1
|
Zur D, Guymer R, Korobelnik JF, Wu L, Viola F, Eter N, Baillif S, Chen Y, Arnold JJ. Impact of residual retinal fluid on treatment outcomes in neovascular age-related macular degeneration. Br J Ophthalmol 2024:bjo-2024-325640. [PMID: 39033013 DOI: 10.1136/bjo-2024-325640] [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: 04/05/2024] [Accepted: 06/30/2024] [Indexed: 07/23/2024]
Abstract
Treatment decisions for neovascular age-related macular degeneration (nAMD) in the setting of individualised treatment regimens are adapted to disease activity. The main marker of disease activity and trigger for re-treatment with anti-vascular endothelial growth factor (anti-VEGF) agents is the presence of retinal fluid on optical coherence tomography (OCT). Recently, attention has focused on the impact of residual retinal fluid on nAMD management. Based on a literature review and the combined clinical experience of an international group of retinal specialists, this manuscript provides expert guidance on the treatment of nAMD according to fluid status and proposes an algorithm for determining when to administer anti-VEGF treatment according to residual fluid status. We explore the role of residual fluid in treatment decisions and outcomes in nAMD, taking into consideration fluid evaluation and, in particular, distinguishing between fluid in different anatomic compartments and at different stages during the treatment course. Current limitations to identifying and interpreting fluid on OCT, and the assumption that any residual retinal fluid reflects ongoing VEGF activity, are discussed.
Collapse
Affiliation(s)
- Dinah Zur
- Faculty of Medical and Health Sciences, Ophthalmology Division, Tel Aviv University, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Robyn Guymer
- Royal Victorian Eye and Ear Hospital, University of Melbourne, Centre for Eye Research Australia, Melbourne, Victoria, Australia
| | - Jean-François Korobelnik
- Service d'ophtalmologie, CHU Bordeaux, Bordeaux, France
- Inserm, Bordeaux Population Health Research Center, Team LEHA, UMR 1219, F-33000, Université de Bordeaux, Bordeaux, France
| | - Lihteh Wu
- Macula, Vitreous and Retina Associates of Costa Rica, San José, Costa Rica
| | - Francesco Viola
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
- Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicole Eter
- Department of Ophthalmology, University of Münster Medical Center, Münster, Germany
| | - Stéphanie Baillif
- Department of Ophthalmology, Pasteur 2 Hospital, Nice Cote d'Azur University, Nice, France
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | | |
Collapse
|
2
|
Arora S, Zur D, Iovino C, Chhablani J. Peripapillary fluid: Obvious and not so obvious! Surv Ophthalmol 2024; 69:311-329. [PMID: 38016521 DOI: 10.1016/j.survophthal.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023]
Abstract
Intraretinal or subretinal fluid in the peripapillary area can be clinically visualized in conditions such as peripapillary choroidal neovascularization, optic disc pit maculopathy, and optic nerve head tumors and granulomas. Optical coherence tomography (OCT) helps to visualize peripapillary fluid in many other chorioretinal conditions such as peripapillary pachychoroid syndrome, posterior uveitis, central retinal vein occlusion, malignant hypertension, hypotonic maculopathy as well as neuro-ophthalmological conditions such as glaucoma, microcystic macular edema and disc edema due papilledema, non-arteritic anterior ischemic optic neuropathy, neuroretinitis, and diabetic papillopathy. Often, the differential diagnosis of peripapillary fluid is a bit tricky and may lead to misdiagnosis and improper management. We describe a diagnostic algorithm for peripapillary fluid on OCT and outline the salient features and management of these conditions.
Collapse
Affiliation(s)
- Supriya Arora
- Bahamas Vision Centre and Princess Margaret Hospital, Nassau NP, Bahamas
| | - Dinah Zur
- Division of Ophthalmology, 26738 Tel Aviv Sourasky Medical Centre, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Claudio Iovino
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Jay Chhablani
- University of Pittsburgh, UPMC Eye Center, Pittsburgh, United States.
| |
Collapse
|
3
|
Zhang C, Mao J, Zhang S, Zheng Z, Zhang Z, Xiang Z, Chen Y, Shen L. Analysis of Cytokine Levels Based on Optical Coherence Tomography Findings in Acute and Chronic Central Serous Chorioretinopathy. Curr Eye Res 2023; 48:1153-1159. [PMID: 37615383 DOI: 10.1080/02713683.2023.2250584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/25/2023] [Accepted: 08/16/2023] [Indexed: 08/25/2023]
Abstract
Purpose: To investigate the characteristics of optical coherence tomography (OCT) and aqueous humor cytokine differences between acute and chronic central serous chorioretinopathy (CSC) and to evaluate the relevance of these findings.Methods: This was a cross-sectional, observational study. Patients with CSC were divided into acute and chronic groups based on the symptom duration and were compared with normal controls. Best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (CT), hyperreflective foci (HF), and cytokines including vascular endothelial growth factor (VEGF), interleukin (IL)-6, IL-8, IL-10, interferon-inducible protein-10 (IP-10), and monocyte chemoattractant protein-1 (MCP-1) were used as comparison metrics.Results: A total of 62 patients (62 eyes) with CSC (22 with acute CSC and 40 with chronic CSC) and 35 patients as controls were included in this study. The chronic CSC group had significantly older average ages and worse BCVA than the acute CSC group (both p < 0.05). Both CSC groups showed significant increases in CMT and CT (both p < 0.05). In chronic CSC, the CMT was thinner, with more HF in the neuroretina (p = 0.034). VEGF levels were significantly higher in patients with chronic CSC than in those with acute CSC and controls (p < 0.05). The levels of inflammatory cytokines showed no significant difference between the CSC and control groups. Spearman's correlation analysis showed that the number of HF was positively correlated with disease duration (r = 0.311, p = 0.014), logMAR BCVA (r = 0.487, P < 0.001) and MCP-1 levels (r = 0.256, p = 0.045).Conclusions: Chronicity of CSC could lead to upregulation of VEGF. HF was associated with a more severe visual impairment in CSC patients and had relations with the levels of MCP-1.
