1
|
Faes L, Bijon J, Bacci T, Freund KB. Review of type 3 macular neovascularization in age-related macular degeneration: no DRAMA (Deep Retinal Age-related Microvascular Anomalies). Eye (Lond) 2024:10.1038/s41433-024-03343-3. [PMID: 39394372 DOI: 10.1038/s41433-024-03343-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 08/24/2024] [Accepted: 09/11/2024] [Indexed: 10/13/2024] Open
Abstract
Type 3 macular neovascularization (MNV) is a unique form of neovascular age-related macular degeneration (AMD) that presents distinct pathogenetic features, clinical manifestations, and prognostic considerations when compared to types 1 and 2 MNV. Insights gained from clinicopathological correlations, bridging in vivo examination techniques with ex vivo histological analysis, have significantly enhanced our comprehension of this MNV phenotype, shaped current management strategies and influenced future directions for therapeutics. The particularities of type 3 MNV, which may largely stem from its origin from the retinal vasculature, are critically important for predicting the disease course. Our current understanding suggests that type 3 MNV occurs in response to retinal pigment epithelium (RPE) disruption and photoreceptor loss when neovessels originating from the deep capillary plexus are accompanied by activated Müller glia as they infiltrate sub-retinal pigment epithelium basal laminar deposits. Dysregulation of angiogenic and angiostatic factors are thought to play a key role in its pathogenesis. The prognosis for type 3 MNV is likely bilateral involvement and progression towards macular atrophy. It may be imperative for practitioners to distinguish type 3 MNV from other mimicking pathologies such as intraretinal microvascular anomalies, which are also part of the type 3 disease spectrum. For instance, deep retinal age-related microvascular anomalies (DRAMA) may present with similar features on multimodal imaging yet may necessitate distinct management protocols. Distinguishing between these conditions may be vital for implementing tailored treatment regimens and improving patient outcomes in the diverse landscape of AMD phenotypes in the future.
Collapse
Affiliation(s)
- Livia Faes
- Vitreous Retina Macula Consultants of New York, New York, USA
| | - Jacques Bijon
- Vitreous Retina Macula Consultants of New York, New York, USA
| | - Tommaso Bacci
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena University Hospital, Siena, Italy
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, USA.
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA.
| |
Collapse
|
2
|
Browning AC, Grinton ME, Quinn S, Jain T, Manikavasagar V, Aftab AM. Long term follow up of patients with MNV3 treated with intra-vitreal Aflibercept. Eur J Ophthalmol 2024; 34:1562-1568. [PMID: 38304945 DOI: 10.1177/11206721241229912] [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] [Indexed: 02/03/2024]
Abstract
PURPOSE MNV3 or Retinal angiomatous proliferation is a subtype of neovascular age-related macular degeneration (nAMD). We present the 5 year long term visual and anatomical outcomes of patients with MNV3 lesions treated with intravitreal Aflibercept. METHODS This is a prospective study of treatment naïve patients with reading centre graded MNV3 lesions. After the loading phase, the patients received intravitreal Aflibercept as per the View study up to year 3, thereafter it was given on a prn basis. At each visit, best corrected visual acuity (BCVA) and optical coherence tomography (OCT) central macular thickness (CMT) was measured. RESULTS Thirty one patients reached study completion. Mean BCVA of treated eyes had decreased by 0.6 ETDRS letters at the end of year 5 compared with baseline. At study completion, 81% of eyes had stable vision while 19% of eyes had gained 15 letters or more. At study end, 26% of eyes had BCVA of 6/12 or better, while 19% had lost 15 letters or more (all had central foveal photoreceptor loss). There was a maximal mean reduction in CMT of 164 microns (p = <0.0001) while 68% of maculae were fluid free at study completion. Eighty seven percent of treated eyes developed nascent GA, of which in 74% of eyes was involving the fovea. DISCUSSION Despite initial improvement in mean BCVA, the improvement in BCVA was not maintained despite good overall control of the MNV3 lesions. The loss of BCVA was most likely due to the majority of eyes developing centre involving macular atrophy.
Collapse
Affiliation(s)
- Andrew C Browning
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Michael E Grinton
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Stephanie Quinn
- Medical Physics Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Tania Jain
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | | - Akhunzada M Aftab
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| |
Collapse
|
3
|
Forte P, Fontana V, Muzio J, Di Cello L, Corazza P, Rosa R, Musetti D, Vagge A, Traverso CE, Nicolò M. Predictors of 24-month onset of macular fibrosis in type 3 macular neovascularisation. Br J Ophthalmol 2024; 108:1240-1248. [PMID: 38290807 DOI: 10.1136/bjo-2023-324713] [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: 10/10/2023] [Accepted: 12/31/2023] [Indexed: 02/01/2024]
Abstract
AIMS To explore prognostic multimarker models for progression to macular fibrosis (MF) over 24 months specific to type 3 macular neovascularisation (T3 MNV). METHODS This retrospective, exploratory, single-centre, cohort study comprised 65 eyes of 43 Caucasian patients with treatment naive T3 MNV, all with a 24-month follow-up post anti-VEGF therapy using a strict pro-re-nata (PRN) regimen. Data on demographic features, clinical findings, frequency of intravitreal treatments and optical coherence tomography biomarkers were collected at baseline and after 12 and 24 months of follow-up. Logistic regression models (LRM) and receiver-operating curve (C-index) analyses were performed to evaluate the prognostic ability of the studied biomarkers in discriminating between MF affected and unaffected patients. RESULTS At final follow-up, MF was present in 46.2% of eyes. Subretinal hyper-reflective material (SHRM) and subretinal pigment epithelium multilaminar hyper-reflectivity (multilaminae) emerged as significant predictors for MF, with adjusted odds ratios (OR) of 18.0 (95% CL 13.4 to 24.1) and 11.8 (95% CL 8.66 to 16.0), respectively. Additionally, the presence of multifocal lesions (OR 0.04, 95% CL 0.01 to 0.30) appeared to decrease the likelihood of MF. C-indexes for the selected LRMs ranged between 0.92 and 0.88, indicating a comparably high discriminant ability. Despite consistent treatment schedules between the two groups (MF: median intravitreal treatment (IVT) number=10.5, IQR=7; non-MF: median IVT=10, IQR=6), a decline in best-corrected visual acuity was noted in the group with MF onset over the 24-month follow-up (-13.0 ETDRS letters; 95% CL -22.1 to -3.9; p=0.006). CONCLUSION Our study identifies SHRM and multilaminae as relevant predictors of 24-month onset of MF in patients with T3 MNV. These findings enrich our understanding of the development of MF in T3 MNV and can guide improved risk prognostication. Future research should consider larger samples and prospective designs to validate these predictors.
Collapse
Affiliation(s)
- Paolo Forte
- IRCCS Ospedale Policlinico San Martino, Eye Unit, Genoa, Italy
- DINOGMI, Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili, University of Genoa, Genoa, Italy
| | - Vincenzo Fontana
- IRCCS Ospedale Policlinico San Martino, Clinical Epidemiology Unit, Genoa, Italy
| | - Julia Muzio
- DINOGMI, Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili, University of Genoa, Genoa, Italy
| | - Luca Di Cello
- IRCCS Ospedale Policlinico San Martino, Eye Unit, Genoa, Italy
| | - Paolo Corazza
- IRCCS Ospedale Policlinico San Martino, Eye Unit, Genoa, Italy
- DINOGMI, Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili, University of Genoa, Genoa, Italy
| | - Raffaella Rosa
- IRCCS Ospedale Policlinico San Martino, Eye Unit, Genoa, Italy
- DINOGMI, Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili, University of Genoa, Genoa, Italy
| | - Donatella Musetti
- IRCCS Ospedale Policlinico San Martino, Eye Unit, Genoa, Italy
- DINOGMI, Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili, University of Genoa, Genoa, Italy
| | - Aldo Vagge
- IRCCS Ospedale Policlinico San Martino, Eye Unit, Genoa, Italy
- DINOGMI, Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili, University of Genoa, Genoa, Italy
| | - Carlo Enrico Traverso
- IRCCS Ospedale Policlinico San Martino, Eye Unit, Genoa, Italy
- DINOGMI, Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili, University of Genoa, Genoa, Italy
| | - Massimo Nicolò
- IRCCS Ospedale Policlinico San Martino, Eye Unit, Genoa, Italy
- DINOGMI, Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili, University of Genoa, Genoa, Italy
- Macula Onlus Foundation, Genoa, Italy
| |
Collapse
|
4
|
Vessey KA, Jobling AI, Greferath U, Fletcher EL. Pharmaceutical therapies targeting autophagy for the treatment of age-related macular degeneration. Curr Opin Pharmacol 2024; 76:102463. [PMID: 38788268 DOI: 10.1016/j.coph.2024.102463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/29/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024]
Abstract
Age-related macular degeneration (AMD) is a major cause of irreversible vision loss in the elderly. Although new therapies have recently emerged, there are currently no ways of preventing the development of the disease. Changes in intracellular recycling processes. Changes in intracellular recycling processes, called autophagy, lead to debris accumulation and cellular dysfunction in AMD models and AMD patients. Drugs that enhance autophagy hold promise as therapies for slowing AMD progression in preclinical models; however, more studies in humans are required. While a definitive cure for AMD will likely hinge on a personalized medicine approach, treatments that enhance autophagy hold promise for slowing vision loss.
Collapse
Affiliation(s)
- Kirstan A Vessey
- Department of Anatomy and Physiology, The University of Melbourne, VIC 3010, Australia; School of Science and Technology, The University of New England, NSW 2350, Australia
| | - Andrew I Jobling
- Department of Anatomy and Physiology, The University of Melbourne, VIC 3010, Australia
| | - Ursula Greferath
- Department of Anatomy and Physiology, The University of Melbourne, VIC 3010, Australia
| | - Erica L Fletcher
- Department of Anatomy and Physiology, The University of Melbourne, VIC 3010, Australia.
| |
Collapse
|
5
|
de Asís Bartol-Puyal F, Monroy JS, Bayod MP, Moreno ÓR, Calvo P, Pablo L. Assistance Burden Comparison Between Age-Related Macular Degeneration and Retinal Angiomatous Proliferation Over a Three-Year Follow-up. Ophthalmic Surg Lasers Imaging Retina 2024; 55:197-203. [PMID: 38319060 DOI: 10.3928/23258160-20240118-01] [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: 02/07/2024]
Abstract
BACKGROUND AND OBJECTIVE We compared assistance burden between neovascular age-related macular degeneration (nAMD) and retinal angiomatous proliferation (RAP) under intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment on a treat-and-extend (T&E) regimen in a third-level hospital in a developed country. PATIENTS AND METHODS This retrospective study using data from the Fight Retinal Blindness! Registry included patients treated between January 2016 and December 2020. Final event was established as best corrected visual acuity (BCVA) lower than 20 Early Treatment Diabetic Retinopathy Study letters. According to choroidal neovascularization (CNV), three different study groups were established: type 1, 2, and 3. RESULTS A total of 285 eyes of 227 patients were included. Mean age was 80.1 ± 6.5, 79.1 ± 7.9, and 81.2 ± 7.2 years, for the three study groups, respectively. Mean injections were 16.0 ± 4.8, 16.5 ± 4.1, and 14.1 ± 5.7, respectively; and mean number of visits were 17.9 ± 4.3, 18.2 ± 3.1, and 16.8 ± 5.3, respectively. No differences were found (P > 0.05). Survival curves and log-rank analysis also showed no differences (P = 0.344). Cox proportional hazard models showed that a lower baseline BCVA, subfoveal geographic atrophy (GA), and subfoveal fibrosis (SF) were associated with a higher risk of reaching ≤ 20 letters. CONCLUSIONS nAMD and RAP under a T&E regimen indicate a high assistance burden during the first three years. The presence of subfoveal GA or SF are associated with a BCVA lower than 20 letters. [Ophthalmic Surg Lasers Imaging Retina 2024;55:197-203.].
