1
|
Daniels AB, Chang EY, Chew EY, Gombos DS, Gorin MB, Shields CL, Wiley HE. Consensus Guidelines for Ocular Surveillance of von Hippel-Lindau Disease. Ophthalmology 2024; 131:622-633. [PMID: 38092079 DOI: 10.1016/j.ophtha.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 03/21/2024] Open
Abstract
PURPOSE To develop guidelines for ocular surveillance and early intervention for individuals with von Hippel-Lindau (VHL) disease. DESIGN Systematic review of the literature. PARTICIPANTS Expert panel of retina specialists and ocular oncologists. METHODS A consortium of experts on clinical management of all-organ aspects of VHL disease was convened. Working groups with expertise in organ-specific features of VHL disease were tasked with development of evidence-based guidelines for each organ system. The ophthalmology subcommittee formulated questions for consideration and performed a systematic literature review. Evidence was graded for topic quality and relevance and the strength of each recommendation, and guideline recommendations were developed. RESULTS The quality of evidence was limited, and no controlled clinical trial data were available. Consensus guidelines included: (1) individuals with known or suspected VHL disease should undergo periodic ocular screening (evidence type, III; evidence strength, C; degree of consensus, 2A); (2) patients at risk of VHL disease, including first-degree relatives of patients with known VHL disease, or any patient with single or multifocal retinal hemangioblastomas (RHs), should undergo genetic testing for pathologic VHL disease gene variants as part of an appropriate medical evaluation (III/C/2A); (3) ocular screening should begin within 12 months after birth and continue throughout life (III/C/2A); (4) ocular screening should occur approximately every 6 to 12 months until 30 years of age and then at least yearly thereafter (III/C-D/2A); (5) ocular screening should be performed before a planned pregnancy and every 6 to 12 months during pregnancy (IV/D/2A); (6) ultra-widefield color fundus photography may be helpful in certain circumstances to monitor RHs, and ultra-widefield fluorescein angiography may be helpful in certain circumstances to detect small RHs (IV/D/2A); (7) patients should be managed, whenever possible, by those with subspecialty training, with experience with VHL disease or RHs, or with both and ideally within the context of a multidisciplinary center capable of providing multiorgan surveillance and access to genetic testing (IV/D/2A); (8) extramacular or extrapapillary RHs should be treated promptly (III/C/2A). CONCLUSIONS Based on available evidence from observational studies, broad agreement was reached for a strategy of lifelong surveillance and early treatment for ocular VHL disease. These guidelines were endorsed by the VHL Alliance and the International Society of Ocular Oncology and were approved by the American Academy of Ophthalmology Board of Trustees. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
- Anthony B Daniels
- Division of Ocular Oncology and Pathology, Department of Ophthalmology and Visual Sciences, and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee.
| | | | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, Maryland
| | - Dan S Gombos
- Section of Ophthalmology, Department of Head & Neck Surgery, Division of Surgery, University of Texas-MD Anderson Cancer Center, Houston, Texas
| | - Michael B Gorin
- Jules Stein Eye Institute, University of California-Los Angeles School of Medicine, Los Angeles, California
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | |
Collapse
|
2
|
Keenan TDL, Bailey C, Abraham M, Orndahl C, Menezes S, Bellur S, Arunachalam T, Kangale-Whitney C, Srinivas S, Karamat A, Nittala M, Cunningham D, Jeffrey BG, Wiley HE, Thavikulwat AT, Sadda S, Cukras CA, Chew EY, Wong WT. Phase 2 Trial Evaluating Minocycline for Geographic Atrophy in Age-Related Macular Degeneration: A Nonrandomized Controlled Trial. JAMA Ophthalmol 2024; 142:345-355. [PMID: 38483382 PMCID: PMC10941022 DOI: 10.1001/jamaophthalmol.2024.0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/20/2023] [Indexed: 03/17/2024]
Abstract
Importance Existing therapies to slow geographic atrophy (GA) enlargement in age-related macular degeneration (AMD) have relatively modest anatomic efficacy, require intravitreal administration, and increase the risk of neovascular AMD. Additional therapeutic approaches are desirable. Objective To evaluate the safety and possible anatomic efficacy of oral minocycline, a microglial inhibitor, for the treatment of GA in AMD. Design, Setting, and Participants This was a phase 2, prospective, single-arm, 45-month, nonrandomized controlled trial conducted from December 2016 to April 2023. Patients with GA from AMD in 1 or both eyes were recruited from the National Institutes of Health (Bethesda, Maryland) and Bristol Eye Hospital (Bristol, UK). Study data were analyzed from September 2022 to May 2023. Intervention After a 9-month run-in phase, participants began oral minocycline, 100 mg, twice daily for 3 years. Main Outcomes and Measures The primary outcome measure was the difference in rate of change of square root GA area on fundus autofluorescence between the 24-month treatment phase and 9-month run-in phase. Results Of the 37 participants enrolled (mean [SD] age, 74.3 [7.6] years; 21 female [57%]), 36 initiated the treatment phase. Of these participants, 21 (58%) completed at least 33 months, whereas 15 discontinued treatment (8 by request, 6 for adverse events/illness, and 1 death). Mean (SE) square root GA enlargement rate in study eyes was 0.31 (0.03) mm per year during the run-in phase and 0.28 (0.02) mm per year during the treatment phase. The primary outcome measure of mean (SE) difference in enlargement rates between the 2 phases was -0.03 (0.03) mm per year (P = .39). Similarly, secondary outcome measures of GA enlargement rate showed no differences between the 2 phases. The secondary outcome measures of mean difference in rate of change between 2 phases were 0.2 letter score per month (95% CI, -0.4 to 0.9; P = .44) for visual acuity and 0.7 μm per month (-0.4 to 1.8; P = .20) for subfoveal retinal thickness. Of the 129 treatment-emergent adverse events among 32 participants, 49 (38%) were related to minocycline (with no severe or ocular events), including elevated thyrotropin level (15 participants) and skin hyperpigmentation/discoloration (8 participants). Conclusions and Relevance In this phase 2 nonrandomized controlled trial, oral minocycline was not associated with a decrease in GA enlargement over 24 months, compared with the run-in phase. This observation was consistent across primary and secondary outcome measures. Oral minocycline at this dose is likely not associated with slower rate of enlargement of GA in AMD.
Collapse
Affiliation(s)
| | | | | | | | | | - Sunil Bellur
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | | | | | | | | | | | - Denise Cunningham
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Brett G. Jeffrey
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Henry E. Wiley
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
- Now with Genentech Inc, South San Francisco, California
| | | | - SriniVas Sadda
- Doheny Eye Institute, Pasadena, California
- University of California, Los Angeles, Los Angeles
| | | | - Emily Y. Chew
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Wai T. Wong
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
- Now with Janssen Research and Development LLC, Brisbane, California
| |
Collapse
|
3
|
Elnahry AG, Bellur S, Wiley HE, Sen HN, Kodati S. Treatment of Intermediate Uveitis-associated Retinal Vasoproliferative Tumors: A Case Series. Retin Cases Brief Rep 2023:01271216-990000000-00226. [PMID: 37756673 DOI: 10.1097/icb.0000000000001494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
PURPOSE To report the use of combination intravitreal pharmacotherapy using anti-vascular endothelial growth factor (VEGF) and short and long-term corticosteroid implants for the treatment of retinal vasoproliferative tumors (VPT) associated with intermediate uveitis. METHODS Retrospective chart review of patients with VPT secondary to idiopathic intermediate uveitis that underwent combination intravitreal pharmacotherapy at a single center was performed. Multimodal imaging including ultrawide field color fundus photography, ultrawide field fluorescein angiography, and optical coherence tomography obtained before and after treatment were reviewed. RESULTS Four eyes of 4 patients were treated with multiple injections of a combination of aflibercept, dexamethasone, and fluocinolone acetonide implants for VPT associated with intermediate uveitis. All 4 patients had improvement in visual acuity, intraocular inflammation, central macular thickness, and retinal vascular leakage, as well as regression of the VPT and reduction in lesion leakage on follow-up. CONCLUSION Combination intravitreal anti-VEGF and corticosteroid implants may be a useful approach for the treatment of intermediate uveitis-associated VPTs and can lead to both functional and structural improvement.
Collapse
Affiliation(s)
- Ayman G Elnahry
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sunil Bellur
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Henry E Wiley
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Shilpa Kodati
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
4
|
Murtaza F, Pereira A, Sen HN, Wiley HE, Christakis PG. Refractory Candida dubliniensis Retinitis in an Immunocompetent Patient. Ocul Immunol Inflamm 2023:1-4. [PMID: 36867499 DOI: 10.1080/09273948.2023.2185264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Fungal endophthalmitis is an intraocular infection that rarely develops in immunocompetent individuals. CASE A 35-year-old healthy, immunocompetent male presented with a 1-week history of pain and redness in the left eye. Visual acuity was 20/50. Dilated fundus examination revealed focal chorioretinitis in the posterior pole with associated vitritis, suspicious for a fungal etiology. He was started empirically on oral voriconazole and valacyclovir. A comprehensive systemic workup returned negative. Inflammation worsened and a diagnostic vitrectomy was performed which revealed Candida dubliniensis. The dose of oral voriconazole was increased, and intravitreal voriconazole and amphotericin B injections were added for refractory disease. Treatment response was gauged by fungal pillar height on optical coherence tomography. Eight months of oral voriconazole and 68 intravitreal antifungal injections were required to achieve complete regression and a final visual acuity of 20/20. CONCLUSION Candida dubliniensis endophthalmitis can affect immunocompetent individuals and require a prolonged treatment course.
