Effects of intravitreal ranibizumab on the untreated eye and systemic gene expression profile in age-related macular degeneration

Effect of intravitreal injection of bevacizumab in treated and untreated eyes of Black African patients with polypoidal choroidal vasculopathy

OBJECTIVE

To evaluate the response of polypoidal choroidal vasculopathy (PCV) in eyes treated with intravitreal bevacizumab (BVZ) and untreated fellow eyes in black Africans.

METHODS

We studied 22 eyes (12 patients) divided into 12 treated and 10 untreated eyes from January 2017 to January 2020. Treated eyes received 1 monthly injection of BVZ 2.5mg for 3 months, with optional additional injections depending on the patient's course. Both groups of eyes were evaluated at presentation and then at 3, 6, 9, and 12 months after treatment. Outcome measures were visual acuity (VA) and ophthalmoscopic and OCT findings.

RESULTS

The mean age of the patients was 66.3±5.6 years. In treated eyes, VA remained stable from 0.10±0.12 at baseline to 0.20±0.30 at month 12, P=0.84. VA was stable in 83.3% and improved in 16.7% of eyes. On OCT, 41.7% of eyes showed decreased and another 41.7% disappearance of subretinal fluid (SRF) at 12 months. Pigment epithelial detachment (PED) height decreased in 9 eyes (75.0%) but remained unchanged in 3 eyes (25%). In untreated eyes, no difference was observed between the baseline (0.53±0.42) and 12-month VA (0.58±0.40), P=0.82. VA improved in 2 eyes, decreased in one eye, and remained unchanged in 7 eyes. OCT lesions remained stable in 6 eyes. The PED enlarged in one eye but remained stable in 3 other eyes.

CONCLUSION

Intravitreal injection of BVZ 2.5mg led to stabilization of VA, resorption of SRF, and reduction in the size of the PED in the majority of eyes with PCV but was ineffective on the polyps. The one-year prognosis in untreated eyes with PCV was favorable and marked by functional and structural stability.

Rates of RNFL Thinning in Patients with Suspected or Confirmed Glaucoma Receiving Unilateral Intravitreal Injections for Exudative AMD

PURPOSE

This study evaluated whether the rate of retinal nerve fiber layer (RNFL) thinning is faster in eyes receiving intravitreal injections than in fellow uninjected eyes among patients suspected of having or confirmed to have glaucoma and exudative age-related macular degeneration (AMD).

DESIGN

Retrospective comparative cohort study.

METHODS

Patients with a diagnosis of unilateral exudative AMD and confirmed to have or suspected of having glaucoma in both eyes receiving unilateral intravitreal injections were identified. Those with ≥3 RNFL optical coherence tomography scans and ≥6 injections were included in the study. Rates of RNFL thinning in the injected eye versus the uninjected eye were estimated using linear mixed models. The main outcome measurement was the differences in rates of RNFL thinning in the injected versus the fellow uninjected eye. The effects of postinjection elevation of intraocular pressure (IOP), injection frequency, and number of injections were also evaluated.

RESULTS

A total of 53 patients met the inclusion criteria, receiving 26.4 ± 15.9 intravitreal injections. The average rate of RNFL thinning in uninjected eyes was -0.620 μm/year (P = .029). Injected eyes had an additional incremental loss of -0.385 μm/year, but this value was not statistically significant (95% confidence interval [CI]: -1.147 to 0.379 μm/year; P = .324). Subgroup analysis with only glaucoma patients (n = 33) also demonstrated a nonsignificant effect of injections (-0.568 μm/year; 95% CI: -1.454 to 0.319 μm/year; P = .212). Postinjection IOP elevation, injection frequency, and total number of injections were not associated with faster RNFL loss.

CONCLUSIONS

Among exudative AMD patients with glaucoma or suspected of having glaucoma, the rate of RNFL thinning in eyes receiving intravitreal injections did not significantly differ from that of fellow uninjected eyes.

The influence of adalimumab treatment on the systemic gene expression in patients with psoriatic arthritis - preliminary report

INTRODUCTION

The primary goal of psoriasis treatment is to reduce the inflammatory response and associated complications. In severe cases of psoriasis that are resistant to local treatment (e.g., keratolytic preparations) and at least two types of general treatment methods (e.g., retinoids and cyclosporine A), biological therapy is used. This study aimed to assess the systemic effects of adalimumab at a given stage of treatment in patients with psoriatic arthritis and evaluate how the drug can improve the clinical condition of the patients.

