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Zarranz-Ventura J, Escobar-Barranco JJ, Gómez-Baldó L, Gallego-Pinazo R. Reasons for Delayed Anti-VEGF Treatment During COVID-19 Lockdown and Clinical Impact in Neovascular Age-Related Macular Degeneration. Ophthalmol Ther 2023; 12:2537-2555. [PMID: 37400599 PMCID: PMC10441892 DOI: 10.1007/s40123-023-00757-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/08/2023] [Indexed: 07/05/2023] Open
Abstract
INTRODUCTION Timely anti-vascular endothelial growth factor (VEGF) treatment is crucial for visual function in neovascular age-related macular degeneration (nAMD). The aim of this study was to assess the reasons for anti-VEGF treatment delay during the COVID-19 lockdown and its clinical impact in patients with nAMD. METHODS A retrospective, observational, multicentre study in patients with nAMD treated with anti-VEGF therapy was performed in 16 centres nationwide. Data were retrieved from the FRB Spain registry, patient medical records and administrative databases. Patients were divided into two groups based on whether they received or missed intravitreal injections during the COVID-19 lockdown. RESULTS A total of 302 eyes from 245 patients were included (timely treated group [TTG] 126 eyes; delayed treatment group [DTG] 176 eyes). Visual acuity (VA; ETDRS letters) decreased from baseline to post-lockdown visit in the DTG (mean [standard deviation] 59.1 (20.8) vs. 57.1 (19.7); p = 0.020) and was maintained in the TTG (64.2 [16.5] vs. 63.6 [17.5]; p = 0.806). VA worsened by an average of - 2.0 letters in the DTG and by - 0.6 in the TTG (p = 0.016). A higher proportion of visits were cancelled due to hospital overload in the TTG (76.5%) than in the DTG (47%), and a higher proportion of patients missed visits in the DTG (53%) than in the TTG (23.5%, p = 0.021), with fear of COVID-19 infection being the main reason for missed visits (60%/50%). CONCLUSIONS Treatment delays were caused by both hospital saturation and patients' decision; the latter being mainly driven by fear of COVID-19 infection. These delays had a detrimental effect on the visual outcomes in nAMD patients.
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Affiliation(s)
- Javier Zarranz-Ventura
- Hospital Clínic of Barcelona, Universitat de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain.
- Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, Ying GS. Age-Related Macular Degeneration Preferred Practice Pattern®. Ophthalmology 2019; 127:P1-P65. [PMID: 31757502 DOI: 10.1016/j.ophtha.2019.09.024] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 12/14/2022] Open
Affiliation(s)
| | | | - Steven T Bailey
- Casey Eye Institute, Oregon Health & Science University, Portland, OR
| | - Amani Fawzi
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - G Atma Vemulakonda
- Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, CA
| | - Gui-Shuang Ying
- Center for Preventative Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Kim CG, Park S, Kim Y. Age-related macular degeneration among the elderly: The 5th National Health and Nutrition Examination Survey, 2010 through 2012. Jpn J Nurs Sci 2019; 17:e12257. [PMID: 31161727 DOI: 10.1111/jjns.12257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 11/22/2018] [Accepted: 12/31/2018] [Indexed: 11/30/2022]
Abstract
AIM This study was conducted to identify the prevalence and factors associated with age-related macular degeneration (AMD) in Korean elderly. METHODS The study population of this cross-sectional survey was the Korean Health and Nutrition Examination Survey (KHANES) 2010 through 2012, the fifth population-based study. RESULTS Analysis of 2,767 elderly (above age 65) from 23,376 participants showed the prevalence of any AMD to be 17.6% in the Korean elderly. Factors that were significantly positively associated with AMD included age, sex, occupation, low socioeconomic status, liver cirrhosis and physical activity (p < .01). Significantly negatively associated with AMD were cardiovascular disease, obesity, and beta-carotene intake (p < .05). CONCLUSIONS This study estimated the prevalence rate and assessed factors associated with AMD in the elderly. This can be used to build a strategy for elderly eye health, and provides valuable information for screening for putative risks in the elderly.