Collapse
Affiliation(s)
- Fahmeeda Murtaza
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Austin Pereira
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Henry E Wiley
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Panos G Christakis
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
5
|
Konstantinou EK, Kodati S, Wiley HE, Keenan TDL, Cukras CA, Johnston RH, Thavikulwat AT. Assessment of Retinal Changes Following Intravitreal Aflibercept in 2 Patients With Von Hippel-Lindau Disease-Related Retinal Capillary Hemangioblastoma. JAMA Ophthalmol 2022; 140:1243-1244. [PMID: 36301552 DOI: 10.1001/jamaophthalmol.2022.4425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This case report of 2 patients describes peripheral Von Hippel-Lindau disease associated with a series of aflibercept injections.
Collapse
Affiliation(s)
| | - Shilpa Kodati
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Henry E Wiley
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Tiarnán D L Keenan
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Catherine A Cukras
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | | | | |
Collapse
|
6
|
Broadhead GK, Wiley HE, Peprah D, Olumba K, Thavikulwat AT. Proliferative Retinopathy Associated with Repeated High-Altitude Exposure in a Patient with Sickle Cell Trait. High Alt Med Biol 2022; 23:369-371. [PMID: 36576888 PMCID: PMC9810343 DOI: 10.1089/ham.2022.0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/30/2022] [Indexed: 12/29/2022] Open
Abstract
Broadhead Geoffrey K., Henry E. Wiley, David Peprah, Kenneth Olumba, and Alisa T. Thavikulwat. Proliferative retinopathy associated with repeated high-altitude exposure in a patient with sickle cell trait. High Alt Med Biol. 23:369-371, 2022.-Sickle cell trait (SCT), a carrier state characterized by one normal copy of the beta-globin gene (producing hemoglobin A) and one abnormal variant (producing hemoglobin S), is typically asymptomatic and very low risk for manifestations of hemoglobinopathy, including development of retinopathy. Reported cases of proliferative retinopathy in patients with SCT have occurred in the context of concurrent ocular or systemic disease. We report a case of an otherwise healthy patient with SCT who developed proliferative retinopathy requiring surgical intervention in the setting of significant exposure to high altitude through increased work hours as a flight attendant in the month leading to her presentation. Significant high-altitude exposure may contribute to development of retinopathy in patients with sickle trait. Practitioners should consider the possibility of sickle cell retinopathy in patients with sickle trait in these circumstances.
Collapse
Affiliation(s)
- Geoffrey K. Broadhead
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Henry E. Wiley
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - David Peprah
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kenneth Olumba
- Department of Ophthalmology, Mid Atlantic Kaiser Permanente, Lutherville, Maryland, USA
| | - Alisa T. Thavikulwat
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
7
|
Dave AD, Thavikulwat AT, De Silva T, Wiley HE, Keenan TD, Wong WT, Cukras CA. Longitudinal characterization and treatment response of retinal arterial macroaneurysms in adult-onset coats disease. Am J Ophthalmol Case Rep 2022; 27:101647. [PMID: 35859699 PMCID: PMC9289817 DOI: 10.1016/j.ajoc.2022.101647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To perform longitudinal analysis of retinal arterial macroaneurysms in 3 patients with adult-onset Coats disease. Observations Three eyes of three patients with adult-onset Coats disease were followed longitudinally for 4–15 years. Ultra-widefield images and montage color fundus photographs of affected eyes were analyzed. Size, retinal location, and grading for predominant characteristic (hemorrhagic, exudative, or quiescent) of each individual macroaneurysm were followed longitudinally from the time of onset. Fifty-one individual retinal arterial macroaneurysms were identified. The distance of any lesion-associated hemorrhage or exudation present from the foveal center was measured. Macroaneurysms were located in all quadrants of the retina, with the majority (37/51) graded as hemorrhagic at lesion onset. Hemorrhagic and exudative macroaneurysms that entered the quiescent phase remained quiescent for an average of 26 months. Seven macroaneurysms were found to have hemorrhage or exudation that came within 125 μm of the fovea and all three eyes followed demonstrated a longitudinal decrease in visual acuity despite laser and intravitreal injection therapy. At the initial visit, visual acuities ranged from 20/40 to 20/200, but decreased to 20/80 to 20/320 by the last follow-up visit. Conclusion and Importance There are many challenges in treating patients with adult-onset Coats disease. Long-term loss of visual acuity often results from sequelae of hemorrhage and exudation affecting the macula.
Collapse
|
8
|
Sun JK, Josic K, Melia M, Glassman AR, Bailey C, Chalam KV, Chew EY, Cukras C, Grover S, Jaffe GJ, Lee R, Nielsen JS, Thompson DJS, Wiley HE, Ferris FL. Conversion of Central Subfield Thickness Measurements of Diabetic Macular Edema Across Cirrus and Spectralis Optical Coherence Tomography Instruments. Transl Vis Sci Technol 2021; 10:34. [PMID: 34967834 PMCID: PMC8727314 DOI: 10.1167/tvst.10.14.34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Develop equations to convert Cirrus central subfield thickness (CST) to Spectralis CST equivalents and vice versa in eyes with diabetic macular edema (DME). Methods The DRCR Retina Network Protocol O data were split randomly to train (70% sample) and validate (30% sample) conversion equations. Data from an independent study (CADME) also validated the equations. Bland–Altman 95% limits of agreement between predicted and observed values evaluated the equations. Results Protocol O included 374 CST scan pairs from 187 eyes (107 participants). The CADME study included 150 scan pairs of 37 eyes (37 participants). Proposed conversion equations are Spectralis = 40.78 + 0.95 × Cirrus and Cirrus = 1.82 + 0.94 × Spectralis regardless of age, sex, or CST. Predicted values were within 10% of observed values in 101 (90%) of Spectralis and 99 (88%) of Cirrus scans in the validation data; and in 136 (91%) of the Spectralis and 148 (99%) of the Cirrus scans in the CADME data. Adjusting for within-eye correlations, 95% of conversions are estimated to be within 17% (95% confidence interval, 14%–21%) of CST on Spectralis and within 22% (95% confidence interval, 18%–28%) of CST on Cirrus. Conclusions Conversion equations developed in this study allow the harmonization of CST measurements for eyes with DME using a mix of current Cirrus and Spectralis device images. Translational Relevance The CSTs measured on Cirrus and Spectralis devices are not directly comparable owing to outer boundary segmentation differences. Converting CST values across spectral domain optical coherence tomography instruments should benefit both clinical research and standard care efforts.
Collapse
Affiliation(s)
- Jennifer K Sun
- Joslin Diabetes Center, Beetham Eye Institute, Harvard Department of Ophthalmology, Boston, Massachusetts, USA
| | - Kristin Josic
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Michele Melia
- Jaeb Center for Health Research, Tampa, Florida, USA
| | | | - Clare Bailey
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Kakarla V Chalam
- Department of Ophthalmology, Loma Linda University Health Care, Loma Linda, California, USA
| | - Emily Y Chew
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Catherine Cukras
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sandeep Grover
- Department of Ophthalmology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, North Carolina, USA
| | - Richard Lee
- Bristol Eye Hospital, Bristol Royal Infirmary NHS Trust, Department of Medical Retina and Uveitis, Bristol, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital, University College London Institute of Ophthalmology, London, UK
| | | | | | - Henry E Wiley
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | | | | |
Collapse
|
9
|
Hwang CK, Chew EY, Cukras CA, Keenan TDL, Wong WT, Linehan WM, Chittiboina P, Pacak K, Wiley HE. Intravitreous treatment of severe ocular von Hippel-Lindau disease using a combination of the VEGF inhibitor, ranibizumab and PDGF inhibitor, E10030: Results from a phase 1/2 clinical trial. Clin Exp Ophthalmol 2021; 49:1048-1059. [PMID: 34549489 DOI: 10.1111/ceo.14001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 09/13/2021] [Accepted: 09/18/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Treatment options for severe ocular von Hippel-Lindau (VHL) disease are limited. This trial evaluated preliminary safety and potential efficacy of combination intravitreous injection with ranibizumab, a vascular endothelial growth factor (VEGF) inhibitor, and E10030, a PDGF inhibitor, for eyes with VHL disease-associated retinal hemangioblastoma (RH) not amenable or responsive to thermal laser photocoagulation. METHODS This was a prospective, single-arm, open-label phase 1/2 study, comprised of three adults with VHL-associated RH and vision loss. Intravitreous injections of ranibizumab (0.5 mg) and E10030 (1.5 mg) were given unilaterally every 4 weeks in the study eye through 16 weeks, then every 8 weeks through 48 weeks. Supplementary standard care therapies were allowed without restriction after 40 weeks. The primary outcome was the ocular and systemic adverse effect profile at 52 weeks. Secondary outcomes included changes in best-corrected visual acuity (BCVA), RH size, exudation, epiretinal proliferation and retinal traction, and need for ablative treatment of RH or ocular surgery at week 52. RESULTS Three participants each received nine injections prior to week 52 and were followed for 104 weeks. One participant manifested mild episodic ocular hypertension in the study eye. Change in BCVA in the study eye at week 52 for the three participants was -5, -12 and +2 letters. No reduction in RH size was measured at 52 weeks. Variable mild improvements in exudation in two participants at week 16 were not sustained through week 52. CONCLUSIONS Combination intravitreous injection with ranibizumab and E10030 demonstrated a reasonable preliminary safety profile, but limited treatment effect.