Collapse
Affiliation(s)
- Caiyun Zhang
- Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, P.R. China
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Jianbo Mao
- Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, P.R. China
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Shian Zhang
- Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, P.R. China
| | - Zicheng Zheng
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Zhengxi Zhang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Ziyi Xiang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Yiqi Chen
- Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, P.R. China
| | - Lijun Shen
- Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, P.R. China
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| |
Collapse
|
4
|
Zvorničanin J, Zvorničanin E, Popović M. Accuracy of biomicroscopy, ultrasonography and spectral-domain OCT in detection of complete posterior vitreous detachment. BMC Ophthalmol 2023; 23:488. [PMID: 38017434 PMCID: PMC10685579 DOI: 10.1186/s12886-023-03233-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND To evaluate the accuracy of preoperative biomicroscopy (BM), ultrasonography (US), and spectral domain optical coherence tomography (SD-OCT) to determine complete posterior vitreous detachment (PVD) confirmed by intraoperative findings of triamcinolone acetonide-assisted pars plana vitrectomy (PPV). METHODS This prospective study included all consecutive patients admitted for surgical treatment of the epiretinal membrane (ERM) and macular hole (MH). The presence of complete PVD was determined one day before PPV using BM, US, SD-OCT. The preoperative findings were compared to the PVD status determined during PPV. RESULTS A total of 123 eyes from 123 patients were included in the study. Indications for PPV included ERM in 57 (46.3%), full thickness macular hole in 57 (46.3%) and lamellar macular hole in 9 (7.3%) patients. Complete PVD during PPV was observed in 18 (31.6%; 95%CI:18.7-49.9) patients with ERM and 13 (19.7%; 95%CI:10.4-33.7) patients with MH. The sensitivity of preoperative BM, US, SD-OCT was 48.4% (95%CI:30.2-66.9), 61.3% (95%CI:42.2-78.2) and 54.8% (95%CI:36.0-72.7) respectively. The specificity of preoperative BM, US, SD-OCT was 81.5% (95%CI:72.1-88.9), 90.2% (95%CI:82.2-95.4) and 85.9% (95%CI:77.0-92.3) respectively. With a prevalence of 25.2% of PVD in our sample the positive predictive value of preoperative BM, US, SD-OCT was 46.9% (95%CI:29.1-65.3), 67.9% (95%CI:47.6-84.1) and 56.7% (95%CI:37.4-74.5) respectively. CONCLUSION Preoperative BM, US, and SD-OCT showed relatively low sensitivity but also good specificity in assessing complete PVD. A combination of all three diagnostic methods can provide a good assessment of the vitreoretinal interface state.
Collapse
Affiliation(s)
- Jasmin Zvorničanin
- Department of Ophthalmology, University Clinical Centre Tuzla, 75000, Tuzla, Bosnia and Herzegovina.
- Faculty of Health Studies, University of Bihać, 77000, Bihać, Bosnia and Herzegovina.
| | - Edita Zvorničanin
- Private Healthcare Institution "Vase Zdravlje", 75000, Tuzla, Bosnia and Herzegovina
| | - Maja Popović
- Department of Medical Sciences, Cancer Epidemiology Unit, University of Turin and CPO-Piemonte, 10125, Turin, Italy
| |
Collapse
|
5
|
Palan P, Bhopalka AK, Takkar B. Intraoperative optical coherence tomography-guided management of optic-disc-pit maculopathy. BMJ Case Rep 2023; 16:e254884. [PMID: 37669826 PMCID: PMC10481729 DOI: 10.1136/bcr-2023-254884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Affiliation(s)
- Parth Palan
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
| | | | - Brijesh Takkar
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
- Indian Health Outcomes, Public Health and Econimics (IHOPE) Research Centre, Hyderabad, India
| |
Collapse
|
6
|
Cehofski LJ, Kojima K, Kusada N, Rasmussen M, Muttuvelu DV, Grauslund J, Vorum H, Honoré B. Macular Edema in Central Retinal Vein Occlusion Correlates With Aqueous Fibrinogen Alpha Chain. Invest Ophthalmol Vis Sci 2023; 64:23. [PMID: 36820679 PMCID: PMC9970003 DOI: 10.1167/iovs.64.2.23] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Purpose The global protein profile of the aqueous humor has been found to correlate with the severity of retinal vascular disease. Studying the aqueous humor in central retinal vein occlusion (CRVO) with proteomic techniques may bring insights to the molecular mechanisms underlying the condition. Methods Aqueous humor samples from treatment naïve patients with CRVO complicated by macular edema (n = 28) and age-matched controls (n = 20) were analyzed by label-free quantification liquid chromatography - tandem mass spectrometry. Best corrected visual acuity (BCVA) was measured as logMAR, and the severity of macular edema was evaluated as central retinal thickness (CRT) with optical coherence tomography. Control samples were obtained prior to cataract surgery. Significantly changed proteins were identified by a permutation-based calculation with a false discovery rate of 0.05. Results A total of 177 proteins were differentially expressed in CRVO. Regulated proteins were involved in complement activation, innate immune response, blood coagulation, and cell adhesion. Upregulated proteins that correlated with BCVA and CRT included fibrinogen alpha, beta, and gamma chains, fibronectin, Ig lambda-6 chain C region, Ig alpha-1 chain C region, and complement C7. Downregulated proteins that correlated negatively with BCVA, and CRT, included procollagen C-endopeptidase enhancer 1, clusterin, opticin, reelin, fibrillin-1, and cadherin-2. Monocyte differentiation antigen CD14 and lipopolysaccharide-binding protein were increased in CRVO. Conclusions Fibrinogen chains, fibronectin, and immunoglobulin components correlated with BCVA and CRT, suggesting a multifactorial response. Protective anti-angiogenic proteins, including procollagen C-endopeptidase enhancer 1, clusterin, and opticin, were downregulated in CRVO and correlated negatively with BCVA and CRT.
