly loading injections was not associated with GA in fellow eyes (P = 0.703), while a lower rate of early recurrence within 3 months after loading treatment was associated with thinner CT in type 3 MNV eyes and GA over one disc area in fellow eyes (P = 0.025 and P = 0.021). CONCLUSION Degenerative features of fellow eyes in patients with unilateral type 3 MNV may be associated with the clinical characteristics of affected eyes.
Collapse
Affiliation(s)
- Mihyun Choi
- Department of Ophthalmology, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, Korea
| | - Eun Gyu Yoon
- Department of Ophthalmology, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, Seoul, Korea
| | - Ki Tae Nam
- Department of Ophthalmology, Jeju University College of Medicine, Jeju, Korea
| | - Cheolmin Yun
- Department of Ophthalmology, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, Seoul, Korea.
| |
Collapse
|
3
|
Qiang W, Wei R, Chen Y, Chen D. Clinical Pathological Features and Current Animal Models of Type 3 Macular Neovascularization. Front Neurosci 2021; 15:734860. [PMID: 34512255 PMCID: PMC8427186 DOI: 10.3389/fnins.2021.734860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/29/2021] [Indexed: 02/05/2023] Open
Abstract
Type 3 macular neovascularization (MNV3), or retinal angiomatous proliferation (RAP), is a distinct type of neovascular age-related macular degeneration (AMD), which is a leading cause of vision loss in older persons. During the past decade, systematic investigation into the clinical, multimodal imaging, and histopathological features and therapeutic outcomes has provided important new insight into this disease. These studies favor the retinal origin of MNV3 and suggest the involvement of retinal hypoxia, inflammation, von Hippel–Lindau (VHL)–hypoxia-inducible factor (HIF)–vascular endothelial growth factor (VEGF) pathway, and multiple cell types in the development and progression of MNV3. Several mouse models, including the recently built Rb/p107/Vhl triple knockout mouse model by our group, have induced many of the histological features of MNV3 and provided much insight into the underlying pathological mechanisms. These models have revealed the roles of retinal hypoxia, inflammation, lipid metabolism, VHL/HIF pathway, and retinoblastoma tumor suppressor (Rb)–E2F cell cycle pathway in the development of MNV3. This article will summarize the clinical, multimodal imaging, and pathological features of MNV3 and the diversity of animal models that exist for MNV3, as well as their strengths and limitations.
Collapse
Affiliation(s)
- Wei Qiang
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.,Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Ran Wei
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.,Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Yongjiang Chen
- The School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
| | - Danian Chen
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.,Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
4
|
Temel E, Örnek K, Aşıkgarip N. Choroidal structural changes determined by the binarization method after intravitreal aflibercept treatment in neovascular age-related macular degeneration. Int J Ophthalmol 2021; 14:1213-1217. [PMID: 34414086 DOI: 10.18240/ijo.2021.08.12] [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: 11/19/2020] [Accepted: 02/05/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To assess the choroidal structural alterations after intravitreal injection of aflibercept in neovascular age-related macular degeneration (nAMD). METHODS Fifty eyes with treatment-naïve nAMD were evaluated at baseline, 3rd, and 12th month. Fifty eyes of 50 healthy subjects were also included as controls. Choroidal thickness (CT) was measured in the subfoveal region. Total circumscribed choroidal area (CA), luminal area (LA), stromal area (SA), and choroidal vascularity index (CVI) was calculated using Image J. RESULTS At baseline, subfoveal CT was increased in nAMD patients compared to controls (P=0.321). Eyes with nAMD had a significantly increased total circumscribed CA and SA (P=0.041, 0.005, respectively). The CVI was decreased (P=0.038). In the 3rd month, the subfoveal CT, LA, and CVI revealed a decrease (P=0.005, P=0.039, 0.043, respectively). In the 12th month, subfoveal CT, LA, and CVI were decreased in comparison to baseline measures (P<0.001, 0.006, 0.010, respectively). CONCLUSION Significant structural alterations are found after intravitreal aflibercept treatment during the 12-month follow-up, in particular at the third month, in eyes with nAMD.