Collapse
|
6
|
Clemens CR, Eter N, Alten F. Current Perspectives on Type 3 Macular Neovascularization due to Age-Related Macular Degeneration. Ophthalmologica 2024; 247:73-84. [PMID: 38266500 PMCID: PMC11160428 DOI: 10.1159/000536278] [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: 02/20/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND The aim of this review was to systematically summarize the current knowledge on type 3 macular neovascularization (MNV3) in age-related macular degeneration (AMD). SUMMARY Recent histopathologic and multimodal imaging findings led to the consensus definition of the new term "type 3 macular neovascularization" in AMD. MNV3 originates in the deep vascular plexus as a neovascular process without connection with the retinal pigment epithelium in the initial stages. This type has numerous clinical and pathomorphologic features that separate it from the other two types of MNV in AMD. Besides, its frequency appears to be higher than previously thought. In optical coherence tomography (OCT), MNV3 can be classified into stages 1-3. Hyperreflective foci in the outer retina possibly represent a precursor lesion. In addition, MNV3 is characterized by a strong association with reticular pseudodrusen, a high rate of bilaterality, close associations with advanced age and arterial hypertension, decreased choroidal thickness, and decreased choriocapillaris flow signals. Data from latest anti-vascular endothelial growth factor studies in MNV3 suggest that the OCT biomarkers in intraretinal and subretinal fluids should be interpreted differently than in the other types. Additionally, data from MNV3 eyes should be analyzed separately, allowing optimal type-specific treatment strategies in the future. KEY MESSAGES This review highlights the need for accurate characterization of neovascular AMD lesions and an MNV type-specific approach, particularly for MNV3.
Collapse
Affiliation(s)
- Christoph R Clemens
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany
| | - Nicole Eter
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany
| | - Florian Alten
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany
| |
Collapse
|
7
|
Difference in characteristics and lesion reactivation between type 3 macular neovascularization with and without subretinal fluid at baseline. Graefes Arch Clin Exp Ophthalmol 2023; 261:401-408. [PMID: 36112220 DOI: 10.1007/s00417-022-05833-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/08/2022] [Accepted: 09/09/2022] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To compare the characteristics and incidence rates of lesion reactivation after anti-vascular endothelial growth factor (VEGF) treatment in type 3 macular neovascularization (MNV) with and without subretinal fluid (SRF) at baseline. METHODS This retrospective study included 95 patients diagnosed with type 3 MNV. After the initial loading injections, re-treatment was performed when lesion reactivation occurred defined as the re-accumulation of subretinal or intraretinal fluid or the new development of a retinal/subretinal hemorrhage. The differences in the baseline characteristics and the incidence rates of lesion reactivation were compared between patients with SRF (SRF group, n = 42) and those without SRF (non-SRF group, n = 53). RESULTS At diagnosis, the mean visual acuity was worse (0.68 ± 0.41 vs 0.50 ± 0.36; P = 0.032), mean central retinal thickness was greater (515.4 ± 145.9 μm vs 383.8 ± 105.5 μm; P < 0.001), and the incidence of focal retinal hemorrhages was higher (90.5% vs 66.0%; P = 0.005) in the SRF group than in the non-SRF group. In the SRF group, the first lesion reactivation was noted in 89.7% at a mean of 5.8 ± 4.4 months after the third injection. In the non-SRF group, the first lesion reactivation was noted in 70.6% at a mean of 6.1 ± 3.8 months. There was a significant difference in lesion reactivation between the two groups (P = 0.019). CONCLUSIONS The difference in the baseline characteristics and incidence of lesion reactivation between type 3 MNV with and without SRF suggests that the presence of SRF may be indicative of more advanced disease with a high risk of visual deterioration. This result also suggests the need for more active treatment to preserve vision in patients with SRF.
Collapse
|
8
|
Wong JHC, Ma JYW, Jobling AI, Brandli A, Greferath U, Fletcher EL, Vessey KA. Exploring the pathogenesis of age-related macular degeneration: A review of the interplay between retinal pigment epithelium dysfunction and the innate immune system. Front Neurosci 2022; 16:1009599. [PMID: 36408381 PMCID: PMC9670140 DOI: 10.3389/fnins.2022.1009599] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/12/2022] [Indexed: 07/30/2023] Open
Abstract
Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss in the older population. Classical hallmarks of early and intermediate AMD are accumulation of drusen, a waste deposit formed under the retina, and pigmentary abnormalities in the retinal pigment epithelium (RPE). When the disease progresses into late AMD, vision is affected due to death of the RPE and the light-sensitive photoreceptors. The RPE is essential to the health of the retina as it forms the outer blood retinal barrier, which establishes ocular immune regulation, and provides support for the photoreceptors. Due to its unique anatomical position, the RPE can communicate with the retinal environment and the systemic immune environment. In AMD, RPE dysfunction and the accumulation of drusen drive the infiltration of retinal and systemic innate immune cells into the outer retina. While recruited endogenous or systemic mononuclear phagocytes (MPs) contribute to the removal of noxious debris, the accumulation of MPs can also result in chronic inflammation and contribute to AMD progression. In addition, direct communication and indirect molecular signaling between MPs and the RPE may promote RPE cell death, choroidal neovascularization and fibrotic scarring that occur in late AMD. In this review, we explore how the RPE and innate immune cells maintain retinal homeostasis, and detail how RPE dysfunction and aberrant immune cell recruitment contribute to AMD pathogenesis. Evidence from AMD patients will be discussed in conjunction with data from preclinical models, to shed light on future therapeutic targets for the treatment of AMD.
Collapse
|
9
|
Mathis T, Holz FG, Sivaprasad S, Yoon YH, Eter N, Chen LJ, Koh A, Cunha de Souza E, Staurenghi G. Characterisation of macular neovascularisation subtypes in age-related macular degeneration to optimise treatment outcomes. Eye (Lond) 2022:10.1038/s41433-022-02231-y. [DOI: 10.1038/s41433-022-02231-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/24/2022] [Accepted: 08/30/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractThe aim of this review is to identify the common characteristics and prognoses of different subtypes of neovascular age-related macular degeneration (nAMD). We also propose recommendations on how to tailor treatments to the subtype of neovessels to optimise patient outcomes. The authors, selected members of the Vision Academy, met to discuss treatment outcomes in nAMD according to macular neovascularisation (MNV) subtypes, using evidence from a literature search conducted on the PubMed database (cut-off date: March 2019). This review article summarises the recommendations of the Vision Academy on how the characterisation of MNV subtypes can optimise treatment outcomes in nAMD. The identification of MNV subtypes has been facilitated by the advent of multimodal imaging. Findings from fluorescein angiography, indocyanine green angiography and spectral-domain optical coherence tomography collectively help refine and standardise the determination of the MNV subtype. To date, three subtypes have been described in the literature and have specific characteristics, as identified by imaging. Type 1 MNV is associated with better long-term outcomes but usually requires more intense anti-vascular endothelial growth factor dosing. Type 2 MNV typically responds quickly to treatment but is more prone to the development of fibrotic scars, which may be associated with poorer outcomes. Type 3 MNV tends to be highly sensitive to anti-vascular endothelial growth factor treatment but may be associated with a higher incidence of outer retinal atrophy, compared with other subtypes. Accurately assessing the MNV subtype provides information on prognosis and helps to optimise the management of patients with nAMD.
Collapse
|
10
|
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
|
11
|
Kang D, Yoon EG, Nam KT, Yun C. Chorioretinal thickness and retinal pigment epithelial degeneration of fellow eyes in patients with unilateral neovascular age-related macular degeneration with subretinal drusenoid deposits. BMC Ophthalmol 2022; 22:304. [PMID: 35836149 PMCID: PMC9284825 DOI: 10.1186/s12886-022-02518-4] [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: 01/27/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background We sought to investigate the chorioretinal thickness and retinal pigment epithelial (RPE) degenerative features of eyes with early age-related macular degeneration (AMD) and subretinal drusenoid deposits (SDDs) according to the presence of macular neovascularization (MNV) in the fellow eyes. Methods We classified 70 eyes into two groups of 47 eyes with non-neovascular AMD and 23 eyes with neovascular AMD, respectively, according to the presence of MNV in the fellow eyes. The mean macular retinal, ganglion cell–inner plexiform layer (GCIPL), and choroidal thickness values and RPE features of the 6-mm-diameter zone were compared. RPE degeneration was defined as a lesion with an incomplete RPE and outer retinal atrophy (iRORA) or attenuated RPE reflectivity with diffuse basal laminar deposits, which was defined as when the eye showed an attenuated RPE line with granular features and mixed reflectivity in combination with sub-RPE deposits with a lesion ≥ 1,000 µm in length. Results Mean retinal, GCIPL, and choroidal thickness values (286.69 ± 15.02 µm, 64.36 ± 4.21 µm, and 156.11 ± 33.10 µm) of the neovascular AMD group were greater than those (278.61 ± 13.96 µm, 61.44 ± 4.63 µm, and 133.59 ± 34.33 µm) of the non-neovascular AMD group (all P < 0.05). RPE degeneration was more prevalent in the neovascular AMD group (65.2%) than the non-neovascular AMD group (38.3%; P = 0.034). Greater mean GCIPL and choroidal thickness values and the presence of RPE degeneration were associated with type 3 MNV in fellow eyes (all P < 0.05). Conclusions Different degenerative features according to MNV in fellow eyes of patients with AMD and SDDs suggest that variable degenerative features might be present during disease progression and have an association with the phenotype. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-022-02518-4.
