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Gao L, Song Y, Sun X, Zhang J, Liu Y, Chen Y, Wu Z, Jian Y, Liu X, Lv L, Chen S, Wang YS, Chen N, Ke X, Zhang F. Safety and efficacy of intravitreal injection of conbercept for the treatment of patients with choroidal neovascularization secondary to pathological myopia: Results from the SHINY study. Acta Ophthalmol 2023. [PMID: 38009430 DOI: 10.1111/aos.15810] [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: 08/31/2023] [Accepted: 11/07/2023] [Indexed: 11/28/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of intravitreal injections of 0.5 mg conbercept in patients with choroidal neovascularization secondary to pathological myopia (pmCNV). METHODS The 177 pmCNV patients were randomly assigned in a 3:1 ratio to receive conbercept or sham injection, respectively. The conbercept group receive conbercept intravitreal injections administered on a pro re nata (PRN) basis after 3 monthly loading doses. The sham group received three consecutive monthly sham injections and then one conbercept injection followed by PRN conbercept intravitreal injections. RESULTS At month 3, the mean BCVA for the two groups were improved by 12.0 letters (conbercept group, from 54.05 letters to 66.05 letters) and 0.6 letters (sham group, from 49.77 letters to 50.33 letters), respectively (p < 0.001). The mean central retinal thickness (CRT) at month 3 in the two groups decreased 62.0 μm (conbercept group, from 348.90 μm to 286.18 μm) and 4.4 μm (sham group, from 347.86 μm to 343.47 μm) (p < 0.001). At month 9, the mean BCVA improved by 13.3 letters in the conbercept group and 11.3 letters in the sham group. The mean CRT decreased 73.6 μm in the conbercept group and 55.9 μm in the sham group (p < 0.001). The most common ocular adverse events were associated with intravitreal injections, such as conjunctival haemorrhage and increased intraocular pressure. CONCLUSION Intravitreal injections of 0.5 mg conbercept provided improvement in visual and anatomical outcomes in pmCNV patients with low rates of ocular and nonocular safety events.
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Affiliation(s)
- Liqin Gao
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Yanping Song
- Department of Ophthalmology, Chinese PLA General Hospital of Central Theater Command, Wuhan, China
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai, China
| | - Junjun Zhang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, China
| | - Yuling Liu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Beijing, China
| | - Zhifeng Wu
- Department of Ophthalmology, Wuxi No.2 People's Hospital, Nanjing Medical University, Wuxi, China
| | - Ye Jian
- Department of Ophthalmology, Daping Hospital and Institute of Surgery Research, Army Medical University, Chongqing, China
| | - Xiaoling Liu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Lin Lv
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Shaojun Chen
- Department of Ophthalmology, He Eye Specialist Hospital, Chongqing, China
| | - Yu-Sheng Wang
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Nan Chen
- Department of Ophthalmology, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
| | - Xiao Ke
- Medical Research Center, Chengdu Kanghong Biotechnology Inc, Chengdu, China
| | - Feng Zhang
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
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Karasu B, Celebi ARC. The efficacy of different anti-vascular endothelial growth factor agents and prognostic biomarkers in monitoring of the treatment for myopic choroidal neovascularization. Int Ophthalmol 2022; 42:2729-2740. [PMID: 35357641 DOI: 10.1007/s10792-022-02261-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 03/12/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate anatomical and visual results of eyes with naive myopic choroidal neovascularization (mCNV) in patients treated with intravitreal anti-vascular endothelial growth factor (VEGF) therapies. MATERIAL AND METHODS This is a retrospective, non-randomized, comperative, intervetional study. One hundred fourteen eyes of 114 patients with mCNV who underwent intravitreal bevacizumab (IVB), intravitreal ranibizumab (IVR) or intravitreal aflibercept (IVA) monotherapy injections were enrolled into the study. The best corrected visual acuity (BCVA), central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) were compared among the groups during the follow-up periods at the beginning, months 1, 3, 6, 12, and the final visit. RESULTS The mean age of the patients was 47.76 ± 10.57 years (range, 33-72 years) and the mean follow-up period was 23.34 ± 6.81 months (range, 13-38 months). The mean BCVA denoted a significantly improve at each group (p < 0.05). In terms of an inter-group analysis of all 3 groups, at months 1, 6, and 12 and final visit, the BCVA were statistically significantly better in the IVA group when compared to both IVB and IVR groups (p = 0.021, p = 0.032, p = 0.024, p = 0.012). There was a significant decrease in CMT following IVB (236.49 ± 40.91 μm-190.74 ± 50.12 μm), IVA (232.91 ± 46.29 μm-193.73 ± 46.81 μm) and IVR (234.78 ± 45.37 μm-192.21 ± 37.27 μm) between baseline and final visit (p = 0.018, p = 0.002, p < 0.001, respectively). There was a statistically significant decrease in SFCT values between baseline and final examination only in the IVA group (p < 0.001). The mean number of injections were 9.18 ± 3.18 (range; 3 to 13) in IVB, 6.46 ± 2.93 (range; 3-11) in IVR and 4.45 ± 1.42 (range; 2-7) in IVA (p = 0.028). CONCLUSION All three anti-VEGFs were found to be effective in terms of visual results in patients with mCNV. However, we demonstrated that IVA reduces the need for anti-VEGF when compared to patients who received both IVB and IVR. Furthermore, IVA induced a prominent reduction in SFCT, whereas IVR and IVB did not have a significant action on SFCT.
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Affiliation(s)
- Buğra Karasu
- Department of Ophthalmology, Tuzla State Hospital, İçmeler Mahallesi, Piri Reis Caddesi, No: 74 Tuzla/İstanbul, 34947, Istanbul, Turkey. .,Department of Ophthalmology, Beyoglu Eye Research and Training Hospital, Istanbul, Turkey.
| | - Ali Rıza Cenk Celebi
- Department of Ophthalmology Istanbul, School of Medicine, Acibadem University, Istanbul, Turkey
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Chen Y, Han X, Gordon I, Safi S, Lingham G, Evans J, Li J, He M, Keel S. A systematic review of clinical practice guidelines for myopic macular degeneration. J Glob Health 2022; 12:04026. [PMID: 35356661 PMCID: PMC8939288 DOI: 10.7189/jogh.12.04026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Yanxian Chen
- Department of Ophthalmology, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Xiaotong Han
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Iris Gordon
- Cochrane Eyes and Vision, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sare Safi
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gareth Lingham
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, Australia
| | - Jennifer Evans
- Cochrane Eyes and Vision, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jinying Li
- Department of Ophthalmology, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, China
| | - Mingguang He
- Department of Ophthalmology, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Centre for Eye Research Australia; Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Stuart Keel
- Vision and Blindness Prevention Programme, World Health Organization, Geneva, Switzerland
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Thorell MR, Goldhardt R. Myopic Choroidal Neovascularization: Diagnosis and Treatment Update. CURRENT OPHTHALMOLOGY REPORTS 2019. [DOI: 10.1007/s40135-019-00200-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ruiz-Medrano J, Montero JA, Flores-Moreno I, Arias L, García-Layana A, Ruiz-Moreno JM. Myopic maculopathy: Current status and proposal for a new classification and grading system (ATN). Prog Retin Eye Res 2019; 69:80-115. [PMID: 30391362 DOI: 10.1016/j.preteyeres.2018.10.005] [Citation(s) in RCA: 182] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/18/2018] [Accepted: 10/22/2018] [Indexed: 02/09/2023]
Abstract
Myopia is a highly frequent ocular disorder worldwide and pathologic myopia is the 4th most common cause of irreversible blindness in developed countries. Pathologic myopia is especially common in East Asian countries. Ocular alterations associated with pathologic myopia, especially those involving the macular area-defined as myopic maculopathy-are the leading causes of vision loss in patients with pathologic myopia. High myopia is defined as the presence of a highly negative refractive error (>-6 to -8 diopters) in the context of eye elongation (26-26.5 mm). Although the terms high myopia and pathologic myopia are often used interchangeably, they do not refer to the same eye disease. The two key factors driving the development of pathologic myopia are: 1) elongation of the axial length and 2) posterior staphyloma. The presence of posterior staphyloma, which is the most common finding in patients with pathologic myopia, is the key differentiating factor between high and pathologic myopia. The occurrence of staphyloma will, in most cases, eventually lead to other conditions such as atrophic, traction, or neovascular maculopathy. Posterior staphyloma is for instance, responsible for the differences between a myopic macular hole (MH)-with and without retinal detachment-and idiopathic MH. Posterior staphyloma typically induces retinal layer splitting, leading to foveoschisis in myopic MH, an important differentiating factor between myopic and emmetropic MH. Myopic maculopathy is a highly complex disease and current classification systems do not fully account for the numerous changes that occur in the macula of these patients. Therefore, a more comprehensive classification system is needed, for several important reasons. First, to more precisely define the disease stage to improve follow-up by enabling clinicians to more accurately monitor changes over time, which is essential given the progressive nature of this condition. Second, unification of the currently-available classification systems would establish standardized classification criteria that could be used to compare the findings from international multicentric studies. Finally, a more comprehensive classification system could help to improve our understanding of the genetic origins of this disease, which is clearly relevant given the interchangeable-but erroneous-use of the terms high and pathologic myopia in genetic research.