MATERIAL AND METHODS

The study group consisted of patients with diagnosed psoriatic arthritis, while the control group consisted of individuals from whom peripheral blood mononuclear cells were obtained. The effects of the administration of adalimumab were assessed by analyzing the gene expression using oligonucleotide microarrays.

RESULT

The apoptosis process was found to be one of the overrepresented categories (the PANTHER classification system 13.1 program, overrepresentation test, p < 0.05). The dermatological indexes decreased, indicating an improvement in the clinical conditions of the patients 3 months after the first dose of adalimumab.

CONCLUSIONS

We found that adalimumab affects apoptosis, which is crucial in the development and course of psoriasis. The differential gene expression in peripheral blood mononuclear cells of patients with psoriatic arthritis indicated the potential systemic effects of adalimumab therapy. The analyses of dermatological (the Psoriasis Area and Severity Index, body surface area and Dermatology Life Quality Index) and inflammatory (Biernacki's reaction) parameters revealed the effectiveness of the therapy.

Comparison of intravitreal injections of Ranibizumab and Aflibercept in neovascular age related macular degeneration

Clinical relevance: Pivotal studies are based on strict treatment regimens of vascular endothelial growth factor blocking drugs in neovascular age-related macular degeneration. However, looser regimens with poorer results have been reported in real-world studies with various outcomes. This results in a search of more precise data to rely on in the management of patients with neovascular age-related macular degeneration.Background: The aim of this study is to analyse the real-world outcome of vascular endothelial growth factor blocking agents in neovascular age-related macular degeneration.Methods: This is a retrospective comparative study of treatment-naïve patients who received intravitreal aflibercept or ranibizumab administration for neovascular age-related macular degeneration for at least 12 months on an as needed regimen following a loading phase of three-monthly injections. Full eye examination and optical coherence tomography scans were provided at all visits. The drugs were compared on the basis of visual acuity, central macular thickness, and subfoveal choroidal thickness. The baseline optical coherence tomography features were analysed seeking a correlation with the outcome.Results: One hundred and forty-one eyes were enrolled. The mean age was 71.7 ± 8.5 years. Sixty-eight (48.2%) patients received aflibercept and 73 (51.8%) received ranibizumab injections. The mean number of injections was 6.5 ± 2.5. The mean number of injections were also similar between groups (6.4 ± 2.5 vs. 6.5 ± 2.6, respectively, p = 0.783). At one year, both drugs caused significant increase in visual acuity and decrease in central macular thickness and subfoveal choroidal thickness.Conclusion: In a real-world setting, aflibercept and ranibizumab yielded similar results at one year in the management of neovascular age-related macular degeneration.

Longitudinal changes in fellow eyes of choroidal neovascularization associated with central serous chorioretinopathy: Optical coherence tomography angiography study

PURPOSE

To report longitudinal changes in fellow eyes of chronic central serous chorioretinopathy (CSCR) associated choroidal neovascularization (CNV) using optical coherence tomography angiography (OCTA) and determine factors affecting neovascular conversion.

METHODS

Medical records of patients with chronic CSCR complicated by CNV and a minimum follow up of 6 months were reviewed. OCT and OCTA features were analyzed at baseline and final follow up. Baseline factors were assessed for predictive value against presence of CNV at follow up and conversion to exudative form.

RESULTS

Twenty-six subjects (26 CNV and 26 fellow eyes) were included in the study and followed up for a mean period of 26 ± 17 months. Nine eyes had CNV network in fellow eye at baseline, out of which three (33%) had a conversion to exudative CNV. Among the remaining 17 eyes, one eye developed a new network during a period of 44 months. An increase in the size of network was seen from 0.886 ± 0.945 mm² at baseline to 1.326 ± 1.263 mm² at follow up. Baseline choroidal thickness at sub-fovea was 345.4 ± 74.9 microns in eyes having network at last visit, compared to 440.1 ± 73.7 microns in eyes having no network.(p < 0.001) None of the baseline variables were found to be significantly associated with conversion to exudative form or presence of CNV on follow up in multivariate analysis.

CONCLUSION

A conversion rate to exudative form was seen in 33% of fellow eyes with CNV. Relatively thinner choroid at baseline was associated with exudative conversion during follow up.

