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Ying GS, VanderBeek BL. Radiotherapy for anti-vascular endothelial growth factor injections for neovascular age-related macular degeneration. Lancet 2024:S0140-6736(24)00915-2. [PMID: 38876134 DOI: 10.1016/s0140-6736(24)00915-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/29/2024] [Indexed: 06/16/2024]
Affiliation(s)
- Gui-Shuang Ying
- Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA; Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA.
| | - Brian L VanderBeek
- Center for Pharmacoepidemiology Research and Training, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA; Leonard Davis Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA; Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
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Shimojima Y, Hirose Y, Nomura T, Takano K, Hara H, Bamba T, Aizawa M, Nogami H, Matsuki A, Maruyama S, Takii Y, Yabusaki H, Sakata J, Wakai T, Shiozawa S, Nakagawa S. Solitary choroidal metastasis of distal cholangiocarcinoma: A case report. Oncol Lett 2023; 26:419. [PMID: 37674862 PMCID: PMC10477709 DOI: 10.3892/ol.2023.14004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 07/13/2023] [Indexed: 09/08/2023] Open
Abstract
Metastatic choroidal carcinoma is rare and generally has a poor prognosis. The present case report describes a case of choroidal metastasis from distal cholangiocarcinoma, which was successfully managed using stereotactic radiotherapy (SRT). A 67-year-old Japanese man underwent pancreaticoduodenectomy for distal cholangiocarcinoma. The pathological stage was T2N0M0 stage IIA, according to the Union for International Cancer Control 8th edition. After surgery, the patient received adjuvant chemotherapy with oral TS-1® for 1 month. A total of 2 months after surgery, the patient was readmitted to hospital due to decreased visual acuity. Fundoscopy revealed a macular hole in the right eye that accounted for the decreased visual acuity. Additionally, Goldmann three-mirror contact lens examination revealed a 4-mm choroidal mass with a yellowish color situated at a considerable distance from the optic nerve. Magnetic resonance imaging revealed an enhanced choroidal mass. Based on the findings of ophthalmologic examinations and the patient's history of cholangiocarcinoma, they were diagnosed with choroidal metastasis from distal cholangiocarcinoma. SRT was administered at a total dose of 40 Gy divided into 8 Gy fractions. A total of 1 year after SRT, the patient achieved complete remission without decreased visual acuity. The patient remains alive and in good health without recurrence, 4 years after the diagnosis of choroidal metastasis. To the best of our knowledge, this is the second reported case of intraocular metastasis from cholangiocarcinoma. In conclusion, SRT may provide an opportunity to control metastatic choroidal carcinoma without decreasing visual acuity.
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Affiliation(s)
- Yukio Shimojima
- Department of Digestive Surgery, Niigata Cancer Center Hospital, Niigata 951-8566, Japan
- Department of Surgery, Tokyo Women's Medical University, Adachi Medical Center, Tokyo 123-8558, Japan
| | - Yuki Hirose
- Department of Digestive Surgery, Niigata Cancer Center Hospital, Niigata 951-8566, Japan
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Tatsuya Nomura
- Department of Digestive Surgery, Niigata Cancer Center Hospital, Niigata 951-8566, Japan
| | - Kabuto Takano
- Department of Digestive Surgery, Niigata Cancer Center Hospital, Niigata 951-8566, Japan
| | - Hiroaki Hara
- Department of Ophthalmology, Niigata Cancer Center Hospital, Niigata 951-8566, Japan
| | - Takeo Bamba
- Department of Digestive Surgery, Niigata Cancer Center Hospital, Niigata 951-8566, Japan
| | - Masaki Aizawa
- Department of Digestive Surgery, Niigata Cancer Center Hospital, Niigata 951-8566, Japan
| | - Hitoshi Nogami
- Department of Digestive Surgery, Niigata Cancer Center Hospital, Niigata 951-8566, Japan
| | - Atsushi Matsuki
- Department of Digestive Surgery, Niigata Cancer Center Hospital, Niigata 951-8566, Japan
| | - Satoshi Maruyama
- Department of Digestive Surgery, Niigata Cancer Center Hospital, Niigata 951-8566, Japan
| | - Yasumasa Takii
- Department of Digestive Surgery, Niigata Cancer Center Hospital, Niigata 951-8566, Japan
| | - Hiroshi Yabusaki
- Department of Digestive Surgery, Niigata Cancer Center Hospital, Niigata 951-8566, Japan
| | - Jun Sakata
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Toshifumi Wakai
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Shunichi Shiozawa
- Department of Surgery, Tokyo Women's Medical University, Adachi Medical Center, Tokyo 123-8558, Japan
| | - Satoru Nakagawa
- Department of Digestive Surgery, Niigata Cancer Center Hospital, Niigata 951-8566, Japan