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Affiliation(s)
- Chul-Gyu Kim
- Department of Nursing, Chungbuk National University, Cheongju-si, Republic of Korea
| | - Seungmi Park
- Department of Nursing & The Research Institute for Basic Sciences, Hoseo University, Asan-si, Republic of Korea
| | - Youngji Kim
- Department of Nursing, College of Nursing and Health, Kongju National University, Gongju-si, Republic of Korea
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Pinna A, Solinas G, Giancipoli E, Porcu T, Zinellu A, D'Amico-Ricci G, Boscia F, Lanzetta P, Avitabile T, Schwartz AG, Carru C. Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency and Late-stage Age-Related Macular Degeneration. Int J Med Sci 2019; 16:623-629. [PMID: 31217728 PMCID: PMC6566738 DOI: 10.7150/ijms.30155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/07/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose: Age-related macular degeneration (AMD) is the leading cause of blindness in the elderly in Western Countries. Evidence indicates that Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency, a common genetic abnormality, may protect against ischemic heart and cerebrovascular disease, ocular vascular disorders, and colorectal cancer. This study was undertaken to ascertain whether G6PD deficiency may protect against AMD. Materials and Methods: 79 men with late-stage AMD and 79 male, age-matched cataract controls without AMD were recruited in March-December 2016. Smoking status, clinical history, and drug use were recorded. A blood sample was taken from each participant. Complete blood count, hemoglobin, glucose, creatinine, cholesterol, triglycerides, transaminases, bilirubin, and erythrocyte G6PD activity were measured. Stepwise logistic regression was used to investigate the association between G6PD deficiency and AMD. Results: G6PD deficiency was found in 7 (8.9%) AMD patients and 8 (10.1%) controls, a not statistically significant difference. Stepwise logistic regression disclosed that AMD was significantly associated with increased diastolic blood pressure (OR=1.09, 95% CI=1.03-1.15, P=0.02) and LDL-cholesterol (OR=1.02, 95% CI=1.0001-1.03, P=0.049) and lower values of white blood cell (WBC) count (OR=0.71, 95% CI=0.56-0.88, P=0.02) and aspartate aminotransferase (AST) (OR=0.92, 95% CI=0.85-0.99, P=0.044). Conclusion: Results suggest that G6PD deficiency has no protective effect on nor is a risk factor for AMD. Larger studies are necessary to confirm whether increased diastolic blood pressure and LDL-cholesterol and lower values of WBC count and AST are risk factors for AMD.
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Affiliation(s)
- Antonio Pinna
- Department of Medical, Surgical, and Experimental Sciences, University of Sassari, Sassari, Italy.,Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | - Giuliana Solinas
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Ermete Giancipoli
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Tiziana Porcu
- Department of Medical, Surgical, and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | | | - Francesco Boscia
- Department of Medical, Surgical, and Experimental Sciences, University of Sassari, Sassari, Italy.,Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | - Paolo Lanzetta
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
| | | | - Arthur G Schwartz
- Fels Institute for Cancer Research and Molecular Biology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy.,Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
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Daniel E, Grunwald JE, Kim BJ, Maguire MG, Jaffe GJ, Toth CA, Ferris FL, Martin DF, Shaffer J, Ying GS. Visual and Morphologic Outcomes in Eyes with Hard Exudate in the Comparison of Age-Related Macular Degeneration Treatments Trials. Ophthalmol Retina 2017; 1:25-33. [PMID: 28620652 DOI: 10.1016/j.oret.2016.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To compare baseline characteristics, visual acuity (VA) and morphological outcomes between eyes with baseline hard exudates (HE) and all other eyes among patients with neovascular age-related macular degeneration (NVAMD) treated with anti-vascular endothelial growth factors (anti-VEGF). DESIGN Prospective cohort study within the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT). PARTICIPANTS Patients with NVAMD. METHODS Readers evaluated baseline and follow-up morphology on digital color images, fluorescein angiography (FA), and optical coherence tomography (OCT) in eyes with NVAMD that were randomly assigned to treatment with either ranibizumab or bevacizumab. Ophthalmologists identified HE on color images in the study eye. MAIN OUTCOME