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Affiliation(s)
- Jorge Ruiz-Medrano
- Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain
| | - Javier A Montero
- Department of Ophthalmology, Rio Hortega University Hospital, Valladolid, Spain; Red Temática de Investigación Cooperativa en Salud: ""Prevención, detección precoz, y tratamiento de la patología ocular prevalente, degenerativa y crónica" (RD16/0008/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Spain; Retina Unit, Oftalvist, Madrid, Spain
| | | | - Luis Arias
- Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain
| | - Alfredo García-Layana
- Red Temática de Investigación Cooperativa en Salud: ""Prevención, detección precoz, y tratamiento de la patología ocular prevalente, degenerativa y crónica" (RD16/0008/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Spain; Department of Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain
| | - José M Ruiz-Moreno
- Red Temática de Investigación Cooperativa en Salud: ""Prevención, detección precoz, y tratamiento de la patología ocular prevalente, degenerativa y crónica" (RD16/0008/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Spain; Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain; Department of Ophthalmology, Castilla La Mancha University, Albacete, Spain; Vissum Corporation, Spain.
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Cheung CMG, Arnold JJ, Holz FG, Park KH, Lai TY, Larsen M, Mitchell P, Ohno-Matsui K, Chen SJ, Wolf S, Wong TY. Myopic Choroidal Neovascularization. Ophthalmology 2017; 124:1690-1711. [DOI: 10.1016/j.ophtha.2017.04.028] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 04/03/2017] [Accepted: 04/24/2017] [Indexed: 02/07/2023] Open
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The other CNVM: A review of myopic choroidal neovascularization treatment in the age of anti-vascular endothelial growth factor agents. Surv Ophthalmol 2015; 60:204-15. [DOI: 10.1016/j.survophthal.2014.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 10/14/2014] [Accepted: 10/31/2014] [Indexed: 01/20/2023]
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Wong TY, Ohno-Matsui K, Leveziel N, Holz FG, Lai TY, Yu HG, Lanzetta P, Chen Y, Tufail A. Myopic choroidal neovascularisation: current concepts and update on clinical management. Br J Ophthalmol 2014; 99:289-96. [PMID: 24990871 PMCID: PMC4345796 DOI: 10.1136/bjophthalmol-2014-305131] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Choroidal neovascularisation (CNV) is a common vision-threatening complication of myopia and pathological myopia. Despite significant advances in understanding the epidemiology, pathogenesis and natural history of myopic CNV, there is no standard definition of myopic CNV and its relationship to axial length and other myopic degenerative changes. Several treatments are available to ophthalmologists, but with the advent of new therapies there is a need for further consensus and clinical management recommendations. Verteporfin photodynamic therapy has been an established treatment for subfoveal myopic CNV for many years, but this treatment does not restore visual acuity and is associated with long-term chorioretinal atrophy. More recently, clinical trials investigating the efficacy and safety of anti-vascular endothelial growth factor agents in patients with myopic CNV have demonstrated substantial visual acuity gains and quality of life increases compared with photodynamic therapy. These enhanced outcomes provide updated evidence-based clinical management guidelines of myopic CNV, and increase the need for a generally accepted definition for myopic CNV. This review critically summarises the latest myopic CNV literature in the context of clinical experience and recommends a myopic CNV treatment algorithm.
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Affiliation(s)
- Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, National University of Singapore, Singapore, Singapore
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nicolas Leveziel
- Faculté de Médecine de Poitiers, Department of Ophthalmology, Poitiers, France
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Timothy Y Lai
- Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, The Chinese University of Hong Kong, People's Republic of China
| | - Hyeong Gon Yu
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Paolo Lanzetta
- Department of Ophthalmology, University of Udine, Piazzale S. Maria della Misericordia, Udine, Italy
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Adnan Tufail
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
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Pece A, Isola V, Vitale L. Management of choroidal neovascularization in myopic macular degeneration. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.3.3.311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wang JH, Jiang W, Kang ZF. Reply to: Effect of axial length on myopic choroidal neovascularization. Graefes Arch Clin Exp Ophthalmol 2013; 251:2271. [DOI: 10.1007/s00417-012-2251-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 12/18/2012] [Indexed: 10/27/2022] Open
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Neelam K, Cheung CMG, Ohno-Matsui K, Lai TYY, Wong TY. Choroidal neovascularization in pathological myopia. Prog Retin Eye Res 2012; 31:495-525. [PMID: 22569156 DOI: 10.1016/j.preteyeres.2012.04.001] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 04/13/2012] [Accepted: 04/16/2012] [Indexed: 12/21/2022]
Abstract
Myopic choroidal neovascularization (CNV) is one of the leading causes of visual impairment worldwide. The clinical and socioeconomic impact of myopic CNV in Asian countries is particularly significant due to rising trend in the prevalence and severity of pathological myopia. The exact pathogenesis of myopic CNV remains unclear and there is paucity of information with respect to incidence and risk factors for myopic CNV from prospective studies. Furthermore, there are no recognized measures that may prevent or delay the development of CNV in eyes with pathological myopia. Advances have been made in the diagnosis and characterization of myopic CNV over the years. Until recently, treatment modalities for myopic CNV were limited to thermal laser photocoagulation and photodynamic therapy with verteporfin, both these modalities primarily aim at prevention of further visual loss. In the last 5 years, inhibitors of vascular endothelial growth factor (VEGF) have been used successfully and may improve vision to some extent. Nevertheless, the long-term safety and efficacy of anti-VEGF agents remains unknown. Furthermore, the risk of developing chorioretinal atrophy remains the key factor in determining the final visual outcome. This review article summarizes the current literature on myopic CNV, highlighting new evolving diagnostic and treatment modalities, prognostic factors influencing visual outcome, and areas of future research.
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Affiliation(s)
- Kumari Neelam
- Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore
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Oishi A, Yamashiro K, Tsujikawa A, Ooto S, Tamura H, Nakata I, Miyake M, Yoshimura N. Long-term effect of intravitreal injection of anti-VEGF agent for visual acuity and chorioretinal atrophy progression in myopic choroidal neovascularization. Graefes Arch Clin Exp Ophthalmol 2012; 251:1-7. [DOI: 10.1007/s00417-012-2022-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 03/23/2012] [Accepted: 03/26/2012] [Indexed: 02/07/2023] Open
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Predictive factors for visual outcome to intravitreal bevacizumab in young Chinese patients with myopic choroidal neovascularization. Retina 2012; 31:1835-40. [PMID: 21878845 DOI: 10.1097/iae.0b013e31821ba2dc] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To report the anatomical and functional outcomes of intravitreal bevacizumab in both young and old Chinese patients with myopic choroidal neovascularization. METHODS Consecutive series of 56 eyes (52 patients) with myopic choroidal neovascularization treated exclusively with intravitreal bevacizumab were reviewed retrospectively. Data from clinical examination, fundus photography, fluorescein angiography, and optical coherence tomography were collected. RESULTS Vision significantly improved after intravitreal bevacizumab in this patient series (P < 0.0001), with an average of 2.2 injections. Higher myopia was positively correlated to a worse outcome (r = -0.3, P = 0.036). Stratifying by age, the correlation between spherical equivalent and final outcome showed statistical significance (r = -0.44, P = 0.027) only in younger patients. In younger patients, both spherical equivalent (P = 0.036) and initial visual acuity (P = 0.004) were predictive factors for visual outcome after adjusting for age, spherical equivalent, and number of injections, whereas in older patients, only initial visual acuity (P < 0.0001) was predictive of visual outcome after similar adjustments. CONCLUSION Younger patients do not have a better outcome when compared with older patients. Initial visual acuity, regardless of age, plays a more significant role. Both initial visual acuity and spherical equivalent are predictive factors for final visual acuity in young Chinese patients.
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Franqueira N, Cachulo ML, Pires I, Fonseca P, Marques I, Figueira J, Silva R. Long-Term Follow-Up of Myopic Choroidal Neovascularization Treated with Ranibizumab. Ophthalmologica 2012; 227:39-44. [DOI: 10.1159/000333213] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 09/14/2011] [Indexed: 11/19/2022]
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Photodynamic therapy in highly myopic eyes with choroidal neovascularization: 5 years of follow-up. Retina 2011; 31:1089-94. [PMID: 21358463 DOI: 10.1097/iae.0b013e3181ff9546] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the long-term safety and efficacy of photodynamic therapy in the treatment of choroidal neovascularization associated with pathologic myopia. METHODS Five-year retrospective study of 43 consecutive eyes of 36 patients with juxtafoveal or subfoveal choroidal neovascularization and pathologic myopia treated with photodynamic therapy. RESULTS Mean best-corrected visual acuity changed from 20/125 +1 letter (0.78 logarithm of the minimum angle of resolution) at baseline to 20/100 (0.70 logarithm of the minimum angle of resolution) at 5 years (P = 0.122). Final best-corrected visual acuity improved in 53.5% of the eyes, remained stable in 11.6%, and decreased in 34.9%. A visual acuity gain of ≥3 lines occurred in 32.6% of the eyes, and a visual acuity decrease of ≥3 lines was registered in 20.9% of the cases at 5 years. Only patient's age and initial visual acuity showed to have a significant predictive value for the final visual acuity outcome (P = 0.024 and P = 0.002, respectively). CONCLUSION Photodynamic therapy with verteporfin may increase the chance of stabilizing and improving vision in patients with choroidal neovascularization from pathologic myopia at 5 years. Better results were found in younger patients (<55 years).
