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Wang N, Zou J, Li S, Deng X, Zeng J, Ding C. Multimodal imaging to distinguish microvascular and morphological changes in retinal vein occlusion after intravitreal ranibizumab with or without triamcinolone acetonide injection. BMC Ophthalmol 2024; 24:354. [PMID: 39164640 PMCID: PMC11334535 DOI: 10.1186/s12886-024-03619-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 08/06/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND The study was designed to investigate microvascular and morphological changes in retinal vein occlusion (RVO) using multimodal imaging after intravitreal ranibizumab (IVR) with or without triamcinolone acetonide (IVTA) injections. METHODS This was a retrospective and observational study. Fifty patients (52 eyes) diagnosed with RVO were enrolled. Best corrected visual acuity (BCVA), ophthalmoscopy, fundus fluorescein angiography (FFA), spectral domain optical coherence tomography (SDOCT), and optical coherence tomography angiography (OCTA) were employed sequentially both before treatment and at the last visit after treatment. RESULTS The mean logMAR VAs in BRVO eyes decreased significantly after treatment (P = 0.029). OCTA showed there was a significant difference in foveal avascular zone (FAZ) in BRVO eyes (P = 0.024), superificial foveal vessel density in both CRVO (P = 0.0004) and BRVO eyes (P = 0.02155). OCT showed the foveal thickness had significant differences after treatment in both CRVO (P < 0.0001) and BRVO eyes (P = 0.0001). BCVA was associated most commonly with ellipsoid zone integrity (P = 0.022). The BCVA in eyes treated with IVR and IVTA was significantly decreased compared with IVR only in BRVO group (P = 0.021). However, the combination of IVR + IVTA significantly improved intraocular pressure (IOP) compared with IVR only in BRVO group (P = 0.037). CONCLUSION Both IVR and IVR + IVTA can significantly improve the central vision, macular structure, and functions in BRVO group. Simultaneous IVR with IVTA can significantly increase BCVA compared with IVR only in BRVO group.
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Affiliation(s)
- Nan Wang
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, 410011, China
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha, China
| | - Jingling Zou
- Department of Ophthalmology, Beijing Tongren Hospital, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Shengguo Li
- Changsha Aier Eye Hospital, Changsha, Hunan Province, China
| | - Xianghui Deng
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, 410011, China
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha, China
| | - Jun Zeng
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, 410011, China
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha, China
| | - Chun Ding
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, 410011, China.
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha, China.
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Santamaría J, Cobos E, Biarnes M, Caminal JM, Rodriguez-Leor R, Morwani R, García-Mendieta M, Lorenzo D, García-Bru P, Arias L. Changes in vessel density patterns assessed with OCTA in patients with diabetic macular edema treated with anti-VEGF therapy. Acta Diabetol 2024:10.1007/s00592-024-02290-5. [PMID: 38802603 DOI: 10.1007/s00592-024-02290-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 04/14/2024] [Indexed: 05/29/2024]
Abstract
AIMS To determine the presence of sectoral changes in vessel density (VD) patterns induced by vascular endothelial growth factor inhibitors (anti-VEGF) in patients with diabetic macular edema (DME) using optical coherence tomography angiography (OCTA). METHODS Prospective, interventional study. A total of 43 patients (63 eyes) were initially enrolled in the study. We performed swept source (SS) OCT and sectorial OCTA measurement to determine parafoveal VD at baseline and after six months of anti-VEGF treatment. In the locations with statistically significant differences in VD between baseline and month 6, we performed univariate and multivariate analyses to determine which, if any, of the baseline variables were associated with the observed changes. RESULTS A total of 34 patients (48 eyes) were included in the final analysis. Mean VD decreased from baseline to month 6 (from 45.2 (± 3.5) to 44.6 (± 3.2) % in the SCP and from 50 (± 3.3) to 49 (± 3.9) % in the DCP). The only significant changes in VD were observed in the nasal sector of the deep capillary plexus, with a decrease of 2.9% (p = 0.001). On univariate and multivariate analyses, the only variable significantly associated with changes in VD in the nasal sector after 6 months of treatment was baseline VD in the same sector. CONCLUSIONS Anti-VEGF therapy has a small impact on VD values over time. These variations observed after treatment seems to be related to changes over areas of vascular anomalies and displaced vessels adjacent to cystic areas, with no significant changes over ischemic areas. No correlation was observed between this trend and other clinical baseline features.
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Affiliation(s)
- Juan Santamaría
- Department of Ophthalmology, Hospital Universitari de Bellvitge, Carrer de La Feixa Llarga, S/N, 08907, L'Hospitalet de Llobregat, Catalunya, Spain.
- Institut de La Màcula, 08022, Barcelona, Spain.
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036, Barcelona, Spain.
| | - Estefanía Cobos
- Department of Ophthalmology, Hospital Universitari de Bellvitge, Carrer de La Feixa Llarga, S/N, 08907, L'Hospitalet de Llobregat, Catalunya, Spain
| | - Marc Biarnes
- Ophthalmology Department, Clínica Teknon, Barcelona, Catalunya, Spain
- OMIQ Research, 08915, Sant Cugat del Valles, Spain
| | - Josep María Caminal
- Department of Ophthalmology, Hospital Universitari de Bellvitge, Carrer de La Feixa Llarga, S/N, 08907, L'Hospitalet de Llobregat, Catalunya, Spain
| | | | - Rahul Morwani
- Department of Ophthalmology, Hospital Universitari de Bellvitge, Carrer de La Feixa Llarga, S/N, 08907, L'Hospitalet de Llobregat, Catalunya, Spain
| | | | - Daniel Lorenzo
- Department of Ophthalmology, Hospital Universitari de Bellvitge, Carrer de La Feixa Llarga, S/N, 08907, L'Hospitalet de Llobregat, Catalunya, Spain
| | - Pere García-Bru
- Department of Ophthalmology, Hospital Universitari de Bellvitge, Carrer de La Feixa Llarga, S/N, 08907, L'Hospitalet de Llobregat, Catalunya, Spain
| | - Luis Arias
- Department of Ophthalmology, Hospital Universitari de Bellvitge, Carrer de La Feixa Llarga, S/N, 08907, L'Hospitalet de Llobregat, Catalunya, Spain
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Hoshi K, Kunikata H, Aizawa N, Yasuda M, Okabe T, Takizawa H, Abe T, Nakazawa T. Baseline characteristics associated with the incidence of intraocular inflammation after the intravitreous injection of brolucizumab. Int Ophthalmol 2023; 43:4701-4709. [PMID: 38044420 DOI: 10.1007/s10792-023-02870-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/20/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE To investigate baseline characteristics associated with the incidence of intraocular inflammation (IOI) after the intravitreal injection of brolucizumab (IVBr) for the treatment of neovascular age-related macular degeneration (nAMD). METHODS This retrospective study included 66 eyes of 62 consecutive patients with nAMD who received IVBr (18 eyes were treatment naïve and 48 eyes had switched from other anti-vascular endothelial growth factor [VEGF] therapy). Baseline clinical characteristics were compared in non-IOI and IOI groups. RESULTS Although a dry macula was achieved at a high rate even 6 months after IVBr, IOI occurred in 8 of 66 eyes (12.1%; all had switched therapy) during the study period. Baseline characteristics including age, sex, nAMD type, lens status, visual acuity, central macular thickness, and a history of diabetes did not differ between the groups. The number of previous anti-VEGF injections before IVBr was greater in the IOI group (P = 0.004), and the ratio of patients with a laser flare-cell photometry (LFCP) value over 15 photon count per millisecond (pc/ms) was higher in the IOI group (P = 0.017). Multivariate logistic regression analysis showed that a greater number of previous anti-VEGF injections (odds ratio [OR]: 1.12, P = 0.006; area under the curve: 0.82, cut-off score: 14.0) and an LFCP value over 15 pc/ms (OR: 81.6, P = 0.031) were significantly associated with the incidence of IOI after IVBr. CONCLUSION A number of previous anti-VEGF injections greater than 14 and an LFCP value more than 15 pc/ms might be useful predictors of the incidence of IOI after IVBr in eyes with nAMD.
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Affiliation(s)
- Keisuke Hoshi
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
| | - Hiroshi Kunikata
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan.
