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Larsson JME, Boberg-Ans LC, Vangsted A, van Dijk EHC, Grauslund J, Hajari JN, Klefter ON, Schneider M, Subhi Y. Topical non-steroidal anti-inflammatory drugs for central serous chorioretinopathy: A systematic review and meta-analysis. Acta Ophthalmol 2024; 102:274-284. [PMID: 37551858 DOI: 10.1111/aos.15743] [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: 02/13/2023] [Revised: 07/07/2023] [Accepted: 07/27/2023] [Indexed: 08/09/2023]
Abstract
Central serous chorioretinopathy (CSC) is a prevalent exudative maculopathy and the ongoing verteporfin shortage restricts current treatment possibilities. Topical non-steroidal anti-inflammatory drugs (NSAID) have previously been proposed as a treatment for CSC, although its exact efficacy remains unclear. In this systematic review and meta-analysis, we outlined the efficacy of topical NSAIDs for the treatment of CSC. We searched 11 literature databases on 13 December 2022, for any study describing topical NSAID treatment for CSC. Thirteen eligible studies were included with a total of 1001 eyes of 994 patients with CSC. Six studies were case reports, two were cohort studies and five were non-randomized comparative studies. Where specified, topical NSAIDs used were bromfenac 0.09%, diclofenac 0.1%, ketorolac 0.4% and 0.5%, pranoprofen 0.1%, and nepafenac 0.1% and 0.3%. Studies were predominantly of cases with acute CSC and several case studies reported treatment outcomes simultaneously with discontinuation of corticosteroid use, which complicated treatment evaluation. Meta-analyses of comparative studies revealed a statistically significant but clinically irrelevant best-corrected visual acuity improvement of -0.04 logMAR (95% CI: -0.07 to -0.01 logMAR; p = 0.01) at 1-month follow-up, which became statistically insignificant at 3-month follow-up (-0.03 logMAR; 95% CI: -0.06 to 0.003 logMAR; p = 0.08). Further, we found no benefit in complete subretinal fluid resolution at 1-month follow-up (OR: 1.20; 95% CI: 0.81-1.76; p = 0.37) or 3-month follow-up (OR: 1.17; 95% CI: 0.86 to 1.59; p = 0.33). Taken together, available evidence does not support the use of topical NSAIDs for the treatment of CSC.
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Affiliation(s)
| | | | | | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jakob Grauslund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Ophthalmology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Javad N Hajari
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Oliver N Klefter
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Miklos Schneider
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Li DS, Liao HX, Zhang CH, Huang JG, Chen W, Zhang JL, Qin B. Aflibercept combined with triamcinolone acetonide in the treatment of diabetic macular edema: optical coherence tomography and optical coherence tomography angiography. Int J Ophthalmol 2024; 17:670-675. [PMID: 38638246 PMCID: PMC10988085 DOI: 10.18240/ijo.2024.04.10] [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: 01/07/2024] [Accepted: 02/08/2024] [Indexed: 04/20/2024] Open
Abstract
AIM To analyze the relationship between optical coherence tomography (OCT) and OCT angiography (OCTA) imaging in patients with diabetic macular edema (DME) who are treated with a combination of aflibercept and triamcinolone acetonide (TA). METHODS A total of 76 eyes newly diagnosed DME were included in this study. They were randomly assigned to receive either aflibercept or a combination of aflibercept and TA. Injections once a month for a total of three injections. Central macular thickness (CMT), number of hyperreflective foci (HRF), height of subretinal fluid (SRF), and area of foveal avascular zone (FAZ) were evaluated using OCT and OCTA at baseline and after each monthly treatment. RESULTS Both groups showed improvement in best corrected visual acuity (BCVA) and reduction in macular edema after treatment, and the difference in BCVA between the two groups was statistically significant after each treatment (P<0.05). The difference in CMT between the two groups was statistically significant after the first two injections (P<0.01), but not after the third injection (P=0.875). The number of HRF (1mo: 7.41±8.25 vs 10.86±7.22, P=0.027; 2mo: 5.33±6.13 vs 9.12±8.61, P=0.034; 3mo: 3.58±3.00 vs 6.37±5.97, P=0.007) and height of SRF (1mo: 82.39±39.12 vs 105.77±42.26 µm, P=0.011; 2mo: 36.84±10.02 vs 83.59±37.78 µm, P<0.01; 3mo: 11.57±3.29 vs 45.43±12.60 µm, P<0.01) in combined group were statistically significant less than aflibercept group after each injection, while the area of FAZ showed no significant change before and after treatment in both groups. CONCLUSION The combination therapy of aflibercept and TA shows more significant effects on DME eyes with decreased HRF and SRF. However, both aflibercept and combination therapy show no significant change in the area of FAZ.
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Affiliation(s)
- De-Shuang Li
- Shenzhen Aier Eye Hospital, Aier Eye Hospital, Jinan University, Shenzhen 518031, Guangdong Province, China
| | - Hong-Xia Liao
- Shenzhen Aier Eye Hospital, Aier Eye Hospital, Jinan University, Shenzhen 518031, Guangdong Province, China
| | - Chuan-He Zhang
- Shenzhen Aier Eye Hospital, Aier Eye Hospital, Jinan University, Shenzhen 518031, Guangdong Province, China
| | - Jian-Guo Huang
- Shenzhen Aier Eye Hospital, Aier Eye Hospital, Jinan University, Shenzhen 518031, Guangdong Province, China
| | - Wei Chen
- Department of Ophthalmology, the University of Hong Kong-Shenzhen Hospital, Shenzhen 518000, Guangdong Province, China
| | - Jing-Lin Zhang
- Guangzhou Aier Eye Hospital, Jinan University, Guangzhou 510040, Guangdong Province, China
| | - Bo Qin
- Shenzhen Aier Eye Hospital, Aier Eye Hospital, Jinan University, Shenzhen 518031, Guangdong Province, China
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Aljundi W, Daas L, Suffo S, Seitz B, Abdin AD. First-Year Real-Life Experience with Intravitreal Faricimab for Refractory Neovascular Age-Related Macular Degeneration. Pharmaceutics 2024; 16:470. [PMID: 38675131 PMCID: PMC11053849 DOI: 10.3390/pharmaceutics16040470] [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: 03/04/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Background: To evaluate the outcomes of intravitreal faricimab (IVF) for refractory neovascular age-related macular degeneration (nAMD) and investigate the impact of baseline optical coherence tomography, biomarkers for total IVF injections are needed. Methods: A retrospective analysis of 33 eyes of patients who completed one year (52 W) of treatment with IVF. The eyes received four IVF injections (6 mg/0.05 mL) as the upload phase. Thereafter, the treatment interval was extended to 8 or 12 weeks if disease activity was not recorded. The outcome measures included best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and retinal fluid distribution. Results: A total of 33 eyes were included. CMT decreased significantly at 52 W (p < 0.01). BCVA and SFCT did not change significantly at 52 W (p > 0.05). The number of eyes with subretinal fluid decreased significantly at 52 W (p < 0.01). Complete fluid resolution was achieved in 20 eyes (60%). The total number of injections was significantly negatively correlated with the presence of hyperreflective dots at baseline (HRDs, p < 0.01) and SFCT at baseline (p < 0.01). Conclusions: IVF led to a significant reduction in CMT with stabilization of BCVA. The total number of injections was lower in eyes with HRDs and increased SFCT at baseline. This might provide clues regarding response to IVF for future studies.
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Affiliation(s)
- Wissam Aljundi
- Department of Ophthalmology, Saarland University Medical Center UKS, 66421 Homburg/Saar, Germany; (L.D.); (S.S.); (B.S.); (A.D.A.)
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Fouad YA, Hamza MN, Wessam MM. Prevalence and Distribution of Macular Fluid with Central Retinal Artery Occlusion and Anterior Ischemic Optic Neuropathy. Clin Ophthalmol 2024; 18:887-893. [PMID: 38529006 PMCID: PMC10962661 DOI: 10.2147/opth.s457503] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/18/2024] [Indexed: 03/27/2024] Open
Abstract
Purpose To examine the prevalence and distribution of fluid within a cohort of eyes with acute central retinal artery occlusion (CRAO) and non-arteritic anterior ischemic optic neuropathy (AION) using optical coherence tomography (OCT). Methods A retrospective analysis of patient records and OCT imaging. Patients presenting with acute CRAO or AION who had available macular OCT imaging and no co-morbidities known to cause macular fluid were included in the analysis. Baseline characteristics, visual acuity (VA), and fluid presence and distribution among the retinal layers were recorded. Results In the 16 eyes with acute CRAO, fluid was noted in 5 eyes (31%), which was mainly subretinal (3 eyes) or intraretinal located within the outer retinal layers (3 eyes). Only one eye had inner retinal cysts. Of the 11 eyes with acute AION, fluid was present in 8 eyes (73%). Subretinal fluid was noted in 4 eyes and extended to the foveal area in 3 of them, and outer retinal versus inner retinal cysts were noted in 6 versus 3 eyes, respectively. None of the eyes showed hard exudate deposition. In the small subset of eyes with CRAO and macular fluid that were followed-up, VA improved, while in eyes with AION, VA remained stable. Conclusion Macular fluid on OCT is not an uncommon feature of acute CRAO and AION and is mainly distributed within the outer retinal layers or subretinal space. Fluid is an understudied feature of retinal and optic nerve head infarction and may have a role in predicting neuronal damage extent and visual outcome.
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Affiliation(s)
- Yousef A Fouad
- Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt
| | | | - Moataz M Wessam
- Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt
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Lee JH, Kim JH. Impact of Prolonged Persisting Subretinal Fluid on the Outcome of Aflibercept Treatment in Neovascular Age-Related Macular Degeneration. J Ocul Pharmacol Ther 2024; 40:136-143. [PMID: 38489060 DOI: 10.1089/jop.2023.0124] [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] [Indexed: 03/17/2024] Open
Abstract
Purpose: To evaluate the effect of prolonged residual subretinal fluid (SRF) on the outcomes of aflibercept treatment in neovascular age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). Methods: This retrospective study included patients diagnosed with neovascular AMD or PCV who presented with fovea-involving residual SRF that persisted for a minimum of 6 months while undergoing aflibercept treatment. Changes in best-corrected visual acuity (BCVA) during persistent SRF were evaluated. The factors associated with the risk of visual deterioration during this period were also investigated. Results: In total, 135 patients were included in this study. During this period, the duration of the presence of residual SRF was 17.1 ± 10.3 months and mean injection interval was 2.6 ± 0.7 months. The mean BCVA was changed from 0.30 ± 0.23(Snellen equivalents, 20/39) to 0.36 ± 0.28 (20/45). In 18 (13.3%) patients, ≥2 lines of visual deterioration was noted. The duration of persisting SRF (P = 0.008) and mean height of SRF (P = 0.005) were significantly associated with a high risk of visual deterioration. Among the 80 patients with mean SRF height <100 μm, ≥2 lines of visual deterioration were noted in 4 (5.0%) patients. Among 41 patients with the mean SRF height ≥100 μm and <200 μm and 14 patients with the mean SRF height ≥200 μm, the visual deterioration was noted in 8 (19.5%) and 6 (42.9%) patients, respectively. Conclusions: In cases of neovascular AMD or PCV in which SRF persists without complete resolution during treatment, minimizing the duration of persistent SRF and mean height of SRF is recommended to mitigate the risk of visual deterioration. ClinicalTrials.gov Identifiers: NCT05662943 (https://clinicaltrials.gov/study/NCT05662943?cond=type%201%20macular%20neovascularization&rank=2).
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Affiliation(s)
- Ji Hyun Lee
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, South Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, South Korea
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Bica M, David A, Balta F, Iacob A. Continuous Laser Versus Micropulse Laser in the Treatment of Central Serous Chorioretinopathy: A Retrospective Study. Cureus 2024; 16:e53799. [PMID: 38465179 PMCID: PMC10924632 DOI: 10.7759/cureus.53799] [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] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Central serous chorioretinopathy (CSCR) is a retinal disorder characterized by complex mechanisms leading to abnormal fluid accumulation under the retina. While management remains controversial, laser therapy has been successfully used. This study compares the efficacy of continuous laser (CL) and micropulse laser (ML) therapy in treating CSCR, focusing on reduction in macular thickness and improvement in visual acuity. METHODS A retrospective cohort study was conducted, including patients with CSCR treated with either CL or ML. The primary outcome measured was the reduction in average macular thickness (AMT), alongside secondary outcomes like changes in best corrected visual acuity (BCVA), subfoveal choroidal thickness (SFCT), and resolution of subretinal fluid (SRF). RESULTS The study evaluated 121 patients with CSCR, treated either with CL or ML. The primary outcome showed that the mean reduction in AMT was 51.14 µm (±20) in the CL group and 29.88 µm (±22) in the ML group, without a statistically significant difference (p=0.10). For the secondary outcomes, the improvement in BCVA was comparable in both groups, with CL at 0.15 (±0.1) and ML at 0.12 (±0.1) and no significant difference (p=0.41). However, in SFCT reduction, CL showed greater efficacy with a mean reduction of 32.19 µm (±15) compared to ML's 4.85 µm (±18), which was statistically significant (p=0.0004). The degree of SRF resolution showed no significant difference between the treatments (p=0.065). CONCLUSIONS Both CL and ML are effective in the management of CSCR, with CL being more effective in reducing SFCT. These findings suggest the need for personalized treatment strategies based on individual patient characteristics and underline the complexity of CSCR management.