MEASURES VA; scar; geographic atrophy; retinal thickness, fluid; and number of anti-VEGF injections. RESULTS HE was present in 128 of 1185 (11%) study eyes at baseline, 77% within 1 disc diameter of the foveal center. Patients with study eye HE were more likely female (81% vs 60%; p<0.001) and non-smokers (53% vs 42%; p=0.004). Both groups had similar proportions of hypercholesterolemia and hypertriglyceridemia. At baseline, eyes with HE had worse VA (mean 57 vs 61 letters; p=0.003), larger total lesion size (3.3 vs 2.4 DA; p <0.001), greater total foveal thickness (522µm vs 452µm; p<0.001), more retinal angiomatous proliferation (18% vs 10%; p=0.009) and sub-RPE fluid (65% vs 47%; p<0.001). At 1 year, VA was similar in both groups; more eyes with baseline HE had no fluid (45% vs 29%; p<0.001) and greater reduction in total foveal thickness (-266µm vs -158u; p<0.001). VA at year 2 was similar but retinas of eyes with baseline HE were thinner (267µm vs 299µm; p=0.03) and fewer eyes had sub-retinal fluid (23% vs 36%; p=0.008). HE was present in 19% of eyes at 1 year and 5% of eyes at 2 years. LIPC promoter SNP rs10468017 was not associated with NVAMD HE. CONCLUSION Eyes with HE have larger CNV lesions and more RAP. Their initially thicker retina rapidly becomes thinner on anti-VEGF treatment. HE is not significantly associated with hyperlipidemia. HE at baseline does not significantly influence VA, scar and GA outcomes in eyes with NVAMD treated with anti-VEGF. Few eyes have HE at year 2.
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Affiliation(s)
- Ebenezer Daniel
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - Juan E Grunwald
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - Benjamin J Kim
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - Maureen G Maguire
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - Glenn J Jaffe
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - Cynthia A Toth
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - Frederick L Ferris
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - Daniel F Martin
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - James Shaffer
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - Gui-Shuang Ying
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
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Shiba T, Takahashi M, Matsumoto T, Shirai K, Hori Y. Arterial stiffness shown by the cardio-ankle vascular index is an important contributor to optic nerve head microcirculation. Graefes Arch Clin Exp Ophthalmol 2017; 255:99-105. [PMID: 27743161 PMCID: PMC5203816 DOI: 10.1007/s00417-016-3521-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/06/2016] [Accepted: 10/05/2016] [Indexed: 11/29/2022] Open
Abstract
PROPOSE The purpose of this study was to determine whether there were significant correlations between the pulse waveform in the capillary area of the optic nerve head (ONH) microcirculation shown by laser speckle flowgraphy (LSFG) and parameters of the systemic condition, especially the cardio-ankle vascular index (CAVI). METHOD We studied 130 men (ages 60.5 ± 10.9 years) who visited the Vascular Function Section of the Department of Cardiovascular Center of Toho University Sakura Medical Center. We evaluated the skew and blowout time (BOT) - which are parameters of pulse waveform analyses - using LSFG in the capillary area of the ONH for each patient. The CAVI, the E/e' ratio as the measure of diastolic left ventricular function, and the mean intima-media thickness (IMT) were evaluated as systemic parameters. We performed a Pearson's correlation analysis and a multiple regression analysis to determine independent factors for skew and BOT. RESULTS Heart rate, spherical refraction, and the CAVI (standard regression = 0.18, t = 2.61, p = 0.01) were revealed as factors contributing independently to the skew by multiple regression analysis. Heart rate, the CAVI (standard regression = -0.27, t = -3.92, p = 0.0002), the urinary albumin concentration, the mean IMT, spherical refraction, body mass index and pulse pressure were revealed as factors contributing independently to the BOT by multiple regression analysis. CONCLUSION The CAVI was demonstrated to be an independent factor contributing to both skew and BOT in the capillary area of the ONH. Our findings clarified that large arterial function shown by the CAVI contributes to smooth hemodynamics of microcirculation, shown by LSFG.
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Affiliation(s)
- Tomoaki Shiba
- Department of Ophthalmology, School of Medicine Toho University, Tokyo, Japan
| | - Mao Takahashi
- Cardiovascular Center, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan.
