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Chen G, Zhang L, Zhao ST, Huang H, Fu Z. Differences in ocular adverse events associated with phosphodiesterase-5 inhibitors: a real-world pharmacovigilance study. Expert Opin Drug Saf 2024; 23:877-884. [PMID: 38739482 DOI: 10.1080/14740338.2024.2355335] [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: 12/17/2023] [Accepted: 03/28/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE Our study aims to characterize the ocular safety profiles of phosphodiesterase type 5 (PDE5) inhibitors and explore the differences among different PDE5 inhibitors. METHODS We analyzed reports on ocular adverse events associated with sildenafil, vardenafil and tadalafil submitted to the FDA Adverse Event Reporting System (FAERS) database from the first quarter of 2004 to the first quarter of 2023. Disproportionality analysis was conducted to evaluate reporting risk profiles. RESULTS Among 61,211 reports qualifying for analysis, 5,127 involved sildenafil, 832 vardenafil, and 3,733 tadalafil. All PDE5 inhibitors showed increased reporting odds ratios (ROR) for ocular adverse events, with vardenafil highest (ROR 4.47) followed by sildenafil and tadalafil. Key ocular adverse events included cyanopsia, optic ischemic neuropathy, visual field defects, unilateral blindness and blindness. Sildenafil showed the highest disproportionality for cyanopsia (ROR 1148.11) while vardenafil and tadalafil showed the highest disproportionality for optic ischemic neuropathy. Time-to-onset analysis also revealed significant differences, with sildenafil having a later median time-to-onset compared to vardenafil and tadalafil. CONCLUSIONS This comprehensive pharmacovigilance study reveals distinct patterns of ocular adverse events associated with PDE5 inhibitors. These findings contribute to a better understanding of the safety profiles of PDE5 inhibitors and may guide healthcare professionals in clinical decision-making.
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Affiliation(s)
- Guixiang Chen
- Department of Pharmacy, Dongguan Hospital of Traditional Chinese Medicine, Dongguan, Guangdong, China
| | - Li Zhang
- Department of Pharmacy, Dongguan Hospital of Traditional Chinese Medicine, Dongguan, Guangdong, China
| | - Si-Ting Zhao
- Department of Pharmacy, Dongguan Hospital of Traditional Chinese Medicine, Dongguan, Guangdong, China
| | - Hao Huang
- Department of Pharmacy, Dongguan Hospital of Traditional Chinese Medicine, Dongguan, Guangdong, China
| | - Zhiwen Fu
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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2
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Roston S, Minkus CL, Armbrust KR. Incident Ocular Inflammation After COVID-19 Infection in a US Veteran Population. Ocul Immunol Inflamm 2024:1-8. [PMID: 38194622 DOI: 10.1080/09273948.2023.2296035] [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: 06/28/2023] [Accepted: 12/11/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE To investigate whether COVID-19 infection is a risk factor for incident ocular inflammatory disease. DESIGN Retrospective case-crossover study. METHODS The US Veterans Health Administration Corporate Data Warehouse was used to identify patients with positive COVID-19 testing and incident ocular inflammatory disease between March 2020 and May 2022. The timing of incident ocular inflammation and COVID-19 testing was assessed for each participant to determine whether positive COVID-19 testing occurred 0-60 days prior to incident ocular inflammation diagnosis (risk period) or 15-75 days after incident ocular inflammation diagnosis (control period). The main outcome measure was the odds of positive COVID-19 testing in the risk period versus control period. RESULTS Of the 1006 patients with incident ocular inflammation and a positive COVID-19 test in the study period, the age mean ± standard deviation was 62.6 ± 9.8 years and 840 (83%) were male. The odds of COVID-19 exposure was higher in the risk than control period (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.04-2.36; P = 0.03). Ocular inflammation was more likely to be bilateral in the risk period (OR, 3.97; 95% CI, 1.01-23.01; P = 0.03). Other ocular features and demographic characteristics were similar in the risk and control periods. Most cases of ocular inflammation were quiescent at the most recent eye examination. CONCLUSIONS Incident ocular inflammation is associated with COVID-19 infection, but the increased risk is small, and the ocular inflammation is typically acute.
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Affiliation(s)
- Sydney Roston
- Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Caroline L Minkus
- Department of Ophthalmology, Park Nicollet Eye Care, St Louis Park, Minnesota, USA
| | - Karen R Armbrust
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Ophthalmology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
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3
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ElHady AK, El-Gamil DS, Abdel-Halim M, Abadi AH. Advancements in Phosphodiesterase 5 Inhibitors: Unveiling Present and Future Perspectives. Pharmaceuticals (Basel) 2023; 16:1266. [PMID: 37765073 PMCID: PMC10536424 DOI: 10.3390/ph16091266] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/25/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Phosphodiesterase 5 (PDE5) inhibitors presented themselves as important players in the nitric oxide/cGMP pathway, thus exerting a profound impact on various physiological and pathological processes. Beyond their well-known efficacy in treating male erectile dysfunction (ED) and pulmonary arterial hypertension (PAH), a plethora of studies have unveiled their significance in the treatment of a myriad of other diseases, including cognitive functions, heart failure, multiple drug resistance in cancer therapy, immune diseases, systemic sclerosis and others. This comprehensive review aims to provide an updated assessment of the crucial role played by PDE5 inhibitors (PDE5-Is) as disease-modifying agents taking their limiting side effects into consideration. From a medicinal chemistry and drug discovery perspective, the published PDE5-Is over the last 10 years and their binding characteristics are systemically discussed, and advancement in properties is exposed. A persistent challenge encountered with these agents lies in their limited isozyme selectivity; considering this obstacle, this review also highlights the breakthrough development of the recently reported PDE5 allosteric inhibitors, which exhibit an unparalleled level of selectivity that was rarely achievable by competitive inhibitors. The implications and potential impact of these novel allosteric inhibitors are meticulously explored. Additionally, the concept of multi-targeted ligands is critically evaluated in relation to PDE5-Is by inspecting the broader spectrum of their molecular interactions and effects. The objective of this review is to provide insight into the design of potent, selective PDE5-Is and an overview of their biological function, limitations, challenges, therapeutic potentials, undergoing clinical trials, future prospects and emerging uses, thus guiding upcoming endeavors in both academia and industry within this domain.
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Affiliation(s)
- Ahmed K. ElHady
- School of Life and Medical Sciences, University of Hertfordshire Hosted by Global Academic Foundation, New Administrative Capital, Cairo 11865, Egypt;
| | - Dalia S. El-Gamil
- Department of Chemistry, Faculty of Pharmacy, Ahram Canadian University, Cairo 12451, Egypt;
| | - Mohammad Abdel-Halim
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy and Biotechnology, German University in Cairo, Cairo 11835, Egypt;
| | - Ashraf H. Abadi
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy and Biotechnology, German University in Cairo, Cairo 11835, Egypt;
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4
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Huang HC, Li WC, Tadrous M, Schumock GT, Touchette D, Awadalla S, Lee TA. Evaluating the use of methods to mitigate bias from non-transient medications in the case-crossover design: A systematic review. Pharmacoepidemiol Drug Saf 2023; 32:939-950. [PMID: 37283212 DOI: 10.1002/pds.5649] [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: 12/09/2022] [Revised: 03/30/2023] [Accepted: 06/02/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE The case-crossover design is a self-controlled study design used to compare exposure immediately preceding an event occurrence with exposure in earlier control periods. The design is most suitable for transient exposures in order to avoid biases that can be problematic when using the case-crossover design for non-transient (i.e., chronic) exposures. Our goal was to conduct a systematic review of case-crossover studies and its variants (case-time-control and case-case-time-control) in order to compare design and analysis choices by medication type. METHODS We conducted a systematic search to identify recent case-crossover, case-time-control, and case-case-time-control studies focused on medication exposures. Articles indexed in MEDLINE and EMBASE using these study designs that were published between January 2015 and December 2021 in the English language were identified. Reviews, methodological studies, commentaries, articles without medications as the exposure of interest, and articles with no available full text were excluded. Study characteristics including study design, outcome, risk window, control window, reporting of discordant pairs, and inclusion of sensitivity analyses were summarized overall and by medication type. We further evaluated the implementation of recommended methods to account for biases introduced by non-transient exposures among articles that used the case-crossover design on a non-transient exposure. RESULTS Of the 2036 articles initially identified, 114 articles were included. The case-crossover was the most common study design (88%), followed by the case-time-control (17%), and case-case-time-control (3%). Fifty-three percent of the articles included only transient medications, 35% included only non-transient medications, and 12% included both. Across years, the proportion of case-crossover articles evaluating a non-transient medication ranged from 30% in 2018 to 69% in 2017. We found that 41% of the articles that evaluated a non-transient medication did not apply any of the recommended methods to account for biases and more than half of which were conducted by authors with no previous publication history of case-crossover studies. CONCLUSION Using the case-crossover design to evaluate a non-transient medication remains common in pharmacoepidemiology. Researchers should apply appropriate design and analysis choices when opting to use a case-crossover design with non-transient medication exposures.
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Affiliation(s)
- Hsiao-Ching Huang
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Wen-Chin Li
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Glen T Schumock
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Daniel Touchette
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Saria Awadalla
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, Illinois, USA
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Sela TC, Zahavi A, Friedman-Gohas M, Weiss S, Sternfeld A, Ilguisonis A, Badash D, Geffen N, Ofri R, BarKana Y, Goldenberg-Cohen N. Azithromycin and Sildenafil May Have Protective Effects on Retinal Ganglion Cells via Different Pathways: Study in a Rodent Microbead Model. Pharmaceuticals (Basel) 2023; 16:ph16040486. [PMID: 37111243 PMCID: PMC10142588 DOI: 10.3390/ph16040486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/12/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
Decreased blood flow to the optic nerve (ON) and neuroinflammation are suggested to play an important role in the pathophysiology of glaucoma. This study investigated the potential neuroprotective effect of azithromycin, an anti-inflammatory macrolide, and sildenafil, a selective phosphodiesterase-5 inhibitor, on retinal ganglion cell survival in a glaucoma model, which was induced by microbead injection into the right anterior chamber of 50 wild-type (WT) and 30 transgenic toll-like receptor 4 knockout (TLR4KO) mice. Treatment groups included intraperitoneal azithromycin 0.1 mL (1 mg/0.1 mL), intravitreal sildenafil 3 µL, or intraperitoneal sildenafil 0.1 mL (0.24 μg/3 µL). Left eyes served as controls. Microbead injection increased intraocular pressure (IOP), which peaked on day 7 in all groups and on day 14 in azithromycin-treated mice. Furthermore, the retinas and ON of microbead-injected eyes showed a trend of increased expression of inflammatory- and apoptosis-related genes, mainly in WT and to a lesser extent in TLR4KO mice. Azithromycin reduced the BAX/BCL2 ratio, TGFβ, and TNFα levels in the ON and CD45 expression in WT retina. Sildenafil activated TNFα-mediated pathways. Both azithromycin and sildenafil exerted a neuroprotective effect in WT and TLR4KO mice with microbead-induced glaucoma, albeit via different pathways, without affecting IOP. The relatively low apoptotic effect observed in microbead-injected TLR4KO mice suggests a role of inflammation in glaucomatous damage.
