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Galvez-Olortegui J, Bouchikh-El Jarroudi R, Silva-Ocas I, Palacios-Herrera H, Cubillas-Martin M, Zavaleta-Mercado M, Burgueño-Montañes C, Galvez-Olortegui T. Systematic review of clinical practice guidelines for the diagnosis and management of retinal vein occlusion. Eye (Lond) 2024; 38:1722-1733. [PMID: 38467863 PMCID: PMC11156943 DOI: 10.1038/s41433-024-03008-1] [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: 09/13/2023] [Revised: 02/08/2024] [Accepted: 02/28/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND/OBJECTIVES To assess the methodological quality of Clinical Practice Guidelines (CPG) for the diagnosis and management of Retinal Vein Occlusion (RVO). METHODS A systematic review of CPGs for the diagnosis and management of RVO was carried out with a search in databases, metasearch engines, CPG development institutions, ophthalmology associations and CPG repositories until April 2022. Search update was performed on April 2023, with no new record available. Five CPGs published in the last 10 years in English/Spanish were selected, and 5 authors evaluated them independently, using the Appraisal of Guidelines for Research and Evaluation (AGREE-II) instrument. An individual assessment of each CPG by domain (AGREE-II), an overall assessment of the guide, and its use with or without modifications were performed. Additionally, a meta-synthesis of the recommendations for the most relevant outcomes was carried out. RESULTS The lowest score (mean 18.8%) was for domain 5 'applicability', and the highest score (mean 62%) was for domain 4 'clarity of presentation'. The 2019 American guideline (PPP) presented the best score (40.4%) in domain 3 'rigour of development'. When evaluating the overall quality of the CPGs analysed, all CPGs could be recommended with modifications. In the meta-synthesis, anti-VEGF therapy is the first-choice therapy for macular oedema associated with RVO, but there is no clear recommendation about the type of anti-VEGF therapy to choose. Recommendations for diagnosis and follow-up are similar among the CPGs appraised. CONCLUSION Most CPGs for the diagnosis and management of RVO have a low methodological quality assessed according to the AGREE-II. PPP has the higher score in the domain 'rigour of development'. Among the CPGs appraised, there is no clear recommendation on the type of anti-VEGF therapy to choose.
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Affiliation(s)
- Jose Galvez-Olortegui
- Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru.
- Service of Ophthalmology, Hospital Universitario Central de Asturias, Oviedo, Spain.
- Universidad Nacional de Tumbes, Tumbes, Peru.
| | - Rachid Bouchikh-El Jarroudi
- Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru
- Service of Ophthalmology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Department of Surgery, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Isabel Silva-Ocas
- Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru
- Centro de Excelencia en Glaucoma, Clinica GO-Vision, Lima, Peru
| | - Hector Palacios-Herrera
- Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru
- Servicio de Retina y Vitreo, EP Oftalmólogos asociados, Lima, Peru
| | | | - Miguel Zavaleta-Mercado
- Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru
- Instituto de Investigaciones Oftalmológicas y Ciencias Visuales Avanzadas Zavaleta Mercado (Innovaz), Oruro, Bolivia
| | - Carmen Burgueño-Montañes
- Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru
- Service of Ophthalmology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Tomas Galvez-Olortegui
- Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru
- Centro de Excelencia en Glaucoma, Clinica GO-Vision, Lima, Peru
- Department of Ophthalmology, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru
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Ragkousis A, Kazantzis D, Georgalas I, Theodossiadis P, Kroupis C, Chatziralli I. PON1, APOE and SDF-1 Gene Polymorphisms and Risk of Retinal Vein Occlusion: A Case-Control Study. Genes (Basel) 2024; 15:712. [PMID: 38927649 PMCID: PMC11203263 DOI: 10.3390/genes15060712] [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: 04/22/2024] [Revised: 05/25/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
Numerous studies have tried to evaluate the potential role of thrombophilia-related genes in retinal vein occlusion (RVO); however, there is limited research on genes related to different pathophysiological mechanisms involved in RVO. In view of the strong contribution of oxidative stress and inflammation to the pathogenesis of RVO, the purpose of the present study was to investigate the association of inflammation- and oxidative-stress-related polymorphisms from three different genes [apolipoprotein E (APOE), paraoxonase 1 (PON1) and stromal cell-derived factor 1 (SDF-1)] and the risk of RVO in a Greek population. Participants in this case-control study were 50 RVO patients (RVO group) and 50 healthy volunteers (control group). Blood samples were collected on EDTA tubes and genomic DNA was extracted. Genotyping of rs854560 (L55M) and rs662 (Q192R) for the PON1 gene, rs429358 and rs7412 for the APOE gene and rs1801157 [SDF1-3'G(801)A] for SDF-1 gene was performed using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Multiple genetic models (codominant, dominant, recessive, overdominant and log-additive) and haplotype analyses were performed using the SNPStats web tool to assess the correlation between the genetic polymorphisms and the risk of RVO. Binary logistic regression analysis was used for the association analysis between APOE gene variants and RVO. Given the multifactorial nature of the disease, our statistical analysis was adjusted for the most important systemic risk factors (age, hypertension and diabetes mellitus). The dominant genetic model for the PON1 Q192R single nucleotide polymorphism (SNP) of the association analysis revealed that there was a statistically significant difference between the RVO group and the control group. Specifically, after adjusting for age and hypertension, the PON1 192 R allele (QR + RR) was found to be associated with a statistically significantly higher risk of RVO compared to the QQ genotype (OR = 2.51; 95% CI = 1.02-6.14, p = 0.04). The statistically significant results were maintained after including diabetes in the multivariate model in addition to age and hypertension (OR = 2.83; 95% CI = 1.01-7.97, p = 0.042). No statistically significant association was revealed between the other studied polymorphisms and the risk of RVO. Haplotype analysis for PON1 SNPs, L55M and Q192R, revealed no statistically significant correlation. In conclusion, PON1 192 R allele carriers (QR + RR) were associated with a statistically significantly increased risk of RVO compared to the QQ homozygotes. These findings suggest that the R allele of the PON1 Q192R is likely to play a role as a risk factor for retinal vein occlusion.
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Affiliation(s)
- Antonios Ragkousis
- 2nd Department of Ophthalmology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (D.K.); (P.T.); (I.C.)
| | - Dimitrios Kazantzis
- 2nd Department of Ophthalmology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (D.K.); (P.T.); (I.C.)
| | - Ilias Georgalas
- 1st Department of Ophthalmology, “G. Gennimatas” General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Panagiotis Theodossiadis
- 2nd Department of Ophthalmology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (D.K.); (P.T.); (I.C.)
| | - Christos Kroupis
- Department of Clinical Biochemistry, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Irini Chatziralli
- 2nd Department of Ophthalmology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (D.K.); (P.T.); (I.C.)
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Wang H, Meng X, Tang Q, Hao Y, Luo Y, Li J. Development and Application of a Standardized Testset for an Artificial Intelligence Medical Device Intended for the Computer-Aided Diagnosis of Diabetic Retinopathy. JOURNAL OF HEALTHCARE ENGINEERING 2023; 2023:7139560. [PMID: 36818382 PMCID: PMC9931476 DOI: 10.1155/2023/7139560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/21/2022] [Accepted: 11/24/2022] [Indexed: 02/10/2023]
Abstract
Objective To explore a centralized approach to build test sets and assess the performance of an artificial intelligence medical device (AIMD) which is intended for computer-aided diagnosis of diabetic retinopathy (DR). Method A framework was proposed to conduct data collection, data curation, and annotation. Deidentified colour fundus photographs were collected from 11 partner hospitals with raw labels. Photographs with sensitive information or authenticity issues were excluded during vetting. A team of annotators was recruited through qualification examinations and trained. The annotation process included three steps: initial annotation, review, and arbitration. The annotated data then composed a standardized test set, which was further imported to algorithms under test (AUT) from different developers. The algorithm outputs were compared with the final annotation results (reference standard). Result The test set consists of 6327 digital colour fundus photographs. The final labels include 5 stages of DR and non-DR, as well as other ocular diseases and photographs with unacceptable quality. The Fleiss Kappa was 0.75 among the annotators. The Cohen's kappa between raw labels and final labels is 0.5. Using this test set, five AUTs were tested and compared quantitatively. The metrics include accuracy, sensitivity, and specificity. The AUTs showed inhomogeneous capabilities to classify different types of fundus photographs. Conclusions This article demonstrated a workflow to build standardized test sets and conduct algorithm testing of the AIMD for computer-aided diagnosis of diabetic retinopathy. It may provide a reference to develop technical standards that promote product verification and quality control, improving the comparability of products.