Collapse
Affiliation(s)
- Christopher K Hwang
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Catherine A Cukras
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Tiarnan D L Keenan
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Wai T Wong
- Section on Neuron-Glia Interactions in Retinal Disease, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - W Marston Linehan
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Prashant Chittiboina
- Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Henry E Wiley
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
10
|
Alvarez R, Mastorakos P, Hogan E, Scott G, Lonser RR, Wiley HE, Chew EY, Chittiboina P. Retrobulbar Hemangioblastomas in von Hippel-Lindau Disease: Clinical Course and Management. Neurosurgery 2021; 88:1012-1020. [PMID: 33442737 DOI: 10.1093/neuros/nyaa565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/04/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Retrobulbar hemangioblastomas involving the optic apparatus in patients with von Hippel-Lindau disease (VHL) are rare, with only 25 reported cases in the literature. OBJECTIVE To analyze the natural history of retrobulbar hemangioblastomas in a large cohort of VHL patients in order to define presentation, progression, and management. METHODS Clinical history and imaging of 250 patients with VHL in an ongoing natural history trial and 1774 patients in a neurosurgical protocol were reviewed. The clinical course, magnetic resonance images, treatment, and outcomes were reviewed for all included patients. RESULTS A total of 18 patients with retrobulbar hemangioblastoma on surveillance magnetic resonance imaging met the inclusion criteria for this study. Of the 17 for whom clinical information was available, 10 patients presented with symptoms related to the hemangioblastoma, and 7 were asymptomatic. The mean tumor volume was larger for symptomatic (810.6 ± 545.5 mm3) compared to asymptomatic patients (307.6 ± 245.5 mm3; P < .05). A total of 5 of the symptomatic patients were treated surgically and all experienced improvement in their symptoms. All 3 symptomatic patients that did not undergo intervention had continued symptom progression. Long-term serial imaging on asymptomatic patients showed that these tumors can remain radiographically stable and asymptomatic for extended periods of time (101.43 ± 71 mo). CONCLUSION This study suggests that retrobulbar hemangioblastomas may remain stable and clinically asymptomatic for long durations. Recent growth and larger tumor volume were associated with symptom occurrence. Surgical treatment of symptomatic retrobulbar hemangioblastomas can be safe and may reverse the associated symptoms.
Collapse
Affiliation(s)
- Reinier Alvarez
- Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland.,Florida International University Herbert Wertheim College of Medicine, Miami, Florida.,Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Panagiotis Mastorakos
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland.,Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Elizabeth Hogan
- Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland.,Department of Neurosurgery, George Washington University, Washington, District of Columbia
| | - Gretchen Scott
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Russell R Lonser
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Henry E Wiley
- Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, Maryland
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, Maryland
| | - Prashant Chittiboina
- Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland.,Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| |
Collapse
|
11
|
Chen Q, Keenan TD, Allot A, Peng Y, Agrón E, Domalpally A, Klaver CCW, Luttikhuizen DT, Colyer MH, Cukras CA, Wiley HE, Teresa Magone M, Cousineau-Krieger C, Wong WT, Zhu Y, Chew EY, Lu Z. Multimodal, multitask, multiattention (M3) deep learning detection of reticular pseudodrusen: Toward automated and accessible classification of age-related macular degeneration. J Am Med Inform Assoc 2021; 28:1135-1148. [PMID: 33792724 PMCID: PMC8200273 DOI: 10.1093/jamia/ocaa302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 11/16/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Reticular pseudodrusen (RPD), a key feature of age-related macular degeneration (AMD), are poorly detected by human experts on standard color fundus photography (CFP) and typically require advanced imaging modalities such as fundus autofluorescence (FAF). The objective was to develop and evaluate the performance of a novel multimodal, multitask, multiattention (M3) deep learning framework on RPD detection. MATERIALS AND METHODS A deep learning framework (M3) was developed to detect RPD presence accurately using CFP alone, FAF alone, or both, employing >8000 CFP-FAF image pairs obtained prospectively (Age-Related Eye Disease Study 2). The M3 framework includes multimodal (detection from single or multiple image modalities), multitask (training different tasks simultaneously to improve generalizability), and multiattention (improving ensembled feature representation) operation. Performance on RPD detection was compared with state-of-the-art deep learning models and 13 ophthalmologists; performance on detection of 2 other AMD features (geographic atrophy and pigmentary abnormalities) was also evaluated. RESULTS For RPD detection, M3 achieved an area under the receiver-operating characteristic curve (AUROC) of 0.832, 0.931, and 0.933 for CFP alone, FAF alone, and both, respectively. M3 performance on CFP was very substantially superior to human retinal specialists (median F1 score = 0.644 vs 0.350). External validation (the Rotterdam Study) demonstrated high accuracy on CFP alone (AUROC, 0.965). The M3 framework also accurately detected geographic atrophy and pigmentary abnormalities (AUROC, 0.909 and 0.912, respectively), demonstrating its generalizability. CONCLUSIONS This study demonstrates the successful development, robust evaluation, and external validation of a novel deep learning framework that enables accessible, accurate, and automated AMD diagnosis and prognosis.
Collapse
Affiliation(s)
- Qingyu Chen
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Tiarnan D.L Keenan
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alexis Allot
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Yifan Peng
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Elvira Agrón
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Amitha Domalpally
- Fundus Photograph Reading Center, University of Wisconsin, Madison, Wisconsin, USA
| | | | | | - Marcus H Colyer
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Catherine A Cukras
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Henry E Wiley
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - M Teresa Magone
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Chantal Cousineau-Krieger
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Wai T Wong
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
- Section on Neuron-Glia Interactions in Retinal Disease, Laboratory of Retinal Cell and Molecular Biology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Yingying Zhu
- Department of Computer Science and Engineering, University of Texas at Arlington, Arlington, Texas, USA
- Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Zhiyong Lu
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | | |
Collapse
|
12
|
Mishra A, Vijayasarathy C, Cukras CA, Wiley HE, Sen HN, Zeng Y, Wei LL, Sieving PA. Immune function in X-linked retinoschisis subjects in an AAV8-RS1 phase I/IIa gene therapy trial. Mol Ther 2021; 29:2030-2040. [PMID: 33601057 DOI: 10.1016/j.ymthe.2021.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/27/2021] [Accepted: 02/10/2021] [Indexed: 12/12/2022] Open
Abstract
This study explored systemic immune changes in 11 subjects with X-linked retinoschisis (XLRS) in a phase I/IIa adeno-associated virus 8 (AAV8)-RS1 gene therapy trial (ClinicalTrials.gov: NCT02317887). Immune cell proportions and serum analytes were compared to 12 healthy male controls. At pre-dosing baseline the mean CD4/CD8 ratio of XLRS subjects was elevated. CD11c+ myeloid dendritic cells (DCs) and the serum epidermal growth factor (EGF) level were decreased, while CD123+ plasmacytoid DCs and serum interferon (IFN)-γ and tumor necrosis factor (TNF)-α were increased, indicating that the XLRS baseline immune status differs from that of controls. XLRS samples 14 days after AAV8-RS1 administration were compared with the XLRS baseline. Frequency of CD11b+CD11c+ DCc was decreased in 8 of 11 XLRS subjects across all vector doses (1e9-3e11 vector genomes [vg]/eye). CD8+human leukocyte antigen-DR isotype (HLA-DR)+ cytotoxic T cells and CD68+CD80+ macrophages were upregulated in 10 of 11 XLRS subjects, along with increased serum granzyme B in 8 of 11 XLRS subjects and elevated IFN-γ in 9 of 11 XLRS subjects. The six XLRS subjects with ocular inflammation after vector application gave a modestly positive correlation of inflammation score to their respective baseline CD4/CD8 ratios. This exploratory study indicates that XLRS subjects may exhibit a proinflammatory, baseline immune phenotype, and that intravitreal dosing with AAV8-RS1 leads to systemic immune activation with an increase of activated lymphocytes, macrophages, and proinflammatory cytokines.
