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Moraes G, Struyven R, Wagner SK, Liu T, Chong D, Abbas A, Chopra R, Patel PJ, Balaskas K, Keenan TD, Keane PA. Quantifying Changes on OCT in Eyes Receiving Treatment for Neovascular Age-Related Macular Degeneration. OPHTHALMOLOGY SCIENCE 2024; 4:100570. [PMID: 39224530 PMCID: PMC11367487 DOI: 10.1016/j.xops.2024.100570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 06/24/2024] [Accepted: 06/24/2024] [Indexed: 09/04/2024]
Abstract
Purpose Application of artificial intelligence (AI) to macular OCT scans to segment and quantify volumetric change in anatomical and pathological features during intravitreal treatment for neovascular age-related macular degeneration (AMD). Design Retrospective analysis of OCT images from the Moorfields Eye Hospital AMD Database. Participants A total of 2115 eyes from 1801 patients starting anti-VEGF treatment between June 1, 2012, and June 30, 2017. Methods The Moorfields Eye Hospital neovascular AMD database was queried for first and second eyes receiving anti-VEGF treatment and had an OCT scan at baseline and 12 months. Follow-up scans were input into the AI system and volumes of OCT variables were studied at different time points and compared with baseline volume groups. Cross-sectional comparisons between time points were conducted using Mann-Whitney U test. Main Outcome Measures Volume outputs of the following variables were studied: intraretinal fluid, subretinal fluid, pigment epithelial detachment (PED), subretinal hyperreflective material (SHRM), hyperreflective foci, neurosensory retina, and retinal pigment epithelium. Results Mean volumes of analyzed features decreased significantly from baseline to both 4 and 12 months, in both first-treated and second-treated eyes. Pathological features that reflect exudation, including pure fluid components (intraretinal fluid and subretinal fluid) and those with fluid and fibrovascular tissue (PED and SHRM), displayed similar responses to treatment over 12 months. Mean PED and SHRM volumes showed less pronounced but also substantial decreases over the first 2 months, reaching a plateau postloading phase, and minimal change to 12 months. Both neurosensory retina and retinal pigment epithelium volumes showed gradual reductions over time, and were not as substantial as exudative features. Conclusions We report the results of a quantitative analysis of change in retinal segmented features over time, enabled by an AI segmentation system. Cross-sectional analysis at multiple time points demonstrated significant associations between baseline OCT-derived segmented features and the volume of biomarkers at follow-up. Demonstrating how certain OCT biomarkers progress with treatment and the impact of pretreatment retinal morphology on different structural volumes may provide novel insights into disease mechanisms and aid the personalization of care. Data will be made public for future studies. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Gabriella Moraes
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Robbert Struyven
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Siegfried K. Wagner
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Timing Liu
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - David Chong
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Abdallah Abbas
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Reena Chopra
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Praveen J. Patel
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Konstantinos Balaskas
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Tiarnan D.L. Keenan
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Pearse A. Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
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Vujosevic S, Lupidi M, Donati S, Astarita C, Gallinaro V, Pilotto E. Role of inflammation in diabetic macular edema and neovascular age-related macular degeneration. Surv Ophthalmol 2024; 69:870-881. [PMID: 39029747 DOI: 10.1016/j.survophthal.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 07/09/2024] [Accepted: 07/15/2024] [Indexed: 07/21/2024]
Abstract
Diabetic macular edema (DME) and neovascular age-related macular degeneration (nAMD) are multifactorial disorders that affect the macula and cause significant vision loss. Although inflammation and neoangiogenesis are hallmarks of DME and nAMD, respectively, they share some biochemical mediators. While inflammation is a trigger for the processes that lead to the development of DME, in nAMD inflammation seems to be the consequence of retinal pigment epithelium and Bruch membrane alterations. These pathophysiologic differences may be the key issue that justifies the difference in treatment strategies. Vascular endothelial growth factor inhibitors have changed the treatment of both diseases, however, many patients with DME fail to achieve the established therapeutic goals. From a clinical perspective, targeting inflammatory pathways with intravitreal corticosteroids has been proven to be effective in patients with DME. On the contrary, the clinical relevance of addressing inflammation in patients with nAMD has not been proven yet. We explore the role and implication of inflammation in the development of nAMD and DME and its therapeutical relevance.
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Affiliation(s)
- Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences University of Milan, Milan, Italy; Eye Clinic, IRCCS MultiMedica, Milan, Italy
| | - Marco Lupidi
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy.
| | - Simone Donati
- Department of Medicine and Surgery, University of Insubria of Varese, Varese, Italy
| | - Carlo Astarita
- AbbVie S.r.l., SR 148 Pontina, Campoverde, LT 04011, Italy
| | | | - Elisabetta Pilotto
- Department of Neuroscience-Ophthalmology, University of Padova, Padova, Italy
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Reiter GS, Mares V, Leingang O, Fuchs P, Bogunovic H, Barthelmes D, Schmidt-Erfurth U. Long-term effect of fluid volumes during the maintenance phase in neovascular age-related macular degeneration: results from Fight Retinal Blindness! CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:350-357. [PMID: 37989493 DOI: 10.1016/j.jcjo.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/09/2023] [Accepted: 10/28/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE To investigate the effect of macular fluid volumes (subretinal fluid [SRF], intraretinal fluid [IRF], and pigment epithelium detachment [PED]) after initial treatment on functional and structural outcomes in neovascular age-related macular degeneration in a real-world cohort from Fight Retinal Blindness! METHODS Treatment-naive neovascular age-related macular degeneration patients from Fight Retinal Blindness! (Zürich, Switzerland) were included. Macular fluid on optical coherence tomography was automatically quantified using an approved artificial intelligence algorithm. Follow-up of macular fluid, number of anti-vascular endothelial growth factor treatments, effect of fluid volumes after initial treatment (high, top 25%; low, bottom 75%) on best-corrected visual acuity, and development of macular atrophy and fibrosis was investigated over 48 months. RESULTS A total of 209 eyes (mean age, 78.3 years) were included. Patients with high IRF volumes after initial treatment differed by -2.6 (p = 0.021) and -7.4 letters (p = 0.007) at months 12 and 48, respectively. Eyes with high IRF received significantly more treatments (+1.6 [p < 0.001] and +5.3 [p = 0.002] at months 12 and 48, respectively). Patients with high SRF or PED had comparable best-corrected visual acuity outcomes but received significantly more treatments for SRF (+2.4 [p < 0.001] and +11.4 [p < 0.001] at months 12 and 48, respectively) and PED (+1.2 [p = 0.001] and +7.8 [p < 0.001] at months 12 and 48, respectively). DISCUSSION Patients with high macular fluid after initial treatment are at risk of losing vision that may not be compensable with higher treatment frequency for IRF. Higher treatment frequency for SRF and PED may result in comparable treatment outcomes. Quantification of macular fluid in all compartments is essential to detect eyes at risk of aggressive disease.
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Affiliation(s)
- Gregor S Reiter
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Virginia Mares
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria; Department of Ophthalmology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Oliver Leingang
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Philipp Fuchs
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Hrvoje Bogunovic
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ursula Schmidt-Erfurth
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
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Klose A, Gounani Z, Ijäs H, Lajunen T, Linko V, Laaksonen T. Doxorubicin-loaded DNA origami nanostructures: stability in vitreous and their uptake and toxicity in ocular cells. NANOSCALE 2024; 16:17585-17598. [PMID: 39228361 PMCID: PMC11372452 DOI: 10.1039/d4nr01995d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 08/21/2024] [Indexed: 09/05/2024]
Abstract
Biocompatibility and precise control over their size and shape make DNA origami nanostructures (DONs) promising for drug delivery applications. Whilst many investigations have focused on cancer treatment, this might not be the best fit for DONs that get degraded by nucleases in blood. In comparison, an eye is a uniquely isolated target organ, which could benefit from DONs to achieve and maintain therapeutic concentrations in diseases that threaten the eyesight of millions of patients every year. We investigated the loading of doxorubicin (DOX) as a model drug into three distinct DONs and tested their stability upon storage. Further, we chose one structure (24HB) to probe its stability under physiological conditions in cell media and porcine vitreous, before examining the uptake and effect of DOX-loaded 24HB (24HB-DOX) on the cell viability in a retinal cell line (ARPE-19). Similar to previous reports, the tested low μM loading concentrations of DOX resulted in high drug loadings of up to 34% (m/m), and remained mostly intact in water for at least 2 months at 4 °C. In cell media and porcine vitreous at 37 °C, however, 24HB required additional Mg2+ supplementation to avoid degradation and the loss of the attached fluorophores. With added Mg2+, 24HB remained stable in vitreous for 7 days at 37 °C. The treatment with 24HB-DOX was well tolerated by ARPE-19 cells, compared to the observed higher toxicity of free DOX. Uptake studies revealed, however, that in contrast to free DOX, very little 24HB-DOX was taken up by the cells. Instead, the particles were observed to attach around the cells. Hence, our results suggest that since the uptake seems to be the bottleneck for therapies using DONs, further strategies such as adding ocular targeting moieties are necessary to increase the uptake and efficacy of doxorubicin-loaded DONs.
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Affiliation(s)
- Anna Klose
- Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5, 00790 Helsinki, Finland.
| | - Zahra Gounani
- Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5, 00790 Helsinki, Finland.
| | - Heini Ijäs
- Biohybrid Materials, Department of Bioproducts and Biosystems, Aalto University, P.O. Box 16100, 00076 Aalto, Finland
| | - Tatu Lajunen
- Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5, 00790 Helsinki, Finland.
- School of Pharmacy, University of Eastern Finland, Yliopistonrinne 3, 70210 Kuopio, Finland
| | - Veikko Linko
- Biohybrid Materials, Department of Bioproducts and Biosystems, Aalto University, P.O. Box 16100, 00076 Aalto, Finland
- Institute of Technology, University of Tartu, Nooruse 1, 50411, Tartu, Estonia.
| | - Timo Laaksonen
- Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5, 00790 Helsinki, Finland.
- Chemistry and Advanced Materials, Faculty of Engineering and Natural Sciences, Tampere University, Korkeakoulunkatu 8, 33720 Tampere, Finland
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Lenhof S, Kodjikian L, Gascon P, Gadiollet E, Feldman A, De Bats F, Wolff B, Pradat P, Mathis T. Subretinal fibrosis occurrence according to macular neovascularisation subtypes in neovascular age-related macular degeneration. Acta Ophthalmol 2024. [PMID: 39319643 DOI: 10.1111/aos.16759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 09/14/2024] [Indexed: 09/26/2024]
Abstract
PURPOSE To assess subretinal fibrosis (SF) occurrence in neovascular age-related macular degeneration (nAMD), according to macular neovascularisation (MNV) subtypes. METHODS A Retrospective national multi centre cohort study included eyes with naive nAMD. Main outcome measures were, according to MNV subtypes, cumulative incidence for SF, risk factors, and best corrected visual acuity (BCVA) for 36 months. RESULTS Four hundred and twenty eyes were included. Cumulative incidence of SF was 34.3% at 1 year, 39.0% at 2 years and 50.6% at 3 years. In multivariable analysis, Type 2 and mixed type 1 and 2 MNV were associated (p < 0.001) with a more frequent and rapid development of SF (respectively 85.5% and 81.0% at 1 year, then 95.8% and 93.1% at 3 years) than Types 1 and 3 (respectively 11.3% and 3.6% at 1 year, then 22.9% and 12.7% at 3 years). In Type 2 and mixed type 1 and 2 MNV combined, at baseline a worse BCVA (p = 0.02) and a higher maximal subretinal hyperreflective material (SHRM) thickness (p = 0.005) were associated with SF development at 3 years. In Type 1 MNV, the presence at baseline of intraretinal fluid (IRF) (p = 0.007) or SHRM (p < 0.001) and a higher percentage of visits with IRF (p < 0.001) or with SHRM (p < 0.001) were associated with SF occurrence. For Type 3 MNV, only a higher percentage of visits with SHRM (p = 0.001) was associated with SF. Including all MNV subtypes, eyes with a worse BCVA at baseline were associated with SF development (p < 0.001). Conversely, presence of SF at 3 years was associated with a worse baseline BCVA (p < 0.001). CONCLUSION Occurrence of SF differs when considering apart MNV subtypes.
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Affiliation(s)
- Scott Lenhof
- Ophthalmology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Laurent Kodjikian
- Ophthalmology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
- MATEIS Laboratory, UMR-CNRS 5510, INSA, University of Claude Bernard Lyon 1, Villeurbanne, France
- University of Claude Bernard Lyon 1, Lyon, France
| | - Pierre Gascon
- Ophthalmology Department, Aix-Marseille University, Hôpital Nord, Marseille, France
- Timone Neuroscience Institute, Aix-Marseille University, Marseille, France
| | - Etienne Gadiollet
- Ophthalmology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Audrey Feldman
- LEO Eye Center, Hôpital Privé de l'Est Lyonnais, Saint-Priest, France
| | - Flore De Bats
- Pôle Vision, Clinique du Val d'Ouest, Ecully, France
| | | | - Pierre Pradat
- Clinical Research Center, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Thibaud Mathis
- Ophthalmology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
- MATEIS Laboratory, UMR-CNRS 5510, INSA, University of Claude Bernard Lyon 1, Villeurbanne, France
- University of Claude Bernard Lyon 1, Lyon, France
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Faatz H, Lommatzsch AP. [Age-related macular degeneration - Part 1: Pathophysiology, classification and diagnostic]. Klin Monbl Augenheilkd 2024. [PMID: 39255815 DOI: 10.1055/a-2367-8346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
Age-related macular degeneration (AMD) continues to be the most common hereditary disease among older people in the western world. In addition to the clinical examination, multimodal imaging with fluorescein angiography, optical coherence tomography, fundus autofluorescence and fundus photography are crucial for the correct diagnosis and classification. This is particularly important with regard to risk assessment for the development of a late form of the disease. Since the introduction of intravitreal therapy against vascular endothelial growth factor (VEGF), the treatment options for neovascular AMD have increased significantly and the prognosis for patients in terms of maintaining their vision has improved. The hope is to develop stronger and longer-lasting drugs and also to obtain approval for drugs to treat geographic atrophy. It is therefore of great importance to be able to make a quick and correct diagnosis for patients. In this paper we want to present an overview of the pathophysiology, classification and diagnosis of AMD.
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Sagong M, Kim JH, Woo SJ, Kim YC, Cho H, Lee YH, Byon I, Jo YJ, Chin HS, Kim J, Chae JE, Kang SW. Predictors of Disease Activity After Anti-VEGF Treatment for Neovascular Age-Related Macular Degeneration Using Real-World Data from the PROOF Study. Ophthalmol Ther 2024:10.1007/s40123-024-01021-x. [PMID: 39237835 DOI: 10.1007/s40123-024-01021-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 08/13/2024] [Indexed: 09/07/2024] Open
Abstract
INTRODUCTION The aim of this study was to investigate the predictive factors for persistent disease activity following anti-vascular endothelial growth factors (anti-VEGF) and their long-term effects in patients to be treated for neovascular age-related macular degeneration (nAMD) under real-world conditions. METHODS Retrospective data analysis of the PROOF study, a multi-center real-world retrospective chart review conducted across Korea in patients with nAMD included treatment-naive patients with nAMD who received first anti-VEGF (ranibizumab, bevacizumab, or aflibercept) between January 2017 and March 2019 was performed. All 600 patients (cohort 1) had a minimum follow-up of 12 months of which 453 patients (cohort 2) were followed-up for 24 months from baseline. RESULTS At month 12 after anti-VEGF therapy, 58.10% (95% confidence interval [CI]: 54.09, 62.12) of patients and at month 24, 66.02% of patients continued to have persistent retinal fluid. At both months 12 and 24, predictive factors for persistent disease activity were fibrovascular pigment epithelial detachments (PED) (P = 0.0494) and retinal fluid at month 3 after loading phase (P = 0.0082). The mean changes in visual acuity were + 6.2, + 10.1, and + 13.3 letters and in the central subfield thickness were - 79.1 µm, - 96.3 µm, and - 134.4 µm at 12 months from baseline, in the bevacizumab, aflibercept, and ranibizumab groups, respectively. CONCLUSIONS The presence of retinal fluid after loading phase and fibrovascular PED were predictors of persistent disease activity after at least 1 year of anti-VEGF treatment.