Collapse
Affiliation(s)
- Emine Temel
- Ophthalmology Clinic, Kırşehir Training and Research Hospital, Kırşehir 40100, Turkey
| | - Kemal Örnek
- Ophthalmology Clinic, Ahi Evran University Medical School, Kırşehir 40100, Turkey
| | - Nazife Aşıkgarip
- Ophthalmology Clinic, Kırşehir Training and Research Hospital, Kırşehir 40100, Turkey
| |
Collapse
|
5
|
Kim JH, Kim JW, Kim CG, Lee DW. LONG-TERM CHANGES IN CHOROIDAL THICKNESS IN EYES WITH TYPE 3 MACULAR NEOVASCULARIZATION. Retina 2021; 41:1251-1258. [PMID: 33136977 DOI: 10.1097/iae.0000000000003010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To evaluate the long-term changes in subfoveal choroidal thickness (SCT) in eyes with Type 3 macular neovascularization that underwent anti-vascular endothelial growth factor therapy. METHODS This retrospective study was performed with 47 patients diagnosed with Type 3 macular neovascularization and treated with anti-vascular endothelial growth factor therapy. All the patients initially received three loading injections. The SCT was compared at diagnosis, 3 months, 12 months, and at the final follow-up visit. The velocity of changes in SCT was also compared between each period. RESULTS The mean follow-up period was 52.1 ± 11.0 months. The mean SCT was 143.3 ± 51.2 µm at diagnosis, and it had significantly decreased to 128.6 ± 47.4 µm at 3 months (P < 0.001), 123.2 ± 45.7 µm at 12 months (P < 0.001), and 110.0 ± 43.0 µm at the final follow-up (P < 0.001). The mean velocity of the decrease in SCT was 4.9 ± 3.9 µm per month during the first 3 months, 0.6 ± 1.2 µm per month between the 3rd and the 12th months, and 0.3 ± 0.3 µm per month between the 12th month and the final follow-up. The velocity of the decrease was significantly greater during the first 3 months than during the 3rd to 12th month (P < 0.001) and 12th month to final follow-up (P < 0.001) periods. The difference was not significant between the 3rd to 12th month and 12th months to final follow-up (P = 0.836) periods. CONCLUSION Subfoveal choroidal thickness continuously decreased over time, with a significant decrease of 23% noted in eyes with Type 3 macular neovascularization. The thickness rapidly decreased during the initial loading phase. Subsequently, a continuous but gradual decrease in the thickness was noted.
Collapse
Affiliation(s)
- Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | | | | | | |
Collapse
|
6
|
Pellegrini M, Bernabei F, Mercanti A, Sebastiani S, Peiretti E, Iovino C, Casini G, Loiudice P, Scorcia V, Giannaccare G. Short-term choroidal vascular changes after aflibercept therapy for neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2020; 259:911-918. [PMID: 33048236 PMCID: PMC8016768 DOI: 10.1007/s00417-020-04957-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/11/2020] [Accepted: 10/01/2020] [Indexed: 01/23/2023] Open
Abstract
Introduction The purpose of this study was to evaluate choroidal vascular changes in patients with neovascular age-related macular degeneration (nAMD) treated with aflibercept injection over a 3-month period. Methods Enhanced depth imaging optical coherence tomography scans of 60 eyes with treatment-naïve nAMD and 60 unaffected fellow eyes were retrospectively analyzed. Data was collected at baseline and after 3 monthly intravitreal injections of aflibercept. The ImageJ software was used to binarize OCT scans and measure total choroid area (TCA), luminal area (LA), and stromal area (SA). Choroidal vascularity index (CVI) was defined as the ratio of LA to TCA. Results After treatment, subfoveal choroidal thickness (CT) in nAMD eyes significantly decreased from 210. 6 ± 61.6 to 194.6 ± 58.7 μm (P < 0.001), TCA from 1.620 ± 0.502 to 1.500 ± 0.451 mm2 (P < 0.001), LA from 1.075 ± 0.335 to 0.985 ± 0.307 mm2 (P < 0.001), SA from 0.545 ± 0.176 to 0.516 ± 0.153 mm2 (P = 0.005), and CVI from 66.36 ± 2.89 to 65.46 ± 2.87% (P = 0.009). The decrease of CVI after treatment was significantly correlated with baseline CVI (Rs = 0.466, P < 0.001), but not with the change in BCVA and presence of dry macula after treatment (always P > 0.05). Conclusion Choroidal thickness and vascularity significantly decreased after treatment with aflibercept in nAMD eyes. Besides the pharmacologic effect on the neovascular lesion, aflibercept may induce vascular changes also on the underlying choroid.