Collapse
Affiliation(s)
- Lasse Jørgensen Cehofski
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kentaro Kojima
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Natsuki Kusada
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Maja Rasmussen
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
| | - Danson Vasanthan Muttuvelu
- Department of Ophthalmology, Copenhagen University Hospital, Copenhagen, Denmark,University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Vorum
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Bent Honoré
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
7
|
Li M, Jiang S, Chen W. Intralenticular Ozurdex injection in an eye with thicker lens and the therapeutic effect maintained for 15 months. Heliyon 2022; 8:e12219. [PMID: 36544831 PMCID: PMC9761714 DOI: 10.1016/j.heliyon.2022.e12219] [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: 03/09/2022] [Revised: 11/01/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction To report a case of accidental intralenticular Ozurdex injection in an eye with thicker lens. During the follow-up period of 15 months, the therapeutic effect of intralenticular Ozurdex was maintained. Case description Ozurdex was accidently injected into the lens of an eye with uveitis, and the lens thickness was measured to be 5.70 mm. The uveitis was under good control, and no significant development of cataract was observed until 7 months after the intralenticular Ozurdex injection. Then due to the outbreak of COVID-19, follow-up was suspended. Fifteen months after the injection, the patient returned to the doctor. At this time, significant cataract development was observed, whereas uveitis was still under good control. Accordingly, cataract surgery and Ozurdex extraction were performed. Two months after surgery, a mild recurrence of uveitis occurred. Conclusions A thicker lens might be an important risk factor for accidental intralenticular Ozurdex injections. However, after intralenticular Ozurdex injection, the development of cataract was slow, and Ozurdex could still have a therapeutic effect on uveitis in this case. Thus, immediate surgery might be unnecessary for certain accidental intralenticular Ozurdex injection cases, and a follow-up strategy could be chosen to maintain the effect of Ozurdex.
Collapse
|
8
|
Uwimana A, Ma C, Chen S, Ma X. Metformin therapy as a strategy to compensate anti-VEGF resistance in patients with diabetic macular edema. Medicine (Baltimore) 2022; 101:e31266. [PMID: 36281139 PMCID: PMC9592524 DOI: 10.1097/md.0000000000031266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Diabetic macular edema (DME) is the complication of diabetic retinopathy, the leading cause of vision loss among diabetic patients. Metformin is the main antidiabetic treatment. It is preferable for its great anti-angiogenic and anti-inflammatory effects. Anti-vascular endothelial growth factor (VEGF) therapy is the preferable treatment for DME despite its lack of convincing results in some patients. To assess whether the combination of metformin and anti-VEGF drugs may decrease the risk of anti-VEGF resistance among DME patients. We included DME patients with a central retinal thickness (CRT) ≥ 250 μm who consecutively underwent at least 3 anti-VEGF therapies from January 1, 2020, to December 30, 2021. Anti-VEGF resistance was defined as persistent macular edema with decreased CRT ≤ 25% after 3 anti-VEGF injections. 109 patients were considered for this research, of whom 65 (59.6%) were resistant to anti-VEGF therapy. The mean CRT of the non-metformin group decreased from 344.88 ± 129.48 to 318.29 ± 123.23 (20.85%) and from 415.64 ± 144.26 to 277.11 ± 99.25 (31.51%) (P = .031) in the metformin group. Moreover, the metformin group had fewer resistant patients than the non-metformin, 24 (45.3%) versus 41 (73.2%). Furthermore, a considerable gain in visual acuity was observed in both groups, with a BCVA gain of 40.41% in the metformin group and 39.9% in the non-metformin group. Metformin may be combined with an anti-VEGF drug to minimize the risk of anti-VEGF resistance among DME patients. Moreover, it can serve to design effective therapeutic deliveries.
Collapse
Affiliation(s)
- Alexandre Uwimana
- Department of Ophthalmology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Cong Ma
- Department of Ophthalmology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shengyao Chen
- Department of Ophthalmology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiang Ma
- Department of Ophthalmology, First Affiliated Hospital of Dalian Medical University, Dalian, China
- *Correspondence: Xiang Ma, Department of Ophthalmology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang District, Dalian 116044, China (e-mail: )
| |
Collapse
|
9
|
Zhang M, Liu Y, Song M, Yu Y, Ruan S, Zheng K, Wang F, Sun X. Intravitreal Dexamethasone Implant Has Better Retinal Perfusion than Anti-Vascular Endothelial Growth Factor Treatment for Macular Edema Secondary to Retinal Vein Occlusion: A Five-Year Real-World Study. Ophthalmic Res 2022; 66:247-258. [PMID: 36215955 DOI: 10.1159/000527447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/15/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of the study was to investigate the long-term effect of intravitreal dexamethasone (DEX) implant and anti-vascular endothelial growth factor (VEGF) injection on macular edema (ME) secondary to retinal vein occlusion (RVO) in a real-world setting. METHODS The medical records of RVO-ME cases, with intravitreal injections and followed up for at least 5 years, were retrospectively reviewed. Changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) were primary outcomes. Images of fluorescence angiography and swept-source optical coherence tomography angiography were analyzed. Foveal avascular zone (FAZ) metrics and perfusion density at the last visit were also compared between the two treatments. RESULTS A total of 16 patients were recruited, 8 in the anti-VEGF group and 8 in the DEX group. At the 5th year, the BCVA and the CMT in the DEX group were not different from those in the anti-VEGF group (0.69 ± 0.36 LogMAR vs. 0.57 ± 0.30 LogMAR, p = 0.574; 183.25 ± 97.31 µm vs. 195.38 ± 40.92 µm, p = 0.442). Compared with the anti-VEGF group, the DEX group had higher FAZ circularity index (0.57 ± 0.14 vs. 0.68 ± 0.14, p = 0.130) and higher retinal perfusion density (0.45 ± 0.02 vs. 0.39 ± 0.03, p = 0.001), especially in the deep capillary plexus. CONCLUSION DEX implant and anti-VEGF injection had comparative long-term effects on RVO-ME. Compared with the anti-VEGF treatment, the DEX treatment had advantages in maintaining retinal perfusion in patients with RVO.