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Naoko Aizawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
| | - Masayuki Yasuda
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
| | - Tatsu Okabe
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
| | - Hiroki Takizawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
| | - Toshiaki Abe
- Division of Clinical Cell Therapy Center for Advanced Medical Research and Development, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Śpiewak D, Witek K, Drzyzga Ł, Mrukwa-Kominek E. An Analysis of Optical Coherence Tomography Angiography (OCT-A) Perfusion Density Maps in Patients Treated for Retinal Vein Occlusion with Intravitreal Aflibercept. Diagnostics (Basel) 2023; 13:3100. [PMID: 37835843 PMCID: PMC10572925 DOI: 10.3390/diagnostics13193100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
AIM The primary goal of this study was to evaluate the reduction in non-perfusion area and improvement in blood flow as well as the reduction in retinal edema on optical coherence tomography angiography (OCT-A) in patients with retinal vein occlusion treated with 2 mg intravitreal injections of aflibercept. MATERIAL AND METHODS Fifty eyes of nine patients with central retinal vein occlusion (CRVO) and sixteen patients with branch retinal vein occlusion (BRVO), aged 50 to 75 years, were collectively analyzed as retinal vein occlusion (RVO). The following parameters were analyzed: superficial vessel density (VDSF), deep vessel density (VDD), flow area in the outer retina (FAOR), choriocapillaris flow area (FACC), non-flow area (NFA) and the foveal avascular zone (FAZ). RESULTS OCT-A revealed a reduction in macular edema. The most significant change in central retinal thickness (CRT) was observed between measurement timepoint "5" and the baseline (46%). The non-flow area was also reduced. Following a significant decrease in superficial vessel density 30 days after the first dose of aflibercept, a non-significant increase was noted at the subsequent timepoints. An increase was also found in deep vessel density and choriocapillaris flow area. Improvements in the above OCT-A parameters resulted in increased retinal blood flow and improved visual acuity. CONCLUSIONS Patients with retinal vein occlusion treated with 2 mg aflibercept exhibited reduced macular edema and FAZ, increased vessel density, improved blood flow, and better visual acuity.
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Affiliation(s)
- Dorota Śpiewak
- Department of Ophthalmology, Prof. K. Gibiński University Clinical Center, Medical University of Silesia, 40-514 Katowice, Poland
| | - Katarzyna Witek
- Department of Ophthalmology, Prof. K. Gibiński University Clinical Center, Medical University of Silesia, 40-514 Katowice, Poland
| | - Łukasz Drzyzga
- Department of Ophthalmology, Prof. K. Gibiński University Clinical Center, Medical University of Silesia, 40-514 Katowice, Poland
| | - Ewa Mrukwa-Kominek
- Department of Ophthalmology, Prof. K. Gibiński University Clinical Center, Medical University of Silesia, 40-514 Katowice, Poland
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
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Yasuda K, Noma H, Mimura T, Nonaka R, Sasaki S, Suganuma N, Shimura M. Effects of Intravitreal Ranibizumab Injection on Peripheral Retinal Microcirculation and Cytokines in Branch Retinal Vein Occlusion with Macular Edema. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1053. [PMID: 37374257 DOI: 10.3390/medicina59061053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: To investigate peripheral blood flow in retinal vessels and vessel diameters after intravitreal ranibizumab injection (IRI) and the relationship between these parameters and cytokines in branch retinal vein occlusion (BRVO) with macular edema. Materials and Methods: We assessed relative flow volume (RFV) and the width of the main and branch retinal arteries and veins in the occluded and non-occluded regions before and after IRI in 37 patients with BRVO and macular edema. Measurements were made using laser speckle flowgraphy (LSFG). When performing IRI, we obtained samples of aqueous humor and analyzed them using the suspension array method to evaluate vascular endothelial growth factor (VEGF), placental growth factor (PlGF), platelet-derived growth factor (PDGF)-AA, soluble intercellular adhesion molecule (sICAM)-1, monocyte chemoattractant protein 1 (MCP-1), interleukin (IL)-6, IL-8, and interferon-inducible 10-kDa protein (IP-10). Results: In both retinal regions, before and after IRI, the RFV in the main artery and vein showed a significant correlation with the summed RFV in the respective branch vessels 1 and 2. In the occluded region, the RFV in the main vein was significantly negatively correlated with MCP-1, PDGF-AA, IL-6, and IL-8; the RFV in branch vein 1 was significantly negatively correlated with PlGF, MCP-1, IL-6, and IL-8; PDGF-AA was significantly negatively correlated with the width of the main and branch veins; and the RFVs of the main artery and vein decreased significantly from before to 1 month after IRI. Conclusions: Contrary to expectations, the study found that anti-VEGF therapy does not affect RFV in arteries and veins in patients with BRVO and macular edema. Furthermore, retinal blood flow is poor in patients with high MCP-1, IL-6, and IL-8. Finally, high PDGF-AA may result in smaller venous diameters and reduced retinal blood flow.
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Affiliation(s)
- Kanako Yasuda
- Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, 1163, Tatemachi, Hachioji, Tokyo 193-0998, Japan
| | - Hidetaka Noma
- Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, 1163, Tatemachi, Hachioji, Tokyo 193-0998, Japan
| | - Tatsuya Mimura
- Department of Ophthalmology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8606, Japan
| | - Ryota Nonaka
- Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, 1163, Tatemachi, Hachioji, Tokyo 193-0998, Japan
| | - Shotaro Sasaki
- Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, 1163, Tatemachi, Hachioji, Tokyo 193-0998, Japan
| | - Noboru Suganuma
- Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, 1163, Tatemachi, Hachioji, Tokyo 193-0998, Japan
| | - Masahiko Shimura
- Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, 1163, Tatemachi, Hachioji, Tokyo 193-0998, Japan
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Huang YT, Wang I, Lin CJ, Lai CT, Hsia NY, Chen HS, Tien PT, Bair H, Lin JM, Chen WL, Chen CH, Wu WC, Tsai YY. Comparison of Choroidal Thickness, Foveal Avascular Zone, and Macular Capillary Density in Macular Edema Secondary to Branch Retinal Vein Occlusion Treated with Ranibizumab or Aflibercept-A Prospective Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58040540. [PMID: 35454378 PMCID: PMC9031043 DOI: 10.3390/medicina58040540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022]
Abstract
This prospective comparative case series aims to compare best-corrected visual acuity (BCVA), retinal microvasculature, and retinal structural changes in patients treated with either ranibizumab or aflibercept for macular edema (ME) secondary to treatment-naïve branch retinal vein occlusion (BRVO) by optical coherence tomography angiography (OCTA). Ten patients were enrolled with macular capillary density of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) and foveal avascular zone (FAZ) measured in both eyes before and after treatment. Final central retinal thickness and BCVA improved significantly (p < 0.05), and densities of SCP and DCP of BRVO sectors were significantly lower at baseline than fellow eye counterparts and remained persistently lower during treatment, particularly in the aflibercept group (p < 0.05). SCP density, DCP density of both BRVO sectors (p = 0.0001, p < 0.0001), and non-BRVO sectors (p < 0.0001, p < 0.0001) were significantly correlated with final BCVA for diseased eyes. Using multivariate general linear model analysis, and including OCTA parameters only, but not all of the available clinical data, DCP density of BRVO sectors in both eyes was the most predictive factor for final visual outcome (probability p < 0.0001). OCTA offered further qualitative and quantitative evaluation of treatment-naïve BRVO. Judging by OCTA parameters, not only in the diseased eye but also in the fellow eye, DCP density of BRVO sectors was the most predictive factor of final visual outcome.
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Affiliation(s)
- Yu-Te Huang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (Y.-T.H.); (I.W.); (N.-Y.H.); (P.-T.T.); (J.-M.L.); (W.-L.C.); (C.-H.C.); (W.-C.W.); (Y.-Y.T.)
| | - I Wang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (Y.-T.H.); (I.W.); (N.-Y.H.); (P.-T.T.); (J.-M.L.); (W.-L.C.); (C.-H.C.); (W.-C.W.); (Y.-Y.T.)
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (Y.-T.H.); (I.W.); (N.-Y.H.); (P.-T.T.); (J.-M.L.); (W.-L.C.); (C.-H.C.); (W.-C.W.); (Y.-Y.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung 404, Taiwan
- Department of Optometry, Asia University, Taichung 413, Taiwan
- Correspondence: (C.-J.L.); (C.-T.L.); Tel.: +886-4-22052121 (ext. 1141) (C.-J.L.); Fax: 886-4-22059265 (C.-J.L.)
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (Y.-T.H.); (I.W.); (N.-Y.H.); (P.-T.T.); (J.-M.L.); (W.-L.C.); (C.-H.C.); (W.-C.W.); (Y.-Y.T.)
- Correspondence: (C.-J.L.); (C.-T.L.); Tel.: +886-4-22052121 (ext. 1141) (C.-J.L.); Fax: 886-4-22059265 (C.-J.L.)