Collapse
Affiliation(s)
- Marco Pellegrini
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, University of Bologna, Via Palagi 9, 40138, Bologna, Italy.
| | - Federico Bernabei
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, University of Bologna, Via Palagi 9, 40138, Bologna, Italy
| | - Andrea Mercanti
- Ophthalmology Unit, Head and Neck Department of Ophthalmology, Infermi Hospital, Rimini, Italy
| | - Stefano Sebastiani
- Ophthalmology Unit, Head and Neck Department of Ophthalmology, Infermi Hospital, Rimini, Italy
| | - Enrico Peiretti
- Department of Surgical Science, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Claudio Iovino
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - Giamberto Casini
- Ophthalmology Unit, Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Pasquale Loiudice
- Ophthalmology Unit, Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, University of "Magna Graecia", Catanzaro, Italy
| | - Giuseppe Giannaccare
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, University of Bologna, Via Palagi 9, 40138, Bologna, Italy.,Department of Ophthalmology, University of "Magna Graecia", Catanzaro, Italy
| |
Collapse
|
7
|
Invernizzi A, Benatti E, Cozzi M, Erba S, Vaishnavi S, Vupparaboina KK, Staurenghi G, Chhablani J, Gillies M, Viola F. Choroidal Structural Changes Correlate With Neovascular Activity in Neovascular Age Related Macular Degeneration. Invest Ophthalmol Vis Sci 2019; 59:3836-3841. [PMID: 30073357 DOI: 10.1167/iovs.18-23960] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To correlate changes in choroidal thickness and vascularity index with disease activity in patients with neovascular age-related macular degeneration (nAMD). Methods Eyes diagnosed with AMD that had two sequential visits within 12 months and that had no choroidal neovascularization (CNV) or had inactive CNV at the first visit were included. Those that had active CNV at follow-up were enrolled as cases. Eyes that did not developed a CNV or that were still inactive at the second visit were enrolled as controls. Disease activity was based on optical coherence tomography (OCT) and fluorescein angiography findings. Subfoveal choroidal thickness (SCT), mean choroidal thickness (MCT), and choroidal vascularity index (CVI) were assessed on enhanced depth imaging OCT and compared between the baseline and follow-up visit. Subgroup analysis accounting for lesion type and previous treatment, if any, were performed. Results Sixty-five eyes from 60 patients (35 females) and 50 age- and sex-matched controls were included. At the active visit, cases had an increase from 164 ± 67 μm to 175 ± 70 μm in mean ± SD SCT and from 144 ± 45 μm to 152 ± 45 μm in MCT (both P < 0.0001). The mean CVI also increased at from 54.5% ± 3.3% to 55.4% ± 3.8% (P = 0.04). Controls did not show significant changes in choroidal measurements between the two visits. Mean SCT, MCT, and CVI values were similar for previously treated and treatment-naive eyes. Conclusions Choroidal thickness and CVI significantly increased with active disease in nAMD eyes. Changes in choroidal thickness may predict CNV development or recurrence before they are otherwise evident clinically.