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Affiliation(s)
- Tal Corina Sela
- Clalit Health Services, Tel Aviv 6209804, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Alon Zahavi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Ophthalmology, Rabin Medical Center-Beilinson Hospital, Petach Tikva 4941492, Israel
- Laboratory of Eye Research, Felsenstein Medical Research Center, Petach Tikva 4941492, Israel
| | - Moran Friedman-Gohas
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Krieger Eye Research Laboratory, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Shirel Weiss
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Krieger Eye Research Laboratory, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Amir Sternfeld
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Ophthalmology, Rabin Medical Center-Beilinson Hospital, Petach Tikva 4941492, Israel
- Krieger Eye Research Laboratory, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Astrid Ilguisonis
- Krieger Eye Research Laboratory, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Danielle Badash
- Krieger Eye Research Laboratory, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Noa Geffen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Ophthalmology, Rabin Medical Center-Beilinson Hospital, Petach Tikva 4941492, Israel
| | - Ron Ofri
- Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot 7610001, Israel
| | - Yaniv BarKana
- The Glaucoma Innovations and Research Laboratory, The Sam Rothberg Glaucoma Center, Sheba Medical Center, Tel Hashomer 5262000, Israel
| | - Nitza Goldenberg-Cohen
- Krieger Eye Research Laboratory, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
- Department of Ophthalmology, Bnai Zion Medical Center, Haifa 3339419, Israel
- Bruce and Ruth Faculty of Medicine, Technion, Technion-Israel Institute of Technology, Haifa 3200003, Israel
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6
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Arda H, Sonmez HK, Sevim DG, Temizyurek O, Evereklioglu C. Comparison of optic disc head vascular density status between crowded and normal discs: An optical coherence tomography angiography study. Photodiagnosis Photodyn Ther 2023; 41:103293. [PMID: 36681258 DOI: 10.1016/j.pdpdt.2023.103293] [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: 11/13/2022] [Revised: 12/31/2022] [Accepted: 01/17/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND To compare the optic disc capillary vascular status between crowded and normal optic discs using optical coherence tomography angiography (OCT-A). METHODS A total of 101 eyes were included in this cross-sectional, comparative study. Fifty-one eyes with crowded optic discs (Group 1) were compared with 50 eyes with normal discs (Group 2). Peripapillary and optic disc head capillary vascular density measurements were obtained quantitatively with OCT-A. RESULTS Mean ages were 46.2 ± 6.2 years in Group1 and 45.9 ± 6.0 years in Group2 (p=0.796).Vertical disc diameters were 1.52±0.2 mm in Group 1 and 1.61±0.16 mm in Group 2 (p=0.022) whereas horizontal disc diameters were 1.53±0.17 mm in Group 1 and 1.61±0.13 mm in Group 2(p˂0.014). OCT-A findings were as follows: radial peripapillary capillary, vascular density whole image measurements (%); 49.6 ± 2.3 in Group 1 and 49.1 ± 2.3 in Group 2 (p=0.292), peripapillary capillary density; 53.3 ± 2.8 in Group 1 and 52.6 ± 2.6 in Group 2 (p=0.176), inside disc measurements 52.4 (48.7-54.7) in Group 1 and 46.5 (42.6-49.6) in Group 2 (p˂0.001). RNFL was 118.2 ± 12.2 µm in Group 1 and 110.8 ± 11.4 µm in Group 2(p=0.002). CONCLUSION The vascular density of the disc circumference in individuals with healthy crowded optic discs is not different from those with normal discs. However, inside disc measurements differ between crowded and normal size discs. This finding suggests that when the disc size is reduced, the amount of vessels in it does not decrease in a way that correlates with the size. Therefore, the vascular structures are suitable for compression in the narrow optic nerve head.
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Affiliation(s)
- Hatice Arda
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, Turkiye.
| | | | - Duygu Gulmez Sevim
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, Turkiye
| | - Ozge Temizyurek
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, Turkiye
| | - Cem Evereklioglu
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, Turkiye
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7
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Citirak G, Malmqvist L, Hamann S. Analysis of Systemic Risk Factors and Post-Insult Visual Development in a Danish Cohort of Patients with Nonarteritic Anterior Ischemic Optic Neuropathy. Clin Ophthalmol 2022; 16:3415-3424. [PMID: 36249446 PMCID: PMC9560866 DOI: 10.2147/opth.s384740] [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: 08/05/2022] [Accepted: 09/09/2022] [Indexed: 11/07/2022] Open
Abstract
Purpose Nonarteritic anterior ischemic optic neuropathy (NAION) is associated with vascular as well as anatomical risk factors. Following the insult, the visual development varies from minor to severe deterioration. The aim of this study was to examine possible prognostic systemic risk factors and their eventual impact on post-insult visual development in NAION patients. Methods A retrospective chart review of all NAION patients (18-79 years at time of diagnosis) seen a minimum of two times in a tertiary eye department during a 10-year period in regard to systemic diseases, medication, lifestyle factors and ophthalmic examination was performed. Visual outcome was assessed according to the development of best corrected visual acuity (BCVA) and visual field from initial to final visit. Results There were 163 eligible patients. A greater proportion of the patients in the total cohort were over 50 years of age (79.8%) and men (66.3%). In total, 59.5% of the patients had a stable BCVA, while 25.8% experienced improvement, and 14.7% had deterioration. Seventy-two percent of the patients had a stable visual field, while 14% had improvement, and 14% had deterioration. No association between visual outcome and clinical characteristics, medication or systemic risk factors were identified. Conclusion We did not find any association between patient characteristics and systemic risk factors at time of diagnosis and visual development post-insult. This could suggest that the optic nerve head anatomy plays a larger role for visual outcome than previously estimated.
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Affiliation(s)
- Gülsenay Citirak
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
| | - Lasse Malmqvist
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
| | - Steffen Hamann
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
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8
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Sodhi M, Mikelberg FS, Etminan M. In Defense of Phosphodiesterase 5 Inhibitors-Reply. JAMA Ophthalmol 2022; 140:908-909. [PMID: 35862036 DOI: 10.1001/jamaophthalmol.2022.2615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mohit Sodhi
- Collaboration for Epidemiology of Ocular Diseases, Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Frederick S Mikelberg
- Collaboration for Epidemiology of Ocular Diseases, Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mahyar Etminan
- Collaboration for Epidemiology of Ocular Diseases, Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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9
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Etminan M, Sodhi M, Mikelberg FS, Maberley D. Risk of Ocular Adverse Events Associated With Use of Phosphodiesterase 5 Inhibitors in Men in the US. JAMA Ophthalmol 2022; 140:480-484. [PMID: 35389459 PMCID: PMC8990352 DOI: 10.1001/jamaophthalmol.2022.0663] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance A number of case reports and small epidemiologic studies have quantified the risk of ocular adverse events associated with the use of phosphodiesterase type 5 inhibitors (PDE5Is). However, results have been conflicting, and epidemiologic data on the risk of serous retinal detachment (SRD) and retinal vascular occlusion (RVO) are not available. Objective To quantify the risk of SRD, RVO, and ischemic optic neuropathy (ION) associated with the use of PDE5Is. Design, Setting, and Participants This cohort study with a nested case-control analysis was performed using data obtained from the PharMetrics Plus database (IQVIA) from January 1, 2006, to December 31, 2020. Cohort members were followed up until the first diagnosis of SRD, RVO, or ION or termination of insurance coverage. For each case, 4 controls were matched by age and time of study entry using density-based sampling. Risk for regular users of PDE5Is was compared with that for nonusers, adjusting for potential confounding variables. Cases with diagnoses of SRD, RVO, and ION in the year before the cohort were excluded. Main Outcomes and Measures First diagnosis of SRD, RVO, or ION identified by International Classification of Diseases, Ninth Revision or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. Adjusted incidence rate ratios (IRRs) with 95% CIs were calculated using conditional logistic regression, controlling for hypertension, coronary artery disease, smoking, and diabetes (for all 3 outcomes) as well as sleep apnea for the ION outcome. Results The cohort consisted of 213 033 men receiving PDE5Is, including sildenafil, tadalafil, vardenafil, and avanafil. The case-control analysis included a total of 1146 cases of SRD (278), RVO (628), and ION (240) and 4584 controls, and the mean (SD) age in both groups was 64.6 (13.3) years. Patients with SRD, RVO, and ION were more likely to have hypertension, diabetes, coronary artery disease, and sleep apnea. The adjusted IRR for the composite end points of any of the 3 outcomes was 1.85 (95% CI, 1.41-2.42; incidence, 15.5 cases per 10 000 person-years). The adjusted IRR for SRD, RVO, and ION as individual outcomes was 2.58 (95% CI, 1.55-4.30; incidence, 3.8 cases per 10 000 person-years), 1.44 (95% CI, 0.98-2.12; incidence, 8.5 cases per 10 000 person-years), and 2.02 (95% CI, 1.14-3.58; incidence, 3.2 cases per 10 000 person-years), respectively. Conclusions and Relevance Findings of this cohort study suggest that regular users of PDE5Is might have an increased risk for SRD, RVO, and ION. Regular users of PDE5Is need to be cognizant of ocular adverse events associated with these drugs and alert their physicians if they experience any visual deficits.
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Affiliation(s)
- Mahyar Etminan
- Collaboration for Epidemiology of Ocular Diseases (CEPOD), Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohit Sodhi
- Collaboration for Epidemiology of Ocular Diseases (CEPOD), Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Frederick S Mikelberg
- Collaboration for Epidemiology of Ocular Diseases (CEPOD), Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Maberley
- Collaboration for Epidemiology of Ocular Diseases (CEPOD), Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Ophthalmology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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10
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Gibbons A, Henderson AD. Non-Arteritic Anterior Ischemic Optic Neuropathy: Challenges for the Future. FRONTIERS IN OPHTHALMOLOGY 2022; 2:848710. [PMID: 38983540 PMCID: PMC11182325 DOI: 10.3389/fopht.2022.848710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/23/2022] [Indexed: 07/11/2024]
Affiliation(s)
- Alison Gibbons
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Amanda D Henderson
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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11
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Katz JS, Rothstein JD, Cudkowicz ME, Genge A, Oskarsson B, Hains AB, Chen C, Galanter J, Burgess BL, Cho W, Kerchner GA, Yeh FL, Ghosh AS, Cheeti S, Brooks L, Honigberg L, Couch JA, Rothenberg ME, Brunstein F, Sharma KR, van den Berg L, Berry JD, Glass JD. A Phase 1 study of GDC-0134, a dual leucine zipper kinase inhibitor, in ALS. Ann Clin Transl Neurol 2022; 9:50-66. [PMID: 35014217 PMCID: PMC8791798 DOI: 10.1002/acn3.51491] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 12/21/2022] Open
Abstract
Objective Dual leucine zipper kinase (DLK), which regulates the c‐Jun N‐terminal kinase pathway involved in axon degeneration and apoptosis following neuronal injury, is a potential therapeutic target in amyotrophic lateral sclerosis (ALS). This first‐in‐human study investigated safety, tolerability, and pharmacokinetics (PK) of oral GDC‐0134, a small‐molecule DLK inhibitor. Plasma neurofilament light chain (NFL) levels were explored in GDC‐0134‐treated ALS patients and DLK conditional knockout (cKO) mice. Methods The study included placebo‐controlled, single and multiple ascending‐dose (SAD; MAD) stages, and an open‐label safety expansion (OLE) with adaptive dosing for up to 48 weeks. Results Forty‐nine patients were enrolled. GDC‐0134 (up to 1200 mg daily) was well tolerated in the SAD and MAD stages, with no serious adverse events (SAEs). In the OLE, three study drug‐related SAEs occurred: thrombocytopenia, dysesthesia (both Grade 3), and optic ischemic neuropathy (Grade 4); Grade ≤2 sensory neurological AEs led to dose reductions/discontinuations. GDC‐0134 exposure was dose‐proportional (median half‐life = 84 h). Patients showed GDC‐0134 exposure‐dependent plasma NFL elevations; DLK cKO mice also exhibited plasma NFL compared to wild‐type littermates. Interpretation This trial characterized GDC‐0134 safety and PK, but no adequately tolerated dose was identified. NFL elevations in GDC‐0134‐treated patients and DLK cKO mice raised questions about interpretation of biomarkers affected by both disease and on‐target drug effects. The safety profile of GDC‐0134 was considered unacceptable and led to discontinuation of further drug development for ALS. Further work is necessary to understand relationships between neuroprotective and potentially therapeutic effects of DLK knockout/inhibition and NFL changes in patients with ALS.