Collapse
Affiliation(s)
- Min Zhang
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China,
| | - Yang Liu
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Minlu Song
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Yu
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Shang Ruan
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kairong Zheng
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
- Nursing Department, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fenghua Wang
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| |
Collapse
|
10
|
Ben Brahim M, Arfa S, Boubaker F, Chelly J, Ammari W, Hammami S, Arbi F, Berriche O. Case Report: Recurrent retinal vein occlusion as the first clinical manifestation of systemic lupus erythematosus in a male patient. F1000Res 2022; 10:761. [PMID: 35814626 PMCID: PMC9226707 DOI: 10.12688/f1000research.55189.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 11/29/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic, autoimmune disease characterized by widespread clinical manifestations and immunological disorders. A myriad of ocular manifestations can be seen in patients with SLE. The most vision-threatening complication is vaso-occlusive retinopathy including retinal vein occlusion (RVO). RVO associated with SLE is well described in the literature and its association with antiphospholipid antibodies is recognized. However, RVO as the initial manifestation of SLE is scarcely reported. Herein, we report the first case of recurrent RVO as the revealing manifestation of SLE in a 40-year-old male patient. He had two consecutive episodes of decreased vision. Ophthalmologic examination disclosed a branch retinal vein occlusion the first time and a central retinal vein occlusion the second time. The diagnosis of SLE was established based on clinical and immunological criteria. He was prescribed antiplatelet therapy, hydroxychloroquine at 5.5 mg/kg/day, and intravitreal anti-vascular endothelial growth factor (VEGF) antibodies regimen. He slowly improved under treatment.
Collapse
Affiliation(s)
- Marwa Ben Brahim
- Department of Internal Medicine and Endocrinology, Taher Sfar University Hospital, University of Monastir, Mahdia, 5100, Tunisia
| | - Sondes Arfa
- Department of Internal Medicine and Endocrinology, Taher Sfar University Hospital, University of Monastir, Mahdia, 5100, Tunisia
| | - Fadia Boubaker
- Department of Internal Medicine and Endocrinology, Taher Sfar University Hospital, University of Monastir, Mahdia, 5100, Tunisia
| | - Jihen Chelly
- Department of Internal Medicine and Endocrinology, Taher Sfar University Hospital, University of Monastir, Mahdia, 5100, Tunisia
| | - Wafa Ammari
- Department of Ophthalmology, Taher Sfar University Hospital, University of Monastir, Mahdia, 5100, Tunisia
| | - Sonia Hammami
- Department of Internal Medicine and Endocrinology, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, 5000, Tunisia
- Biochemistry Laboratory,LR12ES05 LR-NAFS Nutrition-Functional Food and Vascular Health, Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Fatma Arbi
- Department of Internal Medicine and Endocrinology, Taher Sfar University Hospital, University of Monastir, Mahdia, 5100, Tunisia
| | - Olfa Berriche
- Department of Internal Medicine and Endocrinology, Taher Sfar University Hospital, University of Monastir, Mahdia, 5100, Tunisia
- Biochemistry Laboratory,LR12ES05 LR-NAFS Nutrition-Functional Food and Vascular Health, Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| |
Collapse
|
11
|
Martínez-Plaza E, Ruiz-Fortes P, Soto-Negro R, Hernández-Rodríguez CJ, Molina-Martín A, Arias-Puente A, Piñero DP. Characterization of Dysfunctional Lens Index and Opacity Grade in a Healthy Population. Diagnostics (Basel) 2022; 12:diagnostics12051167. [PMID: 35626322 PMCID: PMC9140515 DOI: 10.3390/diagnostics12051167] [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: 04/04/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/28/2022] Open
Abstract
This study enrolled 61 volunteers (102 eyes) classified into subjects < 50 years (group 1) and subjects ≥ 50 years (group 2). Dysfunctional Lens Index (DLI); opacity grade; pupil diameter; and corneal, internal, and ocular higher order aberrations (HOAs) were measured with the i-Trace system (Tracey Technologies). Mean DLI was 8.89 ± 2.00 and 6.71 ± 2.97 in groups 1 and 2, respectively, being significantly higher in group 1 in all and right eyes (both p < 0.001). DLI correlated significantly with age (Rho = −0.41, p < 0.001) and pupil diameter (Rho = 0.20, p = 0.043) for all eyes, and numerous internal and ocular root-mean square HOAs for right, left, and all eyes (Rho ≤ −0.25, p ≤ 0.001). Mean opacity grade was 1.21 ± 0.63 and 1.48 ± 1.15 in groups 1 and 2, respectively, with no significant differences between groups (p ≥ 0.29). Opacity grade significantly correlated with pupil diameter for right and all eyes (Rho ≤ 0.33, p ≤ 0.013), and with some ocular root-mean square HOAs for right and all eyes (Rho ≥ 0.23, p ≤ 0.020). DLI correlates with age and might be used complementary to other diagnostic measurements for assessing the dysfunctional lens syndrome. Both DLI and opacity grade maintain a relationship with pupil diameter and internal and ocular HOAs, supporting that the algorithms used by the device may be based, in part, on these parameters.