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Bachmeier I, Armendariz BG, Yu S, Jäger RJ, Ebneter A, Glittenberg C, Pauleikhoff D, Sadda SR, Chakravarthy U, Fauser S. Fibrosis in neovascular age-related macular degeneration: A review of definitions based on clinical imaging. Surv Ophthalmol 2023; 68:835-848. [PMID: 37023894 DOI: 10.1016/j.survophthal.2023.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023]
Abstract
Despite the success of antiangiogenic therapy in controlling exudation in neovascular age-related macular degeneration (nAMD), the involvement of the outer retina in fibrosis results in gradual vision loss over time. The development of drugs that prevent or ameliorate fibrosis in nAMD requires that it is accurately detected and quantified with reliable endpoints and identification of robust biomarkers. Achievement of such an aim is currently challenging due to the lack of a consensus definition of fibrosis in nAMD. As a first step towards the establishment of a clear definition of fibrosis, we provide an extensive overview of the imaging modalities and criteria used to characterize fibrosis in nAMD. We observed variety in the selection of individual and combinations of imaging modalities, and criteria for detection. We also observed heterogeneity in classification systems and severity scales for fibrosis. The most commonly used imaging modalities were color fundus photography, fluorescein angiography and optical coherence tomography (OCT). A multimodal approach was frequently utilized. Our review suggests that OCT offers a more detailed, objective and sensitive characterization than color fundus photography/fluorescein angiography. Thus, we recommend it as a primary modality for fibrosis evaluation. This review provides a basis for future discussions to reach a consensus definition using standardized terms based on a detailed characterization of fibrosis, its presence and evolution, and taking into consideration impact on visual function. Achieving this goal is of paramount importance for the development of antifibrotic therapies.
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Affiliation(s)
- Isabel Bachmeier
- Pharma Research and Early Development, F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland.
| | - Beatriz G Armendariz
- Pharma Research and Early Development, F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland
| | - Siqing Yu
- Pharma Research and Early Development, F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland
| | - Ralf J Jäger
- Pharma Research and Early Development, F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland
| | - Andreas Ebneter
- Department of Ophthalmology, Cantonal Hospital St. Gallen, University of Bern, Switzerland
| | - Carl Glittenberg
- Pharma Research and Early Development, F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland
| | | | - SriniVas R Sadda
- Doheny Eye Institute, University of California-Los Angeles, Pasadena, 91103 CA, USA
| | - Usha Chakravarthy
- Queens University of Belfast, Institute of Clinical Science Block A, Belfast, UK
| | - Sascha Fauser
- Pharma Research and Early Development, F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland
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Zhang P, Wahl DJ, Mocci J, Miller EB, Bonora S, Sarunic MV, Zawadzki RJ. Adaptive optics scanning laser ophthalmoscopy and optical coherence tomography (AO-SLO-OCT) system for in vivo mouse retina imaging. BIOMEDICAL OPTICS EXPRESS 2023; 14:299-314. [PMID: 36698677 PMCID: PMC9841993 DOI: 10.1364/boe.473447] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/22/2022] [Accepted: 11/22/2022] [Indexed: 05/02/2023]
Abstract
Optical coherence tomography (OCT) and scanning laser ophthalmoscopy (SLO) are imaging technologies invented in the 1980s that have revolutionized the field of in vivo retinal diagnostics and are now commonly used in ophthalmology clinics as well as in vision science research. Adaptive optics (AO) technology enables high-fidelity correction of ocular aberrations, resulting in improved resolution and sensitivity for both SLO and OCT systems. The potential of gathering multi-modal cellular-resolution information in a single instrument is of great interest to the ophthalmic imaging community. Although similar instruments have been developed for imaging the human retina, developing such a system for mice will benefit basic science research and should help with further dissemination of AO technology. Here, we present our work integrating OCT into an existing mouse retinal AO-SLO system, resulting in a multi-modal AO-enhanced imaging system of the living mouse eye. The new system allows either independent or simultaneous data acquisition of AO-SLO and AO-OCT, depending on the requirements of specific scientific experiments. The system allows a data acquisition speed of 200 kHz A-scans/pixel rate for OCT and SLO, respectively. It offers ∼6 µm axial resolution for AO-OCT and a ∼1 µm lateral resolution for AO-SLO-OCT imaging.