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Affiliation(s)
- Min Sagong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yu Cheol Kim
- Department of Ophthalmology, Keimyung University School of Medicine, Daegu, Korea
| | - Heeyoon Cho
- Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | | | - Iksoo Byon
- Department of Ophthalmology, Pusan National Hospital, Busan, Korea
| | - Young Joon Jo
- Department of Ophthalmology, Chungnam National University Hospital, Daejeon, Korea
| | - Hee Seung Chin
- Department of Ophthalmology, Inha University School of Medicine, Incheon, Korea
| | - Jeonghee Kim
- Clinical Development and Medical Affairs, Novartis Korea, Seoul, Korea
| | | | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Montesel A, Pakeer Muhammed R, Chandak S, Kazantzis D, Thottarath S, Chandra S, Chong V, Burton BJL, Menon G, Pearce I, McKibbin M, Kotagiri A, Talks J, Grabowska A, Ghanchi F, Gale R, Giani A, Yamaguchi TCN, Sivaprasad S. Subretinal transient hyporeflectivity in neovascular age-related macular degeneration and its response to a loading phase of aflibercept: PRECISE report 4. Eye (Lond) 2024; 38:2596-2602. [PMID: 38653751 PMCID: PMC11385578 DOI: 10.1038/s41433-024-03087-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/29/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE To describe the prevalence of subretinal transient hyporeflectivity (STHR) in exudative neovascular age-related macular degeneration (nAMD) and its response to a loading phase of aflibercept. METHODS Optical coherence tomography (OCT) scans of treatment-naïve nAMD patients captured at baseline and after a loading phase of aflibercept were graded for presence of STHR, defined as a small, well-defined, round, subretinal, hyporeflective area, delimited between the ellipsoid zone (EZ) and the retinal pigmented epithelium/Bruch membrane complex. OCT parameters recorded were macular neovascularisation (MNV) subtypes, location of retinal fluids (subretinal fluid, SRF and intraretinal fluid, IRF), central retinal and choroidal thickness. Response was defined as absence of IRF and SRF. Factors associated with completely resolved STHR versus persistent STHR post-loading phase were compared. RESULTS 2039 eyes of 1901 patients were analysed. STHR was observed in 79 eyes of 78 patients, with an estimated prevalence of 3.87% (95% CI 3.08-4.81%). STHR were seen in 44 type 1 MNV (56%), 27 with type 2 (34%), and 8 with type 3 (10%). At baseline, a total of 303 STHR were present, ranging between 1-22 per eye. The total number of STHR reduced significantly after the loading phase to 173 (p = 0.002). Complete disappearance of STHR was seen in 44 eyes (56%) and persistent STHR in the rest (44%). CONCLUSIONS STHR may represent a marker of low-grade exudation in nAMD eyes with good response to a loading phase of aflibercept. However, its potential role as an independent nAMD activity biomarker is limited as most resolve after the loading phase.
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Affiliation(s)
- Andrea Montesel
- NIHR Moorfields Biomedical Research Centre and Clinical Research Facility, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Raheeba Pakeer Muhammed
- NIHR Moorfields Biomedical Research Centre and Clinical Research Facility, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Swati Chandak
- NIHR Moorfields Biomedical Research Centre and Clinical Research Facility, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Dimitrios Kazantzis
- NIHR Moorfields Biomedical Research Centre and Clinical Research Facility, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Sridevi Thottarath
- NIHR Moorfields Biomedical Research Centre and Clinical Research Facility, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Shruti Chandra
- NIHR Moorfields Biomedical Research Centre and Clinical Research Facility, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Victor Chong
- Institute of Ophthalmology, University College London, London, UK
| | | | - Geeta Menon
- Frimley Health NHS Foundation Trust, Surrey, UK
| | - Ian Pearce
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Ajay Kotagiri
- South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - James Talks
- Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | - Anna Grabowska
- King's College Hospital NHS Foundation Trust, London, UK
| | - Faruque Ghanchi
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Richard Gale
- York Teaching Hospital NHS Foundation Trust, York, UK
| | | | | | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre and Clinical Research Facility, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
- Institute of Ophthalmology, University College London, London, UK.
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Song JS, Kim MS, Joo K, Park SJ, Woo SJ, Park KH. INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENT IN PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION AND POOR VISUAL ACUITY. Retina 2024; 44:1486-1494. [PMID: 39167570 DOI: 10.1097/iae.0000000000004154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
PURPOSE To investigate the significance of intravitreal anti-vascular endothelial growth factor treatment in patients with neovascular age-related macular degeneration and poor visual acuity. METHODS Retrospective study of patients with neovascular age-related macular degeneration with baseline best-corrected visual acuity of ≤20/200. Patients were divided into regular treatment and scarce treatment groups according to whether they underwent consecutive intravitreal anti-vascular endothelial growth factor treatments at intervals of ≤4 months or not. RESULTS A total of 131 eyes were included: 87 and 44 eyes in the regular treatment and scarce treatment groups, respectively. The regular treatment group showed significantly improved preservation of lesion size at both Years 1 and 2, with significantly fewer incidences of new subretinal hemorrhage. Improvements in visual acuity, reduction in central subfield macular thickness, and maximal height of choroidal neovascularization were significantly favorable in the regular treatment group at Year 1, and central subfield macular thickness was significantly decreased at Year 2. Survival analysis revealed that the regular treatment group had significantly greater preservation of visual acuity and lesion size than that in the scarce treatment group. CONCLUSION Maintaining intravitreal anti-vascular endothelial growth factor treatment for patients with neovascular age-related macular degeneration and poor vision showed significant advantages in visual acuity and lesion size stability and reduced the incidence of new subretinal hemorrhage, which suggests preservation of paracentral vision.
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Affiliation(s)
- Jae Shin Song
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Ophthalmology, Armed Forces Capital Hospital, Seongnam, Korea ; and
| | - Min Seok Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kwangsic Joo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
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Nihei A, Yamamoto M, Hirayama K, Kyo A, Misawa N, Kohno T, Honda S. The impact of removing the epiretinal membrane and inner limiting membrane for sustained subretinal fluid by macular neovascularization refractory to anti-VEGF therapy. Am J Ophthalmol Case Rep 2024; 35:102078. [PMID: 38846070 PMCID: PMC11154113 DOI: 10.1016/j.ajoc.2024.102078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/09/2024] [Accepted: 04/26/2024] [Indexed: 06/09/2024] Open
Abstract
Purpose Anti-vascular endothelial growth factor (VEGF) therapy is the most prevalent intervention for exudative lesions secondary to neovascular age-related macular degeneration (nAMD) and other macular neovascularization (MNV). However, in some cases refractory to the latest anti-VEGF agents is associated with epiretinal membrane (ERM) or vitreomacular traction. We applied a vitrectomy to remove those pathologies which may be effective for reducing the exudation. Observations In this case report, we present 2 cases with sustained subretinal fluid and macular neovascularization secondary to nAMD or dome-shaped macula that poorly responded to anti-VEGF therapy. In both cases, removing thin ERM or vitreomacular traction with an inner limiting membrane peeling promptly resolved the subretinal fluid and no recurrence was observed thereafter. Conclusions and importance Vitrectomy could be an effective modality for anti-VEGF drug-resistant MNV cases with vitreomacular traction or ERM even in the anti-VEGF era.
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Affiliation(s)
- Aki Nihei
- Department of Ophthalmology and Visual Sciences, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Manabu Yamamoto
- Department of Ophthalmology and Visual Sciences, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kumiko Hirayama
- Department of Ophthalmology and Visual Sciences, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Akika Kyo
- Department of Ophthalmology and Visual Sciences, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Norihiko Misawa
- Department of Ophthalmology and Visual Sciences, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Takeya Kohno
- Department of Ophthalmology and Visual Sciences, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Honda
- Department of Ophthalmology and Visual Sciences, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Lee MY, Han K, Min KH, Yu DS, Lee YB. Psoriasis as a Predictor of Neovascular Age-Related Macular Degeneration in Type 2 Diabetes Mellitus: A Nationwide Cohort Study. Am J Ophthalmol 2024; 269:236-245. [PMID: 39218384 DOI: 10.1016/j.ajo.2024.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 08/23/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE The objective of this study is to evaluate the relationship of psoriasis and neovascular age-related macular degeneration (nAMD) in a population with diabetic mellitus (DM). DESIGN Nationwide, population-based, retrospective cohort study. METHODS Records of patients over 40 years of age who had been diagnosed with type 2 diabetes mellitus from January 2009 to December 2012 were analyzed. The incidence of nAMD was observed from the index year to December 2018 in all subjects. The incidence rate of nAMD was compared between the psoriasis group and control group. Covariates include age, sex, body mass index, income level, smoking status, drinking status, regular exercise habits, hypertension, dyslipidemia, end-stage renal disease, diabetic retinopathy, glucose level, prescription of more than 3 oral hypoglycemic agents, and a history of diabetes mellitus exceeding 5 years. RESULTS Of 2,245,358 patients with type 2 DM, 20,853 patients were classified in the psoriasis group and the other 2,224,505 in the control group. A total of 105 nAMD cases were observed in the psoriasis group and 7459 cases in the control group. According to multivariable Cox proportional hazard models, individuals with psoriasis had a significantly higher risk for nAMD compared to controls (hazard ratio = 1.329, 95% CI = 1.096-1.612) after adjustments for covariates. CONCLUSIONS This study demonstrated that psoriasis was an independent risk factor for developing nAMD in DM patients. Therefore, physicians should be alert to the development of nAMD in DM patients who also have psoriasis.
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Affiliation(s)
- Mee Yon Lee
- From the Department of Ophthalmology (M.Y.L.), College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science (K.H.), College of Natural Sciences, Soongsil University, Republic of Korea
| | - Kyung Hyun Min
- Department of Dermatology (K.H.M., D.S.Y., Y.B.L.), College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Dong Soo Yu
- Department of Dermatology (K.H.M., D.S.Y., Y.B.L.), College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Young Bok Lee
- Department of Dermatology (K.H.M., D.S.Y., Y.B.L.), College of Medicine, The Catholic University of Korea, Republic of Korea.
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Downey L, Sivaprasad S, Chhabra R, Bailey C, Chakrabarti S, Elsherbiny S, Patel J, Silvestri G, Watson SL, Williams G, Parker A, Khokhar S, Lotery A. Dual pathway inhibition with faricimab for previously treated neovascular age-related macular degeneration and diabetic macular oedema: guidance from a UK panel of retina specialists. Eye (Lond) 2024:10.1038/s41433-024-03223-w. [PMID: 39215141 DOI: 10.1038/s41433-024-03223-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/16/2024] [Accepted: 07/03/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND/OBJECTIVES Some eyes with neovascular age-related macular degeneration (nAMD) and centre-involving diabetic macular oedema (DMO) fail to respond sufficiently or lose response over time to standard of care intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy. This paper explores clinical scenarios for switching to dual action angiopoietin-2 (Ang-2)/VEGF-A inhibitor faricimab (Vabysmo, Roche Products Limited) in previously anti-VEGF-treated patients. METHODS A national steering group meeting of UK retina specialists was held in London on 27 October 2023. Clinician practice and experience were reviewed together with pivotal clinical trial data and early findings from real-world settings. Roche Products Limited facilitated and funded the meeting. RESULTS While there is no standardised protocol for identifying suboptimal response, the authors review relevant clinical biomarkers of disease activity used in routine clinical practice to determine patient response and guide treatment decisions. Common reasons identified for considering a change of treatment were lack of efficacy demonstrated by suboptimal anatomic or visual improvement and insufficient durability of response. The panel outline strategies for switching to faricimab among eligible patients with a prior anti-VEGF treatment history, with initial monthly loading doses or maintaining the previous treatment interval before attempting to extend, that may be integrated into current treat-and-extend (T&E) clinical pathways for treating patients with nAMD and DMO. General considerations for switching between treatments are also reviewed. CONCLUSION Clinicians may consider a treatment switch to faricimab in nAMD and DMO patients who have suboptimal disease control or insufficient durability of response on initial anti-VEGF therapy.
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Affiliation(s)
- Louise Downey
- Hull University Teaching Hospitals NHS Trust, Hull, UK.
| | - Sobha Sivaprasad
- NIHR Moorfields Clinical Research Facility, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Ramandeep Chhabra
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust and Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Clare Bailey
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | | | - Jignesh Patel
- Colchester District General Hospital, Colchester, UK
| | | | | | - Gwyn Williams
- Swansea Bay University Health Board, Singleton Hospital, Swansea, UK
| | | | | | - Andrew Lotery
- Southampton Eye Unit and Faculty of Medicine, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
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13
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Schranz M, Bogunovic H, Deak G, Sadeghipour A, Reiter GS, Schmidt-Erfurth U. Linking disease activity with optical coherence tomography angiography in neovascular age related macular degeneration using artificial intelligence. Sci Rep 2024; 14:19278. [PMID: 39164449 PMCID: PMC11336074 DOI: 10.1038/s41598-024-70234-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 08/14/2024] [Indexed: 08/22/2024] Open
Abstract
To investigate quantitative associations between AI-assessed disease activity and optical coherence tomography angiography (OCTA)-derived parameters in patients with neovascular age-related macular degeneration (nAMD) undergoing anti-VEGF therapy. OCTA and SD-OCT images obtained from multicenter, randomized study data were evaluated. A deep learning algorithm (RetInSight) was used to detect and quantify macular fluid on SD-OCT. Mixed effects models were applied to evaluate correlations between fluid volumes, macular neovascularization (MNV)-type and OCTA-derived MNV parameters; lesion size (LS) and vessel area (NVA). 230 patients were included. A significant positive correlation was observed between SRF and NVA (estimate = 199.8 nl/mm2, p = 0.023), while a non-significant but negative correlation was found between SRF and LS (estimate = - 71.3 nl/mm2, p = 0.126). The presence of Type I and Type II MNV was associated with significantly less intraretinal fluid (IRF) compared to Type III MNV (estimate type I:- 52.1 nl, p = 0.019; estimate type II:- 51.7 nl, p = 0.021). A significant correlation was observed between pigment epithelial detachment (PED) and the interaction between NVA and LS (estimate:28.97 nl/mm2; p = 0.012). Residual IRF at week 12 significantly correlated to baseline NVA (estimate:38.1 nl/mm2; p = 0.015) and LS (estimate:- 22.6 nl/mm2; p = 0.012). Fluid in different compartments demonstrated disparate associations with MNV OCTA features. While IRF at baseline was most pronounced in type III MNV, residual IRF was driven by neovascular MNV characteristics. Greater NVA in proportion to LS was associated with higher amounts of SRF and PED. The correlation between these parameters may represent MNV maturation and can be used as a biomarker for resolution of disease activity. AI-based OCT analysis allows for a deeper understanding of neovascular disease in AMD and the potential to adjust therapeutic strategies to optimize outcomes through precision medicine.
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Affiliation(s)
- Markus Schranz
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Hrvoje Bogunovic
- Laboratory for Ophthalmic Image Analysis (OPTIMA), Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Gabor Deak
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Ophthalmology and Optometry, Vienna Reading Center (VRC), Medical University of Vienna, Vienna, Austria
| | | | - Gregor Sebastian Reiter
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Laboratory for Ophthalmic Image Analysis (OPTIMA), Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Laboratory for Ophthalmic Image Analysis (OPTIMA), Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
- Department of Ophthalmology and Optometry, Vienna Reading Center (VRC), Medical University of Vienna, Vienna, Austria.
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14
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Owusu-Afriyie B, Peter N, Ivihi F, Kopil I, Gende T. Barriers to the uptake of eye care services: A cross-sectional survey from rural and urban communities. PLoS One 2024; 19:e0308294. [PMID: 39146331 PMCID: PMC11326634 DOI: 10.1371/journal.pone.0308294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/20/2024] [Indexed: 08/17/2024] Open
Abstract
PURPOSE To explore the barriers to the uptake of eye care services in urban and rural communities in Papua New Guinea. METHODS This was a population-based cross-sectional descriptive study and involved multi-stage sampling. Communities were randomly selected from each of the three clusters of Madang District for free eye care outreaches from June to September 2022. A structured questionnaire was used to collect data from the outreach patients. The study excluded attendees who refused to consent. Responses were rated from 1 (not a barrier) to 10 (a very strong barrier). The p-value significance was set at ≤ 0.05. RESULTS The majority of the 972 participants (60.2%) were from rural communities. The mean age of participants was 40.82 ± 13.14 years. Almost two-thirds of the participants (61.4%) never had an eye examination before this study was conducted. All the participants reported that time constraint, insufficient income, good vision in the fellow eye, not considering their eye conditions as serious issues and cultural beliefs were personal barriers to accessing eye care services. Provider-related challenges included long waiting periods at eye clinics and fear of procedure complications. There were differences in barriers with respect to the participants' demographic clusters. CONCLUSION There are major personal- and service-related barriers to eye care services in Madang. These barriers could be overcome through strategic human resource development, health education, school screening programs, and establishing eye care centres in the communities to improve the uptake of eye care services in Madang and more widely across the country.