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Affiliation(s)
- Jonathan S Katz
- Forbes Norris MDA/ALS Research Center, California Pacific Medical Center, San Francisco, California, USA
| | | | - Merit E Cudkowicz
- Sean M. Healey and AMG Center for ALS, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Angela Genge
- Montreal Neurological Institute & Hospital, Montreal, QC, Canada
| | | | - Avis B Hains
- Genentech, Inc., South San Francisco, California, USA
| | - Chen Chen
- Genentech, Inc., South San Francisco, California, USA
| | | | | | - William Cho
- Genentech, Inc., South San Francisco, California, USA
| | | | - Felix L Yeh
- Genentech, Inc., South San Francisco, California, USA
| | | | | | - Logan Brooks
- Genentech, Inc., South San Francisco, California, USA
| | - Lee Honigberg
- Genentech, Inc., South San Francisco, California, USA
| | | | | | | | | | | | - James D Berry
- Neurological Clinical Research Institute, Boston, Massachusetts, USA
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12
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Liu B, Yu Y, Liu W, Deng T, Xiang D. Risk Factors for Non-arteritic Anterior Ischemic Optic Neuropathy: A Large Scale Meta-Analysis. Front Med (Lausanne) 2021; 8:618353. [PMID: 34671609 PMCID: PMC8520961 DOI: 10.3389/fmed.2021.618353] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 09/02/2021] [Indexed: 01/11/2023] Open
Abstract
Objective: We conducted a meta-analysis to explore all the potential risk factors for non-arteritic anterior ischemic optic neuropathy (NAION) based on the published literature. Methods: A comprehensive literature search through the online databases was performed to obtain studies concerning the risk factors of NAION up to June 2020. Pooled unadjusted odds ratios (ORs) or rate ratios (RRs) were calculated to evaluate the weight of risk factors. This study was registered in PROSPERO under the number CRD42018084960. Results: Our meta-analysis included 49 original studies comprising of more than 10 million patients. The following risk factors were proved to be significantly associated with NAION: male gender (OR = 1.67, 95% CI: 1.50-1.85, P < 0.00001), hypertension (RR = 1.28, 95% CI: 1.20-1.37, P < 0.00001), hyperlipidemia (RR = 1.43, 95% CI: 1.26-1.62, P < 0.00001), diabetes mellitus (DM) (RR = 1.53, 95% CI: 1.36-1.73, P < 0.00001), coronary heart disease (CHD) (RR = 1.68, 95% CI: 1.24-2.27, P = 0.0008), sleep apnea (RR = 3.28, 95% CI: 2.08-5.17, P < 0.00001), factor V Leiden heterozygous (RR = 2.21, 95% CI: 1.19-4.09, P = 0.01), and medication history of cardiovascular drugs. Conclusion: We concluded that the above risk factors were significantly related to NAION. Better understanding of these risk factors in NAION can help the direct therapeutic approaches.
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Affiliation(s)
- Bing Liu
- Department of Ophthalmology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ying Yu
- Department of Ophthalmology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wen Liu
- Department of Ophthalmology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Tuo Deng
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Daoman Xiang
- Department of Ophthalmology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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13
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Arora S, Surakiatchanukul T, Arora T, Cagini C, Lupidi M, Chhablani J. Sildenafil in ophthalmology: An update. Surv Ophthalmol 2021; 67:463-487. [PMID: 34175342 DOI: 10.1016/j.survophthal.2021.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 12/14/2022]
Abstract
Sildenafil citrate, a selective oral phosphodiesterase 5 inhibitor, is a widely used drug for erectile dysfunction that acts by elevating cGMP levels and causing smooth muscle relaxation. It also has 10% activity against PDE6, a key enzyme in phototransduction cascade in the retina. Recent ocular imaging developments have further revealed the influence of sildenafil on ocular hemodynamics, particularly choroidal perfusion. Choroidal thickness is increased, and choroidal perfusion is also enhanced by autoregulatory mechanisms that are further dependent on age and microvascular abnormalities. Studies demonstrating high intraocular pressure via a "parallel pathway" from increased choroidal volume and blood flow to the ciliary body have challenged previous concepts. Another new observation is the effect of sildenafil on bipolar cells and cyclic-nucleotide gated channels. We discuss potential deleterious effects (central serous chorioretinopathy, glaucoma, ischemic optic neuropathy, and risks to recessive carriers of retinitis pigmentosa), potential beneficial effects (ameliorate choroidal ischemia, prevent thickening of Bruch membrane, and promote recovery of the ellipsoid zone) in macular degeneration, as well as potential drug interactions of sildenafil.
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Affiliation(s)
- Supriya Arora
- Bahamas Vision Centre and Princess Margaret Hospital, Nassau NP, Bahamas.
| | - Thamolwan Surakiatchanukul
- Department of Ophthalmology, Jamaica Hospital Medical Center, New York Medical College, Jamaica, NY, USA
| | - Tarun Arora
- Bahamas Vision Centre and Princess Margaret Hospital, Nassau NP, Bahamas.
| | - Carlo Cagini
- Department of Biochemical and Surgical Sciences, Section of ophthalmology, University of Perugia, Perugia, Italy
| | - Marco Lupidi
- Department of Biochemical and Surgical Sciences, Section of ophthalmology, University of Perugia, Perugia, Italy
| | - Jay Chhablani
- University of Pittsburgh, UPMC Eye Center, Pittsburgh, PA, USA.
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14
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Leinonen H, Cheng C, Pitkänen M, Sander CL, Zhang J, Saeid S, Turunen T, Shmara A, Weiss L, Ta L, Ton T, Koskelainen A, Vargas JD, Kimonis V, Palczewski K. A p97/Valosin-Containing Protein Inhibitor Drug CB-5083 Has a Potent but Reversible Off-Target Effect on Phosphodiesterase-6. J Pharmacol Exp Ther 2021; 378:31-41. [PMID: 33931547 DOI: 10.1124/jpet.120.000486] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 04/29/2021] [Indexed: 12/16/2022] Open
Abstract
CB-5083 is an inhibitor of p97/valosin-containing protein (VCP), for which phase I trials for cancer were terminated because of adverse effects on vision, such as photophobia and dyschromatopsia. Lower dose CB-5083 could combat inclusion body myopathy with early-onset Paget disease and frontotemporal dementia or multisystem proteinopathy caused by gain-of-function mutations in VCP. We hypothesized that the visual impairment in the cancer trial was due to CB-5083's inhibition of phosphodiesterase (PDE)-6, which mediates signal transduction in photoreceptors. To test our hypothesis, we used in vivo and ex vivo electroretinography (ERG) in mice and a PDE6 activity assay of bovine rod outer segment (ROS) extracts. Additionally, histology and optical coherence tomography were used to assess CB-5083's long-term ocular toxicity. A single administration of CB-5083 led to robust ERG signal deterioration, specifically in photoresponse kinetics. Similar recordings with known PDE inhibitors sildenafil, tadalafil, vardenafil, and zaprinast showed that only vardenafil had as strong an effect on the ERG signal in vivo as did CB-5083. In the biochemical assay, CB-5083 inhibited PDE6 activity with a potency higher than sildenafil but lower than that of vardenafil. Ex vivo ERG revealed a PDE6 inhibition constant of 80 nM for CB-5083, which is 7-fold smaller than that for sildenafil. Finally, we showed that the inhibitory effect of CB-5083 on visual function is reversible, and its chronic administration does not cause permanent retinal anomalies in aged VCP-disease model mice. Our results warrant re-evaluation of CB-5083 as a clinical therapeutic agent. We recommend preclinical ERG recordings as a routine drug safety screen. SIGNIFICANCE STATEMENT: This report supports the use of a valosin-containing protein (VCP) inhibitor drug, CB-5083, for the treatment of neuromuscular VCP disease despite CB-5083's initial clinical failure for cancer treatment due to side effects on vision. The data show that CB-5083 displays a dose-dependent but reversible inhibitory action on phosphodiesterase-6, an essential enzyme in retinal photoreceptor function, but no long-term consequences on retinal function or structure.
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Affiliation(s)
- Henri Leinonen
- Gavin Herbert Eye Institute, Department of Ophthalmology (H.L., C.L.S., J.Z., K.P.), Department of Physiology & Biophysics (K.P.), Department of Chemistry (K.P.), and Division of Genetics and Genomic Medicine, Department of Pediatrics (C.C., A.S., L.W., L.T., T.T., V.K.), University of California Irvine, Irvine, California; Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio (C.L.S.); Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland (M.P., S.S., T.T., A.K.); and Cleave Therapeutics, Inc., San Francisco, California (J.D.V.)
| | - Cheng Cheng
- Gavin Herbert Eye Institute, Department of Ophthalmology (H.L., C.L.S., J.Z., K.P.), Department of Physiology & Biophysics (K.P.), Department of Chemistry (K.P.), and Division of Genetics and Genomic Medicine, Department of Pediatrics (C.C., A.S., L.W., L.T., T.T., V.K.), University of California Irvine, Irvine, California; Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio (C.L.S.); Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland (M.P., S.S., T.T., A.K.); and Cleave Therapeutics, Inc., San Francisco, California (J.D.V.)
| | - Marja Pitkänen
- Gavin Herbert Eye Institute, Department of Ophthalmology (H.L., C.L.S., J.Z., K.P.), Department of Physiology & Biophysics (K.P.), Department of Chemistry (K.P.), and Division of Genetics and Genomic Medicine, Department of Pediatrics (C.C., A.S., L.W., L.T., T.T., V.K.), University of California Irvine, Irvine, California; Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio (C.L.S.); Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland (M.P., S.S., T.T., A.K.); and Cleave Therapeutics, Inc., San Francisco, California (J.D.V.)
| | - Christopher L Sander
- Gavin Herbert Eye Institute, Department of Ophthalmology (H.L., C.L.S., J.Z., K.P.), Department of Physiology & Biophysics (K.P.), Department of Chemistry (K.P.), and Division of Genetics and Genomic Medicine, Department of Pediatrics (C.C., A.S., L.W., L.T., T.T., V.K.), University of California Irvine, Irvine, California; Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio (C.L.S.); Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland (M.P., S.S., T.T., A.K.); and Cleave Therapeutics, Inc., San Francisco, California (J.D.V.)
| | - Jianye Zhang
- Gavin Herbert Eye Institute, Department of Ophthalmology (H.L., C.L.S., J.Z., K.P.), Department of Physiology & Biophysics (K.P.), Department of Chemistry (K.P.), and Division of Genetics and Genomic Medicine, Department of Pediatrics (C.C., A.S., L.W., L.T., T.T., V.K.), University of California Irvine, Irvine, California; Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio (C.L.S.); Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland (M.P., S.S., T.T., A.K.); and Cleave Therapeutics, Inc., San Francisco, California (J.D.V.)
| | - Sama Saeid
- Gavin Herbert Eye Institute, Department of Ophthalmology (H.L., C.L.S., J.Z., K.P.), Department of Physiology & Biophysics (K.P.), Department of Chemistry (K.P.), and Division of Genetics and Genomic Medicine, Department of Pediatrics (C.C., A.S., L.W., L.T., T.T., V.K.), University of California Irvine, Irvine, California; Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio (C.L.S.); Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland (M.P., S.S., T.T., A.K.); and Cleave Therapeutics, Inc., San Francisco, California (J.D.V.)
| | - Teemu Turunen
- Gavin Herbert Eye Institute, Department of Ophthalmology (H.L., C.L.S., J.Z., K.P.), Department of Physiology & Biophysics (K.P.), Department of Chemistry (K.P.), and Division of Genetics and Genomic Medicine, Department of Pediatrics (C.C., A.S., L.W., L.T., T.T., V.K.), University of California Irvine, Irvine, California; Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio (C.L.S.); Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland (M.P., S.S., T.T., A.K.); and Cleave Therapeutics, Inc., San Francisco, California (J.D.V.)