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Chen CH, Wu PC, Chen YJ, Liu YC, Kuo HK. Intravitreal injection of 2.5 mg bevacizumab for treatment of myopic choroidal neovascularization in treatment-naive cases: a 2-year follow-up. J Ocul Pharmacol Ther 2011; 27:395-400. [PMID: 21770740 DOI: 10.1089/jop.2011.0023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the safety and efficacy of intravitreal bevacizumab in treatment-naive patients with choroidal neovascularization (CNV) secondary to pathologic myopia over a 2-year interval. METHODS Patients diagnosed with myopic CNV who had not received previous treatment were given intravitreal injections of bevacizumab (2.5 mg/0.1 mL). All patients were retrospectively evaluated using best-corrected visual acuity (BCVA) and central macular thickness (CMT) measured with optical coherence tomography (OCT). RESULTS Twenty-six eyes of 26 patients aged 15-81 years (mean, 42.6 years) were enrolled. OCT images demonstrated that the mean CMT±standard deviation (SD) significantly changed from 270±47 μm at baseline to 228±35, 218±35, 212±25, 210±29, and 209±30 μm in the 1st, 3rd, 6th, 12th, and 24th post-treatment months, respectively (P<0.001 for all). The BCVA in logarithm of the minimum angle of resolution±SD significantly changed from 0.75±0.43 at baseline to 0.57±0.44, 0.42±0.44, 0.39±0.47, 0.41±0.44, and 0.42±0.41 in the 1st, 3rd, 6th, 12th, and 24th post-treatment months, respectively (P<0.001 for all). The mean number of injections was 1.69 (range, 1-4) within the 24-month period. The follow-up period ranged from 24 to 35 months (mean, 28 months). No other ocular or systemic adverse effects were observed. CONCLUSIONS Although the present study lacked a control group, the results in this small series of patients over the 2-year follow-up period indicate that intravitreal injection of 2.5 mg bevacizumab is effective and safe in patients with myopic CNV.
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Affiliation(s)
- Chih-Hsin Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
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El Matri L, Kort F, Chebil A, Bouraoui R, Merdassi A, Bouladi M. Intravitreal bevacizumab versus photodynamic therapy for myopic choroidal neovascularization in a North-African population. Graefes Arch Clin Exp Ophthalmol 2011; 249:1287-93. [PMID: 21484465 DOI: 10.1007/s00417-011-1654-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 01/04/2011] [Accepted: 02/07/2011] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To compare the 1-year functional and anatomical outcomes of intravitreal bevacizumab (IVB) and photodynamic therapy (PDT) in patients with myopic choroidal neovascularization (CNV). METHODS Review of retrospectively collected data of 80 eyes in 80 patients with myopic CNV treated with standard PDT (n = 40) or IVB (1.25 mg/ 0.05 ml) (n = 40). Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) measured with optical coherence tomography (OCT) were compared between the two groups at baseline, 3, 6 and 12 months. RESULTS In the IVB group, mean BCVA was +0.9 ± 0.85 logMAR at baseline. Mean BCVA was significantly better at 3 and 6 months than baseline (p = .0095 and p = .008, respectively) but not at 12 months (p = .065). In the PDT group, mean BCVA was +0.88 ± 0.45 logMAR at baseline, and improved to +0.85 ± 0.62 logMAR at 3 months and to +0.86 ± 0.44 logMAR at 6 months, which was not significantly different from baseline. Mean BCVA then decreased to +0.9 ± 0.54 logMAR at 12 months (p = .85). Mean logMAR VA was significantly better in the IVB group than in the PDT group after 3 months (p = .0043), 6 months (p = .0001) and 12 months (p = .0168). Mean CRT was significantly lower in IVB group than in PDT group at 3, 6 and 12 months (p = .008, p = .038, p = .040, respectively). Chorioretinal atrophy developed in six eyes (15%) treated with IVB and in 24 eyes (60%) treated with PDT at 12 months (p = 3.2 × 10(-5)). CONCLUSIONS Over a 12-month period, intravitreal bevacizumab seems to be superior to photodynamic therapy in controlling myopic CNV in a North-African population.
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Affiliation(s)
- Leila El Matri
- Department B of Ophthalmology, Hedi Rais Institute of Ophthalmology, Boulevard 9 Avril 1006 Bab Saadoun, Tunis, Tunisia.
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Ruiz-Moreno JM, Montero JA, Amat-Peral P. Myopic choroidal neovascularization treated by intravitreal bevacizumab: comparison of two different initial doses. Graefes Arch Clin Exp Ophthalmol 2011; 249:595-9. [PMID: 21234588 DOI: 10.1007/s00417-010-1599-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 11/28/2010] [Accepted: 12/02/2010] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jose M Ruiz-Moreno
- Department of Ophthalmology, Castilla La Mancha University, Albacete, Spain.
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Ruiz-Moreno JM, Lugo FL, Armadá F, Silva R, Montero JA, Arevalo JF, Arias L, Gómez-Ulla F. Photodynamic therapy for chronic central serous chorioretinopathy. Acta Ophthalmol 2010; 88:371-6. [PMID: 19958296 DOI: 10.1111/j.1755-3768.2008.01408.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to evaluate the efficacy of photodynamic therapy (PDT) in treating chronic central serous chorioretinopathy (CSC). METHODS We describe a non-randomized, multicentre, interventional case series. A total of 82 eyes of 72 patients with chronic CSC were treated by conventional PDT. LogMAR best corrected visual acuity (BCVA) (ETDRS charts) and central foveal thickness (CFT) measured by optical coherence tomography before and after PDT, number of PDT treatments and complications were used as outcome indicators. RESULTS Mean follow-up was 12 +/- 10 months and mean age was 46 +/- 10 years. Mean logMAR BCVA changed from 0.53 (standard deviation [SD] 0.43) before PDT to 0.38 (SD 0.41) at 3 months and 0.48 (SD 0.50) at 6 months (p < 0.0001 and p = 0.007, respectively, Student's t-test for paired data). Mean BCVA at the end of follow-up was 0.37 (SD 0.45; p < 0.0001 from baseline). Macular detachment was resolved and subretinal fluid (SRF) disappeared in all cases. Central foveal thickness decreased from 325 microm (SD 95), to 229 microm (SD 70) at 1 month after PDT, 206 microm (SD 68) at 3 months, and 202 microm (SD 76) at 6 months (all p < 0.0001, Student's t-test for paired data). No cases developed severe visual loss or complications derived from PDT. Reactive retinal pigment epithelium hypertrophy appeared in nine cases after PDT. CONCLUSIONS Photodynamic therapy with verteporfin may be useful in chronic CSC for improving BCVA and reducing SRF and CFT. Randomized studies with longer follow-up are needed to assess the real role of this treatment in chronic CSC.
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Ikuno Y, Nagai Y, Matsuda S, Arisawa A, Sho K, Oshita T, Takahashi K, Uchihori Y, Gomi F. Two-year visual results for older Asian women treated with photodynamic therapy or bevacizumab for myopic choroidal neovascularization. Am J Ophthalmol 2010; 149:140-6. [PMID: 19846061 DOI: 10.1016/j.ajo.2009.08.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 08/05/2009] [Accepted: 08/06/2009] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the long-term visual and anatomic outcome of treatment with photodynamic therapy (PDT) or intravitreal bevacizumab (IVB; Avastin; Genentech Inc, South San Francisco, California, USA) for choroidal neovascularization attributable to pathologic myopia (mCNV). DESIGN An open-label, interventional case series. METHODS SETTING Multi-institutional. PATIENTS Thirty-one eyes of Japanese women who received either PDT or IVB for mCNV. Inclusion criteria were age 50 years or older, greatest linear dimension (GLD) 1200 to 3000 microm, and baseline best-corrected visual acuity (BCVA) 20/200 to 20/40. INTERVENTION PROCEDURES: Patients received either PDT or IVB (1 mg/40 microL) throughout the study, with re-treatment when necessary. MAIN OUTCOME MEASURES BCVA and visual gain/loss at 3, 6, 12, 18, and 24 months after the initial treatment. RESULTS Age, BCVA, location of CNV, refractive error, and symptom duration at baseline did not differ significantly between groups. BCVA was significantly improved at 3 to 12 months (P < .05); however, the significance was lost at 18 and 24 months in the IVB group. The PDT group showed no significant improvement within the first year, and vision slowly worsened after 12 months, becoming significantly worse at 18 and 24 months compared to baseline (P< .01). BCVA was significantly higher in the IVB group at 6 months (P< .05), and 12 months or further (P < .01). Visual gain was significantly greater in the IVB group at 6, 12, 18, and 24 months (P < .05 for 6, 18, and 24 months and P < .01 for 12 months). CONCLUSIONS These findings indicate that the effects of PDT and IVB have a different time course, and that IVB provides a significantly better BCVA than PDT for mCNV over the long-term.
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Affiliation(s)
- Yasushi Ikuno
- Department of Ophthalmology, Osaka University Medical School, Osaka, Japan.