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Affiliation(s)
- Bismark Owusu-Afriyie
- Faculty of Medicine and Health Sciences, Divine Word University, Madang, Papua New Guinea
- The Fred Hollows Foundation NZ, Auckland, New Zealand
| | - Nancy Peter
- Faculty of Medicine and Health Sciences, Divine Word University, Madang, Papua New Guinea
| | - Felix Ivihi
- Faculty of Medicine and Health Sciences, Divine Word University, Madang, Papua New Guinea
| | - Issac Kopil
- Faculty of Medicine and Health Sciences, Divine Word University, Madang, Papua New Guinea
| | - Theresa Gende
- Faculty of Medicine and Health Sciences, Divine Word University, Madang, Papua New Guinea
- The Fred Hollows Foundation NZ, Auckland, New Zealand
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Karkhaneh R, Faghihi H, Riazi-Esfahani H, Abrishami M, Bazvand F, Ebrahimiadib N, Johari M, Akhlaghi M, Shoeibi N, Norouzzadeh MH, Ansari Astaneh MR, Khojasteh H, Imani Fooladi M, Khodabande A, Ghassemi F, Khalili Pour E, Zarei M, Mirshahi A, Fazel F, Ashraf H, Hosseini SM, Dourandeesh M, Feghhi M, Alizadeh Y, Behboudi H, Azadi P, Sabzvari A, Kafi H, Ghasemi Falavarjani K. Evaluating the Efficacy and Safety of Aflibercept Biosimilar (P041) Compared with Originator Product in Patients with Neovascular Age-Related Macular Degeneration. Ophthalmol Retina 2024; 8:744-753. [PMID: 38428459 DOI: 10.1016/j.oret.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/21/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE To assess the noninferiority of biosimilar aflibercept (P041, CinnaGen) to the originator aflibercept (AFL, Regeneron) in terms of efficacy, safety, and immunogenicity. DESIGN This was a phase Ш, 52-week, multicenter, randomized, double-masked, and active control trial involving eyes in a 1:1 ratio. SUBJECTS Patients with active subfoveal choroidal neovascularization secondary to age-related macular degeneration randomized into the 2 groups of P041 and AFL. METHODS Patients received an injection of aflibercept every 4 weeks for 3 doses, followed by administration every 8 weeks up to week 48. MAIN OUTCOME MEASURES The primary outcome was the noninferiority analysis of eyes maintaining vision at week 52. Secondary outcomes included the changes in visual acuity and retinal thickness, safety evaluation, and immunogenicity during the study. RESULTS In total, 168 eyes of 168 patients were included. At week 52, the proportion of patients maintaining vision was 94.44% in the P041 group compared with 94.52% in the AFL group. The 95% confidence interval (CI) for the difference of maintaining vision from baseline did not exceed the predefined noninferiority margin of 10% (difference, -0.0008; 95% CI, -0.074 to 0.074; P = 0.98). Secondary outcomes indicated similar results in both arms (all P > 0.05). Safety measured outcomes and immunogenicity were similar between the 2 study groups. CONCLUSIONS Biosimilar aflibercept was noninferior to AFL in eyes with neovascular age-related macular degeneration. Other efficacy and safety findings also indicated the similarity of 2 products. FINANCIAL DISCLOSURES Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Reza Karkhaneh
- Eye Research Centre, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hooshang Faghihi
- Eye Research Centre, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Riazi-Esfahani
- Eye Research Centre, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Abrishami
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Bazvand
- Eye Research Centre, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazanin Ebrahimiadib
- Department of Ophthalmology, Eye Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadkarim Johari
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadreza Akhlaghi
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasser Shoeibi
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | | | - Hassan Khojasteh
- Eye Research Centre, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Imani Fooladi
- Eye Research Centre, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Khodabande
- Eye Research Centre, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Ghassemi
- Eye Research Centre, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elias Khalili Pour
- Eye Research Centre, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Zarei
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Mirshahi
- Eye Research Centre, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Fazel
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Ashraf
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Maryam Dourandeesh
- Eye Research Center, Department of Eye, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mostafa Feghhi
- Department of Ophthalmology, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Yousef Alizadeh
- Department of Ophthalmology, Eye Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Hassan Behboudi
- Eye Research Center, Department of Eye, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Pejvak Azadi
- Eye Research Center, Emam khomeini Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Araz Sabzvari
- CinnaGen Medical Biotechnology Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Hamidreza Kafi
- Medical Department, Orchid Pharmed Company, Tehran, Iran
| | - Khalil Ghasemi Falavarjani
- Eye Research Center, The Five Senses Health Institute, Rassoul Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran.
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16
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Lee Y, Zalewski D, Oleksy P, Wylęgała E, Orski M, Lee J, Kim S. Usability of the SB11 Pre-filled Syringe (PFS) in Patients with Retinal Diseases. Adv Ther 2024; 41:3426-3436. [PMID: 38976126 PMCID: PMC11263415 DOI: 10.1007/s12325-024-02937-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 06/21/2024] [Indexed: 07/09/2024]
Abstract
INTRODUCTION SB11 (Byooviz™; Samsung Bioepis Co., Ltd.) is a ranibizumab (Lucentis®; Genentech, Inc.) biosimilar targeting vascular endothelial growth factor A for the treatment of retinal diseases. The pre-filled syringe (PFS) presentation of SB11 offers an alternative administration method to the vial, with the potential for enhanced safety and efficient syringe preparation. The objective of this study was to assess the ability of healthcare professionals (HCPs) to follow the instructions for use to prepare and administer SB11 PFS intravitreal (IVT) injections to patients with neovascular age-related macular degeneration (nAMD) or macular edema secondary to retinal vein occlusion (RVO). METHODS This study was an open-label, single-arm, single-dose clinical study to evaluate the usability of the SB11 PFS in patients with nAMD or macular edema secondary to RVO. Four HCPs prepared and administered 0.5 mg SB11 PFS IVT injections to 34 patients. Product use task completion (12 tasks in total) was assessed by independent observers. Safety was assessed up to 7 days after injection of the investigational product. RESULTS A total of 34 patients were enrolled and completed the study. All 12 tasks were successfully completed in 34 (100%) patients without a use-related failure. Most patients (32 patients, 94.1%) experienced no adverse events (AEs), whereas 2 (5.9%) patients experienced three treatment-emergent AEs (TEAEs) which were mild to moderate in severity. There were no severe or serious TEAEs reported during the study. CONCLUSIONS This study showed that HCPs were able to successfully prepare and administer the SB11 PFS via IVT injection. No unexpected safety issues were identified. The SB11 PFS is a promising alternative for therapeutic administration of SB11 in patients with retinal disease. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT06176963; EudraCT number 2021-003566-12.
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Affiliation(s)
- Yujin Lee
- Samsung Bioepis Co., Ltd., 76, Songdogyoyuk-ro, Yeonsu-gu, Incheon, 21987, Republic of Korea.
| | - Dominik Zalewski
- Diagnostic and Microsurgery Center of the Eye LENS, Olsztyn, Poland
| | - Piotr Oleksy
- Department of Ophthalmology, Centrum Medyczne Dietla 19 Sp zoo, Krakow, Poland
| | - Edward Wylęgała
- Department of Ophthalmology, District Railway Hospital in Katowice, Medical University of Silesia, Katowice, Poland
| | - Michał Orski
- Department of Ophthalmology, Rydygier Memorial Hospital, Krakow, Poland
| | - Jiwon Lee
- Samsung Bioepis Co., Ltd., 76, Songdogyoyuk-ro, Yeonsu-gu, Incheon, 21987, Republic of Korea
| | - Sunji Kim
- Samsung Bioepis Co., Ltd., 76, Songdogyoyuk-ro, Yeonsu-gu, Incheon, 21987, Republic of Korea
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17
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Zur D, Guymer R, Korobelnik JF, Wu L, Viola F, Eter N, Baillif S, Chen Y, Arnold JJ. Impact of residual retinal fluid on treatment outcomes in neovascular age-related macular degeneration. Br J Ophthalmol 2024:bjo-2024-325640. [PMID: 39033013 DOI: 10.1136/bjo-2024-325640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/30/2024] [Indexed: 07/23/2024]
Abstract
Treatment decisions for neovascular age-related macular degeneration (nAMD) in the setting of individualised treatment regimens are adapted to disease activity. The main marker of disease activity and trigger for re-treatment with anti-vascular endothelial growth factor (anti-VEGF) agents is the presence of retinal fluid on optical coherence tomography (OCT). Recently, attention has focused on the impact of residual retinal fluid on nAMD management. Based on a literature review and the combined clinical experience of an international group of retinal specialists, this manuscript provides expert guidance on the treatment of nAMD according to fluid status and proposes an algorithm for determining when to administer anti-VEGF treatment according to residual fluid status. We explore the role of residual fluid in treatment decisions and outcomes in nAMD, taking into consideration fluid evaluation and, in particular, distinguishing between fluid in different anatomic compartments and at different stages during the treatment course. Current limitations to identifying and interpreting fluid on OCT, and the assumption that any residual retinal fluid reflects ongoing VEGF activity, are discussed.
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Affiliation(s)
- Dinah Zur
- Faculty of Medical and Health Sciences, Ophthalmology Division, Tel Aviv University, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Robyn Guymer
- Royal Victorian Eye and Ear Hospital, University of Melbourne, Centre for Eye Research Australia, Melbourne, Victoria, Australia
| | - Jean-François Korobelnik
- Service d'ophtalmologie, CHU Bordeaux, Bordeaux, France
- Inserm, Bordeaux Population Health Research Center, Team LEHA, UMR 1219, F-33000, Université de Bordeaux, Bordeaux, France
| | - Lihteh Wu
- Macula, Vitreous and Retina Associates of Costa Rica, San José, Costa Rica
| | - Francesco Viola
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
- Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicole Eter
- Department of Ophthalmology, University of Münster Medical Center, Münster, Germany
| | - Stéphanie Baillif
- Department of Ophthalmology, Pasteur 2 Hospital, Nice Cote d'Azur University, Nice, France
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
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Ehlers JP, Lunasco LM, Yordi S, Cetin H, Le TK, Sarici K, Kaiser PK, Khanani AM, Talcott KE, Hu J, Meng X, Srivastava SK. Compartmental Exudative Dynamics in Neovascular Age-Related Macular Degeneration: Volumetric Outcomes and Impact of Volatility in a Phase III Clinical Trial. Ophthalmol Retina 2024; 8:765-777. [PMID: 38403242 DOI: 10.1016/j.oret.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 02/12/2024] [Accepted: 02/20/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE To examine retinal feature dynamics in eyes with neovascular age-related macular degeneration (nAMD) treated with anti-VEGF therapy and the relationship of these features with visual acuity. DESIGN Post hoc analysis of the phase III, randomized, HAWK nAMD clinical trial. PARTICIPANTS Participants randomized to the brolucizumab 6 mg or aflibercept 2 mg arms of the trial. METHODS Spectral-domain OCT scans collected at 4-week intervals were analyzed using an automated machine learning-enhanced segmentation and feature-extraction platform with manual verification. Quantitative volumetric measures of retinal and exudative features were exported at multiple timepoints over 48 weeks. Volatility of exudative features was calculated as the standard deviation of each feature value during the maintenance phase (week 12-48) of treatment. These features were examined for their associations with anatomic and functional outcomes. MAIN OUTCOME MEASURES Longitudinal intraretinal fluid (IRF) and subretinal fluid (SRF) volume, subretinal hyperreflective material (SHRM) volume, ellipsoid zone (EZ) integrity (EZ-retinal pigment epithelium [RPE] volume/thickness), and correlation with best-corrected visual acuity (BCVA). RESULTS Intraretinal fluid, SRF, and SHRM demonstrated significant volumetric reduction from baseline with anti-VEGF therapy (P < 0.001 at each timepoint). Ellipsoid zone integrity measures demonstrated significant improvement from baseline (P < 0.001 at each timepoint). Both EZ integrity and SHRM measures correlated significantly with BCVA at all timepoints (EZ-RPE volume: 0.38 ≤ r ≤ 0.47; EZ-RPE central subfield thickness: 0.22 ≤ r ≤ 0.41; SHRM volume: -0.33 ≤ r ≤ -0.44). After treatment initiation, correlations of IRF and SRF volume with BCVA were weak or nonsignificant. Eyes with lower volatility of IRF, SRF, and SHRM volumes during the maintenance phase showed greater improvements in EZ integrity (all P < 0.01) and greater gains in BCVA (all P < 0.01) at week 48 compared with eyes with higher volatility in those exudative parameters. CONCLUSIONS Quantitative measures of SHRM volume and EZ integrity correlated more strongly with BCVA than retinal fluid volumes during treatment. High volatility of exudative parameters, including SRF, during the maintenance phase of treatment was associated with loss of EZ integrity and BCVA. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Justis P Ehlers
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Leina M Lunasco
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sari Yordi
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hasan Cetin
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Thuy K Le
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kubra Sarici
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Arshad M Khanani
- Sierra Eye Associates, Reno, Nevada; University of Nevada, Reno School of Medicine, Reno, Nevada
| | - Katherine E Talcott
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joanne Hu
- Novartis Pharmaceuticals, East Hanover, New Jersey
| | - Xiangyi Meng
- Novartis Pharmaceuticals, East Hanover, New Jersey
| | - Sunil K Srivastava
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
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19
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Wu KY, Gao A, Giunta M, Tran SD. What's New in Ocular Drug Delivery: Advances in Suprachoroidal Injection since 2023. Pharmaceuticals (Basel) 2024; 17:1007. [PMID: 39204112 PMCID: PMC11357265 DOI: 10.3390/ph17081007] [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: 06/14/2024] [Revised: 07/22/2024] [Accepted: 07/25/2024] [Indexed: 09/03/2024] Open
Abstract
Despite significant advancements in ocular drug delivery, challenges persist in treating posterior segment diseases like macular edema (ME) and age-related macular degeneration (AMD). Suprachoroidal (SC) injections are a promising new method for targeted drug delivery to the posterior segment of the eye, providing direct access to the choroid and retina while minimizing systemic exposure and side effects. This review examines the anatomical and physiological foundations of the SC space; evaluates delivery devices such as microcatheters, hypodermic needles, and microneedles; and discusses pharmacokinetic principles. Additionally, advancements in gene delivery through SC injections are explored, emphasizing their potential to transform ocular disease management. This review also highlights clinical applications in treating macular edema, diabetic macular edema, age-related macular degeneration, choroidal melanoma, and glaucoma. Overall, SC injections are emerging as a promising novel route for administering ophthalmic treatments, with high bioavailability, reduced systemic exposure, and favorable safety profiles. Key therapeutic agents such as triamcinolone acetonide, dexamethasone, AAV-based gene therapy, and axitinib have shown promise. The field of suprachoroidal injection is progressing rapidly, and this review article, while attempting to encapsulate most of the published preclinical and clinical studies, mainly focuses on those that are published within 2023 and 2024.
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Affiliation(s)
- Kevin Y. Wu
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada; (K.Y.W.)
| | - Angel Gao
- Faculty of Medicine, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Michel Giunta
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada; (K.Y.W.)
| | - Simon D. Tran
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC H3A 1G1, Canada
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20
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Yang J, Lewis GP, Hsiang CH, Menges S, Luna G, Cho W, Turovets N, Fisher SK, Klassen H. Amelioration of Photoreceptor Degeneration by Intravitreal Transplantation of Retinal Progenitor Cells in Rats. Int J Mol Sci 2024; 25:8060. [PMID: 39125629 PMCID: PMC11312009 DOI: 10.3390/ijms25158060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
Photoreceptor degeneration is a major cause of untreatable blindness worldwide and has recently been targeted by emerging technologies, including cell- and gene-based therapies. Cell types of neural lineage have shown promise for replacing either photoreceptors or retinal pigment epithelial cells following delivery to the subretinal space, while cells of bone marrow lineage have been tested for retinal trophic effects following delivery to the vitreous cavity. Here we explore an alternate approach in which cells from the immature neural retinal are delivered to the vitreous cavity with the goal of providing trophic support for degenerating photoreceptors. Rat and human retinal progenitor cells were transplanted to the vitreous of rats with a well-studied photoreceptor dystrophy, resulting in substantial anatomical preservation and functional rescue of vision. This work provides scientific proof-of-principle for a novel therapeutic approach to photoreceptor degeneration that is currently being evaluated in clinical trials.