| | - Alyaa Shmara
- Gavin Herbert Eye Institute, Department of Ophthalmology (H.L., C.L.S., J.Z., K.P.), Department of Physiology & Biophysics (K.P.), Department of Chemistry (K.P.), and Division of Genetics and Genomic Medicine, Department of Pediatrics (C.C., A.S., L.W., L.T., T.T., V.K.), University of California Irvine, Irvine, California; Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio (C.L.S.); Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland (M.P., S.S., T.T., A.K.); and Cleave Therapeutics, Inc., San Francisco, California (J.D.V.)
| | - Lan Weiss
- Gavin Herbert Eye Institute, Department of Ophthalmology (H.L., C.L.S., J.Z., K.P.), Department of Physiology & Biophysics (K.P.), Department of Chemistry (K.P.), and Division of Genetics and Genomic Medicine, Department of Pediatrics (C.C., A.S., L.W., L.T., T.T., V.K.), University of California Irvine, Irvine, California; Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio (C.L.S.); Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland (M.P., S.S., T.T., A.K.); and Cleave Therapeutics, Inc., San Francisco, California (J.D.V.)
| | - Lac Ta
- Gavin Herbert Eye Institute, Department of Ophthalmology (H.L., C.L.S., J.Z., K.P.), Department of Physiology & Biophysics (K.P.), Department of Chemistry (K.P.), and Division of Genetics and Genomic Medicine, Department of Pediatrics (C.C., A.S., L.W., L.T., T.T., V.K.), University of California Irvine, Irvine, California; Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio (C.L.S.); Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland (M.P., S.S., T.T., A.K.); and Cleave Therapeutics, Inc., San Francisco, California (J.D.V.)
| | - Timothy Ton
- Gavin Herbert Eye Institute, Department of Ophthalmology (H.L., C.L.S., J.Z., K.P.), Department of Physiology & Biophysics (K.P.), Department of Chemistry (K.P.), and Division of Genetics and Genomic Medicine, Department of Pediatrics (C.C., A.S., L.W., L.T., T.T., V.K.), University of California Irvine, Irvine, California; Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio (C.L.S.); Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland (M.P., S.S., T.T., A.K.); and Cleave Therapeutics, Inc., San Francisco, California (J.D.V.)
| | - Ari Koskelainen
- Gavin Herbert Eye Institute, Department of Ophthalmology (H.L., C.L.S., J.Z., K.P.), Department of Physiology & Biophysics (K.P.), Department of Chemistry (K.P.), and Division of Genetics and Genomic Medicine, Department of Pediatrics (C.C., A.S., L.W., L.T., T.T., V.K.), University of California Irvine, Irvine, California; Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio (C.L.S.); Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland (M.P., S.S., T.T., A.K.); and Cleave Therapeutics, Inc., San Francisco, California (J.D.V.)
| | - Jesse D Vargas
- Gavin Herbert Eye Institute, Department of Ophthalmology (H.L., C.L.S., J.Z., K.P.), Department of Physiology & Biophysics (K.P.), Department of Chemistry (K.P.), and Division of Genetics and Genomic Medicine, Department of Pediatrics (C.C., A.S., L.W., L.T., T.T., V.K.), University of California Irvine, Irvine, California; Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio (C.L.S.); Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland (M.P., S.S., T.T., A.K.); and Cleave Therapeutics, Inc., San Francisco, California (J.D.V.)
| | - Virginia Kimonis
- Gavin Herbert Eye Institute, Department of Ophthalmology (H.L., C.L.S., J.Z., K.P.), Department of Physiology & Biophysics (K.P.), Department of Chemistry (K.P.), and Division of Genetics and Genomic Medicine, Department of Pediatrics (C.C., A.S., L.W., L.T., T.T., V.K.), University of California Irvine, Irvine, California; Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio (C.L.S.); Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland (M.P., S.S., T.T., A.K.); and Cleave Therapeutics, Inc., San Francisco, California (J.D.V.)
| | - Krzysztof Palczewski
- Gavin Herbert Eye Institute, Department of Ophthalmology (H.L., C.L.S., J.Z., K.P.), Department of Physiology & Biophysics (K.P.), Department of Chemistry (K.P.), and Division of Genetics and Genomic Medicine, Department of Pediatrics (C.C., A.S., L.W., L.T., T.T., V.K.), University of California Irvine, Irvine, California; Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio (C.L.S.); Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland (M.P., S.S., T.T., A.K.); and Cleave Therapeutics, Inc., San Francisco, California (J.D.V.)
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15
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Capece M, Montorio D, Comune C, Aveta A, Melchionna A, Celentano G, Imbimbo C, Crocetto F, Califano G, Cennamo G. Retinal and Optic Disc Vascular Changes in Patients Using Long-Term Tadalafil: A Prospective Non-Randomized Matched-Pair Study. Diagnostics (Basel) 2021; 11:802. [PMID: 33925202 PMCID: PMC8146942 DOI: 10.3390/diagnostics11050802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 12/02/2022] Open
Abstract
Retinal, choroidal and optic disc vascularity has never been evaluated in patients taking PDE5is long-term. The aim of our study was to evaluate the neurostructural and vascular changes after long-term use of tadalafil, using spectral domain (SD)-optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). In the present clinical trial, 27 patients who have been taking tadalafil 20 mg on alternate days (OAD) for at least 6 months (Group A) were enrolled. The matched group consisted of 27 healthy men (Group B). Both groups of patients underwent SD-OCT to study ganglion cell complex (GCC), retinal nerve fiber layer (RNFL) and choroidal thickness and OCTA for the evaluation of superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris (CC) and radial peripapillary capillary (RPC). A reduction in SCP, DCP and RPC vessel density was found in patients using tadalafil long-term. Retinal and optic disc toxicity may be detected using modifications of capillary vessel density. Further studies are needed to investigate the possibility of a causal association.
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Affiliation(s)
- Marco Capece
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy; (M.C.); (D.M.); (C.C.); (A.A.); (A.M.); (G.C.); (C.I.); (F.C.); (G.C.)
| | - Daniela Montorio
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy; (M.C.); (D.M.); (C.C.); (A.A.); (A.M.); (G.C.); (C.I.); (F.C.); (G.C.)
| | - Chiara Comune
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy; (M.C.); (D.M.); (C.C.); (A.A.); (A.M.); (G.C.); (C.I.); (F.C.); (G.C.)
| | - Achille Aveta
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy; (M.C.); (D.M.); (C.C.); (A.A.); (A.M.); (G.C.); (C.I.); (F.C.); (G.C.)
| | - Alberto Melchionna
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy; (M.C.); (D.M.); (C.C.); (A.A.); (A.M.); (G.C.); (C.I.); (F.C.); (G.C.)
| | - Giuseppe Celentano
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy; (M.C.); (D.M.); (C.C.); (A.A.); (A.M.); (G.C.); (C.I.); (F.C.); (G.C.)
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy; (M.C.); (D.M.); (C.C.); (A.A.); (A.M.); (G.C.); (C.I.); (F.C.); (G.C.)
| | - Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy; (M.C.); (D.M.); (C.C.); (A.A.); (A.M.); (G.C.); (C.I.); (F.C.); (G.C.)
| | - Gianluigi Califano
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy; (M.C.); (D.M.); (C.C.); (A.A.); (A.M.); (G.C.); (C.I.); (F.C.); (G.C.)
| | - Gilda Cennamo
- Eye Clinic, Public Health Department, University of Naples “Federico II”, 80131 Naples, Italy
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16
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Truong-Le M, Mallery RM. Neurovascular Causes of Acute Monocular Visual Loss. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00829-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Dunn HP, Kim LN, Popat H, Walker K, Lock J, Smith J. Ophthalmic findings in neonates receiving sildenafil. J Paediatr Child Health 2020; 56:884-888. [PMID: 31916341 DOI: 10.1111/jpc.14766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/10/2019] [Accepted: 12/15/2019] [Indexed: 11/30/2022]
Abstract
AIM To determine the risk of ocular complications of sildenafil therapy in neonates. METHODS Retrospective case review of neonates with persistent pulmonary hypertension of the newborn who received sildenafil therapy between 2010 and 2015 in a single, tertiary surgical neonatal intensive care unit in Australia. Ophthalmic examination findings in the neonatal intensive care unit and follow-up were examined. RESULTS Twenty-seven neonates with persistent pulmonary hypertension of the newborn received sildenafil. The median gestational age (GA) was 38 weeks (range 24-41 weeks), and median birthweight was 2690 g (range 454-4270 g). Ophthalmic review was undertaken in 23 neonates, and 16 neonates were term or near-term infants (GA 31-40 weeks). All of them had a normal initial ophthalmic examination; one child was later diagnosed with hypermetropia and another with infantile esotropia. Amongst the seven premature infants (GA 24-30 weeks), three had retinopathy of prematurity (ROP) diagnosed at the first ophthalmic review and the other four had normal initial examinations. Two patients later developed ROP, one of whom was also diagnosed with congenital motor nystagmus. All five patients diagnosed with ROP were extremely preterm (<28 weeks) with low birthweight (454-635 g). CONCLUSIONS There were no short-term complications attributable to sildenafil therapy identified in term or near-term neonates (GA ≥31 weeks). This cohort of neonates does not typically undergo ophthalmic review as part of the ROP screening protocol in our institution. Routine ophthalmic review of neonates on sildenafil therapy, who are not at risk of ROP, is therefore unlikely to be warranted. Further research is required to clarify the relationship between sildenafil and ROP.
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Affiliation(s)
- Hamish P Dunn
- Department of Ophthalmology, Westmead Hospital, Sydney, New South Wales, Australia.,Department of Ophthalmology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Department of Ophthalmology, University of Sydney, Sydney, New South Wales, Australia
| | - Leah N Kim
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Himanshu Popat
- Department of Ophthalmology, University of Sydney, Sydney, New South Wales, Australia.,Grace Centre for Newborn Intensive Care, Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Karen Walker
- Department of Ophthalmology, University of Sydney, Sydney, New South Wales, Australia.,Grace Centre for Newborn Intensive Care, Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Jane Lock
- Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - James Smith
- Department of Ophthalmology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Children's Hospital Westmead, Sydney, New South Wales, Australia
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18
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[Acute ischemic optic nerve disease: Pathophysiology, clinical features and management (French translation of the article)]. J Fr Ophtalmol 2020; 43:256-270. [PMID: 32057527 DOI: 10.1016/j.jfo.2019.03.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/28/2019] [Indexed: 11/23/2022]
Abstract
Ischemic optic neuropathies are among the leading causes of severe visual acuity loss in people over 50 years of age. They constitute a set of various entities that are clinically, etiologically and therapeutically different. Anatomically, it is necessary to distinguish anterior and posterior forms. From an etiological point of view, the diagnosis of the arteritic form due to giant cell arteritis requires emergent management to prevent blindness and even death in the absence of prompt corticosteroid treatment. When this diagnosis has been ruled out with certainty, non-arteritic ischemic optic neuropathies represent a vast etiological context that in the majority of cases involves a local predisposing factor (small optic nerves, disc drusen) with a precipitating factor (severe hypotension, general anesthesia or dialysis) in a context of vascular disease (sleep apnea syndrome, hypertension, diabetes, etc.). In the absence of specific available treatment, it is the responsibility of the clinician to identify the risk factors involved, in order to reduce the risk of contralateral recurrence that may occur even several years later. Due to their complexity, these pathologies are the subject of debates regarding both the pathophysiological and therapeutic perspectives; this review aims to provide a synthesis of validated knowledge while discussing controversial data.