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Affiliation(s)
- Hao Wang
- Institute for Medical Device Control, National Institutes for Food and Drug Control, 31 Huatuo Rd, Beijing 102629, China
| | - Xiangfeng Meng
- Institute for Medical Device Control, National Institutes for Food and Drug Control, 31 Huatuo Rd, Beijing 102629, China
| | - Qiaohong Tang
- Institute for Medical Device Control, National Institutes for Food and Drug Control, 31 Huatuo Rd, Beijing 102629, China
| | - Ye Hao
- Institute for Medical Device Control, National Institutes for Food and Drug Control, 31 Huatuo Rd, Beijing 102629, China
| | - Yan Luo
- State Key Laboratory of Ophthalmology, Image Reading Center, Zhongshan Ophthalmic Center, Sun Yat-Sen University, No. 54 Xianlie South Road, Yuexiu District, Guangzhou 510060, Guangdong, China
| | - Jiage Li
- Institute for Medical Device Control, National Institutes for Food and Drug Control, 31 Huatuo Rd, Beijing 102629, China
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Park J, Felfeli T, Kherani IZ, Altomare F, Chow DR, Wong DT. Prevalence and clinical implications of subretinal fluid in retinal diseases: a real-world cohort study. BMJ Open Ophthalmol 2023; 8:bmjophth-2022-001214. [PMID: 37039095 PMCID: PMC9945046 DOI: 10.1136/bmjophth-2022-001214] [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: 11/24/2022] [Accepted: 01/15/2023] [Indexed: 02/23/2023] Open
Abstract
Background/aimsTo characterise the baseline prevalence of subretinal fluid (SRF) and its effects on anatomical and visual acuity (VA) outcomes in diabetic macular oedema (DME) and retinal vein occlusion (RVO) following anti-vascular endothelial growth factor (VEGF).MethodsThis is a retrospective cohort study of 122 DME and 54 RVO patients who were initiated on anti-VEGF therapy with real-world variable dosing. The DME and RVO cohorts were subclassified based on the presence of SRF at presentation. Snellen VA was measured and converted to logarithm of the minimum angle of resolution (LogMAR). Changes in VA and central subfield thickness (CST) were assessed up to 24 months.ResultsSRF was present in 22% and 41% in DME and RVO patients, respectively. In the DME subcohort, eyes with SRF showed an improvement of 0.166 logMAR (1.7 Snellen chart lines) at 12 months and 0.251 logMAR (2.6 Snellen chart lines) at 24 months, which were significantly greater compared with those of the non-SRF group. A significantly greater reduction in CST was noted in the SRF eyes compared with the non-SRF eyes at 3 months and 1 month in the DME and RVO subcohorts, respectively.ConclusionBaseline SRF is a good marker for a greater reduction in CST in both DME and RVO, but an improvement in VA associated with SRF may be only noted in DME.
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Affiliation(s)
- Jeff Park
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tina Felfeli
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Imaan Z Kherani
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Filiberto Altomare
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, St Michael's Hospital, Toronto, Ontario, Canada
| | - David R Chow
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, St Michael's Hospital, Toronto, Ontario, Canada
| | - David T Wong
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, St Michael's Hospital, Toronto, Ontario, Canada
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Yuan Q, Gao Y, Liu Y, Xu H, Wang T, Zhang M. Efficacy of single-dose intravitreal dexamethasone implantation for retinal vein occlusion patients with refractory macular edema: A systematic review and meta-analysis. Front Pharmacol 2022; 13:951666. [PMID: 36249811 PMCID: PMC9554209 DOI: 10.3389/fphar.2022.951666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: To assess the functional and anatomical consequences of single-dose dexamethasone (DEX) implants for the treatment of refractory macular edema (ME) secondary to retinal vein occlusion (RVO) after anti-vascular endothelial growth factor agents.Methods: A literature search of studies on switching therapy to DEX implants from anti-VEGF agents in refractory RVO patients was performed with five electronic databases (PubMed, Embase, Web of Science, MEDLINE, and Cochrane Library) prior to January 2022. The main outcomes included best-corrected visual acuity (BCVA) and central macular thickness (CMT) changes at different follow-up endpoints from baseline. All analyses were performed using Stata version 15.0.Results: The final analysis included four eligible studies with a total of 99 patients. After single-dose DEX implant application, BCVA improved significantly at 2, 3, and 6 months with an average gain of −0.23 logarithm of the minimum angle of resolution (logMAR) (p = 0.004), −0.20 logMAR (p = 0.027), and -0.09 logMAR (p = 0.021), respectively. Mean CMT reduction was also significant from baseline to 2 months (-241.89 μm, p < 0.001), 3 months (−222.61 μm, p < 0.001), and 6 months (−90.49 μm, p < 0.001). No serious adverse events were observed in any of the included studies.Conclusion: This meta-analysis showed that RVO patients with refractory ME could benefit significantly from switching therapy to DEX implantation, with efficacy lasting 6 months after a single-dose application. Intravitreal DEX implantation is a safe and effective option for refractory cases.
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Zhou J, Ma H, Zhou X, Wang Q, Li W, Luo S, Cai C, Li Z, Liu D. Two-Week Central Macular Thickness Reduction Rate >37% Predicts the Long-Term Efficacy of Anti-vascular Endothelial Growth Factor Treatment for Macular Edema Secondary to Retinal Vein Occlusion. Front Med (Lausanne) 2022; 9:851238. [PMID: 35355596 PMCID: PMC8959117 DOI: 10.3389/fmed.2022.851238] [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: 01/09/2022] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo determine if the early response assessments can predict the long-term efficacy of anti-vascular endothelial growth factor (VEGF) treatment for macular edema secondary to retinal vein occlusion (RVO-ME).MethodsA retrospective study of patients with diagnosis of RVO-ME and intravitreal anti-VEGF treatment was conducted. Clinical characteristics including age, gender, disease subtype and disease duration were recorded at baseline. The best corrected visual acuity (BCVA and logMAR), intraocular pressure (IOP), and central macular thickness (CMT) were recorded at baseline, 2 weeks, and every month (months 1–6) after injection. Further, we compared the early response assessments between the cured group (6-month CMT ≤ 250 μm) and the uncured group (6-month CMT > 250 μm).ResultsA total of 164 eyes in 164 patients (77 male and 87 female) were included. At each post-injection time point, both BCVA and CMT are significantly decreased from baseline (all P < 0.001). Spearman’s test showed that 2-week CMT reduction rate after the first injection was negatively correlated with BCVA at 6 months (r = −0.359, P < 0.001). Compared with the uncured group (47 cases), the cured group (117 cases) was younger (59.53 ± 11.68 vs. 65.19 ± 13.10 years old, P < 0.01), had more BRVO patients (76.1% vs. 44.7%, P < 0.01), a shorter disease duration (1.92 ± 2.43 vs. 5.05 ± 4.32 months, P < 0.01), lower baseline CMT (527.09 ± 154.95 vs. 768.96 ± 287.75 μm, P < 0.01), and lower baseline BCVA (0.86 ± 0.44 vs. 1.31 ± 0.51, P < 0.01). At each post-injection time point, the cured group had lower CMT and BCVA values when compared to the uncured group (all P < 0.01), and the 2-week CMT reduction rate was identified as the earliest response time to predict the long-term treatment efficacy. Moreover, ROC curve analysis indicated that a 2-week CMT reduction rate >37% yielded the best cut-off point for predicting the long-term cure of anti-VEGF treatment at 6 months (P < 0.001). Multivariable logistic regression confirmed that the 2-week CMT reduction rate >37% was independently associated with the 6-month cured rate (OR = 9.639, 95% Cl = 1.030–90.227, P = 0.047).ConclusionAge, disease duration, baseline CMT, and baseline BCVA are associated with visual outcomes at 6-month of anti-VEGF treatment for RVO-ME. The “2-week CMT reduction rate >37%” after the first injection is an independent factor to predict better long-term outcomes.