| | - Tadashi Matsumoto
- Department of Ophthalmology, School of Medicine Toho University, Tokyo, Japan
| | - Kohji Shirai
- Internal Medicine, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Yuichi Hori
- Department of Ophthalmology, School of Medicine Toho University, Tokyo, Japan
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Association of macular pigment optical density with serum concentration of oxidized low-density lipoprotein in healthy adults. Retina 2015; 35:820-6. [PMID: 25473786 DOI: 10.1097/iae.0000000000000382] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To analyze the association between macular pigment optical density (MPOD), which reflects lutein (L), zeaxanthin (Z), and meso-zeaxanthin (MZ) in the macula, and background characteristics. METHODS Fifty-five healthy adult volunteers were analyzed. Macular pigment optical density was measured using a heterochromatic flicker photometry technique, and serum concentrations of carotenoids and lipoproteins were by high-performance liquid chromatography and enzyme-linked immunosorbent assay, respectively. Dietary intake of nutrient was determined by a validated self-administered questionnaire on ingestion frequency. RESULTS Macular pigment optical density was positively correlated with serum concentrations of L and Z and dietary L intake and inversely correlated with serum oxidized low-density lipoprotein (LDL). Although MPOD decreased with age (95% confidence interval, -0.011 to -0.002; correlation coefficient, -0.269; P = 0.007), serum L/Z and dietary L intake did not. In contrast, serum oxidized LDL was positively correlated with age (95% confidence interval, 0.69-2.34; correlation coefficient, 0.333; P = 0.0004). After adjusting for age, sex, and oxidized LDL, serum L was positively correlated with MPOD (95% confidence interval, 0.88-1.69; P = 0.000001). After adjusting for age, sex, and serum L, serum oxidized LDL was inversely correlated with MPOD (95% confidence interval, -0.002 to -0.0004; P = 0.006). CONCLUSION Macular pigment optical density was inversely correlated with serum oxidized LDL. Further study to know the impact of oxidized LDL on MPOD may be warranted.
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Fischer T. [The age-related macular degeneration as a vascular disease/part of systemic vasculopathy: contributions to its pathogenesis]. Orv Hetil 2015; 156:358-65. [PMID: 25702256 DOI: 10.1556/oh.2015.30017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The wall of blood vessels including those in choroids may be harmed by several repeated and/or prolonged mechanical, physical, chemical, microbiological, immunologic, and genetic impacts (risk factors), which may trigger a protracted response, the so-called host defense response. As a consequence, pathological changes resulting in vascular injury (e. g. atherosclerosis, age-related macular degeneration) may be evolved. Risk factors can also act directly on the endothelium through an increased production of reactive oxygen species promoting an endothelial activation, which leads to endothelial dysfunction, the onset of vascular disease. Thus, endothelial dysfunction is a link between the harmful stimulus and vascular injury; any kind of harmful stimuli may trigger the defensive chain that results in inflammation that may lead to vascular injury. It has been shown that even early age-related macular degeneration is associated with the presence of diffuse arterial disease and patients with early age-related macular degeneration demonstrate signs of systemic and retinal vascular alterations. Chronic inflammation, a feature of AMD, is tightly linked to diseases associated with ED: AMD is accompanied by a general inflammatory response, in the form of complement system activation, similar to that observed in degenerative vascular diseases such as atherosclerosis. All these facts indicate that age-related macular degeneration may be a vascular disease (or part of a systemic vasculopathy). This recognition could have therapeutic implications because restoration of endothelial dysfunction may prevent the development or improve vascular disease resulting in prevention or improvement of age-related macular degeneration as well.
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Ittermann T, Jürgens C. Thyroid function: a new road to understanding age-related macular degeneration? BMC Med 2015; 13:95. [PMID: 25903272 PMCID: PMC4407388 DOI: 10.1186/s12916-015-0343-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 04/07/2015] [Indexed: 11/30/2022] Open
Abstract
Age-related macular degeneration (AMD) continues to be amongst the leading causes of blindness and visual impairment worldwide. AMD remains a degenerative disorder of unknown etiology with rising prevalence. It induces retinal changes and damages those parts of the retina which are essential for central vision. The risk of developing this condition is associated with increasing age. Early stages usually progress without warning signs over years. The major identified risk factors for AMD development are age, ethnicity, family history, and current smoking. Associations of other modifiable risk factors with AMD have been widely published but these studies have reported conflicting results and showed a lack of consistency. According to recent data published in BMC Medicine from the population-based Rotterdam study, thyroid hormones may contribute to a better characterization of AMD in clinical practice. In that study serum free thyroxine levels were positively associated with development of AMD. More studies are needed to validate these findings and to understand better the role of thyroid hormones in the pathogenesis of AMD disease. Please see related article: http://dx.doi.org/10.1186/s12916-015-0329-0.