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (Y.-T.H.); (I.W.); (N.-Y.H.); (P.-T.T.); (J.-M.L.); (W.-L.C.); (C.-H.C.); (W.-C.W.); (Y.-Y.T.)
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung 401, Taiwan;
| | - Peng-Tai Tien
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (Y.-T.H.); (I.W.); (N.-Y.H.); (P.-T.T.); (J.-M.L.); (W.-L.C.); (C.-H.C.); (W.-C.W.); (Y.-Y.T.)
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung 404, Taiwan
| | - Henry Bair
- Byers Eye Institute, Stanford University School of Medicine, Stanford, CA 94303, USA;
| | - Jane-Ming Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (Y.-T.H.); (I.W.); (N.-Y.H.); (P.-T.T.); (J.-M.L.); (W.-L.C.); (C.-H.C.); (W.-C.W.); (Y.-Y.T.)
| | - Wen-Lu Chen
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (Y.-T.H.); (I.W.); (N.-Y.H.); (P.-T.T.); (J.-M.L.); (W.-L.C.); (C.-H.C.); (W.-C.W.); (Y.-Y.T.)
| | - Chang-He Chen
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (Y.-T.H.); (I.W.); (N.-Y.H.); (P.-T.T.); (J.-M.L.); (W.-L.C.); (C.-H.C.); (W.-C.W.); (Y.-Y.T.)
| | - Wen-Chuan Wu
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (Y.-T.H.); (I.W.); (N.-Y.H.); (P.-T.T.); (J.-M.L.); (W.-L.C.); (C.-H.C.); (W.-C.W.); (Y.-Y.T.)
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan; (Y.-T.H.); (I.W.); (N.-Y.H.); (P.-T.T.); (J.-M.L.); (W.-L.C.); (C.-H.C.); (W.-C.W.); (Y.-Y.T.)
- School of Medicine, College of Medicine, China Medical University, Taichung 404, Taiwan
- Department of Optometry, Asia University, Taichung 413, Taiwan
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Campochiaro PA. Retinal and Choroidal Vascular Diseases: Past, Present, and Future: The 2021 Proctor Lecture. Invest Ophthalmol Vis Sci 2021; 62:26. [PMID: 34817536 PMCID: PMC8637787 DOI: 10.1167/iovs.62.14.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Peter A Campochiaro
- Departments of Ophthalmology and Neuroscience, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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Takahashi N, Kunikata H, Yasuda M, Hariya T, Nishiguchi KM, Nakazawa T. Polypoidal choroidal vasculopathy in a case of retinitis pigmentosa, successfully treated with intravitreal aflibercept. Am J Ophthalmol Case Rep 2021; 23:101123. [PMID: 34136721 PMCID: PMC8181791 DOI: 10.1016/j.ajoc.2021.101123] [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: 06/10/2020] [Revised: 01/16/2021] [Accepted: 05/10/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Polypoidal choroidal vasculopathy (PCV) is a subtype of age-related macular degeneration that is seen frequently in Asians. Nevertheless, it is rare for this condition to be combined with retinitis pigmentosa (RP). The purpose of this paper is to present findings from this rare combination in a Japanese patient, and to describe its successful treatment with intravitreal aflibercept (IVA). Observations The patient was a 71-year-old Japanese woman with RP (diagnosed at the age of 30) and PCV. She noticed a decrease in vision in her right eye 6 months previously. Decimal best-corrected visual acuity (BCVA) was 0.05 in her right eye. Optical coherence tomography and indocyanine green angiography (IA) revealed serous retinal detachment (SRD) and PCV in her right eye. The SRD was initially resolved after 3 monthly treatments with IVA, but recurrences began 5 months later, requiring four more treatments with IVA, performed about every 4 months within the next 12 months, for successful resolution. There were no recurrences of PCV in 7 more months of follow-up, as confirmed with IA at the final appointment. Final decimal BCVA in the right eye improved to 0.15. Furthermore, macular retinal sensitivity, measured with microperimetry, increased after the treatment, and RP-related visual field narrowing, determined by Goldmann perimetry, did not progress throughout follow up of 26 months. Conclusion More than 2 years of follow up showed that IVA may be effective for treating PCV, even in RP patients, and can increase central visual function without causing progression of RP-related visual field narrowing.
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Affiliation(s)
- Nana Takahashi
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Japan
| | - Hiroshi Kunikata
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Japan
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Japan
- Corresponding author. Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
| | - Masayuki Yasuda
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Japan
| | - Takehiro Hariya
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Japan
| | - Koji M. Nishiguchi
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Japan
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Japan
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Japan
- Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Japan
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Asano T, Kunikata H, Yasuda M, Nishiguchi KM, Abe T, Nakazawa T. Ocular microcirculation changes, measured with laser speckle flowgraphy and optical coherence tomography angiography, in branch retinal vein occlusion with macular edema treated by ranibizumab. Int Ophthalmol 2020; 41:151-162. [PMID: 32894391 DOI: 10.1007/s10792-020-01562-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 08/17/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE This study searched for early predictive vascular biomarkers for visual outcomes in eyes with macular edema caused by branch retinal vein occlusion (BRVOME). METHODS Twenty-four eyes of 24 subjects with BRVOME were treated with the intravitreal injection of ranibizumab (IVR) for at least 6 months. We measured mean blur rate (MBR) in the optic nerve head (ONH) and vessel density (VD) in the macula with laser speckle flowgraphy and optical coherence tomography angiography, respectively. RESULTS Six-month post-IVR best-corrected visual acuity (BCVA) was correlated positively with age, pre-IVR BCVA, 1-month post-IVR BCVA, 3-month post-IVR BCVA and pre-IVR systolic blood pressure (P < 0.001, P < 0.001, P < 0.001, P < 0.001 and P = 0.02, respectively) and negatively with pre-IVR overall MBR, 1-month post-IVR overall MBR, 6-month post-IVR overall MBR, 3-month post-IVR deep retinal capillary plexus (DCP) VD and 6-month post-IVR DCP VD (P = 0.03, P = 0.03, P = 0.02, P = 0.01 and P = 0.005, respectively). Furthermore, a multiple regression analysis showed that pre-IVR overall MBR (β = - 0.67, P = 0.009) was among independent prognostic factors predicting 6-month post-IVR BCVA. Six-month post-IVR DCP VD was also correlated with overall MBR at all time points. CONCLUSION ONH blood flow may be a pre-IVR biomarker of both visual outcomes and post-IVR deep macular microcirculation in eyes with BRVOME.
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Affiliation(s)
- Toshifumi Asano
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hiroshi Kunikata
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan. .,Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Masayuki Yasuda
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Koji M Nishiguchi
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Toshiaki Abe
- Division of Clinical Cell Therapy, United Centers for Advanced Research and Translational Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.,Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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10
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Faghihi H, Riazi-Esfahani H, Khodabande A, Khalili Pour E, Mirshahi A, Ghassemi F, Mirshahi R, Khojasteh H, Bazvand F, Hashemi A, Tayebi F, Faghihi S, Riazi Esfahani M. Effect of panretinal photocoagulation on macular vasculature using optical coherence tomography angiography. Eur J Ophthalmol 2020; 31:1877-1884. [PMID: 32820946 DOI: 10.1177/1120672120952642] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND To evaluate the changes of macular vascular density in the superficial capillary (SCP) and the deep capillary plexus (DCP), foveal avascular area (FAZ), choroidal flow, and macular thickness after pan-retinal photocoagulation (PRP). METHODS In this prospective interventional non-comparative case series, patients with very severe nonproliferative (NPDR) and early proliferative diabetic retinopathy (PDR) and no significant macular edema who were candidates for pan-retinal photocoagulation underwent measurement of corrected distance visual acuity (CDVA), optical coherence tomography (OCT), Optical coherence tomography angiography (OCTA) at the baseline, 1, and 6 months following completion of PRP treatment. RESULTS Thirty-nine eyes from 21 patients with diabetes were enrolled. Superficial and deep capillary plexus densities in the foveal and parafoveal area didn't change significantly 1 and 6 months post-PRP (p > 0.1 in all of them). The FAZ area constricted 6 months following PRP (p = 0.075). Based on the calculated circularity index, the FAZ became significantly more circular after 6 months of follow-up (p = 0.047). Although the choroidal flow area increased after PRP this increase wasn't statically significant neither at 1 month nor at 6 months post-PRP (p = 0.31 and 0.23, respectively). CONCLUSION Although OCTA parameters were not significantly affected by PRP at both short-term (1 month) and long-term (6 months) follow-ups, the FAZ area became significantly circular after PRP may be due to redistribution of blood flow in hypoperfused foveal capillary plexus.