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Affiliation(s)
- Jialin Zhou
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huafeng Ma
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiyuan Zhou
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiuyu Wang
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weihou Li
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shuai Luo
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chang Cai
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zefeng Li
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Danning Liu
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Yan Y, Chen Y, Liu Z. Significant vision improvement and successful prevention of recurrence by electroacupuncture in hemiretinal vein occlusion combined with macular edema: A case report. Medicine (Baltimore) 2021; 100:e28202. [PMID: 34918680 PMCID: PMC8678008 DOI: 10.1097/md.0000000000028202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/22/2021] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Retinal vein occlusion (RVO) is the second commonest retinal vascular pathology, with macular edema (ME) as one of its major complications, which could finally cause vision loss. Anti-vascular endothelial growth factor (anti-VEGF therapy), as the standard therapy, has an unsustainable effect and needs repeated injections, which associates with frequent adverse events and significant economic burden. We reported a patient who had developed RVO and ME, and finally recovered after electroacupuncture treatment. PATIENT CONCERNS A 56-year-old woman complained a decrease of visual acuity in the right eye for 1 year. She received injection of 0.5 mg Conbercept, one of the anti-VEGF therapies, in the vitreous cavity 6 times in 1 year, and finally turned to acupuncture for help out of short-term effectiveness after each injection and high expenditure (CNY 40,800). No other severe medical history was reported. DIAGNOSIS Under comprehensive consideration of clinical manifestations and the results of fluorescein fundus angiography and optical coherence tomography, the patient was diagnosed with hemi-RVO and ME. INTERVENTIONS The patient received electroacupuncture 3 sessions per week throughout 8 months (93 sessions in total). OUTCOMES The visual acuity of the patient was improved from 0.6 to 0.9 after the 8-month electroacupuncture treatment and remained stable during the 24-month follow-up; the central retinal thickness remained stable between 350 and 414 throughout the treatment and follow-up periods. Patients regarded the vision-related quality of life as satisfactory. The total expenditure of electroacupuncture treatment was CNY 6045. The patient did not receive any Conbercept injection over the whole period of 32 months. No relevant adverse events occurred. LESSONS Electroacupuncture might be effective in alleviating the symptoms of hemi-RVO-associated ME, with a potential of long-lasting effect. The frequency of anti-VEGF therapy could be reduced to the most extent, and the possibility of recurrence could be reduced as well, resulting good economic benefits.
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Affiliation(s)
- Yan Yan
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yu Chen
- New Zealand College of Chinese Medicine, Auckland, New Zealand
| | - ZhiShun Liu
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Yuksel B, Karti O, Celik O, Kerci SG, Kusbeci T. Low frequency ranibizumab versus dexamethasone implant for macular oedema secondary to branch retinal vein occlusion. Clin Exp Optom 2021; 101:116-122. [DOI: 10.1111/cxo.12586] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/27/2017] [Accepted: 03/31/2017] [Indexed: 01/20/2023] Open
Affiliation(s)
- Bora Yuksel
- Department of Ophthalmology, Bozyaka Training and Research Hospital, Izmir, Turkey,
| | - Omer Karti
- Department of Ophthalmology, Bozyaka Training and Research Hospital, Izmir, Turkey,
| | - Ozan Celik
- Department of Ophthalmology, Bozyaka Training and Research Hospital, Izmir, Turkey,
| | | | - Tuncay Kusbeci
- Department of Ophthalmology, Bozyaka Training and Research Hospital, Izmir, Turkey,
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Hayreh SS. Photocoagulation for retinal vein occlusion. Prog Retin Eye Res 2021; 85:100964. [PMID: 33713810 DOI: 10.1016/j.preteyeres.2021.100964] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
The role of photocoagulation in retinal vein occlusion (RVO) has been studied since 1974. The most serious complications of central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) are: (i) visual deterioration, most commonly due to macular edema, and (ii) the development of ocular neovascularization (NV), particularly neovascular glaucoma (NVG), with hazardous consequences for vision and even the eye itself. Before discussing the role of photocoagulation in the management of NV and macular edema in RVO, it is crucial to gain a basic scientific understanding of the following relevant issues: classification of RVO, ocular NV in RVO, and the natural history of macular edema and visual outcome of RVO. These topics are discussed. In CRVO, ocular NV is a complication of ischemic CRVO but not of nonischemic CRVO. Photocoagulation has been advocated to prevent and/or treat the development of ocular NV and NVG. Since NVG is the most dreaded, intractable and blinding complication of ischemic CRVO, the role of photocoagulation and its management are discussed. Findings of three randomized, prospective clinical trials dealing with photocoagulation in ischemic CRVO are discussed. The role of photocoagulation in the management of ocular NV and macular edema in BRVO, and three randomized, prospective clinical trials dealing with those are discussed. Recent advent of intravitreal anti-VEGF and corticosteroid therapies has drastically changed the role of photocoagulation in the management of macular edema and NV in CRVO and BRVO. This is discussed in detail.
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Affiliation(s)
- Sohan Singh Hayreh
- Department of Ophthalmology and Visual Sciences, College of Medicine, University of Iowa, Iowa City, IA, USA.
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Khokhlova DY, Drozdova EA, Kurysheva NI, Loskutov IA. Optical coherence tomographic patterns in patients with retinal vein occlusion and macular edema treated by ranibizumab: a predictive and personalized approach. EPMA J 2021; 12:57-66. [PMID: 33786090 DOI: 10.1007/s13167-021-00233-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/26/2021] [Indexed: 11/24/2022]
Abstract
Purpose To establish the morphological and functional parameters to predict the effectiveness of intravitreal injections (IVI) of ranibizumab in macular edema due to retinal vein occlusion and to develop a mathematical model for personalized treatment algorithms. Material and methods This is a retrospective study of 98 patients (98 eyes) with macular edema, who received IVI of ranibizumab and were followed up for 12 months. Spectral optical coherence tomography scans and best corrected visual acuity (BCVA) assessments were conducted every 3 months. Treatment outcome predictors were calculated based on logistic regression analysis. Results The most significant prognostic factors for the long-term BCVA were baseline BCVA (OR 11.1, p = 0.001), foveal volume (OR 10.8, p = 0.001), destruction of external limiting membrane (OR 15.8, p = 0.001), photoreceptor inner/outer segments (OR 11.1, p = 0.001) and retinal pigment epithelium (OR 9.1, p = 0.001). It has also been discovered that post-treatment BCVA correlated with the height of serous retinal detachment (SRD) (r = -0.4, p = 0.001), ganglion cell complex thickness (r = + 0.3, p = 0.01) and focal loss of ganglion cells (r =-0.3, p = 0.005). Patients without SRD required fewer ranibizumab injections (3.8 ± 1.1) for macular edema fluid resorption compared to those with SRD (5.7 ± 1.2, p = 0.03). A mathematical model for predicting and personalized approach therapy of ranibizumab has been obtained (accuracy of 89%). Conclusion The effectiveness of IVI of ranibizumab depends on baseline morphological and functional changes. The obtained mathematical model allows for predicting the outcomes of therapy, determining individualized algorithms to increase the treatment effectiveness and to prevent low vision that corresponds to the principles of predictive, preventive, and personalized medicine.
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Affiliation(s)
- D Yu Khokhlova
- State Clinical Hospital No.11, 17a Dzerzhinsky Street, Chelyabinsk, 454129 Russian Federation
| | - E A Drozdova
- Department of Ophthalmology, South-Ural State Medical University of the Ministry of Health of the Russian Federation, 64 Vorovsky Street, Chelyabinsk, 454092 Russian Federation
| | - N I Kurysheva
- The Ophthalmological Center of the Federal Medical and Biological Agency (FMBA) of the Russian Federation, the Medical Biological University of Innovations and Continuing Education of the A.I. Burnasyan Federal Medical Biophysical Center of the Federal Medical Biological Agency (FMBA), 15 Gamalei street, Moscow, 123098 Russian Federation
| | - I A Loskutov
- Ophthalmology Department, Research Clinical Center of JSC «Russian Railways», 84 Volokolamskoe highway, Moscow, 125367 Russian Federation
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Willekens K, Gijbels A, Smits J, Schoevaerdts L, Blanckaert J, Feyen JHM, Reynaerts D, Stalmans P. Phase I trial on robot assisted retinal vein cannulation with ocriplasmin infusion for central retinal vein occlusion. Acta Ophthalmol 2021; 99:90-96. [PMID: 32701225 DOI: 10.1111/aos.14480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 04/29/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the safety and feasibility of robot-assisted retinal vein cannulation with Ocriplasmin infusion for central retinal vein occlusion. METHODS Prospective phase I trial including four patients suffering from central retinal vein occlusion (CRVO). Diagnosis was confirmed by preoperative fluo-angiography and followed by a standard three-port pars plana vitrectomy. Afterwards, a custom-built microneedle was inserted into a branch retinal vein with robotic assistance and infusion of Ocriplasmin started. Primary outcomes were the occurrence of intra-operative complications and success of cannulation. Secondary outcomes were change in visual acuity, central macular thickness (CMT) and venous filling times (VFT) during fluo-angiography two weeks after the intervention. RESULTS Cannulation with infusion of ocriplasmin was successful in all four eyes with a mean total infusion time of 355 ± 204 seconds (range 120-600 seconds). Best corrected visual acuity (BCVA) remained counting fingers (CF) in case 3 and 4, increased in case 1 from CF to 0.9LogMAR and decreased in case 2 from 0.4 to 1.3 LogMAR. CMT and VFT both showed a trend towards significant decrease comparing preoperative measurements with two weeks postintervention (1061 ± 541 μm versus 477 ± 376 μm, p = 0.068) and 24 ll 4 seconds versus 15 ± 1 seconds, p = 0.068, respectively). In one eye a needle tip broke and could be removed with an endoforceps. There were no other intervention-related complications. CONCLUSION Robot-assisted retinal vein cannulation is feasible and safe. Local intravenous infusion with Ocriplasmin led to an improved retinal circulation.