In vivo imaging of the hyaloid vascular regression and retinal and choroidal vascular development in rat eyes using optical coherence tomography angiography

This study investigates the hyaloid vascular regression and its relationship to the retinal and choroidal vascular developments using optical coherence tomography angiography (OCTA). Normal and oxygen-induced retinopathy (OIR) rat eyes at postnatal day 15, 18, 21, and 24 were longitudinally imaged using OCTA. At each day, two consecutive imaging for visualizing the hyaloid vasculature and the retinal and choroidal vasculatures were conducted. The hyaloid vessel volume and the retinal and choroidal vessel densities were measured. The hyaloid vessel volumes gradually decreased during the regression, although the OIR eyes exhibited large vessel volumes at all time points. A spatial relationship between persistent hyaloid vasculature and retardation of underlying retinal vascular development was observed in the OIR eyes. Furthermore, anti-vascular endothelial growth factor (VEGF) was administered intravitreally to additional OIR eyes to observe its effect on the vascular regression and development. The VEGF injection to OIR eyes showed reduced persistent hyaloid vessels in the injected eyes as well as in the non-injected fellow eyes. This study presents longitudinal imaging of intraocular vasculatures in the developing eye and shows the utility of OCTA that can be widely used in studies of vascular development and regression and preclinical evaluation of new anti-angiogenic drugs.

Bevacizumab versus triamcinolone for persistent diabetic macular edema: a randomized clinical trial

PURPOSE

To evaluate 24-week visual acuity and anatomic outcomes of two "pro re nata" (prn) treatment strategies (intravitreal bevacizumab [IVB] prn versus intravitreal triamcinolone acetonide [IVT] prn) in patients with persistent diabetic macular edema (pDME) after 24 weeks of prn-IVB.

METHODS

One hundred eyes with center-involving DME were enrolled and treated with prn-IVB for 24 weeks; at week 24, eyes with pDME (central subfield thickness [CST] on spectral domain optical coherence tomography > 300 μm) were randomized to IVB monthly prn (group I; prn-IVB) or IVT every 3 months prn (group II; prn-IVT) and eyes in which the CST was ≤ 300 μm were assigned to continue prn-IVB (group III).

RESULTS

Seventy-four eyes completed a 48-week study period. At week 24, 65 (79.3%) eyes still had DME with CST > 300 μm and, therefore, were randomized to prn-IVB (group I, n = 33) or prn-IVT (group II, n = 32); the remaining 17 (20.7%) eyes had CST ≤ 300 μm and were assigned to continued treatment with prn-IVB (group III). At baseline, mean CST (μm) ± standard error of the mean (SEM) was 447.2 ± 24.4, 478.0 ± 19.7, and 386.0 ± 21.0 in groups I, II, and III, respectively (p > 0.05). At week 48, there was no significant difference in mean CST between groups I and II (369.9 ± 23.3 and 426.0 ± 26.1, respectively; p = 0.9995). A significant reduction in mean CST, compared with baseline, was noted at weeks 28 (p = 0.0002) and 44 (p = 0.0002) in group II. Group I did not show a significant reduction in mean CST compared with baseline at any study visit. There were no significant differences in mean CST between groups I and II at any study visit. At baseline, mean ± SEM best-corrected visual acuity (BCVA) (logMAR) was 0.50 ± 0.00, 0.60 ± 0.10, and 0.50 ± 0.10 in groups I, II, and III, respectively (p > 0.05). At week 48, there was no statistically significant difference in mean BCVA between groups I and II (0.50 ± 0.10 and 0.80 ± 0.10, respectively; p = 0.4473). There was no significant improvement in mean BCVA, as compared with baseline, at any study follow-up visit in any of the groups. Group II demonstrated significantly lower BCVA after 24 weeks of IVT (at week 48) compared with baseline (p = 0.0435). There was no significant difference in mean BCVA between groups I and II at any time-point.

CONCLUSION

In eyes with pDME after 24 weeks of treatment with prn-IVB, there was no difference between continued treatment with prn-IVB versus a treatment switch to prn-IVT with respect to mean BCVA or mean CST at week 48. However, BCVA was stable in the prn-IVB group, while prn-IVT was associated with BCVA reduction from baseline and a higher risk of IOP elevation.

Different imaging characteristics between unilateral and bilateral polypoidal choroidal vasculopathy

PURPOSE

To investigate the different imaging characteristics between unilateral and bilateral polypoidal choroidal vasculopathy (PCV) cases, based on confocal scanning laser ophthalmoscope assessment.

METHODS

For this retrospective case series study, diagnostic indocyanine green angiography (ICGA) and spectral domain optical coherence tomography (SD-OCT) were performed to assess the eligible PCV eyes.