Collapse
Affiliation(s)
- Alaknanda Mishra
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | | | - Catherine A Cukras
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Henry E Wiley
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Yong Zeng
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Lisa L Wei
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Paul A Sieving
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA; Department of Ophthalmology, University of California Davis, Davis, CA 95817, USA.
| |
Collapse
|
13
|
Song H, Zeng Y, Sardar Pasha SPB, Bush RA, Vijayasarathy C, Qian H, Wei L, Wiley HE, Wu Z, Sieving PA. Trans-Ocular Electric Current In Vivo Enhances AAV-Mediated Retinal Transduction in Large Animal Eye After Intravitreal Vector Administration. Transl Vis Sci Technol 2020; 9:28. [PMID: 32844051 PMCID: PMC7416894 DOI: 10.1167/tvst.9.7.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/06/2020] [Indexed: 01/25/2023] Open
Abstract
Purpose Electric micro-current has been shown to enhance penetration and transduction of adeno-associated viral (AAV) vectors in mouse retina after intravitreal administration. We termed this: “electric-current vector mobility (ECVM).” The present study considered whether ECVM could augment retinal transduction efficiency of intravitreal AAV8-CMV-EGFP in normal rabbit and nonhuman primate (NHP) macaque. Potential mechanisms underlying enhanced retinal transduction by ECVM were also studied. Methods We applied an electric micro-current across the intact eye of normal rabbit and monkey in vivo for a brief period immediately after intravitreal injection of AAV8-CMV-EGFP. Retinal GFP expression was evaluated by fundus imaging in vivo. Retinal immunohistochemistry was performed to assess the distribution of retinal cells transduced by the AAV8-EGFP. Basic fibroblast growth factor (bFGF) was analyzed by quantitative RT-polymerase chain reaction (PCR). Müller glial reactivity and inner limiting membrane (ILM) were examined by the glial fibrillary acidic protein (GFAP) and vimentin staining in mouse retina, respectively. Results ECVM significantly increased the efficiency of AAV reaching and transducing the rabbit retina following intravitreal injection, with gene expression in inner nuclear layer, ganglion cells, and Müller cells. Similar trend of improvement was observed in the ECVM-treated monkey eye. The electric micro-current upregulated bFGF expression in Müller cells and vimentin showed ILM structural changes in mouse retina. Conclusions ECVM promotes the transduction efficiency of AAV8-CMV-GFP in normal rabbit and monkey retinas following intravitreal injection. Translational Relevance This work has potential translational relevance to human ocular gene therapy by increasing retinal expression of therapeutic vectors given by intravitreal administration.
Collapse
Affiliation(s)
- Hongman Song
- Section for Translational Research on Retinal and Macular Degeneration, National Institute on Deafness and Other Communication Disorders, Bethesda, MD, USA.,National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yong Zeng
- Section for Translational Research on Retinal and Macular Degeneration, National Institute on Deafness and Other Communication Disorders, Bethesda, MD, USA.,National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Ronald A Bush
- Section for Translational Research on Retinal and Macular Degeneration, National Institute on Deafness and Other Communication Disorders, Bethesda, MD, USA.,National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Camasamudram Vijayasarathy
- Section for Translational Research on Retinal and Macular Degeneration, National Institute on Deafness and Other Communication Disorders, Bethesda, MD, USA.,National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Haohua Qian
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Wei
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Henry E Wiley
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Zhijian Wu
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Paul A Sieving
- Section for Translational Research on Retinal and Macular Degeneration, National Institute on Deafness and Other Communication Disorders, Bethesda, MD, USA.,National Eye Institute, National Institutes of Health, Bethesda, MD, USA.,Department of Ophthalmology, School of Medicine, University of California at Davis, Sacramento, CA, USA
| |
Collapse
|
14
|
Zeng Y, Boyd R, Bartoe J, Wiley HE, Marangoni D, Wei LL, Sieving PA. "Para-retinal" Vector Administration into the Deep Vitreous Enhances Retinal Transgene Expression. Mol Ther Methods Clin Dev 2020; 18:422-427. [PMID: 32695844 PMCID: PMC7363691 DOI: 10.1016/j.omtm.2020.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/18/2020] [Indexed: 01/22/2023]
Abstract
Intravitreal administration for human adeno-associated vector (AAV) delivery is easier and less traumatic to ocular tissues than subretinal injection, but it gives limited retinal transduction. AAV vectors are large (about 4,000 kDa) compared with most intraocular drugs, such as ranibizumab (48 kDa), and the large size impedes diffusion to reach the retina from the usual injection site in the anterior/mid-vitreous. Intuitively, a preferred placement for the vector would be deep in the vitreous near the retina, which we term “para-retinal” delivery. We explored the consequences of para-retinal intravitreal delivery in the rabbit eye and in non-human primate (NHP) eye. 1 h after para-retinal administration in the rabbit eye, the vector concentration near the retina remained four times greater than in the anterior vitreous, indicating limited vector diffusion through the gelatinous vitreous matrix. In NHP, para-retinal placement showed greater transduction in the fovea than vector applied in the mid-vitreous. More efficient retinal delivery translates to using lower vector doses, with reduced risk of ocular inflammatory exposure. These results indicate that para-retinal delivery yields more effective vector concentration near the retina, thereby increasing the potential for better retinal transduction in human clinical application.
Collapse
Affiliation(s)
- Yong Zeng
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ryan Boyd
- Charles River Laboratories, Matawan, MI, USA
| | | | - Henry E Wiley
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Dario Marangoni
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA.,Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa L Wei
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Paul A Sieving
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA.,Center for Ocular Regenerative Therapy; Department of Ophthalmology, University of California at Davis, Sacramento, CA, USA
| |
Collapse
|
15
|
Keenan TD, Wiley HE, Agrón E, Aronow ME, Christen WG, Clemons TE, Chew EY. The Association of Aspirin Use with Age-Related Macular Degeneration Progression in the Age-Related Eye Disease Studies: Age-Related Eye Disease Study 2 Report No. 20. Ophthalmology 2019; 126:1647-1656. [PMID: 31358390 DOI: 10.1016/j.ophtha.2019.06.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/09/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To analyze the potential association between aspirin use and progression of age-related macular degeneration (AMD). DESIGN Two prospective cohort studies within 2 controlled clinical trials of oral supplementation for age-related eye disease. PARTICIPANTS Age-Related Eye Disease Study (AREDS) participants 55 to 80 years of age and AREDS2 participants 50 to 85 years of age. METHODS Propensity scores for aspirin use were calculated for AREDS and AREDS2 participants separately by logistic regression. Of the participants without late AMD (geographic atrophy [GA] or neovascular AMD) in either eye at study baseline, aspirin users were matched 1:1 with nonusers by propensity score (separately for AREDS and AREDS2). Proportional hazards regression was performed, adjusting for age, on the matched participants to evaluate associations between aspirin propensity score and progression to late AMD (and its subtypes). MAIN OUTCOME MEASURES Progression to late AMD on color fundus photographs, graded centrally. RESULTS Of the 3734 eligible AREDS participants, 1049 (28.1%) were taking aspirin, and of the 2403 eligible AREDS2 participants, 1198 (49.9%) were taking aspirin. After matching by propensity score, the characteristics of the users and nonusers were similar in both studies. Of the 1950 matched AREDS participants and 1694 matched AREDS2 participants, over a median follow-up of 10.1 years and 5.0 years, respectively, the numbers who progressed to late AMD, GA, or neovascular AMD were 454 (23.3%), 345 (17.7%), and 278 (14.3%), respectively, in AREDS and 643 (38.0%), 402 (24.6%), and 341 (20.1%) in AREDS2. The hazard ratios of progression in quintile 5 (highest propensity for aspirin use) versus 1 (reference) were 1.17 (P = 0.35), 1.24 (0.25), and 0.95 (0.81), respectively, in AREDS and 1.26 (0.09), 1.46 (0.03), and 1.12 (0.58) in AREDS2. No significant association with progression to late AMD was observed for quintiles 2 through 5 for any of the 3 outcomes in either study. CONCLUSIONS Aspirin use was not associated significantly with progression to late AMD or its subtypes in either the AREDS or AREDS2. Patients with AMD need not avoid aspirin for this reason when its use is medically indicated.
Collapse
Affiliation(s)
- Tiarnan D Keenan
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Henry E Wiley
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Elvira Agrón
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Mary E Aronow
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - William G Christen
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland.
| | | |
Collapse
|
16
|
|
17
|
McDermott DH, Heusinkveld LE, Zein WM, Sen HN, Marquesen MM, Parta M, Rosenzweig SD, Fahle GA, Keller MD, Wiley HE, Murphy PM. Case Report: Ocular toxoplasmosis in a WHIM syndrome immunodeficiency patient. F1000Res 2019; 8:2. [PMID: 31249677 PMCID: PMC6587139 DOI: 10.12688/f1000research.16825.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2019] [Indexed: 01/17/2023] Open
Abstract
A patient with WHIM syndrome immunodeficiency presented with sudden painless right eye blindness associated with advanced retinal and optic nerve damage.
Toxoplasma gondii was detected by PCR in vitreous fluid but not serum. The patient was treated with pyrimethamine/sulfadiazine for 6 weeks due to evidence of active ocular inflammation and then received prophylaxis with trimethoprim-sulfamethoxazole due to his immunosuppression. Vision did not return; however, the infection did not spread to involve other sites. Toxoplasmosis is rare in primary immunodeficiency disorders and is the first protozoan infection reported in WHIM syndrome.