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Affiliation(s)
- Pengfei Zhang
- School of Optoelectronic Engineering and Instrumentation Science, Dalian University of Technology, Dalian, China
- UC Davis EyePod Small Animals Ocular Imaging Laboratory, Department of Cell Biology and Human Anatomy, University of California Davis, Davis, CA 95616, USA
| | - Daniel J. Wahl
- Engineering Science, Simon Fraser University, Burnaby BC, V5A 1S6, Canada
| | - Jacopo Mocci
- Dynamic Optics srl, Piazza Zanellato 5, 35131, Padova, Italy
| | - Eric B. Miller
- Center for Neuroscience, University of California, Davis, CA 95616, USA
| | - Stefano Bonora
- CNR-Institute for Photonics and Nanotechnology, Via Trasea 7, 35131, Padova, Italy
| | - Marinko V. Sarunic
- Engineering Science, Simon Fraser University, Burnaby BC, V5A 1S6, Canada
- Medical Physics and Biomedical Engineering, University College London, United Kingdom
- Institute of Ophthalmology, University College London, United Kingdom
| | - Robert J. Zawadzki
- UC Davis EyePod Small Animals Ocular Imaging Laboratory, Department of Cell Biology and Human Anatomy, University of California Davis, Davis, CA 95616, USA
- UC Davis Eye Center, Dept. of Ophthalmology & Vision Science, University of California Davis, 4860 Y Street, Suite 2400, Sacramento, California 95817, USA
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Yan H, Sun W, Mruthyunjaya P, Beadle B, Yu W, Kanwal B, MacDonald CA, Liu W. Dosimetry modeling of focused kV x‐ray radiotherapy for wet age‐related macular degeneration. Med Phys 2020; 47:5123-5134. [DOI: 10.1002/mp.14404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/22/2020] [Accepted: 07/07/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Huagang Yan
- School of Biomedical Engineering Capital Medical University Beijing100069 China
| | - Weiyuan Sun
- Department of Physics University at AlbanySUNY Albany NY12222 USA
| | - Prithvi Mruthyunjaya
- Department of Ophthalmology Stanford University School of Medicine Stanford CA94305 USA
| | - Beth Beadle
- Department of Radiation Oncology Stanford University School of Medicine Stanford CA94305 USA
| | - Weihong Yu
- Department of Ophthalmology Key Laboratory of Ocular Fundus Diseases Peking Union Medical College HospitalChinese Academy of Medical Sciences Beijing100730 China
| | - Bushra Kanwal
- Center for High Energy Physics University of the Punjab Lahore Pakistan
| | | | - Wu Liu
- Department of Radiation Oncology Stanford University School of Medicine Stanford CA94305 USA
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Mukkamala LK, Mishra K, Daftari I, Moshiri A, Park SS. Phase I/II randomized study of proton beam with anti-VEGF for exudative age-related macular degeneration: long-term results. Eye (Lond) 2020; 34:2271-2279. [PMID: 32055016 DOI: 10.1038/s41433-020-0807-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/09/2019] [Accepted: 10/28/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND/OBJECTIVE To determine if treatment of exudative age-related macular degeneration (eAMD) using proton beam therapy (PBT) combined with intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy is safe and effective long term. SUBJECT/METHODS Thirty eyes with newly diagnosed eAMD were enrolled in a phase I/II prospective, sham-controlled double-masked university study. Eyes were randomized 1:1:1-24 GyE, 16 GyE or sham radiation, and treated with three initial monthly intravitreal ranibizumab or bevacizumab. Subsequent anti-VEGF reinjection was based on monthly optical coherence tomography and examination for 2 years and standard of care thereafter. RESULTS A total of 23 eyes completed 2-year study follow-up, of which 16 maintained monthly follow-up. Mean best-correct visual acuity (BCVA) at 2 years was similar among treatment groups (p > 0.05). The 24 GyE group required fewer anti-VEGF injections when compared with the sham group at 2 years (4.67 ± 1.9 vs 9.67 ± 3.5; p = 0.017). Extended follow-up (mean 4 years) available in 22 eyes showed persistent reduced need for anti-VEGF therapy among eyes treated with 24 GyE compared with sham radiation (2.0 ± 1.6 vs 4.84 ± 2.4 per year, p = 0.008). New and increasing geographic atrophy (GA), noted in some eyes in all treatment groups, resulted in decreased mean BCVA from baseline for the 24 GyE group on extended follow-up (p = 0.009). Possible mild radiation retinopathy noted in 15% of eyes was not visually significant. CONCLUSIONS Initial treatment combining PBT (24 GyE) with intravitreal anti-VEGF therapy appears to decrease the need for anti-VEGF reinjection in eyes with newly diagnosed eAMD. Radiation retinopathy risk was low and does not appear visually significant. Long-term vision was limited by GA development especially in the 24 GyE group.
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Affiliation(s)
- Lekha K Mukkamala
- Vitreoretinal Service, Department of Ophthalmology & Vision Science, University of California Davis Eye Center, Sacramento, CA, USA
| | - Kavita Mishra
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Inder Daftari
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Ala Moshiri
- Vitreoretinal Service, Department of Ophthalmology & Vision Science, University of California Davis Eye Center, Sacramento, CA, USA
| | - Susanna S Park
- Vitreoretinal Service, Department of Ophthalmology & Vision Science, University of California Davis Eye Center, Sacramento, CA, USA.