Collapse
Affiliation(s)
- Dongwan Kang
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Eun Gyu Yoon
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Ki Tae Nam
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Cheolmin Yun
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea.
| |
Collapse
|
12
|
MEHTA ALEXANDER, STEEL DAVIDH, MULDREW ALYSON, PETO TUNDE, REEVES BARNABYC, EVANS REBECCA, CHAKRAVARTHY USHA. Associations and Outcomes of Patients with Submacular Hemorrhage Secondary to Age-related Macular Degeneration in the IVAN Trial. Am J Ophthalmol 2022; 236:89-98. [PMID: 34626573 DOI: 10.1016/j.ajo.2021.09.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE To compare demographics, visual acuity (VA) and retinal morphology between those with, and without baseline submacular hemorrhage (SMH) for patients enrolled in the Inhibit VEGF in Age-related Choroidal Neovascularization trial (IVAN). DESIGN Secondary analyses of a randomized, controlled trial of image and clinical data. METHODS Setting; The IVAN trial collected data in 23 UK hospitals. Study population; IVAN study eyes (with untreated neovascular age-related macular degeneration at randomization) with at least 12 months of follow-up and adequate imaging. Intervention; Study eyes were randomly assigned between monthly ranibizumab, as-needed ranibizumab, monthly bevacizumab, or as-needed bevacizumab. Imaging at baseline was graded independently for the presence, type, position, and extent of SMH. Main outcome measures; The main outcome measures were VA (primary outcome), subretinal fibrosis, atrophic scarring, and retinal thickness outcomes at 12 and 24 months RESULTS: Of 605 IVAN trial participants, 535 were included in this analysis. Patients with SMH at baseline (286 [53%]) were older (P = .010) and affected eyes were more likely to have intraretinal fluid present (P = .038). The VA was significantly worse in those with baseline SMH at month 0 (P < .001; estimate of difference 6 letters; 95% CIs, 4-8 letters), but the difference decreased and was not significant at month 12 or 24. No significant association was found between baseline SMH and subretinal fibrosis, atrophic scarring, or central retinal thickness. CONCLUSIONS The presence of SMH at baseline was associated with age, intraretinal fluid, and decreased baseline VA. By month 12, VA was no longer significantly different in those who presented with SMH at baseline.
Collapse
|
13
|
Haj Najeeb B, Deak GG, Mylonas G, Sacu S, Gerendas BS, Schmidt-Erfurth U. THE RAP STUDY, REPORT 5: REDISCOVERING MACULAR NEOVASCULARIZATION TYPE 3: Multimodal Imaging of Fellow Eyes over 24 months. Retina 2022; 42:485-493. [PMID: 35188490 PMCID: PMC8852687 DOI: 10.1097/iae.0000000000003330] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore the condition of fellow eyes of patients with macular neovascularization Type 3 (MNV3) and to verify whether the retinal-choroidal anastomosis (RCA) develops equally in all MNV types. METHODS The contralateral eyes of 94 patients with MNV3, 96 patients with MNV1, and 96 patients with MNV2 were included. Multimodal imaging was performed. The MNV3 stage including the development of fibrosis and RCA over 24 months was determined. RESULTS In the contralateral eyes of patients of the solitary (one lesion) MNV3 group, 32 eyes (42.1%) showed early/intermediate age-related macular degeneration, 25 eyes (33%) showed MNV3, and 11 eyes (14.5%) experienced fibrosis, of which 4 eyes (5.2%) had a RCA, 7 eyes (9.2%) had atrophy after resolved MNV3, and 1 eye (1.3%) developed MNV1. In the multifocal (more than one lesion) MNV3 group, 2 eyes (11.1%) showed early/intermediate age-related macular degeneration, 9 eyes (50%) showed 15 MNV3 lesions, and 4 eyes (22.2%) showed fibrosis, of which 2 eyes (11.1%) manifested with a RCA and 3 eyes (16.7%) showed atrophy after resolved MNV3. The number of eyes with a RCA accounted for 40% of all eyes with fibrosis. The count of simultaneous bilateral multifocal MNV3 was 5 (55.6%). In the MNV1 and MNV2 groups, no eye developed a RCA. The incidence of RCAs in the scarred eyes in MNV3 was significantly higher (P < 0.0001). CONCLUSION Retinal-choroidal anastomosis is an exclusive clinical feature of MNV3. The development of the multifocal MNV3 is usually bilateral and simultaneous. The occurrence of fibrosis in MNV3 has decreased dramatically after the introduction of the antiangiogenic therapy.
Collapse
Affiliation(s)
- Bilal Haj Najeeb
- Department of Ophthalmology, Vienna Reading Center, Medical University of Vienna, Vienna, Austria; and
- Department of Ophthalmology, Macula Clinic, Medical University of Vienna, Vienna, Austria
| | - Gabor G. Deak
- Department of Ophthalmology, Vienna Reading Center, Medical University of Vienna, Vienna, Austria; and
- Department of Ophthalmology, Macula Clinic, Medical University of Vienna, Vienna, Austria
| | - Georgios Mylonas
- Department of Ophthalmology, Vienna Reading Center, Medical University of Vienna, Vienna, Austria; and
| | - Stefan Sacu
- Department of Ophthalmology, Macula Clinic, Medical University of Vienna, Vienna, Austria
| | - Bianca S. Gerendas
- Department of Ophthalmology, Vienna Reading Center, Medical University of Vienna, Vienna, Austria; and
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology, Vienna Reading Center, Medical University of Vienna, Vienna, Austria; and
- Department of Ophthalmology, Macula Clinic, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
14
|
Haj Najeeb B, Deak GG, Schmidt‐Erfurth U, Gerendas BS. The RAP study, report 3: Discoloration of the macular region in patients with macular neovascularization type 3. Acta Ophthalmol 2022; 100:e270-e277. [PMID: 33821577 PMCID: PMC9292611 DOI: 10.1111/aos.14866] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/02/2021] [Accepted: 03/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND/AIMS To explore whether the existence and pattern of distribution of macular haemorrhage or exudate can be valuable diagnostic markers for macular neovascularization type 3 (MNV3) in patients with neovascular age-related macular degeneration. METHODS Eighty-three eyes of 83 consecutive treatment naïve patients with stage 3 MNV3 were enrolled. The diagnosis was based on fluorescein angiography (FA) and optical coherence tomography (OCT). Subretinal and intraretinal haemorrhage and dense exudates were evaluated on colour fundus photography. Fluorescein angiography (FA) images and OCT scans were used to identify the axial location of the haemorrhage. 83 patients with MNV1 and 83 with MNV2 were included as two control groups. RESULTS In the MNV3 group, 62 (75%) eyes had intraretinal haemorrhage and 52 (63%) had dense exudates. 73 (88%) eyes had intraretinal haemorrhage and/or dense exudates. 41 (49%) had both pathologies. The intraretinal haemorrhage was flame shaped over the lesion and punctate or semi-punctate further away from it and directed to the fovea. No subretinal haemorrhage was noticed. In the MNV1 and MNV2 groups, 11 (13%) and 24 (29%) eyes had subretinal haemorrhage or dense exudates, respectively. No intraretinal haemorrhage was seen in the two control groups. The prevalence of exudates and haemorrhage (irrespective of its location) was greater in MNV3 than in MNV1 or 2 (p < 0.0001). CONCLUSION The existence and pattern of distribution of intraretinal haemorrhage is pathognomonic of MNV3. It makes (alone or with dense exudates) the diagnose MNV3 possible using fundoscopy or colour fundus photo and without further diagnostic expenditure.
Collapse
Affiliation(s)
- Bilal Haj Najeeb
- Vienna Reading Center Department of Ophthalmology Medical University of Vienna Vienna Austria
| | - Gabor G. Deak
- Vienna Reading Center Department of Ophthalmology Medical University of Vienna Vienna Austria
| | - Ursula Schmidt‐Erfurth
- Vienna Reading Center Department of Ophthalmology Medical University of Vienna Vienna Austria
| | - Bianca S. Gerendas
- Vienna Reading Center Department of Ophthalmology Medical University of Vienna Vienna Austria
| |
Collapse
|
15
|
Saito M, Itagaki K, Sekiryu T. Fundus autofluorescence of retinal angiomatous proliferation. PLoS One 2020; 15:e0243458. [PMID: 33296421 PMCID: PMC7725377 DOI: 10.1371/journal.pone.0243458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/21/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose The present study aimed to evaluate the characteristics of fundus autofluorescence in Japanese patients with retinal angiomatous proliferation (RAP). Methods We retrospectively reviewed 100 eyes from 76 patients (male, n = 45; female, n = 31; age range, 50–94 years; mean ± standard deviation, 81.4 ± 6.4 years) with treatment-naïve RAP, which was diagnosed based on the identification of retinal–retinal anastomosis on early-phase fluorescein angiography or indocyanine green angiography (ICGA) and the identification of a hot spot on late-phase ICGA. RAP was classified into the following three stages: stage 1, proliferation of intraretinal capillaries originating from the deep retinal complex (intraretinal neovascularization); stage 2, growth of the retinal vessels into the subretinal space (subretinal neovascularization); and stage 3, clinically or angiographically observed choroidal neovascularization. In all cases, short-wavelength and near-infrared autofluorescence (SW-AF, NIR-AF) was evaluated using a confocal scanning laser ophthalmoscope. Results The conditions of the 100 eyes were as follows: stage 1 RAP, n = 6 (6%); stage 2 RAP without retinal pigment epithelial detachment (PED), n = 40 (40%); stage 2 RAP with PED, n = 44 (44%); and stage 3 RAP, 10 (10%). On NIR-AF imaging, the number of abnormalities that were observed to correspond to the RAP lesions on ICGA (87 eyes, 87%) was significantly greater in comparison to SW-AF imaging (27 eyes, 27%). The mean follow-up period in all 76 patients was 39.2 months. In the 76 patients with unilateral disease, 21 (21%) eyes developed RAP in the fellow eye during the follow-up period. Among 18 eyes that were examined by both SW-AF and NIR-AF imaging before the onset of RAP lesions, NIR-AF imaging showed hypoautofluorescence in 15 (83%) eyes before the onset of RAP lesions. Conclusions SW-AF and NIR-AF abnormalities may be related to the dysfunction of the photoreceptor/retinal pigment epithelium complex. Hypoautofluorescence on NIR-AF imaging may accurately indicate the presence or onset of RAP lesions.