Collapse
Affiliation(s)
- Elena Martínez-Plaza
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, 03690 Alicante, Spain; (E.M.-P.); (C.J.H.-R.); (A.M.-M.)
- University of Valladolid, 47002 Valladolid, Spain
| | - Pedro Ruiz-Fortes
- Department of Ophthalmology, Vithas Medimar International Hospital, 03016 Alicante, Spain; (P.R.-F.); (R.S.-N.); (A.A.-P.)
| | - Roberto Soto-Negro
- Department of Ophthalmology, Vithas Medimar International Hospital, 03016 Alicante, Spain; (P.R.-F.); (R.S.-N.); (A.A.-P.)
| | - Carlos J. Hernández-Rodríguez
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, 03690 Alicante, Spain; (E.M.-P.); (C.J.H.-R.); (A.M.-M.)
- Department of Ophthalmology, Vithas Medimar International Hospital, 03016 Alicante, Spain; (P.R.-F.); (R.S.-N.); (A.A.-P.)
| | - Ainhoa Molina-Martín
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, 03690 Alicante, Spain; (E.M.-P.); (C.J.H.-R.); (A.M.-M.)
| | - Alfonso Arias-Puente
- Department of Ophthalmology, Vithas Medimar International Hospital, 03016 Alicante, Spain; (P.R.-F.); (R.S.-N.); (A.A.-P.)
| | - David P. Piñero
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, 03690 Alicante, Spain; (E.M.-P.); (C.J.H.-R.); (A.M.-M.)
- Department of Ophthalmology, Vithas Medimar International Hospital, 03016 Alicante, Spain; (P.R.-F.); (R.S.-N.); (A.A.-P.)
- Correspondence: ; Tel.: +34-965-903400
| |
Collapse
|
12
|
Han R, Gong R, Liu W, Xu G. Proteome changes associated with the VEGFR pathway and immune system in diabetic macular edema patients at different diabetic retinopathy stages. Curr Eye Res 2022; 47:1050-1060. [PMID: 35435079 DOI: 10.1080/02713683.2022.2068181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Diabetic macular edema (DME) is a major cause of vision loss in all stages of diabetic retinopathy (DR). However, there is limited recognition of aqueous humor (AH) proteome profiles of DME patients at different DR stages. In this study, we aimed to investigate the AH proteome changes between DME patients at the nonproliferative diabetic retinopathy (NPDR) stage and those at the proliferative diabetic retinopathy (PDR) stage. METHODS A label-free data-independent acquisition based liquid chromatography tandem mass spectrometry (LC-MS/MS) analysis was performed to profile the abundances of AH proteins in 73 eyes from DME patients at different DR stages. Enzyme-linked immunosorbent assay (ELISA) was used to confirm the proteomics results with AH samples from non-diabetic patients and DME patients at the NPDR or PDR stage. RESULTS LC-MS/MS results showed significantly changed expression of 308 proteins between DME patients in the NPDR and PDR groups. Compared to the NPDR group, the proteins relatively up-regulated in the PDR group are involved in the immune system and/or negative regulation of the cell cycle, while proteins relatively down-regulated in the PDR group are associated with the vascular endothelial growth factor receptor (VEGFR) pathway and/or metabolism. ELISA results further verified the proteomic result of down-regulated expression of the immune-associated protein cystatin C (CST3) in the PDR group compared to that in the NPDR and non-diabetic groups. CONCLUSIONS In this study, we reported for the first time the decreased abundances of AH proteins associated with the VEGFR pathway and both down- and up-regulated expression of AH proteins associated with the immune system in the PDR group compared to that in the NPDR group. Furthermore, we found negative correlations of immune-associated protein, CST3 concentration in AH with DR severity and central retinal thickness, suggesting CST3 as a promising target independent of the VEGFR pathway in DME-involved DR treatment.
Collapse
Affiliation(s)
- Ruyi Han
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, 200030, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, 200030,China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, 200030, China
| | - Ruowen Gong
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, 200030, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, 200030,China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, 200030, China
| | - Wei Liu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, 200030, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, 200030,China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, 200030, China
| | - Gezhi Xu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, 200030, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, 200030,China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, 200030, China
| |
Collapse
|
13
|
Chen B, Yang S, Su W. First observation of intraocular extranodal natural killer/T-cell lymphoma secondary to a retroperitoneal tumour: a case report and comparative review. BMC Ophthalmol 2022; 22:141. [PMID: 35346113 PMCID: PMC8962092 DOI: 10.1186/s12886-022-02362-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 03/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Vitreoretinal lymphomas are difficult to diagnose due to their insidious onset and inaccessible focal points. Natural killer/T-cell derived malignancies are rare as intraocular lymphomas and usually have a rapid progression and a poor prognosis. Therefore, it is essential to make a definite diagnosis, especially differentially with B-cell-derived lymphomas, which account for most cases of vitreoretinal lymphomas. Case presentation This case report describes a 55-year-old female reporting a 10-month history of painless decline in her vision of the right eye. Optical coherence tomography of the patient revealed hyperreflective nodules and irregular humps in the retinal pigment epithelium layer. The right vitreous was aspirated for diagnostic assessment, revealing an interleukin-10 level of 39.4 pg/mL and an interleukin-10/interleukin-6 ratio of 1.05. The right vitreous humor was positive for Epstein–Barr virus DNA. Upon a systemic examination, a high metabolic nodule was found in the retroperitoneal area and proven to be positive for Epstein–Barr virus-encoded mRNA, CD2, CD3ε, TIA-1, and Ki-67. Considering the homology of the two lesions, the patient was diagnosed with metastatic vitreoretinal lymphoma secondary to retroperitoneal extranodal natural killer/T-cell derived lymphoma. The patient received systemic chemotherapy and regular intravitreal injections of methotrexate. Her visual acuity of the right eye had improved from 20/125 to 20/32 at the latest follow-up. No new lesions were found. Conclusions A definitive diagnosis of vitreoretinal lymphoma is challenging. On some occasions in which pathological evidence is missing, the available examination results and clinical observations must be comprehensively considered. This study herein summarized pertinent pieces of literature and reports and reviewed available practicable methods to make a definitive diagnosis of intraocular extranodal natural killer/T-cell lymphoma, which was particularly distinct from the common diffuse large B-cell lymphomas.