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Affiliation(s)
- Mihai Bica
- Ophthalmology, Spitalul Clinic de Urgente Oftalmologice Bucuresti, Bucharest, ROU
| | - Alexandru David
- Ophthalmology, Spitalul Clinic de Urgente Oftalmologice Bucuresti, Bucharest, ROU
| | - Florian Balta
- Ophthalmology, Spitalul Clinic de Urgente Oftalmologice Bucuresti, Bucharest, ROU
- Ophthalmology, Clinica Retina, Bucharest, ROU
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Dabir S, Mohankumar A, Khatri MG, Rajan M. Brolucizumab in age-related macular neovascularization (BRAIN study): Efficacy, optical coherence tomography biomarkers, and safety profile. Indian J Ophthalmol 2024; 72:S33-S36. [PMID: 38131539 PMCID: PMC10833154 DOI: 10.4103/ijo.ijo_927_23] [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: 04/07/2023] [Revised: 07/22/2023] [Accepted: 08/01/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Brolucizumab is a new anti-vascular endothelial growth factor (anti-VEGF) in the treatment of neovascular age-related macular degeneration (nAMD) and idiopathic polypoidal choroidal vasculopathy (IPCV). MATERIALS AND METHODS A retrospective, consecutive, interventional study was conducted from a tertiary eye hospital, in which treatment-naïve and treatment-switch patients were included. They underwent an intravitreal injection of brolucizumab. The decision to reinject was made based on the presence of fluid on spectral domain optical coherence tomography (SD-OCT) or worsening of vision at follow-up. Outcome measures were changes in best-corrected visual acuity (BCVA), central subfield thickness (CST), fluid (subretinal/intraretinal/sub-retinal pigment epithelium fluid) levels, and OCT biomarkers and safety analysis. RESULTS A total of 59 eyes of 50 patients with a total of 132 intravitreal injections were included. There was a statistically significant improvement (P < 0.05) in BCVA from baseline in logMAR treatment-naïve patients (mean BCVA at baseline 0.6 ± 0.41 and 0.37 ± 0.56). The mean baseline CST of all patients significantly reduced from 582.92 ± 233.11 µm at baseline to 474.06 ± 252.89 µm at the final treatment visit. Thirty-eight percent of patients showed complete resolution of SHRM after a single injection. The interval between each subsequent injection increased from a mean of 67 to 96 days in treatment-switch patients and from 47 to 151 days in treatment-naïve patients. CONCLUSION Brolucizumab promises reduced number of injections with longer treatment intervals.
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Affiliation(s)
- Supriya Dabir
- Rajan Retina Foundation, Rajan Eye Care Hospital, Chennai, Tamil Nadu, India
| | - Arthi Mohankumar
- Rajan Retina Foundation, Rajan Eye Care Hospital, Chennai, Tamil Nadu, India
| | - Manoj G Khatri
- Rajan Retina Foundation, Rajan Eye Care Hospital, Chennai, Tamil Nadu, India
| | - Mohan Rajan
- Rajan Retina Foundation, Rajan Eye Care Hospital, Chennai, Tamil Nadu, India
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Tibaldi T, Roccuzzo G, Fazio A, Cattani I, Nuzzi R, Quaglino P, Reibaldi M. Visual symptoms in a patient treated with MEK inhibitors. Eur J Ophthalmol 2024; 34:NP144-NP147. [PMID: 36517976 DOI: 10.1177/11206721221145739] [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] [Indexed: 12/31/2023]
Abstract
PURPOSE to report an uncommon presentation of Encorafenib-Binimetinib retinal side effects. CASE REPORT A 56-year-old Caucasian woman, naïve to previous chemotherapies, was started on Encorafenib/Binimetinib for metastatic melanoma. After seven hours from the first 45 mg Binimetinib dose, the patient developed blurry vision with coloured halos. The symptoms were transient and the following day a complete ophthalmological examination revealed the presence of subretinal fluid (SRF) at Optical coherence tomography (OCT). After one week, the patient remained asymptomatic, with no signs of SRF at the follow up reevaluation. However, six weeks later, the symptoms originally experienced with the first drug intake appeared again. This time fundus examination revealed an irregular macular region. At infrared OCT an almond shaped hyporeflective lesion, surrounded by hyperreflectivity, was demonstrated without signs of SRF. Encorafenib/Binimetinib was continued at the same dose and strict monitoring was scheduled, according to the European Medicine's Agency indication to withhold the drug only in presence of symptomatic retinal pigment epithelial detachment. CONCLUSION Visual symptoms associated with SRF induced by Binimetinib have been described in the literature. In our case, visual symptoms were experienced by the patient at different times, both with and without evidence of SRF. This finding seems to suggest that while Binimetinib-induced SRF is an asymptomatic finding in most cases, with excellent outcome and rapid resolution, visual symptoms could be initially triggered by detectable SRF, yet persist without any further evidence of abnormal fluid accumulation and manifest intermittently.
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Affiliation(s)
- Tommaso Tibaldi
- Ophthalmology Unit, A.O.U. City of Health and Science of Turin, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Gabriele Roccuzzo
- Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
| | - Alessandra Fazio
- Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
| | - Ilaria Cattani
- Ophthalmology Unit, A.O.U. City of Health and Science of Turin, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Raffaele Nuzzi
- Ophthalmology Unit, A.O.U. City of Health and Science of Turin, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
| | - Michele Reibaldi
- Ophthalmology Unit, A.O.U. City of Health and Science of Turin, Department of Surgical Sciences, University of Turin, Turin, Italy
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Annam R, Padyala P, Annam P, Nandennagari S, Bethala K. Risks and Management of Central Serous Chorioretinopathy in a Middle-Aged Female. Cureus 2023; 15:e51325. [PMID: 38288177 PMCID: PMC10824147 DOI: 10.7759/cureus.51325] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 01/31/2024] Open
Abstract
Central serous chorioretinopathy (CSC) is the buildup of fluid in the posterior pole distorting the vision resulting from either neurosensory or retinal pigment epithelial detachment. This is a case report of a 33-year-old female complaining of cloudiness in the left eye who was subsequently diagnosed with CSC using optical coherence tomography (OCT). Remission was observed in four months, possibly from ocular drop treatment or spontaneous. Our case report is unique as the incidence of CSC is more common in males, almost six times higher than in females. Also, the etiology of CSC in this case report is questionable because all the risks are excluded from our patient history.
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Affiliation(s)
- Reshma Annam
- Medicine, Windsor University School of Medicine, Saint Kitts, KNA
| | | | - Preethi Annam
- Surgery, Avalon University School of Medicine, Curacao, CUW
| | | | - Krupavaram Bethala
- Pharmacology and Therapeutics, Centre of Excellence in Pharmaceutical Sciences, School of Pharmacy, KPJ Healthcare University College, Kuala Lumpur, MYS
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Wilson DS, Pinto AM, Gupta RR. Pars Plana Vitrectomy for Vitreomacular Traction Resulting in Persistent Postoperative Loculated Foveal Subretinal Fluid. J Vitreoretin Dis 2023; 7:552-556. [PMID: 38022795 PMCID: PMC10649448 DOI: 10.1177/24741264231176137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Purpose: To describe a case of postoperative persistent loculated subretinal fluid (SRF) that developed after pars plana vitrectomy (PPV) for vitreomacular traction (VMT) syndrome. Methods: A case was analyzed and a literature review performed. Results: A healthy 64-year-old man with no significant ocular history presented with persistent, symptomatic VMT. Combined phacoemulsification and PPV, epiretinal membrane and internal limiting membrane peeling, and gas-fluid exchange were performed. Postoperative spectral-domain optical coherence tomography imaging showed loculated foveal SRF. The SRF persisted for 8 months, with minimal change in size and little best-corrected visual acuity improvement. Conclusions: Although persistent loculated SRF has been reported after vitrectomy for rhegmatogenous retinal detachment (RD) in high myopia and tractional RD in diabetes, it has not yet been reported postoperatively after PPV for VMT. Studies of the pathophysiology and long-term course of persistent SRF after PPV for VMT are needed to inform management decisions for this rare complication.
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Affiliation(s)
| | - Ashlyn M. Pinto
- Department of Ophthalmology & Visual Sciences, Dalhousie University, Halifax, NS, Canada
| | - R. Rishi Gupta
- Department of Ophthalmology & Visual Sciences, Dalhousie University, Halifax, NS, Canada
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Suzuki T, Sasajima H, Otaki C, Ueta Y, Tate H. Association of Subretinal Fluid Duration and Baseline Chorioretinal Structure With Optical Coherence Tomography in Central Serous Chorioretinopathy. Transl Vis Sci Technol 2023; 12:12. [PMID: 37831445 PMCID: PMC10587855 DOI: 10.1167/tvst.12.10.12] [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: 05/25/2023] [Accepted: 09/14/2023] [Indexed: 10/14/2023] Open
Abstract
Purpose This study investigated the association between subretinal fluid (SRF) duration and baseline chorioretinal structure in patients with naïve (first-episode and untreated) central serous chorioretinopathy (CSC). Methods We divided 59 patients into non-prolonged (<3 months) and prolonged (>3 months) groups based on SRF fluid persistence from the initial visit. The follow-up period varied as the shorter duration was chosen between SRF disappearance time and 3 months from the initial visit. We measured the central retinal thickness (CRT), central choroidal thickness (CCT), SRF height (SRFH), and outer nuclear layer thickness (ONL) using spectral-domain optical coherence tomography (SD-OCT) at the initial visit and recorded SRF duration. We compared these parameters between the groups, conducted multivariate analysis for SRF duration of more than 3 months, and investigated the correlation among CCT and CRT, SRFH, or ONL, and among SRF duration and CRT, CCT, SRFH, or ONL. Results CCT was significantly thicker in the prolonged than in the non-prolonged group at the initial visit (P = 0.044) and significantly correlated with CRT and SRFH (P = 0.007, r = 0.35 and P = 0.002, r = 0.39). SRF duration significantly correlated with CRT and SRFH (P = 0.009, r = 0.40 and P = 0.003, r = 0.41). The optimal model for SRF duration more than 3 months included age (P = 0.054) and CCT (P = 0.008). Conclusions Thicker baseline CCT can lead to a longer SRF duration in naïve CSC. Translational Relevance This association aids in early detection of cases at a higher risk of prolonged SRF.
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Affiliation(s)
- Takafumi Suzuki
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu, Japan
- Department of Ophthalmology, The University of Tokyo Hospital, Tokyo, Japan
| | - Hirofumi Sasajima
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu, Japan
- Yamada Eye Clinic, Nagasaki, Japan
| | - Chisato Otaki
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu, Japan
| | - Yoshiki Ueta
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu, Japan
| | - Hideo Tate
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu, Japan
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Joshi S, Verma L, Ayachit G, Salvi R, Asad Y, Gupta A, Patil A, Ayachit A. Efficacy of a single injection of brolucizumab in neovascular age-related macular degeneration on visual acuity and micromorphometry. Indian J Ophthalmol 2023; 71:3375-3380. [PMID: 37787238 PMCID: PMC10683673 DOI: 10.4103/ijo.ijo_210_23] [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: 01/22/2023] [Revised: 06/18/2023] [Accepted: 07/03/2023] [Indexed: 10/04/2023] Open
Abstract
Purpose To assess short-term efficacy of a single injection of brolucizumab in neovascular AMD. Methods This was a multicenter, retrospective chart review of 25 eyes of 25 patients who received a single injection of brolucizumab. Visual acuity (VA) and optical coherence tomography (OCT) features such as central subfield thickness (CSFT), subretinal fluid (SRF), intraretinal fluid, and pigment epithelial detachment (PED) were recorded at baseline, first month, and third month. Results Of the 25 eyes, 14 eyes were treatment-naïve and 11 eyes had received previous injections. VA improved from 0.68 ± 0.59 log MAR at baseline to 0.31 ± 0.43 log MAR at the end of 3 months. SRF height in first and third month was significantly reduced from baseline (P < 0.001). Subretinal hyperreflective material height significantly reduced from baseline (P value 0.008 at first month and 0.01 at third month, respectively). CSFT was 464.16 ± 247.97 microns at baseline and showed a significant reduction in first month (P < 0.001) and third month (P < 0.001). There was a significant reduction of PED height from baseline at both follow-ups. None of the eyes showed a recurrence of fluid at the end of 3 months. Conclusion Our study demonstrated sustained improvement in VA and OCT parameters after a single injection of brolucizumab at 3 months. A longer follow-up may demonstrate even farther effects of a single injection.
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Affiliation(s)
- Shrinivas Joshi
- Department of Vitreoretina, M Joshi Eye Institute, Hubli, Karnataka, India
| | - Lalit Verma
- Department of Retina, Centre for Sight, Safdarjung Enclave, Delhi, India
| | - Guruprasad Ayachit
- Department of Vitreoretina, M Joshi Eye Institute, Hubli, Karnataka, India
| | - Rajashree Salvi
- Department of Vitreoretina, M Joshi Eye Institute, Hubli, Karnataka, India
| | - Yusra Asad
- Department of Retina, Centre for Sight, Safdarjung Enclave, Delhi, India
| | - Avnindra Gupta
- Department of Retina, Centre for Sight, Safdarjung Enclave, Delhi, India
| | - Anuja Patil
- Department of Retina, Centre for Sight, Safdarjung Enclave, Delhi, India
| | - Apoorva Ayachit
- Department of Vitreoretina, M Joshi Eye Institute, Hubli, Karnataka, India
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Huang X, Shao Y, Li X. Persistent subretinal fluid following tractional retinal detachment repair: An exploring use of dexamethasone implant. Eur J Ophthalmol 2023; 33:NP115-NP120. [PMID: 36120856 DOI: 10.1177/11206721221127159] [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] [Indexed: 11/16/2022]
Abstract
INTRODUCTION To report a successful application of dexamethasone implants in the treatment of a massive amount of persistent subretinal fluid (SRF) following a tractional retinal detachment (TRD) surgery. CASE REPORT A 44-year-old woman was found to have SRF 1 week after a diabetic TRD surgery. The central macular thickness (CMT) reached up to 1.47 mm and remained high after a month's observation. For better restoration, 2 dexamethasone implants (Ozurdex) were applied at postoperative week 5 and 32 respectively and got good outcomes. The SRF decrease showed a close correlation with Ozurdex treatments: The CMT declined quickly in the next 16 weeks both after 2 times of Ozurdex applications (the linear regression slopes of CMT changes: -12.54 and -22.94, respectively). In contrast, in the interval of 2 injections, the CMT had few changes (the slope: -4.667) even if applying an anti-VEGF agent. Eventually, SRF was completely resolved 48 weeks after the surgery. DISCUSSION Dexamethasone implant can be an option for effective treatment of persistent SRF after TRD repair, especially in some refractory cases. However, the mechanism remains unclear, and the treatment regimen needs to be explored based on more clinical trials.
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Affiliation(s)
- Xinyuan Huang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, P. R. China
| | - Yan Shao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, P. R. China
| | - Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, P. R. China
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Carpineto P, Licata AM, Ciancaglini M. Proliferative Vitreoretinopathy: A Reappraisal. J Clin Med 2023; 12:5287. [PMID: 37629329 PMCID: PMC10455099 DOI: 10.3390/jcm12165287] [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: 06/15/2023] [Revised: 07/31/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Proliferative vitreoretinopathy (PVR) remains the main cause of failure after retinal detachment (RD) surgery. Despite the development of modern technologies and sophisticated techniques for the management of RD, the growth of fibrocellular membranes within the vitreous cavity and on both sides of the retinal surface, as well as intraretinal fibrosis, can compromise surgical outcomes. Since 1983, when the term PVR was coined by the Retina Society, a lot of knowledge has been obtained about the physiopathology and risk factors of PVR, but, despite the proposal of a lot of therapeutic challenges, surgical skills seem to be the only effective way to manage PVR complications.