Collapse
Affiliation(s)
- Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy.,Save Sight Institute, Sydney Eye Hospital, University of Sydney, Sydney, Australia
| | - Eleonora Benatti
- Department of Clinical Sciences and Community Health, University of Milan, Ophthalmological Unit, IRCCS-Cà Granda Foundation - Ospedale Maggiore Policlinico, Milan, Italy
| | - Mariano Cozzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Stefano Erba
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, 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
| | | | - Mark Gillies
- Save Sight Institute, Sydney Eye Hospital, University of Sydney, Sydney, Australia
| | - Francesco Viola
- Department of Clinical Sciences and Community Health, University of Milan, Ophthalmological Unit, IRCCS-Cà Granda Foundation - Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
8
|
Kim JH, Chang YS, Kim JW, Kim CG, Lee DW. Long-term incidence and timing of reactivation in patients with type 3 neovascularization after initial treatment. Graefes Arch Clin Exp Ophthalmol 2019; 257:1183-1189. [PMID: 30931489 DOI: 10.1007/s00417-019-04306-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 02/12/2019] [Accepted: 03/21/2019] [Indexed: 01/20/2023] Open
Abstract
PURPOSE The purpose of the present study was to evaluate the long-term incidence and timing of reactivation in patients with type 3 neovascularization who were treated with three monthly anti-vascular endothelial growth factor (VEGF) injections. METHODS A total of 179 patients (179 eyes) diagnosed with type 3 neovascularization with dry macula after three monthly anti-VEGF loading injections were included in this retrospective study. After the initial treatment, patients were followed up without further injection until the first reactivation. The incidence and timing of the first reactivation after the initial treatment were recorded, and factors predictive of early reactivation (≤ 6 months after the third anti-VEGF injection) were investigated. RESULTS During a mean follow-up of 37.5 ± 18.8 months, the first reactivation was noted in 145 patients (81.0%) at a mean of 6.6 ± 4.1 months after the third injection. In 94 eyes (64.8%), reactivation was noted 2-6 months after the third injection, while in 37 eyes (25.5%) it was noted 7-12 months after the third injection. In the remaining 14 eyes (9.7%), the reactivation was noted after this period. The incidence of early reactivation was higher in women (P = 0.014) and patients with thicker choroid (P = 0.026). CONCLUSIONS In patients with type 3 neovascularization, almost all reactivation was noted within 15 months of the third anti-VEGF injection, suggesting the need for close follow-up and detailed examination during this period. Female patients with thick choroid should be monitored more frequently during this early period.
Collapse
Affiliation(s)
- Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea.
| | - Young Suk Chang
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, South Korea
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
| | - Dong Won Lee
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
| |
Collapse
|
9
|
Bouteleux V, Kodjikian L, Mendes M, Agard E, Machkour-Bentaleb Z, El-Chehab H, Denis P, Mathis T, Dot C. Increased choroidal thickness: a new feature to monitor age-related macular degeneration recurrence. Graefes Arch Clin Exp Ophthalmol 2018; 257:699-707. [PMID: 30554268 DOI: 10.1007/s00417-018-04216-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/27/2018] [Accepted: 12/06/2018] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The main objective of this study was to assess choroidal thickness (CT) changes during an exudative recurrence of age-related macular degeneration (AMD). METHODS A real-life prospective non-interventional 9-month study was conducted in two centers in consecutive patients with exudative AMD between November 2016 and July 2017. CT was measured manually in both eyes based on enhanced-depth imaging spectral-domain optical coherence tomography at different follow-up visits scheduled in the morning. RESULTS A total of 134 patients were included. Ninety-five patients presented at least one episode, defined by a follow-up visit under controlled condition (dry retina) followed by a visit for exudative recurrence. A total of 119 episodes were analyzed. The mean CT change in the treated eye was + 8.45 ± 13.52 μm (p < 0.001) and + 5.62 ± 14.77 μm (p = 0.009) respectively in the subfoveal area and nasal area. No significant change in CT was observed in the fellow eye. No significant association between CT changes and treatment, number of intravitreal injections, and blood pressure was observed. CONCLUSION CT increased in case of exudative recurrence of neovascular AMD. The increase was mild but significant. Thus, CT could be used as a monitoring criterion, like the central retinal thickness, in AMD management.