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Affiliation(s)
- Jing Yang
- Gavin Herbert Eye Institute, Sue & Bill Gross Stem Cell Research Center, University of California, Irvine, CA 92697, USA
| | - Geoffrey P. Lewis
- Neuroscience Research Institute, University of California, Santa Barbara, CA 93106, USA
| | - Chin-Hui Hsiang
- Gavin Herbert Eye Institute, Sue & Bill Gross Stem Cell Research Center, University of California, Irvine, CA 92697, USA
| | - Steven Menges
- Gavin Herbert Eye Institute, Sue & Bill Gross Stem Cell Research Center, University of California, Irvine, CA 92697, USA
| | - Gabriel Luna
- Neuroscience Research Institute, University of California, Santa Barbara, CA 93106, USA
| | - William Cho
- Gavin Herbert Eye Institute, Sue & Bill Gross Stem Cell Research Center, University of California, Irvine, CA 92697, USA
| | - Nikolay Turovets
- Gavin Herbert Eye Institute, Sue & Bill Gross Stem Cell Research Center, University of California, Irvine, CA 92697, USA
| | - Steven K. Fisher
- Neuroscience Research Institute, University of California, Santa Barbara, CA 93106, USA
| | - Henry Klassen
- Gavin Herbert Eye Institute, Sue & Bill Gross Stem Cell Research Center, University of California, Irvine, CA 92697, USA
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21
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Guymer RH, Silva R, Ghadessi M, Leal S, Gashaw I, Damask A, Paulding C, Rittenhouse KD. ANO2 Genetic Variants and Anti-VEGF Treatment Response in Neovascular AMD: A Pharmacogenetic Substudy of VIEW 1 and VIEW 2. Invest Ophthalmol Vis Sci 2024; 65:17. [PMID: 38980270 PMCID: PMC11244643 DOI: 10.1167/iovs.65.8.17] [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: 07/10/2024] Open
Abstract
Purpose This analysis investigated potential associations between gene variants and clinical end points in the VIEW 1 and 2 randomized clinical trials of intravitreal aflibercept and ranibizumab in neovascular age-related macular degeneration (AMD). Methods A genome-wide association analysis was conducted in a subgroup of patients from VIEW 1 and 2 consenting to the optional pharmacogenetic analysis. Results Data were pooled from 780 samples from patients representative of the overall VIEW 1 and 2 populations. After Bonferroni correction for multiplicity and statistical adjustment for baseline risk factors, no significant associations were found between previously identified prognostic AMD gene variants and treatment response according to key prespecified VIEW 1 and 2 end points. Genome-wide, there were no significant genetic associations in patients experiencing gains of ≥15 Early Treatment of Diabetic Retinopathy Study letters after 1 or 2 years of treatment. A cluster of variants in ANO2 (encoding anoctamin 2, a calcium-activated chloride channel expressed on photoreceptor cells) on chromosome 12 reached the level of significance for loss of ≥5 letters after 1 year of treatment (P < 5 × 10-8), with the ANO2 rs2110166 SNP demonstrating highly significant association (P = 1.99 × 10-8). Carriers of the ANO2 rs2110166 TT genotype showed a robust increase in visual acuity versus baseline compared with a small decrease in those with the TC genotype. Conclusions None of the potential prognostic candidate genes were associated with the clinical end points for treated patients. Preliminary analyses suggest an association of ANO2 with retinal function, with a potential impact on vision of approximately one line over at least the first year. Further investigation of the function of ANO2 in retinal pathophysiology is merited.
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Affiliation(s)
- Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- The University of Melbourne, Melbourne, Australia
| | - Rufino Silva
- Faculty of Medicine, University of Coimbra (FMUC-UC), Coimbra, Portugal
- Unidade Local de Saude de Coimbra (ULS-Coimbra), Coimbra, Portugal
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
- Clinical and Academic Centre of Coimbra (CACC), Coimbra, Portugal
| | | | | | | | - Amy Damask
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, United States
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22
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Salehi MA, Frounchi N, Zakavi SS, Mohammadi S, Harandi H, Shojaei S, Gouravani M, Fernando Arevalo J. Retinal and choroidal changes after anti-VEGF therapy in neovascular-AMD patients: A systematic review and meta-analysis of SD-OCT studies. Surv Ophthalmol 2024; 69:547-557. [PMID: 38641181 DOI: 10.1016/j.survophthal.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND In recent years, the progress made in the field of optical coherence tomography has helped to understand the changes in eye layers in patients with exudative age-related macular degeneration (nAMD). Early diagnosis of nAMD, a leading cause of irreversible vision impairment, is helpful. Therefore, we performed a meta-analysis on OCT measurement alterations before and after anti-VEGF therapy in patients with nAMD and controls. METHOD We systematically searched Scopus, PubMed, Cochrane, and Web of Science to find articles that measured choroidal and retinal layer changes after anti-VEGF therapy in nAMD Patients. We chose either a fixed-effects or random-effects model based on the assessed heterogeneity level to perform a meta-analysis. In addition, we conducted meta-regression, subgroup analyses, publication bias, and quality assessment for included studies. RESULTS Thirteen studies were included in the meta-analysis, with 733 total participants. Foveal thickness and subfoveal choroidal thickness (CT) decreased significantly in the first 3 years after injections, except for subfoveal CT in the third year after injection. It also showed that CT at 1500 µm temporal and nasal to the fovea did not significantly change. CONCLUSION Our results showed anti-VEGF treatment for nAMD patients was associated with a significant reduction in foveal thickness and subfoveal CT in the first 2 years after treatment. Our analysis did not reveal any correlation between changes in foveal thickness and subfoveal CT with best-corrected visual acuity or other factors.
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Affiliation(s)
| | - Negin Frounchi
- Kidney Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Sina Zakavi
- Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Soheil Mohammadi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Harandi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Shayan Shojaei
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Gouravani
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - J Fernando Arevalo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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23
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Abraldes MJ, Calvo P, Gámez Lechuga M, Merino M, Martín Lorenzo T, Maravilla-Herrera P, Gil Jiménez B, Ruiz-Moreno JM. Burden of Disease Study of Patients with Neovascular Age-Related Macular Degeneration in Spain. Ophthalmol Ther 2024; 13:1925-1935. [PMID: 38771461 PMCID: PMC11178696 DOI: 10.1007/s40123-024-00960-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/25/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION Neovascular age-related macular degeneration (nAMD) is a progressive retinal disease that causes severe and irreversible vision loss. The disease can therefore have a significant impact on the life of patients' and their families. The aim of this study was to evaluate the socio-economic burden of nAMD in Spain. METHODS The annual cost per patient with nAMD was estimated for the first, second, and third year (or beyond) of treatment since diagnosis. Several cost categories were considered including direct healthcare costs (DHC), direct non-healthcare costs (DNHC), labor productivity losses (LPL), and intangible costs (IC) related to loss of quality of life. The average annual cost per patient was estimated by assigning a unit price or financial proxy to the resources consumed per patient. Reference year of costs was 2021. RESULTS The mean annual cost of nAMD was estimated at €17,265, €15,403, and €14,465 per patient in the first, second, and third year of treatment after diagnosis. There was an additional one-off cost of €744 associated with the diagnosis of nAMD. DHC accounted for most of the total annual cost per patient independent of the year of treatment since diagnosis (48% in year 1; 42% in year 2; 39% in year 3). Similarly, DNHC had an important contribution to the total costs (32% in year 1; 35% in year 2; 37% in year 3), followed by IC (20% in year 1; 23% in year 2; 24% in year 3), while the contribution of patients' LPL was minimal. CONCLUSION This study estimated a high economic burden associated with nAMD for patients and their families, the healthcare system, and society at large. There is a need to improve the management of these patients to reduce the impact of nAMD disease progression.
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Affiliation(s)
- Maximino J Abraldes
- Medical Retina and Ocular Diabetes Unit, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Pilar Calvo
- Medical Retina Unit, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - María Merino
- Health Outcomes Research Department, Weber, C/Moreto, 17-5º dcha, 28014, Madrid, Spain.
| | - Teresa Martín Lorenzo
- Health Outcomes Research Department, Weber, C/Moreto, 17-5º dcha, 28014, Madrid, Spain
| | | | | | - José M Ruiz-Moreno
- Ophtalmology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
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24
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Kazemi MS, Shoari A, Salehibakhsh N, Aliabadi HAM, Abolhosseini M, Arab SS, Ahmadieh H, Kanavi MR, Behdani M. Anti-angiogenic biomolecules in neovascular age-related macular degeneration; therapeutics and drug delivery systems. Int J Pharm 2024; 659:124258. [PMID: 38782152 DOI: 10.1016/j.ijpharm.2024.124258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/10/2024] [Accepted: 05/20/2024] [Indexed: 05/25/2024]
Abstract
Blindness in the elderly is often caused by age-related macular degeneration (AMD). The advanced type of AMD known as neovascular AMD (nAMD) has been linked to being the predominant cause of visual impairment in these people. Multiple neovascular structures including choroidal neovascular (CNV) membranes, fluid exudation, hemorrhages, and subretinal fibrosis, are diagnostic of nAMD. These pathological alterations ultimately lead to anatomical and visual loss. It is known that vascular endothelial growth factor (VEGF), a type of proangiogenic factor, mediates the pathological process underlying nAMD. Therefore, various therapies have evolved to directly target the disease. In this review article, an attempt has been made to discuss general explanations about this disease, all common treatment methods based on anti-VEGF drugs, and the use of drug delivery systems in the treatment of AMD. Initially, the pathophysiology, angiogenesis, and different types of AMD were described. Then we described current treatments and future treatment prospects for AMD and outlined the advantages and disadvantages of each. In this context, we first examined the types of therapeutic biomolecules and anti-VEGF drugs that are used in the treatment of AMD. These biomolecules include aptamers, monoclonal antibodies, small interfering RNAs, microRNAs, peptides, fusion proteins, nanobodies, and other therapeutic biomolecules. Finally, we described drug delivery systems based on liposomes, nanomicelles, nanoemulsions, nanoparticles, cyclodextrin, dendrimers, and composite vehicles that are used in AMD therapy.
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Affiliation(s)
- Mir Salar Kazemi
- Biotechnology Research Centre, Venom and Biotherapeutics Molecules Laboratory, Pasteur Institute of Iran, Iran
| | - Alireza Shoari
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA
| | - Neda Salehibakhsh
- Biotechnology Research Centre, Venom and Biotherapeutics Molecules Laboratory, Pasteur Institute of Iran, Iran; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Hooman Aghamirza Moghim Aliabadi
- Protein Chemistry Laboratory, Department of Medical Biotechnology, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Mohammad Abolhosseini
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Shahriar Arab
- Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093, USA; Department of Biophysics, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mozhgan Rezaei Kanavi
- Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mahdi Behdani
- Biotechnology Research Centre, Venom and Biotherapeutics Molecules Laboratory, Pasteur Institute of Iran, Iran.
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25
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Li X, Li J, Zeng W, Wang B, Du M, Liang L, Gao Y. Mingjing granule inhibits the subretinal fibrovascular membrane of two-stage laser-induced neovascular age-related macular degeneration in rats. Front Pharmacol 2024; 15:1384418. [PMID: 38983912 PMCID: PMC11231192 DOI: 10.3389/fphar.2024.1384418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/31/2024] [Indexed: 07/11/2024] Open
Abstract
Objective The study aims to investigate the protective effect of Mingjing granule (MG) in a fibrovascular membrane rat model of neovascular age-related macular degeneration (nAMD) and explore the underlying mechanism. Methods The nAMD fibrovascular membrane model was established by two-stage laser photocoagulation. BN rats were randomly divided into four groups: the model group was gavaged with distilled water, the anti-VEGF group was given an intravitreous injection of ranibizumab, the MG + anti-VEGF group was gavaged with MG combined with an intravitreous injection of ranibizumab, and the normal group not modeled only fed conventionally. Lesions were evaluated by color fundus photograph, optical coherence tomography, fundus fluorescein angiography, and retinal pigment epithelial-choroid-sclera flat mount. The changes in the retinal structure were observed by histopathology. The expression of inflammatory cell markers F4/80, Iba-1, and glial fibrillary acidic protein (GFAP); the fibrosis-related factors collagen-1, fibronectin, α-smooth muscle actin (α-SMA), and transforming growth factor-beta (TGF-β); and the complement system-related factors C3a and C3aR in the retina were detected by immunofluorescence or qRT-PCR. Results The current study revealed that MG + anti-VEGF administration more significantly reduced the thickness of fibrovascular lesions, suppressed vascular leakage (exudation area and mean density value), inhibited the area of fibrovascular lesions, and restrained the formation of the fibrovascular membrane than the anti-VEGF agent alone in the two-stage laser-induced rat model. The fluorescence intensities of F4/80, Iba-1, collagen-1, fibronectin, TGF-β, and C3aR showed more significant inhibition in MG + anti-VEGF-treated rats than the anti-VEGF agent alone. The mRNA expression levels of F4/80, Iba-1, GFAP, collagen-1, fibronectin, α-SMA, TGF-β, and C3a showed lower levels in rats treated with MG + anti-VEGF than the anti-VEGF agent alone. Conclusion Combining MG with anti-VEGF treatment inhibits the growth of the fibrovascular membrane more effectively than using anti-VEGF treatment alone. The mechanism underlying this effect may involve limiting inflammatory cell aggregation, controlling complement system activation, and decreasing the expression of the fibrotic protein.
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Affiliation(s)
- Xiaoyu Li
- Eye Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Ophthalmic Disease Project Group, China Evidence-based Medicine Center of Traditional Chinese Medicine, Beijing, China
| | - Jiaxian Li
- Eye Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Weixin Zeng
- Eye Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Baoli Wang
- Eye Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Maobo Du
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Lina Liang
- Eye Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Ophthalmic Disease Project Group, China Evidence-based Medicine Center of Traditional Chinese Medicine, Beijing, China
| | - Yun Gao
- Eye Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Ophthalmic Disease Project Group, China Evidence-based Medicine Center of Traditional Chinese Medicine, Beijing, China
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26
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Mares V, Schmidt-Erfurth UM, Leingang O, Fuchs P, Nehemy MB, Bogunovic H, Barthelmes D, Reiter GS. Approved AI-based fluid monitoring to identify morphological and functional treatment outcomes in neovascular age-related macular degeneration in real-world routine. Br J Ophthalmol 2024; 108:971-977. [PMID: 37775259 DOI: 10.1136/bjo-2022-323014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 09/12/2023] [Indexed: 10/01/2023]
Abstract
AIM To predict antivascular endothelial growth factor (VEGF) treatment requirements, visual acuity and morphological outcomes in neovascular age-related macular degeneration (nAMD) using fluid quantification by artificial intelligence (AI) in a real-world cohort. METHODS Spectral-domain optical coherence tomography data of 158 treatment-naïve patients with nAMD from the Fight Retinal Blindness! registry in Zurich were processed at baseline, and after initial treatment using intravitreal anti-VEGF to predict subsequent 1-year and 4-year outcomes. Intraretinal and subretinal fluid and pigment epithelial detachment volumes were segmented using a deep learning algorithm (Vienna Fluid Monitor, RetInSight, Vienna, Austria). A predictive machine learning model for future treatment requirements and morphological outcomes was built using the computed set of quantitative features. RESULTS Two hundred and two eyes from 158 patients were evaluated. 107 eyes had a lower median (≤7) and 95 eyes had an upper median (≥8) number of injections in the first year, with a mean accuracy of prediction of 0.77 (95% CI 0.71 to 0.83) area under the curve (AUC). Best-corrected visual acuity at baseline was the most relevant predictive factor determining final visual outcomes after 1 year. Over 4 years, half of the eyes had progressed to macular atrophy (MA) with the model being able to distinguish MA from non-MA eyes with a mean AUC of 0.70 (95% CI 0.61 to 0.79). Prediction for subretinal fibrosis reached an AUC of 0.74 (95% CI 0.63 to 0.81). CONCLUSIONS The regulatory approved AI-based fluid monitoring allows clinicians to use automated algorithms in prospectively guided patient treatment in AMD. Furthermore, retinal fluid localisation and quantification can predict long-term morphological outcomes.
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Affiliation(s)
- Virginia Mares
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
- Department of Ophthalmology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Oliver Leingang
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Philipp Fuchs
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Marcio B Nehemy
- Department of Ophthalmology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Hrvoje Bogunovic
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Daniel Barthelmes
- Department of Ophthalmology, University of Zurich Faculty of Medicine, Zurich, Switzerland
- Department of Ophthalmology, The University of Sydney, Sydney, New South Wales, Australia
| | - Gregor S Reiter
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
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27
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Garg SJ, Hadziahmetovic M. Verteporfin Photodynamic Therapy for the Treatment of Chorioretinal Conditions: A Narrative Review. Clin Ophthalmol 2024; 18:1701-1716. [PMID: 38881707 PMCID: PMC11178081 DOI: 10.2147/opth.s464371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
Photodynamic therapy (PDT) with verteporfin involves intravenous administration of a photosensitizer followed by its laser light activation at the target site to inhibit aberrant choroidal vascularization. This narrative review provides an overview of the role verteporfin PDT plays in the management of chorioretinal conditions. A PubMed literature review of all English-language articles published through October 19, 2023, was conducted to identify relevant references. Verteporfin PDT has been shown to be safe and effective for the treatment of patients with choroidal neovascularization (CNV) due to neovascular age-related macular degeneration and is often used in combination with a vascular endothelial growth factor (VEGF) inhibitor. Additionally, patients with polypoidal choroidal vasculopathy, a subtype of neovascular age-related macular degeneration, also benefit from verteporfin PDT combined with a VEGF inhibitor for improving visual acuity. Verteporfin PDT has also been effective in treating patients with peripapillary CNV, as well as eyes with CNV due to ocular histoplasmosis and pathologic myopia. Reduced dose and/or fluence PDT protocols have been effective in patients with central serous chorioretinopathy while reducing adverse effects. In eyes with choroidal hemangioma, tumor regression and visual outcomes have been improved with verteporfin PDT treatment. Photodynamic therapy with verteporfin continues to play an important role in the management of chorioretinal conditions.