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Affiliation(s)
- Paolo Carpineto
- Department of Medical, Oral and Biotechnological Sciences, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy;
| | - Arturo Maria Licata
- Department of Medical, Oral and Biotechnological Sciences, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy;
| | - Marco Ciancaglini
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
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Contieri F, Barreiro Lucas JC, Casalino G, Sánchez Vicente JL, Gómez Torres MÁ, Pugliese Rojas FA, Ibarra de La Rosa E. Peripapillary pachychoroid syndrome coincident to a presumed pulsating extramacular choroidal macrovessel. Clin Exp Optom 2023; 106:683-685. [PMID: 35605624 DOI: 10.1080/08164622.2022.2071603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/12/2022] [Accepted: 04/24/2022] [Indexed: 10/18/2022] Open
Affiliation(s)
- Fabio Contieri
- Department of Ophthalmology, Reina Sofía University Hospital, Cordoba, Spain
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Cheng AM, Joshi S, Banoub RG, Saddemi J, Chalam KV. Faricimab Effectively Resolves Intraretinal Fluid and Preserves Vision in Refractory, Recalcitrant, and Nonresponsive Neovascular Age-Related Macular Degeneration. Cureus 2023; 15:e40100. [PMID: 37425528 PMCID: PMC10328548 DOI: 10.7759/cureus.40100] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
PURPOSE To evaluate the functional and anatomic outcomes of faricimab treatment in patients with neovascular age-related macular degeneration (nAMD) who are unresponsive to other anti-vascular endothelial growth factor (VEGF) therapies. METHODS A retrospective interventional study was conducted on patients with refractory nAMD who were initially treated with intravitreal bevacizumab, ranibizumab, or aflibercept. These patients were switched to monthly faricimab injections. The central subfield thickness (CST), intraretinal fluid (IRF) or subretinal fluid (SRF) height, and visual acuities were compared before and after faricimab treatment. RESULTS A total of 13 eyes (eight right eyes and five left eyes) from 11 patients were followed for 10.4 ± 6.9 months after bevacizumab treatment and 40.3 ± 28.7 months after aflibercept treatment before switching to faricimab. The follow-up time for patients receiving a mean number of 3.7 ± 1.3 faricimab injections was 3.4 ± 1.2 months. The overall median CST was reduced by 18µm (p=0.001) from 342µm to 318µm, along with a reduction of 89µm (p=0.03) in IRF/SRF height from 97µm to 40µm. Following three consecutive injections, the CST showed a significant reduction of 21.5µm (p=0.004) from 344µm to 322.5µm, and IRF/SRF height was reduced by 89µm (p=0.03) from 104µm to 18.5µm. The intraretinal fluid size decreased and leakage stopped, as seen on fluorescein angiography. Visual acuity remained stable after switching to faricimab treatment (0.59 ± 0.45 logMAR vs 0.58 ± 0.45 logMAR, p=1). CONCLUSIONS Faricimab has proven to be an effective treatment for nAMD patients resistant to other anti-VEGF agents. It demonstrates significant anatomical improvement and vision preservation in this challenging patient population.
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Affiliation(s)
- Anny M Cheng
- Ophthalmology, Broward Health, Fort Lauerdale, USA
- Ophthalmology, Specialty Retina Center, Coral Springs, USA
- Ophthalmology, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Sunir Joshi
- Ophthalmology, South Florida Vision, Fort Lauerdale, USA
| | - Raphael G Banoub
- Ophthalmology, Broward Health, Fort Lauerdale, USA
- Ophthalmology, Specialty Retina Center, Coral Springs, USA
| | - Jackson Saddemi
- Ophthalmology, Broward Health, Fort Lauerdale, USA
- Ophthalmology, Specialty Retina Center, Coral Springs, USA
| | - Kakarla V Chalam
- Ophthalmology, Loma Linda University School of Medicine, Loma Linda, USA
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Munsell MK, Carducci NM, Eton EA. Exudative Retinal Detachment and Ciliochoroidal Effusion in Preeclampsia. J Vitreoretin Dis 2023; 7:254-258. [PMID: 37188210 PMCID: PMC10170621 DOI: 10.1177/24741264221147986] [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] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Purpose: To describe a novel case of focal exudative retinal detachment, choroidal effusion, and acute angle closure in preeclampsia. Methods: A case report is presented. Results: A 37-year-old woman at 38 weeks gestation presented with 2 weeks of progressive blurred vision in the left eye. She had a visual acuity (VA) of 20/800 and an intraocular pressure (IOP) of 26 mm Hg in the left eye (compared with 17 mm Hg in the right eye). Examination showed subretinal fluid in the posterior pole, ciliochoroidal effusion, and angle closure in the left eye without pathology in the right eye. She was found to have hypertension and proteinuria consistent with preeclampsia. The visual symptoms resolved after delivery. At the 1-month follow-up, she had a VA of 20/60 OS, symmetric IOPs, and resolved subretinal and choroidal effusions. Conclusions: To our knowledge, this is the first reported case of ciliochoroidal effusion in the setting of preeclampsia. It may aid in the diagnosis of preeclampsia's ocular manifestations and broaden pathophysiological understanding.
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Affiliation(s)
- Mary K. Munsell
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, MI, USA
- Harvard Medical School, Boston, MA, USA
| | - Nicholas M. Carducci
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, MI, USA
| | - Emily A. Eton
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, MI, USA
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18
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Sasajima H, Zako M, Murotani K, Ishida H, Ueta Y, Tachi N, Suzuki T, Watanabe Y, Hashimoto Y. Visual Prognostic Factors in Eyes with Subretinal Fluid Associated with Branch Retinal Vein Occlusion. J Clin Med 2023; 12:jcm12082909. [PMID: 37109246 PMCID: PMC10146202 DOI: 10.3390/jcm12082909] [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: 02/09/2023] [Revised: 03/29/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
We investigated whether foveal ellipsoid zone (EZ) status affects visual prognosis in eyes with subretinal fluid (SRF) associated with branch retinal vein occlusion (BRVO). We included 38 eyes retrospectively and classified those with or without a continuous EZ on the SRF of the central foveola on the vertical optical coherence tomography (OCT) image at the initial visit as intact (n = 26) and disruptive EZ (n = 12) groups, respectively. In addition, we classified the intact EZ eyes into clear (n = 15) and blurred (n = 11) EZ groups according to whether EZ on the SRF was observed distinctly or not. Multiple regression analyses showed that baseline EZ status significantly correlated (p = 0.0028) with the 12-months logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), indicating that baseline intact EZ significantly improves visual prognosis. The 12-months logMAR BCVA of the intact EZ group was significantly better (p < 0.001) than that of the disruptive EZ group, and did not differ significantly between the clear and blurred EZ groups. Thus, baseline foveal EZ status on vertical OCT images can be a novel biomarker for visual prognosis in eyes with SRF associated with BRVO.
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Affiliation(s)
- Hirofumi Sasajima
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu 939-0243, Japan
- Yamada Eye Clinic, Nagano 380-0813, Japan
| | - Masahiro Zako
- Department of Ophthalmology, Asai Hospital, Seto 489-0866, Japan
| | - Kenta Murotani
- Biostatistics Center, Kurume University, Kurume 830-0011, Japan
| | - Hidetoshi Ishida
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu 939-0243, Japan
- Department of Ophthalmology, Kanazawa Medical University, Kahoku 920-0293, Japan
| | - Yoshiki Ueta
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu 939-0243, Japan
| | - Naoko Tachi
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu 939-0243, Japan
- Tachi Eye Clinic, Toyama 930-0002, Japan
| | - Takafumi Suzuki
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu 939-0243, Japan
- Department of Ophthalmology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Yuji Watanabe
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu 939-0243, Japan
| | - Yoshihiro Hashimoto
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu 939-0243, Japan
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Chang YC, Huang YT, Hsu AY, Meng PP, Lin CJ, Lai CT, Hsia NY, Chen HS, Tien PT, Lin JM, Chen WL, Tsai YY. Optical Coherence Tomography Biomarkers in Predicting Treatment Outcomes of Diabetic Macular Edema after Ranibizumab Injections. Medicina (Kaunas) 2023; 59:medicina59030629. [PMID: 36984630 PMCID: PMC10053215 DOI: 10.3390/medicina59030629] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/13/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023]
Abstract
Background and Objectives: The identification of possible biomarkers that can predict treatment response among DME eyes is important for the individualization of treatment plans. We investigated optical coherence tomography (OCT)-based biomarkers that may predict the one-year real-life outcomes among diabetic macular edema (DME) eyes following treatment by intravitreal ranibizumab (IVR) injections. Materials and Methods: A total of 65 eyes from 35 treatment-naïve patients with DME treated with ranibizumab injection were recruited. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), intraocular pressure (IOP), and OCT scans were retrospectively recorded at baseline before treatment and at 3 months, 6 months, and 12 months after treatment. The OCT scans were evaluated for biomarkers of interest, which included central retinal thickness (CRT), amount and locations of hyperreflective foci (HRF), subretinal fluid (SRF), intraretinal cysts (IRC), large outer nuclear layer cyst (LONLC), ellipsoid zone disruption (EZD), disorganization of retinal inner layers (DRIL), hard exudates (HE), epiretinal membrane (ERM), and vitreomacular interface (VMI). Correlations between these OCT biomarkers and outcome measures (visual and structural) were statistically analyzed. Results: A total of 65 eyes from 35 patients with DME were enrolled. The mean age was 64.2 ± 10.9 years old. Significant improvement in terms of mean BCVA (p < 0.005) and mean CRT was seen at final follow-up compared to baseline. The biomarkers of DRIL, LONLC, and SRF were found to be predictive for at least 50 μm CRT reduction after treatment (with odds ratio of 8.69, 8.5, and 17.58, respectively). The biomarkers of IRC, LONLC, and SRF were predictive for significant improvement in terms of BCVA and CRT after treatment. Finally, the number of HRF was predictive for both BCVA improvement and a CRT reduction of less than 100 μm after treatment. No serious complications were reported during the study. Conclusion: Our study demonstrated the utility of OCT biomarkers as therapeutic predictors of ranibizumab treatment among DME eyes.
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Affiliation(s)
- Yen-Chieh Chang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404333, Taiwan
| | - Yu-Te Huang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404333, Taiwan
| | - Alan Y Hsu
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404333, Taiwan
- Department of General Medicine, College of Medicine, China Medical University Hospital, Taichung 404332, Taiwan
| | - Ping-Ping Meng
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404333, Taiwan
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404333, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 404333, Taiwan
- Department of Optometry, Asia University, Taichung 40447, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404333, Taiwan
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404333, Taiwan
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung 43655, Taiwan
| | - Peng-Tai Tien
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404333, Taiwan
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung 404333, Taiwan
| | - Jane-Ming Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404333, Taiwan
| | - Wen-Lu Chen
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404333, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404333, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 404333, Taiwan
- Department of Optometry, Asia University, Taichung 40447, Taiwan
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Oribio-Quinto C, Fernández-Vigo JI, Bilbao-Malavé V, Pérez-García P, Burgos-Blasco B, Arias-Barquet L, Donate-López J. Anatomical and functional impact of verteporfin shortage in patients with chronic central serous chorioretinopathy. Photodiagnosis Photodyn Ther 2023; 42:103501. [PMID: 36893954 DOI: 10.1016/j.pdpdt.2023.103501] [Citation(s) in RCA: 2] [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: 01/19/2023] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND To describe the functional and anatomical impact that the worldwide shortage of verteporfin has had on patients diagnosed with chronic central serous chorioretinopathy (cCSCR) whose treatment with photodynamic therapy (PDT) had to be delayed. METHODS Prospective observational study. Patients were divided into two groups based on the time interval since PDT had been indicated: groups 1 and 2, with waiting times of less and more than 9 months respectively. Best corrected visual acuity (BCVA), the maximum height of the subretinal fluid (MSRF) and subfoveal choroidal thickness (SFCT) at the baseline visit and the last visit were compared. RESULTS 49 eyes of 48 patients with cCSCR were included. The mean waiting time for PDT was 9.0 ±3.8 months. The mean BCVA was 69.0 ±17.1 letters and 68.9 ±16.4 letters for the baseline and last visit respectively, showing no difference (p= 0.958). Although there was no difference in the mean global BCVA, 15 eyes (30.5%) showed a deterioration of ≥5 letters, including 7 eyes (14%) with a decrease of ≥10 letters. Mean MSRF height was 151.4 ±97.2 μm and 98.2 ±83.1 μm for the baseline and last visit respectively (p= 0.005), persisting in 74.5% of the eyes. CONCLUSION No significant impact was observed in the BCVA in cCSCR due to the shortage of verteporfin. However, one-third of patients had BCVA loss. There was a significant spontaneous decrease in MSRF, but it persisted in the majority of the patients, still susceptible to PDT.
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Affiliation(s)
- Carlos Oribio-Quinto
- Department of Ophthalmology, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria (IdISSC). Madrid, Spain.
| | - José Ignacio Fernández-Vigo
- Department of Ophthalmology, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria (IdISSC). Madrid, Spain; Centro Internacional de Oftalmología Avanzada, Madrid, Spain
| | - Valentina Bilbao-Malavé
- Department of Ophthalmology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pilar Pérez-García
- Department of Ophthalmology, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria (IdISSC). Madrid, Spain
| | - Barbara Burgos-Blasco
- Department of Ophthalmology, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria (IdISSC). Madrid, Spain
| | - Luis Arias-Barquet
- Department of Ophthalmology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan Donate-López
- Department of Ophthalmology, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria (IdISSC). Madrid, Spain
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Haji H, Gianniou C, Brynskov T, Sørensen TL, Olsen R, Krogh Nielsen M. Association between structural and functional treatment outcomes in neovascular age-related macular degeneration. Acta Ophthalmol 2023; 101:177-184. [PMID: 36036674 DOI: 10.1111/aos.15233] [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: 11/22/2021] [Revised: 05/24/2022] [Accepted: 08/14/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The administration frequency of intravitreal anti-vascular endothelial growth factor (anti-VEGF) in neovascular age-related macular degeneration (AMD) have been widely discussed. The primary objective of the study was to explore the association between anatomical outcomes and changes in functional outcome. METHODS This was a retrospective cohort study of patients with newly diagnosed neovascular AMD with a minimum of 12 months of follow-up. Only one eye per patient was included. Patients were treated according to the observe-and-plan or the pro-re-nata regimen. All patients were regularly examined from the time of diagnosis up to 24 months. The effect of intraretinal fluid (IRF), subretinal fluid (SRF) and pigment epithelium detachment (PED) at any time point on visual acuity (VA) was tested, as well as the long-term effect and the risk of losing VA. Further, the variability of central retinal thickness (CRT) was calculated for each eyes' individual measures during the observation period, excluding the monthly loading phase. The prognostic effect of each factor on VA was estimated by regression analysis. The primary outcome measure was VA, which was correlated with the presence or absence of fluid, seen as IRF, SRF or PED. RESULTS A total of 504 treatment naïve eyes from 504 patients was included. The presence of IRF was associated with lower VA at all visits (p < 0.001). However, the presence of SRF or PED was not significantly associated with worse VA at any time point during the observation period. Patients in the upper quartile of CRT variance had a greater loss in VA after 12 and 24 months (p < 0.001). CONCLUSIONS In this retrospective cohort study, the presence of intraretinal fluid was associated with poorer visual outcome in neovascular AMD patients treated with anti-VEGF, but the presence of subretinal fluid and PEDs was not. This suggests that IRF is worse than subretinal fluid and PEDs for AMD outcomes and therefore requires the most intensive treatment. Further, we found that patients with the highest CRT variability during the study period had poorer visual outcomes after 12 and 24 months, indicating that stringent control of retinal fluid volume fluctuations is important to prevent visual acuity decline over time.
