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Toto L, Ruggeri ML, D'Aloisio R, De Nicola C, Trivigno C, Cerino L, Di Marzio G, Di Nicola M, Porreca A, Mastropasqua R. Brolucizumab Intravitreal Injection in Macular Neovascularization Type 1: VA, SD-OCT, and OCTA Parameter Changes during a 16-Week Follow-Up. Ophthalmic Res 2022; 66:218-227. [PMID: 36162382 DOI: 10.1159/000526851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/31/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to assess early anatomical and functional changes after brolucizumab intravitreal injection (BIVI) in patients with age-related macular degeneration (AMD) and macular neovascularization type 1 (MNV1). METHODS A total of 24 eyes of 24 patients suffering from naïve AMD with MNV1 candidates to BIVI as per label with q12/q8 dosing regimen after the loading dose were enrolled in this prospective study. Main outcome measures during a 16-week follow-up period included changes in best corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal subretinal fluid (SSRF) thickness (SSRFT), subfoveal sub-retinal pigment epithelium (RPE) fluid thickness (SSRPEFT), subfoveal choroidal thickness (SFCT), and pigment epithelial detachment (PED) maximum height (PED-MH). In addition, MNV1 flow area; percentages of eyes with intraretinal fluid (IRF), subretinal fluid, and sub-RPE fluid at different time points; and percentages of eyes candidates to a q8 or q12 injection interval after disease activity assessment at week 16 were evaluated. RESULTS BCVA improved significantly from baseline (T0) to week 12 (T3) (p = 0.028). CMT showed a significant reduction from 456 ± 123 µm at T0 to 265 ± 85 µm at T3 (p < 0.001). SSRFT and SSRPEFT reduced significantly as well (p < 0.001 and p = 0.049, respectively). PED-MH and SFCT reduced significantly at the different time points (p = 0.020; p = 0.006, respectively). IRF presence changed significantly from 41.7% of eyes at T0 to 20.8% at T3 (p = 0.045). SSRF reduced significantly during follow-up, being present in 62.5% of eyes at T0 and 4.2% of eyes at T3 (p < 0.001). Subfoveal sub-RPE fluid decreased significantly during time, being present in 20.8% of eyes at T0 and 0% at T3 (p = 0.013). Most of the eyes (18 eyes, 75%) at week 16 after disease activity assessment were shifted in the q12 interval, and only a minority of eyes shifted in a q8 interval (6 eyes, 25%). CONCLUSION Brolucizumab is efficient in AMD patients with MNV1 by reducing all retinal fluids during the loading phase and shows reduction of macular thickness, choroidal thickness, and PED height. Most eyes at disease activity assessment (75%) fall into 12-week interval and the minority (25%) into the 8-week interval.
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Affiliation(s)
- Lisa Toto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Maria Ludovica Ruggeri
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Rossella D'Aloisio
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Chiara De Nicola
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Chiara Trivigno
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Luca Cerino
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Guido Di Marzio
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Marta Di Nicola
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, University "G. D'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Annamaria Porreca
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, University "G. D'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Rodolfo Mastropasqua
- Ophthalmology Clinic, Department of Neurosciences, Imaging and Clinical Science, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
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Modern trends in diagnostics and prediction of results of anti-vascular endothelial growth factor therapy of pigment epithelial detachment in neovascular agerelated macular degeneration using deep machine learning method (literature review). ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.6-1.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Detachment of the pigment epithelium is the separation of the basement membrane of the retinal pigment epithelium from the inner collagen layer of Bruch’s membrane, which occurs in 80 % of cases in patients with neovascular age-related macular degeneration. The outcome of anti-VEGF therapy for pigment epithelial detachment may be adherence of the pigment epithelium, the formation of pigment epithelium tear, or preservation of the detachment. The pigment epithelium tear of 3–4th degrees can lead to a sharp decrease in visual acuity.Most retrospective studies confi rm the absence of a proven correlation between anatomical and functional outcomes in the treatment of pigment epithelial detachment in cases of maintaining the integrity of the pigment epithelium monolayer, and therefore the main attention of researchers is focused on studying the morphological features of pigment epithelial detachment during therapy with angiogenesis inhibitors. Modern technologies of spectral optical coherence tomography make it possible to evaluate detailed quantitative parameters of pigment epithelium detachment, such as height, width, maximum linear diameter, area, volume and refl ectivity within the detachment.Groups of Russian and foreign authors identify various biomarkers recorded on optical coherence tomography images. Dynamic registration of such biomarkers expands the ability of clinicians to predict morphological changes in pigment epithelial detachment during anti-VEGF therapy, as well as to optimize treatment regimens to prevent complications in the form of pigment epithelium tear leading to a decrease in visual acuity.Modern methods of deep machine learning and the use of neural networks allow achieving higher accuracy in diff erentiating the types of retinal fluids and automating the quantitative determination of fl uid under the pigment epithelium. These technologies allow achieving a high level of compliance with manual expert assessment and increasing the accuracy and speed of predicting morphological results of treatment of pigment epithelium detachments.