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Affiliation(s)
- Hooshang Faghihi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Riazi-Esfahani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Khodabande
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elias Khalili Pour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Mirshahi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Ghassemi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Mirshahi
- Eye Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Hassan Khojasteh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Bazvand
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Hashemi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Tayebi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Faghihi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Riazi Esfahani
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA, USA
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11
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Mirshahi R, Falavarjani KG, Molaei S, Habibi A, Anvari P, Khorasani MA, Ghasemizadeh S, Sarraf D. Macular microvascular changes after intravitreal bevacizumab injection in diabetic macular edema. Can J Ophthalmol 2020; 56:57-65. [PMID: 32768391 DOI: 10.1016/j.jcjo.2020.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/23/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the changes in retinal capillary plexus and the choriocapillaris after a single intravitreal injection of bevacizumab in eyes with diabetic macular edema using optical coherence tomography angiography (OCTA). DESIGN Prospective interventional case series. PARTICIPANTS Patients having diabetes with centre-involving diabetic macular edema. METHODS In this prospective interventional case series, eyes with centre-involving diabetic macular edema were enrolled. Vascular density (VD), vascular diameter index (VDI), vascular length density (VLD), foveal avascular zone (FAZ) area, and foveal density (FD)-300 were measured using en face OCTA images before and 1 month after administration of intravitreal bevacizumab. VD and VDI measurements were performed in the superficial capillary plexus (SCP) and deep retinal capillary plexus (DCP) and in the choriocapillaris. Additionally, capillary nonperfusion area (CNPA) was detected automatically based on vessel distance map in 4 concentric rings around the foveal centre. The segmentation error was manually corrected, and the measurements were performed by 2 expert graders. RESULTS Twenty-three eyes of 19 patients with a mean age of 62.76 ± 6.88 years were included. There were no significant changes in the FAZ area, FD-300, or in the VD of the foveal and parafoveal SCP and DCP. Also, VLD and VDI of the SCP and DCP remained unchanged. The change in the CNPA was not statistically significant. The VD of choriocapillaris increased significantly after injections (p = 0.005). CONCLUSIONS FAZ area and VD of the retinal capillary plexus remained stable in the short-term period after intravitreal bevacizumab. In addition, the choriocapillaris blood flow improved after bevacizumab injection.
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Affiliation(s)
- Reza Mirshahi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Khalil Ghasemi Falavarjani
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Saber Molaei
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Habibi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Pasha Anvari
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Ashraf Khorasani
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shahriar Ghasemizadeh
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - David Sarraf
- Stein Eye Institute, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA; Greater Los Angeles VA Healthcare Center, Los Angeles, CA, USA
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12
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Evaluation of Microvascular Structure Changes after Conbercept Treatment on Macular Edema Secondary to Retinal Vein Occlusion. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9046781. [PMID: 32685542 PMCID: PMC7322615 DOI: 10.1155/2020/9046781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/27/2020] [Indexed: 11/18/2022]
Abstract
Aims To confirm the therapeutic efficacy of conbercept for the treatment of macular edema (ME) secondary to retinal vein occlusion (RVO) by using optical coherence tomography angiography (OCTA) and to find out the differences in therapeutic efficacy between ischemic and nonischemic retinal vein occlusion (iRVO or non-iRVO) after conbercept treatment. Methods In this prospective, randomized, and comparative study, 60 unilateral eyes suffered from RVO combined with macular edema were included and fellow eye as controls. After an initial intravitreal injection of conbercept (IVIC), a pro re nata (PRN) strategy was adopted, and the follow-up time was 6 months. The foveal avascular zone (FAZ), vascular density of superficial capillary plexus (SCP), and vascular density of deep retinal capillary plexus (DCP), nonperfused areas (NPAs) were evaluated with OCTA on baseline and after treatment. Results The mean intravitreal injection number was 2.9 ± 0.89 times during six months in iRVO patients and 2.1 ± 0.86 times in non-iRVO patients, with statistically significant difference (p < 0.05). On baseline, central macular thickness (CMT) and FAZ were significantly thickened and enlarged compared to those of healthy fellow eyes; the vascular density of SCP and DCP were significantly decreased, and the differences were statistically significant (p < 0.05). Compared to baseline, after treatment, the best-corrected visual acuity (BCVA) was improved in either iRVO or non-iRVO (−0.601 ± 0.387, −0.241 ± 0.341 logMAR, p < 0.05). In iRVO, the improvement was more substantial than that of the non-iRVO group. FAZ in the non-iRVO group had significantly decreased compared to that in iRVO group (−0.044 ± 0.040 versus 0.014 ± 0.043 mm2, p < 0.05). CMT, the vascular density of SCP, and DCP had no significant difference. Conclusions The changes of microvascular structure can be quantitatively evaluated by using OCTA for the patients with RVO. Conbercept had a significant effect on treatment of RVO with macular edema. A more profound effect was achieved in the iRVO group on visual improvement and FAZ reduction in the non-iRVO group after conbercept treatment.
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13
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Karst SG, Deak GG, Gerendas BS, Waldstein SM, Lammer J, Simader C, Guerin T, Schmidt-Erfurth UM. Association of Changes in Macular Perfusion With Ranibizumab Treatment for Diabetic Macular Edema: A Subanalysis of the RESTORE (Extension) Study. JAMA Ophthalmol 2019; 136:315-321. [PMID: 29494727 DOI: 10.1001/jamaophthalmol.2017.6135] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Anti-vascular endothelial growth factor treatment is the first-line therapy in the treatment of center-involving diabetic macular edema. Data on capillary perfusion changes under repeated treatment in a possibly compromised vascular network are limited. Objective To evaluate the association of repeated ranibizumab injections on macular perfusion in patients with diabetic macular edema. Design, Setting, and Participants This study analyzed prospectively collected data from the 12-month RESTORE core study and the 24-month open label RESTORE extension study, which assessed the efficacy and safety of ranibizumab in patients with visual impairment due to diabetic macular edema. Of 345 patients with center-involving diabetic macular edema who had enrolled in the 12-month RESTORE core study, 240 entered the 24-month RESTORE extension study. Of these, 83 (34.6%) received ranibizumab, 83 (34.6%) received ranibizumab and laser combination therapy, and 74 (30.8%) received laser monotherapy in the first year of the study; 208 completed the 24-month extension study. Fluorescence angiography images were taken from each participant twice each year graded by Vienna Reading Center on severity of capillary loss in the parafoveal area, regularity of the foveal avascular zone outline, and measurement of the size of the foveal avascular zone, following a standardized protocol. Data analysis took place from July 2014 through December 2017. Main Outcomes and Measures Change in 3 fluorescence angiography perfusion parameters over the course of treatment. Results Mean (SD) patient age was 62.6 (8.8) years; 124 of 208 (59.2%) were male and 197 of 208 (94.6%) were white. The number of patients with definite altered foveal avascular zone regularity at baseline was 103 of 240 patients (42.9%); another 118 patients (49.2%) had questionably altered regularity at baseline. Definitive capillary loss was found in 65 of 240 patients (27.1%) at baseline. Mean (SD) foveal avascular zone size at baseline was 0.261 (0.232) mm2 in ranibizumab monotherapy, 0.231 (0.219) mm2 in ranibizumab and macular laser combination therapy, and 0.201 (0.13) mm2 in laser monotherapy. No treatment arm experienced significant increase in foveal avascular zone size at any time in the study period. At month 36, ranibizumab monotherapy resulted in a mean increase of 0.073 mm2 (95% CI, 0.005-0.142 mm2) and combination therapy resulted in a mean increase of 0.117 mm2 (95% CI, 0.045-0.188 mm2), but no changes were statistically significant. No changes occurred in foveal avascular zone regularity in any treatment group, and no differences were found in capillary loss around the fovea in the 3 treatment groups; neither element could be correlated with visual acuity or central retinal thickness. Conclusions and Relevance Repeated ranibizumab treatment was not associated with impaired macular perfusion in our study cohort. Because our data do not suggest a harmful effect of anti-vascular endothelial growth factor therapy on capillary integrity, patients with severe microangiopathy and advanced capillary dropout should not be denied these treatments.