Collapse
Affiliation(s)
- Victor Bouteleux
- Hôpital d'Instruction des Armées Desgenettes, 108 Boulevard Pinel, 69003, Lyon, France.
- Hôpital de la Croix-Rousse - HCL, 103 Grande rue de la Croix Rousse, 69004, Lyon, France.
- Service d'Ophtalmologie, Hopital de la Croix Rousse, 103 grande rue de la Croix Rousse, 69317, Lyon cedex 04, France.
| | - Laurent Kodjikian
- Hôpital de la Croix-Rousse - HCL, 103 Grande rue de la Croix Rousse, 69004, Lyon, France
| | - Maud Mendes
- Hôpital d'Instruction des Armées Desgenettes, 108 Boulevard Pinel, 69003, Lyon, France
- Hôpital de la Croix-Rousse - HCL, 103 Grande rue de la Croix Rousse, 69004, Lyon, France
| | - Emilie Agard
- Hôpital d'Instruction des Armées Desgenettes, 108 Boulevard Pinel, 69003, Lyon, France
| | | | - Hussam El-Chehab
- Hôpital de la Croix-Rousse - HCL, 103 Grande rue de la Croix Rousse, 69004, Lyon, France
| | - Philippe Denis
- Hôpital de la Croix-Rousse - HCL, 103 Grande rue de la Croix Rousse, 69004, Lyon, France
| | - Thibaud Mathis
- Hôpital de la Croix-Rousse - HCL, 103 Grande rue de la Croix Rousse, 69004, Lyon, France
- CNRS UMR, 5510 Matéis, 69621, Villeurbanne, France
| | - Corinne Dot
- Hôpital d'Instruction des Armées Desgenettes, 108 Boulevard Pinel, 69003, Lyon, France
- Ecole du Val-de-Grâce, 74 Boulevard de Port-Royal, 75005, Paris, France
| |
Collapse
|
10
|
Kumar JB, Wai KM, Ehlers JP, Singh RP, Rachitskaya AV. Subfoveal choroidal thickness as a prognostic factor in exudative age-related macular degeneration. Br J Ophthalmol 2018; 103:918-921. [PMID: 30150279 DOI: 10.1136/bjophthalmol-2018-312625] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/25/2018] [Accepted: 08/03/2018] [Indexed: 11/04/2022]
Abstract
AIMS To investigate the relationship between subfoveal choroidal thickness (SFCT), visual acuity (VA), optical coherence tomography (OCT) features and total anti-vascular endothelial growth factor (VEGF) treatments to determine whether SFCT serves as a prognostic factor in age-related macular degeneration (AMD). METHODS This is a retrospective case series of 62 consecutive treatment-naive patients with exudative AMD followed for 1 year and treated with treat-and-extend or pro re nata anti-VEGF protocols. SFCT was measured at three locations using Cirrus HD-OCT (the foveal centre and 500 um nasal and temporal to the fovea) at presentation, 3, 6 and 12 months. Demographic characteristics, OCT imaging biomarkers and VA were recorded. RESULTS Mean SFCT at baseline was 187 µm (range: 70-361 µm). There was a trend of decreasing SFCT at 1 year (173 µm) compared with 3 months (175 µm) and baseline (188 µm) (p=0.2). There was no correlation between baseline SFCT and presence of subretinal fluid (p=0.2), intraretinal fluid (p=0.6) or subretinal hyper-reflective material (p=0.4) at baseline. The mean number of injections at 1 year was 6.6 (range: 2-12). Increased SFCT at baseline showed statistically significant correlation with a higher number of intravitreal injections at 1 year (p=0.004). Eyes with SFCT>1 SD above the mean required 50% more injections compared with others. There was no association between SFCT on presentation with baseline and 1 year VA (p=0.7 and p=0.2). CONCLUSIONS SFCT in naïve patients with exudative AMD may be an important prognostic tool in determining treatment burden. Patients with thicker subfoveal choroid may require increased intravitreal injections.