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19
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Tzoumas N, Farrah TE, Dhaun N, Webb DJ. Established and emerging therapeutic uses of PDE type 5 inhibitors in cardiovascular disease. Br J Pharmacol 2020; 177:5467-5488. [PMID: 31721165 PMCID: PMC7707100 DOI: 10.1111/bph.14920] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/15/2019] [Accepted: 10/21/2019] [Indexed: 12/21/2022] Open
Abstract
PDE type 5 inhibitors (PDE5Is), such as sildenafil, tadalafil and vardenafil, are a class of drugs used to prolong the physiological effects of NO/cGMP signalling in tissues through the inhibition of cGMP degradation. Although these agents were originally developed for the treatment of hypertension and angina, unanticipated side effects led to advances in the treatment of erectile dysfunction and, later, pulmonary arterial hypertension. In the last decade, accumulating evidence suggests that PDE5Is may confer a wider range of clinical benefits than was previously recognised. This has led to a broader interest in the cardiovascular therapeutic potential of PDE5Is, in conditions such as hypertension, myocardial infarction, stroke, peripheral arterial disease, chronic kidney disease and diabetes mellitus. Here, we review the pharmacological properties and established licensed uses of this class of drug, along with emerging therapeutic developments and possible future indications.
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Affiliation(s)
- Nikolaos Tzoumas
- British Heart Foundation/University Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.,Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - Tariq E Farrah
- British Heart Foundation/University Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Neeraj Dhaun
- British Heart Foundation/University Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - David J Webb
- British Heart Foundation/University Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
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20
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Augstburger E, Héron E, Abanou A, Habas C, Baudouin C, Labbé A. Acute ischemic optic nerve disease: Pathophysiology, clinical features and management. J Fr Ophtalmol 2020; 43:e41-e54. [PMID: 31952875 DOI: 10.1016/j.jfo.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/18/2019] [Indexed: 11/28/2022]
Abstract
Ischemic optic neuropathies are among the leading causes of severe visual acuity loss in people over 50 years of age. They constitute a set of various entities that are clinically, etiologically and therapeutically different. Anatomically, it is necessary to distinguish anterior and posterior forms. From an etiological point of view, the diagnosis of the arteritic form due to giant cell arteritis requires emergent management to prevent blindness and even death in the absence of prompt corticosteroid treatment. When this diagnosis has been ruled out with certainty, non-arteritic ischemic optic neuropathies represent a vast etiological context that in the majority of cases involves a local predisposing factor (small optic nerves, disc drusen) with a precipitating factor (severe hypotension, general anesthesia or dialysis) in a context of vascular disease (sleep apnea syndrome, hypertension, diabetes, etc.). In the absence of specific available treatment, it is the responsibility of the clinician to identify the risk factors involved, in order to reduce the risk of contralateral recurrence that may occur even several years later. Due to their complexity, these pathologies are the subject of debates regarding both the pathophysiological and therapeutic perspectives; this review aims to provide a synthesis of validated knowledge while discussing controversial data.
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Affiliation(s)
- E Augstburger
- Ophthalmology Service III, CHNO des Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012 Paris, France
| | - E Héron
- Internal medicine service, CHNO des Quinze-Vingts, Paris, France
| | - A Abanou
- Neuroradiology center, CHNO des Quinze-Vingts, Paris, France
| | - C Habas
- Neuroradiology center, CHNO des Quinze-Vingts, Paris, France; Inserm, U968; Inserm-DHOS CIC 503, UPMC Univ Paris 06, UMR_S968, CNRS, UMR 7210, institut de la Vision, CHNO des Quinze-Vingts, Paris, France
| | - C Baudouin
- Ophthalmology Service III, CHNO des Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012 Paris, France; Inserm-DHOS CIC 1423, CHNO des Quinze-Vingts, IHU FOReSIGHT, Paris, France; Inserm, U968; Inserm-DHOS CIC 503, UPMC Univ Paris 06, UMR_S968, CNRS, UMR 7210, institut de la Vision, CHNO des Quinze-Vingts, Paris, France; Ophthalmology service, université de Versailles Saint-Quentin-en-Yvelines, hôpital Ambroise-Paré, AP-HP, Versailles, France
| | - A Labbé
- Ophthalmology Service III, CHNO des Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012 Paris, France; Inserm-DHOS CIC 1423, CHNO des Quinze-Vingts, IHU FOReSIGHT, Paris, France; Inserm, U968; Inserm-DHOS CIC 503, UPMC Univ Paris 06, UMR_S968, CNRS, UMR 7210, institut de la Vision, CHNO des Quinze-Vingts, Paris, France; Ophthalmology service, université de Versailles Saint-Quentin-en-Yvelines, hôpital Ambroise-Paré, AP-HP, Versailles, France.
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Abstract
PURPOSE OF REVIEW Vision is often threatened or lost by acute ischemic damage to the optic nerves. Such pathology most often affects the anterior portion of the nerve and is visible on funduscopic examination. Ischemic optic neuropathy is associated with typical vascular risk factors and with one systemic disease in particular: giant cell arteritis (GCA). This article provides an overview of the three major classes of ischemic optic neuropathy, including information on risk factors, differential diagnosis, evaluation, and management. RECENT FINDINGS Optical coherence tomography provides precise anatomic imaging in ischemic optic neuropathy, showing neural loss weeks before it is visible on examination. Refinements of optical coherence tomography reveal optic nerve microvasculature and may assist in understanding pathogenesis and verifying diagnosis. New diagnostic algorithms and cranial vascular imaging techniques help define the likelihood of GCA in patients with ischemic optic neuropathy. Finally, intraocular drug and biological agent delivery holds promise for nonarteritic ischemic optic neuropathy, whereas newer immunologic agents may provide effective steroid-sparing treatment for GCA. SUMMARY It is essential to recognize ischemic optic neuropathy upon presentation, especially to determine the likelihood of GCA and the need for immediate steroid therapy. A broad differential diagnosis should be considered so as not to miss alternative treatable pathology, especially in cases with retrobulbar optic nerve involvement.
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Research on Association of the Diameter of the Internal Carotid Artery Siphon and Nonarteritic Anterior Ischaemic Optic Neuropathy. J Ophthalmol 2019; 2019:7910602. [PMID: 31565427 PMCID: PMC6745138 DOI: 10.1155/2019/7910602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/17/2019] [Accepted: 08/09/2019] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate the association of the diameter of the internal carotid artery siphon (ICAS) and nonarteritic anterior ischaemic optic neuropathy (NAION). Methods Thirty patients clinically diagnosed with NAION (unilateral affected) who presented to Beijing Friendship Hospital from January 2017 to October 2018 were selected. The eyes suffered from NAION were enrolled as the observation group, and the fellow healthy eyes were enrolled as the control group. The following indexes were measured: diameter of the ICAS and the ophthalmic artery (OA), intima-media thickness (IMT) of the internal carotid artery (ICA), degree of stenosis of the ICA and plaque formation, and hemodynamic parameters of the ICA and the short posterior ciliary arteries (SPCAs). All the values were compared between the two groups. Results The diameter of the ICAS in the observation group (0.30 ± 0.07 cm) significantly narrowed compared with that of the control group (0.32 ± 0.06 cm) (P < 0.05), but the diameter of the OA of the two groups had no significant difference. The detection rate of carotid atherosclerosis plaque, the average blood flow velocity (Vm), and the resistance index (RI) of the ICA in the observation group (46.67%, 26.81 ± 1.78 cm/s, and 0.72 ± 0.06) had significant differences compared with those of the control group (16.67%, 28.19 ± 2.75 cm/s, and 0.70 ± 0.05) (P < 0.05), but the gradings of ICA stenosis and IMT between the two groups had no significant differences. The peak systolic velocity (PSV) and the end diastolic velocity (EDV) of the SPCAs in the observation group (10.72 ± 2.88 cm/s and 3.43 ± 1.01 cm/s) were significantly lower than those of the control group (13.62 ± 3.93 cm/s and 4.59 ± 1.71 cm/s) (P < 0.05), but the RI of the SPCAs of the two groups had no significant differences. Conclusion The diameter of the ICAS has a close relationship with NAION.
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Gul M, Serefoglu EC. An update on the drug safety of treating erectile dysfunction. Expert Opin Drug Saf 2019; 18:965-975. [DOI: 10.1080/14740338.2019.1659244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Murat Gul
- Department of Urology, Aksaray University School of Medicine, Aksaray, Turkey
- Laboratory of Reproductive Biology, University of Copenhagen, Copenhagen, Denmark
| | - Ege Can Serefoglu
- Department of Urology, Bahceci Health Group, Istanbul, Turkey
- Department of Embriology and Histology, Medipol University, Istanbul, Turkey
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Gatto NM, Reynolds RF, Campbell UB. A Structured Preapproval and Postapproval Comparative Study Design Framework to Generate Valid and Transparent Real-World Evidence for Regulatory Decisions. Clin Pharmacol Ther 2019; 106:103-115. [PMID: 31025311 PMCID: PMC6771466 DOI: 10.1002/cpt.1480] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/18/2019] [Indexed: 12/28/2022]
Abstract
Real‐world evidence provides important information about the effects of medicines in routine clinical practice. To engender trust that evidence generated for regulatory purposes is sufficiently valid, transparency in the reasoning that underlies study design decisions is critical. Building on existing guidance and frameworks, we developed the Structured Preapproval and Postapproval Comparative study design framework to generate valid and transparent real‐world Evidence (SPACE) as a process for identifying design elements and minimal criteria for feasibility and validity concerns, and for documenting decisions. Starting with an articulated research question, we identify key components of the randomized controlled trial needed to maximize validity, and pragmatic choices are considered when required. A causal diagram is used to justify the variables identified for confounding control, and key decisions, assumptions, and evidence are captured in a structured way. In this way, SPACE may improve dialogue and build trust among healthcare providers, patients, regulators, and researchers.
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Affiliation(s)
- Nicolle M Gatto
- Epidemiology, Pfizer Inc., New York, New York, USA.,Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Robert F Reynolds
- Epidemiology, Pfizer Inc., New York, New York, USA.,Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Ulka B Campbell
- Epidemiology, Pfizer Inc., New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
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González Martín-Moro J, Contreras I, Gutierrez-Ortiz C, Gómez-Sanz F, Castro-Rebollo M, Fernández-Hortelano A, Pilo-De-La-Fuente B. Disc Configuration as a Risk and Prognostic Factor in NAION: The Impact of Cup to Disc Ratio, Disc Diameter, and Crowding Index. Semin Ophthalmol 2019; 34:177-181. [PMID: 31162995 DOI: 10.1080/08820538.2019.1620792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: The presence of the so called disc at risk (a small disc with no cupping) has been considered the main risk factor for the development of non-arteritic anterior ischemic optic neuropathy (NAION). However its role as a prognostic factor has not been studied. Our aim was to determine the weight of disc configuration as a risk and a prognostic factor for NAION. Methods: Case control study. Forty eyes of 40 patients who were diagnosed with NAION between 2008 and 2017, and 120 controls (3 controls for each patient) were included in the study. Disc diameter (DD), cup to disc ratio (CDR), and peripapillar retinal nerve fiber layer thickness (RNFLT) of the non-affected eye were measured using optic coherence tomography (3D OCT 2000, Topcon). Crowding index (CI) was defined as the quotient of average RNFLT and disc area. Mean deviation (MD) at the time of diagnosis and at least three months later was determined using a Humphrey Visual Field Analyzer (SITA standard 24-2 strategy). Visual acuity (VA) was measured using Snellen charts and transformed into LogMAR values. Results: Only CDR was found to be a risk factor for NAION. No correlationship was found between CI and visual loss. Conclusions: DD and CI did not show value as either prognostic or risk factors. Glial tissue may be a part of the content of the optic disc as important as axons. Our results are in line with the latest studies about NAION pathophysiology. Contrary to classic thinking, these papers have not found smaller disc diameters, but smaller values of lamina cribosa depth in NAION patients.