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Besozzi G, Sborgia L, Furino C, Cardascia N, Dammacco R, Sborgia G, Modoni AP, Boscia F. Low-fluence-rate photodynamic therapy to treat subfoveal choroidal neovascularization in pathological myopia. A study of efficacy and safety. Graefes Arch Clin Exp Ophthalmol 2009; 248:497-502. [PMID: 19916015 DOI: 10.1007/s00417-009-1232-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 10/20/2009] [Accepted: 10/22/2009] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND To evaluate the efficacy and safety of low-fluence-rate photodynamic therapy (LFPDT) to treat choroidal neovascularisation (CNV) secondary to pathological myopia (PM). METHODS Twenty-five eyes with CNV in PM underwent LFPDT, with a standard dose of verteporfin and timing but adopting fluence and irradiance rates reduced to 25 mJ/cm2 and 300 mW/cm2, respectively. Best corrected visual acuity (BCVA) was measured and biomicroscopy and fluorescein angiography (FA) were evaluated. Particular attention was paid to choroidal hypoperfusion, and to changes (depigmentation/atrophy) at the RPE level in areas exposed to laser light. RESULTS After a mean follow-up of 13.4+/-2.46 months (range: 12-21), and 1.37+/-0.66 treatments (range: 1-3), BCVA was stable in 29 (91%) eyes. Two (6%) patients gained more than three lines and one (3%) eye lost more than three lines. Mean greatest linear dimension did not change significantly (p=0.08) at the end of follow-up. RPE depigmentation was present in six eyes (18%) and no patient showed RPE atrophy. CONCLUSIONS LFPDT is effective and safe for CNV secondary to PM treatment, stabilizing visual acuity and lesion size and determining only mild RPE changes. Further controlled studies are needed to demonstrate the long-term efficacy and safety of this treatment option.
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Affiliation(s)
- Gianluca Besozzi
- Department of Ophthalmology and ENT, University of Bari, Piazza Giulio Cesare, 11-70124 Bari, Italy
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Intravitreal ranibizumab for the primary treatment of choroidal neovascularization secondary to pathologic myopia. Retina 2009; 29:750-6. [PMID: 19357555 DOI: 10.1097/iae.0b013e31819ed6bd] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the efficacy of intravitreal ranibizumab for the primary treatment of myopic choroidal neovascularization (CNV). METHODS Sixteen eyes of 16 consecutive patients who received 3 monthly injections of intravitreal ranibizumab for primary treatment of myopic CNV were reviewed. Additional ranibizumab injections were performed in eyes with persistent or recurrent CNV after 3 months. RESULTS The mean age of the patients was 60.8 years, and the spherical equivalent refractive error was -10.9 D. The mean logMAR best-corrected visual acuity at baseline was 0.58 (20/76). At 1 month and 12 months, the mean logMAR best-corrected visual acuity improved significantly to 0.39 (20/49) and 0.28 (20/37), respectively (P = 0.001 and P < 0.001, respectively). The mean improvement at 12 months was 3.0 lines, and 12 (75.0%) eyes had improvement of 2 or more lines. Fifteen (93.8%) eyes had angiographic closure at 3 months and 1 (6.2%) required further treatment because of persistent leakage at 3 months. Two (12.5%) patients had recurrence of CNV and required retreatment between 3 months and 9 months. Optical coherence tomography showed significant reduction in the mean central foveal thickness after treatment (P < 0.001). None of the patients developed any ocular or systemic side effects associated with intravitreal ranibizumab. CONCLUSION Intravitreal ranibizumab appeared to be effective for the primary treatment of myopic CNV, with a high proportion of patients sustaining visual gain after treatment.
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Costagliola C, Campa C, Incorvaia C, Parmeggiani F, Menzione M, Della Corte M, Rinaldi M, Romano M, Semeraro F. Verteporfin photodynamic therapy for subfoveal choroidal neovascularization in pathologic myopia: a 12-month retrospective review. Eur J Ophthalmol 2009; 18:955-9. [PMID: 18988168 DOI: 10.1177/112067210801800616] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the visual outcome of patients with subfoveal choroidal neovascularization (CNV) secondary to pathologic myopia treated with verteporfin photodynamic therapy (PDT-V) and to verify the predictive role of visual and angiographic parameters. METHODS This is a retrospective, interventional, consecutive case series study of subjects with subfoveal CNV secondary to pathologic myopia. All patients received PDT-V according to VIP guidelines. A complete ophthalmologic evaluation was performed on all patients and included best-corrected visual acuity (BCVA), fundus examination, and fluorescein angiography (FA, IMAGEnet System, Topcon Corp., Japan). CNV size (mm2) was directly measured on the early phase of the angiogram using the software included with the IMAGEnet package. All checks were scheduled at 3-month intervals for a period of 1 year. A review of medical and angiographic records was performed and assessed throughout a 12-month follow-up period. RESULTS A total of 62 patients (62 eyes) were examined. Best-corrected visual acuity (BCVA) moderately decreased without reaching a statistically noticeable level throughout the followup; reduction in lesion size reached a significant level at the second checkup. A significant correlation between higher baseline BCVA and better final visual outcome was detected. CONCLUSIONS Standardized PDT-V minimizes central vision deterioration in patients with CNV secondary to pathologic myopia. Better BCVA at presentation represents a good predictive sign.
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Affiliation(s)
- C Costagliola
- Dipartimento di Scienze per la Salute, Università degli Studi del Molise, Campobasso - Italy.
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Gharbiya M, Allievi F, Mazzeo L, Gabrieli CB. Intravitreal bevacizumab treatment for choroidal neovascularization in pathologic myopia: 12-month results. Am J Ophthalmol 2009; 147:84-93.e1. [PMID: 18774547 DOI: 10.1016/j.ajo.2008.07.022] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Revised: 07/10/2008] [Accepted: 07/12/2008] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate the short-term efficacy and safety of intravitreal bevacizumab for the treatment of myopic choroidal neovascularization (CNV). DESIGN Prospective, nonrandomized, interventional case series. METHODS Twenty eyes from 20 patients with CNV secondary to pathologic myopia participated in this prospective nonrandomized interventional case series. All patients were scheduled for three monthly intravitreal bevacizumab 1.25 mg injections. Early Treatment Diabetic Retinopathy Study best-corrected visual acuity (BCVA), foveal center thickness (FCT) on optical coherence tomography (OCT), and fluorescein angiographic findings were examined before and after treatment. Patients were followed up for 12 months. RESULTS The mean BCVA (+/- standard deviation [SD]) at baseline was 24.8 (+/- 11.86) letters (Snellen equivalent: 20/80). At 12 months after treatment, the mean BCVA (+/- SD) improved significantly (P = .000001) to 43 (+/- 12.38) letters (Snellen equivalent: 20/35). At 12 month follow-up, BCVA improved 10 letters or more in 18 (90%) out of 20 treated eyes and improved 15 letters or more in 14 (70%) out of 20 treated eyes. No treated eyes experienced a worsening of BCVA from baseline. The mean FCT (+/- SD) at baseline was 223 (+/- 47.43) microns. At 12 months after treatment, the mean FCT (+/- SD) reduced to 206 (+/- 50.87) microns. This reduction in FCT after treatment was not statistically significant (P = .11). At 12 months follow-up, absence of fluorescein leakage from the CNV was demonstrated in 19 (95%) out of 20 treated eyes and persistent leakage in one eye (5%). None of the 19 eyes that had CNV closure experienced recurrence at 12-month follow-up. No ocular or systemic adverse effects from treatment were encountered. CONCLUSION These results of intravitreal bevacizumab in myopic CNV are very promising with no apparent short-term safety concerns. At 12 months, treated eyes had a significant improvement in visual acuity (VA). OCT findings, as well, showed a trend consistent with the beneficial changes observed for VA. Treatment resulted in complete absence of angiographic leakage in 95% of eyes. Further studies will be needed to better determine long-term efficacy and safety.
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Affiliation(s)
- Magda Gharbiya
- Department of Ophthalmology, University of Rome La Sapienza, Rome, Italy.
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Pece A, Isola V. Retinal pigment epithelial marginal retraction after photodynamic therapy for choroidal neovascularization in pathologic myopia. Eur J Ophthalmol 2008; 18:841-4. [PMID: 18850572 DOI: 10.1177/112067210801800533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the incidence of retinal pigment epithelial (RPE) marginal retraction after verteporfin photodynamic therapy (PDT) for subfoveal choroidal neovascularization (CNV) in pathologic myopia (PM). METHODS Retrospective review of 236 patients treated with PDT for subfoveal CNV due to PM. RESULTS RPE marginal retraction was found in 3 eyes (1.3%), and a decrease of a mean of five lines of vision was reported to occur 10-15 days after treatment. At the end of followup two eyes lost three lines and one six lines from baseline. CONCLUSIONS RPE marginal retraction as an early complication of PDT for subfoveal CNV secondary to PM is rare. The low incidence of this adverse event, however, should not preclude recommendations for PDT in myopic eyes that could benefit from this treatment modality.
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Affiliation(s)
- A Pece
- Department of Ophthalmology, Melegnano Hospital, Milano - Italy.