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Affiliation(s)
- Sonja G Karst
- Department of Ophthalmology, Medical University Vienna, Vienna, Austria
| | - Gabor G Deak
- Department of Ophthalmology, Medical University Vienna, Vienna, Austria.,Vienna Reading Center, Medical University Vienna, Vienna, Austria
| | - Bianca S Gerendas
- Department of Ophthalmology, Medical University Vienna, Vienna, Austria.,Vienna Reading Center, Medical University Vienna, Vienna, Austria
| | | | - Jan Lammer
- Department of Ophthalmology, Medical University Vienna, Vienna, Austria
| | - Christian Simader
- Department of Ophthalmology, Medical University Vienna, Vienna, Austria.,Vienna Reading Center, Medical University Vienna, Vienna, Austria
| | | | - Ursula M Schmidt-Erfurth
- Department of Ophthalmology, Medical University Vienna, Vienna, Austria.,Vienna Reading Center, Medical University Vienna, Vienna, Austria
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14
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Effects of panretinal photocoagulation on retinal vasculature and foveal avascular zone in diabetic retinopathy using optical coherence tomography angiography: A pilot study. J Curr Ophthalmol 2019; 31:287-291. [PMID: 31528763 PMCID: PMC6742621 DOI: 10.1016/j.joco.2019.06.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/20/2019] [Accepted: 06/09/2019] [Indexed: 02/03/2023] Open
Abstract
Purpose To evaluate the optical coherence tomography angiography (OCTA) parameters in patients with diabetic retinopathy following panretinal photocoagulation (PRP). Methods Eleven eyes of 6 patients with very severe nonproliferative diabetic retinopathy (NPDR) or early proliferative diabetic retinopathy (PDR) were recruited in this prospective interventional pilot study. All patients underwent OCTA imaging at baseline, and choroidal flow, foveal avascular zone (FAZ), retinal thickness, and vascular density were measured at baseline. Three months after treatment, OCTA was repeated, and the alteration in variables was analyzed. Results The FAZ area remained unchanged following treatment, (P = 0.75). Retinal thickness increased along (P = 0.02) with an increase in vascular density in the superficial and deep foveal area and the macular temporal sector (P = 0.007, 0.03 and 0.049, respectively). Choroidal flow surface area was unchanged (P = 0.10). Conclusion In this study, foveal vascular density increased and FAZ remained unchanged after PRP for diabetic retinopathy.
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15
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Sorour OA, Sabrosa AS, Yasin Alibhai A, Arya M, Ishibazawa A, Witkin AJ, Baumal CR, Duker JS, Waheed NK. Optical coherence tomography angiography analysis of macular vessel density before and after anti-VEGF therapy in eyes with diabetic retinopathy. Int Ophthalmol 2019; 39:2361-2371. [PMID: 31119505 DOI: 10.1007/s10792-019-01076-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/14/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE To evaluate changes in macular vessel density following intravitreal anti-VEGF injection in patients with diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). METHODS In this retrospective case series, optical coherence tomography angiography (OCTA) images from 55 eyes of 35 patients with either DME (46 eyes) or PDR (9 eyes) were included. Macular capillary vessel density at the level of the superficial retinal capillary plexus (SCP), deep retinal capillary plexus (DCP) and total retinal capillary plexus (TCP) before and after anti-VEGF treatment was calculated. Longitudinal changes in vessel density following serial anti-VEGF treatment were analyzed in a subset of eyes. RESULTS Vessel density in the SCP, DCP or TCP was not found to be significantly different after one, two or three intravitreal injections (p > 0.05 for all time points). Subgroup analysis revealed no significant change in the DME and PDR subgroups (all p > 0.05). Multivariate analysis revealed no effect of type of injected anti-VEGF agent or presence of previous treatment on VD measurements (all p > 0.05). There was no correlation between the anatomic response of DME to treatment and VD measurements. CONCLUSIONS In this study, macular vessel density remained statistically unchanged following up to three intravitreal injections of any anti-VEGF agent. This indicates that there may not be an early effect of anti-VEGF treatment on macular vessel density and its effect on macular perfusion may not be a direct change in microvascular flow.
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Affiliation(s)
- Osama A Sorour
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,Ophthalmology Department, Tanta University, Tanta, Egypt
| | - Almyr S Sabrosa
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,Institute Ophthalmology Rio de Janeiro/Hospital da Gamboa, Rio de Janeiro, Brazil
| | - A Yasin Alibhai
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Malvika Arya
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Akihiro Ishibazawa
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,Department of Ophthalmology, Asahikawa Medical University, Hokkaido, Japan
| | - Andre J Witkin
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | | | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.
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16
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Kida T. Mystery of Retinal Vein Occlusion: Vasoactivity of the Vein and Possible Involvement of Endothelin-1. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4816527. [PMID: 28904960 PMCID: PMC5585553 DOI: 10.1155/2017/4816527] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/13/2017] [Indexed: 01/24/2023]
Abstract
Retinal vein occlusion (RVO) is a common vascular disease of retina; however, the pathomechanism leading to RVO is not yet clear. In general, increasing age, hypertension, arteriosclerosis, diabetes mellitus, dyslipidemia, cardiovascular disorder, and cerebral stroke are systemic risk factors of RVO. However, RVO often occur in the unilateral eye and sometimes develop in young subjects who have no arteriosclerosis. In addition, RVO show different variations on the degrees of severity; some RVO are resolved without any treatment and others develop vision-threatening complications such as macular edema, combined retinal artery occlusion, vitreous hemorrhage, and glaucoma. Clinical conditions leading to RVO are still open to question. In this review, we discuss how to treat RVO in practice by presenting some RVO cases. We also deliver possible pathomechanisms of RVO through our clinical experience and animal experiments.
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Affiliation(s)
- Teruyo Kida
- Department of Ophthalmology, Osaka Medical College, Takatsuki, Japan
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17
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Optical coherence tomography angiography microvascular findings in macular edema due to central and branch retinal vein occlusions. Sci Rep 2017; 7:40763. [PMID: 28098203 PMCID: PMC5241684 DOI: 10.1038/srep40763] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/09/2016] [Indexed: 01/10/2023] Open
Abstract
The aim of this study was to evaluate retinal and choriocapillaris vessel density using optical coherence tomography angiography (OCTA) in eyes with central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) complicated by macular edema (ME). Sixty eyes of 60 patients with CRVO or BRVO and ME and 40 healthy subjects underwent measurements of superficial and deep foveal and parafoveal vessel density (FVD, PFVD) and choricapillary density using OCTA at baseline and 60 days after intravitreal dexamethasone implant (IVDEX). FVD and PFVD of the superficial plexus were not significantly lower in CRVO group compared to the controls while in the BRVO group overall PFVD were significantly lower compared to control group (p < 0.001). Overall PFVD of the deep plexus was significantly lower in CRVO and BRVO groups compared to the control group (p < 0.001). FVD and overall PFVD of choriocapillaris were significantly reduced compared to controls in CRVO group (p < 0.001) and PFVD of choriocapillaris was significantly reduced compared to controls in the affected hemi fields in BRVO groups (p < 0.001). OCTA showed vessel density reduction in BRVO and CRVO with main involvement of the deep retinal plexus compared to the superficial retinal plexus due to ischemia that did not recover after intravitreal dexamethasone implant.
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18
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Noma H, Yasuda K, Minezaki T, Watarai S, Shimura M. Changes of retinal flow volume after intravitreal injection of bevacizumab in branch retinal vein occlusion with macular edema: a case series. BMC Ophthalmol 2016; 16:61. [PMID: 27225268 PMCID: PMC4879754 DOI: 10.1186/s12886-016-0239-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 05/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although intravitreal injection of bevacizumab (IVB) is effective for macular edema in patients with branch retinal vein occlusion (BRVO), the changes of retinal hemodynamics remain unclear. We investigated retinal hemodynamic changes in BRVO patients after IVB by performing laser speckle flowgraphy (LSFG). METHODS In 35 BRVO patients with macular edema, the relative flow volume (RFV) of the retinal artery and vein passing through the optic disc was measured in both the occluded and non-occluded regions of the retina before IVB and 1 month after IVB by LSFG. The ischemic region of retina was measured with the Scion Image program and the severity of retinal ischemia was assessed by dividing the non-perfused area by the disc area. RESULTS Macular edema improved significantly by 1 month after IVB. The venous RFV ratio showed a significant increase in the non-occluded region at 1 month after IVB. There was a significant negative correlation between the venous RFV ratio and the severity of retinal ischemia in the occluded region. On the other hand, arterial RFV ratio showed no significant change after IVB in either the occluded or non-occluded region. In addition, there was no significant correlation between the arterial RFV ratio and the severity of retinal ischemia in either the occluded or non-occluded region. CONCLUSIONS These results suggest that an increase of retinal venous outflow after IVB may possibly influence the resolution of macular edema and that the response of venous outflow after IVB depends on the severity of retinal ischemia in the occluded region.