Collapse
Affiliation(s)
- Masaaki Saito
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- * E-mail:
| | - Kanako Itagaki
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tetsuju Sekiryu
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima, Japan
| |
Collapse
|
16
|
Kim JH, Kim JW, Kim CG, Lee DW. Long-Term Treatment Outcomes in Type 3 Neovascularization: Focus on the Difference in Outcomes between Geographic Atrophy and Fibrotic Scarring. J Clin Med 2020; 9:jcm9041145. [PMID: 32316276 PMCID: PMC7230588 DOI: 10.3390/jcm9041145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/03/2020] [Accepted: 04/14/2020] [Indexed: 11/29/2022] Open
Abstract
Background: To evaluate the difference in the long-term treatment outcomes of type 3 neovascularization between eyes with geographic atrophy and those with fibrotic scars. Methods: This retrospective study included 195 eyes diagnosed with type 3 neovascularization and treated with anti-vascular endothelial growth factor (VEGF) agents. The included eyes were divided into three groups according to the fundus findings at the final visit: patients with fovea-involving geographic atrophy (GA group), patients with fovea-involving fibrotic scars (scar group), and patients with no fovea-involving geographic atrophy or fibrotic scars (non-GA/scar group). The best-corrected visual acuities (BCVA) of the three groups at the final visits were compared. Results: The mean follow-up period was 47.5 ± 20.7 months. The mean logMAR BCVA at the final visit was 1.18 ± 0.58 in the GA group (n = 58), 1.67 ± 0.58 in the scar group (n = 62), and 0.69 ± 0.64 in the non-GA/scar group (n = 75). The BCVA was significantly worse in the scar group than in the GA (p < 0.001) and the non-GA/scar groups (p < 0.001). Conclusion: Eyes with fibrotic scars showed the poorest visual outcomes in type 3 neovascularization among the studied groups. Preventing the development of fibrotic scars should be considered an important treatment goal.
Collapse
Affiliation(s)
- Jae Hui Kim
- Correspondence: ; Tel.: +82-2-2639-7664; Fax: +82-2-2639-7824
| | | | | | | |
Collapse
|
17
|
Maruyama-Inoue M, Sato S, Yamane S, Kadonosono K. Predictive Factors And Long-Term Visual Outcomes After Anti-Vascular Endothelial Growth Factor Treatment Of Retinal Angiomatous Proliferation. Clin Ophthalmol 2019; 13:1981-1989. [PMID: 31631966 PMCID: PMC6790115 DOI: 10.2147/opth.s224319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/10/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To report the results of 9-year follow-up examinations and predictive factors for visual acuity outcome after intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents to treat retinal angiomatous proliferation (RAP). Methods We conducted a retrospective observational study of 85 treatment-naïve eyes in 61 patients (21 men, 40 women; age range, 70-95 years; mean age, 84.0 years) treated with intravitreal injections of anti-VEGF agents. All patients received three consecutive monthly injections as an induction treatment. During the maintenance phase, the patients received intravitreal injections as needed or fixed dosing. The primary outcome measures were best-corrected visual acuity (BCVA) during the follow-up period. Furthermore, we investigated potential predictive factors of improvement in visual acuity. The proportion of patients who developed specific complications were also analyzed. Results The mean BCVA gradually decreased from 0.58 at baseline to 0.70 at 36 months (P = 0.146), 0.82 at 48 months (P = 0.004), and 0.92 at 108 months (P = 0.021). Improvement in visual acuity at the final visits was associated with baseline visual acuity and central foveal thickness. Massive subretinal hemorrhage, fibrotic scars, and macular atrophy developed in 4 (4.7%), 9 (10.6%), and 50 (56.8%) eyes, respectively, at the final visits, and were all significantly associated with final visual acuity (P = 0.013, P < 0.001, and P = 0.001, respectively). Conclusion Long-term stabilization of vision in patients with RAP, regardless of treatment modality, was difficult to achieve by using intravitreal injections of anti-VEGF agents. Earlier detection and treatment are important to maintain visual acuity in patients with RAP.
Collapse
Affiliation(s)
- Maiko Maruyama-Inoue
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
| | - Shimpei Sato
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
| | - Shin Yamane
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazuaki Kadonosono
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
| |
Collapse
|
18
|
Focal retinal pigment epithelium atrophy at the location of type 3 neovascularization lesion: a morphologic feature associated with low reactivation rate and favorable prognosis. Graefes Arch Clin Exp Ophthalmol 2019; 257:1661-1669. [PMID: 31144056 DOI: 10.1007/s00417-019-04373-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 03/18/2019] [Accepted: 05/20/2019] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To investigate the clinical significance of focal retinal pigment epithelium (RPE) atrophy in the eyes with type 3 neovascularization. METHODS This retrospective study included 184 eyes those were diagnosed with type 3 neovascularization and were treated with antivascular endothelial growth factor (VEGF) therapy. Focal RPE atrophy was defined as a localized RPE atrophy found at the same location as the type 3 lesion. The incidence of reactivation after 3 loading injections and the visual outcomes was compared between a focal RPE atrophy group and a nonfocal RPE atrophy group. In the focal RPE atrophy group, the number of injections was compared between before and after the development of RPE atrophy. RESULTS The mean follow-up period was 37.6 ± 18.8 months; focal RPE atrophy developed in 24 eyes (13.0%). Reactivation of the lesion after 3 loading injections was significantly less frequent in the focal RPE atrophy group (58.3%) than that in the nonfocal RPE atrophy group (85.0%) (P = 0.004). In the focal RPE atrophy group, the mean best-corrected visual acuity (BCVA) was 0.68 ± 0.28 (Snellen equivalent = 20/95) at diagnosis and 0.70 ± 0.48 (20/100) at the final follow-up. In the nonfocal RPE atrophy group, the values were 0.75 ± 0.34 (20/112) and 1.12 ± 0.68 (20/263), respectively. The BCVA at the final follow-up was significantly better in the focal RPE atrophy group (P < 0.001). The mean number of injections per year was 4.9 ± 1.8 and 1.3 ± 1.6 before and after the development of focal RPE atrophy, respectively (P < 0.001). CONCLUSIONS Development of focal RPE atrophy was associated with a low incidence of reactivation of type 3 neovascularization and was therefore predictive of a favorable visual prognosis.
Collapse
|
19
|
Waugh N, Loveman E, Colquitt J, Royle P, Yeong JL, Hoad G, Lois N. Treatments for dry age-related macular degeneration and Stargardt disease: a systematic review. Health Technol Assess 2019; 22:1-168. [PMID: 29846169 DOI: 10.3310/hta22270] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Age-related macular degeneration (AMD) is the leading cause of visual loss in older people. Advanced AMD takes two forms, neovascular (wet) and atrophic (dry). Stargardt disease (STGD) is the commonest form of inherited macular dystrophy. OBJECTIVE To carry out a systematic review of treatments for dry AMD and STGD, and to identify emerging treatments where future NIHR research might be commissioned. DESIGN Systematic review. METHODS We searched MEDLINE, EMBASE, Web of Science and The Cochrane Library from 2005 to 13 July 2017 for reviews, journal articles and meeting abstracts. We looked for studies of interventions that aim to preserve or restore vision in people with dry AMD or STGD. The most important outcomes are those that matter to patients: visual acuity (VA), contrast sensitivity, reading speed, ability to drive, adverse effects of treatment, quality of life, progression of disease and patient preference. However, visual loss is a late event and intermediate predictors of future decline were accepted if there was good evidence that they are strong predictors of subsequent visual outcomes. These include changes detectable by investigation, but not necessarily noticed by people with AMD or STGD. ClinicalTrials.gov, the World Health Organization search portal and the UK Clinical Trials gateway were searched for ongoing and recently completed clinical trials. RESULTS The titles and abstracts of 7948 articles were screened for inclusion. The full text of 398 articles were obtained for further screening and checking of references and 112 articles were included in the final report. Overall, there were disappointingly few good-quality studies (including of sufficient size and duration) reporting useful outcomes, particularly in STGD. However we did identify a number of promising research topics, including drug treatments, stem cells, new forms of laser treatment, and implantable intraocular lens telescopes. In many cases, research is already under way, funded by industry or governments. LIMITATIONS In AMD, the main limitation came from the poor quality of much of the evidence. Many studies used VA as their main outcome despite not having sufficient duration to observe changes. The evidence on treatments for STGD is sparse. Most studies tested interventions with no comparison group, were far too short term, and the quality of some studies was poor. FUTURE WORK We think that the topics on which the Health Technology Assessment (HTA) and Efficacy Mechanism and Evaluation (EME) programmes might consider commissioning primary research are in STGD, a HTA trial of fenretinide (ReVision Therapeutics, San Diego, CA, USA), a visual cycle inhibitor, and EME research into the value of lutein and zeaxanthin supplements, using short-term measures of retinal function. In AMD, we suggest trials of fenretinide and of a potent statin. There is epidemiological evidence from the USA that the drug, levodopa, used for treating Parkinson's disease, may reduce the incidence of AMD. We suggest that similar research should be carried out using the large general practice databases in the UK. Ideally, future research should be at earlier stages in both diseases, before vision is impaired, using sensitive measures of macular function. This may require early detection of AMD by screening. STUDY REGISTRATION This study is registered as PROSPERO CRD42016038708. FUNDING The National Institute for Health Research HTA programme.
Collapse
Affiliation(s)
- Norman Waugh
- Division of Health Sciences, University of Warwick, Coventry, UK
| | | | | | - Pamela Royle
- Division of Health Sciences, University of Warwick, Coventry, UK
| | | | | | - Noemi Lois
- Ophthalmology, Royal Victoria Hospital, Belfast, UK.,Wellcome-Wolfson Centre for Experimental Medicine, Queens University, Belfast, UK
| |
Collapse
|
20
|
|
21
|
Jaki Mekjavic P, Zaletel Benda P. Outcome of 5-Year Treatment of Neovascular Age-Related Macular Degeneration With Intravitreal Anti-VEGF Using "Treat and Extend" Regimen. Front Med (Lausanne) 2018; 5:125. [PMID: 29765959 PMCID: PMC5938349 DOI: 10.3389/fmed.2018.00125] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 04/16/2018] [Indexed: 01/19/2023] Open
Abstract
Objective The aim of this study is twofold. First, to evaluate the long-term outcome of anti-vascular endothelial growth factor (anti-VEGF) treatment in a clinical setting using the “treat-and-extend regimen” (TER) in patients with neovascular age-related macular degeneration (nAMD). Second, to determine the proportion of patients treated with anti-VEGF with good visual acuity (VA), i.e., vision sufficient to maintain a high level of independence. Design We conducted a single center retrospective review of patients with treatment-naive nAMD who were treated with anti-VEGF. Patients were treated with anti-VEGF intravitreal injections according to the TER. Patients started treatment with monthly injections of either bevacizumab (1.25 mg/0.05 mL) or ranibizumab (0.5 mg/0.05 mL) until there were no signs present of choroidal neovascularization (CNV) activity. CNV activity was determined from fundus examination and SD-OCT imaging. Follow-up administration of intravitreal injections was extended by 2-week intervals, up to a total of 14 weeks, provided no signs of CNV activity were detected. In some patients, the first treatment was replaced with aflibercept (2 mg/0.05 mL). Participants On the basis of the inclusion criterion for the study, that patients had to be treated for 5 years, a total of 101 patients were included in the study. In all patients, one eye was treated for a 5-year period, and thus we studied 101 eyes. Measurements Best corrected VA was analyzed at baseline and each year during the 5-year follow-up. Results VA improved initially after year 1 of the treatment. VA decreased in the subsequent 4 years of treatment, but remained significantly higher from year 1 to year 3 of the treatment compared to baseline values. Patients with good VA followed a similar trend: the proportion increased in the first year, and thereafter gradually decreased during the course of the 5-year follow up. At year 5, the number of patients with good VA decreased to baseline values. Conclusion TER with anti-VEGF for nAMD treatment prevents long-term severe visual loss in real-world setting and maintains patients’ VA at levels sufficient to ensure independence.