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Affiliation(s)
- Julio González Martín-Moro
- a Department of Ophthalmology , University Hospital of Henares , Madrid , Spain.,b University Francisco de Vitoria , Madrid , Spain
| | - Inés Contreras
- c Department of Ophthalmology , Ramón y Cajal University Hospital , Madrid , Spain
| | | | - Fernando Gómez-Sanz
- a Department of Ophthalmology , University Hospital of Henares , Madrid , Spain.,e School of Optometry , Complutense University , Madrid , Spain
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Zahavi A, Weiss S, Vieyra M, Nicholson JD, Muhsinoglu O, Barinfeld O, Zadok D, Goldenberg-Cohen N. Ocular Effects of Sildenafil in Naïve Mice and a Mouse Model of Optic Nerve Crush. ACTA ACUST UNITED AC 2019; 60:1987-1995. [DOI: 10.1167/iovs.18-26333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Alon Zahavi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Shirel Weiss
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Krieger Eye Research Laboratory, Felsenstein Medical Research Center, Petach Tikva, Israel
| | - Mark Vieyra
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - James D. Nicholson
- The Krieger Eye Research Laboratory, Felsenstein Medical Research Center, Petach Tikva, Israel
| | - Orkun Muhsinoglu
- Department of Ophthalmology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Orit Barinfeld
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Krieger Eye Research Laboratory, Felsenstein Medical Research Center, Petach Tikva, Israel
| | - David Zadok
- Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University Medical Center, Jerusalem, Israel
| | - Nitza Goldenberg-Cohen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Krieger Eye Research Laboratory, Felsenstein Medical Research Center, Petach Tikva, Israel
- Department of Ophthalmology, Bnai Zion Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Dharmarajan S, Lee JY, Izem R. Sample size estimation for case-crossover studies. Stat Med 2018; 38:956-968. [PMID: 30397907 DOI: 10.1002/sim.8030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 11/06/2022]
Abstract
Case-crossover study designs are observational studies used to assess postmarket safety of medical products (eg, vaccines or drugs). As a case-crossover study is self-controlled, its advantages include better control for confounding because the design controls for any time-invariant measured and unmeasured confounding and potentially greater feasibility as only data from those experiencing an event (or cases) are required. However, self-matching also introduces correlation between case and control periods within a subject or matched unit. To estimate sample size in a case-crossover study, investigators currently use Dupont's formula (Biometrics 1988; 43:1157-1168), which was originally developed for a matched case-control study. This formula is relevant as it takes into account correlation in exposure between controls and cases, which are expected to be high in self-controlled studies. However, in our study, we show that Dupont's formula and other currently used methods to determine sample size for case-crossover studies may be inadequate. Specifically, these formulas tend to underestimate the true required sample size, determined through simulations, for a range of values in the parameter space. We present mathematical derivations to explain where some currently used methods fail and propose two new sample size estimation methods that provide a more accurate estimate of the true required sample size.
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Affiliation(s)
- Sai Dharmarajan
- Office of Biostatistics, Division of Biometrics VII, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Joo-Yeon Lee
- Office of Biostatistics, Division of Biometrics VII, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Rima Izem
- Office of Biostatistics, Division of Biometrics VII, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
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Liu B, Zhu L, Zhong J, Zeng G, Deng T. The Association Between Phosphodiesterase Type 5 Inhibitor Use and Risk of Non-Arteritic Anterior Ischemic Optic Neuropathy: A Systematic Review and Meta-Analysis. Sex Med 2018; 6:185-192. [PMID: 29884471 PMCID: PMC6085407 DOI: 10.1016/j.esxm.2018.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/28/2018] [Accepted: 03/30/2018] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Phosphodiesterase type 5 inhibitors (PDE5-Is) are first-line drugs for erectile dysfunction. Non-arteritic anterior ischemic optic neuropathy (NAION) has been linked with PDE5-I use. However, no meta-analysis or conclusive review has explored the association between NAION and PDE5-I use. AIM To investigate the association between PDE5-I use and risk of NAION. METHODS A comprehensive literature search was conducted using online databases in October 2017 to obtain studies researching the association between PDE5-I application and occurrence of NAION. Summarized unadjusted risk ratios (RRs) with 95% CIs were calculated for the strength of this association. This study was conducted in accordance to Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines and registered in PROSPERO under number CRD42017080865. MAIN OUTCOME MEASURES The strength of association between PDE5-I use and risk of NAION was assessed through pooled unadjusted RRs and 95% CIs. RESULTS 5 original articles with 6 clinical observations were included in the meta-analysis. No significant higher risk of NAION was observed after the use of PDE5-Is within a 1-month period (RR = 1.16, 95% CI = 0.98-1.39, P = .09). Subgroup analyses indicated 2 PDE5-Is were significantly related to NAION (tadalafil: RR = 2.14, 95% CI = 1.20-3.84, P = .01; sildenafil: RR = 2.25, 95% CI = 1.29-3.94, P = .004). CONCLUSIONS Although we found no association between NAION and PDE5-I use, our results should be interpreted cautiously because we included only observational studies and could not control for potential confounders. Because NAION is a rare ocular disease and difficult to diagnose, this association should be confirmed in prospective comparative studies with larger samples and more rigorous designs. Liu B, Zhu L, Zhong J, et al. The Association Between Phosphodiesterase Type 5 Inhibitor Use and Risk of Non-Arteritic Anterior Ischemic Optic Neuropathy: A Systematic Review and Meta-Analysis. Sex Med 2018;6:185-192.
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Affiliation(s)
- Bing Liu
- Department of Ophthalmology, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Linxin Zhu
- Department of Ophthalmology, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jingxiang Zhong
- Department of Ophthalmology, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Guohua Zeng
- Department of Urology, Minimally Invasive Surgery Center, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Urology, Guangzhou, China; Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Tuo Deng
- Department of Urology, Minimally Invasive Surgery Center, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangzhou Institute of Urology, Guangzhou, China; Guangdong Key Laboratory of Urology, Guangzhou, China.
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Gaier ED, Wang M, Gilbert AL, Rizzo JF, Cestari DM, Miller JB. Quantitative analysis of optical coherence tomographic angiography (OCT-A) in patients with non-arteritic anterior ischemic optic neuropathy (NAION) corresponds to visual function. PLoS One 2018; 13:e0199793. [PMID: 29953490 PMCID: PMC6023180 DOI: 10.1371/journal.pone.0199793] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 06/13/2018] [Indexed: 11/25/2022] Open
Abstract
Purpose Non-arteritic anterior ischemic optic neuropathy (NAION) is the most common cause of non-glaucomatous optic neuropathy in older adults. Optical coherence tomographic angiography (OCT-A) is an emerging, non-invasive method to study the microvasculature of the posterior pole, including the optic nerve head. The goal of this study was to assess the vascular changes in the optic nerve head and peripapillary area associated with NAION using OCT-A. Design Retrospective comparative case series. Methods We performed OCT-A in 25 eyes (7 acute and 18 non-acute) in 19 patients with NAION. Fellow, unaffected eyes were analyzed for comparison. Patent macro- and microvascular densities were quantified in the papillary and peripapillary regions of unaffected, acutely affected, and non-acutely affected eyes and compared across these groups according to laminar segment and capillary sampling region, and with respect to performance on automated visual field testing. Results In acutely affected eyes, OCT-A revealed a reduction in the signal from the major retinal vessels and dilation of patent superficial capillaries in the peripapillary area. By contrast, non-acutely affected eyes showed attenuation of patent capillaries. The peripapillary choriocapillaris was obscured by edema in acute cases, but was similar between non-acute and unaffected eyes. The degree of dilation of the superficial microvasculature in the acute phase and attenuation in the non-acute phase each correlated inversely with visual field performance. The region of reduced patent capillary density correlated with the location of visual field defects in 80% of acute cases and 80% of non-acute cases. Conclusions OCT-A reveals a dynamic shift in the superficial capillary network of the optic nerve head with strong functional correlates in both the acute and non-acute phases of NAION. Further study may validate OCT-A as a useful adjunctive diagnostic tool in the evaluation of ischemic optic neuropathy.
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Affiliation(s)
- Eric D. Gaier
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States of America
| | - Mengyu Wang
- Schepens Eye Research Institute, Harvard Medical School, Boston, MA, United States of America
| | - Aubrey L. Gilbert
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States of America
| | - Joseph F. Rizzo
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States of America
| | - Dean M. Cestari
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States of America
| | - John B. Miller
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States of America
- * E-mail:
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Liu W, Antonelli PJ, Dahm P, Gerhard T, Delaney JAC, Segal R, Crystal S, Winterstein AG. Risk of sudden sensorineural hearing loss in adults using phosphodiesterase type 5 inhibitors: Population-based cohort study. Pharmacoepidemiol Drug Saf 2018; 27:587-595. [PMID: 29512263 DOI: 10.1002/pds.4405] [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] [Received: 07/10/2017] [Revised: 12/11/2017] [Accepted: 01/18/2018] [Indexed: 11/06/2022]
Abstract
PURPOSE The objective of the study was to determine the risk of sudden sensorineural hearing loss (SNHL) associated with use of phosphodiesterase type 5 (PDE5) inhibitors. METHODS We conducted a retrospective cohort study in the MarketScan Commercial Claims and Encounters Database including adult men who initiated a PDE5 inhibitor (n = 377,722) and 1,957,233 nonusers between 1998 and 2007. Periods of drug exposure were assessed on a weekly basis based on pharmacy billing records, assuming use of 1 dose per week (current use). Incident sudden SNHL was defined based on inpatient or outpatient visits with International Classification of Diseases, Ninth Revision, Clinical Modification codes 389.1x, 389.2x, or 388.2 plus ≥2 procedure codes for audiometric hearing testing within ±30 days of sudden SNHL diagnosis. We used age- and propensity score-adjusted Cox proportional hazards model to evaluate the risk of sudden SNHL during periods of current or recent use compared with that of nonuse. We conducted sensitivity analyses by varying the assumed drug utilization frequency and sudden SNHL case definition. RESULTS We evaluated 1233 sudden SNHL cases, resulting in an incidence of 4.35, 5.58, and 2.38 per 10,000 person-years for current, recent, and nonuse of PDE5 inhibitors, respectively. Compared with nonuse, the adjusted hazard ratio was 1.25 (1.01-1.55) for current use with a risk difference of 1.97 (1.12-2.82) per 10,000 person-years. For recent use, the adjusted hazard ratio was 1.60 (1.33-1.94) and risk difference was 3.19 (2.24-4.14). Estimates were consistent across the sensitivity analyses. CONCLUSIONS Use of PDE5 inhibitors is associated with a small but significantly increased risk of sudden SNHL.