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Tripathy K, Chawla R, Temkar S, Sagar P, Kashyap S, Pushker N, Sharma YR. Phthisis Bulbi-a Clinicopathological Perspective. Semin Ophthalmol 2018; 33:788-803. [PMID: 29902388 DOI: 10.1080/08820538.2018.1477966] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Phthisis bulbi denotes end-stage eye disease characterized by shrinkage and disorganization of the eye with the resultant functional loss. The major factors associated with the pathogenesis of phthisis are hypotony, deranged blood-ocular barriers, and inflammation. Common causes include trauma, surgery, infection, inflammation, malignancy, retinal detachment, and vascular lesions. A phthisical globe shows a small squared off shape, opaque and thickened cornea, thickened sclera, neovascularization of iris, cataract, cyclitic membrane, ciliochoroidal detachment, and retinal detachment. Microscopic features include internal disorganization, inflammatory reaction, a reactive proliferation of various cells, calcification, and ossification. Early treatment of the causative etiology is the best strategy available to avoid an eye from going into phthisis. A phthisical eye has no visual potential and cosmetic rehabilitation or symptomatic relief of pain remains the mainstay in the management. The authors present a comprehensive review of the etiopathogenesis, pathology, clinical features, and management of the end-stage ocular disease.
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Affiliation(s)
- Koushik Tripathy
- a Department of Ophthalmology, Dr. Rajendra Prasad Centre for ophthalmic sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Rohan Chawla
- a Department of Ophthalmology, Dr. Rajendra Prasad Centre for ophthalmic sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Shreyas Temkar
- a Department of Ophthalmology, Dr. Rajendra Prasad Centre for ophthalmic sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Pradeep Sagar
- a Department of Ophthalmology, Dr. Rajendra Prasad Centre for ophthalmic sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Seema Kashyap
- b Department of Ophthalmic Pathology, Dr. Rajendra Prasad Centre for ophthalmic sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Neelam Pushker
- a Department of Ophthalmology, Dr. Rajendra Prasad Centre for ophthalmic sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Yog Raj Sharma
- a Department of Ophthalmology, Dr. Rajendra Prasad Centre for ophthalmic sciences , All India Institute of Medical Sciences , New Delhi , India
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Osmanovic S, Moisseiev E, Mishra KK, Daftari I, Moshiri A, Morse L, Park SS. Phase I/II Randomized Study of Proton Beam with Anti-Vascular Endothelial Growth Factor for Exudative Age-Related Macular Degeneration: One-Year Results. Ophthalmol Retina 2016; 1:217-226. [PMID: 31047424 DOI: 10.1016/j.oret.2016.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/10/2016] [Accepted: 11/11/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess the safety and efficacy of proton beam therapy (PBT) as an adjunct to intravitreal anti-vascular endothelial growth factor (VEGF) for the treatment of exudative age-related macular degeneration. DESIGN Phase I/II, interventional, prospective, randomized, sham-controlled double-blinded study. PARTICIPANTS Eyes with newly diagnosed exudative age-related macular degeneration with vision between 20/40 and 20/400 were included. Exclusion criteria included diabetes or other ocular comorbidities affecting vision. METHODS Eyes were randomized to receive either 16 GyE, 24 GyE, or sham PBT. All eyes had 3 monthly intravitreal anti-VEGF treatments, followed by monthly visits with treatments as needed. MAIN OUTCOME MEASURES Mean change in best-corrected visual acuity (BCVA), mean number of anti-VEGF injections, proportion of eyes with >15 letters BCVA decrease, proportion of eyes developing radiation retinopathy or papillopathy, proportion of eyes with cataract progression, and mean changes central retinal thickness on OCT and lesion size on angiography at 1 year. RESULTS Of 30 enrolled eyes, 22 completed follow-up monthly for 12 months for analysis. The BCVA improved by a mean of 8 letters (0.48±0.36 logarithm of the minimum angle of resolution) overall from baseline. Overall, central retinal thickness decreased from 340±155 to 246±48 (P = 0.008) at 12 months. The mean change in BCVA and central retinal thickness was not different among the 3 study groups. The mean number of anti-VEGF injections at 12 months was 6.13 for sham irradiation arm, 5.52 in the 16 GyE arm, and 3.83 for the 24 GyE arm (P = 0.004 between sham and 24 GyE). No eye had severe visual loss, radiation retinopathy, or papillopathy. CONCLUSIONS No safety issue was noted associated with combining 16 GyE or 24 GyE PBT with intravitreal anti-VEGF therapy in eyes with exudative age-related macular degeneration. Overall improvements in BCVA and imaging parameters were not affected by the addition of PBT, but the number of anti-VEGF treatments needed was significantly lower with the addition of 24 GyE PBT.