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Affiliation(s)
- Sunir J Garg
- Retina Service, Wills Eye Hospital, Philadelphia, PA, USA
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Arrigo A, Aragona E, Battaglia Parodi M, Bandello F. Quantitative Multimodal Imaging Characterization of Intraretinal Cysts versus Degenerative Pseudocysts in Neovascular Age-Related Macular Degeneration. Ophthalmol Retina 2024:S2468-6530(24)00268-9. [PMID: 38848872 DOI: 10.1016/j.oret.2024.05.019] [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: 03/25/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVE To differentiate intraretinal fluid (IRF) cysts from degenerative pseudocysts in neovascular age-related macular degeneration (AMD) by quantitative multimodal imaging. DESIGN Observational, cross-sectional. PARTICIPANTS Patients affected by macular neovascularization secondary to AMD. METHODS All patients were analyzed by OCT, OCT angiography (OCTA), and dense automatic real-time (ART) OCTA. New-onset cysts were considered IRF, whereas those cysts that were found to be persistent for at least 3 months were categorized as degenerative pseudocysts. Intraretinal cysts were automatically segmented to calculate cyst circularity. Peri-cyst space was quantitatively analyzed to assess the presence of perfusion signal and hyperreflective foci (HF). MAIN OUTCOME MEASURES Best-corrected visual acuity, cyst circularity, peri-cyst perfusion, peri-cyst HF, fibrosis, and outer retinal atrophy. RESULTS We analyzed 387 cysts collected from 35 eyes of 35 patients with neovascular AMD (14 men; mean age, 80 ± 5 years). We classified 302 IRF cysts and 85 degenerative pseudocysts. Intraretinal fluid cysts were characterized by significantly higher circularity (0.86; range, 0.81-0.91), perfusion signal in the peri-cyst space, and peri-cyst HF in 89% of cases (all P < 0.05). Degenerative pseudocysts showed significantly lower circularity (0.68; range, 0.64-0.76), no perfusion signal in the peri-cyst space, and peri-cyst HF in only 29% of cases (all P < 0.05). The adopted quantitative metrics significantly correlated with disease duration, number of injections, fibrosis, and outer retinal atrophy. CONCLUSIONS Intraretinal fluid cysts can be discriminated from degenerative pseudocysts using a quantitative multimodal imaging approach. These findings are clinically relevant and should be included in future training models for artificial intelligence algorithms to improve the diagnostic power and fluid monitoring in neovascular AMD. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Alessandro Arrigo
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Eye Repair Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Emanuela Aragona
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Francesco Bandello
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Woo SJ, Jung JA, Kim T, Oh I, Kim MY, Bressler NM. Association of baseline factors with 1-year outcomes in the SB11-ranibizumab equivalence trial: A post hoc analysis. Asia Pac J Ophthalmol (Phila) 2024:100069. [PMID: 38759795 DOI: 10.1016/j.apjo.2024.100069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 05/19/2024] Open
Abstract
PURPOSE To identify baseline factors associated with 1-year outcomes when treating neovascular age-related macular degeneration (nAMD) with ranibizumab biosimilar SB11 or reference ranibizumab (rRBZ), and to compare efficacy of the two products within subgroups judged to be clinically relevant. DESIGN Post hoc analysis of a prospective, equivalence phase 3 randomized clinical trial (RCT) METHODS: 705 patients with nAMD were randomized 1:1 to receive SB11 or rRBZ for 48 weeks. Pooled and randomized groups were used to identify baseline factors associated with clinical outcomes at Week 52 using multiple linear regression models. Significant factors identified in regression analyses were confirmed in analyses of variance. Subgroup analyses comparing best-corrected visual acuity (BCVA) changes between SB11 and rRBZ were conducted. RESULTS 634 (89.9%) participants completed the 52-week visit. Regression analyses showed that younger age, lower BCVA, and smaller total lesion area at baseline were associated with greater BCVA gain at Week 52, while older age, lower BCVA, and thicker central subfield thickness (CST) at baseline were predictors of greater CST reduction in the pooled group. Subgroup analyses demonstrated that BCVA outcomes appeared comparable for the SB11 and rRBZ groups. CONCLUSION Post hoc analyses of the SB11-rRBZ equivalence study showed that baseline age, BCVA, CST, and total lesion area were prognostic factors for visual or anatomical outcomes of nAMD, while subgroup analyses demonstrated comparable results for SB11 and rRBZ. Collectively, the results appear comparable to similar RCTs of anti-vascular endothelial growth factor reference products for nAMD and strengthen confidence in the biosimilarity of SB11.
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Affiliation(s)
- Se Joon Woo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Republic of Korea
| | | | | | - Inkyung Oh
- Samsung Bioepis, Incheon, Republic of Korea
| | | | - Neil M Bressler
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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Luo S, Jiang H, Li Q, Qin Y, Yang S, Li J, Xu L, Gou Y, Zhang Y, Liu F, Ke X, Zheng Q, Sun X. An adeno-associated virus variant enabling efficient ocular-directed gene delivery across species. Nat Commun 2024; 15:3780. [PMID: 38710714 DOI: 10.1038/s41467-024-48221-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 04/24/2024] [Indexed: 05/08/2024] Open
Abstract
Recombinant adeno-associated viruses (rAAVs) have emerged as promising gene therapy vectors due to their proven efficacy and safety in clinical applications. In non-human primates (NHPs), rAAVs are administered via suprachoroidal injection at a higher dose. However, high doses of rAAVs tend to increase additional safety risks. Here, we present a novel AAV capsid (AAVv128), which exhibits significantly enhanced transduction efficiency for photoreceptors and retinal pigment epithelial (RPE) cells, along with a broader distribution across the layers of retinal tissues in different animal models (mice, rabbits, and NHPs) following intraocular injection. Notably, the suprachoroidal delivery of AAVv128-anti-VEGF vector completely suppresses the Grade IV lesions in a laser-induced choroidal neovascularization (CNV) NHP model for neovascular age-related macular degeneration (nAMD). Furthermore, cryo-EM analysis at 2.1 Å resolution reveals that the critical residues of AAVv128 exhibit a more robust advantage in AAV binding, the nuclear uptake and endosome escaping. Collectively, our findings highlight the potential of AAVv128 as a next generation ocular gene therapy vector, particularly using the suprachoroidal delivery route.
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Affiliation(s)
- Shuang Luo
- Chengdu Origen Biotechnology Co. Ltd, Chengdu, 610036, China
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, 610041, China
- Sichuan Provincial Key Laboratory of Innovative Biomedicine, Chengdu, 610036, China
| | - Hao Jiang
- Chengdu Origen Biotechnology Co. Ltd, Chengdu, 610036, China
- Sichuan Provincial Key Laboratory of Innovative Biomedicine, Chengdu, 610036, China
| | - Qingwei Li
- Chengdu Origen Biotechnology Co. Ltd, Chengdu, 610036, China
- Sichuan Provincial Key Laboratory of Innovative Biomedicine, Chengdu, 610036, China
| | - Yingfei Qin
- Chengdu Origen Biotechnology Co. Ltd, Chengdu, 610036, China
| | - Shiping Yang
- Chengdu Origen Biotechnology Co. Ltd, Chengdu, 610036, China
| | - Jing Li
- Chengdu Origen Biotechnology Co. Ltd, Chengdu, 610036, China
| | - Lingli Xu
- Chengdu Origen Biotechnology Co. Ltd, Chengdu, 610036, China
| | - Yan Gou
- Chengdu Origen Biotechnology Co. Ltd, Chengdu, 610036, China
| | - Yafei Zhang
- Chengdu Origen Biotechnology Co. Ltd, Chengdu, 610036, China
| | - Fengjiang Liu
- Innovative Center for Pathogen Research, Guangzhou Laboratory, Guangzhou, 510005, China
| | - Xiao Ke
- Chengdu Origen Biotechnology Co. Ltd, Chengdu, 610036, China.
- Chengdu Kanghong Pharmaceuticals Group Co Ltd, Chengdu, 610036, China.
| | - Qiang Zheng
- Chengdu Origen Biotechnology Co. Ltd, Chengdu, 610036, China.
- Sichuan Provincial Key Laboratory of Innovative Biomedicine, Chengdu, 610036, China.
| | - Xun Sun
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, 610041, China.
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Arrigo A, Saladino A, Aragona E, Barresi C, Mularoni C, Bandello F, Battaglia Parodi M. Clinical and Imaging Biomarkers Associated with Outer Retinal Atrophy Onset in Exudative Age-Related Macular Degeneration: A Real-Word Prospective Study. Ophthalmol Ther 2024; 13:1185-1196. [PMID: 38446282 DOI: 10.1007/s40123-024-00903-4] [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: 11/30/2023] [Accepted: 01/31/2024] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION Macular neovascularization (MNV) secondary to age-related macular degeneration (AMD) is well managed by anti-vascular endothelial growth factor (anti-VEGF) intravitreal injections. However, outer retinal atrophy represents an unavoidable occurrence detected during follow-up. Several imaging metrics have been proposed as clinically relevant in stratifying the risk of onset of outer retinal atrophy. The main goal of this study is to evaluate the impact of noninvasive imaging metrics on the assessment of outer retinal atrophy onset in a large cohort of eyes with neovascular AMD managed in a real-world setting. METHODS This study was a prospective, observational, case series. We included patients affected by newly diagnosed neovascular AMD, requiring anti-VEGF intravitreal injections. We collected clinical and imaging data, with a planned follow-up of 24 months. The multimodal imaging protocol included optical coherence tomography, optical coherence tomography angiography, and fundus autofluorescence. We collected noninvasive imaging metrics and we assessed the relationship with the morphological and functional outcome evaluated at 12-month and 24-month time points. RESULTS We included 370 eyes of 370 patients with exudative AMD (210 male; mean age 79 ± 8 years). MNV were classified as follows: type 1, 198 (54%); type 2, 89 (24%); polypoidal choroidal vasculopathy, 29 (7%); and type 3, 54 (15%). A total of 120 out of 370 eyes (33%) showed complete outer retinal atrophy at the end of the 2-year follow-up. The presence of intraretinal fluid, thinning of the Sattler choroidal layer, late anti-VEGF switch, the overall number of anti-VEGF injections, and the perfusion characteristics of the MNV were found to be the most relevant factors associated with the onset of outer retinal atrophy. The other collected metrics were found to be less clinically relevant, also showing no cumulative effect in the multivariate analysis (p > 0.05). CONCLUSIONS We identified imaging metrics significantly associated with the 2-year risk onset of outer retinal atrophy. These metrics might pave the way for the development of future customized anti-VEGF treatment strategies.
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Affiliation(s)
- Alessandro Arrigo
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Andrea Saladino
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Emanuela Aragona
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Costanza Barresi
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Cecilia Mularoni
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Maurizio Battaglia Parodi
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
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Eckardt F, Lorger A, Hafner M, Klaas JE, Schworm B, Kreutzer TC, Priglinger SG, Siedlecki J. Retinal and choroidal efficacy of switching treatment to faricimab in recalcitrant neovascular age related macular degeneration. Sci Rep 2024; 14:9600. [PMID: 38671028 PMCID: PMC11053147 DOI: 10.1038/s41598-024-59632-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
Aim of this study was to evaluate the efficacy of switching treatment to faricimab in neovascular age-related macular degeneration (nAMD) from other anti-VEGF agents. Fifty-eight eyes of fifty-one patients with nAMD and a full upload series of four faricimab injections were included. Demographic data, multimodal imaging and treatment parameters were recorded. The primary outcome measures were changes in central subfield thickness (CST) and subfoveal choroidal thickness (SFCT). A subgroup analysis was performed for eyes with prior ranibizumab (R) or aflibercept (A) treatment. Mean injection intervals before and after switching were comparable (33.8 ± 11.2 vs. 29.3 ± 2.6 days; p = 0.08). Mean CST of 361.4 ± 108.1 µm prior to switching decreased significantly to 318.3 ± 97.7 µm (p < 0.01) after the third faricimab injection, regardless of prior anti-VEGF treatment (p < 0.01). Although SFCT slightly improved for the whole cohort from 165.8 ± 76.8 µm to 161.0 ± 82,8 µm (p = 0.029), subgroup analysis did not confirm this positive effect (subgroup R: p = 0.604; subgroup A: p = 0.306). In patients with a suboptimal response to aflibercept or ranibizumab in nAMD, farcimab can improve CST and slightly improve or maintain SFCT. Further prospective randomized trials are warranted.
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Affiliation(s)
- Franziska Eckardt
- Department of Ophthalmology, LMU University Hospital, LMU Munich, LMU Augenklinik, Mathildenstraße 8, 80336, Munich, Germany.
| | - Anna Lorger
- Department of Ophthalmology, LMU University Hospital, LMU Munich, LMU Augenklinik, Mathildenstraße 8, 80336, Munich, Germany
| | - Michael Hafner
- Department of Ophthalmology, LMU University Hospital, LMU Munich, LMU Augenklinik, Mathildenstraße 8, 80336, Munich, Germany
| | - Julian Elias Klaas
- Department of Ophthalmology, LMU University Hospital, LMU Munich, LMU Augenklinik, Mathildenstraße 8, 80336, Munich, Germany
| | - Benedikt Schworm
- Department of Ophthalmology, LMU University Hospital, LMU Munich, LMU Augenklinik, Mathildenstraße 8, 80336, Munich, Germany
| | - Thomas Christian Kreutzer
- Department of Ophthalmology, LMU University Hospital, LMU Munich, LMU Augenklinik, Mathildenstraße 8, 80336, Munich, Germany
| | - Siegfried Georg Priglinger
- Department of Ophthalmology, LMU University Hospital, LMU Munich, LMU Augenklinik, Mathildenstraße 8, 80336, Munich, Germany
| | - Jakob Siedlecki
- Department of Ophthalmology, LMU University Hospital, LMU Munich, LMU Augenklinik, Mathildenstraße 8, 80336, Munich, Germany
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Schuster AK, Leisle L, Picker N, Bubendorfer-Vorwerk H, Lewis P, Hahn P, Wasem J, Finger RP. Epidemiology of Diagnosed Age-related Macular Degeneration in Germany: An Evaluation of the Prevalence Using AOK PLUS Claims Data. Ophthalmol Ther 2024; 13:1025-1039. [PMID: 38386186 PMCID: PMC10912065 DOI: 10.1007/s40123-024-00901-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/26/2024] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION Epidemiologic data on age-related macular degeneration (AMD) are mainly based on cohort studies, including both diagnosed and undiagnosed cases. Using health claims data allows estimating epidemiological data of diagnosed subjects with AMD within the health care system using diagnosis codes from a regional claims database (AOK PLUS) to estimate the prevalence and incidence of non-exudative and exudative AMD in Germany. METHODS Patients with AMD were identified among AOK PLUS insured patients based on at least two outpatient, ophthalmologic or one inpatient H35.3 diagnoses for the years 2012 to 2021. Patients without continuous observation in a calendar year were excluded. Prevalence was assessed, and 1-year cumulative incidence was determined by the number of newly diagnosed patients divided by the number of individuals at risk. For 2020 and 2021, the AMD stage was assessed by diagnostic subcodes for non-exudative and exudative AMD, respectively. For 2012 to 2019, patient numbers were estimated based on the average proportions of non-exudative AMD and exudative AMD, respectively, in 2020 and 2021. Incidence and prevalence numbers were then extrapolated to Germany. RESULTS Between 2012 to 2021, the prevalence of diagnosed AMD cases remained relatively stable among approximately 3.27 million AOK PLUS insured persons, ranging from 0.96% (minimum in 2021) to 1.31% (maximum in 2014) for non-exudative AMD, about twice as high as for exudative AMD (min-max: 0.53-0.72%). The age- and sex-adjusted projections amounted to 644,153 diagnosed non-exudative and 367,086 diagnosed German patients with exudative AMDs in 2021. The 1-year cumulative incidence for non-exudative and exudative AMD, respectively, ranged from 122,427-142,932 to 46,092-86,785 newly diagnosed cases. CONCLUSION The number of diagnosed cases with AMD in Germany has increased slightly over the past decade. For the first time, patient counts with non-exudative and exudative AMD were approximated for Germany based on a representative, large-scale database study.