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PREDICTIVE ACTIVATION BIOMARKERS OF TREATMENT-NAIVE ASYMPTOMATIC CHOROIDAL NEOVASCULARIZATION IN AGE-RELATED MACULAR DEGENERATION. Retina 2021; 40:1224-1233. [PMID: 31259809 DOI: 10.1097/iae.0000000000002604] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the long-term evolution of treatment-naive quiescent choroidal neovascularization (CNV), in age-related macular degeneration (AMD), to identify predictive activation biomarkers. METHODS Patients with quiescent CNV underwent a comprehensive ophthalmological examination, including fluorescein and indocyanine green angiographies, structural optical coherence tomography (OCT), and OCT angiography. Qualitative and quantitative analyses of structural OCT and OCT angiography images were performed during the study period. At the last follow-up evaluation, the enrolled eyes were divided into two groups: eyes with quiescent CNV converting to exudative AMD (eAMD) and those not progressing to eAMD. RESULTS Sixty-eight eyes of 68 patients were enrolled in the study. Mean follow-up duration was 40 ± 28 months using multimodal imaging and 22 ± 13 months using OCT angiography. On structural OCT, quiescent CNV not converting to eAMD showed a preferential growth of the pigment epithelium detachment greatest linear diameter (P = 0.009), whereas the eAMD group presented a preferential growth of the pigment epithelium detachment maximal height (P < 0.0001) during the study period. Quantitative analysis of choriocapillaris OCT angiograms confirmed the CNV area growth during follow-up (from 4.18 ± 4.77 mm at baseline to 5.10 ± 5.06 mm at the last follow-up visit; P = 0.02). CONCLUSION A close follow-up is recommended to early identify predictive activation biomarkers of treatment-naive quiescent CNV.
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Budzinskaya MV, Shelankova AV. [Retinal pigment epithelial tear in age-related macular degeneration]. Vestn Oftalmol 2021; 137:115-120. [PMID: 34156786 DOI: 10.17116/oftalma2021137031115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Retinal pigment epithelial tear (RPET) occurs in a number of diseases, most often in age-related macular degeneration (AMD). RPET develops in the setting of retinal pigment epithelium (RPE) detachment and represents a violation of the integrity of its monolayer accompanied by the formation of a demarcation line between the RPE atrophy area and RPE folds. Its incidence varies widely. In the earlier studies, diagnosis of RPET was performed using fluorescent angiography or angiography with indocyanine green (ICG-FA). The advent of optical coherence tomography made the detection of RPET easier and more accessible. The mechanism of RPET formation is quite polymorphic and ambiguous. Scientific literature contains descriptions of the occurrence of RPET when using both ranibizumab and aflibercept, and bevacizumab in equal proportions, implying that the drug choice does not affect the occurrence of complications. Continuous monitoring and adherence to anti-VEGF therapy leads to better anatomical and functional results in the long term, which is crucial for improving the quality of life of patients with age-related macular degeneration. This article reviews the literature and presents current data on RPET, identifies risk factors and mechanisms of its development, provides classification, and describes modern options for its diagnosis and treatment.
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Rispoli M, Eandi CM, Di Antonio L, Kilian R, Montesel A, Savastano MC. Biomarkers in Early Response to Brolucizumab on Pigment Epithelium Detachment Associated with Exudative Age-Related Macular Degeneration. Biomedicines 2021; 9:biomedicines9060668. [PMID: 34200829 PMCID: PMC8230427 DOI: 10.3390/biomedicines9060668] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/05/2021] [Accepted: 06/07/2021] [Indexed: 01/05/2023] Open
Abstract
Background: The purpose of this study was to describe early changes in the morphology of pigment epithelium detachments (PED) after an intravitreal injection of Brolucizumab into eyes with macular neovascularization secondary to exudative age-related macular degeneration (e-AMD). Method: We included twelve eyes of 12 patients with PED secondary to e-AMD which were not responding to prior anti-VEGF treatments. An ophthalmic examination and an assessment of PED-horizontal maximal diameter (PED-HMD), PED-maximum high (PED-MH) and macular neovascularization (MNV) flow area (MNV-FA) by the means of structural optical coherence tomography (OCT) and OCT Angiography (OCT-A) were performed at baseline, as well as 1, 7, 14 and 30 days after the injection. Results: The mean age of the population of study was 78.4 (SD ± 4.8). The mean number of previous Ranibizumab or Aflibercept injections was 13 (SD ± 8). At the last follow-up visit, the PED-HMD did not significantly change (p = 0.16; F(DF:1.94, 20,85) = 1.9), the PED-MH showed a significant reduction [p = 0.01; F(DF:1.31, 14.13) = 6.84.] and the MNV-FA did not significantly differ (p = 0.1; F(1.97, 21.67) = 2.54) from baseline. No signs of ocular inflammation were observed during follow-up. Conclusions: A single Brolucizumab injection was able to determine the short-term effects on PEDs’ anatomical features of eyes with an unresponsive e-AMD.