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Affiliation(s)
- Koen Willekens
- Department of Ophthalmology University Hospitals Leuven Leuven Belgium
| | - Andy Gijbels
- Department of Mechanical Engineering University of Leuven Leuven Belgium
| | - Jonas Smits
- Department of Mechanical Engineering University of Leuven Leuven Belgium
| | | | - Johan Blanckaert
- Department of Ophthalmology University Hospitals Leuven Leuven Belgium
| | | | - Dominiek Reynaerts
- Department of Mechanical Engineering University of Leuven Leuven Belgium
| | - Peter Stalmans
- Department of Ophthalmology University Hospitals Leuven Leuven Belgium
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Sakanishi Y, Tamaki K, Mashimo K, Sakuma T, Ebihara N. Relationship between Recurrence of Macular Edema Due to Branch Retinal Vein Occlusion and Changes in Choroidal Thickness. Ophthalmic Res 2020; 64:363-368. [PMID: 33070137 DOI: 10.1159/000512357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/12/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The role of vascular endothelial growth factor in macular edema (ME) due to branch retinal vein occlusion (BRVO) by enhancing vascular permeability has been well studied. ME due to BRVO often recurs; however, there has been no report on the relationship between this recurrence and choroidal thickness (CT), considering the high vascularity of the choroid. This study was designed to investigate this relationship. METHODS In this retrospective consecutive case series, patients with recurrence of ME within 6 months of receiving intravitreal aflibercept injection treatment for naive ME due to BRVO at Juntendo University Urayasu Hospital were included. Retinal thickness (RT) and CT were measured in the fovea and on the occlusion, non-occlusion, nasal, and temporal sides at baseline, after the first intravitreal aflibercept administration, and before and after recurrence. We also examined the change for each side before and after reinjection. RESULTS This study included 11 patients and 11 eyes. The subfoveal CT and RT at baseline were 261.9 ± 93.4 μm and 691.5 ± 254.4 μm, respectively, which significantly decreased to 208.5 ± 70.3 μm and 188.6 ± 33.8 μm, respectively, at 1 month after the first injection (p = 0.001 and p < 0.01, respectively). These values also significantly decreased at all the other sites after treatment. There were 14 recurrences within the 6 months following intravitreal aflibercept injection; RT significantly changed at all sites before and after recurrence and reinjection. CT significantly changed at the subfovea and on the occlusion and non-occlusion sides; however, there was no significant change on the nasal and temporal sides. CONCLUSION In patients with BRVO, the CT around the macula after initial treatment was significantly reduced; however, at the time of ME recurrence and reinjection, there were site-dependent differences in the changes observed in the CT. These findings suggest that the pathologies of ME at initial occurrence and at the time of recurrence are different.
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Affiliation(s)
- Yoshihito Sakanishi
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Japan,
| | - Kazunori Tamaki
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Japan
| | - Keitaro Mashimo
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Japan
| | - Toshiro Sakuma
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Japan
| | - Nobuyuki Ebihara
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Japan
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Zhong P, He M, Yu H, Wu Q, Peng Q, Huang M, Xue Y, Yang X. A Meta-Analysis of Cardiovascular Events Associated with Intravitreal Anti-VEGF Treatment in Patients with Retinal Vein Occlusion. Curr Eye Res 2020; 45:615-622. [PMID: 31670978 DOI: 10.1080/02713683.2019.1687727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/17/2019] [Accepted: 10/25/2019] [Indexed: 02/05/2023]
Abstract
Purpose: Retinal vein occlusion is associated with an increased risk of cardiovascular diseases. Anti-vascular endothelial growth factor has been widely used as a treatment option. However, the systemic safety of intravitreal anti-vascular endothelial growth factor for retinal vein occlusion patients is still unclear.Materials and Methods: A meta-analysis was conducted to investigate all randomized controlled trials published up to February 2019 of retinal vein occlusion patients who received intravitreal anti-vascular endothelial growth factor vs. control treatments. Fixed effect models were used and results were reported as odds ratios and 95% confidence intervals.Results: Eight trials that evaluated 2320 patients were retrieved. Anti-vascular endothelial growth factor did not significantly increase the risks of cardiovascular events (odds ratio,1.54; 95% confidence interval, 0.66-3.57), hypertension (odds ratio, 0.92; 95% confidence interval, 0.63-1.33), or heart rate disorders (odds ratio,1.53; 95% confidence interval, 0.37-6.28) when compared with control treatment. Subgroup analyses did not show a significant increase of cardiovascular events in aflibercept (odds ratio,1.96; 95% confidence interval, 0.44-8.81) vs. ranibizumab trials (odds ratio, 1.47; 95% confidence interval, 0.54-4.02); 0.5 mg ranibizumab trials (odds ratio, 1.73; 95% confidence interval, 0.61-4.96) vs. 0.3 mg ranibizumab trials (odds ratio, 0.70; 95% confidence interval, 0.14-3.59); nor branch retinal vein occlusion (odds ratio, 1.32; 95% confidence interval, 0.40-4.33) vs. central retinal vein occlusion trials (odds ratio, 1.93; 95% confidence interval, 0.59-6.29).Conclusions: Intravitreal administration of anti-vascular endothelial growth factor did not significantly increase the risks of cardiovascular events, hypertension or heart rate disorders in retinal vein occlusion patients.
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Affiliation(s)
- Pingting Zhong
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Miao He
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Honghua Yu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qiaowei Wu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Southern Medical University, Guangzhou, China
| | - Qingsheng Peng
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Manqing Huang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yunlian Xue
- Statistics Office, Information and Statistics Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaohong Yang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Pielen A, Feltgen N, Hattenbach LO, Hoerauf H, Bertelmann T, Quiering C, Vögeler J, Priglinger S, Lang GE, Schmitz-Valckenberg S, Wolf A, Rehak M. Ranibizumab Pro Re nata versus Dexamethasone in the Management of Ischemic Retinal Vein Occlusion: Post-hoc Analysis from the COMRADE Trials. Curr Eye Res 2019; 45:604-614. [PMID: 31665935 DOI: 10.1080/02713683.2019.1679839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To compare ischemia-related clinical outcomes in patients treated with either ranibizumab pro re nata (PRN) or single dexamethasone implant in the Branch Retinal Vein Occlusion (COMRADE-B) or Central Retinal Vein Occlusion (COMRADE-C) trials.Methods: A post-hoc analysis of the Phase IIIb, 6-month, multicenter, double-masked, randomized, COMRADE-B and COMRADE-C trials. Change over 6 months in retinal ischemia status (central avascular [CA] zone and peripheral nonperfusion [PNP]), mean best-corrected visual acuity (BCVA), the development of shunt vessels and neovascularization, and frequency of laser therapy were assessed in retinal vein occlusion (RVO) patients treated with either ranibizumab 0.5 mg PRN or single dexamethasone 0.7 mg implant, as per European labels, in the COMRADE-B (N = 244; ranibizumab, 126, dexamethasone, 118) or COMRADE-C (N = 243; ranibizumab, 124, dexamethasone, 119) trials. BCVA progression in ischemic vs. non-ischemic patients based on the ischemia assessment at month 6 was carried out.Results: Visual acuity (VA) gains from baseline to month 6 were higher with ranibizumab than with dexamethasone in both patients with central ischemia and those with peripheral retinal nonperfusion, independent of the type of RVO (branch or central). The presence of CA and PNP had a significant impact on VA gain over 6 months in CRVO patients (p < .0001), while there was no significant impact in BRVO. Ranibizumab was associated with less new ischemia than dexamethasone. Central RVO patients treated with dexamethasone received more laser treatments over the 6 months than those treated with ranibizumab, while there was no difference in the frequency of laser therapy between the branch RVO treatment groups.Conclusions: VA gain over six months in ranibizumab-treated RVO patients is not affected by ischemia, and is associated with less development of new ischemia during the first 6 months of treatment and equal or fewer laser treatments than dexamethasone implant.