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Affiliation(s)
- Senad Osmanovic
- Department of Ophthalmology & Vision Science, University of California Davis Eye Center, Sacramento, California
| | - Elad Moisseiev
- Department of Ophthalmology & Vision Science, University of California Davis Eye Center, Sacramento, California
| | - Kavita K Mishra
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Inder Daftari
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Ala Moshiri
- Department of Ophthalmology & Vision Science, University of California Davis Eye Center, Sacramento, California
| | - Lawrence Morse
- Department of Ophthalmology & Vision Science, University of California Davis Eye Center, Sacramento, California
| | - Susanna S Park
- Department of Ophthalmology & Vision Science, University of California Davis Eye Center, Sacramento, California.
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Milgrom SA, Cheah CY, Pinnix CC, Smith GL, Dabaja BS, Horace P, Chevez-Barrios P, Fowler NH, Gombos DS. Acute and late toxicity of bilateral orbital irradiation in the management of primary intraocular lymphoma. Leuk Lymphoma 2016; 57:2612-8. [PMID: 27075636 PMCID: PMC6047351 DOI: 10.3109/10428194.2016.1166490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Primary intraocular lymphoma (PIOL) is a rare malignancy with poor outcomes. Concerns regarding toxicity lead some clinicians to exclude orbital radiation therapy (RT). We aimed to quantify the ocular toxicity of RT in 11 PIOL patients treated with chemoimmunotherapy and bilateral orbital RT (median 36 Gy). A multidisciplinary team, including an ocular oncologist, followed patients for a median of 42 months after RT. Common adverse events included dermatitis (100%), conjunctivitis (82%), xerophthalmia (64%), and keratopathy (45%). All phakic eyes developed cataracts (100%); correction resulted in good vision recovery. New, visually significant retinopathy was observed in only one eye (<5%) and affected a patient with preexisting diabetes. This report suggests that severe, vision-threatening complications following orbital RT are uncommon. In the absence of comorbidities, orbital RT should not be withheld due to fear of vision-threatening toxicity. The risk of toxicity may be augmented by comorbidities, so an individualized approach is recommended.
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Affiliation(s)
- Sarah A Milgrom
- a Department of Radiation Oncology , MD Anderson Cancer Center , Houston , TX , USA
| | - Chan Y Cheah
- b Department of Medical Oncology , MD Anderson Cancer Center , Houston , TX , USA
| | - Chelsea C Pinnix
- a Department of Radiation Oncology , MD Anderson Cancer Center , Houston , TX , USA
| | - Grace L Smith
- a Department of Radiation Oncology , MD Anderson Cancer Center , Houston , TX , USA
| | - Bouthaina S Dabaja
- a Department of Radiation Oncology , MD Anderson Cancer Center , Houston , TX , USA
| | - Patricia Horace
- a Department of Radiation Oncology , MD Anderson Cancer Center , Houston , TX , USA
| | | | - Nathan H Fowler
- b Department of Medical Oncology , MD Anderson Cancer Center , Houston , TX , USA
| | - Dan S Gombos
- d Department of Ophthalmology , MD Anderson Cancer Center , Houston , TX , USA
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Rice SR, Katz MSJ, Mehta MP. Context for Protons as Adjunctive Therapy in Neovascular Age-Related Macular Degeneration: A Review. Int J Part Ther 2016; 2:555-569. [PMID: 31772967 DOI: 10.14338/ijpt-15-00019.1] [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: 07/07/2015] [Accepted: 12/04/2015] [Indexed: 11/21/2022] Open
Abstract
In the last few years we have witnessed increasing availability of proton therapy in the United States and worldwide. As a result, proton therapy is considered as either a primary or adjunctive approach for numerous indications where conventional radiation therapy shows promise but is accompanied by toxicities. Age-related macular degeneration (AMD) remains the leading cause of adult blindness in industrialized nations, and third worldwide, following cataract and glaucoma. Current standard therapy is intravitreal injection of anti-vascular endothelial growth factor agents. While this treatment shows improvement and stabilization in visual acuity for 40% of patients, 60% still experience disease progression. These injections are costly, necessitate repeated office visits, and carry the risk of endophthalmitis. The pathophysiology underlying neovascular AMD (nAMD) underscores the need to simultaneously target multiple pathways to retain useful vision. Radiation can be antiangiogenic, anti-inflammatory, and antiproliferative. Early photon therapy clinical trials were heterogeneous, and a Cochrane review of data demonstrated usefulness in treatment of nAMD but recommended further studies. Advantages of proton therapy over photon therapy include the ability to deliver a focal dose to the target while minimizing dose to normal structures, which is enhanced by unique treatment planning software that uses fluorescein angiography to verify target location and allows conformation of dose to the irregular shape and thickness characteristic of choroidal neovascular membranes, the pathognomonic finding in nAMD. Preliminary data suggest a potential role for proton therapy in the treatment of nAMD. In this article we review previous treatments for AMD, including those with both photon and proton radiation, and recommend future directions for clinical investigations to evaluate the role of proton therapy as an adjunct to antiangiogenic therapy, the current standard of care in this challenging setting.