Collapse
Affiliation(s)
- Binyao Chen
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China.,Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Shizhao Yang
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China.,Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wenru Su
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China. .,Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China.
| |
Collapse
|
14
|
Mangum AJ. Case Report: Bilateral Cecocentral Visual Field Defect Secondary to Congenital Optic Disc Pit. Optom Vis Sci 2022; 99:308-314. [PMID: 35001062 DOI: 10.1097/opx.0000000000001864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE Congenital optic disc pits are known to cause complications, commonly maculopathy due to retinoschisis and/or neurosensory retinal detachment. Retinal nerve fiber layer defects with associated visual field defects without maculopathy are another complication and can result in decreased visual function but have rarely been reported in the literature, especially bilaterally. PURPOSE This case report describes a patient with bilateral cecocentral visual field defects due to congenital optic nerve pits without associated maculopathy. CASE REPORT A 42-year-old Black man presented with blur symptoms at near uncorrected. Of note, there was no history of substance abuse or nutritional deficiencies. Best-corrected acuities were 20/20 in the right eye and 20/30 in the left eye. Clinical examination revealed bilateral focal grayish depression of the temporal optic nerve cup with associated papillomacular retinal nerve fiber layer defects. Optical coherence tomography (OCT) imaging revealed bilateral focal excavation of the temporal cup, temporal thinning of the retinal nerve fiber layer, and correlated binasal thinning of the ganglion cell complex, in the absence of retinoschisis or neurosensory detachment. Threshold visual field testing revealed stable bilateral cecocentral visual field defects. A diagnosis of bilateral cecocentral visual field defect secondary to congenital optic disc pits was made based on the patient's history and clinical examination. CONCLUSIONS A cecocentral visual field defect, unrelated to maculopathy, is a less common complication of congential optic disc pits that can cause decreased visual function. This case report provides evidence of this bilateral ocular condition and reviews the reported clinical, OCT, and threshold visual field manifestations of the disease. Specifically, spectral-domain OCT ganglion cell analysis seems useful in localizing the visual field defect.
Collapse
|
15
|
Datlinger F, Datlinger A, Pollreisz A, Sacu S, Schmidt-Erfurth U, Datlinger P. Intraprocedural OCT monitoring of the immediate treatment response during indocyanine green angiography-guided laser therapy of teleangiectatic capillaries in diabetic macular edema. Sci Rep 2022; 12:2315. [PMID: 35145156 PMCID: PMC8831600 DOI: 10.1038/s41598-022-05950-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 01/20/2022] [Indexed: 11/24/2022] Open
Abstract
In this retrospective study the morphological response of teleangiectatic capillaries (TCs) to focal laser treatment and the functional and morphological outcome after Indocyanine green angiography (ICGA)-guided laser therapy was evaluated. TCs in eyes with diabetic macular edema (DME) were treated with laser therapy. The immediate and subsequent reaction of the TCs lumina to direct photocoagulation was monitored with customized OCT single scans. Additionally, patients were treated with intravitreal anti-VEGF as needed. 12 eyes of 9 patients with treatment naive (6 eyes) and pretreated (6 eyes) DME were followed-up for a mean of 24 months (± 8.1SD). Best-corrected visual acuity improved from 0.25 logMar (± 0.2SD) to 0.12 (± 0.10SD; p = 0.06) at each patient’s last visit. During laser treatment a darkening of the TCs lumina was achieved in 91.3% of lesions. All these lesions fully resolved, whereas TCs, which showed no darkening of their lumen in OCT persisted and required re-treatment with laser. Additional anti-VEGF injections were indicated in only one eye (8.3%). The darkening of the TCs lumina visible in OCT might provide an image-biomarker that indicates successful coagulation of aneurysmatic lesions. Consequently, a significant functional and morphological improvement with need for anti-VEGF treatment in only one eye, was achieved. Information concerning the registration of the trial: date of registration: 11th of december, 2019. Trial registration number: 107/2019.
Collapse
Affiliation(s)
- Felix Datlinger
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.,Ophthalmological Practice Datlinger, Sonnwendgasse 5, 7210, Mattersburg, Austria.,Vienna Clinical Trial Center, Medical University of Vienna, Vienna, Austria
| | - Anja Datlinger
- Ophthalmological Practice Datlinger, Sonnwendgasse 5, 7210, Mattersburg, Austria
| | - Andreas Pollreisz
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Stefan Sacu
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.,Vienna Clinical Trial Center, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.,Vienna Clinical Trial Center, Medical University of Vienna, Vienna, Austria.,Laboratory for Ophthalmic Image Analysis, Medical University of Vienna, Vienna, Austria
| | - Peter Datlinger
- Ophthalmological Practice Datlinger, Sonnwendgasse 5, 7210, Mattersburg, Austria.