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Affiliation(s)
- Hauraz Haji
- Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
| | - Christina Gianniou
- Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Troels Brynskov
- Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
| | - Torben L Sørensen
- Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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22
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van Dijk EHC, Feenstra HMA, Bjerager J, Grauslund J, Boon CJF, Subhi Y. Comparative efficacy of treatments for chronic central serous chorioretinopathy: A systematic review with network meta-analyses. Acta Ophthalmol 2023; 101:140-159. [PMID: 36178171 DOI: 10.1111/aos.15263] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 08/06/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/27/2022]
Abstract
Treatment of chronic central serous chorioretinopathy (cCSC) remains a topic of controversy. As cCSC is a disease that can wax and wane, treatment efficacy is difficult to assess especially when trials compare active treatments without any placebo/control group. In this study, we systematically reviewed short-term efficacies of any cCSC treatment tested in randomized controlled trials (RCT) and employed network meta-analyses to compare to non-treatment controls. We searched 11 literature databases on 20 March 2022 for RCTs of treatment of cCSC. We identified 17 RCTs including a total of 1172 eyes. Treatments included conventional laser (44 eyes), half-dose or half-fluence photodynamic therapy (PDT) (298 eyes), ranibizumab (16 eyes), antioxidants (50 eyes), mineralocorticoid receptor antagonists (187 eyes), rifampicin (91 eyes), selective retina therapy (SRT) (67 eyes) and subthreshold micropulse laser (192 eyes). Compared with controls, significant benefit on complete subretinal fluid resolution was only obtained from half-dose or half-fluence PDT (OR: 20.6; 95% CI: 6.3-66.7; p < 0.0001) and conventional laser (OR: 36.4; 95% CI: 2.0-655.7; p = 0.015), and at an order of magnitude lower degree from SRT (OR: 3.4; 95% CI: 1.7-6.8; p = 0.00075). Compared with controls and after sensitivity analyses, significant benefit in the change in best-corrected visual acuity was only obtained by half-dose/-fluence PDT (-0.13 logMAR; 95% CI: -0.20 to -0.06 logMAR; p = 0.00021). In conclusion, three treatment options provide significant improvement over no treatment: half-dose/-fluence PDT, conventional laser and to a much lesser degree SRT. Considering that conventional laser can only be applied for extrafoveal leaks, and the long-term data available for PDT-based treatments finding persisting treatment results, half-dose or half-fluence PDT is the only viable treatment option for patients with cCSC. Shortage issues with verteporfin should not lead to employment of ineffective treatment modalities, as they put patients at unnecessary risk of adverse events.
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Affiliation(s)
- Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Ophthalmology, Haga Hospital, The Hague, The Netherlands
| | - Helena M A Feenstra
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jakob Bjerager
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Jakob Grauslund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Ophthalmology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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23
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Ersöz MG, Hocaoğlu M, Sayman Muslubaş I, Arf S, Yıldız E, Karaçorlu M. Artifact-Removed Quantitative Analysis of Choriocapillaris Flow Voids. Turk J Ophthalmol 2023; 53:37-43. [PMID: 36847632 PMCID: PMC9973212 DOI: 10.4274/tjo.galenos.2022.23855] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Objectives To investigate choriocapillaris flow voids (FV) with a new optical coherence tomography angiography (OCTA) image processing strategy that can eliminate artifacts caused by vitreous opacities, sub-retinal pigment epithelium fluid and deposits, and subretinal fluid (SRF) by thresholding the en-face OCT image of the outer retina. Materials and Methods We retrospectively reviewed medical records of patients with drusen and patients with active central serous chorioretinopathy (CSC). FV number (FVn), average area (FVav), and maximum area (FVmax) and the percentage of nonperfused choriocapillaris area (PNPCA) obtained using the proposed strategy were compared with those obtained by removing only artifacts caused by the superficial capillary plexus (SCP). Results The SRF group included 21 eyes with active CSC and the drusen group included 29 eyes with nonexudative age-related macular degeneration. FVav, FVmax, FVn, and PNPCA obtained using the algorithm were significantly lower than those obtained by removing only SCP-related artefacts in both groups (all p<0.05). The algorithm was also able to remove 96.9% of artifacts secondary to vitreous opacities and all artifacts secondary to serous pigment epithelial detachments. Conclusion Choriocapillaris nonperfusion areas on OCTA images may be overestimated in eyes with RPE abnormalities and SRF due to artifacts. These artifact areas on choriocapillaris OCTA images can be removed using thresholded images of the outer retina en-face OCT scans. Our new artifact-removal strategy is useful in the assessment of choriocapillaris FV in eyes with SRF, drusen, drusen-like deposits, and pigment epithelial detachment.
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Affiliation(s)
- M Giray Ersöz
- Biruni University Faculty of Medicine, Department of Ophthalmology, İstanbul, Türkiye
| | | | | | - Serra Arf
- İstanbul Retina Institute, İstanbul, Türkiye
| | - Erdost Yıldız
- Koç University Faculty of Medicine, Translational Medicine Application and Research Center, İstanbul, Türkiye
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24
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Ahmad TR, Bever GJ, Stewart JM. External Subretinal Fluid Drainage in Scleral Buckling: Before Versus after Cryotherapy and Buckle Placement, A Pilot Study. Life (Basel) 2023; 13. [PMID: 36836642 DOI: 10.3390/life13020284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/20/2023] Open
Abstract
In this retrospective comparative case series at a teaching hospital, we reviewed adult patients with rhegmatogenous retinal detachment who underwent scleral buckling surgery with external drainage of subretinal fluid performed before versus after placement of the scleral buckle. Eight eyes in each group were roughly matched for age, sex, baseline visual acuity (VA), and detachment characteristics. The complication rate was 0% for the "before" group and 37% for the "after" group (p = 0.100). In the "after" group, two eyes (25%) developed iatrogenic retinal holes and one eye (12%) developed self-limited subretinal hemorrhage during external needle drainage. The duration of surgery was significantly shorter for the "before" group (mean 89 ± 16 min) compared to the "after" group (118 ± 20 min) (p = 0.008). The primary anatomic success rate was 100% for the "before" group and 75% for the "after" group (p = 0.233). Final VA was not significantly different between the groups or from baseline. In conclusion, while limited by our small sample size, this pilot study suggests that drainage of subretinal fluid before scleral buckle placement may be safer and more efficient compared to draining after buckle placement. Initial drainage may facilitate retinochoroid apposition to allow targeted cryopexy and precise buckle placement.
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25
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Warren A, Wang DW, Lim JI. Rhegmatogenous retinal detachment surgery: A review. Clin Exp Ophthalmol 2023; 51:271-279. [PMID: 36640144 DOI: 10.1111/ceo.14205] [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: 11/13/2022] [Revised: 01/02/2023] [Accepted: 01/07/2023] [Indexed: 01/15/2023]
Abstract
Rhegmatogenous retinal detachment (RRD) is a serious surgical condition with significant ocular morbidity if not managed properly. Once untreatable, approaches to the repair of RRD have greatly evolved over the years, leading to outstanding primary surgical success rates. The management of RRD is often a topic of great debate. Scleral buckling, vitrectomy and pneumatic retinopexy have been used successfully for the treatment of RRD. Several factors may affect surgical success and dictate a surgeon's preference for the technique employed. In this review, we provide an overview and supporting literature on the options for RRD repair and their respective preoperative and postoperative considerations in order to guide surgical management.
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Affiliation(s)
- Alexis Warren
- The University of Illinois at Chicago, Department of Ophthalmology, Chicago, Illinois, USA
| | - Daniel W Wang
- The University of Illinois at Chicago, Department of Ophthalmology, Chicago, Illinois, USA
| | - Jennifer I Lim
- The University of Illinois at Chicago, Department of Ophthalmology, Chicago, Illinois, USA
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26
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Lai L, Javier T, Lee S, Gallemore RP. A Masquerade Case: Choroidal Hemangioma Misdiagnosed As Central Serous Retinopathy. Int Med Case Rep J 2023; 16:239-244. [PMID: 37038550 PMCID: PMC10082599 DOI: 10.2147/imcrj.s398844] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/28/2023] [Indexed: 04/12/2023] Open
Abstract
Purpose To report a case of misdiagnosed choroidal hemangioma, initially treated as central serous retinopathy (CSR) complicated by choroidal neovascularization (CNV), and to improve the proper identification of this disorder. Observations Fundus images revealed a subtle, elevated choroidal lesion with an associated exudative detachment and choroidal vascular lesion on indocyanine green (ICG) angiography. Combined treatment with photodynamic therapy (PDT) and anti-VEGF therapy led to resolution of fluid and improvement in VA from 20/50 to 20/25. Conclusion It is critical to understand the clinical features of choroidal hemangiomas and their physical presentation on retinal testing to diagnose and treat them in a timely and appropriate manner.
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Affiliation(s)
- Leo Lai
- Department of Clinical Research, Retina Macula Institute, Torrance, CA, USA
| | - Therese Javier
- Department of Clinical Research, Retina Macula Institute, Torrance, CA, USA
| | - Sol Lee
- Department of Clinical Research, Retina Macula Institute, Torrance, CA, USA
| | - Ron P Gallemore
- Department of Clinical Research, Retina Macula Institute, Torrance, CA, USA
- Correspondence: Ron P Gallemore, Department of Clinical Research, Retina Macula Institute, 4201 Torrance Blvd, Torrance, CA, 90503, USA, Tel +1 310 - 944 – 9393, Fax +1 310 - 944 – 3393, Email
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27
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Karaca I, Korot E, Ghoraba H, Regenold J, Mobasserian A, Khan Y, Zaidi MH, Or C, Nguyen QD. Acute iridocyclitis and cystoid macular edema related to kinked Hydrus ® Microstent in advanced glaucoma. Saudi J Ophthalmol 2022; 36:390-393. [PMID: 36618568 PMCID: PMC9811929 DOI: 10.4103/sjopt.sjopt_215_21] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/30/2021] [Indexed: 01/10/2023] Open
Abstract
A 58-year-old male who underwent cataract extraction with combined intraocular lens and Hydrus® Microstent (Ivantis Inc, Irvine, CA, US) implantation 2 years ago in the right eye (OD) due to advanced glaucoma presented with blurry vision in right eye (OD) for 3 months. The visual acuity was 20/60 and slit-lamp examination indicated mild anterior chamber inflammation with unexposed, functioning tube shunt superotemporally in OD. Optical coherence tomography demonstrated cystoid macular edema (CME) with subretinal fluid. Fluorescein angiography demonstrated petaloid pattern leakage of CME. Gonioscopy revealed a kinked appearance of a Hydrus® Microstent protruding into the anterior chamber and causing iris chafing. Topical ketorolac tromethamine and prednisolone acetate were started. At the 2nd month of follow-up, the anterior chamber was quiet, and the CME resolved completely. Protruded kinked Hydrus® Microstent may lead to acute iridocyclitis and CME through iris chafing, which may be responsive to topical anti-inflammatory drops.
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Affiliation(s)
- Irmak Karaca
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Edward Korot
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Hashem Ghoraba
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Jonathan Regenold
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Azadeh Mobasserian
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Youan Khan
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Moosa H. Zaidi
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Christopher Or
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Quan D. Nguyen
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA,Address for correspondence: Prof. Quan D. Nguyen, Spencer Center for Vision Research, Byers Eye Institute, Stanford University, 2370 Watson Court, Palo Alto, California, USA. E-mail:
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28
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Hsu AY, Lin CY, Lin CJ, Lai CT, Hsia NY, Lin JM, Tien PT, Meng PP, Ku WN, Chen WL, Tsai YY. Short-Term Effects of Brolucizumab in the Treatment of Wet Age-Related Macular Degeneration or Polypoidal Choroidopathy Refractory to Previous Anti-Vascular Endothelial Growth Factor Therapy. Medicina (B Aires) 2022; 58:medicina58121703. [PMID: 36556905 PMCID: PMC9784980 DOI: 10.3390/medicina58121703] [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: 09/18/2022] [Revised: 10/21/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022] Open
Abstract
Background and objectives: To report the initial response to a single intravitreal brolucizumab (IVI-B) injection in wet age-related macular degeneration (wAMD) or polypoidal choroidopathy (PCV) complicated with either persistent subretinal fluid (SRF) or pigment epithelial detachment refractory to previous anti-vascular endothelial growth factor (anti-VEGF) therapy. Material and methods: In this retrospective study, all eyes received a single IVI-B (6 mg/0.05 mL) for wAMD or PCV with treatment-resistant SRF or PED. Outcome measures included assessment in central retinal thickness (CRT), visual acuity, and evaluation for changes in the SRF or PED on OCT. Follow-up was prior to the first brolucizumab injection, then at 1 week and 5 weeks afterwards. Results: In total, 10 eyes of 10 patients (6 women [60%]) were enrolled. Five patients had wAMD and five patients had PCV. Average age of participants was 67.6 years. All patients received one IVI-B. All patients were not treatment-naïve to anti-VEGF agents. At the first week and fifth week following the first IVI-B, seven out of seven patients (100%) had resolved SRF. However, seven out of nine patients (78%) had no improvement of their PED at 5 weeks follow-up. Mean PED height and width before the first IVI-B was 339.77 µm and 2233.44 µm, respectively. Mean PED height and width at the fifthweek following the first IVI-B was 328.125 µm and 2129.5 µm, respectively. Overall mean visual acuity before the first IVI-B was 0.224; and 5 weeks following the first IVI-B was 0.38. Conclusions: Treatment with brolucizumab resulted in anatomical improvement for all patients with persistent SRF. Limited efficacy was seen for persistent PED. Brolucizumab appears to be a safe and effective option for treatment-resistant SRF. Future multicenter collaborative studies are warranted.