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Affiliation(s)
- Amelie Pielen
- Hannover Medical School, University Eye Hospital, Hannover, Germany.,Eye Center, University Medical Center Freiburg, Freiburg, Germany
| | - Nicolas Feltgen
- Eye Hospital, University Medical Center, Goettingen, Germany
| | | | - Hans Hoerauf
- Eye Hospital, University Medical Center, Goettingen, Germany
| | | | - Claudia Quiering
- Department of Ophthalmology, Novartis Pharma GmbH, Nuremberg, Germany
| | - Jessica Vögeler
- Department of Ophthalmology, Novartis Pharma GmbH, Nuremberg, Germany
| | - Siegfried Priglinger
- Department of Ophthalmology, University Eye Hospital, Ludwig Maximilian Universität, München, Germany
| | - Gabriele E Lang
- Department of Ophthalmology, University Eye Hospital Ulm, Ulm, Germany
| | | | - Armin Wolf
- Department of Ophthalmology, University Eye Hospital, Ludwig Maximilian Universität, München, Germany
| | - Matus Rehak
- Eye Hospital, Universitätsklinikum Leipzig, Leipzig, Germany
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Georgalas L, Tservakis I, Kiskira EE, Petrou P, Papaconstantinou D, Kanakis M. Efficacy and safety of dexamethasone intravitreal implant in patients with retinal vein occlusion resistant to anti-VEGF therapy: a 12-month prospective study. Cutan Ocul Toxicol 2019; 38:330-337. [PMID: 31060385 DOI: 10.1080/15569527.2019.1614020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To evaluate the safety and efficacy of repeated intravitreal dexamethasone implant (Ozurdex) injections administrated on an "as-needed" protocol for retinal vein occlusion patients with macular oedema, previously subjected to at least five anti-vascular endothelial growth factor (VEGF) injections with poor or no response. Methods: Prospective interventional case series of 13 branch retinal vein occlusion (BRVO) and 10 central retinal vein occlusion (CRVO) patients with persistent macular oedema (>250 μm) after at least five anti-VEGF injections. Exclusion criteria included: baseline visual acuity worse than 1.5 logMAR, previous intravitreal implant, history of vitreoretinal surgery, manifest glaucoma or ocular hypertension, epiretinal membrane, retinal neovascularization, massive retinal or macular ischaemia, vitreous haemorrhage or severe lens opacity, previous laser photocoagulation treatment. Each patient received an initial intraocular dexamethasone implant and the procedure was repeated at 6 months "as needed." Patients were followed up at months 2, 4, 6, 8, 10 and 12 with spectral domain optical coherence tomography and best corrected visual acuity measurements. Exclusion criteria included: baseline visual acuity worse than 1.5 logMAR, previous intravitreal implant, history of vitreoretinal surgery, manifest glaucoma or ocular hypertension, epiretinal membrane, retinal neovascularization, retinal or macular ischaemia, vitreous haemorrhage or severe lens opacity, previous laser photocoagulation treatment. Patients on topical or systemic corticosteroid therapy (during the last 3 months), and known steroid responders as well as diabetic patients were also excluded. Results: In the BRVO group, the mean central retinal thickness (CRT) and best corrected visual acuity (BCVA) significantly improved from 482.92 ± 139.99 μm (0.55 ± 0.12 logMAR) at baseline, to 369.31 ± 119.72 μm (0.43 ± 0.18 logMAR) at 6 months (p = 0.011/p = 0.019). At 12 months CRT was 295.82 ± 135.48 μm (p = 0.026) and BCVA 0.29 ± 0.17 logMAR (p = 0.002). Minimum CRT values were achieved at 3.45 months after the first injection, and 2.46 months after the second injection (197.00 ± 84.27 and 180.00 ± 76.89 μm, respectively). Best BCVA values were achieved at a mean of 4 ± 0.853 months after the first injection, and 4 months after the second injection (0.219 ± 0.129 and 0.222 ± 0.078 logMAR, respectively). In the CRVO group, neither the mean CRT nor BCVA improved significantly at 6 months: from 669.70 ± 203.20 μm (0.80 ± 0.231 logMAR) at baseline, to 586.20 ± 237.63 μm (0.740 ± 0.268 logMAR) at 6 months (p = 0.131/p = 0.333). At 12 months CRT was significantly improved: 549.90 ± 191.26 μm (p = 0.047), but BCVA lacked significant improvement: 0.690 ± 0.285 logMAR (p = 0.072). Minimum CRT values were achieved at a mean of 2 months after the first injection, and also 2 months after the second injection (261.60 ± 121.31 and 280.00 ± 177.43 μm, respectively). Best BCVA values were achieved at a mean of 2 months after the first injection, and 2 months after the second injection and were 0.390 ± 0.173 and 0.385 ± 0.233 logMAR, respectively. Cataract progression was a rare event (2/23 eyes), while transient steroid-induced ocular hypertension (5/23 eyes) was managed successfully with IOP-lowering medication Conclusion: Dexamethasone implant should be considered as an effective and safe alternative in patients with BRVO and CRVO who have failed anti-VEGF therapy. Shortening the re-injection interval especially for CRVO cases should be considered.
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Affiliation(s)
- Lias Georgalas
- 1st Department of Ophthalmology, National and Kapodistrian University of Athens, "G.Gennimatas" Hospital , Athens , Greece
| | - Ioannis Tservakis
- Department of Ophthalmology, "G.Gennimatas" Hospital , Athens , Greece
| | | | - Petros Petrou
- 1st Department of Ophthalmology, National and Kapodistrian University of Athens, "G.Gennimatas" Hospital , Athens , Greece
| | - Dimitris Papaconstantinou
- 1st Department of Ophthalmology, National and Kapodistrian University of Athens, "G.Gennimatas" Hospital , Athens , Greece
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Choi EY, Kang HG, Lee SC, Kim M. Intravitreal dexamethasone implant for central retinal vein occlusion without macular edema. BMC Ophthalmol 2019; 19:92. [PMID: 30999889 PMCID: PMC6471867 DOI: 10.1186/s12886-019-1097-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/28/2019] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate the efficacy of an intravitreal dexamethasone (IVD) implant (Ozurdex®) for the treatment of central retinal vein occlusion (CRVO) without macular edema (ME). Methods A retrospective cohort study was designed, and 20 eyes of 20 patients diagnosed with non-ischemic CRVO without ME were included. A total of 10 CRVO eyes were observed without treatment, and another 10 CRVO eyes received a single IVD injection at baseline. Mean changes in pathomorphologic parameters of fundus and optical coherence tomography parameters were measured at baseline and at 1, 3, 6, and 12 months. Results The decreases in venous tortuosity (p = 0.014 for superior; 0.036 for inferior arcades) and width (p = 0.024 for superior; 0.003 for inferior arcades) from baseline to 12 months after injection were significantly greater in the treated group than the observed group. The improvements in RNFL swelling (p = 0.010) and retinal hemorrhage (p = 0.006) were also significantly greater in the treated group. Visual symptom improvement was significantly faster in the treated group (p = 0.001). In two cases, IVD injection resulted in complete resolution of cilioretinal artery occlusion associated with the CRVO, leading to complete visual recovery in 1 week. None of the treated eyes showed signs of ME development, ischemia progression, or neovascularization. Conclusions IVD implant was significantly effective in improving venous engorgement, retinal hemorrhage, RNFL swelling, and visual symptoms by presumed alleviation of disc swelling and venous outflow. This treatment may be a considerable treatment option in CRVO patients with no ME.
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Affiliation(s)
- Eun Young Choi
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, South Korea
| | - Hyun Goo Kang
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, South Korea
| | - Sung Chul Lee
- Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Min Kim
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, South Korea.