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Affiliation(s)
- Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Walther Rathenau Str. 48, D-17475, Greifswald, Germany.
| | - Clemens Jürgens
- Institute for Community Medicine, University Medicine Greifswald, Walther Rathenau Str. 48, D-17475, Greifswald, Germany.
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Marin Garcia PJ, Marin-Castaño ME. Angiotensin II-related hypertension and eye diseases. World J Cardiol 2014; 6:968-984. [PMID: 25276298 PMCID: PMC4176806 DOI: 10.4330/wjc.v6.i9.968] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 06/17/2014] [Accepted: 07/14/2014] [Indexed: 02/07/2023] Open
Abstract
Systemic vascular disease, especially hypertension, has been suspected as a risk factor for some eye diseases including, diabetic retinopathy and age-related macular degeneration. Hypertension can contribute to chronic diseases by hemodynamic injury and/or cellular actions induced by hypertension-related hormones or growth factors. Among the most important is Angiotensin II (Ang II), which controls blood pressure and induces different cellular functions that may be dependent or independent of its effect on blood pressure. Importantly, as is true for heart, kidney and other organs, the renin-angiotensin system (RAS) is present in the eye. So, even in the absence of hypertension, local production of Ang II could be involved in eye diseases. The goal of this manuscript is to review the most relevant scientific evidence supporting the role of the RAS activation, in the development of age-related macular degeneration and diabetic retinopathy, and highlight the importance of Ang II in the etiology of these diseases.
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Varshney N, Jain A, Chan V, Yu L, Sarraf D. Anti-VEGF response in macular hemorrhage and incidence of retinal pigment epithelial tears. Can J Ophthalmol 2013; 48:210-5. [DOI: 10.1016/j.jcjo.2013.01.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 01/14/2013] [Accepted: 02/01/2013] [Indexed: 10/26/2022]
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Ocular and systemic safety of bevacizumab and ranibizumab in patients with neovascular age-related macular degeneration. Curr Opin Ophthalmol 2013; 24:205-12. [PMID: 23518613 DOI: 10.1097/icu.0b013e32835f8ec0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW This study reviews differences in both ocular and systemic safety between intravitreal bevacizumab and ranibizumab in the setting of neovascular age-related macular degeneration. RECENT FINDINGS Serious adverse events associated with either bevacizumab or ranibizumab injections are generally rare. However, acute intraocular inflammation (AII) tends to occur more frequently following bevacizumab injection. Systemic absorption of bevacizumab is greater than with ranibizumab, and many studies have shown an increased risk of systemic adverse events in patients receiving bevacizumab compared with those receiving ranibizumab. SUMMARY Although rare, adverse events with off-label use of bevacizumab are more common than with ranibizumab. Continued study into long-term safety of the two agents is warranted.
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Aspirin use and risk of age-related macular degeneration: a meta-analysis. PLoS One 2013; 8:e58821. [PMID: 23516561 PMCID: PMC3597550 DOI: 10.1371/journal.pone.0058821] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 02/07/2013] [Indexed: 11/19/2022] Open
Abstract
Background Age-related macular degeneration (AMD) is the main cause of blindness and the curative options are limited. The objective of this meta-analysis was to determine the association between aspirin use and risk of AMD. Methods A comprehensive literature search was performed in PubMed, Embase, Web of Science, and reference lists. A meta-analysis was performed by STATA software. Results Ten studies involving 171729 individuals examining the association between aspirin use and risk of AMD were included. Among the included studies, 2 were randomized-controlled trials (RCTs), 4 were case-control studies and 4 were cohort studies. The relative risks (RRs) were pooled using a random-effects model. Relative risks with 95% confidence intervals (CIs) of aspirin use as a risk for AMD. The pooled RR of 10 included studies between the use of aspirin and risk of AMD was 1.09 (95% CI, 0.96–1.24). The same result was detected in early and late stage AMD subgroup analysis. In the subgroup analyses, the pooled RR of RCTs, case-control studies and cohort studies were 0.81 (95% CI, 0.64–1.02), 1.02 (95% CI, 0.92–1.14) and 1.08 (95% CI, 0.91–1.28), respectively. Conclusions The use of aspirin was not associated with the risk of AMD.
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