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Affiliation(s)
- Hidetaka Noma
- Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, 1163, Tatemachi, Hachioji, Tokyo, 193-0998, Japan.
| | - Kanako Yasuda
- Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, 1163, Tatemachi, Hachioji, Tokyo, 193-0998, Japan
| | - Terumi Minezaki
- Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, 1163, Tatemachi, Hachioji, Tokyo, 193-0998, Japan
| | - Sho Watarai
- Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, 1163, Tatemachi, Hachioji, Tokyo, 193-0998, Japan
| | - Masahiko Shimura
- Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, 1163, Tatemachi, Hachioji, Tokyo, 193-0998, Japan
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19
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Kida T, Tsujikawa A, Muraoka Y, Harino S, Osaka R, Murakami T, Ooto S, Suzuma K, Morishita S, Fukumoto M, Suzuki H, Ikeda T. Cotton Wool Spots after Anti-Vascular Endothelial Growth Factor Therapy for Macular Edema Associated with Central Retinal Vein Occlusion. Ophthalmologica 2016; 235:106-13. [PMID: 26800210 DOI: 10.1159/000443622] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 12/21/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE To report a case series, whereby we encountered a transient increase in retinal cotton wool spots (CWS) following anti-vascular endothelial growth factor (anti-VEGF) therapy for the treatment of macular edema secondary to central retinal vein occlusion (CRVO). METHODS Eighteen eyes were treated with intravitreal aflibercept (IVA), and 5 were treated with intravitreal ranibizumab (IVR). Fundus photographs obtained 1 month after initial IVA or IVR injections were retrospectively evaluated for the presence of CWS. RESULTS Twenty-one (91.3%) patients had the following systemic diseases: hypertension, diabetes mellitus without retinopathy, dyslipidemia, or chronic renal failure requiring dialysis. One month after treatment, reduced macular edema was observed in 21 (91.3%) eyes. Initial injections facilitated complete resolution in 14 eyes, and CWS gradually became fainter with additional injections. CONCLUSION Some eyes with CRVO-related macular edema can show a transient increase in CWS after initial anti-VEGF therapy; however, macular edema, retinal hemorrhage, and visual acuity were improved in almost every case.
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Affiliation(s)
- Teruyo Kida
- Department of Ophthalmology, Osaka Medical College, Takatsuki, Japan
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Humayun M, Santos A, Altamirano JC, Ribeiro R, Gonzalez R, de la Rosa A, Shih J, Pang C, Jiang F, Calvillo P, Huculak J, Zimmerman J, Caffey S. Implantable MicroPump for Drug Delivery in Patients with Diabetic Macular Edema. Transl Vis Sci Technol 2014; 3:5. [PMID: 25653883 PMCID: PMC4315583 DOI: 10.1167/tvst.3.6.5] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 08/11/2014] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To demonstrate the safety and surgical feasibility of the first-in-man ocular implant of a novel Posterior MicroPump Drug Delivery System (PMP) in patients with diabetic macular edema (DME) and to report on the device capabilities for delivering a programmable microdose. METHODS This was a single center, single arm, open-label, prospective study. Eleven patients with DME and visual acuity equal to or worse than 20/40 were included. The PMP prefilled with ranibizumab was implanted into the subconjunctival space. After implantation, the PMP was wirelessly controlled to deliver a programmed microdose. Comprehensive ophthalmic exams and optical coherence tomography were performed biweekly for 90 days. At the end of the study, the PMP was explanted and the subjects thereafter received standard of care for DME (i.e., laser or intravitreal injections). RESULTS All 11 surgical implantations were without complications and within the skill sets of a retinal surgeon. No serious adverse events occurred during the follow-up period. At no point were visual acuity and central foveal thickness worse than baseline in the implanted eye. The PMP delivered the programmed ranibizumab dosage in seven subjects. The remaining four patients received a lower than target dose, and the treatment was complemented with standard intravitreal injection. CONCLUSIONS This study demonstrates the first-in-man safety of the Replenish MicroPump implant for a period of 90 days and its capability to deliver a microdose into the vitreous cavity. Further studies to enable longer-term safety and to demonstrate the feasibility of multiple programmable drug delivery are necessary.
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Affiliation(s)
- Mark Humayun
- Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Arturo Santos
- Medical School, Technologic University of Monterrey, Guadalajara, Mexico
- Centro de Retina Médica y Quirúrgica SC, Guadalajara, Mexico
| | - Juan Carlos Altamirano
- Medical School, Technologic University of Monterrey, Guadalajara, Mexico
- Centro de Retina Médica y Quirúrgica SC, Guadalajara, Mexico
| | - Ramiro Ribeiro
- Replenish, Inc., Pasadena, CA, USA
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Roberto Gonzalez
- Medical School, Technologic University of Monterrey, Guadalajara, Mexico
- Centro de Retina Médica y Quirúrgica SC, Guadalajara, Mexico
| | - Alejandro de la Rosa
- Medical School, Technologic University of Monterrey, Guadalajara, Mexico
- Centro de Retina Médica y Quirúrgica SC, Guadalajara, Mexico
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Campochiaro PA, Wykoff CC, Shapiro H, Rubio RG, Ehrlich JS. Neutralization of Vascular Endothelial Growth Factor Slows Progression of Retinal Nonperfusion in Patients with Diabetic Macular Edema. Ophthalmology 2014; 121:1783-9. [PMID: 24768239 DOI: 10.1016/j.ophtha.2014.03.021] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 03/14/2014] [Accepted: 03/17/2014] [Indexed: 11/19/2022] Open
Affiliation(s)
- Peter A Campochiaro
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Kelkar A, Gandhi P, Amoaku W, Kelkar J, Kelkar S, Raut P, Shah R. Hemorrhagic macular infarction after intravitreal bevacizumab for chronic multifocal central serous chorioretinopathy. Case Rep Ophthalmol 2014; 5:207-11. [PMID: 25126075 PMCID: PMC4130817 DOI: 10.1159/000365442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We hereby report a case of hemorrhagic macular infarction after intravitreal bevacizumab for chronic multifocal central serous chorioretinopathy (CSC). Issues regarding safety and adverse effects of bevacizumab are discussed. To the best of our knowledge, this is the first reported case of hemorrhagic macular infarction after intravitreal bevacizumab for chronic multifocal CSC.
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Affiliation(s)
| | | | | | - Jai Kelkar
- National Institute of Ophthalmology, Pune, India
| | | | | | - Rachana Shah
- National Institute of Ophthalmology, Pune, India
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Nitta F, Kunikata H, Aizawa N, Omodaka K, Shiga Y, Yasuda M, Nakazawa T. The effect of intravitreal bevacizumab on ocular blood flow in diabetic retinopathy and branch retinal vein occlusion as measured by laser speckle flowgraphy. Clin Ophthalmol 2014; 8:1119-27. [PMID: 24959068 PMCID: PMC4061168 DOI: 10.2147/opth.s62022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background This study evaluated the effect of intravitreal injection of bevacizumab (IVB) on macular edema associated with diabetic retinopathy (DME) or branch retinal vein occlusion (BRVOME) using laser speckle flowgraphy. Methods A comparative interventional study of 25 eyes from 22 patients with macular edema (DME group: 12 eyes; BRVOME group: 13 eyes) who underwent IVB. Mean blur rate (MBR) was measured in the retinal artery, retinal vein, optic nerve head (ONH), and choroid before and after IVB. Results In the BRVOME group, there was no significant change in MBR in the retinal artery, retinal vein or ONH, but choroidal MBR decreased significantly (P=0.04). In the DME group, the MBR in the retinal artery, retinal vein, ONH, and choroid decreased significantly (P=0.02, P=0.04, P<0.001, and P=0.04, respectively). In the DME group, pre-IVB MBR in the ONH was significantly correlated with post-IVB foveal thickness (R= −0.71, P=0.002). There was no such correlation in the BRVOME group in the ONH. Conclusion IVB had a suppressive effect on circulation in eyes with DME but not in those with BRVOME. This suggests that this noninvasive and objective biomarker may be a useful part of pre-IVB evaluations and decision-making in DME.