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Affiliation(s)
- Alexander K Schuster
- Department of Ophthalmology, University Medical Center Mainz, Geb. 101, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Lilia Leisle
- Real World and Advanced Analytics, Ingress-Health HWM GmbH, A Cytel Company, Wismar/Berlin, Germany
| | - Nils Picker
- Real World and Advanced Analytics, Ingress-Health HWM GmbH, A Cytel Company, Wismar/Berlin, Germany
| | | | - Philip Lewis
- Value, Access and Policy DACH, Apellis Germany GmbH, München, Germany
| | - Philipp Hahn
- Institut für Pharmakoökonomie und Arzneimittellogistik e.V, Wismar, Germany
| | - Jürgen Wasem
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
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Blinder KJ, Calhoun C, Maguire MG, Glassman AR, Mein CE, Baskin DE, Vieyra G, Jampol LM, Chica MA, Sun JK, Martin DF. Home OCT Imaging for Newly Diagnosed Neovascular Age-Related Macular Degeneration: A Feasibility Study. Ophthalmol Retina 2024; 8:376-387. [PMID: 37879537 PMCID: PMC10997472 DOI: 10.1016/j.oret.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/03/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To assess the feasibility of daily Home OCT imaging among patients with neovascular age-related macular degeneration (nAMD). DESIGN Prospective observational study. PARTICIPANTS Participants with ≥ 1 eye with previously untreated nAMD and visual acuity 20/20 to 20/320. METHODS Participants meeting the ocular eligibility criteria were considered for enrollment; those who provided consent received a Notal Vision Home OCT device. Participants were instructed to scan both eyes daily. Retina specialists managed treatment according to their standard practice, without access to the Home OCT data. The presence of fluid detected by a reading center (RC) from in-office OCT scans was compared with fluid volumes measured by the Notal OCT Analyzer (NOA) on Home OCT images. MAIN OUTCOME MEASURES Proportion of participants meeting ocular eligibility criteria who participated in daily scanning, frequency and duration of scanning, proportion of scans eligible for fluid quantification, participant experience with the device, agreement between the RC and NOA fluid determinations, and characteristics of fluid dynamics. RESULTS Among 40 participants meeting ocular eligibility criteria, 14 (35%) initiated self-scanning. Planned travel (n = 7, 17.5%) and patient-reported inadequate cell reception for the upload of images (n = 5, 12.5%) were the most frequent reasons for not participating. Considering scans of the study eye only, the mean (standard deviation) was 6.3 (0.6) for weekly scanning frequency and 47 (17) seconds for scan duration per eye. Among 2304 scans, 86.5% were eligible for fluid quantification. All participants agreed that scanning became easier over time, and only 1 did not want to continue daily scanning. For 35 scan pairs judged as having fluid by in-office OCT, the NOA detected fluid on 31 scans (89%). For 14 scan pairs judged as having no fluid on in-office OCT, the NOA did not detect fluid on 10 scans (71%). Daily fluid patterns after treatment initiation varied considerably between patients. CONCLUSIONS For patients with nAMD who initiated home scanning, frequency and quality of scanning and accuracy of fluid detection were sufficient to assess the monitoring of fluid at home. Accommodations for travel and Wi-Fi connectivity could improve uptake of the Home OCT device. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
| | | | | | | | | | | | | | - Lee M Jampol
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Jennifer K Sun
- Joslin Diabetes Center, Beetham Eye Institute, Harvard Department of Ophthalmology, Boston, Massachusetts
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Nebbioso M, Franzone F, Milanese A, Artico M, Taurone S, La Cava M, Livani ML, Bonfiglio V, Vestri A. Psychophysical, electrofunctional, and morphological evaluation in naïve neovascular AMD patients treated with intravitreal anti-VEGF. Aging Med (Milton) 2024; 7:189-201. [PMID: 38725692 PMCID: PMC11077329 DOI: 10.1002/agm2.12296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 03/01/2024] [Accepted: 03/28/2024] [Indexed: 05/12/2024] Open
Abstract
Objectives The aim of this study was to investigate the retinal morpho-functional characteristics of patients with neovascular wet age-related macular degeneration (nAMD) treated with intravitreal injection (IV) of aflibercept (AFL). Methods The study was conducted on 35 patients previously diagnosed with type 1 nAMD who received a fixed-dosing regimen of aflibercept injections over 12 months. The goal was to assess trends in visual abilities over time by measuring visual acuity (VA), contrast sensitivity (CS), visual evoked potentials (VEPs), and spectral domain-optical coherence tomography (SD-OCT). The same psychophysical, electro-functional, and morphological tests administered at baseline (T0) were repeated 4 to 8 weeks after the last aflibercept injection (Tn), resulting in a total of six examinations. Results At Tn, all subjects exhibited improved VA for both far and near distances compared to values detected at T0. Similarly, VEP amplitude and latency values at Tn showed a greater P100 improvement than those observed at T0. Additionally, the CS examination at Tn demonstrated improvement, particularly at high spatial stimulation frequencies. The Tn SD-OCT results highlighted a reduction in macular thickness compared to T0 values. Conclusions This exploratory research indicates that intravitreal injections of AFL, following a fixed-dosing regimen, represent a valuable therapeutic approach for enhancing visual performance. This conclusion is supported by comprehensive statistical analysis of psychophysical, electro-functional, and morphological examinations within the same group of patients with nAMD, as demonstrated for the first time.
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Affiliation(s)
- Marcella Nebbioso
- Department of Sense Organs, Faculty of Medicine and OdontologySapienza University of RomeRomeItaly
| | - Federica Franzone
- Ophthalmic Hospital, Medicine and SurgeryUniversity of TurinTurinItaly
| | - Alberto Milanese
- Department of Public Health and Infectious DiseaseSapienza University of RomeRomeItaly
| | - Marco Artico
- Department of Sense Organs, Faculty of Medicine and OdontologySapienza University of RomeRomeItaly
| | - Samanta Taurone
- Department of Movement, Human and Health SciencesUniversity of Rome Foro ItalicoRomeItaly
| | - Maurizio La Cava
- Department of Sense Organs, Faculty of Medicine and OdontologySapienza University of RomeRomeItaly
| | | | - Vincenza Bonfiglio
- Department of Experimental Biomedicine and Clinical NeuroscienceUniversity of PalermoPalermoItaly
| | - Annarita Vestri
- Department of Public Health and Infectious DiseaseSapienza University of RomeRomeItaly
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de Asís Bartol-Puyal F, Monroy JS, Bayod MP, Moreno ÓR, Calvo P, Pablo L. Assistance Burden Comparison Between Age-Related Macular Degeneration and Retinal Angiomatous Proliferation Over a Three-Year Follow-up. Ophthalmic Surg Lasers Imaging Retina 2024; 55:197-203. [PMID: 38319060 DOI: 10.3928/23258160-20240118-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND AND OBJECTIVE We compared assistance burden between neovascular age-related macular degeneration (nAMD) and retinal angiomatous proliferation (RAP) under intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment on a treat-and-extend (T&E) regimen in a third-level hospital in a developed country. PATIENTS AND METHODS This retrospective study using data from the Fight Retinal Blindness! Registry included patients treated between January 2016 and December 2020. Final event was established as best corrected visual acuity (BCVA) lower than 20 Early Treatment Diabetic Retinopathy Study letters. According to choroidal neovascularization (CNV), three different study groups were established: type 1, 2, and 3. RESULTS A total of 285 eyes of 227 patients were included. Mean age was 80.1 ± 6.5, 79.1 ± 7.9, and 81.2 ± 7.2 years, for the three study groups, respectively. Mean injections were 16.0 ± 4.8, 16.5 ± 4.1, and 14.1 ± 5.7, respectively; and mean number of visits were 17.9 ± 4.3, 18.2 ± 3.1, and 16.8 ± 5.3, respectively. No differences were found (P > 0.05). Survival curves and log-rank analysis also showed no differences (P = 0.344). Cox proportional hazard models showed that a lower baseline BCVA, subfoveal geographic atrophy (GA), and subfoveal fibrosis (SF) were associated with a higher risk of reaching ≤ 20 letters. CONCLUSIONS nAMD and RAP under a T&E regimen indicate a high assistance burden during the first three years. The presence of subfoveal GA or SF are associated with a BCVA lower than 20 letters. [Ophthalmic Surg Lasers Imaging Retina 2024;55:197-203.].
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Özen O, Koçak Altıntaş AG. Can objective parameters in optical coherence tomography be useful markers in the treatment and follow-up of type 1 and type 2 macular neovascularizations related to neovascular age-related macular degeneration? Int Ophthalmol 2024; 44:134. [PMID: 38483688 DOI: 10.1007/s10792-024-03073-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 02/16/2024] [Indexed: 03/19/2024]
Abstract
PURPOSE The aim of this study was to compare the responses of type 1 and type 2 macular neovascularizations (MNV) caused by neovascular type age-related macular degeneration (n-AMD) to intravitreal anti-vascular endothelial growth factor (VEGF) treatments using quantitative parameters determined by optical coherence tomography (OCT). Additionally, it was also intended to assess the connections between these quantitative parameters and changes in best-corrected visual acuity (BCVA) and the number of intravitreal anti-VEGF injections required within a year. MATERIALS AND METHODS In our retrospective and observational study, the data of 90 eyes of 90 patients diagnosed with n-AMD and treated with intravitreal anti-VEGF with the "Pro re nata" method were evaluated. Subtypes of existing MNVs were distinguished with previously taken optical coherence tomography angiography (OCTA) images. In spectral domain OCT examinations, central macular thickness (CMT) and central macular volume (CMV) values were recorded at baseline and 12th month. The number of intravitreal anti-VEGF injections during the 12 month follow-up period was also recorded for each patient. Obtained data were compared between MNV types. RESULTS Of the n-AMD cases examined in the study, 56.66% had type 1 MNV and 43.34% had type 2 MNV. The mean baseline BCVA logMAR values in eyes with type 2 MNV (1.15 ± 0.43) were higher than those observed in eyes with type 1 MNV (0.76 ± 0.42) (p = 0.001). Similarly, mean baseline CMT and CMV values in eyes with type 2 MNV were higher than those observed in eyes with type 1 MNV (respectively 424.89 ± 49.46 μm vs. 341.39 ± 37.06 μm; 9.17 ± 0.89 μm3 vs. 8.49 ± 0.53 μm3; p < 0.05). After 12 months of treatment, logMAR values of BCVA (0.86 ± 0.42) in subjects with type 2 MNV were higher than those in subjects with type 1 MNV (0.57 ± 0.37) (p = 0.001). Mean CMT and CMV values at 12th month in subjects with type 2 MNV (379.11 ± 46.36 μm and 8.66 ± 0.79 μm3, respectively) were observed to be higher than those with type 1 MNV (296.95 ± 33.96 μm and 8.01 ± 0.52 mm3, respectively) (p < 0.05). In type 2 MNVs, positive correlations were observed between both baseline and 12th month BCVA logMAR values and baseline CMV (p < 0.05). Similarly, in type 2 MNVs, a positive correlation was observed between 12th month BCVA logMAR values and 12th month CMV (p < 0.05). The total number of intravitreal anti-VEGF injections at 12 months was similar in both groups (p = 0.851). CONCLUSION In this study, in which we performed a subtype analysis of MNV cases, we observed that the visual function was worse at the beginning and the end of the 12th month, and the CMT and CMV values were higher in the type 2 MNV group compared to the type 1 MNV cases. In addition, we found significant correlations between BCVA logMAR values and CMV values in type 2 MNV cases. In the follow-up of these cases, CMT, which is a more widely used quantitative method, and CMV, which is a newer OCT measurement parameter, may be more useful in patient follow-up and evaluation of treatment efficacy, especially for type 2 MNV cases.
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Affiliation(s)
- Osman Özen
- Polatlı Duatepe State Hospital, Ankara, Turkey.
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Chronopoulos A, Huynh E, Ashurov A, Schutz JS, Jonas JB, Hattenbach LO. Brolucizumab for recalcitrant macular neovascularization in age-related macular degeneration with pigment epithelial detachment. Eur J Ophthalmol 2024; 34:487-496. [PMID: 37461836 DOI: 10.1177/11206721231187663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
PURPOSE To analyze anatomic and functional response to intravitreal brolucizumab in age-related macular degeneration recalcitrant to previous intravitreal anti-VEGF therapies. METHODS In this monocentric, one arm, retrospective study, eyes affected by neovascular age-related macular degeneration (nAMD) resistant to other intravitreally injected anti-vascular endothelial growth factor inhibitors were switched to intravitreal brolucizumab. All patients underwent ophthalmological examinations at baseline and in regular follow-up intervals. Best registered visual acuity (BRVA), Goldmann tonometry, intraocular pressure (IOP), central retinal thickness (CRT) and pigment epithelial detachment (PED) characteristics were analyzed at initiation of anti-VEGF treatment, at treatment switch, and at the end of brolucizumab loading phase. RESULTS The study included 20 eyes of 18 consecutively treated patients (age: 77 ± 6 years). All eyes had macular neovascularization with PED. Previous treatments included intravitreal aflibercept, bevacizumab, and ranibizumab and had not resulted in a significant improvement in BRVA (0.5 ± 0.5 logMAR vs 0.5 ± 0.6 logMAR) or mean CRT (320 ± 60 µm vs 313 ± 83 µm) up to treatment switch to brolucizumab. At the end of the brolucizumab loading phase, there was significant improvement for both BRVA (0.3 ± 0.2 logMAR, P < 0.05) and CRT (264 ± 55 µm, P < 0.05). Under previous anti-VEGF therapy, there was a significant increase/deterioration in both PED area (2.68 mm2 to 5.18 mm2, P < 0.05) and PED volume (0.39 mm3 to 1.07 mm3, P < 0.05); however, both parameters improved after switching to brolucizumab (3.81 mm2 and 0.37 mm3, P < 0.05). CONCLUSION Our results suggest a favourable anatomical and visual response after treatment switch to brolucizumab in patients with nAMD refractory to previous anti-VEGF agents.
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Affiliation(s)
- Argyrios Chronopoulos
- Department of Ophthalmology, Ludwigshafen City Hospital, Ludwigshafen am Rhein, Germany
| | - Elisa Huynh
- Department of Ophthalmology, Ludwigshafen City Hospital, Ludwigshafen am Rhein, Germany
| | - Agharza Ashurov
- Department of Ophthalmology, Ludwigshafen City Hospital, Ludwigshafen am Rhein, Germany
| | - James S Schutz
- Department of Ophthalmology, Ludwigshafen City Hospital, Ludwigshafen am Rhein, Germany
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Lars-Olof Hattenbach
- Department of Ophthalmology, Ludwigshafen City Hospital, Ludwigshafen am Rhein, Germany
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Burchard CVD, Roider J, Kepp T. Analysis of OCT Scanning Parameters in AMD and RVO. Diagnostics (Basel) 2024; 14:516. [PMID: 38472988 DOI: 10.3390/diagnostics14050516] [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: 02/02/2024] [Revised: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
Optical coherence tomography (OCT) is an extensively used imaging tool for disease monitoring in both age-related macular degeneration (AMD) and retinal vein occlusion (RVO). However, there is limited literature on minimum requirements of OCT settings for reliable biomarker detection. This study systematically investigates both the influence of scan size and interscan distance (ISD) on disease activity detection. We analyzed 80 OCT volumes of AMD patients and 12 OCT volumes of RVO patients for the presence of subretinal fluid (SRF), intraretinal fluid (IRF), and pigment epithelium detachment (PED). All volume scans had a scan size of 6 × 6 mm and an ISD of 125 µm. We analyzed both general fluid distribution and how biomarker detection sensitivity decreases when reducing scan size or density. We found that in AMD patients, all fluids were nearly normally distributed, with most occurrences in the foveal center and concentric decrease towards the periphery. When reducing the scan size to 3 × 3 and 2 × 2 mm, disease activity detection was still high (0.98 and 0.96). Increasing ISD only slightly can already compromise biomarker detection sensitivity (0.9 for 250 µm ISD against 125 µm ISD).
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Affiliation(s)
| | - Johann Roider
- Department of Ophthalmology, Kiel University, 24105 Kiel, Germany
| | - Timo Kepp
- German Research Center for Artificial Intelligence, 23562 Lübeck, Germany
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Blasiak J, Pawlowska E, Ciupińska J, Derwich M, Szczepanska J, Kaarniranta K. A New Generation of Gene Therapies as the Future of Wet AMD Treatment. Int J Mol Sci 2024; 25:2386. [PMID: 38397064 PMCID: PMC10888617 DOI: 10.3390/ijms25042386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
Age-related macular degeneration (AMD) is an eye disease and the most common cause of vision loss in the Western World. In its advanced stage, AMD occurs in two clinically distinguished forms, dry and wet, but only wet AMD is treatable. However, the treatment based on repeated injections with vascular endothelial growth factor A (VEGFA) antagonists may at best stop the disease progression and prevent or delay vision loss but without an improvement of visual dysfunction. Moreover, it is a serious mental and financial burden for patients and may be linked with some complications. The recent first success of intravitreal gene therapy with ADVM-022, which transformed retinal cells to continuous production of aflibercept, a VEGF antagonist, after a single injection, has opened a revolutionary perspective in wet AMD treatment. Promising results obtained so far in other ongoing clinical trials support this perspective. In this narrative/hypothesis review, we present basic information on wet AMD pathogenesis and treatment, the concept of gene therapy in retinal diseases, update evidence on completed and ongoing clinical trials with gene therapy for wet AMD, and perspectives on the progress to the clinic of "one and done" therapy for wet AMD to replace a lifetime of injections. Gene editing targeting the VEGFA gene is also presented as another gene therapy strategy to improve wet AMD management.