Collapse
Affiliation(s)
- Polona Jaki Mekjavic
- Eye Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | | |
Collapse
|
22
|
Chae B, Su D, Gal-Or O, Freund KB, Sarraf D. Type 3 neovascularisation: long-term analysis of visual acuity and optical coherence tomography anatomical outcomes. Br J Ophthalmol 2018. [PMID: 29519877 DOI: 10.1136/bjophthalmol-2018-311850] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND To investigate the long-term visual and optical coherence tomography (OCT) anatomical outcomes of type 3 neovascularisation (NV) and to identify any baseline predictors of poor outcomes. METHODS In this retrospective study, patients diagnosed with treatment naïve type 3 NV were identified and categorised into two groups: good or poor vision based on final vision at 1 year. Baseline demographic features and visual acuity (VA) and baseline and 1-year spectral domain OCT (SD-OCT) anatomical findings were studied and correlated with good versus poor visual outcomes. RESULTS Ten of 25 eyes were classified as having a poor visual outcome (20/50 or worse) at 1 year. Increased age (P=0.049), male gender (p=0.041) and worse baseline VA (ρs=0.61, p=0.001) were associated with poor vision at 1 year. Greater foveal atrophy was noted at 1 year in the poor visual outcome group (p=0.030). Subretinal hyper-reflective material and choroidal thinning were additional features noted more commonly in this group. CONCLUSION Increased age, male gender and lower baseline vision may be important baseline predictors of poor visual outcomes in eyes with type 3 NV. The development of central outer retinal atrophy and fibrosis, as identified with SD-OCT, may limit long-term vision in eyes with type 3 NV.
Collapse
Affiliation(s)
- Bora Chae
- Stein Eye Institute, University of California, Los Angeles, California, USA
| | - Daniel Su
- Stein Eye Institute, University of California, Los Angeles, California, USA
| | - Orly Gal-Or
- Vitreous, Retina Macula, Consultants of New York, New York City, New York, USA.,LuEsther T Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, USA.,Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
| | - K Bailey Freund
- Vitreous, Retina Macula, Consultants of New York, New York City, New York, USA.,LuEsther T Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, USA.,Department of Ophthalmology, New York University School of Medicine, New York, New York, USA
| | - David Sarraf
- Stein Eye Institute, University of California, Los Angeles, California, USA.,Department of Ophthalmology, Kaiser Permanente, Woodland Hills, California, USA
| |
Collapse
|
23
|
Zarubina AV, Gal-Or O, Huisingh CE, Owsley C, Freund KB. Macular Atrophy Development and Subretinal Drusenoid Deposits in Anti-Vascular Endothelial Growth Factor Treated Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2017; 58:6038-6045. [PMID: 29196768 PMCID: PMC5710629 DOI: 10.1167/iovs.17-22378] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose To explore the association between presence of subretinal drusenoid deposits (SDD) at baseline in eyes with neovascular age-related macular degeneration (nAMD) with the development of macular atrophy (MA) during anti-vascular endothelial growth factor (VEGF) therapy. Methods There were 74 eyes without pre-existing MA receiving anti-VEGF therapy for nAMD for 2 years or longer analyzed. At least two image modalities that included spectral-domain optical coherence tomography, near-infrared reflectance, fluorescein angiography, and color fundus photos were used to assess for SDD presence, phenotype (dot and ribbon), and location, neovascularization type, and MA. Logistic regression models using generalized estimating equations assessed the association between SDD and the development of MA adjusting for age, neovascularization type, and choroidal thickness. Results SDD were present in 46 eyes (63%) at baseline. MA developed in 38 eyes (51%) during the mean of 4.7 ± 1.2 years of follow-up. Compared with eyes without SDD, those with SDD at baseline were 3.0 times (95% confidence interval [CI] 1.1–8.5, P = 0.0343) more likely to develop MA. Eyes with SDD present in the inferior macula and inferior extramacular fields at baseline were 3.0 times and 6.5 times more likely to develop MA at follow-up than eyes without SDD in these locations (95% CI 1.0–8.9, P = 0.0461 and 95% CI 1.3–32.4, P = 0.0218, respectively). MA development was not associated with a specific SDD phenotype. Conclusions MA frequently developed in eyes during anti-VEGF treatment. SDD were independently associated with MA development. The extension of SDD into the inferior fundus, particularly in the inferior extramacular field, conferred higher odds of subsequent MA development.
Collapse
Affiliation(s)
- Anna V Zarubina
- Department of Ophthalmology, School of Medicine; University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Orly Gal-Or
- Vitreous Retina Macula Consultants of New York, New York, New York, United States.,Rabin Medical Center, Petach-Tikva, Israel
| | - Carrie E Huisingh
- Department of Ophthalmology, School of Medicine; University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Cynthia Owsley
- Department of Ophthalmology, School of Medicine; University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, United States.,Department of Ophthalmology, New York University School of Medicine, New York, New York, United States
| |
Collapse
|
24
|
Gharbiya M, Giustolisi R, Marchiori J, Bruscolini A, Mallone F, Fameli V, Nebbioso M, Abdolrahimzadeh S. Comparison of Short-Term Choroidal Thickness and Retinal Morphological Changes after Intravitreal Anti-VEGF Therapy with Ranibizumab or Aflibercept in Treatment-Naive Eyes. Curr Eye Res 2017; 43:391-396. [DOI: 10.1080/02713683.2017.1405045] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Magda Gharbiya
- Ophthalmology Unit, University of Rome “Sapienza”, Umberto I University Hospital, Rome, Italy
| | - Rosalia Giustolisi
- Ophthalmology Unit, University of Rome “Sapienza”, Umberto I University Hospital, Rome, Italy
| | - Jessica Marchiori
- Ophthalmology Unit, University of Rome “Sapienza”, Umberto I University Hospital, Rome, Italy
| | - Alice Bruscolini
- Ophthalmology Unit, University of Rome “Sapienza”, Umberto I University Hospital, Rome, Italy
| | - Fabiana Mallone
- Ophthalmology Unit, University of Rome “Sapienza”, Umberto I University Hospital, Rome, Italy
| | - Valeria Fameli
- Ophthalmology Unit, University of Rome “Sapienza”, Umberto I University Hospital, Rome, Italy
| | - Marcella Nebbioso
- Ophthalmology Unit, University of Rome “Sapienza”, Umberto I University Hospital, Rome, Italy
| | - Solmaz Abdolrahimzadeh
- Ophthalmology Unit, University of Rome “Sapienza”, Umberto I University Hospital, Rome, Italy
| |
Collapse
|
25
|
DIFFERENCE IN TREATMENT OUTCOMES ACCORDING TO OPTICAL COHERENCE TOMOGRAPHY-BASED STAGES IN TYPE 3 NEOVASCULARIZATION (RETINAL ANGIOMATOUS PROLIFERATION). Retina 2017; 38:2356-2362. [PMID: 29019795 DOI: 10.1097/iae.0000000000001876] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To compare 12-month treatment outcomes of Type 3 neovascularization among its different stages as classified using an optical coherence tomography-based method. METHODS This retrospective observational study included 40 patients (40 eyes) who were newly diagnosed with Type 3 neovascularization. The patients were initially administered 3 monthly anti-vascular endothelial growth factor injections. Repeat treatment was performed when recurrence of fluid was noted. Disease staging was classified using the optical coherence tomography-based method. The best-corrected visual acuity at diagnosis and at 12 months and degree of change in best-corrected visual acuity were compared among the different stages of the disease. In addition, incidence of progression in the disease stages was estimated. RESULTS Among the 40 patients, 14 (35.0%) were classified as Stage 2 and 26 (65.0%) were classified as Stage 3. The best-corrected visual acuity values at diagnosis and at 12 months were 0.61 ± 0.31 (20/81 Snellen equivalents) and 0.46 ± 0.30 (20/57) in the Stage 2 group and 0.67 ± 0.42 (20/93) and 0.70 ± 0.49 (20/100) in the Stage 3 group, respectively. There was a significant difference in best-corrected visual acuity change between the two groups (P = 0.036). During the follow-up period, 3 retinal pigment epithelium tears and 2 submacular hemorrhages had developed in the Stage 3 group. Progression of the disease from Stage 2 to Stage 3 was noted in 2 patients (14.3%). CONCLUSION The visual outcome was worse in Stage 3 than in Stage 2, and adverse events that may lead to abrupt visual deterioration developed only in Stage 3. Further studies are needed to reveal whether anti-vascular endothelial growth factor therapy can suppress the progression of the disease stages.