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Callizo J, Atili A, Striebe NA, Bemme S, Feltgen N, Hoerauf H, Bertelmann T. Bevacizumab versus bevacizumab and macular grid photocoagulation for macular edema in eyes with non-ischemic branch retinal vein occlusion: results from a prospective randomized study. Graefes Arch Clin Exp Ophthalmol 2019; 257:913-920. [PMID: 30610424 DOI: 10.1007/s00417-018-04223-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 12/18/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The objective of the study was the investigation of the effects of intravitreal bevacizumab (BEV) with or without additional macular grid laser photocoagulation (GRID) for macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS Prospective, randomized, monocentric study. Thirty-two patients were included. Initially, all eyes in both groups received three monthly injections of BEV, followed by additional injections if re-treatment criteria were met. In the BEV + GRID group, photocoagulation was performed 2 weeks after the first BEV injection and laser re-treatment was allowed. The follow-up was 38 weeks. Main outcome measures were best-corrected visual acuity (BCVA) and central retinal thickness (CRT). Changes of foveal avascular zone (FAZ) and of retinal ischemia, as well as the number of injections were also evaluated. RESULTS Sixteen eyes were randomized into each group. At baseline, BCVA was similar in both groups (BEV + GRID: 20/71; BEV: 20/60; P = 0.51). At 38 weeks, BCVA significantly improved in the two groups (BEV + GRID gain of 9 ± 11.2 letters and 16.25 ± 10.08 letters in the BEV) with no difference between them (P < 0.06). With regard to anatomical findings, initial CRT in BEV + GRID was 496.2 μm ± 138.4 μm and 538.9 μm ± 156.9 μm in BEV (P < 0.1697). At 38 weeks, CRT decreased in both groups significantly, 98.2 μm in the BEV + GRID (P = 0.02) and 141.7 μm in the BEV group (P = 0.01), with no significant difference between groups (P < 0.17). The area of FAZ a significantly increased in both groups (41% (P = 0.04) in BEV + GRID; 35% (P = 0.03) in BEV) during the study and the grade of peripheral ischemia remained unchanged. The mean number of injections was 3.8 (range 3-6) with no significant difference between groups. CONCLUSIONS Our data demonstrate a beneficial effect of bevacizumab in ME in eyes with BRVO. A loading phase of three injections led to a significant improvement in vision in both groups, which persisted at week 38. Additional grid laser photocoagulation exhibited no beneficial functional or anatomical effect during the study, nor did it reduce the number of injections. The FAZ area increased significantly in both groups, but overall retinal ischemia did not. Further studies investigating more numerous eyes and longer follow-up are needed to confirm these data.
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Affiliation(s)
- Josep Callizo
- Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Str 40, 37075, Goettingen, Germany.
| | - Abed Atili
- Augen Praxis Klinik Esslingen, Adler-Str6, 73728, Esslingen, Germany
| | - Nina Antonia Striebe
- Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Str 40, 37075, Goettingen, Germany
| | - Sebastian Bemme
- Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Str 40, 37075, Goettingen, Germany
| | - Nicolas Feltgen
- Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Str 40, 37075, Goettingen, Germany
| | - Hans Hoerauf
- Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Str 40, 37075, Goettingen, Germany
| | - Thomas Bertelmann
- Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Str 40, 37075, Goettingen, Germany
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Zlobin IV, Zhukova SI, Shchuko AG, Iureva TN. [Complex assessment of retinal ischemic damage in patients with retinal vein occlusion]. Vestn Oftalmol 2019; 135:62-69. [PMID: 31215536 DOI: 10.17116/oftalma201913502162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To evaluate the effectiveness of treatment and the possibility of restoring visual functions in patients with retinal vein occlusion (RVO) depending on the initial degree of macular ischemia. MATERIAL AND METHODS The study included 84 patients with RVO. The main inclusion criteria were the presence of macular edema in the setting of RVO with the duration of no more than 3 months and without any previous treatment. All patients underwent intravitreal injections of an angiogenesis inhibitor, followed by laser treatment when necessary. A comparative analysis of the results was carried out in groups that were opposite in terms of the clinical effect - before the start of the therapy, after 1 month, and after 12 months. All patients and the control group members underwent standard ophthalmological examination as well as electroretinography, fluorescence angiography, optical coherence tomography (OCT), and OCT angiography. RESULTS Based on data obtained during 12 months of the follow-up, the comparative analysis of the initial ophthalmic status of patients with RVO with opposite clinical effect resulted in derivation of 3 clinical groups that correspond to the degrees of macular ischemia - mild, moderate and severe. CONCLUSION Determination of the degree of macular ischemia at the stage of primary diagnosis can improve the treatment effectiveness and inform the patients about the sequence and duration of anti-VEGF therapy. Intravitreal injections of ranibizumab in retinal vein occlusion are carried out before the elimination of macular edema and further in the on-demand mode, while the number of injections can vary from one to monthly injections during the year.
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Affiliation(s)
- I V Zlobin
- Irkutsk branch of S. Fyodorov Eye Microsurgery Federal State Institution, 337 Lermontova St., Irkutsk, Russian Federation, 664033
| | - S I Zhukova
- Irkutsk branch of S. Fyodorov Eye Microsurgery Federal State Institution, 337 Lermontova St., Irkutsk, Russian Federation, 664033
| | - A G Shchuko
- Irkutsk branch of S. Fyodorov Eye Microsurgery Federal State Institution, 337 Lermontova St., Irkutsk, Russian Federation, 664033; Irkutsk State Medical Academy of Postgraduate Education, 100 Yubileiny microrayon, Irkutsk, Russian Federation, 664079; Irkutsk State Medical University, 1 Krasnogo Vosstaniya St., Irkutsk, Russian Federation, 664003
| | - T N Iureva
- Irkutsk branch of S. Fyodorov Eye Microsurgery Federal State Institution, 337 Lermontova St., Irkutsk, Russian Federation, 664033; Irkutsk State Medical Academy of Postgraduate Education, 100 Yubileiny microrayon, Irkutsk, Russian Federation, 664079; Irkutsk State Medical University, 1 Krasnogo Vosstaniya St., Irkutsk, Russian Federation, 664003
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Feltgen N, Hattenbach LO, Bertelmann T, Callizo J, Rehak M, Wolf A, Berk H, Eter N, Lang GE, Pielen A, Schmitz-Valckenberg S, Quiering C, Rose U, Hoerauf H. Comparison of ranibizumab versus dexamethasone for macular oedema following retinal vein occlusion: 1-year results of the COMRADE extension study. Acta Ophthalmol 2018; 96:e933-e941. [PMID: 29855153 DOI: 10.1111/aos.13770] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 03/01/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE The COMRADE studies are the first randomized controlled head-to-head trials comparing the efficacy and safety of intravitreal ranibizumab versus dexamethasone (DEX) in patients with macular oedema secondary to retinal vein occlusion (RVO). The COMRADE extension trial was designed to provide additional 6-month data of patients who completed the core studies. METHODS In this open-label, phase IV study patients who completed the COMRADE core studies were prospectively enrolled. Overall, 92 branch RVO (BRVO) patients (ranibizumab 52, DEX 40) and 83 central RVO (CRVO) patients (ranibizumab 61, DEX 22) were treated, and 94.6% of BRVO patients and 97.6% of CRVO patients completed the extension study. Patients were assigned to the same treatment group as in the core studies. Patients were monitored monthly and received either 0.5 mg ranibizumab or a 0.7 mg DEX implant as needed. RESULTS Over the course of the extension, treatment-emergent adverse events (TEAEs) of the study eye occurred in 55.8% of BRVO patients on ranibizumab and in 62.5% of those on DEX. Among CRVO patients, 65.5% in the ranibizumab group and 59.1% in the DEX group developed TEAEs. Overall, elevated intraocular pressure (IOP) was more frequent with DEX than ranibizumab treatment. Mean average change in best-corrected visual acuity (BCVA) in BRVO patients was significantly better for ranibizumab than DEX (p = 0.0249). The CRVO results were consistent with BRVO's, although not significant (p = 0.1119). CONCLUSION When used according to the European labels, ranibizumab revealed a better ocular safety profile and produced greater average BCVA gains than DEX. By the end of the additional 6-month study period, this difference in BCVA was more pronounced in BRVO as in CRVO patients. The main limitation of the COMRADE studies was that DEX patients received only a single intravitreal treatment during the first 6 months, which is presumably not adequate. However, frequent DEX implants could lead to more steroid-related side effects, especially to an increased intraocular pressure.