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Affiliation(s)
- Janusz Blasiak
- Faculty of Medicine, Collegium Medicum, Mazovian Academy in Plock, 09-402 Plock, Poland
| | - Elzbieta Pawlowska
- Department of Pediatric Dentistry, Medical University of Lodz, 92-217 Lodz, Poland; (E.P.); (M.D.); (J.S.)
| | - Justyna Ciupińska
- Clinical Department of Infectious Diseases and Hepatology, H. Bieganski Hospital, 91-347 Lodz, Poland;
| | - Marcin Derwich
- Department of Pediatric Dentistry, Medical University of Lodz, 92-217 Lodz, Poland; (E.P.); (M.D.); (J.S.)
| | - Joanna Szczepanska
- Department of Pediatric Dentistry, Medical University of Lodz, 92-217 Lodz, Poland; (E.P.); (M.D.); (J.S.)
| | - Kai Kaarniranta
- Department of Ophthalmology, University of Eastern Finland, 70210 Kuopio, Finland;
- Department of Ophthalmology, Kuopio University Hospital, 70210 Kuopio, Finland
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Hieb AR, Horvath J, Rea J, Tam T, Chang DP, de Jong I, Zheng K, Yohe ST, Ranade SV. Stability of ranibizumab during continuous delivery from the Port Delivery Platform. J Control Release 2024; 366:170-181. [PMID: 38128885 DOI: 10.1016/j.jconrel.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/28/2023] [Accepted: 12/17/2023] [Indexed: 12/23/2023]
Abstract
The Port Delivery System with ranibizumab (PDS) is an innovative intraocular drug delivery system that has the potential to reduce treatment burden in patients with retinovascular diseases. The Port Delivery Platform (PD-P) implant is a permanent, indwelling device that can be refilled in situ through a self-sealing septum and is designed to continuously deliver ranibizumab by passive diffusion through a porous titanium release control element. We present results for the studies carried out to characterize the stability of ranibizumab for use with the PD-P. Simulated administration, in vitro release studies, and modeling studies were performed to evaluate the compatibility of ranibizumab with the PD-P administration components, and degradation and photostability in the implant. Simulated administration studies demonstrated that ranibizumab was highly compatible with the PD-P administration components (initial fill and refill needles) and commercially available administration components (syringe, transfer needle, syringe closure). Subsequent simulated in vitro release studies examining continuous delivery for up to 12 months in phosphate buffered saline, a surrogate for human vitreous, showed that the primary degradation products of ranibizumab were acidic variants. The presence of these variants increased over time and potency remained high. The stability attributes of ranibizumab were consistent across multiple implant refill-exchanges. Despite some degradation within the implant, the absolute mass of variants released daily from the implant was low due to the continuous release mechanism of the implant. Simulated light exposure within the implant resulted in small increases in the relative amount of ranibizumab degradants compared with those seen over 6 months.
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Affiliation(s)
- Aaron R Hieb
- Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Judit Horvath
- Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Jennifer Rea
- Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Tammy Tam
- Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Debby P Chang
- Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | | | - Kai Zheng
- Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Stefan T Yohe
- Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
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Akbulut E, Kirik F, Ekinci Aslanoglu C, Hekimoglu ER, Haciosmanoglu Aldogan E, Ozdemir MH. The Inflammatory and Cytological Effect of Repeated Povidone-Iodine Application in Patients Receiving Intravitreal Injections. Eye Contact Lens 2024; 50:73-78. [PMID: 37791838 DOI: 10.1097/icl.0000000000001044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE To investigate the effect of repeated povidone-iodine (PVI) application on the ocular surface parameters of patients who received intravitreal injections. MATERIALS AND METHODS In this prospective study, 52 eyes of 52 patients with age-related macular degeneration who underwent unilateral intravitreal injection at least three times in the last 1 year (intravitreal injection [IVI] group), 52 fellow eyes with no previous intravitreal injection (NIVI group), and 51 eyes of 51 healthy subjects (control) were included. Tear break-up time (TBUT), the Schirmer test, the Oxford staining score, the Ocular Surface Disease Index questionnaire, conjunctival impression cytology, and tear inflammatory cytokine levels (interleukin [IL]-1β and IL-6) were analyzed in all participants. RESULTS The IVI group had lower TBUT and higher Oxford staining score than the NIVI and control groups ( P <0.05). No significant difference was found between the groups in the Schirmer test ( P =0.161). Conjunctival impression cytology analysis revealed that the IVI group had a significantly lower goblet cell count and significantly higher Nelson staging result than the NIVI and control groups ( P <0.05). As a result of tear cytokine analysis, although IVI and NIVI groups had higher IL-1β and IL-6 levels than the control group ( P <0.05), there was no difference between NIVI and IVI groups ( P ≥0.05). CONCLUSIONS Repeated PVI application caused cytotoxic injury to the ocular surface, resulting in goblet cell loss and squamous metaplasia of epithelial cells. As a result, the stability of the tear film layer was found to be impaired and ocular surface-related symptoms developed in patients.
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Affiliation(s)
- Ersin Akbulut
- Department of Ophthalmology (E.A.), Sultanbeyli State Hospital, Istanbul, Turkey; Department of Ophthalmology (F.K., C.E.A., M.H.O.), Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey; Department of Histology and Embryology (E.R.H.), Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey; and Department of Biophysics (E.H.A.), Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Martin-Pinardel R, Izquierdo-Serra J, De Zanet S, Parrado-Carrillo A, Garay-Aramburu G, Puzo M, Arruabarrena C, Sararols L, Abraldes M, Broc L, Escobar-Barranco JJ, Figueroa M, Zapata MA, Ruiz-Moreno JM, Moll-Udina A, Bernal-Morales C, Alforja S, Figueras-Roca M, Gómez-Baldó L, Ciller C, Apostolopoulos S, Mosinska A, Casaroli Marano RP, Zarranz-Ventura J. Artificial intelligence-based fluid quantification and associated visual outcomes in a real-world, multicentre neovascular age-related macular degeneration national database. Br J Ophthalmol 2024; 108:253-262. [PMID: 36627173 DOI: 10.1136/bjo-2022-322297] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/27/2022] [Indexed: 01/12/2023]
Abstract
AIM To explore associations between artificial intelligence (AI)-based fluid compartment quantifications and 12 months visual outcomes in OCT images from a real-world, multicentre, national cohort of naïve neovascular age-related macular degeneration (nAMD) treated eyes. METHODS Demographics, visual acuity (VA), drug and number of injections data were collected using a validated web-based tool. Fluid compartment quantifications including intraretinal fluid (IRF), subretinal fluid (SRF) and pigment epithelial detachment (PED) in the fovea (1 mm), parafovea (3 mm) and perifovea (6 mm) were measured in nanoliters (nL) using a validated AI-tool. RESULTS 452 naïve nAMD eyes presented a mean VA gain of +5.5 letters with a median of 7 injections over 12 months. Baseline foveal IRF associated poorer baseline (44.7 vs 63.4 letters) and final VA (52.1 vs 69.1), SRF better final VA (67.1 vs 59.0) and greater VA gains (+7.1 vs +1.9), and PED poorer baseline (48.8 vs 57.3) and final VA (55.1 vs 64.1). Predicted VA gains were greater for foveal SRF (+6.2 vs +0.6), parafoveal SRF (+6.9 vs +1.3), perifoveal SRF (+6.2 vs -0.1) and parafoveal IRF (+7.4 vs +3.6, all p<0.05). Fluid dynamics analysis revealed the greatest relative volume reduction for foveal SRF (-16.4 nL, -86.8%), followed by IRF (-17.2 nL, -84.7%) and PED (-19.1 nL, -28.6%). Subgroup analysis showed greater reductions in eyes with higher number of injections. CONCLUSION This real-world study describes an AI-based analysis of fluid dynamics and defines baseline OCT-based patient profiles that associate 12-month visual outcomes in a large cohort of treated naïve nAMD eyes nationwide.
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Affiliation(s)
- Ruben Martin-Pinardel
- IDIBAPS, Barcelona, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
| | | | | | | | | | - Martin Puzo
- Miguel Servet Ophthalmology Research Group (GIMSO), Miguel Servet University Hospital, Zaragoza, Spain
| | | | - Laura Sararols
- Fundació Privada Hospital Asil Granollers, Granollers, Spain
| | | | - Laura Broc
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | | | | | - Aina Moll-Udina
- IDIBAPS, Barcelona, Spain
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Socorro Alforja
- IDIBAPS, Barcelona, Spain
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | | | | | | | - Ricardo P Casaroli Marano
- IDIBAPS, Barcelona, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - Javier Zarranz-Ventura
- IDIBAPS, Barcelona, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
- Hospital Clinic de Barcelona, Barcelona, Spain
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Almuiña-Varela P, García-Quintanilla L, Rodríguez-Cid MJ, Gil-Martínez M, Abraldes MJ, Gómez-Ulla F, Estany-Gestal A, Alcántara-Espinosa JM, Fernández-Rodríguez M, Fernández-Ferreiro A. Relationships between Patient-Reported Outcome Measures and Clinical Measures in Naïve Neovascular Age-Related Macular Degeneration Patients Treated with Intravitreal Ranibizumab. Pharmaceuticals (Basel) 2024; 17:157. [PMID: 38399372 PMCID: PMC10893278 DOI: 10.3390/ph17020157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/15/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024] Open
Abstract
Our objective was to evaluate changes in patient-reported outcome measures using the NEI-VFQ 25 questionnaire during a treat and extend regimen in naive neovascular Age-Related Macular Degeneration patients, and its correlation with anatomical and functional data. We conducted a prospective observational study. Patients underwent a treat and extend regimen with intravitreal ranibizumab for neovascular Age-Related Macular Degeneration. Initial response was evaluated at 4th month, and subsequently in every follow-up visit. If a clinical response was achieved, the injection interval was extended in two-week increments, up to a maximum of 12 weeks. Quality of life was assessed using the NEI-VFQ 25 questionnaire at baseline, 4th months, and 12th months. Patients were categorized as good or poor responders based on Best corrected visual acuity, central foveal thickness, intraretinal fluid, or subretinal fluid. Treatment with ranibizumab led to a significant improvement in quality of life, with a mean increase in NEI-VFQ 25 score of 4.27 points in the 12th month. No significant differences in improvement were observed between good and poor responders. Quality of life scores in neovascular Age-Related Macular Degeneration patients improved with intravitreal treatment regardless of the clinical response. The early response following the loading phase could indicate better quality of life after one year of treatment, with Best corrected visual acuity being the clinical parameter with the greatest influence on quality of life.
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Affiliation(s)
- Pablo Almuiña-Varela
- Ophthalmology Department, University Clinical Hospital of Santiago de Compostela, (SERGAS), 15706 Santiago de Compostela, Spain; (P.A.-V.); (M.J.R.-C.); (M.G.-M.); (M.J.A.)
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain;
| | - Laura García-Quintanilla
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain;
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - María José Rodríguez-Cid
- Ophthalmology Department, University Clinical Hospital of Santiago de Compostela, (SERGAS), 15706 Santiago de Compostela, Spain; (P.A.-V.); (M.J.R.-C.); (M.G.-M.); (M.J.A.)
| | - María Gil-Martínez
- Ophthalmology Department, University Clinical Hospital of Santiago de Compostela, (SERGAS), 15706 Santiago de Compostela, Spain; (P.A.-V.); (M.J.R.-C.); (M.G.-M.); (M.J.A.)
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain;
| | - Maximino J. Abraldes
- Ophthalmology Department, University Clinical Hospital of Santiago de Compostela, (SERGAS), 15706 Santiago de Compostela, Spain; (P.A.-V.); (M.J.R.-C.); (M.G.-M.); (M.J.A.)
- Instituto Oftalmológico Gómez-Ulla, 15706 Santiago de Compostela, Spain;
- Department of Surgery, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | | | - Ana Estany-Gestal
- FIDIS-Unidad de Epidemiología e Investigación Clínica, 15706 Santiago de Compostela, Spain; (A.E.-G.); (J.M.A.-E.)
| | | | - Maribel Fernández-Rodríguez
- Ophthalmology Department, University Clinical Hospital of Santiago de Compostela, (SERGAS), 15706 Santiago de Compostela, Spain; (P.A.-V.); (M.J.R.-C.); (M.G.-M.); (M.J.A.)
- Instituto Oftalmológico Gómez-Ulla, 15706 Santiago de Compostela, Spain;
- Department of Surgery, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Anxo Fernández-Ferreiro
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain;
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
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Gao Y, Zhang S, Zhao Y, Yang T, Moreira P, Sun G. Reduction of retinal vessel density in non-exudative macular neovascularization: a retrospective study. Front Med (Lausanne) 2024; 10:1219423. [PMID: 38239611 PMCID: PMC10794739 DOI: 10.3389/fmed.2023.1219423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 12/05/2023] [Indexed: 01/22/2024] Open
Abstract
Purpose The purpose of this study is to identify predictive activation biomarkers in retinal microvascular characteristics of non-exudative macular neovascularization (MNV) and avoid delayed treatment or overtreatment of subclinical MNV. The main objective is to contribute to the international debate on a new understanding of the role of retinal vessel features in the pathogenesis and progression of non-exudative MNV and age-related macular degeneration (AMD). A discussion on revising-related clinical protocols is presented. Methods In this retrospective study, the authors included eyes with non-exudative MNV, eyes with exudative AMD, and normal eyes of age-matched healthy subjects. The parameters were obtained by optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Results In total, 21 eyes with exudative AMD, 21 eyes with non-exudative MNV, and 20 eyes of 20 age-matched healthy subjects without retinal pathology were included. Vessel density (VD) of the deep vascular complex (DVC) in eyes with non-exudative MNV was significantly greater than that in eyes with exudative AMD (p = 0.002), while for superficial vascular plexus (SVP) metrics, no VD differences among sectors were observed between eyes with non-exudative MNV and eyes with exudative AMD. Conclusion The reduction in retinal vessel density, especially in the DVC, seems to be involved in or be accompanied by non-exudative MNV activation and should be closely monitored during follow-up visits in order to ensure prompt anti-angiogenic therapy. A discussion on applicable clinical protocols is presented aiming to contribute to new insights into ophthalmology service development which is directed to this specific type of patient and diagnosis.
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Affiliation(s)
- Yang Gao
- Department of Ophthalmology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China
| | - Su Zhang
- The Affiliated Eye Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yue Zhao
- The Affiliated Eye Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Tingting Yang
- The Affiliated Eye Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Paulo Moreira
- International Healthcare Management Research and Development Center (IHM-RDC), Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China
- Atlantica Instituto Universitario, Gestao em Saude, Oeiras, Portugal
| | - Guangli Sun
- The Affiliated Eye Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
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Sil Kar S, Cetin H, Srivastava SK, Madabhushi A, Ehlers JP. Texture-Based Radiomic SD-OCT Features Associated With Response to Anti-VEGF Therapy in a Phase III Neovascular AMD Clinical Trial. Transl Vis Sci Technol 2024; 13:29. [PMID: 38289610 PMCID: PMC10833054 DOI: 10.1167/tvst.13.1.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 11/03/2023] [Indexed: 02/01/2024] Open
Abstract
Purpose The goal of this study was to evaluate the role of texture-based baseline radiomic features (Fr) and dynamic radiomics alterations (delta, FΔr) within multiple targeted compartments on optical coherence tomography (OCT) scans to predict response to anti-vascular endothelial growth factor (VEGF) therapy in neovascular age-related macular degeneration (nAMD). Methods HAWK is a phase 3 clinical trial data set of active nAMD patients (N = 1082) comparing brolucizumab and aflibercept. This analysis included patients receiving 6 mg brolucizumab or 2 mg aflibercept and categorized as complete responders (n = 280) and incomplete responders (n = 239) based on whether or not the eyes achieved/maintained fluid resolution on OCT. A total of 481 Fr were extracted from each of the fluid, subretinal hyperreflective material (SHRM), retinal tissue, and sub-retinal pigment epithelium (RPE) compartments. Most discriminating eight baseline features, selected by the minimum redundancy, maximum relevance feature selection, were evaluated using a quadratic discriminant analysis (QDA) classifier on the training set (Str, n = 363) to differentiate between the two patient groups. Classifier performance was subsequently validated on independent test set (St, n = 156). Results In total, 519 participants were included in this analysis from the HAWK phase 3 study. There were 280 complete responders and 219 incomplete responders. Compartmental analysis of radiomics featured identified the sub-RPE and SHRM compartments as the most distinguishing between the two response groups. The QDA classifier yielded areas under the curve of 0.78, 0.79, and 0.84, respectively, using Fr, FΔr, and combined Fr, FΔr, and Fc on St. Conclusions Utilizing compartmental static and dynamic radiomics features, unique differences were identified between eyes that respond differently to anti-VEGF therapy in a large phase 3 trial that may provide important predictive value. Translational Relevance Imaging biomarkers, such as radiomics features identified in this analysis, for predicting treatment response are needed to enhanced precision medicine in the management of nAMD.