| |
Collapse
|
16
|
Almogbil HH, Nasrallah FP, Zderic V. Feasibility of Therapeutic Ultrasound Application in Topical Scleral Delivery of Avastin. Transl Vis Sci Technol 2021; 10:2. [PMID: 34851358 PMCID: PMC8648056 DOI: 10.1167/tvst.10.14.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose Macromolecules have been shown to be effective in vision-saving treatments for various ocular diseases, such as age-related macular degeneration and diabetic retinopathy. The current delivery of macromolecules requires frequent intraocular injections and carries a risk of serious adverse effects. Methods We tested the application of therapeutic ultrasound as a minimally invasive approach for the delivery of Avastin into the diseased regions of the eye. Avastin (bevacizumab) is an anti-vascular endothelial growth factor (VEGF) antibody with a molecular weight of 149 kDa. We tested the effectiveness and safety of Avastin delivery through rabbit sclera in vitro using a standard diffusion cell model. Ultrasound at frequencies of 400 kHz or 3 MHz with an intensity of 1 W/cm2 was applied for the first 5 minutes of 1-hour drug exposure. Sham treatments mimicked the ultrasound treatments, but ultrasound was not turned on. Absorbance measurements of the receiver compartment solution were performed at 280 nm using a spectrophotometer. Results Absorbance measurements indicated no statistical difference between the sham (n = 13) and 400 kHz ultrasound group (n = 15) in the delivery of Avastin through the sclera. However, the absorbance values were statistically different (P < 0.01) between the 3 MHz ultrasound group (0.004, n = 8) and the matched sham group (0.002, n = 7). There was 2.3 times increase in drug delivery in the 3 MHz ultrasound when compared to the corresponding sham group. Histological studies indicated no significant damage in the ultrasound-treated sclera due to ultrasound application. Conclusions Our preliminary results provided support that therapeutic ultrasound may be effective in the delivery of Avastin through the sclera. Translational Relevance Our study offers clinical potential for a minimally invasive retinopathy treatment.
Collapse
Affiliation(s)
- Hanaa H Almogbil
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| | | | - Vesna Zderic
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| |
Collapse
|
17
|
Oli A, Balakrishnan D. Treatment outcomes of optic disc pit maculopathy over two decades. Ther Adv Ophthalmol 2021; 13:25158414211027715. [PMID: 34263136 PMCID: PMC8252332 DOI: 10.1177/25158414211027715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022] Open
Abstract
Aim To study the long-term outcomes of optic disc pit maculopathy. Methods Electronic medical records of 154 patients with optic disc pit were reviewed and 50 patients with optic disc pit maculopathy who met the study criteria were included in the study. Demographic profile of patients, along with clinical characteristics, optical coherence tomography (OCT) features and change in best-corrected visual acuity (BCVA) was recorded. Patients were treated either by observation, barrage laser alone or pars plana vitrectomy (PPV) with optional additional surgical procedures. The primary outcome measures were the change in BCVA and resolution of fluid on OCT. Results The mean age of patients was 29.96 years (3-62 years) with a follow-up of 27.16 months. The mean baseline BCVA in observation, laser and vitrectomy group was log MAR 0.94, 0.76 and 0.87 and final BCVA was log MAR 0.9, 0.67 and 0.46, respectively. There was a statistically significant improvement in the final BCVA and reduction in subretinal fluid with resolution of the schisis cavity in vitrectomy group than in other groups. On regression analysis significant association was found between final BCVA with baseline BCVA (R 2 = 0.815, p = 0.002), use of C3 F8 endotempanode (p = 0.004) ILM peeling (p = 0.012) and use of triamcinolone (TA; p = 0.003). No significant association was found with juxtapapillary endolaser (p = 0.062). Conclusions In patients with disc pit maculopathy, PPV lead to better functional and anatomical outcomes as compared to laser or observation alone. Use of surgical adjuvants like ILM peeling, TA and C3F8 tamponade improved the outcomes, unlike juxtapapillary endolaser treatment.
Collapse
Affiliation(s)
- Avadhesh Oli
- Smt Kanuri Santhamma Centre of Vitreoretinal diseases, LV Prasad Eye Institute, Kallam Anji Reddy Campus, L. V. Prasad Marg, Banjara Hills, Hyderabad 500034, Telangana, India
| | - Divya Balakrishnan
- Smt Kanuri Santhamma Centre of Vitreoretinal diseases, LV Prasad Eye Institute, Hyderabad, India
| |
Collapse
|
18
|
Ferro Desideri L, Traverso CE, Nicolò M. Brolucizumab: a novel anti-VEGF humanized single-chain antibody fragment for treating w-AMD. Expert Opin Biol Ther 2021; 21:553-561. [PMID: 33899632 DOI: 10.1080/14712598.2021.1915278] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Wet age-related macular degeneration (w-AMD) represents the leading cause of visual impairment in the elderly in the developed countries. Intravitreal antivascular endothelial growth factor (VEGF) drugs are currently considered as the first-line treatment option for treating w-AMD; however, the frequent injection intervals have lit the way to investigate novel anti-VEGF agents allowing a more extended treatment regimen. Brolucizumab is a single-chain antibody fragment targeting all the isoforms of VEGF-A. Phase III HAWK and HARRIER trials have shown a longer durability and superior anatomical outcomes as compared with the standard of care by adopting a quarterly regimen for treating w-AMD. Brolucizumab has been approved in Europe, USA, and Japan for the management of w-AMD. AREAS COVERED This article presents an overview of w-AMD and investigates the progress of brolucizumab through clinical trials. It offers insights into where brolucizumab may be placed in the current market of anti-VEGF agents and its potential advantages over the previous molecules adopted for treating w-AMD. EXPERT OPINION The possibility of administering brolucizumab with more dilated treatment intervals represents an important advantage to decrease the treatment burden and improve patient compliance. Brolucizumab represents a possible drug switching option in non-responding patients to other anti-VEGF drugs.