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Affiliation(s)
- Marco Rispoli
- Chorioretinal Vasculopathies Unit, Surgery and Emergency Ophthalmology Department, Eye Hospital, 00136 Rome, Italy;
| | - Chiara M. Eandi
- Department of Ophthalmology, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, 1002 Lausanne, Switzerland;
- Department of Surgical Sciences, University of Torino, 10126 Torino, Italy
- Correspondence: ; Tel.: +41-21-626-8880
| | - Luca Di Antonio
- UOC Ophthalmology and Surgery Department, ASL-1 Avezzano-Sulmona, 67051 L’Aquila, Italy;
| | - Raphael Kilian
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy;
| | - Andrea Montesel
- Department of Ophthalmology, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, 1002 Lausanne, Switzerland;
| | - Maria C. Savastano
- Unit of Ophthalmology, Fondazione Policlinico A Gemelli, IRCCS, 00168 Rome, Italy;
- Department of Ophthalmology, Università Cattolica Sacro Cuore, 00168 Rome, Italy
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Capuano V, Sacconi R, Borrelli E, Miere A, Gelormini F, Farci R, Bandello F, Souied EH, Querques G. Dimple in vascularized serous pigment epithelial detachment secondary to neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2020; 258:1597-1605. [PMID: 32409980 DOI: 10.1007/s00417-020-04732-6] [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: 11/11/2019] [Revised: 03/24/2020] [Accepted: 04/29/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND To describe the "dimple," a previously unreported structural optical coherence tomography (OCT) finding in vascularized serous pigment epithelial detachment (PED) secondary to neovascular age-related macular degeneration (AMD). METHODS Retrospective, longitudinal, case series study. Clinical charts and multimodal imaging including OCT (structural and angiography) and dye-based angiography (fluorescein and indocyanine green) examinations of patients with dimple-defined as a localized invagination of the vascularized serous PED-were analyzed in 2 high-volume referral centers. RESULTS Nineteen eyes of 18 patients were included. Mean follow-up was at 64.1 ± 35.8 months. The greater basal and height diameters of the vascularized serous PED were respectively 3425.8 ± 1049.6 μm and 667.1 ± 279.9 μm at baseline and 3076.2 ± 1649.9 μm (p = 0.8) and 368.3 ± 295.1 at last follow-up (p = 0.0006). OCT analysis identified 2 phenotypes of dimple: type 1 or ("top denting") (9 eyes) and type 2 (or "side denting") (10 eyes). Both phenotypes are associated with hyper-reflective holding sub-retinal pigment epithelium (RPE) band encompassing the posterior face of the RPE and extending to the Bruch's membrane. Hyper-reflective holding band is not correlated with angiographic signs of neovascular tissue in all cases. During follow-up, no case of RPE tear was observed. CONCLUSIONS We describe the characteristics of the dimple and its association with hyper-reflective holding sub-RPE bands in the context of large vascularized serous PED in neovascular AMD. The presence of a dimple does not seem to be an additional risk factor for the development of RPE tearing in high-risk PED secondary to neovascular AMD.
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Affiliation(s)
- Vittorio Capuano
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil University Paris Est Créteil, 40 Avenue de Verdun, 94000, Créteil, France
| | - Riccardo Sacconi
- Department of Ophthalmology, IRCCS Hospital San Raffaele, University Vita-Salute, Milan, Italy
| | - Enrico Borrelli
- Department of Ophthalmology, IRCCS Hospital San Raffaele, University Vita-Salute, Milan, Italy
| | - Alexandra Miere
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil University Paris Est Créteil, 40 Avenue de Verdun, 94000, Créteil, France
| | - Francesco Gelormini
- Department of Ophthalmology, IRCCS Hospital San Raffaele, University Vita-Salute, Milan, Italy
| | - Roberta Farci
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil University Paris Est Créteil, 40 Avenue de Verdun, 94000, Créteil, France
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS Hospital San Raffaele, University Vita-Salute, Milan, Italy
| | - Eric H Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil University Paris Est Créteil, 40 Avenue de Verdun, 94000, Créteil, France
| | - Giuseppe Querques
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil University Paris Est Créteil, 40 Avenue de Verdun, 94000, Créteil, France. .,Department of Ophthalmology, IRCCS Hospital San Raffaele, University Vita-Salute, Milan, Italy.
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Au A, Hou K, Dávila JP, Gunnemann F, Fragiotta S, Arya M, Sacconi R, Pauleikhoff D, Querques G, Waheed N, Freund KB, Sadda S, Sarraf D. Volumetric Analysis of Vascularized Serous Pigment Epithelial Detachment Progression in Neovascular Age-Related Macular Degeneration Using Optical Coherence Tomography Angiography. ACTA ACUST UNITED AC 2019; 60:3310-3319. [DOI: 10.1167/iovs.18-26478] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Adrian Au
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
| | - Kirk Hou
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
| | - Juan Pablo Dávila
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
| | | | - Serena Fragiotta
- Vitreous Retina Macula Consultants of New York, New York, New York, United States
| | - Malvika Arya
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - Riccardo Sacconi
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | | | - Giuseppe Querques
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Nadia Waheed
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - K. Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, United States
| | - SriniVas Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, United States
| | - David Sarraf
- Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California, United States
- Greater Los Angeles VA Healthcare Center, Los Angeles, California, United States
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