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Chan WM, Lai TYY, Liu DTL, Lam DSC. Intravitreal bevacizumab (Avastin) for myopic choroidal neovascularisation: 1-year results of a prospective pilot study. Br J Ophthalmol 2008; 93:150-4. [PMID: 18801766 DOI: 10.1136/bjo.2008.145797] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM The aim of the study was to examine the 1-year results of intravitreal bevacizumab for myopic choroidal neovascularisation (CNV). METHODS Twenty-nine eyes of 29 patients with myopic CNV were prospectively recruited to receive three initial monthly intravitreal bevacizumab injections. Three additional monthly injections were performed in eyes with persistent or recurrent CNV after 3 months. RESULTS The mean spherical equivalent refractive error was -10.0 D. Sixteen eyes had previous photodynamic therapy (PDT) and 13 eyes had no prior PDT. All patients completed follow-up at 1 year. Following the initial three bevacizumab injections, 27 (93.1%) eyes had angiographic closure and two (6.9%) required further treatment. Two additional patients required re-treatment for CNV recurrence between 6 and 9 months. The mean baseline logarithm of the minimum angle of resolution (logMAR best-corrected visual acuity) was 0.62 (20/83), which improved to 0.38 (20/48) at 12 months (p<0.001). The mean visual improvement was 2.4 lines and 21 (72.4%) eyes had improvement of > or =2 lines. Optical coherence tomography showed significant reduction in central foveal thickness following treatment. Eyes without previous PDT were more likely to gain > or =2 lines after treatment than eyes that had previous PDT (p = 0.010). CONCLUSIONS The 1-year outcomes confirmed the results of previous short-term studies that intravitreal bevacizumab is effective for myopic CNV, with a high proportion of patients sustaining visual gain after treatment.
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Affiliation(s)
- W-M Chan
- Hong Kong Eye Hospital, Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.
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SHORT-TERM EFFICACY AND SAFETY OF INTRAVITREAL RANIBIZUMAB FOR MYOPIC CHOROIDAL NEOVASCULARIZATION. Retina 2008; 28:1117-23. [DOI: 10.1097/iae.0b013e31817eda41] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hayashi K, Ohno-Matsui K, Teramukai S, Shimada N, Moriyama M, Hara W, Yoshida T, Tokoro T, Mochizuki M. Photodynamic therapy with verteporfin for choroidal neovascularization of pathologic myopia in Japanese patients: comparison with nontreated controls. Am J Ophthalmol 2008; 145:518-526. [PMID: 18207125 DOI: 10.1016/j.ajo.2007.10.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 10/28/2007] [Accepted: 10/30/2007] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine the effects of photodynamic therapy (PDT) with verteporfin on subfoveal or juxtafoveal choroidal neovascularization (CNV) secondary to pathologic myopia in Japanese patients and to compare the visual outcomes of PDT-treated patients with that of age-matched and visual acuity-matched untreated controls. DESIGN Prospective, open-label, consecutive, interventional case series. METHODS We prospectively followed up 43 eyes of 42 consecutive patients with pathologic myopia (>6 diopters or axial length>26.5 mm) who received PDT for myopic CNV. In addition, the visual outcomes of these patients who were followed up for more than one year were compared with those of age- and initial visual acuity-matched untreated controls. RESULTS The average follow-up was 15.0+/-7.0 months. Patients received an average of 1.40+/-0.73 treatments during follow-up, and 30 eyes (69.8%) required only one treatment. The best-corrected visual acuity (BCVA) improved by more than two Snellen lines in seven eyes (16.3%), decreased in six eyes (14.0%), and remained stable in 30 eyes (69.7%). In three eyes with a juxtafoveal CNV, CNV could not be detected ophthalmoscopically or angiographically after PDT. Statistical analysis showed that the PDT-treated patients had significantly better visual acuity at one year after PDT than the age- and initial BCVA-matched untreated controls. CONCLUSIONS These results indicate that PDT was beneficial for maintaining vision in Japanese patients with myopic CNV. The visual outcome after PDT was better than the natural course of the disease as determined from untreated controls. The effect on chorioretinal atrophy around CNV should be investigated with a long-term study.
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Ruiz-Moreno JM, Gomez-Ulla F, Montero JA, Ares S, Lopez-Lopez F, Rodriguez M, Fernandez M. Intravitreous bevacizumab to treat subfoveal choroidal neovascularization in highly myopic eyes: short-term results. Eye (Lond) 2007; 23:334-8. [DOI: 10.1038/sj.eye.6703052] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Chan WM, Lai TYY, Liu DTL, Lam DSC. Intravitreal Bevacizumab (Avastin) for Myopic Choroidal Neovascularization. Ophthalmology 2007; 114:2190-6. [PMID: 17599414 DOI: 10.1016/j.ophtha.2007.03.043] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Revised: 03/12/2007] [Accepted: 03/12/2007] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of intravitreal bevacizumab in the treatment of choroidal neovascularization (CNV) secondary to pathologic myopia (PM). DESIGN Prospective, consecutive, nonrandomized, interventional case series. PARTICIPANTS Twenty-two eyes of 22 patients with CNV secondary to PM. METHODS Consecutive patients with subfoveal or juxtafoveal CNV secondary to PM were recruited prospectively to receive an initial course of 3 monthly intravitreal injections of bevacizumab. Three additional monthly injections were performed in eyes with persistent CNV leakage after 3 months. Patients were followed up for 6 months, and the best-corrected visual acuity (BCVA), changes in fluorescein angiography, and optical coherence tomography (OCT) results were assessed. MAIN OUTCOME MEASURES Changes in BCVA, angiographic closure, and OCT central foveal thickness (CFT) at the 6-month follow-up. RESULTS The mean+/-standard deviation (SD) spherical equivalent refractive error of the 22 eyes was -10.3+/-3.7 D (range, -6.0D to -18.0D). All patients completed follow-up at 6 months. Twenty (90.9%) eyes had angiographic closure after 3 monthly injections of intravitreal bevacizumab, and 2 (9.1%) eyes required further treatment up to 6 months. The mean+/-SD logarithm of the minimum angle of resolution (logMAR) BCVA at baseline was 0.60+/-0.18 (Snellen equivalent, 20/80). At 1 and 6 months, the mean+/-SD logMAR BCVA improved significantly to 0.43 (Snellen equivalent, 20/53; P = 0.003) and 0.35 (Snellen equivalent, 20/45; P<0.001), respectively. The mean lines of improvements at 1 and 6 month compared with baseline were 1.7 and 2.6 lines, respectively. Fifteen (68.2%) eyes had an improvement of 2 or more lines at 6 months. The OCT results also showed significant reduction in CFT after treatment. No ocular or systemic complications were noted after intravitreal injections. CONCLUSIONS The 6-month outcomes suggest intravitreal bevacizumab to be a promising treatment method for CNV secondary to PM, resulting in both visual and anatomic improvements. Treatment resulted in complete absence of angiographic leakage in 90.9% of eyes at 3 months. Further studies to evaluate the safety, efficacy, and optimal treatment regimen are justified.
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Affiliation(s)
- Wai-Man Chan
- Hong Kong Eye Hospital, Department of Ophthalmology & Visual Sciences, Chinese University of Hong Kong, Hong Kong, China.
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Chen YS, Lin JYS, Tseng SY, Yow SG, Hsu WJ, Tsai SC. PHOTODYNAMIC THERAPY FOR TAIWANESE PATIENTS WITH PATHOLOGIC MYOPIA:. Retina 2007; 27:839-45. [PMID: 17891006 DOI: 10.1097/iae.0b013e31804b1e6f] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine the efficacy of photodynamic therapy with verteporfin (VPDT) for treatment of subfoveal choroidal neovascularization (CNV) in patients with pathologic myopia. METHODS In a prospective study, adult patients (18 years of age or older) with new onset subfoveal CNV were treated in two tertiary centers with the standard protocol of VPDT. Snellen best-corrected visual acuity was measured at baseline and at 1 month, 3 months, 6 months, 12 months, 15 months, 18 months, and 24 months after VPDT. Stratified analyses for single and multiple treatments and different age groups were performed by paired t-tests, and the results were compared with baseline findings. RESULTS Thirty-three patients with single VPDT and 13 patients with multiple treatments were enrolled for analysis. Significant improvement in measurement of visual acuity was found after 24 months of follow-up for the group with single therapy. For patients receiving multiple treatments, an improving trend was not as clear. In prognosis analysis by age groups in the single-treatment group, the younger group had better mean visual acuity at the end of the 24-month study period than the older group. Improvement was much more evident in the younger group, although it was not statistically significant at every follow-up time point. CONCLUSION In patients with response to single VPDT, visual acuity significantly improved over a 2-year period. In patients receiving multiple treatments, improvement was not as distinctive, suggesting alternative treatment options might be relevant for this subgroup.
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Affiliation(s)
- Ying-Shan Chen
- Department of Ophthalmology, Cathay General Hospital, Hsinchu, Taiwan.