Collapse
Affiliation(s)
- Lorenzo Ferro Desideri
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Italy
| | - Carlo Enrico Traverso
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Italy.,Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Massimo Nicolò
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Italy.,Ospedale Policlinico San Martino IRCCS, Genoa, Italy.,Fondazione per La Macula Onlus, Genoa, Italy
| |
Collapse
|
19
|
Yang K, Cui L, Zhang G, Wang X, Zhu X, Xiao Y, Su B, Song D, Zhang X, Zheng Y, Lu F, Qu J, Li M. The Jidong Eye Cohort Study: objectives, design, and baseline characteristics. EYE AND VISION 2020; 7:58. [PMID: 33372640 PMCID: PMC7771074 DOI: 10.1186/s40662-020-00223-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/23/2020] [Indexed: 12/02/2022]
Abstract
Background To describe the objective, design and baseline characteristics of the Jidong Eye Cohort Study (JECS), a community-based cohort in China based on etiology, imaging and biomarkers. The JECS will clarify the pathogenesis of visual impairment and status of ocular indicators in the occurrence and progression of cardio-cerebrovascular and neurological diseases. Methods Between August 2019 and January 2020, the JECS recruited consecutive participants aged 18 years and older from the Jidong communities in China. The demographic and clinical characteristics were collected by trained site personnel via face-to-face interviews. The relevant biological samples were also collected. The participants underwent comprehensive ophthalmic examination, such as retinal photography and optical coherence tomography (OCT) angiography. The following outcomes were measured annually: ocular vascular abnormality, optic nerve degeneration, cardiovascular diseases (CVD) and neurological diseases. The study will be performed until 2024. Results Among 3377 participants, the average age was 45.0 ± 12.5 years and 1809 (53.6%) were women. Hypertension occurred in 825 individuals (25.0%), diabetes in 258 (7.7%), hyperglycemia in 474 (14.2%), and a CVD history in 100 (3.0%). The mean best-corrected visual acuity was 0.1 logMAR in the recruited subjects. The average OCT signal index was 8.2 ± 1.2. Additionally, the mean vessel densities for the entire measured area were 46.4% and 50.8% for the superficial and deep vascular complex, respectively. Mean area and perimeter of foveal avascular zone was 0.3 mm2 and 2.3 mm. Conclusions The JECS is a large community-based prospective cohort in North China. Rich data collected from this study will provide the opportunity to identify risk factors, imaging, and biomarkers of visual impairment (either ocular vascular anomalies or optic nerve degeneration) and to evaluate their associations with CVD and neurological diseases.
Collapse
Affiliation(s)
- Kai Yang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Lele Cui
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Guoyun Zhang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Xianwei Wang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Xiaoxuan Zhu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Yunfan Xiao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Binbin Su
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Daiyu Song
- Dezhou Center for Disease Control and Prevention, Dezhou, Shandong, China
| | - Xinyao Zhang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Yang Zheng
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Fan Lu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China. .,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China.
| | - Jia Qu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China. .,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China.
| | - Ming Li
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China. .,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China.
| |
Collapse
|
20
|
Sharef N, Kassem R, Hecht I, Bar A, Maharshak I, Burgansky-Eliash Z, Weinberger Y, Tuuminen R, Achiron A. Interdigitation and Ellipsoid Zones Disruption Correlate with Visual Outcomes among Treatment-Naive Patients with Diabetic Macular Edema. Ophthalmic Res 2020; 64:476-482. [PMID: 33221809 DOI: 10.1159/000513204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/06/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We have recently shown that defects in interdigitation and ellipsoid zones (IZ and EZ) can predict response to anti-VEGF therapy in a small group of treatment-naive diabetic macular edema (DME) patients. The aim of the current study is to further evaluate this association in a larger study group of patients over a longer follow-up time. METHODS Thirty eyes of 30 treatment-naive DME patients were analyzed in this retrospective study. The integrity of foveal IZ and EZ was evaluated using optical coherence tomography at the diagnosis of DME and following anti-VEGF injections. The defect size was correlated with best-corrected visual acuity (BCVA) and central macular thickness (CMT). RESULTS The mean patients' age at baseline was 63.0 ± 10.0 years. Patients underwent 3.9 ± 2.9 anti-VEGF injections for a mean of 9.1 ± 4.8 months. Following treatment, the mean Snellen visual acuity (VA) improved from 20/52 to 20/44 (p = 0.05), CMT decreased from 432.5 ± 141.4 μm to 375.2 ± 121.4 µm (p = 0.05) and IZ/EZ defect size decreased from 259.83 ± 375.94 µm to 65.34 ± 143.97 µm (p = 0.001). In patients with no IZ/EZ defects at baseline, the mean Snellen VA was better when compared to those with IZ/EZ defects (20/36 vs. 20/70, p = 0.031). The number of eyes with IZ/EZ defects decreased from 17 (57%) at baseline to 6 (20%) at end of follow-up (p < 0.01). BCVA gain correlated with IZ/EZ defect size reduction (r = 0.41, p = 0.02) but not with improvement in CMT (r = 0.28, p = 0.121). CONCLUSIONS IZ/EZ defect size correlated not only with baseline BCVA but also predicted the change in BCVA after anti-VEGF treatment. Possible future automatic measurement of IZ/EZ defect size might prove helpful for the evaluation of treatment response.
Collapse
Affiliation(s)
- Nardine Sharef
- Department of Ophthalmology, Edith Wolfson Medical Center, Holon, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rabea Kassem
- Department of Ophthalmology, Kaplan Medical Center, Rehovot and the Hebrew University of Jerusalem-Hadassah Medical School, Jerusalem, Israel
| | - Idan Hecht
- Department of Ophthalmology, Shamir Medical Center, Zerifin, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Bar
- Department of Ophthalmology, Edith Wolfson Medical Center, Holon, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idit Maharshak
- Department of Ophthalmology, Edith Wolfson Medical Center, Holon, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zvia Burgansky-Eliash
- Department of Ophthalmology, Meir Medical Center, Kfar Sava, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehonatan Weinberger
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland and Eye Centre, Kymenlaakso Central Hospital, Kotka, Finland
| | - Asaf Achiron
- Department of Ophthalmology, Edith Wolfson Medical Center, Holon, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, .,Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom,
| |
Collapse
|