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Affiliation(s)
- Alan Y. Hsu
- Department of Ophthalmology, China Medical University Hospital, China Medical University, 2 Yuh-Der Road, Taichung 40447, Taiwan
- Department of General Medicine, China Medical University Hospital, Taichung 406040, Taiwan
| | - Chih-Ying Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, 2 Yuh-Der Road, Taichung 40447, Taiwan
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, 2 Yuh-Der Road, Taichung 40447, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 406040, Taiwan
- Department of Optometry, Asia University, Taichung 413305, Taiwan
- Correspondence: (C.-J.L.); (C.-T.L.); Tel.: +886-4-22052121 (ext. 1141) (C.-J.L.); Fax: +886-4-22059265 (C.-J.L.)
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, 2 Yuh-Der Road, Taichung 40447, Taiwan
- Correspondence: (C.-J.L.); (C.-T.L.); Tel.: +886-4-22052121 (ext. 1141) (C.-J.L.); Fax: +886-4-22059265 (C.-J.L.)
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, 2 Yuh-Der Road, Taichung 40447, Taiwan
| | - Jane-Ming Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, 2 Yuh-Der Road, Taichung 40447, Taiwan
| | - Peng-Tai Tien
- Department of Ophthalmology, China Medical University Hospital, China Medical University, 2 Yuh-Der Road, Taichung 40447, Taiwan
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung 406040, Taiwan
| | - Ping-Ping Meng
- Department of Ophthalmology, China Medical University Hospital, China Medical University, 2 Yuh-Der Road, Taichung 40447, Taiwan
| | - Wei-Ning Ku
- Department of Ophthalmology, China Medical University Hospital, China Medical University, 2 Yuh-Der Road, Taichung 40447, Taiwan
| | - Wen-Lu Chen
- Department of Ophthalmology, China Medical University Hospital, China Medical University, 2 Yuh-Der Road, Taichung 40447, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, 2 Yuh-Der Road, Taichung 40447, Taiwan
- Department of General Medicine, China Medical University Hospital, Taichung 406040, Taiwan
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29
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Jia YJ, Liu HB, Qin Y, Liu JH, Jia FL, Zhang H, Li JH, Li YJ. Received anti-VEGF therapy in a patient with CRAO sparing the CLRA with subretinal fluid: A case report. Medicine (Baltimore) 2022; 101:e31204. [PMID: 36397396 PMCID: PMC9666146 DOI: 10.1097/md.0000000000031204] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
RATIONALE Central retinal artery occlusion (CRAO) sparing the cilioretinal artery (CLRA) with severe subretinal fluid and non-characteristic cherry-red spot is uncommon. In the present case, the patient received an intravitreal injection of anti- vascular endothelial growth factor, which is very rare. PATIENT CONCERNS A 59-year-old man underwent vitrectomy of the left eye for diabetic retinopathy and vitreous hemorrhage. Six months after the operation, the patient presented with sudden painless visual-acuity decline in his left eye and was diagnosed with CRAO; his best corrected visual acuity was weak light perception. Whole retinal edema was seen on the fundus, and macular gray retinal opacification was present without a characteristic cherry-red spot. Optical coherence tomography revealed subretinal fluid (SRF) in the papillomacular bundle and inner retinal thickening. Fundus fluorescein angiography confirmed that the central retinal artery was not filled at 40 seconds and that the CLRA supplied a part of the macular area. Eight months after the second intravitreal injection of ranibizumab, Optical coherence tomography showed a significant reduction in inner retinal hyperreflectivity and the thickness of the nasal macular retina. The SRF was clearly absorbed, and the visual acuity improved to 1.1 logMAR units. DIAGNOSIS Atypical CRAO. INTERVENTIONS The patient was treated with intravitreal injection of anti-VEGF in his left eye. The thickness of the nasal macular retina decreased. OUTCOMES The SRF was clearly absorbed, and the patient's visual acuity significantly improved. LESSONS When CRAO occurs in patients with diabetic retinopathy sparing the CLRA, the non-characteristic cherry-red spot may be due to macular inner retinal edema, SRF and other factors. According to the patient's condition, anti-vascular endothelial growth factor can be administered as appropriate to inhibit choroidal neovascularization, reduce SRF in the macular retina, and save some vision.
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Affiliation(s)
- Yu-Jie Jia
- Department of Ophthalmology, Fuyang People’s Hospital of Anhui Medical University, Fuyang, Anhui, China
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji, Jilin, China
| | - Hong-Bo Liu
- Department of Emergency Medicine, Fuyang People’s Hospital of Anhui Medical University, Fuyang, Anhui, China
| | - Yuan Qin
- Department of Ophthalmology, Fuyang People’s Hospital of Anhui Medical University, Fuyang, Anhui, China
| | - Jing-Hui Liu
- Department of Ophthalmology, Fuyang People’s Hospital of Anhui Medical University, Fuyang, Anhui, China
| | - Fa-Li Jia
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji, Jilin, China
| | - Han Zhang
- Department of Ophthalmology, Fuyang People’s Hospital of Anhui Medical University, Fuyang, Anhui, China
| | - Jia-Hao Li
- Department of Ophthalmology, Fuyang People’s Hospital of Anhui Medical University, Fuyang, Anhui, China
| | - Ying-Jun Li
- Department of Ophthalmology, Fuyang People’s Hospital of Anhui Medical University, Fuyang, Anhui, China
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30
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Meng Y, Long K, Chen J, Luo J. Effect of High Myopia on Delayed Absorption of Subretinal Fluid after Scleral Buckling Surgery. J Clin Med 2022; 11:jcm11133906. [PMID: 35807191 PMCID: PMC9267211 DOI: 10.3390/jcm11133906] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 02/04/2023] Open
Abstract
This study compared the absorption of subretinal fluid (SRF) in patients with rhegmatogenous retinal detachment (RRD) with and without high myopia after scleral buckling (SB) and investigated the effect of high myopia on SRF absorption. This retrospective study included patients with primary macula-off RRD grouped according to myopia and age. The optical coherence tomography (OCT) and OCT angiography indicators included subretinal fluid height (SRFH), subfoveal choroidal thickness (SFCT), and choroidal capillary blood flow density (CCFD) measured regularly. The presence of SRF 3 months after surgery was defined as delayed absorption. Overall, 90 eyes of 89 patients were enrolled, and 46 eyes (51.11%) had high myopia. In 43 eyes (47.78%), SRF absorption was delayed. There was no significant difference in SRF absorption after SB between the high and non-high myopia groups; younger patients (<35 years) had a higher probability of delayed absorption (p < 0.05). The SFCT in high myopia was significantly thinner than that in the non-high myopia group (p < 0.05); SFCT and SRFH were positively correlated (rs = 0.275, p = 0.002), and there was a significant difference between the average CCFD with and without SRF (p < 0.05). High myopia had no significant effect on SRF absorption after SB.
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Affiliation(s)
- Yongan Meng
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha 410011, China;
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha 410000, China
| | - Kejun Long
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China; (K.L.); (J.C.)
| | - Jing Chen
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China; (K.L.); (J.C.)
| | - Jing Luo
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha 410011, China;
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha 410000, China
- Correspondence:
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31
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Huang YT, Chang YC, Meng PP, Lin CJ, Lai CT, Hsia NY, Chen HS, Tien PT, Bair H, Lin JM, Chen WL, Tsai YY. Optical Coherence Tomography Biomarkers in Predicting Treatment Outcomes of Diabetic Macular Edema After Dexamethasone Implants. Front Med (Lausanne) 2022; 9:852022. [PMID: 35755055 PMCID: PMC9218219 DOI: 10.3389/fmed.2022.852022] [Citation(s) in RCA: 1] [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: 01/10/2022] [Accepted: 05/23/2022] [Indexed: 01/09/2023] Open
Abstract
Purpose To identify optical coherence tomography (OCT) biomarkers that may predict functional and anatomical outcomes in diabetic macular edema (DME) patients treated with intravitreal dexamethasone (DEX) implant. Materials and Methods Sixty-four eyes from 50 patients with DME were enrolled. Best-corrected visual acuity (BCVA) and OCT biomarkers including central retinal thickness (CRT), subretinal fluid (SRF), intraretinal cysts (IRC), ellipsoid zone disruption (EZD), disorganization of retinal inner layers (DRIL), hard exudate (HE), hyperreflective foci (HRF), epiretinal membrane (ERM), and vitreomacular interface (VMI) changes were evaluated at baseline and at 3, 6, and 12 months after treatment. Multiple logistic analysis was performed to evaluate each OCT biomarker as a predictive factor for functional and anatomical improvement at the end of treatment. Results The presence of SRF at baseline was associated with a favorable outcome, with CRT improving by more than 100 μm after treatment from multivariate logistic regression analysis [odds ratio 6.16 (1.75-21.6)]. In addition, baseline SRF predicted a greater CRT improvement from multiple regression analysis (model R-square 0.11, p = 0.006). The reduction of DRIL, SRF, LONLC, IRC, and EZD were correlated with better CRT improvement (more than 100 μm) (P < 0.05). SRF and EZD recovery can also predict better visual prognosis (P < 0.05). Conclusion OCT biomarkers can be used to predict who may benefit the most after DEX treatment. We suggest that the DEX implant should be considered as a first line treatment in DME patients with SRF.
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Affiliation(s)
- Yu-Te Huang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yen-Chieh Chang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ping-Ping Meng
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung, Taiwan
| | - Peng-Tai Tien
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
| | - Henry Bair
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Byers Eye Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Jane-Ming Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
| | - Wen-Lu Chen
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
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Mundae R, Wagley S, Ryan EH, Parke DW, Mittra RA, Tang PH. COVID-19 vaccination hesitancy and its association with altered presentation of primary rhegmatogenous retinal detachment. Am J Ophthalmol 2022; 242:7-17. [PMID: 35609676 PMCID: PMC9122843 DOI: 10.1016/j.ajo.2022.05.013] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Evaluate factors associated with coronavirus 2019 (COVID-19) vaccine hesitancy and clinical trends in primary rhegmatogenous retinal detachments (RRDs) during the first year of vaccine availability. DESIGN Single-center, clinical cohort study. METHODS Consecutive patients from December 14, 2020, to December 12, 2021, presenting vaccinated (Prior-), subsequently vaccinated (Later-), or remaining unvaccinated (Never-Vax). Primary outcome was proportion with macula-off (mac-off) RRD. Secondary outcomes included logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), primary proliferative vitreoretinopathy (PVR), proportion lost to follow-up, and distance traveled. RESULTS 1047 patients were divided into 391 Prior-, 252 Later-, and 404 Never-Vax cohorts. Significantly greater proportions of Later- and Never-Vax cohorts presented with mac-off RRDs (Prior-Vax = 44.5%; Later-Vax = 54%, P < .0001; Never-Vax = 57.9%, P < .0001) and primary PVR (Prior-Vax = 4.3%; Later-Vax = 13.6%, P < .0001; Never-Vax = 17.1%, P < .0001) compared to Prior-Vax cohort. Significantly greater proportion of Never-Vax cohort (7.7%, P < .0001) were lost to follow-up compared to Prior- (2.3%) and Later-Vax (2.2%) cohorts. Never-Vax cohort (median = 35 miles) traveled farther compared to Prior- (median = 22.3 miles; P < .0001) and Later-Vax cohorts (25.45 miles; P = .0038). Prior-Vax cohort had significantly better (P < .05) initial (median = 0.30 logMAR) and final (0.18 logMAR) BCVA compared to Later- (Initial: 0.54 logMAR; Final: 0.30 logMAR) and Never-Vax (Initial: 0.70 logMAR; Final: 0.40 logMAR) cohorts. CONCLUSIONS COVID-19 vaccine hesitancy is associated with worse clinical presentation and outcomes for primary RRD.
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Affiliation(s)
- Rusdeep Mundae
- From the Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School (R.M., E.H.R., D.W.P., P.H.T.), and VitreoRetinal Surgery, PLLC (S.W., E.H.R., D.W.P., R.A.M., P.H.T.), Minneapolis, Minnesota, USA
| | - Sushant Wagley
- From the Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School (R.M., E.H.R., D.W.P., P.H.T.), and VitreoRetinal Surgery, PLLC (S.W., E.H.R., D.W.P., R.A.M., P.H.T.), Minneapolis, Minnesota, USA
| | - Edwin H Ryan
- From the Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School (R.M., E.H.R., D.W.P., P.H.T.), and VitreoRetinal Surgery, PLLC (S.W., E.H.R., D.W.P., R.A.M., P.H.T.), Minneapolis, Minnesota, USA
| | - D Wilkin Parke
- From the Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School (R.M., E.H.R., D.W.P., P.H.T.), and VitreoRetinal Surgery, PLLC (S.W., E.H.R., D.W.P., R.A.M., P.H.T.), Minneapolis, Minnesota, USA
| | - Robert A Mittra
- From the Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School (R.M., E.H.R., D.W.P., P.H.T.), and VitreoRetinal Surgery, PLLC (S.W., E.H.R., D.W.P., R.A.M., P.H.T.), Minneapolis, Minnesota, USA
| | - Peter H Tang
- From the Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School (R.M., E.H.R., D.W.P., P.H.T.), and VitreoRetinal Surgery, PLLC (S.W., E.H.R., D.W.P., R.A.M., P.H.T.), Minneapolis, Minnesota, USA..