Collapse
Affiliation(s)
- David H McDermott
- Laboratory of Molecular Immunology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Lauren E Heusinkveld
- Laboratory of Molecular Immunology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Wadih M Zein
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, 20892, USA
| | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, 20892, USA
| | - Martha M Marquesen
- Laboratory of Clinical Immunology and Microbiology, National Institute Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, 20892, USA
| | - Mark Parta
- Clinical Research Directorate/Clinical Monitoring Research Program, Bethesda, MD, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Bethesda, Maryland, 20892, USA
| | - Sergio D Rosenzweig
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, 20892, USA
| | - Gary A Fahle
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, 20892, USA
| | - Michael D Keller
- Division of Allergy & Immunology, Children's National Medical Center, Washington, DC, 20010, USA
| | - Henry E Wiley
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, 20892, USA
| | - Philip M Murphy
- Laboratory of Molecular Immunology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, 20892, USA
| |
Collapse
|
18
|
Chen KG, Alvarez JA, Yazdanie M, Papudesu C, Wong WT, Wiley HE, Keenan TD, Chew EY, Ferris FL, Cukras CA. Longitudinal Study of Dark Adaptation as a Functional Outcome Measure for Age-Related Macular Degeneration. Ophthalmology 2018; 126:856-865. [PMID: 30278196 DOI: 10.1016/j.ophtha.2018.09.039] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/25/2018] [Accepted: 09/25/2018] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To investigate the natural history of dark adaptation (DA) function as measured by the change in rod intercept time (RIT) over 4 years and to correlate RIT change with age-related macular degeneration (AMD) severity. DESIGN Longitudinal, single-center, observational study. PARTICIPANTS A total of 77 participants aged ≥50 years with a range of AMD severities. METHODS Participants each contributing a single study eye to the analysis were assigned into person-based AMD severity groups based on fundus characteristics (drusen, pigmentary changes, late AMD, and subretinal drusenoid deposits [SDDs]). The DA function was assessed in study eyes at baseline and 3, 6, 12, 18, 24, 36, and 48 months. Mean change in DA function over time was calculated using the slope of linear regression fits of longitudinal RIT data. Patient-reported responses on a Low Luminance Questionnaire (LLQ) were obtained at baseline and yearly. Nonparametric statistical testing was performed on all comparisons. MAIN OUTCOME MEASURE The RIT, defined as the time taken after a photobleach for visual sensitivity to recover detection of a 5×10-3 cd/m2 stimulus (a decrease of 3 log units), was monitored in study eyes over 4 years, and the mean rate of change was computed. RESULTS Longitudinal analysis of 65 study eyes followed on the standard testing protocol (mean age, 71±9.3 years; 49% were female) revealed that higher rates of RIT prolongation were correlated with AMD severity group assignment at baseline (P = 0.026) and with severity group assignments at year 4 (P = 0.0011). Study eyes that developed SDD during follow-up demonstrated higher rates of RIT prolongation relative to those that did not (P < 0.0001). Overall, higher rates of RIT prolongation were significantly correlated with greater 4-year decreases in LLQ scores (total mean score, P = 0.0032). CONCLUSIONS Longitudinal decline in DA function, which correlated with patient-reported functional deficits, was accelerated in eyes with greater AMD severity and especially in eyes with SDD both at baseline and at 4 years. The RIT prolongation as a measure of changing DA function may be a functional outcome measure in AMD clinical studies.
Collapse
Affiliation(s)
- Katherine G Chen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Jason A Alvarez
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Mohammad Yazdanie
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Chandana Papudesu
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Wai T Wong
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Henry E Wiley
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Tiarnan D Keenan
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Emily Y Chew
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Frederick L Ferris
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Catherine A Cukras
- National Eye Institute, National Institutes of Health, Bethesda, Maryland.
| |
Collapse
|
19
|
Knickelbein JE, Jacobs-El N, Wong WT, Wiley HE, Cukras CA, Meyerle CB, Chew EY. Systemic Sunitinib Malate Treatment for Advanced Juxtapapillary Retinal Hemangioblastomas Associated with von Hippel-Lindau Disease. Ophthalmol Retina 2017; 1:181-187. [PMID: 28670632 DOI: 10.1016/j.oret.2016.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To describe the clinical course of advanced juxtapapillary retinal capillary hemangioblastomas (RCH) associated with von Hippel-Lindau (VHL) disease treated with systemic sunitinib malate, an agent that inhibits both anti-vascular endothelial growth factor and anti-platelet-derived growth factor signaling. DESIGN Observational case review. PARTICIPANTS Three patients with advanced VHL-related juxtapapillary RCH treated with systemic sunitinib malate. METHODS Patient 1 was followed routinely every 4 months while on systemic sunitinib prescribed by her oncologist for metastatic pancreatic neuroendocrine and kidney tumors. Patients 2 and 3 were part of a prospective clinical trial evaluating the use of systemic sunitinib for ocular VHL lesions during a period of 9 months. Visual acuity, size of RCH, and degree of exudation were recorded at each visit. Optical coherence tomography (OCT) and fluorescein angiography were also obtained at some visits. MAIN OUTCOME MEASURES Visual acuity, size of RCH, and degree of exudation. RESULTS Three patients with advanced VHL-associated juxtapapillary RCH were treated with systemic sunitinib malate. While none of the patients lost vision during therapy, treatment with sunitinib malate did not improve visual acuity or reduce the size of RCH. Improvements in RCH-associated retinal edema were observed in two patients. All patients experienced multiple adverse effects, including thyroid toxicity, thrombocytopenia, nausea, fatigue, jaundice, and muscle aches. Two of the three patients had to discontinue treatment prematurely and the third required dose reduction. CONCLUSIONS Systemic sunitinib malate may be useful in slowing progression of ocular disease from VHL-associated RCH. However, significant systemic adverse effects limited its use in this small series, and systemic sunitinib malate may not be safe for treatment of RCH when used at the doses described in this report. Further studies are required to determine if this medication used at lower doses with different treatment strategies, other medications in the same class or drugs directed at multiple targets in the tumor, may be safer and more effective for the treatment of advanced VHL-associated RCH.
Collapse
Affiliation(s)
- Jared E Knickelbein
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Naima Jacobs-El
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Wai T Wong
- Unit on Neuron-Glia Interactions in Retinal Disease, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Henry E Wiley
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Catherine A Cukras
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Catherine B Meyerle
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD
| |
Collapse
|
20
|
Willoughby AS, Chiu SJ, Silverman RK, Farsiu S, Bailey C, Wiley HE, Ferris FL, Jaffe GJ. Platform-Independent Cirrus and Spectralis Thickness Measurements in Eyes with Diabetic Macular Edema Using Fully Automated Software. Transl Vis Sci Technol 2017; 6:9. [PMID: 28180033 PMCID: PMC5295813 DOI: 10.1167/tvst.6.1.9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 11/17/2016] [Indexed: 12/18/2022] Open
Abstract
PURPOSE We determine whether the automated segmentation software, Duke Optical Coherence Tomography Retinal Analysis Program (DOCTRAP), can measure, in a platform-independent manner, retinal thickness on Cirrus and Spectralis spectral domain optical coherence tomography (SD-OCT) images in eyes with diabetic macular edema (DME) under treatment in a clinical trial. METHODS Automatic segmentation software was used to segment the internal limiting membrane (ILM), inner retinal pigment epithelium (RPE), and Bruch's membrane (BM) in SD-OCT images acquired by Cirrus and Spectralis commercial systems, from the same eye, on the same day during a clinical interventional DME trial. Mean retinal thickness differences were compared across commercial and DOCTRAP platforms using intraclass correlation (ICC) and Bland-Altman plots. RESULTS The mean 1 mm central subfield thickness difference (standard error [SE]) comparing segmentation of Spectralis images with DOCTRAP versus HEYEX was 0.7 (0.3) μm (0.2 pixels). The corresponding values comparing segmentation of Cirrus images with DOCTRAP versus Cirrus software was 2.2 (0.7) μm. The mean 1 mm central subfield thickness difference (SE) comparing segmentation of Cirrus and Spectralis scan pairs with DOCTRAP using BM as the outer retinal boundary was -2.3 (0.9) μm compared to 2.8 (0.9) μm with inner RPE as the outer boundary. CONCLUSIONS DOCTRAP segmentation of Cirrus and Spectralis images produces validated thickness measurements that are very similar to each other, and very similar to the values generated by the corresponding commercial software in eyes with treated DME. TRANSLATIONAL RELEVANCE This software enables automatic total retinal thickness measurements across two OCT platforms, a process that is impractical to perform manually.