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Affiliation(s)
- Nicolas Feltgen
- Georg-August-University Goettingen; University Eye Hospital; Goettingen Germany
| | | | - Thomas Bertelmann
- Georg-August-University Goettingen; University Eye Hospital; Goettingen Germany
| | - Josep Callizo
- Georg-August-University Goettingen; University Eye Hospital; Goettingen Germany
| | - Matus Rehak
- Eye Hospital; University Hospital Leipzig; Leipzig Germany
| | - Armin Wolf
- Department of Ophthalmology; Ludwig-Maximilians-University; Munich Germany
| | - Hüsnü Berk
- Department of Ophthalmology; St. Elisabeth-Hospital; Koeln-Hohenlind Germany
| | - Nicole Eter
- Department of Ophthalmology; University of Muenster Medical Center; Muenster Germany
| | | | - Amelie Pielen
- Department for Ophthalmology; University Hospital of Freiburg; Freiburg Germany
| | | | | | - Uwe Rose
- Novartis Pharma GmbH; Nuremberg Germany
| | - Hans Hoerauf
- Georg-August-University Goettingen; University Eye Hospital; Goettingen Germany
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[Statement of the Professional Association of Ophthalmologists (BVA), the German Ophthalmological Society (DOG) and the Retinological Society (RG) on intravitreal treatment of vision-reducing macular edema by retinal vein occlusion : Treatment strategies, status 24 April 2018]. Ophthalmologe 2018; 115:842-854. [PMID: 30143857 DOI: 10.1007/s00347-018-0775-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wen L, Wen YC, Ke GJ, Sun SQ, Dong K, Wang L, Liao RF. TRPV4 regulates migration and tube formation of human retinal capillary endothelial cells. BMC Ophthalmol 2018; 18:38. [PMID: 29433476 PMCID: PMC5809855 DOI: 10.1186/s12886-018-0697-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 01/29/2018] [Indexed: 02/03/2023] Open
Abstract
Background Ca2+ entry plays an important role in modulating endothelial cell migration and tube formation. Transient receptor potential cation channel subfamily V member 4 (TRPV4) is a Ca2+-permeable channel that is widely expressed in endothelial cells. It has been reported that TRPV4 is expressed in HRCECs and regulates Ca2+ entry. However, the function of TRPV4 in human retinal capillary endothelial cells (HRCECs) remains unknown. Methods In this study we used western blot and immunostaining assay to verify TRPV4 expression in HRCECs. And then we pretreated HRCECs with HC067047 and transfected with specific shRNA of TRPV4. The functional presence of TrpV4 was determined by using fluorescence, migration and tube formation assay in TrpV4 knockdown cells or control cells. Results Using western blot and immunostaining, we confirmed TRPV4 expression in HRCECs. Moreover, inhibition of TRPV4 using the specific inhibitor HC067047 and the knockdown of TRPV4 with shRNA significantly suppressed tube formation and migration by HRCECs. Conclusions TRPV4 is essential for HRCEC migration and tube formation, and maybe a potential therapeutic target for retinal vascular diseases. Electronic supplementary material The online version of this article (10.1186/s12886-018-0697-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lei Wen
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui, 230022, China.,Department of Ophthalmology, Anhui Provincial Hospital, Hefei, Anhui, China
| | - Yue-Chun Wen
- Department of Ophthalmology, Anhui Provincial Hospital, Hefei, Anhui, China
| | - Gen-Jie Ke
- Department of Ophthalmology, Anhui Provincial Hospital, Hefei, Anhui, China
| | - Si-Qin Sun
- Department of Ophthalmology, Anhui Provincial Hospital, Hefei, Anhui, China
| | - Kai Dong
- Department of Ophthalmology, Anhui Provincial Hospital, Hefei, Anhui, China
| | - Lin Wang
- Department of Ophthalmology, Anhui Provincial Hospital, Hefei, Anhui, China
| | - Rong-Feng Liao
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui, 230022, China.
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Boguniewicz M, Alexis AF, Beck LA, Block J, Eichenfield LF, Fonacier L, Guttman-Yassky E, Paller AS, Pariser D, Silverberg JI, Lebwohl M. Expert Perspectives on Management of Moderate-to-Severe Atopic Dermatitis: A Multidisciplinary Consensus Addressing Current and Emerging Therapies. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:1519-1531. [PMID: 28970084 DOI: 10.1016/j.jaip.2017.08.005] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/24/2017] [Accepted: 08/07/2017] [Indexed: 12/17/2022]
Abstract
Atopic dermatitis (AD) is a common, chronic, relapsing, inflammatory skin disease that affects children and adults. Until recently, the only Food and Drug Administration-approved systemic treatment option for patients with moderate-to-severe AD was systemic steroids, which are not recommended by current guidelines and are commonly associated with disease rebound. Instead, clinicians choose from several off-label immunosuppressants, which can have serious adverse effects. A significant number of these patients go untreated. Research on the immunopathogenesis of AD has paved the way for new, targeted, systemic therapies for moderate-to-severe AD. In early 2017, the Food and Drug Administration approved dupilumab for adults with moderate-to-severe AD whose disease is not adequately controlled with topical therapies. Although the national guidelines can be very helpful to clinicians, the process for updating them does not allow for timely incorporation of novel therapies. A steering committee of AD experts, including dermatologists, allergists, and a patient advocacy group representative, developed recommendations on the basis of a literature review and expert opinion to help clinicians understand how new therapies fit into the current treatment paradigm and to provide practical recommendations for assessing AD severity, treatment response, and treatment failure.
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Affiliation(s)
- Mark Boguniewicz
- Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, Denver, Colo.
| | - Andrew F Alexis
- Department of Dermatology, Skin of Color Center, Mount Sinai St Luke's and Mount Sinai West, New York, NY
| | - Lisa A Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY
| | - Julie Block
- National Eczema Association, San Rafael, Calif
| | - Lawrence F Eichenfield
- Departments of Dermatology and Pediatrics, University of California, San Diego, Calif; Rady Children's Hospital San Diego, San Diego, Calif
| | - Luz Fonacier
- Section of Allergy and Clinical Immunology, Department of Medicine, NYU Winthrop-University Hospital, Mineola, NY
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - David Pariser
- Department of Dermatology, Eastern Virginia Medical School and Virginia Clinical Research, Inc, Norfolk, Va
| | - Jonathan I Silverberg
- Departments of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
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Loureiro M, Matos R, Sepulveda P, Meira D. Intravitreal Injections of Bevacizumab: The Impact of Needle Size in Intraocular Pressure and Pain. J Curr Glaucoma Pract 2017; 11:38-41. [PMID: 28924336 PMCID: PMC5577117 DOI: 10.5005/jp-journals-10028-1220] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 03/27/2017] [Indexed: 11/23/2022] Open
Abstract
Aim To compare the effect of 30-gauge vs 27-gauge needle size on intraocular pressure (IOP) rise and patients’ pain experience after intravitreal injection (IVI) of bevacizumab. Materials and methods Cross-sectional, randomized, double-armed study. Patients were randomized to IVI with 30-gauge or 27-gauge needle. The IOP was measured pre and post IVI. Patients’ pain was graded using the visual analog scale (VAS). Results A total of 54 eyes were included. The IVI caused a significant IOP rise in both groups (p < 0.001). In the 30-gauge group, the mean pre- and postinjection IOP was 16.3 ± 3.6 mm Hg and 24.1 ± 9.0 mm Hg. The corresponding figures in the 27-gauge group were 18.0 ± 2.54 (p = 0.26) and 23.1 ± 7.5 mm Hg (p = 0.66). In the 30-gauge group, the mean VAS pain score was 3.2 ± 2.6 compared to 3.0 ± 2.5 in the 27-gauge group (p = 0.78). Conclusion The IVI caused a significant rise in IOP after the injection, independently of the needle size used. The 27-gauge needle coursed with lower postinjection IOP without prejudice of the patient comfort. Clinical significance The IVI with 27-gauge may be considered for glaucomatous eyes (higher risk eyes), for which IOP spikes are not recommended. How to cite this article Loureiro M, Matos R, Sepulveda P, Meira D. Intravitreal Injections of Bevacizumab: The Impact of Needle Size in Intraocular Pressure and Pain. J Curr Glaucoma Pract 2017;11(2):38-41.
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Affiliation(s)
- Mónica Loureiro
- Resident, Department of Ophthalmology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Porto, Portugal
| | - Rita Matos
- Resident, Department of Ophthalmology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Porto, Portugal
| | - Paula Sepulveda
- Consultant, Department of Ophthalmology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Porto, Portugal
| | - Dália Meira
- Consultant, Department of Ophthalmology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Porto, Portugal
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Switch of Intravitreal Therapy for Macular Edema Secondary to Retinal Vein Occlusion from Anti-VEGF to Dexamethasone Implant and Vice Versa. J Ophthalmol 2017; 2017:5831682. [PMID: 28828184 PMCID: PMC5554567 DOI: 10.1155/2017/5831682] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 06/28/2017] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To evaluate the anatomical and functional outcome of intravitreal dexamethasone implant for macular edema secondary to central (C) or branch (B) retinal vein occlusion (RVO) in patients with persistent macular edema (ME) refractory to intravitreal antivascular endothelial growth factor (VEGF) treatment compared to treatment naïve patients and to dexamethasone-refractory eyes switched to anti-VEGF. METHODS Retrospective, observational study including 30 eyes previously treated with anti-VEGF (8 CRVO, 22 BRVO, mean age 69 ± 10 yrs), compared to 11 treatment naïve eyes (6 CRVO, 5 BRVO, 73 ± 11 yrs) and compared to dexamethasone nonresponders (2 CRVO, 4 BRVO, 69 ± 12). Outcome parameters were change in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) measured by spectral-domain optical coherence tomography. RESULTS Mean BCVA improvement after switch to dexamethasone implant was 4 letters (p = 0.08), and treatment naïve eyes gained 10 letters (p = 0.66), while we noted no change in eyes after switch to anti-VEGF (p = 0.74). Median CFT decrease was most pronounced in treatment naïve patients (-437 μm, p = 0.002) compared to anti-VEGF refractory eyes (-170 μm, p = 0.003) and dexamethasone-refractory eyes (-157, p = 0.31). CONCLUSIONS Dexamethasone significantly reduced ME secondary to RVO refractory to anti-VEGF. Functional gain was limited compared to treatment naïve eyes, probably due to worse BCVA and CFT at baseline in treatment naïve eyes.