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Affiliation(s)
- Stephanie R Rice
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Matthew S J Katz
- Department of Ophthalmology, National Retina Institute, Towson, MD, USA
| | - Minesh P Mehta
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA.,Department of Ophthalmology, National Retina Institute, Towson, MD, USA
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11
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Nagendran ST, Finger PT. Anti-VEGF intravitreal bevacizumab for radiation-associated neovascular glaucoma. Ophthalmic Surg Lasers Imaging Retina 2015; 46:201-7. [PMID: 25707045 DOI: 10.3928/23258160-20150213-08] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/19/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To report outcomes of intravitreal bevacizumab therapy in radiation-associated neovascular glaucoma (NVG). PATIENTS AND METHODS In this retrospective interventional case series, 12 eyes with NVG after radiation therapy for ocular malignancy were treated with periodic intravitreal injections of 1.25 mg bevacizumab. Outcome measures included changes in iris neovascularization, intraocular pressure (IOP), visual acuity, and pain. RESULTS One month after the first injection, iris neovascularization regressed in nine of 12 eyes (75%), and IOP decreased in eight of 12 eyes (67%) by a mean of 10.1 mm Hg. Patients were monitored for a mean of 26.5 months after their first injection. Six eyes subsequently underwent enucleation for pain control (four eyes; 66%), chronic uveitis (one eye; 17%), and tumor recurrence (one eye; 17%). All remaining patients experienced deterioration in visual acuity (range: 20/160 to no light perception), but pain control was good and IOP normalized in four patients. CONCLUSION Intravitreal bevacizumab therapy should be considered for patients with radiation-associated NVG who wish to avoid enucleation.
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12
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The effects of Nigella sativa oil, thymoquinone, propolis, and caffeic acid phenethyl ester on radiation-induced cataract. Wien Klin Wochenschr 2015; 128:587-595. [DOI: 10.1007/s00508-015-0736-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 01/19/2015] [Indexed: 01/25/2023]
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Daniel E, Toth CA, Grunwald JE, Jaffe GJ, Martin DF, Fine SL, Huang J, Ying GS, Hagstrom SA, Winter K, Maguire MG. Risk of scar in the comparison of age-related macular degeneration treatments trials. Ophthalmology 2014; 121:656-66. [PMID: 24314839 PMCID: PMC3943618 DOI: 10.1016/j.ophtha.2013.10.019] [Citation(s) in RCA: 209] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 10/11/2013] [Accepted: 10/11/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To describe risk factors for scar in eyes treated with ranibizumab or bevacizumab for neovascular age-related macular degeneration (AMD). DESIGN Prospective cohort study within a randomized clinical trial. PARTICIPANTS Patients with no scar on color fundus photography (CFP) or fluorescein angiography (FA) at enrollment in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT). METHODS Eyes were assigned to ranibizumab or bevacizumab treatment and to 1 of 3 dosing regimens for 2 years. Masked readers assessed CFP and FA. Baseline demographic characteristics, visual acuity, morphologic features on photography and optical coherence tomography (OCT), and genotypes associated with AMD risk were evaluated as risk factors using adjusted hazard ratios (aHRs) and associated 95% confidence intervals (CIs). Scars were classified as fibrotic with well-demarcated elevated mounds of yellowish white tissue or nonfibrotic with discrete flat areas of hyperpigmentation with varying amounts of central depigmentation. MAIN OUTCOME MEASURES Scar formation. RESULTS Scar developed in 480 of 1059 eyes (45.3%) by 2 years. Baseline characteristics associated with greater risk of scarring were predominantly classic choroidal neovascularization (CNV) (aHR, 3.1; CI, 2.4-3.9) versus occult CNV, blocked fluorescence (aHR, 1.4; CI, 1.1-1.8), foveal retinal thickness >212 μm (aHR, 2.4; CI, 1.7-3.6) versus <120 μm, foveal subretinal tissue complex thickness >275 μm (aHR, 2.4; CI, 1.7-3.6) versus ≤75 μm, foveal subretinal fluid (aHR, 1.5; CI, 1.1-2.0) versus no subretinal fluid, and subretinal hyperreflective material (SHRM) (aHR, 1.7; CI, 1.3-2.3) versus no SHRM. Eyes with elevation of the retinal pigment epithelium had lower risk (aHR, 0.6; CI, 0.5-0.8) versus no elevation. Drug, dosing regimen, and genotype had no statistically significant association with scarring. Fibrotic scars developed in 24.7% of eyes, and nonfibrotic scars developed in 20.6% of eyes. Baseline risk factors for the scar types were similar except that eyes with larger lesion size or visual acuity <20/40 were more likely to develop fibrotic scars. CONCLUSIONS Approximately half of eyes enrolled in CATT developed scar by 2 years. Eyes with classic neovascularization, a thicker retina, and more fluid or material under the foveal center of the retina are more likely to develop scar.