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Affiliation(s)
- Sudeshna Sil Kar
- Wallace H. Coulter Department of Biomedical Engineering, Emory University, Atlanta, GA, USA
| | - Hasan Cetin
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sunil K. Srivastava
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anant Madabhushi
- Wallace H. Coulter Department of Biomedical Engineering, Emory University, Atlanta, GA, USA
- Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH, USA
| | - Justis P. Ehlers
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
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Li B, Fan K, Zhang T, Wu Z, Zeng S, Zhao M, Ren Q, Zheng D, Wang L, Liu X, Han M, Song Y, Ye J, Pei C, Yi J, Wang X, Peng H, Zhang H, Zhou Z, Liang X, Yu F, Wu M, Li C, Lei C, Hao J, Tang L, Yuan H, Cai S, Li Q, Zhong J, Li S, Liu L, Ke M, Wang J, Wang H, Zhu M, Wang Z, Yan Y, Wang F, Chen Y. Efficacy and Safety of Biosimilar QL1207 vs. the Reference Aflibercept for Patients with Neovascular Age-Related Macular Degeneration: A Randomized Phase 3 Trial. Ophthalmol Ther 2024; 13:353-366. [PMID: 37987893 PMCID: PMC10776547 DOI: 10.1007/s40123-023-00836-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/11/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION This trial aimed to compare the efficacy and safety between biosimilar QL1207 and the reference aflibercept for the treatment of neovascular age-related macular degeneration (nAMD). METHODS This randomized, double-blind, phase 3 trial was conducted at 35 centers in China. Patients aged ≥ 50 years old with untreated subfoveal choroidal neovascularization secondary to nAMD and best-corrected visual acuity (BCVA) letter score of 73-34 were eligible. Patients were randomly assigned to receive intravitreous injections of QL1207 or aflibercept 2 mg (0.05 ml) in the study eye every 4 weeks for the first 3 months, followed by 2 mg every 8 weeks until week 48, stratified by baseline BCVA ≥ or < 45 letters. The primary endpoint was BCVA change from baseline at week 12. The equivalence margin was ± 5 letters. The safety, immunogenicity, pharmacokinetics (PK), and plasma vascular endothelial growth factor (VEGF) concentration were also evaluated. RESULTS A total of 366 patients were enrolled (QL1207 group, n = 185; aflibercept group, n = 181) from Aug 2019 to Jan 2022 with comparable baseline characteristics. The least-squares mean difference in BCVA changes was - 1.1 letters (95% confidence interval - 3.0 to 0.7; P = 0.2275) between the two groups, within the equivalence margin. The incidences of treatment-emergent adverse events (TEAE; QL1207: 71.4% [132/185] vs. aflibercept: 71.8% [130/181]) and serious TEAE (QL1207: 14.1% [26] vs. aflibercept: 12.7% [23]) appeared comparable between treatment groups, and no new safety signal was found. Anti-drug antibody, PK profiles, and VEGF concentration were similar between the two groups. CONCLUSIONS QL1207 has equivalent efficacy to aflibercept for nAMD with similar safety profiles. It could be used as an alternative anti-VEGF agent for clinical practice. TRIAL REGISTRATION ClinicalTrials.gov: NCT05345236 (retrospectively registered on April 25, 2022); National Medical Products Administration of China: CTR20190937 (May 20, 2019).
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Affiliation(s)
- Bing Li
- Ophthalmology Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Ke Fan
- Ophthalmology Department, Henan Provincial Eye Hospital, Zhengzhou, China
| | - Tonghe Zhang
- Ophthalmology Department, Jinan Second People's Hospital, Jinan, China
| | - Zhifeng Wu
- Ophthalmology Department, Wuxi Second People's Hospital, Wuxi, China
| | - Siming Zeng
- Ophthalmology Department, Guangxi Zhuang Autonomous Region People's Hospital, Nanning, China
| | - Mingwei Zhao
- Ophthalmology Department, Peking University People's Hospital, Beijing, China
| | - Qian Ren
- Ophthalmology Department, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Dongping Zheng
- Ophthalmology Department, Shanxi Ophthalmic Hospital, Taiyuan, China
| | - Lifei Wang
- Ophthalmology Department, Hebei Eye Hospital, Xingtai, China
| | - Xiaoling Liu
- Ophthalmology Department, Eye Hospital, WMU Zhejiang Eye Hospital, Wenzhou, China
| | - Mei Han
- Ophthalmology Department, Tianjin Eye Hospital, Tianjin, China
| | - Yanping Song
- Ophthalmology Department, General Hospital of Central Theater Command, Wuhan, China
| | - Jian Ye
- Ophthalmology Department, Army Medical Center of PLA, Chongqing, China
| | - Cheng Pei
- Ophthalmology Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jinglin Yi
- Ophthalmology Department, Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Xian Wang
- Ophthalmology Department, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Hui Peng
- Ophthalmology Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hong Zhang
- Ophthalmology Department, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhanyu Zhou
- Ophthalmology Department, Qingdao Municipal Hospital, Qingdao, China
| | - Xiaoling Liang
- Ophthalmology Department, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Fangliang Yu
- Ophthalmology Department, The First Hospital of Nanchang, Nanchang, China
| | - Miaoqin Wu
- Ophthalmology Department, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Chaopeng Li
- Ophthalmology Department, Huai'an First People's Hospital, Huai'an, China
| | - Chunling Lei
- Ophthalmology Department, Xi'an People's Hospital, Xi'an, China
| | - Jilong Hao
- Ophthalmology Department, First Hospital of Jilin University, Changchun, China
| | - Luosheng Tang
- Ophthalmology Department, The Second Xiangya Hospital of Center South University, Changsha, China
| | - Huiping Yuan
- Ophthalmology Department, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shanjun Cai
- Ophthalmology Department, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Qiuming Li
- Ophthalmology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingxiang Zhong
- Ophthalmology Department, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Suyan Li
- Ophthalmology Department, Xuzhou First People's Hospital, Xuzhou, China
| | - Lin Liu
- Ophthalmology Department, Renji Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Min Ke
- Ophthalmology Department, Wuhan University Zhongnan Hospital, Wuhan, China
| | - Jing Wang
- Clinical Research Center, Qilu Pharmaceutical Co., Ltd., Jinan, China
| | - Hui Wang
- Clinical Research Center, Qilu Pharmaceutical Co., Ltd., Jinan, China
| | - Mengli Zhu
- Clinical Research Center, Qilu Pharmaceutical Co., Ltd., Jinan, China
| | - Zenghua Wang
- Clinical Research Center, Qilu Pharmaceutical Co., Ltd., Jinan, China
| | - Yang Yan
- Clinical Research Center, Qilu Pharmaceutical Co., Ltd., Jinan, China
| | - Feng Wang
- Ophthalmology Department, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157, Xiwu Road, Xincheng District, Xi'an, 710004, China.
| | - Youxin Chen
- Ophthalmology Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China.
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Joseph A, Bullimore M, Drawnel F, Miranda M, Morgan Z, Wang YZ. Remote Monitoring of Visual Function in Patients with Maculopathy: The Aphelion Study. Ophthalmol Ther 2024; 13:409-422. [PMID: 38015309 PMCID: PMC10776523 DOI: 10.1007/s40123-023-00854-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION Remote monitoring of vision, using tools such as the shape discrimination hyperacuity (SDH) test, can detect disease activity in patients with maculopathy. We determined the in-clinic accuracy and repeatability of three myVisionTrack expanded version (mVTx) tests for self-testing of visual acuity (VA) and contrast sensitivity. METHODS Aphelion, a single-arm, prospective study conducted at two sites in the USA, included adults with any maculopathy and a baseline VA of 0.7 log of minimum angle of resolution (logMAR) (Snellen 20/100) or better. Participants completed the mVTx tests (tumbling E, Landolt C, contrast sensitivity, and SDH) and standard clinical tests (near and distance Early Treatment Diabetic Retinopathy Study [ETDRS] charts and the Pelli-Robson contrast sensitivity chart). Test-retest repeatability and agreement between the mVTx tests and the corresponding clinical test were assessed by Bland-Altman analyses. Participants also completed a usability survey. RESULTS The mean age of the 122 participants was 67 years. The most common diagnosis was age-related macular degeneration (42% of patients). The tumbling E test had a test-retest 95% limit of agreement (LoA) of ± 0.18 logMAR; the Landolt C test, ± 0.23 logMAR; the SDH test, ± 0.24 logMAR; and the contrast sensitivity test, ± 0.32 log contrast threshold (logCT). Compared with the distance ETDRS chart, the LoA was ± 0.35 logMAR for the tumbling E test (mean difference, - 0.07 logMAR) and ± 0.39 logMAR for the Landolt C test (mean difference, 0.03 logMAR). For the contrast sensitivity test, the LoA compared with the Pelli-Robson chart was ± 0.30 logCT (mean difference, - 0.25 logCT). Most participants (85%) reported that they learned the tests quickly. The tumbling E test scored the highest on ease of use. CONCLUSION The mVTx tests of VA are accurate and repeatable, supporting their potential use alongside the SDH test to detect disease progression remotely between clinic visits.
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Affiliation(s)
| | - Mark Bullimore
- University of Houston College of Optometry, Houston, TX, USA
| | | | - Marco Miranda
- Roche Products, Ltd., Welwyn Garden City, UK
- University College London Institute of Ophthalmology, London, UK
| | - Zoe Morgan
- F. Hoffmann-La Roche AG, Basel, Switzerland
| | - Yi-Zhong Wang
- Retina Foundation of the Southwest, 9600 N. Central Expressway, Suite 200, Dallas, TX, 75321, USA.
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, USA.
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Mastropasqua R, Gironi M, D’Aloisio R, Pastore V, Boscia G, Vecchiarino L, Perna F, Clemente K, Palladinetti I, Calandra M, Piepoli M, Porreca A, Di Nicola M, Boscia F. Intraoperative Iridectomy in Femto-Laser Assisted Smaller-Incision New Generation Implantable Miniature Telescope. J Clin Med 2023; 13:76. [PMID: 38202083 PMCID: PMC10779865 DOI: 10.3390/jcm13010076] [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: 11/06/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND In this study, we aimed to report the short-term (6 months) effects on visual functionality and safety of femto-laser assisted smaller-incision new-generation implantable miniature telescope (SING-IMT™) implanting, particularly related to postsurgical intraocular pressure increase, in patients suffering from end-stage age-related macular degeneration (AMD) and cataract. This device, designed for monocular use, aims to minimise the impact of the central scotoma by projecting the images onto a larger area of the photoreceptors surrounding the macula. METHODS In this prospective multicentric observational case series study, 6 eyes of 6 patients who underwent SING-IMT™ implantations were enrolled. At baseline and 6 months follow-up, best corrected distance visual acuity (BCDV) and best corrected near visual acuity (BCNVA), intraocular pressure (IOP), anterior chamber depth, endothelial cells count were assessed. In addition, IOP was also measured at 7, 15, 30, 45 days, and at 3 months follow-up. Finally, the incidence of complications was evaluated. RESULTS At final follow-up, in the study eyes, mean BCDVA improved by +10.0 letters (6.25; 13.8) letters and mean BCNVA improved by -0.30 logMAR (-0.55; -0.20). At postoperative month 6, we reported a mean IOP decrease of 4.50 mmHg (-5.75; -0.25). Interestingly, 83.3% of patients had an increased IOP value in at least one of the first two postoperative follow-ups (7 days and 15 days). In patients in whom intraoperative mechanical iridotomy was not performed, it was necessary to perform a postoperative YAG laser iridotomy to improve IOP management. Compared to the baseline, ECD loss at 6 months follow-up was 12.6%. CONCLUSIONS The SING IMT™ device was found to be effective in the distance and near vision improvement, without serious postoperative complications. We recommend intraoperative mechanical iridectomy in order to easily manage post-operative IOP and to avoid sudden IOP rise with its possible consequences. These good results can be a hope to partially improve the quality of life of patients suffering from severe end stage macular atrophy.
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Affiliation(s)
- Rodolfo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (R.M.); (M.G.); (L.V.); (F.P.); (K.C.); (I.P.); (M.C.)
| | - Matteo Gironi
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (R.M.); (M.G.); (L.V.); (F.P.); (K.C.); (I.P.); (M.C.)
| | - Rossella D’Aloisio
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (R.M.); (M.G.); (L.V.); (F.P.); (K.C.); (I.P.); (M.C.)
| | - Valentina Pastore
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70121 Bari, Italy; (V.P.); (G.B.); (M.P.); (F.B.)
| | - Giacomo Boscia
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70121 Bari, Italy; (V.P.); (G.B.); (M.P.); (F.B.)
| | - Luca Vecchiarino
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (R.M.); (M.G.); (L.V.); (F.P.); (K.C.); (I.P.); (M.C.)
| | - Fabiana Perna
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (R.M.); (M.G.); (L.V.); (F.P.); (K.C.); (I.P.); (M.C.)
- International Agency of Prevention of Blindness, 00185 Rome, Italy
| | - Katia Clemente
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (R.M.); (M.G.); (L.V.); (F.P.); (K.C.); (I.P.); (M.C.)
| | - Ilaria Palladinetti
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (R.M.); (M.G.); (L.V.); (F.P.); (K.C.); (I.P.); (M.C.)
| | - Michela Calandra
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (R.M.); (M.G.); (L.V.); (F.P.); (K.C.); (I.P.); (M.C.)
| | - Marina Piepoli
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70121 Bari, Italy; (V.P.); (G.B.); (M.P.); (F.B.)
| | - Annamaria Porreca
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (A.P.); (M.D.N.)
| | - Marta Di Nicola
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (A.P.); (M.D.N.)
| | - Francesco Boscia
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70121 Bari, Italy; (V.P.); (G.B.); (M.P.); (F.B.)
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Reiter GS, Bogunovic H, Schlanitz F, Vogl WD, Seeböck P, Ramazanova D, Schmidt-Erfurth U. Point-to-point associations of drusen and hyperreflective foci volumes with retinal sensitivity in non-exudative age-related macular degeneration. Eye (Lond) 2023; 37:3582-3588. [PMID: 37170011 PMCID: PMC10686390 DOI: 10.1038/s41433-023-02554-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 04/13/2023] [Accepted: 04/20/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVES To evaluate the quantitative impact of drusen and hyperreflective foci (HRF) volumes on mesopic retinal sensitivity in non-exudative age-related macular degeneration (AMD). METHODS In a standardized follow-up scheme of every three months, retinal sensitivity of patients with early or intermediate AMD was assessed by microperimetry using a custom pattern of 45 stimuli (Nidek MP-3, Gamagori, Japan). Eyes were consecutively scanned using Spectralis SD-OCT (20° × 20°, 1024 × 97 × 496). Fundus photographs obtained by the MP-3 allowed to map the stimuli locations onto the corresponding OCT scans. The volume and mean thickness of drusen and HRF within a circle of 240 µm centred at each stimulus point was determined using automated AI-based image segmentation algorithms. RESULTS 8055 individual stimuli from 179 visits from 51 eyes of 35 consecutive patients were matched with the respective OCT images in a point-to-point manner. The patients mean age was 76.85 ± 6.6 years. Mean retinal sensitivity at baseline was 25.7 dB. 73.47% of all MP-spots covered drusen area and 2.02% of MP-spots covered HRF. A negative association between retinal sensitivity and the volume of underlying drusen (p < 0.001, Estimate -0.991 db/µm3) and HRF volume (p = 0.002, Estimate -5.230 db/µm3) was found. During observation time, no eye showed conversion to advanced AMD. CONCLUSION A direct correlation between drusen and lower sensitivity of the overlying photoreceptors can be observed. For HRF, a small but significant correlation was shown, which is compromised by their small size. Biomarker quantification using AI-methods allows to determine the impact of sub-clinical features in the progression of AMD.
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Affiliation(s)
- Gregor S Reiter
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Hrvoje Bogunovic
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Ferdinand Schlanitz
- Vienna Clinical Trial Center (VTC), Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | | | - Philipp Seeböck
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Dariga Ramazanova
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
- Vienna Clinical Trial Center (VTC), Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
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