Collapse
Affiliation(s)
| | | | | | - Sina Farsiu
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | - Clare Bailey
- University Hospitals Bristol National Health Service Foundation Trust, Bristol, UK
| | - Henry E Wiley
- National Eye Institute, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Frederick L Ferris
- National Eye Institute, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, NC, USA
| |
Collapse
|
21
|
Thavikulwat AT, Jacobs-El N, Kim JS, Agrón E, Hasan J, Meyerle CB, Valent D, Cukras CA, Wiley HE, Wong WT, Chew EY. Evolution of Geographic Atrophy in Participants Treated with Ranibizumab for Neovascular Age-related Macular Degeneration. Ophthalmol Retina 2017; 1:34-41. [PMID: 28630947 PMCID: PMC5473650 DOI: 10.1016/j.oret.2016.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE To evaluate the risk factors, incidence, and rate of progression of geographic atrophy (GA) in eyes with neovascular age-related macular degeneration (nAMD) treated with ranibizumab. DESIGN Post-hoc analysis of a prospective clinical study. PARTICIPANTS 69 participants with nAMD in at least one eye. METHODS Participants were prospectively treated in the study eye with 0.5 mg intravitreal ranibizumab. Study eyes received 4 monthly injections followed by pro re nata injections until a fluid-free macula was achieved on optical coherence tomography. Risk factors assessed included baseline demographics, treatment, and ocular characteristics on imaging. Eyes were evaluated on fundus autofluorescence (FAF) for GA. The rate of GA area growth in study and fellow eyes was analyzed by linear regression of square-root transformed areas. MAIN OUTCOME MEASURES Development of new-onset GA and rate of GA area growth measured on ocular imaging, including FAF images of the study eyes. RESULTS Sixty-nine participants (mean age 78.8±7.8 years) with an average of 40.0±13.6 months of follow-up were analyzed. Twenty-two of 69 study eyes (32%) were treatment naïve. During their first year of the study, participants received an average of 9.2±3.3 injections in the study eye. Of 63 study eyes with quality baseline images, 22 (35%) had pre-existing GA. Of the remaining 41 eyes, 7 (17%) developed new-onset GA during study follow-up. Those who developed new GA were older (all ≥79 years old) and had received fewer study injections on average (6.9 vs. 10.4 injections at 1 year) compared to those who did not develop new GA. Of the 12 treatment naïve study eyes without GA at baseline, 1 (8.3%) developed new GA during the study. In 21 study eyes with quantifiable GA area, eyes with GA present at baseline (16/21) enlarged by 0.34±0.26 mm/year, compared to 0.19±0.12 mm/year in eyes developing new-onset GA (5/21). CONCLUSIONS While 17% of study eyes without GA present at baseline receiving ranibizumab developed new GA, the role of ranibizumab in the development of GA is unclear. Further prospective longitudinal studies are required to determine the eyes most at risk of developing GA in the setting of anti-VEGF treatment.
Collapse
Affiliation(s)
- Alisa T. Thavikulwat
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Naima Jacobs-El
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Jane S. Kim
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Elvira Agrón
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Jesia Hasan
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Catherine B. Meyerle
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David Valent
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Catherine A. Cukras
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Henry E. Wiley
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Wai T. Wong
- Unit on Neuron-Glia Interactions in Retinal Disease, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Emily Y. Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD
| |
Collapse
|
22
|
Abbott AB, Knickelbein JE, Wiley HE, Chew EY, Wong WT. Ocular von Hippel-Lindau Disease – clinical characteristics and future directions. Expert Review of Ophthalmology 2016. [DOI: 10.1080/17469899.2016.1224652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
23
|
Wiley HE, Thompson DJS, Bailey C, Chew EY, Cukras CA, Jaffe GJ, Lee RWJ, Loken EK, Meyerle CB, Wong W, Ferris FL. A Crossover Design for Comparative Efficacy: A 36-Week Randomized Trial of Bevacizumab and Ranibizumab for Diabetic Macular Edema. Ophthalmology 2016; 123:841-9. [PMID: 26875003 DOI: 10.1016/j.ophtha.2015.11.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/16/2015] [Accepted: 11/17/2015] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To investigate the comparative efficacy of bevacizumab (Avastin) and ranibizumab (Lucentis; both Genentech, Inc, South San Francisco, CA) for diabetic macular edema (DME) using a crossover study design. DESIGN Randomized, double-masked, 36-week, 3-period crossover clinical trial. PARTICIPANTS Fifty-six subjects with DME involving the center of the macula in one or both eyes. METHODS Monthly intravitreous injections of bevacizumab (1.25 mg) or ranibizumab (0.3 mg). MAIN OUTCOME MEASURES Comparison of mean changes in visual acuity and central retinal thickness, tested using a linear mixed-effects model. RESULTS Based on the linear mixed-effects model, the 3-month estimated mean improvement in visual acuity was 5.3 letters for bevacizumab and 6.6 letters for ranibizumab (difference, 1.3 letters; P = 0.039). Estimated change in optical coherence tomography (OCT) central subfield mean thickness (CSMT) was -89 μm for bevacizumab and -137 μm for ranibizumab (difference, 48 μm; P < 0.001). Incorporating cumulative treatment benefit, the model yielded a predicted 36-week (9-month) average improvement in visual acuity of 7.1 letters (95% confidence interval [CI], 5.0-9.2) for bevacizumab and 8.4 letters (95% CI, 6.3-10.5) for ranibizumab, and a change in OCT CSMT of -128 μm (95% CI, -155 to -100) for bevacizumab and -176 μm (95% CI, -202 to -149) for ranibizumab. There was no significant treatment-by-period interaction (i.e., treatment difference was constant in all 3 periods), nor was there a significant differential carryover effect from one period to the next. CONCLUSIONS This trial demonstrated a statistically significant but small relative clinical benefit of ranibizumab compared with bevacizumab for treatment of DME, using a markedly reduced sample size relative to a full comparative efficacy study. The effects on visual acuity and central retinal thickness for the 2 drugs are consistent with those reported at 1 year for the concurrent parallel-group trial by the Diabetic Retinopathy Clinical Research Network testing bevacizumab, ranibizumab, and aflibercept for DME. The 3-period crossover design allowed for meaningful and efficient comparison, suggesting that this approach may be useful for future comparative efficacy studies of anti-vascular endothelial growth factor drugs for DME.
Collapse
Affiliation(s)
- Henry E Wiley
- National Eye Institute, National Institutes of Health, Bethesda, Maryland.
| | | | - Clare Bailey
- University Hospitals Bristol National Health Service Foundation Trust, Bristol, United Kingdom
| | - Emily Y Chew
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Catherine A Cukras
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Richard W J Lee
- University Hospitals Bristol National Health Service Foundation Trust, Bristol, United Kingdom; School of Clinical Sciences, University of Bristol, Bristol, United Kingdom; National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital, National Health Service Foundation Trust, and University College London Institute of Ophthalmology, London, United Kingdom
| | | | | | - Wai Wong
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Frederick L Ferris
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
24
|
Flamendorf J, Agrón E, Wong WT, Thompson D, Wiley HE, Doss EL, Al-Holou S, Ferris FL, Chew EY, Cukras C. Impairments in Dark Adaptation Are Associated with Age-Related Macular Degeneration Severity and Reticular Pseudodrusen. Ophthalmology 2015; 122:2053-62. [PMID: 26253372 DOI: 10.1016/j.ophtha.2015.06.023] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 06/12/2015] [Accepted: 06/15/2015] [Indexed: 11/16/2022] Open
Abstract
PURPOSE We investigate whether ocular and person-based characteristics were associated with dark adaptation (DA). DESIGN Cross-sectional, single-center, observational study. PARTICIPANTS One hundred sixteen participants older than 50 years of age with a range of age-related macular degeneration (AMD) severity. METHODS Participants underwent best-corrected visual acuity (BCVA) testing, ophthalmoscopic examination, and multimodal imaging. Presence of reticular pseudodrusen (RPD) was assessed by masked grading of fundus images and was confirmed with optical coherence tomography. Eyes also were graded for AMD features (drusen, pigmentary changes, late AMD) to generate person-based AMD severity groups. One eye was designated the study eye for DA testing. Nonparametric statistical testing was performed on all comparisons. MAIN OUTCOME MEASURES The primary outcome of this study was the rod intercept time (RIT), which is defined as the time for a participant's visual sensitivity to recover to a stimulus intensity of 5×10(-3) cd/m(2) (a decrease of 3 log units), or until a maximum test duration of 40 minutes was reached. RESULTS A total of 116 study eyes from 116 participants (mean age, 75.4±9.4 years; 58% female) were analyzed. Increased RIT was associated significantly with increasing AMD severity, increasing age (r = 0.34; P = 0.0002), decreasing BCVA (r = -0.54; P < 0.0001), pseudophakia (P = 0.03), and decreasing subfoveal choroidal thickness (r = -0.27; P = 0.003). Study eyes with RPD (15/116 [13%]) had a significantly greater mean RIT compared with eyes without RPD in any AMD severity group (P < 0.02 for all comparisons), with 80% reaching the DA test ceiling. CONCLUSIONS Impairments in DA increased with age, worse visual acuity, presence of RPD, AMD severity, and decreased subfoveal choroidal thickness. Analysis of covariance found the multivariate model that best fit the data included age, AMD group, and presence of RPD (R(2) = 0.56), with the presence of RPD conferring the largest parameter estimate.