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Affiliation(s)
- Ebenezer Daniel
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Cynthia A Toth
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Juan E Grunwald
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | | | - Stuart L Fine
- Department of Ophthalmology, University of Colorado-Denver, Aurora, Colorado
| | - Jiayan Huang
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gui-shuang Ying
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Katrina Winter
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Maureen G Maguire
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
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Pollithy S, Celik N, Höh H, Dithmar S. [Adjuvant stereotactic low energy radiation therapy of exudative age-dependent macular degeneration (Oraya system)]. Ophthalmologe 2013; 110:460-3. [PMID: 23559322 DOI: 10.1007/s00347-012-2741-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
With respect to the increasing number of patients and the risk and burden for patients caused by injections, a reduction in the number and frequency of injections with vascular endothelial growth factor (VEGF) inhibitors in exudative age-related macular degeneration (ARMD) is desirable. Stereotactic low-voltage x-ray irradiation seems to be a promising approach. For this purpose the Oraya system is available and has shown positive results in initial studies. Pending presentation of phase II and III study data this adjuvant irradiation should only be used in clinical trials.
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Affiliation(s)
- S Pollithy
- Schwerpunkt Retinologie, Universitäts-Augenklinik Heidelberg, Heidelberg
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15
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Haidar YM, Korn BS, Rose MA. Complete regression of a choroidal metastasis secondary to breast cancer with stereotactic radiation: case report and review of literature. JOURNAL OF RADIOSURGERY AND SBRT 2013; 2:155-164. [PMID: 29296355 PMCID: PMC5658888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 07/20/2012] [Indexed: 06/07/2023]
Abstract
Metastatic choroidal tumors from breast carcinoma are an uncommon entity but the signs must be recognized immediately in order to avoid delays in treatment and irreversible blindness. We present the case of a 49-year-old woman who presented with vision loss and redness of her right eye two years after being treated for a stage I infiltrating ductal carcinoma status-post lumpectomy, chemotherapy, and radiation treatment to the left breast. Computed tomographic (CT) scans and magnetic resonance imaging (MRI) of the head demonstrated an intraocular metastasis to the right eye with development of a serous retinal detachmentcausing vision loss. The posterior pole and peripheral retina of the right globe were treated for the ocular metastasis and received a total dose of 25 Gy in 5 Gy fractions given every other day. MRI obtained one month after completion of radiation therapy demonstrated complete resolution of the right posterior chamber lesion with reduction in retinal thickening and resolution of subretinal fluid. The patient had moderate improvement of her vision and a more comfortable sensation in her eye after treatment. Subsequent PET, CT, and MRI demonstrated progression of pulmonary, abdominal, and CNS metastatic disease, which were unsuccessfully attempted to control with multiple chemotherapeutic and radiotherapy attempts. Despite the continued metastatic progression of her disease 5 years after diagnosis, the patient's vision remained stable and there was no evidence of recurrence of the choroidal metastasis 3 years after treatment with stereotactic radiation. An overview of the diagnosis and management of metastatic choroidal tumors is presented here.
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Affiliation(s)
- Yarah M. Haidar
- UC San Diego School of Medicine, Department of Radiation Oncology, La Jolla, CA, USA
| | - Bobby S. Korn
- UC San Diego School of Medicine, Department of Ophthalmology, Shiley Eye Center, La Jolla, CA, USA
| | - Mary Ann Rose
- UC San Diego School of Medicine, Department of Radiation Oncology, La Jolla, CA, USA
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16
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Kishan AU, Modjtahedi BS, Morse LS, Lee P. Radiation therapy for neovascular age-related macular degeneration. Int J Radiat Oncol Biol Phys 2012; 85:583-97. [PMID: 22975610 DOI: 10.1016/j.ijrobp.2012.07.2352] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 07/15/2012] [Indexed: 12/29/2022]
Abstract
In the enormity of the public health burden imposed by age-related macular degeneration (ARMD), much effort has been directed toward identifying effective and efficient treatments. Currently, anti-vascular endothelial growth factor (VEGF) injections have demonstrated considerably efficacy in treating neovascular ARMD, but patients require frequent treatment to fully benefit. Here, we review the rationale and evidence for radiation therapy of ARMD. The results of early photon external beam radiation therapy are included to provide a framework for the sequential discussion of evidence for the usage of stereotactic radiation therapy, proton therapy, and brachytherapy. The evidence suggests that these 3 modern modalities can provide a dose-dependent benefit in the treatment of ARMD. Most importantly, preliminary data suggest that all 3 can be used in conjunction with anti-VEGF therapeutics, thereby reducing the frequency of anti-VEGF injections required to maintain visual acuity.