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Singh RP, Jhaveri C, Wykoff CC, Gale RP, Staurenghi G, Iida T, Koh A, B G, Gedif K, Singer M. Efficacy Outcomes of Brolucizumab Versus Aflibercept in Neovascular Age-Related Macular Degeneration Patients with Early Residual Fluid. Ophthalmol Retina 2022; 6:377-86. [PMID: 34968756 DOI: 10.1016/j.oret.2021.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To compare the outcomes of brolucizumab versus aflibercept in patients with neovascular age-related macular degeneration with early residual fluid in the HAWK and HARRIER studies. DESIGN Post hoc analysis using pooled data from the phase 3 studies HAWK (NCT02307682) and HARRIER (NCT02434328). PARTICIPANTS The early residual fluid cohort for this post hoc analysis consisted of patients treated with either brolucizumab 6 mg (n = 730 patients) or aflibercept 2 mg (n = 729 patients) and who had the presence of intraretinal fluid (IRF), subretinal fluid (SRF), or both verified by spectral-domain OCT at the week 12 clinic visit. METHODS After 3 initial monthly doses, patients treated with brolucizumab received injections every 12 weeks (q12w) or every 8 weeks (q8w), depending on the neovascular age-related macular degeneration disease activity, whereas patients treated with aflibercept received fixed q8w dosing. MAIN OUTCOME MEASURES The mean change in best-corrected visual acuity and central subfield thickness (CST) from the baseline to that at weeks 48 and 96, the proportion of patients treated with brolucizumab remaining on q12w dosing to week 96, and the change in fluid status at weeks 48 and 96. RESULTS All analyses were based on 149 of 730 (20.4%) patients treated with brolucizumab and 217 of 729 (29.8%) patients treated with aflibercept with spectral-domain OCT-verified IRF, SRF, or both at their week 12 visit. The best-corrected visual acuity improvements from baseline at weeks 48 and 96 were numerically better for brolucizumab than for aflibercept (least square mean [standard error] 7.9 ± 1.1 vs. 4.6 ± 0.9 and 7.4 ± 1.3 vs. 2.9 ± 1.1 letters, respectively). The CST reductions from baseline at weeks 48 and 96 were consistently greater with brolucizumab than with aflibercept (least square mean [standard error], μm: -194.9 ± 13.7 vs. -123.9 ± 11.3; and -201.1 ± 14.5 vs. -134.2 ± 12.0, respectively). At weeks 48 and 96, patients treated with brolucizumab had a 40.4% and 31.3% probability of remaining on q12w dosing intervals, respectively. Fewer patients treated with brolucizumab had remaining IRF, SRF, or both at weeks 48 and 96 than patients treated with aflibercept (59.1% vs. 75.1% and 49.0% vs. 60.4%, respectively). CONCLUSIONS In patients with early residual fluid, defined as spectral-domain OCT-verified IRF, SRF, or both at the week 12 clinic visit, brolucizumab resolved the early residual fluid and reduced CST more effectively than aflibercept, resulting in greater best-corrected visual acuity improvements through week 96 of anti-VEGF treatment.
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Mundae R, Velez A, Sodhi GS, Belin PJ, Kohler JM, Ryan EH, Tang PH. Trends in the Clinical Presentation of Primary Rhegmatogenous Retinal Detachments During the First Year of the COVID-19 Pandemic. Am J Ophthalmol 2022; 237:49-57. [PMID: 34801509 PMCID: PMC8603252 DOI: 10.1016/j.ajo.2021.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/02/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022]
Abstract
Purpose To evaluate the effect of 1 full year of the coronavirus disease 2019 (COVID-19) pandemic on clinical presentation of acute, primary rhegmatogenous retinal detachment (RRD). Design Single-center, retrospective observational cohort study. Methods Patients were divided into 2 cohorts: consecutive patients treated for primary RRD during the COVID-19 pandemic (March 9, 2020, to March 7, 2021; pandemic cohort) and patients treated during the corresponding time in previous year (March 11, 2019, to March 8, 2020; control cohort). Main outcome measures: Proportion of patients presenting with macula-involving (mac-off) or macula-sparring (mac-on) RRD. Results A total of 952 patients in the pandemic cohort and 872 patients in the control cohort were included. Demographic factors were similar. Compared with the control cohort, a significantly greater number of pandemic cohort patients presented with mac-off RRDs ([60.92%] pandemic, [48.17%] control, P = .0001) and primary proliferative vitreoretinopathy ([15.53%] pandemic, [6.9%] control, P = .0001). Pandemic cohort patients (10.81%) had significantly higher rates of lost to follow-up compared with the control cohort (4.43%; P = .0001). Patients new to our clinic demonstrated a significant increase in mac-off RRDs in the pandemic cohort (65.35%) compared with the control cohort (50.40%; P = .0001). Pandemic cohort patients showed worse median final best-corrected visual acuity (0.30 logarithm of the minimum angle of resolution) compared with the control cohort (0.18 logarithm of the minimum angle of resolution; P = .0001). Conclusions Patients with primary RRD during the first year of the COVID-19 pandemic were more likely to have mac-off disease, present with primary proliferative vitreoretinopathy, be lost to follow-up, and have worse final best-corrected visual acuity outcomes.
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Chaudhary V, Matonti F, Zarranz-Ventura J, Stewart MW. IMPACT OF FLUID COMPARTMENTS ON FUNCTIONAL OUTCOMES FOR PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: A Systematic Literature Review. Retina 2022; 42:589-606. [PMID: 34393212 PMCID: PMC8946587 DOI: 10.1097/iae.0000000000003283] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Understanding the impact of fluid in different retinal compartments is critical to developing treatment paradigms that optimize visual acuity and reduce treatment burden in neovascular age-related macular degeneration. This systematic review aimed to determine the impact of persistent/new subretinal fluid, intraretinal fluid, and subretinal pigment epithelial fluid on visual acuity over 1 year of treatment. METHODS Publication eligibility and data extraction were conducted according to Cochrane methods: 27 of the 1,797 screened records were eligible. RESULTS Intraretinal fluid negatively affected visual acuity at baseline and throughout treatment, with foveal intraretinal fluid associated with lower visual acuity than extrafoveal intraretinal fluid. Some studies found that subretinal fluid (particularly subfoveal) was associated with higher visual acuity at Year 1 and longer term, and others suggested subretinal fluid did not affect visual acuity at Years 1 and 2. Data on the effects of subretinal pigment epithelial fluid were scarce, and consensus was not reached. Few studies reported numbers of injections associated with fluid status. CONCLUSION To optimally manage neovascular age-related macular degeneration, clinicians should understand the impact of fluid compartments on visual acuity. After initial treatment, antivascular endothelial growth factor regimens that tolerate stable subretinal fluid (if visual acuity is stable/improved) but not intraretinal fluid may enable patients to achieve their best possible visual acuity. Confirmatory studies are required to validate these findings.
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Affiliation(s)
- Varun Chaudhary
- Hamilton Regional Eye Institute, St Joseph's Healthcare Hamilton, Department of Health Research Methods, Evidence and Impact, McMaster University, Division of Ophthalmology, Department of Surgery, McMaster University, Canada;
| | - Frédéric Matonti
- Centre Monticelli Paradis, 433 bis rue Paradis, Marseille, France and Aix Marseille University, CNRS, INT, Inst Neurosci Timone, Marseille, France and Clinique Juge, Groupe Almaviva Santé, Marseille, France;
| | - Javier Zarranz-Ventura
- Institut Clínic d'Oftalmologia, Hospital Clínic de Barcelona, and Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; and
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Shi R, Guo Z, Yang X, Che X. Aggravation of retinal hard exudates after intravitreal anti-vascular endothelial growth factor therapy for cystoid macular edema and the risk factors: a retrospective study. BMC Ophthalmol 2022; 22:92. [PMID: 35197011 PMCID: PMC8867860 DOI: 10.1186/s12886-022-02315-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/26/2021] [Accepted: 01/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background/aims To evaluate retinal hard exudates (HEs) progression in patients with cystoid macular edema (CME) secondary to diabetic retinopathy (DR) or branch retinal vascular occlusion (BRVO) after intravitreal injections of ranibizumab (IVR) treatment and identify the risk factors for the deterioration of HEs. Methods This retrospective study enrolled 288 eyes with center-involving CME secondary to DR or BRVO from 288 patients (one eye per patient). All patients were treated with three loading doses of ranibizumab intravitreally at a monthly interval. The morphologic features of HEs were observed, and the HEs areas were quantified using a semi-automatic method at baseline, 1 month after the first dose of IVR and 1 month after the third dose of IVR therapy. HEs progression was defined as having a > =2-grade increase in the HEs severity scale. The best-corrected vision acuity (BCVA) and alterations in HEs areas were compared between DR and BRVO groups. And logistic regression analyses were used to identify the risk factors for HEs exacerbation. Results Morphological changes of retinal HEs occurred in all eyes after IVR therapy, although HEs area was not significantly changed in some eyes. DR group has a higher percentage of eyes with progressed HEs area than the BRVO groups (34.9% vs. 21.8%, P = 0.019) 1 month after the first dose of IVR. Both DR and BRVO groups had a decreased percentage of enlarged HEs 1 month after the third injection, but the DR group is still higher than the BRVO group (17.1% vs. 8.4%, P = 0.027). At baseline, there was no correlation between VA and HEs areas. After the first and third doses of IVR, there still was no consistent correlation between HEs severity and change in VA over time. Furthermore, CME with subretinal fluid (SRF) is associated with a higher risk of HEs progression (P = 0.001). Long CME duration and high serum low-density lipoprotein cholesterol (LDL-C) level were identified as risk factors for HEs progression following IVR treatment in both univariable and multivariable regression analyses (Odds ratio (OR) = 1.88, P = 0.012 and OR = 1.14, P = 0.021, respectively). Conclusions Alterations in the area of retinal HEs are widely observed after IVR treatment for CME. The eyes with CME secondary to DR have a higher percentage of progressed HEs than the BRVO eyes. DME with SRF, extended duration of CME, and high LDL-C level are potential risk factors of deteriorated HEs after IVR treatment.
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Affiliation(s)
- Rui Shi
- Department of Ophthalmology, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Zhonglan Guo
- Department of Ophthalmology, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Xiangxiang Yang
- Department of Ophthalmology, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Xuanyi Che
- Department of Ophthalmology, Shaanxi Provincial People's Hospital, Xi'an, 710068, China.
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Kim JH, Kim JW, Kim CG. Difference Between the Incidence of Retinal Fluid Subtypes and Their Association with Visual Outcomes According to the Types of Macular Neovascularization in a Korean Population. J Ocul Pharmacol Ther 2022; 38:261-268. [PMID: 35119292 DOI: 10.1089/jop.2021.0103] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose: To investigate differences in the incidence of retinal fluid subtypes among different subtypes of macular neovascularization (MNV) and evaluate the influence of the presence of retinal fluid subtypes on visual outcome in each subtype of MNV. Methods: This retrospective study included 248 patients (248 eyes) diagnosed with treatment-naive neovascular age-related macular degeneration and polypoidal choroidal vasculopathy (PCV). The incidence of retinal fluid subtypes at diagnosis and during the 24-month follow-up was compared among the different subtypes of MNV. In addition, visual acuity was compared between patients with and without the retinal fluid subtypes. Results: At diagnosis, there was a significant difference in the incidence of subretinal fluid (SRF), intraretinal fluid (IRF), and subretinal pigment epithelial fluid among type 1 MNV, type 2 MNV, type 3 MNV, and PCV (P < 0.001). The incidence of SRF (P < 0.001) during follow-up also differed among the 4 groups. In patients with type 1 MNV and IRF, the visual acuity at diagnosis (P = 0.004) and at 24 months (P < 0.001) were significantly worse. However, the presence of SRF was not associated with poor visual acuity. In type 3 MNV, there was no significant difference in visual acuity between patients with and without SRF/IRF. Conclusion: The results of this study indicate that the clinical significance of retinal fluid subtypes may differ in different subtypes of MNV, suggesting the need for analysis in isolation of each MNV subtype in fluid-based prognostication.
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Affiliation(s)
- Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
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Subhi Y, Bjerager J, Boon CJ, van Dijk EH. Subretinal fluid morphology in chronic central serous chorioretinopathy and its relationship to treatment: a retrospective analysis on PLACE trial data. Acta Ophthalmol 2022; 100:89-95. [PMID: 33998168 PMCID: PMC9292654 DOI: 10.1111/aos.14901] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/18/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To explore subretinal fluid (SRF) morphology in chronic central serous chorioretinopathy (cCSC) after one session of either high-density subthreshold micropulse laser (HSML) treatment or half-dose photodynamic therapy (PDT). METHODS We retrospectively obtained optical coherence tomography (OCT) scans from a subset of patients from a randomized controlled trial on treatment-naïve eyes with cCSC allocated to either HSML treatment or half-dose PDT. OCT scans were evaluated prior to treatment and 6-8 weeks post-treatment, where we measured maximum SRF height and width, calculated the maximum height-to-maximum width-ratio (maxHWR) and calculated the total SRF volume. RESULTS Forty-one eyes of 39 cCSC patients were included. SRF morphology ranged from flat to dome-shaped, quantified as maxHWR ranging between 0.02 and 0.12. SRF volume was median 0.373 μl (range: 0.010-4.425 μl) and did not correlate to maxHWR (rho = -0.004, p = 0.982). Half-dose PDT was superior to HSML treatment in complete SRF resolution (RR = 3.28, p = 0.003) and in morphological changes of SRF (Δmaximum height , p = 0.001; Δmaximum width , p < 0.001; Δvolume , p = 0.025). SRF resolved completely in 19/22 PDT-treated eyes (86%) and 5/19 HSML-treated eyes (26%). SRF volume increased in five eyes (26%) after HSML treatment, and in none of the eyes after half-dose PDT. SRF morphology at baseline did not predict treatment outcomes. CONCLUSION SRF morphology changed after both HSML treatment and half-dose PDT in cCSC, with SRF disappearing in most PDT-treated patients, whereas SRF volume increased in a sizeable proportion of HSML-treated patients. Baseline SRF characteristics measured in this study were unable to predict outcomes after either HSML treatment or half-dose PDT.
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Affiliation(s)
- Yousif Subhi
- Department of Ophthalmology Rigshospitalet‐Glostrup Copenhagen Denmark
- Department of Ophthalmology Zealand University Hospital Roskilde Denmark
| | - Jakob Bjerager
- Department of Ophthalmology Rigshospitalet‐Glostrup Copenhagen Denmark
| | - Camiel J.F. Boon
- Department of Ophthalmology Leiden University Medical Center Leiden the Netherlands
- Department of Ophthalmology Amsterdam University Medical Centers University of Amsterdam the Netherlands
| | - Elon H.C. van Dijk
- Department of Ophthalmology Leiden University Medical Center Leiden the Netherlands
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Abstract
A 23-year-old female presented with a 3-day history of bilateral (OU) diminution of vision 3 weeks after COVID-19 infection. Best corrected visual acuity (BCVA) was 20/30 in right eye and 20/40 in left eye. Anterior segment showed OU 1+ cells in anterior chamber and anterior vitreous face. Fundus OU showed disc hyperemia and multiple pockets of subretinal fluid (SRF), confirmed on optical coherence tomography. Fundus fluorescein angiography showed multiple pin point leaks suggestive of Vogt Koyanagi Harada disease. Oral corticosteroids 1 mg/kg/day were started. At 2-months’ follow-up, her BCVA improved to 20/25 OU with complete resolution of SRF.