Collapse
Affiliation(s)
- Jason Flamendorf
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Elvira Agrón
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Wai T Wong
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Darby Thompson
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Henry E Wiley
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - E Lauren Doss
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Shaza Al-Holou
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Frederick L Ferris
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Emily Y Chew
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Catherine Cukras
- National Eye Institute, National Institutes of Health, Bethesda, Maryland.
| |
Collapse
|
25
|
Marangoni D, Wu Z, Wiley HE, Zeiss CJ, Vijayasarathy C, Zeng Y, Hiriyanna S, Bush RA, Wei LL, Colosi P, Sieving PA. Preclinical safety evaluation of a recombinant AAV8 vector for X-linked retinoschisis after intravitreal administration in rabbits. HUM GENE THER CL DEV 2015; 25:202-11. [PMID: 25211193 DOI: 10.1089/humc.2014.067] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
X-linked retinoschisis (XLRS) is a retinal disease caused by mutations in the gene encoding the protein retinoschisin (RS1) and one of the most common causes of macular degeneration in young men. Currently, no FDA-approved treatments are available for XLRS and a replacement gene therapy could provide a promising strategy. We have developed a novel gene therapy approach for XLRS, based on the administration of AAV8-scRS/IRBPhRS, an adeno-associated viral vector coding the human RS1 protein, via the intravitreal route. On the basis of our prior study in an Rs1-KO mouse, this construct transduces efficiently all the retinal layers, resulting in an RS1 expression similar to that observed in the wild-type and improving retinal structure and function. In support of a clinical trial, we carried out a study to evaluate the ocular safety of intravitreal administration of AAV8-scRS/IRBPhRS into 39 New Zealand White rabbits. Two dose levels of vector, 2e(10) and 2e(11) vector genomes per eye (vg/eye), were tested and ocular inflammation was monitored over a 12-week period by serial ophthalmological and histopathological analysis. A mild ocular inflammatory reaction, consisting mainly of vitreous infiltrates, was observed within 4 weeks from injection, in both 2e(10) and 2e(11) vg/eye groups and was likely driven by the AAV8 capsid. At 12-week follow-up, ophthalmological examination revealed no clinical signs of vitreitis in either of the dose groups. However, while vitreous inflammatory infiltrate was significantly reduced in the 2e(10) vg/eye group at 12 weeks, some rabbits in the higher dose group still showed persistence of inflammatory cells, histologically. In conclusion, intravitreal administration of AAV8-scRS/IRBPhRS into the rabbit eye produces a mild and transient intraocular inflammation that resolves, at a 2e(10) vg/eye dose, within 3 months, and does not cause irreversible tissue damages. These data support the initiation of a clinical trial of intravitreal administration of AAV8-scRS/IRBPhRS in XLRS patients.
Collapse
Affiliation(s)
- Dario Marangoni
- 1 National Institute on Deafness and Other Communication Disorders, National Institutes of Health , Bethesda, MD 20892
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Zein WM, Jeffrey BG, Wiley HE, Turriff AE, Tumminia SJ, Tao W, Bush RA, Marangoni D, Wen R, Wei LL, Sieving PA. CNGB3-achromatopsia clinical trial with CNTF: diminished rod pathway responses with no evidence of improvement in cone function. Invest Ophthalmol Vis Sci 2014; 55:6301-8. [PMID: 25205868 DOI: 10.1167/iovs.14-14860] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Ciliary neurotrophic factor (CNTF) protects rod photoreceptors from retinal degenerative disease in multiple nonhuman models. Thus far, CNTF has failed to demonstrate rod protection in trials for human retinitis pigmentosa. Recently, CNTF was found to improve cone photoreceptor function in a canine CNGB3 achromatopsia model. This study explores whether this finding translates to humans with CNGB3 achromatopsia. METHODS A five-subject, open-label Phase I/II study was initiated by implanting intraocular microcapsules releasing CNTF (nominally 20 ng/d) into one eye each of CNGB3 achromat participants. Fellow eyes served as untreated controls. Subjects were followed for 1 year. RESULTS Pupil constriction in treated eyes gave evidence of intraocular CNTF release. Additionally, scotopic ERG responses were reduced, and dark-adapted psychophysical absolute thresholds were increased, attributable to diminished rod or rod pathway activity. Optical coherence tomography revealed that the cone-rich fovea underwent structural changes as the foveal hyporeflective zone (HRZ) became diminished in CNTF-treated eyes. No objectively measurable enhancement of cone function was found by assessments of visual acuity, mesopic increment sensitivity threshold, or the photopic ERG. Careful measurements of color hue discrimination showed no change. Nonetheless, subjects reported beneficial changes of visual function in the treated eyes, including reduced light sensitivity and aversion to bright light, which may trace to decreased effective ambient light from the pupillary constriction; further they noted slowed adaptation to darkness, consistent with CNTF action on rod photoreceptors. CONCLUSIONS Ciliary neurotrophic factor did not measurably enhance cone function, which reveals a species difference between human and canine CNGB3 cones in response to CNTF. (ClinicalTrials.gov number, NCT01648452.).
Collapse
Affiliation(s)
- Wadih M Zein
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Brett G Jeffrey
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Henry E Wiley
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Amy E Turriff
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Santa J Tumminia
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Weng Tao
- Neurotech Pharmaceuticals, Inc., Cumberland, Rhode Island, United States
| | - Ronald A Bush
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, United States
| | - Dario Marangoni
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, United States Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Rong Wen
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miller School of Medicine, Miami, Florida, United States
| | - Lisa L Wei
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Paul A Sieving
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, United States
| |
Collapse
|
27
|
Grange LK, Jacobs-El N, Wiley HE, Kurup S, Chan CC, Sen HN. Intraocular (vitreoretinal) lymphoma following primary testicular lymphoma. Can J Ophthalmol 2013; 48:e95-7. [PMID: 23931497 DOI: 10.1016/j.jcjo.2013.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 03/19/2013] [Indexed: 01/19/2023]
|
28
|
Abràmoff M, Abrams GW, Agarwal A, Ai E, Aiello LM, Aiello LP, Albert DM, Aschbrenner MW, Ávila M, Aylward GW, Bedell M, Belfort R, Bennett J, Bergstrom C, Besirli CG, Bhende PS, Binder S, Bird AC, Blodi BA, Blumenkranz MS, Boldt HC, Bornfeld N, Bottoni F, Boulton ME, Bowne SJ, Brantley MA, Bressler NM, Bressler SB, Bringmann A, Brinton DA, Brown GC, Brown JC, Brunner S, Bush RA, Cao D, Capone A, Carruthers D, Cavallerano JD, Chakravarthy U, Chan CC, Chan W, Charles S, Charteris DG, Chen DF, Chen J, Chen Y, Cheung CYL, Chew EY, Chiang A, Chiang MF, Constable IJ, Coscas G, Cruess AF, Cunningham ET, Curcio CA, Daiger SP, Damato BE, Davis JL, Davis MD, Day S, De Potter P, de Smet MD, Denniston AK, Dhaliwal RS, Ding X, Do DV, Dou G, Dunn WA, Ehlers JP, Engelbert M, Faia LJ, Falsini B, Fawzi AA, Fekrat S, Feldon SE, Fernandes RAB, Ferreyra HA, Ferrington DA, Ferris FL, Finger PT, Fisher SK, Fishman GA, Fleckenstein M, Flynn HW, Fok AC, Foulds WS, Freeman WR, Freton A, Friedlander M, Frishman LJ, Fu AD, Garcia Filho CADA, Garcia-Valenzuela E, Gaudric A, Gayed M, Genead MA, Gerding H, Giani A, Goldberg MF, Gombos DS, Gopal L, Gordon C, Goto H, Gragoudas ES, Grant MB, Green WR, Gregg RG, Gregor Z, Gregori G, Gregory-Evans K, Grob S, Groenewald C, Grossniklaus HE, Grover S, Gullapalli VK, Gupta A, Guthoff RF, Hahn P, Haller JA, Harbour JW, Haritoglou C, Hartnett ME, Hawkins BS, He S, Herwig MC, Heussen FM, Hinton DR, Holz FG, Houston SK, Hui YN, Humayun MS, Ikuno Y, Isaac D, Ishibashi T, Jabs DA, Jaffe GJ, Jampol LM, Joffe L, Johnson M, Johnson MW, Johnson RN, Joussen AM, Julian K, Jumper JM, Kaiser PK, Kampik A, Katamay R, Kay CN, Keane PA, Kenney MC, Khaderi KR, Khodair MA, Kim IK, Kim TW, Kirchhof B, Klein BE, Klein R, Konstantinidis L, Kozak I, Kuppermann BD, Labriola LT, Lai TY, Lam DS, Lam LA, Landers MB, Lane AM, Lavik EB, Leary JF, Lee SY, Lee TC, Leung LSB, Lewis DA, Lewis GP, Leys A, Li X, Liakopoulos S, Lin CP, Lin P, Liu DT, London NJ, Lujan