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Affiliation(s)
- Wei Liu
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Patrick J Antonelli
- Department of Otolaryngology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Philipp Dahm
- Department of Urology, College of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Tobias Gerhard
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA.,Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA
| | - Joseph A C Delaney
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Richard Segal
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Stephen Crystal
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Department of Epidemiology, Colleges of Medicine and Public Health and Health Professions, University of Florida, Gainesville, FL, USA
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Antón-López A, Moreno-Montañés J, Duch-Tuesta S, Corsino Fernández-Vila P, García-Feijoo J, Millá-Griñó E, Muñoz-Negrete FJ, Pablo-Júlvez L, Rodríguez-Agirretxe I, Urcelay-Segura JL, Ussa-Herrera F, Villegas-Pérez MP. Lifestyles guide and glaucoma (II). Diet, supplements, drugs, sleep, pregnancy, and systemic hypertension. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2018; 93:76-86. [PMID: 29150215 DOI: 10.1016/j.oftal.2017.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/21/2017] [Accepted: 10/03/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE To establish evidence based guidelines to advise patients on the relationship between habits, diet, certain circumstances, diseases and glaucoma. METHODS Review of all published articles on glaucoma and sports or other activities. The papers were classified according to the level of scientific evidence based on the Oxford Centre for Evidence-based Medicine classification. RESULTS The evidence on the relationship between diet or supplements and the incidence or progression of glaucoma is insufficient to make a general recommendation for glaucoma patients. Although some studies on normal tension glaucoma suggest that Gingko biloba could reduce glaucoma progression, the results do not allow a general recommendation for all these patients. Similarly, the evidence on the usefulness of vitamin supplements is not conclusive. The studies on smoking do not clearly demonstrate the relationship between this habit and incidence of glaucoma. Marihuana is not a useful treatment for glaucoma. Although the results on the relationship between sleep apnoea and glaucoma are heterogeneous, it is recommended that patients with moderate to intense apnoea are tested for glaucoma. Pregnancy does not influence the course of the disease, but several hypotensive drugs may be harmful for the foetus. Nocturnal systemic hypotension is a risk factor for glaucoma progression. CONCLUSIONS Certain habits, circumstances, or diseases may have an influence on the onset or progression of glaucoma. It is important to have adequate information about the scientific evidence in the publications in order to properly advise patients.
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Affiliation(s)
- A Antón-López
- Institut Català de Retina, Universitat Internacional de Catalunya, Parc de Salut Mar, Barcelona, España.
| | | | | | | | - J García-Feijoo
- Hospital Clínico San Carlos, Universidad Complutense, Madrid, España
| | - E Millá-Griñó
- Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - F J Muñoz-Negrete
- Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Alcalá de Henares, Madrid, España
| | - L Pablo-Júlvez
- Hospital Miguel Servet, Universidad de Zaragoza, Zaragoza, España
| | | | | | - F Ussa-Herrera
- Instituto de Oftalmobiología Aplicada, Valladolid, España
| | - M P Villegas-Pérez
- Hospital General Universitario Reina Sofía, Universidad de Murcia, Murcia, España
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Takeuchi Y, Shinozaki T, Matsuyama Y. A comparison of estimators from self-controlled case series, case-crossover design, and sequence symmetry analysis for pharmacoepidemiological studies. BMC Med Res Methodol 2018; 18:4. [PMID: 29310575 PMCID: PMC5759844 DOI: 10.1186/s12874-017-0457-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 12/12/2017] [Indexed: 12/14/2022] Open
Abstract
Background Despite the frequent use of self-controlled methods in pharmacoepidemiological studies, the factors that may bias the estimates from these methods have not been adequately compared in real-world settings. Here, we comparatively examined the impact of a time-varying confounder and its interactions with time-invariant confounders, time trends in exposures and events, restrictions, and misspecification of risk period durations on the estimators from three self-controlled methods. This study analyzed self-controlled case series (SCCS), case-crossover (CCO) design, and sequence symmetry analysis (SSA) using simulated and actual electronic medical records datasets. Methods We evaluated the performance of the three self-controlled methods in simulated cohorts for the following scenarios: 1) time-invariant confounding with interactions between the confounders, 2) time-invariant and time-varying confounding without interactions, 3) time-invariant and time-varying confounding with interactions among the confounders, 4) time trends in exposures and events, 5) restricted follow-up time based on event occurrence, and 6) patient restriction based on event history. The sensitivity of the estimators to misspecified risk period durations was also evaluated. As a case study, we applied these methods to evaluate the risk of macrolides on liver injury using electronic medical records. Results In the simulation analysis, time-varying confounding produced bias in the SCCS and CCO design estimates, which aggravated in the presence of interactions between the time-invariant and time-varying confounders. The SCCS estimates were biased by time trends in both exposures and events. Erroneously short risk periods introduced bias to the CCO design estimate, whereas erroneously long risk periods introduced bias to the estimates of all three methods. Restricting the follow-up time led to severe bias in the SSA estimates. The SCCS estimates were sensitive to patient restriction. The case study showed that although macrolide use was significantly associated with increased liver injury occurrence in all methods, the value of the estimates varied. Conclusions The estimations of the three self-controlled methods depended on various underlying assumptions, and the violation of these assumptions may cause non-negligible bias in the resulting estimates. Pharmacoepidemiologists should select the appropriate self-controlled method based on how well the relevant key assumptions are satisfied with respect to the available data. Electronic supplementary material The online version of this article (10.1186/s12874-017-0457-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yoshinori Takeuchi
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan. .,Department of Healthcare Information Management, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Tomohiro Shinozaki
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yutaka Matsuyama
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
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Colson M, Cuzin B, Faix A, Grellet L, Huyghes E. Les traitements oraux de la dysfonction érectile aujourd’hui, pour quel patient ? SEXOLOGIES 2018. [DOI: 10.1016/j.sexol.2018.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Are Erectile Dysfunction Medications Causally Related to Nonarteritic Anterior Ischemic Optic Neuropathy? J Neuroophthalmol 2017; 36:202-7. [PMID: 26828844 DOI: 10.1097/wno.0000000000000342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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Berry S, Lin WV, Sadaka A, Lee AG. Nonarteritic anterior ischemic optic neuropathy: cause, effect, and management. Eye Brain 2017; 9:23-28. [PMID: 29033621 PMCID: PMC5628702 DOI: 10.2147/eb.s125311] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common form of ischemic optic neuropathy and the second most common optic neuropathy. Patients are generally over the age of 50 years with vasculopathic risk factors (eg, diabetes mellitus, hypertension, and obstructive sleep apnea). The exact mechanism of NAION is not fully understood. In addition, several treatment options have been proposed. This article summarizes the current literature on the diagnosis, treatment, and management of NAION.
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Affiliation(s)
- Shauna Berry
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Weijie V Lin
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | - Ama Sadaka
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA.,Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA.,Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch (UTMB), Galveston, TX, USA.,Department of Ophthalmology.,Department of Neurology.,Department of Neurosurgery, Weill Cornell Medicine, Houston, TX, USA.,Department of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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36
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Prospective Case-crossover Study Investigating the Possible Association Between Nonarteritic Anterior Ischemic Optic Neuropathy and Phosphodiesterase Type 5 Inhibitor Exposure. Urology 2017; 105:76-84. [DOI: 10.1016/j.urology.2017.02.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 02/04/2017] [Accepted: 02/24/2017] [Indexed: 11/19/2022]
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Mentek M, Aptel F, Godin-Ribuot D, Tamisier R, Pepin JL, Chiquet C. Diseases of the retina and the optic nerve associated with obstructive sleep apnea. Sleep Med Rev 2017; 38:113-130. [PMID: 29107469 DOI: 10.1016/j.smrv.2017.05.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 03/27/2017] [Accepted: 05/19/2017] [Indexed: 10/19/2022]
Abstract
Many associations between ocular disorders and obstructive sleep apnea (OSA) have been studied, such as nonarteritic anterior ischemic optic neuropathy, glaucoma, papilledema, retinal vein occlusion, eyelid hyperlaxity, lower-eyelid ectropion and recurrent corneal erosions. The objective of this review is to synthetize the possible vascular disorders of the retina and the optic nerve associated with sleep apnea patients and to discuss the underlying pathophysiological hypotheses. Main mechanisms involved in the ocular complications of OSA are related to intermittent hypoxia, sympathetic system activation, oxidant stress, and deleterious effects of endothelin 1. The main evidence-based medicine data suggest that OSA should be screened in patients with ischemic optic neuropathy and diabetic retinopathy. The effect of OSA treatment and emerging therapies are discussed.
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Affiliation(s)
- Marielle Mentek
- Grenoble Alpes University, HP2 Laboratory, INSERM U1042, Grenoble, France
| | - Florent Aptel
- Grenoble Alpes University, HP2 Laboratory, INSERM U1042, Grenoble, France; Department of Ophthalmology, University Hospital of Grenoble, Grenoble, France
| | - Diane Godin-Ribuot
- Grenoble Alpes University, HP2 Laboratory, INSERM U1042, Grenoble, France
| | - Renaud Tamisier
- Grenoble Alpes University, HP2 Laboratory, INSERM U1042, Grenoble, France; Pôle Thorax et Vaisseaux, University Hospital of Grenoble, Grenoble, France
| | - Jean-Louis Pepin
- Grenoble Alpes University, HP2 Laboratory, INSERM U1042, Grenoble, France; Pôle Thorax et Vaisseaux, University Hospital of Grenoble, Grenoble, France
| | - Christophe Chiquet
- Grenoble Alpes University, HP2 Laboratory, INSERM U1042, Grenoble, France; Department of Ophthalmology, University Hospital of Grenoble, Grenoble, France.
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38
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Biousse V, Newman NJ. Diagnosis and clinical features of common optic neuropathies. Lancet Neurol 2017; 15:1355-1367. [PMID: 27839652 DOI: 10.1016/s1474-4422(16)30237-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 12/25/2022]
Abstract
Disorders of the optic nerves (optic neuropathies) are some of the most common causes of visual loss, and can present in isolation or with associated neurological or systemic symptoms and signs. Several optic neuropathies-especially inflammatory optic neuropathies-are associated with neurological disorders and thus are often diagnosed and treated by neurologists. The mechanisms underlying optic neuropathies are diverse and typically manifest with decreased visual acuity, altered colour vision, and abnormal visual field in the affected eye. Diagnosis is made on the basis of clinical history and clinical examination, of which several aspects are particularly important, including the mode of onset of visual loss, the presence of pain with eye movements, the visual acuity, and the retention of colour vision. Advances in optic nerve imaging-particularly retinal digital photography, optical coherence tomography, and MRI techniques-have revolutionised the diagnosis and follow-up of patients with an optic neuropathy. Furthermore, improvement and generalisation of some ancillary tests, such as diagnostic antibodies for neuromyelitis optica, allows better phenotyping of the heterogeneous inflammatory optic neuropathies.
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Affiliation(s)
- Valérie Biousse
- Neuro-Ophthalmology Unit, Emory Eye Center, Emory University, Atlanta, GA, USA.
| | - Nancy J Newman
- Neuro-Ophthalmology Unit, Emory Eye Center, Emory University, Atlanta, GA, USA
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Valenzuela RM, Rai R, Kirk BH, Sanders JN, Sundar S, Hamann S, Warner JEA, Digre KB, Crum AV, Jones KP, Katz BJ. An Estimation of the Risk of Pseudotumor Cerebri among Users of the Levonorgestrel Intrauterine Device. Neuroophthalmology 2017; 41:192-197. [PMID: 29344058 DOI: 10.1080/01658107.2017.1304425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 03/05/2017] [Accepted: 03/05/2017] [Indexed: 10/19/2022] Open
Abstract
Because of a previous association of pseudotumor cerebri (PTC) with levonorgestrel, we wished to evaluate the use of levonorgestrel-eluting intrauterine devices ("levonorgestrel intrauterine systems", LNG-IUS) in our University of Utah and Rigshospitalet PTC patients. In our retrospective series, PTC prevalence was approximately 0.18% and 0.15% in the LNG-IUS population versus 0.02% and 0.04% in the non-LNG-IUS population (Utah and Rigshospitalet, respectively), with no significant differences in PTC signs and symptoms among the two groups. Our investigation suggests that women with an LNG-IUS may have increased risk of developing PTC but does not suggest an LNG-IUS can cause PTC.