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Affiliation(s)
- Eliza Anthony
- Retina - Vitreous Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Archana Rajamani
- Retina - Vitreous Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Prabu Baskaran
- Retina - Vitreous Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Anand Rajendran
- Retina - Vitreous Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
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Qin S, Zhang C, Qin H, Xie H, Luo D, Qiu Q, Liu K, Zhang J, Xu G, Zhang J. Hyperreflective Foci and Subretinal Fluid Are Potential Imaging Biomarkers to Evaluate Anti-VEGF Effect in Diabetic Macular Edema. Front Physiol 2022; 12:791442. [PMID: 35002773 PMCID: PMC8733589 DOI: 10.3389/fphys.2021.791442] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: The aim was to investigate the effect and underlying mechanism of anti-vascular endothelial growth factor (anti-VEGF) in diabetic macular edema (DME) by optical coherence tomography angiography (OCTA). Methods: Twenty-five eyes in 18 treatment-naïve patients with DME were included. All eyes were imaged by OCTA at baseline and 1 week after monthly intravitreal aflibercept injection (IAI). Visual acuity was measured as best corrected visual acuity (BCVA). Additional parameters were evaluated by OCTA, including central macular thickness (CMT), the number of hyperreflective foci (HRF), foveal avascular zone (FAZ), vessel density (VD) in the deep capillary plexus (DCP), the en-face area of cystoid edema in DCP segmentation, and subretinal fluid (SRF) height. Results: The mean time between baseline and final follow-up by OCTA was 79.24 ± 38.15 (range, 28-163) days. Compared with baseline, BCVA was increased significantly after the 3rd IAI, while CMT was decreased significantly from the 1st IAI. SRF height and the area of cystoid edema in DCP segmentation were decreased significantly after the 2nd IAI compared with baseline. The number of HRF was decreased significantly after the 1st IAI (8.87 ± 9.38) compared with baseline (11.22 ± 10.63). However, FAZ's area and perimeter as well as VD in DCP showed no significant changes post-treatment. Conclusion: Anti-VEGF is effective in treating DME, improving visual acuity and decreasing macular edema. The decreased HRF indicates anti-inflammatory effects of aflibercept to deactivate retinal microglia/macrophages. The decreased cystoid edema and SRF height indicated improved drainage function of Müller glial cells and retinal pigment epithelium after IAI.
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Affiliation(s)
- Shiyue Qin
- Department of Ophthalmology, the Second Affiliated Hospital of Soochow University, Suzhou, China.,Department of Ophthalmology, Taizhou People's Hospital, Taizhou, China
| | - Chaoyang Zhang
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University, Shanghai, China.,National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Haifeng Qin
- Department of Ophthalmology, the Second Affiliated Hospital of Soochow University, Suzhou, China.,Department of Ophthalmology, Changhai Hospital, Shanghai, China
| | - Hai Xie
- Department of Regenerative Medicine, Tongji Eye Institute, Tongji University School of Medicine, Shanghai, China.,Department of Pharmacology, Tongji Eye Institute, Tongji University School of Medicine, Shanghai, China
| | - Dawei Luo
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University, Shanghai, China.,National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Qinghua Qiu
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University, Shanghai, China.,National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China.,Department of Ophthalmology, Shigatse People's Hospital, Xizang, China
| | - Kun Liu
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University, Shanghai, China.,National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Jingting Zhang
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University, Shanghai, China.,National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Guoxu Xu
- Department of Ophthalmology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jingfa Zhang
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University, Shanghai, China.,National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
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Huang YT, Lin CJ, Hsia NY, Lai CT, Bair H, Tsai YY. Intravitreal aflibercept combined with transpupillary thermotherapy in the treatment of refractory macular edema due to primary uveal melanoma. Taiwan J Ophthalmol 2022; 12:482-486. [PMID: 36660121 PMCID: PMC9843562 DOI: 10.4103/tjo.tjo_44_21] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/07/2021] [Indexed: 01/22/2023] Open
Abstract
We reported a 74 year old Asian female with a uveal tumor with subretinal fluid (SRF) and cystoid macula edema. Since she declined biopsy, multimodal imaging study was performed, including fundus photography, ultrasonography, optical coherence tomography, fluorescein angiography, and magnetic resonance imaging. Uveal melanoma was diagnosed. However, despite aggressive treatment with TTT and three adjuvant intravitreal bevacizumab doses, SRF, and cystoid macula edema were persistent. Therefore, aflibercept was administered, resulting in anatomical and functional improvement within 1 month, which lasted for 12 months. Aflibercept offered great efficacy in improving refractory macular edema in this case of primary uveal melanoma. Multimodal imaging can provide us with more diagnostic clues in differentiating the nature of intraocular tumors.
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Affiliation(s)
- Yu-Te Huang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan,Department of Optometry, Asia University, Taichung, Taiwan,Address for correspondence: Dr. Chun-Ju Lin, Department of Ophthalmology, 2 Yuh-Der Road, Taichung 40447, Taiwan. E-mail:
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Henry Bair
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan,Stanford University School of Medicine, Stanford, California, USA
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan,Department of Optometry, Asia University, Taichung, Taiwan
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Cristea AP, Stan C. Bilateral multifocal and recurrent chorioretinopathy - case report. Rom J Ophthalmol 2022; 66:373-381. [PMID: 36589323 PMCID: PMC9773119 DOI: 10.22336/rjo.2022.67] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 12/24/2022] Open
Abstract
Objective: The aim of this report is to highlight a rare condition that raises serious diagnosis and treatment difficulties. Case presentation: A 34-year-old male patient presented at the Department of Ophthalmology accusing reduced visual acuity (VA), dyschromatopsia and slight photophobia in his left eye (OS). Posterior pole examination revealed serous retinal detachment superior to the optic nerve head in his right eye (OD) and a well-defined macular oedema in the OS. Optical coherence tomography (OCT) confirmed the presence of subretinal fluid accumulations, fundus fluorescein angiography (FFA) revealed punctate hyperfluorescent pinpoint foci in the macular region of both eyes in the early venous phase and dye pooling in the late phase. The first diagnosis was Probable Vogt-Koyanagi-Harada (VKH) syndrome, but the evolution under corticosteroid therapy and shifting of the position of the serous retinal detachments in time, changed the diagnosis to multifocal, recurrent central serous choroidopathy. The patient received treatment with anti-vascular endothelial growth factor (VEGF) agents and presented multiple episodes of partial remission and shift of the subretinal fluid. Conclusions: The persistent, recurrent, multifocal and bilateral exudative retinal detachments raised significant diagnosis difficulties. In the absence of a well-established treatment, the current prognosis is unfavorable. Abbreviations: MARC = multifocal and recurrent choroidopathy, CSCR = Central Serous Chorioretinopathy, RPE = retinal pigment epithelium, CFH = complement factor H, VA = visual acuity, OD = right eye, OS = left eye, OCT = ocular coherence tomography, VEGF = vascular endothelial growth factor, FFA = Fundus fluorescein angiography, p-ANCA = Perinuclear anti-neutrophil cytoplasmic antibodies, PR3 = IgG antibodies against proteinase 3, ANA = antinuclear antibodies, CIC = Circulating immune complexes, CMV = Cytomegalovirus, VKH = Vogt-Koyanagi-Harada.
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Affiliation(s)
| | - Cristina Stan
- Department of Ophthalmology, Emergency County Hospital, Cluj-Napoca, Romania
,Department of Ophthalmology “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
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Reiter GS, Schmidt-Erfurth U. Quantitative assessment of retinal fluid in neovascular age-related macular degeneration under anti-VEGF therapy. Ther Adv Ophthalmol 2022; 14:25158414221083363. [PMID: 35340749 PMCID: PMC8949734 DOI: 10.1177/25158414221083363] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/07/2022] [Indexed: 11/22/2022] Open
Abstract
The retinal world has been revolutionized by optical coherence tomography (OCT) and anti-vascular endothelial growth factor (VEGF) therapy. The numbers of intravitreal injections are on a constant rise and management in neovascular age-related macular degeneration (nAMD) is mainly driven by the qualitative assessment of macular fluid as detected on OCT scans. The presence of macular fluid, particularly subretinal fluid (SRF) and intraretinal fluid (IRF), has been used to trigger re-treatments in clinical trials and the real world. However, large discrepancies can be found between the evaluations of different readers or experts and especially small amounts of macular fluid might be missed during this process. Pixel-wise detection of macular fluid uses an entire OCT volume to calculate exact volumes of retinal fluid. While manual annotations of such pixel-wise fluid detection are unfeasible in a clinical setting, artificial intelligence (AI) is able to overcome this hurdle by providing real-time results of macular fluid in different retinal compartments. Quantitative fluid assessments have been used for various post hoc analyses of randomized controlled trials, providing novel insights into anti-VEGF treatment regimens. Nonetheless, the application of AI-algorithms in a prospective patient care setting is still limited. In this review, we discuss the use of quantitative fluid assessment in nAMD during anti-VEGF therapy and provide an outlook to novel forms of patient care with the support of AI quantifications.
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Affiliation(s)
- Gregor S Reiter
- Christian Doppler Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Christian Doppler Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
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Sumarová P, Ovesná P, Matušková V, Beránek J, Michalec M, Michalcová L, Autrata D, Vysloužilová D, Chrapek O. EFFECT OF RANIBIZUMAB AND AFLIBERCEPT ON RETINAL PIGMENT EPITHELIAL DETACHEMENT, SUBRETINAL AND INTRARETINAL FLUID IN AGE-RELATED MACULAR DEGENERATION. Cesk Slov Oftalmol 2022; 78:176-185. [PMID: 35922146 DOI: 10.31348/2022/20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The aim of the study was to compare the effect of three initial doses of the anti-VEGF ranibizumab and aflibercept medication on serous pigment epithelial detachment (PED), subretinal fluid (SRF) and intraretinal fluid (IRF) in the macula of treatment naive neovascular AMD (nvAMD) patients. MATERIAL AND METHODS The cohort consists of 148 patients, of which 74 patients were treated with ranibizumab (51 females and 23 males) and 74 with aflibercept (46 females and 28 males). The data was recorded prospectively from the moment of diagnosis and start of treatment for a period of 3 months. At the moment of diagnosis and 3 months later, an OCT examination (Spectralis OCT, Heidelberg Engineering, Heidelberg, Germany) was performed. The OCT examination included a macular scan with 25 scans. Using the OCT instrument software, we measured the maximum anterior-posterior elevation of serous PED, the highest thickness of SRF and the largest diameter of the intraretinal cystic space. The statistical significance of differences between groups was evaluated using the t-test for continuous data and the Fisher exact test for categorical data. Changes in values of continuous variables over time were evaluated using the Wilcoxon paired test. Paired comparisons of binary parameters were determined by the McNemar test. RESULTS Full regression of PED, SRF and IRF occurred in 3 (4.1%), 25 (39%) and 20 (51%) patients treated with ranibizumab, and in 5 (7.9%, p = 0.470), 28 (47%, p = 0.470) and 25 (57%, p = 0.827) patients treated with aflibercept, respectively. The average regression of PED, SRF and IRF was -60.4 μm (median -37.5 μm), -84.3 μm (median -85 μm) and -109.3 μm (median -81 μm) in patients treated with ranibizumab, and -46.3 μm (median -30 μm, p = 0.389), -127.7 μm (median -104 μm, p = 0.096) and -204.4 μm (median -163 μm, p = 0.005) in patients treated with aflibercept, respectively. We did not show a statistically significant difference in the regression rates of PED, SRF and IRF between the ranibizumab and aflibercept groups. (in patients with IRF after adjustment of the higher baseline IRF volumes in patients treated with aflibercept, p = 0.891). CONCLUSION We are convinced that ranibizumab and aflibercept have the same effect on serous PED, SRF and IRF in the macula in patients with treatment naive nvAMD during the initial loading phase.
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Holekamp NM, Sadda S, Sarraf D, Guymer R, Hill L, Blotner S, Spicer G, Gune S. Effect of Residual Retinal Fluid on Visual Function in Ranibizumab-Treated Neovascular Age-Related Macular Degeneration. Am J Ophthalmol 2022; 233:8-17. [PMID: 34289338 DOI: 10.1016/j.ajo.2021.06.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 03/22/2021] [Revised: 06/26/2021] [Accepted: 06/26/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate the relationship between retinal fluid and vision in ranibizumab-treated patients with neovascular age-related macular degeneration (nAMD). DESIGN Clinical cohort study using post hoc analysis of clinical trial data. METHODS We assessed data from HARBOR (NCT00891735), a phase III, randomized, controlled trial. We reviewed 917 patients ≥50 years of age with subfoveal nAMD associated with subretinal (SRF) and/or intraretinal fluid (IRF) at baseline, screening, or week 1. The intervention was intravitreal ranibizumab 0.5 or 2.0 mg (all treatment arms pooled). Outcomes included mean best-corrected visual acuity (BCVA) and BCVA change from baseline at months (M) 12 and 24 evaluated by the presence/absence of SRF and/or IRF. RESULTS Baseline BCVA was higher with residual vs resolved SRF at M12 (mean [95% confidence interval {CI}] 58.8 letters [57.2-60.4] vs 53.5 [52.4-54.5]) and M24 (59.3 letters [57.8-60.8] vs 53.5 [52.5-54.5]). Mean BCVA change (adjusted for baseline) to M12 was greater with residual vs resolved SRF (mean difference [95% CI], +2.4 letters [+0.1 to +4.7]), but lower with residual vs resolved IRF (-3.5 letters [-5.8 to -1.2]). Eyes with residual SRF (no IRF) exhibited the largest mean BCVA gains (M12, +14.1 letters; M24, +13.2 letters), followed by resolved SRF/IRF (M12, +10.6 letters; M24, +10.0 letters), residual SRF/IRF (M12, +7.2 letters; M24, +8.5 letters), and residual IRF only (M12, +5.5 letters; M24, +3.6 letters). CONCLUSIONS Vision outcomes (adjusted for baseline BCVA) through M24 were better in ranibizumab-treated eyes with residual vs resolved SRF, and worse with residual vs resolved IRF. Presence of residual retinal fluid requires a more complex and nuanced assessment and interpretation in the context of nAMD management.