RESULTS

Among the 53 patients at baseline, 14 showed bilateral PCV lesions, including two cases of branching vessel network (BVN) without leakage. Concerning the subfoveal choroidal thickness (SFCT), unilateral PCV eyes (326 [155-547] μm) were statistically comparable to their fellow eyes (330 [163-477] μm) (p = 0.257). However, the SFCT (228[141-273] μm) from the bilateral PCV group was significantly lower compared with both the PCV (p = 0.002) and fellow eyes (p < 0.001) from the unilateral group. Moreover, ICGA related hyperfluorescent spots were shown to have a significant positive correlation with SFCT in the unilateral PCV eyes and their fellow eyes, other than bilateral PCV cases. In addition, the drusens tended to prevail in the fellow eyes of the unilateral PCV group (46.2%), compared with bilateral cases.

CONCLUSIONS

Our results indicate that SFCT, ICGA related hyperfluorescent spots, and drusen were the three main imaging characteristic differences between unilateral and bilateral PCV cases.

Inflammatory mediators in the vitreal reflux of patients with diabetic macular edema

PURPOSE

To quantify inflammatory, growth/angiogenic, and tissue remodeling mediators in vitreal reflux (VR) in patients with diabetic macular edema (DME), as collected at first and third intravitreal anti-vascular endothelial growth factor (anti-VEGF, ranibizumab) injection.

METHODS

Thirty (30) consecutive patients (type-2 diabetes mellitus) with visual impairments due to DME and undergoing the first (untreated DME) or the third (treated DME) intravitreal injection of anti-VEGF were included in the study. At the time of surgery, patients were subjected to clinical assessment and spectral domain-optical coherence tomography (SD-OCT), including central retinal thickness (CRT), macular volume, and outer nuclear layer/retinal pigment epithelial (ONL/RPE) measurements. VR sampling was performed at the time of needle removal and subjected to customized protein-array, Western blotting (WB), Ella™ microfluidic, and/or enzyme-linked immunosorbent assay (ELISA) analysis. Biostrumental and biochemical data were collected just prior to the surgery and are representative of disease state. Clinical, biostrumental, and numerous biomarkers and cytokines were statistically compared.

RESULTS

Decreased CRT values were detected in treated DME retinas, as compared to untreated ones (p ≤ 0.05). Differences in VEGF and other mediator expressions between treated and untreated DME were detected in VR samples. Particularly, osteopontin (p ≤ 0.05), interleukin 6 (IL6) (p ≤ 0.05), and VEGF (p ≤ 0.1) values were decreased after treatment. Significant changes were validated by WB, ELISA, and Ella™ analysis.

CONCLUSION

Overall, the biostrumental and biochemical data suggest the presence of a specific pattern of inflammation in VR after treatment. The data would suggest the presence of other mechanisms and mediators, in addition to VEGF, accountable for DME progression.

Therapeutic Effect of Anti-VEGF for Age-Related Macular Degeneration in the Untreated Fellow Eye

Intravitreal injections of antivascular endothelial growth factor (anti-VEGF) agents have been reported to occasionally produce a therapeutic effect in the uninjected fellow eye. Here, three patients with bilateral neovascular age-related macular degeneration are presented. In all three patients, unilateral anti-VEGF injection resulted in bilateral reduction of macular thickness as measured by spectral domain optical coherence tomography.

Gene expression levels of the insulin-like growth factor family in patients with AMD before and after ranibizumab intravitreal injections

Purpose

The present study focused on the assessment of the mRNA levels of the insulin-like growth factor (IGF) family in patients with the exudative form of age-related macular degeneration (AMD) before and after ranibizumab intravitreal injections.

Patients and methods

An analysis of the expression profile of the IGF family of genes in patients with AMD was carried out using the oligonucleotide microarray and quantitative reverse transcriptase polymerase chain reaction (RT-qPCR) methods.

Results

In the peripheral blood mononuclear cells (PBMCs) obtained from AMD group receiving ranibizumab compared to the peripheral blood mononuclear cells from AMD group before ranibizumab treatment using oligonucleotide microarray technique, six statistically significant differentially expressed transcripts related to the IGF family were detected (unpaired t-test, p<0.05, fold change >1.5). Moreover, analysis using the real-time RT-qPCR technique revealed statistically significant differences in the IGF2 and IGF2R mRNA levels (Mann–Whitney U test, p<0.05) between the two groups that were studied. Statistical analyses of both oligonucleotide microarray and real-time RT-qPCR results demonstrated a significant decreased expression only for IGF2 mRNA.

Conclusion

Our results revealed a changed expression of IGF2 mRNA after ranibizumab treatment.