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Pece A, Vadalà M, Isola V, Matranga D. Photodynamic therapy with verteporfin for juxtafoveal choroidal neovascularization in pathologic myopia: a long-term follow-up study. Am J Ophthalmol 2007; 143:449-54. [PMID: 17317390 DOI: 10.1016/j.ajo.2006.11.037] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2006] [Revised: 10/29/2006] [Accepted: 11/14/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the effect of verteporfin photodynamic therapy (PDT) in juxtafoveal choroidal neovascularization (CNV) secondary to pathologic myopia (PM). DESIGN Prospective, open-label, consecutive, interventional case series. METHODS We prospectively followed a series of 48 consecutive patients (49 eyes) with pathologic myopia (> or = 6 diopters) who received verteporfin PDT for juxtafoveal CNV. This population was divided into two groups based on age (group A < or = 55 years old, group B >55 years old), in three subgroups based on CNV lesion size, and in three categories based on refractive error at baseline. RESULTS The median follow-up was 32 months (range, 12 to 56 months). Visual acuity (VA) improved by 1 or more Snellen lines in 18 eyes (37%), decreased in 12 eyes (24%), and remained stable in 19 eyes (39%). The median number of lines gained was 2.15, while the median number of lines lost was 2.4. The final mean VA in group A (mean age, 43.9 years) was 20/50 (logMAR 0.41, standard deviation [SD] 0.3) and significantly better (P = .01) than the 20/105 (logMAR 0.72, SD 0.5) in group B (mean age, 67.8 years). Neither CNV size nor refractive error magnitude influenced visual outcomes. CONCLUSION Verteporfin PDT is a promising treatment modality resulting in stable or improved vision in 76% of the myopic eyes with juxtafoveal CNV. Younger patients appear to respond more favorably to treatment.
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Affiliation(s)
- Alfredo Pece
- Department of Ophthalmology, Melegnano Hospital, Milan, Italy.
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Montero JA, Ruiz-Moreno JM. Combined photodynamic therapy and intravitreal triamcinolone injection for the treatment of choroidal neovascularisation secondary to pathological myopia: a pilot study. Br J Ophthalmol 2007; 91:131-3. [PMID: 17244656 PMCID: PMC1857612 DOI: 10.1136/bjo.2006.106526] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2006] [Indexed: 11/04/2022]
Abstract
Intravitreous triamcinolone associated with PDT should preferably be used among elderly patients who usually show lower visual acuity and a poorer response to PDT, or among patients with recurrent or greater CNVs
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Ruiz-Moreno JM, Montero JA. Photodynamic therapy in macular diseases. EXPERT REVIEW OF OPHTHALMOLOGY 2006. [DOI: 10.1586/17469899.1.1.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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El Matri L, Bouraoui R, Merdassi A, Baccouri R, Mghaieth F, Ben Rejeb S, Meddeb S. Traitement des néo-vaisseaux choroïdiens rétrofovéolaires du myope fort par photothérapie dynamique : résultats à 1 an et à 2 ans. J Fr Ophtalmol 2006; 29:765-70. [PMID: 16988626 DOI: 10.1016/s0181-5512(06)73845-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the visual outcome of photodynamic therapy with verteporfin in patients with subfoveal choroidal neovascularization (CNV) caused by pathologic myopia. METHODS Retrospective and noncomparative analysis of 42 patients with CNV secondary to pathologic myopia recruited between September 2001 and 2003, who were treated with a standard regimen of photodynamic therapy with verteporfin. RESULTS Forty-two patients were followed up for 12 months; 15 out of 42 completed 24 months of follow-up. Initial visual acuity ranged from 1/10 to 5/10 with a mean of 1.6/10. Twenty-five (56.7%) eyes had stable or improved visual acuity at 12 months with a mean of 2.5/10. In the group of patients who completed 24 months of follow-up, six eyes (39.9%) had stable or improved visual acuity with a mean of 1.6/10 at 1 year and 1.25/10 at 2 years. The average photodynamic therapy treatment required in 1 and 2 years were 1.5 and 2.1, respectively, and they are less than those reported by the Verteporfin in Photodynamic Therapy (VIP) study. CONCLUSION Photodynamic therapy with verteporfin for subfoveal choroidal neovascularization caused by pathologic myopia maintained a visual benefit at 1 and 2 years.
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Affiliation(s)
- L El Matri
- Service d'Ophtalmologie B, Institut Hédi Rais, Boulevard 9 avril, 1006 Tunis, Tunisie.
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Pece A, Isola V, Vadalà M, Matranga D. PHOTODYNAMIC THERAPY WITH VERTEPORFIN FOR SUBFOVEAL CHOROIDAL NEOVASCULARIZATION SECONDARY TO PATHOLOGIC MYOPIA. Retina 2006; 26:746-51. [PMID: 16963846 DOI: 10.1097/01.iae.0000244256.60524.c0] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the safety and effectiveness of photodynamic therapy (PDT) with verteporfin for subfoveal choroidal neovascularization (CNV) secondary to pathologic myopia (PM). METHODS Sixty-two patients (62 eyes) with PM underwent PDT according to the guidelines of the Verteporfin in Photodynamic Therapy Study. Clinical evaluations performed at all study visits included measurement of best-corrected Snellen visual acuity, slit-lamp biomicroscopy, and fundus fluorescein angiography. Patients were followed up at 1 month and 3 months after treatment and thereafter at 3-month intervals. RESULTS The final visual acuity of the study patients, after a median follow-up of 31 months, improved by >or=1 Snellen lines in 8 patients (13%), deteriorated in 20 (32%), and remained stable in 34 (55%). The baseline visual acuity was similar in the various study groups. The final mean visual acuity in group A (55 years of age or younger) was 20/80 and significantly (P=0.006) better than that (20/138) in group B (older than 55 years of age). The mean final visual acuity in eyes with higher refractive error at baseline (greater than -17 diopters) was significantly better (P=0.014) than that in eyes with lower refractive error (-6 to -10 diopters). CNV size did not affect visual outcomes. CONCLUSION PDT preserves vision in patients with CNV associated with PM. Younger patients and eyes with higher refractive error appear more likely to benefit from PDT with verteporfin.
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Affiliation(s)
- Alfredo Pece
- Department of Ophthalmology, Melegnano Hospital, Milan, and NOOP Department, Sezione di Oftalmologia, Università di Palermo, Palermo, Italy.
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Byeon SH, Kwon OW, Lee SC, Kim SS, Koh HJ. Indocyanine green angiographic features of myopic subfoveal choroidal neovascularization as a prognostic factor after photodynamic therapy. KOREAN JOURNAL OF OPHTHALMOLOGY 2006; 20:18-25. [PMID: 16768186 PMCID: PMC2908812 DOI: 10.3341/kjo.2006.20.1.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose To determine the influence of clinical features and Indocyanine green (ICG) angiographic features on the visual outcome of patients with myopic sub-foveal choroidal neovascularization (CNV) who received photodynamic therapy (PDT). Methods Thirty-six consecutive patients (39 eyes) with myopic CNV who were followed up for more than one year after PDT were enrolled in this study. Clinical features included age, gender, refractive error, great linear dimension, and subretinal hemorrhage. ICG features included the lesion size, lacquer cracks, hypofluorescence surrounding the CNV (dark rim), peripapillary atrophy size, and visible prominent choroidal veins under the macula. Linear regression analysis was performed using the change in visual acuity (ΔlogMAR) as the dependent variable and the above factors as independent variables. Results At one-year follow-up after PDT, a younger age (p=0.002) and the presence of a dark rim (p=0.002) were significantly correlated with an improvement of visual acuity (decrement in logMAR) after PDT. Other factors had no significant influence on changes in visual acuity. Conclusions Younger patients and patients with a dark rim on ICG angiography had a higher chance of visual improvement after PDT in myopic CNV.
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Affiliation(s)
- Suk Ho Byeon
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
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Kojima A, Ohno-Matsui K, Teramukai S, Ishihara Y, Shimada N, Yoshida T, Sugamoto Y, Tokoro T, Mochizuki M. Estimation of visual outcome without treatment in patients with subfoveal choroidal neovascularization in pathologic myopia. Graefes Arch Clin Exp Ophthalmol 2006; 244:1474-9. [PMID: 16628418 DOI: 10.1007/s00417-006-0324-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Revised: 02/05/2006] [Accepted: 03/02/2006] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To clarify prognostic factors of long-term visual outcome without treatment in patients with myopic choroidal neovascularization (CNV) and estimate a regression equation to predict visual acuity at 5 years after CNV onset. METHODS Fifty-four eyes of 54 consecutive patients with high myopia and subfoveal CNV who did not receive treatment were identified using clinical records from 1988 to 2004. Photodynamic therapy not approved for myopic CNV in Japan during this period. The association of best-corrected visual acuity (BCVA) at 5 years after CNV onset with patient age, refractive error, axial length, initial BCVA, myopic retinopathy grade, duration of persistent hemorrhage, CNV size at onset, and size of hemorrhage around the CNV was analyzed using Spearman's correlation and multiple linear regression analysis. RESULTS BCVA at 5 years after onset was significantly associated with patient age, CNV size, and initial BCVA (P<0.05, Spearman's correlation). The regression equation estimating BCVA at 5 years after CNV onset was based on age and initial BCVA (R2=0.43). When subjects were divided into groups according to age (<40 and >or=40 years), CNV size, axial length and duration of persistent hemorrhage influenced BCVA at 5 years in patients under 40 years; while only initial BCVA was an influence in those at least 40 years old. CONCLUSIONS We developed a linear predictive model to estimate BCVA at 5 years after onset of myopic CNV without treatment based on the identified prognostic factors. This information might be important for managing patients with myopic CNV.