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17
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Chan CC, Rubenstein JL, Coupland SE, Davis JL, Harbour JW, Johnston PB, Cassoux N, Touitou V, Smith JR, Batchelor TT, Pulido JS. Primary vitreoretinal lymphoma: a report from an International Primary Central Nervous System Lymphoma Collaborative Group symposium. Oncologist 2011. [PMID: 22045784 DOI: 10.1634/theoncologist.2011-2010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Primary vitreoretinal lymphoma (PVRL), also known as primary intraocular lymphoma, is a rare malignancy typically classified as a diffuse large B-cell lymphoma and most frequently develops in elderly populations. PVRL commonly masquerades as posterior uveitis and has a unique tropism for the retina and central nervous system (CNS). Over 15% of primary CNS lymphoma patients develop intraocular lymphoma, usually occurring in the retina and/or vitreous. Conversely, 65%-90% of PVRL patients develop CNS lymphoma. Consequently, PVRL is often fatal because of ultimate CNS association. Current PVRL animal models are limited and require further development. Typical clinical findings include vitreous cellular infiltration (lymphoma and inflammatory cells) and subretinal tumor infiltration as determined using dilated fundoscopy, fluorescent angiography, and optical coherent tomography. Currently, PVRL is most often diagnosed using both histology to identify lymphoma cells in the vitreous or retina and immunohistochemistry to indicate monoclonality. Additional adjuncts in diagnosing PVRL exist, including elevation of interleukin-10 levels in ocular fluids and detection of Ig(H) or T-cell receptor gene rearrangements in malignant cells. The optimal therapy for PVRL is not defined and requires the combined effort of oncologists and ophthalmologists. PVRL is sensitive to radiation therapy and exhibits high responsiveness to intravitreal methotrexate or rituximab. Although systemic chemotherapy alone can result in high response rates in patients with PVRL, there is a high relapse rate. Because of the disease rarity, international, multicenter, collaborative efforts are required to better understand the biology and pathogenesis of PVRL as well as to define both diagnostic markers and optimal therapies.
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Affiliation(s)
- Chi-Chao Chan
- Immunopathology Section, Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland 20892-1857, USA.
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Chan CC, Rubenstein JL, Coupland SE, Davis JL, Harbour JW, Johnston PB, Cassoux N, Touitou V, Smith JR, Batchelor TT, Pulido JS. Primary vitreoretinal lymphoma: a report from an International Primary Central Nervous System Lymphoma Collaborative Group symposium. Oncologist 2011; 16:1589-99. [PMID: 22045784 DOI: 10.1634/theoncologist.2011-0210] [Citation(s) in RCA: 295] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Primary vitreoretinal lymphoma (PVRL), also known as primary intraocular lymphoma, is a rare malignancy typically classified as a diffuse large B-cell lymphoma and most frequently develops in elderly populations. PVRL commonly masquerades as posterior uveitis and has a unique tropism for the retina and central nervous system (CNS). Over 15% of primary CNS lymphoma patients develop intraocular lymphoma, usually occurring in the retina and/or vitreous. Conversely, 65%-90% of PVRL patients develop CNS lymphoma. Consequently, PVRL is often fatal because of ultimate CNS association. Current PVRL animal models are limited and require further development. Typical clinical findings include vitreous cellular infiltration (lymphoma and inflammatory cells) and subretinal tumor infiltration as determined using dilated fundoscopy, fluorescent angiography, and optical coherent tomography. Currently, PVRL is most often diagnosed using both histology to identify lymphoma cells in the vitreous or retina and immunohistochemistry to indicate monoclonality. Additional adjuncts in diagnosing PVRL exist, including elevation of interleukin-10 levels in ocular fluids and detection of Ig(H) or T-cell receptor gene rearrangements in malignant cells. The optimal therapy for PVRL is not defined and requires the combined effort of oncologists and ophthalmologists. PVRL is sensitive to radiation therapy and exhibits high responsiveness to intravitreal methotrexate or rituximab. Although systemic chemotherapy alone can result in high response rates in patients with PVRL, there is a high relapse rate. Because of the disease rarity, international, multicenter, collaborative efforts are required to better understand the biology and pathogenesis of PVRL as well as to define both diagnostic markers and optimal therapies.
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Affiliation(s)
- Chi-Chao Chan
- Immunopathology Section, Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland 20892-1857, USA.
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