Collapse
|
26
|
RECURRENCE IN PATIENTS WITH TYPE 3 NEOVASCULARIZATION (RETINAL ANGIOMATOUS PROLIFERATION) AFTER INTRAVITREAL RANIBIZUMAB. Retina 2017; 37:1508-1515. [PMID: 27787444 DOI: 10.1097/iae.0000000000001383] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
27
|
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]
|
28
|
PROGRESSION OF MACULAR ATROPHY IN PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION UNDERGOING ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY. Retina 2017; 36:1843-50. [PMID: 27135213 DOI: 10.1097/iae.0000000000001059] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE To define the frequency and quantify the progression of macular atrophy (MA) in patients with neovascular age-related macular degeneration undergoing treatment with antivascular endothelial growth factor therapy for >2 years. METHODS Fifty-four eyes of 46 patients (86.7 ± 6.8 years, 53.7% women) diagnosed with wet age-related macular degeneration were included in this retrospective study. Eyes that received photodynamic therapy or laser treatment were excluded. All eyes were imaged at baseline and after 2 years with the Cirrus spectral domain optical coherence tomography using a 512 × 128 macular cube scan protocol centered on the fovea. Optical coherence tomography en face fundus images were obtained for each 3-dimensional data set using the U.S. Food and Drug Administration-cleared Advanced RPE Analysis software, which automatically identifies atrophic areas by segmenting regions of increased reflectivity in en face choroidal slab images. Segmentation errors were manually corrected by trained Doheny Image Reading Center graders using a standardized grading protocol. The prevalence rates of atrophy at baseline and at 2-years follow-up and enlargement rates were computed. Baseline demographic factors and types and numbers of antivascular endothelial growth factor injections received over time were correlated with the development and enlargement of atrophy. RESULTS Macular atrophy was noted at baseline in 32 (59.3%) eyes and progressed in all eyes over the next 2 years. Among the 28 eyes without atrophy at baseline, MA developed by 2 years in 6 eyes (21.4% of eyes without MA at baseline). Of note, 22 eyes (40.7% of overall cohort) never developed atrophy during the course of the study. Among eyes with atrophy at baseline, the annual growth rate of MA was found to be 0.89 ± 0.93 mm. A multiple regression analysis was performed to evaluate the influence of gender, age, smoking status, medication injected, and number of injections on MA. Except for the number of total injections (R = 0.3, P < 0.01), the studied variables could not significantly predict development or progression of MA (F [0.73, 13] = 0.378, P = 0.86, R = 0.05). However, the study was not powered to detect small effects. CONCLUSION Macular atrophy is a frequent finding in eyes with wet age-related macular degeneration both before and after antivascular endothelial growth factor therapy. The frequency of new optical coherence tomography-defined atrophy (21% at 2 years) after starting therapy was close to the rates reported in CATT, IVAN, and HARBOR. The rate of MA enlargement was positively correlated with the number of injections, but did not appear to be greater than that reported for atrophy in the absence of choroidal neovascularization.
Collapse
|
29
|
|
30
|
Abstract
BACKGROUND Retinal angiomatous proliferations (RAP) are a subgroup of exsudative or "wet" age-related macular degeneration (wAMD) with devastating reduction of visual acuity in later stages. Intravitreal ranibizumab provides good therapy, but is considered to be less effective than in other choroidal neovascularizations (CNV). OBJECTIVE We investigated the efficacy of ranibizumab in late-stage III RAP with retinochoroidal anastomosis compared to the outcome of other CNV lesions. MATERIALS AND METHODS The data of all patients with wAMD treated with ranibizumab were retrospectively analyzed. Patients were divided into groups depending on the lesion type into RAP (identified and selected clinically, proven by fluorescein angiography) and CNV lesions (identified by fluorescein angiography only) named occult, minimally and predominantly classic groups. The best-corrected visual acuity (BCVA) was obtained before (at the timepoint "diagnosis"), during (1st, 2nd, and 3rd injection), and after upload ("1st control"). RESULTS Before first injection, visual acuity decreased in all groups (0.73 to 0.78 logMAR for all CNV, 0.95 to 1.02 logMAR for RAP). During upload there was no further decline in visual acuity but no improvement as well up to the 1st control visit in the RAP group (1.02 to 1.03 logMAR), but a statistically significant increase in all other groups (0.78 to 0.67 logMAR). CONCLUSION Treatment of late-stage III RAP with ranibizumab is effective. Stabiliziation of visual acuity can be achieved, but-in contrast to other forms of CNV lesions-no further improvement. Therefore, patients with this special form need to be identified and treated as early as possible.
Collapse
|
31
|
Sikorav A, Semoun O, Zweifel S, Jung C, Srour M, Querques G, Souied EH. Prevalence and quantification of geographic atrophy associated with newly diagnosed and treatment-naïve exudative age-related macular degeneration. Br J Ophthalmol 2016; 101:438-444. [DOI: 10.1136/bjophthalmol-2015-308065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 07/13/2016] [Accepted: 07/14/2016] [Indexed: 01/15/2023]
|
32
|
PREVALENCE OF SUBTYPES OF RETICULAR PSEUDODRUSEN IN NEWLY DIAGNOSED EXUDATIVE AGE-RELATED MACULAR DEGENERATION AND POLYPOIDAL CHOROIDAL VASCULOPATHY IN KOREAN PATIENTS. Retina 2016; 35:2604-12. [PMID: 26049615 DOI: 10.1097/iae.0000000000000633] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the prevalence and characteristics of subtypes of pseudodrusen in newly diagnosed exudative age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). METHODS This retrospective cross-sectional study included 321 eyes of 321 patients who were newly diagnosed with exudative AMD or PCV. Reticular pseudodrusen was classified into dot pseudodrusen and ribbon pseudodrusen; the prevalence of each subtype was estimated and compared between exudative AMD excluding retinal angiomatous proliferation (RAP), PCV, and RAP. Patient age and choroidal thickness were compared between patients with dot pseudodrusen only and those with ribbon pseudodrusen. RESULTS The prevalence of reticular pseudodrusen was 13.9% (15 of 108 eyes) in exudative AMD excluding RAP, 3.4% (6 of 175 eyes) in PCV, and 68.4% (27 of 38 eyes) in RAP. Among the eyes with pseudodrusen, dot pseudodrusen and ribbon pseudodrusen were noted in 100% and 40.0%, respectively, in exudative AMD excluding RAP, 100% and 16.7%, respectively, in PCV, and 96.2% and 69.2%, respectively, in RAP. Ribbon pseudodrusen was more frequently observed in RAP (P = 0.032). Patients with ribbon pseudodrusen were significantly older (77.3 ± 6.6 years vs. 72.9 ± 8.1 years, P = 0.042) than those with dot pseudodrusen only. CONCLUSION The markedly higher incidence of ribbon pseudodrusen in RAP may suggest possible influence of ribbon pseudodrusen on the development of RAP.
Collapse
|
33
|
Sakurada Y, Yoneyama S, Sugiyama A, Tanabe N, Kikushima W, Mabuchi F, Kume A, Kubota T, Iijima H. Prevalence and Genetic Characteristics of Geographic Atrophy among Elderly Japanese with Age-Related Macular Degeneration. PLoS One 2016; 11:e0149978. [PMID: 26918864 PMCID: PMC4769020 DOI: 10.1371/journal.pone.0149978] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 02/08/2016] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate the prevalence and genetic characteristics of geographic atrophy (GA) among elderly Japanese with advanced age-related macular degeneration (AMD) in a clinic-based study. Methods Two-hundred and ninety consecutive patients with advanced AMD were classified into typical neovascular AMD, polypoidal choroidal vasculopathy (PCV), retinal angiomatous proliferation (RAP) or geographic atrophy (GA). Genetic variants of ARMS2 A69S (rs10490924) and CFH I62V (rs800292) were genotyped using TaqMan Genotyping Assays. The clinical and genetic characteristics were compared between patients with and without GA. Results The number of patients diagnosed as having typical neovascular AMD, PCV, RAP and GA were 98 (33.8%), 151 (52.1%), 22 (7.5%) and 19 (6.6%), respectively. Of 19 patients with GA, 13 patients (68.4%) had unilateral GA with exudative AMD in the contralateral eye. Patients with GA were significantly older, with a higher prevalence of reticular pseudodrusen, bilateral involvement of advanced AMD and T-allele frequency of ARMS2 A69S compared with those with typical AMD and PCV; although there were no differences in the genetic and clinical characteristics among patients with GA and RAP. Conclusions The prevalence of GA was 6.6% among elderly Japanese with AMD. Patients with GA and RAP exhibited genetic and clinical similarities.
Collapse
Affiliation(s)
- Yoichi Sakurada
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
- * E-mail:
| | - Seigo Yoneyama
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Atsushi Sugiyama
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Naohiko Tanabe
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Wataru Kikushima
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Fumihiko Mabuchi
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Atsuki Kume
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Takeo Kubota
- Department of Epigenetics, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hiroyuki Iijima
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| |
Collapse
|
34
|
A paradigm shift in imaging biomarkers in neovascular age-related macular degeneration. Prog Retin Eye Res 2016; 50:1-24. [DOI: 10.1016/j.preteyeres.2015.07.007] [Citation(s) in RCA: 210] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 07/17/2015] [Accepted: 07/24/2015] [Indexed: 12/13/2022]
|
35
|
Ahn SE, Ahn DS, Yang H, Yoon HS. Comparison of Optical Coherence Tomography Characteristics among Three Subtypes of Exudative Age-related Macular Degeneration. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.7.1093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
36
|
Park YG, Roh YJ. One year results of intravitreal ranibizumab monotherapy for retinal angiomatous proliferation: a comparative analysis based on disease stages. BMC Ophthalmol 2015; 15:182. [PMID: 26691185 PMCID: PMC4685625 DOI: 10.1186/s12886-015-0172-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 12/14/2015] [Indexed: 11/13/2022] Open
Abstract
Background Retinal angiomatous proliferation (RAP) has been known as a variant of exudative age-related macular degeneration (AMD) with a unfavorable prognosis. To evaluate the effect of ranibizumab administered initially as three loading doses for patients with various stages of RAP. Methods A retrospective chart review of 40 patients (41 eyes) with RAP was conducted. The study divided patients into three groups of Group I (8 eyes in stage I), Group II (17eyes in stage II), and Group III (16 eyes in stage III). All patients received three initial monthly intravitreal injections (0.5 mg) of ranibizumab and were monitored monthly for 12 months. Reinjection of ranibizumab after three initial monthly doses was administered on as-needed basis. The main outcome measures were the change in the mean of best-corrected Snellen visual acuity (BCVA) and central macular thickness (CMT), and the total number of injections received during the 12 months. Results The mean change in BCVA at 12 months was-0.286,-0.165, and-0.151 (logMAR) in Group I, II, and III, respectively. CMT was also reduced by a mean of 32.72 ± 56.75, 57.45 ± 56.48 and 148.37 ± 98.59 μm. The mean number of injections in Group I was significant lower than those in Group II and III (P < 0.001, P < 0.001, and P = 0.15 for Group I versus Group II, Group I versus Group III, and Group II versus Group III, respectively). Conclusions The 12-month follow-up outcomes suggest that three consecutive loading doses of intravitreal ranibizumab is an effective treatment on early stage (stage I) of RAP. Patients in stage I showed a significantly lower recurrence rate than patients in later stages.