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Affiliation(s)
- Fumihiko Nitta
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroshi Kunikata
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan ; Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naoko Aizawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuko Omodaka
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yukihiro Shiga
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masayuki Yasuda
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan ; Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan ; Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Isola V, Pece A, Massironi C, Reposi S, Dimastrogiovanni F. Accelerated ischemic vascular retinopathy after intravitreally injected bevacizumab for central retinal vein occlusion in elderly patients. Clin Ophthalmol 2013; 7:455-60. [PMID: 23467497 PMCID: PMC3589185 DOI: 10.2147/opth.s30156] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Indexed: 11/23/2022] Open
Abstract
Background: Ischemic changes in the retinal circulation are an uncommon but severe adverse vascular reaction to intravitreal bevacizumab (Avastin®, Genentech, San Francisco, CA, USA/Roche, Basel, Switzerland) for central retinal vein occlusion (CRVO). In the two cases reported here, ischemic changes in the retina vasculature following intravitreal bevacizumab for CRVO were observed with the aim of describing the clinical and angiographic features of these changes. Methods: Two elderly patients with recent-onset CRVO received one off-label intravitreal injection of bevacizumab 0.05 mL/1.25 mg. Results: In Case 1, the patient’s pre-treatment visual acuity was 20/400. At 3 weeks post injection, the patient could count fingers at a distance of 1 ft (30 cm) and fluorescein angiography showed reduction in intraretinal hemorrhages and areas of retinal non-perfusion. However, at 6 weeks these were markedly increased compared with those seen in the photograph taken 3 weeks after treatment. In Case 2, the patient’s pre-treatment visual acuity was 20/200. At 1 month post injection, vision had decreased to 20/400 and fluorescein angiography showed severe macular ischemia with a remarkable capillary dropout throughout the macula. Conclusion: Ischemic retinal injury may be an uncommon but severe adverse vascular reaction to intravitreal bevacizumab for CRVO. Although progression of retinal ischemia in CRVO could be observed shortly after intravitreal bevacizumab, whether this is a drug- or procedure-related effect or part of the natural history of the condition remains uncertain.
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Affiliation(s)
- Vincenzo Isola
- Department of Ophthalmology, Melegnano Hospital, Milano, Italy
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Campochiaro PA, Bhisitkul RB, Shapiro H, Rubio RG. Vascular endothelial growth factor promotes progressive retinal nonperfusion in patients with retinal vein occlusion. Ophthalmology 2012; 120:795-802. [PMID: 23260261 DOI: 10.1016/j.ophtha.2012.09.032] [Citation(s) in RCA: 169] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 09/14/2012] [Accepted: 09/17/2012] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO) causes hypoperfusion, high levels of vascular endothelial growth factor (VEGF), macular edema, and loss of vision. Many patients also show areas of complete closure of retinal vessels (retinal nonperfusion [RNP]) that increase over time. The objective was to assess the effect of blocking VEGF on progression of RNP. DESIGN Retrospective analysis of prospectively collected data from 2 randomized, sham injection-controlled, double-masked, multicenter clinical trials. PARTICIPANTS A total of 392 and 397 patients with macular edema due to CRVO or BRVO. METHODS An independent reading center measured the area of RNP on fluorescein angiograms (FAs) in 2 phase III trials investigating the effect of ranibizumab (RBZ; Lucentis; Genentech, Inc, South San Francisco, CA) in patients with CRVO or BRVO. MAIN OUTCOME MEASURES The percentage of patients with no posterior RNP at months 0, 3, 6, 9, and 12. RESULTS There was no difference among treatment groups at baseline, but at the month 6 primary end point the percentage of patients with CRVO and no RNP was significantly greater in the RBZ groups (0.3 mg, 82.0%, P = 0.0092; 0.5 mg, 84.0%, P = 0.0067) versus the sham group (67.0%). Reperfusion of nonperfused retina was rare (1%) in sham-treated patients with CRVO, but occurred in 6% to 8% of patients with CRVO treated with RBZ (30% of those who had RNP and could improve). Results in patients with BRVO mirrored those in patients with CRVO. Crossover to 0.5 mg RBZ from sham at month 6 halted the progression of RNP and resulted in improvement in both CRVO and BRVO. CONCLUSIONS Treatment with RBZ did not worsen RNP in patients with RVO, but rather reduced its occurrence compared with sham. These data provide an important new insight regarding the pathogenesis of RVO; the initial vein occlusion is a precipitating event that causes baseline ischemia and release of VEGF, which then contributes to progression of RNP and thus worsening of ischemia. Timely, aggressive blockade of VEGF prevents the worsening of RNP, promotes reperfusion, and eliminates a positive feedback loop.
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Affiliation(s)
- Peter A Campochiaro
- Departments of Ophthalmology and Neuroscience, Johns Hopkins School of Medicine, Baltimore, Maryland 21287-9277, USA.
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Nishimura T, Machida S, Harada T, Kurosaka D. Retinal ganglion cell function after repeated intravitreal injections of ranibizumab in patients with age-related macular degeneration. Clin Ophthalmol 2012; 6:1073-82. [PMID: 22888205 PMCID: PMC3413340 DOI: 10.2147/opth.s31674] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background The purpose of this study was to evaluate the safety of intravitreal ranibizumab injection in patients with age-related macular degeneration. Materials and methods We examined retinal ganglion cell function using the photopic negative response of the electroretinogram (ERG) in patients with age-related macular degeneration (AMD) treated with intravitreal injections of ranibizumab. We studied 32 eyes of 32 patients with AMD and aged 50–84 years with a mean of 71 years. An intravitreal ranibizumab injection was given three times at monthly intervals. Additional injections were given according to an optical coherence tomography-guided variable dosing regimen. ERG recordings were made before treatment (baseline) and at 3, 6, 9, and 12 months postoperatively. Full-field cone ERGs were elicited by red stimuli on a blue background. The focal macular ERGs were elicited by a 15 degree white stimulus spot centered on the macular region. We measured the amplitudes of the a and b waves, oscillatory potentials, and the photopic negative response of the full-field cone and focal macular ERGs. Results Visual acuity was significantly better than the baseline acuity, and macular thickness was significantly reduced after the intravitreal injections of ranibizumab. The amplitudes and implicit times of each wave of the full-field cone ERGs were not significantly changed after intravitreal ranibizumab injections. However, the amplitudes of each wave of the focal macular ERGs were increased after the injections. The implicit times of the a and b waves of the focal macular ERGs were significantly shortened after intravitreal injections of ranibizumab. The ratio of the full-field and focal photopic negative response/b-wave amplitude was not significantly changed after the injections. Conclusion The amplitudes of the focal macular ERGs, including the photopic negative response improved after repeated intravitreal ranibizumab injections, accompanied by a recovery of visual acuity and macular structure. The results of the full-field cone ERGs indicate that retinal ganglion cell function was not altered by repeated intravitreal ranibizumab injection.
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Affiliation(s)
- Tomoharu Nishimura
- Department of Ophthalmology, Iwate Medical University School of Medicine, Morioka, Iwate, Japan
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Arima M, Miyazaki M, Arakawa S, Mochizuki Y, Ishibashi T. Post-treatment change in the localization of recurrent or persistent macular edema secondary to branch retinal vein occlusion. Ophthalmologica 2012; 228:1-6. [PMID: 22653313 DOI: 10.1159/000334620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 10/11/2011] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate the change in localization of recurrent or persistent macular edema (ME) secondary to branch retinal vein occlusion (BRVO) after a therapeutic intervention. METHODS Twenty-six eyes of 23 patients with recurrent or persistent ME secondary to BRVO were included in this retrospective case series. We analyzed the distance between the fovea and the top of the ME (fovea-ME top distance) and the ME area using optical coherence tomography before treatment and when ME recurred or persisted. RESULTS The fovea-ME top distance decreased from 1.8 ± 1.6 to 1.2 ± 1.3 mm (p = 0.008). The ME area also decreased from 11.9 ± 4.9 to 7.6 ± 5.0 mm(2) (p = 0.0003). The retinal vascular leakage area correlated with the ME area in all eyes. CONCLUSION The site of recurrent or persistent ME tends to shift toward the fovea. These results suggest that residual perifoveal vascular leakage might be the predominant cause of recurrent or persistent ME.