BJ, Luo Y, Lutty GA, MacLaren R, Madreperla S, Maguire AM, Mainster MA, Mansfield NC, Markoe AM, Marmor MF, Martin DF, Massey SC, McCall MA, McCannel TA, McCutchan JA, McDonald HR, Mehta MP, Meier P, Merbs S, Meredith TA, Meyer CH, Mieler WF, Miller JW, Mirza RG, Mitter SK, Mittra RA, Miyake Y, Montemagno C, Moshiri A, Mruthyunjaya P, Muccioli C, Mullins RF, Murata T, Murphree AL, Murphy RP, Murray PI, Murray TG, Nagpal M, Namperumalsamy P, Nanda SK, Nguyen QD, Nussenblatt RB, Oh KT, Ohji M, Ohno-Matsui K, Palanker D, Patel PS, Pavlick AC, Peereboom DM, Pennesi ME, Pepose JS, Perry JD, Puliafito CA, Quiram PA, Raman R, Ramchandran RS, Rao HV, Rao NA, Rao PK, Rathinam SR, Recchia FM, Redmond KJ, Reh TA, Reichenbach A, Ritch R, Rosenfeld PJ, Rubin GS, Ruiz-Garcia H, Ryan SJ, Sadda SR, Sadun AA, Sakamoto T, Sampath AP, Schachat AP, Schmitz-Valckenberg S, Schwartz SG, Scott AW, Sebag J, Seddon JM, Sen HN, Sepah YJ, Sharma S, Sharma T, Sheu SJ, Shields CL, Shields JA, Shinoda K, Shukla D, Sieving PA, Silva PA, Silveira C, Singh AD, Smith SB, Smith WM, Sobrin L, Sodhi A, Sohn EH, Soubrane G, Spielberg L, Srivastava SK, Stachs O, Staurenghi G, Sternberg P, Stone EM, Sugino IK, Sullivan LS, Sullivan P, Sun JK, Sunness JS, Tadayoni R, Tang S, Terasaki H, Thomas MA, Thompson JT, Thumann G, Toth CA, Trese MT, Tsai JH, Turell ME, Turner PL, Udar N, Ulrich JN, Van Gelder RN, van Meurs JC, Vasconcelos-Santos DV, Vavvas DG, Vemulakonda GA, Wang H, Wang Y, Weiland JD, Weleber RG, Wharam MD, Wickham L, Wiedemann P, Wiley HE, Wilkinson C, Wilson DJ, Wolfensberger TJ, Wong D, Wong IY, Wong TY, Wu DM, Yandiev Y, Yang CH, Yang CM, Yannuzzi LA, Yasuda M, Yeh PT, Yehoshua Z, Yiu G, Yoon YH, Yu HG, Yuan A, Zarbin MA, Zhang JJ, Zhang K, Zhao M, Zhou P. Contributors. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00159-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
29
|
|
30
|
Abstract
PURPOSE To describe a case of primary meningococcal conjunctivitis mimicking epidemic keratoconjunctivitis. METHODS Review of a case history and current literature. RESULTS A 28-year-old man presented with 5 days of a bilateral follicular conjunctivitis and subepithelial corneal infiltrates. Initial diagnosis of adenoviral conjunctivitis was made. Initial Gram stain of conjunctival exudates was negative. Cultures grew Neisseria meningitidis. Systemic antibiotics were instituted with adjunctive topical therapy. The conjunctivitis resolved with no evidence of systemic invasion. CONCLUSIONS The clinical picture of Neisseria meningitidis conjunctivitis can overlap with other infectious organisms including adenovirus. Early diagnosis and systemic antibiotic therapy are critical to prevent bacteremic spread of infection.
Collapse
Affiliation(s)
- Christopher M Andreoli
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
| | | | | | | |
Collapse
|
31
|
Wiley HE, Gonzalez EB, Maki W, Wu MT, Hwang ST. Expression of CC chemokine receptor-7 and regional lymph node metastasis of B16 murine melanoma. J Natl Cancer Inst 2001; 93:1638-43. [PMID: 11698568 DOI: 10.1093/jnci/93.21.1638] [Citation(s) in RCA: 279] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND CC chemokine receptor-7 (CCR7), which plays a critical role in the migration of activated dendritic cells to regional lymph nodes via afferent lymphatic vessels, is also expressed by human breast and melanoma cell lines. Because neoplastic cells also enter lymphatic vessels before metastasis to the lymph nodes, we investigated whether CCR7 expression enhances metastasis of B16 murine melanoma cells to regional lymph nodes. METHODS B16 cells were transduced with a retroviral vector containing CCR7 complementary DNA (CCR7-B16 cells) or with vector alone (pLNCX2-B16 control cells). The functional assay for CCR7 protein was Ca(2+) flux stimulated by the chemokine CCL21, a CCR7-specific ligand produced by lymphatic endothelial cells. B16 tumor cells were injected into the footpad of mice. Tumor cell metastasis to draining lymph nodes was assessed by measuring messenger RNA (mRNA) for tyrosinase-related protein-1 (TRP), a melanocyte-specific enzyme, with real-time, quantitative reverse transcription-coupled polymerase chain reaction. All statistical tests were two-sided. RESULTS One week after injection into the footpad, 701-fold (95% confidence interval [CI] = 64- to 1336-fold) more TRP mRNA was detected in draining lymph nodes from CCR7-B16 cell-injected mice than in those from control cell-injected mice. Three weeks after footpad injection, 58% (11 of 19) of the draining lymph nodes from CCR7-B16 cell-injected mice and 5% (one of 19) of those from control mice showed gross metastases (P<.001). CCR7-B16 cells isolated from lymph node metastases retained functional CCR7 expression. Lymph node metastasis of CCR7-B16 cells was blocked by neutralizing anti-CCL21 antibodies (metastasis in none of five lymph nodes) but not by control immunoglobulin G (three of five). Enhanced metastasis of CCR7-B16 cells was specific for a lymphatic route because both CCR7-B16 and control cells co-injected intravenously metastasized to the lung at the same frequency. CONCLUSION Expression of a single chemokine receptor gene, CCR7, increased B16 cell metastasis to draining lymph nodes, suggesting that cancer cells may co-opt normal mechanisms of lymph node homing during metastasis.
Collapse
Affiliation(s)
- H E Wiley
- Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | | | | | | | | |
Collapse
|
32
|
Wiley HE. Pediatric dermatology in primary care medicine. Prim Care 1989; 16:809-22. [PMID: 2678181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Dermatologic conditions in children pose a special dilemma to primary care physicians. On the one hand, dermatologic problems are so common in childhood that the primary care physician is forced to become involved with many of them; on the other hand, the scope of dermatologic conditions found in children is so broad as to be beyond the skills of most primary care physicians. The secret to managing dermatologic problems in children within a primary care setting is to recognize that a relatively small group of conditions encompass the vast majority of reasons for which a primary care physician will be consulted. By recognizing those conditions and becoming expert in the treatment of those well-defined areas, the primary care physician can perform a true service. Critical to this approach, however, is to establish clear limits and to practice within the framework of one's competence. Recognizing the importance of early referral of those cases that fall outside one's expertise is an important measure of the primary care physician's competence as seen by patients and their families. This article attempts to assist primary care physicians in developing their own set of guidelines.
Collapse
Affiliation(s)
- H E Wiley
- University of Florida College of Medicine, Gainesville
| |
Collapse
|
33
|
|
34
|
Penneys NS, Wiley HE. Herpetiform blisters in systemic lupus erythematosus. Arch Dermatol 1979; 115:1427-8. [PMID: 533288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Four patients with systemic lupus erythematosus (SLE) had a vesicobullous eruption that histologically resembled dermatitis herpetiformis. Immunofluorescence microscopy patterns in the skin studied in three patients, however, were characteristic of SLE. Treatment of the underlying collagen-vascular disease improved the eruption, while recurrence coincided with exacerbation of the systemic disease. This distinctive lesion is an important parameter of SLE activity.
Collapse
|
35
|
Wiley HE, Weinstein GD. Abnormal proliferation of uninvolved psoriatic epidermis: differential induction by saline, propranolol, and tape stripping in vivo. J Invest Dermatol 1979; 73:545-7. [PMID: 512406 DOI: 10.1111/1523-1747.ep12541532] [Citation(s) in RCA: 37] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cell proliferation of the uninvolved psoriatic skin was compared with normal skin of volunteers following stimulation by the intradermal injections of saline or propranolol, or stripping of the stratum corneum with pressure-sensitive tape. Initially, no significant in vivo difference in tritiated thymidine labeling indices were observed between normal and uninvolved epidermal cells. However, 48 hr after each stimulus more DNA synthesizing cells were found in the uninvolved psoriatic than in normal epidermis. Of these 3 stimuli, propranolol was the most effective in distinguishing between uninvolved psoriatic skin and skin from normal control subjects. Thus, uninvolved psoriatic skin appears to possess an abnormal regulation of epidermopoiesis that may be amplified by propranolol injection.
Collapse
|
36
|
Wiley HE, Eaglstein WE. Calcinosis cutis in children following electroencephalography. JAMA 1979; 242:455-6. [PMID: 448965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
37
|
|