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Sakanishi Y, Usui-Ouchi A, Tamaki K, Mashimo K, Ito R, Ebihara N. Short-term outcomes in patients with branch retinal vein occlusion who received intravitreal aflibercept with or without intravitreal ranibizumab. Clin Ophthalmol 2017; 11:829-834. [PMID: 28496301 PMCID: PMC5422553 DOI: 10.2147/opth.s133594] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to determine the short-term outcomes for patients who received intravitreal aflibercept (IVA) with or without intravitreal ranibizumab (IVR) for macular edema (ME) due to branch retinal vein occlusion (BRVO). Patients and methods Patients received IVA for ME due to BRVO. Patients who initially received IVA were defined as the treatment-naïve group and those who were switched from IVR to IVA after ME recurrence were defined as the switching group. Patient outcomes were examined at 1 week and 1 month postinjection. Results Both groups comprised 27 eyes from 27 patients. There was a significant decrease in central macular thickness (CMT) at 1 week and 1 month postinjection in both groups. There was also a significant improvement in best-corrected visual acuity (BCVA) at 1 week and 1 month postinjection in the treatment-naïve group and 1 month in the switching group. Younger age was associated with a good BCVA at 1 month postinjection in the switching group, and the absence of epiretinal membrane was associated with a reduction in CMT at 1 month postinjection in the switching group. Conclusion IVA is temporarily effective for treating ME due to BRVO regardless of a history of IVR use.
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Affiliation(s)
- Yoshihito Sakanishi
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Chiba, Japan
| | - Ayumi Usui-Ouchi
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Chiba, Japan
| | - Kazunori Tamaki
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Chiba, Japan
| | - Keitaro Mashimo
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Chiba, Japan
| | - Rei Ito
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Chiba, Japan
| | - Nobuyuki Ebihara
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Chiba, Japan
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Willekens K, Gijbels A, Schoevaerdts L, Esteveny L, Janssens T, Jonckx B, Feyen JHM, Meers C, Reynaerts D, Vander Poorten E, Stalmans P. Robot-assisted retinal vein cannulation in an in vivo porcine retinal vein occlusion model. Acta Ophthalmol 2017; 95:270-275. [PMID: 28084059 DOI: 10.1111/aos.13358] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 11/06/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the feasibility of robot-assisted retinal vein cannulation for retinal vein occlusion. METHODS Prospective experimental study performed in in vivo porcine eyes. A standard three port pars plana vitrectomy was followed by laser-induced branch retinal vein occlusion. Consequently, a retinal vein cannulation with the help of a surgical robot and a microneedle was performed. Complete success was defined as a stable intravenous position of the needle tip confirmed by blood washout for at least 3 min. Secondary outcomes were the occurrence of intra-operative complications and technical failures. RESULTS Cannulation was successful in 15 of 18 eyes with a complete success rate (duration of infusion of more than 3 min) of 73% after exclusion of two eyes from analysis due to failure in establishing a blood clot. There were no technical failures regarding the robotic device. The intravessel injections of ocriplasmin in two of two eyes led to a clot dissolution. In a subset of five eyes, a second cannulation attempt at the border of the optic disc resulted in a stable intravessel position and infusion during 362 (±138) seconds. CONCLUSION Robot-assisted retinal vein cannulation with prolonged infusion time is technically feasible. Human experiments are required to analyse the clinical benefit of this new therapy.
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Affiliation(s)
- Koen Willekens
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
| | - Andy Gijbels
- Department of Mechanical Engineering; University of Leuven; Leuven Belgium
| | | | - Laure Esteveny
- Department of Mechanical Engineering; University of Leuven; Leuven Belgium
| | | | | | | | | | - Dominiek Reynaerts
- Department of Mechanical Engineering; University of Leuven; Leuven Belgium
| | | | - Peter Stalmans
- Department of Ophthalmology; University Hospitals Leuven; Leuven Belgium
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Sakanishi Y, Lee A, Usui-Ouchi A, Ito R, Ebihara N. Twelve-month outcomes in patients with retinal vein occlusion treated with low-frequency intravitreal ranibizumab. Clin Ophthalmol 2016; 10:1161-5. [PMID: 27382250 PMCID: PMC4922787 DOI: 10.2147/opth.s107594] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of this study was to determine the clinical efficacy of low-frequency intravitreal ranibizumab to treat macular edema due to retinal vein occlusion (RVO). PATIENTS AND METHODS This was a retrospective examination of cases that received intravitreal ranibizumab for untreated RVO over a period of 12 months. Instead of the conventional three monthly injections, injections were given once during the introductory period. If the recurrence of macular edema was diagnosed during the monthly visit, additional injections were given as needed. There were 21 eyes of 21 patients with branch RVO (BRVO) and ten eyes of ten patients with central RVO (CRVO). The parameters examined included the number of injections over the 12-month period, improvements in best-corrected visual acuity (BCVA), and the central macular thickness (CMT). For BRVO, preinjection parameters that had an effect on the prognosis of BCVA after the 12-month period were also examined. RESULTS The total mean number of injections over the 12-month period was 3.4 for CRVO and 2.1 for BRVO. For CRVO, the BCVA in log minimum angular resolution changed from a preinjection value of 0.80 to 0.55 at 12 months. For BRVO, the change was from 0.51 to 0.30. For all diseases, BCVA improved after 12 months compared with the preinjection values (P<0.05). There was improvement in the CMT, and the CRVO changed from 765.0 μm at preinjection to 253.5 μm 12 months later. BRVO changed from 524.1 to 250.1 μm, and pre-injection BCVA was associated with a prognosis of visual acuity after 12 months of the initial injection (P=0.0485). CONCLUSION Even with a low number of injections during the introductory period, there were still improvements in both visual acuity and CMT in RVO patients after 12 months, indicating that it was an effective treatment.
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Affiliation(s)
- Yoshihito Sakanishi
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Chiba, Japan
| | - Ami Lee
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Chiba, Japan
| | - Ayumi Usui-Ouchi
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Chiba, Japan
| | - Rei Ito
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Chiba, Japan
| | - Nobuyuki Ebihara
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Chiba, Japan
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Rayat JS, Grewal PS, Whelan J, Tennant MT, Choudhry N. Canadian preference and trends survey results for anti-VEGF treatment of macular edema. Can J Ophthalmol 2016; 51:233-7. [DOI: 10.1016/j.jcjo.2015.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 10/13/2015] [Accepted: 10/18/2015] [Indexed: 11/25/2022]
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Kuhli-Hattenbach C, Hellstern P, Miesbach W, Kohnen T, Hattenbach LO. Selective Thrombophilia Screening in Young Patients with Retinal Artery Occlusion. Ophthalmologica 2016; 235:189-94. [DOI: 10.1159/000446028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/04/2016] [Indexed: 11/19/2022]
Abstract
Purpose: To investigate the prevalence of various thrombophilic disorders among young patients with retinal artery occlusion (RAO). Procedures: We retrospectively reviewed thrombophilia screening data of young patients ≤60 years of age with RAO and healthy controls matched for gender and age. Results: Thrombophilia screening data of 25 young patients and 62 healthy controls were analyzed. Mean patient age by the time of the RAO was 43.3 ± 10.8 years. Overall, thrombophilic defects were found to be present in 17 patients (68%) compared with 11 of 62 controls (17.7%; p < 0.0001). Multivariate logistic regression analysis confirmed a statistically significant association between the development of RAO and increased levels of lipoprotein(a) (odds ratio: 9.48; p = 0.001) and factor VIII (odds ratio: 6.41; p = 0.024). There was a strong association between the presence of thrombophilic disorders and a personal or family history of thromboembolism (p = 0.01). Conclusions: Our results indicate that screening for thrombophilic disorders among selected young patients with RAO yields positive results in a high percentage of cases.
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