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Affiliation(s)
- Mitsuru Arima
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Mansour AM, Shahin M, Kofoed PK, Parodi MB, Shami M, Schwartz SG. Insight into 144 patients with ocular vascular events during VEGF antagonist injections. Clin Ophthalmol 2012; 6:343-63. [PMID: 22419856 PMCID: PMC3299557 DOI: 10.2147/opth.s29075] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM To record ocular vascular events following injections of vascular endothelium growth factor (VEGF) antagonists. METHODS Collaborative multicenter case series (48 cases), literature reviews (32 cases), and reports to the FDA (64 cases) of patients that had vascular occlusions during anti-VEGF therapy were collected and analyzed. RESULTS A total of 144 cases of ocular vascular events were identified, with these diagnosed a median of 15 days after anti-VEGF injection. The majority of patients had pre-existing risk factors for cardiovascular events and nine patients had a prior history of glaucoma. Mean visual acuity dropped by 6.4 lines with severe visual loss after injection to NLP (five eyes), LP (six eyes), and HM (two eyes). The overall risk of ocular vascular events following a VEGF antagonist injection was 0.108% in the general population and 2.61% in the diabetic population. Mean retinal arterial constriction after intravitreal bevacizumab in 13 eyes was 21% (standard deviation = 27%), and mean retinal venous constriction was 8% (standard deviation = 30%). CONCLUSION Ocular vascular events are rare during anti-VEGF therapy, but can lead to severe visual loss and may be caused by a number of factors including the vasoconstrictor effect of the drug, a post-injection rise of intraocular pressure, patient stress as a result of the procedure, and the patient's natural history of underlying ocular or systemic diseases. The diabetic population appears to have a tendency towards ocular vascular occlusions.
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Affiliation(s)
- Ahmad M Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon, Rafic Hariri University Hospital, Beirut, Lebanon
| | | | - Peter K Kofoed
- Glostrup Hospital, University of Copenhagen, Denmark, National Eye Clinic, Kennedy Center, Glostrup, Denmark
| | - Maurizio B Parodi
- University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Michel Shami
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Stephen G Schwartz
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Naples and Miami, FL, USA
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Bone marrow-derived monocyte lineage cells recruited by MIP-1β promote physiological revascularization in mouse model of oxygen-induced retinopathy. J Transl Med 2012; 92:91-101. [PMID: 21912378 DOI: 10.1038/labinvest.2011.141] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Recent clinical observations have indicated that vascular endothelial growth factor (VEGF) is a key factor that stimulates the development of preretinal pathological neovascularization (NV). However, it has not been established how intraretinal physiological revascularization of hypoxic avascular areas is regulated. Our earlier study on the gene expression profile of hypoxic retinas in a mouse model of oxygen-induced retinopathy (OIR) showed that macrophage inflammatory protein-1β (MIP-1β) was the most upregulated protein. The purpose of this study was to investigate the role played by MIP-1β in recruiting bone marrow-derived monocyte lineage cells (BM-MLCs) in a mouse model of OIR. Our results showed that MIP-1β was upregulated, and its receptor, CCR5, was expressed in BM-MLCs in the hypoxic inner retina. Neutralizing Ab against MIP-1β reduced the infiltration of BM-MLCs into the OIR retinas and increased the avascular area and preretinal neovascular tufts. A very strong significant correlation was found between the area of the preretinal neovascular tufts and the avascular area, regardless of the extent of BM-MLC infiltration into the OIR retinas. Additional treatment with VEGF-A-neutralizing Ab showed that the MIP-1β-regulated pathological NV strongly depended on VEGF-A, which was probably secreted by the hypoxic avascular retinas. These results indicate that MIP-1β is involved in the recruitment of BM-MLCs, which have a significant role in the physiological revascularization of hypoxic avascular retinas. Overall, these findings indicate that the MIP-1β induction of BM-MLCs might possibly be used to promote intraretinal revascularization and thus prevent the abnormal NV in ischemic vision-threatening retinal diseases.
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Intravitreal bevacizumab for severe vaso-occlusive retinopathy in systemic lupus erythematosus. Rheumatol Int 2011; 33:247-51. [DOI: 10.1007/s00296-011-2139-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 08/22/2011] [Indexed: 10/17/2022]
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Marek N, Raczyńska K, Siebert J, Myśliwiec M, Zorena K, Myśliwska J, Reiwer-Gostomska M, Trzonkowski P. Decreased angiogenin concentration in vitreous and serum in proliferative diabetic retinopathy. Microvasc Res 2011; 82:1-5. [PMID: 21539846 DOI: 10.1016/j.mvr.2011.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 03/07/2011] [Accepted: 04/18/2011] [Indexed: 01/07/2023]
Abstract
Diabetic retinopathy is the most common cause of vision loss in young adults in developed countries. The disease therapy with anti-vascular endothelial growth factor (VEGF) agents gives some positive results, but is associated with retinal ischemia and vasoconstriction. Therefore, determination of factors involved in the physiological and pathological angiogenesis in the diabetic eye is of great importance for understanding of the pathogenesis of diabetic retinopathy and its effective treatment. Previously, we found that diabetic patients were characterized by increased serum concentration of VEGF, but decreased levels of other proangiogenic factor-angiogenin. The involvement of VEGF in pathogenesis of diabetic retinopathy is well established, but there is lack of data regarding angiogenin in retinopathy. Therefore, in the present study we measured angiogenin concentration in vitreous and serum samples of the patients with type 1 diabetes to determine its role in diabetic retinopathy. In addition, in each time, we compared the level of angiogenin with level of VEGF as a known factor involved in the pathogenesis of the disease. Angiogenin was found to be significantly more abundant in serum than in vitreous in both diabetic groups. In addition, patients with retinopathy had twofold lower vitreous angiogenin levels than diabetic individuals without complications. On the contrary, vitreous concentration of VEGF was dramatically increased only in participants with retinopathy. Patients without diabetic complications had significantly lower VEGF levels in vitreous than in serum and were characterized by high local and systemic concentration of angiogenin. These data suggest a local imbalance between two proangiogenic factors-VEGF and angiogenin in retinopathy. Low vitreous concentration of angiogenin in diabetic patients suggests that this factor is not responsible for pathological neovascularization in diabetic eye. Further studies will elucidate if angiogenin can be used to improve the insufficient angiogenesis in diabetes and prevent retinal ischemia after retinopathy treatment with anti-VEGF agents.
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Affiliation(s)
- Natalia Marek
- Department of Clinical Immunology and Transplantology, Medical University of Gdańsk, ul. Dębinki 7, 80-211 Gdańsk, Poland.
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Tolentino M. Systemic and Ocular Safety of Intravitreal Anti-VEGF Therapies for Ocular Neovascular Disease. Surv Ophthalmol 2011; 56:95-113. [DOI: 10.1016/j.survophthal.2010.08.006] [Citation(s) in RCA: 204] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 08/25/2010] [Accepted: 08/31/2010] [Indexed: 01/11/2023]
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Chung EJ, Kang SJ, Koo JS, Choi YJ, Grossniklaus HE, Koh HJ. Effect of intravitreal bevacizumab on vascular endothelial growth factor expression in patients with proliferative diabetic retinopathy. Yonsei Med J 2011; 52:151-7. [PMID: 21155048 PMCID: PMC3017691 DOI: 10.3349/ymj.2011.52.1.151] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To investigate the effect of bevacizumab (Avastin; Genentech, San Francisco, CA, USA) on vascular endothelial growth factor (VEGF) expression and inflammation in fibrovascular membranes in patients with proliferative diabetic retinopathy (PDR). MATERIALS AND METHODS Fibrovascular membranes from 19 eyes of 18 patients with PDR were studied using immunohistochemistry and analyzed in the following 3 groups; group 1: 4 inactive PDR eyes, group 2: 10 active PDR eyes treated preoperatively with adjunctive intravitreal bevacizumab, group 3: five active PDR eyes not treated preoperatively with bevacizumab. Immunohistochemical staining for VEGF, CD31 and CD68 were done. RESULTS The immunoreactivity to VEGF and CD 31-positive blood vessels was significantly higher in membranes from group 3 than group 1 (p = 0.007 for VEGF, 0.013 for CD 31-positive vessels). Intravitreal bevacizumab caused a reduction in VEGF expression and vascular densities in 4 out of 10 (40%) excised membranes from eyes with PDR. However, six membranes (60%) in group 2 still demonstrated relatively strong VEGF expression and high vascular density. Infiltration of macrophages was observed in 16 out of the 19 membranes, and the density of macrophages was increased in group 2 compared with group 1 (p = 0.043). CONCLUSION Intravitreal bevacizumab injections caused some reduction in VEGF expression and vascular densities in a limited number of active PDR patients. A single intravitreal bevacizumab injection may not be enough to induce complete blockage of VEGF and pathologic neovascularization in active PDR patients. Repeated injections, panretinal photocoagulation and/or PPV may be necessary following intravitreal bevacizumab to reinforce the anti-VEGF effect of the drug.
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Affiliation(s)
- Eun Jee Chung
- Department of Ophthalmology, NHIC Ilsan Hospital, Goyang, Korea
| | - Shin Jeong Kang
- Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ja Seung Koo
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Jung Choi
- Department of Pathology, NHIC Ilsan Hospital, Goyang, Korea
| | - Hans E. Grossniklaus
- Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Pathology, Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hyoung Jun Koh
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
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