Collapse
Affiliation(s)
- Jaya B Kumar
- Cleveland Clinic Department of Ophthalmology, Cole Eye Institute, Cleveland, Ohio, USA
| | - Karen M Wai
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Justin P Ehlers
- Cleveland Clinic Department of Ophthalmology, Cole Eye Institute, Cleveland, Ohio, USA
| | - Rishi P Singh
- Cleveland Clinic Department of Ophthalmology, Cole Eye Institute, Cleveland, Ohio, USA
| | | |
Collapse
|
11
|
Wong SS, Vuong VS, Cunefare D, Farsiu S, Moshiri A, Yiu G. Macular Fluid Reduces Reproducibility of Choroidal Thickness Measurements on Enhanced Depth Optical Coherence Tomography. Am J Ophthalmol 2017; 184:108-114. [PMID: 29038011 PMCID: PMC5705394 DOI: 10.1016/j.ajo.2017.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/04/2017] [Accepted: 10/06/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE To determine if different types of retinal fluid in the central macula affect the reproducibility of choroidal thickness (CT) measurements on enhanced depth imaging optical coherence tomography (EDI-OCT). DESIGN Retrospective reliability analysis. METHODS EDI-OCT images were obtained and the choroidal-scleral junction was analyzed through semiautomated segmentation. CT was measured at the fovea and averaged across the central 3-mm horizontal segment. Demographic data, central macular thickness, and type of fluid present were recorded. Intragrader and intergrader repeatability were assessed using the intraclass correlation coefficient (ICC) and coefficient of repeatability (CR). RESULTS Of 124 eyes analyzed, 60 (48.4%) had diabetic macular edema, 32 (25.8%) had neovascular age-related macular degeneration, and 32 (25.8%) had other causes of fluid. Intergrader ICC (CR) was 0.95 (74.1 μm) and 0.96 (63.9 μm) for subfoveal and average CT, respectively. CR was similar across various causes of retinal fluid, but was worst for subretinal fluid compared to intraretinal or sub-retinal pigment epithelial fluid. CR also worsened with increasing choroidal thickness, but was not affected by retinal thickness. Intragrader repeatability was generally greater than intergrader values, and followed the same trend. CONCLUSIONS The presence of macular fluid reduces CT measurement reproducibility, particularly in eyes with subretinal fluid and greater choroidal thickness. A difference of 74.1 μm in subfoveal CT or 63.9 μm in average CT may be necessary to detect true clinical change in eyes with macular fluid.
Collapse
Affiliation(s)
- Sophia S Wong
- Department of Ophthalmology, University of California, Davis, Sacramento, California
| | - Vivian S Vuong
- Department of Ophthalmology, University of California, Davis, Sacramento, California
| | - David Cunefare
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Sina Farsiu
- Department of Biomedical Engineering, Duke University, Durham, North Carolina; Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Ala Moshiri
- Department of Ophthalmology, University of California, Davis, Sacramento, California
| | - Glenn Yiu
- Department of Ophthalmology, University of California, Davis, Sacramento, California.
| |
Collapse
|
12
|
Tsai AS, Cheung N, Gan AT, Jaffe GJ, Sivaprasad S, Wong TY, Cheung CMG. Retinal angiomatous proliferation. Surv Ophthalmol 2017; 62:462-492. [DOI: 10.1016/j.survophthal.2017.01.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 01/24/2017] [Accepted: 01/27/2017] [Indexed: 01/06/2023]
|
13
|
Vujosevic S, Martini F, Midena E. Stage 1 Type 3 Neovascularization With Choroidal Dilation Unresponsive to Anti-VEGF Treatment. Ophthalmic Surg Lasers Imaging Retina 2016; 47:956-959. [DOI: 10.3928/23258160-20161004-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 06/13/2016] [Indexed: 11/20/2022]
|