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Affiliation(s)
| | - Srinivas Sadda
- Doheny Eye Institute, University of California, Los Angeles, Pasadena, California, USA
| | - David Sarraf
- Stein Eye Institute, University of California, Los Angeles, Los Angeles, California, USA
| | - Robyn Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, and Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Australia
| | - Lauren Hill
- Genentech, Inc., South San Francisco, California, USA
| | - Steve Blotner
- Genentech, Inc., South San Francisco, California, USA
| | - Galin Spicer
- Genentech, Inc., South San Francisco, California, USA
| | - Shamika Gune
- Genentech, Inc., South San Francisco, California, USA
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Budzinskaya MV, Plyukhova AA, Afanasyeva MA, Gorkavenko FV. [New criteria of effectiveness of anti-VEGF therapy in exudative age-related macular degeneration]. Vestn Oftalmol 2022; 138:58-66. [PMID: 36004592 DOI: 10.17116/oftalma202213804158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of anti-angiogenic therapy using fluctuation and variability in patients with exudative age-related macular degeneration (AMD). MATERIAL AND METHODS This study included 200 patients with types 1, 2, 3 neovascularization and polypoidal choroidal vasculopathy (PCV). All patients underwent standard ophthalmological examination, as well optical coherence tomography (OCT) and OCT angiography (OCT-A). Patients were divided into 4 quartiles based on fluctuation and variability. All patients underwent intravitreal administration of the anti-VEGF drug aflibercept (Eylea) manufactured by Bayer, Germany, using the Treat-and-Extend regimen. RESULTS As a result of the study, a significant increase in visual acuity was revealed on the second year of treatment in patients in the 2nd and 3rd quartiles, best corrected visual acuity (BCVA) decreased in the 1st and 4th quartiles. In the group with paracentral fluctuation, a significant increase in BCVA by the end of the second year of treatment was observed in the 1st (p=0.05) and 3rd quartiles. As a result of a 2-year follow-up, it was found that BCVA values were lower in patients with the greatest variability (2nd, 3rd, and 4th quartiles). A significant increase in BCVA was observed in the 1st quartile (p=0.047). The largest number of patients with subretinal fibrosis that had fluctuations in the central zone and peripheral fluctuations was observed in the 4th quartile, the smallest - in the 2nd quartile. Similar pattern was observed in the variability group. In the setting of anti-VEGF therapy, a significant increase in BCVA was observed in patients with the lowest variability - in the 1st quartile (p=0.047), but in patients with fluctuations the highest BCVA values were observed in the 2nd and 3rd quartiles, while in the 4th quartile BCVA decreased (p=0.0562). CONCLUSIONS The results of this study indicate that when treating patients with neovascular AMD, clinicians should aim for a treatment strategy that minimizes fluctuation and variability.
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Affiliation(s)
| | | | | | - F V Gorkavenko
- Center for Healthcare Quality Assessment and Control, Moscow, Russia
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Budzinskaya MV, Afanasyeva MA, Plyukhova AA, Novikov IA, Shelankova AV, Andreeva IV. [Effectiveness of anti-VEGF therapy for neovascular age-related macular degeneration in different types of exudative fluid localization]. Vestn Oftalmol 2021; 137:12-17. [PMID: 34965062 DOI: 10.17116/oftalma202113706112] [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] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the effectiveness of anti-VEGF therapy in different types of fluids localization in neovascular age-related macular degeneration (AMD). MATERIAL AND METHODS The study included 16 people (16 eyes) with exudative AMD. The study included patients with fibrovascular detachment of the retinal pigment epithelium (RPE), subretinal and intraretinal fluid. The patients were divided into two groups: in the first group, fibrovascular RPE detachment was combined with subretinal fluid (9 eyes); in the second group, fibrovascular RPE detachment was accompanied by both sub- and intraretinal fluid (7 eyes). All patients underwent standard ophthalmological examination, which included visometry, biomicroscopy, and ophthalmoscopy under conditions of drug-induced mydriasis. Additionally, OCT of the macular region and OCT-angiography were performed. RESULTS Over the entire observation period, the first group of patients received an average of 5.11 intravitreal injections (IVI), the second group - 5.14 IVI. Visual acuity was comparable in both groups at the beginning of the study. Subsequently, the treatment resulted in an increase in visual acuity after 3 months in the first (p=0.066) and second (p=0.043) groups, as well as after 12 months in both groups (p=0.043). In the first group of patients, after 12 months, an increase in RPE detachment was observed (p=0.942), which suggests that the disease activity remains underestimated on OCT when RPE detachment and subretinal fluid are combined. In the first group, complete resorption of subretinal fluid occurred in 2 people. In the second group, resorption of subretinal and intraretinal fluid occurred in 6 people. CONCLUSION Regardless of the subtype of fluid, anti-VEGF therapy is an effective method for treating exudative AMD. Intravitreal injections are necessary both in the presence of intra- and/or subretinal fluid, and fluid under RPE. The greatest difficulty is assessment of the fluid under the RPE.
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Affiliation(s)
| | | | | | - I A Novikov
- Research Institute of Eye Diseases, Moscow, Russia
| | | | - I V Andreeva
- Research Institute of Eye Diseases, Moscow, Russia
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Saenz‐de‐Viteri M, Recalde S, Fernandez‐Robredo P, López Gálvez MI, Arias Barquet L, Figueroa MS, García‐Arumí J, García‐Layana A, Figueroa MS, Rodríguez MF, Arumí JG, Amat P, Alicante V, García‐Layana A, Barquet LA, Moreno JMR, Puyuelo JA, Maresca FA, Taulet EC, Gálvez MIL, Imaz RT, Sánchez EG, Dorta LMC, González EE, Osés SV, Hernández SA, Miguel MR, Rementería EB, Castilla RC, Castillo JV, Guajardo LL, Pinazo RG, Iribarren JJA, García LR, López FC, Garrido JAL, López‐Herrera ML, Castiella MSA, Moreno ÓR, Alday NM, Sanz ÁF, Campos JG, Hernandez M, Llorente S, Sayar O, Iriarte EO. Role of intraretinal and subretinal fluid on clinical and anatomical outcomes in patients with neovascular age-related macular degeneration treated with bimonthly, treat-and-extend and as-needed ranibizumab in the In-Eye study. Acta Ophthalmol 2021; 99:861-870. [PMID: 33720541 DOI: 10.1111/aos.14786] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 05/13/2020] [Accepted: 01/18/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE To assess the effect of fluid status at baseline (BL) and at the end of the loading phase (LP) of three different ranibizumab regimens: treat-and-extend (T&E), fixed bimonthly (FBM) injections and pro re nata (PRN), in patients with neovascular age-related macular degeneration (nAMD). DESIGN Post hoc analysis of the In-Eye study (phase IV clinical trial). METHODS Patients were randomized 1:1:1 to the three study arms and were treated accordingly. The presence and type of fluid, intraretinal fluid (IRF) or subretinal fluid (SRF) and the anatomical and visual outcomes were analysed. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA), the mean change from baseline BCVA (BL BCVA), and the proportion of eyes gaining more than 15 letters or losing more than five letters were analysed. Morphological characteristics including the subtype of choroidal neovascular membrane and the development of atrophy and fibrosis were also evaluated. RESULTS Patients with SRF at LP had better visual outcomes than patients with IRF. The persistence of SRF did not affect the mean change from BL BCVA among the three treatment regimens. However, in patients with IRF mean change from BL BCVA was significantly lower in the FBM group. The presence of IRF at BL and at the end of the loading phase was associated with the development of fibrosis at the end of the study; this result was contrary to that observed for patients with SRF. CONCLUSIONS While SRF is compatible with good visual and anatomical outcomes, IRF leads to worse results in patients with nAMD; our results suggest that patients with IRF have better outcomes when individualized treatment regimens are used (PRN or T&E) in contrast with a FBM regimen.
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Affiliation(s)
- Manuel Saenz‐de‐Viteri
- Department of Ophthalmology Clínica Universidad de Navarra Pamplona Spain
- Experimental Ophthalmology Laboratory Universidad de Navarra Pamplona Spain
- Red Temática de Investigación Cooperativa en Salud: ‘Prevention, Early Detection, and Treatment of the Prevalent Degenerative and Chronic Ocular Pathology’ from (RD16/0008/0021) Ministerio de Ciencia, Innovación y Universidades Instituto de Salud Carlos III Madrid Spain
| | - Sergio Recalde
- Experimental Ophthalmology Laboratory Universidad de Navarra Pamplona Spain
- Red Temática de Investigación Cooperativa en Salud: ‘Prevention, Early Detection, and Treatment of the Prevalent Degenerative and Chronic Ocular Pathology’ from (RD16/0008/0021) Ministerio de Ciencia, Innovación y Universidades Instituto de Salud Carlos III Madrid Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA) Pamplona Spain
| | - Patricia Fernandez‐Robredo
- Experimental Ophthalmology Laboratory Universidad de Navarra Pamplona Spain
- Red Temática de Investigación Cooperativa en Salud: ‘Prevention, Early Detection, and Treatment of the Prevalent Degenerative and Chronic Ocular Pathology’ from (RD16/0008/0021) Ministerio de Ciencia, Innovación y Universidades Instituto de Salud Carlos III Madrid Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA) Pamplona Spain
| | | | - Lluís Arias Barquet
- Red Temática de Investigación Cooperativa en Salud: ‘Prevention, Early Detection, and Treatment of the Prevalent Degenerative and Chronic Ocular Pathology’ from (RD16/0008/0021) Ministerio de Ciencia, Innovación y Universidades Instituto de Salud Carlos III Madrid Spain
- Department of Ophthalmology Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat Barcelona Spain
| | - Marta S. Figueroa
- Department of Ophthalmology Hospital Universitario Ramón y Cajal Madrid Spain
| | - José García‐Arumí
- Department of Ophthalmology Hospital Universitari Vall d’Hebron Barcelona Spain
| | - Alfredo García‐Layana
- Department of Ophthalmology Clínica Universidad de Navarra Pamplona Spain
- Experimental Ophthalmology Laboratory Universidad de Navarra Pamplona Spain
- Red Temática de Investigación Cooperativa en Salud: ‘Prevention, Early Detection, and Treatment of the Prevalent Degenerative and Chronic Ocular Pathology’ from (RD16/0008/0021) Ministerio de Ciencia, Innovación y Universidades Instituto de Salud Carlos III Madrid Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA) Pamplona Spain
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Xu F, Liu S, Xiang Y, Lin Z, Li C, Zhou L, Gong Y, Li L, Li Z, Guo C, Huang C, Lai K, Zhao H, Hong J, Lin H, Jin C. Deep Learning for Detecting Subretinal Fluid and Discerning Macular Status by Fundus Images in Central Serous Chorioretinopathy. Front Bioeng Biotechnol 2021; 9:651340. [PMID: 34805102 PMCID: PMC8604280 DOI: 10.3389/fbioe.2021.651340] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 10/11/2021] [Indexed: 11/19/2022] Open
Abstract
Subretinal fluid (SRF) can lead to irreversible visual loss in patients with central serous chorioretinopathy (CSC) if not absorbed in time. Early detection and intervention of SRF can help improve visual prognosis and reduce irreversible damage to the retina. As fundus image is the most commonly used and easily obtained examination for patients with CSC, the purpose of our research is to investigate whether and to what extent SRF depicted on fundus images can be assessed using deep learning technology. In this study, we developed a cascaded deep learning system based on fundus image for automated SRF detection and macula-on/off serous retinal detachment discerning. The performance of our system is reliable, and its accuracy of SRF detection is higher than that of experienced retinal specialists. In addition, the system can automatically indicate whether the SRF progression involves the macula to provide guidance of urgency for patients. The implementation of our deep learning system could effectively reduce the extent of vision impairment resulting from SRF in patients with CSC by providing timely identification and referral.
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Affiliation(s)
- Fabao Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Shaopeng Liu
- School of Computer Science, Guangdong Polytechnic Normal University, Guangzhou, China
| | - Yifan Xiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhenzhe Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Cong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lijun Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yajun Gong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Longhui Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhongwen Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chong Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chuangxin Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Kunbei Lai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Hongkun Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jiaming Hong
- School of Medical Information Engineering, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Center of Precision Medicine, Sun Yat-sen University, Guangzhou, China
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Abstract
CLINICAL RELEVANCE Diabetic macular oedema (DME) is a significant cause of visual impairment and inflammation plays an important role in its pathophysiology. BACKGROUND This study evaluates the diagnostic value of systemic immune-inflammation index (SII) in the occurrence of DME in patients with non-proliferative diabetic retinopathy. METHODS In this prospective study, the SII was applied to 150 consecutive patients with non-proliferative diabetic retinopathy. The relationship between the SII and the occurrence of DME was examined. Patients with DME were also divided into two subgroups according to the presence of accompanying sub-retinal fluid. The SII value was calculated as follows: platelet count × (neutrophil/lymphocyte). The risk factors for DME were evaluated using multivariate logistic regression analysis. A receiver operating characteristic (ROC) curve analysis of SII for predicting DME was performed. RESULTS Patients with DME had significantly higher levels of SII than those without DME (599.7 ± 279.2 and 464. 9 ± 172.2, respectively, p < 0.001). However, The SII values were similar between sub-retinal fluid subgroups. Multivariate regression analysis indicated that SII, together with duration of diabetes, was an independent factor for DME occurrence [Odds ratio (OR) = 1.005, 95% confidence interval = 1.001-1.009, p = 0.04, and OR = 1.146, 95% CI = 1.049-1.252, p = 0.003, respectively]. ROC curve analysis revealed that the best cut-off value of SII was 399 (area under the curve: 0.633; sensitivity: 70%; specificity: 60%). CONCLUSION An elevated SII value is strongly associated with the development of DME. The SII may be a diagnostic biomarker for identifying DME to improve the risk stratification and management of non-proliferative patients with diabetic retinopathy.
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Affiliation(s)
- Ahmet Elbeyli
- Department of Ophthalmology, Hatay Mustafa Kemal University Tayfur Ata Sökmen Faculty of Medicine, Hatay, Turkey
| | - Bengi Ece Kurtul
- Department of Ophthalmology, Hatay Mustafa Kemal University Tayfur Ata Sökmen Faculty of Medicine, Hatay, Turkey
| | - Sait Coskun Ozcan
- Department of Ophthalmology, Hatay Mustafa Kemal University Tayfur Ata Sökmen Faculty of Medicine, Hatay, Turkey
| | - Deniz Ozarslan Ozcan
- Department of Ophthalmology, Hatay Mustafa Kemal University Tayfur Ata Sökmen Faculty of Medicine, Hatay, Turkey
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