Collapse
Affiliation(s)
- Young Gun Park
- Department of Ophthalmology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #62 Yeouido-dong, Yeongdeungpo-gu, Seoul, 150-713, Korea
| | - Young-Jung Roh
- Department of Ophthalmology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #62 Yeouido-dong, Yeongdeungpo-gu, Seoul, 150-713, Korea.
| |
Collapse
|
37
|
Marques MF, Marques JP, Gil JQ, Costa J, Almeida E, Cachulo MDL, Pires I, Figueira J, Silva R. Long-Term Management of RAP Lesions in Clinical Practice: Treatment Efficacy and Predictors of Functional Improvement. Ophthalmic Res 2015; 55:119-25. [PMID: 26671015 DOI: 10.1159/000441797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 10/19/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the long-term efficacy of ranibizumab in the treatment of retinal angiomatous proliferation (RAP) and to identify predictors of functional outcome. METHODS Retrospective case series comprised 79 eyes of 68 consecutive patients with RAP followed up ≥36 months. Primary end-points were best-corrected visual acuity (BCVA) and central macular thickness (CMT) variation at 36 months and at the last visit. RESULTS Mean follow-up time was 59.8 ± 16.0 months. All eyes were treated with pro re nata ranibizumab, with (n = 33) or without (n = 46) photodynamic therapy (PDT). Stabilization or improvement in BCVA was observed in 50.6% of the patients at 36 months, and in 40.5% at the end of the follow-up, where 20.3% preserved reading vision. A significant decrease in CMT was observed at 36 months (p < 0.001), but not at the end of the follow-up. Geographic atrophy (GA) was present in 59.5% of the eyes at the final visit. Baseline subretinal fluid was associated with better visual outcomes (p = 0.001). Results of combination treatment with intravitreal ranibizumab and PDT did not significantly differ from ranibizumab monotherapy. CONCLUSION Modest functional outcomes can be expected from the long-term treatment of RAP lesions in clinical practice, most likely due to the advent of GA. Baseline subretinal fluid positively correlated with final BCVA.
Collapse
Affiliation(s)
- Marco Frederico Marques
- Department of Ophthalmology, Centro Hospitalar e Universitx00E1;rio de Coimbra (CHUC), Coimbra, Portugal
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Saito M, Iida T, Kano M, Itagaki K. Two-year results of combined intravitreal ranibizumab and photodynamic therapy for retinal angiomatous proliferation. Jpn J Ophthalmol 2015; 60:42-50. [DOI: 10.1007/s10384-015-0417-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/09/2015] [Indexed: 01/14/2023]
|
39
|
|
40
|
Type 3 neovascularization: evolution, association with pigment epithelial detachment, and treatment response as revealed by spectral domain optical coherence tomography. Retina 2015; 35:638-47. [PMID: 25650713 DOI: 10.1097/iae.0000000000000488] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To demonstrate the evolution and treatment response of Type 3 neovascularization using spectral domain optical coherence tomography. METHODS We retrospectively analyzed 40 eyes treated with intravitreal anti-vascular endothelial growth factor therapy for Type 3 neovascularization over a variable follow-up period. RESULTS In 17 eyes, spectral domain optical coherence tomography captured the development of Type 3 neovascularization from punctate hyperreflective foci that preceded any outer retinal defect. The more mature Type 3 lesions were associated with outer retinal disruption and adjacent cystoid macular edema. In addition, 37 of 40 Type 3 lesions (93%) were associated with an underlying pigment epithelial detachment, of which 26 (70%) were drusenoid, 6 (16%) serous, and 5 (14%) mixed. Type 3 vessels appeared to leak fluid into the pigment epithelial detachment cavity, creating serous pigment epithelial detachments as large as 925 μm in maximal height. Treatment with anti-vascular endothelial growth factor agents led to prompt involution of the lesion and resorption of the intraretinal and subretinal pigment epithelium fluid after one or two injections (median = 1). CONCLUSION In some eyes with age-related macular degeneration, the earliest sign of Type 3 neovascularization is punctate hyperreflective foci above the external limiting membrane. The mature Type 3 lesions and associated serous pigment epithelial detachments are highly responsive to anti-vascular endothelial growth factor therapy.
Collapse
|
41
|
How has high-resolution multimodal imaging refined our understanding of the vasogenic process in type 3 neovascularization? Retina 2015; 35:603-13. [PMID: 25621948 DOI: 10.1097/iae.0000000000000487] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
42
|
Dhrami-Gavazi E, Balaratnasingam C, Lee W, Freund KB. Type 1 neovascularization may confer resistance to geographic atrophy amongst eyes treated for neovascular age-related macular degeneration. Int J Retina Vitreous 2015; 1:15. [PMID: 27847608 PMCID: PMC5088476 DOI: 10.1186/s40942-015-0015-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 08/16/2015] [Indexed: 12/20/2022] Open
Abstract
Background To report a series of age-related macular degeneration (AMD) patients in whom progression to geographic atrophy (GA) in one eye receiving frequent intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) therapy for type 1 neovascularization (NV) was slower than that of the fellow eye with non-neovascular AMD. Methods Retrospective, observational case series examining the clinical course and GA progression rate in four consecutive patients in which one eye harbored type 1 neovascular AMD and was receiving anti-VEGF therapy, while the fellow eye manifested signs of non-neovascular AMD only. Eligibility criteria included anti-VEGF therapy duration of over 4 years and over 50 injections. Lesion evolution was documented via multimodal imaging. GA at baseline and final visits was quantified and GA progression rate for each eye was determined. Results Four consecutive patients were followed for a mean interval of 94 months (range 62–120). One eye harbored type 1 NV while the fellow eye remained non-neovascular. The former received a mean of 65.5 ± 15.2 anti-VEGF injections. Mean rate of GA progression in non-neovascular eyes was 0.076 ± 0.024 mm2/month and in type 1 NV eyes was 0.004 ± 0.005 mm2/month. Difference in GA progression rate between type 1 and non-neovascular eyes was found to be statistically significant (P = 0.001). Conclusions These findings support previous hypotheses that, unlike type 2 and 3 lesions, type 1 NV may represent a neovascular AMD subtype more resilient to GA formation. This may have implications for anti-VEGF regimens in the management of type 1 NV.
Collapse
Affiliation(s)
- Elona Dhrami-Gavazi
- Vitreous Retina Macula Consultants of New York, 460 Park Avenue, 5th Floor, New York, NY 10022 USA ; grid.413748.d000000009647995XThe LuEsther T. Mertz Retinal Research Center, Manhattan Eye Ear and Throat Hospital, New York, NY USA ; grid.21729.3f0000000419368729Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, College of Physicians and Surgeons, New York, NY USA
| | - Chandrakumar Balaratnasingam
- Vitreous Retina Macula Consultants of New York, 460 Park Avenue, 5th Floor, New York, NY 10022 USA ; grid.413748.d000000009647995XThe LuEsther T. Mertz Retinal Research Center, Manhattan Eye Ear and Throat Hospital, New York, NY USA
| | - Winston Lee
- grid.21729.3f0000000419368729Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, College of Physicians and Surgeons, New York, NY USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, 460 Park Avenue, 5th Floor, New York, NY 10022 USA ; grid.413748.d000000009647995XThe LuEsther T. Mertz Retinal Research Center, Manhattan Eye Ear and Throat Hospital, New York, NY USA ; grid.21729.3f0000000419368729Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, College of Physicians and Surgeons, New York, NY USA ; grid.137628.90000000121698901Department of Ophthalmology, New York University School of Medicine, New York, NY USA
| |
Collapse
|
43
|
Re: Wu et al.: Optical coherence tomography−defined changes preceding the development of drusen-associated atrophy in age-related macular degeneration (Ophthalmology 2014;121:2415-22). Ophthalmology 2015; 122:e53. [DOI: 10.1016/j.ophtha.2015.02.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 02/05/2015] [Accepted: 02/06/2015] [Indexed: 11/20/2022] Open
|
44
|
The progress in understanding and treatment of diabetic retinopathy. Prog Retin Eye Res 2015; 51:156-86. [PMID: 26297071 DOI: 10.1016/j.preteyeres.2015.08.001] [Citation(s) in RCA: 633] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 08/12/2015] [Accepted: 08/13/2015] [Indexed: 12/15/2022]
Abstract
Diabetic retinopathy is the most frequently occurring complication of diabetes mellitus and remains a leading cause of vision loss globally. Its aetiology and pathology have been extensively studied for half a century, yet there are disappointingly few therapeutic options. Although some new treatments have been introduced for diabetic macular oedema (DMO) (e.g. intravitreal vascular endothelial growth factor inhibitors ('anti-VEGFs') and new steroids), up to 50% of patients fail to respond. Furthermore, for people with proliferative diabetic retinopathy (PDR), laser photocoagulation remains a mainstay therapy, even though it is an inherently destructive procedure. This review summarises the clinical features of diabetic retinopathy and its risk factors. It describes details of retinal pathology and how advances in our understanding of pathogenesis have led to identification of new therapeutic targets. We emphasise that although there have been significant advances, there is still a pressing need for a better understanding basic mechanisms enable development of reliable and robust means to identify patients at highest risk, and to intervene effectively before vision loss occurs.
Collapse
|
45
|
Parodi MB, Iacono P, Sacconi R, Iuliano L, Bandello F. Fundus Autofluorescence Changes After Ranibizumab Treatment for Subfoveal Choroidal Neovascularization Secondary to Pathologic Myopia. Am J Ophthalmol 2015; 160:322-327.e2. [PMID: 25935099 DOI: 10.1016/j.ajo.2015.04.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 04/21/2015] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe fundus autofluorescence (FAF) patterns of myopic choroidal neovascularization (CNV) treated with intravitreal ranibizumab and their correlation with visual acuity. DESIGN Prospective interventional case series. METHODS Twenty-seven eyes (27 patients) affected by myopic CNV were enrolled from January 2011 to January 2013. All patients underwent a complete ophthalmologic examination, including best-corrected visual acuity (BCVA) determination and fundus autofluorescence (FAF). The patients underwent ranibizumab injections following a pro re nata treatment regimen. The main outcome measure was the identification of the FAF patterns of myopic CNV over a 12-month follow-up. The secondary outcome was the correlation of the FAF patterns with the BCVA. RESULTS At baseline 17 eyes (63%) showed a hyperautofluorescent pattern and 10 eyes (37%) a patchy pattern. BCVA changed from 0.48 ± 0.23 (logMAR) to 0.30 ± 0.32 at the 12-month examination (P = .027) in the hyper-FAF subgroup. In the subgroup showing the patchy pattern, the BCVA declined slightly from 0.51 ± 0.27 to 0.56 ± 0.37 (P = .53). The 14 eyes preserving the hyper-FAF pattern during the follow-up had a final BCVA of 0.20 ± 0.17, whereas the 9 eyes maintaining the patchy pattern showed a final BCVA of 0.60 ± 0.37 (P = .002). The atrophic area of the retinal pigment epithelium assessed on the basis of FAF increased from 1.27 ± 2.80 mm(2) to 1.83 ± 3.74 mm(2) at the 12-month examination (P = .016). The mean atrophic area increased by 0.37 mm(2) in the hyper-FAF subgroup and by 0.90 mm(2) in the patchy FAF subgroup. CONCLUSIONS Two main patterns were identified on FAF in myopic CNV and were related to the prognostic evolution, the hyperautofluorescent CNV being associated with a greater visual gain and fewer atrophic changes over a 12-month follow-up.