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Affiliation(s)
- Ariko Kojima
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Tokyo 113-8519, Japan
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Chan WM, Ohji M, Lai TYY, Liu DTL, Tano Y, Lam DSC. Choroidal neovascularisation in pathological myopia: an update in management. Br J Ophthalmol 2005; 89:1522-8. [PMID: 16234465 PMCID: PMC1772951 DOI: 10.1136/bjo.2005.074716] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Choroidal neovascularisation (CNV) secondary to pathological myopia is an important cause of significant visual impairment in young and middle aged adults globally and is particularly prevalent in Asian populations. In the past few years, there have been rapid advancements in the different treatments for myopic CNV. The purpose of this perspective is to give an overview of the natural history of myopic CNV and the various treatment options including laser photocoagulation, photodynamic therapy, sub-macular surgery, and macular translocation surgery. Future directions in the management of myopic CNV are also discussed.
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Affiliation(s)
- W-M Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, 3/F, Hong Kong Eye Hospital, Kowloon, Hong Kong.
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Krebs I, Binder S, Stolba U, Glittenberg C, Brannath W, Goll A. Choroidal neovascularization in pathologic myopia: three-year results after photodynamic therapy. Am J Ophthalmol 2005; 140:416-25. [PMID: 16139000 DOI: 10.1016/j.ajo.2005.03.050] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Revised: 03/14/2005] [Accepted: 03/19/2005] [Indexed: 11/15/2022]
Abstract
PURPOSE To examine whether the encouraging functional results one year after photodynamic therapy (PDT) can be maintained up to three years. DESIGN Prospective interventional case series. METHODS Highly myopic eyes that had been treated with PDT for subfoveal choroidal neovascularization and had been observed at least 36 months were included. Distance acuity (Early Treatment of Diabetic Retinopathy charts), reading acuity (Jaeger charts), 10-degree static threshold perimetry, fluorescein angiography, and optical coherence tomography were performed. The main outcome measures were the differences of the values among the baseline and the month 12 and the month 36 examinations. RESULTS Twenty eyes of 18 patients were included: 15 patients were female, and 3 patients were male. The average age was 64 years (range, 36 to 85 years). The mean distance acuity was 43 letters at baseline and 53 letters after 12 months and after 36 months. The mean reading acuity changed from mean J10.8 to mean J8.1 after 12 months and to mean J9.85 after 3 years. The mean defect decreased from mean 13.5 dB at baseline to mean 12.5 dB after 12 months and mean 11.2 dB after 36 months. The maximum retinal thickness decreased from mean 360 mum at baseline to mean 259 mum after one year and mean 238 mum after 36 months. CONCLUSION Distance acuity and central visual field showed stabilization after the month 12 examination up to the month 36 examination. The reading acuity decreased between the month 12 and the month 36 examinations, which might be related to an increase of retinal atrophy.
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Affiliation(s)
- Ilse Krebs
- Department of Ophthalmology, Rudolf Foundation Clinic, Juchgasse 25, 1030 Vienna, Austria.
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Schnurrbusch UEK, Jochmann C, Wiedemann P, Wolf S. Quantitative assessment of the long-term effect of photodynamic therapy in patients with pathologic myopia. Graefes Arch Clin Exp Ophthalmol 2005; 243:829-33. [PMID: 16133036 DOI: 10.1007/s00417-005-1147-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2004] [Revised: 12/02/2004] [Accepted: 01/14/2005] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND In patients with classic subfoveal choroidal neovascularization (CNV) secondary to pathologic myopia (PM), photodynamic therapy (PDT) has been shown to stabilize the visual acuity. We have analyzed the long-term visual prognosis after PDT in patients with CNV secondary to PM. METHODS In a retrospective study we reviewed the clinical charts of 102 patients. PDT was performed following the procedures described in the VIP and TAP study protocols. Follow-up examinations and PDT treatment were scheduled in 3-month intervals. Indications for retreatment were an active leaking CNV in combination with visual disturbances or visual loss. To assess treatment effects we analyzed the number of letters read on the ETDRS charts. The primary efficacy outcome was the proportion of eyes that had fewer than eight letters loss or gain at 24 months. Secondary efficacy outcomes included the proportion of eyes that had fewer than 15 letters loss or gain and the proportion of eyes that had fewer than 30 letters loss or gain at month 24. RESULTS One hundred and two patients were included into the study. Mean follow-up was 32.5+/-5.7 months. Patients received an average of 2.2 treatments from study entry through the last follow-up, resulting in a total of 221 PDT sessions throughout the study. At 24 months 46% lost at least eight letters. A loss of at least 15 (30) letters was observed in 25% (8%). Improvement of at least eight letters was noted in 8%. Larger improvements of at least 15 letters occurred only in 4% of study eyes. CONCLUSION Our study suggests that PDT can increase the chance of stabilizing or improving vision compared with the placebo arm of VIP trial.
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Affiliation(s)
- Ute E K Schnurrbusch
- Klinik und Poliklinik für Augenheilkunde, University Bern, Inselspital, 3010 Bern, Switzerland
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Leslie T, Lois N, Christopoulou D, Olson JA, Forrester JV. Photodynamic therapy for inflammatory choroidal neovascularisation unresponsive to immunosuppression. Br J Ophthalmol 2005; 89:147-50. [PMID: 15665342 PMCID: PMC1772526 DOI: 10.1136/bjo.2004.046623] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To report on visual and angiographic outcomes of a consecutive series of patients with inflammatory choroidal neovascular membranes (CNV) unresponsive to systemic immunosuppression treated with photodynamic therapy (PDT). METHODS The medical records of six consecutive patients with inflammatory CNVs that failed to respond to systemic immunosuppression and that later underwent PDT were retrospectively reviewed. Patient demographics, visual acuity, and fluorescein angiographic findings were evaluated. RESULTS There were five females and one male with a mean age of 40.8 years (range 35-58 years). Four patients had clinical features consistent with punctate inner choroidopathy and two with presumed ocular histoplasmosis. In all cases clinical signs of CNV activity, including subretinal fluid, subretinal blood, hard exudates, and/or recent decrease in visual acuity were present prior to PDT. All patients had been treated with high dose systemic immunosuppressants, which failed to induce regression of the CNV and/or to improve vision. The CNVs were subfoveal in five patients and juxtafoveal in one; all were classified as predominantly classic. Following PDT an improvement in vision occurred in all cases (median improvement of 18 letters, range 3-42 letters). At last follow up, signs of decreased activity in the CNV were detected in all cases. Patients were followed for a median of 10 months (range 9-20 months). CONCLUSION PDT appears to be a useful option in the management of patients with inflammatory CNVs unresponsive to immunosuppressive therapies.
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Affiliation(s)
- T Leslie
- Retina Service, Ophthalmology Department, Aberdeen University Hospital, Foresterhill, Aberdeen AB25 2ZN, Scotland, UK
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Lam DSC, Chan WM, Liu DTL, Fan DSP, Lai WW, Chong KKL. Photodynamic therapy with verteporfin for subfoveal choroidal neovascularisation of pathologic myopia in Chinese eyes: a prospective series of 1 and 2 year follow up. Br J Ophthalmol 2004; 88:1315-9. [PMID: 15377558 PMCID: PMC1772358 DOI: 10.1136/bjo.2004.041624] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To evaluate the visual and fluorescein angiographic outcomes of photodynamic therapy (PDT) with verteporfin in patients with subfoveal choroidal neovascularisation (CNV) caused by pathologic myopia in the Chinese. METHODS Prospective, non-comparative, two centre interventional study. Patients with CNV secondary to pathologic myopia of Chinese ethnicity were recruited and treated with a standard regimen of PDT with verteporfin. Results of this study in Chinese eyes with pigmented retinal pigment epithelium were compared with those from the Verteporfin in Photodynamic Therapy (VIP) Study of predominantly white eyes. RESULTS Thirty one and 22 eyes that completed the 12 month and 24 month follow up studies respectively were analysed. The mean and median best corrected visual acuities (BCVA) could be maintained at the baseline level at the 12 month and 24 month visits. Fourteen (63.6%) eyes had stable or improved BCVA at 24 months and six (27.3%) of them had a moderate gain in vision (improved by three or more lines). Visual results were comparable with that of the VIP study, but the average accumulative PDT treatments required in one and two years were 1.7 and 2.3 respectively, which were significantly less than 3.4 and 5.1 treatments in VIP study. Mean logMAR BCVA of the younger age group (<55 years) at 24 months was 0.41 (SD 0.29), which was significantly better than the older age group (>/= = 55 years) of 0.82 (SD 0.40) (Mann-Whitney U test, p = 0.029). CONCLUSIONS PDT using the predetermined treatment protocol has achieved similar visual outcomes in the Chinese population as in white people with subfoveal myopic CNV over a 2 year study period. The complete cessation of CNV leakage can be accomplished, on average, with fewer PDT retreatments than reported in the VIP study. The disparity may be due to ethnic differences in these two populations.