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Affiliation(s)
- Reuben M Valenzuela
- Department of Ophthalmology and Visual Sciences; John A. Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.,Department of Neurology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Ruju Rai
- Department of Ophthalmology and Visual Sciences; John A. Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Brian H Kirk
- Department of Ophthalmology and Visual Sciences; John A. Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Jessica N Sanders
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Subhashree Sundar
- Department of Operations and Information Systems, David Eccles School of Business, University of Utah, Salt Lake City, Utah, USA
| | - Steffen Hamann
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
| | - Judith E A Warner
- Department of Ophthalmology and Visual Sciences; John A. Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.,Department of Neurology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Kathleen B Digre
- Department of Ophthalmology and Visual Sciences; John A. Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.,Department of Neurology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Alison V Crum
- Department of Ophthalmology and Visual Sciences; John A. Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.,Department of Neurology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Kirtly P Jones
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Bradley J Katz
- Department of Ophthalmology and Visual Sciences; John A. Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.,Department of Neurology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
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A case of non-arteritic anterior ischemic optic neuropathy after completion of Harvoni therapy. Am J Ophthalmol Case Rep 2017; 6:55-57. [PMID: 29260058 PMCID: PMC5722139 DOI: 10.1016/j.ajoc.2017.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 01/09/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose To report the first reported case of non-arteritic anterior ischemic optic neuropathy (NAION) associated with the use of Harvoni (Gilead Sciences, Foster City, CA, USA), a newly approved treatment for Hepatitis C. Observations We report a case of NAION in a hepatitis C patient who completed Harvoni therapy just prior to presentation. Harvoni was suspected to be the causative agent given a lack of NAION risk factors in an otherwise healthy young patient. Conclusions and importance NAION is an acute, painless vision loss that typically affects adults over 50. The mechanism of NAION remains uncertain although numerous associations have been identified including certain medications. Harvoni, a combination drug of ledipasvir/sofosbuvir, is a recently FDA-approved treatment for Hepatitis C. To date, however, no ophthalmological side effects have been reported with its use. Continued surveillance of patients treated with Harvoni will be needed to determine if additional events are observed in the future.
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The enigma of nonarteritic anterior ischemic optic neuropathy: an update for the comprehensive ophthalmologist. Curr Opin Ophthalmol 2016; 27:498-504. [PMID: 27585212 DOI: 10.1097/icu.0000000000000318] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common cause of acute optic nerve injury, and frequently presents to comprehensive ophthalmologists. We review the typical and atypical clinical features and current literature on various treatment modalities for NAION. RECENT FINDINGS The epidemiology and clinical presentation of this disease can be variable, making a definitive diagnosis difficult in many cases. In addition, the differential diagnoses for this disorder, although comprising much less prevalent entities, are quite broad and can have substantial systemic implications if these alternatives go unrecognized. NAION has many systemic associations and comorbidities that deserve inquiry when the diagnosis is made. There are currently no widely accepted, evidence-based treatments for NAION. All recommendations made to patients to reduce their risk of sequential eye involvement, including avoidance of potential nocturnal hypotension, erectile dysfunction medication, and treatment of obstructive sleep apnea, have theoretical bases. SUMMARY NAION is a common cause of acute vision loss in adult and older patients, and thus, comprehensive ophthalmologists need to be able to diagnose and appropriately manage this disorder. We anticipate fruitful results from current and future trials aimed at neuroprotection in the affected eye and prevention of sequential eye involvement.
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Hong JH, Kwon YS, Kim IY. Pharmacodynamics, pharmacokinetics and clinical efficacy of phosphodiesterase-5 inhibitors. Expert Opin Drug Metab Toxicol 2016; 13:183-192. [PMID: 27690667 DOI: 10.1080/17425255.2017.1244265] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Phosphodiesterase type 5 inhibitors (PDE5Is) are the first-line drugs in the management of erectile dysfunction (ED). However, over the past two decades tremendous efforts have been made to identify new clinical uses of PDE5Is beyond their roles in ED. Areas covered: Basic science articles, clinical trials, reviews, and meta-analysis published between 1996 and 2015 were searched using MEDLINE (PubMed interface) to collect the most relevant and impactful studies from our perspectives as practicing urologists. This review mainly focuses on the level one evidence-based clinical efficacy and drug-related toxicity of oral PDE5Is. In addition, drug discovery, pharmacokinetics and pharmacodynamics, potential use in other diseases, and future directions are discussed. Expert opinion: On-demand PED5Is for the treatment of ED has shifted toward chronic administration in a broad spectrum of conditions that are thought to be associated with endovascular health. Several studies have shown that PDE5Is may play a cardioprotective or neuroprotective role. Further studies are under way to verify beneficial effects of PDE5I in non-urological conditions.
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Affiliation(s)
- Jeong Hee Hong
- a Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology , Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey , New Brunswick , NJ , USA.,b Department of Urology , Dankook University College of Medicine , Cheonan , South Korea
| | - Young Suk Kwon
- a Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology , Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey , New Brunswick , NJ , USA
| | - Isaac Yi Kim
- a Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology , Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey , New Brunswick , NJ , USA
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Subramanian PS, Gordon LK, Bonelli L, Arnold AC. Progression of asymptomatic optic disc swelling to non-arteritic anterior ischaemic optic neuropathy. Br J Ophthalmol 2016; 101:671-675. [PMID: 27565987 DOI: 10.1136/bjophthalmol-2016-309250] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 07/21/2016] [Accepted: 08/04/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND The time of onset of optic disc swelling in non-arteritic anterior ischaemic optic neuropathy (NAION) is not known, and it is commonly assumed to arise simultaneously with vision loss. Our goal is to report the presence and persistence of optic disc swelling without initial vision loss and its subsequent evolution to typical, symptomatic NAION. METHODS Clinical case series of patients with optic disc swelling and normal visual acuity and visual fields at initial presentation who progressed to have vision loss typical of NAION. All subjects underwent automated perimetry, disc photography and optic coherence tomography and/or fluorescein angiography to evaluate optic nerve function and perfusion. RESULTS Four patients were found to have sectoral or diffuse optic disc swelling without visual acuity or visual field loss; the fellow eye of all four had either current or prior NAION or a 'disc at risk' configuration. Over several weeks of clinical surveillance, each patient experienced sudden onset of visual field and/or visual acuity loss typical for NAION. CONCLUSIONS Current treatment options for NAION once vision loss occurs are limited and may not alter the natural history of the disorder. Subjects with NAION may have disc swelling for 2-10 weeks prior to the occurrence of visual loss, and with the development of new therapeutic agents, treatment at the time of observed disc swelling could prevent vision loss from NAION.
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Affiliation(s)
- Prem S Subramanian
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lynn K Gordon
- Jules Stein Eye Institute, University of California at Los Angeles, Los Angeles, California, USA
| | - Laura Bonelli
- Jules Stein Eye Institute, University of California at Los Angeles, Los Angeles, California, USA
| | - Anthony C Arnold
- Jules Stein Eye Institute, University of California at Los Angeles, Los Angeles, California, USA
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The Relationship Between Phosphodiesterase-5 Inhibitors and Nonarteritic Anterior Ischemic Optic Neuropathy. J Neuroophthalmol 2016; 36:193-6. [DOI: 10.1097/wno.0000000000000299] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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45
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46
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Coca MN, Morgan ML, Gupta P, Elkeeb A, Lee AG. Bilateral posterior ischemic optic neuropathy associated with the use of Sildenafil for pulmonary hypertension. Can J Ophthalmol 2016; 51:e96-9. [PMID: 27316292 DOI: 10.1016/j.jcjo.2016.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/07/2016] [Accepted: 02/10/2016] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | - Ahmed Elkeeb
- University of Texas Medical Branch. Galveston, Tex
| | - Andrew G Lee
- University of Texas Medical Branch. Galveston, Tex; Houston Methodist Hospital, Houston, Tex; Weill Cornell Medical College, Houston, Tex; The University of Iowa Hospitals and Clinics, Iowa City, Iowa; Baylor College of Medicine, Houston, Tex; UT MD Anderson Cancer Center, Houston, Tex.
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47
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Colaianna M, Ilmjärv S, Peterson H, Kern I, Julien S, Baquié M, Pallocca G, Bosgra S, Sachinidis A, Hengstler JG, Leist M, Krause KH. Fingerprinting of neurotoxic compounds using a mouse embryonic stem cell dual luminescence reporter assay. Arch Toxicol 2016; 91:365-391. [PMID: 27015953 PMCID: PMC5225183 DOI: 10.1007/s00204-016-1690-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 03/10/2016] [Indexed: 02/05/2023]
Abstract
Identification of neurotoxic drugs and environmental chemicals is an important challenge. However, only few tools to address this topic are available. The aim of this study was to develop a neurotoxicity/developmental neurotoxicity (DNT) test system, using the pluripotent mouse embryonic stem cell line CGR8 (ESCs). The test system uses ESCs at two differentiation stages: undifferentiated ESCs and ESC-derived neurons. Under each condition, concentration–response curves were obtained for three parameters: activity of the tubulin alpha 1 promoter (typically activated in early neurons), activity of the elongation factor 1 alpha promoter (active in all cells), and total DNA content (proportional to the number of surviving cells). We tested 37 compounds from the ESNATS test battery, which includes polypeptide hormones, environmental pollutants (including methylmercury), and clinically used drugs (including valproic acid and tyrosine kinase inhibitors). Different classes of compounds showed distinct concentration–response profiles. Plotting of the lowest observed adverse effect concentrations (LOAEL) of the neuronal promoter activity against the general promoter activity or against cytotoxicity, allowed the differentiation between neurotoxic/DNT substances and non-neurotoxic controls. Reporter activity responses in neurons were more susceptible to neurotoxic compounds than the reporter activities in ESCs from which they were derived. To relate the effective/toxic concentrations found in our study to relevant in vivo concentrations, we used a reverse pharmacokinetic modeling approach for three exemplary compounds (teriflunomide, geldanamycin, abiraterone). The dual luminescence reporter assay described in this study allows high-throughput, and should be particularly useful for the prioritization of the neurotoxic potential of a large number of compounds.
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Affiliation(s)
- Marilena Colaianna
- Department of Pathology and Immunology, Medical School, University of Geneva, Geneva, Switzerland
| | - Sten Ilmjärv
- Department of Pathology and Immunology, Medical School, University of Geneva, Geneva, Switzerland
| | | | - Ilse Kern
- Department of Pediatrics, Geneva University Hospital, Geneva, Switzerland.,Department of Genetic and Laboratory Medicine, Geneva University Hospital, Centre Medical Universitaire, Rue Michel-Servet, 1211, Geneva 4, Switzerland
| | - Stephanie Julien
- Department of Pathology and Immunology, Medical School, University of Geneva, Geneva, Switzerland
| | | | - Giorgia Pallocca
- Doerenkamp-Zbinden Chair for In Vitro Toxicology and Biomedicine, University of Konstanz, Constance, Germany
| | - Sieto Bosgra
- TNO, Zeist, The Netherlands.,BioMarin Pharmaceutical Inc., Leiden, The Netherlands
| | - Agapios Sachinidis
- Institute of Neurophysiology and Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Jan G Hengstler
- Leibniz Research Centre for Working Environment and Human Factors (IfADo), Technical University of Dortmund, Dortmund, Germany
| | - Marcel Leist
- Doerenkamp-Zbinden Chair for In Vitro Toxicology and Biomedicine, University of Konstanz, Constance, Germany
| | - Karl-Heinz Krause
- Department of Pathology and Immunology, Medical School, University of Geneva, Geneva, Switzerland. .,Department of Genetic and Laboratory Medicine, Geneva University Hospital, Centre Medical Universitaire, Rue Michel-Servet, 1211, Geneva 4, Switzerland.
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Peeler C, Cestari DM. Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION): A Review and Update on Animal Models. Semin Ophthalmol 2016; 31:99-106. [PMID: 26959135 DOI: 10.3109/08820538.2015.1115248] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Crandall Peeler
- a Neuro-Ophthalmology Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston , Massachusetts , USA
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- a Neuro-Ophthalmology Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston , Massachusetts , USA
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Gaier ED, Boudreault K, Rizzo JF, Falardeau J, Cestari DM. Atypical Optic Neuritis. Curr Neurol Neurosci Rep 2015; 15:76. [DOI: 10.1007/s11910-015-0598-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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