Collapse
|
46
|
Geographic atrophy in patients receiving anti-vascular endothelial growth factor for neovascular age-related macular degeneration. Retina 2015; 35:176-86. [PMID: 25387047 DOI: 10.1097/iae.0000000000000374] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To examine factors associated with the apparent growth of geographic atrophy (GA) in a consecutive series of eyes with treatment-naive neovascular age-related macular degeneration receiving intravitreal anti-vascular endothelial growth factor therapy on a treat-and-extend regimen. METHODS This was a retrospective cohort study. Two independent graders identified areas of GA using near-infrared reflectance imaging and spectral domain optical coherence tomography (SD-OCT). Neovascular lesion subtypes were classified based on fluorescein angiography (FA) as occult choroidal neovascularization, classic choroidal neovascularization, retinal angiomatous proliferation, or mixed choroidal neovascularization, and by the anatomical classification system which utilizes FA and SD-OCT as Types 1 (sub-retinal pigment epithelium), 2 (subretinal), 3 (intraretinal), or mixed neovascularization. RESULTS Ninety-one patients (94 eyes) fit the inclusion criteria, of which 52 eyes (55.3%) experienced apparent GA growth. The odds of developing apparent GA were significantly lower in Type 1 neovascularization compared to the other lesion types (P < 0.001). Using both FA and SD-OCT to classify neovascular age-related macular degeneration significantly improves the goodness of fit in the correlation between apparent GA growth and baseline neovascular lesion type (P < 0.001). CONCLUSION Treatment-naive neovascular age-related macular degeneration eyes with Type 1 neovascularization at baseline were less likely to develop GA than eyes with other types. The correlation between apparent GA growth and subtype of neovascularization is stronger when lesions are classified with an anatomic grading that utilizes both FA and SD-OCT.
Collapse
|
47
|
Mrejen S, Jung JJ, Chen C, Patel SN, Gallego-Pinazo R, Yannuzzi N, Xu L, Marsiglia M, Boddu S, Freund KB. Long-Term Visual Outcomes for a Treat and Extend Anti-Vascular Endothelial Growth Factor Regimen in Eyes with Neovascular Age-Related Macular Degeneration. J Clin Med 2015; 4:1380-402. [PMID: 26239682 PMCID: PMC4519796 DOI: 10.3390/jcm4071380] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 06/22/2015] [Accepted: 06/26/2015] [Indexed: 02/07/2023] Open
Abstract
With the advent of anti-vascular endothelial growth factor (VEGF) therapy, clinicians are now focused on various treatment strategies to better control neovascular age-related macular degeneration (NVAMD), a leading cause of irreversible blindness. Herein, we retrospectively reviewed consecutive patients with treatment-naïve NVAMD initially classified based on fluorescein angiography (FA) alone or with an anatomic classification utilizing both FA and optical coherence tomography (OCT) and correlated long-term visual outcomes of these patients treated with an anti-VEGF Treat-and-Extend Regimen (TER) with baseline characteristics including neovascular phenotype. Overall, 185 patients (210 eyes) were followed over an average of 3.5 years (range 1-6.6) with a retention rate of 62.9%, and visual acuity significantly improved with a TER that required a mean number of 8.3 (±1.6) (± standard deviation) intravitreal anti-VEGF injections/year (range 4-13). The number of injections and the anatomic classification were independent predictors of visual acuity at 6 months, 1, 2, 3 and 4 years. Patients with Type 1 neovascularization had better visual outcomes and received more injections than the other neovascular subtypes. There were no serious adverse events. A TER provided sustained long-term visual gains. Eyes with Type 1 neovascularization had better visual outcomes than those with other neovascular subtypes.
Collapse
Affiliation(s)
- Sarah Mrejen
- Vitreous, Retina, Macula Consultants of New York, New York, NY 10022, USA; E-Mails: (S.M.); (J.J.J.); (M.M.)
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY 10065, USA
- Quinze-Vingts Hospital, DHU ViewMaintain, INSERM-DHOS CIC 1423, 75012 Paris, France
| | - Jesse J. Jung
- Vitreous, Retina, Macula Consultants of New York, New York, NY 10022, USA; E-Mails: (S.M.); (J.J.J.); (M.M.)
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY 10065, USA
- Department of Ophthalmology, New York University School of medicine, New York, NY 10016 USA; E-Mail:
- Edward S. Harkness Eye Institute Columbia, New York, NY 10032, USA
| | - Christine Chen
- Department of Surgery, Monash University, Melbourne, VIC 3800, Australia; E-Mail:
- Center for Eye Research Australia, University of Melbourne, East Melbourne, VIC 3002, Australia
| | - Samir N. Patel
- Weill Cornell Medical College, New York, NY 10065, USA; E-Mails: (S.N.P.); (N.Y.)
| | - Roberto Gallego-Pinazo
- Department of Ophthalmology, University and Polytechnic Hospital La Fe, 46026 Valencia, Spain; E-Mail:
| | - Nicolas Yannuzzi
- Weill Cornell Medical College, New York, NY 10065, USA; E-Mails: (S.N.P.); (N.Y.)
| | - Luna Xu
- The New York Eye and Ear Infirmary, New York, NY 10003, USA; E-Mail:
| | - Marcela Marsiglia
- Vitreous, Retina, Macula Consultants of New York, New York, NY 10022, USA; E-Mails: (S.M.); (J.J.J.); (M.M.)
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY 10065, USA
- Edward S. Harkness Eye Institute Columbia, New York, NY 10032, USA
| | - Sucharita Boddu
- Department of Ophthalmology, New York University School of medicine, New York, NY 10016 USA; E-Mail:
| | - K. Bailey Freund
- Vitreous, Retina, Macula Consultants of New York, New York, NY 10022, USA; E-Mails: (S.M.); (J.J.J.); (M.M.)
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY 10065, USA
- Department of Ophthalmology, New York University School of medicine, New York, NY 10016 USA; E-Mail:
| |
Collapse
|
48
|
Long-term visual outcome and prognostic factors of Intravitreal anti-vascular endothelial growth factor treatment for retinal angiomatous proliferation. Graefes Arch Clin Exp Ophthalmol 2015; 254:23-30. [DOI: 10.1007/s00417-015-2993-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 02/26/2015] [Accepted: 03/13/2015] [Indexed: 01/29/2023] Open
|
49
|
Cho HJ, Yoo SG, Kim HS, Kim JH, Kim CG, Lee TG, Kim JW. Risk factors for geographic atrophy after intravitreal ranibizumab injections for retinal angiomatous proliferation. Am J Ophthalmol 2015; 159:285-92.e1. [PMID: 25447115 DOI: 10.1016/j.ajo.2014.10.035] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/27/2014] [Accepted: 10/29/2014] [Indexed: 02/08/2023]
Abstract
PURPOSE To describe the risk factors for the development of geographic atrophy (GA) following intravitreal ranibizumab injection treatment for retinal angiomatous proliferation (RAP). DESIGN Retrospective interventional series. METHODS Forty-three eyes (38 South Korean patients) from patients being treated for naïve RAP with intravitreal ranibizumab injection were included in this study. All patients were treated with an initial series of 3 monthly loading injections, followed by further injections as required. Baseline ocular characteristics and lesion features assessed using fluorescein angiography (FA), indocyanine angiography (ICGA), and spectral-domain optical coherence tomography (SD OCT) were evaluated as potential risk factors for GA through 2 years of follow-up. RESULTS At 2 years follow-up, GA had developed in 16 of 43 eyes (37.2%). The mean number of ranibizumab injections was 7.52 ± 2.11. Using multiple logistic regression, thinning of the subfoveal choroid at baseline (odds ratio [OR], 0.955; 95% confidence interval [CI], 0.929-0.982; P = .002), presence of reticular pseudodrusen (OR, 1.092; 95% CI, 1.017-1.485; P = .039), and presence of GA in the fellow eye at baseline (OR, 1.433; 95% CI, 1.061-1.935; P = .025) were identified as significant risk factors for GA development. CONCLUSIONS GA developed in 37.2% of eyes with RAP during the 24 months following intravitreal ranibizumab injections. Subfoveal choroidal thinning at baseline, the presence of reticular pseudodrusen, and the presence of GA in the fellow eye at baseline were associated with increased risk of GA development after treatment.
Collapse
|
50
|
Optical coherence tomography for the monitoring of neovascular age-related macular degeneration: a systematic review. Ophthalmology 2014; 122:399-406. [PMID: 25444343 DOI: 10.1016/j.ophtha.2014.07.055] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/05/2014] [Accepted: 07/31/2014] [Indexed: 11/23/2022] Open
Abstract
TOPIC To compare the accuracy of optical coherence tomography (OCT) with alternative tests for monitoring neovascular age-related macular degeneration (nAMD) and detecting disease activity among eyes previously treated for this condition. CLINICAL RELEVANCE Traditionally, fundus fluorescein angiography (FFA) has been considered the reference standard to detect nAMD activity, but FFA is costly and invasive. Replacement of FFA by OCT can be justified if there is a substantial agreement between tests. METHODS Systematic review and meta-analysis. The index test was OCT. The comparator tests were visual acuity, clinical evaluation (slit lamp), Amsler chart, color fundus photographs, infrared reflectance, red-free images and blue reflectance, fundus autofluorescence imaging, indocyanine green angiography (ICGA), preferential hyperacuity perimetry, and microperimetry. We searched the following databases: MEDLINE, MEDLINE In-Process, EMBASE, Biosis, Science Citation Index, the Cochrane Library, Database of Abstracts of Reviews of Effects, MEDION, and the Health Technology Assessment database. The last literature search was conducted in March 2013. We used the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) to assess risk of bias. RESULTS We included 8 studies involving more than 400 participants. Seven reported the performance of OCT (3 time-domain [TD] OCT, 3 spectral-domain [SD] OCT, 1 both types) and 1 reported the performance of ICGA in the detection of nAMD activity. We did not find studies directly comparing tests in the same population. The pooled sensitivity and specificity of TD OCT and SD OCT for detecting active nAMD was 85% (95% confidence interval [CI], 72%-93%) and 48% (95% CI, 30%-67%), respectively. One study reported ICGA with sensitivity of 75.9% and specificity of 88.0% for the detection of active nAMD. Half of the studies were considered to have a high risk of bias. CONCLUSIONS There is substantial disagreement between OCT and FFA findings in detecting active disease in patients with nAMD who are being monitored. Both methods may be needed to monitor patients comprehensively with nAMD.
Collapse
|