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Affiliation(s)
- D S C Lam
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, University Eye Center, Hong Kong Eye Hospital, 147K, Argyle Street, Kowloon, Hong Kong. People's Republic of China
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Axer-Siegel R, Ehrlich R, Weinberger D, Rosenblatt I, Shani L, Yassur Y, Priel E, Kramer M. Photodynamic therapy of subfoveal choroidal neovascularization in high myopia in a clinical setting: visual outcome in relation to age at treatment. Am J Ophthalmol 2004; 138:602-7. [PMID: 15488787 DOI: 10.1016/j.ajo.2004.05.074] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2004] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the visual outcome of patients with myopic subfoveal choroidal neovascularization (CNV) given photodynamic therapy (PDT) in a clinical setting, and to identify potential relation between the visual outcome and the age at treatment. DESIGN Interventional case series. METHODS Retrospective comparative study. SETTING Outpatient ophthalmology clinic. PATIENTS Twenty-nine consecutive patients (30 eyes) with subfoveal CNV caused by pathologic myopia who were treated with verteporfin PDT from January 2000 to May 2003. INTERVENTION All the patients received verteporfin PDT and were followed clinically and with fluorescein angiography (FA). Review of the medical records and angiograms was performed. Patients were divided into two groups by age, using the median age (60 years) as the cutoff. MAIN OUTCOME MEASURES Visual acuity (VA) at the end of follow-up in the older-patient group compared with the younger-patient group. RESULTS The mean age was 63.1 years. Mean follow-up was 11.5 months. Patients received a mean of 3.48 treatments. Mean VA improved in the younger group from 0.63 to 0.39 logMAR (P = .02, paired t test) and deteriorated in the older group from 0.71 to 0.99 logMAR (P = .03, paired t test). In the whole cohort, 33% of eyes lost 3 or more lines of Snellen best-corrected VA; in the older age group, 50% of eyes lost 3 or more lines, whereas in the younger age group, only 8% of eyes did so (P = .024, Fisher's exact test). CONCLUSIONS In our consecutive case series, visual prognosis of myopic CNV after PDT was found to be influenced by age at treatment.
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Ergun E, Heinzl H, Stur M. Prognostic factors influencing visual outcome of photodynamic therapy for subfoveal choroidal neovascularization in pathologic myopia. Am J Ophthalmol 2004; 138:434-8. [PMID: 15364227 DOI: 10.1016/j.ajo.2004.04.055] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2004] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine the influence of age, lesion size, degree of myopia, and baseline visual acuity on the visual outcome of patients with pathologic myopia and choroidal neovascularization (CNV) who received photodynamic therapy (PDT) with verteporfin. DESIGN Retrospective, noncomparative consecutive case series. METHODS Forty-three eyes of 41 patients were treated in a two-year time span; 36 eyes of 36 patients who had received PDT for CNV due to pathologic myopia were examined for the above-mentioned factors 24 months after first treatment. All patients had been treated according to the Verteporfin in Photodynamic Therapy (VIP) study criteria. Patients were examined in two- to three-month intervals with Snellen visual acuity, biomicroscopy, and fluorescein angiography. RESULTS Baseline visual acuity and age were both prognostic factors for visual outcome (P =.0097, P =.0055). Lesion size (greatest linear dimension) at baseline, refractive error, or the number of treatments had no influence on the outcome. CONCLUSION Age and baseline visual acuity have an effect on visual outcome in patients receiving PDT due to CNV secondary to pathologic myopia. Younger patients and patients with higher baseline visual acuity had a better treatment outcome.
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Affiliation(s)
- Erdem Ergun
- Department of Ophthalmology, University of Vienna Medical School, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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Abstract
PURPOSE OF REVIEW Choroidal neovascularization (CNV) is the most common vision-threatening complication of high myopia. Myopic CNV has recently attracted a lot of attention, mainly because of a variety of newly developed treatments. To evaluate the efficacy of these new treatments against myopic CNV, we need to know more precisely the natural course of myopic CNV. The results of most previously reported studies regarding the natural course of myopic CNV, however, are somewhat contradictory. In this review, we describe the recently reported long-term prognosis of myopic CNV and the effectiveness of newly developed treatments as well as an overview of possible future treatments. RECENT FINDINGS A recent study evaluating the visual outcome of myopic CNV for at least 10 years after onset in a large series of patients reported that the visual prognosis of myopic CNV without treatment is extremely poor, mainly because of the secondary development of chorioretinal atrophy around the area of regressed CNV. Although conventional treatments against myopic CNV, such as laser photocoagulation or surgical extraction of CNV, have not been effective, newly developed treatments such as foveal translocation or photodynamic therapy have had favorable results on myopic CNV in the short-term. Pharmacologic interventions to treat or prevent CNV are also expected in the future. SUMMARY Because the natural prognosis of myopic CNV is extremely poor, treatment to prevent further visual loss is necessary. Based on the steady and gradual visual decrease in myopic CNV over the long term, however, long-term results are needed before the true effectiveness of the newly developed active treatments can be determined.
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Affiliation(s)
- Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
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Keam SJ, Scott LJ, Curran MP. Verteporfin : a review of its use in the management of subfoveal choroidal neovascularisation. Drugs 2004; 63:2521-54. [PMID: 14609361 DOI: 10.2165/00003495-200363220-00016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
UNLABELLED Verteporfin (Visudyne) therapy (photodynamic therapy with intravenous liposomal verteporfin) is the first treatment to effectively prevent the loss of visual acuity in patients with subfoveal choroidal neovascularisation (CNV) secondary to age-related macular degeneration (AMD), pathological myopia or presumed ocular histoplasmosis syndrome (POHS). In adult patients with classic subfoveal CNV or occult with no classic subfoveal CNV secondary to AMD, or subfoveal CNV secondary to pathological myopia or POHS, verteporfin therapy slows or prevents loss of visual acuity. In well designed clinical trials, verteporfin therapy was superior to placebo in patients with subfoveal classic-containing CNV and occult with no classic CNV secondary to AMD at 12 and/or 24 months (Treatment of Age-related macular degeneration with Photodynamic therapy [TAP] Investigation and Verteporfin In Photodynamic therapy [VIP-AMD] trial) and in patients with pathological myopia at 12 months (Verteporfin In Photodynamic therapy [VIP-PM] trial). Limited data suggest that verteporfin therapy also prevents loss of visual acuity in patients with subfoveal CNV secondary to POHS. Verteporfin therapy was generally well tolerated in clinical trials; most adverse events were mild to moderate in intensity and transient. The most frequently reported verteporfin therapy-related adverse events (incidence >2%) were visual disturbance, injection-site reactions, photosensitivity reactions and infusion-related back pain. Approximately 5% of patients with occult with no classic subfoveal CNV secondary to AMD reported severe vision decrease within 7 days of treatment in clinical trials; 3 months later, several patients had recovered some of this loss. CONCLUSION Photodynamic therapy with verteporfin, the first photosensitiser approved for the treatment of subfoveal CNV, is a well tolerated treatment that stabilises or slows visual acuity loss in adult patients with predominantly classic or occult with no classic subfoveal CNV secondary to AMD, and subfoveal CNV secondary to pathological myopia or POHS. Thus, verteporfin therapy provides a valuable option for the management of these patients for whom treatment options are few, and should be considered as a first-line therapy in these difficult-to-manage conditions.
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Affiliation(s)
- Susan J Keam
- Adis International Limited, Auckland, New Zealand.
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Kojima A, Ohno-Matsui K, Teramukai S, Yoshida T, Ishihara Y, Kobayashi K, Shimada N, Yasuzumi K, Futagami S, Tokoro T, Mochizuki M. Factors associated with the development of chorioretinal atrophy around choroidal neovascularization in pathologic myopia. Graefes Arch Clin Exp Ophthalmol 2003; 242:114-119. [PMID: 14648134 DOI: 10.1007/s00417-003-0803-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2003] [Revised: 09/02/2003] [Accepted: 10/08/2003] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To examine the influencing factors on the development of chorioretinal atrophy, which is the main cause of long-term visual decrease in myopic choroidal neovascularization (CNV), in a large series of highly myopic patients. METHODS Sixty-five patients (81 eyes) with myopic CNV were studied retrospectively. The influence of the patient's age, refractive error, axial length, visual acuity at onset of CNV, size of CNV, and grade of myopic retinopathy on the extent of chorioretinal atrophy more than 3 years after CNV onset was investigated by means of multiple linear regression analysis. RESULTS Seventy-seven of 81 eyes (95.1%) developed chorioretinal atrophy around myopic CNV during the follow-up period. Multiple linear regression revealed that age was the most influencing factor for the development of chorioretinal atrophy in all the subjects. When we divided the subjects into two groups according to their age, however, CNV size was the only factor to influence the development of chorioretinal atrophy in the patients younger than 40 years, whereas age was still the only influencing factor in those older than 40 years. CONCLUSIONS The factors influencing the development of chorioretinal atrophy differ according to patient age. Local factors, such as CNV size, determine the tendency to develop chorioretinal atrophy in young patients. Systemic factors, such as patient age, play a greater part in older subjects.
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Affiliation(s)
- Ariko Kojima
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo , Japan
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo , Japan.
| | - Satoshi Teramukai
- Division of Clinical Trial Design and Management, Translational Research Center, Kyoto University Hospital, Kyoto, Japan
| | - Takeshi Yoshida
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo , Japan
| | - Yoko Ishihara
- Department of Hygiene and Public Health, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Kanako Kobayashi
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo , Japan
| | - Noriaki Shimada
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo , Japan
| | - Kenjiro Yasuzumi
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo , Japan
| | - Soh Futagami
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo , Japan
| | - Takashi Tokoro
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo , Japan
| | - Manabu Mochizuki
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo , Japan
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